Cardiovascular Health

High Cholesterol and High Homocysteine?

Both markers are an indication of cardiovascular risk. If left unchecked high homocysteine can lead to conditions such as neurovascular diseases ie: Alzheimer’s, atherosclerosis and cardiovascular disease, breast cancer, depression, and diabetes.

Homocysteine is often something I get my clients to test. It is a nice easy one and doesn’t cost much but this test can give me an indication on how someone is methylating and whether they have a higher cardiovascular risk. It is a problem if it is either high or low. High is indicative of inflammatory conditions while low can be associated with mood and hormonal issues.

Phosphatidylethanolamine N-methyltransferase or PEMT is an enzyme that encodes to make a product called phosphatidylcholine (PC) through a methylation reaction.

PEMT makes sure you get enough choline in the absence of food sources. It’s expressed mainly in the liver and accounts for 30% of liver PC production. Choline and PC are essential for

  • Fat transport and metabolism
  • Heart and brain health
  • Cell membranes and cellular communication

Estrogen is the main stimulator for this PEMT activity and therefore women have a higher risk of these variants.  This is especially important post-menopause as estrogen production reduces, the risk of cardiovascular events increases. If you also carry the PEMT SNP (r7946) then you are at an even higher risk, and you should be keeping an eye on your homocysteine and cholesterol levels on a regular basis.

The role of homocysteine is to be converted into methionine which then makes SAMe,  you may have heard about this enzyme especially in mood disorders. For SAMe to start the methylation process we need the presence of PEMT which allows PC to become choline. Choline then oxidises to betaine, and this allows Homocysteine to pass through and be appropriately used and the cycle starts again.

As our bodies are incredibly clever there are a couple of other ways that your body can use homocysteine. One is via the B12 and folate pathway which is dependent of both nutrients being available and functioning. The other is via the transsulfuration pathway or CBS. And this is dependent on zinc and vitamin B6. This pathway is also associated with pyroles or mauve disease.

If you are deficient in the folate and B12 pathways your body relies on choline to do most of the work for homocysteine. If there is not enough choline it will be sequested from the liver. This can leave a choline deficient liver that cannot break down cholesterol and therefore leads to higher LDL’s. Which can impact on your overall cholesterol levels and can participate in your increasing cholesterol level (again especially post menopause). This choline deficiency can also lead to non-alcoholic fatty liver disease.

So high cholesterol, high homocysteine and non-alcholic fatty liver can all be related and should be considered as a whole. Looking at just your cholesterol without the full picture can miss the important information. Just recently I had a client (post menopause) who had increased cholesterol, was on the border of becoming diabetic, had raised liver enzymes and increased inflammatory markers, only to be told she was all good and should just lose some weight. When we tested her homocysteine, it was the highest I have ever seen. This clearly is not a picture of someone in good health and without intervention would end up on diabetes medication, probably a statin (for cholesterol) but was also a very high cardiovascular risk and left unchecked for another year  (which was the GP recommendation) could suffer a cardiovascular event.

Diet and lifestyle will always be a critical factor when assessing cardiovascular risk. But sometimes we also need to know what is happening in the DNA methylation pathways as this will influence your homocysteine levels as well.

If you have family history of cardiovascular events, high cholesterol that is unexplained by diet/lifestyle, a family history of estrogen positive cancers, mental health conditions like bipolar or alzhiemers then getting a homocysteine check might be a useful tool. It may also be useful to have a health and wellness DNA check as well, as this will tell quiet a story and can allow for more specific and targeted treatment.

You can have a free 15 minute health chat with me and we can discuss any of these issues. Just book a time here



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