What do health pro­fes­sion­als truly think of the Pa­leo diet, and what is ho­mo­cys­teine, ex­actly?


Jonny Bowden digs into the sci­ence be­hind the Pa­leo diet and ho­mo­cys­teine.

Q: What is ho­mo­cys­teine? Do I need to worry about it?

Ho­mo­cys­teine is a nor­mal by-prod­uct of pro­tein me­tab­o­lism. It be­comes a prob­lem when the body isn’t able to get rid of it, in which case it ac­cu­mu­lates in the blood­stream. And that’s de­cid­edly not a good thing. El­e­vated ho­mo­cys­teine lev­els are a sig­nif­i­cant risk fac­tor for heart dis­ease and stroke. El­e­vated ho­mo­cys­teine is also as­so­ci­ated with in­flam­ma­tion, de­pres­sion and de­men­tia.

High ho­mo­cys­teine is typ­i­cally treated with a trio of B vi­ta­mins, specif­i­cally folic acid (in its bioac­tive form ,5- methyl tetra hy­dro fol ate, or 5-MTHF), vi­ta­mins B6 and B12. Th­ese are the nu­tri­ents that are needed to me­tab­o­lize ho­mo­cys­teine and clear it from the blood­stream, and they’re of­ten lack­ing when your ho­mo­cys­teine is high.

Ho­mo­cys­teine can be mea­sured by a sim­ple and in­ex­pen­sive blood test that can be or­dered by your doc­tor. Lev­els above 13 to 15 µmol/L are con­sid­ered high, and lev­els be­low 10 to 12 µmol/L are con­sid­ered nor­mal. (In func­tional and in­te­gra­tive medicine and nu­tri­tion, we like to see lev­els un­der 10 µmol/L.)

The dis­cov­ery of ho­mo­cys­teine is an in­ter­est­ing story and a les­son in how con­ser­va­tive the con­ven­tional medicine es­tab­lish­ment can be. Ho­mo­cys­teine was dis­cov­ered in 1969 by a re­search sci­en­tist at Har­vard Uni­ver­sity, Kilmer McCully, MD. Dr. McCully no­ticed that young peo­ple stricken with heart dis­ease had one thing in com­mon – very high lev­els of this weird thing in the blood called ho­mo­cys­teine. He thought that ho­mo­cys­teine might

be as good as or bet­ter than choles­terol as a pre­dic­tor of heart dis­ease, a hereti­cal the­ory that chal­lenged the es­tab­lish­ment the­ory of choles­terol as the main player in heart dis­ease and that lit­er­ally got McCully driven out of Har­vard.

About 25 years later, ho­mo­cys­teine had come to be ac­cepted by that same es­tab­lish­ment as the risk fac­tor McCully al­ways knew it was. Dr. McCully was wel­comed back to Har­vard where he serves part-time as as­so­ci­ate clin­i­cal pro­fes­sor of pathol­ogy at Har­vard Med­i­cal School in ad­di­tion to his day job work­ing at the US Depart­ment of Vet­er­ans Af­fairs Med­i­cal Cen­ter.

Q: What do doc­tors, nu­tri­tion­ists and other health pro­fes­sion­als think of the Pa­leo diet?

The US News and World Re­port ranked the Pa­leo diet num­ber 32 out of 40 in their “Best Di­ets Over­all” list. I – and hun­dreds of my col­leagues – think they have their prover­bial heads up their prover­bial der­ri­eres. If that kind of ro­bust dis­agree­ment among health pro­fes­sion­als sur­prises you, read on.

The ba­sic as­sump­tion of your ques­tion is that doc­tors, nu­tri­tion­ists and other health pro­fes­sion­als are a sin­gle, uni­fied, ho­mo­ge­neous group and agree on ba­sic prin­ci­ples of nu­tri­tion. That couldn’t be fur­ther from the truth. (About the only thing ev­ery­one agrees on is that veg­eta­bles are good for you.) We dis­agree as of­ten as the mem­bers of congress, and some­times just as ve­he­mently.

Medicine and nu­tri­tion have their “left wing” and “right wing” sides, just as pol­i­tics does. Con­ven­tional medicine and di­etet­ics tends to be “cen­ter right.” The con­ser­va­tive fac­tion defends old bro­mides like that vi­ta­mins give you ex­pen­sive urine, low-fat di­ets are good for you, sat­u­rated fat is bad, and you need carbs for en­ergy.

The “left” side has a much dif­fer­ent view. This fac­tion rec­og­nizes that the Stan­dard Amer­i­can Diet (SAD) is a com­plete dis­as­ter, be­lieves that sugar – not fat – is the true enemy of health, and that our genes are not suited to a diet high in pro­cessed car­bo­hy­drates like ce­re­als. This side has a slightly skep­ti­cal view of much of con­ven­tional wis­dom when it comes to diet, cit­ing the aw­ful 1992 USDA Food Pyra­mid as a case in point. I am very much a mem­ber of this “left wing” party.

So from the point of view of the med­i­cal and nu­tri­tion pro­fes­sion­als I know and work with, the Pa­leo diet ranks very high. It’s not just a fad but a re­turn to a diet in which we ate mainly from what I call “The Jonny Bowden Four Food Groups,” or foods you can hunt, fish, gather or pluck. That’s what kept our hu­man an­ces­tors alive, and it makes a lot more sense to me than a diet based on things like low-fat milk, ce­real and pro­cessed soy burg­ers.

JONNY BOWDEN, PhD, CNS Board-cer­ti­fied nu­tri­tion spe­cial­ist, mo­ti­va­tional speaker, au­thor and ex­pert in the ar­eas of weight loss and health.

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