The Role of Nutrients in Autism

This information is designed for use by physicians and licensed health practitioners interested in autism and PDD. Parents should use these as instructive concepts, and we caution against tinkering on your own. Find a naturopath, nutritionist, or physician knowledgeable about these substances to guide you in specifics. We still have much to learn and we are daily impressed by how much individual variation there is in this disorder/disorders. Autism may be a symptom of several different biological entities which merely present as a similar behavioral complex in early child development. Recommendations are general in nature and individual children vary greatly in their response to supplements. Any given supplement may cause significant side-effects or generate wonderful gains in a particular child. If in doubt about supplement reactions withdraw the supplement and reintroduce at lower levels.

Primary Goals of Supplementation

I) OPTIMIZATION OF NORMAL PHYSIOLOGY (THE CORE OF REBUILDING)

a. Support of Normal Growth and Neurodevelopment

i. Zinc deficiency: we feel it is safe to supplement just about everyone with ASD with 10-20 mg of zinc daily. Serum zinc levels or packed red blood cell element evaluations may reveal higher levels of supplementation are necessary.

ii. Selenium deficiency: many of our children with ASD require additional selenium. We will start with 50-100 mcg daily. Packed red blood cell element evaluations may reveal higher levels of supplementation are necessary.

iii. Ca/Mg deficiency: Since most of our children are dairy free, alternative sources for calcium are necessary for proper growth and development. We typically recommend 500-1000 mg of calcium citrate (not Turns) daily. Magnesium should be given with calcium to enhance absorption. Recommended dosing for magnesium is 1mg of Calcium to 1 mg ofMagnesium. Therefore, for example, 500mg of Calcium is given with 500mg of Magnesium. Note: magnesium may cause loose stools, and smaller doses may be needed. Calcium and magnesium blood levels should be checked regularly.

iv. Chromium deficiency: if this is revealed to be lowon blood level tests, we recommend about 50 to 100 mcg daily.

v. Protein deficiency: many children do not consume protein, or if they do, very small amounts. We recommend supplementation with a rice protein powder put directly into their drink. NutribioticsTM makes a very clean product. 1 tablespoon typically is equal to 14 gIns of protein. The amount our children require usually depends on age: if under 3 years, supplement with I gIn per 2 pounds of body weight. Ages 4-6 years, I tablespoon daily. 7 -10 years of age supplement with I 3/4 tablespoons daily. Older boys and girls require 2 tablespoons daily. This protein powder can easily mixed into any fluid as it contributes only a very bland flavor. It does have "texture" that some of our kids can detect. This can be minimized if mixed into juice, rice milk, etc. with a blender.

vi. EFA deficiency: Just about all the children will require Omega 3 fatty acids. We recommend starting with the RDA of vitamin A. Usually this is Y2 tsp of cod liver oil for children ages 2-5, I tsp for children who are older. A blood test, called an Essential Fatty Acid Profile will reveal other possible fatty acid deficits that can be supplemented. Some children react poorly to cod liver oil and can get very hyper and aggressive. This will resolve one to two days after discontinuing. Also recommended are EP A ( eicosapentaenoic acid) and DHA ( docosahexaenoic acid). Great sources of these can be found in Eskimo 3oil.

vii. Iron deficiency: this can be easily evaluated by simple blood tests that need to include a CBC, ferritin level, reticululocyte count, and total iron binding capacity. We included these specific tests because we were made aware by a physician in a conference that these have been forgotten in this age ofHMO medicine. Currently, they just screen with a hematocrit ("crit"). Ifiron deficiency is noted, your local physician can prescribe iron and give close follow-up.

viii. Calorie deficient: some of our special needs kids just will not eat. In this case, you may have to hide calories in the foods that they will eat or drink. This can get tricky and you may have to involve a physician. There are tricks you can do to "beef' up the calorie content of the things your child does eat. We commonly recommend cooking in high oleic saffiower oil, and adding extra oil to things such as gf pasta, rice, on popcorn, etc. We can even add MCT oil to drinks, just to increase total daily calories.

ix. Carbohydrate Excess: French-fries anyone? Just about all our kids love French fries and other carbohydrates. Remember, carbohydrates are just complex forms of sugar. Kids generally crave this sugar, which can really alter behaviors. The important thing to remember here is to try to balance each meal with some protein, a carbohydrate, and fat.

x. Vitamin deficiency: because of extreme food selectivity, our children become measurably deficient in many of the vitamins. These vitamins must be replenished in order to insure normal physiologic functioning. We also have to keep in mind, that even though we may be giving them these vitamins, they may not be absorbing them well (see below). It is beyond the scope of this syllabus to discuss each vitamin in detail (that could be a book in itselfl) but here is a very abbreviated presentation:

Vitamin A: there are two forms of this vitamin called a "trans" form and a "cis" form. The trans form is found in most manufactured sources called Vitamin A Palmitate. This may not be as effective in many of our children. The "cis" form is found in natural sources such as oils from Cod and Salmon. Briefly, Vitamin A is important to vision, cell membrane function, and to the immune system. Vitamin B Group: Thiamin, Riboflavin, Niacin, pyridoxine, and Cyanocobalamin are the names they commonly go by. Each one must be supplemented. Vitamins B6 (pyridoxine ), and its activated form called P5P, and B12 (cyanocobalamin) seem to be very important to the Autistic child and can minimize many autistic behaviors. Vitamins B6 and B12 have a major impact on the methylation pathyway.

Vitamin C: Books have written about vitamin C. Also know as ascorbic acid, we generally use 500mg to 1000mg (or more!) in our kids. This is a potent anti-oxidant and important in many physiological operations of the body. With higher doses of Vitamin C, be sure your source is buffered.

Vitamin D: also known" as calcitrol, regulates absorption and deposition of calcium and phosphorus. This vitamin can be found in some fish oils (think omega!) and exposure to sunlight.

Vitamin E: is another potent anti-oxidant. We recommend to our children in the range of 100-400 ill daily depending on their weight. Vitamin K: this is important to the formation of blood clotting factors. Bacteria in our gut produce this for us and this is another good reason to return the bowels to normal function as soon as possible. This is generally not needed to be supplemented except in extreme cases of gut maldigestion, malabsorption, and inflammation.

xi. Maldigestion and malabsorption: it has been demonstrated repeatedly that many of our children lack the digestive enzymes needed for breaking down foods. This can be demonstrated in comprehensive stool studies offered at the Great Plains Laboratory. It is advisable to start slow with digestive enzymes. We currently recommend Enzyme Complete with DPP4. We start with ~ to 'h capsule with each meal.

xii. Mineral deficiency: because of multiple dietary limitations, minerals are surely deficient.

b. Improved Function of the Immune System: Many children with autism have a dysfunctional immune system (that can be Thlffh2 imbalance). Critical nutrients to rebuild the immune system and move the Thlffh2 back toward Thl will require:

Zinc: this mineral is almost always deficient in children. It is crucial in many processes the body carries out day to day. It is easily measured in the blood. We do recommend 20 mg as a starting dose to most of our patients.

Selenium: can raise Immunoglobulin G-2 and G-4. This will decrease the number of infectious diseases and many also help with those children with intractable seizures. We dose 10mcg of Selenium per 2 pounds of body weight up to a maximum of 100 mcg daily. Once re-established in the body, levels can rise quickly and should be monitored erythrocyte levels (a blood test).

Chromium: this can aid in shifting Th2 to Thl by promoting the formation ofDHEA (which antagonizes cortisol). We recommend starting with 50-100mcg for children we see in our clinic.

Vitamins A, C, E, and 86: These vitamins are known to be absolutely necessary for normal immune system function. Vitamin A, in Cod Liver Oil, is recommended to our patients with a starting dose of Y2 tsp daily. Vitamin C is started at 25Omg to 500mg daily. We recommend 100IU of Vitamin E. B6 and its activated form, P5P , are usually always recommended. We recommend 25-50mg P5P daily.

Fatty acids: omega 3, and omega 6 are usually needed. The omega 3 fatty acids are supplied by Cod Liver Oil, DHAjr., and flax oil, Eskimo 3, and Coromega. Omega 3's are also supplied by using high oleic saffiower oil as cooking oil. Omega 6' s are also needed in some children. A blood test, called the fatty acid profile, will reveal individual deficits and excesses.

Amino acids: specific deficits can be determined with blood testing (plasma amino acid profile -quantitative ).

Probiotics: these are friendly bacteria that live in our gut. They help to create an environment that is very hostile for yeast and unfriendly bacteria. There are many good sources of probiotics: Klaire Labs Ther-biotics, Culturelle, Primal Defense and Natren. By removing the yeast and unfriendly bacteria, we can "unburden" the immune system of this task and see remarkable improvement in our children. We try many different ones and often have to change brands. Colostrum: can also be considered transfer factor. It appears to be toxic to many viruses and fungi (yeast) and promote repair of intestinal cells.

Treatment of candida (yeast) infections

i. Decrease Inflammation: most often these are gut issues. We will have to eradicate yeast, harmful bacteria, and solve the problem of diarrhea and/or constipation in order to eliminate the inflammation in this area.

ii. Increase NK activity with IP-6: this is a naturally occurring (plant fiber) substance that is an antioxidant that has been shown to increase natural killer cell activity; and Aloe.

iii. Secretory 19A deficiency (Colostrum) iv. Normal Gut Biosis (probiotics)

v. Beta Glucan (Macrophage Stimulator)

c. Increased Detoxification

i. Methylation Pathways GENOMICS testing can determine if there are problems in this pathway. Specific supplements can raise the products of this pathway (Jill James, PhD). We typically recommend: TMG or DMG, and folinic acid, methyl B 12, N-acetyl cysteine and glutathione.

ii. Sulphanation Pathways (MSM) These children classically dump sulfur and require replacement. We do this with Epson salt baths, topical glutathione, topical N-acetyl cysteine, and MSM. A word of caution, sulfur can enhance yeast growth. We can start children with 250 mg ofMSM twice daily. Glucosamine Sulfate (GS) may be even better if the early observations hold up.

iii. Alpha Lipoic Acid (25-50mg daily) is a potent anti-oxidant that goes after free radicals. CAUTION- many children experience difficulty with this product. Some do great.

iv. N-acetyl Cysteine (125- 250 BID) BUT NOT EARL Y in treatment. Plasma and intracellular cysteine can be measured with a blood test, and if low, can be given intravenously

v. Milk thistle: this herb has demonstrated to help the liver with phase I detoxification (NONTOXIC)

vi. Epsom salt baths: as explained elsewhere, this has wonderful detoxifying characteristics. We recommend If2 cup per tub of water, 3-4 times weekly with a sprinkle of baking soda.

d. Enhanced Cognitive Abilities

i. B vitamins (Child Essence @) many children really respond to the B vitamins, especially B6, B 12, and to magnesium.

ii. Essential Fatty Acids: The children usually have such a poor dietary intake, and the "good" fats are no exception. We will often get a blood test, "Fatty Acid Profile" and supplement according to the results. It is safe to assume the children will need omega 3 fatty acids. That is why we start with Cod Liver Oil.

iii. Minerals: Because of dietary limitations, many minerals are lacking.

iv. CoQIO v. NADH

vi. TMG/DMG

vii. Gingko Biloba?

viii. DMAE -Tyler Sea Buddies: CONCENTRA TE! Learners Edge @

e. Improved Red Cell Membrane Function

i. EF A: already explained elsewhere.

ii. Grape Seed Extract (GSE) -PhytoPharmica

iii. Antioxidants in general: Vitamin C, E and Grape Seed Extract (just to name a few)

iv. Chelation in selected cases

v. Removal of Nitrites (cured meats)

2) REDUCTION OF AUTISTIC BEHAVIORS

a. Restoration of Neurotransmitter Function

i. Normalized Neurotransmitter Levels (see below) 1. Tyrosine, TMG, GA BA, NADH

ii. Improved Receptor Site Activity I.TMG 2. NADH(maybe)

iii. Removal of Interfering Substances -False Transmitters 1. DigestRightTM I cap with each meal 2. Remove MSG, Nutrasweet, Aapartame, Hydrolyzed Vegetable Proteins Excitotoxins 3. Food Dyes 4. Reducing high phenol containing foods (blueberries, strawberries, etc. )

iv. Protection from Excitotoxins 1. Vitamin C 500-1000 mg daily 2. Vitamin E 100-200 ill daily 3. Magnesium 2mg per pound daily 4. Grape Seed Extract (50 to 100mg/day- PhytoPharrnica)

v. Increase of the Seizure Threshold -Stabilization of Neuronal Cell Membrane Potentials I.EFA 2. Taurine 250-500 mg daily

b. Improve Gastrointestinal Function

i. Improved Motility

1. Secretin: This hormone is normally released by specialized cells in the duodenum (the channel that directly follows the stomach outlet) that tells the pancreas to secrete bicarbonate (neutralizes the acidic stomach content). Given IV or transdermally, this has had profound positive effects on many of the children we see. It can normalize bowel function with respect to the child having formed, brown, and one to twice-daily stools that smell like, regular BM's. Secretin can also have profound effects on autistic behaviors with some of the children responding remarkably. The children who tend to benefit most from secretin have loose stools and very limited to no language. Unfortunately, Secretin needs a physicians involvement and prescription.

2. Fiber: always has been helpful for developing regular stooling behavior. We currently are using Benefiber, available at most phannacies. The typical dose is I tsp in juice or water three times daily. It dissolves completely and has no taste.

3. Calcium: as previously discussed, calcium HAS to be supplemented in our dairy free kids. We follow general RDA guidelines, 500 to 1000 mg daily given with magnesium.

4. Magnesium (avoid Magnesium Oxide)

ii. Probiotics (Many products and we often have to rotate). These provide live cultures of Lactobacillus Acidophilus, Bifidobacterium and many others. These friendly bacteria produce vitamin B complex and vitamin K. We try to supplement-with 20- 40 billion organisms daily (1-2 capsules daily). Suppository?

iii. Decreased Inflammation

I. EFA: ProEPA, Eskimo Oil, Artic Orange CLO 2. Grape Seed Extract (Up to 200mg daily) 3. NAC (Caution with use early in ASD treatment), we use this in Intravenous form (IV) or oral 4. Bromelain : 250 mg twice daily, contains pineapple (allergy in some) between meals -found in the Enzyme Digest Right

iv. Improved Autonomic Neuronal Function -Neuropeptide Activity (TMG)

3) NUTRITIONAL PHARMACOLOGY FOR SPECIFIC ISSUES

a. Hyperactivity

i. Suspect Gluten/Casein leaks

ii. GABA (500- 1000mg TID)

iii. Taurine (500- 100Omg Till)

iv. EFA (1000- 2000mg QD)

v. Calcium/Magnesium (doses vary)

vi. TMG (125 BID and work the dose up slowly)

vii. DMSA (chelation by protocol in selected cases only) viii. No refined Sugars

ix. Elimination of Artificial Colors

x. Magnesium glycinate (200 to 400mg twice daily) xi. Glycine: we start with 250 mg twice daily

b. Inattention

i. Suspect Gluten/Casein leaks

ii. Tyrosine (500 BID)

iii. EFA (up to 2000mg QD)

iv. CoQ10 (25- 50mg BID)

v. NADH (2.5- 5mg BID)

vi. 1MG (125 -250mg BID)

vii. (No refined Sugars )

viii. DMAE (Learner's EdgeTM)

ix. THEANINE (Learner's EdgeTM)

x. DMSA (by protocol )

xi. Ginkgo Biloba

c. Self-Abusive Behaviors and Rage, impulsivity, disinhibition: this is often linked to disturbances in serotonin metabolism.

i. Suspect Gluten/Casein leaks

ii. Inositol 1-6 gms three .times daily

iii. Chromium 100-200 mcg daily

iv. Taurine (up to 10,000mg total daily)

v. GABA (up to 10,000mg total daily)

vi. Low Carbohydrate Diet (No refined Sugars)

vii. Elimination of Artificial Colors

viii. Often Improve with Chelation (DMSA)

ix. Naltrexone

x. Consider Risperdal (Rx)

d. Poor Sleep

i. Melatonin (1 -3 mg at bed): this may be split up twice daily if the child wakes up 1-2 am. We can give .5mg in am and 1.5 mg in pm. They may be sleepy during the day for a few days.

ii. Taurine (1000- 4000mg at bed)

iii. GABA (1000- 5000mg at bed)

iv. DMSA (by protocol )

v.1MG +1- (daytime doses set up a better sleep pattern in many children (250 -750 mg)

vi. Magnesium 400-800 mg at bed vii. 5HTP 50 to 100mg at bedtime

e. Diarrhea: We often obtain an Xray of the abdomen as some times diarrhea is a sign of constipation.

i. Colostrum (variable dosing)

ii. Probiotics (Probiotic pearls, Primal Defense, Culturelle )

iii. Digestive Enzymes (Food Sensitivity -Malabsorption - Osmotic)

iv. Cranberry Extract YeastlBacteria Fighter (1- three times daily)

v. Lauricidin TM Y4 tsp three times daily titrate to stool consistency

VI. various

vii. 1MG

viii. Echinacea +1- ix. Aloe Extacts

x.EFA

xi. Specific Rx Meds (Metronidazole Benzoate or Generic Flagyl, Vancomycin, Antifungals, Antiparasitics (Yodoxin - Bastocystisis )

f. Constipation (Suspect and get the KUB -Toe-walking)

i. Fiber (various -Benefiber, BasicGreen, mtraGreen, Citracel, ProEFA) Soluble fiber is easily mixed in drink, has no flavor.

ii. Xprep (prune Concentrate )1 Fruit Eze

iii. Senna- Smooth Move TEA!

iv. Mineral Oil ( caution re fatty acid and fat vitamin malabsorption) use for no more than two weeks) v. Aloe Resin (leaf not gel) can be harsh

vi. PediFleets Daily if necessary until the plug is out

vii. Miralax (RX) Yz or 1 teaspoon daily as needed up to a tablespoon

viii. HIGH dose Vitamin C ix. Magnesium

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