High cholesterol? What about high homocysteine???

These days cholesterol still gets all the attention when it comes to heart disease. In fact, I think way too much attention. There are other, often better predictors of heart disease than standard cholesterol tests. And these are routinely missed, even when the patient’s (and doctor’s) motive is to assess the potential risk of future cardiovascular events. I’ll talk about one very important one of those risk factors now. It is an amino acid called homocysteine.

Homocysteine was discovered by a man named Dr. Kilmer McCully. He is a Harvard Medical School graduate; and discovered this amino acid was responsible for arteriosclerosis (or hardening of the arteries) while researching a rare condition called homocysteinuria, forty years ago. He was researching two cases where an eight year-old child and and a two-month old child both had arteriosclerosis. Through further research he eventually made a connection between homocysteine and arteriosclerosis. Unfortunately though, when he first voiced this discovery, he was shunned by just about every medical professional. In 1976, the (“new”) chairman at Harvard said the “elders” at the school “felt” he had not proved his theory; and unless he could get grant money he would lose his position. They went as far putting his lab in the basement so he would have no contact with others, and then he decided to leave. For the next 27 months he could not find a single position in North America that would allow him to continue his research. McCully was later told that Harvard and Massachusetts General Hospital did not want to be associated with his work, because it did not go along with the conventional wisdom that cholesterol and fats caused heart disease. You can read more about that story in an interview with McCully here. By the way, one main reason that he was discredited might be because one of the most common ways to treat excess homocysteine levels is through nutritional supplements.

Anyhow, homocysteine is naturally produced in the body through the necessary breakdown of the essential amino acid, methionine. However, just because it is naturally produced does not mean that it is benign. An article in the Journal of the American Medical Association concluded this: “An increased plasma total homocysteine level confers an independent risk of vascular disease similar to that of smoking or hyperlipidemia” (or high blood lipids/fats). There are many more studies in existence that speak of the risk of high homocysteine levels in relation to (cardio)vascular disease so I won’t bore you with repeating this information.

Homocysteine causes several problems. For instance, it can oxidize cholesterol (making it harmful to blood vessels), cause scarring inside the lining of blood vessels, and increase blood clotting. Essentially, high levels of homocysteine will ultimately damage cells and the walls of the blood vessels. As a result, cholesterol will get deposited in the arteries in an attempt to “patch” up the damage. That is why cholesterol can “cause” cardiovascular events such as heart attacks and strokes. Also, this damage can lead to peripheral arterial disease, usually in the legs and feet, which in a worst case scenario can eventually result in the need for amputation like in diabetics. So does cholesterol really “cause” vascular problems? Well, that can be argued, but it is really the body’s attempt to heal. Hmmm, I guess cholesterol is not so bad to begin with. I will talk about that in another article. By the way, there are many causes of blood vessel damage.

High homocysteine levels have been implicated in coranary artery disease, heart attack, stroke, deep vein thrombosis, rheumatoid arthritis, osteoporosis, Alzheimer’s disease and more.

So what’s the solution? Some fancy well-marketed drug? No, B-vitamins of course! That’s right vitamins B6, B12, and folic acid (in addition to other biochemicals) will metabolize homocysteine properly and prevent high levels in the bloodstream. Folic acid and B12 will recycle homocysteine back into methionine and B6 will convert it down to cystathionine (and then hopefully down into cysteine and sulfate). So if these vitamins lower homocysteine levels, then a deficiency in them can cause high blood levels. McCully also reports other causes such as imbalances in thyroid and “female” hormones, in addition to kidney problems.

Please don’t get me wrong, many doctors are aware of homocysteine, but not enough in my opinion. I have seen blood tests from patients with known peripheral artery disease and cardiovascular complications without reporting their homocysteine levels. Also, some patients show me their blood tests with normal cholesterol levels (but no homocysteine); and report that their doctor has told them they don’t need to be concerned with heart disease. Also, look at a recent blood test of your own and (depending on the lab) you may find that they claim to determine your heart disease risk factor based on cholesterol levels alone.

One more thing, measuring homocysteine can also be used to find out if you have a deficiency in these B-vitamins. Again, there could be other causes, but it’s as simple as doing a follow-up test after supplementation for a few months.

PS: One common sign I have discovered in patients, which stems from high homocysteine (perhaps B-vitamin deficiency) is easy bruising. Bruising is basically damage to blood vessels. This is true even in those who “should” be bruising like some of the professional aerial acrobats (or intense athletes) I work with; but it’s also common in people who are not extremely active. The flip side to easy bruising would therefore also mean an inability to heal the vessels as well. And interestingly your body will not produce collagen (a main component of blood vessels and other structures) properly if your homocysteine levels are too high. But that concept, along with the other necessary nutrients to make proper collagen is for another discussion. Now don’t go trying to judge your homocysteine levels based on if you bruise easily or not; that’s just one observation I’ve made working with patients. It is worth asking your doctor to run this test – and remember those B-vitamins are necessary for a lot more functions than homocysteine metabolism.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology