Vanguard Neurologist

By David Perlmutter, MD, FACN, ABHM

While most people recognize the importance of regular monitoring of medical tests like cholesterol because of its role in coronary artery disease, prostate specific antigen (PSA) as a marker of prostate cancer risk, and mammograms for early breast cancer detection, very few seem to appreciate that there’s a powerful risk marker for brain degeneration that is easily evaluated. Homocysteine is an amino acid that is produced in humans as a normal part of metabolism. Elevation of homocysteine represents a significant threat to brain health.

Research appearing in the journal Neurology reports that elevation of homocysteine is related both to atrophy of the brain (wasting away of vital brain tissue) as well as damage to the brain’s vital blood vessel system. These factors explain why elevation of homocysteine is associated with a dramatically increased risk for Alzheimer’s disease. In fact, a homocysteine level of just 14 or above has been shown to double a person’s risk of this devastating disease. Most labs consider a normal value for homocysteine to be in the neighborhood of 10 or below.

Beyond Alzheimer’s, high homocysteine, because of its effects on blood vessels, can lead to another common cause of dementia called vascular dementia. Essentially, brain function declines as a result of damage to the small blood vessels carrying blood to the brain tissue. This leads to numerous small strokes that ultimately compromise mental function. And beyond the brain, individuals with elevated homocysteine are also at high risk for other vascular issues like myocardial infarction, angina, coronary artery disease and blood clots in the legs that can migrate to the lungs.

So why isn’t homocysteine part of the typical medical examination blood profile? My guess is that there is little public awareness of homocysteine as there is no patented drug fix for this problem. Because homocysteine is lowered with specific vitamins, it’s not likely you will see adds describing the importance of lowering homocysteine appearing on the evening news or in magazines. But vitamins do indeed fix the problem. “This is exciting information because homocysteine levels can be reduced by taking the vitamins B6, B12, and folic acid,” said James F. Toole, MD, Professor of Neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, and author of a recent editorial commenting on the new research in the journal Neurology.

Dr. Toole is indeed right on the money. Homocysteine is almost always brought under control with a regimen of vitamins including B6, B12 and folic acid. And further, those whose diets are generally low in these nutrients put themselves at risk for elevation of homocysteine and as a consequence, increase their risk for the various medical conditions that elevation of homocysteine can cause.

So while your doctor may not choose to include a homocysteine blood test with your next examination, it’s a good idea to become proactive and ask to have it included, as the important role of this test in preserving brain health is now clear. And the best part of is that fixing the problem doesn’t require a prescription, just a trip to the health food store.