Why You Need to Have Your Homocysteine Levels Checked
Many doctors limit their cardio screening process to a cholesterol and triglyceride test, despite the fact that other factors have been shown to contribute significantly to the development of heart disease. More Americans die each year from heart disease than from any other cause. This fact alone should make it standard practice to use every screening tool available to detect possible risk factors associated with heart disease. Cardiac specific c-reactive protein is a marker of inflammation in the blood vessels, now thought to be a serious risk factor in heart disease. In addition to c-reactive protein, there is a blood test that can reveal important information about a person’s risk level. This test measures levels of a blood marker called homocysteine.
What Is Homocysteine?
Homocysteine is a naturally occurring amino acid produced in our body by a process of conversions carried out during various metabolic cycles. In most people it does not stick around for long. Shortly after being synthesized, the body quickly metabolizes it back into a non-harmful amino acid. However, for various reasons some individuals do not efficiently recycle homocysteine, resulting in elevated blood levels of this potentially harmful amino acid.
In 1968, a Harvard researcher observed that children with a specific genetic disorder that predisposed them to elevated homocysteine levels had a 50% increased risk of death due to vascular disease. He also observed that using interventions to lower homocysteine levels decreased this risk. He summarized that elevated homocysteine levels could serve as an independent risk factor for a person’s likelihood of developing vascular disease.
Further research has confirmed his theory many times over. The most recent evidence of this was published in the Mayo Clinic Proceedings Journal in November of 2008. It evaluated the outcome of 26 other studies related to how homocysteine levels affect cardiovascular risk. The study was unique in that it was the first one to only use data from individuals who had never had coronary disease before. This is in response to two recent studies showing no benefit for B vitamin therapy among patients with established coronary heart disease. Having pre-existing coronary disease might mask potential benefits of lowering homocysteine using folic acid and other B vitamins.
The results of the meta-analysis were impressive. It showed that every 5-point elevation in blood homocysteine levels resulted in a 20% increase risk for the development of coronary heart disease. This increase in risk is totally independent of any other factors that influence coronary heart disease development, which makes it a very significant risk factor in and of itself.
What Is Normal?
- Normal – 5 to 15 µmol/L
- Moderate – 16 to 30 µmol/L
- Intermediate – 31 to 100 µmol/L
- Severe – Above 100 µmol/L
There are many reasons why a person may have elevated homocysteine levels. To understand some of these reasons it is important to explain the process our body uses to naturally keep homocysteine levels low. Homocysteine is recycled into two other amino acids called methionine and cysteine. For this process to occur, some very key nutrients are needed. Folic acid, vitamin B6 and vitamin B12 are the primary nutrients needed to recycle homocysteine into non-harmful amino acids.
A large percentage of the American population has elevated homocysteine levels. This is likely due to a poor diet devoid of the critical nutrients necessary for the conversion of homocysteine into its inert amino acid counterparts. Fast food and heavily processed foods can rob the body of important nutrients. Research has shown that switching to a diet that contains foods rich in folic acid and other B vitamins can reduce homocysteine levels. Dark leafy greens like spinach, kale and collard greens typically have the highest levels of folic acid. Whole grains like brown rice and other fruits and vegetables typically have high levels of vitamin B6. B12 is most commonly found in animal products. Some great sources include wild salmon, dairy products like yogurt and cheese, and eggs.
The process of aging also creates an increased risk of elevated homocysteine levels due to decreased intestinal absorption of folic acid and other B vitamins. As we age, our digestive secretions such as stomach acid, bile acids and pancreatic enzymes decrease. This reduces the ability of our body to break down and extract nutrients from our foods.
A small percentage of the American population has elevated homocysteine levels due to a genetic abnormality. The methylenetetrahydrofolate reductase enzyme (MTHFR) is the enzyme responsible for converting homocysteine into methinonine. The genetic abnormality affects the activity of this enzyme. Up to 10% of the population may have some form of this genetic irregularly and never know it unless tested properly. People with elevated homocysteine levels have a much higher risk of forming blood clots. This is of particular concern for people taking certain medications. Women who form blood clots while taking oral birth control pills or hormone replacement often have this genetic abnormality. Because the formation of blood clots can lead to life threatening conditions such as a pulmonary embolism, heart attack or stroke it should be standard practice to test for these genetic abnormalities before giving medications that might increase the risk of a potential problem. Patients receiving potent drugs for chemotherapy are also at a greater risk of forming clots if they have the MTHFR deficiency. Ten percent is a very high number when looking at the relative rate of a genetic abnormality in the general public.
Why Is Homocysteine Bad for Me?
Although it is not fully understood, there are several possible mechanisms that are responsible for homocysteine’s negative effect on the cardiovascular system.
The initial trigger responsible for the initiation of plaque formation in an artery is injury. The delicate layer of endothethial cells that line our arteries are subject to damage from high blood pressure, toxins from alcohol, pollution and cigarette smoke and free radical damage. When that endothethial lining becomes damaged, the body is prompted to fix it by coating the damaged area with cholesterol. If other factors in the body are just right, that deposition of cholesterol can cascade into the formation of an artery blocking plaque. Homocysteine is thought to be one of the unique compounds capable of causing the initial damage to the delicate lining of arteries and thus triggering the cascade of plaque formation.
Another mechanism by which homocysteine can facilitate cardiovascular disease is related to its ability to make your platelets more likely to stick together. This increases the risk of clot formation and perpetuates the formation of arterial plaques.
So How Can I Fix It?
The first step is to identify if this is an issue for you. Asking your primary care doctor for a simple blood test to measure homocysteine is the first step. If elevated, there are several natural vitamins that can lower homocysteine levels.
What Nutrients Should I Consider?
The most important are going to be folic acid, B12 and B6. All three play a crucial role in the enzymatic steps necessary to convert homocysteine into its benign amino acid counterparts.
Folic acid is one of the most important nutrients for lowering homocysteine levels. It is the primary nutrient used by the body for converting homocysteine into methionine. Doses anywhere from 1 mg to 10 mg are commonly used and seen to create significant drops in homocysteine levels in most individuals.
B12 also plays an important role in the recycling process. It is most effective when given in its activated form often referred to as methylcobalamin. The more common form called cyanocobalamin has to be activated by the body before it can help with homocysteine metabolism making it less effective. B12 is best given as an injection or in a sublingual (dissolves under the tongue) lozenge.
B6 plays an important role in the metabolism of homocysteine into something called cysteine. This is another recycling pathway the body has for homocysteine and works greatly in our favor because cysteine is a direct precursor to the potent antioxidant called glutathione. Glutathione plays a critical role in helping our body eliminate toxins via the liver and serves as the most potent circulating antioxidant. Again, it is recommended to use the activated form of B6 (pyridoxine-5 phosphate) to maximize effectiveness.
Make sure to have your doctor check your blood homocysteine levels at your next visit. If your levels are high, adding folic acid, B12, and B6 to your supplement regimen is almost guaranteed to lower elevated homocysteine levels. And due to the absence of virtually any side effects and little known toxicity issues, this is a low risk way to greatly reduce a major risk factor for heart disease.
Dr. Passero completed four years of post-graduate medical education at the National College of Naturopathic Medicine in Portland, Oregon after receiving a Bachelor’s Degree in Environmental Biology from the University of Colorado. Dr. Passero has trained with some of the nation’s leading doctors in the field of natural medicine. In his practice, Dr. Passero focuses on restoring harmony to both the body and mind using advanced protocols that incorporate herbal therapy, homeopathy, vitamin therapy and nutritional programs. Through education and guidance patients are able to unlock the natural healing power contained within each one of us. For more information, visit his website, Green Healing Wellness, or follow him on Facebook.