Autism – What are the most effective naturopathic treatments for autism?

Autism is a very complex disorder, and involves many genetic and environmental factors that are not well understood. However, there are many biomedical abnormalities that have been identified, and most can be treated to some degree. By following the testing and treatments outlined below, many individuals will improve to some degree, usually slowly and steadily over months and years. Sometimes one treatment shows great benefit, but it is more common that each treatment helps a small amount. However, the cumulative effect of multiple treatments can be substantial.

 

Table 1: The following is a list of the most effective treatments for children with autism after the Autism Research Institute (ARI) interviewed more than 27,000 parents (based on 2013 report).

Treatment Got Better No Effect Got Worse Better:Worse # of cases
Detox (chelation) 74% 23% 3% 24:1 1382
Methyl B12 injections (subQ) 72% 22% 6% 12:1 899
Gluten-/Casein Free Diet 69% 28% 3% 24:1 3593
Food Allergy Removal 67% 31% 2% 27:1 1294
Digestive Enzymes 62% 35% 3% 19:1 2350
Fatty Acids 59% 39% 2% 31:1 1680
Feingold Diet 58% 40% 2% 26:1 1041
Candida Diet 58% 39% 3% 21:1 1141
Removed Dairy 55% 44% 2% 32:1 6950
Removed Wheat 55% 43% 2% 30:1 4340
Zinc 54% 44% 2% 24:1 2738
Removed Sugar 52% 46% 2% 27:1 4589
Vitamin C 46% 52% 2% 20:1 3077

Reproduced by Dr. Nicholas Anhorn, BSc, ND from the data of the Autism Research Institute. The following data have been collected from the more than 27,000 parents who have completed our questionnaires designed to collect such information. For the purposes of the present table, the parents responses on a six-point scale have been combined into three categories: “made worse” (ratings 1 and 2), “no effect” (ratings 3 and 4), and “made better” (ratings 5 and 6). The “Better:Worse” column gives the number of children who “Got Better” for each one who “Got Worse.”

 

From going through the above list we can organize these successful treatments into 5 categories.

 

The 5 categories that need to be assessed for patients with autism include: 

  1. Detoxification & Chelation
  2. Food Sensitivity Elimination Diets: food sensitivity testing (IgG), allergy testing (IgE), gluten free, dairy (casein) free, dye/additive/preservative free (Feingold diet), sugar free, etc.
  3. Gut Dysbiosis: abnormal microbes in the digestive tract, candida/yeast overgrowth, etc.
  4. Digestive Function: digestive enzyme deficiency, leaky gut, etc.
  5. Nutrient Deficiencies: vitamin B12, omega 3, Zinc, vitamin C, etc.

1) Detoxification & Chelation

Individuals with autism appear to be more sensitive than the general population, since they often lack the nutrients needed to detoxify chemicals, toxins, food additives/preservatives, etc. A major study reviewed the reported benefits of organic foods. It analyzed a total of 17 studies in humans and 223 studies of food content/contamination. The major differences were:

 

1) Organic foods rarely had detectable levels of pesticides (7%) compared to conventional foods (37%). Two studies found that children on organic diets had lower levels of pesticides in their urine.

2) Organic milk and organic chicken had higher amounts of certain essential omega-3 fatty acids. Similarly, two studies of mothers found that those who ate mostly organic dairy and meat products had higher levels of beneficial essential fatty acids in their breast milk compared to mothers on more conventional diets.

3) Vitamins and most minerals were present in similar amounts in organic foods vs. conventional foods. However, organic foods had higher levels of phosphorus, an essential mineral.

Smith-Spangler C et al., Are Organic Foods Safer or Healthier Than Conventional Alternatives? A Systematic Review, Ann Intern Med. 2012;157 Crystal Smith-Spangler,

 

Organic foods have lower levels of pesticides, and one study found that people living near areas with higher usage of agricultural pesticides had a significantly higher risk of having a child with autism. Pesticide use inside the home is probably a similar concern.

Roberts EM et al., Maternal residence near agricultural pesticide applications and autism spectrum disorders among children in the California Central Valley. Environ Health Perspect. 2007 Oct;115(10):1482-9.

Shelton et al., Tipping the balance of autism risk: potential mechanisms linking pesticides and autism. Environ Health Perspect. 2012 Jul;120(7):944-51.

 

Toxic metals such as mercury can greatly decrease the body’s ability to make glutathione, and removing toxic metals seems to normalize glutathione levels. One study investigated treatment with oral DMSA, a medication that is FDA-approved for treating lead poisoning in infants and children. Initially, many children with autism had glutathione levels that were much below or much above that of the adult reference range, but after treatment they had levels that were almost all within the adult reference range; i.e., those with initially low levels increased towards normal, and those with high levels decreased towards normal. This treatment was safe and effective, and seemed to improve behavior.

 

Adams JB et al., Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A-- medical results. BMC Clin Parmacol. 2009 Oct 23:9:16

Adams JB, et al., Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: part B - behavioral results. BMC Clin Pharmacol. 2009 Oct 23;9:17.

 

In order to test for toxin accumulation in the body we have access to two different tests -- 1) Urinary Toxic Metal Testing (urine), and 2) Toxic Element Exposure Profile (hair). Although the urinary test is usually preferred, if children are still in diapers, then the hair test works just as well.  Below are examples of the two tests available.

 

Sample report of the Urinary Toxic Metal Testing:

Sample report of theToxic Metal Exposure Testing (Hair):


2) Food Sensitivity Elimination Diets: food sensitivity testing (IgG), allergy testing (IgE), gluten free, dairy (casein) free, dye/additive/preservative free (Feingold diet), sugar free, etc.

 

Food sensitivity tests at the Moncton Naturopathic Medical Clinic are analyzed by Alletess Medical Laboratories.

 

Alletess Medical Laboratories is one of the leaders in testing for food allergies/sensitivities. Alletess is committed in assisting Dr. Anhorn with the most accurate testing results using the enzyme-linked immunosorbent assay (ELISA) medical technology. The assay is highly sensitive, specific and reproducible.

 

An Alletess food sensitivity test can assist you and Dr. Anhorn in determining the specific allergens that are responsible for your symptoms. With a single blood sample, we can determine the exact amount of allergen-specific IgG (Immunoglobulin G) antibodies in your blood serum.

 

Two allergy tests are available that measures serum concentration of IgG antibodies specific to either 96 or 184 foods (see below).

 

Theses panels include specific fruits, vegetables, dairy and grain products, peanuts, tree nuts, fish, shellfish, meat, herbs and spices.

 

Once your blood is drawn and sent to Alletess, we can expect results back in typically 1-2 weeks. The results will be discussed at your next visit so that Dr. Anhorn can help you understand the significance of the test results. He will help you implement these dietary changes and will explain its role along with the rest of your treatment plan in achieving your health goals.

 

Notes about terminology:

The use of the term ‘food allergy’ is technically reserved to IgE antibody (vs IgG antibody) related reactions. IgE reactions are the immediate, anaphylaxis type reactions to foods which can be tested via the skin scratch test (MD referral) or blood test at hospitals. The IgG reactions are termed ‘food sensitivity’ to differentiate from the IgE reactions. 

 

The following is an example of an 184 IgG food sensitivity test results:

 

Research linking food sensitivities with Autism

Cade’s large study of 150 children with autism found that 87% had IgG antibodies (allergy) to gluten, vs. 1% of the age and gender-matched controls, and 90% had IgG antibodies to casein, vs. 7% of the controls.  He also studied 70 autistic children who followed a GFCF diet for 1-8 years, and found that 81% improved significantly by the third month, with improvements continuing over the next 12 months. Large improvements were observed in social isolation, eye contact, mutism, learning skills, hyperactivity, stereotypic activity, and panic attacks. Among the 19% who did not improve, about 1/3 of them were not following the GFCF diet, and had lots of gluten and casein peptides still in their blood.

 

Cade R, Privette M et al. "Autism and Schizophrenia: Intestinal Disorders" Nutr. Neurosci 3 (2000) 57-72. Published by Overseas Publishers Association, (OPA) N.V.

Knivsberg AM, Reichelt KL, Nodland M. Reports on dietary intervention in autistic disorders. Nutr Neurosci. 2001;4(1):25-37. Review. 

 

Children who most crave dairy and/or wheat, and who eat a lot of it, are most likely to benefit. Casein-free diets usually produce benefits within a month, and sometimes within a week. Gluten free diets usually take 1-3 months to produce benefits. In some children there is a worsening of symptoms for a few days (similar to a drug withdrawal) followed by improvement.

 

 Many children with autism have food sensitivities, due to abnormalities in their digestive and/or immune systems. If food is not fully digested into individual sugars, amino acids, etc., then the partly digested food can cause the immune system in the gut to react to those foods. This reaction is much more likely to occur if there is inflammation of the gut. Immune reactions can involve an immediate allergic reaction (mediated by IgE antibodies), or they can be delayed by several hours to 1-2 days due to other parts of the immune system being involved (so-called non-IgE mediated food allergy).

 

Immediate-type responses can range from mild to severe, and may involve hives, respiratory problems such as choking/wheezing, diarrhea, vomiting, dizziness/feeling faint, or even severe reactions such as anaphylaxis.

 

For delayed-type food allergy, symptoms are typically limited to GI tract, but may involve headaches, migraines, or other reactions. For example, some patients with celiac disease (immune reaction to wheat mediated by IgA antibodies) may develop migraines in addition to severe gut inflammation.

 

Blood and skin testing

Food allergen specific IgE testing by blood testing (called RAST) or skin prick testing can be helpful to detect immediate-type food allergies. These tests are readily available but have a high frequency of false positive results (i.e., many safe foods will be falsely reported as being allergens), so they should only be used as a guide as to possible foods to consider removing and then reintroducing. These tests do NOT help diagnose delayed-type food allergies. Blood IgG testing for food allergens is available

 

A study by Vojdani et al. found that many children with autism have food allergies.

Vojdani A, et al., Immune response to dietary proteins, gliadin and cerebellar peptides in children with autism. Nutr Neurosci. 2004 Jun;7(3):151-61.

 

There are also 3 studies by Jyonouchi et al, which found that children with autism had more hypersensitivities to food allergens than did typical children, which seemed to contribute to gut problems.

Jyonouchi et al., Dysregulated innate immune responses in young children with autism spectrum disorders: their relationship to gastrointestinal symptoms and dietary intervention. Neuropsychobiology. 2005;51(2):77-85.

Jyonouchi et al., Evaluation of an association between gastrointestinal symptoms and cytokine production against common dietary proteins in children with autism spectrum disorders. J Pediatr. 2005 May;146(5):605-10.

Jyonouchi et al., Innate immunity associated with inflammatory responses and cytokine production against common dietary proteins in patients with autism spectrum disorder. Neuropsychobiology. 2002;46(2):76-84.

 

A study by Lucarelli et al found that an 8-week diet that avoided allergic foods resulted in benefits in an open study of 36 children. 

Lucarelli et al, Food allergy and infantile autism. Panminerva Med. 1995 Sep;37(3):137-41.

 

Three studies have demonstrated that children and adults with autism often have low levels of digestive enzymes for sugars and carbohydrates, especially the sugar in milk, which reduces the ability to digest those foods (see section on Digestive Enzymes).

 

Three studies have demonstrated that some individuals have increased intestinal permeability, so that large sugar molecules that normally would not be absorbed are able to pass through the intestinal wall into the blood stream. This “leaky gut” may allow other partly digested foods to pass into the body, potentially causing an allergic or immune response to those foods. It is unclear if this test for sugars is relevant to proteins since they are absorbed by a different mechanism.

de Magistris L et al., Alterations of the intestinal barrier in patients with autism spectrum disorders and in their first-degree relatives. J Pediatr Gastroenterol Nutr. 2010 Oct;51(4):418-24.

D'Eufemia P, Celli M, Finocchiaro R, et al.: Abnormal intestinal permeability in children with autism. Acta Paediatr 1996,85:1076–1079.

Horvath K, Zielke H, Collins J, et al.: Secretin improves intestinal permeability in autistic children. J Pediatr Gastroenterol Nutr 2000, 31(suppl 2):S30–S31.

 

There are many studies of gastrointestinal problems in children and adults with autism (see reviews by Buie et al 2010 and Coury et al 2012), and inflammation of the gut will greatly increase the likelihood that the immune cells in the gastrointestinal tract will react to foods.

Buie, T., et al. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics 125 Suppl 1, S1-18.

Coury DL et al (2012) Gastrointestinal Conditions in children with Autism Spectrum Disorder: Developing a Research Agenda, Pediatrics V130, Supplement 2 pp S160-168.

 

It is important to note that human digestive systems have not evolved on a diet containing high amounts of wheat and dairy products. Humans are the only animal who drink milk as adults, and the only ones to drink the milk of another animal. Cow’s milk is a perfect food for baby cows, but not for humans or infants.

 

Over the last several hundred years, wheat has been bred to greatly increase its gluten content, and a typical US diet contains far higher amounts of wheat than humans were eating 1000-10,000 years ago. Gluten (in wheat, rye, barley, and possibly oats) and cow’s milk proteins (including casein, β lactoglobulin, α-lactoalbumin which are present in all dairy products, including milk, yogurt, cheese, ice cream, caseinate) can cause several problems:

1. They are common food allergens (see previous section), causing both immediate- and delayed type food reactions.

2. Many individuals with autism have low levels of lactase, the enzyme needed to digest lactose (the sugar in milk). This results in bacteria consuming the lactose, resulting in painful gas, bloating, and diarrhea.

3. Certain peptides from gluten and casein can bind to opioid-receptors in the brain, and can have a potent effect on behavior (like heroin or morphine), causing problems including sleepiness, giddiness, inattention/”zoning out,” and aggressive and self-abusive behavior. Like opioids, they can be highly addictive, and a lack of them can cause severe behaviors. This problem appears to be due to an inability to fully digest the gluten and casein peptides into single amino acids, and due to inflammation of the gut, which allows the gluten and casein peptides to enter the bloodstream and reach opioid receptors in the brain. However, the evidence for this “opioid hypothesis” is limited.

4. Consumption of dairy products can cause the immune system to create antibodies against a similar protein in the body, the folate transport receptor, which carries folic acid into the brain. Individuals with cerebral folate deficiency have benefitted from a dairy-free diet.

 

Sugar Free

Reduction in sugar intake can prevent rapid rises and falls in blood sugar, which can cause irritability and difficulty concentrating.

Kohlboeck G, et al. Food intake, diet quality and behavioral problems in children: results from the GINIplus/LISA-plus studies. Ann Nutr Metab. 2012;60(4):247-56.

 

Dye/additive/preservative free (Feingold diet)

Artificial colors and flavors can irritate some sensitive individuals, causing behavioral and other problems. A randomized, double-blind, placebo-controlled study of food additives found that they increased hyperactivity in typical children. This was a large study of 153 3-year-old and 144 8/9-year-old typical children, and found that either artificial colors or sodium benzoate (a food preservative) at levels typically found in foods caused hyperactivity.

McCann et al, Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007 Nov 3;370(9598):1560-7. Erratum in: Lancet. 2007 Nov 3;370(9598):1542

 


3) Gut Dysbiosis: abnormal microbes in the digestive tract, candida/yeast overgrowth, etc.

 

The human gut contains a large number of bacteria (10x more gut bacteria than cells in the entire body). Most of these gut bacteria are beneficial, helping with food digestion and water balance, producing some vitamins, and limiting the growth of harmful bacteria and yeast.

 

One of the most striking differences in the medical history of children with autism is that several studies have reported much higher use of oral antibiotics (usually for ear infections) in infancy of children with autism compared to controls. These oral antibiotics will destroy most of the beneficial gut bacteria, and thus increase the risk of overgrowth of harmful bacteria and/or yeast. Harmful bacteria and yeast produce toxins that can severely affect mental functioning and behaviour; alcohol is just one of many toxins that yeast can produce, and is a good example of a yeast toxin that can severely affect behaviour.

Konstantareas MM, Homatidis S: Ear infections in autistic and normal children. Journal of Autism and Developmental Disorders 1987, 17(4):585-594.

Niehus R, Lord C: Early medical history of children with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics 2006, 27(2):S120-S127.

Adams JB et al., Analyses of Toxic Metals and Essential Minerals in the Hair of Arizona Children with Autism and their mothers, Biol Tr El Res 2006, 110:193-209.

Adams JB et al., Mercury, Lead, and Zinc in Baby Teeth of Children with Autism vs. Controls J Toxicol Environ Health 2007, 70(12):1046-51.

Adams JB et al., Mercury in First-Cut Baby Hair of Children with Autism vs. Typically-Developing Children. 2008, 90(4):739-753. 

 

One study of 58 children with autism vs. 39 controls found that the severity of gut problems strongly correlated with autism severity. Individuals with gut problems had much worse scores on the ATEC subscales of speech, social, sensory cognitive, and health/physical behavior. That study found some abnormalities in gut bacteria, including decreased levels of bifidobacteria (an important beneficial bacteria) in children with autism compared to controls.

Adams JB et al., Gastrointestinal Flora and Gastrointestinal Status in Children with Autism -- Comparisons to Neurotypical Children and Correlation with Autism Severity, BMC Gastroenterology 2011, 11:22 (16 March 2011).

 

Two small studies using DNA-based methods to investigate all gut bacteria have been conducted. One study (Finegold et al 2011) found increased levels of desulfovibrio bacteria in children with autism, while another study (Williams et al 2012) found Sutterela bacteria in half of the 23 children with autism but not in any of the 9 controls.

Finegold SM et al., Pyrosequencing study of fecal microflora of autistic and control children., Anaerobe. 2010 Aug;16(4):444-53. Epub 2010 Jul 9.

Williams BL et al., Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances. PLoS One. 2011;6(9):e24585. Epub 2011 Sep 16.

 

Historically it has been very difficult to assess gut bacteria, because there are about 1000 different types of bacteria in each person’s gut, and standard culture methods can only assess a few dozen of them. However, new DNA-based methods are rapidly changing the ability to assess gut bacteria. A will reveal the amount of some types of normal and abnormal bacteria and yeast. We use Doctors Data Laboratories which offer a Comprehensive Digestive Stool Analysis to determine which dysbiotic organisms are present (bacteria, yeast/candida, parasites) and which good organisms are missing (e.g. which species of probiotic).  Then if it finds any dysbiotic organisms it tests which therapies would be most effective at eradicating the patient’s particular dysbiotic organism.
Here is an example of the Comprehensive Parasitology Stool Analysis:

 


4) Digestive Function: digestive enzyme deficiency, leaky gut, etc.

 

The body normally produces a variety of digestive enzymes to break large food molecules into smaller ones that can be absorbed. Different enzymes are needed for different types of protein, carbohydrates, and fats. Children with autism sometimes have low levels of certain enzymes, or less active enzymes, or both – enzyme problems are especially common in children with gut problems (chronic constipation or diarrhea).

 

One digestive enzyme, DPP4, is easily deactivated by small amounts of toxins including mercury and organophosphates (pesticide sprays). DPP4 is needed to digest some peptides from casein, gluten, and other substances that can have an opioid-like effect.

 

Note that we recommend digestive enzymes in addition to special diets, and they should not be used instead of special diets. If a child has a problem digesting wheat or dairy products, it is best to just avoid them, and use the digestive enzymes as a precaution against unknown exposures.

 

Studies by Horvath et al. 1999, Williams et al 2011, and Kushak et al 2011 have found that many children with autism and major gastrointestinal problems have low levels of enzymes needed to digest sugars/carbohydrates, especially lactase, the enzyme needed to digest lactose (the sugar in milk). Insufficient lactase would result in gas, pain, and diarrhea after consuming milk products. Their studies involved tissue biopsies taken during an endoscopy, so these were from children/adults with substantial gastrointestinal problems – problems with digestive enzymes are probably less likely in individuals without obvious gastrointestinal symptoms.

 

One large study by Horvath, et al (1999) evaluated disaccharidase (sugar) activity from endoscopic biopsies in 90 children with autism. They found that 49% had at least one deficient enzyme activity, and 20% had deficiencies in two or more disaccharidase enzymes. “Lactase and maltase deficiencies were the most frequent, followed by low activity of sucrase, palatinase, and glucoamylase. All of the children with low enzyme activity had loose stools and/or gaseousness.”

Horvath K et al, Gastrointestinal abnormalities in children with autistic disorder,” J. Pediatrics 135 no. 5 (1999) 559-563.

Horvath K and Perman JA “Autistic disorder and gastrointestinal disease,” Curr. Opinion in Pediatrics, 14 (2002) 583.

A small study by Williams et al 2011 also found substantial decreases in disaccharidases, resulting in abnormal gut bacteria.

Williams BL et al., Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances. PLoS One. 2011;6(9):e24585. Epub 2011 Sep 16. 

 

A new large study at Harvard Medical School (Kushak et al 2011) involving intestinal biopsy samples of 199 children and adults with autism (ages 22 months to 28 years) found that many had deficiencies in disaccharidases (enzymes for digesting simple sugars). Specifically, they found that 62% had deficiencies in lactase, 16% were deficient in sucrase, and 10% were deficient in maltase. The problems seemed to be equally common in children and adults, suggesting that these problems are lifelong.

Kushak RI et al., Intestinal disaccharidase activity in patients with autism: effect of age, gender, and intestinal inflammation. Autism. 2011 May;15(3):285-94. Epub 2011 Mar 17. 

 

There are many studies of gastrointestinal problems in children and adults with autism (see review by Buie et al 2010), and most of the studies indicate that chronic gastrointestinal problems (constipation, diarhea, abdominal pain, esophagitis, etc.) are common and should be evaluated and treated.

Buie, T., et al. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics 125 Suppl 1, S1-18.

 


5) Nutrient Deficiencies: vitamin B12, omega 3, Zinc, vitamin C, etc.

 

At the Moncton Naturopathic Medical Clinic we assess each patient individually to determine which nutrients are required.  Each person has unique deficiencies.  The following is just a description of some of the most common deficiencies, but in order to determine which nutrients are deficient for your child, it is best to visit your Naturopathic Doctor (ND). 

 

In order to be classified as a “vitamin” or “essential mineral,” many studies were conducted that showed that the lack of that vitamin or mineral resulted in disease or even death. The RDA is the minimum amount required to prevent disease, but may be less than the amount needed for optimal mental and physical health. Most people in the US consume less than the Required Daily Allowance (RDA) of one or more vitamins and minerals. For example, many women lack enough calcium and iron, leading to osteoporosis and anemia, respectively.

 

One large comprehensive study found that children with autism had lower levels of several vitamins (especially biotin) and some minerals (lithium, calcium, and magnesium) and impairments in sulfation, methylation, glutathione, ATP, and oxidative stress, compared to neurotypical children of the same age. The severity of autism was strongly associated with the level of certain vitamins and minerals.

Adams JB et al., Nutritional and Metabolic Status of Children with Autism vs. Neurotypical Children, and the Association with Autism Severity, Nutr. Metab (Lond) 2011 Jun 8:8(1):34.

 

OMEGA 3 DEFICIENCY 

Essential fatty acids (EFAs) are critical nutrients for humans. They exist in the cell membrane of every cell, and roughly 20% of an infant’s brain is composed of essential fatty acids. Mother’s milk is very rich in essential fatty acids, but some infant formulas lack this key ingredient needed for brain development. Two general categories of essential fatty acids are omega-3 and omega-6. Omega-3 fatty acids have relatively short shelf lives, so commercial food processing often hydrogenates or partially hydrogenates them, which provides long shelf life but eliminates their nutritional value. Thus, over 80% of the US population has low levels of omega-3 fatty acids – this is one of the most widespread nutritional problems in the US. Low levels of EFAs are associated with a wide range of psychological disorders, including depression, post-partum depression, bipolar disorder (manic/depression), and Rett’s syndrome (similar to autism). Most importantly, four published studies have found that children with autism have lower levels of omega–3 fatty acids than the general population. 

  1. Vancassel et al., Plasma fatty acid levels in autistic children, Prostaglandins Leukot Essent Fatty Acids 2001 65:1-7. 

Bell et al Essential fatty acids and phospholipase A2 in autistic spectrum disorders. Prostaglandins Leukot Essent Fatty Acids. 2004 Oct;71(4):201-4.

Wiest et al Plasma fatty acid profiles in autism: a case-control study Prostaglandins Leukot Essent Fatty Acids. 2009 Apr;80(4):221-7.

Bell et al 2010, 7The fatty acid compositions of erythrocyte and plasma polar lipids in children with autism, developmental delay or typically developing controls and the effect of fish oil intake. Br. J. Nutri. 103 1160-7.

 

B12 DEFICIENCY

Adding subcutaneous injections of Vitamin B12 (methyl-cobalamin) resulted in normalization of levels of SAM, cysteine, total glutathione in plasma, and the ratio of oxidized to total glutathione levels.

James SJ, Cutler et al., Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am J Clin Nutr. 2004, 80(6):1611-7. 

 

The needles that we use are very small -- about the width of a hair and only 4-8mm in length (less than 1cm in length). We formulate the B12 based on body weight, and only the smallest amount of fluid (less than 0.1ml) gets put just below the skin (subcutaneous). More information about the protocol will be described in the visit. 

 

GLUTATHIONE DEFICIENCY

Glutathione is the primary antioxidant in the body, and it is also an important defense against toxic metals (it binds to them and is excreted with them in the bile and urine). It also indirectly supports many metabolic reactions, including DNA synthesis/ repair and protein synthesis. Every cell in the body and every system in the body is affected by glutathione, especially the immune system, nervous system, gastrointestinal tract, and lungs. Glutathione is a tri-peptide made from three amino acids – cysteine, glycine, and glutamate, and is the major antioxidant and detoxification system in cells. The amount of cysteine precursor is usually the limiting factor in how much glutathione is made by the body. Some cysteine is made from SAM, so low levels of SAM can result in low levels of cysteine. Several studies have found that children with autism have low cysteine and low glutathione, probably due in part to low SAM.

 

Oxidative stress occurs when too many free radicals are produced and glutathione antioxidant capacity is insufficient. Free radicals are highly-reactive molecules that can attack any cell in the body, interfering with their function and causing damage. One common cause is when mitochondria (energy-producing organelles in every cell of the body) are functioning incorrectly when they “burn” oxygen when it reacts with “fuel” (sugars, fats, etc) to make energy.

 

Glutathione and other anti-oxidants can reduce oxidative stress by quenching free radicals, but they need to be recycled after each time they act. Several studies have demonstrated that children with autism often have impaired mitochondrial function, impaired glutathione recycling, and increased oxidative stress. 

 

However, only about 10% of oral glutathione is absorbed, so even the best glutathione supplements are not very effective at raising body levels. One small study of children with autism found that oral doses of 15 mg/kg bodyweight led to a 19% increase in reduced (active) glutathione in plasma, and increased the total level of glutathione in whole blood by 12%. However, it did not improve the level of oxidized glutathione in plasma, so oxidative stress was still high. Therefore, we choose better options to increase plasma glutathione levels.

Kern JK et al., A clinical trial of glutathione supplementation in autism spectrum disorders. Med Sci Monit 2011 Dec 1;17(12):CR677-682

 

One study in Romania found normal levels of vitamin B12 and folate in children with autism compared to controls, but low levels of plasma glutathione, consistent with the Adams et al 2011 study. In other words, it seems that children with autism need extra amounts of vitamin B12 and folate to have normal glutathione.

Paşca SP et al., One carbon metabolism disturbances and the C677T MTHFR gene polymorphism in children with autism spectrum disorders. J. Cell. Mol. Med. 2009, 13(10):4229-4238.

 

SULFATE DEFICIENCY

Sulfur is the fourth most common mineral in the body [Chang, 2007]. Most sulfate is produced in vivo by metabolism of cysteine [Stipanuk et al 2010]. Sulfation is important for many reactions, including detoxification, maintaining the lining of the gut, hormone production, synthesis of brain tissue, and more.

 

Low free and total plasma sulfate in children with autism has been reported in three studies [Waring et al 1997; Geier et al 2009; Adams et al 2011], and is consistent with four studies [Waring et al 1997; O’Reilly et al 1993; Alberti et al 1999; Horvath et al 2002] which found that children with ASD had a significantly decreased sulfation capacity compared to controls. The finding of low plasma sulfate is also consistent with a large study that found high sulfate in the urine of children with autism [Waring and Kovsra 2000], as sulfate wasting in the urine partly explains low levels in the plasma.

Chang, Raymond Chemistry, Ninth Edition, 2007. McGraw-Hill. p. 52.

Stipanuk MH, Ueki I. Dealing with methionine/homocysteine sulfur: cysteine metabolism to taurine and inorganic sulfur. J Inherit Metab Dis. 2011 Feb;34(1):17-32. Epub 2010 Feb 17.

Waring RH, Ngong JM, Klovrza L, Green S, Sharp H: Biochemical Parameters in Autistic Children. Dev Brain Dysfunct 1997, 10:40-43.

Geier DA, Kern JK, Garver CR, Adams JB, Audhya T, Geier MR: A prospective study of transsulfuration biomarkers in autistic disorders. Neurochem Res. 2009, 34(2):386-93. Erratum in: Neurochem Res. 2009, 34(2):394.

O’Reilly BA and Warning RH: Enzyme and Sulphur Oxidation Deficiencies in Autistic Children with Known Food/Chemical Sensitivities. J. Orthomolecular Medicine 1993, 8(4):198-200.

Alberti A, Pirrone P, Elia M, Waring RH, Romano C, Alberti A, Pirrone P, Elia M, Waring RH, Romano C: Sulphation deficit in "low-functioning" autistic children: a pilot study. Biol Psychiatry. 1999, 46(3):420-4.

Horvath K and Perman JA: Autistic disorder and gastrointestinal disease. Curr Opin Pediatr 2002, 14:583-587.

Waring RH and Klovrza LV: Sulfur Metabolism in Autism. J. Nutritional & Environmental Medicine 2000, 10:25-32.

 

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