STEP 10

Explore Additional Supplements

There are many other vitamins, minerals, antioxidants, amino acids, nutraceuticals, and herbs believed to benefit autistic children. These supplements are accepted and commonly used as advanced nutritional treatment in the autism community.

Before we get started, it’s important to understand that each of these advanced nutritional supplementations serves a very specific purpose, and not every autistic child needs them. Some autistic children will use most of them, other children only a few supplements, and still others should not try any advanced supplements because they aren’t appropriate for their individual conditions. Also, contrary to what many medical practitioners tell parents, you should not start your child on all of these supplements at once, nor should they all be used at the same time. Many parents end up purchasing dozens of expensive supplements and try to get their child to take all of these supplements every day, which never works. Doing so will only make you feel frustrated, overwhelmed, and totally disillusioned with all nutritional interventions. Treating autism is like running a marathon—you need to start slowly and pace yourself. Work with your child’s registered dietitian or nutrition-oriented physician to figure out which advanced supplements, if any, might be appropriate for your child. Lastly, do not even attempt to implement this step until your child has mastered the first nine steps of my program. His basic nutrition must be in place before you delve into more advanced interventions.

ADVANCED SUPPLEMENTS

Since there are so many advanced supplements to consider, it’s easiest to group them together by their intended purpose. Some supplements are used to enhance the detoxification or immune systems, some to enhance cognitive function, and others to improve behavioral or other autistic symptoms. You’ll quickly see which groups of supplements may be appropriate to treat your child’s individual symptoms. Please note that the groupings are not all-inclusive but rather a general guideline to help you start a discussion with your child’s registered dietitian or physician. A few of these supplements are considered controversial and are not recommended by some medical professionals. You’ll need to work with someone who’s willing to have open discussions about all of these supplements so you can make a well-informed decision regarding their use for your child.

Supplements to Enhance Cognitive Function

The following supplements are used because of their ability to enhance a child’s comprehension, reasoning, decision making, planning, and learning abilities:

• carnitine

• choline

• coenzyme Q₁₀ (CoQ₁₀)

• iron

• zinc

Carnitine

Carnitine is the generic term for the compounds L-carnitine, acetyl-L-carnitine, and propionyl-L-carnitine. It’s synthesized in the body from the essential amino acids lysine and methionine. Carnitine plays a critical role in energy production, transporting long-chain fatty acids into the mitochondria so they can be burned to produce energy. It then transports waste out of the cell to prevent waste accumulation. Carnitine may also have brain and central nervous system protection abilities, cardio protective activity, triglyceride-lowering effects, and antioxidant properties. One research study has suggested that 50 percent of boys with ADD have a positive response to L-carnitine supplements.

A deficiency in carnitine can cause your child to have muscle weakness, hypoglycemia , and elevated blood-ammonia concentrations. Carnitine deficiencies can be caused by valproic acid, which is a medication used to treat seizures, as well as some antibiotics. There’s also a genetic disorder called primary carnitine deficiency, which manifests by five years of age, in which a child’s carnitine transporters don’t work properly. I recommend that you ask your child’s physician to order a carnitine blood test to determine if he has a deficiency and needs supplementation. The following are carnitine-rich foods:

meat (the redder the meat, the higher the carnitine content)	milk
	dairy products (in the whey component)
fish
poultry

 

To determine if your child may benefit from carnitine supplementation, you should do a trial response under the supervision of his doctor. (See page 124 in Step 9 for a refresher on how to conduct a trial response. You’ll find trial response forms in Appendix 5 that you can use to document your child’s symptoms and response to carnitine.) Be on the lookout for symptoms of excess carnitine, such as nausea, vomiting, abdominal cramps, and diarrhea. Carnitine is available by prescription under the brand name Carnitor and the generic levocarnitine and over-the-counter in the form of L-carnitine and acetyl-L-carnitine. There is currently no RDA for carnitine. For dosage recommendations for over-the-counter carnitine, refer to the PDR for Nutritional Supplements.

Choline

Choline is a water-soluble nutrient that the body needs to make several important compounds necessary for healthy cell membranes. It’s a component of phosphatidylcholine (lecithin) and the neurotransmitter acetylcholine, which is one of the crucial brain chemicals involved in memory. Choline is also a precursor for the methyl donor trimethylglycine (TMG). A few reports indicate that choline can improve short-term memory skills and enhance memory in poor learners. The Food and Nutrition Board of the National Academy of Sciences recommends that pregnant and nursing women increase their intake of choline to help ensure normal fetal brain development. The American Academy of Pediatrics (AAP) recommends that infant formula contain choline. There’s currently no RDA for choline, but the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences has established Adequate Intakes, which are listed in Appendix 3. The following are choline-rich foods:

organ meats	pork	nuts
egg yolks	fish	beans
beef	poultry	peanut butter
soy protein powder	cauliflower	Brussels sprouts

 

Too much supplemental choline has been reported to cause nausea, diarrhea, and loose stools. Supplemental choline comes in several different forms, and I recommend that you stay away from choline in the form of choline bitartrate. There are indications that it may increase symptoms of depression.

Coenzyme Q₁₀

Coenzyme Q₁₀ is a fat-soluble substance that belongs to a family of substances called ubiquinones. CoQ₁₀ has antioxidant properties that protect the central nervous system and the brain from neurodegenerative diseases. Since CoQ₁₀ is recognized as such an important antioxidant for the brain, it’s commonly added to daily multivitamin and mineral supplements. Check your child’s daily supplement to see if he’s already getting CoQ₁₀. If so, an additional supplement isn’t necessary. If you do decide to try your child on a CoQ₁₀ supplement, discuss dosage with your child’s registered dietitian or physician, as there’s no RDA for CoQ₁₀. For dosage recommendations, I refer to the PDR for Nuttritional Supplements. Excess amounts of CoQ₁₀ can cause your child to experience mild gastrointestinal symptoms such as nausea, diarrhea, and indigestion. The following are CoQ₁₀-rich foods:

meat	fish	nuts
poultry	soybean oil	canola oil

Iron

Iron is an essential trace mineral that’s critical to your child’s brain function. It transports oxygen to cells throughout the body, helps produce carnitine, and is involved in the production of the neurotransmitters serotonin, dopamine, and norepinephrine. Iron is also important to your child’s immune function, increasing his resistance to disease and infections. If your child is suffering from an iron deficiency , it can prevent his brain cells from getting the proper amount of oxygen, which can result in compromised mental function, apathy, short attention span, irritability, decreased ability to learn, and impaired school performance. He may also be more vulnerable to Candida, viruses, and other pathogens. There are several routine blood tests, such as the serum ferritin, total iron binding capacity, hemoglobin and hematocrit tests, that can identify whether your child has even a mild case of iron deficiency anemia. Research studies show that when children with iron deficiency anemia take an iron supplement, their cognitive skills improve and their learning problems diminish.

Since iron is so critical to your child’s health, it should already be included in his daily diet through food or a multivitamin and mineral supplement. The following are iron-rich foods:

organ meats	beans	tofu
red meat	soybeans	spinach
fish	lentils	peas
poultry	blackstrap molasses	raisins

 

If your child doesn’t have an iron deficiency and is already getting 100 percent of his RDA for iron, I don’t suggest giving him an additional supplement. If too much iron builds up in the body, it can lead to the formation of harmful free radicals that damage cells and contribute to cancer. If tests show your child does suffer from an iron deficiency and requires iron supplementation beyond his RDA, a physician should prescribe it.

Taking too much iron at one time is toxic and can have serious consequences, such as the following:

vomiting	renal failure	lethargy
diarrhea	shock	hypoglycemia
central nervous	coma	liver damage
system depression

 

It’s extremely important to keep iron supplements in a childproof bottle and away from children. You can find your child’s RDA and Tolerable Upper Intake Level (UL) for iron in Appendix 3.

Zinc

Zinc is an essential mineral involved in the activity of more than one hundred enzymes in the body. Perhaps most importantly, zinc is required for the development and activation of T-lymphocytes, which are the white blood cells that fight infection. Like iron, it’s important for your child’s growth and development and should already be included in his daily diet through food or a multivitamin and mineral supplement. A zinc deficiency can result in immune dysfunction, growth retardation, loss of appetite, diarrhea, and mental lethargy. Even a moderate zinc deficiency will negatively affect your child’s immune system. (Too much zinc will also impair your child’s immune function.) The following is a list of zinc-rich foods:

oysters and some other types of seafood	beans	poultry
fortified breakfast cereals	nuts	dairy products
red meat	whole grains

 

You can find your child’s RDA and UL for zinc in Appendix 3.

SUPPLEMENTS TO ENHANCE THE IMMUNE SYSTEM

• Dimethylglycine (DMG)

• Iron

• Magnesium

• Selenium

• Vitamin A

• Vitamin C

• Vitamin D

• Vitamin E

• Zinc

By now you know that many medical professionals within the autism community believe that autistic children are more prone to immune system dysfunction than other children. Physicians who treat autism with alternative and complementary interventions often recommend controversial treatments such as intravenous immune globulin (IVIG), oral immunoglobulin (OIG), transfer factors, and antiviral, antifungal, and antibacterial medications. Many parents prefer to play it safe by sticking with vitamins, minerals, and nutrients that naturally enhance their child’s immune system. Your child’s registered dietitian can help you ensure he’s getting enough iron, magnesium, selenium, zinc, and vitamins A, C, D, and E through food and/or a daily multivitamin and mineral supplement. Your child should be taking in at least his RDA but should not exceed his UL.

Dimethylglycine (DMG)

Dimethylglycine is a water-soluble substance found naturally in animal and plant cells. Animal research indicates that DMG may support the immune system. Some foods that are rich in dimethlyglycine are beans, cereal grain, and liver. The PDR for Nutritional Supplements suggest the typical dose is 125 mg per day. DMG is nontoxic, and no adverse reactions have been reported.

In the autism community, many have reported that DMG can improve an autistic child’s behavior, eye contact, and expressive language. Unfortunately, the three small research studies that have been conducted on DMG and autism don’t support this. Still, parents continue to try DMG with their autistic children, and it remains one of the most popular supplements. If you are interested in trying DMG to enhance your child’s expressive language, you can check the Autism Research Institute Web site for dosage suggestions for your child. I encourage you to first talk with his registered dietitian or physician before starting a trial response to determine if he’s a positive responder to DMG.

David’s Story

Five-year-old David was diagnosed with autism. He made little eye contact, repeated words in place of normal language, lined up toys, had numerous tantrums and behavioral problems, was easily frustrated, and had difficulty falling and staying asleep at night. David’s mother said he had developmental delays since birth. He’d had frequent ear infections as an infant that were treated with numerous rounds of antibiotics. He suffered with loose stools, was gaseous, and never had normal formed bowel movements. He also had a history of frequent illnesses such as colds, bronchitis, and pneumonia. David refused to eat any fruits or vegetables and consumed a very limited variety of foods. An IgE RAST allergy test indicated that he was allergic to egg white, but eggs hadn’t been eliminated from his diet. The only supplement David was taking was a liquid baby vitamin supplement. David’s parents had not tried any nutritional interventions or dietary changes before consulting with me.

I had the opportunity to work with David over several months and help his parents implement the entire 10-Step Nutrition Plan. His parents were eager to get started and quickly completed steps 1 and 2. The entire family transitioned to consuming healthier, whole, organic foods and avoided foods with trans fat, excess sugar, and refined carbohydrates. David’s parents made sure he was consuming adequate protein, healthy fats, complex carbohydrates, and filtered water on a daily basis. Step 3 and 4 were quickly and easily achieved by replacing the liquid baby vitamin supplement with a children’s daily multivitamin and mineral supplement and starting David on an omega-3 fatty acid supplement. To address his refusal of fruits and vegetables and his limited food repertoire, David began feeding therapy at a private out-patient feeding clinic (Step 5). Since he had gastrointestinal problems, we initiated the gut healing program (Step 6) using probiotics, digestive enzymes, and antifungals, which resolved his runny, loose stools. We knew that David might be allergic to egg white, so we conducted an elimination/challenge diet (Step 7) to determine if he had any negative reactions. He didn’t, so eggs were allowed to remain in his diet. Then we began to transition David to the GFCF diet (Step 8). Soon he no longer had sleep problems and his excess gas and bowel problems were resolved, so the GFCF diet was continued. David’s parents were interested in how David would respond to high dose vitamin B₆ (Step 9), so we conducted a one-month trial response. It was determined that David was not a positive responder, and the high dose vitamin B₆ was discontinued. After completing steps 1 through 9, David had significant improvements in his bowel function, sleep, behavior, feeding problem, and overall autistic symptoms.

David’s parents wanted to begin Step 10 and address some of the individual issues impacting David. We first considered trying additional nutritional supplements to enhance his immune system, since he had a history of frequent illness. David’s frequent illnesses were a serious concern for his parents because during the winter months David was always sick, missed an extensive number of days from school, and regressed academically. He also missed out on critical speech and occupational therapy sessions, which slowed down his progress. I assessed David’s diet and vitamin and mineral supplement to make sure he was getting at least 100 percent of his RDA for the nutrients critical for immune function—iron, magnesium, selenium, zinc and vitamins A, D, and E. I also suggested an additional supplement of 200 mg vitamin C and 125 mg dimethylglycine (DMG) to support the immune system. David’s mother reported that this was the first winter during which he didn’t suffer from any colds or bronchitis and wasn’t hospitalized for pneumonia. She was thrilled that David was able to get through the entire winter without getting sick, being absent from school, and missing speech and occupational therapy sessions.

Magnesium

Magnesium plays a role in more than three hundred biochemical reactions in the body. Its numerous functions include supporting the immune system, helping to build bones, regulating blood sugar levels, protein synthesis, energy metabolism, maintaining normal nerve function, and regulating heart rhythm. If your child isn’t getting enough magnesium, he may experience a loss of appetite, confusion, diarrhea, nausea, fatigue, and muscle weakness. Here are some magnesium-rich foods:

Taking too much magnesium in supplement form often causes diarrhea, nausea, and abdominal cramping. Appendix 3 shows your child’s RDA and UL for magnesium.

Selenium

Selenium is a trace mineral that the body requires only in very small amounts. Its most important role is as an antioxidant that helps prevent cellular damage caused by free radicals. Selenium also helps support the immune system, regulate thyroid function, protect against some cancers, and rid the body of heavy metals by forming an inactive complex with these metals. If your child suffers from a selenium deficiency, it can weaken his immune system, cause hypothyroidism, spur the development of heart disease, and increase his risk of some cancers. If your child has a gastrointestinal problem such as chronic diarrhea and inflammation, he has an increased risk for selenium deficiency because his body is less able to absorb it. The following are selenium-rich foods:

Taking too much selenium can result in selenosis, the symptoms of which include irritability, fatigue, nausea, vomiting, garliclike breath, hair loss, and white, blotchy nails. See Appendix 3 for your child’s RDA and UL for selenium.

Vitamin A

Vitamin A is actually a group of fat-soluble substances. Preformed vitamin A, or vitamin A that occurs in a form ready to be used by the body, is found in animal sources. Carotenoids are found in plant sources and must be converted to vitamin A. (You’ve probably heard of beta carotene, which is the most common carotenoid.) Vitamin A is critical to the proper functioning of the immune system. It’s involved in making white blood cells, which destroy harmful bacteria and viruses. Vitamin A also plays a major role in vision, brain development, growth, and bone development, and its antioxidant properties may help prevent cancer. If your child has a vitamin A deficiency, it will compromise his immune system and make him susceptible to many types of infection. Even a mild deficiency can cause a loss of appetite, decreased growth rate, slow bone development, and night blindness. Some foods that are rich in preformed vitamin A are:

Here are some carotenoid-rich foods:

Too much vitamin A can result in hypervitaminosis A, a condition where high levels of the vitamin are stored within the body. This excess of vitamin A can be toxic and cause reactions such as nausea, vomiting, headache, muscular uncoordination, reduced bone density, liver damage, and birth defects. Hypervitaminosis A typically occurs only when taking preformed vitamin A supplements. Turn to Appendix 3 to find your child’s RDA and UL for vitamin A.

Vitamin C

Vitamin C is a water-soluble vitamin that performs a variety of important functions. It helps support the immune system; in fact, several research studies indicate that vitamin C decreases the incidence, duration, and severity of the common cold. Its antioxidant properties help prevent chronic diseases such as cancer, heart disease, and cataracts caused by oxidative damage. Vitamin C increases the body’s ability to absorb iron, heal wounds, and protects against asthma. Vitamin C is a cofactor in the carnitine transport system and the conversion of tryptophan to serotonin, and it preserves intracellular glutathione concentrations. It also plays a major role in the detoxification system, helping the body get rid of pesticides and heavy metals. Research indicates that high serum levels of ascorbic acid (the major dietary form of vitamin C) are associated with a decreased incidence of high blood lead levels. One research study indicated that ascorbic acid had chelating properties comparable to EDTA, a lead-chelating agent, and is equally able to lower blood-lead levels. (See the section about Chelation Therapy on page 140 for more on this topic).

If your child is vitamin C deficient, his wounds may not heal as quickly, he may have a lower resistance to colds and infections, and he may be more susceptible to a variety of chronic diseases. In severe instances, scurvy can occur, which causes bleeding gums, loosened teeth, muscle weakness, fatigue, loss of appetite, diarrhea, pulmonary problems, and kidney problems. Here are some vitamin C-rich foods:

Since excess vitamin C is excreted in the urine, your child can consume large amounts without risk to his health. However, large doses for an extended period of time sometimes result in problems such as nausea, vomiting, stomach cramps, and diarrhea. You can find your child’s RDA and UL for vitamin C in Appendix 3. For suggested dosages to enhance the immune and detoxification systems, his dietitian may refer to the PDF for Nutritional Supplements.

In the autism community, vitamin C gained attention because emerging research showed that magadoses of vitamin C had a positive effect on the behavior of autistic children. If you are interested in conducting a trial response of high dose vitamin C to see if your child is a positive responder, be sure to discuss dosage with your child’s registered dietitian or physician.

Vitamin D

Vitamin D is a fat-soluble vitamin that aids in the absorption of calcium and phosphorus, helping to form and maintain strong bones and teeth. Vitamin D supports the immune system by boosting natural killer cells. Recent research suggests vitamin D may provide protection from certain cancers, type I and type II diabetes, glucose intolerance, high blood pressure, cochlear deafness, and multiple sclerosis. There’s also speculation that it plays a role in modulating mood by affecting serotonin levels in the brain. In children, vitamin D deficiency causes rickets, which results in skeletal deformities, soft bones, muscle weakness, and delayed development of teeth. Deficiencies are most often found in children who follow a milk-free or strict vegetarian diet. Some foods that are rich in vitamin D are (note: Vitamin D is also produced by our bodies when our skin is exposed to sunlight):

cod liver oil	sardines	eggs
salmon	fortified milk	liver
mackerel	fortified margarine	cheese
tuna fish	ready-to-eat cereals

 

Too much vitamin D can result in symptoms such as nausea, vomiting, weakness, weight loss, constipation, poor appetite, headache, and confusion, though this is unlikely to occur from eating vitamin D food sources. Toxicity is more likely to occur from taking too much of a supplement, such as cod liver oil. Appendix 3 lists your child’s RDA and UL for vitamin D.

Vitamin E

Vitamin E is a fat-soluble vitamin that exists in eight different forms, with alpha-tocopherol the most active form. It works to support the immune system and has powerful antioxidant properties that protect cells against the damaging effects of free radicals that may contribute to chronic diseases and cancer. Its antioxidant properties also work to protect the brain and central nervous system. A vitamin E deficiency can result in peripheral neuropathy (the degeneration of nerves in the hands and feet) and increase the risk of cancer, Alzheimer’s disease, and heart disease. Even the slightest vitamin E deficiency can impair your child’s immune function. Here are some vitamin E-rich foods:

wheat germ	vegetable oils
nuts and seeds	green leafy vegetables

 

Too much vitamin E isn’t toxic, but since it acts as an anticoagulant, taking an excess amount can increase the risk of prolonged bleeding. Appendix 3 lists your child’s RDA and UL for vitamin E.

SUPPLEMENTS TO ENHANCE THE DETOXIFICATION SYSTEM

• Alpha-Lipoic Acid

• Glutathione

• N-acetylcysteine (NAC)

• Selenium

• Trimethylglycine (TMG)

• Vitamin C

Many people in the autism community also believe that autistic children have a dysfunctional detoxification system within their liver. The theory goes that an autistic child’s liver can’t effectively excrete toxins such as mercury, lead, arsenic, pesticides, herbicides, certain solvents, and other chemicals. Toxins that aren’t excreted can cross the blood-brain barrier, cling to brain tissue, and damage the brain; therefore autistic children are more vulnerable to neurological damage caused by exposure to these toxins. Neurotoxin chemicals are particularly dangerous to the rapidly developing brain of a fetus, infant, and young child. Exposure to neurotoxins at these vulnerable times may result in learning disabilities, attention deficit, hyperactivity, impulsiveness, aggressive behavior, speech delay, lower I.Q., and mental retardation. To learn more about neurotoxins and the impact they can have on your child, I recommend you read the report “In Harm’s Way: Toxic Threats to Child Development,” which you can find at www.igc.org/psr. This excellent resource discusses the environmental factors that contribute to learning, behavioral, and developmental disabilities in our children.

Chelation Therapy

Physicians who use alternative and complementary interventions to treat autism often recommend a highly controversial treatment called chelation therapy. In chelation therapy, a drug that binds to heavy metals in the blood, such as EDTA, DMSA, or DMPS, is infused intravenously into your child’s body to help eliminate toxins through urine and stool. Chelation therapy is typically used to treat mercury and lead poisoning that involves life-threatening high levels; not chronic, low-level exposure to toxins. This treatment method is controversial because little scientific research has been done to establish its effectiveness to treat autism, and it may pose serious risks to your child. Chelation therapy can lead to mineral depletion, the rupture of blood cells, liver damage, and bone marrow suppression. Some children have died because of medication errors. If you decide to try chelation therapy, your child’s kidney and liver function and blood composition has to be closely monitored to avoid potential damage.

The effects of chronic, low-level exposure to multiple toxic chemicals on your child should be taken seriously, but I recommend you consider a less controversial treatment. Vitamins, minerals, sulfur-containing amino acids, nutraceuticals, and dietary modifications can all work to naturally enhance your child’s detoxification system. Turn to Appendix 6 on page 237 for my comprehensive nutritional plan to enhance detoxification, which includes reducing exposure to toxins, following a protective diet, and choosing nutrients to support your child’s detoxification function.

Alpha-Lipoic Acid

Alpha-lipoic acid is a disulfide compound found in plant and animal sources. It functions as an antioxidant, helps the immune system, and may have anti-aging effects. Alpha-lipoic acid plays a critical role in the detoxification system as a precursor to L-cysteine and recycler of glutathione, an important antioxidant that helps eliminate toxins from the body. In fact, alpha-lipoic acid actually has the ability to increase glutathione levels in the body. Here are some alpha-lipoic acid-rich foods:

organ meats	broccoli	Brussels sprouts
spinach	peas	tomatoes

 

There’s been no report of adverse reactions to taking too much alpha-lipoic acid. Still, you should consult with your child’s registered dietitian or physician for dosage recommendations. I suggest dosages suggested in the PDR for National Supplements.

Glutathione

Glutathione is a tripeptide made within the body from the amino acids cysteine, glutamate, and glycine. As I mentioned above, glutathione is critical for your child’s detoxification system. It’s a cofactor for the glutathione S-transferase enzymes involved in the detoxification of chemical toxins. It also functions as an antioxidant and helps the immune system work properly. Glutathione in supplement form is not well-absorbed in the gastrointestinal tract, so it’s not usually recommended as an oral supplement. The way around this problem is to take the precursors—that is, the molecules the body needs to make glutathione—rather than glutathione itself. The major precursors of glutathione are L-cysteine and N-acetylcysteine (NAC), both of which are available in supplement form. The glutathione precursor cysteine is found in high-protein foods such as the following:

There’ve been no reports of adverse reactions to taking too much glutathione orally. However, medical professionals advise using caution with L-cysteine supplements because no long-term safety studies have been done. In fact, most medical practitioners suggest that children avoid L-cysteine in supplement form. NAC is the preferred supplement for both adults and children because the body absorbs it better than glutathione. NAC supplements can cause nausea, vomiting, diarrhea, headache, and rashes. If you’re interested in supplementing your child with NAC, it’s crucial that you discuss dosage with his registered dietitian or physician, who may refer to the PDR for National Supplements.

Trimethylglycine (TMG)

Trimethylglycine, also known as betaine, is a water-soluble substance related to choline. An important function of TMG is its ability to donate a methyl group and convert homcysteine to methionine, which is then converted to S-Adenosyl-L-Methionine (SAMe). SAMe may have a positive effect on mood, emotional well-being, and depression. SAMe may also play a role in detoxification by increasing glutathione levels in the liver. (Please note: SAMe in supplement form is not recommended for use in children.) TMG works closely with other methyl donors, such as choline, folic acid, vitamin B₁₂, and SAMe, and it plays an important role in the production of carnitine. Once TMG has donated a methyl group, it becomes DMG, which has also been identified as having potential positive benefits in autistic children (see page 133 for more on DMG). Trimethylglycine can be found in foods such as sugar beets, spinach, wheat, and shellfish.

There are no reports of adverse reactions to a TMG overdose, but some people have reported experiencing nausea, vomiting, and diarrhea. Experts estimate that people who eat a regular diet that contains whole wheat and seafood get approximately 100-1,000 mg of TMG per day, so if you want to conduct a trial response of supplemental TMG, I suggest basing your child’s dosage amount on what’s found in a typical diet. I also encourage you to discuss specific dosages for your child with his dietitian or physician.

OTHER SUPPLEMENTS OF INTEREST

These supplements have generated a lot of interest in the autism community, as many parents and medical practitioners have found them beneficial for autistic children. If you’re interested in trying your child on one or more of these supplements, do a one-month trial response to determine if he’s a positive responder or not. If you find the supplement isn’t helping your child, stop giving it to him.

Carnosine

Carnosine is a dipeptide (a combination of two amino acids—alanine and histidine) that’s highly concentrated in brain and muscle tissue. It functions as a powerful antioxidant, protecting the body from free radicals, and also plays a part in neurotransmission. It’s sold as a supplement under the name L-carnosine. An eight-week research study in 2002 published in the Journal of Child Neurology reported that children with autism who were supplemented with 400 mg of L-carnosine twice a day showed improvement in behavior, socialization, communication, and an increase in their language comprehension. Carnosine can be found in meat, poultry, and fish.

Too much L-carnosine can result in irritability, hyperactivity, and insomnia. If you want to try your child on an L-carnosine supplement, you should do so only under medical supervision.

Flavonoid

Flavonoid, or bioflavonoid, refers to a class of compounds found in plants. They are known most commonly for their antioxidant properties, but recent research has shown that flavonoids also have anticancer, antimicrobial, anti-allergic, and anti-inflammatory properties. The most common flavonoid used to treat autism is oligomeric proanthocyanidins (OPC). It’s thought to improve the symptoms of ADHD, but there have been few research studies done to substantiate this belief. Flavonoids can be found in citrus fruits, berries, tea, ginkgo biloba, red wine, and dark chocolate.

Only a small amount of flavonoid is necessary for health benefits. Taking too much in a dietary supplement not only provides no additional benefit; it may actually be harmful. If you want to see if supplemental OPC improves your child’s ADHD symptoms, talk to his registered dietitian or physician about dosage before starting a one-month trial-response.

Vitamin B₁₂

Vitamin B₁₂ in the form of methylcobalamin, also known as methyl-B₁₂, has become a very popular supplemental nutritional intervention for autism. It’s theorized that autistic children may have abnormalities in their methylation pathways, which affect their bodies’ ability to maintain the myelin sheath (the layer of insulation covering the axon of nerve cells in the brain) and produce neurotransmitters. Vitamin B₁₂, folic acid, and vitamin B₆ (in the form of pyridoxal 5 phosphate) work in conjunction with each other to convert homocysteine to methionine, which is then converted to S-adenosylmethionine (SAMe). SAMe is the major methyl group donor in methylation reactions. Since vitamin B₁₂ is a key cofactor in methylation, large doses of the vitamin may help correct abnormalities in your child’s methylation pathway.

Vitamin B₁₂ is difficult for the body to absorb through the gastrointestinal tract. Those who have a gastrointestinal disorder, an intrinsic factor deficiency, low hydrochloric acid in the stomach, bacterial overgrowth in the small intestines, parasites, an inflammatory bowel disorder, or gastrointestinal problems such as chronic diarrhea and inflammation have even greater trouble absorbing B₁₂ and are particularly at risk for a deficiency. If your child has a B₁₂ deficiency, he may experience symptoms such as weight loss, loss of appetite, diarrhea, constipation, abdominal pain, and a burning sensation in his tongue called glossitis. He may also experience cognitive changes and memory loss. Vitamin B₁₂ can be found in egg yolks, clams, oysters, crabs, sardines, salmon, and fortified cereals.

Unlike the other supplements I’ve discussed, methyl-B₁₂ is administered by injection to maximize absorption within the body. There have been anecdotal reports of remarkable improvements in autistic children taking methyl-B₁₂ injections, but so far there’s been no supporting evidence from published research studies. If you want your child to try a trial response of high dosage methyl-B₁₂ injections, discuss it first with his physician.

Supplements Can Be Toxic

It’s extremely difficult to take in too much of a vitamin or mineral through diet alone, but supplements are a different story. To avoid the risk of toxicity, do not exceed your child’s UL for a particular vitamin or mineral unless his registered dietitian or physician recommends it and is monitoring his progress. Also, make sure that any potential adverse reactions are clearly explained to you.

PROJECT NO. 10

1. As you read through this chapter, make a list of the supplements that might benefit your child based on his symptoms.

2. Take your list to your child’s registered dietitian or physician and discuss which supplements are appropriate for him. Here’s a list of questions I suggest you ask regarding the supplements I discuss in this chapter:

• Which of these nutrients can my child get from food?

• Is my child already getting enough of any of these nutrients from his current multivitamin and mineral supplement?

• Are there any lab tests required prior to taking the supplements? (Basic lab tests are listed in Appendix 7.)

Regarding each individual supplement you’re considering for your child:

• What type of symptom relief should I expect?

• Are there any potential side effects or adverse reactions?

• Are there any potential interactions with my child’s medications?

• What is a safe and effective dosage for my child?

• How long should he take the supplement?

• How do I assess the effectiveness of the supplement?

• Is this particular supplement intended for short-term or long-term use?

• When should I discontinue the supplement?

3. Together, develop a plan to incorporate the supplements you choose to try into your child’s current nutritional care plan.

Congratulations—you’ve reached the end of my 10-Step Nutrition Plan, and hopefully you’ve seen some exciting and encouraging improvement in your child’s symptoms. Keep in mind that, as with any treatment, some of these nutritional interventions will be very helpful for your child and some will not. Improving your child’s nutritional status is an ongoing and often slow process. But if you’re consistent, patient, and maintain a positive attitude, you will find the right nutritional path for your child. Enjoy the journey!