The Chiropractic Connection: The Structural Manifestations of Elevated Homocysteine Levels

Cardiovascular disease is the number one cause of death in the United States. The pharmaceutical industry spends an enormous amount of money on advertising prescription drugs that will lower “bad” LDL cholesterol to lower the risk of heart attack or stroke. In fact, according to a report aired on 60 Minutes,1 much more money is spent on advertising than on researching solutions.

One of the factors involved in cardiovascular disease is an amino acid called homocysteine. The correlation between cardiovascular disease and elevated homocysteine levels was first suggested in 1969 and confirmed in 1976. Yet, little definitive information has confirmed homocysteine as a primary contributing factor. Those studies that have been done concern the role of vitamins B6, B12, folate and betaine in protein metabolism in the liver.

What Is Homocysteine?
Homocysteine is a transitional sulfur-containing amino acid that is formed in the liver by the breakdown of methionine, which should be quickly transformed into other compounds. If this transformation does not happen and elevated levels of homocysteine are found in the blood, this indicates that a metabolic enzyme reaction was inadequate to meet demand.

The first step in this process is that protein must be adequately digested, beginning in the stomach with the conversion of pepsinogen to pepsin by hydrochloric acid, and continued in the duodenum by the pancreatic enzymes. After absorption, the resulting mixture of peptides and amino acids is carried to the liver.

Metabolic Enzyme Pathways in the Liver
Methionine is the major sulfur-containing amino acid and plays a role in cysteine, carnitine and taurine synthesis, as well as lecithin production and the synthesis of phosphatidylcholine and other phospholipids. This conversion is performed in three metabolic enzyme stages culminating with the production of homocysteine which now must be converted to S-adenosylmethionine (SAM).

The conversion of homocysteine to SAM involves three separate metabolic enzymes that each contain either vitamin B6, B12, folate or betaine as their prosthetic group or cofactors.

I am not suggesting that you begin using over-the-counter SAM (commonly marketed as SAM-e), vitamins B6, B12, and folate, or betaine supplements. I am suggesting that you direct your efforts at restoring normal function and recognize the early warning signs of failure of the above enzyme pathways.

One of the most common problems chiropractors face in day-to-day practice involves protein digestion and its metabolism in the liver, yet the pharmaceutical approach is to begin by supplementing enzyme cofactors for the liver and ignoring the need for the much larger protein portion of the enzyme. Worse yet, antacids are used to block gastric digestion.

Homocysteine and LDL Cholesterol
Pharmaceutical interest in homocysteine stems from the fact that it can cause cholesterol to change to oxidized low-density lipoprotein (“bad” LDL cholesterol), which is associated with atherosclerosis. In addition, high homocysteine levels may increase the potential for blood clots, intensifying the risk of stroke. While no studies have shown that lowering homocysteine levels helps reduce strokes, heart attacks, and other cardiovascular events, homocysteine levels have been shown to be elevated in those at risk for heart disease.

Dietary Recommendations for Lowering
Homocysteine Levels
Most people with a high homocysteine level don’t get adequate amounts of betaine, vitamins B6, B12, and folic acid in their diet. It is well known that diets high in meat and dairy products are deficient in these compounds, usually because of processing. Thus, marginal deficiencies can result in the accumulation of homocysteine.

Eating more fruits and vegetables (especially leafy green vegetables) can help lower your homocysteine level by increasing how much folate you get in your diet. Good sources of folate include many breakfast cereals, lentils, asparagus, spinach and most beans.

If you or your patients do not have enough vitamin B6 in your diet, add good dietary sources, like fortified breakfast cereals, potatoes, bananas, garbanzo beans and chicken. Dairy products, organ meats (such as liver), beef, and some types of fish are good sources of vitamin B12.

Dietary sources of betaine include beets, broccoli, and spinach. Interestingly, many wines contain betaine, particularly less expensive wines that use beet sugar to increase the alcohol content. Some experts suggest that this may be part of the “French paradox,” in which wine drinkers from France tend to have low rates of heart disease despite diets high in fat and cholesterol.

Dietary Supplement Approach for Lowering
Homocysteine Levels
If adjusting your diet is not enough to lower your homocysteine levels, you may need to improve protein digestion with digestive enzyme supplementation and improve liver function by using betaine, vitamin B6 and vitamin B12 supplements.

Elevated levels of homocysteine have been linked to increased fractures in elderly persons. Recall that vitamin B12 absorption is severely reduced in elderly patients. Homocysteine does not appear to have any effect on bone density. Instead, it appears that homocysteine affects collagen by interfering with the cross-linking between collagen fibers and the tissues they reinforce.

Can vitamin supplements counter the effects of homocysteine on collagen? Possibly. Recent data show that the use of folate fortification of foods has reduced the average level of homocysteine in the U.S. population.2,3

Studies with rats have suggested that betaine may help protect against fatty deposits in the liver, which can occur from chronic alcohol use, protein malnutrition, obesity, poorly controlled diabetes, and other causes.4 A few studies have also been conducted on people. But, those who received a betaine combination supplement had improved liver function, reduced fat in the liver, and diminished abdominal pain.5

Studies reported in 2006 have shown that giving folic acid to reduce homocysteine levels does not give any benefit, and suggested that, if given with B12, it might increase some cardiovascular risks.6,7

The American Heart Association does not currently recommend population-wide homocysteine screening and suggests that obtaining appropriate amounts of betaine, as well as folic acid and vitamins B6 and B12, be met through diet alone. Individuals at high risk for developing heart disease, however, may be screened for blood levels of homocysteine. They do recommend that, IF ELEVATED LEVELS ARE DETECTED, a healthcare practitioner should suggest nutritional supplements in addition to dietary changes.

Pharmaceutical Approach for Lowering
Homocysteine Levels

Vitamin supplementation may be important pharmaceutically to lower elevated homocysteine levels in the blood. But, accumulation of homocysteine has also been shown in patients with low levels of thyroid hormone, kidney disease, psoriasis, hallucinations, psychoses, and use of some prescription medicines.

At this point, I could present a list of pharmaceutical attempts to lower homocysteine levels but, frankly, there isn’t a clear-cut known way to do that yet. What is known is well documented in the literature. For example, while a high level of blood serum homocysteine is considered to be a marker of potential cardiovascular disease, current research is attempting to determine if serum homocysteine is the problem or merely an indicator of extant problems.

It is more important to point out that all prescription drugs have side effects, because they interfere with or block normal enzyme systems in the body. Clearly, this is needed to save lives after damage has been done; but, if you could identify patients at risk before abnormal test results are identified, these problems could be prevented.

What is needed is an examination that will identify metabolic subluxations and viscerosomatic stress points in the body before elevated laboratory values are found. Only then can preventive measures be instituted that will remove the stress and restore normal function.

Chiropractic Approach for Recognizing Potential CV Disease
Poor protein digestion is the first step and poor liver metabolism of protein is the second step on the path to elevated homocysteine levels in the blood and cardiovascular degeneration. Both of these “metabolic subluxations” are seen in chiropractic offices everyday and are easy to recognize. Obviously, structural problems also begin with poor protein digestion, its metabolism in the liver, and maintenance of adequate calcium in the blood and tissues. The following is only a brief list of related problems:

Have you considered that a chiropractic examination can probably identify those patients at risk for elevated homocysteine levels and LDL cholesterol levels long before abnormal laboratory tests reveal the problem? The trick, of course, is early detection. For medicine, that means waiting for blood and urine tests to become positive before treatment can begin. Treatment then consists of recommendations of lifestyle changes and prescription drugs.

Metabolic Subluxations and Viscerosomatic Stress Points
For the chiropractor, “very early” detection of physiological stress means recognizing chronic or recurring subluxation patterns emanating from a visceral source and involving poor protein and calcium metabolism. This is easily accomplished by recognizing muscle contraction patterns involving the spinal innervation to the digestive organs in the mid-thoracic spine, beginning with frequent occurrence of a Pottenger’s Saucer. After that, particular interest should be muscle contractions related to:

• Cardiovascular dysfunction and recurring back pain in the shoulders and upper thoracic spinal area, as well as
• Liver and kidney dysfunction and recurring back pain in the dorso-lumbar spinal area

I believe that by broadening its vision and recognizing that metabolic subluxations produce viscero-somatic stress points, muscle contractions, and loss of range of motion, the chiropractic profession could ultimately serve as a true health care provider and leave sick care to medicine and the pharmaceutical industry.

Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison, WI 53719, or by phone at 1-800-662-2630. Visit his website at


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