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By David Mendosa

Last Update: August 21, 2002

We all know the potential risk factors for heart disease. The preventable ones include high cholesterol, high blood pressure and smoking.

Part of the answer is more B vitamins.

But there's another risk factor that you may never have heard about or may not even know how to say. It's homocysteine, pronounced homo-cyst-eh-een.

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All of us have some homocysteine in our blood. But high levels of homocysteine damage the interior lining of our blood vessels and are associated with heart attacks and strokes.

More recently, studies have looked at the link between homocysteine and diabetes. One study found that elevated homocysteine levels might contribute to diabetic nephropathy or kidney damage. Just this year another study found that neuropathy in type 2 diabetes may be associated with high levels of homocysteine. Yet another study of people with type 2 diabetes suggests a connection between insulin deficiency and high levels of homocysteine.

So, for people with diabetes, keeping the levels of homocysteine under control seems particularly important. How can we do this?

Homocysteine is an intermediate in the interconversion of the amino acids methionine and cysteine. This process requires folic acid (vitamin B9) and vitamins B6 and B12 at various stages. So part of the answer is easy: more of these vitamins.

The American Heart Association, however, recommends supplements only when our diet fails to provide 400 micrograms of folic acid per day. Orange juice, leafy green vegetables, and folic acid-fortified cereals are the major food sources.

Lifestyle Improvement Tip
Diet alone is unlikely to provide enough of these vitamins, many people believe. A paper by Ayana Herbert, "Homocysteine and Cardiovascular Disease," on the UCLA School of Medicine Web site, recommends supplements. "They are not harmful and inexpensive." The question is how much.

Experts suggest that we should consume 400 micrograms of folic acid every day. They also recommend that we take vitamins B6 and B12.

Already several "homocysteine defense" or "homocysteine control" formulations are available through online pharmacies that contain 400 micrograms of folic acid and various amounts of vitamins B6 and B12.

What if you are already taking a multiple vitamin? It may well be enough, many experts think. Vitamin B complex supplements are also a good choice, they say.

If you drink a lot of unfiltered coffee, you might want to be especially sure that your requirements for these B vitamins are covered. Several reports in recent issues of the American Journal of Clinical Nutrition show that drinking large amounts of unfiltered coffee can raise homocysteine levels. The good news is that "the effect of coffee is modest and much less than the changes associated with variation in B-vitamin status." 

Related Web Site Reviews
Marion A. Hofmann et al., "Hyperhomocyst(e)inemia and Endothelial Dysfunction in IDDM, Diabetes Care, December 1997, online at . This study concluded that, "Hyperhomocyst(e)inemia is common in nephropathic diabetic patients and may contribute to the enhanced morbidity and mortality from cardiovascular diseases characteristically observed in IDDM patients with diabetic nephropathy." A. Ambrosch et al., "Relation between homocysteinaemia and diabetic neuropathy in patients with Type 2 diabetes mellitus," Diabetic Medicine: Journal of Diabetes UK, March 2001, online at This study concluded that, "homocysteine is independently associated with the prevalence of diabetic neuropathy in a collective of Type 2 diabetic patients."

JÛzef Drzewoski et al., "Total Plasma Homocysteine and Insulin Levels in Type 2 Diabetic Patients With Secondary Failure to Oral Agents, " Diabetes Care, December 1999, online at

Ayana Herbert, "Homocysteine and Cardiovascular Disease," Nutrition Bytes, 1998, online at This is a careful review of the literature.

Stein Emil Vollset et al., "Coffee and homocysteine," American Journal of Clinical Nutrition, February 2000, online at This article reviews a randomized crossover trial carried out in 64 Dutch men and women conduced by Marina J. Grubben and others reported in the same issue of the journal.

This article was originally written for the LXN Corp. Web site.

    David Mendosa is a freelance journalist and consultant specializing in diabetes and lives in Boulder, Colorado. When he was diagnosed with type 2 diabetes in February 1994, he began to write entirely about that condition. His articles and columns have appeared in many of the major diabetes magazines and websites. His own website, David Mendosa’s Diabetes Directory, established in 1995, was one of the first and is now one of the largest with that focus. Every month he also publishes an online newsletter called “Diabetes Update.” He is a co-author of What Makes My Blood Glucose Go Up...And Down? (New York: Marlowe & Co., August 2003).

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