Associated with increased risk of cardiovascular disease, elevated plasma levels of the amino acid homocysteine are affected by genetic, physiologic, and nutritional factors. Increased homocysteine levels are considered to be, collectively, an independent predictor for atherosclerosis and thromboembolism and are correlated with significant risk of coronary artery disease, myocardial infarction, peripheral vascular occlusive disease, cerebral vascular occlusive disease, and retinal vascular disease.77 Research has also shown that elevated homocysteine is associated with an increase risk of developing Alzheimer's disease, cognitive impairment, pregnancy complications, and osteoporosis.78 The association between homocysteinemia and CVD is causal, because an increase in plasma homocysteine precedes the onset of cardiovascular disease.79 Desirable plasma levels are below 10 mmol=L. The plasma concentration ranges for mild, moderate, and severe homocysteinemia are, respectively 15-25; 25-50; and 50-500 mmol=L. Homocysteine can beelevated in the absence of an increased mean corpuscular volume (MCV), if a patient presents with a MCV above 92 (range 80-100) and there is a family or personal history of osteoporosis, Alzheimer's, or heart disease, testing is essential. In preventive medicine practice, homocysteine testing is routine screening.
Nutritional factors that can mitigate elevated homocysteine levels include vitamins B12, B6, B2, and folic acid. The presence of these vitamins has been found to be inversely related to plasma homocysteine concentration, thus, combination therapy with these vitamins is an effective way to reduce homocysteine levels.80 In addition to supplementation, patients are encouraged to consume green leafy vegetables and fruits, all food items that are rich in B vitamins and folate.
Homocysteinemia is a standard laboratory value that is treated similarly by both allopathic and naturopathic physicians, if not more vigorously by naturopathic physicians as a result of their particular view of nutritional status as a generalized health predictor. Patients with homocysteinemia and known coronary artery disease are encouraged to take 1 mg per day of folic acid, 400 mg per day of vitamin B12, and 10 mg per day vitamin of vitamin B6, but the side effects of this therapy are relatively unknown.81 In addition, treatment of homocysteinemia also includes a low-methionine diet because homocysteine is an intermediate product of methionine metabolism in the body. Foods that are rich in methionine include cheddar cheese, eggs, chicken, and beef.
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