Heart disease is a hot topic. Nobody wants to end up with an increased risk of heart attack or stroke. So, how can you assess your risk. One of my favorite markers to look at on a blood test is something called Homocysteine.
What exactly is Homocysteine? It is an inflammatory Amino Acid that can cause damage to the walls of your arteries if elevated. This increases risk of heart attack and stroke. Homocysteine is a by-product of protein metabolism. When levels on a blood test are elevated, it can increase your risk of blood clots and decrease blood flow (this is called ischemia, where tissues do not receive enough oxygen)
I like to take a look at Homocysteine on a blood panel that has a list of other markers that help paint a picture of what is going on with a person as a whole. I look at C-Reactive Protein, another indicator of inflammation, liver enzymes, nutrient levels (B vitamins especially!), and a lipid panel that includes cholesterol and triglycerides. That helps us evaluate what is really going on.
Homocysteine is broken down in the body by 2 pathways: 1) Methylation – A process requiring adequate B9 (Folate) and B12 and 2) Transsulfuration – a process highly dependent on B6 and B9. So, you can see that if you are low on those B vitamins, you may not be breaking down Homocysteine. This can explain why it is elevated on your blood test.
Low levels of B vitamins are super common. I do a high volume of nutrient testing in my clinical practice, so I see this on almost everyone I test. In fact, it’s a rare exception when I see someone who is NOT deficient in at least some of the B vitamins. I would say that at least 80% of people I see are deficient in several of the B vitamins.
Why are these low on so many people? Let’s start with the diet. Eating foods that are highly processed, especially “Fortified” and “Enriched” wheat is a big problem. When wheat is processed, the bran is stripped off. This is the part that has all the B vitamins in it. To try to make up for this, the manufacturers add a few cheap, synthetic B vitamins to the food (you see this in parenthesis after wheat is listed – Riboflavin, Thiamin, Folic Acid, those are the biggies). Unfortunately, that really isn’t a good substitute and in order to digest these “Enriched” foods, your body has to come up with B vitamins because what they put in the food was a cheap imposter for the real B vitamins that would have been found in the bran of the wheat, but is almost always stripped out in processing. So, we end up low in B vitamins.
We can also have a genetic issue called an MTHFR variant where we have a higher need for B vitamins because of a genetic mutation that effects up to 40% of the population. When this is present, a person has a higher need for B vitamins (specifically Folate and B12). They also need those vitamins in a specific, methylated form so that they can use them. Unfortunately, the form used in most vitamin supplements and added to processed foods is not in that methylated form. So, not only are they not helpful. They can cause an issue in those who have this genetic issue and can’t break them down.
Homocysteine will ideally break down into Cysteine, another amino acid, that will then convert to N-Acetyl Cysteine, or NAC. NAC is one of the important pre-cursors to the production of Gluatathione, our body’s “Master Antioxidant”. This process requires adequate amounts of vitamins B2, B6, B9, B12, Magnesium and Vitamin C. If we lack these, we can see Homocysteine accumulate and low levels of Glutathione. This is a double whammy… The solution is to look upstream and make sure we have all of the nutrients we need to break down homocysteine and create Gluathione. I actually see this pattern very often on nutrient and organic acid testing when I look at the whole picture.
Gut issues are another reason we see nutrient levels low. A “leaky gut” and insufficient stomach acid levels can decrease a person’s ability to absorb and utilize nutrients. The consumption of refined and processed foods is part of this situation as well. Those foods disrupt the health of the gut and cause many health problems.
So, what is the optimal level of Homocysteine? In the functional health world, our range is less than 8 micromoles/L. When you see levels go above this, you know it’s time to take a look at why that has elevated. That is where all of the other tests like nutrient levels, omega 3 fatty acid profiles and other inflammatory markers are very important. That way, we can take a root cause approach and solve the problem.
Beginning with a diet low in processed, refined foods is a great starting point. Be sure to include lots of healthy proteins, plenty of antioxidant rich vegetables and fruits plus healthy fats and you will help keep inflammation at bay. Sometimes, people are eating foods that cause inflammation and can benefit from a food sensitivity test to help them pin-point their specific issues. Making sure to incorporate adequate B vitamins, antioxidants and Omega 3’s in your supplement routine is another great step in the right direction.
If you have questions about Homocysteine or a health issue you have been struggling with, my team and I are happy to speak with you on a short, Free Consultation to see if we can help. You can use this link to schedule.
You can also visit quiz.drjeni.com to take a short quiz to help you identify which supplements might be right for you.
I hope you have found this helpful!
To your health,
Dr. Jeni
