Autism

Introduction

Autism, a syndrome characterized by profound language and social disabilities, is increasing in incidence. Thanks to the parents who refuse to give up on their children and to the scientists who discard the accepted dogma, the causes of autism are emerging. Present research indicates that autism is a complex gastrointestinal (GI), immunological, endocrinological, and neurological disorder arising from a mix of genetic factors and environmental exposures. The genetics are multifactorial. There is no one gene that causes autism. The environmental issues are serious nutritional deficiencies resulting from the Western diet, exposure to toxic metals and materials, and atypical exposure to common childhood diseases. Vaccines may expose children to unacceptable levels of toxic metals like mercury and aluminum, to toxic materials like formaldehyde, endotoxins and adjuvant formulations, and to altered strains of viruses, which are introduced into the body through unnatural routes.

Gastrointestinal (GI) damage in many of the children leads to a leaky gut, which exposes the developing brain to morphine-like peptides, causing delayed and altered maturation. Developmental changes in the limbic and subfrontal systems of the brain directly affect language and social development and impact the autonomic nervous system through limbic brainstem pathways. Defective digestion causes nutritional deficiencies affecting all systems, but most notably neurological functions and behavior, liver detoxification, immune functions, and endocrine balance. Resulting imbalances of the GI environment lead to overgrowths of unfriendly bacteria, parasites, and yeast, which produce their own toxic substances. Clearly a major emphasis of treatment must be targeted toward fixing the damaged gut. It is recommended that autistic children be under the care of a physician who understands the complexity of the disorder. A list of physicians is available from the Autism Research Institute (www.autism.com/ari/).

There are two major impediments to the writing of any autism protocol. First, every child is unique. Each child's biochemical and education needs must be individualized. Dr. Mary Megson, Assistant Professor of Pediatrics, Medical College of Virginia (Richmond), best described the treatment of autism as being like a pizza, with the many therapies representing individual slices and the sizes of the slices varying for each child. While secretin, a powerful pro-oxidant and a GI and central nervous system hormone, may be an extremely effective intervention for one child, it may be disaster for another. Thus, the treatment of autism can become a nightmare of therapeutic trials leading to great angst, with many disappointments for the parents and family of the autistic child. The second impediment is that our understanding of autism, its biochemistry, toxicology, neurology, physiology, and clinical presentation is changing both constantly and rapidly. The protocol written today is different from what would have been written 1 year ago and what might be composed a year in the future. It is critical for parents to continually learn from many sources.

Getting Started
Oddly enough, the place to get started is with the parents. Raising a neurologically injured and developmentally disabled child places extreme pressures and stress on the family. If the child's parents cannot agree on an overall plan of action, the problems will be compounded at least tenfold. Can both parents accept the diagnosis and begin working together for the child and family? Will professional counseling be accepted and implemented? Who will focus on the autistic child? Who will tend to other normally developing children? Who will decide on the therapies for the autistic child and will both parents agree? What support systems will be put into place? What mechanisms can be instituted to create as much normalcy as possible? Who will stay up night after night with a child whose imbalanced brain chemistry results in severe insomnia? Who will teach the child when a therapist cancels a teaching session? How can the rest of the family get some time off? Will the whole family join in eating a special diet designed for the one sick child? Who will pursue the legal actions to acquire the educational and financial support that the child with autism deserves? These are some of the many and difficult questions that must be addressed, and preferably at the outset. One fact is very clear: the sooner an effective and total intervention is established, the better the outcome for the child with autism.

This protocol was initially meant to be a general guide to help families get started in the overwhelming process of caring for an autistic child who has a damaged GI tract. However, in many children, a GI disturbance may be clinically unnoticeable. Therefore, it is imperative that parents of both newly- and remotely-diagnosed children with autism begin to think about the very real possibility of an underlying GI disorder as a major part or influence in their child's biological illness and behavioral disorder. Most diagnosticians do not understand the relationship between the gut and the brain, and they will not lead the family in the direction of gut disorder and therapy. Again, finding the right doctor is critical. Incidentally, there is an increasing number of disorders for which GI dysbiosis and leaky gut appear to play a prominent role, such as schizophrenia, attention deficit disorder (ADD), or attention deficit hyperactivity disorder (ADHD), and possibly Tourette's syndrome. This protocol may be applied to these disorders as well.

Mainstream allopathic medicine has done a great disservice to healthcare by dividing the body into organ systems, by focusing on sub-specialization, and by promoting mainly drug therapies. Autism is a total body disease that requires thinking about the body as a whole organism. Unless there is a known underlying genetic defect, such as in Rett 's syndrome or Fragile X syndrome, it is necessary to accept the developing fetus, the newborn infant, or the toddler as starting out with normal biochemistry, physiology, and neurology. The developing child is then hit with one or many environmental insults. The fetus is exposed through the mother who may receive mercury-containing vaccines for Rh incompatibility, measles-mumps-rubella (MMR) vaccine for negative rubella titers, mercury through dental amalgams placed during early pregnancy, or other environmental toxins (Buynak et al. 1969; Warren et al. 1990; Wakefield et al. 2000c).

In the case of the susceptible newborn infant and toddler, multiple exposures to mercury-containing and multiple antigen vaccines are highly suspect in the causation of multiple organ injury (Bernard et al. 2000). The GI tract, the liver, the pancreas, the kidneys, the immune system, and the brain are major sites of mercury absorption. Researchers have clearly shown a chronic inflammatory bowel disease due to vaccine strain measles in a subset of children with autism (Thompson et al. 1995; Wakefield et al. 1995, 1999, 2000a,b; Kawashima et al. 2000; Pardi et al. 2000; Uhlmann et al. 2002). Because the gut is the portal of entry for all ingested materials, damage to the gut, and thus damage to digestion, absorption, and immune response leads to alterations and dysfunctions in all other body systems. Poorly digested foods lead to allergic response and to absorption of biologically and specifically neurologically active peptides. Incomplete digestion results in poor absorption of many nutrients and chronic nutrient deficiencies (D'Eufemia et al. 1996). Nutrient deficiencies lead to decreased cellular functions including diminished protein and thus enzyme production, cell membrane imbalances with disturbed function, and abnormal carbohydrate metabolism (Horvath et al. 1999).

The cycle continues with poor stomach acid production, poor stimulation of small intestine secretions, and further disruption of digestion. Chronic infection of the gut lining causes swelling and further impeding of nutrient absorption. It becomes clear that if the body is to acquire the foodstuff necessary to heal itself, then attention to resting and healing the GI tract first is a leading focus for therapy. Simply stated, foods need to be predigested as much as possible and clean of toxins, antibiotics, and hormones. Stomach acid needs to be stimulated with oral acid-forming supplements or stimulated with medicinal agents. Oral enzymes must be given to substitute for insufficient or absent stomach, pancreas, and small bowel enzyme production. Good bacteria are necessary to displace anaerobes and fungi. Healing substances must be taken in adequate quantity. Remember, a child with a gut disorder is starving in the midst of plenty.

Wakefield et al. (2000a) has elaborated a newly defined inflammatory bowel disease that is associated with vaccine-strain measles. In Japan, Kawashima et al. (2000) has detected and sequenced vaccine-strain measles virus from peripheral blood mononuclear cells in patients with inflammatory bowel disease and autism. In a few children, researchers have demonstrated the presence in large quantities of copies of a vaccine-strain measles genome in the cerebral spinal fluid that surrounds the brain (Kreis et al. 1998; O'Leary 2000; Bradstreet 2002, http://www.house.gov/reform/pdf/bradstreet.pdf ; Singh et al. 2002). These findings strongly suggest that in autistic children with bowel symptoms, there exists an extremely complex disorder that will not be cured by this protocol. It has yet to be determined if this chronic measles infection can be controlled and possibly reversed with restoration of the immune system. However, for the healing process to begin, the broken biochemistry must be addressed first. This is the goal of this protocol.

First, it is imperative to determine the presence of GI damage and leaky gut. Although not always obvious, symptoms and signs of bowel dysfunction should be observed. Most commonly, constipation develops, which may present as large, hard stools, infrequent stools, or small rabbit pellet-like stools. There may be episodes of diarrhea which are actually an overflow of liquid stool around an impaction. Toe-walking in some children is due to large impacted stools. Following a cleansing enema, the toe-walking resolves temporarily. Signs of chronic allergies such as dark circles under the eyes or redness of the ears may be seen with food allergies from incompletely digested proteins crossing a damaged gut wall to enter the bloodstream. Laboratory testing should include a complete digestive stool analysis (CDSA); mannose/lactulose challenge for leaky gut; and urinary peptides for leaky gut, morphine-like peptides, and bacterial/fungal metabolites.

These children deserve a diagnosis and therefore combined endoscopy and ileocolonoscopy should be considered for biopsies of the GI tract. An equally important step is to test for the presence of toxic heavy metals, specifically mercury and lead. An exceptional monograph on mercury and autism can be found at www.autism.com/ari. Testing for mercury requires a urine challenge test utilizing either oral DMSA (2,3-dimercaptosuccinic acid) or intravenous dimercaptopropanesulfonate (DMPS). Both are chelating agents. These tests require an experienced physician for administration and interpretation. In the presence of positive findings from the tests above, the following therapies are recommended.

One of the most common problems found in many autistic and some ADD/ADHD children is the presence of neurologically active peptide metabolites arising from gluten in wheat, rye, oats, and barley, and from casein in dairy products (Brudnak 2001; Knivsber et al. 2001). These proteins incompletely break down to form morphine-like substances that adversely affect development and signal processing in the brain. More recent research suggests certain incompletely digested soy proteins also have morphine-like neurological activity. In the United States, testing now available from Antibody Assay Laboratories (AAL Reference Laboratories, Inc., (714) 972-9979, http://www. antibodyassay.com ), and urine testing available at the Great Plains Laboratory, (913) 341-8949, can determine if these metabolites are present and whether a casein- and gluten-free diet is required. The tests are not perfect and there are children with no detectable gluten or casein byproducts in their urine who still benefit from a casein-free, gluten-free diet. A 6- to 12-month trial of the casein- and gluten-free diet may be necessary to observe benefits as these neurologically active peptides are retained by and have prolonged clearance from the body. Lisa Lewis has written an excellent book, Special Diets for Special Kids, which is very helpful for parents trying to learn how to manage the diet (Lewis 1998). The book is available through most bookstores and on the Internet. Another helpful book is Unraveling the Mystery of Autism and Pervasive Developmental Disorder: A Mother's Story of Research and Recovery by Karen Seroussi (2000).

Digestive Enzyme Supplements

SerenAid and EnZymAid are digestive enzyme products with dipeptidyl-peptidase 4 (DPP4, i.e., casoglutenase) activity necessary to break down the undesirable morphine-like peptides from casein and gluten. These products may speed up the process of peptide elimination and are helpful in handling the accidental ingestion of gluten or casein. SerenAid and EnZymAid are not intended to enable people with casein and gluten problems to continue eating these foods. EnZymAid also contains phytase to digest phytic acid found in soybeans as well as in wheat, corn, rye, and barley. Digestion of phytic acids, which can negatively affect absorption of minerals, will result in better absorption of calcium, zinc, copper, manganese, iron, and magnesium. Other enzymes in the product are bromelain, acid-fast protease, lactase, and galactose.

Another product called EnZymAid Complete contains 19 different enzymes including caso-glutenase and may be used with every meal. It needs to be understood that children with autism have difficulty digesting all types of foods, and every effort should be made to simplify and predigest foods as much as possible. For example, soups and pureed foods mixed with digestive enzymes will provide nutrients to the gut in a more simplified form. Because incompletely-digested-then-absorbed small proteins and peptides stimulate food allergies, a rotation of food types on a four- or five-day basis can reduce stimulation of allergic responses. Elimination diets can help identify foods which stimulate bad behaviors such as hyperactivity and obsessive-compulsive activity. The Feingold diet seeks to eliminate food additives and food colorings in addition to phenols, which add to the detoxification burden of the liver.

Friendly Bacteria to Eliminate Gastrointestinal Pathogens

GI tract damage results in a change in the gut environment and an imbalance in the normal bacterial flora. Overgrowths of yeast, parasites, and undesirable anaerobic bacteria occur. The bad organisms not only negatively affect digestion, but also produce toxic substances such as alcohols and aldehydes (Gracey 1982; Simenhoff et al. 1996; Sanders et al. 2001). There are many natural herbs as well as antibiotics available to try to control these bad organisms. However, a somewhat simple way to help restore the gut flora to normal is to overwhelm the unfriendly bacteria with large doses of good bacteria. Strains of acidophilus, lactobacillus, and soil-based organisms, which adhere well to the gut wall, can be given in daily doses of up to and even over 100 billion organisms. The success of this therapy may be evaluated by measuring the child's urine for metabolites from yeast and other pathogens. Some acidophilus products are grown in a milk base which results in casein contamination. If these products are used, then simultaneous supplementation with digestive enzymes that contain DPP4 activity is necessary. However, it is best to avoid any source of casein. Saccharomyces boulardii (pure encapsulations) is a "good" yeast that produces substances that are toxic to and help eliminate the other "bad" yeast organisms. Use of S. boulardii may lead to a severe die-off reaction, making the child clinically worse for several days. In these situations, activated charcoal can significantly help absorb toxic materials released from dying yeast and carry these toxins out with the feces.

Body pH, Buffering, and the Autonomic Nervous System

Simply stated, the body works best at the right pH levels. Blood pH is typically in a very tight range, with a mean of 7.44. Maintaining pH is a function of complex buffering mechanisms managed by the kidneys, lungs, and autonomic nervous system. Enzyme function, mineral absorption, and nutrient assimilation are dependent on proper pH. When the GI tract is damaged, the resulting imbalances and abnormalities of digestion and absorption eventually shift the buffering mechanisms and cause fragility of the autonomic nervous system. This results more often in metabolic acidosis but also metabolic alkalosis and sometimes vacillating shifts between both acidosis and alkalosis.

Metabolic acidosis is associated with lethargy, while alkalosis is irritating to the nervous system and associated with hyperactivity. Controlling pH can be a daunting, but necessary task. The simplest method is to measure urine pH and urine refractive index. Small pocket pH meters are easy to use and not expensive, although pH paper is adequate. The optimal urine pH after a 2-hour fast is 6.4, with a range of 6.0-6.8 being acceptable.

Refraction is the bending of light as it passes from one medium to another such as air to water. A refractometer (0-32) is a handheld device that can measure the refractive index of urine. It is simple to use, but is more expensive, typically about $150. Increasing solutes in the urine will cause an increase in the measured refraction. A fasting index of 1.5 is optimal. Normal renal function will usually keep the index below 5.0. In a hyperactive child whose sympathetic nervous system is overactive, indices of 7-10 may be observed. Electrolytes such as potassium, chloride, and sulfates are typically responsible for elevations in refractive index. However, E e levated urinary glucose or ketones may also cause a rise in the index. Therefore, T t he urine should occasionally be tested using a multitest strip to exclude glucose and ketones as sources for elevated refractive index and to rule out diabetes. It is important to note that T t he diagnosis of diabetes in the presence of autism is increasing.

Correcting abnormal pH and refractive indices is not too difficult. For an elevated refractive index above 5.0, give 4-8 ounces of diluted lemon water. Lemon water is made from a whole, preferably organic lemon pureed in a food processor, with the entire compote placed in a gallon of distilled water. Strain the mixture before using. If the urine pH is elevated above 7.4, add cranberry juice to the lemon water. If this mixture is insufficient to bring down the pH, then add 1-2 grams of ascorbic acid (nonbuffered vitamin C). If the urine pH is below 5.5, using lemon water alone is generally sufficient to bring the pH back up. Changes in the urine pH and refractive index may not be seen for 40-60 minutes. Behavioral changes, however, may be evident in 15-20 minutes.

Typically, blood and urine pH levels parallel each other as the kidneys function to adjust the blood to the proper pH of 7.44. Rarely, a paradoxical situation occurs where there is a metabolic acidosis, but the urine pH is in the alkaline range. In this very unusual case, correcting the urine with acidic fluids will worsen the body's metabolic acidosis.

It is a good idea to keep autistic children adequately hydrated at all times. If kidney function is normal, then the child's thirst mechanism should prevent dehydration. One should also be careful of the water source, being sure it is free of chlorine, chemicals, pesticides, and heavy metals. There is concern regarding the exclusive use of distilled water over long periods due to the absence of minerals. Plastic containers may leach phenols which many autistic persons with liver toxicity problems may have difficulty detoxifying. Phenols also interfere with sulfate chemistry.

Vitamin and Mineral Supplementation

Various vitamin and nutritional supplements may benefit an autistic child. It is preferable to find a single multivitamin with minerals (but without copper, iron, or beta-carotene) rather than attempting to crush and mix numerous pills with juice. There may be no single product that will have the exact proportion of the correct vitamins and minerals for your child. However, it will be easier to start with a good base and then add a few items.

Although all the vitamins and minerals are important, some deserve additional attention. Sulfur, in the form of sulfate, is extremely low in virtually every autistic child. Sulfur chemistry is terribly complex and there are very many enzyme systems that will not function without sulfation. However, oral sulfates are often a bad idea if the GI tract dysbiosis is not adequately addressed. Sulfates will feed the bad bacteria and fungi, causing a bloom of bad organisms, release of toxic substances, and a worsening of symptoms. A better option is Epsom salts baths, which provide sulfate and magnesium through the skin. A cup of Epsom salts in the bath water ought to be sufficient. The nice part of the bath is that you virtually cannot overdo it. An additional source of sulfur is the amino acid taurine. Taurine, which is necessary for liver detoxification, can be added to the vitamin mix in a daily dosage of 500 mg.

Magnesium is an essential mineral acting as a cofactor for the functioning of many enzyme systems and is necessary for proper nervous system and muscle function. It is also a key mineral along with potassium, lining some of the cellular transmembrane calcium channels. In children with constipation, magnesium is also helpful as a cathartic. Amino acid magnesium chelaters, such as magnesium glycinate or magnesium lysinate, are well absorbed. Magnesium chloride is also very well absorbed. Dosages of 200-300 mg daily of magnesium should be adequate and tolerated. Toxicity is rare. A magnesium supplement with potassium is suggested to help maintain normal intracellular potassium levels.

Every child with autism is zinc deficient until proven otherwise. Zinc is another mineral required by many enzyme systems. Zinc is absolutely necessary to make stomach acid and is required by several of the body's own digestive enzymes. Thus, zinc is critical for the digestive process, which, as stated above, is damaged and dysfunctional. Zinc is best given alone before bed, and 50 mg daily in the form of zinc citrate is a good place to start. Some children may require up to 150 mg daily, but red blood cell zinc levels should be checked first. The zinc-copper ratio is often grossly abnormal with copper being high. Thus, the zinc-copper ratio, which should be approximately one to one, is another good indicator of the need for more zinc. Another acceptable form of zinc is zinc picolinate which has been shown in some children to be better absorbed across the inflamed GI tract.

Selenium is often low and can be supplemented in the amount of 50 mcg daily. This mineral is very helpful in detoxification of heavy metals as it replaces the toxic metals that are removed by the detoxifying chelating agents discussed below. Selenium also functions as an antioxidant working closely with vitamin E and helping to promote growth. Very high doses can be toxic and should be avoided.

Vitamin A is deficient in nearly 8% of all children in America. This is especially true in children with autism. Unfortunately, the most common form of vitamin A, beta carotene, can only be broken down in the presence of bile, at the correct acid concentration, and by an enzyme that normally is found at the tip of the mucosal surface of the intestine. In autistic children with gut dysfunction, the lack of sufficient stomach acid fails to stimulate the proximate small intestine to release bile, fails to stimulate the pancreas to release bicarbonate to raise the pH, and lacks an intact mucosal surface to provide the necessary enzyme.

There is an excellent alternative, -- which is vitamin A from deep-sea fish. This source of the vitamin is in the form of retinol, which is easily absorbed. Only the recommended daily allowance of vitamin A should ever be given. Vitamin A is fat soluble, can build up in the tissue, and may infrequently reach toxic levels. Repletion of vitamin A is necessary for proper immune system function. Very often repletion of vitamin A in the form of retinol found in cod liver oil can reverse the lack of direct eye contact which is so common in autism. One should be careful to use cod liver oil that is fresh and not fishy smelling. The oil also needs to come from a source not contaminated by mercury. Norwegian cod is presently the best available source. Depending on a child's weight, the dose of cod liver oil ranges from 2500 IU for a toddler to 7500 IU for an older child.

Vitamin E is a powerful antioxidant. Children with autism are often under significant oxidative stress and require the addition of antioxidants. However, these same children frequently have fatty acid imbalances due to immune damage and alteration of the intracellular organelles called peroxisomes. These organelles are responsible for metabolism of long- and very long- chain fatty acids which build up in excess. These fats must be burned off and metabolized. Unfortunately, too much vitamin E will shut down this fatty acid metabolism. Therefore, care should be taken not to be too aggressive with vitamin E. A maximal daily dose of 50-100 mg, depending on weight, should be quite sufficient. A supplement containing mixed tocopherols and tocotrienols is preferred. Cold-pressed vegetable oils and raw seeds are a good natural source of vitamin E.

Reduced glutathione (GSH) is an antioxidant which combines with hydrogen peroxide (H2O2) in cells to form oxidized glutathione (GSSG) and water. In the process of normal metabolism, superoxide, a powerful oxidant, is generated by several mechanisms. Superoxide, spontaneously and with the help of the enzyme superoxide dismutase, converts into oxygen and hydrogen peroxide. Hydrogen peroxide is also damaging to tissues, and the conversion of hydrogen peroxide to water by the oxidation of reduced glutathione completes the reduction process, protecting cellular components from oxygen radicals.

Intracellular calcium is often low in autistic children and a variety of calcium chelates along with magnesium will need to be tried to find the best tolerated combination. Calcium should be given separately from fatty acid supplements because the combination results in saponification, the formation of soaps, which will cause diarrhea consisting of dark paste-like stools. The best, safest, and most easily absorbed source of calcium is dark, leafy green vegetables. Other good sources are sunflower seeds, dried beans, sardines, and salmon.

Essential fatty acids are absolutely necessary for the body to rebalance itself. These fats are major components of cell membranes and are precursors for natural body steroids and important cell-to-cell messengers called cytokines. Children with bowel inflammation poorly absorb many important short-, intermediate-, and long-chain fats. Many children with autism also have dysfunctional cellular organelles called peroxisomes, which metabolize the very long-chain fatty acids. Thus, most of these children have deficiencies and marked imbalances of their important body fats and oils.

Additionally, the fast food diet of burgers and French fries and most of the processed foods found on grocery store shelves contain bad fats such as trans fats, saturated fats, and oils that have become rancid. Good fats in the form of polyunsaturated fatty acids allow membrane-bound proteins to function more efficiently and aid in balancing the inflammatory pathways. The brain is 60-70% fat, a fact that should indicate how important good fats are to good brain function. The problem arises as to which fatty acids need to be supplemented. It can be damaging to supplement individual fatty acids without knowing what fatty acid imbalances exist. Thus, a fairly simple way to add fats is to start with evening primrose oil, which is high in the omega-6 fat gamma linolenic acid, and then slowly add in the omega-3 fats. Remember: go low and slow with oils and frequently rotate oils in and out of the diet. It is best to use cold-pressed whole oils such as sesame seed, almond, flaxseed, and walnut oils. Oils with long-chain fats are difficult for autistic children to metabolize and should be avoided. These include canola and peanut oils. Remember: refrigerate your good oils. You may wish to add a touch of vitamin E to prevent the oils from becoming rancid.

Mercury Chelation

Heavy metal toxicity is a consistent finding in many autistic children. Many of these children have weakened detoxification pathways resulting in accumulation of heavy metals. Selenium and glutathione are typically low and replacement with 50 mcg of selenium daily is a reasonable dose. Glutathione taken orally helps replenish the GI tract mucosa, but transdermal, subcutaneous, or intravenous routes may be necessary to restore body levels. Glutamine in a dose of 500 mg daily is helpful to the gut mucosa and is also a precursor to glutathione. Zinc is typically low and should be supplemented alone. Copper is often high and should be avoided. Many children require a more aggressive approach to removing toxic metals. DMSA is an oral heavy metal chelator which is available as a prescription and as a supplement. Data suggest that systemic removal of mercury may be very important in the treatment of autistic children. However, mercury removal requires a carefully designed and physician-monitored program of chelation.

Physicians and scientists on the DAN (Defeat Autism Now) mercury panel have devised a protocol for the removal of mercury from deep tissues. The Autism Research Institute can provide the names of DAN doctors familiar with the protocol. A consensus paper on mercury detoxification can be found on the web at http://www.autism.com/ari. A separate detoxification protocol of equal value is written by Drs. Mercola and Klinghardt. The protocol can be found on Dr. Mercola's Web site ( www.mercola.com ). Additionally, mercury-containing amalgams should not be used in these children who detoxify mercury very poorly.

Sleep

Needless to say, sleep is needed by every person in the household. It is well-known that very many children with autism, as well as other individuals with psychiatric and neurological disorders, have dysfunctional sleep patterns. The child with autism often has great difficulty falling asleep and will awaken for several hours during the night. This dysfunctional sleep pattern can wreak havoc on the entire family. The reasons for this dysfunctional pattern are not yet understood. Many of the children have gastroesophageal reflux, which some researchers believe is the source of the night awakenings (Ghaem et al. 1998; Carr et al. 1999). Another hypothesis focuses on elevated ammonia levels. This author hypothesizes that the sleep disorder is due to a fragile, hair-trigger sympathetic nervous system which may be stimulated by low blood sugar (hypoglycemia) which occurs during the night. Autistic children are in constant "fight or flight." A reasonable comparison is akin to most of us trying to fall asleep after five cups of coffee. It is further hypothesized that the norepinephrine, dopamine, and serotonin pathways in the brain are imbalanced. Additional study in this area is needed.

In the meantime, the following suggestions may be helpful: an hour before bedtime, and preferably on an empty stomach, a combination of calming amino acids, magnesium (100 mg), and zinc (50 mg) may be mixed in a juice and given to the child. The amino acids are taurine (250-500 mg), glycine (1-2 g), glutamine (0.5-1.0 g), and tryptophan (1-2 g). Tryptophan is available over the counter in selected stores. If, however, you cannot find tryptophan, hydroxytryptophan (5-HTP) may be purchased over the counter and substituted for tryptophan. 5-HTP is readily converted to serotonin in many sites outside the brain and may have side effects such as GI distress. If there are any GI side effects such as diarrhea, reduce the dosages and then slowly increase based on tolerance and effect. If the child is jumpy and hyperactive, give lemon water. Melatonin may then be added at comparatively high dosages ranging from 0.3-5.0 mg. Melatonin has a relative long-term record of safety and also has protective effects against mercury in the brain. It should still be remembered that melatonin is a hormone and overuse of any substance should be avoided.

Additional Supplements

There are many additional supplements that should only be used under the direct supervision of a physician who is clearly knowledgeable in the biological approach to autism. It must be understood that some of these additional supplements will only work after the body has been replenished with vitamins and minerals, which function as cofactors for the supplements. Secretin has stimulated speech in some children and wild hyperactivity in others (Horvath 1999; Sandler et al. 1999; Chez et al. 2000; Horvath et al. 2000; Lamson et al. 2001). Secretin is a powerful pro-oxidant as well as a GI and central nervous system hormone. Without proper preparation of the body with vitamins, minerals, amino acids, and good fatty acids, the response of the body to secretin and other more complex supplemental therapies is unpredictable. Sphingolin has been used to attempt to repair damaged myelin in the brain. However, sphingolin should not be used alone, but given with other appropriate fats and cofactors. Cholecystokinin (CCK) is a GI hormone that also has central nervous system effects. Some individuals believe that secretin works by stimulating the release of cholecystokinin. CCK and bicarbonate should be given 1 hour after meals to simulate the natural release by the small intestine duodenum. Other agents such as growth hormone, DHEA, and steroids should only be given under physician supervision.

A Novel Nutritional Approach

At the 31st Annual Meeting of the Child Neurology Society (Oct. 9-12, 2002), researchers announced the findings of a double-blind study where autistic children were given 400 mg of carnosine twice a day or placebo for 8 weeks. The findings revealed that the group receiving carnosine showed statistically significant improvements in most of the tests used to assess neurological function in autistic children.

Carnosine is an amino acid dipeptide that may enhance function in the frontal lobe area of the brain. More and more research shows that the frontal lobes of the brain control emotion, epileptic activity, cognitive function, expressive speech, and abstract thinking. The doctor (Michael D. Chez) who conducted this study states that he has used carnosine on about 1,000 children with a 90% success rate. According to Dr. Chez, children in his study improved in receptive language, auditory processing, socialization, awareness of surroundings, fine motor planning, and expressive language (Chez et al. 2002).

Responses to carnosine supplementation are usually seen in 1 to 8 weeks. In some of the children, the improvements have been described as dramatic. In this most recent study, parents of the children receiving carnosine reported that overall improvement more than doubled through the 8-week study period. Just 4 weeks into the study, social interaction improved by 27%.

For autistic children, Dr. Chez finds a dosage of 400 mg of carnosine, 50 IU of vitamin E, and 5 mg of zinc two times a day most beneficial. The zinc and vitamin E are included because Dr. Chez believes that the addition of small doses of zinc may augment intracellular carnosine activation and vitamin E may enhance the antioxidant neuroprotective properties of carnosine. In some children, too high of a dose of carnosine may over stimulate frontal lobe activity. This can cause increased irritability, hyperactivity, or insomnia, which was observed already in hyperactive autistic children.

While more studies are needed to confirm this remarkable discovery, some parents may consider supplementing their children with 400 mg of carnosine twice a day along with the small amounts of vitamin E and zinc that are often found in children's multi-vitamin formulas.

Other Therapies

There is a myriad of other therapies being offered to help the child with autism. It cannot be overstated that each child is different and one child's cure is another child's poison. Before jumping into any therapy, parents need to ask and have answered several questions:

What is the focus of an individual therapy?

• Is it targeting a metabolic problem or attempting to repair a damaged area of the body or brain?
• Is the timing right for a particular intervention?
• How long should it take to see some result, good or bad? There will be little accomplished with speech therapy if the child's hyperactivity is out of control.

When should you quit a therapy?
With these questions in mind, the following additional therapies are to be seriously considered. Applied behavioral therapy should be started as soon as possible after the diagnosis is made. There is no one behavioral therapy that works for all children and the technique chosen (whether discrete trial or the Treatment and Education of Autistic and Related Communication Handicapped Children [TEACCH] method) should fit the child's needs. Speech therapy should be started immediately to help establish a communication system that works. A child who can communicate by words, pictures, or sign language will have a much lower frustration level with fewer behavioral problems. Occupational therapy is needed immediately to address the sensory and motor planning problems that are typically pervasive. Auditory Integration training is now supported by several studies as having a positive role. Auditory Integration training is just one method to help stimulate development in the brainstem. Other therapies need to be evaluated on an individual basis.

NAET (Nambudripad's Allergy Elimination Techniques) for the treatment of allergies has been very helpful in some children. Sound resonance therapy is not yet well known or well documented, but there are early positive anecdotal reports. Electromedicine techniques and acupuncture as adjunctive therapies may be quite useful for some children. Patterning as a form of neural stimulation has a positive record in helping some profoundly injured children. Craniosacral therapy is another better-known treatment to show good results in some children. Again, interventions must be tailored to the child and have a definite purpose and a definite endpoint.

The treatment of autism as a biological disorder is a complex problem requiring that each child be individually assessed. This protocol is meant primarily to help the family with a newly diagnosed child to get started in addressing the damaged GI tract. It is imperative for the child to then be placed under the care and supervision of a physician well versed in the biology of autism.

• Prior to beginning a treatment plan, laboratory testing is required to determine the presence of food allergies, heavy metals, and a compromised GI tract due to leaky gut or other disorders.
• To maintain proper systemic pH of 7.44, test urine for acidosis and/or alkalosis. Diluted lemon water with added cranberry juice will help bring down an elevated pH. Add 1 or 2 grams of nonbuffered vitamin C if this mixture is ineffective. Urine levels below pH 5.5 may be corrected with lemon water alone.
• Digestive enzyme supplements such as SerenAid (Klaire Laboratories) and EnZymAid (Kirkman Laboratories) are formulated especially for children with autism. Oral enzyme supplementation will assist in replacing insufficient enzyme production and help with accidental ingestion of allergic substances such as gluten or casein. Follow manufacturers' dosing instructions.
• Life Flora and NutraFlora will help restore friendly bacteria to the GI tract. Life Flora will help colonize the intestinal tract. NutraFlora contains fructo - oligosaccharides (FOS) that are used as fuel for healthy bacteria to proliferate. Depending on the size, age, and overall health of your child, consult with your physician before beginning supplementation. (Life Flora and NutraFlora may contain trace amounts of whey or casein.)
• A daily children's multivitamin/mineral supplement without copper, iron, or beta-carotene children's should be administered.
• Insufficient sulfur needed for liver detoxification may be replaced with Epsom salts baths.
• The amino acid taurine (500 mg daily) is a good source of sulfur that helps with liver detoxification. Magnesium chloride is necessary for enzyme and nervous system functioning. Dosages of 200-300 mg daily are well tolerated.
• Selenium is an antioxidant and heavy metal detoxifier. Supplement in the amount of 50 mcg daily.
• Vitamin E should be taken to prevent undue oxidative stress, 50-100 mg daily. A formula containing mixed tocopherols and tocotrienols is superior.
• Calcium levels are often deficient in autistic children. Dark green leafy vegetables are the best and safest source. A calcium-magnesium supplement may also be taken. Dosage will depend upon the child's tolerance.
• Essential fatty acids are needed to maintain cell membrane integrity and reduce systemic inflammation. Borage oil is a good source of gamma linolenic acid (GLA). Perilla oil and flaxseed oil are sources of omega-3 fatty acids. A daily equivalent of approximately 100-200 mg of GLA and 250-500 mg of omega-3 fatty acids is suggested. Go low and slow.
• Glutamine is a precurs o e r to the antioxidant glutathione and also benefits the gut mucosa: 500 mg daily should be taken.
• Melatonin may be given to help induce sleep at dosages from 0.3-5.0 mg nightly.
• Carnosine has been shown to improve neurological functioning in autistic children at doses of 400 mg twice daily. Small doses of vitamin E (50 mg) and zinc (5 mg) should be administered with carnosine to enhance its benefits. A smaller dosage of may be advisable in autistic children who are also hyperactive.
• Supplementing with GI hormones, growth hormone, DHEA, and steroids should be done only under physician supervision.

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. For a more detailed description of specific products, see Stephen Smith's protocol at www.owt.com/pmc/autismprot.htm.

Product Availability

Life Flora, NutraFlora, taurine, glutamine, Super Selenium Complex, vitamin E, Gamma E Tocopherol/Tocotrienols, vitamin C, Calcium Magnesium Powder, borage oil, perilla oil, flaxseed oil, melatonin, Super Carnosine, zinc, and some of the special products designed for autistic children are available by telephoning (800) 544-4440 or by ordering online. Some of the products are only available through a physician who understands the complexity of the disorder. A physician list is available from the Autism Research Institute (www.autism.com/ari/).