Open to Debate Okay - I'll bite.
That was my first thought when I came across this opening sentence from a new study published in the British Medical Journal (BMJ): "Debate remains over whether raised serum homocysteine concentrations cause ischaemic heart disease and stroke and whether folic acid, which lowers homocysteine, will help reduce the risk of these disorders."
All right, so let's say there still really is a debate over a link between high homocysteine and heart disease and stroke. And let's say there's also still a question about whether or not folic acid supplements reduce homocysteine - in effect, lowering heart disease and stroke risk.
HSI members have known about folic acid benefits since we first told you about them years ago. But we'll go along with BMJ and take another look at these "debates" for some heart-healthy confirmation you can share with your family and friends.
Adding it up
As I've noted in previous e-Alerts, homocysteine is an amino acid that promotes the buildup of plaque on blood vessel walls. But homocysteine metabolism depends on nutrients such as folate, and vitamins B-6 and B-12. So homocysteine levels tend to drop when these nutrients are increased.
The new BMJ study was conducted by a team of British heart specialists who reviewed a wide range of homocysteine research. Three types of studies were examined: cohort studies, genetic studies, and randomized, controlled trials. - In cohort studies, where medical and dietary records (and sometimes blood test results) for large groups of people are followed over time, the combined analysis showed that lower homocysteine is clearly linked to a lower risk of heart disease and stroke.
- This protection was also observed in two studies that included patients with homocystinuria, a rare genetic condition in which homocysteine levels may be as much as five times higher than the average person's. In both studies, homocysteine reduction significantly cut the risk of vascular events.
- In the randomized, controlled trials examined by the British team, the protective effect of folic acid supplements on high homocysteine was considered modest. Nevertheless, it was significant enough for the authors of the study to make this statement: "Increasing folic acid consumption will reduce the risk of heart attack and stroke by an amount related to the homocysteine reduction achieved."
Although the folic acid intervention trials didn't produce dramatic results, remember that many of these types of trials use insufficient doses of the supplements being studied. In your own home
Vascular events - such as ischaemic heart disease and stroke - are not the only health problems associated with high homocysteine levels. Others include Alzheimer's disease, memory loss, age-related macular degeneration, and osteoporotic fractures. And it's not a coincidence that these disorders are all associated with aging. Studies have shown that homocysteine levels tend to rise as we age.
So - step one: Eat your folate! Dietary sources include dark green vegetables (especially spinach), brewers yeast, lima beans, cantaloupe, watermelon, wheat germ, and liver from organically raised animals.
As I mentioned last month in an e-Alert about folate and pregnancy, the recommended daily allowance for folate is 400 micrograms. But for most people, that won't be enough to reverse dangerously high homocysteine levels.
Here's HSI Panelist Allan Spreen, M.D., from a previous e-Alert I sent you about addressing vascular dangers with folic acid supplements: "Low doses of folate may work in many individuals, but for some the requirements may be as high as 20 mg of folic acid, which isn't available in the U.S. due to a moronic decision of the FDA years ago (only 0.8 mg is available without a prescription). But the FDA only has jurisdiction over what dosage can be sold - not the amount you may choose to take in your own home, so my recommendation is that high homocysteine individuals might consider 5 milligrams of folic acid, 100 milligrams of B-6, and 1 milligram of B-12 (the last taken under the tongue, not orally). In a great many cases 0.8 milligrams of folate, 50 milligrams of B-6, and 1 milligram of B-12 will do the trick.
"In some cases even the higher amount of folate isn't adequate, and the addition of TMG (trimethylglycine, also called 'betaine') is necessary, from 500-1200 milligrams daily."
If your doctor is concerned about your cholesterol levels (and what conventional doctor ISN'T these days?), ask about having your homocysteine checked as well. Then, if homocysteine is high, talk with your doctor about the use of folic acid and other supplements before adding them to your daily regimen.
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