Paul Saladino’s anti-folic acid advice for pregnant women is not just wrong—it could be dangerous
Dr. Paul Saladino recently advised against using folic acid in prenatal vitamins, preferring ‘natural’ L-5-methylfolate, citing a Boston Birth Cohort paper on cord unmetabolized folic acid (UMFA) and autism risk. We compared that advice with current guidelines and the broader evidence, and consulted experts to bring you a reality check.
The most robust evidence and clinical guidelines worldwide recommend 400 µg of folic acid daily before conception and through early pregnancy to prevent NTDs. The study Saladino cites does not show that standard prenatal folic acid causes autism, nor does it justify abandoning folic‑acid–containing prenatals.
Influencers with large platforms can shape health behaviour. When they discourage long-standing, well established and robust guidelines (like folic acid supplementation) without strong data, they risk real‑world harm: fewer people following proven guidance, and more anxiety around ordinary foods and standard prenatals. Public figures should be accountable for claims that contradict established guidance. This article supports readers to confidently fact-check nutrition and health claims, to make decisions based on understanding, not fear.
Cross-check facts: Compare the information with multiple trusted sources to confirm accuracy.
Claim 1: “Get rid of folic acid in your diet and only consume foods that have added folate as L5 methylfolate, that is the natural form of folate. Folic acid and unmetabolized folic acid are potentially very harmful for humans and for babies.”
Fact-check: The implications of this claim conflict with guidelines that have been shown to prevent serious birth defects for decades.
For more information on what exactly folic acid or folate is, you can read our other fact-check on similar claims. Here we focus on the implications of this claim in the specific context of pregnancy and babies’ health.
What the science says about folic acid fortification and supplementation
Folic acid supplementation before and during pregnancy helps to prevent serious, sometimes fatal birth defects. Multiple randomized trials and large population programmes highlight the benefits of folic acid to prevent Neural Tube Defects (NTDs) in babies (source, source).
The prevalence of babies born with NTDs reduced substantially after mandatory fortification of enriched cereal grain products began in the United States in 1998. “Fortification was estimated to avert approximately 1,000 NTD-affected pregnancies annually” according to the Morbidity and Mortality Weekly Report from the CDC (source). A systematic review also found that flour fortification with folic acid had a major impact on the incidence of NTDs in all of the countries where it was reported.
Scientific reviews continue to assess the latest evidence to update recommendations, concluding on the benefits of folic acid supplementation for preventing NTDs.
Looking specifically at prenatal supplementation guidelines, Dr. Federica Amati explains the reasoning behind established recommendations and why they endorse folic acid, not methylfolate, which Saladino claims is superior:
The best available evidence does not show that methylfolate (5‑MTHF) is superior to folic acid for clinically important pregnancy outcomes. Small randomized trials in pregnancy demonstrate that 5-MTHF achieves similar folate levels in the mother’s bloodstream and in her red blood cells as folic acid, while producing lower circulating unmetabolized folic acid.
The clinical relevance of lowering unmetabolized folic acid is uncertain. No trial has demonstrated better prevention of neural tube defects (NTDs) or other perinatal outcomes with 5‑MTHF over folic acid, and reviews highlight the absence of such outcome data.
Current guideline recommendations therefore continue to endorse folic acid, not methylfolate, for NTD prevention. The US Preventive Services Task Force (USPSTF) recommends a daily supplement containing 0.4–0.8 mg folic acid for all who could become pregnant, beginning at least one month preconception through the first 2–3 months of pregnancy. These recommendations are based on randomized and observational evidence showing folic acid reduces NTD risk; comparable NTD-prevention data for 5‑MTHF are lacking.
Dr. Federica Amati concludes that while “5‑MTHF provides equivalent folate repletion at equimolar doses,” “superiority has not been established for maternal–fetal outcomes.” That matters because recommendations are based on the totality of benefits and risks, which strongly favour continuing folic acid for NTD prevention.
Generalising from isolated studies can sidestep core principles of scientific literacy; the rest of this fact-check provides the wider context.
Claim 2: A study “found that higher levels of unmetabolized folic acid, a synthetic form of folate found in most prenatal vitamins in umbilical cord blood in Black children was associated with a significantly higher rate of autism spectrum disorders.”
Fact-check: The single study mentioned (from the Boston Birth Cohort) is observational and does not test whether taking standard prenatal folic acid is unsafe. It did find an association between higher concentrations of cord blood unmetabolized folic acid (UMFA) and a greater risk of ASD in Black children. However, as this is an observational study, with a relatively small sample size, it is not sufficient to draw these conclusions. It does not support the claim that folic acid supplementation should be avoided.
In a recent video, Dr. Idz details the reasons why Saladino’s cited study does not support his claims:
“This [study] wasn't even testing the effect of folic acid supplementation, it was looking at unmetabolised folic acid in umbilical cord blood, a completely different metric to assess which is not even proven to increase a risk of autism in the first place.
Also [the researchers] didn't even test the amount of unmetabolised folic acid in the mother's circulation, so you can't attribute the unmetabolised folic acid in the cord to the mother. And not to mention the Boston Birth cohort had a high number of pre-term births, which is a consistent risk factor for autism spectrum disorders” (Dr. Idz on Instagram on August 12, 2025).
When we encounter claims on social media that something in our food could be dangerous, based on a single cited study, it is crucial to pause and ask the right questions. This step is especially important as unverified claims can cause unnecessary anxiety among vulnerable groups like parents or pregnant women. One such question is: does the cited study actually answer the question asked by the influencer? And what does the rest of the evidence say?
These are important questions, because confidence in scientific research works like building blocks. Every study might be seen as a building block, and one will inform others by prompting new questions. Gradually, the picture builds up, and so does confidence in conclusions.
Saladino supports his argument by looking solely at one study, which does not directly address the question he’s asking.
More importantly, the video omits to mention all of the existing data on folic acid, its safety and benefits which include averting around 1000 NTD-affected pregnancies annually. By contrast, evidence-based recommendations take into account the totality of the evidence available. If a study points to slightly different results, it is not ignored; rather it prompts further exploration and questioning (such as: does this study overturn prior evidence?), and updated recommendations.
You can watch the entire video in which Dr. Idz continues to provide evidence (the other ‘building blocks’ that Saladino does not mention) looking specifically at associations between folic acid supplementation during pregnancy and autism spectrum disorders, and finding the exact opposite of what Saladino is claiming. Namely that folic acid is “not only effective at preventing neural tube defects both in supplements and in food, but it also leads to a lower risk of autism spectrum disorders” (Dr. Idz).
A few red flags to keep in mind
The claims presented in Saladino’s video exhibit a couple of red flags which can be indicative of misinformation. We summarise them below:
- ‘What you think is healthy is actually harmful’ claims merit source-checking.
This common framing is not misleading in itself. However when it is regularly reinforced, it can be a red flag. Yes, misleading marketing can get people to think they are making healthy choices when they are not. However, the success of folic acid supplementation is not the result of a marketing stunt. As we’ve seen, it follows from evidence-based recommendations.
- ‘Natural vs synthetic’ framing doesn’t answer whether a food or ingredient is safe.
The decisive question is clinical outcomes. For preventing NTDs, folic acid (a synthetic form) has population‑level proof; L‑5‑MTHF currently does not show superior outcomes.
Final take away
Do not stop a standard prenatal because of social‑media claims. When in doubt, discuss your specific situation with your clinician.
We invited Dr. Saladino to comment on August 13 and will update here with any response.
Disclaimer
This fact-check is intended to provide information based on available scientific evidence. It should not be considered as medical advice. For personalised health guidance, consult with a qualified healthcare professional.
Sources
WHO (2023). “Periconceptional folic acid supplementation to prevent neural tube defects.”
NHS (2022). “How and when to take folic acid.”
Blencowe, H. et al. (2010). “Folic acid to reduce neonatal mortality from neural tube disorders.”
Kancherla, V. (2023). “Neural tube defects: a review of global prevalence, causes, and primary prevention.”
Viswanathan, M. et al. (2023). “Folic Acid Supplementation to Prevent Neural Tube Defects: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.”
US Preventative Services Task Force (2023). “Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication.”
CDC (2015). “Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification — United States, 1995–2011.”
Cancillo-Lancelloti, C. et al. (2012). “Impact of folic acid fortification of flour on neural tube defects: a systematic review.”
Raghavan, R. et al. (2020). “A prospective birth cohort study on cord blood folate subtypes and risk of autism spectrum disorder.”
Further Reading
Sadler, I. (2025). “Yes, folic acid is synthetic, but that doesn’t mean it’s harming your child’s behaviour.”
Dr. Idz’s social media post commenting on the same video.
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