Friday, February 26, 2010

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.

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.


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,

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,

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