Could Folic Acid Help Reduce the Rates of Autism and Schizophrenia?

Ever notice something called folic acid listed in the ingredients of your grain and cereal products? While avoiding additives has become a popular practice, you might want to think twice before putting that folic acid-enriched product back on the shelf. Unlike other common additives, folic acid has proven to be very beneficial for brain development.

It was only 20 years ago that the FDA mandated that all grain products be fortified with folic acid, a B vitamin that is known to decrease the risk of neural tube defects and spina bifida. Once implemented, folic acid fortification led to a doubling of folate levels in U.S. women and a reduced incidence of spina bifida and neural tube defects nationwide.

Folate levels have, once again, become an area of interest for a Massachusetts General Hospital -based research team after finding that increased in utero folic acid exposure is associated with changes in brain development later in life that could reduce the risk of psychosis and schizophrenia. To investigate these effects, researchers leveraged data collected at Mass General, the Philadelphia Neurodevelopmental Cohort, and the National Institutes of Health around the rapid two-year period of U.S. implementation of folic acid between 1996-1998.

Brain images taken between 1993-2001 revealed that young people born after full implementation of folic acid fortification had different patterns of cortical maturation compared with participants born before the program began. These differences were characterized by significantly thicker brain tissue and delayed thinning of the cerebral cortex in regions associated with schizophrenia. While a thinning of the cerebral cortex in school-aged children is a normal part of brain maturation – probably associated with processes like the elimination of unnecessary connections between neurons – previous studies have associated early and accelerated cortical thinning with autism and with symptoms of psychosis.

Since disorders like schizophrenia tend to develop later in life, it has been difficult to establish a cause and effect relationship between folic acid exposure and schizophrenia. However, since psychotic symptoms are related to schizophrenia, the results are promising for schizophrenia prevention. The oldest participants in these studies are now nearing the age of the greatest risk for showing symptoms of these disorders, so only time will tell if folic acid exposure does indeed have a positive effect.

“These illnesses are thought to start in the womb, so it makes sense to focus our efforts there. If even a fraction of these cases could be prevented through a benign and readily available intervention during pregnancy, it could be as transformative for psychiatry as vaccines have been for infectious disease or fluoridation for dentistry,” says Joshua Roffman, MD, MMSc, of the Mass General Department of Psychiatry.

While grains and additives have recently been getting a bad rap, next time you are adding that pasta or cereal to your grocery cart, remember those grains have been fortified with something that appears to promote healthy brain development in your children.

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