Autism - Prevention & Curing Protocol
About Autism
Mercury Detox Autism Protocol
Part 1 of 3 (Part 2, Part 3)
DR. MERCOLA'S COMMENT:
This is such a long article I wanted to put my comment at the beginning so my newsletter subscribers can view my perspective prior to reading the document.
First of all the professionals who put this protocol together are to be strongly congratulated. They did a tremendous effort in getting together and developing a consensus statement among some of the top clinicians treating this problem in the country.
This is exactly what is required if we are going to advance natural medicine in this country and I am grateful to these professionals for their dedication, commitment and hard work in developing this document.
I was part of the Great Lakes Chelation Panel on mercury toxicity, and have co-authored one of the leading papers in clinical mercury detoxification, and have worked with hundreds of patients with mercury detoxification issues, so I have some experience in this area.
In general, the panel's review of this subject is thorough and I would strongly recommend reading it if you have an interest in this area.
However, I cannot endorse a number of the panel's recommendations and I will provide my objections to the protocol at the beginning.
The major objection to the recommendation is the use of DMSA for mercury detoxification. My affinity for the use of DMPS is likely one of the reasons I was not invited to participate in this panel.
However, one needs to know that in the overall treatment of this problem our approaches are very similar. The KEY strategy to improve children with brain injury is to optimize their gut flora and diet and this is something the panel makes very clear.
Mercury detox with DMSA or DMPS is not a huge magic bullet, it is just one of many strategies that can be implemented to help these children. If one uses either of these chemicals without first properly preparing the child, there can be great harm and damage.
The panel refuses to support the DMPS recommendation, despite the fact that it is, as they admit, a clearly more effective agent, due to DMPS's history of complications in adults and its lack of FDA approval in children.
The issue of DMPS, and for that matter DMSA, toxicity, is not related to the direct toxicity of the drugs, but to the drug's ability to take the heavy metals out of the body. It is actually the heavy metals that cause the side effects. If one does not properly prepare the body to address these heavy metals then one will have complications from the chealting agent.
DMPS was, and still is, frequently improperly used in many adults. Primarily by well-intentioned physicians who provide DMPS when the person still has amalgam fillings in their mouth. Because DMPS is so effective at removing mercury, it will actually pull the mercury right out of the fillings and cause huge problems in some patients.
It is has been my and Dr. Klinghardt's combined thirty year experience that DMPS when used properly is far safer then DMSA.
The other issue the panel raises of FDA approval is really moot as DMSA, although approved for lead chelation, clearly is not approved for removing mercury.
Additionally, please pay special attention to the huge list of complications of DMSA that are listed in this protocol. They require that the child have regular blood draws for a chemistry profile and a CBC to monitor for these complications.
This is not necessary for DMPS, which is another reason I prefer it. Through my use of IV secretin I have become very proficient in drawing blood from children. But after doing that for several years I realized that I was inflicting emotional trauma and scaring that was worsening their problem overall.
For this reason, at this time I cannot endorse any protocol that requires regular blood draws on children below the age of 6.
Other areas of disagreement are in the negative recommendation for chlorella. Their information on chlorella is seriously flawed. It is based on a small study done by Doctor's Data. They never demonstrated increased absorption of mercury from the chlorella, only that mercury was present in the chlorella. Since hundreds of tons of mercury are deposited into the oceans every year, this is not surprising.
However, what the investigators failed to account for was that the binding coefficient of chlorella to mercury is far in excess of its potential to release mercury into the body. It only ABSORBS mercury, it does NOT release it into the body.
The other issue of potential for contamination with toxic dinoflagellates is only true for blue green algae and NOT for chlorella since chlorella is a cultured product and is NOT contaminated with it.
Mineral replacement is a critical element of mercury detoxification when using chelating agents. Monitoring the child's mineral status prior to and during chelation is essential.
The panel recommends the use of the more expensive blood tests for monitoring mineral status. As I wrote in my letter in JAMA, I believe that hair analysis from specific labs is far less expensive, more clinically valid and clearly less traumatic on the child then the blood tests.
With those objections aside, I invite you to review the Panel's outstanding compilation of an effective Autism Protocol.
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Autism Panel Report
An enormous, alarming, and unexplained increase in the prevalence of autism is being reported, on an almost daily basis, in the U.S., the U.K., and elsewhere.
California maintains what is probably the world's best and most systematic database on autism and other developmental disabilities. In California the reported increase in the prevalence of autism over a 20-year period is over one thousand percent.
Similar enormous increases have been reported from studies in New Jersey and elsewhere in the US, in the UK, in the Middle East, and in Asia. While the reality of the increase is beyond doubt, there is great controversy over the cause. Many experts believe the primary cause is the increase in the number of vaccines given to children from birth to age two, which has risen from 8 in 1980 to 22 in the year 2001.
The increased number of vaccines has brought with it an increased exposure of young infants to mercury intoxication. The preservative thimerosal, which is used in many vaccines, consists of approximately 50% mercury.
In 1998 the Food and Drug Administration requested the vaccine manufacturers to begin the process of removing thimerosal from the vaccines. Thimerosal containing vaccines are still being used in 2001.
Mercury is highly toxic in even very small doses, and some individuals are exquisitely sensitive to mercury.
Some infants have been given, in one day, as much as 100 times the maximum dosage of mercury permitted by the Environmental Protection Agency's standards, based on the weight of an adult. An infant's system is much less capable of dealing with toxins than an adult's.
In early 2000, parent Sallie Bernard and several other concerned and inquisitive parents began looking into the mercury issue. They learned that thimerosal was used in most vaccines at levels that greatly exceeded the upper limits decreed safe by the US Environmental Protection Agency (EPA). The scientific paper by Bernard et al. may be found on the website of the Autism Research Institute (www.autismresearchinstitute.com).
In her testimony before the US House of Representatives in July, 2000, Sallie, the primary author of the report, testified: "The symptoms which are diagnostic of or strongly associated with autism itself are found to arise from mercury exposure, as described in available literature on past cases of mercury poisoning."
"These similarities," she testified, "include the defining characteristics of autism - and they include traits strongly associated with autism and found in nearly all cases of the disorder - sensory disturbances such as numbness in the extremities and mouth, aversion to touch, and unusual response to noise; movement disorders like toe-walking, hand flapping, clumsiness, and choreiform movements; and cognitive impairments in specific domains like short-term, verbal and auditory memory and in understanding abstract ideas."
In addition, she noted, mercury poisoning can cause many of the same biological abnormalities as are seen in autism, including immune system dysfunction and anomalies in the cerebellum, amygdala, and hippocampus.
Bernard noted that the growing prevalence rate of autism closely matches the introduction and spread of thimerosal-containing vaccines and that autistic symptoms generally emerge at the time the child is given these vaccines.
She added "Our group has also documented a number of cases of autistic children with toxic levels of mercury in hair, urine and blood." In addition, she noted, mercury is more toxic to males than to females, and the male-to-female ratio in autism is 4 to 1.
Noting that low doses of mercury tend to harm genetically susceptible individuals, Bernard pointed out that "autism has been recognized as one of the most heritable of all neurological disorders and is strongly associated with familial autoimmune disorders."
Bernard and her colleagues called for an immediate ban on thimerosal-containing childhood vaccines in October 2000. The meeting was attended by a number of physicians and scientists. One of the physicians, Dr. Stephanie Cave of Baton Rouge, Louisiana, told the group that in her experience over a number of years in treating over 400 autistic children with various modalities, she had found no modality which was more effective in a great many autistic children than mercury detoxification.
Other physicians who also had experience with mercury detoxification in autistic children, including several who were themselves parents of autistic children, strongly supported Dr. Cave's remarks.
The Autism Research Institute convened a weekend Consensus Conference on the Detoxification of Autistic Children in Dallas, Texas in February, 2001. The attendees were 25 carefully selected physicians and scientists knowledgeable about mercury and mercury detoxification.
The 15 physicians present included 7 who were parents of autistic children and who had detoxified their own children with good results. The physician attendees present had treated well over 3,000 patients for heavy metal poisoning, about 1,500 of them being autistic children. The chemists, toxicologists and other scientists present had a combined total of almost 90 years of experience in research on the toxicology of mercury.
The purpose of the meeting was to arrive at a consensus document that would delineate the safest and most effective methods of detoxifying autistic children. Nine candidate detoxification protocols, including five submitted by non-attendees, were considered in detail by the conferees.
James R. Laidler, M.D.
The DAN! mercury detoxification consensus group met in Dallas, Texas on February 9 - 11, 2001 to gather some of the top scientists and practitioners in the field to develop a protocol for mercury detoxification in the autistic child.
Rationale
Many of the features of autism bear striking similarity to certain features of mercury poisoning, especially the immune dysfunctions1,2, visual disturbances3,4, and motor/coordination defects5 seen in a growing number of autistic children. Treating autistic children with agents to remove mercury and/or other heavy metals has brought about significant improvement in many of them, sometimes dramatic improvement.
This improvement is coincident with increased excretion of mercury and/or other metals in most but not all patients. Some have theorized that those who improve without increased mercury excretion are suffering from some other metal toxicity. Another possibility, which also explains those patients who improve without significant heavy metal excretion, is that the chelating agents are working in some other fashion and that the heavy metal excretion is coincidental to this other effect.
For example, there are clinical studies showing that autistic children with significant allergy problems have elevated cysteine/sulfate ratios in their blood, and there are other indications of disordered sulfur amino-acid chemistry. Sulfhydrylbearing agents, such as DMSA and others, remove cysteine6 and thereby improve some sulfur amino acid imbalances.
Yet another possibility under investigation is the anti-oxidant effect of the drugs and supplements used and their ability to compensate for deficiencies in the native anti-oxidant systems. Quite a few autistic children have laboratory evidence of anti-oxidant deficiency; low intracellular glutathione is commonly found in these children.
What may be happening in these children is that the DMSA7 and other agents "put out the fire" of intracellular oxidation and help restore the 7 normal anti-oxidant functions. Whatever the action may be, DMSA therapy has been shown to help a large number of autistic children. It is important to remember that autism is a syndrome, not a disease.
The "diagnosis" of autism covers a wide spectrum of children, many as different from each other as they are different from "typical" children. No one causative factor has been identified for autism and the possibility exists that autism is not a single disease but several individual diseases that share a similar presentation.
With that in mind, it is not surprising that no single treatment has been found that works for all children with autism. Preparatory treatment Many, if not most, autistic children suffer from some degree of intestinal dysbiosis, abnormal intestinal permeability and nutritional derangements which must all be corrected as much as possible prior to any attempt at detoxification.
Without this preparatory treatment, the adverse side effects of therapy may be magnified. Without the correction of their intestinal dysfunctions, any improvement from the treatment may be hard to detect. Many of the drugs and supplements used for mercury detoxification are rich sources of nutrition for bacteria and fungi.
If treatment is started while the child is suffering from overgrowth of abnormal or pathogenic organisms, they will experience explosive growth of these organisms with subsequent worsening of their symptoms. This monograph is but a part of the DAN! treatment protocol for autistic children, so this is not the place for a detailed discussion of how to correct their intestinal problems. However, a brief outline of the process is included (Appendix B) to help practitioners who are not familiar with the process.
Inclusion testing
Urine, blood and hair mercury are typically normal or negative unless the mercury exposure has been fairly recent. On occasion, urinary mercury will be elevated if the child is in a catabolic state due to growth or malnutrition. In these situations, the mercury stored in tissues may be released as those cells are broken down.
Provoked excretion of mercury and heavy metals is the only accurate way to estimate the total body burden of heavy metals. This is performed by administering a chelating agent prior to collection of urine for heavy metal analysis. The usual provoking agents are 2,3-dimercaptosuccinic acid (DMSA) and 2,3-dimercapto-propane-sulfonate (DMPS). Of these two, DMSA is safer, but DMPS is somewhat more effective8,9.
The usual way to gather a provoked urine specimen is to administer the chelating agent and then to collect the next six to twelve hours of urine produced. The usual DMSA dose for a single-dose provocation is 10 mg/kg. No reference ranges exist for provoked urinary heavy metal excretion, so the interpretation of the results is problematic.
Given that the problem in autistic children may be excessive sensitivity to mercury or other heavy metals, any level over the reference range for unprovoked urine heavy metals may be sufficient indication for a trial of therapy. In addition to mercury, lead, cadmium, arsenic, antimony and many other metals are extracted by DMSA10, so the urine metal analysis may show a number of toxic metals. 8
Other than looking for the heavy metals directly, one can look for evidence of their effects. Mercury and other heavy metals suppress the effect of a number of enzymes, some of which can be easily tested. The most commonly available of these is glucose-6 phosphodiesterase (G-6PD); a quantitative G-6PD activity may reveal levels intermediate between normal and deficient in heavy metal poisoning11.
Of note, there has been one report of hemolysis in a patient with absolute G-6PD-deficiency12, but DMSA has been used extensively in populations with a high incidence of G-6PD deficiency and sickle cell disease without problems. Less commonly available is glutathione reductase, which is also reduced in heavy metal poisoning13.
Low glutathione levels in the red cells are not specific for heavy metal toxicity, but may be supporting evidence. Another commonly available test is blood or urine pyruvic acid. Pyruvic acid can be elevated for a number of reasons, but mercury is notorious for interfering with the mitochondrial pyruvate dehydrogenase complex, where it binds to and deactivates the lipoic acid coenzyme, resulting in elevated pyruvic acid.
Mercury and other heavy metals interfere with heme synthesis, leading to urinary excretion of uroporphyrin and coproporphyrin. Mercury also causes production of pre-coproporphyrin, which may be considered a specific marker for mercury poisoning14,15. Analysis of uroporphyrin and coproporphyrin can be done at most clinical laboratories; pre-coproporphyrin analysis can also be done, but most laboratories do not routinely have that test available.
Mercury and other heavy metals (such as lead) can cause progressive myelin degeneration with the development of antibodies to myelin basic protein (MBP) and glial fibrillary acidic protein (GFAP)16,17. While these changes are not diagnostic of mercury intoxication, they point to ongoing degeneration in the central nervous system.
Depletion or deficiency of the cellular antioxidant systems is seen in a number of autistic children. A common finding in autistic children is an abnormally low erythrocyte glutathione level. The potential causes for this deficiency in cellular antioxidant substances are myriad, ranging from congenital deficiency to toxins; heavy metals are well-documented causes of intracellular antioxidant depletion.
Whether the cause is too little production, rapid consumption or a combination of the two, many of these children can benefit from exogenous antioxidant support. Since DMSA and many of the other supplements used to treat mercury and heavy metal intoxication are powerful antioxidants, this may be mechanism of action in some children who improve, especially those who show little excretion of toxic metals.
Since it is possible that neither removal of metals nor supplementing cellular antioxidants are the mechanism of action, an empiric trial of DMSA therapy may be warranted. This trial should be done for a limited time and without changing any other therapy, including physical therapy, occupational therapy, speech therapy, etc. If no definitive results are seen in four to six weeks, discontinue therapy and look again for any changes.
Pre-treatment testing
DMSA can cause bone marrow suppression and is potentially hepatotoxic18. There have been no reports yet of permanent bone marrow suppression or liver damage, but the literature has many case reports of significant neutropenia and thrombocytopenia during therapy with DMSA.
Prior to starting therapy, it is important that a complete blood count (CBC) with platelet count be 9 checked, both to provide a baseline as well as to detect any pre-existing abnormalities. Blood levels of liver transaminases (ALT and AST) are also important for the same reasons. DMSA is primarily excreted in the urine19, so kidney dysfunction will cause it to accumulate in the blood.
To prevent serious toxicity, it is important to detect any decreased renal function prior to starting therapy. In the absence of any signs or symptoms of renal insufficiency, blood urea nitrogen (BUN) and creatinine levels should be adequate to document normal renal function. If there are any reasons to suspect renal insufficiency, creatinine clearance should be measured.
Periodic checks of blood urea nitrogen and creatinine should also be performed when other blood studies are done. Several investigators have found that autistic children are typically low in blood zinc and high in blood copper. Many other minerals, such as selenium and magnesium, are often low as well.
The body stores of these minerals can be estimated by measuring the red blood cell mineral content. Serum copper and plasma zinc levels are considered to be the most accurate reflections of total body content of these two minerals, but not many laboratories can perform this assay consistently. Other options are platelet and erythrocyte copper and zinc levels.
Practitioners who decide to use copper and zinc levels routinely are advised to closely monitor their analytical laboratory and to perform periodic quality-control checks with known samples.
Detoxification Of the chelating agents available at present, DMSA (succimer, Chemet®) provides the optimal combination of safety and efficacy. DMSA has been used extensively for nearly fifty years and is approved by the USFDA to treat lead poisoning in children; its safety record is exemplary20.
There is far less experience using DMPS, especially in children, and the adult experience with it has shown that it is significantly more toxic than DMSA. DMPS is currently not approved for any use by the USFDA.
Several animal studies have shown that DMSA is capable of removing a portion of the mercury bound in the brain21,22. Some of these studies have also shown that, months after exposure, mercury still moves between the blood and brain in both directions23.
It should be noted that, to date, no studies have definitively shown any chelating agent capable of removing mercury from the human brain, no doubt due to the reluctance of human subjects to have their brains removed for analysis. One autopsy study has demonstrated that, despite urine and blood mercury levels in the normal range, mercury will persist in the brain and other organs for many years without adequate chelation therapy24.
DMSA should be given in doses of no more than 10 mg/kg/dose and no more than 30 mg/kg/day with a maximum dose of 500 mg (1500 mg/day maximum). Exceeding these limits has been associated with a significantly higher incidence of side effects and toxicity.
The dosing interval can be any convenient period, as long as the dose limits are not exceeded. There is no convincing evidence to suggest that dosing intervals shorter than eight hours provide any inherent benefit, although a lower dose given more frequently may help to reduce troublesome side effects.
In addition, the subset of children who experience improvement only while receiving DMSA may benefit from more frequent dosing. Clinical experience supporting 3- or 4-hour dosing intervals is matched by equally good results with 8-hour dosing. As always, the dosing interval should be based on the clinical response of the individual patient. 10 DMSA is usually given orally but it can, if necessary, be given intravenously.
There is also some experience with rectal administration via suppository. Despite the sulfurous smell, most children will take it if it is mixed with a suitable masking liquid, such as orange juice or other sweet beverage. One study has shown that mercury-intoxicated rats prefer water containing DMSA to pure water, while the control animals would shun the water with DMSA25; this phenomenon has been seen in some children as well.
Acidic or neutral liquids are best to maintain the activity of the DMSA while in solution. DMSA will retain approximately 80% of its activity after 24 hours in solution, but prolonged storage in solution may result in significant degradation and loss of effectiveness26. If the child will swallow capsules, the whole issue of taste and smell can be neatly bypassed.
The treatment period can last from three to five days with a "rest period" of at least as long as the treatment period. A treatment of three days followed by a rest period of eleven days provides adequate time for bone marrow suppression to resolve and yet is short enough for rapid removal of tissue mercury. A three-day treatment period allows the drug to be administered over the weekend (Friday evening through Monday morning), which can be a tremendous convenience.
Common side effects of DMSA are nausea, diarrhea, anorexia, flatulence and fatigue. If these become serious enough, reducing the dose will usually make the symptoms tolerable. Occasionally, patients develop a maculopapular rash during treatment; this should not to be confused with an allergic reaction27. Some autistic children are reported to experience a transient regression in language and behavior during and shortly after treatment. Reducing the dose may also make these symptoms less bothersome.
Clinical experience suggests that most children who experience regression at the start of therapy will have less regression with each subsequent cycle of treatment. Serious side effects of DMSA are extremely rare and include allergic reaction, toxic epidermal necrolysis (TEN) and erythema multiforme (Stevens-Johnson syndrome)a. Potentially dangerous neutropenia and thrombocytopenia may also occur28. While reducing the dose may reduce the severity of the neutropenia and thrombocytopenia, truly dangerous reductions in cell count are a contraindication to continued therapy without a compelling reason to do so.
Obviously, allergic a No cross-sensitivity between DMSA and the sulfa antibiotics has been reported. If the patient has a history of sensitivity or allergy to other dithiol chelating agents (e.g. DMPS, DMPA, dimercaprol/BAL), they may not be a candidate for DMSA therapy, depending on the severity of the reaction. If the reaction was mild or ambiguous, a small test dose can help resolve the issue. Toxic epidermal necrolysis and erythema multiforme occur without predictable pattern and their etiologies are poorly understood. Both may occur with the initial treatment or may appear after several months of therapy.
Both have been reported only a few times in connection with DMSA even though tens of thousands of children have received the drug. Erythema multiforme (Stevens-Johnson syndrome) is a selflimited inflammatory disorder of the skin and mucous membranes. It is thought to be induced by immune complexes and mediated by lymphocytes. It is characterized by distinctive target-shaped skin lesions, sore throat, mucous ulcers and fever. It usually begins a week or more after therapy starts and will usually resolve spontaneously if the inciting medication is stopped.
Toxic epidermal necrolysis (TEN) is the most serious cutaneous drug reaction and may be fatal if not recognized. Its onset is generally very acute and characterized by epidermal necrosis without significant dermal inflammation. Its pathology is poorly understood but it also usually resolves when the inciting agent is stopped. There are no other specific treatments other than supportive therapy and symptom relief. 11 reaction, TEN and Stevens-Johnson syndrome are absolute contraindications to continued therapy.
More beneficial "side effects" reported with DMSA therapy in autistic children include rapid progression of language ability, improved social interaction, improved eye contact, and decreased self-stimulatory behaviors ("stimming"). Children with motor problems have experienced significant improvement in both strength and coordination.
Mineral supplements
Because of poor nutrition (often due to idiosyncratic food preferences), poor absorption, and other, poorly understood factors, autistic children usually have numerous mineral deficiencies. Chief among these deficiencies is zinc. Zinc supplements should be given prior to, during and after detoxification therapy.
Zinc given with DMSA will complex with it and will be more readily absorbed as a consequence29,30. Supplementation with 1 - 2 mg/kg/day of zinc is recommended (maximum of 50 mg/day unless guided by laboratory evidence of marked deficiency); more may be needed and plasma, erythrocyte or platelet zinc levels can be used to guide doses higher than this.
Autistic children are also often deficient in selenium. Since this mineral is one of the few that can cause a significant toxicity if it is present in excess, caution should be exercised. In the absence of laboratory evidence of a profound deficiency, selenium supplementation should be limited to 1 - 4 mcg/kg/day.
Magnesium, molybdenum, manganese, vanadium and chromium are all among the minerals that are deficient in autistic children; these can be supplied by a multi-mineral supplement. Be sure that this supplement does not contain copper. Copper is the one mineral that autistic children often have in excess and additional supplements will only worsen the excess.
Vitamin supplements
Although the conventional wisdom is that the "average American" receives all the vitamins and nutrients they require in a balanced diet, there are several reasons why this is not true in autistic children. First, autistic children rarely eat a balanced diet. They often have an extremely limited number of foods they will accept and these rarely encompass all of the major food groups.
Additionally, some of the vitamins are anti-oxidants and are depleted in autistic children. Finally, many autistic children are deficient in vitamin B6, vitamin B12, folate and niacin, either from poor diet, poor absorption or both. Vitamin C: An important anti-oxidant, vitamin C can be a great benefit to autistic children. Since it is a water-soluble vitamin, it is rare to see true toxicity, although ascorbic acid crystals in the urine (and the potential for renal stones) will result from sustained use of extremely high doses.
More commonly (and usually at doses over 2000 mg/day), gastrointestinal distress and diarrhea are the only side effects from vitamin C. Using the buffered preparation or vitamin C esters can significantly reduce the incidence of gastrointestinal side effects, as will dividing the dose.
Vitamin C supplementation should start at 5 -10 mg/kg/day and gradually increase to tolerance. Some may tolerate and, in fact, need more than 50 mg/kg/day.
Vitamin E: Another of the anti-oxidant vitamins, vitamin E has received more press lately than vitamin C. Since it is fat soluble, it can accumulate if given to excess. Dosing in the range of 2 - 4 12 mg/kg/day (3 - 6 IU/kg/day) is within safe limits. Mixed tocopherols are the preferred preparation. Many vitamin E supplements are prepared from soybeans and may be a problem in children who are sensitive to soy products.
Since vitamin E is important in preventing fatty acid oxidation and peroxidation, more may be needed if the child is also receiving essential fatty acid supplements.
Vitamin B6: Vitamin B6 can be found as B6 (pyridoxine), pyridoxal-5-phosphate (P5P), or a mixture of the two (rare). Up to 15 mg/kg/day of B6 or 3 mg/kg/day of pyridoxal-5-phosphate should be used (to a maximum of 500 mg B6 or 100 mg P5P). Be aware that many of the pyridoxal-5-phosphate preparations contain supplemental copper to prevent pyridoxal retinopathy in copper-deficient people.
Since autistic children are typically high in copper, be sure to use a copper-free preparation.
Other supplements Alpha-Lipoic acid: A dithiol fatty acid, alpha-lipoic acid is a native chelating agent but is also a powerful anti-oxidant. It has been extensively used in Germany to treat diabetic neuropathy with excellent results31. Its anti-oxidant effects may be particularly helpful in autistic children, since many of them show clear evidence of anti-oxidant depletion. Start with 1 - 3 mg/kg/day of alpha-lipoic acid and increase to 10 mg/kg/day as tolerated.
Alphalipoic acid is a natural product of human cells and so has minimal toxicity; doses of up to 25 mg/kg/day given over more than three years have been studied in adults with no detectable toxicity32. There is a theoretical concern that alpha-lipoic acid may bind to DMSA and reduce the availability of both, but this has not been seen clinically.
Another concern is that alpha-lipoic acid reduces the removal of methyl-mercury by glutathione, which is a reason why it should be given with DMSA. There is also evidence that alpha-lipoic acid reduces copper excretion33. Since DMSA increases copper excretion34 (it has been used to treat the copper intoxication of Wilson's disease35), this should not be a problem if alpha-lipoic acid is used with DMSA.
A serious concern with alpha-lipoic acid is that it can facilitate the movement of mercury out of and into the cells. It can be very useful in mobilizing mercury from within the cells and making it available for DMSA to chelate. Without the DMSA to "grab" the mercury from lipoic acid, it may readily enter other tissues.
Melatonin: The pineal hormone that helps to regulate the sleep/wake cycle, melatonin is also an anti-oxidant. It is relatively unique among natural anti-oxidants in that it is a terminal antioxidant: once oxidized, it cannot be reduced36. This characteristic means that melatonin cannot participate in destructive redox cycling, where an oxidized compound is reduced by oxidizing another compound. One study has found that neurons are protected from mercury damage by hormonal levels of melatonin37.
Melatonin is also concentrated in the mitochondria and protects them from oxidative damage.38 Aside from its anti-oxidant properties, melatonin helps to regulate the sleep/wake cycle, which is often seriously deranged in autistic children. Its long-term use in institutionalized children has established its safety39.
Doses of up to 0.1 mg/kg at bedtime should be adequate to help with sleep disturbances. Some clinicians have noted that smaller doses of melatonin (0.3 mg in adults) are just as effective for sleep and may cause fewer problems with nightmares and/or night terrors. A sustained release form of melatonin is currently under development and should help with those children who awaken four to six hours after the dose of melatonin. 13
Taurine: Taurine is a sulfur-containing amino acid which is important in the production of bile salts and, therefor, in the native excretion of toxins and absorption of fats and fat-soluble substances. Many autistic children are deficient in taurine and benefit from a supplementation of 250 - 500 mg/day. A maximum dose of 2 grams/day in adults and adult-sized children is recommended.
Glutathione: Glutathione is the keystone of the cellular anti-oxidant system and is often deficient in autistic children. Despite numerous rodent studies that show good systemic absorption of oral glutathione, the two human studies looking at oral absorption have shown it to be nil40. In humans, oral glutathione is readily absorbed by the gut mucosa, repleting its glutathione supply; the mucosa then breaks down the remaining glutathione. This may explain why oral glutathione has been of help to autistic children even when there is apparently no systemic absorption. Given the gut dysfunction found in many autistic children, oral glutathione 250 - 500 mg/day may be of significant help.
Supplements to be wary of
Cysteine/cystine: As sulfur-containing amino acids (cystine is the dimer of cysteine), both can bind to and mobilize mercury. Like alpha-lipoic acid, cysteine and cystine may worsen mercury intoxication by spreading it to other tissues. Furthermore, cysteine and cystine are excellent culture media for the Candida genus of yeast and can promote or worsen intestinal candidiasis.
In addition, many autistic children have high blood levels of cysteine. N-Acetyl-L-Cysteine (NAC): NAC should not be used initially or by itself with anyone suspected of having a significant body burden of mercury. Like alpha-lipoic acid, cysteine and cystine, NAC can bind with mercury and carry it across cell membranes.
NAC is also a good culture medium for yeast, like its parent molecule, cysteine. Since many autistic children also have high cysteine levels, giving them NAC will only exacerbate this problem. NAC is often recommended because it can rapidly increase intracellular glutathione levels41,42. For that reason, it can be tremendously useful in treating the antioxidant deficiencies seen in so many autistic children.
NAC should be used either in conjunction with DMSA or after mercury detoxification is well under way. In addition, NAC should be used with extreme caution in children with elevated cysteine levels.
Chlorella/other algae: Often touted as an herbal remedy for mercury poisoning, chlorella has a great affinity for mercury and other heavy metals. Unfortunately, it will also readily extract mercury from the water it is grown in. Analysis of at least one specimen of commercially available chlorella has shown high levels of mercury. Other unicellular algae preparations are available on the market, advertised as a remedy for a variety of problems. They should also be viewed with caution, not only because of possible mercury content but also because of the potential for contamination with toxic dinoflagellates.
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Note from Dr. Mercola:
This information on chlorella is seriously flawed. It is based on a small study done by Doctor's Data. They NEVER demonstrated increased absorption of mercury from the chlorella, only that mercury was present in the chlorella. Since hundreds of tons of mercury are deposited into the oceans every year, this is not surprising. However, what the investigators failed to account for was that the binding coefficient of chlorella to mercury is far in excess of its potential to release mercury into the body. It only ABSORBS mercury it does NOT release it into the body.
The other issue of potential for contamination with toxic dinoflagellates is only true for blue green algae and NOT for chlorella since chlorella is a cultured product and is NOT contaminated.
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Concurrent testing
Since DMSA has been reported to cause elevations in hepatic transaminases, serum ALT and AST should be monitored during therapy. Likewise, white cell and platelet counts should be followed. Both elevation of liver enzymes and bone marrow suppression are dose-related and 14 have been, to date, completely reversible.
Also, review of the literature indicates that, while some patients are more sensitive, sensitivity appears to remain constant. This would suggest that patients who tolerate DMSA well initially will rarely, if ever, develop sensitivity later in therapy.
Complete blood count (CBC) with platelet count and liver enzymes should be checked after the first or second cycle and, assuming no abnormalities are found, rechecked periodically while therapy continues. If elevated liver enzymes or depressed cell counts are found, the DMSA should be stopped and the laboratory tests followed until the values return to baseline.
If the abnormalities were not too severe and they return to baseline promptly, the DMSA can be resumed at a lower dose with careful monitoring.
Urine metal analysis for mercury and other toxic metals may help direct the duration of therapy. The optimum time for collecting the urine specimen is after the second dose of the cycle and within six hours of the last dose of the cycle. Timed specimens are best, but may not be practical in children who are not toilet-trained.
When a 24-hour specimen is not possible, 12- or 6-hour specimens are completely acceptable. In children who are continent at night, the first morning urine represents an 8-hour collection, on average. Random or spot urine specimens are problematic, as they may miss the time of peak excretion, especially when DMSA is given every eight hours.
One way to overcome this problem is to obtain two or more random specimens and combine them. This will "average" the mercury excretion over several samples. The best time to get a spot urine sample is two to four hours after a dose.
Some practitioners have found stool mercury analysis to be helpful, as much of the mercury excreted with alpha-lipoic acid will be found in the bile. The major limitation to stool mercury is that the stool contains both mercury excreted in the bile as well as any mercury ingested in the diet and not absorbed.
Without knowing the amount of mercury in the diet, it is impossible to accurately interpret stool mercury levels. The best way to use stool mercury levels is to obtain a level before treatment. Assuming that the dietary mercury remains relatively constant, this will provide a baseline for subsequent measurements.
End-of-treatment indications
If one could assume that the benefits seen in autistic children were exclusively due to mercury detoxification, then treatment could stop when mercury excretion dropped below detectable limits. Since this may not be the sole mechanism of action, the decision to end treatment needs to be based on both laboratory and clinical evidence.
One obvious indication to stop treatment is when improvement ceases. Halt therapy when the child reaches a "plateau" and watch for any indication of regression. Some parents and practitioners may want to continue treatment for a few months after reaching a "plateau" in the hopes that a small amount of additional progress may occur.
Also, the possibility of a "false plateau" due to illness or other stress should be considered. Obviously, if the child shows no significant progress during therapy or experiences regression, this would be another indication to stop treatment. Keep in mind that a significant number of autistic children will undergo some degree of regression during initial treatment with DMSA while later experiencing significant gains.
If intestinal dysbiosis is not adequately treated prior to 15 starting DMSA, any improvement from the DMSA may be masked when the intestinal dysbiosis worsens on exposure to a rich culture medium. A number of children have shown significant improvement while taking the DMSA, which regresses when they stop, even for the "rest period" of each cycle. These children need to be dealt with on a case-by-case basis, since there is insufficient clinical experience so far to recommend a course of action.
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Disclaimers:
1. The therapies outlined in this monograph should not be used except by and under the supervision of a physician.
2. This is not a "stand-alone" protocol and must be preceded by correction of intestinal dysbiosis and nutritional deficiencies.
3. These therapies may not help all autistic children and may potentially make some autistic children significantly worse. Even those children who will ultimately benefit from these therapies may show transient deterioration during treatment.
4. The drugs and nutritional supplements discussed in this monograph, with the exception of DMSA (Succimer, Chemet®), antibiotics and antifungals, are not approved by the United States Food and Drug Administration (USFDA). DMSA is currently approved by the USFDA only for lead poisoning.
5. The quality and purity of drugs and supplements that are not FDA approved will vary with different suppliers. All such drugs and nutritional supplements mentioned are allowed by the USFDA, but it does not guarantee their safety, purity or effectiveness.
6. The theories and medical models on which these therapies are based are not universally accepted in the medical community and are being vigorously studied by a number of researchers. The clinical evidence supporting these therapies is compelling but no wellcontrolled outcome studies have yet been performed; the evidence is largely based on clinical experience at this point.
7. The theories and therapies discussed in this monograph are subject to change without notice if significant clinical or research data indicates a need for change.
Disclaimers for medical practitioners:
1. Attempting mercury or other heavy metal detoxification before the patient's underlying gastrointestinal and nutritional problems are corrected will likely be disappointing to you and to the patient's family.
2. The dosing of the drugs and nutritional supplements in this monograph is within the limits supported by the majority of the peer-reviewed literature published as of January 2001. The maximum limits should be exceeded only if you have good reasons to do so.
3. At the present, it is impossible to determine which patients will benefit from these therapies with great accuracy. Some patients who seem to be perfect candidates will have no improvement and others who seem to have little to recommend the therapy will show marked improvement
4. The treatment of autism is in a state of continual flux. 16
Disclaimers for parents and family members:
1. Many families are treating their autistic children with therapies similar to those listed in this monograph without involving a physician or other health care provider. That most of them do so without any adverse consequences is a testament to the safety of the drugs and supplements used. However, DMSA and some of the supplements present a small but nonzero risk of serious side effects. Life, in general, is a series of risks; the risk of serious side effects can be reduced by careful medical monitoring during treatment.
2. Not every physician is able or willing to carry out the therapies described in this monograph. Have a frank and open discussion with your physician or other medical practitioner before embarking on these treatments.
3. Despite miraculous case reports heard on the grapevine and on the Internet, these therapies will not work for every autistic person. Even those who do improve may have slow or incremental improvement
4. In general, younger patients appear to respond more quickly than older patients, but this has not yet been adequately investigated.
Autism Research Institute
References
Autism Home Remedies
We Cured Our Son's Autism
By Karyn Seroussi
Copyright © 2000 Karyn Seroussi
When the doctors said our son would be severely disabled for life, we set out to prove them wrong.
When the psychologist examining our 18-month-old son told me that she thought Miles had autism, my heart began to pound. I didn't know exactly what the word meant, but I knew it was bad. Wasn't autism some type of mental illness -- perhaps juvenile schizophrenia? Even worse, I vaguely remembered hearing that this disorder was caused by emotional trauma during childhood. In an instant, every illusion of safety in my world seemed to vanish.
Our pediatrician had referred us to the psychologist in August 1995 because Miles didn't seem to understand anything we said. He'd developed perfectly normally until he was 15 months old, but then he stopped saying the words he'd learned -- cow, cat, dance -- and started disappearing into himself. We figured his chronic ear infections were responsible for his silence, but within three months, he was truly in his own world.
Suddenly, our happy little boy hardly seemed to recognize us or his 3-year-old sister. Miles wouldn't make eye contact or even try to communicate by pointing or gesturing. His behavior became increasingly strange: He'd drag his head across the floor, walk on his toes (very common in autistic children), make odd gurgling sounds, and spend long periods of time repeating an action, such as opening and closing doors or filling and emptying a cup of sand in the sandbox. He often screamed inconsolably, refusing to be held or comforted. And he developed chronic diarrhea.
As I later learned, autism -- or autistic spectrum disorder, as doctors now call it -- is not a mental illness. It is a developmental disability thought to be caused by an anomaly in the brain. The National Institutes of Health estimates that as many as 1 in 500 children are affected. But according to several recent studies, the incidence is rapidly rising: In Florida, for example, the number of autistic children has increased nearly 600 percent in the last ten years. Nevertheless, even though it is more common than Down syndrome, autism remains one of the least understood developmental disorders.
We were told that Miles would almost definitely grow up to be severely impaired. He would never be able to make friends, have a meaningful conversation, learn in a regular classroom without special help, or live independently. We could only hope that with behavioral therapy, we might be able to teach him some of the social skills he'd never grasp on his own.
I had always thought that the worst thing that could happen to anyone was to lose a child. Now it was happening to me but in a perverse, inexplicable way. Instead of condolences, I got uncomfortable glances, inappropriately cheerful reassurances, and the sense that some of my friends didn't want to return my calls.
After Miles' initial diagnosis, I spent hours in the library, searching for the reason he'd changed so dramatically. Then I came across a book that mentioned an autistic child whose mother believed that his symptoms had been caused by a "cerebral allergy" to milk. I'd never heard of this, but the thought lingered in my mind because Miles drank an inordinate amount of milk -- at least half a gallon a day.
I also remembered that a few months earlier, my mother had read that many kids with chronic ear infections are allergic to milk and wheat. "You should take Miles off those foods and see if his ears clear up," she said. "Milk, cheese, pasta, and Cheerios are the only foods he'll eat," I insisted. "If I took them away, he'd starve."
Then I realized that Miles' ear infections had begun when he was 11 months old, just after we had switched him from soy formula to cow's milk. He'd been on soy formula because my family was prone to allergies, and I'd read that soy might be better for him. I had breast-fed until he was 3 months old, but he didn't tolerate breast milk very well -- possibly because I was drinking lots of milk. There was nothing to lose, so I decided to eliminate all the dairy products from his diet.
What happened next was nothing short of miraculous. Miles stopped screaming, he didn't spend as much time repeating actions, and by the end of the first week, he pulled on my hand when he wanted to go downstairs. For the first time in months, he let his sister hold his hands to sing "Ring Around a Rosy."
Two weeks later, a month after we'd seen the psychologist, my husband and I kept our appointment with a well-known developmental pediatrician to confirm the diagnosis of autism. Dr. Susan Hyman gave Miles a variety of tests and asked a lot of questions. We described the changes in his behavior since he'd stopped eating dairy products. Finally, Dr. Hyman looked at us sadly. "I'm sorry," the specialist said. "Your son is autistic. I admit the milk allergy issue is interesting, but I just don't think it could be responsible for Miles' autism or his recent improvement."
We were terribly disheartened, but as each day passed, Miles continued to get better. A week later, when I pulled him up to sit on my lap, we made eye contact and he smiled. I started to cry -- at last he seemed to know who I was. He had been oblivious to his sister, but now he watched her play and even got angry when she took things away from him. Miles slept more soundly, but his diarrhea persisted. Although he wasn't even 2 yet, we put him in a special-ed nursery school three mornings a week and started an intensive one-on-one behavioral and language program that Dr. Hyman approved of.
I'm a natural skeptic and my husband is a research scientist, so we decided to test the hypothesis that milk affected Miles' behavior. We gave him a couple of glasses one morning, and by the end of the day, he was walking on his toes, dragging his forehead across the floor, making strange sounds, and exhibiting the other bizarre behaviors we had almost forgotten. A few weeks later, the behaviors briefly returned, and we found out that Miles had eaten some cheese at nursery school. We became completely convinced that dairy products were somehow related to his autism.
I wanted Dr. Hyman to see how well Miles was doing, so I sent her a video of him playing with his father and sister. She called right away. "I'm simply floored," she told me. "Miles has improved remarkably. Karyn, if I hadn't diagnosed him myself, I wouldn't have believed that he was the same child."
I had to find out whether other kids had had similar experiences. I bought a modem for my -- not standard in 1995 -- and discovered an autism support group on the Internet. A bit embarrassed, I asked, "Could my child's autism be related to milk?"
The response was overwhelming. Where had I been? Didn't I know about Karl Reichelt in Norway? Didn't I know about Paul Shattock in England? These researchers had preliminary evidence to validate what parents had been reporting for almost 20 years: Dairy products exacerbated the symptoms of autism.
My husband, who has a Ph.D. in chemistry, got copies of the journal articles that the parents had mentioned on-line and went through them all carefully. As he explained it to me, it was theorized that a subtype of children with autism break down milk protein (casein) into peptides that affect the brain in the same way that hallucinogenic drugs do. A handful of scientists, some of whom were parents of kids with autism, had discovered compounds containing opiates -- a class of substances including opium and heroin -- in the urine of autistic children. The researchers theorized that either these children were missing an enzyme that normally breaks down the peptides into a digestible form, or the peptides were somehow leaking into the bloodstream before they could be digested.
In a burst of excitement, I realized how much sense this made. It explained why Miles developed normally for his first year, when he drank only soy formula. It would also explain why he had later craved milk: Opiates are highly addictive. What's more, the odd behavior of autistic children has often been compared to that of someone hallucinating on LSD.
My husband also told me that the other type of protein being broken down into a toxic form was gluten -- found in wheat, oats, rye, and barley, and commonly added to thousands of packaged foods. The theory would have sounded farfetched to my scientific husband if he hadn't seen the dramatic changes in Miles himself and remembered how Miles had self-limited his diet to foods containing wheat and dairy. As far as I was concerned, there was no question that the gluten in his diet would have to go. Busy as I was, I would learn to cook gluten-free meals. People with celiac disease are also gluten-intolerant, and I spent hours on-line gathering information.
Within 48 hours of being gluten-free, 22-month-old Miles had his first solid stool, and his balance and coordination noticeably improved. A month or two later, he started speaking -- "zawaff" for giraffe, for example, and "ayashoo" for elephant. He still didn't call me Mommy, but he had a special smile for me when I picked him up from nursery school. However, Miles' local doctors -- his pediatrician, neurologist, geneticist, and gastroenterologist -- still scoffed at the connection between autism and diet. Even though dietary intervention was a safe, noninvasive approach to treating autism, until large controlled studies could prove that it worked, most of the medical community would have nothing to do with it.
So my husband and I decided to become experts ourselves. We began attending autism conferences and phoning and e-mailing the European researchers. I also organized a support group for other parents of autistic children in my community. Although some parents weren't interested in exploring dietary intervention at first, they often changed their mind after they met Miles. Not every child with autism responded to the diet, but eventually there were about 50 local families whose children were gluten- and casein-free with exciting results. And judging by the number of people on Internet support lists, there were thousands of children around the world responding well to this diet.
Fortunately, we found a new local pediatrician who was very supportive, and Miles was doing so well that I nearly sprang out of bed each morning to see the changes in him. One day, when Miles was 2 1/2, he held up a toy dinosaur for me to see. "Wook, Mommy, issa Tywannosauwus Wex!" Astonished, I held out my trembling hands. "You called me Mommy!" I said. He smiled and gave me a long hug.
By the time Miles turned 3, all his doctors agreed that his autism had been completely cured. He tested at eight months above his age level in social, language, self-help, and motor skills, and he entered a regular preschool with no special-ed supports. His teacher told me that he was one of the most delightful, verbal, participatory children in the class. Today, at almost 6, Miles is among the most popular children in his first-grade class. He's reading at a fourth-grade level, has good friends, and recently acted out his part in the class play with flair. He is deeply attached to his older sister, and they spend hours engaged in the type of imaginative play that is never seen in kids with autism.
My worst fears were never realized. We are terribly lucky.
But I imagined all the other parents who might not be fortunate enough to learn about the diet. So in 1997, I started a newsletter and international support organization called Autism Network for Dietary Intervention (ANDI), along with another parent, Lisa Lewis, author of Special Diets for Special Kids (Future Horizons, 1998). We've gotten hundreds of letters and e-mails from parents worldwide whose kids use the diet successfully. Although it's best to have professional guidance when implementing the diet, sadly, most doctors are still skeptical.
As I continue to study the emerging research, it has become increasingly clear to me that autism is a disorder related to the immune system. Most autistic children I know have several food allergies in addition to milk and wheat, and nearly all the parents in our group have or had at least one immune-related problem: thyroid disease, Crohn's disease, celiac disease, rheumatoid arthritis, chronic fatigue syndrome, fibromyalgia, or allergies. Autistic children are probably genetically predisposed to immune-system abnormalities, but what triggers the actual disease?
Many of the parents swore that their child's autistic behavior began at 15 months, shortly after the child received the MMR (measles, mumps, rubella) vaccine. When I examined such evidence as photos and videotapes to see exactly when Miles started to lose his language and social skills, I had to admit that it had coincided with his MMR -- after which he had gone to the emergency room with a temperature of 106°F and febrile seizures. Recently, a small study was published by British researcher Andrew Wakefield, M.D., linking the measles portion of the vaccine to damage in the small intestine -- which might help explain the mechanism by which the hallucinogenic peptides leak into the bloodstream. If the MMR vaccine is indeed found to play a role in triggering autism, we must find out whether some children are at higher risk and therefore should not be vaccinated or should be vaccinated at a later age.
Another new development is giving us hope: Researchers at Johnson and Johnson's Ortho Clinical Diagnostics division -- my husband among them -- are now studying the abnormal presence of peptides in the urine of autistic children. My hope is that eventually a routine diagnostic test will be developed to identify children with autism at a young age and that when some types of autism are recognized as a metabolic disorder, the gluten and dairy-free diet will move from the realm of alternative medicine into the mainstream.
The word autism, which once meant so little to me, has changed my life profoundly. It came to my house like a monstrous, uninvited guest but eventually brought its own gifts. I've felt twice blessed -- once by the amazing good fortune of reclaiming my child and again by being able to help other autistic children who had been written off by their doctors and mourned by their parents.
Adapted from the book Unraveling the Mystery of Autism and Pervasive Developmental Disorder: A Mother's Story of Research and Recovery by Karyn Seroussi. Published by Simon & Schuster February 2000.
Autism Diet
Let's start with most simple part of this program: Autism diet. When it comes to diet, it is very important to avoid eating Toxins and Foods that Kill. Please follow those links and learn what are The Toxins I am talking about and what are those " Foods that Kill". Now, important part of your diet should also be Water Cure. Please, become familiar with Water Cure. Your Diet should contain: Foods That Heal, Vegetable juices, Fats that Heal, Unrefined Sea Salt. Also, try to understand food tolerance. You can not find the right Autism diet, unless you fully understand and learn about food tolerance.
Take some time to implement and learn all what you have read here, and then continue reading further.
Psychotherapy and Spiritual Therapy
Human body is not just this what we can se. There is more to it. To treat other level of us, to treat soul and to treat mind and unconscious parts of us, I suggest you Hellinger's therapy.
Get in Touch
If you have questions, or if you would like to get in touch with people who are dealing with same problems, then you should visit Public Discussion Board.
There, you can read messages, ask questions and give answers.