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.
As a practitioner, you know foot pain should be addressed as soon as possible, as pain in one or both feet can potentially lead to impairment of foot function. But rather than treating foot pain with over-the-counter pain and anti-inflammatory medications such as ibuprofen, or prescription nonsteroidal anti-inflammatory drugs (NSAIDs), or even corticosteroid injections for chronic foot pain, why not try red light / infrared therapy?
The recent systematic review by the Clinical Compass on spine-related musculoskeletal pain – the latest study comparing chiropractic vs. medical care that demonstrates lower health care utilization when a DC is the initial provider – has been voted the top published article for 2024 by Chiropractic and Manual Therapies.
There is great interest among the tribes in expanding access to chiropractic for their tribal members; however, there is confusion as to how to do it; as well as a lack of knowledge in the greater chiropractic community of the need and process. This article is intended to help bring awareness to the issue and be a guide for those interested in working in this arena.
