Why is Methyl-B12 stressed at our clinic and how does it help kids with ASD?

Image showing how MTHFR and Methionine Synthase interact.Since May of 2002, Dr. Neubrander has been stressing the importance of MB12 for children on the spectrum. His initial finding of MB12′s benefits came by accident. In treating a non-verbal  seven-year-old autistic patient, he decided to try a new form of B12 to help with some of the nutritional issues seen in this particular patient. One week later, in the middle of a huge storm that was hitting New Jersey, the parents of that child came unannounced to the office and ran down the hall shouting, “What was that you gave our child? He started speaking!” Thus history was made that day.

So why does MB12 help so many on the spectrum? This first series of blog posts will go through the various aspects of why MB12 is needed and how it helps. To start the series, I will be getting a little scientific but hopefully can explain it in such a way that an ordinary, non-medical person can understand.

First I am going to discuss the MTHFR mutation.  I will probably be touching on this subject in future posts, but today I will start off with one study showing that people with ASD have a higher rate of mutation in the MTHFR gene, and then will follow with the doctor’s explanation of how this impacts persons with the mutation.  Dr. Neubrander has written a preface for the study that we give our patients and I will begin with that comment, follow with the abstract, and end with an explanation of what this means in lay-terms.

JUNE 2009:  Preface by Dr. Neubrander to the following published study  –   Please note that in my practice I have been testing most patients for MTHFR and homocysteine status.  Though I have not yet officially tabulated the results from my patient population, I can definitely say by “seat-of-the-pants science” that the incidence of the MTHFR mutations, whether C677T or A1298C, are much higher than what was reported in this study.  I can also say that most of my patients have at least one mutation; many have two.  It has been my observation that children with the C677T homozygous (double) mutation are the most likely to respond to MB12 and with some of the best “initial intensities of response”.  Children who have a single (heterozygous) mutation of the C677T allele or who have two single mutations on the two different alleles, C677T (heterozygous) and A1298C (heterozygous) or who have double mutations (homozygous) of the A1298 allele are the next most likely group of children to respond  to MB12 injections.  As a general rule, this group of children demonstrate responses fewer in number and of a lesser intensity when present. Children with a single (heterozygous) mutation of the A1298C allele represent the group of children whose responses, though present, are usually the fewest in number and of the least intensity.  It is interesting to hypothesize why some of the best responders, both in number of responses and intensity of responses, have no MTHFR mutations.

Psychiatr Genet. 2009 May 13. [Epub ahead of print]
Aberrations in folate metabolic pathway and altered susceptibility to autism.

Mohammad NS, Jain JM, Chintakindi KP, Singh RP, Naik U, Akella RR.

a. Center for DNA Fingerprinting and Diagnostics
b.Institute of Child Health, Niloufer Hospital, Hyderabad, India.

OBJECTIVE: To investigate whether genetic polymorphisms are the underlying causes for aberrations in folate pathway that was reported in autistic children. BASIC METHODS: A total of 138 children diagnosed as autistic based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria and Autism Behavior Checklist scoring and 138 age and sex matched children who are nonautistic were tested for five genetic polymorphisms, that is, cytosolic serine hydroxyl methyl transferase (SHMT1 C1420T), methylene tetrahydrofolate reductase (MTHFR C677T and MTHFR A1298C), methionine synthase reductase (MTRR A66G), methionine synthase (MS A2756G) using PCR-restriction fragment length polymorphism methods. Fisher’s exact test and logistic regression analysis were used for statistical analyses. RESULTS: MTHFR 677T-allele frequency was found to be higher in autistic children compared with nonautistic children (16.3 vs. 6.5%) with 2.79-fold increased risk for autism [95% confidence interval (CI): 1.58-4.93]. The frequencies of MTRR 66A allele (12.7 vs. 21.0%) and SHMT 1420T allele (27.9 vs. 45.3%) were lower in autistic group compared with nonautistic group with odds ratios 0.55 (95% CI: 0.35-0.86) and 0.44 (95% CI: 0.31-0.62), respectively, indicating reduced risk. MTHFR 1298C-allele frequency was similar in both the groups (53.3 vs. 53.6%) and hence individually not associated with any risk. However, this allele was found to act additively in the presence of MTHFR 677T allele as evidenced by 8.11-fold (95% CI: 2.84-22.92) risk associated with MTHFR 677CT+TT/1298AC+CC genotypes cumulatively. CONCLUSION: MTHFR C677T is a risk factor, whereas MTRR A66G and SHMT C1420T polymorphisms reduce risk for autism. MTHFR A1298C acts additively in increasing the risk for autism.


So what does this mean? Of what importance is MTHFR to ASD? I am including a comment we give our patients to explain in simpler terms what MTHFR does.

The way that the MTHFR enzymatic defect fits into this whole scenario is that folic acid family members from food must travel down a biochemical pathway and present itself to the enzyme MTHFR [methyltetrahydrofolate reductase].  This enzyme then will catalyze the biochemical reaction that allows the precursor “unmethylated” folic acid molecule to grab onto extra hydrogen atoms and now become a “methylated” folic acid molecule [5-methyltetrahyrdofolic acid].  It is the methyl group from this methylated folic acid molecule that can now donate the methyl group to “rabbit B12″ — the plain ole’ ordinary B12 that comes from food or supplements – so that rabbit B12 now becomes “methyl”-B12.  It is this methyl-B12, whose methyl group originated from the “MTHFR processing plant”, that will react with the enzyme methionine synthase to go on to donate this same methyl group to homocysteine to now become “methylated homocysteine” whose “other name” is methionine.  It is this methionine that moves on to eventually donate this same methyl group to the brain to make proper functioning RNA, DNA, neurotransmitters, speech and language molecules [creatine], and nervous signal synchronization molecules [phospholipids].  Once this methyl group has been donated, the “methyl carrier molecule — metabolic smoke” eventually winds up to become homocysteine again.  Once homocysteine is formed, it acts like a traffic cop deciding to send traffic to the left or to the right.  “About” half the time homocysteine goes back to get another methyl group from “the next” methyl-B12 that shows up as the process described above repeats itself.  “About” the other half of the time homocysteine decides to become glutathione which is the body’s major intracellular antioxidant and one of the body’s major way to detoxify many types of poison, only one of which is mercury.

The MTHFR enzyme has legs just like we have legs.  We call our legs “left leg — right leg”.  On both legs we are supposed to have ankles and knees.  MTHFR’s legs have funny names.  The name of one leg is C677T and the name of the other leg is A1298T.  The name of MTHFR’s ankles and legs are C and T or A and T.  Now here’s what’s happening.  When we try to run, we do very well if we have two legs with knees and ankles.  If we have an amputation of one ankle, we can still get around but we will definitely be slowed down.  If we have an amputation above the knee, we will still be able to get around but much, much slower.  If we had an amputation of a knee or ankle on the other leg, once again we would get around much, much slower.  So it is with the ankles and legs on the MTHFR enzyme.  If there is a single mutation, called heterozygous, one of the legs will have been amputated at the ankle.  It there is a double mutation on the same leg, called homozygous, that leg will have been amputated above the knee.  Combinations of heterozygous and homozygous mutations [analogous here to "amputations"] can occur.

What the developing research is finding is that mutations of the MTHFR enzyme occur quite frequently in children on the autistic spectrum.  Therefore, as you can now see, these children will have a “slowed ability” to produce the methylated folic acid molecules that are required to form “enough” methyl-B12 at the rate necessary to make “brain things” and to make “detoxification things”.  Therefore, in order to bypass this defect, methyl-B12 must be administered on a continual steady-state basisThis is the reason that injectable methyl-B12 into the subcutaneous tissue accomplishes this goal.  By being in the subcutaneous tissue it slowly leaches out and provides a continual supply of “just a little bit” of methyl-B12 to be available for methionine synthase to use to recycle homocysteine.


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  • lynn

    my son is on the mb12 and just got tested and was homo for the mthfr a1298c gene… what is the treatment for this and does this have anything to do with him getting kawasaki disease at age 2?

    • RickNeubrander

      We cannot give medical advice unless you are a patient. In general if you have that mutation you have an impaired methyation pathway and should seek out treatments that address that issue. MB12 is a treatment that works in this area and you should seek a doctor who can look at your methylation and prescribe treatments for that condition.

  • Mrsjaybrewer

    My son is 8 yrs old and non verbal. We have followed the DAN! Dr’s treatment plan. We did MB12 shots and nasal spray with hyperactivity as a result. We decided to try the nasal spray again a year after chelation and now the B12 has a calming effect. No speech as of yet, started on L carnosine as well to try to calm seizures. Our son is lead mercury and aluminum toxic and he has severe PICA slightly helped by mineral supplements. Even if we can’t recover our son we know we are helping him to some small degree and it’s worth all the money and years of research, keep up the good work!

  • http://www.facebook.com/andree.proulx.37 Andree Proulx

    My daughter has a dual diagnosis – Down syndrome and Autism. We tried methyl B-12 injections in the past and saw definite improvements in her behavior. I would like to continue with the injections however, I have concerns about the safely of the methyl b-12 shots we are purchasing since there is often visible precipitate in the syringes. The precipitate usually goes backing into solution upon warming to room temperature. But, in light of this recent news of the Massachusetts compounding pharmacy’s problems with meningitis, I would like to be certain I am obtaining the Methyl-B12 from a reputable source. How can I find one? Can you recommend a pharmacy?

    Thank you

    • RickNeubrander

      I cannot recommend publicly a pharmacy. If you google mb12 autism pharmacy you will find many posts referring to the same pharmacies. Read the posts and see what parents see as far as quality and customer service.

      It sounds like the particulates you see is MB12 crystallizing out of solution. It has been stated by pharmacies that at low temps this can happened with some formulations. Without submitting a sample to be tested this is no more than an educated guess.

      If you are worried ask the pharmacy to provide you with their latest certificate of analysis to see if purity and concentration are being met.

  • Kim Siebert

    You might consider also having your patients tested for the MTR A1298C rs1801131 mutation. My son has one copy (along with MTHFR 677, one copy) and he has gut dysbiosis (due to antibiotics) causing large amounts of histamine production leading to depression because SAMe is being drained to get rid of the histamine (SAMe supplies the methyl group for histamine methyltransferase). I tried many things and although methylfolate improved him greatly, it wasn’t until I added the methyl B12 (oral, he doesn’t have autism) that his symptoms went away completely. He has to take it about every 2-3 hours in order to keep his levels high enough. He also has 2 MTRR mutations (H595Y and K350A) so those might contribute, but it’s my opinion at this time that the MTR mutation is more significant. It probably won’t surprise you to know that I had to do all the research and find this out myself because even his naturopathic doctor didn’t have a clue.

    Now I am trying to find some injectable for my one year old granddaughter who has severe allergies because my daughter also has the MTR and MTHFR 677 mutations, and this granddaughter has tested positive for MTHFR 677 (and 1298, one copy each) but she hasn’t been tested for the MTR mutation, but I bet she has it. Thank you for your information.