In This Issue...
New Marker for Debilitating Disease -- The
New Marker for Debilitating Disease
Much news has been made recently about homocysteine levels
becoming a new critical marker for heart disease and stroke --
possibly being even more important than cholesterol levels. Now
it seems that high levels of this amino acid also have been
linked to osteoporosis. To find out more, I spoke with Kilmer
McCully, MD, probably the most respected authority on
homocysteine in America and author of
The Homocysteine Revolution (Keats).
BACKGROUND ON HOMOCYSTEINE
Homocysteine is a naturally occurring metabolite of the amino
acid L-methionine used by the body for many functions
including detoxification. It normally shows up in the blood at
levels of about 6 millimeters(mm) to 8 mm for women and 8 mm to
12 mm for men. As long as the body keeps levels in check,
there's not much of a problem. However, homocysteine may be
toxic and inflammatory when in excess, and this can lead to
serious consequences, including heart disease.
Dr. McCully first became interested in homocysteine back in
the 1960s when he came across a few unusual cases involving
children with atherosclerosis, a heart disease that generally is
associated with much older people. Dr. McCully also found
atherosclerosis scattered through the arteries of a boy who had
died of a stroke. After some rigorous detective work, he noted
that all these children had high levels of homocysteine. In
1969, he wrote his first paper suggesting that homocysteine was
causing arthero sclerotic plaque. Now, 35 years and a
substantial amount of research later, it is well accepted that
elevated homocysteine is a risk factor for vascular disease.
LINK TO OSTEOPOROSIS
So the connection to cardiovascular disease is well-known --
but what about the connection to osteoporosis? Could high
homocysteine levels really have a correlation with osteoporosis?
And if so, what can be done about it?
"Osteoporosis is a prominent feature of children with high
levels of homocysteine. About two-thirds of the children with
high levels of homocysteine also have severe osteoporosis," said
Dr. McCully. "They also get scoliosis, a curvature of the spine,
and have an increased risk for fractures. More recently, we've
found that adult patients with elevated homocysteine also have
an increased risk for osteoporosis."
Dr. McCully explained that the osteoporosis connection was
revealed through a rather ingenious study in Japan, published in
The Journal of the American Medical Association in the
spring of this year. The study was done on stroke victims who,
for reasons not completely understood, have a much greater risk
for hip fractures. The Japanese researchers divided a number of
stroke patients into two groups and followed them for two years.
One group was given a combination of 5 milligrams (mg) of folic
acid and 1,500 micrograms (mcg) of vitamin B-12 while the other
group received a placebo. Researchers wanted to see if the B
vitamins would reduce hip fractures in this high-risk
population. The results were dramatic: In the placebo
group, 43 people had hip fractures, but in the vitamin group,
only 10 did. And, homocysteine levels dropped in the treatment
group by 38%, while they increased in the placebo group.
Could homocysteine be the connection? It sure looks like it.
"Two other studies, in Germany and the Netherlands, also
demonstrated that patients with higher homocysteine have a
higher risk for osteoporotic fracture," Dr. McCully said. "It's
likely that homocysteine affects the matrix upon which calcium
and other minerals are deposited in the bone. This matrix
becomes calcified during bone formation. Homocysteine seems to
affect the formation of this matrix in a negative way." Dr.
McCully also pointed out that men are less susceptible to
osteoporosis than women, probably because testosterone maintains
the bone matrix better. In women, it's a double whammy since
osteoporosis risk goes up after menopause, and -- for reasons
not fully understood -- so do homocysteine levels.
GETTING CONTROL OF HOMOCYSTEINE LEVELS
How do we bring homocysteine down?
"Easily," Dr. McCully replied. "It can be done with dietary
improvement and by increasing B vitamins. Eliminate processed
foods, including flour and sugar, and eat more fresh vegetables,
fresh meats, fresh fruits and whole grains." The three vitamins
which have been shown to markedly reduce homocysteine are B-6,
folic acid and B-12. "Only about 400 mcg of folic acid and 3.5
mg of B-6 are needed," said Dr. McCully.
Vitamin B-12 is another story, since older people have a
harder time absorbing it. "About 15% of people over age 65 are
deficient in B-12," Dr. McCully told me, "but not because they
don't eat enough -- they don't absorb it well." He recommends
taking B-12 (at least 1,000 mcg) sublingually -- under the
tongue -- as directed on the bottle, since part of it is
absorbed directly through the mucous membranes. Make sure that
the B-12 is in either the hydroxycobalamine or methylcobalamine
form. The conventional cyanocobalamine is poorly absorbed
through the mucous membranes. The bottle will indicate which
kind it is.
The take-home point: Get your
homocysteine checked by a blood test. Improve your diet and talk
to a trained professional about B-12, B-6 and folic acid
supplements. Assuming proper dosing, taking these supplements is
one of the easiest possible things you can do to improve your
health and reduce your risk for both heart disease and
Bottom Line's Daily Health News
New Marker for Debilitating Disease
- Kilmer S. McCully,
MD, chief, pathology and laboratory medicine service, West
Roxbury Veterans Affairs Medical Center, Massachusetts, and
associate clinical professor of pathology, Harvard Medical
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