Tuesday, September 4, 2007

Homocysteine and B Vitamins

The Western Norway B-Vitamin Intervention Trial (WENBIT) results presented at the European Society of Cardiology Congress 2007 today, showed NO benefit for either supplemental folate with vitamin B12, or vitamin B6 in patients with established heart disease.

Could these CVD / homocysteine /folate /B12 /B6 studies possibly be collecting the wrong data on the wrong group?

It may be that faulty methionine metabolism hyperhomocysteinemia , which is most always caused by deficiencies of folate, B12 and B6, triggers gene-based (mRNA) inflammatory signals in the cells of the vascular walls representing a major pathogenetic pathway of atherosclerosis. This could be happening years before heart disease is established.
This concept is not dissimilar to metabolic syndrome (insulin resistance) being an issue years before type 2 diabetes is diagnosed.

Treatment with folate, B12 and B6 after disease is established may be too late, just as treatment with folate after the 28th day of fetal gestation is too late to prevent neural tube defects, although it's still important for the folate deficient pregnant Mom at risk for megaloblastic anemia.

A number of epidemiological studies have clearly shown that higher blood homocysteine levels are associated with higher risks of coronary, cerebral, and peripheral vascular disease and are inversely related to blood levels of folate and of vitamin B12 and vitamin B6.

Observational studies cannot exclude the possibility that elevated homocysteine levels may be associated with some other factor, rather than being causally related to vascular disease.

Large-scale randomized trials on healthy people are now in order to determine if supplemental folate, B12 and B6 could PREVENT hyperhomocysteinemia before it triggers the endothelium inflammatory process associated with most all heart and vascular disease.


Burton Goldberg said...

How interesting!

Are there any published studies that support your hyperhomocysteinemia hypothesis?

Anonymous said...

Great theory Ms.Troyer, but who do you think is going to fund a study on disease prevention? There's no money in that!!!

Do understand that large trials are funded by those who will profit from the published results; ligitiment or not.

Ellen Troyer, MT MA said...

Good Morning Anonymous,

Your point is well taken, but I'm curious why you did not use your name since blog comments are rarely taken seriously if they do not have a name attached.

This important information might already be available in the data collected from the tens of thousands of health professionals in the Physicians Health Study or the Nurses Health Study.

Wouldn't it be interesting to look at CVD diagnoses in those health professionals who never suffered from methionine metabolism issues, or who kept their homocysteine levels in check by supplementing with folate, B12 and B6 (probably in a multiple) when they were young adults vs. those who did not?

This information could be particularly important since we know that elevated homocysteine is a marker for inflammatory vascular disease, which is linked to most all degenerative disease including macular degeneration and diabetic retinopathy.

This might be a medical school Ophthalmology Department project that would qualify for funding from Research to Prevent Blindness since they have the freedom and the ability to fund disease prevention studies.

Jeffrey Anshel, OD said...

As I've been reviewing the research, the one thing that keeps popping up is that most of the studies are using vitamins for existing conditions! It may be too difficult to look at prevention because we're not really sure who is truly at risk for a particular disease. But maybe not....

In any case, we shouldn't be waiting until we manifest a disease to try to get better when we already know how to prevent them.

George Harding said...


Don't be such a "Debbie Downer". I'm not sure if you're being sarcastic when you say 'who do you think is going to fund a study on disease prevention?' or not. But by clamming anonymous it tells me that you're being serious. And unfortunately, I think you're right. There's not as much funding for prevention research as in curing (almost rightfully so). However, if we can get the word out on how to prevent diseases like: cancer, glaucoma, CVD, and so on we can do our own part in showing the big wigs where to invest some research money; and like Ms. Troyer suggested: maybe we can put interest out there for med schools to write up some grant proposals on prevention research!

Ellen Troyer, MT MA said...

Your "almost rightfully so" comment suggests you might be missing the point Mr. Harding.

If we spent a lot more of our research dollars on ways to prevent disease (including patient education), instead of spending most every cent on ways to treat disease after the fact (the allopathic focus) the overall financial burden of health care would be less and we would all be healthier and able to live independently doing what we like...far longer.