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Homocysteine and heart health

Mrs. Howell’s Secret

You wouldn’t buy a house after looking at it just from the outside. The exterior is important, but you’d want to look around inside of course, check the foundation, the plumbing, the roof, the yard, the neighborhood.

Along the same lines, it’s hard for me to understand why anyone would assess cardiovascular health by looking just at cholesterol levels when there are other factors to consider that are far more important.

And yet all too often, when LDL levels are high, doctors write the scrip for a statin drug and feel that this alone is an adequate therapy for addressing arteriosclerosis and heart disease. But this narrow protocol can leave high levels of homocysteine, triglycerides and C-reactive protein unchecked and untreated.

Today we’ll focus on just one of those other factors – homocysteine – with some study results that reveal an effective way to help keep homocysteine levels in check.

First, the folate factor

Homocysteine is an amino acid that promotes the buildup of plaque on blood vessel walls, increasing the risk of heart attack and stroke. In fact HSI Panelist Allan Spreen, M.D., believes that homocysteine is a far more important indicator of arteriosclerosis risk than cholesterol.

In previous e-Alerts, Dr. Spreen has told us how homocysteine metabolism depends on nutrients such as folate, vitamin B6 and B12. That’s why homocysteine levels drop when folate intake is increased. However, it doesn’t always happen quite that easily. Most people who raise their dietary folate intake – by eating asparagus, lentils, chickpeas, most varieties of beans, and especially spinach and other leafy green vegetables – respond with a lower homocysteine reading. But if the diet doesn’t do the trick, then vitamin supplements often will.

In the e-Alert “World Domination – Part II” (9/17/02), Dr. Spreen outlined his recommendations for folate supplementation:

“Low doses of folate may work in many individuals, but for some the requirements may be as high as 20 mg of folic acid, which isn’t available in the U.S. due to a moronic decision of the FDA years ago (only 0.8 mg is available without a prescription). But the FDA only has jurisdiction over what dosage can be sold – not the amount you may choose to take in your own home, so my recommendation is that high homocysteine individuals might consider 5 milligrams of folic acid, 100 milligrams of B-6, and 1 milligram of B-12 (the last taken under the tongue, not orally). In a great many cases 0.8 milligrams of folate, 50 milligrams of B-6, and 1 milligram of B-12 will do the trick.”

To that advice, Dr. Spreen suggested one more supplement that can help address elevated homocysteine: “In some cases even the higher amount of folate isn’t adequate, and the addition of TMG (trimethylglycine, also called ‘betaine’) is necessary, from 500-1200 milligrams daily.”

And now a recent study confirms that betaine may be very effective in quickly lowering homocysteine.
Short term & long term

As reported in a recent issue of the Journal of Nutrition, researchers at Wageningen University in the Netherlands enrolled 76 subjects who were divided into four groups of 19 subjects each. For six weeks, one group received 1.5 grams of a betaine supplement daily, another received 3 grams, another received 6 grams, and the fourth group received a placebo.

Throughout the testing period, researchers measured homocysteine levels in two ways: with a methionine loading test (see below), and a fasting homocysteine blood test. Results were immediate. After just one day, the 1.5-gram group had an average homocysteine level 16 percent lower than the average of the placebo group. In the 6-gram group, the average was a full 35 percent lower than the placebo subjects.

At the end of the study period the results were even more impressive. Subjects in the 1.5-group had an average homocysteine level of 23 percent lower than placebo, and in the 6-gram group the average level was 40 percent lower. The Wageningen researchers concluded that these significant drops in homocysteine showed that a betaine-rich diet might lower cardiovascular disease risk.

In addition to lowering homocysteine levels, betaine also assists in the processing of fats in the liver. And some studies have shown that betaine may help protect the liver from damage caused by chemicals and excessive alcohol consumption. Dietary sources of betaine include beets, fish and legumes. Supplements of betaine usually comprise sugar beet extract.
Test types

The next time you have a physical exam, ask your doctor to conduct a methionine loading test, which is considered to be more accurate in assessing homocysteine concentrations than a fasting homocysteine level blood test.

As we age, homocysteine tends to increase, and this is especially true for postmenopausal women. So it’s important to regularly test for this key heart disease marker, and then supplement as necessary with folate, vitamins B-6 and B- 12, and betaine.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

“Low Dose Betaine Supplementation Leads to Immediate and Long Term Lowering of Plasma Homocysteine in Healthy Men and Women” Journal of Nutrition, Vol. 133, No. 12, December 2003,
“Betaine Supplementation Lowers Homocysteine in Healthy Men and Women” Life Extension Foundation, December 22, 2003,



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