Folate/B9 for Autism Spectrum Disorder
- Sara L
- Mar 11, 2024
- 4 min read
Updated: Mar 12, 2024
Folate is a water soluble B vitamin also known as B9 and is an umbrella term for the many different forms of B9. It is essential for methylation, a process that turns on good genes and turns off unhealthy genes that could cause disease. It is important for cells and keeps them healthy. Folate is also important for making the building blocks that our body needs, like genetic material and cells, and for healthy brain and spinal cord development. That is one of the reasons we give pregnant Mother's folate for their babies.
Potential benefits of Folate supplementation¹
But what type of folate should you take?
Folate is a generic term that describes the many different forms of Vitamin B9 such as folic acid, Folinic acid (5-formyl-tetrahydrofolic acid), Dihydrodfolate (DHF), tetrahydrofolate (THF), 5,10-methylenetetrahydrofolate (5, 10-MTHF) and 5-methyltetrahydrofolate (5-MTHF).
5-MTHF is considered ‘active’ and easy for the body to use. Despite this, for ASD it may not be the best form to use. In ASD there appears to be problems in using folate.
Antibodies, which are the body’s defense system against infection, accidentally destroy folate and prevent it from getting to the brain. Therefore their brains do not get as much as they need². As a results there is there is not enough methylation happening in more than 95% of people with ASD (Godbout Laake & Compart, 2013).
Folinic acid is a form of folate that is able to sneak past the antibodies and reach the brain³. Therefore Folinic acid supplementation in ASD diagnosed children can help improve symptoms.
It is not clear from the literature whether active 5 MTHF is able to sneak past antibodies, so it might be worth starting with Folinic acid first, assessing for improvements and then switching to 5 MTHF if needed.
Folate dosages
A word on the Recommended Daily Allowances (RDAs) numbers. These guidelines were established by The Institute of Medicine of the national academies as well as the food and nutrition boards. These RDA values are based on meeting the nutrient requirements of 97 to 98% of ‘healthy individuals’ without the metabolic and nutritional complexities of ASD leading to malnutrition. The Food and Nutrition Board acknowledges that the RDAs that they recommend are not intended for individuals with specific health conditions, like ASD (Godbout Laake & Compart, 2013).
In addition, the RDAs are the amounts recommended from all sources, food and supplements. Children with ASD may be getting a lot less folate from food compared to their neurotypical friends due to their antibodies attacking the folate and stopping it from going where it needs to go.
I have provided the RDA values below for reference so you get an idea of how folate doses run for ‘healthy’ individuals.
Recommended Dietary Allowances (RDAs)⁴
Age | Dose (mcg) |
1-3 years | 75 |
4-8 years | 100 |
9-13 years | 150 |
14-18 years | 200 |
19+ years | 200 |
Please see the folinic acid dosing table below for ASD (and ADHD) by Godbout Laake and Compart (2013). These numbers for folinic dosing for ASD are higher than the numbers for folate dosing for ‘healthy individuals’, which is to be expected given the issues with the methylation machinery in ASD.
Folinic acid total daily goal dosing
Age (years) | Dose (mcg) | Total daily dose from all sources |
2 - 5 | 100 | 100 |
6 - 10 | 200 | 200 |
11+ | 400 | 400 |
Do not take levels higher than that in the chart above without first consulting with your child's health care provider so that they are able to adequately advise and monitor your child during supplementation.
High doses of folinic acid may increase the risk of chronic diseases in certain people⁵ and giving the body more B9 than it can process can weaken the immune system⁶ so best to stick to the suggested ranges above.
Medications your child may be taking that folate interacts with:
Sulfasalazine. This treats ulcerative colitis and can decrease the amount of Folate and the body.
Methotrexate. this is used to treat cancer and autoimmune disease and reduces the amount of Folate in the body.
Antiseizure medications/mood stabilizers. Includes phenytoin, carbamazepine and valproate. Folate may decrease the amounts of these medications in the body making them less effective, and putting your child at risk of seizure or breakthrough mood issues (based on what they take the anti seizure/mood stabilizing medications for)
Talk to your medical provider so that they can do a medication check to make sure that your supplement won't be hurting the levels of prescribed medications your child might already be taking.
Side effects and toxicity
Side effects to look out for: Feeling sick (nausea), loss of appetite, tummy bloating.
Toxicity has not been reported however if folate supplementation is something that you are interested in, first talk to your doctor about doing a blood test for B12 to get a baseline for this nutrient.
This is because if your child has low B12 and you supplement with folate at home, it might mean that the healthcare provider may miss the low B12 because the folate will ‘mask’ the B12 deficiency.
This means the B12 deficiency will go unrecognized and untreated and cause nerve damage if not caught in time.
We are unsure as to whether high doses of B9 are toxic at this time⁷.
Who shouldn't take Folate without first talking to their health care provider:
People with cancer
People on dialysis
People with a heart stent
People with low B12 levels
In the PDF here that I have attached here I have provided a Cheat Sheet for Moms with a summary of B9's characteristics discussed above, as well as a ‘cut the dotted line’ section for when it comes time to shop for B9 with steps and recommendations to keep in mind when purchasing including checking for third party testing to ensure that what you are buying is high quality.
This site is for general informational purposes only and does not constitute the giving of medical advice. The contents do not constitute the practice of medicine, nursing, or other professional health care services. No provider–patient relationship is formed. Please consult with your child's healthcare provider when considering supplementation for children.
²https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8398778/#:~:text=Folate%20receptor%20antibodies%20and%20cerebral,with%20 neurological%20 deficits%20%5B11%5D.
Godbout Laake, D. & Compart, P. J. MD (2013) The ADHD and Autism Nutritional Supplement Handbook. Fair Winds Press. To purchase on Amazon click here.
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