The Homocysteine/AD connection

[SusanJ]

Angie, if you don't have MTFHR, you may not need methyl-folate (slightly more expensive). But, given your homocysteine level, it looks like you have something not working right in the methylation family of snps.

You can just try the B vitamins, and see if the number comes down. If it doesn't come down far enough, add the TMG.

[Haslk]

Just finished watching the two presentations. THANK YOU so much for supplying the links, again.

I learned last July that I am E4/ E4, so I've been on the learning curve less than a year. My primary care doc started me on B Complex and Methyl Folate right off the bat, but now I think I'll go back and ask for blood work and possibly some fine tuning.

I took pictures of some of the more salient slides from the presentations to aid our discussion.

Thanks again for being here.

[Tincup]

For what it is worth, Dr. Gundry told us that he observed a rise in homocysteine when people lose weight. Here is the Abstract Poster

And what Ron Rosedale had to say (don't recall if I already posted this):

Homocysteine is a by-product of the metabolism of methionine, an amino acid found in protein. In a process called methylation, homocysteine is rapidly converted into harmless amino acids. However, sometimes the methylation process goes awry, and homocysteine builds up in the blood. This is bad news, for this amino acid is extremely irritating to the arteries. It dampens the production of nitric oxide, which protects the endothelial cells lining the arteries and allows arteries to dilate, and sets the stage for atherosclerosis. Homocysteine also accelerates the oxidation of LDL cholesterol and makes the platelets in the blood stickier, increasing the risk of blood clots that may cause heart attacks or stroke.

If your homocysteine level is elevated, you have more to worry about than heart disease. It also damages neurons in the hippocampus, an area of the brain involved in memory and learning, conferring a threefold elevation in risk of Alzheimer’s disease, according to some studies. Methylation is also crucial for DNA repair, so elevations in homocysteine may illuminate underlying problems that may lead to cancer and premature aging. Most labs consider the normal range to be 5 to 15 umol/ L. I suggest you aim for the low end of that range— an ideal level would be no more than 6 umol/ L. Some studies have shown a progressive increase in risk of heart attack when homocysteine climbs above 6.3 umol/ L. Up to 7 umol/ L is acceptable, but when you get over 9 umol/ L and especially up toward 13, you can get into trouble. Early studies suggest that homocysteine and leptin are, if not interactive, then at least coexisting: when homocysteine levels are elevated, so are leptin accelerates the oxidation of LDL cholesterol and makes the platelets in the blood stickier, increasing the risk of blood clots that may cause heart attacks or stroke.

If your homocysteine level is elevated, you have more to worry about than heart disease. It also damages neurons in the hippocampus, an area of the brain involved in memory and learning, conferring a threefold elevation in risk of Alzheimer’s disease, according to some studies. Methylation is also crucial for DNA repair, so elevations in homocysteine may illuminate underlying problems that may lead to cancer and premature aging. Most labs consider the normal range to be 5 to 15 umol/ L. I suggest you aim for the low end of that range— an ideal level would be no more than 6 umol/ L. Some studies have shown a progressive increase in risk of heart attack when homocysteine climbs above 6.3 umol/ L. Up to 7 umol/ L is acceptable, but when you get over 9 umol/ L and especially up toward 13, you can get into trouble.

Early studies suggest that homocysteine and leptin are, if not interactive, then at least coexisting: when homocysteine levels are elevated, so are leptin levels, indicating the presence of leptin resistance. Fortunately, lowering homocysteine levels is relatively easy. Cutting back on coffee and methionine-rich meat will help to some degree, but getting adequate amounts of folic acid, vitamin B12, and vitamin B6 is a sure ticket to lowering homocysteine. The nutrient-rich Rosedale Diet supplies a good portion of your daily vitamin needs, and the supplement program provides the rest. I

f your homocysteine level does not respond to the suggested levels of these B-complex vitamins, you likely have a genetic variation that requires more intense supplementation. Simply increase your B-vitamin intake, and your homocysteine level will drop. The recommended levels of the homocysteine-lowering vitamins are 800 micrograms of folic acid, 150 micrograms of vitamin B12, and 75 milligrams of vitamin B6. (If you are older than age 55, consider increasing your vitamin B12 intake up to 1,000 micrograms to compensate for age-associated declines in vitamin B12 absorption.) If your homocysteine level is high, double your folic acid intake and increase your vitamin B12 to 1,000 micrograms. If that doesn’t do the trick, you can go as high as 5,000 micrograms of folic acid and 2,500 micrograms of vitamin B12 and add 1,000 milligrams of trimethylglycine (TMG, sometimes called betaine), which also facilitates the methylation process. These vitamins are quite safe, but I wouldn’t go too high on vitamin B6, for prolonged use of very high doses has been implicated in nerve damage. Homocysteine: less than 6 umol/ L optimal; Up to 8 umol/ L acceptable; over 9 umol/ L high; over 13umol/ L very high.

Rosedale M.D., Ron; Carol Colman (2009-10-13). The Rosedale Diet (pp. 178-179). HarperCollins. Kindle Edition.

[Fidel]

Thought my 11.5 Hcy reading while eating 20% protein 20% fat in 2015 would go down to under 10 when returning to a 10% protein 35% fat diet in 2016 (since less protein = less methionine) but Hcy actually increased to 12.3. Blood B12 reading was high both years while folate was high in 2015 and in the high normal range in 2016, so it seems the drop in folate is what made the difference. This year while remaining on a 10% protein 35% fat diet, drank a homemade concoction including some dissolved folic acid tablets, a couple oz. of it every couple hours during the day, and got a Hcy reading of 9.4. Since the B12 reading was in the normal range this year, it seems folate is a more important factor for me in driving down Hcy.

Am over 8 years into 100% vegan eating and have been maintaining a slightly lower than normal BMI the past few years, with a grazing eating pattern, a couple hundred calories every couple hours during the day. Since i personally don't like eating large amounts of food, especially at any one time, am going to supplement more, in the same pattern that i eat, a little every couple hours. The drink mentioned with the dissolved folic acid tablets also contained wheatgrass, matcha, ginger, ascorbic acid, whole leaf stevia & zinc gluconate. Recently started adding a multivitamin to that. A couple oz. of the nutrient drink every couple hours seems smarter than taking a blast of nutrients all at once.

[KatieS]

Fidel, that's an interesting observation that for these water soluble vitamins like the Bs, we might consider staging our doses. I've staggered my B doses, AM, noon & later afternoon & like you, decreased my protein percentage particularly dairy yogurt (now almond, cashew or coconut), but only when I added LE liquid TMG did the Hcy plummet to 3.1, less TMG stabilized at 5.9. However, I did continue on the B vitamins and a Pure Encapsulation PSP, so I'm not a completely pure experiment.

[Julie G]

Fidel, have you tried supplementing with B-6? The trifecta of B-12, folate and B-6 is the typical starting place for reducing homocysteine. I take 20mg of the activated form, pyridoxal 5' phosphate (P5P) daily, along with my sublingual 1mg methylcobalamin, and 800mcg of folate.

[Fidel]

One of our vegan superhero doctors, Michael Greger tells us to get the Hcy to below 10 which i've just done, so i feel pretty good about that. As a 3-4, i don't feel as much urgency as a 4-4 does to get it further down, and maybe a vegan at 9.4 is good enough? If i feel the need to do more, i can maybe incorporate some of what KatieS & Juliegee do. Due to eating a banana every 4 hours 4 times a day, supplementing B6 isn't something i've felt the need to do, but since i'm going to supplement a bunch of stuff now, that will include B6.
Got down to 9.4 without supplementing B6, somewhere around 1-2x the RDA of folate, and only 1000 mcg of sublingual liquid methylcobalamin once a week. Did get a tiny bit of cyanocobalamin from a tablespoon of nutritional yeast daily, and one serving of marmite once a week but that won't do much. The nutritional yeast does naturally contain a good amount of B6, so that was helping me.