Beta-oxidation is up-regulated in schizophrenia. Malonyl-CoA inhibits beta-oxidation. Malonyl-CoA is synthesized by acetyl-CoA carboxylase which is a biotin-dependent enzyme. With deficiencies in biotin due to dysregulation of the SMVT malonyl-CoA will not be synthesized which will lead to low levels of malonyl-CoA and increased beta-oxidation which is what is seen in schizophrenia.
The sodium-dependent multivitamin transporter (SMVT) also transports iodide. How important the SMVT is for iodide transport is not clear. Supplementing with biotin and pantothenic acid, however, could competitively block the transport of iodide by the SMVT. There is another transporter of of iodide, the sodium/iodide cotransporter, (SLC5A5) which is largely expressed in the thyroid. The SMVT is expressed in the digestive tract.
‘Furthermore, the equimolar replacement of NaCl with LiCl or lowering the pH of the uptake assay from pH 7.4 to pH 5.5 (generation of a proton gradient across the oocyte membrane) resulted in R-[3H]LA accumulation in hSMVT-expressing oocytes that was indistinguishable from that observed in control oocytes (Fig. 2E)’ Control oocytes lack the hSMVT. The SMVT is the sodium-dependent multivitamin transporter and LiCl is lithium chloride. The SMVT transports biotin, pantothenic acid and lipoate.
The hSMVT is pH sensitive. Sodium bicarbonate buffers pH. If dysregulation of the SMVT in a key to to bipolar disorder as is argued in the page on bipolar disorder then sodium bicarbonate could be a key to the treatment of bipolar disorder. Sodium bicarbonate would also supply sodium which is required for transport by the SMVT.
The sodium of sodium bicarbonate could raise blood pressure. Each dosage of sodium bicarbonate would have to be taken with a 24 ounce glass of water to prevent dehydration which could raise blood pressure.
Blood pressure would have to be monitored. Individuals with high blood pressure may simply not be able to take sodium bicarbonate.
Sodium bicarbonate would be taken with biotin and pantothenic acid where biotin and pantothenic acid would be taken away from each other. Lipoic acid would not be taken as lipoic acid could competitively block the transport of pantothenic acid and biotin by the SMVT. Lipoic acid is synthesized on residues so there is no need to take lipoic acid.
Acetyl-CoA carboxylase is a biotin-dependent enzyme that is involved in the synthesis of non-essential fatty acids. Supplementation with beef tallow or ghee could be helpful. Taurine would be supplemented to assist with digestion of fatty acids.
If sodium bicarbonate, biotin, pantothenic acid, beef tallow or ghee and taurine are effective in the treatment of bipolar disorder then sodium bicarbonate, biotin, pantothenic beef tallow or ghee and taurine acid would be infinitely preferable for the treatment of bipolar disorder than lithium and/or anti-convulsants.
Supplements on the ‘supplements to be avoided’ list on the Treatment page would also be avoided. See the page on bipolar disorder for more on the SMVT
In the treatment of bipolar disorder anti-psychotics have increasingly become more commonly prescribed, increasing from 12.4% of outpatient visits for bipolar disorder in the 1997-2000 period to 51.4% in the 2013-2016 period.
The page on bipolar disorder of this site both points to why lithium and anti-convulsants work at all while also pointing to why lithium and anti-convulsants are very inadequate treatments for bipolar disorder. Lithium and anti-convulsants target the SMVT but do so poorly where the dysregulation of the sodium-dependent multivitamin transporter (SMVT) is only one factor that gives rise to bipolar disorder.
Anti-psychotics are terrible drugs but many psychiatrists and patients find them preferable to lithium and anti-convulsants.