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Inconsistent energy and afternoon fatigue Low fluid intake or irregular hydration Low electrolyte intake despite activity or sweating Diet high in sugar or refined carbohydrates Low vegetable and mineral intake Blood-sugar crashes after eating Cravings for sugar or stimulants Bloating, fermentation or gut-imbalance symptoms Sedentary lifestyle or low aerobic activity Sleep apnea or impaired nighttime oxygenation Alcohol, diuretics, stimulants or metabolic medications Elevated SAH Low SAM:SAH ratio High homocysteine Low bicarbonate or carbon dioxide Kidney filtration concerns Impaired liver or metabolic clearance Hydration and electrolyte deficits Conditions that impair adenosine disposal Why buffering and clearance matter The SAH hydrolase reaction is reversible

10.1124/jpet.112.192799 J

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Derangement of hepatic polyamine, folate, and methionine cycle metabolism in cystathionine beta-synthase-deficient homocystinuria in the presence and absence of treatment: Possible implications for pathogenesis