In my last blog, I explained how high homocysteine levels can cause heart disease. This week I will discuss how to lower high homocysteine levels, helping to prevent or reverse heart disease.
Normalizing elevated homocysteine
One of the answers to high homocysteine levels is to increase one’s intake of vitamin B6, B12, and folic acid. While most conventional medical practitioners and dietitians do not recommend supplementing the diet with any of these B vitamins in capsule or tablet form, they do advise the public to at least increase their intake of high folic acid-containing foods. The American Heart Association, for example, advises a "healthy, balanced diet that's rich in fruits and vegetables, whole grains, and fat-free or low-fat dairy products."
The current RDA for folic acid is 400 mcg, the minimum dose thought to prevent neural tube defects in the fetus of a pregnant woman. Dark leafy greens, kidney beans, lentils, oranges, and orange juice are especially good sources of folic acid.
Folate content of foods:
Fresh spinach (1 cup)-262 mcg
Kidney beans (1 cup)-229 mcg
Lentils, cooked (½ cup)-179 mcg
Chickpeas, cooked (½ cup)-145 mcg
Asparagus, cooked (½ cup)-131 mcg
Orange juice (1 cup)-109 mcg
Broccoli (1 cup)-107 mcg
Split peas, cooked (½ cup)-64 mcg
Good sources of vitamin B6 are meat, poultry, fish, fruits, vegetables, and whole grain products. A daily intake of 50 mg is optimal.
Vitamin B12 can be obtained in highest amounts from meat, poultry, fish, milk, and dairy products. B12 is not found in fruits, vegetables, beans, grains, nuts, or seeds but may be found in cultured soy products, algae, and seaweeds. A daily intake of 500 mcg is considered to be optimal.
Regular aerobic exercise (more than 3 times weekly) also lowers the harmful levels of homocysteine.
Adequate amounts of trace minerals in the diet can also help lower homocysteine. Minerals such as zinc, copper, and magnesium are required as cofactors for enzymes that lower homocysteine to function properly and maintain proper DNA methylation.
Betaine (1000 mg) a.k.a. trimethylglycine (TMG) is yet another important nutrient. Derived from sugar beets, betaine functions as a methyl donor (much like folic acid) and also helps lower homocysteine levels.
Poor absorption
One unsuspected problem for some people is the inability to assimilate or absorb certain nutrients from their foods. For example, older individuals (age 65 or older) may not produce enough stomach acid to help absorb vitamin B12, folic acid, zinc, copper, manganese, iron, and dozens of other nutrients. Others may be deficient in the gut levels of intrinsic factor and pancreatic digestive juices. Still others have had damage to their intestinal absorption capacity due to illnesses like celiac disease, food allergies or chronic gut infections. In some people vitamin B6 is not converted efficiently enough to its active form (pyridoxyl-5’-phosphate). Supplementing these people with pyridoxyl-5’-phosphate (50 mg) directly is necessary.
Sometimes the only way that these individuals can be helped is by intramuscular or intravenous injections or high dose oral vitamin and mineral supplementation combined with digestive enzymes like glutamic acid and pepsin, pancreatin or others. If one suspects an absorption or nutrient assimilation problem, this can be verified by tests done through a health care practitioner.
Dissenting voices of ultra orthodoxy
Despite considerable evidence to the contrary, the conservative forces of orthodoxy within the medical profession and dietetics establishments continue to downplay the importance of keeping homocysteine levels under control. The main bulk of literature from similar bastions of ultra orthodoxy continue to claim that the only known risk factors for heart disease are age (being 45 or older for men; 55 or older for women), a family history of early heart disease, high blood pressure, high blood cholesterol, smoking, obesity, physical inactivity, and diabetes. There are even several recent studies funded by the manufacturers of cholesterol-lowering drugs concluding that there is no relationship between homocysteine and heart disease.
While it is always wise to make health decisions on sound scientific principles, there is no harm in taking a daily B complex and multi-mineral supplement while we wait for the scientific, economic, and political conflicts to play themselves out.
The bottom line
While it may cost you some money ($50-$100), get at least one blood test for homocysteine done. If the test shows a high level, change your diet to include foods high in folic acid, vitamin B6, and vitamin B12. Also, take at least one high potency B complex vitamin and multi-mineral supplement daily. Keep rechecking your homocysteine blood test until it normalizes.
If there is no improvement, discuss vitamin injections or other options with your natural health care provider. Chances are you will prevent a great deal more unpleasant future medical attention.
Dr. Zoltan Rona
References
American Heart Association website: http://www.amhrt.org
Challem, Jack. Homocysteine: The New "Cholesterol", Keats Publishing, New Canaan, CT, 1996.
Malinow MR, Bostom AG, Krauss RM. Homocyst(e)ine, diet, and cardiovascular diseases: a statement for health care professionals from the nutrition committee, American Heart Association. Circulation 1999; 99:178-182.
Malinow MR, Duell PB, Hess DL, Anderson PH, Kruger WD, Phillipson BE, Gluckman RA, Block PC, Upson BM. Reduction of plasma homocyst(e)ine levels by breakfast cereal fortified with folic acid in patients with coronary heart disease. N Engl J Med 1998; 338:1009-1015.
McCully K. The Homocysteine Revolution. Keats Publishing, New Canaan, CT,1997.
McCully KS. Editorial: Homocysteine, folate, vitamin B6, and cardiovascular disease. JAMA 1998; 279:392-393.
Nygard O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset SE. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med 1997; 337:230-6.
Rimm EB, Willett WC, Hu FB, Sampson L, Colditz GA, Manson JE, Hennekens C, Stampfer MJ. Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. JAMA 1998; 279:359-364
Welch GN, Loscalzo J. Review: Homocysteine and atherothrombosis. N Engl J Med 1998; 1042-1050.
