Stop naturopathic pediatrics: autism and MTHFR?

autistic-boy

I used to be a naturopathic pediatrician. I graduated from Bastyr University and did a one-year residency in naturopathic pediatrics and family medicine. Like many naturopaths, I branded myself as an expert in treating children with behavioral and developmental problems, including autism, ADHD, anxiety, and learning disabilities. If you were the parent of a kid with one of these conditions and had an appointment with me, you would have left my office with a bottle of pills containing L-methylfolate.

Naturopaths are taught that children exhibiting behavioral and developmental problems should be checked for MTHFR gene mutations, which could affect an enzyme called methylenetetrahydrofolate reductase—that attaches a methyl (CH3) group to folic acid allowing it to be used in DNA biosynthesis and in the processing of the amino acids methionine and homocysteine.

There are real health consequences of having certain polymorphisms in the MTHFR gene, but genetic testing is not necessary to detect them. The most severe problems with this gene are neural tube defects, such as spina bifida and anencephaly, which are detectable during pregnancy with ultrasound. Other MTHFR polymorphisms result in high blood levels of homocysteine which can cause problems with the eyes, blood clotting, skeletal formation, and cognition. Okay, but there is a simple blood test for homocysteine levels.

In fact, the American College of Medical Genetics and Genomics states that “MTHFR polymorphism testing has minimal clinical utility.”


Naturopathic MTHFR testing

Naturopaths disagree. In school, we were taught to hyper focus on clinically insignificant genetic differences in the MTHFR gene of patients who report a dizzying array of health conditions. We were told that such polymorphisms caused patients to be depleted in L-methylfolate, so supplementation was required in order to offset their alleged enzymatic dysfunction. For children with autism and other behavioral problems, it was absolutely the norm to test for MTHFR mutations and treat indefinitely with L-methylfolate.

Now as a former naturopath, I want to call out these bogus MTHFR practices as completely exploitative.

Watch this short video of Jared Skowron, ND (co-founder of the Pediatric Association of Naturopathic Physicians) talking about the MTHFR gene and treatment with L-methylfolate:

Here are some selected quotes:

Skowron: “The MTHFR gene has been associated with anxiety and depression. There’s a lot of research behind it.”

Skowron: “It is actually this gene that regulates the formation of serotonin.”

Host: “Should people have genetic testing done?”

Skowron:

Yes! …If they find out the gene’s not working, it’s a very simple treatment to take it, and all of a sudden your brain is going to be producing more serotonin. You’re going to be feeling better immediately. When the gene is not working, we actually treat with a special form of folic acid, because folic acid is necessary for the brain to make serotonin.

MTHFR research

First, there is not much good research supporting an association between polymorphisms in the MTHFR gene and anxiety and depression. Even if there were glimmers of an association, Skowron is falling prey to the “correlation does not equal causation” fallacy. He is overstating the research. The Genetics Home Reference of the National Institutes of Health mentions psychiatric disorders in their overview of the MTHFR gene, but do not specify which ones.

A meta-analysis by Peerbooms et al. (2011) suggest that schizophrenia, bipolar disorder, and unipolar depression share a genetic vulnerability related to a polymorphism in the MTHFR gene. However, the authors note serious limitations in their meta-analysis, including lack of consistency in diagnostic criteria and wide variability in research design of the included studies. Furthermore, their results are not consistent with previous meta-analyses assessing correlations between MTHFR polymorphisms and these disorders. The correlation seems to be inconclusive. Perhaps more importantly, there is nothing in this research that suggests patients should be treated with L-methylfolate.

A paper published this month in the Journal of Genetic Counseling flat-out recommends against testing for MTHFR polymorphisms. The authors note that patients who have serious MTHFR dysfunction would have significantly elevated blood levels of homocysteine. Therefore, this sign would always be present if there were any causal link between MTHFR polymorphisms and mood disorders, in addition to autism and ADHD. The authors explicitly note that a correlation between autism and MTHFR polymorphisms, found in an earlier meta-analysis of eight case-control studies, disappeared after controlling for dietary intake of folic acid. There remains inadequate data to suggest a link between MTHFR polymorphisms and autism. In other words, it doesn’t exist.

Finally, the MTHFR gene does not regulate the formation of serotonin, and there is no reason to think that supplementing with L-methylfolate will lead to increased levels of serotonin in the brain. Folic acid is a co-factor for the conversion of tryptophan into 5-HTP, which is then converted into serotonin using other co-factors. Increasing levels of L-methylfolate will not make the enzyme that converts tryptophan into 5-HTP work faster. There will only be a benefit if a patient has a folic acid deficiency, but that would also result in anemia and, perhaps, depression.

Conclusion

The bottom line is that MTHFR genetic screening is inferior to testing blood levels of folic acid and homocysteine, even in the presence of a suspected genetic disorder.

No one should have confidence that Skowron is a competent and ethical practitioner based on how he urges patients to get tested for MTHFR mutations against the advice of genetic experts. He has created his own nutritional supplement company, Spectrum Awakening, that allegedly “creates high-quality supplements to help children with ADHD, Autism, and Anxiety.” He also boasts about lecturing with Jenny McCarthy at her Generation Rescue conference, where one can truly fly their anti-vaccine and vaccines cause autism colors.

Skowron appears to be yet another profit-driven naturopath who misleads patients away from medical experts using fear and incorrect information.

Here’s the fun part.

I welcome readers to join me for Skowron’s free webinar on October 26th (details below) about using naturopathic medicine on children. I firmly believe that naturopaths pose a danger to children, and I have called for lawmakers to block naturopaths from treating patients under the age of 18. I want to ask him questions. I hope you do too.

How Treating Children with Naturopathic Medicine will slowly change the medicine of the world.

Image credit: Nicole Mays, some rights reserved.
This entry was posted in Autism, Mental Illness, Pediatrics, What is naturopathic medicine?. Bookmark the permalink.
  • Thomas Mohr

    I did a quick publication research on Skowron. The result is basically a best selling book on amazon. Real research – zero. Taught pediatry at the University of Bridgeport which has only a college of naturopathy but no medical school. This guy highlights like no other the shortcomings of naturopathic medicine. No research experience, 15000 hours short of real medical education – and co-founder of the Pediatric Association of Naturopathic Physicians. In Germany and Austria this guy would not be able to practice any pediatry due to (a) a lack of medical degree and (b) a lack of speciality training.

    • http://www.naturopathicdiaries.com Britt Hermes

      Absolutely. A fine example of a charlatan.

      • Thomas Mohr

        What I am wondering is why NBC gives time to such an idiot. A clear fail of the editorial staff. One should clarify to the mass media that ND means Not a Doctor.

        • Marcel

          Another case of American urinalism; not proper journalism.

        • Marcel

          Another case of American urinalism; not proper journalism.

  • NS Alito

    [T]here is no reason to think that supplementing with L-methylfolate will lead to increased levels of serotonin in the brain.

    I was specifically prescribed L-methylfolate by an MD because it was purported to be a serotonin precursor which would increase serotonin availability (as a backup to my SSRI). Do you by any chance know where the idea came from?

    • Thomas Mohr

      The idea comes from this study:

      Ginsberg LD, Oubre AY, Daoud YA. L-methylfolate plus SSRI or SNRI from
      treatment initiation compared to SSRI or SNRI monotherapy in a major
      depressive episode. Innov Clin Neurosci. 2011;8(1):19-28.

      However, the difference is that L-methylfolate in this case is prescribed for manifest clinical symptoms in combination with working drugs and not after some genetic testing that detects a SNP that may have an influence in gene function – or not.

    • Thomas Mohr

      The idea comes from this study:

      Ginsberg LD, Oubre AY, Daoud YA. L-methylfolate plus SSRI or SNRI from
      treatment initiation compared to SSRI or SNRI monotherapy in a major
      depressive episode. Innov Clin Neurosci. 2011;8(1):19-28.

      However, the difference is that L-methylfolate in this case is prescribed for manifest clinical symptoms in combination with working drugs and not after some genetic testing that detects a SNP that may have an influence in gene function – or not.

      • NS Alito

        However, the difference is that L-methylfolate in this case is prescribed for manifest clinical symptoms in combination with working drugs…

        Ah, because I’m an established nutcase. Got it. 🙂

        • Thomas Mohr

          I am sorry it came over this way. But …. it is said that being a little bit of a nutcase makes life a lot easier 😉 Anyway. what I wanted to say is that your MD followed a guideline that was backed up a bit by science wheres the connection between MHTFR SNPs and depression is very murky.

          • NS Alito

            When I throttled him, followed by extensive sobbing, he agreed with my self-diagnosis as a nutcase.

            In any case, over the years of following the self-delusional nature of healthy human brains, I am beginning to believe that sanity is a myth.

          • NS Alito

            When I throttled him, followed by extensive sobbing, he agreed with my self-diagnosis as a nutcase.

            In any case, over the years of following the self-delusional nature of healthy human brains, I am beginning to believe that sanity is a myth.

      • NS Alito

        However, the difference is that L-methylfolate in this case is prescribed for manifest clinical symptoms in combination with working drugs…

        Ah, because I’m an established nutcase. Got it. 🙂

    • http://www.naturopathicdiaries.com Britt Hermes
      • NS Alito

        Hmm… Well, I haven’t been on a killing spree* since the 90s, so maybe it actually works.

        Thanks for your reply.
        ___
        *Two is not a “spree”.

      • NS Alito

        Hmm… Well, I haven’t been on a killing spree* since the 90s, so maybe it actually works.

        Thanks for your reply.
        ___
        *Two is not a “spree”.

  • Marcel

    “Spectrum Awakening”, a company that “allegedly “creates high-quality supplements to help children with ADHD, Autism, and Anxiety.” If that’s the case, then the company is most likely guilty of violating federal laws set out in the Dietary Supplement Health and Education Act (DSHEA):

    “Disease claims require prior approval by FDA and may be made only for
    products that are approved drug products or for foods under separate
    legal provisions that apply to claims called “health claims.”

    In the event that the company has made “health claims” for their products, they would require approval from the FDA pending substantial scientific agreement that they are effective in each instance and for each disease.

    American citizens can report illegal claims to the FDA for dietary supplements sold on the Internet at the following address:

    http://www.fda.gov/Safety/ReportaProblem/ucm059315.htm

    Obviously, if the products are being marketed for use by children or adults to “help” them with any diseases, including “ADHD, Autism, and Anxiety”, they would have to be approved as prescription drugs with established safety and effectiveness and could not be legally sold or approved as dietary supplements. For consumers, the US FDA provides the following guidance:

    “Is it legal to market a dietary supplement product as a treatment or cure for a specific disease or condition?

    No, a product sold as a dietary supplement and promoted on its label or in labeling* as a treatment, prevention or cure for a specific disease or condition would be considered an unapproved–and thus illegal–drug. To maintain the product’s status as a dietary supplement, the label and labeling must be consistent with the provisions in the Dietary Supplement Health and Education Act (DSHEA) of 1994.*Labeling refers to the label as well as accompanying material that is used by a manufacturer to promote and market a specific product.”

    Labeling also extends to speech, Web presentations, Facebook posts, and any open communications in regard to a supplement, whether by the manufacturer or someone selling a product made by the manufacturer.

    In one of the products marketed by his company (“Power & Focus”), for the ingredients “Activated B Vitamins” (pyridoxal 5’-phosphate, (6S)-5-methyltetrahydrofolic acid, and methylcobalamin), the labelling reads as follows:

    “Methylation defects also correlate with neurological abnormalities such as gaze abnormalities, motor abnormalities, self-injurious behavior, and hyperactivity children.3 Those with a genetic MTHFR mutation or deficiencies in B6, folate, or B12 may have impaired methylation.”

    Other ingredients in the formula, such as GABA and L-theanine, would act as relaxing agents, which might give the impression of improvement in children with conditions attended by hyperactivity.

    • David

      I am canadian. I hope one of you american citizens reports his illegal claims to the FDA.

    • http://www.naturopathicdiaries.com Britt Hermes

      I just looked over the claims made on his product website. They appear to be vague enough that the FDA might not be able to step in. For example,

      • Supports Relaxed Mood

      • Supports Inhibitory Neurotransmitter Functions

      • Supports Neurotransmitter Balance and Neuronal Stabilization

      • Addresses Brain Osmotic Regulation, Glial Cell Function, and Effective Neuronal Transmission

      Or,

      • Promotes Healthy Adrenal Gland Function

      • Supports Normal Cortisol and Aldosterone Levels

    • http://www.naturopathicdiaries.com Britt Hermes

      I just looked over the claims made on his product website. They appear to be vague enough that the FDA might not be able to step in. For example,

      • Supports Relaxed Mood

      • Supports Inhibitory Neurotransmitter Functions

      • Supports Neurotransmitter Balance and Neuronal Stabilization

      • Addresses Brain Osmotic Regulation, Glial Cell Function, and Effective Neuronal Transmission

      Or,

      • Promotes Healthy Adrenal Gland Function

      • Supports Normal Cortisol and Aldosterone Levels

  • Marcel

    “Spectrum Awakening”, a company that “allegedly “creates high-quality supplements to help children with ADHD, Autism, and Anxiety.” If that’s the case, then the company is most likely guilty of violating federal laws set out in the Dietary Supplement Health and Education Act (DSHEA):

    “Disease claims require prior approval by FDA and may be made only for
    products that are approved drug products or for foods under separate
    legal provisions that apply to claims called “health claims.”

    In the event that the company has made “health claims” for their products, they would require approval from the FDA pending substantial scientific agreement that they are effective in each instance and for each disease.

    American citizens can report illegal claims to the FDA for dietary supplements sold on the Internet at the following address:

    http://www.fda.gov/Safety/ReportaProblem/ucm059315.htm

    Obviously, if the products are being marketed for use by children or adults to “help” them with any diseases, including “ADHD, Autism, and Anxiety”, they would have to be approved as prescription drugs with established safety and effectiveness and could not be legally sold or approved as dietary supplements. For consumers, the US FDA provides the following guidance:

    “Is it legal to market a dietary supplement product as a treatment or cure for a specific disease or condition?

    No, a product sold as a dietary supplement and promoted on its label or in labeling* as a treatment, prevention or cure for a specific disease or condition would be considered an unapproved–and thus illegal–drug. To maintain the product’s status as a dietary supplement, the label and labeling must be consistent with the provisions in the Dietary Supplement Health and Education Act (DSHEA) of 1994.*Labeling refers to the label as well as accompanying material that is used by a manufacturer to promote and market a specific product.”

    Labeling also extends to speech, Web presentations, Facebook posts, and any open communications in regard to a supplement, whether by the manufacturer or someone selling a product made by the manufacturer.

    In one of the products marketed by his company (“Power & Focus”), for the ingredients “Activated B Vitamins” (pyridoxal 5’-phosphate, (6S)-5-methyltetrahydrofolic acid, and methylcobalamin), the labelling reads as follows:

    “Methylation defects also correlate with neurological abnormalities such as gaze abnormalities, motor abnormalities, self-injurious behavior, and hyperactivity children.3 Those with a genetic MTHFR mutation or deficiencies in B6, folate, or B12 may have impaired methylation.”

    Other ingredients in the formula, such as GABA and L-theanine, would act as relaxing agents, which might give the impression of improvement in children with conditions attended by hyperactivity.

  • loupgarous

    Thank you for presenting truly disinterested commentary on the value of naturopathy. You could just have quietly retrained in medicine which has been tested scientifically, or remained a naturopath with misgivings about the field, but instead you’re taking a courageous stand, for no immediate benefit to you I can discern – apart from moral satisfaction.

    We need more people like you who can and do see the logical and scientific drawbacks to much of “alternative medicine” (mostly, that when many “alternative cures” are subjected to clinical research either at the National Institutes of Health’s Center for Complementary, Alternative and Integrative Health or by independent contract research organizations and not by researchers with an axe to grind, they fail to show significant effectiveness at treating the target condition). I’ve noticed that this agency is in its third renaming after having been criticized by former US Senator Tom Harkin for doing its job, or in his words, “disproving things rather than seeking out and approving.”

    The burden of proof is on anyone who presents a medical treatment as being safe and effective, and such clinical research is very expensive if it’s done correctly. This led to the formation and funding of the NCCIH (and its predecessor agencies). The agency’s current Web site shows a positive focus on alternative medicine. I hope this is not evidence that the research funded by taxpayers is equally “positive” toward the specific alternative cures on which it does research. We don’t have William Proxmire around any more to ridicule tax-funded research which is anything but objective.

    Please keep up the good work raising awareness of the dark side of alternative medicine.

  • loupgarous

    Thank you for presenting truly disinterested commentary on the value of naturopathy. You could just have quietly retrained in medicine which has been tested scientifically, or remained a naturopath with misgivings about the field, but instead you’re taking a courageous stand, for no immediate benefit to you I can discern – apart from moral satisfaction.

    We need more people like you who can and do see the logical and scientific drawbacks to much of “alternative medicine” (mostly, that when many “alternative cures” are subjected to clinical research either at the National Institutes of Health’s Center for Complementary, Alternative and Integrative Health or by independent contract research organizations and not by researchers with an axe to grind, they fail to show significant effectiveness at treating the target condition). I’ve noticed that this agency is in its third renaming after having been criticized by former US Senator Tom Harkin for doing its job, or in his words, “disproving things rather than seeking out and approving.”

    The burden of proof is on anyone who presents a medical treatment as being safe and effective, and such clinical research is very expensive if it’s done correctly. This led to the formation and funding of the NCCIH (and its predecessor agencies). The agency’s current Web site shows a positive focus on alternative medicine. I hope this is not evidence that the research funded by taxpayers is equally “positive” toward the specific alternative cures on which it does research. We don’t have William Proxmire around any more to ridicule tax-funded research which is anything but objective.

    Please keep up the good work raising awareness of the dark side of alternative medicine.