DAN! – Defeat Autism Now! BioMedical Interventions

BIOMEDICAL TREATMENTS FOR AUTISM

Autism is a very complex disorder, and we do not fully understand it. However, there are many biomedical abnormalities that have been identified, and most can be treated to some degree.

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. Younger children are the ones most likely to benefit, especially those who had a period of normal development followed by regression, but older children and adults can often benefit from the same treatments outlined also.

Biomedical treatments will not help every child, but they have helped thousands of children improve, sometimes dramatically.

Biomedical therapy may help improve the efficacy of other interventions, by improving brain and body health and making it easier for the child to learn.

DAN ! – Biomedical Treatments include:

1. Improve Diet
2. Food Allergies
3. GFCF Diet (DAN ! recommended)
4. Vitamin/Mineral Supplements
5. High-Dose Vitamin B6 and Magnesium
6. Essential Fatty Acids
7. Gut treatments  -
   1. Antifungal
   2. Probiotics
   3. Digestive Enzymes
8. Amino Acids
9. Melatonin
10. Thyroid supplements
11. Sulfation
12. Glutathione
13. Chelation
14. Immune system regulation

1. DAN ! – Improving Diet

A balanced diet rich in vegetables, fruits, and protein is important to help provide those key nutrients.

Explanation of Diet:

• Consume 3-4 servings of nutritious vegetables and 1-2 servings of fruit each day
• Consume at least 1-2 servings/day of protein (meat, chicken, eggs, nuts, beans)
• Greatly reduce or avoid added sugar (soda, candy etc)
• Avoid “junk food” – cookies, fried chips, etc – they contain empty calories.
• Greatly reduce or avoid fried chips or foods containing transfats.
• Avoid artificial colors, artificial flavors, and preservatives.

2. DAN ! – Food Allergies

Many children with autism have food allergies, due to abnormalities in their digestive and or immune systems. If food is not fully-digested into individual sugars, amino acids, et., then the partly digested food can pass from the gastrointestinal tract into the bloodstream, especially if the child has a “leaky gut” due to inflammation. The immune system recognizes those foods as foreign, and may launch an immune response to those foods, resulting in an allergic response.

3. DAN ! – Gluten-Free, Casein-Free Diet (and often corn-free and soy-free)

• Gluten and Casein are common food allergens, especially in children and adults with autism.
• 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, inattention/ “ zoning out”, and aggressive and self-abusive behavior. Like opiioids, they can be highly addictive, and a lack of them can cause severe behaviors.

These problems appear to be due to:

1. A failure of the digestive tract to fully digest the gluten and casein peptides into single amino acids.
2. Inflammation of the gut, allowing the gluten and casein peptides to enter the bloodstream and reach opioid receptors in the brain.

4. DAN ! – Vitamin/Mineral Supplements

Vitamins and minerals are available in vegetables, fruits, ,meat, and other sources. However, the typical diet is lacking in key vitamins and minerals, so many people need to take a supplement.

Juicing: Fresh vegetable/fruit juice is a rich source of vitamins, minerals, and other nutrients.

Calcium supplements are especially important if a person is on a dairy-free diet.

For more information, go to: http://autism.asu.edu

5. DAN ! – High dose Vitamin B6 and Magnesium

There are over 20 studies of vitamin B6 with Magnesium for autism, including 12 double blind, placebo-controlled studies, making it one of most studied treatments for autism. Almost all of these studies found that 45-50% of children and adults with autism benefited form high-dose supplementation of vitamin B6 with magnesium. Vitamin B6 is required for over 100 enzymatic reactions, including the production of major neurotransmitters (serotonin, dopamine, and others) and glutathione (needed for detoxification). Magnesium is used to prevent the possibility of hyperactivity, which can occur if the vitamin B6 is taken by itself.

The reason why many children and adults benefit from high-dose of Vitamin B6 is still unclear, but a possible explanation is that many children and adults with autism have both 1) a decreased ability to convert vitamin B6 to its active form, and 2) defective enzymes for making key neurotransmitters that require an unusually high amount of the active form of vitamin B6.

(For more explanation see Adams et al, Abnormally high plasma levels of vitamin B6 in children with autism not taking supplements compared to controls not taking supplements.

Recommended dosage is of about 8mg/pound of vitamin B6 (maximum of 1000mg) and half as much magnesium.

For more info: A summary of vitamin B6 studies in autism is available at http://www.autismwebsite.com/ari/treatment/b6studies.htm

6. DAN ! – Essential Fatty Acids

Essential fatty acids 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 most 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. Two published studies have found that children with autism have lower levels of omega-3 fatty acids than the general population.

One of the best sources of omega-3 fatty acids are fish, who obtain them from algae and plankton in the sea. Unfortunately, many fish are high in mercury and other toxins, especially the large predators (shark, swordfish and tuna). So, it is generally safer for children to obtain essential fatty acids from fish oil, since little mercury is stored in the oil.

• Omega-3: 20-60mg/kg
• Omega-6: ¼ as much omega-6 as omega-3

One study by Adams et al. found that 2 months supplementation of fish oil (rich in DHA) led to significant improvements in sociability and other areas, especially in children and adults who consumed 0-1 servings of fish/month.

For more info: see www.nordicnaturals.com

7. DAN ! – Digestive enzymes

The body normally produces a variety of digestive enzymes to break large food molecules into smaller ones which 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 and other substances that can have an opioid-like effect.

Take a digestive enzyme with each meal, usually at the start of the meal. Use enzymes that are as complete as possible.

8. DAN ! – Gut treatments: Anti-fungals and Probiotics

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, and help with food digestion, water balance, and limiting the growth of harmful bacteria and yeast.

Some children with autism have low levels of beneficial bacterial, and high levels of harmful bacteria and yeast. The harmful bacteria and yeast produce toxins that can severely affect mental functioning and behavior; alcohol is just one of many toxins that yeast can produce, and is a good example of a yeast toxin that can severely affect behavior. It seems that the best way to treat these problems is with a combination of anti-fungal diet, anti-fungal medications (if yeast are present) and probiotics (beneficial bacteria). These can help restore normal gut function.

Anti-fungal diet: Yeast feed on sugar and simple carbohydrates, so reducing or avoiding those foods is important. Also it can be helpful to avoid foods containing yeast  or yeast products, including fruit juice, vinegar (in ketchup and other foods), leavened foods (bread, pizza, bagels, rolls), cheese and mushrooms (a type of yeast/fungus).

Anti-fungal medications: There are several prescription and non-prescription anti-fungal treatments, and sometimes several need to be tried before finding an effective one for a given strain of yeast.

Probiotics: Probiotics are mixtures of one or more beneficial bacteria which are normally present in the gut. Many probitotics contain only a few billion or less Colony Forming Units (CFU’s), but some strong probiotics contain 30-75 billion CFU’s, and some prescription probiotics contain up to 500 billion CFU’s.

9. DAN ! – Amino Acids

Protein is made of long strands of individual amino acids. When protein is digested properly, digestive enzymes split the long protein molecule into small peptides and individual amino acids, which the body can absorb. Those amino acids can then be reassembled to make a wide array of critical substances, such as neurotransmitters, hormones, enzymes, antibodies, immunoglobulins, glutathione, and many other substances. Amino acids are the “building blocks” of life.

Some children with autism have self-limited diets that are low in protein, and some have digestive problems that limit their ability to digest protein into individual amino acids. Either of these problems can lead to insufficient amino acids.

1. Ensure diet contains sufficient protein (two 4-oz servings/day).
2. Consider digestive enzymes to more completely digest the protein into individual amino acids.
3. Give “free-form” amino acids; “free-form” means that the amino acids exist as individual molecules, rather than part of a large protein molecule that needs to be digested. General amino acid supplements are available, and they can also be customized by a compounding pharmacy.

10. DAN ! – Melatonin

Many children and adults with autism have sleep problems, including falling asleep, nighttime walking, and early waking. These sleep problems have a strong correlation with gut problems, and healing the gut seems to reduce many of those sleep problems.

However, if sleep problems continue, supplementation with melatonin can help. Melatonin is the hormone the body naturally produces at nighttime to regulate sleep. It is formed from the neurotransmitter serotonin, so low serotonin levels can cause low melatonin levels.

Melatonin production is greatly reduced by light, and evena simple nightlight can greatly decrease melatonin production. So first try eliminating all sources of light.

For problems falling asleep, first try a behavioral approach of a regular nighttime routine (at a fixed time, begin bath/shower, brush teeth, story, etc.). Also, be sure to eliminate caffeine and reduce sugar intake at nighttime.

If sleep problems persist, start with 1mg of melatonin (0.5mg for children), and increase up to 2-5 mg if necessary (1-2 mg for children).

For more info, go to www.melatonin.com

11. DAN ! – Thyroid supplementation

About 5-10% of the general population has a thyroid disorder requiring supplementation, and that percentage may be higher in autism.

If iodine levels are low, then one can begin with iodine supplementation. If that does not normalize thyroid levels, then one can consider thyroid supplements.

12. DAN ! – Sulfation

Sulfate is used for many functions in the body, including detoxification, maintaining the lining of the gut, and hormone production. Some children with autism have a low level of sulfate in their bodies, due to a variety of reasons including poor absorption in the gut, excess loss in the urine, poor recycling of sulfate by the kidney, or oxidant stress and inflammation can shut down cysteine dioxygenase, which throttles the cysteine – > sulfate route.

The two effective methods were oral MSM (500-2000mg depending on size and sulfate level) and Epsom salt (magnesium sulfate) baths – 2 cups of Epsom salts in warm/hot water, soak for 20 minutes, 2-3x/week.

Many parents and physicians have anecdotally reported that Epsom salt baths were beneficial to their children. However, there is less experience with MSM for children with autism, and more research is needed.

13. DAN ! – Glutathione Therapy

Many children with autism have low levels of active glutathione, which is needed to protect the body from many toxins including toxic metals.

There are many ways to increase active glutathione levels. They include:

1. Oral glutathione: Only about 10% of glutathione is absorbed, so this method is not very effective at raising body levels, but it may improve levels in the gut.
2. IV glutathione: The IV form is highly effective, but temporary, and it can be difficult to administer regularly to the child.
3. Vitamin C: 500mg of vitamin C was found to raise RBC glutathione levels 50% in college students.
4. TMG/Folinic Acid/methyl-B12: A study by James et al. found that 800mcg of folinic acid and 1000mcg of TMG somewhat improved plasma glutathione levels in children with autism. Adding subcutaneous injections of methyl-Vitamin B12 (methyl-cobalamin) resulted in normalization of plasma glutathione levels.
5. DMSA(Chelation): Toxic metals such as mercuty can greatly decrease the body’s ability to make glutathione, so removing toxic metals by chelation seems to greatly help glutathione production.

14. DAN ! – Chelation: Removal of Toxic Metals

Many children with autism have a low amount of active glutathione, and a higher fraction of their glutathione is oxidized (inactive). Glutathione is the body’s primary defense against mercury, toxic metals, and many toxic chemicals, so a low level of glutathione results in a higher body burden of toxins. Also many children with autism had increased use of oral antibiotics in infancy, which alter gut flora and thereby almost completely stop the body’s ability to excrete mercury. Normalizing glutathione, restoring gut flora, and removing toxic metals often results in reduction of the symptoms of autism.

The chelation treatments recommended by DAN! Include DMSA, DMPS, and TTFD.

DMSA: Oral DMSA is approved by the FDA for treating lead poisoning in children. Some of the compounded rectal suppositories also appear to increase excretion of toxic metals, but the transdermal forms do not measurably increase excretion of toxic metals.

Safety: DMSA only slightly affects excretion of most essential minerals, so a basic mineral supplement can compensate for this. The exception is that the first dose of DMSA removes a significant amount of potassium (equivalent to that in a banana), and that is not included in mineral supplements, so 1-2 servings of fresh fruit or vegetables should be consumed to restore potassium levels. DMSA also significantly increases excretion of cysteine, so that should be supplemented before and/or during therapy.

DMSA has a small chance of increasing liver enzymes or decreasing blood cell count, so those should be monitored during treatment.

15. DAN ! – Immune system Regulation

Several studies have found abnormal immune systems in autism, generally with shift to Th-2, and some evidence for auto-immunity.

IVIG: Gupta et al. found IVIG benefited 4 of 10 children, with 1 case of marked improvement. This is an expensive treatment, as the immunoglobulins need to be collected from hundreds or thousands of human donors.

ACTOS: ACTOS (pipglitazone) has multiple effects, including the ability to decrease inflammation. An open study of ACTOS in 25 children with autism for 3-4 months found substantial improvements in irritability, lethargy, stereotypy, and hyperactivity, with greater benefits in the younger children. Doses were 30mg (younger children) and 60mg (older children).

Low dose naltrexone: There have been 14 clinical trials of naltrexone for children with autism. A review paper by Elchaar et al. reported “Naltrexone has been used most commony at doses ranging from 0.5 to 2 mg/kg/day and found to be predominantly effective in decreasing self-injurious behavior. Naltrexone may also attenuate hyperactivity, agitation, irritability, temper tantrums, social withdrawal, and stereotyped behaviors. Patients may also exhibit improved attention and eye contact.

It has been suggested that low dose naltrexone, at about 3-5mg/day (much lower than the doses mentioned above) may be beneficial to children with autism and may improve the regulation of their immune system.