Homocysteine Levels: What Lowers Homocysteine Levels Effectively and Safely?

In people who have dramatically elevated levels of homocysteine, different food supplements have been shown to bring down homocysteine levels and to reduce the risk of heart disease and strokes.

A link between high levels of homocysteine, a sulfur-containing amino acid, and heart disease was first suggested in the 1960s, when it became clear that patients with inborn errors of homocysteine metabolism were prone to develop severe cardiovascular disease in their teens and twenties.

Treatment with homocysteine-lowering substances such as folate, vitamin B12, vitamin B6 and betaine reduces the incidence of heart attacks and strokes in these patients.

Homocysteine is an amino acid in the blood (amino acids are the building blocks of proteins). Too much homocysteine in the blood is related to a higher risk of stroke and heart disease. Mildly elevated levels (which are quite common) might promote atherosclerosis (furring up of the arteries), but this link has not been proven yet. Studies are currently under way to test whether reducing homocysteine levels in people who have mildly elevated levels could prevent heart disease or stroke.

Several studies have found higher homocysteine levels in patients with coronary, peripheral, and cerebral vascular disease, particularly in those with vascular disease (vessels of the body, especially the arteries and veins) not readily explained by conventional risk factors such as high low-density lipoprotein (LDL) cholesterol, diabetes, or smoking.

Several studies then sought to determine whether elevated homocysteine levels were a cause or effect of cardiovascular disease, and evidence for a causal relationship is accumulating.

A study conducted in the Netherlands looked at the effects of betaine, folic acid, and phosphatidylcholine on blood lipids (fats) in healthy people. The researchers wanted to study blood lipids (fats), especially “bad” cholesterol (LDL cholesterol), because they are known to influence the risk of heart disease.

“We are keenly awaiting the results from several ongoing trials. In the meantime, our group is trying to determine the risks and benefits associated with different homocysteine-lowering nutrients,” said Margreet Olthof.

She and her colleagues at the Wageningen Centre for Food Science analysed four independent, placebo-controlled, randomized intervention studies that examined the effects of betaine, folic acid, and phosphatidylcholine on blood plasma homocysteine concentrations in healthy volunteers.

They analysed the blood samples (which had previously been used to measure homocysteine) for lipid levels (fats such as cholesterol and triglycerides) from the individual studies and compared changes in blood lipid concentrations between individuals taking homocysteine-lowering nutrients and those taking placebo.

The researchers found that betaine increased the level of “bad” cholesterol. Folic acid did not affect lipid (fat) levels. The data for phosphatidylcholine were not conclusive.

This suggests that the beneficial effects of betaine (which lowers homocysteine) might be undone at least in part by its negative effects on blood lipids.

Based on these results, folic acid would be a better choice for people who want to lower their homocysteine levels, since folic acid doesn't cause a rise in “bad” cholesterol.

References:
Olthof MR, van Vliet T, Verhoef P, Zock PL, Katan MB (2005) Effect of Homocysteine-Lowering Nutrients on Blood Lipids: Results from Four Randomised, Placebo-Controlled Studies in Healthy Humans. PLoS Med 2(5): e135 doi:10.1371/journal.pmed.. Copyright: © 2005 Olthof et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License.

(2005) Comparison of Homocysteine-Lowering Drugs. PLoS Med 2(5): e145 doi:10.1371/journal.pmed..

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