Folic acid and brain health--don't forget it!

As my last post discussed, depression is not just about mood. It's about the integrity of neurons and the systems that support them. One very strong connection that research is increasingly supporting, is the link between depression and inflammation. Inflammatory markers commonly used to identify heart disease, such as homocysteine, are being correlated as well with depression.

Here, 27 subjects were divided into two groups. One group was given fluoxetine (Prozac) and folic acid, while the other was given fluoxetine and placebo. (Folic acid was given because it has been shown to help prevent elevated homocysteine.) Another 15 subjects were given nothing at all, for a basis of comparison.

As happens in cardiovascular studies using folate as an intervention, plasma homocysteine levels dropped with folate supplementation. The interesting finding, however, was that when subjects took the Hamilton Depression Rating Score, those who had received the folate showed greater improvement than those who only received the fluoxetine. There was no significant difference in serotonin levels, so the researchers concluded that folate was not affecting the mechanism by which fluoxetine works.

So the bottom line seems to be...you can't just fix depression with a pill. How you take care of yourself (i.e., how you choose to eat) can be a crucial factor in whether or not your brain works at its absolute best.

If you want to add more folate to your diet, here are your best food choices: fortified breakfast cereal, whole wheat products, meat, beans, liver, eggs, sunflower seeds, asparagus, leafy green vegetables, oranges, strawberries, melons.

Resler G, Lavie R, Campos J, Mata S, Urbina M, García A, Apitz R, Lima L. Effect of folic acid combined with fluoxetine in patients with major depression on plasma homocysteine and vitamin B12, and serotonin levels in lymphocytes. Neuroimmunomodulation. 2008;15(3):145-52. Epub 2008 Aug 21.

Hyperglycemia-induced membrane lipid peroxidation and elevated homocysteine levels are poorly attenuated by exogenous folate in embryonic chick brains

Today I wanted to share some recent findings about the effects of elevated glucose on a developing baby's nervous system. I often think we start too late when looking for origins of many medical issues. I've learned to start way back in utero when evaluating a situation and trying to sort through what's going on. Here's an example of why that can be important.

A group of chick eggs were injected with glucose. Significant changes were found in the babies that developed from those eggs, including:
--their own hyperglycemia
--elevated oxidative (degenerative) activity in body and brain tissue
--lower body weight
--lower brain weight
There also seems to be lower levels of DHA in babies exposed to hyperglycemia. This may be due to the elevated oxidative activity destroying any DHA that might be there.

You're likely aware that taking folate is pretty much an across the board recommendation to pregnant women. In this study, hyperglycemia seemed to induce a level of oxidation/inflammation that was not significantly helped with a folate supplement.

Bottom line, it's important to eat well not just to avoid weight gain or to keep your blood sugar low to keep your doctor and dietitian happy, but because your baby's brain and body depend on you to do so.

Most of my clients express surprise that healthy eating includes as many tasty foods as it does. So before you write off a visit to the dietitian because you're afraid of what you WON'T be able to eat, consider that it may be your ticket to freedom and guilt relief to work with someone who can introduce you to the many foods that will BENEFIT you and baby!

Cole NW, Weaver KR, Walcher BN, Adams ZF, Miller RR Jr. Hyperglycemia-induced membrane lipid peroxidation and elevated homocysteine levels are poorly attenuated by exogenous folate in embryonic chick brains. Comp Biochem Physiol B Biochem Mol Biol. 2008 Jul;150(3):338-43.

For women with epilepsy--get the facts straight before you worry

Here's an interesting abstract. I post it partly for the important medical information it provides but also to comment on the interesting editorial twist that may affect how readers interpret the information.

The subjects: women with epilepsy and the children they bore.
The question: whether epilepsy affects the development of those children. (As quoted by the authors of the study, "We aimed to ascertain the prevalence of cardiac malformation (CM) and its association with antenatal exposure to an antiepileptic drug (AED) in infants of mothers with epilepsy.")

At 3 months of age, 462 babies born to mothers with epilepsy were examined by a cardiologist to see if they had at least one of several heart defects: atrial septal defect, tetrology of Fallot, patent ductus arteriosus, pulmonic stenosis, ventricular septal defect, tricuspid regurgitation, and transposition of great arteries. Possible correlations between the existence of these defects and any of the following were evaluated: mother's epilepsy history, use of antiepileptic medications in the first trimester of pregnancy, mother's age, seizure frequency during pregnancy, and folate supplementation.

There were a few significant relationships. Prematurely born children were more likely to have heart defects. Use of more than one medication was also a significant contributing factor. And there was a trend, though not significant, for children whose mothers who had used valproic acid (Depakote) to have heart defects. No relationships to mother's age, epilepsy history, seizure frequency, or folate usage were noted.

So even though there were only three identified contributing factors, two of which involved antiepileptic medications, the authors were allowed to title their publication in a way that somewhat masked this relationship. It also, for someone skimming research abstracts, could lead to an impression that epilepsy itself, and not the way in which epilepsy is treated, is the problem.

I am a diligent scientist and try to get the facts straight before I put anything on this blog, or in anything I write. But anyone reading this blog knows that all you have to do is turn on the evening news and see how vague headlines become top news stories and "facts" are generated without any meat behind them.

It's simply not fair to generalize to all mothers with epilepsy. There were an awful lot of babies in this study who did not have heart defects, 426 to be exact. That's a lot of unnecessary fear to be putting out there for women with epilepsy. Of course, the take home message is that women of childbearing age may not be the most appropriate candidates for valproic acid, but somehow that got lost in the analysis.

Thomas SV, Ajaykumar B, Sindhu K, Francis E, Namboodiri N, Sivasankaran S, Tharakan JA, Sarma PS. Cardiac malformations are increased in infants of mothers with epilepsy. Pediatr Cardiol. 2008 May;29(3):604-8.

Epilepsy, medications, heart disease, and dietary strategies

In recent years, researchers have identified that elevated homocysteine levels are associated with cardiovascular risk. This compound builds up in the blood when it cannot be converted into methionine. Two important nutrients, folate, and vitamin B-12, are important in this chemical reaction; when deficient, homocysteine can accumulate and cause problems.

For people with epilepsy, this is important to know, as some common epilepsy medications can decrease folate and vitamin B-12 levels, and in turn increasing cardiovascular risk.

In a recent study, children receiving carbamazapine (Tegretol) and valproate(Depakote) had statistically lower folate and higher homocysteine levels than children without epilepsy who were not on these medications.

There are several strategies you might consider if your child needs to be on these medications:

1. Give your child a daily multivitamin supplement containing folate and vitamin B-12.
2. Know your dietary sources of folate and include them in your family's meals on a regular basis: fortified cereal, sunflower seeds, dried beans and peas, and leafy greens.
3. Know your dietary sources of vitamin B-12 and include them in your family's meals on a regular basis, namely meat and dairy products.
4. Consider using a fish oil supplement. Their omega-3 fatty acids have shown promise in helping to control seizures. Using the supplement may not eliminate the need for the medication, but it may reduce the necessary dose and therefore reduce the associated side effects.
5. Limit the use of pro-inflammatory fats and oils, as they reduce the effectiveness of omega-3 fatty acids. They're easy to remember: any oil, alone or in food, beginning with the letters "S" or "C". The only exception to this is canola oil.

Vurucu S, Demirkaya E, Kul M, Unay B, Gul D, Akin R, Gokçay E. Evaluation of the relationship between C677T variants of methylenetetrahydrofolate reductase gene and hyperhomocysteinemia in children receiving antiepileptic drug therapy.Prog Neuropsychopharmacol Biol Psychiatry. 2008 Jan 28