ASK DR. BAUGHAN                                                                     August 15, 1997

HERE COMES HOMOCYSTEINE

After spending 30 years in the basement of medical research, the homocysteine story is finally seeing daylight, from the July 24, 1997 issue of The New England Journal of Medicine to the August 11, 1997 issue of Newsweek.  This story demonstrates how medical research is strongly influenced by the same forces as much of the rest of our society – gambles, biases, politics and economics.  Flashback three decades to which research proposal would be funded: one that proposed cholesterol causes heart disease or homocysteine caused heart disease.  At the time, it would be fair to say that it was a gamble on the part of the decision makers to funnel more money toward the cholesterol theory than toward the homocysteine theory.  And studies showed that cholesterol had an effect, so more research gained momentum.  Once we glimpse a possible solution, enthusiasm for a cure can easily develop into a bias.  Modest results can be pumped up to look like a big deal.  By then you have multiple mid-to-senior career researchers committed to the intricacies of cholesterol metabolism, and of course, they are now the ones who will decide who gets the next round of research grants.  By the late 1980s, the pharmaceutical industry was gearing up to treat high cholesterol with medicines that cost over $100/month for millions of people for decades.  Research support from the drug companies could provide some reliable support for young or even established researchers, who could not always count on the more competitive government or private foundation grants.

But homocysteine is still with us.  It always will be.  All of us have it in our bodies.  How much of it varies, though.  Those born with an inherited excess (called homocysteinuria) develop heart disease and strokes usually in their 20s or 30s.  A growing body of research has shown that with homocysteine, less is best.  The 1992 Framingham Heart Study found that those with levels in the upper 5% were three times as likely to have heart attacks as those in the lowest 5%.  This is a much higher risk ratio as high compared to low cholesterol.  The recent New England Journal study found that those with known heart disease and high homocysteine levels were six times more likely to die in 5 years than those with low levels.

So can we expect blood tests for homocysteine to pop up in doctors’ offices and health fairs?  Can we expect another generation of expensive drugs to add to our current batch of cholesterol medications?  It will be interesting to see the story unfold further, because the treatment may be easier than the diagnosis.  It seems (more research still needed!) that eating more folic acid, vitamin B6 and vitamin B12 can lower your homocysteine level.  All of these are found in a good old multivitamin and (revolutionary concept!) GOOD FOODS, like orange juice, cooked beans and (bless Popeye’s wisdom) spinach.  If you like to measure the nutrients, current information suggests 0.4mg folic acid, 4mg vitamin B6 and 15 micrograms of B12.  Megadosing does not help and can be harmful.  Instead of the cholesterol psychology of “don’t eat this or that,” it appears the homocysteine approach may be “eat more of these things.”  Neither is the whole story, and doubtless there are more pieces of the puzzle to heart disease.  Hopefully, one of the lessons we can learn from this is that the path to a healthy heart requires an open mind.