209 The Folate Fix: A New Frontier in Autism Care

In this episode of The Pediatric Lounge podcast, Dr. Richard Fry and Dr. James Riellly discuss innovative treatments in autism care. Dr. Fry, an expert in pediatric neurodevelopmental medicine, emphasizes the role of folate, mitochondrial dysfunction, and autoantibodies in autism.  Dr. Riley shares clinical anecdotes attesting to these benefits and underscores the importance of comprehensive care, including diet and sleep. 

00:00 Introduction to the Pediatric Lounge Podcast 00:38 Meet the Guests: Dr. Richard Fry and Dr. James Riley 02:48 Dr. Fry's Journey into Pediatric Neurology and Autism 04:57 Discovering the Folate Connection in Autism
09:14 Dr. Riley's Path to Nutrition and Autism Care 12:11 The Role of Folate in Neurodevelopmental Disorders 16:48 Challenges and Solutions in Autism Treatment 19:44 Understanding the Complexities of Autism and Nutrition
29:57 The Importance of Comprehensive Medical Evaluation in Autism
31:41 Complexities of Pediatric Neurology 33:06 Approaches to Nonverbal Children 33:50 Folinic Acid and Autism 35:37 Success Stories with Leucovorin
39:13 Challenges in Pediatric Practice 45:54 Empowering Parents and Pediatricians
51:59 Concluding Thoughts and Reflections

Neurobiological Rationale and Effects on the Brain

Leucovorin is a reduced form of folate that bypasses the folate receptor alpha, the primary transporter of folate across the blood-brain barrier. In ASD, a high prevalence of FRAA (up to 75%) has been documented, leading to impaired cerebral folate transport and subsequent deficiency despite normal serum folate levels.[1][2] Leucovorin utilizes the reduced folate carrier to restore central nervous system folate levels, thereby addressing a key pathophysiological mechanism in a subset of children with ASD.[1][2]

1. Treatment of Folate Metabolism Abnormalities in Autism Spectrum Disorder. Frye RE, Rossignol DA, Scahill L, et al. Seminars in Pediatric Neurology. 2020;35:100835. doi:10.1016/j.spen.2020.100835.
2. Efficacy of Oral Folinic Acid Supplementation in Children With Autism Spectrum Disorder: A Randomized Double-Blind, Placebo-Controlled Trial. Panda PK, Sharawat IK, Saha S, et al. European Journal of Pediatrics. 2024;183(11):4827-4835. doi:10.1007/s00431-024-05762-6.