Quick Fix for Physical Function in Elderly?

Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at

Yesterday I looked at a study suggesting that MetaNx, a medical food comprised of L-methylfolate, pyridoxal-5'-phosphate, and methylcobalamin, led to a decrease hospitalization rate in those suffering from diabetic neuropathy. Coincidentally, in a cross-sectional study to be published in print next month in the American Journal of Clinical Nutrition, the authors concluded that homocysteine & folate (but not vitamin B12) were linked to physical & functional decline.

Specifically the authors evaluated 796 participants (avg 65 yo) in the Singapore Longitudinal Aging Study. After taking into account just about everything, high homocysteine & low folate were linked to decrease in physical and functional ability, as measured by Performance Oriented Mobility Assessment and self-reports of instrumental activities of daily living.

However, we need to assess the link between homocysteine, folate & physical/functional decline since all the conclusions drawn suggest a decline but no proof as to which caused the other, e.g. did an increase homocysteine & folate decrease cause the decline in function or did the decline in physical function cause the increase in homocysteine & decrease in folate? As an observational study, this can only suggest hypotheses for us to research but is clearly not proof of cause & effect. Something to mull over . . .