The celebrated sign that James Carville hung in Bill Clinton's campaign headquarters to keep his campaign workers "on message" back in 1992 was, "It's the economy, stupid!"
A mere 15 years later, I'd like to propose a variant of that celebrated phrase by substituting the word "homocysteine." Make no mistake about it: In the medical literature, homocysteine has appeared in so many places as a bad actor - an evildoer as was so commonly expressed by an American president not too long ago - that you would almost think that homocysteine has wreaked more havoc upon personal health than the 1918 flu pandemic, Hurricane Katrina and the December 2005 tsunami combined.
Atherosclerosis: Let us begin with a biggie - a clearly life-threatening condition. The newer models of arterial disease center around inflammation as being just as important a determinant as elevated cholesterol and triglyceride levels, if not more so.1 Plasma homocysteine has been identified as an independent risk factor for cardiovascular disease.2-4 Numerous mechanisms have been proposed to account for this anomaly, including (a) promotion of endothelial dysfunction of coronary resistance vessels;5 (b) increasing oxidative stress, known to promote myocardial dysfunction;6 and (c) stimulating left-ventricular remodeling brought on by the increased cardiac fibrosis and activation of matrix metallopriteinases.7 Left-ventricular remodeling produced by homocysteine also has been linked to renal failure in humans.8
Arterial dissection, ischemia, stroke: The activation of matrix metalloproteinases is but a part of the sordid story of how homocysteine dismembers collagen and elastin, the basic building blocks of arterial walls. Homocysteine also interferes with the aldehyde groups that are indispensable for the cross-linking of the collagen and elastin networks which constitute the arterial wall. With high homocysteine levels having been correlated for years with strokes and arterial dissections, it is easy to imagine how elevated levels of this metabolite may have brought on many of the vertebral arterial dissections that have hounded the chiropractic profession for years. I have previously discussed the background and mechanisms of this chain of events, together with its implications for chiropractic, in some detail.9
Cognitive decline: An alarmingly large number of references are suggesting that individuals with high homocysteine levels suffer from impaired cognitive ability, usually demonstrated by significant declines in copying scores.10-14 Why does this occur? One clue might be offered by a recent observation which demonstrates that each 1 mumuol/L increase of total plasma homocysteine is independently associated with a 7 percent increase of severe leukoaraoisis, otherwise known as white matter disease of the brain.15 This could be a manifestation of an autoimmune inflammatory reaction with obvious detrimental effects.
Bone resorption: In cultured blood mononuclear cells, one enzyme which quantifies osteoclast activity and another which reflects dentine-resorbing activity can be shown to increase specifically with increasing concentrations of homocysteine. No such increases are seen with the molecular analogues cysteine and glutathione. This experiment is thought to shed light upon how homocysteine might be involved in bone resorption.16 This observation is only reinforced by the finding that plasma levels of homocysteine are inversely related to bone mineral density in middle-aged and elderly women.17
Retinal occlusion: In a case-control study, it has been shown that the highest tertile of homocysteine is associated with greater than a twofold elevation of risk for retinal occlusion.18 To paraphrase a superb phrase put forward by Manny Ramirez19 of the World Series-victorious Boston Red Sox, when so many indicators are pointing in the same direction to one component that signifies clinical distress and, at times, life-threatening conditions, you know that homocysteine is definitely a bad man.
So, how does one deal with this state of affairs? From the genetic standpoint, the news is not encouraging. When you face the facts that such factors as defects or deficiencies of methylenetetrahydrofolate reductase [MTHFR]20 or cystathione-beta-synthetase [CBS]21 lead to elevations of homocysteine levels, you have a formidable challenge indeed. But from the clinical point of view, the paths for escaping this dilemma are remarkably clear and attest to the fact that we must pay far more attention to our nutritional supplements.
For it is well-known that deficiencies of folate,10,11,22,23 cobalamin [vitamin B12]22,23 and pyridoxal [vitamin B6]24 lead to elevations of homocysteine, supported by either multiple well-designed randomized controlled clinical trials, meta-analyses, or multiple well-designed cohort or case-control studies.25 Therefore, it is not too far of a stretch of the mind to figure that taking these compounds as nutritional supplements will, in fact, lower plasma homocysteine levels and reverse the adverse effects described earlier.
This in fact is the case, clearly shown by taking folate in the neighborhood of 0.8 mg/day.26,27 Vitamin B6 enters the picture as well in a study which clearly demonstrates the reversal of cognitive decline with dietary intakes exceeding 2-3 mg/day.11 And vitamin B12 gets into the act also to complete the triumvirate of supplements capable of depressing elevated levels of homocysteine. The Homocysteine Lowering Trialists' Collaboration has shown that including vitamin B12 enhances the ability of folate to decrease elevated homocysteine levels.27
How can all this be succinctly summed up? Starting from the premise that a picture is worth 1,000 words, you can simply consult the pathways of homocysteine metabolism, which clearly demonstrate the abilities of folate, vitamin B12 and vitamin B6 to reduce homocysteine levels by converting this obnoxious amino acid to other products.28 With this discussion, hopefully, it should then become obvious how important nutritional research and a few biochemical principles are to understanding and gaining control of personal health. By connecting the dots, therefore, we need to appreciate how essential approaches such as these are to future endeavors to all health care research, not just chiropractic.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
