Problems with High Homocysteine

Diabetes Chromium, Antioxidants, B vitamins - The problems with High Homocysteine and Metformin

Diabetes has become so widespread that you, or someone you know are likely to be affected. World Diabetes Day on the 14th of November is a campaign that calls on each of us to promote action to prevent or delay the complications of diabetes [1]. Diabetes is rising alarmingly, but you can do so much to prevent it, and to delay the devastating effects it has on your body. The complications of diabetes are mainly related to the damage high blood sugar levels cause to the blood vessels. The result of this damage can include; loss of sight, loss of limbs and an early death.

There are two Types of diabetes. About 90% of people with diabetes have Type 2 diabetes. The great news is that a lot is known about how you can avoid getting Type 2 diabetes. Not only that but you can delay or prevent the problems that arise as a result of diabetes. Less is known about why Type 1 diabetes occurs it is much harder to maintain stable blood sugar levels, even with insulin; but you can take action to support your body, giving yourself the best chance of avoiding or lessening the severity of the complications.

In previous articles I have talked about important foods to include, foods to avoid, and exercise, so here we will look more at the nutrients. Remember getting the food right is vital; so be focused. If you are with anybody who has diabetes, trying to tempt them with foods that will damage them is like tempting someone with cancer to smoke cigarettes. So do all you can to support and encourage them, at the same time you will be decreasing your chances of getting Type 2 diabetes.

Recent studies have highlighted the problems of relying on medication to manage Type 2 diabetes. The reality is there is no quick fix solution. Several recent studies have demonstrated that Metformin, a drug used widely to control the blood sugar levels for Type 2 diabetes depletes the body of Vitamin B12 [2, 3, 4].

Use of supplementation of Vitamin B12 has been suggested to remedy the depletion rather that stopping the drug [2, 5] . The most recent clinical trial called for regular testing of Vitamin B12 levels for anyone taking Metformin [4]. Some studies found Metformin reduced folic acid as well as Vitamin B12 [3, 6]. Low levels of these two B vitamins result in high homocysteine levels[ [4,6]. High Homocysteine has been found in many chronic diseases, particularly cardiovascular disease. So if homocysteine is high the diabetic will be more likely to get cardiovascular complications of diabetes [7, 8, 9, 10]. Another sometimes fatal complication of diabetes is kidney damage. Diabetics who have kidney damage are likely to have high homocysteine levels and low vitamin B12 levels [ 11], 12, 5].

Homocysteine levels are likely to be high in diabetes [13]. This seems to happen if diabetes is poorly controlled so the blood sugar levels are frequently too high [13, 14]. When there are raised homocysteine levels there will be deficiencies of nutrients such as folic acid and Vitamin B12 and vitamin B6. Supplements of these have been shown to decrease homocysteine in diabetics, decreasing risk of cardiovascular and kidney problems.[15] [ 12] [5]. Interestingly either folic acid, or Vitamin B12[5]alone or taken together can both reduce homocysteine levels [16].

Chromium is another hugely important nutrient for diabetics, particularly those with Type 2 Diabetes. Diabetics are likely to be deficient in chromium[ 17], in particular if they have diabetic cataract [18]. Insulin resistance happens when the body produces insulin but does not use it properly; so the blood sugar levels are high. People with insulin resistance are very likely to develop Type 2 Diabetes. Chromium can help people with insulin resistance by helping to lower blood sugar levels [19, 20]. Chromium alone has been shown to help stabilize blood sugar levels [21]. Food State GTF chromium reduced blood sugar levels by 16.8%, compared to only 6% with chromium chloride [20]. Chromium is very effective when combined with other nutrients such as Vitamin C, Vitamin E [22], Zinc [23, 24].

Antioxidants such as Vitamin E, Zinc and Vitamin C are crucial to preventing damage from diabetes [25]. By taking antioxidant supplements after a meal they will be more protective to the blood vessels [26]. Research has shown the importance of Zinc, which is also likely to be low in diabetics [27, 28, 29, 30, 31, 32].

Food State Vitamin C was found to be effective in reducing signs the body is developing complications of diabetes [33, 34].

A study that lasted 27 years, showed that people with low levels of vitamin E and betacarotene were more likely to develop insulin resistance which can lead to diabetes [35]. When diabetes is poorly controlled, Vitamin E can help protect the body from damage caused by high blood sugar levels [36]. Scientific studies are exploring the possibility that Vitamin E may protect against Type 1 Diabetes [37].

Selenium is an important antioxidant [38]. The role it has to play in protecting the body from the damage of diabetes is an area being explored in scientific studies. High levels of selenium have been show to increase the risk for Type 2 diabetes in some parts of the world [39]. Other studies show low selenium levels in diabetics [40, 32]. We may not all have the same risk factors for all aspects of diet throughout the world [41]. Different forms of selenium and the interaction with other factors may influence results [38, 42, 43]. In New Zealand we do have particularly low levels of selenium [42], so it is likely to be needed for diabetics here. If I do use supplements I recommend the Entire Katoa Food State range for the optimum absorption, low dose and low toxicity.

Contact Bay Health Clinic today to find out more or to book a consultation with one of our Naturopaths; if needed they will also prepare tailored herbal medicines and recommend supplements to help you feel your best. Call 07 571 3226 or email us: ask@bayhealth.nz

References

1. World Diabetes Day [http://www.worlddiabetesday.org/node/4494]

2. Pongchaidecha M, Srikusalanukul V, Chattananon A, Tanjariyaporn S: Effect of metformin on plasma homocysteine, vitamin B12 and folic acid: a cross-sectional study in patients with type 2 diabetes mellitus. J Med Assoc Thai 2004, 87(7):780-787. http://www.ncbi.nlm.nih.gov/pubmed/15521233

3. Sahin M, Tutuncu NB, Ertugrul D, Tanaci N, Guvener ND: Effects of metformin or rosiglitazone on serum concentrations of homocysteine, folate, and vitamin B12 in patients with type 2 diabetes mellitus. J Diabetes Complications 2007, 21(2):118-123. http://www.ncbi.nlm.nih.gov/pubmed/17331860

4. de Jager J, Kooy A, Lehert P, Wulffelé MG, van der Kolk J, Bets D, Verburg J, Donker AJM, Stehouwer CDA: Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ 2010, 340. http://www.bmj.com/content/340/bmj.c2181.abstract

5. Jawa AA, Akram J, Sultan M, Humayoun MA, Raza R: Nutrition-related vitamin B12 deficiency in patients in Pakistan with type 2 diabetes mellitus not taking metformin. Endocr Pract 2010, 16(2):205-208. http://www.ncbi.nlm.nih.gov/pubmed/20061275

6. Wulffele MG, Kooy A, Lehert P, Bets D, Ogterop JC, Borger van der Burg B, Donker AJ, Stehouwer CD: Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomized, placebo-controlled trial. J Intern Med 2003, 254(5):455-463.http://www.ncbi.nlm.nih.gov/pubmed/14535967

7. Luo D, Yan S, Cheng X, Song Y: [Levels of homocysteine and polymorphisms of homocysteine metabolism-related enzymes in patients with type 2 diabetes mellitus and coronary heart disease]. Wei Sheng Yan Jiu 2009, 38(1):39-42. http://www.ncbi.nlm.nih.gov/pubmed/19267073

8. Alexandru N, Jardin I, Popov D, Simionescu M, Garcia-Estan J, Salido GM, Rosado JA: Effect of homocysteine on calcium mobilization and platelet function in type 2 diabetes mellitus. J Cell Mol Med 2008, 12(6B):2586-2597. http://www.ncbi.nlm.nih.gov/pubmed/18088391

9. Signorello MG, Viviani GL, Armani U, Cerone R, Minniti G, Piana A, Leoncini G: Homocysteine, reactive oxygen species and nitric oxide in type 2 diabetes mellitus. Thromb Res 2007, 120(4):607-613.http://www.ncbi.nlm.nih.gov/pubmed/17188741

10. Sakuta H, Suzuki T, Ito T: Serum gamma-glutamyl transferase is associated with plasma total homocysteine in Japanese patients with type 2 diabetes. Acta Diabetol 2007, 44(4):177-180. http://www.ncbi.nlm.nih.gov/pubmed/17882350

11. Looker HC, Fagot-Campagna A, Gunter EW, Pfeiffer CM, Sievers ML, Bennett PH, Nelson RG, Hanson RL, Knowler WC: Homocysteine and vitamin B(12) concentrations and mortality rates in type 2 diabetes. Diabetes Metab Res Rev 2007, 23(3):193-201. http://www.ncbi.nlm.nih.gov/pubmed/16845688