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Saturday, 14 March 2020

Should you treat Severe Autism yourself? Consider what may happen if you do not




RMS Carpathia  picked up Titanic survivors from life boats, the others had drowned


I was recently asked by some friends of ours, how come Monty, now aged 16 with autism, has changed so much over the last ten years. It turns out they have a relative with a 12-year-old son, who has autism and does not speak.

A few weeks later I was asked to have a chat with the boy’s mother and tell her what I have been doing, regarding treating autism, for the last 13 years.  Following the standard practice where we live does not give good results.  The boy does not talk, was not taught sign language, or to use any augmentative communication device, he cannot write and cannot read.  He goes to mainstream school and has a 1:1 assistant, but what does he learn there?

When we started treating Monty after his diagnosis aged three, he was entirely non-verbal, cried a lot and was not interested in anything.  From the age of four he was sitting at a little table being instructed at home, as well as going to kindergarten four hours a day.   Only from the age of 11 did he become full time at school. 

A couple of weeks ago Monty was skiing on black slopes (the hardest ones) in Slovenia and Austria, with his elder brother. He had to read a very dull 220-page book during the school break. We are practicing quite hard maths at home, using an online teaching resource.  When getting fitted for ski boots, Monty’s mother explained to the guy in the ski rental store, “he’s autistic … but he can ski”.  Yes, he can ski, but it was not a simple road to get there. He started when he was 6 years old with a special needs instructor; when he was eight he fell on the ski slope and broke his collar bone - a perfect opportunity to give up for good, but we did not.  Now he skis all week without a fall. It did not just happen, ditto playing the piano, ditto tying shoelaces, learning to cross roads and everything else.

I explained to the mother of the 12 year old how much easier it became to teach Monty, after starting his Polypill therapy, but that you still need to use personalized education alongside personalized medicine.  If you use neither, the result is what it is.

Instruction at home does not have to cost anything, it just requires a vast amount of perseverance.  All the books you might need have existed for decades.  The advent of the internet and touch screens makes everything so much easier.

Even in rich countries like the US and UK, the outcomes in severe autism are usually pretty terrible and yet could be so much better.

Some parents seem to be waiting to be extracted from their “autism hell”, but nobody is coming to help them.

I recall visiting Romania after the fall of communism and being told how many people endured a pretty tough life in the 1980s.  Some people actually believed during Communism that “the Americans will come” and liberate them; they never came and Romanians liberated themselves in 1989. It took them 42 years and a little prompting from a man in Gdansk (Lech Wałęsa). 

Below is an excerpt from Thinking Autism’s current blog post.




What autism means for my son

My son is 20, has very high support needs, minimal speech, and his communication is limited to basic requests. His sensory processing difficulties are severe enough to have a significant impact upon his attention, focus and learning. He can’t hold a conversation, talk about past experiences, or tell me if he is in pain. He has little awareness of danger, and needs round-the-clock supervision.

Unless an effective medical treatment is found, he will never be able to keep himself safe or make any important decisions for himself, and will eventually require some form of closely supervised residential care for the rest of his life.
That is the stark reality of the impact of autism on my son.

Clearly, if my son’s disability were cured or corrected, then all the barriers to his full participation in society would be completely removed, and he would have no need for societal accommodations. If his disability were managed or diminished, he may well have greater independence and freedom; for example, improved communication skills might enable him to exercise a greater degree of choice and control over his life.

A drug called bumetanide has also been shown to ameliorate symptoms of ASD in a number of trials … The first bumetanide studies were carried out in 2010, but ten years later, translation into clinical practice still seems a long way off.

In the intervening decade, my son’s childhood and teenage years have passed by, and he has entered adulthood, with no prospect of accessing any of these potentially life changing treatments.


When the Titanic sank in the Atlantic Ocean, those without a place in the lifeboats waited 160 minutes for the ship to sink.  120 minutes after Titanic sank, the rescue ship, Carpathia, appeared.  Do you stand on the deck listening to the band playing as the ship sinks, or at least try and build yourself a raft?

My suggestion to those left on the deck of the Titanic, or parents enduring their “autism hell”, is to do something about it.  If your child learns nothing at school, then teach him at home.  If you want bumetanide, go and buy some.  If you want a doctor to help you, go and find one.


Why do some autism parents, particularly those dealing with severe autism, not help themselves? 

This recent study suggests something that we probably already knew. Some people call it denial, others depression.  I actually think it is best described as the "freeze" response, which does actually exist in psycho-babble speak. In the freeze response to a shock there is no fight, no flight, just nothing.

https://www.psychologytoday.com/us/blog/evolution-the-self/201507/trauma-and-the-freeze-response-good-bad-or-both 


According to new autism research, we can now call it post traumatic stress disorder (PTSD).   


Challenging child behaviours positively predict symptoms of post-traumatic stress disorder (PTSD) in parents of children with Autism Spectrum Disorder and Rare Diseases



·        18.6% of the sample of parents of children with ASD met criteria for a provisional diagnosis of PTSD.
         
·        Health professionals should screen parents for PTSD when potentially traumatic challenging behaviours are present in children with ASD.


In reality, if health professionals do not want to treat children with autism, they are unlikely to want to treat post-traumatic stress disorder (PTSD) in their parents. but it is a nice idea.


It does not help that autism organisations often give very poor advice (advice proven not to yield good results) and doctors are usually taught nothing about autism; only a very few can help you.

Mainstream schools should not accept children if they cannot teach them at least basic skills.  The most basic skill is some form of communication, be it sign language or some form of augmentative communication.

Special schools that do not at least try to teach some form of augmentative communication should not exist, but they do.




42 comments:

  1. They really shouldn't call it PTSD for parents of children with severe disabilities... ..many of them are living with an ongoing trauma, and so there is no "post" in their condition.

    /Ling

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    Replies
    1. Hi Ling and Peter and All. For treatment resistant PTSD that needs to be treated faster than how long it takes for Clemastine to start to make major improvement, I extremely highly recommend trying 100mg 1 to 3 times. A week, and to keep in mind the minocycline works as a PTSD prophylaxis much better/faster than or does as repairing damage line clemastine. I recommend trying mini 100mg once a week for prophylaxis and 2 to 3 days a week non-consecutively for reversing an active "flare-up"of PTSD. Yes it has is side effects, but I found taking it this way soonest entirely stopped my night terrors prior to getting a script for daily Clemastine. On multiple sclerosis blog communities I have found that many of them who are prescribed Minocyclind often take it in the same way once or twice a week so that's why I decided to try taking it that way. I am actually legitimately prescribed 100mg minocycline once daily as needed for blepharitis. I have found that all I need for a minocycline dose when my blepharitis is under control and just needs a maintenance dose.

      Also I have seen studies inner before they claim taking vitamin c when on minocycline helps reduce the likelihood of minocycline causing changes/increase in skin pigment.

      Delete
    2. Ling, Peter and all, cont.d:

      In my experience with minocycline, I have found during the first 2 to 4 goes following a dose my sense of smell becomes very over powered and if I smell something like tobacco smoke or Axe body spray I immediately start feeling the need to throw up. A week and a half ago I began trialing ondansetron from my neurologist, and I have so far found 4mg to be extremely helpful with this side effect of minocycline.

      I hope I what I said makes sense,

      -Martin, Jr.

      Delete
    3. Hi Martin,

      I find your above posts very interesting! I am not knowledgeable in the mechanism behind PTSD, but it doesn't surprise me neuroinflammation is involved here too. I did thought about the condition when I wrote the recent comment about propranolol/monocytes stored in the spleen, and I see now that the same work is cited in PTSD research (like this one https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00222/full)
      Did I get you right that you have used Clemastine for PTSD too? At what dose? Also, since Ondansetron is highly interesting for autism, have you experienced any additional effect except anti-nausea from it?
      Thanks for sharing,

      /Ling

      Delete
    4. Ling,

      I have found clemastine and ondansetron amazingly helpful. I have been on the ondansetron for only half a month and it is absolutely amazing in how fast it works in me. I'm sorry I haven't responded I had tried to a couple times then accidentally hit my back button instead of enter and then I just couldn't get myself to try again, and I had started feeling off from not starting my morning routine. The ondansetron is incredible it's like if my eye movements and sensory integration received a [very good] software update. The under tongue pill tastes isgusting but I don't want to rock the boat with a regular pill form unless my neurologist suggests it. It took me months to get the confidence to ask and be able to explain why I think it will help me and what my on-label symptoms were so my insurance would cover it. It also has been amazing on-label nausea wise. I actually love it's that it's 4mg every 8 hours not more than 3 times a day as needed because its me adjust my reaction to things in my life. Also, suddenly I can take food based ASD helpful stuff like tourmeric and pepper with ease, and I have much more tolerance to car sickness.

      I will post more at some point, also thank you all so much for discussing Coronavirus 19 because I have been getting more and more worried and I had been extremely curious about the meds we use in this blog and the ones people like my grandparents are on regarding ace2 and it's nice to have a rough draft of it rather than not now. One if my best friends has had me watch the English stream of the Chinese media when the American media was doing nothing but misreporting the data and causing panic.

      I wish you, and everyone else on Peter's blog community here the best of health and all of your asd and asd-lite frie D's and family the best of health.

      -Martin

      Delete
  2. I was curious enough to check, indeed it's been 10 years since Lemonnier and Ben-Ari published a case series suggesting that "bumetanide decreases autistic behaviour with no side effects" and it's still in trials, while chloroquine got literally overnight approval from regulatory authority for COVID-19 in Poland yesterday. Why such an emergency is needed for a helpful step forward?

    In our case, personalized treatment brought the need for parent-led education. Before no education was really possible. My son has his own, personalized half home/half school system. At least until last week as we now all have to teach kids at home due to the lock down.

    Here is a word of caution for parents living in coronavirus outbreak areas: there is a concern about certain drugs’ impact on ACE2 receptor, which is required for virus-cell fusion. It has been suggested that ACE2 upregulation might increase the disease severity risk. ACE2 can be increased by thiazolidinediones e.g. pioglitazone, ibuprofen and possibly drugs targeting angiotensin. Apologize “coronavirus spam”, but all of these drugs were previously mentioned in the blog. Little is really known about this novel pathogen and it is only a controversial hypothesis, however I would be extremely cautious using these drugs without clear indication in countries affected by COVID-19 until there is more data. Take care (and in Poland - stay at home).

    https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext

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    Replies
    1. I did stop my self-trial of Pioglitazone and noted that yesterday the French minister of health, who happens to be a doctor, has warned people not to use Ibuprofen. Elsewhere the link between Ibuprofen and Covid-19 is being portrayed as fake news.

      A cytokine storm, covered previously in this blog, is needed for the severe outcome of the virus to occur. Therapies to combat cytokine storms are among the drugs being used in China. They do overlap with autism therapies (Atorvastatin, NAC, IL-6R antibodies) but there are some interesting new ideas.

      Delete
    2. The paper also suggests that ACE inhibitors and ARBs, taken by many older people to lower blood pressure, will make the virus worse and alternative medications to lower blood pressure would be advisable. There is a long list of alternatives, the paper suggests switching to calcium channel blockers.

      There is a conflict because ACE2 is generally very good for you, but it just happens to be that the Covid-19 virus binds to its target cells using ACE2. At this time you want less ACE2 in your body.

      People with type 2 diabetes are raising ACE2 with their glitazone drugs. It is not clear if Metformin raises ACE2.

      Many older people are on both glitazone drugs and ACE inhibitors.

      Delete
    3. Thank you, Agnieszka Wroczyńska

      Delete
  3. Dear Peter, there are personality traits which significantly alter how you react to anything. I did 8 years of very helpful psyhotherapy. Now I know it was mostly an amazing course in how to mask my Asperges better, but it was nevertheless very useful. Among other things it made me understand how many different makeups of people there were and how this affects their behaviour. First, there are people who are nowhere near as analytical as you and me. Example: when I ask other autism parents what their kids specific traits of asd are, they often give me so vague answers (he doesn’t like to play with kids, he doesn’t speak) that I am prevented by giving any sort of useful advice. Often they also don’t understand what they see. A family told me that their child was not exhibitint anxiety, when I met the child he was the most anxious child I have met so far. As far as what is called ‘helplessness’ in psychology goes (the idea of a saviour that will come), that is just a very common human characteristic that I don’t understand. At age 20 any person should have already experienced that nobody is coming to help, but people prefer this illusion of comfort. When I was pregnant, I was thrown out of the biggest FB parent group in my country because I was trying to explain to the fellow parents that their expectations of society (which they were upset about not being met) were very strange considering that our society had given them no reason to have such expectations. If they wanted to be good parents, they should have decided whether or not to have children based on a realistic view of society. They insulted me thoroughly, which made no sense at all logically but made all the sense from an ‘classic illogical human’ point of view - they disliked me telling them that the king had no clothes. A large percentage of humans would in reality prefer feudalism as a society organisation, which is clearly visible in who they vote in - ‘I shall lead and save you’. I even have now quite close friends whose 2 year old is obviously autistic, and they are soundly ignoring that fact and both me and experts they saw are unable to call them to it. You and I, we are logical people. Humans, mostly, are not.

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  4. So no ibuprofen re virus. Use paracetamol? Thank you

    ReplyDelete
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    1. I think it is either nothing, or paracetamol.

      Paracetamol depletes the body's key antioxidant GSH. It looks unwise to give paracetamol to a young child with autism.

      Delete
    2. It sounds a bit odd that both NAC and Paracetamol would be beneficial here, as I see them mostly as opposites of each other. Maybe in combination, to get the antiinflammatory effects of paracetamol and use NAC to up GSH?

      /Ling

      Delete
    3. NAC, in combination with other drugs can arrest the cytokine storm that may end in death. NAC may also interfere with virus replication. Paracetamol is just going to make you feel better. NSAIDs do not halt the cytokine storm.

      You ideally want an S1P1 agonist (Gilenya, used for MS) or IL-6R antibodies (Tocilizumab, used for arthritis), but only if the disease progresses in severity, when you might need a ventilator.

      Delete
    4. Tocilizumab has been successfully used in Italy in severe disease.

      I wasted too much of time today looking into the ibuprofen/ACE2 issue. If significant, it would be very important and google translator told me that the French minister of health mentioned young people without risk factors developed respiratory failure when treated with ibuprofen at early stages. Elsewhere I've read it happened in Toulouse.

      Here the Toulouse hospital denies it:
      https://www.facebook.com/chudetoulouse/posts/2495617567353991?hc_location=ufi

      So the risk is still to be seen as theoretical.

      ACE inhibitors were previously found to be helpful in acute lung injury in sepsis. So, who could predict the net effect in COVID-19?

      Chloroquine is officially recommended in China and now in Italy, but in combination with anitvirals.

      Delete
  5. Re: covid 19 and lithium - Interesting:
    https://f1000research.com/articles/9-93

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  6. 1. the cdc has now listed children with neurodevelopmental issues as groups at risk of corona virus problems, interested to hear the explanations if ever any come out. 2. got curious about the special italian genetics related to ACE and looked a bit into it. seems what usually makes them healthier overall as a people and what makes their population grow old now is really bad for them. this makes a lot of sense, especially having in mind that their patient 0 was a very accomplished sportsman of 38 who spent several weeks on respirators - a strange occurence that would not be seen in China, but makes a lot of sense when reading up in detail on the genetics of Italy in that regard.

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    Replies
    1. It may be more to do with behavioural reasons, rather than biology that otherwise healthy people, but with ID/autism are noted as an at-risk group. If you live in a group home you are at increased risk of many diseases, but often have much less care than you would have at home with parents.

      People with ID may not follow advice regarding hand washing and social distancing, but then neither would many teenagers.

      The only good data would come from Wuhan, based on hospital admissions. They have already published a lot of data.

      Delete
  7. Hello, Peter. How are you?
    So, since my last post on your blog, I started giving my son bumetanide (1mg) and NAC (300mg). Ihave been doing this for almost 12 days. I really feel like he's been smarter ever since. He presented speeches that I had never heard before, improved his understanding of what I say and is presenting more sporadic speeches.
    However, some red spots on the skin began to appear on his body. I think it's NAC, since he never had this kind of problem and they only started to manifest after the moment I gave NAC (I started giving NAC two days after the bumetanide). I looked in the literature on your blog and google and I didn't find that kind of side effect. Considering your knowledge, do you think that these red spots are being cause by NAC? If so, is it better to stop or try some more time to see if the red spots are a temporary effect? Is is 300mg too much for his age?
    Besides, considering the success of bumetanide, I am thinking of increasing its treatment with clemastine, atorvastatin and verapamil. What do you think of these additions?
    In your blog, the doses of verapamil and clemastine are very clear. However, I am in doubt about the dose of atorvastatin. I think that 10 mg for a child of almost four years is too much. I saw in a comment that a father gave a very small dose and that it worked. Anyway, if you can give me any tips on what to do about dosage.
    About verapamil, I am thinking of giving because of the cognitive and calming effects, but my son does not exhibit any aggressive or self-aggressive behavior. Even so, do you believe that it is worth giving him verapamil?
    One last thing: what is your opinion on stem cells for autism? I have seen parents who are very excited to do this type of treatment for their children. In addition, there is the phase 1 study by Duke that looked promising.

    Best regards,

    Bruno

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    Replies
    1. Bruno, I think you can be allergic to any drug. Also, many people are allergic to fillers and colourants used in pharmaceuticals (often yellows). Sometimes you have to switch brands. Some people are allergic to sulfonamide drugs, and a rash is a common symptom; bumetanide is a sulphonamide drug.

      If you stop NAC you will see where the allergy is coming from.
      I think 300mg of NAC is a small dose for autism. I would give something like 200mg 3 times a day, if it does not cause an allergic response.

      Your son is below the age many drugs were envisioned to be used, which does not mean they are not safe, but does mean you have to be very careful and accept that you are taking a risk.

      The beneficial effect of Atorvastatin comes quite quickly. You could split a 10mg tablet into 2 or even 3. I think if the dose is a too high, it may well cause a headache.

      Some parents do report a calming effect from verapamil, but you do need to monitor heart rate and blood pressure, to be safe. This drug is given to one year olds.

      It always best to start with a very low dose to make sure the drug is tolerated.

      Delete
    2. Thanks for your answer, Peter.
      I started with a small dose of NAC to see if there is already an effect with that amount. I even intended to increase the dose, but I think I will stop giving it at that moment to see if the red spots disappear.
      As for breaking the Atorvastatin pill, I am afraid that the pieces have a different amount between each others. So, if I decide to move on, it is likely that I will have the medicine done at a compound pharmacy. Woudl 3 mg be ok?
      About verapamil, I wonder how could I monitor the heartbeat and pressure of an autistic child of four years. I think it will not be an easy task.

      Delete
  8. Bruno, as someone who both did stem cells (cord blood) and is a bit of a celebrity in the stem cell world, I can say that there is an effect. I know there are people who got more than we did out of them, and I personally know people whose child only got significantly worse, so its a risk. But most people get a good result. We got a sort of overall maturity and just absolutely fantastic results in fine motorics which is the basic building block of a functioning nervous system. I can recommend both cord blood and msc, I don’t think you need to be too picky...both give good results.

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  9. Hello Peter, I started to give bumetanide to my son a week ago he is 3 and a half years old, I started giving him .5mg. I live in Monterrey Mexico and I think the COVID-19 tsunami is hitting us very soon. I read your post, and then I came across this article which I started to read because I have hypertension, but I'm concerened about what it says about hypokalemia, that it may be a prevalent feature of COVID-19. I don't have a scientific background, so I'm a bit confused, it states that hypokalemia does not respond well to oral potassium supplementation because kidney potassium losses persists until patients begin to recover. They only observed this in two patients. Can you advise me if I should continue giving him bumetanide.

    This is the link: http://www.nephjc.com/news/covidace2?fbclid=IwAR1sOoSNZWgSRIIyIAQFygNiFAaUjZeUWbuh609hC6teguNmPfgs1Kan-8I

    Lisa

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    Replies
    1. Lisa, in China they found that many patients in hospital with Covid-19 had low levels of potassium. They were giving some of them 3,000mg of potassium a day to try to raise potassium levels. This all relates to angiotensin/ACE2. As they got better they stopped losing potassium.

      Indeed, the falling level of potassium in urine was suggested as a marker for recovery from severe Covid-19.

      If you have severe Covid-19 you should not be taking bumetanide. Indeed you might be wise to take a potassium sparing diuretic like Spironolactone.

      I continue to give my son bumetanide and 500mg of potassium daily.

      If he did get sick with what looked like Covid-19, I would stop the bumetanide.

      Delete
    2. Thank you Peter! I will continue to give him bumetanide.

      Delete
  10. Hi Peter,
    Could you recommend anything for my son who is 8 and has become aggressive all of a sudden.Biting,hitting etc has become everyday occurance.His doctor gave him abilify but it has not helped at all.
    Please advice
    SB

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    Replies
    1. SB, there are many possible causes of SIB.

      Some are biological, some are a response to pain like dental problems, GI problems (reflux, GERD/GORD, IBS, IBD etc). Sometimes the cause is emotional stress.

      In my son’s case it was allergy triggered SIB that responds to Verapamil.

      For other types of the SIB there are numerous therapies that do work for certain people. Here is "cut and paste" from a list I have:-


      BCAAs (Branch Chained Amino Acids)
      Tyler and now Nancy use BCAA (branch chained amino acid) therapy, based on the idea of Acute Tryptophan Depletion, to control one type of self-injury. BCAAs are widely available and used by body builders.

      α7-nicotinic acetylcholine receptor agonists
      Some people with SIB respond very well to nicotine patches. This is likely to be the result of its effect on α7-nicotinic acetylcholine receptors, where it is an agonist.


      NSAIDS (Nonsteroidal anti-inflammatory drugs)
      Ibuprofen and other NSAIDS can be effective in minimizing some types of SIB triggered by inflammation.


      High dose Vitamin B6 with Magnesium
      For more than 30 years some people have been treating SIB with high dose vitamin 6 and a moderate dose of magnesium. Bernie Rimland, the founder of ARI, wrote extensively about this treatment he used in his son. The therapy is not supported by the literature, but is easy to find out about.

      Low-dose Fluoexetine/Prozac
      There are case histories in the literature showing that low doses of Prozac (2.5 – 5 mg/day) can be effective in controlling SIB in autism;

      NAC (N-acetylcysteine)
      Some people find the antioxidant NAC is effective in treating SIB and this is being studied at Emory University


      Clonidine
      Clonidine is an alpha-agonist type drug that is used to treat high blood pressure but also ADHD, it has long been used to reduce SIB in psychiatric patients. It stimulates the alpha-2 adrenergic receptor.

      Propranolol
      Propranol is a beta blocker type drug used to lower blood pressure. It is widely used in psychiatry to treat conditions including SIB.

      Lithium
      Lithium is a very old drug used to treat Bipolar Disorder that has been found to reduce SIB in some people.

      Piracetam
      The Nootropic drug/supplement Piracetam is reported to reduce aggression and SIB in some people.


      Immunomodulators
      Some people with autism respond very well to immuno-modulatory therapies, of which there are many. The benefits reported include reduced SIB. Even some probiotics modulate the immune system, a good example is L. reuteri ATCC PTA 6475 found in one OTC probiotic (Biogaia Gastrus), which reduces SIB in some cases and produces SIB in other people.

      Cannabinoids
      Various substances derived from Cannabis, such as cannabidiol (CBD) and cannabidivarin (CBDV) have been to have anti-epileptic effects and effects in autism that include moderating SIB.

      Palmitoylethanolamide (PEA)
      Palmitoylethanolamide, widely used an OTC therapy in Italy and Spain, was shown to reduce aggression and SIB in autism in an Italian case series.

      Antipsychotics
      Antipsychotics are associated with numerous side effects, some like Tardive Dyskinesia may become permanent. Although widely used by psychiatrists, antipsychotics should be used only in the very last resort.

      Delete
  11. Thanks Peter for the detailed explanation

    ReplyDelete
  12. Good morning
    I need some help, I can not find where to buy azosemide , I can not enter in mimakis pharmacy and I dont find it in germany pharmacies.
    I would like share-ask some more questions
    Thank you very much Peter for your help , some have been great
    NAC did great but it stopped B 12 like you said first fix it, but verapamil did not , I think it is maybe for disbiosis ...
    Other issue is with calcium he is on a GFCF diet , he is 14 years now , and he has a long history of pains in legs , even a fracture in the armwrist, I am sure there is a problem with that , i think sometimes it did well with calcium , now he is not taking cacium but vitamin K

    ReplyDelete
    Replies
    1. Jorge, my daughter has genetic syndrome that very often results in osteoporosis, even in childhood. While very few things enhance the expression of her specific gene, there are several interventions that target the co-factors in bone building.

      Standard recommendation is of course calcium + vitamin D. Kids with autism seem to respond differently to these supplements. If a kid drinks a lot of milk, I wouldn't bother with adding calcium and if it lives in a place with a lot of sun year round I wouldn't bother with vitamin D either.
      Vitamin K2 is the third necessary leg in that triad, and you want a lot of it. Thorne (brand) has a high K2 supplement which is very expensive but also the only one on the market that will yield the same amount as prescribed by japanese doctors (it's not the version with vit D in it).
      The last co-factor for building Osteocalcin is a gene called ATF4. In some autisms it is already highly expressed, in other autisms it is low. You can enhance it with supplements like sulforaphane, fisetin or bacopa.
      Good luck!

      /Ling

      Delete
    2. Jorge, it is much easier to get Bumetanide than Azosemide. If you have a prescription from Germany, you can buy Bumetanide in Austria. Bumetanide is not available in Germany.

      If you have a prescription for Azosemide you can go to a special International Pharmacy in Germany, who will order it from Japan to be collected in Germany.

      In Spain, Bumetanide is sold without a prescription as Fordiuran. In Mexico they sell it as Miccil and ship it worldwide.

      That Japanese pharmacy does list both generic Azosemide and the expensive version.

      Delete
    3. Peter, there's no Miccil in Mexico, I called to the laboratory that distributes it and they said they don't know if it will be discontinued or not. They gave me free samples, but they said that they didn't have many left. The president of Mexico said that many laboratories in Mexico were shut down because the medicines they distributed had toxic components and that many medicines are going to be imported. I just listened to him this morning. I'm not sure if the laboratory that makes and distributes Miccil is one of them, but it's been a while that there's no Miccil in the farmacies.

      Delete
    4. Lisa, where we live they have run out of Bumetanide several times, so I always have a reserve stock of it.

      If they do not manufacture it in Mexico, they can import it. It seems to be a simple/cheap drug to produce.

      Also, most of the world's generic pharmaceuticals are made from intermediary chemicals made in China. For two months production in China has stopped. So there will be consequences.

      Delete
    5. Ok thank you for the information!

      Delete
  13. Peter I remember you discussing the use of EPO in a different context in a previous blog posting. Here is some new research describing EPO's mechanism of action in the brain in driving neuroplasticity and neurogenesis.

    Press Release:

    https://www.sciencedaily.com/releases/2020/03/200313115659.htm

    Paper:

    https://www.nature.com/articles/s41467-020-15041-1

    The mechanism of action for neuroplasticity and neurogenesis as it relates to EPO is hypoxia as hypoxia in the kidney induces EPO, the researchers theorized that it might happen in the brain as well and so the proved that a cognitive challenge (for mice) would utilize more oxygen locally in pyramidal neurons in the hippocampus, thereby creating a temporary state of hypoxia which would then cascade into upregulating EPO which then causes the neuroplasticity and neurogenesis in the hippocampus. Mice which had the EPO gene deleted did not get any neurogenesis benefits after exercise. However, mice which had EPO applied to their neurons via injection, mice which exercised profusely for a significant period of time, as well as mice which were placed in a mild state of exogenous hypoxia (12% oxygen) all had boosts in neuroplasticity and neurogenesis.

    EPO seems to boost learning, but with respect to autism one could reason that too much hypoxia in the autism brain could induce excessive neuroplasticity (learning is hyperplastic) and excessive neurogenesis indirectly. In this context, blocking some EPO in the brain might be a good thing if other interventions cannot boost oxygen to a normal level (normoxia).

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    Replies
    1. Tyler, that is interesting. Yet another drug used to boost athletic performance has potential benefits for the brain.

      Perhaps increasing EPO, without hypoxia, might be useful experiment for some researcher. In sport all the following are banned for use:-

      – Erythropoiesis-Stimulating Agents [e.g. erythropoietin (EPO), darbepoetin (dEPO), hypoxia-inducible factor (HIF) stabilizers, methoxy polyethylene glycol-epoetin beta (CERA), peginesatide (Hematide).

      The drug Peginesatide is an analog of erythropoietin.

      Another drug that cyclists use is Mircera.

      EPO and the other equivalent drugs all need to be injected.

      Delete

  14. Dear Peter,

    About the red spots that were appearing on my son's body, when I stopped giving NAC they disappeared. Well, I tried to give NAC in liquid form. I don't know if powder could change the result? I fear that the excipients may have caused a problem.
    If powdered NAC also causes allergies, do you know of any other medications that can replace NAC? I remember reading that you use NAC because it is the most powerful in its category. Am I wrong? Could you help me with this
    My son's doctor recommended Memantine to him. Anyway, I'm going to start managing it and I will take the opportunity to read your post about memantine. After that, I will return here to give a report about the use of it.

    ReplyDelete
    Replies
    1. One study showed that about 8% of people are allergic to NAC. (it is used in hospitals to treat acetaminophen/paracetamol overdose)

      Many supplements contain numerous other ingredients which you might also be allergic to.

      The closest alternative is ALA (alpha lipoic acid). I think a person allergic to NAC might also be allergic to ALA.

      I would try different brands of NAC.

      I use NAC Sustain, but the pills are solid and very large. the advantage is that the NAC has not oxidized (no smell of rotten eggs)

      Good luck with Memantine.

      Delete
    2. Thanks, Peter. I will try another NAC brand before trying ALA.
      In the future, if I have a problem with ALA, what can be tried? A desensitization of sulfonamide components or is there something outside the category of sulfonamide drugs that can help with stereotypies?
      I am concerned about stereotypes as they will hinder his socialization.

      Delete
    3. Other ways to reduce oxidative stress include activating Nrf-2 for example with sulforaphane/broccoli powder. Large doses of vitamin B-12 do increase GSH and this works well for some people.

      Not all stereotypy is caused by oxidative stress.

      Some people find inositol helps. It seems to work in about half of cases in humans and is even used to treat primates in zoos who have stereotypy/OCD.

      Inositol is produced in your body, but also widely available OTC. It is used by women with PCOS among other uses.

      Delete
  15. I tried building the raft. I’m now under water with a piece of wood and hammer in my hand.

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    Replies
    1. Melanie it sounds like it is time to seek some help.

      Most people will need some help to treat autism.

      What to do next does depend greatly on where you live, much more so than how much money you have.

      The good thing is that you are not just standing idly by and accepting the situation.

      Delete

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