Caution: Consult with your diabetes care team before starting a lower-carbohydrate meal plan. Diabetes medications such as insulin or oral drugs that stimulate insulin production (sulfonylureas or meglitinides) will need adjustment to prevent hypoglycemia (low blood glucose) when carbohydrate intake is decreased. In addition, blood glucose levels need to be checked more often.

What You Need to Know About This Silent Threat

| Jun 1, 2005

In the last two articles in this series, we discussed the significance of HDL cholesterol, triglycerides and C-reactive protein (CRP) in evaluating—and lowering— your risk of cardiovascular disease. Now we’ll discuss another lesser known but extremely important blood marker: homocysteine.

Dangers of High Homocysteine
You don’t often hear people talking about homocysteine, yet a high level of this amino acid in the blood is an independent risk factor for heart and vascular disease. This means that even when your cholesterol and other health markers are within normal ranges, elevated homocysteine levels raise your risk.

Evidence suggests that excess homocysteine promotes plaque buildup in blood vessels and causes damage to the inner linings of arteries, increasing the likelihood of blood clots.

What’s Your Risk?
If you have type 2 diabetes, elevated homocysteine levels significantly increase your mortality risk, whether or not you have any other cardiovascular risk factors and regardless of your overall health. In fact, one study showed that for each five-point increase in homocysteine, risk of dying within five years rose by 17 percent in nondiabetic subjects and by 60 percent in diabetic subjects. Even a moderate elevation in homocysteine appears to be an independent risk factor for fatal heart attacks in people with type 2 diabetes.

How to Lower Homocysteine Levels
Although the normal range for homocysteine is 5.2 mmol/l to 12.9 mmol/l, Robert C. Atkins, MD, had a goal for patients of 8 mmol/l or less. Most of his patients were able to achieve this with a controlled-carbohydrate meal plan. Atkins prescribed his controlled-carbohydrate plan along with supplemental nutrients that target homocysteine: vitamins B6 and B12 and folic acid.

Why the Supplements?
Blood levels of homocysteine increase when you have an inadequate supply of these nutrients. As processed and refined foods have crowded out whole foods in our diets, our intake of these vital nutrients has dropped. Refining destroys folate (folic acid) and vitamins B6 and B12. Dark leafy greens, whole grains and legumes are some of the best sources of folic acid and vitamin B6; meat and dairy provide B12, although many people over 60 years of age may not have adequate stomach acid to absorb B12. If you eat proteins, natural fats, whole grains, legumes and green vegetables, your homocysteine levels probably reflect that healthful diet. If not, it’s time to change your eating habits and consider taking supplements to reduce this deadly risk factor. You may also want to discuss homocysteine with your physician.

A Note From R. Keith Campbell, RPh, CDE
I would like to point out that homocysteine levels are never ordered as part of a lab evaluation of patients, and many patients would have to pay for the test to get the results. I have all of the patients I work with take the folic acid plus B vitamins. They do not do any harm, and they can do good.

Research has implicated homocysteine in a host of diseases and conditions, including:

  • Cardiovascular disease, stroke, depression and cancer
  • Blood clots
  • Narrowing of blood vessels
  • Diabetic neuropathy
  • Dementia and Alzheimer’s
  • Cirrhosis of the liver
  • Kidney disease
  • Bone fractures

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