Homocysteine may seem like yet another confusing medical word, but it surprisingly takes center stage when it comes to your health. It’s a naturally occurring amino acid and a byproduct of metabolism. Normally, your body regulates its levels with assistance from essential B vitamins specifically B6, B12, and folate. When all is well, homocysteine is rapidly catabolized and converted into other necessary molecules. But when something disrupts this process, homocysteine can build up in your blood, and that’s when things can get tricky.
The body’s ability to process homocysteine hinges on having enough of those B vitamins. If you’re low on B6, B12, or folate, your homocysteine levels can start to climb. This is why individuals who have limited diets such as strict vegetarians or vegans are more likely to have increased homocysteine, as vitamin B12 occurs primarily in foods of animal origin. A person’s age also has something to do with it, as elderly people have difficulty absorbing B12 from food. Genetics may be involved as well; some gene mutations, like ones in the MTHFR enzyme, can make it more difficult for your body to utilize folate effectively, causing increased homocysteine. Smoking, alcohol consumption, some medications, and chronic diseases like kidney disease or hypothyroidism may also drive levels up.
But why does elevated homocysteine even matter? For decades, scientists have associated high homocysteine alternatively referred to as hyperhomocysteinemia with a heightened risk of cardiovascular issues. When homocysteine gets elevated above the normal range of 5 to 15 micromoles per liter, it can weaken the lining of your arteries, allowing it to be simpler for cholesterol and fat to accumulate and create blockages. This increases your risk for heart attacks, strokes, and treatment-resistant hypertension. A few studies have estimated that for each small elevation of homocysteine, there’s an increase in the risk of cardiovascular disease mortality. There’s also evidence linking high homocysteine with cognitive impairment, dementia, osteoporosis, and even some cancers.
But things are not entirely as simple. Whereas it’s certain that elevated homocysteine is linked with these medical dangers, the large question has been whether or not reducing homocysteine actually lowers your risk of heart attack or stroke. Initial trials using folic acid supplements to decrease homocysteine didn’t indicate much benefit in warding off cardiovascular events, which left doctors skeptical. Critics noted that they had relatively brief follow-up times, enrolled individuals who had already had vascular disease, or didn’t reduce homocysteine sufficiently to be effective. Later research indicates that using the correct types of B vitamins particularly natural folates and riboflavin, not merely synthetic folic acid may be more helpful, especially in individuals with specific genetic histories.
It’s a fairly straightforward test your levels can be identified through a blood test. Your physician might order the test if you’re experiencing symptoms of vitamin B deficiency, like tiredness, light-headedness, numbness in your hands or feet, or mouth ulcers. It’s also looked for individuals at increased risk of heart disease, stroke, or those with unexplained elevated blood pressure that does not respond to routine treatments. Yet, testing may be unavailable. Most insurance companies do not pay for routine homocysteine tests, claiming there isn’t enough proof of their value. This leaves high levels to possibly go unnoticed, particularly in individuals who could be helped most by prompt treatment.
If your homocysteine is elevated, the first response is typically to examine your diet and supplement. Increased intake of B6, B12, and folate through foods such as leafy greens, beans, fortified cereals, meats, eggs, and dairy has been shown to lower levels. For individuals with inherited conditions such as homocystinuria, or with severe absorption issues, lifetime supplementation and at times a special diet are required. In others, eliminating underlying conditions such as kidney disease or thyroid disorders is crucial.
Homocysteine science continues to progress. Though there is no single answer, maintaining healthy homocysteine levels is a good bet for your heart, mind, and well-being. With ongoing research, the expectation is that more individualized strategies considering genetics, nutrition, and specific risk factors will enable it to become simpler to detect and treat those who most require it.
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