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While we need methionine and protein in the diet, one way to increase homocysteine is to significantly increase dietary methionine without a concomitant increase in choline, B12, or folate.[ref] Timing of testing: Homocysteine levels are lowest in the first hour after a meal, so if you test your homocysteine level after eating, it will likely be different than what a fasting blood test will show.[ref] Down syndrome, CBS, and low homocysteine: People with Down syndrome usually have very low homocysteine levels due to the extra copy of chromosome 21, which causes an extra copy of the CBS gene

(2020): Trimethylamine-N-oxide has prognostic value in coronary heart disease: a meta-analysis and dose-response analysis

Attanzio A, Frazzitta A, Cilla A, Livrea MA, Tesoriere L, Allegra M