Primary Goals of Supplementation

Jerry Kartzinel, MD FAAP

ICDRC

1)       Optimization of Normal Physiology (THE CORE OF REBUILDING)

a.       Support of Normal Growth and Neurodevelopment 

                                                     i.     Zinc deficiency:  it is safe to supplement just about everyone with ASD with 10-20 mg of zinc daily.  Serum zinc levels or packed red blood cell element evaluations may reveal higher levels of supplementation are necessary.

                                                    ii.     Selenium deficiency:  many of our children with ASD require additional selenium.  We will start with 50-100 mcg daily.  Packed red blood cell element evaluations may reveal higher levels of supplementation are necessary.  

                                                   iii.     Ca/Mg deficiency:  Since most of our children are dairy free, alternative sources for calcium are necessary for proper growth and development.  We typically recommend 500-1000 mg of calcium citrate (not Tums) daily.  Magnesium should be given with calcium to enhance absorption.  Recommended dosing for magnesium is 1mg of Calcium to 1 mg of Magnesium.  Therefore, for example, 500mg of Calcium is given with 500mg of Magnesium.  Note: magnesium may cause loose stools, and smaller doses may be needed.  Calcium and magnesium blood levels should be checked regularly.

                                                   iv.     Chromium deficiency:  if this is revealed to be low on blood level tests, we recommend about 50 to 100 mcg daily.

                                                    v.     Protein deficiency:  many children do not consume protein, or if they do, very small amounts.  We recommend supplementation with a rice protein powder put directly into their drink. Nutribiotics™ makes a very clean product.  1 tablespoon typically is equal to 14 gms of protein.   The amount our children require usually depends on age: if under 3 years, supplement with 1 gm per 2 pounds of body weight.  Ages 4-6 years, 1 tablespoon daily. 7-10 years of age supplement with 1 ¾ tablespoons daily.  Older boys and girls require 2 tablespoons daily.  This protein powder can easily mixed into any fluid as it contributes only a very bland flavor.  It does have “texture” that some of our kids can detect.  This can be minimized if mixed into juice, rice milk, etc. with a blender.           

                                                   vi.     EFA deficiency:  Just about all the children will require Omega 3 fatty acids.  We recommend starting with the RDA of vitamin A.  Usually this is ½ tsp of cod liver oil for children ages 2-5,  1 tsp for children who are older.  A blood test, called an Essential Fatty Acid Profile will reveal other possible fatty acid deficits that can be supplemented.  Some children react poorly to cod liver oil and can get very hyper and aggressive.  This will resolve one to two days after discontinuing.  Also recommended are EPA  (eicosapentaenoic acid) and DHA (docosahexaenoic acid).  Great sources of these can be found in Eskimo 3

                                                  vii.     Iron deficiency: this can be easily evaluated by simple blood tests that need to include a CBC, ferritin level, reticululocyte count, and total iron binding capacity.  We included these specific tests because we were made aware by a physician in a conference that these have been forgotten in this age of HMO medicine. Currently, they just screen with a hematocrit (“crit”). If iron deficiency is noted, your local physician can prescribe iron and give close follow-up.

                                                 viii.     Calorie deficient:  some of our special needs kids just will not eat.  In this case, you may have to hide calories in the foods that they will eat or drink.  This can get tricky and you may have to involve a physician.  There are tricks you can do to “beef” up the calorie content of the things your child does eat.   We commonly recommend cooking in high oleic safflower oil, and adding extra oil to things such as gf pasta, rice, on popcorn, etc.  We can even add MCT oil to drinks, just to increase total daily calories.

b.       Improved Function of the Immune System: Many children with autism have a dysfunctional immune system (that's the Th1/Th2 imbalance).  Critical nutrients to rebuild the immune system and move the Th1/Th2 back toward Th1 will require:

Zinc: this mineral is almost always deficient in children.  It is crucial in many processes the body carries out day to day.  It is easily measured in the blood.  We do recommend 20 mg as a starting dose to most of our patients.

Selenium: can raise Immunoglobulin G-2 and G-4.  This will decrease the number of infectious diseases and many also help with those children with intractable seizures.  We dose 10mcg of Selenium per 2  pounds of body weight up to a maximum of 100 mcg daily.  Once re-established in the body, levels can rise quickly and should be monitored erythrocyte levels (a blood test).

Chromium: this can aid in shifting Th2 to Th1 by promoting the formation of DHEA (which antagonizes cortisol).  We recommend starting with 50-100mcg for children we see in our clinic.

Vitamins A, C, E, and B6:  These vitamins are known to be absolutely necessary for normal immune system function.  Vitamin A, in Cod Liver Oil, is recommended to our patients with a starting dose of ½ tsp daily.  Vitamin C is started at 250mg to 500mg daily.  We recommend 100IU of Vitamin E.  B6 and its activated form, P5P, are usually always recommended.  We recommend 25-50mg P5P daily.

Fatty acids: omega 3, and omega 6 are usually needed.  The omega 3 fatty acids are supplied by Cod Liver Oil, DHA jr., and flax oil, Eskimo 3, and Coromega.  Omega 3's are also supplied by using high oleic safflower oil as cooking oil.  Omega 6's are also needed in some children.  A blood test, called the fatty acid profile, will reveal individual deficits and excesses.   

Amino acids: specific deficits can be determined with blood testing (plasma amino acid profile – quantitative).

Probiotics:  these are friendly bacteria that live in our gut.  They help to create an environment that is very hostile for yeast and unfriendly bacteria.  There are many good sources of probiotics:   Klaire Labs Ther-biotics, Culturelle, Primal Defense and Natren.  By removing the yeast and unfriendly bacteria, we can “unburden” the immune system of this task and see remarkable improvement in our children. We try many different ones and often have to change brands.

Colostrum: can also be considered transfer factor.  It appears to be toxic to many viruses and fungi (yeast) and promote repair of intestinal cells.

c.       Increased Detoxification

                                                     i.     Methylation Pathways GENOMICS testing can determine if there are problems in this pathway.  Specific supplements can raise the products of this pathway (Jill James, PhD).   We typically recommend: L methionine, TMG or DMG, and folinic acid, and methyl B12.. 

                                                    ii.     Sulphonation Pathways (MSM) These children classically dump sulfur and require replacement.  We do this with Epson salt baths, topical glutathione, topical N-acetyl cysteine, and MSM.  A word of caution, sulfur can enhance yeast growth.  We can start children with 250 mg of MSM twice daily. Glucosamine Sulfate (GS) may be even better if the early observations hold up.

                                                   iii.     Alpha Lipoic Acid (25-50mg daily) is a potent anti-oxidant that goes after free radicals. CAUTION – many children experience difficulty with this product. Some do great.

                                                   iv.     N-acetyl Cysteine  (125 – 250 BID) BUT NOT EARLY in treatment.  Plasma and intracellular cysteine can be measured with a blood test, and if low, can be given intravenously

                                                    v.     Milk thistle: this herb has demonstrated to help the liver with phase 1 detoxification (NONTOXIC)

                                                   vi.     Epsom salt baths: as explained elsewhere, this has wonderful detoxifying characteristics.  We recommend ½ cup per tub of water, 3-4 times weekly with a sprinkle of baking soda.

d.       Enhanced Cognitive Abilities

                                                     i.     B vitamins (NuThera or SNT) many children really respond to the B vitamins, especially B6, B12, and to magnesium.   

                                                    ii.     Essential Fatty Acids:  The children usually have such a poor dietary intake, and the “good” fats are no exception.  We will often get a blood test, “Fatty Acid Profile” and supplement according to the results.  It is safe to assume the children will need omega 3 fatty acids.  That is why we start with Cod Liver Oil. 

                                                   iii.     Minerals: Because of dietary limitations, many minerals are lacking.   

                                                   iv.     CoQ10

                                                    v.     NADH

                                                   vi.     TMG/DMG

                                                  vii.     Gingko Biloba?

                                                 viii.     DMAE –Tyler Sea Buddies: CONCENTRATE!

2)       Reduction of Autistic Behaviors

a.       Restoration of Neurotransmitter Function

                                                     i.     Normalized Neurotransmitter Levels (see below)

1.       Tyrosine, TMG, GA BA, NADH

                                                    ii.     Improved Receptor Site Activity

1.       TMG

2.       NADH (maybe)

                                                   iii.     Removal of Interfering Substances – False Transmitters

1.       DigestRight™ 1 cap with each meal

2.       Remove MSG, Nutrasweet, Aapartame, Hydrolyzed Vegetable Proteins Excitotoxins

3.       Food Dyes

4.       Reducing high phenol containing foods (blueberries, strawberries, etc.)

                                                   iv.     Protection from Excitotoxins

1.       Vitamin C 500-1000 mg daily          

2.       Vitamin E 100-200 IU daily             

3.       Magnesium 2mg per pound daily

4.       Grape Seed Extract (50 to 100mg/day – PhytoPharmica)

                                                    v.     Increase of the Seizure Threshold -Stabilization of Neuronal Cell Membrane Potentials

1.       EFA

2.       Taurine 250-500 mg daily

b.       Improve Gastrointestinal Function

                                                     i.     Improved Motility

1.       Fiber: always has been helpful for developing regular stooling behavior.  We currently are using Benefiber, available at most pharmacies.  The typical dose is 1 tsp in juice or water three times daily.  It dissolves completely and has no taste.

2.       Calcium: as previously discussed, calcium HAS to be supplemented in our dairy free kids.  We follow general RDA guidelines, 500 to 1000 mg daily given with magnesium. 

3.       Magnesium (avoid Magnesium Oxide)

                                                    ii.     Probiotics (Many products and we often have to rotate). These provide live cultures of Lactobacillus Acidophilus, Bifidobacterium and many others.  These friendly bacteria produce vitamin B complex and vitamin K.  We try to supplement with 20-40 billion organisms daily (1-2 capsules daily). Suppository?

                                                   iii.     Decreased Inflammation

1.       EFA: ProEPA, Eskimo Oil, Artic Orange CLO

2.       Grape Seed Extract (Up to 200mg daily)

3.       NAC (Caution with use early in ASD treatment), we use this in Intravenous form (IV) or oral

4.       Bromelain : 250 mg twice daily, contains pineapple (allergy in some) between meals -  found in the Enzyme Complete with DPP IV - (EZC – DPP-IV)for digestion not inflammation

3)       Nutritional Pharmacology for Specific Issues

a.       Hyperactivity

                                                     i.     Suspect Gluten/Casein leaks

                                                    ii.     GABA (500 – 1000mg TID)

                                                   iii.     Taurine (500 – 1000mg TID)

                                                   iv.     EFA (1000 – 2000mg QD)

                                                    v.     Calcium/Magnesium (doses vary)

                                                   vi.     TMG (125 BID and work the dose up slowly)

                                                  vii.     DMSA (chelation by protocol in selected cases only)

                                                 viii.     No refined Sugars

                                                    ix.     Elimination of Artificial Colors

                                                     x.     Magnesium glycinate (200 to 400mg twice daily)

b.       Poor Sleep

                                                     i.     Melatonin (1 –3 mg at bed): this may be split up twice daily if the child wakes up 1-2 am.  We can give .5mg in am and 1.5 mg in pm.  They may be sleepy during the day for a few days.

                                                    ii.     Taurine (1000 – 4000mg at bed)

                                                   iii.     GABA (1000 – 5000mg at bed)

                                                   iv.     TMG +/- (daytime doses set up a better sleep pattern in many children (250 – 750 mg)

                                                    v.     Magnesium 400-800 mg at bed

                                                   vi.     5HTP 50 to 100mg at bedtime

c.       Diarrhea: We often obtain an Xray of the abdomen as some times diarrhea is a sign of constipation.

                                                     i.     Colostrum (variable dosing)

                                                    ii.     Probiotics (Probiotic pearls, Primal Defense, Culturelle)

                                                   iii.     Digestive Enzymes (Food Sensitivity – Malabsorption – Osmotic) 

                                                   iv.     Cranberry Extract Yeast/Bacteria Fighter (1 – three times daily)

                                                    v.      Lauricidin ™ ¼ tsp three times daily titrate to stool consistency

                                                   vi.      various

                                                  vii.     TMG

                                                 viii.     Echinacea +/-

                                                    ix.     Aloe Extacts

                                                     x.     EFA 

                                                    xi.     Specific Rx Meds (Metronidazole Benzoate or Generic Flagyl, Vancomycin, Antifungals, Antiparasitics (Yodoxin – Bastocystisis)

d.       Constipation (Suspect and get the KUB – Toe-walking)

                                                     i.     Fiber (various –Benefiber, BasicGreen, UltraGreen, Citracel, ProEFA)  Soluble fiber is easily mixed in drink, has no flavor.

                                                    ii.     Xprep (Prune Concentrate)/ Fruit Eze

                                                   iii.     Senna- Smooth Move TEA!

                                                   iv.     Mineral Oil (caution re fatty acid and fat vitamin malabsorption) use for no more than two weeks)

                                                    v.     Aloe Resin (leaf not gel) can be harsh

                                                   vi.     PediFleets Daily if necessary until the plug is out

                                                  vii.     Miralax (Rx) ½ or 1 teaspoon daily as needed up to a tablespoon

                                                 viii.     HIGH dose Vitamin C

                                                    ix.     Milk of Magnesia (M.O.M.)