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Homocysteine - The 21st Century
Health Revolution
By lowering your
homocysteine level you can reduce the risk of developing many diseases
including heart disease, stroke, certain cancers, diabetes, depression
and Alzheimer’s. Patrick Holford BSc, Dip.ION outlines the factors that
cause homocysteine levels to increase and provides a ten-step plan on
how to lower it with diet and supplements
Forget your blood pressure, your cholesterol level, and even your
weight. There is one indicator that can determine better than any
other, whether you will live a long and healthy life, or die
young. It’s the level of homocysteine in your blood.
Having
a high
homocysteine
level isn’t just
associated
with a
greater risk
of heart
disease,
it actually
causes heart
disease
Homocysteine is a type of protein produced by the body and found in the
blood that, ideally, should be present in very low quantities. However,
if you are not optimally nourished, homocysteine can and does
accumulate, increasing your risk of over 50 diseases, including heart
disease, stroke, certain cancers, diabetes, depression and Alzheimer’s
disease. One in two people in Britain have high homocysteine levels
and one in two people die from preventable diseases. The good news is
that this new and important risk factor can be reversed in weeks.
Figure
1 – The Homocysteine Pathway
WHAT IS HOMOCYSTEINE?
Homocysteine is produced from the amino acid methionine, which is found
in normal dietary protein. The trouble is, if you don’t have optimal
amounts of B vitamins in your diet, the enzymes that turn homocysteine
into either glutathione (an important antioxidant), or SAMe (s-adenosyl
methionine) (an important biological agent in the human body,
participating in over 40 essential biochemical reactions),don’t work
efficiently, so blood homocysteine levels increase. (See Figure 1.)
Also, it has been discovered that one in ten people have an inherited
genetic mutation that makes them more prone to high homocysteine. This
is because the MTHFR enzyme that converts homocysteine into SAMe doesn’t
work so well. For these individuals to stay healthy, larger daily
intakes of vitamin B12 and folic acid are necessary.
While the importance of antioxidants is now well established, the new
buzz word in medicine is “methylation”. The ability for the body to
maintain chemical balance hinges upon its ability to add or subtract
molecules called methyl groups. This is how the body turns one compound
into another. To make this clearer, imagine that all this talk about
homocysteine and premature death is causing you to feel stressed. Your
body responds by adding a methyl group to noradrenalin to produce
adrenalin – the stress hormone. On learning that homocysteine is
rapidly reversible, you relax. The body responds by removing a methyl
group from adrenalin, turning it back into noradrenalin. This kind of
chemical reaction occurs a billion times every second, keeping
everything in balance.
If there was one measure of your antioxidant “IQ” it would be the level
of glutathione inside your cells. Similarly, if there was one measure
of your methyl “IQ” it would be the level of SAMe inside your cells.
This is because SAMe can easily donate a methyl group, or accept one
back, keeping the body’s biochemistry flexible. Normally, both SAMe and
glutathione are made in the body from the amino acid methionine, via
homocysteine. However, if the conversion of homocysteine is blocked in
any way, homocysteine levels go up and SAMe and glutathione levels go
down.
This is only half of the story. The other half is the discovery that
homocysteine damages the brain, arteries and DNA. That’s why your
homocysteine level is theoretically the most important indicator of
the health and adaptability of your body’s total biochemistry, and your
risk of developing degenerative diseases. But where’s the hard proof?
HEART ATTACKS AND STROKES
– REDUCE YOUR RISK BY 75 PER CENT
The largest review of 92 studies by David Wald, specialist registrar in
cardiology, and colleagues from the Department of Cardiology at
Southampton General Hospital, examined the association between
homocysteine levels and the risk for cardiovascular disease in 20,000
people.
They found that with every 5-unit increase in homocysteine measured in
the blood, the risk for heart disease went up 42 per cent in those with
the MTHFR gene mutation and 32 per cent in those without. The risk for
stroke went up 65 per cent in those with the genetic mutation and 59
per cent in those without. The researchers concluded that these “highly
significant results indicate strong evidence that the association
between homocysteine and cardiovascular disease is causal.” (1) This
means that having a high homocysteine level isn’t just associated with
a greater risk of heart disease, it actually causes heart disease – a
conclusion that is being reached by other research groups. (2)
While the average homocysteine level – or H score - is approximately 10
units, an ideal level is 6 units or below. Those with a history of
cardiovascular disease often have a homocysteine level above 15 units.
By lowering a high homocysteine level from 16 to 6 units, a 10-point
drop, the risk of heart disease could be cut by 75 per cent! This is
not only a much more substantial risk reduction than can be achieved by
lowering cholesterol, it’s also more attainable.
CANCER – CUT YOUR RISK BY
A THIRD
Cancer is about 85 per cent preventable. Research published in the New
England Journal of Medicine, describing a study involving 45,000 pairs
of twins, found that cancer is more likely to be caused by diet and
lifestyle choices than by genes. Identical twins, who are genetically
the same, had no more than a 15 per cent chance of developing the same
cancer. This suggests that the cause of most cancers is about 85 per
cent environmental – that is, down to factors such as diet, lifestyle
and exposure to toxic chemicals. This study found that choices
regarding diet, smoking and exercise accounted for 58 to 82 per cent of
cancers studied. (3)
So where does homocysteine come in to all this? Cancer is triggered by
damage to DNA – and having a high homocysteine level means your DNA is
more vulnerable to damage, and poorly repaired once the damage has
occurred. At the other end of the scale, homocysteine levels have been
found to be a very good indicator of whether cancer therapies are
working. The homocysteine level rises when tumours grow, and falls when
they shrink. Forms of cancer already clearly linked to high
homocysteine include cancer of the breast and colon, and leukaemia,
among others. Low homocysteine is likely to reduce your risk of these
cancers by a third.
DIABETES – LOWER YOUR
RISK
Type 2 (non-insulin dependent) diabetes is highly preventable, yet more
and more young people are developing it. The obesity “epidemic” in the
West has helped fuel this rise. If you are obese, the risk of
developing diabetes goes up 77 times! Diabetics are at risk of having
high homocysteine because it is now known that the abnormally raised
insulin seen in most diabetics stops the body from lowering and
maintaining a healthier homocysteine level. By following a
homocysteine-lowering diet, plus taking appropriate supplements, you
will be able to reduce your risk of diabetes or, if you are diabetic,
you’ll be able to help keep it under better control and reduce
complications.
ALZHEIMER’S DISEASE –
HALVE YOUR RISK
The evidence indicates that if you can lower your homocysteine level,
you will significantly lower your risk of developing Alzheimer’s
disease. Homocysteine is strongly linked to damage in the brain. Dr
Matsu Toshifumi and colleagues at Tohoku University, Japan, conducted
brain scans on 153 elderly people and checked the results against each
individual’s homocysteine level. The evidence was crystal clear – the
higher the homocysteine, the greater the damage to the brain. (4)
A recent study in the New England Journal of Medicine charted the
health of 1,092 elderly people without dementia, measuring their
homocysteine levels. Within the following eight years, 111 were
diagnosed with dementia. Eighty-three of this group were diagnosed with
Alzheimer’s. Those with high blood homocysteine levels (in this study,
above 14 units) had nearly double the risk of Alzheimer’s. These
studies strongly suggest that following a homocysteine-lowering regime
should, at the very least, halve your risk of developing Alzheimer’s
disease in later life. (5)
HALVE YOUR RISK OF DEATH
FROM ALL CAUSES
One of the best ways to extend your lifespan is by reducing your
homocysteine level. With every five-point decrease in your H score, you
will gain:
- A 49 per
cent reduced risk of death from all causes
- A 50 per
cent reduced risk of death from cardiovascular disease
- A 26 per
cent reduced risk of death from cancer
- A 104 per
cent reduced risk of death from causes other than cancer or
heart disease
These are the extraordinary findings from a comprehensive research
study at the University of Bergen in Norway, published in 2001 in the
American Journal of Clinical Nutrition.6 Scientists measured the
homocysteine levels of 4,766 men and women aged 65 to 67 back in 1992,
and then recorded any deaths over the following five years, during
which 162 men and 97 women died. They then looked at the risk of death
in relation to their homocysteine levels. Remarkably, they not only
reconfirmed the relationship between heart attacks, stroke and high
homocysteine, but also observed that “a strong relation was found
between homocysteine and all causes of mortality.” In other words,
homocysteine is an accurate predictor of how long you are going to
live, whatever the eventual cause of death may be!
If you are already in your fifties or sixties, you might be tempted to
view all this news with gloom. But with a tried and tested solution the
news is all good, because you can begin to do something about it right
now.
It was formerly believed that a “high” homocysteine level was
above 15 units. But now, levels as low as 7 units are being linked to
increased disease risk
MEASURING YOUR
HOMOCYSTEINE LEVEL
Your homocysteine level is easy to measure at home. York test
Laboratories (call 0800 074 6185 or visit www.yorktest.com) offers a
home test kit that requires just a pin prick of blood. You put a drop
of blood onto a card which separates and stabilises the plasma portion
of the blood. You then send in your card and you’ll know your H score
within days.
Homocysteine is measured in mmol/l. It was formerly believed that a
“high” homocysteine level was above 15 units. This is what increases
your risk of a heart attack and doubles your Alzheimer’s risk. But now,
levels as low as 7 units are being linked to increased disease risk.
Basically, there’s no safe level and no guarantee that the diet and
supplements you are currently taking are keeping your homocysteine
level at bay. Up to 30 per cent of people with a history of heart
disease have a homocysteine level above 14 units. The average level in
Britain is 10.5. What you want is a level below 6 units. If you have
any of the associated risk factors below, it’s especially important to
get your homocysteine level tested.
HIGH HOMOCYSTEINE RISK
FACTORS
- Inherited
genetic mutation (abnormal functioning of the MTHFR enzyme)
- Family
history of heart disease, stroke, cancer,Alzheimer’s disease,
schizophrenia, diabetes
- Folic acid
deficiency
- Increasing
age
- Male sex
- Oestrogen
deficiency
- Excessive
alcohol, coffee or tea intake
- Smoking
- Lack of
exercise
- Hostility
and repressed anger
- Inflammatory
bowel diseases (coeliac disease,
- Crohn’s
disease, ulcerative colitis)
- H.pylori-generated
ulcers
- Pregnancy
- Strict
vegetarian or vegan diet (due to a possible lack
- of vitamin
B12)
- High fat
diet, excessive red meat and/or dairy intake
- High salt
intake
LOWERING YOUR
HOMOCYSTEINE LEVEL
Whatever your homocysteine level is, you can lower it with the right
combination of nutrients and diet, together with lifestyle changes
designed to reduce your risk. Follow the H Factor Diet below.
THE TEN-STEP H FACTOR
DIET
Eat Less Fatty Meat, More Fish and Vegetable Protein
Eat no more than four servings of lean meat a week; eat unfried fish at
least three times a week; and if you’re not allergic or intolerant,
have a serving of a soya-based food (such as tofu, tempeh or soya
sausages) or beans, such a kidney beans, chickpea hummus or baked
beans, at least
five times a week.
Eat Your Greens
Have at
least five servings of fruit or vegetables a day. This means
two pieces of fruit every day, and three servings of vegetables. Vary
your selection from day to day. Make sure half of what’s on your plate
for each main meal is vegetables.
Have a Clove of Garlic a
Day
Either eat a clove of garlic a day, or take a garlic supplement. You
can take garlic oil capsules or a powdered garlic product.
Don’t Add Salt to Your
Food
Don’t add salt while you’re cooking or to the food on your plate. The
only salt that is considered reasonably healthy is a product called
Solo, which has half the sodium of table salt, together with potassium
and
magnesium. If desired, this can be used in moderation instead.
Cut Back on Tea and
Coffee
Don’t drink more than one cup of caffeinated or non-caffeinated coffee,
or two cups of tea a day. Instead choose from the wide variety of
herbal teas and grain coffees available.
Limit Your Alcohol
Limit your alcohol intake to no more than half a pint of beer, or one
glass of red wine a day. Ideally, limit your intake to two pints of
beer or four glasses of wine a week.
Reduce Your Stress
If you are under a lot of stress, or find yourself reacting stressfully
much of the time, make a decision to reduce your stress load, both by
changing the circumstances that are causing you stress and by changing
your attitude.
Simple additions to your life, such as yoga, meditation and/or
exercise, or seeing a counsellor if you’ve got some issues to resolve,
can make all the difference.
Stop Smoking
If you smoke, make a decision to stop, and seek help to do it. There is
simply no safe level of smoking as far as homocysteine and your health
is concerned. Smoking is nothing less than slow suicide. The sooner you
stop the longer you’ll live.
Correct Oestrogen
Deficiency
If you are postmenopausal, or have menopausal symptoms or other
menstrual irregularities, check your oestrogen and progesterone levels
with a hormone saliva test (available from Higher Nature on 01435 882880). If you are
oestrogen or progesterone deficient, you can correct this with “natural
progesterone”, in the form of a transdermal skin cream. Natural
progesterone has none of the associated risks of HRT and your body can
make its own oestrogen from progesterone.
Supplement a
High-Strength Multivitamin and Mineral Every Day
Take a high-strength multivitamin and mineral supplement, providing at
least 25 mg of the main B vitamins, 200 µg of folic acid and 10 µg of
B12, plus vitamins A, D, E and the minerals magnesium, selenium,
chromium and zinc. Also supplement 1 gm of vitamin C daily for general
health.
HOMOCYSTEINE-LOWERING
SUPPLEMENTS
The most powerful and quickest way to restore a normal H score, below 6
units, is to supplement specific homocysteine-lowering nutrients. These
include vitamins B2, B6, B12, folic acid, tri-methyl glycine (TMG) and
zinc. Here are the guidelines.
| Nutrient |
Very
Low Risk
Below 6 |
Low
Risk
6-9 |
High
Risk
9-15 |
Very
High Risk
Above 15 |
| Folic
Acid |
200 µg |
400 µg |
1200 µg |
2000 µg |
| B12 |
10 µg |
500 µg |
1000 µg |
1500 µg |
| B6 |
25 mg |
50 mg |
75 mg |
100 mg |
| B2 |
10 mg |
15 mg |
20 mg |
50 mg |
| Zinc |
5 mg |
10 mg |
15 mg |
20 mg |
| TMG |
500 mg |
750 mg |
1.5-3 gm |
3-6 gm |
The current vogue to lower homocysteine is by recommending folic acid,
however this alone is far less effective than the right nutrients in
combination. The amount you need also depends on your current
homocysteine level. One study found that H scores were reduced by 17
per cent with high dose folic acid alone, 19 per cent with B12 alone;
57 per cent with folic acid plus B12; and 60 per cent with folic acid,
B12 and B6 in combination.(7) All this was achieved in three weeks!
The combination of supplements recommended,
plus correct diet, has the potential to
halve your homocysteine score in weeks
However, even better results would have been achieved by including TMG.
TMG is the best “methyl donor” to take as a supplement; even better
than SAMe. This is because it can immediately donate a methyl group to
homocysteine, thus detoxifying it. (See Figure 2 opposite)
In a study in New Zealand, patients with chronic kidney failure and
very high homocysteine levels, homocysteine was reduced by a further 18
per cent when 4 gm of TMG was given, along with 50 mg of B6 and 5,000
µg of folic acid, compared to patients taking just B6 and folic acid.(8)
Some supplement companies produce combinations of these nutrients such
as Solgar’s Homocysteine Modulators or Higher Nature’s H Factors. These
are the most cost-effective supplements for restoring a healthy
homocysteine level.
The combination of supplements recommended, plus the diet, has the
potential to halve your homocysteine score in weeks. The goal is to
achieve an H score of 6 or below. Mine is 4.5. Your H score is probably
the best objective measure of whether you are achieving optimum
nutrition.
REFERENCES
-
Wald DS, Morris, JK. Homocysteine and cardiovascular disease: evidence
on causality from a meta-analysis. BMJ 2002;325:1202.
-
Clerk M, et al. MTHFR 677C>T Polymorphism and Risk of Coronary
Heart Disease. JAMA 2002;288(16):2023-2031.
-
Lichtenstein P, et al. Environmental and heritable factors in the
causation of cancer - analyses of cohorts of twins from Sweden,
Denmark, and Finland. New England Journal of Medicine
2000;343(2):78-85.
-
Toshifumi M, et al. Elevated plasma homocysteine levels and risk of
silent brain infarction in elderly people. Stroke 2001;32:1116.
-
Seshadri S, et al. Plasma homocysteine as a risk factor for dementia
and Alzheimer’s disease. New England Journal of Medicine
2002;346(7):476-483.
-
Vollset SE, et al. Plasma total homocysteine and cardiovascular and
noncardiovascular mortality: the Hordaland Homocysteine Study. American
Journal of Clinical Nutrition 2001;74(1):130-136.
-
Koyama K, et al. Efficacy of methylcobalamin on lowering total
homocysteine plasma concentrations in haemodialysis patients receiving
high-dose folate supplementation. Nephrol Dial Transplant
2002;17:916-22.
-
McGregor, et al. Betaine supplementation decreases post-methionine
hyperhomocysteinemia in chronic renal failure. Kidney Int
2002;61(3):1040-1046.
Patrick Holford and Dr James Braly are co-authors of the H Factor Diet
(Piatkus, £8.99). For further information see w www.thehfactor.com
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