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Autism Coach

Folate - Not Folic Acid - Prevents Birth Defects and Supports Neurological Development


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Folic acid is not folate! Folic Acid is incorrectly identified as a vitamin since its synthetic crystallization in the 1940s.  Unfortunately the terms folic acid and folate are used interchangeably.

The FDA has recommended supplementing with folic acid to prevent birth defects, but it is actually folate that prevents birth defects.  The biologically available forms of folate (5MTHF, folinic acid, methyltetrahydrofolate, Metafolin and Quatrefolate), Vitamin B6 (P5P) and Vitamin B12 (methylcobalamin, hydroxycobalamin) work together to support the methylation cycle, which is frequently impaired in individual within the autism spectrum. For information on the methylation cycle, please click here.

Folates are found in leafy and green vegetables such as spinach, asparagus, turnip greens, romaine, lettuce, broccoli, Brussels sprouts, and bok choy. Other sources include corn, beets, tomatoes, dried or fresh beans and peas, fortified sunflower seeds and some fruits, including oranges, grapefruit, pineapple, cantaloupe, honeydew melon, banana, raspberries, and strawberries.  These folate degrade rapidly and so we typically do not get enough folate in our diet and benefit from folate supplementation.

Folate was originally isolated from brewer’s yeast and spinach in the 1930s. Once isolated and exposed to air it becomes unstable and breaks down, and is generally no longer useful in nutrition.  But when oxidized it has a long shelf life.  While human cells can't use folic acid in normal metabolic processes, the liver, when working properly, can transform folic acid back into metabolilcally useful folate. 

However, many individuals within the autism spectrum and the elderly cannot convert folic acid into folate.  Studies show significantly elevated levels of unmetabolized folic acid building up in the bloodstreams of supplemented elderly.  This inability to convert folic acid to folate may have to do with impaired digestion and/or genetic abberations that impair the function of the methylation cycle.  Most individuals within the autism spectrumand their parents have genetic abberations that impair the functioning of the methayltion cycle and require the more bioavalble forms of folate, B12, and B6 to function optimally. Folate and B12 are critical for optimal division of rapidly growing cells of the fetus in pregnancy and in infants and young children.

The reason folic acid is used more frequently than natural forms of folate in supplements and food products is because it is a cheaper raw material and has a longer shelf life.

Pregnancy and Folate

If you are thinking of becoming pregnant, there's an inexpensive blood test called the neutrophile hypersegmentation index (NHI) that determines if you can metabolize folic acid. This test determines which percentage of your nuetrophils - a type of white blood cell - where supplied with optimal amounts of folate while they were growing.  When neutrophils are "born" and "incubate" in the bone marrow, their DNA arrange themselves into five segment. A final step in neutrophil DNA maturation is re-arrangement of those five segments into three. Normal folate metabolism is a key to this final step. Very shortly after the five-to-three segment DNA re-arrangement, the fully mature neutrophil is released from the bone marrow into the bloodstream, where it lives out its months-long life doing its job—one very important part of which is defending our bodies against germs. 

But if there isn’t enough folate, the neutrophil’s DNA stays in five (instead of three) segments. When the neutrophil is needed, it’s released into the bloodstream anyway, where it’s called a hypersegmented (too many segments) neutrophil. Fortunately, a hypersegmented neutrophil can still fight germs as well as a “regular,” three-segmented neutrophil.

The reason this is important in pregnancy is because cells are rapidly dividing during pregnancy.  Without sufficient folate and B12, the cells may not divide properly and common birth defects, such as neural tube defect may occur (this occurs on days 27-29 after conception).

Neutrophils, other circulating blood cells, and the cells that line our gastrointestinal tracts are the most rapidly dividing cells in our bodies. So if there’s a shortage of any of the three key nutrients for keeping cell division normal—folate, vitamin B12, and/or zinc—these rapidly dividing cells are likely to show the effects first.

For women who want to conceive whose blood test indicates they have a high level of these immature white blood cells, they should be on natural forms of folate and B12 before conceiving and during pregnancy to prevent birth defects.

Frequently individuals within the autism spectrum a combination of low levels of folate, B6, and B12.  Methylation is critical for supporting detoxification and neurological development.  Supplementation with the active forms of these vitamins helps the majority of individual within the autism spectrum detoxify and improve level of functioning. 

Folate and B12 deficiency are also implicated as a factor in dementia.  Supplementation with these vitamins can provide neurological support for the elderly.

What is Folic Acid? 

Folic acid is a single type of molecule, crystallized in 1943 by a scientist working for the patent medicine company Lederle Laboratories, then a subsidiary of American Cyanamid Corporation. Folic acid is the fully oxidized form of naturally occurring folates.

Naturally occuring folates are found in leafy and green vegetables such as spinach, asparagus, turnip greens, romaine, lettuce, broccoli, Brussels sprouts, and bok choy. Other sources include corn, beets, tomatoes, dried or fresh beans and peas, fortified sunflower seeds and some fruits, including oranges, grapefruit, pineapple, cantaloupe, honeydew melon, banana, raspberries, and strawberries. None of these vegetables, fruits, liver or yeast naturally contain a molecule of folic acid!

Other Signs of Folate Acid Deficiency

Individuals who test as being slightly anemic may be deficient in B12 and folate, suffering from pernicious anemia.  Supplementing with the active forms of these B vitamins can help to correct this.

(Note:  There is a subset of individuals within the autism spectrum who need some but not all of the active forms of B vitamins.  Genetic testing can be obtained (often testing the MTFHR gene) to determine which forms and what amounts of B Vitamins best support methylation.)

Natural Forms of Folate Available in Supplements

Forms of folate that are available in supplement form that are useable by the body to support methylation are Metafolin, Methyltetrahydrofolate, and Quatrefolate.

Some of the Autism Coach supplements containing active folate include: