Lowering homocysteine levels
A high blood homocysteine level can be easily lowered by taking
supplements of B vitamins, particularly folic acid, B6, and B12 .or by taking
betaine. Unfortunately, at
this time, having reviewed the positive results and the negative results, 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 not supplement with B
vitamins to lower homocysteine? I still say yes. In addition to lowering
homocysteine level in the blood and brain, B vitamins have many benefits
including mental health and more energy. But, I don't think high doses are
required. One, two, or three times the RDA should be fine. I 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 may be counterproductive. Unfortunately, as with many
simple nutritional questions, such as the role of calcium supplements in
osteoporosis, more research will be needed to sort out the real answers.
Cochrane Database Syst Rev. 2013. Homocysteine-lowering interventions for preventing cardiovascular events. This updated Cochrane review found no evidence to suggest that homocysteine-lowering interventions in the form of supplements of vitamins B6, B9 or B12 given alone or in combination should be used for preventing cardiovascular events. Furthermore, there is no evidence suggesting that homocysteine-lowering interventions are associated with an increased risk of cancer.
Homocysteine lowering by using B vitamins had no significant effect on individual cognitive domains or global cognitive function or on cognitive aging. Effects of homocysteine lowering with B vitamins on cognitive aging: meta-analysis of 11 trials with cognitive data on 22,000 individuals. Am J Clin Nutr 2014.
Mind Power Rx with Trimethylgycine (betaine) and B12
Mind Power Rx is a sophisticated cognitive formula. It combines a delicate
balance of brain circulation agents and neurotransmitter precursors with
powerful natural brain chemicals that support:
• Memory and Mood
• Mental clarity
• Concentration
• Alertness and Focus
How to reduce high
homocysteine
level
Why purchase all the individual
memory
herbs and nutrients separately -- at great expense
-- when you can buy this excellent combination?
The herbs in
Mind Power Rx include: Ashwagandha,
Bacopa,Ginkgo biloba, Ginseng, Mucuna pruriens, Fo-Ti, and Reishi. The
nutrients and vitamins are: Acetyl-l-carnitine, Carnitine,
Carnosine, Choline,
DMAE, Inositol, Methylcobalamin, Pantothenic acid,
Trimethylglycine, Tyrosine, and
Vinpocetine.
Products formulated by
talented physician:
Passion Rx
-
highly popular sexual
enhancement product for men and women
Prostate Power Rx
- for optimal prostate health with
saw palmetto and
pygeum and
stinging nettle
5-HTP 50 mg - for
serotonin
support
Acetyl-l-Carnitine 300 mg - mind
and memory support, antioxidant
R- Alpha Lipoic Acid 50 mg - powerful
antioxidant and blood
sugar control
Curcumin
the active extract
from turmeric, found in
curry
Tribulus Terrestris
- one of the common
sexual enhancers
Mangosteen - contains powerful
xanthones
Serrapeptase - blood clot dissolver
Graviola herb from the Amazon
Ashwagandha for
brain health
Beta sitosterol
is an important
phytoestrogen often used for prostate health and cholesterol
management
Adequate intake of folic acid, B6, and B12 will assure that the blood homocysteine
level is kept under control. 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 a high homocysteine level would be by supplementing
with these vitamins. Keep dosages low.
In addition to potentially contributing to cardiovascular conditions, homocysteine may 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 an article discussing
its role
in cognitive decline. They say, "Homocysteine may represent a
metabolic link in the cause of atherosclerotic vascular diseases and old-age
dementias.
An excessive amount is an independent risk factor for coronary artery disease,
peripheral vascular disease, and cerebrovascular disease. 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 SAM-e and an
increase in homocysteine, which can be critical in the aging brain."
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.
In older people, higher blood levels of homocysteine
are associated with lower mental functioning.
homocysteine, an amino acid that has been tied to heart disease and
stroke, can be lowered with folate and vitamins B6 and B12. The latest
finding suggests to researchers that B vitamin supplements may help
prevent homocysteine related cognitive decline.
S-adenosylhomocysteine, a
better test for vascular disease than homocysteine?
Some studies indicate higher blood concentration of S-Adenosylhomocysteine
appears to be a more sensitive indicator of vascular disease.
Phosphatidylcholine
A report in the 2005 issue of the American Journal of Clinical
Nutrition, indicates that a high daily dose of
choline,
supplemented as
phosphatidylcholine, lowers fasting as well as postmethionine-loading
plasma homocysteine concentrations in healthy men with mildly elevated
concentrations. If high homocysteine concentrations indeed
cause cardiovascular disease, choline intake may reduce cardiovascular
disease risk in humans.
Liver
health
High homocysteine level is also
associated with higher ALT levels
when liver enzyme levels are checked.
Memory loss
A population-based, prospective study of elderly British
individuals shows that risk of memory loss increases over time with
increasing levels of total blood homocysteine and decreasing folate
levels. Homocysteine is an amino acid in the blood. Too much of it ups the
risk for coronary heart disease, stroke and fatty deposits in peripheral
arteries. High circulating levels of homocysteine, especially with
advancing age, have also been associated with cognitive impairment.
Homocysteine levels in the blood are strongly influenced by diet and
genetics. Folic acid and other B vitamins help break down homocysteine in
the body. Annals of Neurology 2005.
Osteoporosis
Women who have high levels of the amino acid homocysteine in the
blood are at increased risk for low bone mineral density (BMD). Using data
from a population-based cohort of more than 5,300 middle-aged and elderly
men and women, researchers observed that total homocysteine level was
inversely related to hip BMD among middle-aged and elderly women, but not
among men. Women with high levels were nearly two times more
likely to have low BMD compared with women with low levels.
Moreover, high homocysteine predicted
osteoporosis
among women after adjusting for confounding factors such as smoking,
physical activity, intake of vitamin D and calcium, and use of
estrogen.
Stroke
Zhonghua Nei Ke Za Zhi. 2015. A prospective study on the association of
plasma homocysteine level with stroke in hypertensive patients. Elevated
Hcy levels were associated with stroke in hypertensive patients.
Review and Summary
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, may 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
but there is still not definite proof that taking B vitamins lowers the
risk of heart disease or stroke. If you do take B vitamins, keep your
dosage to one or two times the RDA. Higher doses may be counterproductive
or harmful in some people.
Homocysteine Study in
New England Journal of Medicine - Controversy
Supplementation with folic acid and vitamins
B-12 and B-6 did not reduce the risk of major cardiovascular events in
patients with cardiovascular disease (CVD) according to two reports in the
New England Journal of Medicine for April 13, 2006. The Heart Outcomes Prevention Evaluation (HOPE)-2 investigators, led by
Dr. Eva Lonn at McMaster University in Hamilton, Ontario, enrolled
5522 patients age 55 and older who had a history of vascular disease or
diabetes and other risk factors for atherosclerosis.
Subjects were randomly assigned a daily tablet containing 2.5 mg folic
acid, 50 mg vitamin B-6 and 1 mg vitamin B-12 or matching placebo.
Baseline homocysteine levels were similar in the two groups (12.2 mol/L).
After a mean of 5 years of follow-up, levels had declined to 9.7 mol/L in
the active treatment group, but had increased to 12.9 mol/L in the
placebo group.
Despite the changes in homocysteine levels, no major changes were noticed
in myocardial infarction and stroke (18.8% in the supplement group
and 19.8% in the placebo group). There were also no significant
differences in hospitalization for heart failure or revascularization,
total ischemic events, or venous thromboembolism.
Even among subjects with the highest baseline levels of homocysteine,
outcomes were similar between the two groups.
The only significant differences were a slightly decreased risk of stroke
in the active treatment group and an
increased hazard of hospitalization for unstable angina (9.7% versus 7.9%). The investigators note that the confidence intervals were wide
and the results were not adjusted for confounders.
In the second report, Dr. Kaare Harald Bonaa, from the University of
Tromso, and members of the Norwegian Vitamin (NORVIT) trial group
conducted a similar prospective study that included 3749 patients ages 30
to 85 years who had had an acute MI.
Participants were randomly assigned to one of four groups. They were given
0.8 mg folic acid plus 0.4 mg vitamin B-12 and 40 mg vitamin B6
(combination therapy), 0.8 mg folic acid and 0.4 mg vitamin B-12, 40 mg of
vitamin B6 or placebo.
Supplements were taken once daily, and outcomes were assessed after an
average of 36 months. In the two groups treated with folate and vitamin B-12,
total homocysteine levels declined by 27%, while B-6 alone and placebo had
no effect.
In the combination therapy group, the odds of stroke, MI, or
cardiovascular death was increased 22% compared with placebo. Vitamin B-6
was associated with a 17% increase in the risk of MI, and combination
therapy increased the risk of nonfatal MI by 30%.
N Engl J Med 2006.
Homocysteine Research
Complex multivitamin supplementation improves homocysteine and
resistance to LDL-C oxidation.
J Am Coll Nutr. 2003.
We previously reported in an open-label pilot trial that a 24-ingredient
multivitamin formula favorably influenced homocysteine concentration and LDL-C
oxidation indices following 24 weeks of supplementation. Our current aim was to
more thoroughly examine this same formula in a randomized, placebo-controlled,
clinical study. We examined 182 participants for selected plasma
vitamin concentrations and clinically relevant variables including homocysteine,
lipids and LDL-C oxidation indices at baseline and six months. RESULTS: We found
no significant differences between groups for any parameter at baseline.
Following six months of vitamin supplementation, we observed elevations in
plasma concentrations of vitamin B6 (as pyridoxal 5'-phosphate; PLP), vitamin
B12, folate, vitamin C, vitamin E and beta-carotene, all of which were
significantly greater than respective placebo group changes. Homocysteine decreased in the treatment and placebo group from baseline to
six months, respectively, with reductions in the treatment group being greater
than placebo. LDL-C oxidation indices were also improved. We
conclude that a multi-ingredient vitamin formula with antioxidant properties has
measurable effects on homocysteine and LDL-C oxidation indices.
Effects of betaine intake on plasma homocysteine concentrations and
consequences for health.
Curr Drug Metab. 2005.
High plasma concentrations of homocysteine may increase risk of
cardiovascular disease. Folic acid lowers plasma homocysteine by 25% maximally,
because 5-methyltetrahydrofolate is a methyl donor in the remethylation of
homocysteine to methionine. Betaine (trimethylglycine) is also a methyl donor in
homocysteine remethylation, but effects on homocysteine have been less
thoroughly investigated. Betaine in high doses (6 g/d and higher) is used as
homocysteine-lowering therapy for people with hyperhomocysteinemia due to inborn
errors in the homocysteine metabolism. Betaine intake from foods is estimated at
0.5-2 g/d. Betaine can also be synthesized endogenously from its precursor
choline. Studies in healthy volunteers with plasma homocysteine concentrations
in the normal range show that betaine supplementation lowers plasma fasting
homocysteine dose-dependently to up to 20% for a dose of 6 g/d of betaine.
Moreover, betaine acutely reduces the increase in homocysteine after methionine
loading by up to 50%, whereas folic acid has no effect. Betaine doses in the
range of dietary intake also lower homocysteine. This implies that betaine can
be an important food component that attenuates homocysteine rises after meals.
If homocysteine plays a causal role in the development of cardiovascular
disease, a diet rich in betaine or choline might benefit cardiovascular health
through its homocysteine-lowering effects. However betaine and choline may
adversely affect serum lipid concentrations, which can of course increase risk
of cardiovascular disease. However, whether the potential beneficial health
effects of betaine and choline outweigh the possible adverse effects on serum
lipids is as yet unclear.
Homocysteine and cognitive function in elderly people.
CMAJ. 2004.
Dementia is highly prevalent among elderly people, and projections show that the
number of people affected might triple over the next 50 years, mainly because of
a large increase in the oldest-old segment of the population. Because of this
and the disease's devastating effects, measures for the prevention and early
detection of dementia are crucial. Age and years of education are among the most
relevant risk factors for dementia, but in recent years the role of homocysteine
has also been investigated. Homocysteine is an amino acid produced in the
metabolism of methionine, a process dependent on the B vitamins cobalamin,
vitamin B6 and folic acid. There is evidence that increased serum homocysteine
levels are associated with declining cognitive function and dementia. We review
this evidence in addition to the potential mechanisms through which homocysteine
acts on the brain to cause cognitive dysfunction, the metabolism of homocysteine
and factors associated with alteration of the normal metabolism.
Homocysteine and the production of collagens,
proliferation and apoptosis in human arterial smooth muscle cells.
APMIS. 2004.
Homocysteine is an important and independent risk factor for atherosclerosis.
We showed that human aortic smooth muscles in cultures proliferated
significantly at a concentration of 25 mumol/L Homocysteine without the presence
of serum. There was no effect of Homocysteine on apoptosis. However, collagen
types I, III and IV increased significantly in a dose-dependent manner at
elevated concentrations of Homocysteine and the amount of type VI collagen was
significantly reduced in a dose-dependent manner. Homocysteine induced increased
cell replication with an unaffected apoptosis rate. The present observations
suggest that Homocysteine may contribute to accelerated progression of
atherosclerotic lesions with collagen alterations which transform the injury
into fibrotic plaques.
Low dose betaine supplementation leads to immediate and long term lowering
of plasma homocysteine in healthy men and women.
Olthof MR. J Nutr. 2003.
High plasma homocysteine is a risk for cardiovascular disease and can be lowered
through supplementation with 6 g/d of betaine. However, dietary intake of
betaine is approximately 0.5-2 g/d. Therefore, we investigated whether betaine
supplementation in the range of dietary intake lowers plasma homocysteine
concentrations in healthy adults. Four groups of 19 healthy subjects ingested
three doses of betaine or placebo daily for 6 wk. A methionine loading test was
performed during run in, on d 1 of betaine supplementation, and after 2 and 6 wk
of betaine supplementation. Fasting plasma homocysteine after 6-wk daily intakes
of 1.5, 3 and 6 g of betaine was 12% less than in the placebo group, respectively. Furthermore, the increase
in plasma homocysteine after methionine loading on the 1st d of betaine
supplementation was 16% less
than in the placebo group, respectively, and after 6 wk of supplementation was
23% less, respectively. Thus,
doses of betaine in the range of dietary intake reduce fasting and
postmethionine loading plasma homocysteine concentrations. A betaine-rich diet
might therefore lower cardiovascular disease risk.
Betaine supplementation
decreases plasma homocysteine concentrations but does not affect body
weight, body composition, or resting energy expenditure in human subjects.
Am J Clin Nutr. 2002.
Betaine (trimethylglycine) is found in several tissues in
humans. Betaine is involved in homocysteine metabolism as an alternative methyl
donor and is used in the treatment of homocystinuria in humans. In pigs,
betaine decreases the amount of adipose tissue. The aim of the
study was to examine the effect of betaine supplementation on body weight,
body composition, plasma homocysteine concentrations, blood pressure, and
serum total and lipoprotein lipids. Forty-two obese, white
subjects (14 men, 28 women) treated with a hypoenergetic diet were
randomly assigned to a betaine-supplemented group (6 g/d) or a control
group given placebo for 12 wk. The intervention period was preceded by a
4-wk run-in period with a euenergetic diet. Body weight, resting
energy expenditure, and fat mass decreased significantly in both groups
with no significant difference between the groups. Plasma homocysteine
concentrations decreased in the betaine group. Diastolic blood pressure decreased
without a significant difference between the groups. Serum total and LDL-cholesterol
concentrations were higher in the betaine group than in the control group. A hypoenergetic diet with betaine supplementation
(6 g daily for 12 wk) decreased the plasma homocysteine concentration but
did not affect body composition more than a hypoenergetic diet without
betaine supplementation did.
Emails
Q.
I am wondering if you can tell me what my best course of action might be to
lower my homocystine levels. They have bounced around between 10.9 and 15.9 for
years, but I am not entirely sure what causes the fluctuation. I cannot seem to
get them any lower. I have sarcoidosis, otherwise generally ok. Prescriptions:
10mg prednisone and 10mg benicar (not hct). Supplements - Including a
multivitamin, 1000mg methyl b-12, additional 25mg b-6, 1500mg TMG, 2500mg of
fish oil, 100mg ALA, curcumin, zyflamend (combo for anti-inflamatory), 100mg
co-q10, 1000 mg aged garlic extract, etc.
A. I prefer not to focus on any particular blood level but to take
a comprehensive approach to one's overall health.
Q. I've just purchased some Sam-e for depression as
I experience too many side-effects with anti-depressants. I have read that it is
wise to take additional B vitamins, particularly B6, B12 and folic acid, when
taking Sam-e in order to prevent toxic build-up of homocysteine. Apparently
these vitamins assist in the breakdown of homocysteine which is formed when
Sam-e breaks down.
A. We're not totally sure whether extra B vitamins are
needed if someone is taking SAM-e. Perhaps it depends on one's diet and
biochemistry. It would not hurt to take 1 to 3 times the RDA of the B vitamins.
Q.
I've just read about Trimethyglycine on
your site. I recently had blood work done and everything was great except my
Homocysteine, which was 11.1. I want to lower it to the 6-7 range. I've been
researching and found sites with TMG protocols of up to 6 grams along with B6
(100-500 mg), B12 (1000-3000 mcg), and folic acid (800-5000 mcg). My question:
Does taking these supplements at these dosages have side effects? Especially the
TMG, which is very high? One site mentioned someone who had a Homocysteine
number of 18. He took TMG at 6 grams and 500 mg of B6 and lowered it to 4 in 60
days. I'm just curious as to your opinion of these kind of dosages. Your
thoughts are appreciated. Your site is very informative.
A. TMG at high doses can increase body temperature and cause irritability
and insomnia. My preference is not to use TMG in a dosage greater than 750 mg
daily. Also, massive doses of B vitamins are not required to lower homocysteine.
A fraction of the doses mentioned in your email can be effective. Each person is
unique in their response, though, and some require less, others more.
Q. Do you think testing for
homocysteine blood level is important?
A. I'm not really sure homocysteine levels need to be
checked since taking B vitamins will lower them anyway. We do so many
blood tests in this country, and medical expenses are skyrocketing. Why
not just take a cheap B vitamin complex? That' s my opinion, another
doctor may disagree.
Q. Which supplement, choline or betaine, is more
effective at lowering homocysteine levels?
A. A combination of low doses of B vitamins, one or two
times the RDA, would be more effective, along with low doses of betaine or
choline, such as 50 mg. Each person is unique, it is difficult to say
which will work in a particular person but the important point is to use
low dosages.
Q. Are homocysteine and
metabolic
syndrome X related?
A. Not directly, but those with poor dietary habits and
who do not exercise enough are likely to have high homocysteine and have
metabolic syndrome x.
Q. I read your
May newsletter on homocysteine and that is disturbing news. Everyione,
including Dr Jonahtan Wright is saying that homocysteine causes more heart
attacks than high chlosterol. Now I don't know what to think?
A. Unfortunately, science does not always give us clear
answers. It takes a long time, often decades, to find out good answers to
even simple nutritional questions.
Q.
My letter is actually about your statement on B vitamins (especially in
the effort to reduce homocysteine levels) - I was wondering if you had
read the H-Factor, where the authors describe clinical studies
where the homocysteine levels were not reduced using B-vitamins because
TMG amounts were not included. Could it be that the trials you were
referencing did not include the proper amounts of TMG? I did not test for
homocysteine levels before starting on the regime (I believe you have to
go outside the
US for testing) and I do plan to test in the future, but also feel
confident that meanwhile I am reducing it significantly so that when I do
test, I should have a very healthy number.
A. B vitamins lower homocysteine levels, but whether
that leads to a change in health is not fully answered at this time.
Homocysteine levels can be routinely tested in a doctor's office. TMG can
also lower homocysteine levels.
Q. I
have a question about Source Naturals Homocysteine Defense. Is there a
problem in taking only a few of the B vitamins? I've been under the
impression that they should all be taken together.
A. As a general statement, I think taking one or two
times the RDA for all the B vitamins is a good option at this point until
we learn more about this complex issue.
Q. I have read about TMG and it states that it helps convert
homocystine to methionine. Doesn't methionine all convert back to homocystine?
Also, I have read that TMG raises LDL. Is this actually a benefit if it raises
LDL but lowers Homocystine?
A. The whole methionine, homocysteine, TMG, SAM-e, etc.
biochemistry is quite complicated, and rather than focusing on the individual
biochemical steps that are involved, it is more practical to take a
comprehensive approach to reducing heart disease risk factors. TMG is quite
potent, and most people don't need more than 100 or 200 mg a day even though
tablets come in 750 mg. TMG may lower homocysteine, but if too high doses are
used, insomnia can occur or heart rate could increase and thus negate the
homocysteine lowering benefits. Much of the benefit or risk of a supplement
depends on the dosage.
Do you have an opinion
on supplementing hydroxocobalamine, cyanocobalamine or methylcobalamine with
Folic acid and Trimethylglycine TMG to help reduce high homocysteine level and
to support recovery of nerve damage caused by B12 deficiency? You seem to
recommend against it because TMG does the same thing as the other two.
Without specific research on these nutrients and comparisons, it is
difficult to know which one or combination is best and what dosage to use.