With June being Brain Injury Awareness month it seems fitting to discuss Traumatic Brain Injury (TBI) and specifically mild TBI (aka concussion). With the goal of spreading awareness, it’s important to recognize important facts about concussion, how it can be misdiagnosed, and a few areas of research that need more attention. The Brain Injury Association of Canada estimates that there are over 165,000 concussions a year in Canada, this translates into 452 new brain injuries a day. They go on to report that in Ontario 92% of men and 100% of woman who sustain a TBI never return to full
Schizophrenia affects about 1% of the Canadian population. This number is continually growing and Canada has over 1 more case of Schizophrenia per 1,000 people, than the rest of the world.
Schizophrenia is a mental illness that seems to be a mystery to scientists and researchers; it’s often referred to as a puzzle with missing pieces. It is a complex disorder involving numerous biochemical pathways and neurotransmitters. There currently is no cure for Schizophrenia, but medication has been shown to help decrease the risk of relapse by about 60%.
Recent research has emerged involving the use of folate and Vitamin B12 in combination with antipsychotic medication, for patients dealing with Schizophrenia. Researchers have found when they added folate and vitamin B12 to standard anti-psychotic treatment protocols, it led to improvements in schizophrenia symptoms from decreased emotional expressiveness, apathy to social withdrawal.
However, they did find that the results were most significant in individuals carrying specific variants in genes involving folate metabolism. In patients where there was not an issue in genetic folate metabolism, the degree of improvement was not statistically significant.
They followed 140 participants at community health centres, to receive daily doses of folate and Vitamin B12 or placebo for a period of 16 weeks. They found for those that received improvement from the treatment, it took the full 16 weeks of supplementation for the improvement in symptoms to occur.
Folate has often been thought of as a possible ‘missing puzzle’ piece to Schizophrenia. A 2008 study reported low blood levels of folate in people suffering from schizophrenia, in which poor dietary intake has been a confirmed epidemiological factor. This highlights the potential role for supplemental folate as an important piece to a schizophrenia treatment protocol.
Folate is extremely important in the synthesis of DNA and neurotransmitters. It is also an important player in methylation and for keeping levels of homocysteine low (along with additional important methylators like Methylcobalamin, Vitamin B6 and others). Researchers have shown that when homocysteine is high, the functioning of brain receptors called NMDA become interfered with. NMDA is crucial to processes such as memory, learning, brain development and general neural processing.
Folate/Folic Acid becomes quite interesting in its importance for schizophrenia, when you pair this with data showing folic acid deficiencies in pregnancy might play a role in a child’s risk of developing schizophrenia later in life; and a meta-analysis showing when a mutation in MTHFR C677T (a gene involved in proper folate metabolism and its proper activity in the brain) is present, there is an association between [this genetic mutation] and numerous psychiatric disorders like schizophrenia, depression, and bipolar disorder. It has been shown that those MTHFR variants can lead to elevated levels of homocysteine in people who have the genetic defect. [See Dr. McIntyre’s blog post on homocysteine]
The pregnancy study highlights the importance of folic acid in pregnancy, beyond just prevention of neural tube defects; but highlighted in the research, the importance of proper methylation and a low homocysteine levels, as a preventative factor for conditions such as schizophrenia.
The association between the genetic mutation and psychiatric disorders shows a key theory of why supplementation
with 5-MTHF as a folate supplemental source, might provide better outcomes and act as a more usable form of folate.
If you are thinking about adding folate and/or vitamin B12 to your treatment regime, alongside anti-psychiotic medications, please consult your health care provider.
Public Health Agency of Canada: http://www.phac-aspc.gc.ca/pub…
Prof Stefan Leucht MD, Magdolna Tardy MSC, Katja Komossa MD, Stephan Heres MD, Werner Kissling MD, Georgia Salanti PhD, Prof John M Davis MD. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. The Lancet . May 2012, doi:10.1016/S0140-6736(12)60239-6
Joshua L. Roffman et al. Randomized Multicenter Investigation of Folate Plus Vitamin B12 Supplementation in Schizophrenia. JAMA Psychiatry, 2013 DOI: 10.1001/jamapsychiatry.2013.900
Picker JD, Coyle JT. Do maternal folate and homocysteine levels play a role in neurodevelopmental processes that increase risk for schizophrenia? Harv Rev Psychiatry. 2005 Jul-Aug ; 13(4): 197-205
Am. J. Epidemiol. (2007) 165 (1): 1-13. doi: 10.1093/aje/kwj347 First published online: October 30, 2006. http://aje.oxfordjournals.org/content/165/1/1.long Circulation. 2005; 111: e289-e293. http://circ.ahajournals.org/co…
NARSAD, The Mental Health Research Association (2008, June 4). Folate As A Cause And Treatment For Schizophrenia: Who Will Benefit? Science Daily. Retrieved March 14, 2013, from http://www.sciencedaily.com /releases/2008/06/080604155820.htm