“Your cholesterol levels are very high”, the GP says, shaking their head. “I am going to have to put you on statins.” Quite apart from the concerning implications of the GP’s statement, the thing you should really be saying at this point is: “Please check my homocysteine levels.”
Homocysteine?
It’s not something that gets a lot of airtime, even though a lot of the stuff that cholesterol takes the blame for may well be down to homocysteine. Evidence has been building for more than two decades that high homocysteine levels increase our risk of over 100 diseases. Heart disease, high blood pressure, stroke, dementia, deep vein thrombosis (blood clots), Parkinson’s disease, osteoporosis, kidney disease, complications in pregnancy, age-related macular degeneration and even some cancers are all being linked to high levels of homocysteine.
Everyone knows cholesterol is bad for you, right?
Except it isn’t. Not really. Back in the 1960s cholesterol was seen as a threat to health because studies that fed vast quantities of cholesterol to animals that don’t eat cholesterol-containing foods found that cholesterol levels increased.
Things have changed since then.
Although some cholesterol does come from what we eat, our liver actually makes most of it. And if we are eating a lot of food containing cholesterol, then the liver tends to slow down production. What really drives cholesterol production is sugar and highly processed carbohydrates – but that’s another story.
Cholesterol provides structure and flexibility to our 30 trillion cell membranes. It allows water to be absorbed or repelled (depending on the type of cell). And it facilitates cells sending messages to each other about what’s going on in and around them.
We use cholesterol to make a lot of our hormones, including oestrogen, progesterone, and testosterone. Without cholesterol, we wouldn’t be able to make more people. And it gets turned into vitamin D when our skin is exposed to sunshine.
Cholesterol is used to make bile that we need to digest and absorb fat. And the liver dumps a lot of the toxins that get filtered out during detoxification into it. Then that bile, the toxins it carries, and the rest of the waste in the gut, head for the exit (bile is what makes poo brown).
So what exactly is homocysteine?
Homocysteine is an amino acid, the building blocks of protein. There are hundreds of amino acids, but only 22 of them are relevant to humans. Of those 22, nine are ‘essential’ because we can’t make them in our bodies, we can only get them from the food that we eat.
Homocysteine is created when our metabolism breaks down the amino acid methionine (one of the essential ones). The breakdown of methionine is supposed to end up making yet another amino acid, cysteine. But sometimes the metabolic pathway (a series of chemical enzyme reactions that changes one substance into another) gets stuck halfway.
The pathway gets stuck because the enzymes that chop up methionine and turn it into cysteine don’t work properly. There are several reasons for this including genetics, age (as we get older stuff doesn’t always work as well as it used to), or it could be about nutrients. Vitamins B2, B6, B12 and folate (sometimes called folic acid), along with betaine and choline (substances that work alongside the B vitamins), are crucial to keep the pathway moving. It grinds to a halt if we don’t have enough of one or more of those nutrients.
How does homocysteine cause health problems?
The diseases linked to homocysteine have one thing in common. Inflammation.
At a cellular level, inflammation is more than just a bit of swelling that happens if you bash a knee or manage to burn yourself by taking a cake out of the oven. In cells which have been injured, invaded by a virus or bacteria, or exposed to a toxic substance, blood flow increases, and signals are sent out to the immune system. Immune cells swarm into the injury site with the intention of repairing it. Which is great, because we need repairing. The problem arises when the inflammation goes on for a long time.
In long-term (chronic) inflammation, the cells that rush to inflamed areas can end up making it worse. Those cells produce inflammatory chemicals and remove damaged tissue. Unfortunately in chronic inflammation, immune cells keep producing those chemicals and stop being able to differentiate between healthy and damaged tissues. So they continue to remove tissue, causing further injury, eventually creating scar tissue and permanent damage.
Although the mechanisms of how homocysteine creates inflammation have not been fully worked out, we do know that high homocysteine blocks the formation of some enzymes, over-stimulates the formation of others, and reduces the ability of cells to create energy. The result of all of this is an increase in inflammation, which damages cells and can ultimately lead to disease developing.
Why don’t doctors test for it?
In the UK, the National Institute for Health and Care Excellence (NICE) provides guidance to healthcare practitioners on the management of disease, evaluates new health technologies, makes recommendations on what healthcare practitioners should prioritise and supposedly ensures value for the taxpayer.
Yet despite all of the evidence, NICE has no guidelines for testing for homocysteine. In fact, it is barely mentioned in any NICE documentation and when it is, it is broadly dismissed as irrelevant. The main NHS website talks about high homocysteine being “a rare but potentially serious inherited condition”. But hundreds of studies show it is mostly neither rare nor inherited. And regional NHS trusts all seem to suggest that routine testing is not recommended. So even though evidence that homocysteine is a clear marker, and possibly a risk factor for a wide range of diseases has been building up for decades, the NHS has yet to catch up.
What? Risk marker? Risk factor?
Both risk markers and risk factors are things which indicate that there could be an underlying health problem.
Risk markers are predictors of health issues because they indicate that damage (to a system or organ) has already occurred. Risk factors are things that can be modified, like obesity or high blood pressure. There has been a lot of debate about whether homocysteine is a risk marker or a risk factor. It is entirely possible that it could be both as it is known to cause damage, but levels can be modified.
How can I bring my homocysteine levels down?
Although not having enough B vitamins isn’t the only thing that raises homocysteine levels, it is the one thing that we can control. Taking a high dose B vitamin supplement every day has been shown to reduce homocysteine levels. And lower homocysteine levels may help to prevent a huge range of chronic diseases.
T C Callis’ articles are very well-researched and always come with a wealth of references. If you are interested in following up on anything in the article, don’t hesitate to contact us at Kent & Surrey Bylines for more information.
