Follow-up Guest Blog by Arland Hill, DC, MPH, DACBN
The metabolic marker homocysteine has gained attention as an area of treatment for various conditions ranging from cardiovascular disease to general skin health. Homocysteine as a marker for disease risk modification has been seen as a factor not ideally suited for pharmacological intervention, but more so for nutrient supplementation. This makes sense as the methylation pathways, of which homocysteine is a marker for, are dependent on the nutrients folate, B12, B6 and SAMe. Moreover, being able to realize the interplay between these nutrients is critical when it comes to repletion so as to make sure that nutrient deficiencies are not obscured or induced by therapeutic repletion dosages. This states the necessity of having a valid nutrient testing method.
SpectraCell’s micronutrient assessment allows for targeted intervention with regards to homocysteine, a marker identifiable on the Lipoprotein particle profile. By being able to see the individual micronutrients, various pieces of the metabolic pathway picture can be put together. This allows the clinician to know exactly which treatment options to reach for to have the greatest impact on homocysteine. Of course, all of this is based on the notion that homocysteine is an inflammatory marker than responds mostly to nutrients. While nutrients are indeed a very critical part of homocysteine lowering therapy, they are hardly the entire story.
More recent studies have shown that while homocysteine will respond to those nutrients that can act as methyl donors, it will also respond to more classical anti-inflammatories such as omega 3 fatty acids and plant based extracts. This underscores the point that in some ways homocysteine acts similar to other inflammatory markers in responding to more classical non-pharmacologic anti-inflammatories. But how do you know if either of these are an option for homocysteine lowering? For this information, we transition back to those tests offered by SpectraCell. The micronutrient test offers a novel marker known as Spectrox which allows for the assessment of total antioxidant function. As plant based phytonutrients are known for their potent anti-inflammatory properties, a lower Spectrox marker, indicating lower antioxidant / anti-inflammatory capacity, would confirm that usng plant based antioxidants would be a viable treatment option. One such example of this in when homocysteine is showing increased clotting potential. Introduction of resveratrol would have multiple effects in this scenario including elevation of total antioxidant function and the Spectrox marker, lower clotting potential and reduction of homocysteine. Similar effects can be seen with omega 3 fatty acids which collective studies have shown will lower homocysteine. A useful tool to determine omega 3 status is the Omega 3 Index, a test which can guide treatment intervention.
Then there are the tough cases where homocysteine levels are excessively high compared to the normal ranges. At this point, consideration should be given to the potential for genetic variants for folate metabolism, specifically with regards to MTHFR (Methylenetetrahydrofolate Reductase). Those patients that are showing excessively high levels of homocysteine are likely to be carriers of the gene variants, thus warranting MTHFR genotyping.
The more we have come to know about homocysteine, the more we understand that looking at the past day status quo of treatment, while valid, is not comprehensive. Moreover, it is insufficient to fully determine the appropriate intervention to recommend as homocysteine lowering therapy.
Arland Hill, DC, MPH, DACBN - Complete Care Chiropractic and Wellness
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