Homocysteine, a revolutionary look at arteriosclerosis (Pt. 2)
No disease has been investigated more thoroughly and painstakingly than arteriosclerosis, not even cancer. For the longest time, the cholesterol/fat interpretation was the only explanation available. With the work of Dr. McCully, new evidence showed a different view of the disease that revolutionized this field of medicine. One of his major contributions can be summarized as follows:
“The idea that plaques are filled with only greasy fat deposits is incorrect for the vast majority of plaques. Many arteriosclerotic plaques even in advanced disease are of the fibrous and fibrocalcific type that are found in subjects with homocystinuria. Typically, arteriosclerotic plaques are tough, inelastic, thickened and heavily encrusted with calcium deposits, making them difficult to dissect with scalpel or scissors. In advanced plaques, their complex structure also includes cholesterol crystals, fatty deposits, areas of degeneration or death of tissue, blood clots, protein deposits, the growth of small blood vessels into the artery wall and areas of bleeding that predispose the sufferer to a complete blockage by formation of blood clots“.
Dr. McCully did not seek to dispose of the cholesterol theory. He felt that the many years of research on the theory could be integrated into his new discoveries. For this reason, he honored the work of other researchers in the cholesterol field by asserting:
“Experts in the development of plaques agree that lipoproteins do participate in the early stages of plaque formation by forming foam cells. Adherents of the cholesterol/fat hypothesis correctly point out that elevated cholesterol levels are associated with increased risk of arteriosclerosis.”
But association is not cause, therefore he saw many shortcomings in the traditional view of the disease and he sought to find answers. In his autopsy study of almost 200 veterans, for instance, the group with the most severe disease had a mean cholesterol of 16 and 2/3 had no evidence of diabetes, high blood pressure or elevated cholesterol. The defenders of the cholesterol theory claim that even if cholesterol is low, it must cause the disease because of the correlation of risk with elevated levels. The homocysteine theory can explain arteriosclerosis even with low levels of cholesterol.
Dr. McCully recognized the challenge that treating the disease had become and this prompted him to assert:
“When treating manifestations of arteriosclerosis, heart attack, stroke, kidney failure or gangrene of feet and legs, the medical profession frequently encounters the disease in its late stages, when decades of gradual narrowing of coronary, carotid renal or iliac arteries by arteriosclerosis have occurred silently before symptoms occur. In attempting to treat serious disease late in its course, difficult problems are encountered by physicians and surgeons. Drug therapy to lower cholesterol may be ineffective and complicated by toxic side effects and by failure to respond, mainly because the disease is so far advanced. Efforts to stop the progress of arteriosclerosis by controlling blood cholesterol and lipoproteins through dietary modification and drug therapy are difficult. And changing lifetime habits of poor diet and nutritional abuse are usually ineffective in the elderly. Some practitioners in the arteriosclerosis field because of their training have neglected nutritional and preventive measures to treat advanced disease and have been reluctant to accept the new approach. Nutritional scientists, on the contrary, have just recently began to concentrate on the role of partial vitamin deficiencies and imbalances in degenerative diseases.”
A new era in cardiovascular testing
When Dr. McCully did his research, the homocysteine theory had not been widely accepted and it was just beginning to be re-examined by increasing numbers of medical investigators worldwide. A reliable test for blood homocysteine levels had just began to be applied to human studies. Dr. McCully saw the need to plan and conclude long-term prospective trials to test the homocysteine theory of arteriosclerosis. He also called for the need to have some funding which for decades, he said, had been “lavished on the cholesterol/fat hypothesis”. He saw the need for clinical tests to document changes in blood homocysteine, levels of vitamins B 6, folic acid, B 12, LDL, HDL and tests of major organ function. He also saw the need to document the clinical complications of arteriosclerosis such as heart attack, stroke, gangrene and embolism to be established by reliable criteria. Several decades later, his desire might have come true.
Today a test for homocysteine can be obtained from independent laboratories and most alternative medicine doctors are on board with it. Dr. David Jockers, asserts that “lipid panels are archaic and scientists have demonstrated that these tests have many limitations and only identify 40% of those at risk for coronary heart disease.” He asserts “People drop dead everyday with “normal” cholesterol levels, “normal” blood pressure and “normal” EKG findings. Scientists have found much more advanced blood tests that can far more accurately assess your risk of heart disease.” These kinds of tests have opened “a new era of cardiovascular testing” (1)
In his article titled ‘What are your homocysteine levels?’ Dr. Jockers explains that “The best way to test homocysteine levels is through a combination lab that looks at other factors involved in cardiovascular health.” One of these tests is C-Reactive Protein, which looks at inflammation levels in the body and is a much better way of assessing cardiovascular risk than total cholesterol. Also the Lp(a) and the VAP test. The Vertical Auto Profile Test (VAP) test “identifies twice as many people at risk than routine cholesterol tests, including those with inherited risk factors who often develop premature heart disease. It measures total cholesterol, HDL (“good” cholesterol), LDL (“bad” cholesterol), and triglycerides. The VAP Test also measures cholesterol subclasses that play important roles in the development of heart disease.” (2)
Similarly, Dr. Whitaker, in his article ‘Nutrient spotlight: Benefits of B vitamins’ mentions how deficiencies of the B vitamins can elevate homocysteine levels, among other things. (3) Dr. Stephen Sinatra, in his article ‘Heart risk factor: homocysteine’ explains how homocysteine can be a risk factor for heart disease. (4)
How can you protect yourself from the damaging effects of homocysteine?
According to the author, arteriosclerosis is a disease which begins in childhood and adolescence, develops gradually without symptoms during the early adult years and affects men often suddenly in their 40’s, 50’s and 60’s. Because of the silent, gradual, and prolonged onset of arteriosclerosis, the most successful strategy for prevention must start in childhood and continue in adolescence and adulthood, providing the elder years with little risk of developing heart attack, angina pectoris, stroke, kidney failure or peripheral vascular disease. This lifelong strategy requires control of known modifiable risk factors, especially consumption of an optimal diet, moderate physical activity and avoidance of tobacco, drugs and alcohol.
Dr. McCully’s research yielded enough information to make prevention of the disease within our reach. The best way to carry out this preventive strategy is outlined in the rest of this article. In this sense, one of the most appealing features of the homocysteine theory is its simplicity and ease of application in its prevention, even though from a scientific point of view the theory is complex in many ways. Anybody can understand the basic principles of the theory and do something about it. He suggests prevention should emphasize limitation of methionine consumption and augmentation of natural sources of B 6, B 12 and folic acid. Prevention and treatment with supplemental vitamins must be at sufficient doses to ensure control of blood homocysteine. Other factors affecting homocysteine levels, such as age, gender, family history, thyroid function, kidney function, blood pressure, diabetes, drugs, hormones and toxins must also be taken into consideration.
A person at risk has to understand this: homocysteine is derived from methionine, a normal amino acid building block of all proteins in the diet. This amino acid can damage the artery walls if allowed to accumulate excessively in the body’s blood and tissues. The other important aspect to understand is that the level of homocysteine in the blood is controlled by the action of three B vitamins- B 6, B 12 and folic acid- within the body. Consumption of these vitamins on a daily basis can protect against the development of homocysteine for a lifetime. In a disease of aging like arteriosclerosis some risk factors can be modified, others cannot (age, gender, genetics). Attention to all of the contributing factors will guarantee protection from the disease. The blood homocysteine level ideally should be kept on the 8 to 10 micromole per liter range to be protected from the progression of the disease. Dietary and lifestyle changes can accomplish this. Even in the case of genetic predisposition to the disease, increasing the consumption of B 6, B 12 and folic acid can keep homocysteine levels from building up in the blood. Despite the known fact that individuals require different amounts of vitamins and minerals for optimal health according to their genetic makeup, gender, etc. These measures are best coordinated with physicians and surgeons who specialize in the treatment of established vascular disease.
Dietary prevention of arteriosclerosis
In its simplest form, an optimal diet to prevent arteriosclerosis consists of abundant fresh vegetables and fruits, whole grains and legumes, limited quantities of fresh meat and dairy products, a minimum of highly processed and packaged foods and strictly limited consumption of fats and sugars. Unfortunately, the typical American diet of fast convenient foods is the major cause for the high risk of arteriosclerosis and its complications of coronary heart disease, stroke, kidney failure and generalized vascular disease in the U.S.
Because of persuasive evidence that dietary deficiency of folic acid in pregnant women leads to birth defects in newborn infants, especially neural tube defects such as spina bifida, the FDA ruled back in 1998 that sufficient folic acid be added to enriched foods to ensure that a minimum intake of 400 mcg of folic acid per day for pregnant women. The amounts of dietary folic acid and vitamin B 6 that are required to prevent abnormal elevation of blood homocysteine are 350 to 400 mcg per day of folic acid and 3 to 3.5 mg per day of vitamin B 6.
Vitamin B 12
Unlike B 6 and folic acid which are found in foods of animal and plant origin, B 12 is formed only by bacteria, fungi and algae. Yeast, plants and animals cannot make it and they depend on microorganisms to obtain B 12. When we consume these animal foods we can obtain B 12. When it comes to absorption, a protein made in the stomach called ‘intrinsic factor’ helps B 12 be absorbed. Additional protein factors in the blood are required for transport of vitamin B 12 to the liver and other organs. Eating a diet of animal products will provide 5 mcg per day of B 12, vs the 3 mcg established by the RDA.
Absorption of B 12 is impaired by inflammation of the stomach, ulcer disease typical of the elderly, etc. In conditions like pernicious anemia, because of lack of intrinsic factor required for absorption, there is no absorption of B 12. In this case injections of B 12 are necessary to avoid pernicious anemia and neurological damage to the spinal cord. Strict vegetarians can develop pernicious anemia after 20-30 years. In subjects with low levels of vitamin B 12 in the blood homocysteine becomes elevated (13-15 micromoles per liter) Elevations of homocysteine and B 12 are so related that hematologists use this as an indicator of inadequate B 12 absorption or inadequate dietary folic acid intake.
Of all the 20 amino acids, homocysteine is derived only from methionine. All proteins contain methionine, but animal foods like meat, eggs, milk and cheese contain more methionine than plant foods, 2 to 3 times more. Plant foods on the contrary contain larger amounts of B 6 and folic acid. The key to understanding homocysteine for animal food eaters is that the more these foods are consumed, the higher the intake of B 6 and folic acid has to be. Processing, cooking and storing foods causes loses of these vitamins, which can lead to elevations of homocysteine.
Fresh meats, liver and eggs, if not excessively processed, heated or preserved, contain abundant amounts of vitamin B 12, B 6 and folic acid. On the contrary, cooked or baked foods that contain cane or beet sugar, corn syrup or fruit sugars are highly processed carbohydrates that contain no vitamins or minerals. A diet that is 25-30 % sugar and contains 40-50% calories from fats, forces the body to obtain its dietary requirement for B vitamins from the remaining 25-30% of food calories. Consequently, this diet can lead to deficiencies of the B vitamins.
Food processing, milling, heating, chemical additives, radiation and storage can lead to up to 85-90% loss of B vitamins. Raw ingredients that are frozen will only lose 10-15%. A highly processed diet, together with high consumption of fats and sugars will lead to elevation of homocysteine, arterial damage and arteriosclerosis over a period of months and years. The brain has appetite control centers capable of producing eating behavior sufficient to supply the body with vitamins and minerals adequate with survival. This means that a diet that is high in fats and sugars and therefore deficient in crucial vitamins and minerals will force the body to eat more in order to obtain these vital nutrients. This will lead to obesity and diabetes, which will accelerate the development of arteriosclerosis.
Fiber is the indigestible starch-like roughage of plants. It can be soluble (fruit pectins) or insoluble (vegetable lignins and celluloses). In either case, fiber is not digested or absorbed into the bloodstream, but stays in the stomach, intestine and colon during digestion of food. Therefore, it fills the stomach, producing satiety and increases the intestinal contents promoting regular elimination. It has no calories or nutritional value but the fiber of plants is rich in vitamins and minerals. Studies have shown an inverse relation between consumption of dietary fiber and many major diseases like arteriosclerosis.
Vitamin E and other antioxidants
Numerous studies have shown that vitamin E can reduce arteriosclerosis and coronary heart disease up to 50%.
Magnesium is essential for the action of enzymes that process proteins and the amino acids methionine and homocysteine. Zinc is also important for numerous functions of the body, including expressions of DNA and the aging process. These and other minerals are seriously depleted when whole grains are refined (up to 50-90%). Chromium, copper, manganese, selenium and molybdenum are required for optimal health. Fresh meats, seafood, and fresh vegetables will ensure adequate intake of these elements. Iodine is also important to make thyroid hormone, deficiencies in this vital mineral will cause goiter, elevation of blood homocysteine, increased blood cholesterol and lipoproteins and therefore susceptibility to coronary heart disease. The ‘Heart and Body Extract’ is formulated with kelp as one of its ingredients. Kelp is a rich source of iodine as well as other nutrients and is renown for its powerful nutritional benefits.
According to the research of Dr. Jockers, “Kelp is extraordinarily rich in alkaline buffering nutrients such as sodium, potassium, magnesium and calcium. It is also a phenomenal source of chlorophyll that boosts blood cell formation and purifies the body”. According to him, “kelp is considered the world’s most potent source of naturally occurring iodine”, it assists in blood sugar control because of its vanadium content, helps with poor digestion, supports the prostate, rebuilds and maintains all glands in the body, detoxifies the body of heavy metals and radiation and heals the liver, among other things. Kelp is also a wonderful source of a “unique group of polysaccharides called fucoidans” which have been shown to reduce pain, fight viruses and prevent arteriosclerosis. These sulfated polysaccharides “are also revered for their powerful ability to reduce blood clots” (5)
Dr. McCully emphasized how the B vitamins are key to the prevention of arteriosclerosis. He singled out three key B vitamins, namely B 6, B 12 and folic acid. Since the B vitamins work together as a complex, it would be a good idea in my opinion to take the whole B complex together. The ‘Female Balance Extract‘ contains other key B vitamins therefore it is a good complement to the homocysteine protocol. The ‘Ginseng Extract‘ is also a perfect complement to the B complex.
Other dietary factors
Other trace compounds in the diet are known to lower homocysteine levels. These compounds are found in foods like beets, garlic and onion. The sulfur compounds in these foods are also beneficial in lowering homocysteine levels in the blood. The ‘Heart an Body Extract’ contains garlic, which in combination with other herbs, makes a wonderful complement to the homocysteine diet proposed by Dr. McCully. Like kelp, garlic is considered a superfood herb, it is anti-inflammatory and one of nature’s powerful antibiotics. According to the research of Dr. Jockers “garlic is also used to lower blood pressure, cholesterol and help prevent/reverse cancer” (6)
Other foods like omega 3 unsaturated fish oil and plant oils are also helpful in lowering homocysteine levels. Apart from this, fish oil is a good source of B 6.
Oxycholesterols, the products of reaction of highly purified cholesterol with oxygen rapidly cause arteriosclerotic plaques as shown in animal experiments. The highly damaging oxycholesterols are found in foods in which cholesterol is subjected to heating and exposure to the oxygen of air during food processing, cooking and preservation. Examples are dried egg yolk, milk powder and fried foods. The oxycholesterols of these foods are absorbed into the blood stream during digestion where they become concentrated in the LDL fraction of the plasma causing damage to arterial wall cells and tissues promoting arteriosclerosis.
Optimal diet for health
The most important prerequisites for health are quality, freshness, variety and balance. Fresh means the food has been minimally processed and consumed quickly after harvesting if possible. B 6 is available abundantly in fresh vegetables, meats and fish. Folic acid is abundant in dark leafy vegetables and in liver. Vitamin B 12 is needed in extremely low amounts and is available only in foods of animal origin such as meat, eggs, fish and dairy products. Vegetables should be eaten with the peel and cooked with minimum heat as the B vitamins are sensitive to loss through heating, 6-10 servings a day is optimal. 2 to 4 oz of meat, poultry, fish or eggs provide more than adequate animal protein in a single day. Flavor can be provided by herbs, spices and oils like olive oil.
Animal foods need not be consumed everyday. For those who want to avoid meat, a serving of several ounces of eggs, milk or cheese several times per week will provide adequate B 12 to prevent anemia and a buildup of homocysteine in the blood. Vegans who do not consume animal products of any kind need to supplement their diets with 0.1 mg vitamin B 12 per day or 1 mg intramuscular injection per month to prevent deficiency of this important vitamin. Avoidance of pastries, cakes, heavy fried foods, sugary foods of all kinds will constitute a major improvement in overall health.
Selecting the best processed foods
The main purpose of processed foods is to increase storage potential, however major losses of vitamins occur. Examples are flour from whole grains, sugar from sugar beets, cane or corn, oils from olives or grains, etc. In the case of flour, almost 90% of the vitamins are lost. With beets, cane or corn, the final product is pure sucrose with none of the vitamins present in the original product. Separation of olive oil from olives removes virtually all of the water soluble vitamins, minerals and fiber with the exception of cold pressed olive oil which keeps the antioxidants.
Cholesterol is protected in the body against the oxygen of air by an elaborate combination of antioxidant vitamins, minerals and enzymes. When cholesterol of animal foods is exposed to the oxygen of air by food processing highly damaging cholesterol oxides are formed This is the case of powdered egg yolks, highly used in processed foods.
Canning foods require heating food and cans are sealed hot to exclude as much air as possible, this affects two important vitamins B 6 and folic acid as much as 35%.
Lifestyle factors and homocysteine levels
Non smokers have lower levels of homocysteine than smokers. Cigarette smoke contains over 60 different toxic substances besides carbon monoxide.
Drugs and toxins
Some chemotherapy drugs, antiepileptic and antihypertensive drugs have been found to increase blood homocysteine levels because they antagonize the action of folic acid or B 6 in the body.
There are no doubts of the benefits of moderate exercise for overall health and to lower the levels of homocysteine. Vigorous exercise, however, may cause heart attack in an individual with arteriosclerosis and coronary heart disease because of nutritional, genetic or lifestyle history.
The fully oxidized form of homocysteine has been demonstrated to be a very potent exciter of brain function. Some children with high levels of homocysteine have been observed to have increased risk of convulsions and patients with fibromyalgia/chronic fatigue syndrome have highly elevated levels of homocysteine in cerebrospinal fluid. This may suggest that elevated homocysteine may modify behavior to produce stressful personality traits or neuropsychiatric disorders.
People who abuse alcohol have been shown to have elevated blood homocysteine levels. Alcohol intake leads to serious depletion of body stores of folic acid. There are numerous examples of severe arteriosclerosis with stroke, coronary heart disease, kidney failure and peripheral vascular disease in alcoholics. Moderate consumption of alcohol however, 12 drinks per day, depending on body weight has long been known to increase longevity.
Heavy consumption of coffee, more than 9 cups a day, was associated with some elevation of homocysteine. While tea had the opposite effect.
Genetic background, sex hormones and aging
Genetics accounts for 1/3 of the cases of coronary heart disease. One important cause of this predisposition is an abnormal inherited form of methylene-tetra-hydrofolate reductase which affects around 5% of the population in the homozygous form (when both parents are carriers of the gene) and 38% of the French Canadian population in the heterozygous form. An individual from a family that carries this mutation requires more folic acid in the diet or from supplements than somebody without this defect. Dr. McCully recommends 1,000 mcg per day in this case. 50 % of cases of homozygous homocystinuria respond to large doses of B 6. Any individual with a family history either in ancestors or descendants would be advised to consume a lifelong supplement of 125 mg per day of B 6. A family history of arteriosclerosis and heart disease implies a major contribution of genetic factors in causation.
Several medical conditions that may be determined genetically to some degree have a major effect on the risk of arteriosclerosis and coronary heart disease. These are diabetes, hypertension, high levels of blood cholesterol or lipoprotein(a) and decreased thyroid function. Excessive, intensive medical therapy is usually required to control these medical conditions, favorably decreasing the risk of heart disease.
Individuals with a significant elevated level of total blood cholesterol and LDL have an increased risk of cardiovascular disease. The treatment of this condition with diet, drugs, hormones and exercise has proven unsuccessful and dangerous when you consider the unpleasant side effects on muscle optic lens and carcinogenic effects. The effects of supplementation with B 6, folic acid and B 12 in lowering homocysteine, cholesterol and LDL was demonstrated in a small number of patients with elevated cholesterol levels, although the effect on vascular disease risk has not been determined. Theoretically, a significant decrease in the homocysteine content of LDL by this strategy should be beneficial because the strategy also decreases the formation of LDL aggregates containing homocysteine.
Elevation of homocysteine and arteriosclerosis is correlated with aging in both men and women. Because of decreased intake of nutrients and poorer absorption and mastication by the elderly, it is recommended that B vitamins be given as a supplement in this amount: 10 mg of vitamin B 6, 1.0 mg of folic acid, and 0.1 mg of vitamin B 12 per day may help minimize the risk in homocysteine levels.
Prevention of arteriosclerosis
Many clinical studies have shown the effectiveness that dietary improvements and supplemental B 6, folic acid and vitamin B 12 have in lowering homocysteine. A diet with fewer processed foods that contained adequate levels of B vitamins was effective in lowering blood homocysteine levels. A multicenter European study with 75 vascular cases and 800 controls showed that consumption of B 6, folic acid or B 12 reduced the risk of vascular disease by approximately two thirds.
The homocysteine revolution: medicine for the new millennium
What began as a chance observation in children with rare inherited diseases of homocysteine metabolism started a promising new field of medical research with the potential to unlock mysteries that had long puzzled medical scientists.
Since the discovery of homocysteine in the 70’s by Dr. McCully, a lot of new information has shed light in the understanding of the role that this seemingly unimportant byproduct of protein breakdown, homocysteine, could have in living cells and tissues, degenerative diseases of cancer and arteriosclerosis. This new field of research also opened up new understanding of how vital nutrients like vitamins A, C, B 12, B 2, folic acid, E and B 6 function within cells and tissues to control the basic processes of life itself: cellular respiration, cell and tissue growth, cell removal and replacement, maintenance of connective tissues, expression of genetic information, reproduction and embryonic development.
A large number of human studies have confirmed the validity of the homocysteine approach to arteriosclerosis, which has caused the causes to be rewritten. The simplicity of the homocysteine theory has led to new proposals for the control of the disease with promising strategies for the successful treatment of cardiovascular disease.
Anybody can assure adequate dietary intake of vitamins, minerals, fiber, antioxidants and other beneficial nutrients to prevent or delay the onset of homocysteine. The different studies on the disease explain the supreme importance of lifelong consumption of an optimal diet combined with cessation of smoking, adequate exercise and other simple measures. This strategy for prevention of arteriosclerosis is revolutionary because it shifts the emphasis toward consumption of beneficial nutrients and places the consumption of fats and sugars in a new context, emphasizing that depletion of essential nutrients is the key factor in understanding the origin of disease. Rather than seeing the disease as caused by excess consumption of cholesterol and fats, homocysteine sees arteriosclerosis as a deficiency disease. Several discoveries by medical scientists in biochemistry, physiology and oncology are showing how the homocysteine theory is helping us understand cancer and the aging process as well as arteriosclerosis.
In conclusion, the research of Dr. McCully provided a powerful breakthrough in the understanding of degenerative diseases like arteriosclerosis. Thanks to his work, we have a great tool to take our health in our own hands. All the products at ‘Healthy Heart Club’ are a great addition to your health protocol.
Thanks for reading.