Abstract 4133: Dietary Change Induced Weight Loss Produces a Dramatic Rise in Serum Homocysteine Levels: Modification by Folic Acid and B Vitamin Supplementation
It has recently been suggested that homocysteine levels rise following bariatric- surgical induced weight loss; the mechanism by which this occurs is unclear. It is also unknown whether this occurs with dietary change induced weight loss. We followed serum homocysteine levels in 300 consecutive pts with Metabolic Syndrome and/or CAD who enrolled in a lifestye modification program that included a weight loss goal. The first 200 pts (Group A) had no high dose folic acid or B-Vitamin supplementation during initial weight loss but took a regular multivitamin; the subsequent 100 pts (Group B) received 2000 mcg Folic Acid and one B-100 tablet/day (supplying 100 mcg of each B Vitamin). Serum Homocysteine levels were measured at a single lab at baseline and every three months during followup, which now extends to 3 years. Pts ages range from 19 to 87, M/F ratio 3/2, and include all ethnicities, which did not differ between groups. Homocysteine levels rose from 9.7+/-2.1 umol/L to 14.5 +/-2.0 in the 1st 6 months of wt loss (mean 15 lbs) in Group A; in contrast, serum homocysteine levels in Group B remained constant (10.1+/-2 to 10.3+/-2.3) during the same time period despite similar wt loss (mean 17lbs) p<.0001 B vs A and A baseline vs A 6 months. At 6 months, Group A was started on Group B’s high dose regimen: at 9 months, Group A’s levels fell to 11.2+/-2.5, p<0.001 vs 6month group A. We conclude that during weight loss induced by dietary changes, serum homocysteine levels dramatically increase unless patients are given high dose folic acid and B Vitamin supplementation. Unless treated, elevated homocysteine levels induced by “healthly” weight loss, may have serious negative cardiovascular health consequences.