Homocysteine and Choline | The Paleo Diet®
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Homocysteine and Choline

By The Paleo Diet Team
February 26, 2010
Homocysteine and Choline image

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.

Regards,
Ben

Dr Cordain's Response

Hi Ben,

Good to touch bases with you and hopefully we can get together when I am in Sydney in June. Although we haven't done the computerized dietary analysis yet -- specific to homocysteine, it is almost certain that sub-arctic 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 selective 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,
Loren Cordain

Dr. Balzar's Response

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.

FoodServingTotal Choline (mg)
Beef liver, pan fried3 ounces*355
Wheat germ, toasted1 cup172
Egg1 large126
Atlantic cod, cooked3 ounces71
Beef, trim cut, cooked3 ounces66
Brussel sprouts, cooked1 cup63
Broccoli, cooked1 cup, chopped62
Salmon3 ounces56
Shrimp, canned3 ounces49
Peanut butter, smooth2 tablespoons20
Milk chocolate1.5-ounce bar20

By the way, here’s the adequate intake:

Adequate Intake (AI) for Choline
Life stageAgeMales (mg/day)Females (mg/day)
Infants0-6 months125125
Infants7-12 months150150
Children1-3 years200200
Children4-8 years250250
Children9-13 years375375
Adolescents14-18 years550400
Adults19 years and older550425
PregnancyAll ages-450
BreastfeedingAll 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,
Pedro Bastos MA MS Ph.D. candidate in Medical Sciences at Lund University, Sweden

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