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Some people with schizophrenia may have a vitamin deficiency

A new hypothesis from researchers at the University of Toronto links a vitamin deficiency with schizophrenia and could have profound implications for treating psychosis in developing nations.

Mothers who experience famine in the first trimester of pregnancy are twice as likely to have offspring who develop schizophrenia. Researchers have long suspected a nutrient deficiency is to blame, and the new hypothesis suggests it could be niacin, also known as vitamin B3.

Professor Esme Fuller-Thomson from the University of Toronto came up with the idea after seeing a study done in India that showed a link between schizophrenia and a variant of a gene that reduces the body’s ability to process niacin, which occurs in meat, poultry, fish and eggs.

Identifying the gene variant could also explain another medical mystery – why some people with schizophrenia do not develop reddened skin with a burning, tingling sensation in the same way that most people do when given high doses of niacin. These patients may simply be unable to absorb the vitamin.

The niacin hypothesis also fits with a now-rare disease known as pellagra. Between 1906 and 1940, pellagra was the leading cause of death in psychiatric institutions in the USA. Its symptoms include dermatitis, dementia and death, and in up to 10% of cases leads to active psychosis, which mimics schizophrenia. Treatment with niacin quickly and permanently cures the condition, which is now rare thanks to the widespread fortification of flour with niacin.

Pellagra patients usually present with a bad rash, but in people with the gene variant that reduces niacin uptake, patients could show the symptoms of psychosis without the associated dermatitis, leading to a misdiagnosis of schizophrenia.

Fuller-Thomson suspects that such misdiagnosis might be occurring in poorer countries. Studies by the World Health Organization show that patients with schizophrenia in developing countries recover at a higher rate than those in the West. This discrepancy could be explained if some of those patients did not actually have schizophrenia at all, but instead were suffering from pellagra. In such cases, their symptoms could be cured simply by being in a hospital where niacin-rich food was served to them.

The new hypothesis could allow many patients in poorer countries to be quickly and cheaply healed, and it also sheds new light on the connections between nutrition and wellbeing. This knowledge could also lead to broader applications in western countries, as the chemical drivers of brain function become clearer and better understood.

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