Paleo Diet Q & A - Homocysteine

Dear Readers,

Here's today's edition of Paleo Diet Q & A regarding Homocysteine.

Dr. Cordain and his associate Pedro Bastos, were recently contacted by Ben Balzer, M.D. a well known Australian GP, friend and colleague regarding homocysteine issues. According to the American Heart Association, homocysteine is "an amino acid in the blood. Epidemiological studies have shown that too much homocysteine in the blood (plasma) is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease."

Included below are Dr. Balzer's original correspondence, as well as the replies from Dr. Cordain and Mr. Bastos.

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Dear Loren and Pedro,

I was writing to a cardiologist today about homocysteine (alternate spelling: homocystine), among other issues. I don’t think I’ve raised it with you before, but it occurs that it may be of interest or relevance, so I’ve repeated it here below. Clinical medicine takes me up a few nutritional pathways that aren’t necessarily paleo, but as I always say paleo is the unifying field theory of nutrition, so it has always made it easier.

I’m a firm believer in homocysteine related issues, but the way modern medicine works it will never be driven hard as there is no commercial imperative--as all the treatments are vitamins and cannot be patented. Though there have been attempts to make a "drug" that will lower homocysteine, which would then magically spark interest.

I am also aware that choline has been given vitamin status and also participates in the 1-carbon cycle. Perhaps you could let me know how the choline intake of the SAD compares to our modern day urban hunter gatherer. Maybe we can shorten that to urban hunter gatherer, but I don’t think UHG will catch on, though it does have a caveman like ring to it.

What is amazing about homocysteine and triple B therapy is how little most Australian cardiologists knew about it. Yet when Lange published a highly flawed negative paper, they all knew about it overnight- highly suggestive of a commercial push.

Regards,
Ben

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Hi Ben,

Good to touch bases with you and hopefully we can get together when I am in Sydney in June. Although we havent done the computerized dietary analysis yet -- specific to homocysteine, it is almost certain that sub-artic hominids would have had high plasma concentrations of folic acid, B6 and B12 (see my paper: Cordain L. "The nutritional characteristics of a contemporary diet based upon Paleolithic food groups." J Am Nutraceut Assoc 2002; 5:15-24.) Hence hyperhomocysteinemia likely was not an environmental seletive pressure that routinely affected Homo until very recent times (evolutionarily speaking -- ergo the past 10,000 years). I suspect that modern western diets are significantly lower in choline-rich foods than diets based upon fruits, veggies, meats, seafood, nuts, fish, and organ meats. Once again, we have not done the computerized dietary analyses.

Best wishes,
Loren

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Hi Ben.

Good to hear from you. I definitely agree with Loren.

Regarding choline, I would just like to add that from computer analysing several types of diets, I have come to the conclusion that without eating liver or a high amount of egg yolks, it is virtually impossible to achieve 500 mg of choline a day. So, I believe our H/G ancestors got their choline from organ meats. Since today, most of us do not eat organ meats, I would like to know how we can ingest the choline we need.

Here’s a table from the Linus Pauling Institute with some dietary sources of choline. In addition, I would refer you to two papers: one by Bruce Ames on choline and another on food sources of choline and betaine.

Food	Serving	Total Choline (mg)
Beef liver, pan fried	3 ounces*	355
Wheat germ, toasted	1 cup	172
Egg	1 large	126
Atlantic cod, cooked	3 ounces	71
Beef, trim cut, cooked	3 ounces	66
Brussel sprouts, cooked	1 cup	63
Broccoli, cooked	1 cup, chopped	62
Salmon	3 ounces	56
Shrimp, canned	3 ounces	49
Peanut butter, smooth	2 tablespoons	20
Milk chocolate	1.5-ounce bar	20

By the way, here’s the adequate intake:

Adequate Intake (AI) for Choline
Life stage	Age	Males (mg/day)	Females (mg/day)
Infants	0-6 months	125	125
Infants	7-12 months	150	150
Children	1-3 years	200	200
Children	4-8 years	250	250
Children	9-13 years	375	375
Adolescents	14-18 years	550	400
Adults	19 years and older	550	425
Pregnancy	All ages	-	450
Breastfeeding	All ages	-	550

It would be very interesting to estimate the various micronutrient intake of various H/G diets based on Loren’s model.

Best wishes,
Pedro