Subject: Nutrition_Autism.html
Nutritional Influences on Illness
by Melvyn R. Werbach
Nutritional Treatments for Autism
About 1 out of 2,000 children has infantile autism, a severe brain
disorder whose victims are unable to socialize normally and often
exhibit bizarre behaviors. Despite the severity of the disorder,
nutritional medicine may be of some assistance in its treatment.
Particularly exciting are the results of studies in which autistic
patients were supplemented with vitamin B6. For example, in one study,
autistic children who appeared to benefit from supplementation either
continued to receive the supplement or were switched to placebo under
double-blind conditions. Only those children who were withdrawn from
the supplement showed significant behavioral deterioration.1
Moreover, vitamin B6 supplementation changes the abnormal
electrophysiological and biochemical measures of autistic children to
more normal ones.2 Homovanillic acid is the principal derivative of
the neurotransmitter dopamine. While the supplement normally increases
urinary homovanillic acid excretion, it has been shown to decrease its
excretion in autistic children.3
Magnesium is usually added to vitamin B6 to prevent the vitamin
from causing magnesium depletion while also preventing the
irritability, sound hypersensitivity and enuresis that sometimes
follows B6 supplementation.4 While dosages vary, 500 mg of vitamin B6
is often given along with 250 mg magnesium. (Be aware that this large
a dose of the vitamin can, over time, cause a peripheral neuropathy.)
One crossed-sequential double-blind study found that a behavioral
improvement was only noted when the two nutrients were given together;
then urinary homovanillic acid excretion decreased and the EEG
cortical evoked potential normalized.5
The combination of vitamin B6 and magnesium does not cure autism,
but improvements are sometimes dramatic. Moreover, all of the more
than a dozen research studies, some of them double-blind, have
reported positive outcomes. When roughly 4,000 parents of autistic
children were asked to rate the various treatments, the nutrient
combination received the highest rating of any biomedical treatment,
with 8.5 parents reporting behavioral improvement for every parent who
reported worsening on the regimen. By contrast, thioridazine, the most
commonly used drug on the list, had an improvement to worsening ratio
of only 1.4 to 1.6
Supplementation with another B complex vitamin has also proven to
be beneficial in autism, although only for a specific sub-group of
autistic patients. Folic acid plays an important role in DNA
synthesis, repair and methylation.7 Tissue folate deficiency may
provoke chromosomal breakage at a fragile site, while folate
supplementation may interfere with the detection of constitutive
fragile sites.8
Behaviors from the autistic spectrum are often seen in males with
the fragile X syndrome, the most common known familial form of mental
retardation and developmental disability. Can folate supplementation
aid patients with this syndrome by reducing breakage at the fragile
site on the chrornosome? The results of studies have been mixed,
possibly because the earlier in life folate supplementation is
started, the more likely it is to be effective. In one study, for
example, boys with fragile X syndrome showed improvement in their
behavior as well as in their motor ability after receiving folate
supplements while adult males showed no change. Concurrently, the
fragile X positive cells of the autistic boys became rarer or
disappeared.9 Ten milligrams of folate daily for at least a few months
appears to be necessary to achieve changes.
Finally, some autistic patients are food-sensitive.10,11 Try
removing common foods from their diets for at least a week and see if
their behavior improves. If so, try to identify the inciting food(s)
by returning individual foods every two or three days and observing
for signs of regression.Doctor Werbach cautions that the nutritional
treatment of illness should be supervised by physicians or
practitioners whose training prepares them to recognize serious
illness and to integrate nutritional interventions safely into the
treatment plan.
References
1. Rimland, B et al. The effect of high doses of vitamin B6 on
autistic children: A double-blind crossover study. Am J Psychiatry
135:472-5, 1978.
2. Lelord G et al. Electrophysiological and biochemical studies in
autistic children treated with vitamin B6, in D Lehmann, E Callaway,
Eds. Human Evoked Potentials; Applications and Problems. New York,
Plenum Press, 1979.
3. Lelord G et al. [Modifications in urinary homovanillic acid after
ingestion of vitamin B6: Functional study in autistic children.] Rev
Neurol (Paris) 134(12):797-801, 1978.
4. Rimland B. An orthomolecular study of psychotic children. J
Orthomol Psychiatry. 3:371-7, 1974.
5. Martineau J et al. Vitamin B6, magnesium, and combined B6-Mg:
Therapeutic effects in childhood autism. Biol Psychiatry 20:467-78,
1985.
6. Rimland B. Controversies in the treatment of autistic children:
vitamin and drug therapy. J Child Neurol 3 Suppl:S68-72, 1988.
7. Heimburger DC. Localized deficiencies of folic acid in
aerodigestive tissues. Ann NY Acad Sci 669:87-96, 1992.
8. Yunis JJ, Soreng AL. Constitutive fragile sites and cancer. Science
226:1199-204, 1984.
9. Gustavson KH et al. Effect of folic acid treatment in the fragile X
syndrome. Clin Genet 27(5):463-67, 1985.
10. Torisky DM, Torisky CV, Kaplan S, Speicher C. The NAC pilot
project: a model for nutrition screening and intervention for
developmentally disabled children with behavior disorders. J Orthomol
Med 8(1):25-42, 1993.
11. Reichelt KL et al. Gluten, milk proteins and autism: Dietary
intervention effects on behavior and peptide secretion. J Appl Nutr
432(1):1-111, 1990.
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Subject: melatonin/iron/pineal/endocrine
query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8264970&dopt=Abstract
[_] 1: Neurosci Lett 1993 Sep 3;159(1-2):211-4 Related Articles,
Books, LinkOut
Effect of iron and estrogen on melatonin secretion by the
chicken pineal gland.
Pablos MI, Agapito MT, Recio JM, Perez-Gallardo L, Cordova MD,
Mori JO
Departamento Bioquimica, Biologia Molecular y Fisiologia,
Facultad de Ciencias, Valladolid, Spain.
Estrogen effects on pineal secretion of melatonin are
controversial. Some feel that estrogen inhibits melatonin
output in vitro but not in vivo. Melatonin levels vary with the
age in chickens where circulating estrogen levels also vary.
Laying hens have minimal melatonin levels and maximal serum
iron concentrations. Thus, we reasoned that iron released by
estrogen may inhibit melatonin secretion from the chick pineal
gland. The present study shows that perifusion of
estrogen-treated chick pineal glands with several
concentrations of iron greatly inhibited melatonin secretion.
PMID: 8264970, UI: 94088947
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Subject: melatonin
Melatonin - The Sleep Master
An emerging role for this over-the-counter supplement in the treatment
of autism.
Jaak Panksepp, Ph.D.
Bowling Green State University
Bowling Green, OH
One of the most co (HOME) mmon and most troubling times we experience is when
we or our children cannot fall asleep effectively. Autistic children
appear to be especially prone to this problem, and in has been
estimated that more than half exhibit some disturbance in sleep
patterns. This suggests some form of deficit in the brain systems that
normally promote sleep. During the past decade there has been great
progress in understanding the normal brain mechanisms which sustain
restful sleep. Since a great number of sleep promoting substances
exist in the brain and body, any of them might be deficient in
neurological condition we call autism. Here we will focus on one of
the major factors, melatonin, which is presently proving to be a
remarkably effective natural sleeping aid not only for restless
autistic children but also their often bedraggled parents.
As many parents have already discovered, this natural sleep molecule
is presently available over-the-counter at many health food stores and
distributors (although the ever present danger exists that
special-interests will succeed in coaxing the FDA into taking this
safe and effective aid off the shelves, as has already been done for
several other important supplements, most notably tryptophan). Of
course, as with any powerful and effective substance, there are
certain guidelines that one should follow to maximize benefits and
avoid problems. Although there are sound theoretical reasons for
believing that autistic children may be manufacturing either too much
melatonin (see Chamberlain & Herman, 1990) or too little, our own
viewpoint has been that many kids do not secrete enough (see Panksepp,
Lensing, Leboyer & Bouvard, 1991).
Unfortunately, there presently is simply not enough good data to
decide which viewpoint is correct. However, the fact that melatonin
can stabilize and promote normal sleep and daily bodily rhythms is
presently certain. However, it is important to learn how to use this
remarkably safe and powerful substance wisely. After briefly
summarizing how melatonin works in the brain, we will share some
important advice in the proper use of melatonin (including when it
should be given, how much should be given, and what to do if melatonin
stops working, as sometimes does happen). The first thing that is
important to know is that our brains contain a wonderful clock-like
mechanisms that normally keeps time with about a 24 Hr. period, but
its accuracy is controlled by many factors such as light (i.e.,..,
day-night cycles) and various brain chemicals, especially melatonin.
This clock-like control center is situated in two small clusters of
neurons at the base of the brain called the suprachiasmatic nuclei
(SCN) which, as the name implies, are situated directly above the
optic chiasm, the place where half the nerves from each of our eyes
cross over to the opposite halves of our brains. The many output
pathways from the SCN control practically all behavioral rhythms that
have been studied, from feeding to sleep. When both nuclei are
destroyed, animals scatter their behavior haphazardly throughout the
day instead of maintaining a well-patterned routine of daily
activities. Our own natural melatonin secretions, which normally occur
during the early morning hours when we have our deepest sleep,
coordinates the accuracy of the SCN clock. People who have lost their
sight, and hence are unable to coordinate their bodily clock via the
influence of natural day-night cycles, are able to stabilize their
rhythms by taking small amounts of melatonin at exactly the same time
each day. And that is really the secret to proper melatonin use--it
should be given only once a day in small amounts, and the proper time
is about half an hour before one's normal sleep-time.
Within our bodies, melatonin is naturally produced within the pineal
gland, a glandular organ nestled between the cerebral hemispheres,
that the great French philosopher Descartes once proposed to be the
"seat of the soul." In that gland, melatonin is synthesized in two
steps from the precursor neurotransmitter serotonin. Pineal stores of
melatonin are typically released into the circulation when
illumination diminishes, and may help explain why most of us sleep
better when the lights are off. During those morning hours when
melatonin levels begin to diminish, birds begin to sing and we also
tend to wake up, restored, to start our daily activities. It is easy
to understand why lack of sleep might increase behavioral and
psychological problems during the day. In addition, melatonin does a
remarkable number of beneficial tasks in the body: Not only is it a
powerful inducer of sleep, but it also regulates a variety of other
bodily processes ranging from brain maturation to the vigor of our
immune responses. It has been found to retard the growth of some
cancers, and quite independently of that beneficial effect, it can
also alleviate certain forms of anxiety and depression. Most
remarkably, given in the drinking water, it has increased life-span in
various experimental animals by about 20%. It also helps control the
onset of puberty during adolescence.
In short, melatonin exerts many beneficial effect on the brain and
body, but parents are well advised to follow certain guidelines in its
use as a sleep-promoting agent:
1. WHEN? It should be given only once a day, about half an hour
before the regular sleep-time. Supplementing with additional
melatonin in the middle of the night may be effective, but it is
not a smart policy, for that can shift the biological clock in
chaotic and undesirable ways.
1. HOW MUCH? Although melatonin is very safe (people have consumed
grams each day for many day with no ill effects), very small
amount can go a long way. Commercially available preparations
usually come in 2.5 or 3 milligram (mg) tablets, and a young child
should do well on a third of this amount. The higher amounts will
produce deeper sleep, but the hormone may still be circulating at
quite high levels in the morning, and there are reasons to believe
that is undesirable.
1. POTENCY CHANGE? Melatonin usually does not diminish in its effects
even with prolong use, but for unknown reasons, this is not the
case in all individuals. If a low dose of melatonin that has been
effective for some time seems to be losing its effect (i.e.,
tolerance is setting in), one is wiser to stop giving the
supplement for a while rather than increasing the dose. Some
parents seek to restore the desired effects by increasing the
doses, but that only seems to intensify the tolerance process. It
is better to take a week to a month off, and then see whether
sensitivity has returned. In our experience, sensitivity is
usually restored in this way. Many autistic children that have
been receiving melatonin on a regular schedule appear to exhibit
benefits above and beyond the improvements in sleep. They are more
"with it" during the day. These may be the side-benefits of the
still mysterious restorative processes that sleep provides for all
of us. Additional benefits may arise from the stabilization of
body rhythms that may have been out of synch before the melatonin
supplementation.
1. Although we do know that melatonin and sleep have many bodily
benefits, we do not have adequate evidence about the many "hows
and whys." Our knowledge of such matters has not progressed much
beyond Shakespeare's speculation that the function of sleep is "to
knit up the raveled sleeve of care" even though modern thinkers
are more likely to suggest that "sleep restores brain
neurochemistries and other bodily resources that have been
depleted by waking activities." Melatonin appears to be a prime
guardian of such restorative processes, and without it, our lives
become raveled indeed. It is likely that the for presently unknown
reasons, the brains of some autistic children are deficient in
this important chemistry. If so, early supplementation with this
hormone may be essential for normalizing development.
Unfortunately we know little about such matters, and only future
research can give us the answers that we desperately need now.
Chamberlain, R.S., & Herman, B.H. (1990) A novel biochemical model
linking dysfunction in the brain melatonin, proopiomelanocortin
peptides, and serotonin in autism. Biological Psychiatry, 1990, 28,
773-793.
Panksepp, J., Lensing, P., Leboyer, M., & Bouvard, M.P. (1991)
Naltrexone and other potential new pharmacological treatments of
autism. Brain Dysfunction, 4, 281-300.
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