The Homocysteine Connection
One interesting discovery is the link between homocysteineHomocysteine is an amino acid found in the blood. Elevated levels of homocysteine have been associated with narrowing and hardening of the arteries, an increased…, low B12 levels and bone and joint health. Over the last five years, there have been more and more studies linking high homocysteine and low B12 levels to increased risk of fractures, osteoporosis and decreased bone mass density, particularly in women. It looks as if homocysteine actually damages bone by encouraging its breakdown and interfering with the collagen matrix which is what holds bone together. Collagen is made from vitamin CWhat it does: Strengthens immune system – fights infections. Makes collagen, keeping bones, skin and joints firm and strong. Antioxidant, detoxifying pollutants and protecting against…, which is yet another reason why I recommend a daily intake of 1000mg taken twice a day.
High homocysteine levels are linked to most inflammatory diseases since homocysteine promotes the release of pro-inflammatory agents in the body. Homocysteine levels are frequently found to be much higher in rheumatoid arthritis sufferers as well as those with ankylosing spondylitis, which is an inflammatory arthritic disease of the spine. Since rheumatoid arthritis is a ‘systemic’ disease, where the whole body’s chemistry is out of balance and many tissues and organs other than the joints are affected, one would suspect that homocysteine plays a leading role in the disease. And it does.
Research from the Department of Biochemistry at the University Hospital in Madrid, Spain, examined the homocysteine scores of women with rheumatoid arthritis versus those without. There was a massive difference. The average homocysteine score for those with rheumatoid arthritis was a sky-high 17.3, compared to 7.6 for those without! Other research groups have found similar differences, especially among rheumatoid arthritis sufferers with a history of thrombosis or abnormal clotting of the blood.
Homocysteine is now thought to damage joints and other tissues directly. All of this suggests that reducing homocysteine may well help keep your bones and joints healthy. Yet, disappointingly, very little research has yet been done to test the homocysteine theory on arthritis. An exception occurred in 1994 when forward-thinking researchers from the highly esteemed American College of Nutrition in Clearwater, Florida, gave B12 and folate supplements to 26 people who had been suffering from osteoarthritis of the hands for an average of more than five years, and had been taking non-steroidal anti-inflammatory, pain-relieving drugs (NSAIDs).
B12 and folate work together to help reduce high homocysteine levels. The results showed that people with arthritis who took the vitamins in place of the NSAIDs had less tenderness in their hand joints, and similar improvement in their ability to grip objects, compared with those just taking NSAIDs, but suffered none of the notorious side-effects seen with the use of these drugs. NSAIDs can cause serious reactions, including premature death from kidney failure, ulcers and bleeding in the digestive tract, and they cost considerably more than B12 and folate supplements. As many as two in five people over 60 are B12 deficient, if tested, and the lowest level that corrects B12 deficiency is 500mcg a day. While fish, meat, eggs and milk all contain B12, only milk and fish consumption are linked to increasing blood B12 levels, possibly indicating that these foods have more bioavailable B12. Even so, you are unlikely to get more than 3mcg of B12 from your food. Most B12 experts think that we could all benefit from a daily intake of 10mcg which is the minimum I’d recommend in a good multivitamin. B6, another homocysteine-lowering vitamin, has also proven helpful for arthritis sufferers.
Back in the 1950s, an insightful physician from Mount Pleasant in Texas, Dr John Ellis, found that giving B6 in higher daily doses of 50mg helped to control pain and restore joint mobility to his arthritic patients. (For further information read, JM Ellis’s book, Free of Pain: A Proven Inexpensive Treatment for Specific Types of Rheumatism, Southwest Publishing,1983). Vitamin B6 shrinks inflamed membranes that line the weight-bearing surfaces of the joints, perhaps by helping decrease homocysteine and increase SAMe and glutathione, both proven anti-inflammatory agents. B6 also helps to regulate production of the prostaglandins, the body’s own anti-inflammatory agents.
Keeping Your Joints Healthy
There are two sides to joint health. The first is keeping cartilage strong and healthy, and the second is reducing joint inflammation, which is the primary cause of cartilage breakdown. The two main components of cartilage are proteoglycans and collagen. As explored earlier, collagen is made from vitamin C. Proteoglycans are made from glucosamine – the only direct source of which you are likely to eat is prawn or shrimp shells, although crunching on these is not to everybody’s taste. Glucosamine is like the 2×4’s of your joints, while the mineral sulphur is like the nails. This is one reason why glucosamine sulphate is often recommended for joint health.
Slightly better, in my opinion, is the combination of glucosamine hydrochloride, a more absorbable form of glucosamine, with MSM, the most bioavailable form of sulphur. Sulphur is found in onions, garlic and eggs. I wrote extensively about glucosamine, and how it works, back in the January 2006 newsletter and not much has changed since then. If you read my blog/e-news on my favourite six anti-inflammatories you’ll know why I recommend curcumin in turmeric, olives, quercitin in red onions, an extract found in hops, and also lots of omega 3 fish oils. Of course, you can eat many of these but the real magic comes when you supplement concentrates of these together.
The combination of glucosamine, MSM and omega 3s is a winning formula if you suffer from joint aches and pains. One recent study compared the effect of glucosamine sulphate (1500mg) with glucosamine sulphate plus omega 3 fish oils on those with hip or knee osteoarthritis. Almost half (44%) of those taking both glucosamine and omega 3s had a greater than 80% reduction in pain, compared to a third (32%) taking glucosamine alone.
Weight and Exercise
Two major causes of cartilage degeneration are too much weight on the joints and poor postural alignment. Being overweight doesn’t just stress the joints, it also switches the body into an inflammatory state. So, losing weight by following my GL diet principles both helps ease pressure on the joints and switches off the inflammatory process. See my GL special report for more information.
Joints need space to move and that’s why exercises that both strengthen the back and joints, but also stretch them, is so important. Most people don’t do these on a regular basis and suffer the consequences as they get older. So building in regular, if not daily, joint stretching exercises is a vital part of keeping both your bones and joints healthy. Bone formation is also stimulated by weight bearing exercise. Many people lose back strength because our modern world requires little upper body strength. My favourite exercises in this regard are yoga and Psychocalisthenics. The thing I like about Psychocalisthenics is it really does work all the joints and muscles, develops back strength and keeps you supple, but only takes 16 minutes a day. It’s been the basis of my exercise routine for almost 30 years and, now in my 50’s, I am as supple as I was as a teenager. The only disadvantage is that if you are already significantly overweight or have back problems, it may be a bit difficult to start with.
Yoga is excellent yet does depend on having a good teacher, of which there are many. But the critical thing is finding something that you can do regularly. Swimming is also excellent.
A Word About Osteoporosis
Everything said above applies to preventing osteoporosis. The main medical treatment is, of course, drugs called bisphosphonates (an example of which is Fosomax). While these do tend to increase BMD, they also have side-effects including oesophageal irritation and ulceration, bone and muscle pain.
Intravenous Fosamax is linked with a horrendous condition called osteonecrosis of the jaw that results in deterioration and death of the jawbone. Bisphosphonates also increases risk of atrial fibrillation and one long-term study revealed that it raises risk of stress fractures in the bones of the legs! These kind of drugs are not very effective. One study in the British Medical Journal reported that if everyone (in Finland) over 50 (1.86 million) was put on a bisphosphonate 343 hip fractures would be prevented, 7,068 would not be. That means 667 people would need to receive the drug for one to benefit. If taken with antacid drugs called PPIs (proton pump inhibitors) even that benefit can drop to zero. However, if you can get your blood level of vitamin DWhat it does: Helps maintain strong and healthy bones by retaining calcium. Deficiency Signs: Joint pain or stiffness, backache, tooth decay, muscle cramps, hair loss…. up to 100nmol/l the drug becomes seven times as effective. If you have an average low vitamin D benefit is a fraction.
Another important factor to consider is hormones. I discuss this in some detail in the September 2006 newsletter. Basically, progesteroneProgesterone is one of the main female sex hormones…. stimulates the formation of new bone by switching on the osteoblasts, while oestrogenOestrogen is one of the main female sex hormones…. stops the loss of old bone. That’s why oestrogen HRT, now considered too dangerous due to its associated increase in breast cancer, stops bone mass loss, while progesterone can actually increase it. Natural progesterone, which is prescribable as Projuven, doesn’t increase breast cancer risk and may even help prevent it.
• Take a twice daily multivitamin that provides at least 15mcg of vitamin D, 40mcg of vitamin KWhat it does: Blood clotting. Deficiency Signs: Symptoms include those of a purpuric syndrome, i.e., ecchymosis, petechiae, bruising, abdominal pain, risk of massive bleeding, cartilage…, 100-400mg of calciumWhat it does: Promotes a healthy heart, clots blood, promotes healthy nerves, contracts muscles, improves skin, bone and dental health, relieves aching muscles and bones,…, 150mg of magnesiumWhat it does: Strengthens bones and teeth, promotes healthy muscles by helping them to relax, also important for PMS, important for heart muscles and nervous… and 1mg of boron.
• If you have joint problems or decreased BMD, take a bone mineral formula as well.
• Take 1000mg of vitamin C twice a day.
• Eat oily fish three times a week and take a supplement providing Omega 3 fish oil every day. If you have joint aches and pains, make sure you are getting 500-1000mg of the EPAEPA is short for Eicosapentaenoic Acid. It is an essential omega-3 fatty acid found in fish such as salmon, mackerel and herring, and is often… Omega 3 oil a day.
• If you have joint problems, supplement a natural anti-inflammatory formula providing glucosamine, MSM, turmeric, quercitin, olive and hop extracts.
• Test your homocysteine and, if high, take a high-strength homocysteine-reducing formula providing at least 500mcg of B12, plus folic acidWhat it does: Critical during pregnancy for the development of a baby’s brain and nerves. Also essential for brain and nerve function. Needed for utilising…, B6 and other homocysteine-lowering nutrients.
• Make an effort to lose weight if you are overweight.
• Build some joint stretching, and back strengthening exercise into your daily regime.
1. M. G. Signorello et al., ‘Effect of homocysteine on arachidonic acid release in human platelets’, European Journal of Clinical Investigation, vol. 32 (4), 2002, pp. 279-84
2. R. Roubenoff et al., ‘Abnormal homocysteine metabolismMetabolism is a term that is used to describe the chemical reactions that take place within the body’s cells. The body gets the energy it… in rheumatoid arthritis’, Arthritis and Rheumatism, vol. 40 (4), 1997, pp.718-22
3. X. M. Gao et al., ‘Homocysteine, Ankylosing Spondylitis and Reactive Arthritis: Homocysteine modification of HLA antigens and its immunological consequences’, European Journal of Immunology, vol. 26 (7), 1996, pp. 1443-1450
4. A. Hernanz et al., ‘Increased plasma levels of homocysteine and other thiol compounds in rheumatoid arthritis women’, Clinical Biochemistry, vol. 32 (1), 1999, pp. 65-70
5. B. Seriolo et al., ‘Homocysteine and antiphospholipid antibodies in rheumatoid arthritis patients: relationships with thrombotic events’, Clinical and Experimental Rheumatology, vol. 19 (5), 2001, pp. 561-4
6. P. E. Lazzerini et al., ‘Homocysteine enhances cytokine production in cultured synoviocytes from rheumatoid arthritis patients’, Clinical and Experimental Rheumatology, vol. 24 (4), 2006, pp. 387-93
7. M. A. Flynn et al., ‘The effect of folate and cobalamin on osteoarthritic hands’, Journal of the American College of Nutrition, vol. 13 (4), 1994, pp. 351-356
8. Teppo Jarvinen, et al., ‘The true cost of pharmacological disease prevention’, British Medical Journal 2011; 342:d2175
9. Bo Abrahamsen, Pia Eiken, Richard Eastell, et al., ‘Proton pump inhibitor use and the antifracture efficacy of alendronate’, Archives of Internal Medicine, 2011;171(11):998–1004
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