tag:theconversation.com,2011:/us/topics/folate-21425/articlesFolate – The Conversation2023-11-29T13:38:49Ztag:theconversation.com,2011:article/2113962023-11-29T13:38:49Z2023-11-29T13:38:49ZMicroRNA is the master regulator of the genome − researchers are learning how to treat disease by harnessing the way it controls genes<figure><img src="https://images.theconversation.com/files/561973/original/file-20231127-27-vqtw0l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">RNA is more than just a transitional state between DNA and protein.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/molecule-of-mrna-illustration-royalty-free-illustration/1450368774">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p>The Earth <a href="https://www.scientificamerican.com/article/evolution-of-earth/">formed 4.5 billion years ago</a>, and life less than a billion years after that. Although life as we know it is <a href="https://sciencing.com/abundant-organic-compound-earth-22851.html">dependent on four major macromolecules</a> – DNA, RNA, proteins and lipids – only one is thought to have been present at the beginning of life: RNA. </p>
<p>It is no surprise that <a href="https://www.khanacademy.org/science/ap-biology/natural-selection/origins-of-life-on-earth/a/rna-world">RNA likely came first</a>. It is the only one of those major macromolecules that can both replicate itself and catalyze chemical reactions, both of which are essential for life. Like DNA, RNA is made from individual nucleotides linked into chains. Scientists initially understood that genetic information flows in one direction: DNA is transcribed into RNA, and RNA is translated into proteins. That principle is called the <a href="https://www.genome.gov/genetics-glossary/Central-Dogma">central dogma of molecular biology</a>. But there are many deviations.</p>
<p>One major example of an exception to the central dogma is that some RNAs are never translated or coded into proteins. This fascinating diversion from the central dogma is what led me to <a href="https://scholar.google.com/citations?user=4JMQMLgAAAAJ&hl=en">dedicate my scientific career</a> to understanding how it works. Indeed, research on RNA has lagged behind the other macromolecules. Although there are multiple classes of these so-called noncoding RNAs, researchers like myself have started to focus a great deal of attention on short stretches of genetic material called <a href="https://www.ibiology.org/genetics-and-gene-regulation/introduction-to-micrornas/">microRNAs</a> and their potential to treat various diseases, including cancer.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/t5jroSCBBwk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">MicroRNAs play a key role in regulating gene expression.</span></figcaption>
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<h2>MicroRNAs and disease</h2>
<p>Scientists regard microRNAs as <a href="https://doi.org/10.1146/annurev-pharmtox-010510-100517">master regulators of the genome</a> due to their ability to bind to and alter the expression of many protein-coding RNAs. Indeed, a single microRNA can regulate anywhere from 10 to 100 protein-coding RNAs. Rather than translating DNA to proteins, they instead can bind to protein-coding RNAs to silence genes. </p>
<p>The reason microRNAs can regulate such a diverse pool of RNAs stems from their ability to bind to target RNAs they don’t perfectly match up with. This means a single microRNA can often regulate a pool of targets that are all involved in similar processes in the cell, leading to an enhanced response.</p>
<p>Because a single microRNA can regulate multiple genes, many microRNAs can contribute to disease when they become dysfunctional.</p>
<p>In 2002, researchers first identified the role dysfunctional microRNAs play in disease through patients with a type of blood and bone marrow cancer called <a href="https://doi.org/10.1073/pnas.242606799">chronic lymphocytic leukemia</a>. This cancer results from the <a href="https://doi.org/10.1038/cdd.2009.69">loss of two microRNAs</a> normally involved in blocking tumor cell growth. Since then, scientists have identified <a href="https://mirbase.org/browse/results/?organism=hsa">over 2,000 microRNAs in people</a>, many of which are altered in various diseases. </p>
<p>The field has also developed a fairly solid understanding of how microRNA dysfunction contributes to disease. Changing one microRNA can change several other genes, resulting in a plethora of alterations that can collectively reshape the cell’s physiology. For example, over half of all cancers have significantly reduced activity in a <a href="https://doi.org/10.3389/fcell.2021.640587">microRNA called miR-34a</a>. Because miR-34a regulates many genes involved in preventing the growth and migration of cancer cells, losing miR-34a can increase the risk of developing cancer.</p>
<p>Researchers are looking into using microRNAs as therapeutics for cancer, heart disease, neurodegenerative disease and others. While results in the laboratory have been promising, bringing microRNA treatments into the clinic has <a href="https://doi.org/10.1016/j.tig.2022.02.006">met multiple challenges</a>. Many are related to inefficient delivery into target cells and poor stability, which limit their effectiveness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/561975/original/file-20231127-26-jqjjuh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram showing a loop of microRNA binding to a strand of mRNA as it's being translated from DNA" src="https://images.theconversation.com/files/561975/original/file-20231127-26-jqjjuh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561975/original/file-20231127-26-jqjjuh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561975/original/file-20231127-26-jqjjuh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561975/original/file-20231127-26-jqjjuh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561975/original/file-20231127-26-jqjjuh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561975/original/file-20231127-26-jqjjuh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561975/original/file-20231127-26-jqjjuh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">MicroRNA can silence genes by binding to mRNA.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Conceptual_overview_of_multiomics_-_digital_skewed.png">Kajsa Mollersen/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Delivering microRNA to cells</h2>
<p>One reason why delivering microRNA treatments into cells is difficult is because microRNA treatments need to be delivered specifically to diseased cells while avoiding healthy cells. Unlike <a href="https://theconversation.com/how-mrna-and-dna-vaccines-could-soon-treat-cancers-hiv-autoimmune-disorders-and-genetic-diseases-170772">mRNA COVID-19 vaccines</a> that are taken up by scavenging immune cells whose job is to detect foreign materials, microRNA treatments need to fool the body into thinking they aren’t foreign in order to avoid immune attack and get to their intended cells.</p>
<p>Scientists are studying various ways to deliver microRNA treatments to their specific target cells. One method garnering a great deal of attention relies on directly <a href="https://doi.org/10.1093/narcan/zcab030">linking the microRNA to a ligand</a>, a kind of small molecule that binds to specific proteins on the surface of cells. Compared with healthy cells, diseased cells can have a disproportionate number of some surface proteins, or receptors. So, ligands can help microRNAs home specifically to diseased cells while avoiding healthy cells. The first ligand approved by the U.S. Food and Drug Administration to deliver small RNAs like microRNAs, <a href="https://doi.org/10.1007/s40265-020-01269-0">N-acetylgalactosamine, or GalNAc</a>, preferentially delivers RNAs to liver cells.</p>
<p>Identifying ligands that can deliver small RNAs to other cells requires finding receptors expressed at high enough levels on the surface of target cells. Typically, <a href="https://doi.org/10.1038/nrd4519">over one million copies per cell</a> are needed in order to achieve sufficient delivery of the drug.</p>
<p>One ligand that stands out is <a href="https://theconversation.com/adding-folic-acid-to-staple-foods-can-prevent-birth-defects-but-most-countries-dont-do-it-55533">folate, also referred to as vitamin B9</a>, a small molecule critical during periods of rapid cell growth such as fetal development. Because some tumor cells have over one million folate receptors, this ligand provides sufficient opportunity to deliver enough of a therapeutic RNA to target different types of cancer. For example, my laboratory developed a new molecule <a href="https://doi.org/10.1126/scitranslmed.aam9327">called FolamiR-34a</a> – folate linked to miR-34a – that reduced the size of breast and lung cancer tumors in mice.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/561976/original/file-20231127-18-5pbfrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image juxtaposing endothelial cells sprouting extensions to form new blood vessels and a cell bathed in microRNA unable to sprout" src="https://images.theconversation.com/files/561976/original/file-20231127-18-5pbfrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561976/original/file-20231127-18-5pbfrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561976/original/file-20231127-18-5pbfrd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561976/original/file-20231127-18-5pbfrd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561976/original/file-20231127-18-5pbfrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561976/original/file-20231127-18-5pbfrd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561976/original/file-20231127-18-5pbfrd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tumors can exploit healthy cells to grow blood vessels that provide them nutrients, as seen in the endothelial cells to the left sprouting extensions. Exposing these cells to certain microRNAs, however, can disable that growth, as seen in the cell to the right.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/2hrJ3g4">Dudley Lab, University of Virginia School of Medicine/NIH via Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<h2>Making microRNAs more stable</h2>
<p>One of the other challenges with using small RNAs is their <a href="https://doi.org/10.1093/narcan/zcab030">poor stability</a>, which leads to their rapid degradation. As such, RNA-based treatments are generally short-lived in the body and require frequent doses to maintain a therapeutic effect. </p>
<p>To overcome this challenge, researchers are <a href="https://doi.org/10.1093/narcan/zcab030">modifying small RNAs</a> in various ways. While each RNA requires a specific modification pattern, successful changes can <a href="https://doi.org/10.1038/s41388-023-02801-8">significantly increase their stability</a>. This reduces the need for frequent dosing, subsequently decreasing treatment burden and cost. </p>
<p>For example, <a href="https://doi.org/10.1089%2Fnat.2018.0736">modified GalNAc-siRNAs</a>, another form of small RNAs, reduces dosing from every few days to once every six months in nondividing cells. My team developed <a href="https://doi.org/10.1038/s41388-023-02801-8">folate ligands</a> linked to modified microRNAs for cancer treatment that reduced dosing from once every other day to once a week. For diseases like cancer where cells are rapidly dividing and quickly diluting the delivered microRNA, this increase in activity is a significant advancement in the field. We anticipate this accomplishment will facilitate further development of this folate-linked microRNA as a cancer treatment in the years to come.</p>
<p>While there is still considerable work to be done to overcome the hurdles associated with microRNA treatments, it’s clear that RNA shows promise as a therapeutic for many diseases.</p><img src="https://counter.theconversation.com/content/211396/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea Kasinski receives funding from the National Institutes of Health, Department of Defense, and the American Lung Association. Kasinski is also the inventor on multiple patients associated with her discoveries in the RNA therapeutics field. </span></em></p>When just one of the thousands of microRNAs in people go awry, it can cause diseases ranging from heart disease to cancer.Andrea Kasinski, Associate Professor of Biological Sciences, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927142022-11-23T13:18:04Z2022-11-23T13:18:04ZVitamin B12 deficiency is a common health problem that can have serious consequences – but doctors often overlook it<figure><img src="https://images.theconversation.com/files/494905/original/file-20221111-12-d6vtg1.jpg?ixlib=rb-1.1.0&rect=61%2C12%2C7983%2C5395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fatigue can be a sign of a potential B12 deficiency.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/unhappy-african-american-woman-suffering-from-royalty-free-image/1387710368?adppopup=true">Maca and Naca/E+ via Getty Images</a></span></figcaption></figure><p>For several months during the summer of 2022, my dog Scout vomited at 3 a.m. nearly every day. If you have a dog, you know the sound. And each time, she gobbled up her mess before I could get to it, making diagnosis of the cause difficult.</p>
<p>The vet and I eventually settled on my hydrangeas as the source of the problem – but keeping Scout away from them didn’t work. She started to seem tired all the time – highly concerning in a typically hyper yellow Lab puppy. </p>
<p>Then one day Scout vomited up a hairball – but not just any hairball. In dogs, hair normally passes easily through the digestive system, but this hairball was wrapped around a brillo pad that was too big to move through. Once this foreign object was removed, the overnight vomiting ended. Scout still needed treatment, though, for a different and surprising reason: The object had inhibited a step in her body’s absorption of vitamin B12. B12 is an essential nutrient involved in proper functioning of blood cells, nerves and many other critical processes in the body. </p>
<p>I’m a registered dietitian, and <a href="https://s.wayne.edu/cress/">I teach nutrition and food science</a> to college students, but still I missed the B12 deficiency that was causing my puppy’s fatigue. Doctors can just as easily be blind to it in people – even though B12 deficiency is a common health problem that affects an estimated <a href="https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/">6% to 20%</a> of the U.S. population. </p>
<p>B12 is scarce in the diet, and it is found only in foods from animal sources. Fortunately, humans need only <a href="https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/">2.4 micrograms of B12 daily</a>, which is equivalent to one ten-millionth of an ounce – a very, very small amount. Without adequate B12 in the body, overall health and quality of life are negatively affected. </p>
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<a href="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An overhead shot of an array of B12-containing foods, including oysters, fish, eggs, red meat and more." src="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An array of vitamin B12-rich foods – all of which come from animals.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/vitamin-b12-containing-foods-royalty-free-image/511052342?phrase=B12%20foods&adppopup=true">photka/iStock via Getty Images Plus</a></span>
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<h2>Signs and symptoms</h2>
<p>One primary symptom of B12 deficiency is fatigue – a level of tiredness or exhaustion so deep that it affects daily life activities. </p>
<p>Other symptoms are neurological and may include tingling in the extremities, confusion, memory loss, depression and difficulty maintaining balance. Some of these <a href="https://doi.org/10.1182/blood-2016-10-569186">can be permanent</a> if the vitamin deficiency is not addressed.</p>
<p>However, since there can be so many causes for these symptoms, health care providers may overlook the possibility of a B12 deficiency and fail to screen for it. Further, having a healthy diet may seem to rule out any vitamin deficiency. Case in point: Because I knew Scout’s diet was sound, I didn’t consider a B12 deficiency as the source of her problems. </p>
<h2>How B12 is absorbed</h2>
<p>Research is clear that people who consume plant-based diets <a href="https://doi.org/10.1080/10408398.2022.2107997">must take B12 supplements</a> in amounts typically provided by standard multivitamins. However, hundreds of millions of Americans who do consume B12 may also be at risk because of conditions that could be hampering their body’s absorption of B12.</p>
<p>B12 absorption is a <a href="https://doi.org/10.1038/nrgastro.2012.76">complex multistep process</a> that begins in the mouth and ends at the far end of the small intestine. When we chew, our food gets mixed with saliva. When the food is swallowed, a substance in saliva called <a href="https://doi.org/10.3390/nu12123838">R-protein</a> – a protein that protects B12 from being destroyed by stomach acid – travels to the stomach along with the food. </p>
<p>Specific cells in the stomach lining, called parietal cells, secrete two substances that are important to B12 absorption. One is stomach acid – it splits food and B12 apart, allowing the vitamin to bind to the saliva’s R-protein. The other substance, called intrinsic factor, mixes with the stomach’s contents and travels with them into the first part of the small intestine – the duodenum. Once in the duodenum, pancreatic juices release B12 from R-protein and hand it to intrinsic factor. This pairing allows B12 to be absorbed into cells, where it can then help maintain nerve cells and form healthy red blood cells.</p>
<p>A B12 deficiency typically involves a breakdown at one or more of these points on the way to absorption.</p>
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<figcaption><span class="caption">Dr. Darien Sutton explains symptoms of B12 deficiency in this December 2021 segment of the ABC TV show ‘Good Morning America.’</span></figcaption>
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<h2>Risk factors for B12 deficiency</h2>
<p>Without saliva, B12 will not bind to the saliva’s R-protein, and the body’s ability to absorb it is inhibited. And there are hundreds of different <a href="https://ostrowon.usc.edu/medications-that-cause-dry-mouth/">drugs that can cause dry mouth</a>, resulting in too little saliva production. They include opioids, inhalers, decongestants, <a href="https://doi.org/10.3389/fpsyt.2020.00035">antidepressants</a>, <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6914a1.htm">blood pressure drugs</a> and <a href="https://doi.org/10.1176%2Fappi.ps.201800321">benzodiazepines</a>, like Xanax, used to treat anxiety. </p>
<p>The last three categories alone account for easily 100 million prescriptions in the U.S. each year. </p>
<p>Another potential contributor to B12 deficiency is low levels of stomach acid.
Hundreds of millions of Americans take <a href="https://www.drugs.com/condition/gastric-ulcer.html?page_number=2">anti-ulcer medications</a> that reduce ulcer-causing stomach acids. Researchers have firmly linked the use of these drugs to <a href="https://doi.org/10.1093/advances/nmy023">B12 deficiency</a> – although that possibility <a href="https://doi.org/10.1053/j.gastro.2017.01.031">may not outweigh the need for the medication</a>. </p>
<p>Production of stomach acid <a href="https://doi.org/10.1093/ajcn/nqab193">can also decrease with aging</a>. More than 60 million people in the U.S. are <a href="https://acl.gov/sites/default/files/aging%20and%20Disability%20In%20America/2020Profileolderamericans.final_.pdf">over age 60</a>, and some 54 million are over the age of 65. This population faces a higher risk of B12 deficiency – which may be further increased by use of acid-reducing medications. </p>
<p>Production of gastric acid and intrinsic factor by the specialized parietal cells in the stomach is critical for B12 absorption to occur. But damage to the stomach lining can prevent production of both. </p>
<p>In humans, impaired stomach lining stems from gastric surgery, chronic inflammation or <a href="https://doi.org/10.1038/ajg.2009.231">pernicious anemia</a> – a medical condition characterized by fatigue and a long list of other symptoms.</p>
<p>Another common culprit of B12 deficiency is inadequate <a href="https://doi.org/10.1172/jci108924">pancreas function</a>. About one-third of patients with poor pancreas function <a href="https://doi.org/10.1097/00006676-199009000-00011">develop a B12 deficiency</a>. </p>
<p>And lastly, Metformin, a drug used by around <a href="https://www.statista.com/statistics/780332/metformin-hydrochloride-prescriptions-number-in-the-us/">92 million Americans</a> to treat Type 2 diabetes, has been associated with <a href="https://doi.org/10.1136%2Fbmj.2.5763.685">B12 deficiency for decades</a>.</p>
<h2>Treatment for B12 deficiency</h2>
<p>While some health care providers routinely measure B12 and other vitamin levels, a typical well-check exam includes only a complete blood count and a metabolic panel, neither of which measures B12 status. If you experience potential symptoms of a B12 deficiency and also have one of the risk factors above, you should see a doctor to be tested. A proper lab workup and discussion with a physician are necessary to discover or rule out whether inadequate B12 levels could be at play.</p>
<p>In the case of my dog Scout, her symptoms led the vet to run two blood tests: a complete blood count and a B12 test. These are also good starting points for humans. Scout’s symptoms went away after a few months of taking oral B12 supplements that also contained an active form of the B vitamin folate.</p>
<p>In humans, the type of treatment and length of recovery depend on the cause and severity of the B12 deficiency. Full recovery can take up to a year but is very possible with appropriate treatment. </p>
<p><a href="https://doi.org/10.3389/fphar.2022.972468">Treatment for B12 deficiency</a> can be oral, applied under the tongue or administered through the nose, or it may require various types of injections. A B12 supplement or balanced multivitamin may be enough to correct the deficiency, as it was for Scout, but it’s best to work with a health care provider to ensure proper diagnosis and treatment.</p><img src="https://counter.theconversation.com/content/192714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diane Cress does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The symptoms of B12 deficiency resemble a lot of other health problems, putting millions of Americans at risk of a misdiagnosis.Diane Cress, Associate Professor of Nutrition and Food Science, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1333562020-03-16T19:01:05Z2020-03-16T19:01:05Z5 ways nutrition could help your immune system fight off the coronavirus<figure><img src="https://images.theconversation.com/files/320678/original/file-20200316-18043-1rg6ra8.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4500%2C2977&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The coronavirus presents many uncertainties, and none of us can completely eliminate our risk of getting COVID-19. But one thing we can do is eat as healthily as possible.</p>
<p>If we do catch COVID-19, our immune system is responsible for fighting it. Research shows improving nutrition helps <a href="https://www.ncbi.nlm.nih.gov/pubmed/15337163">support optimal immune function</a>. </p>
<p>Micronutrients essential to fight infection include vitamins A, B, C, D, and E, and the minerals iron, selenium, and zinc. </p>
<p>Here’s what we know about <a href="https://www.ncbi.nlm.nih.gov/pubmed/30336639">how these nutrients support our immune system</a> and the foods we can eat to get them. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-a-balanced-diet-anyway-72432">What is a balanced diet anyway?</a>
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<h2>1. Vitamin A</h2>
<p><a href="https://www.healthdirect.gov.au/vitamin-a">Vitamin A</a> maintains the structure of the cells in the skin, respiratory tract and gut. This forms a barrier and is your body’s first line of defence. If fighting infection was like a football game, vitamin A would be your forward line. </p>
<p>We also need vitamin A to help make <a href="https://en.wikipedia.org/wiki/Antibody">antibodies</a> which neutralise the pathogens that cause infection. This is like assigning more of your team to target an opposition player who has the ball, to prevent them scoring. </p>
<p>Vitamin A is found in oily fish, egg yolks, cheese, tofu, nuts, seeds, whole grains and legumes. </p>
<p>Further, vegetables contain <a href="https://en.wikipedia.org/wiki/Beta-Carotene">beta-carotene</a>, which your body can convert into vitamin A. Beta-carotene is found in leafy green vegetables and yellow and orange vegetables like pumpkin and carrots.</p>
<h2>2. B vitamins</h2>
<p><a href="https://www.betterhealth.vic.gov.au/health/HealthyLiving/vitamin-b">B vitamins</a>, particularly B6, B9 and B12, contribute to your body’s first response once it has recognised a pathogen. </p>
<p>They do this by influencing the production and activity of “<a href="https://en.wikipedia.org/wiki/Natural_killer_cell">natural killer</a>” cells. Natural killer cells work by causing infected cells to “implode”, a process called <a href="https://en.wikipedia.org/wiki/Apoptosis">apoptosis</a>. </p>
<p>At a football match, this role would be like security guards intercepting wayward spectators trying to run onto the field and disrupt play.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fish is a good source of vitamin B6.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>B6 is found in cereals, legumes, green leafy vegetables, fruit, nuts, fish, chicken and meat. </p>
<p>B9 (<a href="https://en.wikipedia.org/wiki/Folate">folate</a>) is abundant in green leafy vegetables, legumes, nuts and seeds and is added to commercial bread-making flour.</p>
<p><a href="https://theconversation.com/have-you-gone-vegan-keep-an-eye-on-these-4-nutrients-107708">B12</a> (cyanocobalamin) is found in animal products, including eggs, meat and dairy, and also in fortified soy milk (check the nutrition information panel). </p>
<h2>3. Vitamins C and E</h2>
<p>When your body is fighting an infection, it experiences what’s called oxidative stress. Oxidative stress leads to the production of <a href="https://en.wikipedia.org/wiki/Reactive_oxygen_species">free radicals</a> which can pierce cell walls, causing the contents to leak into tissues and exacerbating inflammation.</p>
<p><a href="https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/">Vitamin C</a> and <a href="https://www.healthdirect.gov.au/vitamin-e">vitamin E</a> help protect cells from oxidative stress. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-its-time-to-debunk-claims-that-vitamin-c-could-cure-it-132803">Coronavirus: it's time to debunk claims that vitamin C could cure it</a>
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<p>Vitamin C also helps clean up this cellular mess by producing specialised cells to mount an immune response, including <a href="https://en.wikipedia.org/wiki/Neutrophil">neutrophils</a>, lymphocytes and <a href="https://en.wikipedia.org/wiki/Phagocyte">phagocytes</a>. </p>
<p>So the role of vitamin C here is a bit like cleaning up the football ground after the game.</p>
<p>Good sources of vitamin C include oranges, lemons, limes, berries, kiwifruit, broccoli, tomatoes and capsicum. </p>
<p>Vitamin E is found in nuts, green leafy vegetables and vegetables oils.</p>
<h2>4. Vitamin D</h2>
<p>Some immune cells need <a href="https://www.betterhealth.vic.gov.au/health/HealthyLiving/vitamin-d">vitamin D</a> to help destroy pathogens that cause infection. </p>
<p>Although sun exposure allows the body to produce vitamin D, food sources including eggs, fish and some milks and margarine brands may be fortified with Vitamin D (meaning extra has been added).</p>
<p>Most people need just <a href="https://www.cancer.org.au/preventing-cancer/sun-protection/vitamin-d/">a few minutes outdoors</a> most days.</p>
<p>People with vitamin D deficiency may need supplements. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/30675873">review of 25 studies</a> found vitamin D supplements can help protect against <a href="https://www.healthline.com/health/acute-respiratory-disease">acute respiratory infections</a>, particularly among people who are deficient.</p>
<h2>5. Iron, zinc, selenium</h2>
<p>We need iron, zinc and selenium for immune cell growth, among other functions.</p>
<p><a href="https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/iron">Iron</a> helps kill pathogens by <a href="https://www.ncbi.nlm.nih.gov/pubmed/30336639">increasing the number of free radicals</a> that can destroy them. It also regulates enzyme reactions essential for immune cells to recognise and target pathogens. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Whole grain foods contain a variety of important nutrients.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="https://www.healthdirect.gov.au/zinc">Zinc</a> helps maintain the integrity of the skin and mucous membranes. Zinc and <a href="https://en.wikipedia.org/wiki/Selenium">selenium</a> also act as an antioxidant, helping mop up some of the damage caused by oxidative stress. </p>
<p>Iron is found in meat, chicken and fish. Vegetarian sources include legumes, whole grains and iron-fortified breakfast cereals. </p>
<p>Zinc is found in oysters and other seafood, meat, chicken, dried beans and nuts. </p>
<p>Nuts (especially Brazil nuts), meat, cereals and mushrooms are good food sources of selenium.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-i-take-vitamin-c-or-other-supplements-for-my-cold-98309">Health Check: should I take vitamin C or other supplements for my cold?</a>
</strong>
</em>
</p>
<hr>
<h2>Putting it all together</h2>
<p>It’s true some supermarkets are out of certain products at the moment. But as much as possible, focus on eating a variety of foods <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">within each of the basic food groups</a> to <a href="https://www.ncbi.nlm.nih.gov/pubmed/25625814">boost your intake</a> of vitamins and minerals.</p>
<p>While vitamin and mineral supplements are <a href="https://theconversation.com/mondays-medical-myth-take-a-vitamin-a-day-for-better-health-8482">not recommended for the general population</a>, there are some exceptions. </p>
<p>Pregnant women, some people with chronic health conditions, and people with conditions that mean they can’t eat properly or are on very restrictive diets, may need specific supplements. Talk to your doctor, Accredited Practising Dietitian or pharmacist.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-distancing-what-it-is-and-why-its-the-best-tool-we-have-to-fight-the-coronavirus-133581">Social distancing: What it is and why it's the best tool we have to fight the coronavirus</a>
</strong>
</em>
</p>
<hr>
<p>And beyond diet, there are other measures you can take to stay as healthy as possible in the face of coronavirus.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/30789425">Stop smoking</a> to improve your lung’s ability to fight infection, perform <a href="https://www.ncbi.nlm.nih.gov/pubmed/32139352">moderate intensity exercise</a> like brisk walking, <a href="https://www.ncbi.nlm.nih.gov/pubmed/31941836">get enough sleep</a>, practise social distancing and wash your hands with soap regularly.</p><img src="https://counter.theconversation.com/content/133356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p>The food we eat influences our bodies’ immune responses to infection. So focusing on nutrition is one thing we can do to help protect ourselves in the face of the coronavirus threat.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1189772019-06-20T11:21:31Z2019-06-20T11:21:31ZSupplements for brain health show no benefit – a neurologist explains a new study<figure><img src="https://images.theconversation.com/files/280272/original/file-20190619-171188-4p3eur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older people often take many supplements, including ones purported to help with brain health. A recent study says the supplements do not work. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-giving-her-husband-medication-1074887189?src=sujsQgH1LZseo2a3_xKpVw-1-6&studio=1">Mladen Zivkovic/Shutterstock.com</a></span></figcaption></figure><p>Americans and others around the world have turned increasingly to dietary supplements in order to maintain or preserve their brain health. </p>
<p>A <a href="https://www.aarp.org/health/brain-health/global-council-on-brain-health/supplements/">recent study</a> found that a quarter of adults over 50 take a supplement for brain-related health. But that same study, done by experts convened by the AARP, suggests that seniors should spend their money elsewhere. The supplements don’t work.</p>
<p>This is no small issue. Expenditures on non-vitamin brain health supplements such as such as minerals, herbal mixtures, nurtraceuticals or amino acids, have extended <a href="https://www.aarp.org/health/brain-health/global-council-on-brain-health/supplements/">into the billions of dollars</a>. This can amount to between <a href="https://www.aarp.org/health/brain-health/info-2019/report-brain-supplements-ineffective.html">US$20 and US$60 a month</a> for seniors, a sizable sum that could be put toward other expenses, including fresh vegetables and fruit that actually do make a difference.</p>
<p>As <a href="https://scholar.google.com/citations?user=Jbl0lnsAAAAJ&hl=en&oi=ao">a neurologist who studies brain health and prevention of dementia</a>, and who has been involved in research in memory and Alzheimer’s disease for my entire career, I can help explain what we do and don’t know about supplements, nutrition and brain health.</p>
<h2>Freedom to market</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/280275/original/file-20190619-171183-19fd1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/280275/original/file-20190619-171183-19fd1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/280275/original/file-20190619-171183-19fd1hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/280275/original/file-20190619-171183-19fd1hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/280275/original/file-20190619-171183-19fd1hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/280275/original/file-20190619-171183-19fd1hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/280275/original/file-20190619-171183-19fd1hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Labels on supplements can mislead.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-man-taking-pill-710057002?src=Kd4sNBomE5sZpQDY9gZ0Fg-1-26&studio=1">sebra/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>So, what is the problem? Aren’t all of these “medications” approved by the Food and Drug Administration?</p>
<p>Well, no, they’re not. </p>
<p>The <a href="https://www.fda.gov/food/dietary-supplements">FDA does not treat supplements</a> like prescription medications. Supplements are not tested for accuracy of their stated ingredients by independent laboratories, and they overwhelmingly do not have the legitimate scientific evidence that would demonstrate that they are effective. The FDA relies on the manufacturers to test for the supplements’ safety, not for their efficacy. They are not subject to rigorous clinical trials that apply to prescription drugs.</p>
<p>The FDA prohibits supplement makers from making specific health claims, but companies have found a way to tout wondrous benefits nonetheless. </p>
<p>They use phrases such as “research proven,” or “laboratory tested,” and other similar scientific-sounding claims. Some of these claim that the product “maintains good brain health.”</p>
<p>For example, a <a href="https://www.walmart.com/ip/Nature-s-Bounty-Ginkgo-Biloba-Capsules-60-mg-200-count/48006435?athcpid=48006435&athpgid=athenaItemPage&athcgid=null&athznid=PWVUB&athieid=v0&athstid=CS020&athguid=6ab3a840-e0c-16b6bf3becbe4a&athena=true">label</a> on a bottle of Ginkgo biloba, an especially popular supplement that many seniors take for brain health, claims: “Supports healthy brain function and mental alertness.” </p>
<p>But there’s an asterisk. </p>
<p>Turn the bottle around, and you can read the caveat that follows the asterisk: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, prevent or cure any disease.”</p>
<p>A number of companies that sold other kinds of dietary supplements have recently received letters from the <a href="https://www.fda.gov/food/cfsan-constituent-updates/fda-acts-dietary-supplements-containing-dmha-and-phenibut">FDA requiring that they alter their advertisements</a> to not overstate their products’ benefits. </p>
<h2>Eager for help</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/280274/original/file-20190619-171188-fagj70.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/280274/original/file-20190619-171188-fagj70.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/280274/original/file-20190619-171188-fagj70.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/280274/original/file-20190619-171188-fagj70.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/280274/original/file-20190619-171188-fagj70.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/280274/original/file-20190619-171188-fagj70.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/280274/original/file-20190619-171188-fagj70.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ginkgo biloba is a very popular supplement that many believe will help with brain health. It doesn’t.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/chinese-natural-supplements-brain-ginkgo-biloba-1226305297?src=YpDmJWQ6YP9glHlcwmK07g-1-7&studio=1">ValinkoV/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>As baby boomers move into later life, they are trying to <a href="https://journalofethics.ama-assn.org/article/baby-boomers-expectations-health-and-medicine/2014-05">find ways to maintain good health</a>, especially brain health. A 2012 Marist Poll for Home Instead Senior Care revealed that <a href="http://maristpoll.marist.edu/1114-alzheimers-most-feared-disease/#sthash.W3prb6y6.dpbs">Americans fear Alzheimer’s</a> more than any other disease. Surveys also have shown that older people worry most about <a href="https://www.alz.org/media/dsw/facts2019_report.pdf">loss of cognition, either normal memory loss or worse, dementia</a>.</p>
<p>I think that dissatisfaction or worry about the ability of modern medicine to address brain health in a meaningful way had led people to look for other ways to protect their brains.</p>
<p>There is no <a href="https://www.sph.umn.edu/news/study-finds-no-proven-intervention-preventing-late-life-dementia/?utm_source=SPH+People&utm_campaign=3577b68f85-Faculty_Staff_SPHere_01_16_2018&utm_medium=email&utm_term=0_c7be9bacf5-3577b68f85-89020673">scientifically proven way to prevent Alzheimer’s</a> or other forms of dementia, however. </p>
<p>Also, <a href="https://www.cnn.com/2019/03/21/health/alzheimers-drug-trial-failure-aducanumab-bn/index.html">a number of clinical trials</a> for medications to slow down or prevent Alzheimer’s disease have failed.</p>
<h2>Supplements bring money, not health</h2>
<p>Supplements have thus become a profitable area for companies to engage in, as seen by the large percentage of people who take such supplements and the <a href="https://www.aarp.org/health/brain-health/global-council-on-brain-health/supplements/">billions of dollars spent</a> on them annually.</p>
<p>Surely some of them must work?</p>
<p>Yes, the vitamins do, although most people don’t need to take vitamin supplements. The overwhelming evidence shows that if you eat a normal diet you <a href="https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/vitamin-supplements-hype-or-help-for-healthy-eating">do not have need to take supplementary vitamins or minerals</a>. </p>
<p>There are some exceptions. If people have insufficient amounts of foods that provide vitamin B12 or vitamin B6, they may have to take supplements. In the case of B12, some older people have difficulty absorbing this vitamin in the digestive system. In these cases, a physician would test for a low B12 level and treat it. Sometimes, a person would need an injection, as the B12 in a capsule would not be absorbed, either.</p>
<p>Some people may take vitamins and supplements using the rationale that “more is better.” This is not true for supplements, even vitamins. Why? Because the body can only digest a certain quantity of vitamin and any excess simply isn’t absorbed; in the case of water soluble vitamins, it makes your urine expensive. And, sometimes <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164945/">“more” is dangerous</a>. There are some vitamins which if taken in excess can lead to toxicity and illness. This is especially true with excess doses of vitamin A, D, E and K. </p>
<p>Have any of the supplements been subjected to the kinds of safety and effectiveness standards required of our prescription medications? Some have, such as <a href="https://jamanetwork.com/journals/jama/fullarticle/182920">Ginkgo biloba</a> for both prevention and treatment of Alzheimer’s disease and improvement of normal memory. Those studies have shown that they don’t work for any of those. </p>
<h2>Hidden dangers</h2>
<p>To make things even more concerning, many of these supplements <a href="https://medicalxpress.com/news/2018-10-supplements-unapproved-dangerous-ingredients.html">do not always contain the compounds that they are advertised to contain</a>. Some of the mixtures contain small amounts of toxic or harmful ingredients that have gotten into the product somewhere along the gathering and manufacturing process. When these cause illness, it is called to the attention of the FDA and they will investigate, and possibly ban a product.</p>
<p>There’s a lot of news about the <a href="https://theconversation.com/13-ways-to-get-more-antioxidants-and-why-you-need-to-70035">importance of antioxidants</a> in your diet. Antioxidants are important for the continued health of a number of organs in the body, including the brain.</p>
<p>However, a number of scientific studies have been <a href="https://nccih.nih.gov/health/antioxidants/introduction.htm">unable to show that antioxidants given in pill form</a> improve or protect memory from declining with age or brain disease. There just may be something about the interactions of the chemicals in the food on your plate that contribute to good health. Studies that measured the amount of antioxidants contained in diets, as determined from “food diaries” of people in research studies, shows that <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/800716">high levels of antioxidants in foods</a> do help in long term outcomes even though giving pills with more antioxidants does not. Scientists don’t yet know why this happens. It could be that we humans have evolved to get our beneficial substances in food, not in isolation, and there are likely complex ways they work. There may be difficulties in using or metabolizing the pills. We researchers just don’t know yet.</p>
<p>In sum, even the small print in these supplements note that they have not been approved by the FDA, even though the claims sound wonderful. Therefore, I believe that the conclusions of the recent study are sound. (Disclosure: I was one of the experts in the study.) It is best to focus on a healthy diet, and perhaps use some of the money directed at such supplements toward buying more green leafy vegetables and the other food components that make up good nutrition.</p><img src="https://counter.theconversation.com/content/118977/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven DeKosky receives funding from the National Institutes of Health (NIH).
Steven DeKosky receives funding from Amgen (Neuroscience Advisory Board), Biogen (Chair, Drug Safety Monitoring Board), Cognition Therapeutics (Chair, Medical Advisory Board), and Up-To-Date (electronic medical text for point-of-care use); Editor for Dementia.</span></em></p>With fear of a diagnosis of Alzheimer’s a constant concern for many seniors, they turn to supplements. A recent study suggests they’d be better off keeping their money.Steven DeKosky, Professor of Neurology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/953022018-05-02T10:45:26Z2018-05-02T10:45:26ZFolic acid in pregnancy – MTHFR gene explains why the benefits may differ<figure><img src="https://images.theconversation.com/files/216250/original/file-20180425-175061-ym28c4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTUyNDY3Mjc0NCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfNzA3NzgwNjU2IiwiayI6InBob3RvLzcwNzc4MDY1Ni9odWdlLmpwZyIsIm0iOjEsImQiOiJzaHV0dGVyc3RvY2stbWVkaWEifSwiUkIvdzFuRldmNTE3eXZ0bi9ZNXhTZjBDY0xVIl0%2Fshutterstock_707780656.jpg&pi=33421636&m=707780656&src=7ltlrj4qNOP6w7AIm96RSg-1-0">Shutterstock</a></span></figcaption></figure><p>It’s generally recommended that <a href="https://www.nhs.uk/chq/pages/913.aspx?categoryid=54">all women should take folic acid</a>, both while they’re trying to get pregnant and during the <a href="https://theconversation.com/five-ways-to-boost-your-nutrition-before-pregnancy-76352">first 12 weeks of pregnancy</a>. This is because folic acid is considered to be very important for the development of a healthy foetus.</p>
<p>But recently, it has been claimed this “one-size-fits-all” approach may be wrong and that some pregnant women may benefit more from <a href="http://www.foxnews.com/health/2014/07/27/should-skip-prenatal-vitamins-with-folic-acid.html">alternatives to folic acid</a>. Specifically, it has been found that forms of a certain gene that vary among people, may affect how the body utilises folic acid.</p>
<p>The terms “folic acid” and “folate” are often used interchangeably to describe Vitamin B9, but they are not exactly the same. Folate is often called the natural form of vitamin B9, which is found in dark green vegetables, including broccoli and spinach and dried legumes. Folic acid is the synthetic form of vitamin B9, found in supplements and also added to processed, or “fortified,” foods. </p>
<p>By eating foods that are high in folate regularly, most people should be able to get the necessary amount (200 mcg a day). For some people though, more than this recommended amount of folate is necessary.</p>
<p>It is known that folate or folic acid is very important for the development of a healthy foetus. This is why all pregnant women and women trying for a baby are advised to take double this amount (400 mcg a day) – or even more in certain cases, to help prevent the risk of birth defects in unborn babies.</p>
<p>It would be almost impossible to get this much folate just from natural sources. That’s why folic acid is often prescribed to pregnant women in the form of supplements. </p>
<p>It is also the reason why <a href="https://www.theguardian.com/society/2018/jan/31/folic-acid-new-research-is-a-game-changer-in-push-to-fortify-british-foods">folic acid is added to grains</a> (this process is called fortification) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257747/">in many countries</a>. Recently, there has been a push to make it <a href="https://theconversation.com/heres-why-the-uk-should-fortify-flour-with-folic-acid-88354">mandatory in the UK as well</a>.</p>
<h2>Understanding the science</h2>
<p>People differ in how much folate they need and receive in their diet, and this can be corrected with supplements. But people also differ in how much folate or folic acid they need for their health – based on the activity of “the MTHFR gene”. </p>
<p>To understand why this matters, first of all we need to know a bit more about the science of how our bodies work. There are 20,000 genes in the human genome. Each of these genes provides instructions in the form of a DNA sequence for making a specific protein. Proteins play various important roles in our body: from building our cells through to making our brain function.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216251/original/file-20180425-175041-85ua1j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Foods high in folate.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTUyNDY3Mjc0NywiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfNTQzMTg0MzMzIiwiayI6InBob3RvLzU0MzE4NDMzMy9odWdlLmpwZyIsIm0iOjEsImQiOiJzaHV0dGVyc3RvY2stbWVkaWEifSwiQU8wNVB3eVl4MWFkQTRLN041L3U0TjhCYmpFIl0%2Fshutterstock_543184333.jpg&pi=33421636&m=543184333&src=vF120dw2_kj89W-uOelC6Q-1-16">Shutterstock</a></span>
</figcaption>
</figure>
<p>One of these genes – the MTHFR gene – provides the instructions for making the protein methylenetetrahydrofolate reductase. This protein is a key player in the complex process of converting folic acid (or folate) that we receive with foods into methylfolate, the form that our body can use. </p>
<p>The MTHFR gene is responsible for how much methylfolate is produced in the body. Our body needs methylfolate for a proper metabolism. If there is not enough methylfolate in the body, it leads to many serious health problems. </p>
<h2>MTHFR explained</h2>
<p>All people have two copies of the MTHFR gene – one copy is inherited from the mother and another copy is inherited from the father. Each copy of the gene can be normal or can have a defect – a change in DNA sequence that affects how much protein this gene can produce.</p>
<p>These defects are called mutations. The common mutation in the MTHFR gene is a single change in DNA sequence that reduces the activity of the protein produced. About 10-15% of people have both copies of the gene affected by this mutation.</p>
<p>These people have very low activity of the MTHFR protein in the body. This results into a highly reduced ability of the body to convert folic acid into a usable form and can lead to accumulation of the amino acid homocysteine – which is toxic to the body.</p>
<p>The MTHFR gene mutation has been found to be one of the factors that puts people at an <a href="https://link.springer.com/article/10.1007%2Fs10549-010-0783-5">increased risk of cancer</a>, <a href="https://www.sciencedirect.com/science/article/pii/S0378111913012869">cardiovascular disease</a>, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0121147">infertility</a>, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-2982.2007.01400.x">migraine</a>, and <a href="https://academic.oup.com/qjmed/article/90/2/111/1612940">foetal development problems</a>. It has also been found to increase the risk of depression, <a href="https://www.sciencedirect.com/science/article/pii/S0889159110005799">schizophrenia</a> and <a href="https://link.springer.com/article/10.1007%2Fs12035-016-9722-8">dementia</a>. </p>
<h2>To supplement or not</h2>
<p>A diet rich in folate is said to be particularly important for those with the mutation in the MTHFR gene. People with a mutation in the gene may be affected more if they do not receive enough folate with foods. </p>
<p>It has been shown that <a href="https://www.sciencedirect.com/science/article/pii/S0140673611608726">people with this mutation</a> are affected more in Asia than in countries that use grain fortification with folic acid – such as the US, Australia, and New Zealand. But more studies are needed to prove whether alterations in diet and use of folate supplements can be sufficient to overcome negative health effects caused by the MTHFR gene mutations.</p>
<p>Caution is also needed with high-dose supplementation of folic acid in pregnant women with different forms of the MTHFR gene as very high intake of folate may have unintended negative effects on their offspring – particularly on early brain development, as demonstrated by <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/1919923">recent human</a> and <a href="https://academic.oup.com/hmg/article/26/5/888/2856406">animal studies</a>. But ultimately, future studies are critical to determine a safe upper limit for all people – and pregnant women particularly – who have different genetic profiles.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315932/original/file-20200218-11040-p9wweg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of a series tied to Medicine made for you, a series by The Anthill podcast on the future of healthcare and how it could soon get a lot more personal. <a href="https://theconversation.com/uk/topics/medicine-made-for-you-82269">Read more here</a>.</em></p><img src="https://counter.theconversation.com/content/95302/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darya Gaysina does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Folic acid in pregnancy – and the gene which explains why the benefits may differ.Darya Gaysina, Senior Lecturer in Psychology, University of SussexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/883542017-12-04T11:37:24Z2017-12-04T11:37:24ZHere’s why the UK should fortify flour with folic acid<figure><img src="https://images.theconversation.com/files/197339/original/file-20171201-17390-1tovt2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/546641992?size=medium_jpg">GagliardiImages/Shutterstock</a></span></figcaption></figure><p>The UK Health Secretary, Jeremy Hunt, <a href="https://www.gov.uk/government/news/new-maternity-strategy-to-reduce-the-number-of-stillbirths">announced plans</a> to halve the number of infant deaths, stillbirths and brain injuries by 2025. Yet successive UK governments have resisted expert advice to fortify flour with folic acid – including from the Food Standards Agency. This simple measure would prevent many serious birth defects, known as neural tube defects.</p>
<p>Neural tube defects are defects of the central nervous system that occur in the first month of an embryo’s life. They include conditions such as <a href="https://www.nhs.uk/conditions/spina-bifida/">spina bifida</a>, where the spinal column doesn’t close properly, and <a href="https://en.wikipedia.org/wiki/Anencephaly">anencephaly</a>, a condition where large parts of a baby’s brain and skull are missing. The incidence of neural-tube-defect pregnancies in the UK is around <a href="http://adc.bmj.com/content/archdischild/early/2015/11/13/archdischild-2015-309226.full.pdf">13 per 10,000 births</a>.</p>
<p>In 1991, supplements of folic acid given before conception and in early pregnancy were <a href="https://www.ncbi.nlm.nih.gov/pubmed/1677062?dopt=Abstract">shown to reduce the rate of neural tube defects</a>. This finding has since been supported by many other studies. A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160020/">meta-analysis of those studies</a>, conducted in 2010, found that if a woman takes 400 micrograms of folic acid daily before conception, she can reduce the risk of her baby having a neural tube defect by around 70%.</p>
<p>Since 1992, women in Britain and Europe have been <a href="https://www.food.gov.uk/sites/default/files/multimedia/pdfs/publication/eatingwhilepregnant1209.pdf">advised to take folic acid</a> supplements if they are trying to conceive. However, <a href="https://www.ncbi.nlm.nih.gov/pubmed/15722368">a study</a> conducted by the US Centers for Disease Control and Prevention, found that by 1998 this had made no difference to neural tube defect rates in Europe because over-the-counter supplements tend to be taken by those who least need them – because they’re getting enough folic acid in their diet. And the people who do need them, are the least likely to take them. </p>
<p>The US and Canada took a different route. Instead of advising supplementation with folic acid pills, they made it mandatory for <a href="https://www.fda.gov/aboutfda/whatwedo/history/productregulation/selectionsfromfdliupdateseriesonfdahistory/ucm091883.htm">flour to be fortified with folic acid</a>. Since then, more than 70 countries have followed their lead, and neural tube defects have fallen by 25-50%. </p>
<p>Canada implemented flour fortification in 1997. By 2000, neural tube defect rates had halved compared with the rate in 1996 (see graph below).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/197332/original/file-20171201-17360-141owh8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/197332/original/file-20171201-17360-141owh8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=358&fit=crop&dpr=1 600w, https://images.theconversation.com/files/197332/original/file-20171201-17360-141owh8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=358&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/197332/original/file-20171201-17360-141owh8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=358&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/197332/original/file-20171201-17360-141owh8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=450&fit=crop&dpr=1 754w, https://images.theconversation.com/files/197332/original/file-20171201-17360-141owh8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=450&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/197332/original/file-20171201-17360-141owh8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=450&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">NEJM/Laval University in Canada</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>In 2014, a group of British scientists reported in <a href="http://adc.bmj.com/content/101/7/604.long">Archives of Disease in Childhood</a> that UK rates of neural tube defects had not changed much since 1998 (the year the US introduced mandatory fortification). The graph below shows how that played out.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/197333/original/file-20171201-17390-p96no.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/197333/original/file-20171201-17390-p96no.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/197333/original/file-20171201-17390-p96no.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/197333/original/file-20171201-17390-p96no.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/197333/original/file-20171201-17390-p96no.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/197333/original/file-20171201-17390-p96no.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/197333/original/file-20171201-17390-p96no.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Geoff Webb</span>, <span class="license">Author provided</span></span>
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<p>If the UK government had introduced flour fortification at the same time and at the same level as the US, then almost 3,000 cases of neural tube defect would now have been prevented. Without terminations, this would equate to around 1,500 dead or miscarried babies and 1,500 babies with severe disabilities. </p>
<p>To be most effective, folic acid needs to be taken before or just after conception. However, in the UK, <a href="http://news.bbc.co.uk/1/hi/health/3515400.stm">40% of pregnancies are unplanned</a>, meaning the window of opportunity for taking the supplement is lost. A study led by Queen Mary University of London found that only <a href="http://adc.bmj.com/content/101/7/604.long">25% of British women</a> take folic acid supplements at the right time. And, as previously noted, people who take supplements tend to have the best diets and are the <a href="http://eu.wiley.com/WileyCDA/WileyTitle/productCd-1444332406.html">least likely to need them</a>.</p>
<h2>Objections don’t withstand scrutiny</h2>
<p>For every case of neural tube defect prevented, several thousand people eat the fortified food. This could be seen as “medication” without choice or consent, although, since World War II, flour has been <a href="http://www.legislation.gov.uk/">fortified with several vitamins and minerals</a>. Several other objections to fortifying food with folic acid have been suggested by those opposed to fortification:</p>
<ul>
<li>It might mask the symptoms of vitamin B12 deficiency in the elderly and so delay diagnosis and treatment.</li>
<li>It might promote the growth and malignancy of existing benign bowel tumours.</li>
<li>It might interfere with drugs like methotrexate, which is used to treat rheumatoid arthritis, that have an anti-folic-acid action.</li>
</ul>
<p>The US has been fortifying flour for 20 years with no indication that these represent <a href="http://eu.wiley.com/WileyCDA/WileyTitle/productCd-1444332406.html">real hazards</a>. The doses of folic acid involved are <a href="http://eu.wiley.com/WileyCDA/WileyTitle/productCd-1444332406.html">unlikely to seriously affect</a> diagnosis of B12 deficiency. </p>
<p>Rates of bowel cancer in the US <a href="http://www.sciencedirect.com/science/article/pii/S0140673612620017?via%3Dihub#bib18">have been dropping since 1970</a>, and this fall was not slowed by the introduction of fortified breakfast cereals in 1973 nor the mandatory fortification of flour in 1998. Most epidemiological evidence suggests that folic acid might be <a href="http://jn.nutrition.org/content/132/8/2350S.long">protective against bowel cancer</a> and a <a href="http://www.sciencedirect.com/science/article/pii/S0140673612620017?via%3Dihub">meta-analysis</a> of folic acid supplement trials published in The Lancet found no increase in bowel cancer after five years of use. </p>
<p>Folic acid alleviates the side effects of methotrexate and so some methotrexate treatment regimens for rheumatoid arthritis use folic acid for this purpose.</p>
<p>According to the <a href="https://www.ifglobal.org/en/37-temp-news/4768-uk-government-says-no-to-mandatory-fortification-of-flour-with-folic-acid-2">International Federation for Spina Bifida and Hydrocephalus</a>, the UK government has decided not to introduce fortification. More recently, the health ministers of Scotland and Wales wrote a <a href="http://www.bbc.co.uk/news/health-42199080">joint letter to Jeremy Hunt</a>, asking him to reconsider his position on fortification. According to Food Standards Scotland, 80% women of childbearing age in Scotland and Wales are deficient in folic acid.</p>
<p>I <a href="https://drgeoffnutrition.wordpress.com/2017/03/17/fortification-of-uk-flour-with-folic-acid-is-it-finally-time-to-decide/">recently advocated</a> flour fortification with 50% more folic acid than the US level. This could result in 300 fewer affected pregnancies each year. Unfortified flour could be permitted, but with a warning that it does not comply with government fortification advice.</p><img src="https://counter.theconversation.com/content/88354/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoff Webb does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The US and Canada began fortifying flour with folic acid in the late 90s. More than 70 countries followed suit, but not the UK.Geoff Webb, Senior Lecturer, University of East LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/823152017-08-11T05:04:05Z2017-08-11T05:04:05ZPregnant women shouldn’t start taking vitamin B3 just yet: reports it prevents miscarriage and birth defects are overblown<figure><img src="https://images.theconversation.com/files/181722/original/file-20170810-27649-1wsyju7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The much-hyped study didn't actually test vitamin B3 supplementation in humans. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><a href="http://www.abc.net.au/news/2017-08-10/vitamin-b3-supplements-can-prevent-miscarriage-and-birth-defects/8785566">Reports</a> on a <a href="http://www.smh.com.au/national/health/breakthrough-discovery-finds-cause-and-affordable-cure-for-miscarriage-multiple-births-defects-victor-chang-institute-scientists-announce-20170809-gxsq6k.html">new study</a> claim supplementation with vitamin B3 during pregnancy could prevent miscarriages and birth defects. </p>
<p>So should all pregnant women start taking B3 supplements? Not so fast. While this is an interesting and well-done study, the researchers didn’t actually give vitamin B3 to any humans, so we need a lot more information before we can recommend it.</p>
<h2>What the study found</h2>
<p><a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1616361">The study</a> identified genetic causes of a rare type of birth defect called “VACTERL association”. VACTERL stands for vertebral defects, anal atresia (problems with the tissue closing the anus), cardiac defects, tracheo-esophageal fistula (an abnormal connection between the windpipe and the foodpipe), renal anomalies (kidney defects), and limb abnormalities. Affected babies have anomalies in at least three of these. </p>
<p><a href="https://ghr.nlm.nih.gov/condition/vacterl-association#statistics">US statistics show</a> about one in 10,000-40,000 babies are affected by VACTERL association and some of these babies die. There are about <a href="http://www.aihw.gov.au/publication-detail/?id=60129557656">310,000 babies born in Australia</a> each year.</p>
<p>The study authors looked at the genes of 13 families affected by this type of birth defect. For the defect to be passed on to offspring it has to be present in both parents’ genes - if it’s only present in one gene the other healthy one will compensate. </p>
<p>They pinpointed the variations in two genes responsible for these defects in four of the families. These two genes play a role in making “nicotinamide adenine dinucleotide” or NAD, which <a href="https://www.ncbi.nlm.nih.gov/pubmed/18429699">helps cells make</a> energy out of glucose. NAD also <a href="https://www.ncbi.nlm.nih.gov/pubmed/22138132">assists in repairing DNA</a>. NAD is synthesised in the body from tryptophan, an amino acid, or from niacin, also known as vitamin B3.</p>
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<p>
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Read more:
<a href="https://theconversation.com/why-we-dont-know-what-causes-most-birth-defects-78592">Why we don't know what causes most birth defects</a>
</strong>
</em>
</p>
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<p>Then the authors genetically engineered mice and deleted these genes. They found that without them the mice had NAD deficiency, and similar malformations in their offspring. </p>
<p>However, when they provided extra niacin to pregnant mice, the pups were relatively normal despite the absent gene. </p>
<h2>What does this mean?</h2>
<p>This does NOT mean that taking niacin/vitamin B3 in pregnancy prevents miscarriages and all birth defects. </p>
<p>It means that high levels of niacin in pregnancy compensates for defects in the two selected genes, and prevents <em>mice</em> from experiencing miscarriage and birth defects in offspring. The paper does not report on human miscarriage or on malformations in human organs. The study did not supplement pregnant women with vitamin B3, or with anything else.</p>
<p>There have been previous studies showing mutations in other genes are also associated with VACTERL and it’s likely that different genes contribute to these malformations. Not all babies with VACTERL will have the same mutations. </p>
<p>But it’s important we understand the role of different genes in birth anomalies and this paper has not only identified genetic mutations in two genes, but also the mechanism by which they cause them and an easily obtained potential remedy for these cases.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/181748/original/file-20170811-1153-7vc8hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/181748/original/file-20170811-1153-7vc8hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181748/original/file-20170811-1153-7vc8hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181748/original/file-20170811-1153-7vc8hb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181748/original/file-20170811-1153-7vc8hb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181748/original/file-20170811-1153-7vc8hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181748/original/file-20170811-1153-7vc8hb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181748/original/file-20170811-1153-7vc8hb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Several B vitamins are related to birth defects.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Other causes of miscarriage</h2>
<p>A large number of genes when deleted in mice have been shown to cause miscarriage and malformations. Many of these are not involved in the NAD pathway. Most have not been associated with human miscarriage but a few may be. </p>
<p>For example, deficiency in an immune system molecule (cytokine) called “GM-CSF” <a href="https://academic.oup.com/biolreprod/article-lookup/doi/10.1095/biolreprod60.2.251">has been shown to cause</a> miscarriage and defects in the placenta in mice. Addition of this molecule to IVF embryos <a href="https://academic.oup.com/jcem/article/89/12/6139/2844463/Thyrotropin-TSH-Induced-Production-of-Vascular">prevents miscarriage in mice</a> and in humans <a href="https://digital.library.adelaide.edu.au/dspace/handle/2440/80451">prevents miscarriage</a> in high-risk women (those who have previously had a miscarriage following IVF). This is but one example unrelated to NAD.</p>
<h2>Can supplements prevent birth defects?</h2>
<p>From 1986-2007, 5.9% of South Australian births (so 590 out of 10,000) were <a href="http://www.wch.sa.gov.au/services/az/other/phru/birthdefect.html">complicated by congenital malformations</a>, most of which were not severe or life threatening. The most common malformations are in the urinary and genital systems (164/10,000 births) and the cardiovascular system (119/10,000) and range from mild to severe life-threatening malformations requiring extensive surgery. </p>
<p>For many of these there is no known cause nor remedy. For neural tube (brain and spine/spinal cord) defects such as spina bifida (which occur in 16 in 10,000 births), maternal supplementation with folic acid from one month before conception and in the first trimester of pregnancy <a href="https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Vitamin-and-mineral-supplementation-in-pregnancy-(C-Obs-25)-Review-Nov-2014,-Amended-May-2015.pdf?ext=.pdf">has been shown to reduce their incidence</a>.</p>
<p>The Australian population is <a href="http://www.nrv.gov.au/nutrients/niacin">not considered to be deficient in niacin</a>. Most breakfast cereals have niacin added to them as do some flours for baking; it is also present in meat, green vegetables and whole grain cereals.</p>
<p>A <a href="http://onlinelibrary.wiley.com/doi/10.1002/bdra.20648/abstract">2010 study in California</a> showed that in women who did not use micronutrient supplements in pregnancy, low dietary intakes of folate, niacin, riboflavin, and vitamins B12, A and E were associated with one specific major heart defect but not another. So not one, but a number of micronutrients are involved in birth defects, notably several B vitamins.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/181752/original/file-20170811-1188-1ke9v2r.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/181752/original/file-20170811-1188-1ke9v2r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/181752/original/file-20170811-1188-1ke9v2r.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=526&fit=crop&dpr=1 600w, https://images.theconversation.com/files/181752/original/file-20170811-1188-1ke9v2r.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=526&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/181752/original/file-20170811-1188-1ke9v2r.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=526&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/181752/original/file-20170811-1188-1ke9v2r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=661&fit=crop&dpr=1 754w, https://images.theconversation.com/files/181752/original/file-20170811-1188-1ke9v2r.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=661&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/181752/original/file-20170811-1188-1ke9v2r.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=661&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not all of the reports are backed by the science.</span>
<span class="attribution"><a class="source" href="https://www.victorchang.edu.au/pregnancy-breakthrough">Screenshot, victorchang.edu.au</a></span>
</figcaption>
</figure>
<p>Clearly, folic acid supplementation to prevent neural tube defects has been successful, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/19880541">emerging evidence suggests a potential downside</a>. Specifically, the babies of women who supplemented with folic acid in late pregnancy were more likely to have persistent asthma in early childhood. </p>
<p>Since 2009 we’ve had mandatory fortification of flour for bread-making with folic acid in Australia and New Zealand. Together with folic acid supplementation in pregnancy, pregnant women are getting high amounts of folic acid. Given folate plays a part in gene expression (the process by which information from a gene is used), it’s possible too much may not be a good thing. But we’re yet to see hard evidence of this.</p>
<p>This new study is scientifically excellent and the authors have great credentials. But media reports, and the <a href="https://www.victorchang.edu.au/pregnancy-breakthrough">research institution itself</a>, have made claims not supported by the science. Whether niacin is useful in human miscarriage has not been studied. The birth defects studied in the paper are rare and whether the findings apply to others is yet to be determined.</p>
<p>So potential parents need to be aware that, no, we have not found a way to prevent miscarriages and birth defects. And potential mothers should not start supplementing their diets with high levels of vitamin B3 because it hasn’t been tested in humans, and we don’t know what effects it will have.</p><img src="https://counter.theconversation.com/content/82315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Roberts works for University of Adelaide. She receives funding from NHMRC, NIH NICHD and University of Adelaide. </span></em></p>The new study on birth defects and vitamin B3 has important implications, but researchers didn’t actually give any of this vitamin to humans.Claire Roberts, Lloyd Cox Professorial Research Fellow, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/763522017-04-21T04:44:35Z2017-04-21T04:44:35ZFive ways to boost your nutrition before pregnancy<figure><img src="https://images.theconversation.com/files/166204/original/file-20170421-20068-11p72p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women (and their partners) can give their baby the best start in life by eating well even before they conceive.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/613852691?src=fbc33egthBZ5G0EgfU_9PA-2-27&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Thinking about trying to have a baby? Then now is the time for <a href="https://www.ncbi.nlm.nih.gov/pubmed/22742616">future mums</a> (<a href="https://www.ncbi.nlm.nih.gov/pubmed/25523615">and dads</a>) to “spring clean” food and lifestyle habits. Here are our five nutrition tips <em>before</em> pregnancy. </p>
<h2>1. Aim for a healthy weight</h2>
<p>In your 20s and 30s it’s common to have “weight creep”, an extra kilogram or two gained each year, without realising. Carrying too much weight increases the risk of pregnancy complications, including <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-gestational">gestational diabetes</a>, <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-pre-eclampsia">pre-eclampsia</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/19173021">delivery complications</a>. So, it’s worth trying to shift some of the “extra kilos” before trying to conceive.</p>
<p>A mother’s pre-pregnancy weight also has a direct <a href="https://www.ncbi.nlm.nih.gov/pubmed/23613888">effect on her baby’s birth weight</a>. Compared with mothers who are in the healthy weight range, mothers who are overweight or obese are 1.5-2 times more likely to have babies with a high birth weight, increasing the risk of birth complications. For these infants, there is an increased risk of developing <a href="https://www.ncbi.nlm.nih.gov/pubmed/19173021">obesity, heart disease</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/25940642">type 1 diabetes</a> later in life. </p>
<p>But improving eating and physical activity helps you achieve <a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">a healthy weight right for you</a>. For women carrying excess weight, a <a href="https://www.ncbi.nlm.nih.gov/pubmed/25336072">loss of 5-10% of pre-pregnancy weight</a> is enough to improve fertility and reduce the risk of weight-related pregnancy complications.</p>
<h2>2. Improve your food and drink choices</h2>
<p>Increasing the variety of food you eat each week across the basic food groups – vegetables, fruit, wholegrains, vegetarian foods (including legumes like baked beans, kidney beans, lentils, eggs, nuts and seeds), lean meats/poultry/fish and dairy foods – also boosts the vitamins and minerals needed from the very beginning of pregnancy. </p>
<p>Start by assessing the quality of your diet using the free <a href="http://healthyeatingquiz.com.au/">Healthy Eating Quiz</a> and check how it suggests you boost your score. You can also use the <a href="https://www.eatforhealth.gov.au/node/add/calculator-servings">eat-for-health calculator</a> linked to the <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">Australian Guide to Health Eating</a>. This calculates recommended daily serves from each of the five basic food groups, and gives an idea of daily serves to aim for to optimise your nutrients.</p>
<p>Getting your nutrients from food in the first instance is recommended, but some nutrients do need extra attention before conception and early in pregnancy.</p>
<h2>3. Take a folate supplement</h2>
<p><a href="https://en.wikipedia.org/wiki/Folate">Folate</a> is a B-group vitamin. It is needed to complete the development of the <a href="https://en.wikipedia.org/wiki/Neural_tube">neural tube</a>, which forms the baby’s brain and spinal cord in the first few weeks of pregnancy. This can be before you even know you’re pregnant. If the neural tube doesn’t close it can cause a neural tube defect like <a href="https://en.wikipedia.org/wiki/Spina_bifida">spina bifida</a>. </p>
<p>Taking a folate supplement (in the form of folic acid) from one month before pregnancy until the end of the first trimester is the best way to make sure you meet folate requirements during early pregnancy. </p>
<p>Choose a supplement with at least 400 micrograms of folic acid. Talk to your doctor if you have a family history of neural tube defects as you will need <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/folate-for-pregnant-women">higher levels of folic acid</a>. </p>
<p>A folate supplement is in addition to eating good food sources of folate, like green leafy vegetables, fruits, lentils and <a href="http://www.foodstandards.gov.au/consumer/generalissues/pregnancy/folic/Pages/default.aspx">breadmaking flour, most of which is fortified with folic acid in Australia)</a>. Organic breadmaking flour and most regular flour is not fortified, so check the ingredient list on flour you buy for home cooking.</p>
<h2>4. Take an iodine supplement</h2>
<p>In pregnancy, <a href="https://en.wikipedia.org/wiki/Iodine">iodine</a> is needed to support the baby’s developing brain and nervous system. Good food sources of iodine include <a href="http://www.foodstandards.gov.au/consumer/generalissues/pregnancy/Pages/iodineandpregnancy.aspx">seafood, dairy foods, eggs and iodine fortified breadmaking flour (except for regular and organic flour)</a>.</p>
<p>Although seafood is high in iodine, some types such as <a href="http://www.foodstandards.gov.au/consumer/chemicals/mercury/Pages/default.aspx">shark and swordfish should be avoided before and during pregnancy</a> as they may contain large amounts of mercury. </p>
<p>In Australia it is recommended that women planning to become pregnant, take an iodine supplement containing <a href="https://www.nhmrc.gov.au/guidelines-publications/new45">150 micrograms of iodine daily</a> and to continue this while pregnant or breastfeeding.</p>
<p>Talk to your doctor or pharmacist about vitamin supplements to meet your needs. For more personal advice on nutrition consult <a href="https://daa.asn.au/what-dietitans-do/choosing-your-nutrition-expert/">an Accredited Practising Dietitian</a>. </p>
<h2>5. Avoid alcohol</h2>
<p>All health authorities agree it is best to avoid alcohol from the time you start thinking about having a baby. There is no known safe level of alcohol during pregnancy. Alcohol consumed in moderate-to-large quantities can cause <a href="http://www.nofasd.org.au/resources/what-is-fasd-1">foetal alcohol syndrome</a> and increase the risk of having a baby <a href="https://www.ncbi.nlm.nih.gov/pubmed/21729235">preterm birth and of low birth weight</a>, which increases the chance of the baby having medical problems. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/17233797">risks to the baby at lower levels</a> are less clear. <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">The safest option is drinking no alcohol</a> if you are pregnant, planning a pregnancy or breastfeeding.</p>
<h2>Putting it all together</h2>
<p>Now is the time to start make changes to improve the nutritional quality of your food. And it’s not all about mum.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/25523615">Dads-to-be can benefit</a> from eating a variety of nutritious foods, cutting down on alcohol, and <a href="https://theconversation.com/health-check-ten-ways-to-save-2-000-kilojoules-and-drop-a-clothes-size-37039">dropping a pants size</a>. One study found that overweight men were 1.2 times and obese men were 1.3 times <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3521747/">more likely to be infertile</a>. But some good news in our study was that overweight and obese men who <a href="https://www.ncbi.nlm.nih.gov/pubmed/24459689">shed a few kilograms reported better erectile function</a>.</p>
<p>Any improvements you make to your food and lifestyle habits today will benefit you and your family in the future.</p><img src="https://counter.theconversation.com/content/76352/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.</span></em></p><p class="fine-print"><em><span>Jenna Hollis is affiliated with the Priority Research Centre for Physical Activity and Nutrition and the Priority Research Centre for Health Behaviour, at the University of Newcastle (Australia). She is a Project Officer at Hunter New England Population Health. She has received an Endeavour Postdoctoral Research Fellowship from the Department of Education and Training (Australian Government). She has also received funding from the Hunter Medical Research Institute (HMRI) and University of Newcastle, Australia. </span></em></p><p class="fine-print"><em><span>Siân Robinson is supported by the UK Medical Research Council and by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre.</span></em></p>Thinking about trying for a baby? Then now is the time for you and your partner to “spring clean” your food and lifestyle habits.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleJenna Hollis, Conjoint Lecturer, University of NewcastleSiân Robinson, Professor of Nutritional Epidemiology, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/669062016-10-14T05:48:40Z2016-10-14T05:48:40ZGenetic testing isn’t a crystal ball for your health<figure><img src="https://images.theconversation.com/files/141554/original/image-20161013-16233-2a0th1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Providing a sample for a genetic test might not actually give you the health answers you're looking for. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/canadianbloodservices/4911111788/in/photolist-8tYLfj-8tYJrb-9mHqxS-cFfpQG-armU2W-9J1e8L-7XuJsc-6Vzv4K-8KDLxZ-82XgoT-831qhj-82Xh2B-cfvYXs-8KDTTi-8KDJBM-831qrG-5nWpRY-831qxQ-8x7gBf-4GBNB6-fmPUiZ-ehLDn2-27khX2-8UrG7R-5xY1GH-8UuvZf">Canadian Blood Services/flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Choosing Wisely Australia has released its <a href="http://www.choosingwisely.org.au/latest">latest recommendations</a> on the use of genetic testing, suggesting people avoid genetic tests for Alzheimer’s (<a href="http://www.nature.com/gim/journal/v13/n6/full/gim9201195a.html">APOE</a>), coeliac disease and folate conversion (<a href="https://www.ncbi.nlm.nih.gov/pubmed/23288205">MTHFR</a>).</p>
<p>Testing these genes is not recommended as results do not lead to improved health outcomes, and may create anxiety or false hope among patients. </p>
<p>Led by Australia’s health colleges, societies and associations and facilitated by <a href="http://www.nps.org.au/">NPS MedicineWise</a>, <a href="https://theconversation.com/less-is-the-new-more-choosing-medical-tests-and-treatments-wisely-40756">the Choosing Wisely initiative</a> drives conversations for the health care community and consumers about eliminating the use of unnecessary and sometimes harmful tests, treatments, and procedures. </p>
<h2>Genetic testing as a health care tool</h2>
<p>Genetic testing is currently available for <a href="https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=43">more than 2,000 rare and common conditions</a>. It is an important tool for the diagnosis of rare and inherited conditions such as <a href="http://www.genetics.edu.au/Publications-and-Resources/Genetics-Fact-Sheets">cystic fibrosis</a>. It can also guide health care and decisions for families with a strong history of <a href="http://www.racgp.org.au/afp/2014/januaryfebruary/family-history-of-breast-cancer/">cancer</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed?term=Watts%20G,%20Sullivan%20D,%20Poplawski%20N,%20et%20al.%20Familial%20hypercholesterolaemia:%20a%20model%20of%20care%20for%20Australasia.%20Atherosclerosis%202011;12(Suppl%202):221%E2%80%9331.">high cholesterol</a>. </p>
<p>However, its use it not always justified.</p>
<p>Genetic testing involves analysis of a person’s DNA: it looks for variants in genes that have an impact on our health. However many variants do not have a strong association with disease. Indeed, for many we don’t know what affect they have at all. </p>
<p>When the evidence for an association between a genetic variant and a health outcome is weak, genetic testing does not add any value for the health professional in making decisions about treatment and patient management. This reflects the fact that <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/g9_direct_to_consumer_genetic_testing_nhmrc_statement_141208.pdf">gene variants are common in our DNA</a> and often not responsible for disease symptoms.</p>
<p>MTHFR and APOE are examples of genes with known and common variants that are poorly correlated with predicting future health risks. </p>
<h2>Genetic testing to assess folate conversion</h2>
<p><a href="https://theconversation.com/adding-folic-acid-to-staple-foods-can-prevent-birth-defects-but-most-countries-dont-do-it-55533">Folate and folic acid </a> are forms of the vitamin B9. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/23288205">MTHFR (5,10-methylenetetrahydrofolate reductase) gene</a> is involved in converting the vitamin into a form the body can use. </p>
<p>There are <a href="http://www.racgp.org.au/afp/2016/april/mthfr-genetic-testing-controversy-and-clinical-implications/">two common variants in the MTHFR gene</a>, and 60–70% of the general population will have at least one of these variants. </p>
<p>People with MTHFR variants still usually convert sufficient folate for the body to function as normal. With a good diet, the <a href="http://www.racgp.org.au/afp/2016/april/mthfr-genetic-testing-controversy-and-clinical-implications/">effects of a MTHFR variant can be easily overridden</a>.</p>
<p>Low levels of folate are known to <a href="https://www.ranzcog.edu.au/college-statements-guidelines.html">increase the risk of neural tube defects</a>, where part of a baby’s brain or spinal cord does not form correctly during pregnancy. <a href="https://www.ranzcog.edu.au/college-statements-guidelines.html#obstetrics">Australian women are advised</a> to take folic acid for a minimum of one month before conception and for the first three months of pregnancy, irrespective of their MTHFR gene variant status. </p>
<p>Although variants in the MTHFR gene have been suggested to play a role in some blood clotting disorders and heart disease, there is <a href="https://www.ncbi.nlm.nih.gov/pubmed/20937919">insufficient evidence</a> to show that MTHFR variants have any significant impact on these conditions. </p>
<p>Even though folate deficiency in Australia is rare, and people with variants of MTHFR can still convert sufficient folate for good health, there has been a <a href="http://www.racgp.org.au/afp/2016/april/mthfr-genetic-testing-controversy-and-clinical-implications/">rapid increase</a> in consumer-driven MTHFR gene testing as part of “healthy lifestyle” testing. </p>
<p>GPs and genetic clinics also <a href="http://www.racgp.org.au/afp/2016/april/mthfr-genetic-testing-controversy-and-clinical-implications/">report</a> high levels of anxiety among clients seeking clinical advice about their MTHFR test results.</p>
<p>MTHFR genetic testing is not recommended. </p>
<h2>Genetic testing for Alzheimer’s disease</h2>
<p>There are a number of <a>well known variants</a> in the APOE (apolipoprotein E) gene. The APOE E4 form of this gene is often suggested to have a connection <a href="http://www.nature.com/gim/journal/v13/n6/full/gim9201195a.html">with the late-onset form of Alzheimer’s disease</a>, affecting people aged 60 years and over. </p>
<p>However this variant has been found in healthy members of the community as well as those who develop Alzheimer’s disease. Until more is known about the role of the APOE gene, <a href="http://www.genetics.edu.au/Publications-and-Resources/Genetics-Fact-Sheets/FS50ALZHEIMERDISEASE.pdf">determining which form of the gene is present can’t predict</a> accurately whether a person is predisposed to develop the condition. </p>
<p>Current genetic tests that claim to predict risk of Alzheimer’s disease based on APOE are therefore limited and unlikely to do anything other than create unnecessary anxiety. </p>
<p>It can also create a false sense of security because late-onset Alzheimer’s disease also develops in people who don’t carry the APOE E4 variant.</p>
<p>But <a href="http://www.nature.com/gim/journal/v13/n6/full/gim9201195a.html">familial factors do influence the risk of dementia</a>. People with dementia occurring in later life – of which Alzheimer’s disease is the most common form – are about three times more likely to have a parent or sibling with dementia. </p>
<p>Late onset Alzheimer’s disease must not be confused with a very rare form of early onset familial Alzheimer’s disease. Symptoms usually start well before 65 years of age and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857183/">genetic testing of particular genes</a> may be considered for this specific condition.</p>
<h2>Genetic testing for coeliac disease</h2>
<p><a href="http://www.mayoclinic.org/diseases-conditions/celiac-disease/home/ovc-20214625">Coeliac disease</a> is a condition in which the immune system is abnormally sensitive to gluten, a protein found in wheat, rye and barley. When coeliac disease is not well managed it can lead to diarrhoea, fatigue, weight loss, bloating and anaemia, and more serious complications. </p>
<p>Although variants in genes that provide instructions for making proteins in the immune system <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/coeliac-disease-and-gluten-sensitivity">can indicate</a> an increased risk of developing coeliac disease, this field of research is still relatively young. </p>
<p>The new Choosing Wisely Australia recommendation reflects The Gastroenterological Society of Australia’s view that a genetic test should not currently be used to diagnose coeliac disease. Professor Anne Duggan from the society says, </p>
<blockquote>
<p>As a coeliac gene can be found in one-third of the population and a positive result does not make coeliac disease a certainty, serological testing is the appropriate first-line screening tests for coeliac disease. </p>
</blockquote>
<p><a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/coeliac-disease-and-gluten-sensitivity">Serological testing</a> measures levels of specific antibodies in blood, and can be followed up with intestinal biopsies for confirmation. </p>
<h2>Consumer driven genetic testing</h2>
<p>Clear health benefits have come from the rapid development of genetic technologies and increased availability of genetic testing. However, genetic tests are complex. Results often require interpretation from an experienced practitioner, as they have multiple possible outcomes and levels of certainty.</p>
<p>When health consumers undertake testing without the involvement of a health professional, there is <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/g9_direct_to_consumer_genetic_testing_nhmrc_statement_141208.pdf">potential for misinterpretation</a> of results, inappropriate further investigations and treatment, unnecessary anxiety and false reassurance. </p>
<p>Genetic testing results can have implications for family members due to the shared nature of genetic information in families. Misinterpretation and anxiety may be exacerbated as results are relayed to relatives.</p>
<p>With the increase trend towards direct-to-consumer testing – where tests are purchased directly by consumers, often over the internet and usually without the involvement of a health professional – and the translation of testing into mainstream medicine, guidelines from Choosing Wisely Australia are timely. </p>
<p>With the advent of new technologies, we must be circumspect about the validity of testing and over-testing and aim to avoid causing patients and their families unnecessary harm. </p>
<p>Genetic testing is best performed in a clinical setting with the provision of personalised genetic counselling and professional interpretation of tests results.</p><img src="https://counter.theconversation.com/content/66906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Dunlop receives funding from NHMRC. </span></em></p>Testing some genes for Alzheimer’s disease, coeliac disease and folate conversion does not lead to improved health outcomes, and may create anxiety or false hope amongst patients.Kate Dunlop, Director of the Centre for Genetics Education, NSW and Clinical Lecturer, Sydney Medical School-Northern, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/371702015-10-12T03:51:41Z2015-10-12T03:51:41ZHealth Check: seven nutrients important for mental health – and where to find them<figure><img src="https://images.theconversation.com/files/98007/original/image-20151012-23288-t3ve32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While nutrient supplementation can have a role in treating certain psychiatric disorders, all kinds of nutrients should, in the first instance, be consumed as part of a balanced wholefood diet.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nakrnsm/3815441846/">PROPatrick Feller/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Dietary nutrients are critical for brain structure and function, so they have a potentially profound impact on mental health. An increasingly <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract">robust body of research</a> points to the detrimental effect of unhealthy diets and nutrient deficiencies, and to the protective value of healthy diets – along with select nutritional supplements as required – for maintaining and promoting mental health. </p>
<p>Research literature suggests dietary improvement and nutritional interventions may help reduce the risk, or even arrest the progression, of certain psychiatric disorders. <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract">Clinical studies</a> support the use of certain nutrients, which influence a range of neurochemical activities beneficial for treating mental disorders, as medicinal supplements.</p>
<p>Evidence from clinical research supports the use of several nutritional medicines for certain psychiatric disorders: omega-3 fatty acids; N-acetyl cysteine (NAC); S-adenosyl methionine (SAMe); zinc; magnesium; vitamin D; and B vitamins (including folic acid). Other natural compounds such as amino acids, plant-based antioxidants and microbiotics (derived from fermented food or laboratory synthesis) are also known to influence brain health. </p>
<p>But while some evidence supports these natural compounds as having brain chemical-modulating effects, or having a role in treating certain mental disorders, we cannot currently name particular foods as being effective for the treatment of mental illness. The best nutritional advice at this point is to cultivate an unprocessed wholefood diet, with judicious prescriptive use of nutrients (if required) based on advice from a qualified health professional. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=353&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=353&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=353&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=444&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=444&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98010/original/image-20151012-23309-1jxpwuh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=444&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Oily fish such as sardines are the best source of omega-3 fats.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jmenj/9434507959/">Jeanne Menj/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In the meanwhile, here are seven key nutrients that may positively influence brain health, and the foods they appear in.</p>
<p><strong>1. Omega-3</strong> </p>
<p>Polyunsaturated fats (in particular omega-3 fatty acids) <a href="http://www.ncbi.nlm.nih.gov/pubmed/23538073">have a vital role</a> in maintaining proper neuronal structure and function, as well as in modulating critical aspects of the inflammatory pathway in the body. Taking omega-3 supplements appears beneficial for addressing symptoms of depression, bipolar depression and post-traumatic stress disorder. And it may potentially help <a href="http://www.ncbi.nlm.nih.gov/pubmed/20124114">prevent psychosis</a>.</p>
<p>Omega-3 fats can be found in nuts, seeds and oysters, although the highest amounts exist in oily fish such as sardines, salmon (especially King salmon), anchovies and mackerel. Due to higher levels of mercury, larger fish, such as mackerel, should be consumed in moderation.</p>
<p><strong>2. B vitamins and folate</strong></p>
<p>We need B vitamins for a range of cellular and metabolic processes, and they have a critical role in the production of a range of brain chemicals. Folate (B9) deficiency <a href="http://www.psychiatrist.com/JCP/article/Pages/2009/v70s05/v70s0503.aspx">has been reported</a> in depressed populations and among people who respond poorly to antidepressants.</p>
<p>Several studies have assessed the antidepressant effect of folic acid (the synthetic form of folate) with antidepressant medication. <a href="http://www.psychiatrist.com/JCP/article/Pages/2009/v70s05/v70s0503.aspx">Some show positive results</a> in enhancing either antidepressant response rates or the onset of response to these medications. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98012/original/image-20151012-23319-13i4uq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nuts are a good source of folate, amino acids and minerals.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/addiction/62824084/">Ahmed Al Masaood/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Folate is found in abundance in leafy green vegetables, legumes, whole grains, brewer’s yeast and nuts. Unprocessed meats, eggs, cheese, dairy, whole grains and nuts are, in general, richest in B vitamins. If you’re going to take supplements, it’s advisable to take B vitamins together as <a href="http://www.ncbi.nlm.nih.gov/pubmed/23253391">they have a synergistic effect</a>.</p>
<p><strong>3. Amino acids</strong></p>
<p>Amino acids are the building blocks for creating proteins, from which brain circuitry and brain chemicals are formed. Some amino acids are precursors of mood-modulating chemicals; tryptophan, for instance, is needed to create serotonin. Another example is cysteine, a sulphur-based amino acid that can convert into glutathione – the body’s most powerful antioxidant. </p>
<p>When given as a supplement, an amino acid form known as N-acetyl cysteine (NAC) converts into <a href="https://en.wikipedia.org/wiki/Glutathione">glutathione</a> in the body. We have <a href="http://www.ncbi.nlm.nih.gov/pubmed/23369637">evidence that it’s helpful</a> in bipolar depression, schizophrenia, trichotillomania and other compulsive and addictive behaviours. Another amino acid-based nutrient known as S-adenosyl methionine (SAMe) <a href="http://www.ncbi.nlm.nih.gov/pubmed/24856557">has antidepressant qualities</a>. </p>
<p>Amino acids are found in any source of protein, most notably meats, seafood, eggs, nuts and legumes.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98013/original/image-20151012-23319-wauedl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Amino acids are found in sources of protein such as meat.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/wurzeltod/357151207/">Suzanne Gerber/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p><strong>4. Minerals</strong> </p>
<p>Minerals, especially zinc, magnesium and iron, have important roles in neurological function. </p>
<p>Zinc is an abundant trace element, being involved in many brain chemistry reactions. It’s also a key element supporting proper immune function. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25012438">Deficiency has been linked</a> to increased depressive symptoms and there’s emerging evidence for zinc supplementation in <a href="http://www.ncbi.nlm.nih.gov/pubmed/21798601">improving depressed mood</a>, primarily alongside antidepressants. </p>
<p>Magnesium is also involved in many brain chemistry reactions and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19085527">deficiency has been linked</a> to depressive and anxiety symptoms. Iron is involved in many neurological activities and <a href="http://www.biomedcentral.com/1471-244X/13/161">deficiency is associated with</a> anxiety and depressive symptoms as well as developmental problems. This is, in part, due to its role in transporting oxygen to the brain.</p>
<p>Zinc is abundant in lean meats, oysters, whole grains, pumpkin seeds and nuts, while magnesium is richest in nuts, legumes, whole grains, leafy greens and soy. Iron occurs in higher amounts in unprocessed meats and organ meats, such as liver, and in modest amounts in grains, nuts and leafy greens, such as spinach. </p>
<p><strong>5. Vitamin D</strong></p>
<p>Vitamin D is a fat-soluble compound that’s important as much for brain development as it is for bone development. Data suggests low maternal levels of vitamin D are <a href="http://www.ncbi.nlm.nih.gov/pubmed/22796576">implicated in schizophrenia risk</a>, and deficiency is linked to <a href="http://www.ncbi.nlm.nih.gov/pubmed/23377209">increased depressive symptoms</a>. But there’s little evidence to support the use of <a href="http://www.ncbi.nlm.nih.gov/pubmed/24423304">vitamin D supplements for preventing depression</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=362&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=362&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=362&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98015/original/image-20151012-23300-uz3k8j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vitamin D can be synthesised via sunlight.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/naturesdawn/4299041739/">Dawn Ellner/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Vitamin D can be synthesised via sunlight: 15 minutes a day on the skin between 10am and 3pm during summer, although be sure to seek professional health advice regarding skin cancer concerns. Aside from sunlight, vitamin D can also be found in oily fish, UVB-exposed mushrooms and fortified milk.</p>
<p><strong>6. Plant-based antioxidants</strong></p>
<p>An increase in oxidative stress and damage to brain cells has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/22271002">implicated in a range of mental disorders</a>, including depression and dementia. Antioxidant compounds (such as “polyphenols”, which are found in fruits and certain herbs) may “mop up” free radicals that damage cells to <a href="http://www.ncbi.nlm.nih.gov/pubmed/22334236">provide a natural way</a> to combat excessive oxidation.</p>
<p>Consuming natural antioxidant compounds through your diet is better than taking supplements of high doses of synthetic vitamin A, C or E, as the oxidative system is finely tuned and excess may actually be harmful. </p>
<p>Fruits and vegetables contain these antioxidant compounds in relative abundance, especially blackberries, blueberries, raspberries and goji berries; grapes; mangoes and mangosteen; onions; garlic; kale; as well as green and black tea; various herbal teas; and coffee.</p>
<p><strong>7. Microbiotics</strong></p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/23384445">Research</a> shows a connection between the bacteria in our guts and brain health, which may affect mental health. When the composition of the gut microbiota is less than optimal, it can result in inflammatory responses that <a href="http://www.ncbi.nlm.nih.gov/pubmed/21135322">may negatively affect</a> the nervous system and brain function. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98009/original/image-20151012-23283-125i0an.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Diets high in sugary, fatty and processed foods are associated with depression and poor brain health.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/brizzlebornandbred/9375507295/">Paul Townsend/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>A balanced microfloral environment is supported by a diet rich in the foods that nourish beneficial bacteria and reduce harmful microbial species, such as <em>Helicobacter pylori</em>. Beneficial microflora can be supported by eating fermented foods such as tempeh, sauerkraut, kefir and yoghurt, and also by pectin-rich foods such as fruit skin. </p>
<h2>What now?</h2>
<p>Diets high in sugary, fatty and processed foods <a href="https://theconversation.com/you-are-what-you-eat-how-diet-affects-mental-well-being-27115">are associated</a> with depression and poor brain health. While nutrient supplementation can have a role in maintaining proper brain function and treating certain psychiatric disorders, nutrients should, in the first instance, be consumed as part of a balanced wholefood diet.</p>
<p>There is now enough research evidence to show the importance of nutrients for mental as well as physical well-being. A <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract">discussion about diet and nutrition</a> should be the starting point in conversations about mental health, just as it is for physical health.</p>
<p><em>If you’re interested in participating in a clinical trial prescribing nutrients for treating depression (SE Queensland and Victoria only), visit <a href="http://nutrientsdepressionstudy.com/">nutrientsdepressionstudy</a>.</em> </p>
<p><strong>Acknowledgement</strong>: Dr Drew Ramsey contributed to this article.</p><img src="https://counter.theconversation.com/content/37170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jerome Sarris has received funding from Integria Health, Blackmores, Bioceuticals, Pepsico, HealthEd, Soho-Flordis, Pfizer, Elsevier, the Society for Medicinal Plant and Natural Product Research, CR Roper Fellowship, and The National Health and Medical Research Council. He is affiliated with The International Society for Nutritional Psychiatry Research. </span></em></p>A growing body of research points to the detrimental effect of unhealthy diets and the protective value of healthy diets – along with select nutritional supplements as required – for maintaining and promoting mental health.Jerome Sarris, Senior Research Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.