OPTIMIZE YOUR HEALTH
Living With Celiac Disease

The Importance of Folate for Your Mood
By Jannet Huang, MD, FRCPC, FACE, ABHM

Celiac disease may have as its manifestation neuropsychiatric symptoms such as ataxia, depression, anxiety, headache or epilepsy. The frequency of this association appears to be underappreciated. Folate deficiency is often a nutritional consequence of Celiac disease, but even in those without Celiac disease, folate deficiency in the brain can contribute to mood disorders. In this issue of Behavioral Health News, we are going to explore the importance of folate for your mood.

Low serum or low red blood cell (RBC) folate levels have been reported in 15-56% of depressed patients. Low RBC folate levels are correlated with more severe depression, longer episodes and less responsiveness to SSRI antidepressant treatments. Depressed patients with low RBC folate levels have impaired synthesis and release of neurotransmitters including serotonin, norepinephrine and dopamine, all of which are important in the regulation of mood, appetite, sleep, etc.

Folic acid must be converted to L-methylfolate for biological activity and MTHFR (methyltetrahydrofolate reductase) is the enzyme responsible for this conversion. Individuals with MTHFR polymorphisms may have functional folic acid deficits despite normal blood levels. Unmetabolized folic acid is unable to cross the blood brain barrier, whereas L-methylfolate passes readily into the cerebral spinal fluid to aid in neurotransmitter synthesis.

Who is at risk for low folate levels?

• Impaired folate metabolism: Genetic polymorphism in MTHFR gene (10-12% of general population, as high as 22% in Hispanic and Mediterranean heritage)

• Chronic diseases: Atrophic gastritis, inflammatory bowel disease (Crohn’s, Ulcerative Colitis), diabetes, hypothyroidism

• Medications: Anticonvulsants, lithium, oral contraceptives, methotrexate, medications for Parkinson’s (eg. sinemet), lipid-lowering drugs, oral antidiabetic drugs (eg. metformin)

• Lifestyle: Smoking, alcohol, dietary B12/folate deficiency

When addressing depression, it is important to evaluate for nutritional deficiencies (eg. folate, magnesium, B12, iron, vitamin D etc). We at The Center for Optimal Health take the whole-person approach to wellness. Let us assist you in designing a customized program including nutrition, exercise, stress reduction, sleep improvement, vitamin/herbal supplementation and judicious use of medications.

—October 2007

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