HOMOCYSTEINE, GENETICS, AND HEART DISEASE . . .
There is more to maintaining a healthy heart than a good family history and a few good test results.

By Joel Fuhrman, M.D.

This article will explain why some people with excellent cholestrol and lipid profiles still can develop life-threatening cardiac events. You will learn why a favorable family history, consistently "normal" stress test results, and even a long-term vegetarian or vegan diet can not in themselves guarantee protection. You also will get the list of the parameters within which you must stay in order to attain freedom from heart disease.

Family History

I contend that nutrition is such a powerful regulator of disease expression that if an optimal diet is consumed throughout life, genetics will have little effect on your health. A great many people mistakenly consider family history a good indicator of the likelihood that they will develop heart disease. Family history is almost meaningless since most adult Americans have atherosclerosis-cholestrol-ladened plaque linning their arteries. In fact, autopsy studies on adults who die in motor vehicle accidents show that almost all elderly Americans carry this ticking time-bomb in their arteries.

Considering the extraordinarily unhealthful diets that most Americans consume, it should come as no suprise that more than half of us die of heart attacks. Favorable genetics offer little protection against the inescapable biological laws of cause and effect.

Measuring Your Risk

A stress test can be another misleading indicator of cardiac risk. Stress tests only detect blockages occluding more than 85 percent of the vessel's lumen (interior). Most of our arterial lipid deposits are extra-luminal (not protruding into the lumen), and do not show up on an angiogram or during catheterization, but they are still potentially deadly. They account for about 40 percent of all heart attacks. Heart attacks are caused by a rupture or defect in the plaque that leads to the formation of a clot, called a thrombus. You do not need a large blockage to cause a heart attack.

Parameters For Protection From Heart Disease

The best way to assure freedom from heart disease is to eat and live in such a way as to meet the measurable criteria below:

1.) An LDL cholestrol below 100

2.) Triglycerides below 100

3.) A thin waistline

4.) Normal blood pressure (averaging below 130/80)

5.) Correct food choices (including adequate omega 3 fatty acids and DHA)

6.) Adequate exercise

7.) Homocysteine levels below 10

8.) Fasting blood glucose below 80

Are Vegetarians Protected?

In spite of the fact that they have extremely low rates of heart disease compared to meat eaters, some vegetarians still have heart attacks. Over the years, some well-known vegans have died of cardiac disease at relatively young ages. These deaths could have been prevented if these individuals had monitored their homocysteine levels.

An elevation of homocysteine in the blood can lead to vascular damage, which in turn can lead to a heart attack or a stroke. Dangerously high levels of homocysteine can result from vitamin B12 deficiency, but these high levels can occur even with normal B12 levels and an ideal diet.

Homocysteine And Death

I regularly check my patients' homocysteine levels. This experience has given me two strong convictions: 1) elevated homocysteine levels are common, and 2) high homocysteine levels are a significant contributor to heart attacks and strokes. My conclusion is that detection and treatment of elevated homocysteine levels are essential but often overlooked aspects of medical practice.

Proper Evaluation

The medical literature corroborates my experience. Even a mild elevation in homocysteine to over 10 ml/dl is correlated with heart attacks. And these mild elevations also are associated with increased risk for occlusive vascular disease and stroke.

Based on this indisputable evidence, it is clear that everyone should have their homocysteine level checked. In addition, since most doctors have no idea of how to treat high homocysteine, it is important that you know the proper protocol for treating increased homocysteine.

If your homocysteine is elevated, have your MMA (methylmalonic acid) checked. MMA determines whether or not you are deficient in vitamin B12 (500-1000 mcg daily)and confirm with subsequent blood tests that your homocysteine level has decreased into the normal range.

If your MMA level is normal, most physicians would assume that your elevated homocysteine is due to a need for more folate. However, most of my patients who fall into this category of high homocysteine and a normal MMA have high folate levels because of their excellent diets. They have been eating a diet rich in green vegetables, yet they still have high homocysteine levels. In these cases, the elevated homocysteine is most likely because of a decreased activity of the folic acid metabolizing enzyme, methylenetetrahydrofolate reductase (MTHFR). So even with high folate blood levels, these individuals stukk cab ve deficient in the metabolically active form of folate, L-5 methyletetrahydrofolate. This is why so many people who are taking extra vitamin B12, B6, and folate still have not gotten their homocysteine levels down into the normal range.

These individuals can normalize their homocsteine by supplementing with folate's active metabolite, L5 mthf, instead of folic acid found in most preparations. The dose needed to reduce homocysteine below 10 can be determined through followup blood tests.

Conclusion

I hope that the information presented in this article will reinforce the fact that you are in control of your own health destiny.

Remember you need to take active, permanent steps to move within the parameters outlined in this article, and not try to rely solely on family history, reassuring stress tests, or even a healthful diet for protection.