For nearly a year, standard treatment failed to lower my dangerously high homocysteine levels. Then one genetic test revealed the real problem: my body could not efficiently use ordinary folic acid. A simple switch in supplementation finally worked. This changed how I think about medicine, genetics, and preventive healthcare forever.
I am writing this because I think a lot of people in this country are in the situation I was in last year and do not know it.
In March 2025, during a routine annual checkup at one of Delhi’s better diagnostic centres, my doctor flagged that my homocysteine level was high. I had no idea what homocysteine was. He explained that it is an amino acid which, when elevated, is associated with higher cardiovascular risk, including heart attack and stroke. Mine was at 24 µmol/L. The generally accepted healthy range is below 15. I was, in his words, “sitting on something we should fix sooner rather than later.”
He prescribed folic acid. This is standard medical practice worldwide for elevated homocysteine. I took it religiously. But three months later, we re-tested, and my homocysteine had moved only from 24 to 22 µmol/L.
Both of us were puzzled, so he doubled the dose, and I took it for another three months. Yet I was still at 21. We then added vitamin B12, but after six more months, I was still hovering around 20. Since elevated homocysteine is associated with cardiovascular risk, I was getting increasingly concerned.
Then, in November, a friend who is a partner at a Mumbai consulting firm told me he had gotten the Mira One test. He described it as an integrated analysis combining blood markers, pharmacogenomics, and whole exome sequencing, designed to help doctors understand not only what may be going wrong biologically, but also how a person’s body may respond to different medications and supplements.
I was sceptical because I had never heard of most of these terms. Besides, it costs nearly a lakh of rupees. I asked him whether it was one of those “longevity bro” tests where they tell you to take cold showers. He laughed and told me to just get it done.
So I did.
Five weeks later, I received the report and sent it to my cardiologist. Thanks to the surprisingly simple-to-read explanation, I learned that I carried a common variant in the MTHFR gene associated with reduced ability to efficiently convert folic acid into methylfolate, the biologically active form the body actually uses. Variants in this gene are quite common in Indians, although not everyone who carries them develops elevated homocysteine.
In other words, the folic acid tablet I had been taking every day for nine months was probably not being efficiently utilised by my body.
My cardiologist had been prescribing the standard evidence-based treatment. The missing piece was that my biology responded differently to it.
When I took the report to him, he read it carefully. He is an excellent doctor, Apollo-trained with twenty years of cardiology experience. I am paraphrasing here, but he essentially said: “I’m glad you got this tested because otherwise we may not have known you needed a different form of supplementation.”
He switched me from folic acid to methylfolate, which bypasses much of the metabolic bottleneck caused by the MTHFR variant. Three months later, my homocysteine was down to 13, finally within the healthy range.
I wrote this piece because the information turned out to be incredibly useful, both for me and for my cardiologist. It only needed to be done once, and it has probably been the most useful preventive health test I have ever taken. I have now also encouraged my family to do it.
One thing I learned through this process is that medicine is still highly fragmented. Geneticists often understand the variants but may not always see the day-to-day clinical context. Clinicians deeply understand disease management but may not routinely integrate genomics into care decisions. What impressed me about this approach was the attempt to bring both worlds together into a single, understandable report.
If you are taking a chronic medication or supplement and have ever wondered why it does not seem to be working as expected, it may be worth discussing pharmacogenomics and tests like Mira One with your doctor.
My homocysteine is now in range. My wife jokes that I have become evangelical about this. Maybe she is right. But when you spend a year doing the right thing and getting the wrong result, and then someone hands you a plausible biological explanation in a single line of a report, you naturally want other people to know that such explanations now exist, too.
Mira One is an integrated diagnostic that brings blood biomarkers, pharmacogenomics, and whole genome sequencing together into a single easy-to-read report. This helps your doctor understand not only what may be going wrong but also how your body is likely to respond to specific medications. It only needs to be done once. More info at miraone.preventivehealth.ai.
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Views expressed above are the author’s own.
