Homocysteine
by Phillip Treadwell, PharmD

You may have heard the term “homocysteine” mentioned in the media in the last year or so. However, many people - including health care professionals - are still confused about what this substance is, what it means, and what to do about it. This article will focus on what we know about homocysteine.

Homocysteine is an amino-acid, which is a building block for protein. It is created in the body as a natural by-product of the metabolism of methionine, an amino-acid necessary for life. When homocysteine levels are severely elevated, major damage can occur to blood vessels, leading to atherosclerosis. Also, the blood-clotting system can be enhanced, leading to potentially life-threatening clots. Recently some question has been raised as to whether levels of homocysteine that are only mildly elevated might be associated with an increased risk of atherosclerosis. Many researchers have shown that this is probably the case and some consider homocysteine a stronger risk factor for coronary artery disease than elevated cholesterol levels.

Any time we have such a dangerous risk factor, we have to ask what we can do about it. We don’t know all the answers, but one thing is definite, appropriate vitamin supplementation can improve homocysteine levels, and in some studies, reduce vascular damage. Now, not just any vitamins will do. The most important vitamin for reducing homocysteine levels in most people is folic acid. Other important vitamins for this purpose are cobalamin (B-12) and pyridoxine (B-6). Most multi-vitamins probably don’t contain adequate amounts of these vitamins to achieve the goal of reducing homocysteine levels. Taking large amounts of multi-vitamins, or “mega-dose” products, may lead to serious problems with accumulation of fat-soluble vitamins which can be quite toxic. The approach that I recommend is to take folic acid, B-12, and B-6 individually, or in a combination containing only these three agents along with a single, well-balanced multi-vitamin. Typical doses of these vitamins necessary for the purpose of reducing homocysteine levels are: 1-5 mg for folic acid, 400 micrograms to 1 mg of cobalamin (B-12), and 10 to 25 mg for pyridoxine (B-6). These doses are generally well tolerated and are usually adequate to reduce homocysteine levels to a significant degree.

Some people are unable to absorb vitamin B-12 from the gastrointestinal tract because of a deficiency in a co-factor necessary for its absorption called intrinsic factor. Some people are deficient in intrinsic factor for no apparent reason and others are deficient because of stomach surgery or certain medicines. It is important that these people avoid taking folic acid unless they have already fixed the B-12 deficiency. Otherwise, the B-12 deficiency can be masked until nerve damage occurs.

I always recommend evaluation by a healthcare provider before starting any new regimen, but these products are generally safe and problems are extremely rare with the doses mentioned here. I feel that this is a safe, inexpensive step that everyone can take toward better health.