Elevated Homocysteine and Heart Disease

By: Michael Lam, MD, MPH

Elevated homocysteine and the heartHomocysteine is an amino acid commonly found in the blood, and if its levels are high, it becomes a risk factor for heart disease. Elevated homocysteine is associated with meat consumption and low levels of vitamins B6, B12, and folate. Although that may seem to indicate vegetarians have a slight advantage, as we will see later on in the article, that’s actually not always the case.

Since the 1980s, research has shown that homocysteine is an important and independent risk factor of heart disease. Recent studies have also confirmed that an elevated homocysteine level also leads to premature death from a variety of sources, including strokes and cancer.

Researchers at the University of Bergen, for example, studied over 2000 men and 2500 women, aged 65 to 67 years from 1992 onwards. After 5 years, it was shown that for every 5.0 micromol/L increase in homocysteine levels above the baseline level (9.0 micromol/L), mortality from all causes increased by 49 percent, cardiovascular mortality by 50 percent, cancer mortality by 26 percent, and deaths from other causes (respiratory, gastrointestinal and central nervous system diseases) by 104 percent. About 78 percent of the study group had homocysteine levels at or above 9.0 micromol/L and 12 per cent had levels exceeding 15 micromol/L.

These alarming results are obtained after adjusting for cholesterol level, blood pressure, smoking, body weight, height, physical activity level, cardiovascular disease risk status at baseline, age and gender.

Those who smoke and drink coffee tend to have the highest level, while those practicing a healthy lifestyle have the lowest. The take home lesson is simple – lower your level or face risk of pre-mature death.

The Cardiovascular System and the NEM Stress Response

The NeuroEndoMetabolic (NEM) Stress ResponseSM is the body’s overall strategy for handling stress, whether mental, emotional or physical. It is comprised of six circuits: the cardionomic, the hormonal, the metabolic, the neuro-affective, the inflammatory and the detox responses.

The cardionomic stress response is the one that readies the heart, blood vessels and lungs to receive more oxygenated blood for a fight-or-flight response.

With the fight-or-flight response, adrenaline and norepinephrine flood the system. Adrenaline is released by the adrenal glands and then regulated by the autonomic nervous system.

All of these components work together to help you get out of the way of, or fight off, danger. It is a normal and healthy reaction to perceived harm.

The problem arises, however, when there is excessive release of these hormones and a frequently triggered fight-or-flight response. This puts a lot of stress on the body and throws it off balance.

If the cardionomic stress response becomes overactive, metabolism has to keep up and also becomes overactive. The body is now constantly switched “on” and has no break from this excitation in order to rest and repair.

The adrenal glands produce the hormone cortisol to neutralize stress in the body, but with a continuous and heavy workload, they are eventually weakened. This can lead to Adrenal Fatigue Syndrome (AFS) with symptoms like tiredness, sleep disturbances, weight problems, and brain fog.

Furthermore, an imbalance in the cardionomic stress response can lead to high blood pressure, heart palpitations, cardiac arrhythmia, dizziness and shortness of breath, and in more advanced stages, there can be a development of atrial fibrillation.

If this continues, the heart’s functions can be compromised. And, adding to that, if elevated levels of homocysteine accompany these issues, damage to the cardiovascular system is likely. Remember that homocysteine is an indicator of oxidative stress. The higher the number, the higher your risk of cardiac blockage.

Therefore it is imperative that other than lowering your levels of homocysteine, you ensure that your NEM system and your adrenal glands are in balance and functioning well.

But as always, it is very important that you do not make changes to your health plan without proper supervision, especially if your heart is at risk. And if you suffer from AFS, you will need to be careful with supplementation, including supplements that help with lowering elevated homocysteine levels.

Note on Elevated Homocysteine Levels

Elevated homocysteine levels can be lowered by daily supplementation with folic acidIt is interesting to note that below-normal levels of vitamin B12 were found in none of the omnivores, but 26% of the vegetarians and 78% of the vegans had below-normal levels. Elevated homocysteine was found in 29% of the vegetarians compared with only 5% of the omnivores. Even though a vegetarian diet can lower serum cholesterol, the opposite effect on homocysteine could offset any potential benefit.

Another potential cause of elevated homocysteine levels can arise from an MTHFR genetic defect. MTHFR stands for methylenetetrahydrofolate reductase. It is an enzyme that plays a part in processing amino acids, including homocysteine. MTHFR is responsible for converting homocysteine into methionine. As such, an MTHFR genetic defect results in the MTHFR enzyme incorrectly functioning and a build up of homocysteine levels.

Fortunately, homocysteine levels can be safely and effectively lowered naturally by daily supplementation with

  1. Folic acid (800 mcg to 10 mg/day),
  2. Vitamin B6 (50-100 mg/day), and
  3. Vitamin B12 (600-1000 mcg/day).

If you do not wish to take nutritional supplements, following the anti-aging food pyramid can give you similar results. Because folic acid and vitamin B are relatively inexpensive, those whose lifestyles are less than desirable should take these nutrients as an additional insurance.

Elevated homocysteine and the heart


  • Neil says:

    Where can I find the anti-aging food pyramid?

    • Dr.Lam says:

      The anti-aging food pyramid can be found here. . Remember that HEAT is the biggest enemy of good nutrition because it destroys nutrients in high doses. Eggs are good for you and cholesterol is not our enemy.

      Dr Lam.