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Levels of homocysteine

The O Factor

In yesterday’s e-Alert (“Talk To Me”), I told you about research confirming that high protein intake does not contribute to poor bone health (as previously believed). In fact, USDA researchers concluded that high levels of dietary protein may actually improve bone mass density in older adults.

Of course, not everyone will react the same way to high- protein intake, so before beginning any major dietary change it’s a good idea to consult with your doctor. And if your MD or ND has some training in nutrition as well as medicine, all the better.

But if bone health is a concern – and if you’re past the age of 50, it certainly should be – then you might also ask your doctor to check your homocysteine level with a standard blood test. Because according to two new studies, homocysteine is not only a reliable marker for cardiovascular health, it may also provide an important clue about the health of your bones.


Fractures on the rise

The two studies both appeared in a recent issue of the New England Journal of Medicine (NEJM).

One study was a collaboration among several prominent research institutions in Boston, including Harvard and Tufts. Using blood samples collected from the Framingham Heart Study, researchers assessed homocysteine levels of more than 1,100 women and 825 men, all of whom were over the age of 59. The blood samples were taken in the late 70s and early 80s, and subjects’ medical records were followed from then until 1998.

An analysis of the data showed that women with the highest levels of homocysteine had almost twice the risk of hip fracture compared to women with the lowest levels. And among men the association was even more pronounced: Those with high homocysteine levels had nearly four times the risk of hip fracture as the men whose levels were low.

The second study – from researchers in the Netherlands – also compared homocysteine levels with medical records indicating age-related osteoporotic fractures. Data on more than 2,400 men and women was analyzed, with follow up periods that ranged from approximately three years to eight years.

The results were similar to those in the Boston study. Subjects with the highest homocysteine levels were about twice as likely to suffer fractures compared to those with the lowest levels. The researchers concluded that an elevated homocysteine level “appears to be a strong and independent risk factor for osteoporotic fractures in older men and women.”
The folate factor

In an NEJM editorial that accompanied the two studies, Lawrence G. Raisz, M.D. (a bone biology researcher) questioned whether homocysteine actually plays a direct role in weakening bones, or if the association is only tangential, involving other health problems such as poor nutrition. In any case, the association is clear, and as HSI members know, there are already plenty of good reasons to address elevated homocysteine levels.

Fortunately, studies have shown that homocysteine levels may be controlled with ample amounts of folate – the B vitamin also known as folic acid. Dietary sources of folate include citrus fruits, tomatoes, leafy green vegetables, and pinto, navy and kidney beans. But for many people, folate and B vitamin supplements may be necessary to sufficiently lower homocysteine.
Folate helpers

In the e-Alert “The B List” (2/2/04), HSI Panelist Allan Spreen, M.D., discussed folate supplementation, recommending a dose of 1.6 grams per day. And because folate can sometimes mask a vitamin B-12 deficiency, he also recommends 1 mg (1000 mcg) of B-12 per day in sublingual form (dissolved under the tongue). Dr. Spreen also suggests adding 100 mg of B-6 and 400-500 mg of magnesium per day to make folate more effective.

But some people don’t get a good biological response from folate. So when a high homocysteine level doesn’t respond to a folate supplement, Dr. Spreen recommends taking 300-500 mg per day of trimethylglycine (TMG). He describes it as a “powerful homocysteine-lowering agent.” But because TMG is expensive, he doesn’t use it unless folate appears to be ineffective.


Checking in

In previous e-Alerts I’ve encouraged you to ask your doctor to check your homocysteine levels when you have a blood test. (Most doctors recommend keeping levels below 12 micromoles per liter.)

With these new studies, we have an added incentive to keep those levels down, for the health of our bones as well as our hearts.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:

“Homocysteine as a Predictive Factor for Hip Fracture in Older Persons” New England Journal of Medicine, Vol. 350, No. 20, 5/13/04, content.nejm.org
“Homocysteine Levels and the Risk of Osteoporotic Fracture” New England Journal of Medicine, Vol. 350, No. 20, 5/13/04, content.nejm.org
“Homocysteine and Osteoporotic Fractures — Culprit or Bystander?” Lawrence G. Raisz, M.D., New England Journal of Medicine, Vol. 350, No. 20, 5/13/04, content.nejm.org
“Vitamins Ward Off Osteoporosis Fractures” Linda A. Johnson, Associated Press, 5/13/04, apnews.excite.com
“Homocysteine Levels Linked to Fracture Risk” D. Dye, Life Extension Foundation, 5/14/04, lef.org

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