April, 2005 - Nr. 4
Headline
by Dr. Paul Jaconello
Doctor Jaconello is the Medical Director of the Jaconello Health Centre for Nutritional and Preventive Medicine
A Rationale for Vitamin Supplementation
In the Journal of the American Medical Association in August 2002, an article was published with the title "Cost effectiveness of vitamin therapy to lower plasma homocysteine levels in the prevention of coronary heart disease". Homocysteine is produced by methionine an essential amino acid present in our diet. Homocysteine can be converted back into methionine or can be changed into sulfur compounds which are involved in important sulfur reactions in the body and produce the active antioxidant glutathione.
The article postulated the following: "Over the ten year period that was studied, providing vitamin supplementation with vitamin B12, vitamin B6 and folic acid in addition to grain fortification with folic acid to all men 45 years or older without known coronary artery disease was projected to save greater than 300,000 quality of life years and save greater than 2 billion dollars of unnecessary medical expenditure and would be the preferred strategy". It would seem that with a few extra pennies a day of B vitamins, one could ameliorate much morbidity and mortality from heart disease.
It seems that mildly elevated levels of homocysteine can cause endothelial damage to the vascular wall and initiate and propagate atherosclersoosis.
The level of homocysteine is determined by the ability of it to be converted back into methionine by the addition of a methyl group. This methyl group is donated by methyl B12 and the latter is formed by the conversion of 5 methyl tetrahydrofolate to tetrahydrofolate. Folic acid is an essential vitamin that we obtain from our diet which is converted to 5 methyl tetrahydrofolate. When 5-methyl tetrahydrofolate is converted to tetrahydrofolate, it looses a methyl group which attaches to B12 to form methyl B12. The methyl B12 then donates its methyl group to homocysteine to form methionine. Homocysteine is also converted to cysteine by the presence of B6.
Thus if our diets are deficient in B12, folic acid and B6 or if we have high genetic need for these nutrients, homocysteine can increase in the blood and damage the vascular system. Also, homocysteine elevation has been implicated as a risk factor to other serious conditions which include dementia and Parkinson’s Disease.
In addition, low levels of tetrahydrofolate can be a factor in increasing the risk to breast cancer, colon cancer, depression and acute lymphoblastic leukemia in children.
Finally, through the pioneering work of Dr. John Smithes over 30 years ago on prevention of birth defects by the use of the B vitamins B12 and folate before conception, it was only in 2000 when we saw a general agreement that periconceptual under nutrition of folate and vitamin B12 is a major risk factor to neural tube defects and that we should be increasing folic acid levels in women of childbearing years to prevent this major defect.
As a rule, a daily intake of folic acid 1mg, B12 1000 mcg and B6 25 mg, daily would be needed to help prevent such a wide array of health problems in our society.
Paul Jaconello, M.D.
Doctor Jaconello is the Medical Director of the Jaconello Health Centre for Nutritional and Preventive Medicine
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