Homocysteine is an amino acid produced as part of the body’s methylation process and is considered an independent risk factor for cardiovascular disease. This oxidative stress biomarker is associated with many cardiovascular disorders such as increased risk of atherosclerosis, stroke, abdominal aortic aneurysm, essential hypertension, and venous thrombosis as well as chronic kidney disease (CKD), hypothyroidism, and cognitive impairment. The metabolism of homocysteine is highly dependent on in vitamin B12, folate, and vitamin B6. Deficiencies in any of these may be associated with elevated homocysteine levels.

In a new review published two weeks ago in the Nutrients, researchers discussed the significance of hyperhomocysteienemia as controversy persists around its assessment and management as well as insufficient awareness among health care practitioners.

A nutritional approach of lowering homocysteine involves dietary strategies and targeted nutritional therapeutics including B-vitamins and trimeythlyglycine (TMG), which are essential for homocysteine conversion. In addition, a-acetylcysteine acutely lowers plasma homocysteine as well. Oral n-acetylcysteine given for 4 weeks at 1.8 g/d has been shown to lower plasma homocysteine and increase intracellular glutathione concentrations.

It is also important to note that individuals can have a genetic predisposition (ie. MTHFR, CBS, etc.) or be on medications that reduce folate and vitamin B!2 leading to an increase in homocysteine. A common medication that increases homocysteine levels is Metformin.

Lifestyle modifications include smoking cessation and regular physical activity. It is ideal for individuals to maintain a plasma homocysteine concentration below 10 μmol/L to lower the risk of vascular events. Collaboration with healthcare professionals and nutritionists is essential for developing personalized dietary plans addressing the specific needs and underlying health conditions.

Health care providers have many more tools today to assess cardiovascular risk and health. It is essential to perform a thorough assessment for all of these patients including a NMR lipid fractionation profile, ferritin, hs-CRP, nutrient markers (magnesium, potassium, selenium, copper, folate, B12, B6, zinc, and calcium), fat soluble vitamins (CoQ10, vitamin D, vitamin K, Vitamin A, Vitamin E), oxidative stress factors (homocysteine, insulin, and lipid peroxidases), heavy metals, and a fatty acid profile.

Each person’s biochemical individuality exerts a major influence on his or her health. The level of nutrient intake that maintains the best possible health is highly variable from person to person. Lifestyle choices and environmental exposures filtered through genetic predisposition are fundamental factors in the expression of disease and a successful treatment approach must include investigation into these factors.

By Michael Jurgelewicz, DC, DACBN, DCBCN

Source: Gonzalez-Lamuno D, Arrieta-Blanco FJ, et al. Hyperhomocysteinemia in Adult Patients: A Treatable Metabolic Condition. Nutrients. 2023 Dec 30;16(1):135.

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