Homocysteine and Heart Disease

What is Homocysteine?  

Homocysteine is an amino acid produced in the body during the metabolism of a common dietary amino acid called methionine. Vitamins B6, B12, riboflavin and folate help breakdown homocysteine into other beneficial amino acids.

Deficiencies in these vitamins may lead to elevated homocysteine levels a condition known as hyperhomocysteinemia. When homocysteine levels are elevated,  they are associated with the development of atherosclerosis, stroke, cognitive disorders, and hearing loss. Elevated homocysteine is a risk factor for vascular calcification progression suggested in a study published in 2020 in the Journal of the American Heart Association. It effects the calcification of arteries and heart valves and is considered an irreversible state. Homocysteine may also increase blood clotting, reduce the synthesis of HDL, (good cholesterol), and promote the oxidation of LDL which contributes to atherosclerosis.

Brain Aging

When the MRI scans of 36 healthy volunteers between the ages of 59 and 85 were done, it was revealed that those with higher homocysteine levels had a greater loss of white matter, defined as brain tissue for nerve signal conduction.

There is some evidence that elevated homocysteine may indicated markers of Alzheimer’s disease progression in brain tissue including neurofibrillary tangles, dysfunction, dysfunctional protein accumulation, and brain shrinkage.

Studies have also shown that even modest elevations of homocysteine that occur within the normal range has been associated with a substantial increase in risk of dementia in the elderly.


It is recommended that if you have a history of heart disease or dementia, you should talk to your physician as there are simple blood tests to determine your homocysteine status. It is also recommended that if your levels go above the recommended levels, you have a choice to supplement your diet with a common multivitamin that contains vitamin B6, folate, B12, and riboflavin – they all work to lower homocysteine concentrations in the body.  However, it is not necessary to take individual vitamins that are more costly and frankly a ‘lot of pills to take”. Vitamins are best coming from foods and check your health status to make sure there are no underlying conditions that might be caused by even a moderate vitamin deficit. Check your status with your primary care physician.


VitaminFunctionOverdose ConsequenceFood SourcesComments
B6 (pyridoxine)Protein synthesis, nervous systemNumbness,  weakness, loss of balanceMeats, cereal, bananas, potatoes sweet peppersOverdose symptoms can mask multiple sclerosis
Folate (folacin)Protein synthesis, red blood formationCan mask B12 deficiency (pernicious anemia)Fortified grains, bread, pasta, dark green vegetables, dried beansPrevention of neural tube defects in early pregnancy of embryo
B12Nerve tissues, red blood cell formation None knownFish, seafood, milk, cheese, meatFound in animal products and microorganisms only
RiboflavinEnergy release from carbsNone knownMilk, yogurt, cheese, grains, eggs, liver, fish, beefDestroyed by light exposure

Childhood Obesity Rising?

Childhood obesity is rising again and seems to have few programs or solutions that address the issues. Many factors contribute to this epidemic such as genetics, unhealthy habits, lack of physical activity and environmental difficulties. Children are often unaware of the patterns or conditions that cause obesity, therefore, placing the responsibility on adults to lead them in the right direction. Obesity in childhood may lead to the same conditions and associated problems when these children reach adulthood.

Where are the programs????? Perhaps successful approaches should start with the food industry itself. A simple beginning is to check the “Added Sugar” on Nutrition Labels and limit sweetened soft drinks.

“The recommendation is that at most 10% of calories can come from added sugar. But 5% would obviously be better. That ‘s about five teaspoons a day. In terms of 2000 calories per day, that’s a small soda, or a teaspoon of sugar in each of five cups of coffee, or some ice cream or sweetened yogurt … We’re not saying “don’t eat sugar”. We’re saying “don’t eat a lot of sugar.” (Mark Bittman, David L. Katz, MD. How to Eat: All Your Food and Diet Questions Answered. p. 178-9.)


Diet Supplements???

It’s High Noon for Dietary Supplements

— The user fee legislation in Congress proposes useful regulations, but doesn’t go far enough

by Peter Lurie, MD, MPH June 10, 2022

A photo of a woman holding a bottle of vitamin gummies in front of a shelf of dietary supplements in a pharmacy.

By now, calling the dietary supplement marketplace “The Wild West” has taken on the mantle of hoary cliché. But that doesn’t mean it’s wrong.

That moniker seems entirely appropriate for an industry that has grown from about $4 billion in 1994, when Congress clarified the FDA’s authority over the products, to over $40 billion today. At present, the industry sells some 50,000 products (the FDA estimates their number to the nearest 10,000), many without any evidence of effectiveness. Some have clear proof of danger in the form of unintended contaminantspharmaceutical ingredients that presumably were added intentionally, and ingredient quantities that often stray from labeled amounts. Yet, the 1994 legislation sharply curtailed FDA’s authorities over these products.

According to a recent industry survey, 80% of consumers use dietary supplements, with many recently turning to supplements in response to COVID-19. And patients often keep their providers in the dark about their supplement use — or providers fail to ask about it.

But a reckoning might loom over the horizon.

Every 5 years, Congress must pass so-called “user fee legislation” — fees levied upon the various industries regulated by FDA that supplement the often-meager funds appropriated by legislators. Typically, congresspeople use this as an opportunity to pursue their other FDA priorities. This year, one long-overdue target is the dietary supplements industry.

Based on legislation developed by Senators Dick Durbin (D-Ill.) and Mike Braun (R-Ind.), the user fee bill includes what industry cognoscenti call “listing” — a public database of all the dietary supplements currently being marketed. Yes, you heard that right: FDA doesn’t currently have such a list despite being expected to police the marketplace. The bill also improves oversight of high-risk supplements and products with pharmacological activity fraudulently marketed as dietary supplements, such as tianeptine and phenibut.

Those are good ideas, but they don’t go nearly far enough. What else can be done?

The database is critical — even the more responsible members of the industry support it, which ought to tell you something — but it should offer more extensive information. The listings should provide consumers with access to recent FDA enforcement actions where food safety and labeling laws have been violated. It should also be linked to product labels so that consumers can look up those they are considering buying and doctors can thoroughly research those they are considering recommending to patients. There is also a need to address an existing provision whereby companies can simply self-certify new ingredients as safe, without even telling FDA, much less providing any evidence. The FDA also needs to be alerted to any new ingredients, and they should be added to the database before the products can be altered and sold.

The bill should also allocate more funding. FDA’s beleaguered Office of Dietary Supplement Programs should be provided with at least $5 million more per year than appropriated in the bill, as this would bring a level of funding I believe to be sufficient to improving the agency’s oversight of this sprawling industry.

Another hoary cliché has it that the COVID-19 pandemic has shone an unforgiving light upon existing deficiencies in our healthcare system. Right again. One of those issues is the rampant disinformation. Already we’ve seen the defrocked minister Jim Bakker peddling colloidal silver and leading anti-vaxxer Joseph Mercola, DO, pushing, well, just about anything he can. Accurate and transparent information across the healthcare system, including the supplements industry, is critical.

It’s time to bring some law and order to this unruly marketplace. For there’s no telling what these folks will do For a Few Dollars More.

Peter Lurie, MD, MPH, is the president and executive director of the Center for Science in the Public Interest. He is a former associate commissioner of the FDA.

Why Should We Care About Epigenetics?

Epigenetics is a hot topic right now and appears more in news articles as science makes further associations. It is becoming more obvious that our lifestyle and experiences can affect our genes and can be passed down to our children and grandchildren through genetic pathways.

Factors that can influence epigenetics can include: Diet, physical activity, sleep, stress, inflammation, chemicals products, UV rays, and environmental pollution.

DNA is the blueprint for the instructions for the entire body, but chemical tags called methyl groups make up what is called the epigenome to decide which genes are active – this is called methylation or gene expression. It is often referred to as an “on and off switch” that turns on or off certain genes. It is what makes identical twins different over time. Although our DNA code does not change, the epigenome is flexible and reacts to our environment. Our experiences help shape how genes are expressed.

DNA methylation works by adding a chemical group to specific places on the DNA as “tags” where it blocks the proteins that attach to the DNA to “read the gene”. This chemical group called a methyl group can be removed through a process called demethylation. Typically, methylations turn genes “off” and demethylation turns genes “on”.

Women are not solely responsible for the health of their future children. Science is finding that the health of a man’s unborn children can be affected by things like the man’s diet, life experiences and trauma, exposure to toxins and how old he is at conception.

DNA is not our destiny. Epigenetics is the study of how your behaviors and environment can cause changes that affects the way your genes work. Through epigenetic tags, parents’ experiences and lifestyle can affect the genes that are passed down to their children and grandchildren.

A proper lifestyle “turns on” protective genes and “turns off” disease-producing genes by their positive impact on the epigenome.



Why Should I Care About Epigenetics? Utah Valley Pediatrics, September 30, 2013

The Epigenetics of Obesity

Obesity is a chronic condition characterized by excess body fat. Its origins are mulfifactorial including heredity, behavior and environment. Obese people are at risk of developing many diseases. In fact, obesity is the second most important predictor of cancer, preceded only by tobacco use.

Epigenetics refers to those elements of the genetic code that you are able to change without altering your DNA sequence. It includes which genes you express, to what degree and at what time. Consequently, epigenetic processes determine whether a specific gene is active or not at any given time. In the absence of further studies. Genes can be expressed or not expressed.

Your epigenetics develop in the uterus and continues to change throughout your life. A study in the Netherlands during the famine period of 1944-1945 demonstrated how genetics affects obesity. Fetuses of mothers exposed to extreme hunger experienced more glucose intolerance, dyslipidemia, early coronary heart disease, and obesity. Therefore, starving could cause some of the diseases that are prevalent in society today. These genes can be transmitted from generation to generation. Unlike the genome (the complete set of genes in a cell), the epigenome is reversible. Epigenetic marks can be modified throughout life. However, modificationss at critical periods of prenatal development have greater effects on the results. So DNA is not your destiny!!

Lead a healthy lifestyle prior to conceiving a baby, especially the mother; however, there are some indications that the father’s lifestyle can also be influential. Ideally, both expectant parents and the offspring should maintain good lifestyle habits to include healthy diets, physical activity, adequate sleep, stress reduction, and avoidance of inflammation.



Crime and Nourishment???

We have all heard about the rising crime rates occurring in the U.S. Our first inclination is to wonder what could be going on in our country to cause this – or at least what is contributing to this disturbing shift of behavior?

“The issues of diet and criminal behavior are limited but intriguing. If you’ve ever found yourself in front of the TV after a bad day, mindlessly digging ice cream out of the container with a spoon, you know that mood and food are sometimes linked. But while stress eating is a verified phenomenon, the relationship between food and actual mood disorders, depression and even behavior needs some attention. Can dietary changes potentially improve our mental health.? What do the studies say?

Scientists looking for answers – Hints of a Link

Before, we jump into the science (research), some basics:

As we all know, our behavior is mostly controlled by our brain. Every organ in the human body requires nutrition to function properly and when it doesn’t get what it needs it functions abnormally. So, is there any reason that the brain should be an exception? The brain is a complex organ so that alone should be enough to assume that if it does not get the proper nutrition, it might just not work as well as it should.

Recent research offers a viewpoint that the brain and the gut “talk to each other” through the presence of the microbiome – the community of microorganisms that lives inside our digestive tract.  When this communication channel is “out of whack” or missing essential nutrition, major health problems can crop up in both the mind and body, enabling food sensitivities, allergies, digestive disorders, obesity, depression, anxiety, and fatigue.

“A study indicated that when levels of the brain chemical serotonin decrease from stress or not eating, it affects the brain regions regulating anger, potentially resulting in “a whirlwind of uncontrollable emotions”. 

“Prison studies suggest that many inmates have poor blood sugar control, compounded by a high-sugar diet. We all know how it feels when blood sugar drops – we feel moody, foggy. Apply that to someone from a disturbed backgound.”

In a randomized, placebo-controlled trial,  Oxford criminologist Bernard Gesch found that giving prison inmates a multivitamin and fatty acid supplement led to violent offenses dropping 37% compared to 10% for those who were given a placebo – findings that were confirmed by a later Dutch study.

“In a large study of prison diets, Stephen Schoenthaler, Professor of Criminology and Sociology at California State University found that prisoner’s eating habits could be used to predict future violent behavior. Normally, past violent behavior is considered the best prediction of future violence. But professor Schoenthaler found that a poor diet is an even better predictor of violent behavior.”

He also found that that in a study of young offenders in California, young adult men receiving vitamin supplements showed a 38% drop in serious behavior problems.

The types of problems associated with poor diet, such as aggression, attention deficits and hyperactivity can make impulsive behavior more likely. Low levels of iron, magnesium and zinc can lead to increased anxiety, low mood, and poor concentration, leading to attention deficits and sleep disturbances. Omega-3 fatty acids, are often deficient in the U.S. diet and needed to improve cognitive functioning.

“No one blames a poor diet as a cause of crime, nor is it the only solution. But if better nutrition in general can bring about a substantial reduction in violent crime in and out of prisons, that would be something to cheer about. For isn’t a good diet, made up of good food, a better and less expensive solution than just hiring more police and building more prisons?”

Needless to say, The Standard American Diet (SAD) needs more attention for all of us, not just in our prison population. Simply, with the input of nutrition scientists, education of the consumer, and cooperation of the food industry, we desperately need more healthy food choices for our personal health and that of our food culture.

Schoenthaler, S.J., Ames, S. Dorax, W., et al (1997)

The effect of randomized vitamin mineral supplementation on violent and non-violent antisocial behavior among incarcerated juveniles. Journal of Nutritional and Environmental Medicine, 7:343-352.

The Conversation: Crime and Punishment – the link between food and offending behavior. Hazel Flight, John Marsden, Sean Creaney. 2018

The Guardian. Can Food Make You Angry? Rebecca Hardy. Wed.24 Apr 2013.

C. Bernard Gesch, Sean M. Hammond, Sarah E. Hampson, Anita Eves, and Martin J. Crowder

Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behavior of young adult prisoners. British Journal of Psychiatry 2002, 181, 22-28

The Mediterranean Diet Shopping Guide (and How to Use It)

The Mediterranean Diet Shopping List

Jamie Vespa, M.S., R.D –Eating Well Magazine (Special Edition)

There is no one Mediterranean diet but many versions, and at the core of any of them is extra virgin olive oil – rich in vitamin E, carotenoids and polyphenols – all rich in antioxidants and anti-inflammatory properties. It can be used in cooking or in dips, spreads, and salad dressings.


Look for the colors – green, red, purple, yellow, orange are pigments that have protective functions for the plants they come from. Moreover, they furnish the antioxidants we need to thwart oxidative stress or inflammation with phytonutrients needed for optimum health and disease prevention. Buy them fresh and seasonal when possible but canned or frozen are just as effective.


Aromatic herbs and spices are staples in Mediterranean cooking. These reduce the need to use excess salt in addition to their antioxidant properties. You can count on parsley, basil, oregano, coriander, and bay leaves. Use fresh basil to make a pesto.


Omega -3 fish such as tuna, sardines and salmon are

enjoy ed fresh, canned or frozen. Clams and shrimp can used in pasta or grain dishes. Most can be served with lemon, olive oil and herbs. Most Med diet patterns suggest seafood twice per week.


Wheat is the foundation; however, other grains can provide some variety. Farro is one of the traditional grains in dishes in Italy. Another classic grain is bulgur made from cracked wheat berries and used in pilafs. Coucous, pasta and barley are also found in regional cooking. On the ingredient labels. Look for “whole-grain” as the first ingredient.


The chickpea is predominantly used for making hummus. Lentils are used commonly in soups and stews. Both are good sources of fiber.                               


Nuts are good for snacking thanks for their protein, fiber, and healthy fats. A common condiment is tahini made from ground sesame seeds. Use as salad dressing or over roasted vegetables.


Kalamata olives are most popular in the region and often tossed with green salads, pastas or as tapenades. Olives of all kinds are rich in heart-healthy fats and phytochemicals as snacks.  Capers are used to perk up flavors of pasta, baked fish and dressings.


Tomatoes in any form (diced, whole, stewed, crushed, canned, fresh) are rich in a phytochemical called lycopene which may protect against some cancers. There is a plethora of marinara sauces in cans and jars as well as simply home-made.


The Med Diet favors full-fat dairy in small amounts. Yogurt is fermented and healthy for our microbiomes as gut-healthy probiotics. Cheese are made from milk and natural cultures in contrast to some U.S. processed cheeses.  Feta cheese is used classically in salads. Harder cheeses like Pecorino Romano and Parmesan-Reggiano are often grated into pasta.


Wine is commonly served in moderation with food – Not as part of “happy hour” (a 5 oz. pour is the standard). Red wine contains antioxidant polyphenols and the flavonoid resveratrol may help to increase healthy HDL cholesterol and decrease unhealthy LDL cholesterol levels.

Good Luck and Bon Appetit!!

How to Live the Mediterranean Way

How to Live the Mediterranean Way and How to Feed Your Microbiome.

Each country around the Mediterranean Sea offers a rich bounty of delicious ingredients. Many authors have written about the Mediterranean Diet in terms of the health benefits that have been shown by an exhaustive array of scientific studies on its merits. The diet is now recognized as an “intangible cultural heritage” in Italy by the United Nations Educational, Scientific and Cultural Organization (UNESCO). It is a way of life and a way of eating, which the Italians call “Cucina genuina” or “cuisine of the poor”.  This is the diet of those who work the land and feed themselves using seasonal ingredients grown in their small plots outside the kitchen”.

The following characteristics attempt to describe the “Americanized” version of how to live and eat the Mediterranean way – it is not just a diet but a gift to a healthier lifestyle.”

DIET: Eat food, not too much, mostly plants. (Micheal Pollan). Whole grains, unprocessed foods, fruits, and vegetables

Eat meat in moderation. Limit your saturated fat, sugar and salt intake. Snack on nuts. Reduces inflammatory foods

Practice mindfulness, smaller servings, early light dinners.

Try yogurt, beans, chickpeas (hummus (fermentable foods) like sauerkraut – diversifies microbiome

Maintain a healthy Body Mass Index (BMI) 19.0 – 25.0

Drink plenty of water


Take a walk. Enjoy the sunshine.

Stay active. Get gardening.

Exercise improves cognition and stress reduction


1-2 Glasses of red wine (daily): Optional (if you don’t drink wine, don’t start) 

Have a purpose in life (a reason to get up in the morning).

Laugh with friends.

Keep your brain active (read, puzzles, learn a language) card games

Focus on family, God, camaraderie, nature

Reduce stress and avoid eating when angry or sad.

Enjoy the secret pleasures and social aspect of foods.  Become more expert at listening to your gut feelings.(mind/body).  


Diane Phillps, The Mediterranean Slow Cooker Cookbook, Chronicle Books, 2012.

Emeran Mayer, MD. The Mind-Gut Connection, Harper Collins, 2016.

Dan Buettner The Blue Zones Challenge, National Geographic, 2021.

Nutrition, Behavior, and Disease

Biological Changes during Aging and Nutritional Consequences


The combined effects of poor diets, other risky behaviors, and biological aging increase the rates of serious diseases during adulthood. How soon a disease develops largely depends on the intensity of exposure to behavioral risks that contribute to disease development.  These are often referred to as epigenetics (when the DNA is not altered, but environmental factors cause genes to be turned either on or off.) 

What Are Some Nutritional Consequences?

 Lowered stomach acidity may result in decreased absorption of vitamin B12? The consequences of getting less sun exposure may result in less production of vitamin D in the skin.

A person’s need for calories generally declines with age as physical activity, muscle mass, and basal metabolic rate decrease. However, when one chooses to continue their physical activity into their older years can maintain their muscle mass, experience less muscle, and bone pain, and gain less body fat than people who are inactive. 

For the most part, the development of chronic disease in middle-age and older adults can be viewed as a chain that represents the accumulation over time of problems that impair cell functions. Each link that is added to the chain, or each additional insult to cellular function, increases the risk that a chronic disease will develop. The presence of a disease indicates that the chain has gotten too long – that the accumulation of problems is sufficient to interfere with the normal functions of cells and tissues.

Normal cell functions and health promotion are facilitated by healthful dietary lifestyles and other behaviors. For example:

Correcting obesity and stabilizing weight during the adult years tends to lengthen life expectancy.

Dietary intakes that correspond to the Dietary Guidelines for Americans (MyPlate) or following a healthily diet pattern like the Mediterranean Diet is related to a longer life expectancy.

Maintaining adequate calcium, vitamin D, and protein intake and engaging in regular physical activity during the adult years may prevent or postpone the development of osteoporosis and help maintain muscle mass and strength.

Above average intake of vegetables, fruits, and whole grains may delay the development or help prevent a number of types of cancer, heart disease, hypertension, and cataracts. 

The health status of adults is not necessarily ‘FIXED” by age.; it can change for the better or the worst, or not much at all. It’s up to you.