B Vitamins Reduce Homocysteine, But Not Disease in Diabetic Patients
G. Douglas Andersen, DC, DACBSP, CCN
Whenever the topic of kidney disease arises in my practice, the first thought that crosses my mind is diabetes, since almost 40 percent will eventually have kidney problems.1 There is evidence of a correlation between homocysteine levels in diabetic patients and diseases of the kidneys, heart and eyes.2 To lower homocysteine, we have a powerful, proven way to do it with three members of the B vitamin family.3 Many health care professionals have reasonably concluded that lowering homocysteine lowers the risk, degree or progression of secondary problems often seen in patients with diabetes.
Homocysteine: What Is Normal?
Normal plasma homocysteine values vary widely between labs and can range from as low as 2.2 to as high as 17 micromoles per liter (abbreviated as mcmol/L or umol/L). Homocysteine increases with age and runs ~1.5 umol/L higher in males than females. There is a debate on what is optimal, and this too is affected by gender and age. In general, "optimal homocysteine" ranges run from less than 10 to under 6 umol/L.
The DIVINe Study
The Diabetic Intervention with Vitamins to Improve Nephropathy (DIVINe) study followed a screened group of diabetic patients with kidney disease for three years. Those who met the criteria had diabetic nephropathy, but their condition was not considered advanced.4 The 238 subjects who qualified were divided into two groups. One took 2,500 mcg of folic acid, 1,000 mcg of vitamin B12, and 25 mg of vitamin B6 a day. The second group took a look-alike placebo. Eighty-three percent of the patients were white male, 81 percent had type 2 (as opposed to type 1) diabetes, and their mean age was 60. Plasma homocysteine levels at baseline were 16.4 umol/L and 14.7 umol/L in the placebo and B-vitamin groups, respectively.
Results
In approximately three years of follow-up, the B-vitamin group had mean homocysteine levels decline from 14.7 umol/L to 12.5 umol/L, while those assigned to placebo had their averages increase from 16.4 umol/L to 19 umol/L. However, the B-vitamin group also had an accelerated rate of GFR decrease, more strokes and more heart attacks. [See table]
A health economic analysis of screening and optimal treatment of nephropathy in patients with type 2 diabetes and hypertension in the USA. Nephrol Dial Transplant, 2008;23(4):1216-23.
Because they have yet to pass national legislation protecting the chiropractic profession, Japanese DCs are in a similar situation that U.S. DCs faced. We were fortunate enough to be able to pass chiropractic licensure state by state. The DCs in Japan must accomplish this nationally, which has proved to be an extremely difficult task. And in spite of their efforts, Japanese DCs are currently faced with two chiropractic professions.
This article focuses on nine severe injuries that are generally not diagnosable until the third to fourth week following the date of injury, including how to diagnose these severe injuries. The discovery of any of these injuries early can make a significant difference in the case outcome.
There has long been an attempt by those who are not legitimate doctors of chiropractic to usurp the title of chiropractor from those who have earned their degree from an accredited chiropractic program. This generally happens in countries where the local doctors of chiropractic have yet to pass legislation requiring a degree from an accredited institution. The result is essentially two chiropractic professions. Nowhere is this danger more pronounced than in Japan.
