This is a guest post written by Seth Bittker, who previously wrote about Vitamin D in Autsim.
Your child has just been diagnosed with autism. Now what?
Start some form of behavioral therapy and research autism biochemistry. You will soon realize by reading blogs like
Peter’s that biochemical dysfunction is fundamental to most cases of
autism. For example, some biochemical characteristics
that are common in autism are:
1)
Immune dysfunction.
Often this shows up as comorbidity with allergic or autoimmune diseases.
2)
Elevations in monoamine neurotransmitters in the young. http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.1994.tb11911.x/abstract
3)
Methylation deficits.
Often the oxidized to reduced glutathione ratios are high. http://www.ncbi.nlm.nih.gov/pubmed/15585776
4) Low
plasma cysteine and higher sulfate excretion than controls. This means there is a functional sulfation
deficit. http://informahealthcare.com/doi/abs/10.1080/13590840050000861
5)
Lower levels of fatty acids in blood plasma than controls.
http://www.lipidworld.com/content/10/1/62
6)
Higher testosterone than controls. http://www.nature.com/srep/2014/140926/srep06478/full/srep06478.html
7)
Oxidative stress as demonstrated by markers.
8)
Vascular damage as demonstrated by markers. http://archneur.jamanetwork.com/article.aspx?articleid=792009
Given this background, it makes sense to determine whether
there are issues in your child’s biochemistry that may be involved in inducing
autism and how his biochemistry compares to others with autism. After all if his biochemistry is similar to
what is common it may be that therapies that have proven useful in others with
autism will prove useful in the case of your child as well.
How can you get an understanding of your child’s
biochemistry? You can have tests run on
your child’s urine and blood. This
typically involves finding a medical doctor who can order such tests and has
the inclination to do so. One test that
I believe everybody with autism of an unknown cause should have done is a
quantitative urine organic acid test. A good
organic acid test will provide information on fatty acid and carbohydrate
metabolism, Krebs cycle function, B vitamin deficiencies, neurotransmitter
metabolism, oxidative stress, detoxification, and bacterial and fungal activity
in the digestive tract, as well as methylation and sulfation processes. In short it will provide information on a lot
of the biochemistry that is often dysfunctional in autism. Different providers of organic acid tests
include different compounds and provide different information on them. I recommend Genova’s comprehensive test
because it includes a number of metabolites that are of interest in autism, it
is quantitative, and the data is displayed in a logical manner. Here is a link: https://www.gdx.net/product/organix-comprehensive-profile-metabolic-function-test-urine. To be clear I have no relationship to Genova
and I do not recommend that you follow the supplementation guidelines that they
typically include with test results.
After reviewing the information from your child’s organic acid test and
googling various metabolites, you may have some leads on whether the
biochemistry of your child is similar to the biochemistry that is common with
autism as described above.
What
to do next? The next step especially if
there are indications that your child’s autism is similar to what is common in
the medical literature is to develop a food and supplement protocol for your
child by experimentation. To mitigate
risk you should find a physician who you can collaborate with, experiment with
one therapy at a time, use your child’s biochemistry as determined by tests as
a guide, use supplements that have generally found to be helpful in others with
autism, and carefully control any experiments.
Always use low doses of any supplements at first. In fact to obtain positive effects with most
supplements, you need not provide large doses and in my view the amounts used
in supplement trials are often excessive.
Below
are some supplements and experiments and a reasonable order in which to try
them. I recommend that you try these (or
some subset of them) if your child’s biochemistry suggests they may be helpful. If you find significant issues in your
child’s biochemistry that may be ameliorated with a single supplement, you
should certainly consider trying that supplement first. Also if something does not work well for your
child, leave it out of the protocol that you are developing independent of
biologic rationale. The objective is to
improve the functional level and health of your child. If something does not work, discard it. You need not do everything.
1)
Fatty acids. As
mentioned previously fatty acids are often low in autism. You could get a fatty acid panel on your
child to determine if they are low in your child. Two double blinded trials have been done with
fish oil (omega 3 fatty acids) in the context of autism with generally positive
results. http://www.ncbi.nlm.nih.gov/pubmed/16920077 Interestingly it seems some omega 6 and omega
9 fatty acids are often more deficient than omega 3s in autism. As omega 6s like omega 3s are essential fatty
acids, deficiency can be problematic. While
controlled trials have not been done with omega 6s or omega 9s in the context
of autism, it makes sense to experiment with borage oil (omega 6) and olive oil
(omega 9) if deficiency is suggested based on a fatty acid panel.
2)
Methylation cofactors.
Are there elevations (even mild ones) of methylmalonic acid or
forminoglutamic acid from your child’s organic acid test? Does your child have a high ratio of oxidized
to reduced glutathione (a test by the European Laboratory of Nutrients can
measure this)? If so, then your child
may have a methylation deficit. Jill James
among others has found that shots of methylB12 and oral supplementation of
folinic acid can help normalize this biochemistry. http://ajcn.nutrition.org/content/89/1/425.long MethylB12 is absorbed well orally even in
those with dysbiosis. In addition the
methylfolate form of folate is absorbed well and is the active form used in the
body. Also it is methylated which is a
plus for those with methylation deficits.
Therefore, if there is any indication of need, I recommend
supplementation with oral methylB12 and oral methylfolate rather than the forms
that were used by James. In my
experience high doses of methylcobalamin can cause insomnia but low doses are
therapeutic. So be wary of inducing
insomnia.
3)
Thiamine.
Deficiencies of this vitamin lead to a disease known as beriberi. If you set aside the rashes that typically
characterize it, there is significant overlap between the symptoms of beriberi
and those that are common in autism. In
fact some with autism have rashes as well.
The word thiamine means sulfur containing vitamin and thiamine does
indeed contain sulfur. Sulfur deficits
are common in autism as previously noted.
So this is another hint in my view that thiamine may be helpful in
general in autism. Indeed a trial from
2002 of thiamine suppositories found that thiamine deficiency was fairly common
in autism and supplementation even in those without obvious signs of deficiency
could lead to improvement in behavior. http://www.ncbi.nlm.nih.gov/pubmed/12195231
It is my belief that this vitamin is significantly underutilized in treatment
of autism. Some signs that thiamine may
be warranted include high levels of lactate or pyruvate, issues of fatty acid
or carbohydrate metabolism and rashes.
4)
Vitamin C. A double
blinded placebo controlled trial from 1993 found some improvement in behavior
could be attributed to supplementing vitamin C in the context of autism. http://www.ncbi.nlm.nih.gov/pubmed/8255984 This is not surprising given that oxidative
stress is common in autism. Are there
indications of oxidative stress from your child’s organic acid test or other
sources such as high levels of 8-Hydroxy-2’-deoxyguanosine? Then a trial of vitamin C is warranted. I think low doses are preferable to high
doses as high doses have effects on digestion as well as neurotransmitters that
may be undesirable. In addition high
doses can induce copper deficiency. Too
much copper is not uncommon with autism but copper deficiency can be as
problematic as too much copper.
5)
Removal of supplementary and fortified sources of fat
soluble vitamins and particularly vitamin D.
This is controversial and the vast majority of practitioners would
recommend supplementation with vitamin D.
I believe getting rid of supplemental and fortified sources of vitamin D
was vital to improving my son’s biochemistry.
In addition processing oral vitamin D requires sulfation and sulfation
deficits are common in autism. Also many
of the biochemical characteristics of autism including excessive levels of
neurotransmitters, excessive levels of hormones, and a Th2 skew to the immune
system are exacerbated by significant supplementation of oral vitamin D. I wrote a paper on this available here: http://omicsgroup.org/journals/infant-exposure-to-excessive-vitamin-d-a-risk-factor-for-autism-2165-7890.1000125.pdf If you
think there is merit to this view, some indications that excessive fat soluble
vitamins could be a problem for your child include elevation in glucarate and
sulfate on an organic acid test. Please
note sun exposure is positive for those with autism. My concern is only with significant
supplemental oral sources of fat soluble vitamins and particularly vitamin D.
6)
Probiotics. A
number of excellent studies support the notion that dysbiosis is common in
autism. In addition a double blinded
trial from 2010 found marginal improvement in those with autism from
supplementation with a probiotic. http://centaur.reading.ac.uk/17353/ If your child has elevations in dysbiosis
markers, this is worth a try. I
recommend a trial of a probiotic that is high in bifidobacteria and
lactobacilli as there are indications that these are typically lower than
controls in the digestive tracts of those with autism. In addition if there are indications that
your child may have clostridia from an organic acid test or other test, it
probably makes sense to try the probiotic yeast saccharomyces boulardii as it
has proven helpful in cases of clostridia.
Clostridia is common in autism and can lead to dysfunction.
7)
Carnitine. One
study found that about 17% of those with autism have abnormal carnitine
metabolism. In addition a double blinded
placebo controlled trial found significant improvements in behavior from carnitine
supplementation in the context of autism.
http://www.ncbi.nlm.nih.gov/pubmed/21629200 One indication carnitine may be useful is a
high lactate to pyruvate ratio. In
addition one can measure the level of carnitine in the blood and low carnitine
is an indication that supplementation could be benefical. I do not use carnitine in supplementation
with my son as I have not found it to be helpful but the trial mentioned
suggests it will be helpful to a number of others.
8)
Removal of milk
from the diet. I do not believe there
have been double-blinded trials showing efficacy for this treatment. However some open label trials have resulted
in positive results and I attest to the importance of this intervention in the
case of my son. Issues of digestion such
as diarrhea and especially constipation are indicators that a trial of this may
be beneficial.
9)
Removal of gluten from the diet. As with milk free diets, I do not believe
there have been double blinded trials showing efficacy. However some open label trials have resulted
in positive results and it seems helpful to my child. In addition there does appear to be some
comorbidity between celiac (autoimmune disease of the small intestine initiated
by reaction to gluten) and autism. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884520/ Again
issues of digestion such as diarrhea or constipation can be good indicators
that a trial may be beneficial.
10)
Cruciferous vegetables.
Sulfur deficits are common in autism as previously noted. In addition a number of trials with sulfur containing
compounds have had tantalizingly positive results in the context of
autism. Such trials include: NAC, DMSA,
and sulforaphane as well as thiamine (mentioned above). We have tried small doses of all of these
with my son and with the exception of thiamine I have not felt the long term
results were positive. NAC and DMSA both
tend to exacerbate dysbiosis in some cases as well. As dysbiosis can be such a huge issue in
those with autism, I am hesitant to recommend them. We also tried a tiny dose of a sulforaphane
supplement with my son and I believe it induced a temporary verbal tick, which
was awful. In fact the researchers who
conducted the sulforaphane trial acknowledgement that it might raise the risk
of seizures in some. http://www.pnas.org/content/111/43/15550.short?rss=1&ssource=mfr Seeing the results in my son, I think this
caution is warranted and for this reason I feel sulforaphane supplementation
can be dangerous despite the positive results that many have seen. Cruciferous vegetables such as broccoli
(which contain sulforaphane) seem to have a marginally positive effect on my
son. As these are foods I also have less
fear of negative side effects. Thus, I
recommend inclusion of a trial of cruciferous vegetables in your child’s diet if there are any
indications of sulfation deficits (low cysteine) or high sulfur excretion (high
sulfate in urine).
Some other supplements that I believe
are useful in autism include biotin, riboflavin, milk thistle, melatonin (for
sleep), and prunes (for constipation). One
could write a book about treatment protocols for those with autism and a number
of good books have already been written on this topic. What appears above is a summary of an ebook that
I wrote describing this protocol which is available here: http://www.amazon.com/Autism-Getting-Biomedical-Protocol-Biochemistry-ebook/dp/B00R298YNW/. If you have any interest, please feel to
preview it on amazon.
In interest of full disclosure, I am
not a doctor, I do not consider my son “recovered” from autism, the autism
literature I have consulted as well as my own views may later be shown to be
incorrect, and independent of what is true generally your child may have
negative reactions to the supplements mentioned above. I thank Peter for the opportunity to describe
this protocol here and for his wonderful blog on cutting edge treatments for
autism and the science behind them. I
wish you success in your efforts to improve the health of your child.