Oct 1, 2002 5 min read

Ever since Harvard University published its study on homocysteine research a few years ago, experts have been hotly debating this amino acid’s effect on cardiovascular disease. It seems that a high level of homocysteine in the blood dramatically increased an individual’s risk for heart attack, stroke and other vascular disease, in particular atherosclerosis.

Some doctors have gone as far as to say homocysteine, not high cholesterol, is the main culprit in heart disease because many heart attack victims have normal cholesterol levels.

And now, researchers from Boston University have added their voice to the discussion. In a report, which appeared in the Feb. 14, 2002, issue of “The New England Journal of Medicine,” Boston University scientists declared a relationship between high homocysteine levels in the blood with an elevated risk – nearly double – of developing Alzheimer’s and other dementia-related diseases.

Yet doctors are hesitant to recommend the screening of homocysteine as part of a regular checkup. Never mind the fact that the average American probably never heard of homocysteine, and therefore wouldn’t know what to ask the doctor. Just what should we know?

Homocysteine is an amino acid naturally produced by the body, but harmful in elevated amounts. According to the American Heart Association, high levels can damage the interior lining of arteries and promote the clotting of blood. And depending on where blood clots form determines exactly what kind of damage will be done.

The rise of homocysteine levels is not completely understood, but genetics and the environment – particularly Americans’ less than ideal eating and exercise habits – appear to be most relevant. One study from Norway found a possible link between coffee consumption and higher levels. Other conditions that increase homocysteine are kidney disease and alcohol use. Levels also increase as we get older. And certain medications may be problematic as well.

If there’s any bright spot to all the new attention researchers have been giving homocysteine, it’s that the addition of a few vitamins into the diet – folic acid, B6 and B12 – can reduce the amount of homocysteine to a more normal and less destructive level.

The prime homocysteine-buster appears to be folic acid, a vital nutrient for women of childbearing age because of its ability to prevent birth defects of the brain and spine. In fact, folic acid is so essential to the developing fetus that the U.S. Food and Drug Administration requires that the foods most consumed as staples in the average diet – breads, cereals and other grain products -be fortified with folic acid. This would include most breads, flours, corn meal, rice, noodles, macaroni and other grains.

Folic acid can also be found in leafy dark green vegetables. Legumes (dried beans and peas), citrus fruits and juices, tomatoes, and most berries. Avocados, asparagus, sunflower seeds, dry roasted peanuts, tofu and low-fat buttermilk are also good sources.

Folic acid can also be taken by supplement, and here, it seems, is where the controversy begins. The American Heart Association (AHA) “does not recommend widespread use of folic acid and B vitamins to reduce the risk of heart disease and stroke. We advise a healthy, balanced diet that includes five servings of fruits and vegetables a day.”

Part of the controversy may lie in the fact that no one can agree on an optimal dosage. Most studies have suggested consuming 400 micrograms of folate, or folic acid, a day to achieve the best results. But these studies used supplementation, and not natural food sources, to provide the folic acid and B vitamins. Some nutritionists and researchers say a person would have to eat 800 micrograms of dietary folate to equal the 400 received in a supplement since synthetic folate is more easily absorbed by the body.

Despite all the studies, the AHA stills stands by its pronouncement that “supplements should only be used when diet isn’t adequate to achieve these intakes.”

Health conscious individuals most likely pay attention to the revised nutrition guidelines set forth by various government and consumer advocacy groups, but let’s be realistic. How many women regularly eat their five fruits and veggies each and every day? (If we have to consume 800 micrograms, make that 10 fruits and veggies.) How many women consume the less popular Brussels sprouts, collard and mustard greens, cooked spinach, or lentils and black-eyed peas (all excellent sources of folate)?

It’s estimated that less than half of the adult population in the United States consumes even 200 micrograms of folic acid. When regarding the more widely recommended 400 micrograms, only 12 percent of the population reaches this level.

It’s a sad fact, but most women still do not get enough folic acid. Whether to supplement or not will be an individual choice. Some may choose to boost their level of dietary folate while supplementing in smaller doses. Others may choose supplementation alone or diet alone.

Whatever method you choose to consider, it’s important to understand that increasing your level of folic acid just might reduce your risk of having a heart attack.

(Jan Hawkins is a freelance health care journalist residing in northern Kentucky.)