For today’s edition of Dear Mark, I’m answering a bunch of questions from readers. The first one concerns another inflammatory marker, homocysteine. How could CRP be low but homocysteine be high? What could cause that? Next, I answer a barrage of kefir questions, including ones on kefir carb counts, pasteurized kefir, and water and coconut kefir. Finally, I address the elephant in the room: stressing out about your diet.
How do Homocysteine levels figure in this equation? I have C-reactive protein under 1, but Homocysteine levels of 15, slightly high. Seems odd one so low and one a bit high.
Both indicate elevated inflammation, but they can have different causes. There are many nutrient deficiencies and interactions that go into elevated homocysteine levels—that’s why they indicate inflammation. What are they?
It all comes down to methionine. That’s the essential amino acid most abundant in muscle meats, the one most of you are getting a ton of if you’re eating a standard Primal, keto, or carnivore diet. We use it to perform cellular communication, regulate gene expression, repair cells, and build new tissue. It does some really important stuff, but it needs several different co-factors to work properly.
B12 and Folate—Vitamin B12 is a major one. So is folate. In fact, I lumped them together in one section because they are co-dependents. Vitamin B12 requires folate to do its job. Folate requires vitamin B12 to do its job. Both vitamins are necessary co-factors for methionine to do its important cellular work. Without either one, methionine builds up and contributes to homocysteine.
They even tested this in a controlled human trial . Giving a big dose of methionine without increasing B12 or folate increased homocysteine levels. Supplementing with B12 and folate protected against the methionine-induced increase in homocysteine.
Glycine—After teaming up with the B-vitamins to do the gene expression and cellular repair/buildup, any excess methionine combines with glycine to form glutathione. That’s the body’s main antioxidant, and it’s very helpful to have. If you have low glycine levels/intake, then any leftover methionine goes into the homocysteine cycle.
B6—Vitamin B6 is also used to mop up and convert into glutathione any excess methionine after methylation.
Betaine—Similar to glycine, betaine acts as a buffer for excess methionine. In fact, high intakes of methionine deplete the body of betaine, while supplementing with betaine reduces homocysteine levels .
Choline—Choline is another methionine buffer. High methionine increases the need for choline, while adequate choline or supplementation reduces homocysteine .
If you’re missing those co-factors, methionine fails to assist with cellular communication, gene expression, cellular repair, or new tissue formation. Instead, it generates homocysteine.
To get enough betaine, include some beets and/or spinach in your diet. Wheat germ is the best source, but most of you aren’t eating wheat germ (nor would I recommend you start).
To get choline, eat egg yolks. That’s the single best source. If you’re not going to eat betaine-rich foods (beets, spinach, wheat), eat extra choline; you can make betaine from choline.
Isn’t there a relatively large amount of carbs in kefir, when consumed in quantity?
The fermentation process digests most of the lactose present in milk. The sourer the product, the lower the residual lactose. The sweeter the product (or even just less sour), the higher the residual lactose. At any rate, I wouldn’t worry too much about the carb content of kefir. It’s assuredly lower than advertised, and probably low enough for even keto eaters to incorporate at least a little.
There are even lactose-free kefirs that will be definitely near-zero in carbs. If that’s the case, it will be prominently displayed on the label.
Mark, don’t they at least partially”clean up” kefir? Does it really contain all that good stuff, or is pasteurized?
Commercial kefir uses pasteurized dairy, but the fermentation takes places after pasteurization. This means the finished product is fermented with living bacteria (and yeast, in the case of kefir).
Kefir – I just did a test of dairy and it definitely gives me a reaction. I’d love to read your take on water kefir though I’m not pleased that the recipes use sugar. What about coconut milk kefir?
Don’t worry about water kefir that uses sugar. All the sugar gets consumed by the kefir grains, leaving little to no residual sugar for you. You can tell by the taste (and I admit I’m no fan/expert of water kefir, only because I can tolerate dairy kefir). If it’s sweet, it contains sugar. If not, it doesn’t. Even if it has some sugar left, it’ll be far less than indicated on the label.
Coconut milk kefir is a good option too. Again, I prefer the dairy kefir, but I see nothing wrong with coconut milk kefir. I even put up a coconut milk kefir recipe  some time ago.
Funny you mentioned to drink bone broth (for the glycine) to help with sleep. I have been keto-carnivore for 9 months and recently realized that the high level of histamines in bone broth was giving me insomnia. I can eat most foods that contain a moderate level of histamines, but canned fish and long-cooked bone broth have derailed my sleep on carnivore.
If that’s the case, straight glycine can work. That’s what several studies actually used to improve sleep in humans —isolated glycine.
Collagen  may also work for you.
Could all this be too much worry from being obsessed with checking if they are doing the keto diet “right” ?
Ha! Yeah. That’s the issue with a certain subset of the Primal/keto crowd. Worrying about every little thing until it becomes a stressor. Ketone numbers running through the head as you lie awake. Waking up at 2 AM to test your urine. “Did I remember to Amazon Prime the MCT oil?” Wondering “Is the olive oil in my canned sardines truly the highest quality olive oil?”
Then there’s the true classic: stressing out about the stress you’re inducing from worrying about your diet. Educate yourself, but don’t forget to enjoy life. There’s only so much diligence we can orchestrate without losing the forest through the trees.
That’s it for today, everyone. Take care and be well, and make sure to leave any comments or questions down below.