Invasive Cardiology Procedures and Surgeries Are Not Effective

From Dr. Fuhrman's book Cholesterol Protection For Life:

Bypass surgery and angioplasty only attempt to treat a small segment of the diseased heart, usually with only temporary benefit. Since atherosclerotic plaque blankets all the vessels in the heart, bypassing or removing the most diseased portion, still does not address all the shallow and non-obstructive lipid deposits. The major burden of disease is left intact and therefore the potential for a deadly heart attack is largely unaffected. The vast majority of patients who undergo these interventions do not have fewer new heart attacks or longer survival. The procedures themselves expose the patients to more risk of new heart attacks, strokes, infection, encephalopathy, and death. In addition, the symptomatic benefits erode with time.

Since these mechanical interventions do not address the cause of the disease and only treat the symptoms it is not surprising that the patients undergoing bypass and angioplasty experience disease progression, graft shutdown, restenosis, and more procedures because their heart disease continues to advance. The vast majority of these treated patients needlessly die prematurely from heart disease because their disease remains essentially untreated.

Using surgical and high-tech interventions as a substitute for a healthful diet is doomed to fail. When extensive coronary artery disease is present and surgical/high-tech intervention occurs, we still leave the vast bulk of plaque essentially untreated because atherosclerosis is a dietary-induced disease and is spread all over the heart, not only in those areas visualized by angiograms and then treated. When we combine these marginally effective or ineffective medical interventions with the wrong dietary advice given by most doctors and dieticians (to reduce fat and cholesterol and eat less red meat and more chicken and fish) we get predictable future cardiac tragedies. Numerous studies have demonstrated that following the typical dietary recommendations of the American Heart Association to hold cholesterol to less than 200 mg per day and to reduce dietary fat to less than 30 percent doesn't work. These diets fail to realize that the nutritional cause of heart disease is not simply a question of eating less fat. Moderation kills, because heart disease still advances.

Heart attacks result from a defect in the plaque wall which leads to a thrombus (blood clot). Even a small coating of vulnerable plaque, invisible to cardiac testing, can cause a heart attack and typically does. The important point to remember is this: Individuals without major blockages of their great vessels, with only 30 to 50 percent stenosis (narrowing), are even more likely to develop a fatal cardiac event, (compared to those with more significant blockages) yet these individuals are not even shown to have heart disease with a stress test or angiography. Stress testing only identifies blockages that obstruct greater than eighty-five percent of the vessel lumen. A normal stress test is meaningless and does not mean you do not have significant heart disease or won't shortly have a heart attack.

Even coronary catherization (angiography) does not identify those smaller non-occluding atherosclerotic deposits, and therefore interventional strategies do not treat patients with shallower lesions, in spite of the fact that these are the people who suffer the most heart attacks. It is not the extent of the blockage that determines risk; it is the vulnerability of the plaque or its propensity to rupture.

Seventy to eighty percent of all myocardial infarctions (heart attacks) are caused by plaque that is not obstructive or visible on angiography or stress tests.

When atheromas (lipid deposits) first develop on the wall of a blood vessel, the walls remodel outward, preserving the lumen. These are the most vulnerable or lethal plaques and they do not obstruct or encroach on the blood flow. These heart attack prone lesions have dangerous characteristics that are not revealed by cardiac testing. A normal test by your cardiologist means very little in reassuring you about your risk of a future heart attack.

Inflammatory cells, and a large lipid core of cholesterol in the plaques is characteristic of the most dangerous lesions. The breakage or rupture of these vulnerable lesions causes heart attacks. Cardiac surgery and angioplasty does not address one's risk of a later heart attack, as it does not remove or reduce the probability that these unrecognized vulnerable plaques will rupture and create a clot. Most people think going to cardiologists and radiologists to get evaluated to see if they have a significant coronary blockage will enable an intervention at an early enough point to save their life; they are dead wrong. Angioplasties and stent placements as well as cardiac surgery treat symptoms, not the disease.

The good news is symptoms, as well as blockages, easily melt away with nutritional excellence, without any cardiac intervention. The risks and complications of cardiac interventions and bypass surgeries are simply not necessary when people adopt an effective nutritional strategy. Instead of expensive and invasive medicine, we need doctors to educate and motivate patients to take charge of their own health. While our population is committing suicide with their knives and forks, they run to doctors expecting to be saved. Unfortunately, it is almost impossible to escape from the biological laws of cause and effect. Good health has to be earned, it can't be bought.

Compelling data from numerous population and interventional studies show that the combination of a natural plant-based diet and aggressive lipid-lowering will prevent, arrest, and even reverse heart disease. Only via nutritional excellence can you address all the invisible, but potentially dangerous plaque throughout your coronary arteries. Unlike surgery and angioplasty, the dietary approach addressed in this book does not merely treat your heart, but rejuvenates all your blood vessels and protects your entire body against heart attacks, strokes, pulmonary embolisms, venous thrombosis, peripheral vascular disease, and vascular dementia. It is your most valuable insurance policy to secure a longer life free of medical tragedy.

In the 20th century, the average American diet shifted from one based on fresh, minimally processed vegetable foods to one based on animal products and highly refined, processed foods. As a result, Americans now consume far more calories, fat, cholesterol, refined sugar, animal protein, sodium, and alcohol and far less fiber and plant-derived nutrients than is healthful. Obesity, diabetes, heart disease, and cancer have skyrocketed.

Heart attacks and strokes kill more than half of the modern world today and are the largest killers of both men and women. But, the promising news is that these common causes of death are avoidable and can be effectively reversed through aggressive nutritional intervention.

By adopting a program of superior nutrition in conjunction with the judicious use of cholesterol-lowering nutritional supplements with proven cardio-protective effects, you can actually lower your cholesterol more than cholesterol-lowering drugs. It is possible to achieve an LDL cholesterol level below 100, get significantly more benefits, (almost total protection from heart attacks) and none of the risks associated with conventional drugs and invasive procedures to prevent and treat heart disease.

When it comes to your health and your heart, do not be satisfied with mediocrity. This is critical information and the most important decision you may face in your life. I encourage you to make the decision to protect yourself from the possibility of future tragedy.

Member Center: A Meat Eater's Rant

Got a question for Dr. Fuhrman? Want to ask him directly? Do you know about the “Ask the Doctor” section of DrFuhrman.com? That’s where Dr. Fuhrman can address your individual concern or inquiry. Like this one.

Recently one member wanted doctor’s reaction to this tirade by someone bashing the vegetable-based/vegan diet and promoting the advantages of gobbling up lots of animal products and organ meats. Here’s the actual rant:
It's disgraceful that you steer (or help steer) people toward veganism in your capacity as a professional nutrition consultant. No one in your profession should ever be allowed to practice if they approve of veganism as being healthy and safe for most, especially over the long haul. Meat and fish contain many nutrients that are either absent from, or present in only scarce amounts in, plant foods. Here are some examples:


Creatine is used to form adenosine tri-phosphate (ATP), our ultimate source of cellular energy. Creatine availability is critical during situations when neither fat nor glucose can be processed quickly enough to form ATP, such as during the first few seconds of high-intensity physical activities like sprinting and picking up heavy objects. Creatine supplements have been shown in numerous studies to aid performance in power-oriented sports, and to improve muscular strength in patients with congestive heart failure [Kreider RB].

Creatine only occurs naturally in animal foods, with meat by far the richest source. Not surprisingly, habitual vegetarians exhibit poorer creatine status than omnivores [Maughan RJ].

Meat, along with certain species of fish and seafood, is a rich source of taurine, an important amino acid whose concentration in eggs, milk, and plant foods ranges from negligible to none [LaidlowSA][Pasantes-Morales H]. Taurine is found in high concentrations in the heart, brain, and central nervous system, where it helps stabilize the cellular response to nervous stimulation. Taurine possesses antioxidant capabilities and has been shown in double-blind clinical trials to improve cardiac function in patients with congestive heart failure [Schaffer SW][Azuma J][Azuma J].

Taurine cannot be found in plant foods. Humans can manufacture their own taurine but with far less efficiency than herbivorous animals, as evidenced by significantly lower blood taurine levels in vegans and rural Mexican women reporting low meat intakes [Laidlaw][Pasantes-MoralesH].

Carnitine is a remarkable amino acid that plays a pivotal role in energy production, and is absolutely essential for the fat-burning process to proceed. Because of its pivotal role in energy production, high levels of carnitine are found in the heart and skeletal muscle. Clinical trials have observed markedly improved survival outcomes resulting from carnitine supplementation in patients with heart failure and coronary heart disease [Davini P][Rizos I][Singh RB][Iliceto S]. A review of the scientific literature shows that this versatile amino acid has been shown to benefit anorexia, chronic fatigue syndrome, heart disease, male infertility, sexual dysfunction and depression in aging men, and pregnancy outcomes. Exercise, even at moderate levels, can cause a significant drop in muscle carnitine levels; in patients with angina and respiratory disorders, carnitine enhances exercise tolerance [Kelly GS][Cavallini G][Gentile V].

The richest food source of carnitine, by far and away, is meat. Compared to omnivores, vegetarians repeatedly exhibit lower blood levels of carnitine [Krajcovicova-Kudlackova M][Lombard KA]. Carnitine status appears to also be worsened by the high-carbohydrate diets recommended by folks like Campbell. In healthy men receiving the same amount of dietary carnitine, blood levels of this all-important amino acid rose significantly in individuals following a high-fat, low-carb diet, while no change in carnitine levels were observed in individuals on a high carb, low-fat diet [Cederblad G].

Meat is the only food containing significant amounts of carnosine, an amino acid with some rather interesting and highly beneficial properties [Chan KM]. Carnosine is a potent antioxidant, being particularly effective in protecting cellular fats against free radical damage. Research shows carnosine may accelerate wound healing, boost the immune system, protect against cataracts, reduce gastric ulcer formation, rid the body of toxic metals, and even help fight against cancer [Hipkiss AR]. The most potent effect of carnosine however, appears to be its ability to prevent glycation, which, along with free-radical production, is a major contributor to degenerative illness and the aging process [Price DL, et al].

The potent anti-glycation effects of carnosine may explain why a comparison of vegetarians, vegans and meat-eating omnivores revealed the latter to have significantly lower levels of nasty glycation end-products known as advanced glycosylation end-products (AGEs) circulating in their bloodstreams. The difference couldn't be explained by total carbohydrate intake, blood sugar, age or kidney function, as all these variables were similar between the vegetarian and omnivorous groups [Sebekova K].

Meat, especially red meat, is the richest source of B-complex vitamins. The B vitamins perform a myriad of crucial functions in the body and requirements for these vital nutrients are dramatically increased during periods of stress, illness and physical activity. Unfortunately, the body can't store a surplus of B-vitamins for times of increased need, so optimal amounts must be consumed daily.

Meat, especially red meat, is also a rich source of iron. Iron forms an essential component of hemoglobin, the red pigment in blood that transports oxygen from the lungs to the various body tissues. Insufficient iron intake can result in impaired immune function, decreased athletic performance and lack of energy. A double-blind Swiss study of women aged 18-55 who had sought medical advice for fatigue, found that most of the women had low blood concentrations of iron. After four weeks, a significantly greater number of women receiving iron supplements reported a decrease in fatigue symptoms than those receiving placebo [Verdon F]. Australian women complaining of fatigue showed similar improvements when treated with either iron supplements or a high-iron diet [Patterson AJ].

Those who need to boost their iron stores should look to red meat rather than supplements or plant foods. When previously sedentary women were challenged with 12 weeks of aerobic exercise, a high meat diet protected iron stores more effectively than iron supplements[RM Lyle]. Heme iron (the form of iron found in meat) is far more easily absorbed by the body than non-heme iron from plant sources. Men and women on lacto-ovo vegetarian diets consistently exhibit lower blood levels of iron, even when consuming similar total amounts of dietary iron as omnivores [Alexander D][Hunt JR].

Animal foods are also by far and away the richest source of zinc. Apart from oysters, meat is the richest source of this mineral, with red meats again containing greater amounts of this mineral than white meats. Zinc is essential for optimal growth and repair, being involved in the actions of several vital hormones and hundreds of enzymatic reactions in the body. Zinc is essential for the formation of superoxide dismutase, one of the body's most potent antioxidants. Zinc deficiencies can result in growth retardation in children, significantly weakened immune function, poor wound healing and muscle loss, lowered testosterone levels and sperm counts, and have also been linked to depression and gastric cancer [Prasad AS][Brown KH][Siklar Z][Dardenne M][Ibs KH][Maes M][Nakaji S][Prasad AS][Hunt CD].

Overt zinc deficiencies are common to Third World countries where animal protein consumption is low. Milder, 'sub-clinical' zinc deficiencies also appear to be a common phenomenon in modernized nations. Those who follow low fat diets are at even greater risk of zinc deficiency [Retzlaff BM][Baghurst KI, et al].

Animal foods, most notably brains and fatty fish, are the only dietary source of long chain omega 3 fats such as DHA and EPA (special algae supplements containing LCPUFA have only recently become available). Some plant foods do contain omega-3 fatty acids, but in a form known as alpha-linolenic acid (ALA). To obtain the LCPUFA the body needs, ALA must be converted endogenously to longer-chain omega-3s such as DHA and EPA. The conversion rate, however, is very low, with clinical studies repeatedly showing that omega-3 fats from plant sources to be vastly inferior to those from animal foods when it comes to boosting long-chain omega-3 status [Fokkema MR][Francois CA][Tang AB, et al].

Numerous studies have shown that vegetarians consume far lower levels of long-chain omega-3 fats--not surprising considering their avoidance of meat and fish [Rosell MR, et al]. Studies of pregnant women show that, compared to omnivores, vegetarians have significantly lower levels of DHA in their breast milk, with vegans displaying the lowest levels of all. These negative fatty acid profiles are reflected in infants, with vegan newborns displaying significantly lower red blood cell levels of DHA. This is an ominous finding, given the critical role that omega-3 fats play in healthy immune function and cognitive development [Williams C][O'Connor DL][Helland IB][Moriguchi T][Dunstan JA].

Along with lowering one's omega-3 levels, low meat intakes also increase the concentration of omega-6 fats inside the body. A high dietary and bodily ratio of omega-6: omega-3 fats increases the risk of numerous diseases, including cardiovascular disease. A sizable portion of heart attacks are triggered when blood clots lodge themselves in narrowed coronary arteries and prevent the flow of blood to the heart, a process also known as arterial thrombosis. One of the early and key events in the development of thrombosis is platelet aggregation, the 'clumping together' of blood platelets. Researchers from Melbourne, Australia, compared heavy-meat eaters, moderate-meat-eaters, lacto-ovo-vegetarians and vegans and found that as meat consumption increased, platelet aggregation decreased. Heavy-meat-eaters displayed the lowest levels of platelet aggregation, while vegans displayed the highest levels.

While meat eaters ate more of the omega-6 fat arachidonic acid, vegetarians consumed significantly higher concentrations of the omega-6 fat linoleic acid and significantly lower amounts of long chain omega-3's. The resultant unfavorable omega-6: omega-3 is believed to be responsible for the higher levels of thromboxane A2 (TXA2) seen in the vegetarian group[Li D]. TXA2 is an eicosanoid that stimulates platelet aggregation. Chilean researchers have similarly observed significantly lower blood levels of EPA and DHA, and concomitant increases in blood platelet aggregation, among vegetarians [Mezzano D].
Now, check out Dr. Fuhrman’s response. As usual he pulls no punches in his support of the vegetable-based (and not necessarily vegan) diet:
Most people eating omnivorous diets in America are severely deficient in antioxidants and phytochemicals because of a low percentage of calories from fruits and vegetables; especially raw vegetables and green vegetables. It is this major deficiency that is a large component in the development of cancer.


Most people eating vegan, vegetarian or flexitarian diets in America are severely deficient in antioxidants and phytochemicals because of a low percentage of calories from fruits and vegetables; especially raw vegetables and green vegetables. It is this major deficiency that is the biggest factor in the development of cancer, however it has been shown that this deficiency is less compared to the meat-eating counterparts.

But since we are talking here about lifespan and not about success as a linebacker on the Chicago Bears, and since the major cause of death in America is heart disease, it is still true that a person with less B-vitamins, iron, zinc, fatty acids and amino acids on the “junkatarian” vegan diet will still have lower risk of a life threatening disease compared to the average meat-eating American.

We are not just adding up nutrients here, it is end points (age of death and cause of premature death) that should be our main consideration, not just what nutrients might be optimized with one type of diet versus another.

So, while a conventional and unsupplemented vegan diet may be low in Omega-3 fatty acids, B12, other B-vitamins, zinc, and many non-essential amino acids, there are still other advantages that make this less-than-optimal diet better than the conventional omnivorous diet. When supplemented appropriately even the conventional vegan diet would grant a higher probability of a longer life than a conventional omnivorous diet.

When we are considering my nutritional recommendations it is a horse of a different color because we are not comparing a low-nutrient vegan diet to a low nutrient omnivorous diet. We are comparing a vegetable-based vegetarian, flexitarian (near vegetarian diet) that emphasizes lots of green vegetables both raw and cooked in the menus.

Plus my conservative supplemental recommendations assure nobody is low in long-chain omega-3 fatty acids, iodine, B12 or Vitamin D. Some people call this diet-style Eat to Live to match the name of my best-selling book, but it may be more descriptively be described as a high nutrient density, vegetable-based, flexitarian diet. So let’s call it Eat to Live for simplicity here. Since green vegetables are rich in iron, zinc and B-vitamins, you can no longer critique this type of vegan diet as being low in these nutrients. The typical essential amino acids that a vegan diet is low in is lysine and methionine, but these are not deficient in a vegan diet that follows my Eat to Live recommendations as lysine is high in nuts and seeds and beans are rich in methionine and greens have both.

In other words, it would be extremely rare for someone following a truly healthy and well-designed vegan diet to be dangerously low in any essential or non-essential amino acids. When all the essential amino acids are adequately present, the non-essentials will also be produced in an adequate fashion. But even if they were relatively low in amino acids compared to a meat eater that lowness would most likely be a good thing not a bad thing because lower protein diets are linked to longer life and lower cancer risk, not the other way around.

The writer, who proposed a higher level of non-essential amino acids from animal products is favorable, may be able to show muscle growth is enhanced, but he can’t show lifespan is enhanced or cancer rates are lowered because the preponderance of the evidence shows less animal proteins, less cancer.

What is interesting is my book Eat to Live is critiqued on Amazon for not recommended the “proven” benefits of a diet containing grass-fed animal products. As if there are studies showing the consumption of more grass-fed animal products lower cancer rates or increase lifespan? People are just so ignorant about nutrition it is frightening. And, because the review is on Amazon, I cannot comment on some of those inaccurate and even ridiculous critiques.

In fact even a study this month December 2006 in the American Journal of Clinical Nutrition is just about this topic. It is a study that shows that less animal products result in less cancer and more animal protein raises IGF-1 and promotes breast and prostate cancer.

To conclude, my recommendations to eat a whole food, high vegetable, plant-based diet with less than three serving of animal products a week (vegan or flexitarian) is still hands down the most healthful diet to eat. I can’t speak on behalf of other vegetarian diets; they may be less than ideal. This does not mean that a vegan diet is healthier or more lifespan promoting compared to one that eats a small serving of animal products a few times a week. This we don’t know yet.

Here's a good article on the missing nutrients in a vegan diet go to: VeganOutReach
Be sure to click “continue reading” or “permalink” for more references and resources.
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Not Everyone Gets It

From Dr. Fuhrman's book Cholesterol Protection For Life:

What if my family, my friends and my doctor think this is not right?

Keep in mind that nutritional excellence is not for everyone. Some people will choose to smoke cigarettes, eat unhealthful, or pursue other reckless habits. Dangerous habits are powerfully addicting and some people would risk their lives rather than fight them. They have the inalienable right to live their life the way they choose. The problem is that most people have not been given a choice. They haven't been told clearly by authorities and their physicians that they have a choice to get well and enjoy life without serious illness and the real threat of an early death. Watered down, ineffective advice sells out every person hoping for life-saving answers and real help. Giving people what is socially and politically acceptable, rather than what works, causes millions to die needlessly.

I have seen people violently reject this information. This is a physical manifestation of a subconscious process. Our brains are designed to dim awareness to information that causes us anxiety; information that would require people to take action and make changes in their lives. Almost any change can be anxiety provoking. Some people may fear the loss of some beloved food, rejection of their peers or some other irrational consequence. In response, to these subconscious objections many people will chose to ignore or degrade the importance of this message. This may be even more apparent in people who don't think they have imminent health issues. Don't let this happen to you.

Unhealthy foods are a slow-working poison. Many ailments related to food take years to develop; these ailments often won't display visible symptoms until they are well advanced. The only visible issue for most people is their excess weight.

Studies have shown that most overweight people routinely underestimate the extent of their obesity. They don't see themselves as overweight. Consequently, it is not too difficult to imagine how so many can ignore the evidence. They don't see what it has to do with them.

People do the same with their heart disease risk factors. They ignore the threat upon their lives from high cholesterol and they don't act to protect their lives, often until it is too late.

The decision to ignore this information happens on a subconscious level. A multitude of other diets promise weight loss and good health without changing the way you eat. This promise alone is enough to keep people from doing the work to change; it gives our subconscious minds a way out. The allure to the subconscious mind does not have to be logical, and when the mis-information about nutrition is popular or supported by a celebrity, all the more alluring.

The good news is that you do have control over your health and your weight. You are not at the mercy of your genes or your subconscious mind. And you do not have to get the diseases other Americans (including your doctor) do. Heart diseases, strokes, cancer, dementia, diabetes, allergies, arthritis, and other common illnesses are not predominantly genetic; rather they are the result of incorrect dietary choices.

Disease and a premature death are not inevitable. They are however the inevitable consequence of eating a disease-causing diet that Americans and other modern societies eat. We dig our graves with our knives and forks. On the other hand, we have an unprecedented opportunity in human history to use science to live longer and achieve health unobtainable by prior generations. We are only given one body in this lifetime, so take proper care of it. I urge you to become an example of excellent health which will encourage others to take your lead.

Heart Health: Folic Acid Supplementation

Now here’s a question you don’t hear everyday: How effective are folic acid supplements for maintaining a healthy heart? Uh, I don’t know. I wonder what the experts are saying. Serena Gordon of HealthDay News reports some health researchers aren’t exactly impressed with folic acid supplementation:
"Consuming a supplement of folic acid is probably not going to mitigate your risk of cardiovascular disease," said the study's lead author, Dr. Lydia Bazzano, an assistant professor of epidemiology at Tulane University School of Public Health and Tropical Medicine, in New Orleans…


… According to Dr. Stephen Siegel, a cardiologist at New York University Medical Center in New York City: "The whole concept [of folic acid supplementation] began because we know there's an association between homocysteine levels and atherosclerotic disease, and we know that we can safely lower homocysteine with folic acid. But we don't know if there's a cause-and-effect relationship between homocysteine and cardiovascular disease, or simply an association. Many doctors jumped on the bandwagon, however, because folic acid didn't have the potential to do any harm, but it looked like it might help."
Okay, so far we’ve got two thumbs down. Let’s see what Dr. Fuhrman has to say about folic acid supplements for heart health. In Cholesterol Protection For Life it comes up during his analysis of high homocysteine levels:
Consider an abnormal homocysteine that may require treatment above 15, not above 10. Levels between 10 and 15 have not been consistently associated with worse outcomes.1

If one homocysteine is elevated above 15, make sure a blood level of B12, and MMA (methlymalonic acid) and a folate level is drawn.

Mild elevations of homocysteine between 10 and 15 do not appear to place people at higher risk. In most of these cases, the mild elevation is just a marker for a low nutrient diet in general and the correct treatment is the improvement of the entire diet, not just a supplement to lower homocysteine. Folate alone in these cases cannot compare with the value of actually eating a diet rich in folate and gaining all the other essential cardio-protective compounds that are found in natural plant foods. It is similar to taking a cholesterol-lowering drug instead of eating healthfully; a pill cannot take the place of the full symphony of dietary elements that contribute to heart and vascular health.

When the abnormality (elevated homocysteine) is due to B12 deficiency it is wise to take more B12. Whether you are consuming sufficient B12 or not is best ascertained by a normal MMA (methylmalonic acid) because a B12 level in the 200 to 400 range, which is considered in the normal range could still be abnormal. Paradoxically, MMA is actually a better marker for B12 deficiency than B12 itself. If the MMA is elevated a B12 deficiency exists, even if the B12 is in the normal range. When this is the case, extra B12 is the correct treatment for the elevated homocysteine.

If the folate level is excellent (15 – 25) and the B12 level is normal (as documented with a normal MMA) and the homocysteine is still significantly elevated,then the cause of the elevation is most likely a genetic defect in folate conversion. In this case, folate (or folic acid) supplementation may not be totally effective; because the patient is just taking more of the folate that they don’t convert effectively to begin with. They don’t need more folate, rather they need more of the biologically active form of folate that they don’t make well (called methyl tetrahydrofolate or formyl tetrahydrofolate.)

So if the B12 is normal and the folate is normal, and the homocysteine is still significantly elevated, it may make more sense to take a supplement containing additional tetrahydrofolate, and not just pile on huge doses of folate (folic acid) attempting to drive the homocysteine down with overwhelming high doses of folate.

In conclusion, it is wise to target therapy based on known deficiencies and not just blanket patients with high dose supplements that they do not need. Nevertheless, an attempt to uncover the cause of the homocysteine elevation and lower it accordingly may be an important intervention for patients with unique needs.
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