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[4] Clinical assessment should focus on identifying the cause of elevated levels rather than assuming toxicity from supplementation alone

There are risks involved in doing this, including injection-site redness, itching, or irritation, temporary fatigue or drowsiness, headache, nausea, mild water retention and bloating

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Although the contribution of dietary methionine excess (which increases folate, vitamin B 6 , and vitamin B 12 requirements) has not been clinically assessed, folate deficiency (associated or not with the thermolabile MTHFR mutation) and vitamin B 6 deficiency (associated or not with heterozygosity for CBS defects) could largely account for this increased risk of hyperhomocysteinemia-related cardiovascular disease