Recent individual stories in the media have suggested folinic acid as a treatment for anxiety disorders.

Folate is a B vitamin needed for DNA synthesis, repair and replication. It is found in green leafy vegetables, citrus, brown rice,  legumes and is added to many processed foods. The synthetic version is folic acid ( the usual supplementation given) which is more rapidly absorbed, but must be converted back to folate to be used by the body after eating. Folinic acid is a derivative of folic acid which does not require the enzyme conversion for activation and allows the metabolic processes linked to folate to occur in the presence of enzyme inhibition. Methylfolate is also available, a natural active form of folic acid not requiring activation or conversion. L-Methylfolate (methylfolate)is the only form of folic acid crossing the blood brain barrier and plays a role in neurotransmitter synthesis, indirectly being involved in the production of the neurotransmitters involved in mood regulation.( dopamine, serotonin and noradrenaline)

Certain conditions and medications can affect absorption and the enzyme conversion, from liver disease, genetic mutation with enzyme lacking, alcoholism, and drugs such as the oral contraceptive, aspirin, antacids , oral diabetic treatments and antiepileptic medication. Blood levels of folate may not reflect levels present in the central nervous system.

There have been some studies suggesting folic acid supplements increase the risk of malignancy . The mechanism is as yet unknown. Very high doses of folic acid can cause gut upset and can reduce efficacy of antiepileptic medications.

Supplementation has been shown to have a clear role in pregnancy to reduce neural tube defects and to correct deficiency and for those being treated for rheumatoid arthritis with methotrexate.

Anxiety Disorders result from a combination of factors and. The common factors are family history of mental health problems, ongoing stressful events, physical health problems, substance use and personality types. It is often not possible to identify a single cause.

There is a range of treatments, health professionals and services available to those experiencing symptoms. Many people are helped by antidepressant medications, but a proportion of people are not helped or experience significant side effects. Focusing on the biology/chemistry of anxiety may miss what is going on at social and psychological levels There are a number of psychotherapy, cognitive behavioural therapies and interpersonal therapies with high success rates. The relationship between nutrition and foods affecting mental health has not been well studied and was not on the medical research radar five years ago. There is limited literature, but a shift in attitude and acceptance and increasing amount of evidence being generated to improve understanding about the processes involved.

Some studies have suggested improvement in depressive symptoms using folinic acid supplementation, but others demonstrate no difference. One study did show benefit of supplementation in severe depressive symptoms for those suffering who did not respond to antidepressants, and another demonstrated a benefit only to females, not males. No peer review, evidence based studies have yet been published regarding supplementation with folinic acid and anxiety symptoms.

There is now consistent observational data showing the link between diet and mental health. There is also experimental data demonstrating  diet and nutrition as having a clear influence on biological processes important to mental health. Further randomised and controlled trials are needed to be more specific.

It is unlikely that the answer will be an individual nutrients as supplements. They combine in food parcels  with complicated activities.  The strongest evidence base is for a Mediterranean diet and reduced processed and refined foods and soft drinks, providing several improved health outcomes including mental health.

The diet includes increasing plant-based fruits and vegetables, legumes such as chickpeas, beans and lentil ( improving gut microbiota), whole grains, raw nuts. The individual nutrients and elements include magnesium, zinc, folate, omega 3 fatty acids, iron, selenium , tryptophan ( in banana, poultry and salmon), chilli and vinegars ( also improving the gut micribiota).

There is some evidence of the negative effects to body and brain from a diet high in fat and sugar regardless of other intake ( in particular taking supplements),and a diet including reduced protein has been shown to have significant impact on cognitive function.

Regarding anxiety treatments, it is important not to stop treatment for a diet . The condition has many contributing factors and in managing the symptoms will have a range of treatments , health professional and services that may need to be employed.


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