Autism Protocol

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http://www.owt.com/pmc/autismprot.htm

Autism Protocol

By

Stephen Smith, M.D.

Updated: December 17, 2000

 

This protocol is designed to correct the most commonly found nutritional deficiencies and pathology found in children and adults with Autism by laboratory testing. While this is a general protocol, autistic children have a variety of problems that need to be addressed individually. No protocol can completely address the complexities of these children. However, this protocol provides a base which can help resolve many of the health problems found in these children. A given child may not tolerate some of the supplements in this protocol. Each product should be added one at a time to ensure that it is tolerated. The products used in this protocol may be purchased as a group or individually from Agape Nutrition at www.agapenutrition.net. If you wish to have your child tested before starting this protocol that can be arraigned through our office www.owt.com/pmc/office.htm.

The protocol is broken into two phases.

The first phase is a cleansing and detoxification stage designed to clear the body of yeast and intestinal parasites. The only difference between the two phases is the floral product. Defense is designed to repair and cleanse the bowel. Phase II uses a floral maintenance product, which is not strong enough to clear the bowel of pathogens, but will help maintain a healthy bowel. We have also added an intermediate floral product. Since the nutritional requirements of people with Autism vary, there are additional supplements designed to correct other problems found associated with Autism, but that are not needed in every case. This allows you to customize the protocol. A list of these problems and treatment strategies is found in the Additions section. Autistic children should be under the care of a physician preferably one that understands Autism, a list is available from the Autism Research Institute Autistic child have been shown to have severe inflammatory bowel disease. Therefore a good deal of the treatment is directed toward correcting problems in the GI tract. I have found children with as many as three different kinds of parasites in their bowel. Heavy metal toxicity is consistent finding in these children. The minerals and the Mercury Detox products help, but in many children a more aggressive approach to removing toxic metals needs to be used. DMSA is an oral heavy metal chelator, which is available as a prescription and as a supplement. Mercury amalgams should not be used in these children because they detoxify mercury very poorly. This protocol is not designed to deal with severe bowel problems especially parasites, but it will help resolve chronic bowel inflammation . Laboratory testing is highly recommended to ensure there are not intestinal parasites present.

Mercury Chelation

The protocol is not designed to remove tightly bound mercury, but does help augment detoxification pathways. Recent data suggests removing mercury may be very important in the treatment of ASD children. However, mercury removal requires a carefully designed and monitored program of chelation requiring physician supervision. A list of DAN doctors may be found at http://www.autism.com/ari/danlist.html . If you are unable to find a DAN physician in your area a telephone consult service is available from our office.

Protocol Changes

I have added a second fatty acid product EPA/DHA. Epson salt bathes as a source of sulfur and magnesium. Cod liver oil as a source of vitamin A. Eliminating vitamin A products containing palmitate, which is most commercially available vitamin A. Recent work by Mary Megson, MD has found natural vitamin A followed by bethanecol to be very helpful in many children.

Serenaid

The SerenAid product is the newest addition to the protocol. Initial studies in autistic children showed improvement with SerenAid. SerenAid breaks down unwanted peptides that activate the opiate receptors in the brain. Most of the feedback we have on SerenAid has been positive. Serenaid.com has more information on the use of SerenAid.

The enzymes in SerenAid are derived from Aspergillus. Although the product goes through several purification steps designed to remove all traces of aspergillus from the product, some children highly sensitive to aspergillus may react.

General Instructions

Adverse reactions can occur especially at the beginning of the protocol. The most common side effects are fatigue, agitation, body ache, and transient skin rashes. These occur as a result of die off of yeast and other pathogens and with the rapid clearing of toxic metabolites from the body. They should dissipate fairly quickly and can be minimized by drinking lots of water to help flush the toxins from the body. This is generally a good sign, but in some cases it may be too uncomfortable. If this occurs one simply stops the protocol and then restart the protocol gradually. The Extox or Cholacol II products can also be used to help minimize reactions. Both products contain benonite clay, Ex-tox contains other cleansers as well as benonite clay, that absorb toxins from the bowel. If the protocol doesn't seem to be working the problem usually is undiagnosed food allergies or problems in the bowel. This protocol assumes a decent diet and is in addition to good multiple vitamin. Junk food and excessive sugar should be removed from the diet. I recommend phasing in the protocol. Sometimes children will have an adverse reaction to one of supplements. So I recommend keeping careful written records and starting with one supplement then adding another every three days. If an adverse response occurs you will know what caused it. If the adverse response was due to a die off or detox, it should dissipate in a few days, if it does not then the child may have an allergy to the product in which case it should not be taken.

Autistics tend to accumulate long chain fatty acids, so you should eliminate products containing long chain fatty acids from the diet. The most commonly used long chain fatty acid is cannola oil, olive oil should be used instead. Also borage oil should not be used in autistic children, since it contain long chain fatty acids. Primrose oil should be used as a source of omega 6 fatty acids.

Casein and Gluten Free Diets.

One of the most common problems found in autistic and ADD children are metabolites of gluten from wheat and casein the protein found in dairy products. These proteins can break down to morphine like substances that can adversely affect signal processing in the brain. New testing now available in the United States through Antibody Assay Laboratories can determine if these metabolites are present and if a casein and/or gluten free diet are required. The test is not perfect we have found that children with no detectable gluten or casein byproducts in their urine still benefit from a a casein and gluten free diet Serenaid a new enzyme product can reduce these reactions. A recent article in Parent's Magazine (February, 2000) describes one child's success with casein and gluten free diets. I recommend doing testing, but can also try a casein and gluten free diet. Because these peptides are retained by the body using SerenAid can speed up the process and also help handle the accidental ingestion of gluten or casein. Serenaid is not designed to enable people with casein and gluten problems to continue eating these foods, but to help clear out the remaining byproducts and help with occasional inadvertent exposures to casein and gluten. Lisa Lewis has written an excellent book, Special Diets for Special Kids, ISBN: 1885477449, which is very helpful for parents trying to learn how to manage the diet. It is available through most books and at Amazon books on the Internet.

Phase I

DefenseB6 complexMercury DetoxRNAMin TranKirunal or EPA/DHASerenaid

Cod Liver Oil

Phase II Pro-5B6 complexMercury DetoxRNAMin TranKirunal or EPA/DHASerenaid

Cod Liver Oil

 

 

 

Product Descriptions

N-acetyl-L-Cysteine and Glutathione

Mercury Detox

The most prevalent finding I have found in Autistic and ADD patients is glutathione deficiency. Glutathione deficiency leads to the accumulation of toxic compounds in the body especially metals. The Mercury Detox is mixture of glutathione and N-acetyl cysteine (NAC). NAC raises interelluar glutathione levels and mitochondrial glutathione levels. It also contains a mixture of amino acids to protect the brain during detoxification. It is not unusual to see detoxification reactions when one first starts taking Mercury Detox, because there may be a backlog of toxins in the body that will start to clear when Mercury Detox is given. If this occurs one simply stops the Mercury Detox until the reaction subsides then start again slowly. Once the toxins have cleared the body these reactions will no longer occur. It is important to realize that this is not an allergic reaction, but a detoxification reaction. Start with 1 capsule per day and increase to 4 capsules per day as tolerated. Most children do well on one to two capsules per day. After one month on Mercury Detox, you may be able to decrease the dose to 1 to 2 capsules per day. A follow-up Urine Organic Acid test will tell you, if you can decrease the dose or need to increase the dose.

RNA

This product feeds neurons and helps stimulate brain function and memory . It also helps with protein synthesis. However, taking too much may cause excess dreaming. The usual dose is one to five capsules per day. Again start slowly and build up increasing the dose by one capsule per week. If an adverse response develops, just reduce the dose.

Kirunal and EPA/DHA

Flax oil is a good source of omega 3 fatty acids, but only 3% is converted to the more active EPA, which derived from fish oil.. Studies have show that EPA has been effective adjunct in the treatment of several disorders including chronic depression, schizophrenia, manic depression, ADD, and Autism. EPA helps normalize a defect found in the phospholipids in the brains of these patients. This defect disrupts normal signal transmission. Autistic children tend to have defects in both EPA and DHA, so we use EPA/DHA or Kirunal. Kirunal has a higher EPA/DHA ratio.

The usual dose is three capsules of oil per day. The capsules make be broken if desired an the contents added to a blended drink, if the child is unable or unwilling to swallow capsules. These oil deteriorate so they should be protected from the Sun and kept refrigerated for best results. Sufficient vitamin E should be included in the diet to protect against oxidative stress 400 to 800 IU for adults and 200 to 400IUs for children. Dosage is important. Sometimes a child will improve then regress. This usually occurs because the dosage is too high. During the first stage of treatment the deficiency is being addressed, but as treatment continues the dose requirements may decrease because the dose needed to correct the deficiency is higher than the dose that is needed for maintenance. Also too high a dose of omega 3 fats can depress the Omega 6 fatty acids and vice versa. Primrose oil is preferable to Borage oil as a source of omega 6 fatty acids, since Borage oil is a long chain fatty acid, which we want to avoid in autistic children. In general we recommend starting with EPA/DHA only then adding the other essential fats later. Kirunal can be helpful in those children with defects in the brain phospholipids. The dose of Kirunal is 4 capsules per day.

Defense

Abnormalities in the GI tract are almost universal in Autistic patients. Restoring healthy bowel function is essential for success. This may require aggressive intervention especially if parasites are involved. We have several protocols for cleaning and restoring normal bowel function, but Defense is the easiest and one of the most effective. The product contains a strain of soil organisms and green juice extracts. The juice is extracted from Kamut, Barley, Oat, and Alfalfa grasses which feeds the bowel mucosa. It contains no gluten and may be taken by people who are gluten sensitive. The green juice extract feeds the bowel mucosa reducing excessive bowel permeability. The soil based organisms will displace pathogenic organisms in the bowel. These organism also promote an immune response in the GI tract, which helps normalize immune function. One should start slowly with this product to prevent die off reactions. I recommend starting with 1 capsule per day and increasing the dose every three days until a dose of 6 capsules is reached up to 12 per day for adults. Remain at the maintenance dose for 3 to 4 weeks then taper back down to 3 to 6 capsules per day. After a couple of months on Defense one may switch to another form of flora such as Pro-5, Lactobacillus GG (Culturelle) HMF Forte, or EchoRenew to prevent relapse. These products can be dosed at 1 to 2 capsules per day. HMF Forte and EchoRenew will help maintain flora, but are not strong enough to displace pathogenic flora.

Allergy HP

Food and chemical allergies are one of the primary triggers for many Autistic and ADHD symptoms. Definitive treatment requires desensitization, but many of the symptoms may be controlled this homeopathic formulation. Deterioration of handwriting and figure drawing skills after meals is a good sign that food allergy plays a role. Other signs of food allergy are red ears and cheeks. Allergy HP drops can help alleviate these symptoms. Squirt a small amount of the solution under the tongue shortly after meals or at the onset of symptoms. This product is water based and contains no alcohol. Normal use is 3 to 6 times per day. Eliminating problem foods from the diet is also recommended. Dairy and gluten containing foods are the most common allergens. Food allergies are different than the peptide problems you can have a negative allergy test and still have problems with gluten and casein because of the peptides.

Min-Tran

This is a mineral based calming agent. Most children with Autism are mineral depleted. This product contains calcium lactate and minerals from pacific sea kelp. The usual dose is 3 to 9 tablets per day. It also helps the body process toxic heavy metals.

Prophyra-zyme

Prophyra-zyme is a source chlorophyll, which is used to bind heavy metals. Heavy metals are highly disruptive to normal brain function. Heavy metals are hard to remove from the body because they are so reactive. Chlorophyll contains a prophyrin ring which surrounds metal, so that it can't bind. This product must be taken on an empty stomach to be effective. It doesn't need to be taken every day, since it is used as a cleanser it may be used periodically to remove metals. The usual dose is 3 to 4 capsules per dose and it may be taken several times per day. This product is difficult to use in children since it requires a fairly high dose to be effective.

Extox

This product is used to quell adverse reactions due to die off reactions or to remove inflammatory products from the bowel. It contains cleansers such as goldenseal, bennonite clay. If you have problems with Extox then Cholacol II may work better as it only contains benonite clay.

HMF Forte

This is a special strain of normal human GI flora. This product is designed maintain normal bowel flora. The dose is 1 capsule per day. HMF Forte contains live bacteria and should be kept refrigerated.

B6 Complex

Treatment with high doses of vitamin B6 hyas been shown to be helpful in a number of children with ASD. This formula provides high dose vitamin B6 along with other B Vitamins. Vitamin B6 also seems to have a calming effect. It is essential component of many detoxification reactions. The usual dose is 1 to 2 capsules daily.

Similase or Vital Zymes

These products are sources of pancreatic enzymes useful in people that are not digesting their food properly. Intestinal gas, constipation, or diarrhea and stomach aches are signs of insufficient pancreatic enzymes. Most people with ASD need pancreatic enzymes. The dose is 1 to 2 capsules with meals.

ADP

This product is concentrated oregano extract. It is used to clear more persistent GI yeast infections and mild parasitic infections. The dose is 5 capsules 3 times per day for thirty days in adults. Three capsules 3 x a day in children. Again starting slowly with one capsules three times a day is a good idea. This product has a strong spicy odor, which may make it difficult for children to accept.

Inositol

Inositol is one of the vitamin B complex factors. Inositol has a sweet flavor. People who crave sugar may be deficient in inositol. Inositol helps clear the liver and vascular system of cholesterol and fat. I add Inositol to the protocol to help children with sugar cravings.

SerenAid

SerenAid is a new peptidase that breaks down unusual peptides that are found in ADD and autistic children. These peptides including casomorphine (from milk) and gliadomorphin (from wheat) are many times more potent than morphine and can activate the opiate receptor in the brain causing some the behavior associated with ADD and autism. These peptides can remain active for months after the offending food is eaten. SerenAid is designed to inactivate these peptides. The starting dose is 1capsule with each meal or snack increasing to 2 or 3 capsules if no improvement in two weeks. Many children will get worse on Serenaid initially, this is due to opiate withdrawal. Serenaid should be continued for at least a month before evaluating its effectiveness.

Culturelle

Culturelle is high dose lactobacillus GG. The usual dose of probiotic bacteria found in supplements is two billion organisms per capsule. Culturelle contains thirty billion per capsule and is more effective for displacing unwanted organisms from the bowel. We are now using Culturelle for the first two months of the protocol then switching to HMF Forte or EchoRenew, if the child is doing well.

Pro-5

Pro-5 is a new high potency probiotic from Klaire Laboratories. The product has similar potency to Culturelle, but at half the cost. Both products are priced similarly, but Pro-5 has 60 capsules versus 30 for Culturelle, we have changed our protocol to Pro-5 instead of Culturelle because it is more cost effective. Pro-5 is also a smaller capsule which makes it easier to swallow.. Very high dose probiotics are necessary to displace unwanted organism from the GI tract.

Epson Salts

Epson salt baths help provide children with a source of sulfur, which is not readily absorbed from the GI tract. One half a cup of Epson Salts added to the child's bath can be helpful.

Cod Liver Oil

Many children with ASD have a defect which natural vitamin A can correct. They are unable to process most commercial vitamin A, which leads a severe deficiency resulting in visual and membrane defects. Natural vitamin A can correct these problems over the course of several months.

Cod Liver Oil (CLO) provides a natural form of vitamin A.

Pre-treat for a few days pior to CLO (and continue):

Vitamin E 200-400 IU/day plus Vitamin C 250-1000 mg bid

Dose Cod (Salmon) Liver Oil according to Vitamin A content:

<2 years of age--850 IU Vitamin A

2-5 years--2500 IU Vitamin A

5-10 years--3750 IU Vitamin A

>10 years--5000 IU Vitamin A

The Kirkman brand does not contain other additives and is the brand that is recommended.

 

 

Refrigerator Sheet

Post this sheet on the refrigerator door to remind you how to use the supplements

Phase I & II.

Defense or - 2 to 6 per day starting with capsules and adding one capsule every 3 to 4 days until 6 per day remain on 6 per day for 30 days then taper to 4 per day.or

Pro-5- One capsule daily for thirty to sixty days then may switch to lower potency probiotic, such as HMF Forte or EchoRenew which are also dosed at one capsule per day.

Mercury Detox - Start with one capsule a day taken away from food increase dose to two capsules per day after one week.

RNA - Start with one capsule per day and increase to 2 to 4 capsules per day. May be taken any time during the day.

Min-Tran - 3 to 6 capsules per day with meals

B6 Complex - 1 twice daily with food

EPA/DHA or Kirunal - 3 capsules per day preferably with meals may given anytime during the day. Reduce dose if needed..

Additions:

SerenAid

Take 2 to 3 capsules with each meal or snack. Start with 2 capsules increase to 3 if no improvement in one week.

Allergy HP - Squirt a small amount (about a teaspoonful) under the tongue 20 to 30 minutes after eating or at first sign of any food reactions. May be used up to 6 times per day.

Inositol - One capsule per day three times a day with meals.

Similase or Vital Zymes - 1 to 2 capsules with meals

Prophyra-zyme - 3 to 6 capsules on an empty stomach with water up to 3 times per day.

ADP - 4 to 5 capsules three times a day with food for 30 days. Starting with 2 capsules and increasing to regular dose over 4 to 5 days. This product should be given along with some form of floral replacement.

Extox or Cholacol II- Cholacol II take 2 to 4 capsules twice daily away from food. Best given 1 hour after taking the ADP. Extox is dosed one capsule with each meal.

 

 

 

Junk Food and Diet Recommendations

Junk food is an edible product with little or no nutritional benefit. Usually containing excess sugar, white flour and/or chemical compounds which may be harmful to the body.

Beverages

Pop regular and dietBottled Ice tea productscandy barsMost snack chips

Substitute:Ice Tea homemade (sweetened with Stevia)SmoothiesPurified Water

Eliminate:

Most sugary breakfast cereals.

White flour products: white bread, cookies, cake, etc. When the husk is removed from grain to make white flour most of the nutritional value is also removed.

Foods containing partially hydrogenated fats. This is most commercially prepared fried foods such as french fries, and potato chips, etc. You need to read labels, if you find the words partially hydrogenated, you need not read further. Unfortunately these fats are found in many commercially prepared products.

Many children are sensitive to foods containing artificial colorings and MSG.

Use organic milk if your child is not sensitive to dairy products. Organic milk is found in most grocery stores.

In general use as much organically grown or certified pesticide free produce as possible. It is a good idea to keep a daily food diary in which you also keep notes on the child's behavior and ability to concentrate.

Figure drawing and handwriting are good comparison tools as food reactions will usually effect both of these skills. Symptoms are usually worse about one hour after ingesting a food that causes a reaction.

 

 

Laboratory Testing

The protocol is designed to correct the most commonly found problems, but many parents would like to know more specific information. The following is a list of laboratory tests I use to evaluate children with ADD along with the rational for there use.

GI Health Panel - This is a battery of 15 tests including adequacy of pancreatic enzymes, parasites, gluten antibodies, inflammatory markers, immune markers, occult blood, and certain bacterial markers. Test requires two stool specimens and a saliva sample.

Food Allergy - We test for both IgG and IgE food allergies to over 50 different foods. This is blood test.

Urine Organic Acids - This battery of tests provides a wealth of information including: the adequacy of glutathione detoxification, certain B vitamins, bacterial overgrowth, yeast by products, and possible disorders of metabolism. The test requires a morning urine specimen.

Hair Analysis - Checks for the presence of excess heavy metals and adequacy of nutritional minerals. The test is subject to contamination from shampoos, hair dyes, etc. Requires sample of hair from the back of the head or pubic hair.

Fatty Acid Analysis - Checks for the adequacy of essential fatty acids. It also measures levels of non essential and potentially harmful fats and calculates ratios healthy fats. I rarely run this test any more as it almost is abnormal and usually shows the same result for every untreated patient. Almost every untreated patient has a deficiency of omega 3 fatty acids. Given this finding I use this test to determine the adequacy of treatment following supplementation with essential fatty acids

Urinary Peptides & Indolyl-acryloylglycine(IAG) Information provided by Anitbody Assay Laboratory

Increased levels of Indolyl-acryloylglycine (IAG) have been found in several conditions including Autism, Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD), and Obsessive Compulsive Disorder. Indolyl-acryloylglycine (IAG) is a product of abnormal tryptophan metabolism. It is produced by bacterial action in the intestinal track. There is also evidence to support the association of indole metabolism with mental illness (Indolyl-acryloylglycine is a derivative of Indolyl acetic acid: both of which are in the Indole chemical group). In fact many psychoactive drugs contain the indole nucleus, and that under appropriate conditions tryptophan can induce activation of specific behavioral aberrations in individual patients. These facts have lead many physicians and researchers worldwide to be very interested in measuring Indolyl-acryloylglycine (IAG) in the urine of autistic children.

Casomorphine

Casomorphine is a derivative of casein, which is a milk protein. Casomorphine has been found in the urine in several different conditions including ADD and Autism. Dr. Karl Reichelt has even found this in schizophrenia.Dr. Reichelt has also described the presence of other food-derived polypeptides in the urine of children suffering from ADD and Autism. Paul Shattock has also described these peptides in the urine of autistic children. Some of these polypeptides are biologically active with actions similar to endorphins such as casomorphine. We also report Des-Tyr casomorphine, another fragment of casein. Casomorphines are also an indication of increased intestinal permeability. If casomorphine is elevated it may be beneficial to remove milk products from the diet. Removal of milk products has been associated with improvement of behavior.

Urinary Peptides

Anitbody Assay labs also report a value for Urinary Peptides. This is a total of several different peptides that have not yet been identified and among them is gliadomorphin, which is a derivative of gluten or wheat protein. These urinary peptides are also an indication of intestinal permeability. If the urinary peptides are increased it may be an indication that gliadomorphin is elevated. Removal of wheat from the diet may be beneficial and may result in an improvement in behavior.

These tests usually provide the basic data used in our clinical treatment program. In some cases additional testing is required. Follow-up testing is done to ensure the adequacy of the treatment protocol.

 

 

 

DISCLAIMER

None of the statements found in this protocol have been reviewed by the FDA. The opinions expressed here are for informational purposes only. This protocol has not been subjected to rigorous clinical trials.