Medical foods for lowering homocysteine in hypertensive patients

6 Medical foods are not drugs, they are natural food constituents in higher concentrations than found in the diet, manufactured to high purity standards, and only available from physicians or pharmacies. 6 In addition to meeting the general criteria for medical foods, ideally the medical foods for homocysteine would contain vitamin B2, riboflavin; vitamin B9, L-methylfolate; and n-acetylcysteine, NAC. DHFR19del further accounts for the failure of folic acid to maximally reduce homocysteine reported by Du et al. 7,8 MTHFR folate polymorphisms are known to be associated with increased homocysteine and risk of hypertension. 7–11 Unlike folic acid, L-methylfolate is unaffected by DHFR and MTHFR polymorphisms and has superior effectiveness for lowering homocysteine, even in patients with advanced renal disease. 8,10–12 L-methylfolate is a natural food folate with no upper limit safety concerns, unlike folic acid, with the dual benefit of lowering blood pressure.8,12,13 This suggests that future folate trials should use L-methylfolate rather than folic acid. Riboflavin and n-acetylcysteine, NAC, are also associated with dual homocysteine and blood pressure reduction. 1,10,11,14 Ischemic stroke is a dreaded complication of hypertension. [...]it is important to note that NAC also reduces thrombolysis and stroke volume without increasing hemorrhagic complications. 14,15 In view of this literature, we are of the opinion that L-methylfolate, riboflavin, and NAC should be part of non-drug strategies for lowering homocysteine in hypertensive patients. TABLE 1 Recommended medical foods for lowering of homocysteine Product Metanx® Cerefolin® NAC Ocufolin® a Classification Medical Food Medical Food Medical Food Form Tablet/Capsule Tablet/Capsule Capsule Key Ingredients for Homocysteine Reduction Vitamin B12 (cobalamin) 2.0 mg Methylcobalamin 2.0 mg Methylcobalamin 1.5 mg Methylcobalamin Vitamin B9 (folate) 3 mg L-methylfolate 6 mg L-methylfolate 2.7 mg L-methylfolate Vitamin B6 (pyridoxal/pyridoxine) 35 mg Pyridoxal 5- phosphate 9 mg Pyridoxal 5-phosphate Vitamin B2 (riboflavin) 30 mg Riboflavin N-Acetylcysteine 600 mg 540 mg Other Ingredients Vitamin B1 (thiamin) 4.5 mg Thiamine Vitamin B5 (pantothenate) 15 mg Pantothenic Acid Vitamin C (ascorbic acid) 135 mg Vitamin D3 (cholecalciferol) 112.5 mcg Vitamin E (d-alpha tocopherol) 15.08 mg Zinc 80.25 mg Copper 2 mg Selenium 60 mcg Lutein 10.05 mg Zeaxanthin 2.1 mg Proprietary 90.314 mg of Algae-S Powder (Schizochytrium) 90.