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Nat Rev Gastroenterol Hepatol 2015;12:231-242

Significantly elevated homocysteine has been observed in people suffering with cardiovascular disease, stroke, neurodegeneration (Nelson et al, 2016) and frailty in old age (Guaita et al, 2021) and elevated homocysteine is associated with a reduced blood flow to the small vessels in the brain (reduced microcirculation) (Hassan et al, 2004) which is an important connection because a reduced microcirculation may increase the risk of developing Alzheimers disease, amyotrophic lateral sclerosis (ALS) or Parkinsons disease (Erdener and Dalkara, 2019)

The second pathway involves the gut microbiome