Q: I am 27 years old. I had undergone a surgery for cortical venous thrombosis (CVT) on the left side of my brain 4 years ago. Exactly 8 months after that, I was diagnosed with deep venous thrombosis (DVT) on the left leg. Since then I have been on Oxetol 450 mg/day (oxcarbamazepine) and Acitrom 3mg/day (anti-coagulant). Currently I am back to normalcy doing all my daily activities. After all investigations, the inference was that the above mentioned 2 cases might have happened due to elevated levels of serum homocysteine (it was fluctuating between 50 and 100, where the normal range is 5-15). I was advised to take supplements of Vitamin B6, B12 and folic acid regularly. I am taking these regularly.

1. What could be the reason for elevated levels of serum homocysteine?
2. What are the best food items to get B6, B12 and folic acid supplements in sufficient quantity?
3. What best can I do to have better absorption/synthesis of B6, B12 and folic acid?

A:The case highlights the need to investigate all cases of venous and arterial thrombosis to find out the cases of Hyperhomocystenuria/Hyperhomocysteinemia. This is almost imperative in all cases of younger patients, who should not normally have stasis induced DVT. The incidence is quoted to be anything between 1: 50,000 to 1: 100,000 of population. The important fact is that mere anti-coagulation is not enough in these cases. I have encountered cases where the thrombosis has occurred while being anticoagulated with warfarin/acetrom. It is only when the supplements of Folic Acid, Pyridoxine and Cynocobalamin are given in therapeutic doses that a tangible clinical response is seen. Answering specific questions:

1. The cause of the disease is an error in the metabolism of the amino acid methionine due to absence of a certain enzyme. This is an inborn error and cannot be corrected but can be kept under control by taking the required vitamins.
2. The absorption of these vitamins is quite good anyway but it is better to take these in therapeutic doses and, as these are readily available and inexpensive, it is better to take these in the medicine form rather than look for foods rich in these.
3. I think the second question answers this part as well. The Cynocobalamin is an injection to be given once a month and other two are tablets which are absorbed well.