Homocysteine and hip fracture

Elevated homocysteine and hip fracture are closely correlated. For men the risk is four-times; and nearly double for the ladies.

I first came into contact with this dilemma some 30 years ago when attending a lecture by a prominent researcher. He was invited to investigate why sheep brought in from the Karoo to a feedlot in the Western-Cape were fracturing their forelimbs; and walking about on their elbows, so to speak.

On examining their bones he was astonished to discover the calcium-content was high but they were extremely brittle. He went on to research their diet, finding that a Karoo lamb would be eating about 9 percent protein; but when confined in a feedlot it had been artificially raised to over 35%.

Obviously they got a lot less exercise too; couch-potatoes, so to speak.

This page was last updated by Bernard Preston on 4th March, 2024.

Homocysteine

Homocysteine is a toxic breakdown product during the metabolism of the amino-acid called methionine.

Under normal circumstances, in the presence of certain important minerals and vitamins it is immediately deactivated into Glutathione and SAMe.

However if the levels of zinc and the B vitamins riboflavin, pyridoxine or folate are low, the enzymes are unable to do their work with a consequent rise of this toxic amino-acid intermediate in the blood.

Methionine is an essential amino-acid; we cannot survive without it from our food. Those eating meat have no worries but vegetarians often get it from sesame-seeds ground into a paste called tahini; and eggs too.

Commenting in the longevity diet researchers make the point that we need low but adequate amounts of protein; too much methionine isn't good either. It is recommended that only children and the elderly have more.

Researchers report that poor renal-function is another cause of raised homocysteine and the associated risk of hip fracture^[1]. That means that prediabetics need to take note.

• A healthy diet for prediabetics
  

Homocysteine and hip fracture

Homocysteine and hip fracture can be easily modified by simple dietary intervention according to researchers reporting in the influential New England Journal of Medicine^[2].

The alternative is not only cardiovascular disease but also osteoporosis with an increased risk of hip fracture, substantial disability and high medical costs; and even death.

It is their opinion that raised homocysteine interferes with cross-linking in the collagen that forms the substrate of bony tissue, thus weakening the structure and greatly increasing the risk of a break; despite adequate calcium.

Zinc

Zinc is a vitally important mineral for optimal wellness and prevention of a hip fracture. It is known to be a cofactor in over 300 enzymatic reactions, only one of which is breaking down homocysteine; a deficiency thus has far-reaching consequences in widely diverse parts of the body.

We need to aim for at least 11mg per day. It should be easily attainable for both meat-lovers and vegetarians; but it's not.

A typical helping of beef from cattle raised on pastures, the size of the palm of your hand, three-ounces contains about 3mg or a quarter of your daily needs.

However corn-fed cattle have only a quarter of the zinc compared to those raised on pastures. Even foods such as tomatoes, squash and broccoli should have plenty of the mineral but remember it is dependent on the soil they were grown in; and some may be lost in the cooking.

In short if you are eating from a wide-range of foods you will probably be getting enough zinc. But the population at large on the modern "industrial diet" as it is being called is often deficient; raised homocysteine and hip fracture.

Be more than happy to pay extra for free-range beef, pork and chicken; and organic vegetables raised on compost.

• Free-range pork slithers with chives
  

Vitamin B2, or riboflavin

Vitamin B2 is also required for the breakdown of homocysteine to prevent hip fractures; it is involved in many other pathways in the body too. For example, it is very necessary for energy production, absorption of iron and the synthesis of antioxidants like glutathione, mentioned above.

Good sources are your greens like spinach, legumes and dairy products; chicken and eggs too. In short, provided we are eating from a wide range of foods we need have no fear of a deficiency.

Wheat bran also contains large amounts of B2, about 0.5mg per 100 grams but 90% is extracted in milling and used for animal feed^[4].

Eggs Hilton for breakfast, this divine green salad for lunch and butter chicken curry for dinner would see you home.

But a meat and potatoes man would certainly be deficient with risk of hip fracture and homocysteine cardiovascular disease too.

Vitamin B6, or pyridoxine

Pyridoxine is another of the vitamins absolutely essential for the breakdown of homocysteine and the prevention of hip fracture, cardiovascular disease and neurodegenerative conditions like Alzheimer's.

This is a subject on which the last word is yet to be written. Many folk who are eating the required daily amount of 1.7 milligrams still have very low plasma levels; and are thus susceptible to raised homocysteine and hip fracture. A deficiency will also make you anaemic as vitamin B6 is central to the manufacture of haemoglobin.

Fish, poultry and pork are all good sources; as are sweet potatoes and unrefined grains such as brown rice and our 100% wholemeal bread. Avocados and dark-green leafy vegetables like spinach again are other simple ways to increase your pyridoxine without having to take a supplement.

Grass-fed beef is also good.

Because so many people have low plasma levels of vitamin B6 we recommend you overemphasize these coloured foods. Those on the black and white diet are certainly going to be deficient.

Again a wide range of foods will keep you covered. Just feedlot meat and potatoes from cold storage are not sufficient.

It is my understanding that this paradox of seemingly sufficient in the diet, yet low plasma levels can in part be explained by the fact that there are eight different forms of pyridoxine; it is in reality a family of vitamins and each of them is important in its own right. They are found in widely divergent foods and have many dissimilar functions.

Read more about this complex subject at frailty and vitamin B6. The trick is not to get neurotic about whether you have had sufficient pyridoxine-glucoside today; you would go mad but rather to enjoy a wide range of foods.

One of the problems with supplements is that most likely they contain just one of these forms of vitamin B6. Solgar for example, a popular brand contains only pyridoxine HCl. What about the other seven?

Vitamin B9, or folate

Folate is the last of the vitamins we will be discussing in relation to homocysteine and hip fracture. However it has far-reaching benefits into many other areas of the body too, notably prevention of neural tube defects like cleft palate and spina bifida; and the formation of healthy red blood cells.

The richest sources are your legumes like lentils and chickpeas; and the dark-green leafy vegetables such as broccoli, spinach and kale.

There are many different forms of folate so to get an adequate amount we need again to be enjoying a wide range of foods.

Our authentic hummus recipe enjoyed liberally on a green salad will take you a long way home.

Wheat bran

Wheat bran makes up about 15 percent of the whole grain. Most is removed in the milling process and 90% goes to animal feed; only the food snobs^[5] actively search for unrefined flour.

Bran contains the following amounts per 100 grams.

1. 1000 mg of magnesium
2. 15 mg of zinc
3. 0.5 mg riboflavin (B2)
4. 0.8 mg pyridoxine (B6)
5. 0.5 mg folate (B9).
   

Using 100% real flour when baking bread contributes an enormous quantity of the nutrients required to break down homocysteine and help prevent hip fractures.

The bran is also where very important phytonutrients called lignans are found; they help prevent serious conditions like breast tumours and cardiovascular disease.

This blog entitled what are lignans discusses the complex subject in layman's terms.

The elderly are vulnerable

Often when a loved one has passed on, the surviving spouse could not be bothered to cook for him or herself. This is when they are particularly likely to become deficient in one or more of these vitamins and minerals that are so important in the prevention of a devastating hip fracture.

Simple balancing exercises done daily also help to prevent a fall. See newsletter #53 for more specifics^[3].

Take-home

The take-home from all of this complex science is that the elderly in particular need to be eating more greens; and in fact a wide range of coloured foods.

Adding to that legumes and whole grains as in this fried bulgur with turmeric you should have adequate protection against the risk of homocysteine and hip fracture.

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