Lowering Homocysteine Levels with Vitamin B

By Bonnie Jenkins, Advanced Natural Medicine

They’ve gone and done it again! I’m talking about the Journal of the American Medical Association and their anti-supplement agenda. The target this time? The B vitamins. Or more specifically, vitamins B6, B12 and folic acid.

Last month, JAMA published the results of a Norwegian trial that concluded that these B vitamins don’t prevent cardiovascular events like a heart attack or stroke among people with coronary heart disease. And, according to this study, these nutrients certainly won’t prevent you from dying.

B in the Crosshairs

The trial, dubbed the Western Norway B Vitamin Intervention Trial (WENBIT), involved more than 3,000 patients with heart disease at Norway’s Haukeland University Hospital. Most of the patients were about 60 years old and were taking conventional medication like statins and beta-blockers when the study began.

The patients were randomly assigned to receive a daily dose of folic acid plus vitamins B12 and B6; folic acid plus vitamin B12; vitamin B6; or a placebo. These three B vitamins have a reputation for lowering homocysteine levels – and folic acid has been tagged as a heart-healthy superstar.

Homocysteine is the normal breakdown product of the essential amino acid, methionine. Although the body uses small amounts of homocysteine, high levels in the blood can boost LDL cholesterol levels. Homocysteine also irritates the arteries and makes the blood clot more easily than it should, increasing the risk of blood vessel blockages. To make matters worse, homocysteine prevents the small arteries from dilating so they are more vulnerable to obstruction.

Lifestyle factors, like smoking and consuming too much caffeine, can raise homocysteine levels. But, even if you don’t have these bad habits, homocystine levels also rise naturally as you get older. Levels greater than 9 μmol/L are a risk factor for heart disease. At the beginning of this study, all of the participants had levels over 10 μmol/L. By the end, the folks in the folic acid groups experienced an impressive 28 percent drop in homocysteine.

Even so, the researchers came to the conclusion that supplementing with these three B-vitamins wasn’t justified for secondary prevention in cardiovascular disease.

Bad Design, Worse Results

If you are anything like me, the findings of this study have left you a bit confused. If high homocysteine levels are bad for you, and these three B vitamins can reduce the amount in your body, why isn’t it a good way to reduce the risk of a heart attack or stroke?

The Norwegian researchers point to the fact that, during the 38 month study, 422 of the participants experienced angina, a heart attack or a stroke. But there are also a few things they neglect to mention. Did the people in the study continue to take their medication? And did they take other factors, like smoking and weight, into account?

It also looks like the Haukeland team didn’t bother to see how much folate, B6 or B12 the subjects were getting in their diets. Since their homocysteine levels were already elevated at the start of the study, it’s possible that the supplements didn’t bring their levels down enough to make a difference.

Then there was the amount of the nutrients used in the study. While it looks like the folks taking part in the study got plenty of folic acid, the same can’t be said of vitamins B6 and B12. To effectively lower homocysteine levels, you need to take at least 50 mg. of vitamin B-6 and 500 to 1,000 mcg. of B-12 – considerably more than they used in this study.

Other Voices

Of course, not all experts hold these three B vitamins in such distain. About the same time the Haukeland trial was published in JAMA, another study from Italian scientists concluded that it was a good idea to give folic acid to heart transplant recipients to prevent the build-up of homocysteine. According to another study by Austrian researchers, lowing homocysteine with this vitamin combo can prevent 25 percent of heart attacks and stroke. And Israeli investigators have clearly shown that the three Bs, when taken together, keep homocysteine levels in the healthy range.

The JAMA study is also in sharp contrast to an earlier trial by another group of Norwegians, The four and a half year examination of the relationship between plasma homocystine and mortality was carried out by Norwegian researchers in 587 patients with coronary artery disease. Of the 64 patients who died during the study, only 3.8 percent of those whose plasma homocystine was less than 9 μmol/L died, compared with 25 percent of those with plasma homocystine above 15 μmol/L. So does homocysteine matter? You bet it does!

One Last Thing ...

I’m sure this study has left some people wondering whether or not to take these three nutrients. But, instead of fretting, just apply a little common sense. We know for sure that many seniors have high levels of homocysteine and low B12 levels. So if you are trying to prevent heart disease, it seems prudent to me to take a good vitamin B complex that provides at least 400 mcg. of folic acid, at least 50 mg. of vitamin B-6 and 500 to 1,000 mcg. of B-12.

This Just In ...

Are you fishing for new ways to live longer? Try fish oil! According to a new survey of 254 frail, elderly people, those with low blood levels of eicosapentaenoic acid (EPA) – one of the omega-3 fatty acids in fish oil – were 40 percent more likely to die than those with higher levels.

Not only does fish oil boost heart health, it protects against mental decline, supports healthy vision, keeps joints lubricated and guards against depression. With all that going for it, it’s a smart move to include fatty fish like salmon into your meal plan at least twice a week. I would also suggest taking 2,000 to 4,000 mg. of a good quality fish oil supplement every day. Of course, the longer you take omega-3 fatty acids, the more protection you’ll get – but it’s never too late to start enjoying all the health benefits these fishy supplements have to offer.

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References:

Ebbing M, Bleie Ø, Ueland PM, et al. “Mortality and cardiovascular events in patients treated with homocysteine-lowering B vitamins after coronary angiography: a randomized controlled trial.” Journal of the American Medical Association. 2008; 300:795-804.

Lindberg M, Saltvedt I, Sletvold O, et al. “Long-chain n–3 fatty acids and mortality in elderly patients.” American Journal of Clinical Nutrition. 2008 88:722-729.

Nakhoul F, Abassi Z, Plawner M, et al. “Comparative study of response to treatment with supraphysiologic doses of B-vitamins in hyperhomocysteinemic hemodialysis patients.” Israeli Medical Association Journal. 2004;6:213-217.

O Nygård JE, et al. “Plasma homocystine and mortality in patients with coronary artery disease.” New England Journal of Medicine. 1997;337: 230-236.

Stanger O, Herrmann W, Pietrzik K, et al. “Clinical use and rational management of homocysteine, folic acid, and B vitamins in cardiovascular and thrombotic diseases.” Z Kardiologie. 2004;93:439-453.