The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
adma and sdma are cleared by the kidneys and therefore this might this is also proposed as one of the mechanisms by which impaired kidney function is is um uh impacts vascular health because that's a known right if you if your kidneys don't work well your risk of heart disease goes way up
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the thing I like about the ADM SDM a stuff even though we don't have all this great long-term data is it's one biochemical pathway that provides very clear evidence for two observations that are undeniable elevated homocysteine and renal function the SMA I'll not the ADM a but but you get both out of the but it's not like you're ordering selectively you order you get them all three and they're addressing both sides of that equation so it's a very interesting little biomarker there
Our concern is mostly through cardiovascular by the way uh because I think there we have pretty good evidence that homocysteine uh impairs the clearance of two molecules sdma and adma that impair nitric oxide synthase which obviously has an important role in the cardiovascular endothelial World
when we do see people with even compromised kidney function we generally see homosysteine go through the roof and while it might be a bit of a stretch as you recall we used to spend some time looking at uh markers I don't even want to get into it because it's such a mouthful but you you'll recall the days of asymmetric and symmetric dimethyl Arginine and we would see these things Skyrocket in people with high homosysteine because homosysteine impaired their clearance
as homocysteine is elevated it impairs the clearance of something called asymmetric and symmetric dimethyl Arginine I don't know if you've talked about adma and sdma and adma and stdma directly and indirectly inhibit nitric oxide synthes
this mechanism of homosysteine impairing the clearance of adma and sdma is the is the mechanistic link because when you directly inhibit nitric oxide synthes in the endothelium you are preventing the creation of nitric oxide