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July 1997

Vitamin B6 And Homocysteine

By Paul Frankel, Ph.D. and Terri Mitchell

Homocysteine's relationship to heart disease may explain some things that cholesterol never could. It may even explain the increase in heart disease which has occurred in women over the last two decades. Vitamin B6 helps the body lower levels of homocysteine. A rise in heart disease in women coincides with the use of birth control pills. Birth control pills deplete vitamin B6 and raise levels of homocysteine.

Conversion of Homocysteine to SAM

Smoking is a known risk factor for heart disease. Coincidentally, cigarette smoke also depletes Vitamin B6. Low B6 has been shown to correlate with high levels of homocysteine. Researchers in Norway recently found that a combination of smoking and drinking coffee is a sure ticket to elevated homocysteine. It's not surprising that the statistics linking smoking to heart disease are similar to those linking high homocysteine levels to heart disease.


Conversion of Homocysteine to SAM
and non-toxic compounds

Supernutrients Versus Genes

The remarkable potency of the supernutrient combination (TMG, B6, B12, folic acid and choline) can be seen in people with genetic defects in enzyme production that cause elevated homocysteine.

People with these disorders frequently die of cardiovascular disease. A striking case was reported by Dr. T. Kishi and his group in the Journal of Inherited Metabolic Diseases. The authors reported that a 16 year-old Japanese girl had no detectable SAM in her body. She was unable to walk, with or without support, and had severe peripheral neuropathy, muscle weakness and convulsions. Her vascular system was on the verge of collapse. Therapy with vitamins B6 or B12 didn't work. Folate (folic acid) lowered homocysteine, but didn't improve the young woman's symptoms. But two months after adding trimethylglycine (TMG or betaine) to the regimen, her homocysteine level dropped, and she improved and was able to walk with support. Seventeen months later, she was free from convulsions and able to walk normally again.This case history demonstrates the see-saw relationship between homocysteine and SAM. The young woman's SAM levels went from undetectable to near normal after the first few months of treatment, while her homocysteine levels - which started out too high - fell dramatically. The see-saw relationship between "good" SAM and "bad" homocysteine is very evident in this case. If these nutrients can overcome a genetic disorder, consider how powerful they can be in reducing the risks associated with elevated homocysteine in the general population.

The Biochemistry of Homocysteine

There are three biochemical pathways used by the body to reduce homocysteine. In one pathway, TMG donates a methyl group which detoxifies homocysteine. In this reaction, TMG is turned into dimethylglycine (DMG) - yes, that familiar product sold as a supplement for its energizing effects. In the other routes, folic acid, B12 and B6 convert homocysteine into non-toxic substances.

Some people can't utilize one or another of these pathways. That is why a combination of all the supernutrients is the only way to guarantee that homocysteine will be lowered. Nearly all cases of elevated homocysteine can be corrected with a combination of TMG, folic acid, vitamin B12, and vitamin B6. A note about vitamin B6 (pyridoxine): B6 can be toxic in high doses. Some people who take more than 250 mg/day have developed tingling and numbness in their hands and feet, and balance problems. If you develop any of these problems, consult your doctor immediately. The symptoms of vitamin B6 toxicity will subside when the dose of the vitamin is reduced. People taking levodopa (L-dopa) should consult their doctor before taking supernutrients.

Homocysteine and Diet

Dr. Soo-Sang Kang of Rush Medical College in Chicago, reports that, along with genetic predisposition, elevated levels of homocysteine occur because of nutritional inadequacies. B6, B12 and folate deficiencies are common in people of all ages. Betaine deficiency has not yet been studied in the general population.

Although vitamin B6 is found in a variety of foods, processing, canning, and freezing quickly destroy it. Folic acid (originally found in spinach) is in most leafy vegetables, yet numerous studies indicate that people of all ages and cultures are deficient. In one study of healthy elderly patients, one or more elevated metabolites (indicating deficiency) were found in 63% of people tested. Using the metabolite method of measuring these vitamins reveals even greater deficiencies than suspected. In elderly hospitalized patients, 83% showed a deficiency in folic acid. In another study on elderly Spanish people, low folate levels correlated with an impaired mental state and diminished ability to carry out daily activities. The Nationwide Food Consumption Survey of 1980 showed that half of all Americans surveyed were getting less than the RDA of vitamin B6.

Vitamin B12 is found in anything that moves, but is reduced by antibiotics (which are used in most commercial animal farms). TMG (betaine) is found in most vegetables, and small fish and shrimp, although it requires great effort to get enough TMG through the diet to consistently lower homocysteine levels. Coffee may act as a inhibitor of betaine metabolism.

A quick look at the standard Western diet (where the french fry has made the potato the most commonly eaten vegetable) reveals the roots of heart disease. Homocysteine is a product of methionine, an amino acid found in meat protein. It promotes heart disease by promoting the oxidation of lipids. Homocysteine plays a role in the entire heart disease process. It causes platelets to stick together; enhances the binding of Lp(a) to fibrin; and promotes free radical damage to the inside of arteries. Autopsies of young men killed in Vietnam show that vascular degeneration begins very early in Western society - likely due to the American high protein/fat diet which is deficient in supernutrient-containing vegetables.

Cardiovascular Deaths (per 100,000)

Cardiovascular Deaths (Per 100,000)
Homocysteine correlates with vascular disease in selected countries.
Key: DEUa(b) Germany, SPA/Spain, FAO/Faroe Islands, FRA/France,
JPN/Japan, ISR/Israel, ICE/Iceland, SCOa(b) Scotland, DEN/Denmark,
NIR/Northern Ireland, FIN/Finland. Used with permission from Alfthan G,
Aro A, and KF Gey. Plasma homocysteine and cardiovascular disease
mortality. Lancet 349:397 (1997).

A Long-Term Study

Dr. Nicholas Dudman and his group of the University of New South Wales studied 10 people with homocystinuria (genetically-elevated homocysteine levels) who took TMG plus supernutrients vitamin B6 and folic acid for almost 13 years. They found that the TMG supernutrient combination kept homocysteine levels to one-fourth their pre-TMG level, with no negative side effects.

According to the researchers, "it was necessary to continue taking TMG (betaine) regularly to maintain maximum effects." Homocysteine levels would rise within days if people neglected to take the combination; but quickly decreased once the TMG was resumed. The study is particularly striking in that homocysteine levels naturally rise with age, but in the patients taking TMG, levels actually fell substantially, even though the participants were getting older.