Homocysteine information

Homocysteine is a derivative of the amino acid methionine. It received a great deal of media attention in 1997 following publication of articles in medical journals indicating that a high blood level of homocysteine is a potential risk factor for atherosclerosis and heart disease. Kilmer McCully, M.D., a pathologist at the Veterans Affairs Medical Center in Providence, Rhode Island, had been claiming for at least two decades that homocysteine is as important a risk factor for heart disease as cholesterol, but few in the medical profession paid serious attention to his claim. Dr. McCully was vindicated with the publication of additional scientific articles in the 1990s, most of which confirmed the dangers of elevated homocysteine levels. Fortunately, homocysteine levels can be easily lowered by taking supplements of B vitamins, particularly folic acid, B6, and B12. In addition to contributing to cardiovascular conditions, homocysteine may also be detrimental to the brain since it can act as a toxin to brain cells. Dr. L. Parnetti and colleagues, from Perugia University in Italy published in article discussing the role of homocysteine in cognitive decline. They say, "Homocysteine may represent a metabolic link in the cause of atherosclerotic vascular diseases and old-age dementias. Excessive homocysteine is an independent risk factor for coronary artery disease, peripheral vascular disease, and stroke. Homocysteine is a reliable marker of vitamin B12 deficiency, a common condition in the elderly, which is known to induce neurological deficits including cognitive impairment. A high prevalence of folate deficiency has been reported in geriatric patients suffering from depression and dementia. Both these vitamins occupy a key position in the remethylation and synthesis of S-adenosylmethionine (Sam-e), a major methyl donor in the central nervous system. Therefore, deficiencies in either of these vitamins leads to a decrease in SAMe and an increase in homocysteine, which can be critical in the aging brain."

Homocysteine, Heart Disease, Stroke, and B Vitamins
 In two studies published in the New England Journal of Medicine, lowering of homocysteine levels with B vitamins did not result in any significant reduction in stroke or heart disease. In fact, in one of the studies, those who received  0.8 mg folic acid plus 0.4 mg vitamin B-12 and 40 mg vitamin B6 had a higher rate of myocardial infarction. You can find more details at homocysteine.
     High blood homocysteine levels can be easily lowered by taking supplements of B vitamins, particularly folic acid, B6, and B12. Unfortunately, at this time, having reviewed many studies the positive results and the negative results regarding homocysteine, no definite statements can be made regarding the benefits of supplementing with B vitamins in regards to stroke and heart disease prevention or treatment.
     So, what's the bottom line? Should you or should you not supplement with B vitamins? I still say yes. B vitamins have many benefits including support of mental health and providing more physical energy. But, high doses are not required. One, two, or three times the RDA should be fine. We don't think the B50 or the B100 products, which supply 25 to 50 times the RDA for certain B vitamins, are necessarily beneficial. It may be a good idea to just take a multivitamin supplying one, two, or three times the RDA for all the Bs. Higher amounts of B vitamins, or taking too high a dose of just one or two of the B vitamins (such as the study I mentioned above where 40 mg of B6 was given without providing the other B vitamins such as B1 and B2) may be counterproductive. In a study published in JAMA in the year 2002, homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 significantly decreased the incidence of major adverse events after percutaneous coronary intervention. This study used 10 mg of B6 as opposed to the 40 mg used in the study published by the NEJM. Could lower dosages of B vitamins actually be healthier?

Homocysteine can be lowered with B vitamins
Adequate intakes of folic acid, B6, and B12 will assure that homocysteine levels are kept low. Considering the possibility that there may be individuals, especially the elderly, who are deficient in B6, folic acid, and B12, an inexpensive and simple way to decrease the rate of damage to the brain from homocysteine would be by supplementing with these vitamins.

Homocysteine and memory
Nutritionists at Tufts University in Boston have also found a connection between B vitamins, homocysteine, and memory. They investigated the relations between blood concentrations of homocysteine and vitamins B-12, B-6 and folate, and scores from a battery of cognitive tests for seventy male subjects, aged 54-81 years. Lower concentrations of vitamin B-12 and folate and higher concentrations of homocysteine were associated with poorer memory. Furthermore, people with low levels of vitamin B12 or folic acid may have a higher risk of developing Alzheimer's disease

Ray Sahelian, M.D. author of Mind Boosters: A Guide to Natural Supplements That Enhance Your Mind, Memory, and Mood says: Homocysteine, in addition to causing harm to brain cells, can cause hardening of the arteries. Folic acid and B12 deficiencies are common in the elderly, especially those in nursing homes. Supplementing with folic acid, B6, and B12 seems to be a reasonable approach to lowering the risk from excess homocysteine.
   An additional nutrient to consider is TMG. TMG supplements are able to decrease homocysteine levels.

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