The Risk of Homocysteine, and the Folate Counterattack

Every time I visit my lawyer, he asks me for a health tip. The last time I went to see him, he asked me, 'So, Mike, what's the latest thing I should be doing to get younger?'

Without hesitation, I said, 'Taking 400 micrograms of folate a day as a supplement.'

'Folate? What for?' he replied.

'To reduce your homocysteine,' I said.

'My what?'

'Homocysteine. It's worse for your arteries than a sixty-four-ounce steak.'

'I thought cholesterol was the worst thing.'

'If cholesterol is petty crime, homocysteine is grand larceny.' Then I gave him some free medical advice in exchange for some paid legal advice. Lawyers!

Homocysteine is an amino acid that is a by-product of various metabolic processes that may build up in the blood. As you age, your homocysteine levels increase. No one is exactly sure what homocysteine does to the arteries, but it is well established that people with high levels of homocysteine have considerably more arterial disease and much higher rates of atherosclerosis than those who don't.

People with high levels of homocysteine in their blood are at a significantly higher risk of the early onset of arterial disease and suffer markedly greater rates of arterial ageing. Elevated homocysteine levels triple the risk of heart attacks and stroke. More than 42 percent of people with cerebrovascular disease, 30 percent of those with cardiovascular disease, and 28 percent of those with peripheral vascular disease have homocysteine levels that are too high. Getting 400 micrograms (meg) of folate a day can reduce homocysteine levels dramatically, essentially removing any excess from your bloodstream and stopping its ageing effect. It's a quick, easy, and painless way to make your arteries younger. By religiously taking 400 meg of folate a day, you can reduce your RealAge by 0.6 years in just three months. If you already have elevated levels of homocysteine, you can reduce your RealAge by three years in just three months.

As I discussed in the chapter on arterial ageing, one of the main causes of arterial ageing is atherosclerosis. For some reason—no one knows for sure— high levels of homocysteine seem to disturb the endothelium, the inner lining of the artery. Some scientists believe that homocysteine causes small openings in the cell layer, leading to deterioration of the arterial wall and the buildup of plaque. There are other hypotheses as well. Homocysteine may decrease the production of relaxing factors that let our blood vessels dilate. It may stimulate blood clots by changing the shape or form of the cells that form the endothelium. Homocysteine might also oxidize low-density lipoproteins (LDL—remember 'L' for lousy—cholesterol), promoting the buildup of plaque along the walls of the arteries.

Although we don't know all the reasons, there is a clearly established link between high homocysteine levels and arterial ageing and a clearly established link between high folate levels and arterial health. One study estimated that if everyone had proper levels of folate, the number of heart attacks in the United States could be reduced by as much as 40,000 to 150,000 cases a year, and this number may be too conservative! The risk-factor statistics predict that a more realistic estimate would be a reduction of one-third in the rate of heart attacks in the United States a year. In other words, perhaps as many as 450,000 heart attacks occur a year because we don't get enough folate.

As folate levels drop, homocysteine levels increase, and vice versa. The two compounds are part of a complex chemical reaction involving many steps, but the end result is that more of one means less of the other. The more folate you take, the lower your homocysteine levels.

Folate (in its natural form)—or folic acid (in supplements)—is part of the B-complex family of vitamins. Folic acid is often prescribed for pregnant women because it is essential for the normal development of the brain and spinal cord of the fetus. Although we tend to think of folate as being essential during infancy, we need it as adults, too. As you age, folate concentrations drop. The most common vitamin deficiency found in older people is a deficiency of folate. More that 50 percent of all Americans do not get enough folate daily. On average, American men consume 281 meg of folate a day and American women, just 271 meg. Older people ingest even less. All are far below the ideal intake of 1,100 meg of folate in food or 675 meg of folic acid in supplements a day.

Lots of foods contain folate. A glass of orange juice has 43 meg of folate, and many breakfast cereals average 100 meg a serving. Still, to get enough folate, you would have to drink about twenty-five glasses of orange juice a day! A slice of white bread has only 6 meg of folate and a green salad, just 2 meg.

Since the average intake of folate is approximately 275 meg from diet, a 400-mcg supplement is what you should take to get the 675-mcg-a-day RAO, the RealAge optimum. If you are trying to get all your folate from your diet, you will have to consume even more—as much as 1,100 meg—since the body will absorb only about half the folate found in food. For example, 700 meg of folate found in food is equivalent to about 400 meg of the folic acid found in supplements. Don't worry about an overdose of folate. Toxicity occurs only when more than 1,500 meg is ingested a day on a regular basis.

You will need to take folate consistently for the rest of your life. Studies show no known side effects of folate consumption. If your kidneys are not working properly, you should probably not only take folic acid supplements, but also eat a low-protein diet. This will help control homocysteine levels, which normally increase with a high protein diet. Vitamin B6 also lowers homocysteine levels, so you may want to consider that option. Consult your physician.

Should you have your homocysteine level cheeked? Probably not. The test is expensive and difficult to perform. It is far easier to try to get adequate folate every day. If homocysteine is high, folate will bring it down. If it is low, folate will help keep it low.

As a medical student, I was taught that high homocysteine levels were associated only with a rare disease. In those days, we 'hotshot' medical students and residents used to laugh at the 'old, out-of-date clinicians' who gave their elderly patients shots of B12 and folate as placebos, often to make them feel better. Perhaps those 'old fogies' knew something we young hotshots didn't. Getting enough folate makes your RealAge at least 1.2 years younger.

By the way, make sure you get adequate B12 (25 meg) and B6 (4 mg) each day, as well. The highest quantities of B6 are found in almost all beef, parsley, many fish (cod, halibut, herring, salmon, sardines, and tuna), bananas, avocados, some fortified cereals, whole grains, eggs, chestnuts, peanuts and sunflower seeds, beans (garbanzo beans, lima beans, green beans, pin beans, and lentils), soybeans, spinach, potatoes, and green peppers. Most of us get this much B6 and B12 from our diets or multivitamin, but vegetarians may need to take supplements of these two vitamins (see Chapter 8).