Attention first turned toward homocysteine about 25 years ago, when investigators reported that a 2-month-old boy had died of homocysteinuria, a rare genetic disease that causes extremely high levels of homocysteine to accumulate in the urine and blood. Upon further examination, it was discovered that the infant's arteries were hardened and clogged. Homocysteine is an amino acid normally found in the blood, but too much of it may damage the lining of arteries and increase thrombosis (the formation of clots).

This initial link between homocysteine and premature hardening of the arteries was followed up with further studies that showed that up to 20 million Americans with heart disease also have elevated homocysteine in their blood.

Further studies showed that folic acid and vitamins B6 and B12 are needed to metabolize homocysteine to a less toxic substance. When a diet is sufficient in these vitamins, homocysteine doesn't accumulate in the blood and urine. But without them, especially folic acid, homocysteine can become toxic to the lining of the arteries, which leads to a plaque build up and eventual coronary artery disease or other types of vascular disease.

A blood test is available to test for elevated homocysteine, although it is not typically part of routine lab work. Normal serum levels should range between 4-12 umol/dl. Studies show that levels of 12 or more can increase the risk of damage to blood vessels. To help correct a folic acid deficiency, and lower homocysteine levels, make sure you have at least five servings a day of fruits and vegetables. Additionally, a recent FDA mandate has food manufactures now fortifying cereals, flours, breads, pasta, rice and other grain products with folic acid. If diet alone doesn't bring down the homocysteine, a physician may prescribe folic acid as a daily supplement. High doses of folic acid are discouraged, however, because of certain medical conditions.

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