Homocysteine levels: Symptoms, complications

Homocysteine The New Kid On The Block

Have you ever heard of Homocysteine? Or better Yet, Has your doctor ever recommended a blood test to check your personal homo- cysteine level? Probably not. After reading this chapter guarantee you will wonder why. Few people have ever heard of this substance, and fewer still realize that it poses just as great a threat as cholesterol when it comes to cardiovascular disease.

Homocysteine Test

• It is estimated that by itself, an elevated homocysteine level in the blood is responsible for approximately 15 percent of all heart attacks and strokes in the world today which means 225,000 heart attacks and 24,000 strokes each year in the U.S.

Read And Learn More: Nutrition Medicine Physicians Defense Notes

• In addition, are 9 million people who have cardiovascular disease as a direct result of elevated homocysteine levels.
• Needless to say, I believe there is great value in learning more about this major killer, especially when you realize that you can correct it simply by taking B vitamin supplements.

What Is Homocysteine

The history of homocysteine research is a fascinating one, beginning with the career of Dr. Kilmer McCully. A promising pathologist and researcher who graduated from Harvard Medical School in the mid-1960s, Dr. McCully enjoyed studies that involved the connection of biochemistry with the disease.

Homocysteine Test

• His reputation was strong, and he soon landed prestigious positions as an associate pathologist at Massachusetts General Hospital and as an assistant professor of pathology at Harvard Medical School.
• Early in Dr. McCully’s career, he became particularly interested in a disease called homocystinuria. This presented itself in children who had a genetic defect that kept them from breaking down an essential amino acid called methionine.
• These children showed a tremendous buildup of a by-product called homocysteine. McCully reviewed two separate cases involving young boys with this defect who died of heart attacks.
• This was quite amazing since both of these boys were not even eight years old. When he examined the boys’ pathology slides, he discovered that the damage to the arteries was eerily similar to that of an elderly man who had severe hardening of the arteries.
• This led Dr. McCully to wonder whether mild to moderate elevations of homocysteine that were present over a lifetime could be a cause of heart attacks and strokes in the average patient.
• As seen in the case of the two boys, homocysteine is an intermediate by-product that we produce when our bodies metabolize (break down) an essential amino acid called methionine.
• Methionine is found in large quantities in our meats, eggs, milk, cheese, white flour, canned foods, and highly processed foods.
• Our bodies need methionine to survive; however, as you can see from the list of foods that contain large quantities of this nutrient, we in the U.S. have plenty of it. Our bodies normally convert homocysteine into either cysteine or back to methionine again.
• Cysteine and methionine are benign products and are not harmful in any way. But here is the catch: the enzymes needed to break down homocysteine into cysteine or back to methionine need folic acid, vitamin B12, and vitamin B6 to do their job.
• If we are deficient in these nutrients, the levels of homocysteine in the blood begin to rise. So why haven’t we heard of this before? We must turn back to Dr. Kilmer McCully.

Right Stuff Wrong Era

McCully reported his homocysteine theory in several medical journals in the late sixties and early seventies and was initially welcomed with great enthusiasm. Dr. Benjamin Castle, the chief of his department, fully supported Dr. McCully and showcased his work to a prestigious panel of experts. But by the mid-seventies, the homocysteine theory had lost most of its momentum.

Homocysteine Test

• Dr. Castle retired, and the new chief of the department asked Dr. McCully to seek his own research funding or to leave. His lab was moved into the basement.
• McCully fought long and hard, but eventually, time and money ran out: in 1979 the new department chief informed Dr. McCully that Harvard was terminating him because his theory about homocysteine and heart disease had not yet been proven.’
• Since McCully’s positions at Harvard Medical School and Massachusetts General Hospital went hand in hand, he lost both jobs in January of 1979.
• A former classmate from Harvard who was then the director of the arteriosclerosis center at MIT labeled McCully’s ideas “errant nonsense” and a “hoax being perpetrated on the public.”
• Soon the director of public affairs at Massachusetts General also asked Dr. McCully not to associate his homocysteine theories with the hospital or with Harvard. McCully was shut down for good. Dr. Kilmer McCully was certainly ahead of his time.
• But why the hostility toward a man who was simply trying to find the underlying cause of the number-one killer in today’s world? What was the motive for such pessimism and verbal attacks?
• Could the heavily funded research on cholesterol at the time have been the reason? At that time the cholesterol-heart attack theory was gaining tremendous momentum, and Kilmer McCully’s hypothesis clearly challenged its future.
• Dr. Thomas James, cardiologist, president of the University of Texas Medical Branch, and the president of the American Heart Association in 1979 and 1980, said, “You couldn’t get ideas funded that went in other directions than cholesterol.

You were intentionally discouraged from pursuing alternative questions. I’ve never dealt with a subject in my life that elicited such an immediate hostile response.”

• With all opposing theories silenced, the cholesterol theory went great guns. Drug companies began making billions, and everyone was convinced that heart attacks and strokes were simply the result of too much cholesterol in the bloodstream.
• Wouldn’t you say they did an excellent job in selling this to the medical community and to the general public?

Homocysteine Test

Renewed Interest In Homocysteine

In 1990 Dr. Meir Stampfer revitalized interest in Dr. McCully’s homocysteine theory. A professor of epidemiology and nutrition at the Harvard School of Public Health. Stampfer looked at the blood levels of homocysteine in fifteen thousand physicians who were involved in a health study.

• Dr. Stampfer reported that even mildly elevated levels were directly related to an increased risk of developing heart disease.
• Those men who had the highest levels of homocysteine experienced three times the risk of developing a heart attack when compared with those who had the lowest levels.
• This was the first large study that showed the possibility of homocysteine as an independent risk factor for heart disease.
• In February 1995 Dr. Jacob Selhub also reported in the New England Journal of Medicine that high plasma levels of homocysteine were directly related to an increased risk of carotid artery stenosis (the narrowing of the two main arteries supplying blood to the brain).

In addition, Selhub noted that most patients with high homocysteine levels also had low levels of folic acid and vitamins B12 and B6 in their bodies.’ Another large case-control study, The European Concerted Action Project, indicated that the higher the homocysteine level, the greater the risk of developing a heart attack.

High Homocysteine Levels Symptoms

• What was once considered normal levels for homocysteine were suddenly becoming recognized as very dangerous levels.
• If even more concern to the researchers was the fact that when they found elevated levels of homocysteine in patients who also had one or more other major risk factors (hypertension, elevated cholesterol, or smoking), the risk of vascular disease increased dramatically.
• The results of these clinical trials provided evidence that the lower our homocysteine levels are, the better. Suddenly researchers accepted as fact that homocysteine was indeed an independent risk factor for cardiovascular disease.
• Even the old-line supporters of the cholesterol camp, such as Claude L’enfant, director of the National Heart, Lung and Blood Institute, said, “Even if the risk of elevated homocysteine is not entirely proven, it is an extremely important area of research.”
• Today the medical evidence is beyond dispute: homocysteine can help cause coronary artery disease, stroke, and peripheral vascular disease.

Renewed Interest In Homocysteine Show Me The Money! The Economic Powers Of Medicine

You can now appreciate why more than half the people who suffer heart attacks have normal cholesterol levels. Why did it take twenty-five years after Dr. McCully presented his hypothesis on homocysteine for the medical community to pay attention? Dr. Charles Hennekens.

• A professor at Harvard Medical School and chief of preventive medicine at Brigham and Women’s Hospital cites a parallel example.
• “For years now, we’ve known about these large benefits of aspirin in treating [patients] who have suffered an acute heart attack and survivors of heart attacks, and yet we have underutilization of it,” he says.
• “At an FDA advisory committee meeting recently, I joked that if aspirin were half as effective, ten times as expensive, and on prescription, maybe people would take it more seriously.”
• Well, at least the pharmaceutical companies would take it more seriously, and they would definitely share those health benefits with the doctors. The situation here is similar.
• Like aspirin, at a cost of pennies a day vitamin B supplements can effectively lower the majority of elevated homocysteine levels.
• “It’s inescapable that there’s just not the commercial interest for supporting research in homocysteine,” Dr. Stampfer says, “because nobody’s going to make money on it.”
• Take a look at the amount of money the medical community and the pharmaceutical industry have made by lowering cholesterol with synthetic drugs.
• Billions and billions of dollars roll in each and every year. Have you ever considered who educated you about the risk of high cholesterol? Who is taking out that full-page ad in USA Today to tell you the importance of lowering your cholesterol? Pharmaceutical companies.

High Homocysteine Levels Symptoms

Why hasn’t someone taken out a TV or newspaper ad to inform you about the importance of lowering your homo- cysteine? There is not nearly as much money to be made in the sale of vitamin B12, vitamin B6, and folic acid.

• Sad to say, we are caught in the ripple effects of the economics of medicine.
• Could this possibly have been the underlying reason that Dr. Kilmer McCully lost his research funds and his job at Harvard? Dr. McCully takes his own follow-the-money approach, asking who stands the most to gain by not educating people about the dangers of homocysteine.
• “The most dramatic improvements in longevity over the last couple of hundred years have been through public health, not through medicine,” he says. “But public health is notoriously unprofitable.
• People don’t make a profit preventing disease. They make a profit through medicine-treating critical, advanced stages of the disease.”

Renewed Interest In Homocysteine Is There a Healthy Level of Homocysteine?

Unlike cholesterol, which the body needs for the production of certain cell parts and hormones, homocysteine provides no health benefit. The higher the level of homocysteine, the greater the risk of cardiovascular disease.

• Conversely, the lower the level of homocysteine, the better. There is no threshold below which homocysteine becomes okay. You want your homocysteine level to be as low as possible.
• Most labs will report the normal range of homocysteine levels between five and fifteen micromols/L (micromoles per liter of blood).
• The medical literature finds that when this level rises much above seven micromols/L, however, an increased risk of developing cardiovascular disease becomes apparent.
• Most patients will want homocysteine levels below seven. If your level rises above twelve, you are in serious trouble. Whenever the medical community discovers a new entity or risk factor, testing standards lag far behind.
• This happened with cholesterol and will happen with homocysteine. Therefore, do not be pacified by your physician, who might tell you that having a homocysteine level of ten or eleven falls well within the normal range and not to worry.
• You want to get your homocysteine level down to at least nine if you have no sign of cardiovascular disease; and below seven if you already have evidence of cardiovascular disease or have other risk factors for heart disease.

High Homocysteine Levels Symptoms

How Do I Lower My Homocysteine Level

There are really two sides to this problem of high homocysteine levels. One is the amount of methionine in your diet that the body has to metabolize and break down. This requires that you become careful with the amount of meat and dairy products you are consuming.

• Isn’t it interesting that these are the same foods that are high in saturated fat and cholesterol? Obviously, we need to replace these foods with more fruits and vegetables as well as vegetable protein.
• I realize that methionine is an essential amino acid; however, in the American diet, we will always get more than enough. The other side of the coin is providing enough folic acid.
• vitamin B6, and vitamin B12 so that the enzyme systems needed to break down homocysteine can work effectively. It is interesting to note that all studies that have shown harmful aspects of elevated homocysteine have also shown depleted levels of B vitamins.
• I recommend that all of my patients take 1,000 mcg (micrograms) of folic acid, 50 to 150 mcg of vitamin B12, and 25 to 50 mg (milligrams) of vitamin B6.
• Remember, the lower the homocysteine level, the better. I want to see everyone’s level below seven if at all possible.
• When my patients have an initial homocysteine level above nine, I start them on supplemental B vitamins and recheck their blood level within six to eight weeks. With this B-vitamin regime, homocysteine levels tend to fall somewhere between 15 and 75 percent.
• But not all patients will respond adequately to just the B vitamins. This is an indication to me that these patients simply have an overall problem with methylation, the biochemical process used by the body to reduce homocysteine to benign or non-harmful products in the body.

High Homocysteine Levels Symptoms

Methylation Deficiency

Methylation deficiency is responsible not only for elevated homocysteine levels but is also one of the key underlying problems in some of our major chronic degenerative diseases, especially some cancers and Alzheimer’s dementia.

• In fact, as I am writing this chapter, a study has just reported that a new test has been discovered for determining who may be at higher risk of developing Alzheimer’s dementia. I read the results of this study with great anticipation.
• Can you guess what the new test checks? Yes-the homocysteine blood level.” We have been doing this test in my office for the last several years because it points out the fact that elevated homocysteine.
• Levels are not only an indicator of vitamin B deficiency but also serve as an indicator for decreased levels of “methyl” donors in our body.
• Methyl donors are not only necessary to decrease homocysteine levels in the body, but they also produce important nutrients needed by the brain.
• The least expensive methyl donor, which has an excellent effect on homocysteine levels, is called betaine or trimethylglycine (TMG). If the homocysteine level has not come down to the desired level, I add 1-5 g of TMG to the daily supplemental B vitamins.

Dr. Kilmer McCully The Conclusion

A story was published on August 10, 1997, in the New York Times Magazine entitled “The Fall and Rise of Kilmer McCully.” It detailed the end of his story and offered an interesting perspective to our concerns here:

• McCully reveals, briefly, the shadow of disappointment that must have loomed larger two decades ago. “Last October,” he says, “the pathology department at Mass.
• General had a reunion and invited me, and I saw one of the people involved in my leaving the department. ‘Well,’ he said to me, ‘it looks like you were right after all.
• ‘ It’s 20 years later. My career is almost over. There’s really not much that can be done about 20 lost years, is there?” Worse, the political and economic forces that undid McCully back then may even be more intense today.
• Last April, the New England Journal of Medicine published an article titled “The Messenger Under Attack Intimidation of Researchers by Special-Interest Groups.
• ” Which detailed three cases of harassment by advocacy groups, physicians’ associations, or academic consultants who often failed to disclose their close ties to drug companies.
• With more and more pressure groups weighing in on what research gets financed and promoted, the article said, “Such attacks may become more frequent and acrimonious.”
• McCully knew the dangers of homocysteine. I’m sure he also knew that taking B vitamins in supplementation is not only inexpensive insurance against these dangers but safe as well. He was up against a political giant. But the truth is now clear.
• We are left to wonder why doctors are still so reluctant to check their patients’ homocysteine levels and why they are not recommending B vitamins to all of their patients.
• What your doctor doesn’t know maybe killing you. Especially when you consider the fact that homocysteine is an important if not a greater, risk factor for heart disease than cholesterol.

High Homocysteine Levels Symptoms

The New Tests For Heart Disease

The New Tests For Heart Disease Ultrasensitive CRP

• As the medical community begins to realize that coronary artery disease is decidedly an inflammatory and not a cholesterol disease, more clinical studies are appearing in the medical literature advising physicians of effective ways to evaluate patients.
• Several studies have looked at various products in the body that give us evidence of the amount of inflammation that is present in the arteries.
• One such highly preferred blood test is the highly sensitive C-Reactive Protein (hs CRP). This test measures the arterial inflammation currently present.
• This test is actually a better predictor of who is going to develop heart disease than a cholesterol level.
• Why shouldn’t it be? In fact, doing highly sensitive CRPS allows the physician to identify those patients who have normal cholesterol levels and may still be at increased risk of developing cardiovascular disease.

The New Tests For Heart Disease Homocysteine Blood Levels

• Checking patients’ fasting homocysteine blood levels is not only easy but also critical in determining whether they are problematic or not.
• Hopefully, as the test becomes more standardized between labs it will become more affordable. Presently, a serum homocysteine level test costs between $45 and $150.

High Homocysteine Levels Symptoms

The New Tests For Heart Disease Heart Calcification Scores

• Most medical centers have now made modifications to their CT scanners so they can determine the amount of calcification, or plaque buildup, present in coronary arteries.
• This is a simple, non-invasive procedure, but its cost usually ranges between $250 and $600. I recommend this test for all patients with significant risk factors for or a strong family history of heart disease.
• If the test does show calcifications, it gives a doctor some feel for how serious the problem is and how aggressively to treat the patient.
• Remember, more than 30 percent of the time the first sign of heart disease is sudden death. I have found this tool to be very helpful and motivating for my patients.