And why is it a problem?

Homocysteine is an amino acid, a protein produced in the body that plays a role in the body's metabolism. There are two ways it can become a problem: The first is when it measures at a higher than normal level in the blood, say at 10 micro-units per liter or above (opinions differ on this). The second is if it does not respond to therapies to reduce it when it's elevated.

There is plenty of interest today in homocysteine, as evidenced by the abundance of information available in medical and nutrition literature, as well as on the Internet. Elevated homocysteine has been linked to just about every ailment you can think of: heart attack, stroke, peripheral vascular disease, diabetes, obesity, dementia, Alzheimer's disease, kidney disease, osteoporosis, and pregnancy complications. Numerous studies have been conducted to confirm these links. Is it any wonder that serious health-minded persons are committed to monitoring and controlling their homocysteine level?

The history of homocysteine
In 1969 Dr. Kilmer McCully, a Harvard Medical School graduate, proposed the relationship between homocysteine and coronary artery disease. His work did not gain acceptance until recently. Now, research shows that homocysteine is an independent, modifiable risk factor for cardiovascular disease and a strong predictor of mortality in patients with coronary artery disease.

Some studies have found hyperhomocysteinemia (high homocysteine) to be a higher risk factor for coronary artery disease than hypercholesterolemia (high cholesterol) or smoking, and that high homocysteine powerfully increases the risk of vascular disease when combined with smoking and hypertension.

Other studies have shown no relationship between plasma homocysteine and serum cholesterol. Even though homocysteine research is still in progress, many researchers agree that there is a clear relationship between high homocysteine in the blood and many vascular diseases.

The bad effects of high homocysteine levels
Homocysteine, in elevated amounts, is toxic to endothelial cells. In the presence of circulating homocysteine, blood vessels lose their elasticity and ability to dilate, causing injury to the cell walls. Especially in areas of high pressure and turbulent blood flow, calcium, cholesterol, and collagen adhere to areas of cell wall injury to form fibrous atherosclerotic plaques.

Elevated homocysteine also contributes to development of heart disease. It promotes platelet aggregation, stimulates the oxidation of LDL, increases the binding of lipoprotein(a) (Lp[a]) to fibrin, and inhibits natural anticoagulants. In sum, homocysteine increases the likelihood of atherosclerotic aneurysms, thrombus formation, and the progression of narrowing arteries.

In 2006, the American Heart Association and the major medical journals recognized the importance of folic acid and vitamins B6 and B12 for lowering homocysteine levels in the blood as a defense against cardiovascular problems. In one study, researchers found a measurable relationship between blood homocysteine levels and the severity of the atherosclerosis. For every 10% elevation of homocysteine, there was nearly the same rise in the risk of developing severe coronary artery disease.

Elevated homocysteine levels can contribute to heart disease in at least three ways: (1) a direct toxic effect that damages the cells' lining on the inside of the coronary arteries; (2) contributing to arterial blood clotting (thrombosis); and (3) facilitating the bad effects of LDL cholesterol.

Homocysteine and supplements
While the AHA does not explicitly recommend supplements, it strongly advises patients at risk "to be sure to get enough folic acid and vitamins B6 and B12 in their diet. They should eat fruits and green, leafy vegetables daily." At the AHA's recommendation, the U.S. Food and Drug Administration has mandated that all white flour be "enriched" with folic acid. National advisories are always on the conservative side so as to have broadest application.

In clinical practice, however, many factors are taken into account in treating the individual patient: family history, the patient's diet, and other risk factors, such as smoking or obesity. The safest path to follow is to take advantage of every positive therapy available. That's true for supplements, especially since many persons do not get enough vitamins in their usual daily diets.

Health problems with homocysteine can arise in several ways. (1) A person may be predisposed genetically to a high homocysteine level; (2) a kidney disorder in which homocysteine is not adequately flushed from the blood stream; (3) a poor dietary habit with lack of fruits and vegetables; (4) with obesity and diabetes; and there is one study that says alcohol intake may contribute to high homocysteine.

In general, men have higher levels of homocysteine than women, most likely due to higher creatinine values and greater muscle mass. Women, before menopause, have lower levels of homocysteine than do postmenopausal women. Any one of the above conditions may be the cause of a high homocysteine level. If after they are corrected, the level remains high, folic acid, and vitamin B6 and B12 supplements in dosages prescribed by a physician are called for. Also effective are riboflavin, garlic, omega, and betaine.

About Dr. Vagnini
Dr. Frederic J. Vagnini is one of the most unique physicians and health educators in the world. After graduation from St. Louis University School of Medicine in 1963, Dr. Vagnini underwent 8 years of post doctorate internship and residency. These years studying surgery, vascular, heart and lung surgery were spent at the Downstate Medical Center, Brooklyn, New York and Columbia Presbyterian Medical Center, New York. Following completion of training Dr. Vagnini served in the United States Army as a Lieutenant Colonel and subsequently entered into private practice on Long Island, New York.

For the next 25 years Dr. Vagnini practiced as a heart, lung and blood vessel surgeon. He has operated on thousands of patients with heart and blood vessel disease. As his career continued Dr. Vagnini became interested in Health Education, Preventive Medicine and Clinical Nutrition. Because of his vast experience in the area of heart disease and nutrition he became a frequent guest speaker and has appeared numerous times on local and national radio and television.

Dr. Vagnini is ELDR's chief medical advisor. He is the coauthor, along with our Editor Dave Bunnell, of the book Count Down Your Age (McGraw-Hill). To learn more about Dr. Vagnini, visit his website »

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posted at 02:26:19 PM