Taking a “medical food” product to treat hyperhomocysteinemia (HHcy) may delay the rate of brain atrophy in patients with Alzheimer’s disease and related disorders (ADRD), new research suggests.

In a study of 67 participants, those with both HHcy and ADRD who took the L-methylfolate, methylcobalamin, and N-acetyl-cysteine product for 2 years had an adjusted hippocampal atrophy rate more than 4 times slower than that in the participants with ADRD and no HHcy who did not take the prescription medical food. The rate of cortical atrophy was more than 11 times slower in the treatment group.

In addition, the rate of forebrain parenchymal atrophy was significantly less in those with HHcy who also had cerebrovascular disease (CVD).

Lead author William R. Shankle, MD, director of the Orange County Vital Brain Aging Program at the Hoag Neurosciences Institute, Newport Beach, California, told Medscape Medical Newsthat the reductions in rate of brain tissue loss “were quite dramatic” and he especially didn’t expect the cortical finding.

Dr William R. Shankle

“Seeing that big of a treatment effect with a medical food was very surprising,” said Dr Shankle, who is also the Voltmer Chair in Memory and Cognitive Disorders at Hoag Hospital.

“The take-away message…is that elevated homocysteine is common and should be regularly checked for in all persons over 50 years old, and it should be treated when found.”

The findings are published in the current issue of the Journal of Alzheimer’s Disease.

HHcy Linked to Dementia, Heart Attack, Stroke

The investigators note that HHcy has a worldwide prevalence of 5.1% to 29% in individuals who are older than 65 years. “Furthermore, the odds of brain atrophy are up to 10 times higher in HHcy patients than in those with normal homocysteine levels,” they add.

Past research has also suggested that elevated levels of homocysteine can affect cognitive impairment and other outcomes, said Dr Shankle.

“In fact, with an elevated level you’re twice as likely to become demented, twice as likely to have a heart attack, and twice as likely to have a stroke,” He continued.

Foods high in L-methylfolate include:
  • Sprouted legumes (mung bean, lentil, chickpea, etc)
  • Spinach
  • Romaine Lettuce
  • Cauliflower
  • Asparagus
  • Broccoli
  • Kale
  • Cabbage


Methycobalamin:  Vitamin B12 is naturally found in animal products, including fish, meat, poultry, eggs, milk, and milk products. Vitamin B12 is generally not present in plant foods, but fortified breakfast cereals are a readily available source of vitamin B12 with high bioavailability for vegetarians.


Cysteine is found in granola and oat flakes. Vegetables like broccoli, red pepper and onion are significant sources of cysteine. Other plant sources include bananas, garlic, soy beans, linseed and wheat germ. Cysteine and methionine are important amino acids, but deficiency is relatively rare.