DR. KILMER McCULLY’S B-VITAMIN BREAKTHROUGH – discussion of homocysteine levels, diet, and other health factors – includes related Spinach Pie recipe – Interview
Cory Servaas
“Eat more fresh produce and fewer refined foods,” advises Dr. McCully. In this final installment, the father of homocysteine offers useful guidelines on how dietary modifications may help lower homocysteine levels and protect cardiovascular health.
Q: Is there any reason why we wouldn’t add routine screening for high homocysteine levels to the other standard blood tests already done?
A: I think it should be at the top of the list. Honestly, the data that have been published in the last ten years or so indicate that a high homocysteine level is a very powerful risk factor for vascular disease. In a number of studies, an elevated homocysteine level is a more powerful risk factor than dyslipidemia or high cholesterol levels.
I think that the attitude of the American Heart Association, to put this into a secondary category, is misguided and outmoded. I also disagree with the American Heart Association’s dietary recommendations. The idea that a low-cholesterol, low-fat diet is the answer to heart disease is extremely misleading and confusing to the public. When people try to adopt the American Heart Association diet, they follow the food pyramid promulgated by the U.S. Department of Agriculture. They start eating carbohydrates-bread, pasta, white rice, crackers, cookies, yogurt with added sugar–thinking that this is an improvement in their diet, when in fact it is making their diet worse.
By cutting out the fat, you cut out the fat-soluble vitamins, essentially decreasing the supply of the fat-soluble vitamins and essential oils such as omega-3 oils and increasing the amount of refined carbohydrates that are severely depleted in folic acid and vitamin [B.sub.6], particularly. We address this in some detail in my latest book, The Heart Revolution.
Q: You have recently received several awards for your work?
A: Yes. I’ve been given several awards, including the Linus Pauling Award a year ago from the Institute for Functional Medicine and, most recently, the Burton Kellman Award for scientific achievement from the National Nutritional Foods Association in Las Vegas.
Q: Are some individuals at greater risk for high homocysteine levels?
A: Recent studies in the last four or five years have shown that about 12 percent of the population has a variant of an enzyme called the thermal labile reductase variant, which increases their requirement for folic acid. Some of the studies suggest that individuals with this enzyme abnormality who eat a marginal folate intake in the diet have higher homocysteine levels and increased risk of coronary heart disease.
Many medical centers and commercial laboratories are now assaying blood samples for the presence of this enzyme abnormality–the Human Genetics Department, McGill University, Montreal; the Human Nutrition Research Center, Tufts University, Boston; Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis; University of Utah, Salt Lake City; Molecular Diagnostic and Research Center, Cincinnati; Specialty Laboratories, Santa Monica, California; and many more.
Q: If people are having strokes from high homocysteine levels, is tissue plasminogen activator (TPA) helpful in taking care of that thrombosis?
A: I believe it would be in general terms. A very interesting finding came out last year from a prominent researcher in blood coagulation. Katherine Hagaar and her group in New York discovered that homocysteine affects anexon-2–a regulator of TPA. Homocysteine antagonizes this receptor and, in effect, decreases the normal activity of endogenous tissue plasminogen activator. This finding indicates that homocysteine does act in this normal physiological pathway of blood coagulation.
I cited this paper in a lecture I gave in California at the International Dairy Federation. They had an international symposium on the dairy industry and cardiovascular health.
Q: They probably like you in the dairy industry because you take a little of the edge off the cholesterol.
A: I feel that it puts cholesterol in its proper role. Cholesterol is involved in heart disease, but in my opinion, investigators have missed the boat on cholesterol. There are a number of studies implicating oxycholesterols in the genesis of plaques. What has happened over the years is that the people in the dyslipidemia and cholesterol fields have focused on the LDL and HDL, which are important, but they have failed to focus on the importance of dietary oxycholesterols. These are highly angiotoxic and important derivatives of cholesterol produced by food processing. For years, oxycholesterols have been known to produce plaques, whereas highly purified cholesterol, when given to animals, is totally nonatherogenic. As a matter of fact, many experts feel that the elevation of cholesterol is a response of the body to injury and that it’s actually a normal healing response of the body to minimize the damage that has occurred in the plaque. The interpretation of the dyslipidemia and cholesterol elevation, in my view, has been insufficient and inaccurate over the years. I think that the many experiments and other clinical studies done in this area have failed to take into account the significance of these cholesterol oxides.
The same thing can be said for the trans fats. Trans fats were introduced in the 1920s and 1930s. After their introduction into our diets, we began to see the escalation in coronary heart disease. Only within the last decade or so has it been proven that trans fats are deleterious to our health and increase the risk of vascular disease. In my view, the focus in the lipid field should have been on oxycholesterols and trans fats all these years, rather than on the physiology of lipid transport, which is where the focus has been.
Q: We’ve heard that butter is better than margarine. Does margarine contain trans fats?
Margarine is heavily contaminated with trans fats. As a matter of fact, I met a very interesting lady named Mary Enig, Ph.D. For a number of years, she worked in the lipid clinic and research laboratory at the University of Maryland. She’s a lipid chemist, physiologist, and nutritionist. In her independent lab, she analyzed foods for their trans fat content. She came up with percentages that were considerably higher than those published by the industry. Her work was suppressed. She ran into a lot of difficulty because of the economic implications of her work. She showed that margarine, cooking oil, shortening, and hydrogenated oils contain high concentrations of trans fats, instead of only trace concentrations, as the industry was trying to make people believe. Her work has not received the proper attention it should have. She’s very well regarded and internationally known in the lipid field. She published a fascinating article called “The Oiling of America,” in which she points out that at the turn of the 20th century, vegetable oils were practically unknown; the fats in the diet were largely butter, meats, eggs, lard, beef tallow, and so on. Coronary heart disease was rare. With the introduction of the vegetable oils and trans fats during the mid-20th century, the epidemic of vascular disease started. Of course, she thinks they are closely related.
In a sense, this agrees with the homocysteine approach because the more you add these purified oils, the more you depend on the rest of the diet for the supply of the water-soluble B vitamins. For example, if you have a high-fat diet that consists of these added oils along with flour, white flour, sugar, and highly processed nutrients, this diet encourages a deficiency of [B.sub.6] and folic acid, which will cause hyperhomocysteine.
Q: What about Eggbeaters or just eating the egg white?
A: Although I have only briefly looked at the label of Eggbeaters, I was very unimpressed and would never eat them, myself.
Egg white is, of course, a very good source of protein, and protein is good for you. But by eating just the egg whites, you are missing the nutrients in the egg yolk–the vitamins and the minerals, the antioxidants, all the beneficial nutrients. Eggs have received a tremendously bad rap. People have the idea that eating cholesterol is bad for them. The truth of the matter is, only the oxycholesterols are damaging. If you buy a fresh egg from the farm, like I do, and you eat that fresh egg, you can tell a difference. They are wonderful.
When the food industry adds eggs to commercially manufactured foods, the label reads “powdered eggs.” The problem is that powdered eggs are heavily contaminated with oxycholesterols.
Fried foods are also heavily contaminated with oxycholesterols. In fast-food restaurants, they cook fish or chicken, for example, in the hot oil at a very high temperature. The foods are then exposed to oxygen in the oil. Instead of throwing out the oil after each use, fast-food restaurants never throw out the old oil. The level of cholesterol oxides builds up in this oil. When they fry French fries in this contaminated oil, the French fries absorb these cholesterol oxides. So when you eat French fries from a fast-food restaurant, you are dosing yourself with these angiotoxic cholesterol oxides. These are a few of the important sources of these toxic compounds.
Q: So processed foods are one reason the American population is depleted in vitamins [B.sub.6], [B.sub.12], and folate?
A: When I read the article by H.A. Schroeder published in the American Journal of Clinical Nutrition in 1971, I knew that the homocysteine theory was correct. He was a physiologist at Dartmouth Medical College. After analyzing foods in his laboratory for various components, Schroeder showed very clearly that food processing–canning, milling of grains, processing of meats–caused major losses of [B.sub.6], folic acid, and other nutrients, like minerals, fiber, etc. His article helped explain why the population is deficient in B vitamins.
Vitamin [B.sub.12] is a large, complex molecule that is fairly stable through the harsh chemical and physical exposure in the food processing. When absorbed, the body is able to reconvert [B.sub.12] into active forms in the body, so food processing is really not a major problem with [B.sub.12]. The problem with [B.sub.12] is absorption. The Framingham heart study showed that the intake of [B.sub.12] did not correlate with homocysteine levels in their elderly Framingham participants. However, absorption was a big factor in older people who had low [B.sub.12] levels and high homocysteine levels.
Q: Is fortification of grains the answer?
A: As we point out in the book, the original formula for fortifying flour was introduced in 1941. That’s the “big four”–iron plus three other vitamins. Do you know the current number of nutrients that are used to fortify flour? Five. It’s taken 58 years for them to decide to add one micronutrient, namely folic acid. In 1974, it was proposed that the big four be expanded to ten, which would have included folic acid and [B.sub.6]. Incredibly, the Food and Nutrition Board dug in its heels and, for whatever reason, refused to expand the list to ten. More recently, the list was expanded to 22 micronutrients that should be added to refined grain products. As we point out in the book, it took 50 years to add one micronutrient. At this rate, it will be centuries before they decide to add the big ten, not to mention the 22 that are needed. This illustrates why fortification is not the answer. It may be helpful, but it’s not the total answer.
Q: Go back to the farm?
A: That’s right. Eat fresh food from the farm. When I was a teenager, I worked on my uncle’s farm in South Dakota. That’s real food. When you taste it, you know it.
Q: It’s cheaper to eat well than to take medicine.
A: As Benjamin Franklin said so well, “An ounce of prevention is worth a pound of cure.”
SPINACH PIE (Makes 8 servings)
1 pound ricotta cheese
1 cup grated cheese (feta, mozzarella,
or cheddar)
1 pound fresh spinach, cooked and
drained in cheesecloth
3 eggs lightly beaten
2 tablespoons olive oil
Optional ingredients:
1/2 cup sliced and sauteed zucchini, or
1 cup diced red or green pepper
Salt
Freshly ground black pepper
1/2 cup fresh mushrooms
Preheat oven to 350 [degrees] F. Combine ricotta, grated cheese, spinach, eggs, and 1 tablespoon olive oil in a blender or food processor. Mix until blended. Add optional ingredients at this time, and stir by hand to combine. Season with salt and pepper to taste.
Pour into a 10″ glass pie plate that has been rubbed with additional olive oil. Drizzle remaining olive oil over the top. Bake for about 45 minutes or until a knife inserted in the center comes out clean. The top will be browned. Allow to cool slightly before cutting.
SPINACH PIE (Makes 8 servings)
1 pound ricotta cheese
1 cup grated cheese (feta, mozzarella,
or cheddar)
1 pound fresh spinach, cooked and
drained in cheesecloth
3 eggs lightly beaten
2 tablespoons olive oil
Optional ingredients:
1/2 cup sliced and sauteed zucchini, or
1 cup diced red or green pepper
Salt
Freshly ground black pepper
1/2 cup fresh mushrooms
Preheat oven to 350 [degrees] F. Combine ricotta, grated cheese, spinach, eggs, and 1 tablespoon olive oil in a blender or food processor. Mix until blended. Add optional ingredients at this time, and stir by hand to combine. Season with salt and pepper to taste.
Pour into a 10″ glass pie plate that has been rubbed with additional olive oil. Drizzle remaining olive oil over the top. Bake for about 45 minutes or until a knife inserted in the center comes out clean. The top will be browned. Allow to cool slightly before cutting.
Per Serving (1/8 pie):
Calories: 238 Carbohydrate: 7.1 gm
Cholesterol: 113 mg Protein: 14.9 gm
Sodium: 230 mg Fat: 16.7 gm
Fiber: 2.3 gm
Diabetic exchange: 11/2 vegetables + 2 medium-fat
meat + 1 fat
–from The Heart Revolution
COPYRIGHT 2000 Saturday Evening Post Society
COPYRIGHT 2000 Gale Group
