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Homocysteine & Autism: An Interview with Dr. Lawrence Ginsberg, MD! CEO, Red Oak Psychiatry!

Overview!

The interrelated pathways of remethylation and transsulfuration involve several cofactors, which are mostly methylated B-vitamins. These cofactors are Methylfolate, B-12 (Methylcobolamin), and vitamin B-6. ! One of the main objectives of these processes is to convert homocysteine (HCY) into Methionine. High homocysteine (hyperhomocysteinemia) has many implications. Relating to Autism, these are decreased neurological functioning and neural degeneration during fetal development. ! There are three main reasons the remethylation and transsulfuration processes can go wrong in persons with Autism:! Genetic Issues: The enzyme MTHFR is genetically coded for, and responsible in, the 4th step of converting B-9 (folic acid) to L-methylfolate. Dr. Ginsberg states, In my clinical experience in testing my patients on the autism spectrum for MTHFR defects, 90% are heterozygous or homozygous for one of two alleles (C677T or A1298C), or are compound heterozygotes. This will dramatically decrease their ability to convert folic acid to L-methylfolate; this reduction can be as much as 70%.!

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Absorption Issues: Research shows that in Autism, the receptors in the ileum are not functioning appropriately, which impedes adequate absorption of the critical cofactors.! Diet Restrictions: The diet of an Autistic person is many times restricted. As a result, without adequate supplementation, they may not get the essential methylated B-vitamins.! In addition, other medications and lifestyle issues can deplete folate levels or keep HCY high:!

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Fluoxetine (Prozac)! ! ! ! ! ! ! High Coffee Intake! Some anti-seizure medications! Alcohol use!

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Points of Interest!

Although prevention is key, it is never too late to supplement, because of the many problems high HCY can cause (no age is too late to try).! Prenatal folic acid is not enough. Dr. Ginsberg states, folic acid is inadequate; we cannot assume it will be adequately converted to L-methylfolate as we need this methyl group donor in the remethylation pathway. In one study the MTHFR C677T genotype carriers showed a 5-fold increased risk of spontaneous abortions, while the MTHFR A1298C genotype carriers showed a 5.5-fold increased risk of spontaneous abortion.!

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Prenatal care is focused on prevention, and using supplements in the existing patient is focused on treating symptoms and associated behaviors.! The Autism Society has been in favor of supplements for over 20 years, and many parents would welcome an alternative to antipsychotics.! The components of a supplement must be methylated; methylation is the key and L-methylfolate is the engine. Dr. Ginsberg: Methylation is the key mechanism of the remethylation and transsulfuration pathways.! Diet supplementation is not enough, because of the common genetic issues that would prevent folic acid from converting to L-methylfolate. It cant contribute to methyl donation if not converted, and HCY will not decrease.!

Dr. Ginsberg:!

I have used EnLyte in autism spectrum patients in conjunction with other therapies when there is a suspected or known L-methylfolate deficiency and/or deficiency of other methylated B vitamins such as B6 or B12.! If the autistic spectrum patient has a known or suspected increased homocysteine (HCY), which would be caused by a deficiency of methylated B-vitamins, I recommend EnLyte. EnLyte also contains omega-3s attached to a phosphatidylserine backbone which enhances their lipid solubility.!

Learn more about Dr. Ginsberg at www.RedOakPsychiatry.Com! Learn more about EnLyte at www.EnLyteRx.Com