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Homocysteine has been shown to be an independent risk factor for the premature development of coronary artery disease and thrombosis. This test is intended for use in screening individuals who may be at risk for heart disease and stroke. Studies have shown that even moderate levels of homocysteine pose an increased risk for arteriosclerosis compared with the lowest 20th percentile (<7.2 mcmol/L) of population controls.

Homocysteine. High homocysteine levels contribute to inflammation and the production of free radicals that attack endothelial cells and raise thrombotic risk (Riba R et al 2004). Mild elevations in serum homocysteine (homocysteinemia) can be caused by nutrient deficiencies, including deficiencies in folate and vitamin B12. Homocysteine, like cholesterol, is strongly associated with risk of heart disease (Haynes WG 2002; Guilland JC et al 2003).

There are various interpretations of how much homocysteine is dangerous. We advocate relatively low homocysteine levels to help lower risk of disease. By ages 40 to 42, mean homocysteine levels are about 11 micromoles per liter (µmol/L) in men and 9 µmol/L in women. Even homocysteine levels this low has been associated with disease. The Life Extension Foundation recommends homocysteine level between 7 µmol/L and 8 µmol/L.

·         Reduce dietary saturated fats, cholesterol, and trans-fatty acids.

·         Increase intake of fiber to at least 10 g daily.

·         Consume at least five servings of fruits and vegetables daily.

·         Ensure adequate intake of folic acid (400 to 1000 mcg daily) to reduce homocysteine levels.

·         For obese people, lower weight and increase physical activity to reduce the risk factors for metabolic syndrome and to help control blood pressure and reduce cardiac workload.

·         For people with hypertension, limit sodium intake and maintain adequate intake of potassium, calcium, and magnesium.

HEART ATTACK RISK FACTOR : Excess Homocysteine

Optimal Blood Level:  Under 7-8 mcmol/L of homocysteine

Homocysteine is a breakdown product of an amino acid (methionine) most commonly found in meats. Those who consume high-meat diets often have higher homocysteine levels. Excess homocysteine also occurs in response to remethylation deficits and a deficiency of an enzyme called cystathionine b-synthase.

Excess homocysteine can both initiate atherosclerosis and facilitate its progression.97-99 Some poorly designed studies over the past four years have caused the medical establishment to ignore the atherogenic dangers of excess homocysteine. The problem with these studies is that they used varying doses of B vitamins to induce modest reductions in blood homocysteine levels. When there were no reductions in heart attack incidences, doctors claimed there was no benefit to homocysteine reduction. These studies also failed to individualize programs to provide different forms of nutrients to study subjects to ensure maximum homocysteine reduction. For instance, if your homocysteine level is 16, and you take a multivitamin preparation that reduces it to 13, you are unlikely to see a vascular disease risk reduction. If on the other hand you aggressively slash your homocysteine down to below 8, your risks for a wide range of disorders (including heart attack) may be significantly reduced.

Drug options: Elevated homocysteine blood levels can usually be brought into safer ranges by taking folic acid, vitamin B12, trimethylglycine (TMG), and vitamin B6 dietary supplements. Reducing one’s intake of methionine-rich foods (such as meats) also assists in reducing homocysteine. There are individuals, however, who suffer from remethylation deficits and/or cystathionine b-synthase deficiencies. In these cases where homocysteine levels remain stubbornly high despite aggressive use of supplements, an expensive prescription drug called Cerefolin® is available. This drug contains 5,200 mcg of a special form of folic acid called L-methylfolate plus very small amounts of vitamins B12 and B6. The reason this drug is called Cerefolin® is because excess homocysteine is known to damage the brain, ergo the name “Cere”folin to imply “cerebral” folic acid. Due to its high cost, Cerefolin® is recommended only when natural approaches fail.

Nutrient options:

1. To facilitate the remethylation of homocysteine into safer compounds such as SAMe (S-adenosyl-methionine), the following nutrients should be taken in the following doses each day:
Folic acid: 800-3,200 mcg
Vitamin B12: 500-2,000 mcg
Trimethylglycine (TMG): 500-8,000 mg
Multivitamin with B complex and zinc
(High-dose vitamin C has also been reported to help lower homocysteine).

2.  To facilitate the cystathionine b-synthase enzyme that converts homocysteine into beneficial cysteine and glutathione (via the trans-sulfuration pathway), increased doses of vitamin B6 are often needed. The high dose of conventional vitamin B6 (pyridoxine HCl) needed to lower homocysteine has raised concerns among some doctors. Fortunately, a form of vitamin B6 called pyridoxamine provides the body with the most biologically active form of vitamin B6 in a safe dose range.To reduce elevated homocysteine, 100-250 mg a day of pyridoxamine should be used.
        
 Dietary options

1. Consume a vegan diet devoid of meat, with protein obtained primarily from plant sources (nuts, legumes, and soy).

2. Consume a Mediterranean diet, with lots of fresh fruits and vegetables, fish and soy as protein sources, and omega-3 and monounsaturated fats (olive oil), while minimizing meats like beef, pork, chicken, and turkey.

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