Physical Health Profile of the Autistic Child strongly tends toward:

1. Gastrointestinal Abnormality

• Malabsorption (J. Autism/Childhood Schizo, 1971 1(1):48-62)
  • freq. reports acholic stools, undigested fibers, positive Sudans.
  • 85% of autistics meet criteria for malabsorption (B.Walsh, 500 pts)
• Maldigestion--elevated urinary peptides
  • P Shattuck (Brain Dysfunct 1990; 3: 338-45 and 1991; 4: 323-4)
  • KL Reicheldt (Develop Brain Dys 1994; 7: 71-85, and others)
  • Z Sun and R Cade (Autism 1999; 3: 85-96 and 1999; 3: 67-83)
• Microbial Overgrowth--fungal, bacterial and viral
  • William Shaw, Biological Basis of Autism and PDD, 1997.
  • E Bolte on Clostridium (Med Hypoth, 1998; 51: 133-144)
  • P Shattock and A Broughton IAG elevations
  • W Walsh and W McGinnis pyrrole elevations
  • Andrew Wakefield, Lancet 1998; 351: 637-4)
  • TJ Borody, Center for Digestive Diseases, New S. Wales, Austral.
• Abnormal Intestinal Permeability
  • P D'Eufemia (Acta Pediatr 1995; 85; 1076-9)
• G.I. Symptoms reported by parents: diarrhea, constipation, gas, belching, probing, visibly undigested food and need for rubs

2. Compromised Immunity

• Recurrent Infections
  • Euro Child/Adolesc Psych, 1993:2(2):79-90
  • J Autism Dev Disord 1987; 17(4): 585-94
• Abnormal Indices
  • T-cell Deficiency (J Autism Child Schizo 7:49-55 1977)
  • Reduced NK Cell Activity (J Ann Acad Chil Psyc 26: 333-35 '87)
  • Low or absent IgA (Autism Develop Dis 16: 189-197 1986)
  • Low C4B levels (Clin Exp Immunol 83: 438-440 1991)
• Skewed ("elevated") Viral Titers increasing grass-roots reports V Singh University of Michigan

3. Detoxification Weakness

• Phase II Depression (S. Edelson, DAN Conference Sept, 1997, and Toxicology and Industrial Health 14 (4): 553-563 1998)
  • Sulphation low in 15 of 17 (mean 5 vs. nl 10-18)
  • Glutathione Conjugation low in 14 of 17 (mean 0.55 vs 1.4-2.9)
  • Glucuronidation low in 17 of 17 (mean 9.6 vs. 26.0-46.0)
  • Glycine Conjugation low in 12 of 17 (15.4 vs. 30.0-53.0)
• Sulphation Deficit (Biol Psych 1; 46(3): 420-4, 1999)
• Peroxisomal Malfunction (P Kane, J of Orthomolec Med 1997; 12-4: 207-218 and 1999; 14-2: 103-109)
• Higher blood lead levels in Autism and documented response to EDTA Chelation (Am J Dis Chld 130: 47-48, 1976)
• Apparent temporal association autism onset and lead exposure (Clinical Pediatrics 27: 1; 41-44 1988)

4. Abnormal Nutritional Profile in Children with Autism

• Lower serum Magnesium than controls (Mary Coleman, The Autistic Syndromes 197-205, 1976)
• Lower RBC Magnesium than controls (J. Hayek, Brain Dysfunction, 1991)
• Low activated B6 (P5P) in 42%. Autistic group also higher in serum copper. (Nutr. and Beh 2:9-17, 1984)
• Low EGOT (functional B6) in 82% and all 12 subjects low in 4 amino acids (tyrosine, carnosine, lysine, hydroxylysine). Dietary analysis revealed below-RDA intakes in Zinc (12 of 12 subjects, Calcium (8 of 12), Vitamin D (9 of 12), Vitamin E (6 of 12) and Vitamin A (6 of 12) (G. Kotsanis, DAN Conf., Sept, 1996)
• B6 and Magnesium therapeutic efficacy--multiple positive studies (start with Am J Psych 1978; 135: 472-5)
• Low Derivative Omega-6 RBC Membrane Levels 50 of 50 autistics assayed through Kennedy Krieger had GLA and DGLA below mean. Low Omega-3 less common (may even be elevated) (J Orthomolecular Medicine Vol 12, No. 4, 1997)
• Low Methionine levels not uncommon (Observation by J. Pangborn)
• Below normal glutamine (14 of 14), high glutamate (8 of 14) (Invest Clin 1996 June; 37(2): 112-28)
• Higher Copper/Zinc ratios in autistic children. (J. Applied Nutrition 48: 110-118, 1997)
• Reduced sulphate conjugation and lower plasma sulphate in autistics. (Dev. Brain Dysfunct 1997; 10:40-43)
• B12 deficiency suggested by elevated urinary methylmalonic acid (Lancet 1998; 351: 637-41)
• Hypocalcinurics Improve with Calcium Supplementation Lower Hair Calcium in Autistics Reported (Dev Brain Dysfunct 1994; 7: 63-70)

• 50% improved with Zinc (6% worsened)
• 49% improved with Vitamin C
• 46% improved with Magnesium and B6 (5% worsened)
• 58% improved with Calcium (Later survey 42%)

Physical Health Profile in ADHD

1. Gastrointestinal Abnormality

• Colicky Infants and Older Children Diarrhea-Prone (V Colquhoun HACSG, Sussex UK 1987)
• Severe Stomach Aches (Am J Clin Nutr 1995; 62:761-8)
• Elevated Stool Creosols (Lancet 7.12.85)
• Ileal Lymphoid Nodular Hyperplasia (Lancet, July 18, 1998)
• Urinary Peptide Elevations-P. Shattock and A. Broughton
• Urinary Organic Acids Elevations- W. Shaw
• IAG Elevations-A. Broughton
• Parasitosis 67%-M. Lyon and J. Cline

2. Compromised Immunity

• More Infections and Antibiotics (Am J Clin Nutr 1995; 62: 761-8)
• Low Complement C4B (J Am Acad Child Adolesc Psych 1995; 34(8): 1009-14)

3. Detoxification Weakness

• Low-Level Lead Exposure Induces Hyperactivity in Rats (Science 182(116): 1022-1024
• Marked Improvement in 7 of 13 Chelated for "Non-Toxic" Lead Levels (A J Psych 1976 133(10): 1155-1158)
• Neonatal and Maternal Hair Lead Predict LD at Age 6 (Lancet 2:285 1987)
• Hair Lead Levels Correlate with Teacher-Rated and Physician-Diagnosed ADHD (Arch Environ Hlth 1996; 51(3): 214-20)
• Striking Chelation Results in 50 Vancouver Children (Turning Lead into Gold, paperback, Nancy Hallaway and Ziggert Strauts 1996)

4. Abnormal Nutritional Profile In ADHD

• Zinc Deficiency
  • Lower urinary, serum, nail and hair zinc than controls plus quick drop in serum and salivary zinc with double-blind tartrazine. United Kingdom. (J Nutr Med 1:51-57, 1990)
  • Plasma, erthrocytes, urine and hair lower than controls. Poland (Psychiatr Pol 28(3):345-53 1994)
  • Zinc deficiency in attention-deficit hyperactivity disorder. Israel. (Biol Psychiatry 40(12):1308-10 1996)
  • Serum zinc--and free fatty acids--lower. Turkey. (J Child Psychol Psychiatry 37(2):225-7 1996)
  • In vitro study demonstrates decreased loss of fatty acids from mesenteric phospholipids with perfusion of physiological zinc. Canada. (Can J Physiol Pharmacol 68(7): 903-907 1990)

• Fatty Acid Deficiency
  • Lower serum DHA, DGLA and AA in hyperactives than controls. (Clin Pediatr 26(8):406-411 1987)
  • Double-blind administration of evening primrose oil to a subgroup of prior study was associated with improved parent ratings for Attention and Excess Motor Activity compared to placebo. (J Abn Child Psychol 15(1): 75-9 1987)
  • Evening Primrose oil (GLA) 1 gram/day improved 53 of 79 hyperactive children selected as a subgroup on the basis of mood swings. The most striking improvement was noted in children with sleep disorders, crying spells and family history of alcohol or bipolar. (Muriel Blackburn, Crawley Hospital, Sussex , U.K.)
  • Lower plasma DHA, EPA and AA, and lower RBC AA in ADHD than controls (Am J Clin Nutr 62: 761-8 1995)
  • (Same group above correlated greater tendency to behavioral problems with lower total plasma Omega-3, more colds and antibiotics with lower total Omega-6. Physiology and Behavior Vol 59, Nos. 4/5 915-920 1996)
  • Zinc and Evening Primrose Oil the mainstay for thousands of successes claimed by the HACSG, Sussex England (Personal Communication, Vicky Colquhoun 1997)

• Magnesium Deficiency
  • Magnesium deficiency measured in 95% of 116 Polish children with ADHD: 78% low hair, 59% low RBC's, 34% low serum. (Magnesium Research 10(2): 143-148 1997)
  • Double-blind adminstration of 200 mg elemental magnesium per day to 25 of the above group produced measurable decrease in hyperactivity over 6 months compared to control. (Magnesium Research 10(2): 149-156 1997)

• Iron Deficiency
  • Preliminary study showed improved behavior in nonanemic hyper-actives given 5 mg/kg/day of Iron for 30 days, with significant increase in serum ferritin. (Neuropsychobiology 1997; 35(4):178-80)
  • Lower Iron plasma, RBC, Urine and Hair levels in 50 Hyperactives (Psychiatr Pol 1994; 28(3): 343-53)

• Calcium Deficiency
  • Plasma, RBC, urine and hair Calcium in 50 hyperactive Polish children lower than controls. (Psychiatry Pol 1994; 28(3):

• B6 in ADHD
  • B6 to hyperactives with low serotonin levels resulted in normal serotonin levels and behavior. (Pediatrics 55: 437-41, 1975)
  • B6 to 6 hyperactives with low serotonin levels increased serotonin and reduced hyperactivity better than Ritalin in double blind cross-over. Benefit carried over into the following placebo period, but not with Ritalin. (Biol Psychiatry 14(5):741-51 1979)
  • Significant subgroup of patients with ADHD (and Autism) found to have pyrroluria by Bill Walsh (Pfeiffer Treatment Center, Napperville, IL) and Hugh Riordan (BioCenter, Wichita KS). Good clinical track record for response to generous B6 and Zinc in thousands of pyrroluric patients. (Walsh also finds Biotin very useful in "slender malabsorber group")

• B12 in ADHD
  • Elevated urinary methylmalonic acid and early reports of response to oral B12 from John Linnell, research director at The Children's Medical Charity, U.K. Some reports of response to B12 shots.

Emerging Possibilities

• VITAMIN A HYPOTHESIS- M Megson
• CALCIUM DYSREGULATION HYPOTHESIS-W McGinnis

Interventional Strategies for Behavioral Children

• Low Glycemic
• Big Breakfast, Protein First, Frequent Meals
• Good Fats
• No Excitotoxins
• Organic as Possible
• Plenty of Fiber
• Careful with the Copper

• Baseline CBC, UA, Thyroid
• Urinary pyrrole
• RBC Fatty Acid Analysis
• Hair Mineral Analysis/Other Mineral Studies
• (PHF)

Start with these incrementally, continue until proven otherwise:

• Zinc with Manganese
• B6 (and/or P-5-P) with Magnesium
• Calcium
• Vitamins C and E

Then Address Fatty Acids

• Evening Primrose for GLA (Careful Seizures or Asthma)
• Cod Liver Oil (Provides Vit A and D plus EPA/DHA)
• Fish Oil or Neuromins for additional Omega 3

Other: B12, Biotin, Taurine, MSM, Folate, DMG, Amino Acids, Mb, Fe

2. ADDRESS OVERGROWTHS AND GUT CARE

• O&P at a bare minimum
• Urinary Organic Acids

• Nystatin/Oral Amphotericin/Diflucan/Cranberry/Grapefruit Seed

• Reconsider NSAIDS
• Fiber/FOS/Glutamine/Glucosamine
• Pentosan Polysulphate ("Elmiron")?
• Re-populate bowel with probiotics
• Creon or other digestive enzymes

3. ADDRESS FOOD INTOLERANCES

• IgG food antibody blood testing

• Urinary Peptides

  
  

• Address lactose, phenolic and high-arabinose intolerance

Secretin Safety
After many years of use as a diagnostic agent, Secretin has no published reports of serious side effects, which is a fairly remarkable record. As Secretin has been used over the past two years to benefit thousands of autistic individuals, there have been some problems, though few and far between.

Variable degrees of hyperactivity or agitation lasting days to weeks have been associated with Secretin for some time. More worrisome was a relatively brief first-time seizure in a two-year-old boy receiving his first infusion of Secretin early this year. A solitary event of this sort, particularly from a population of children known to have a high natural incidence of seizures, left us unsure about the cause of the event. Now we have additional information.

We have learned of two new cases which parents and physicians should know about in order to ensure that Secretin is administered in the safest possible manner. The first of these also involved a previously seizure-free child. This seven-year-old boy had improved with three prior infusions. At the end of his fourth infusion he experienced a very difficult first-time seizure and required prolonged efforts by physician and paramedic personnel to sustain breathing. He made a rapid, full recovery and his mother is disappointed that he cannot continue infusions, because she feels even this last infusion helped his behavior.

A third case involved a child who had no apparent seizure activity, but like the second case, lost breathing after repeated infusion. The practical lesson from these three cases is that even if only a tiny percentage of autistic children have seizure or breathing problems with Secretin, the prudent thing to do is assure that Secretin is administered in a truly "resucitation- ready" medical setting. Just in case.

From an ethical point of view few would question that the parent needs to know these facts in making the Secretin decision. An informed choice will be the right choice.

Woody McGinnis M.D.
November 18, 1999

• DAN! Protocol
  • Autism Research Institute, San Diego, www.autism.com/ari/
• Urinary Pyrrole
  • BioCenter Lab, Wichita, 800 494 7785
• Urinary Organic Acids
  • Great Plains Lab, KS, 913 341 8949
  • MetaMetrix, GA, 800 221 4640
• Urinary Peptides
  • Antibody Assay Lab, CA, 800 522 2611
• Membrane Fatty Acids
  • Body Bio (Kennedy Kreiger), 609 825 8338
  • Great Smokies, NC, 800 522 4762
  • MetaMetrix, GA, 800 221 4640
• IgG Food Allergy Blood Test
  • Great Plains Lab, KS, 913 341 8949
  • Great Smokies Lab, NC, 800 522 4762
  • Immuno Laboratories, FL, 800 231 9197
  • Meridian Valley Lab, WA, 253 859 8700
  • MetaMetrix, GA, 800 221 4640
• Hair Mineral Analysis
  • Doctor's Data, IL, 800 323 2784
  • Great Plains Lab, KS, 913 341 8949
  • Great Smokies, NC, 800 522 4762
  • Meridian Valley Lab, WA, 252 859 8700
  • MetaMetrix, GA, 800 221 4640
• Amino Acids
  • Doctor's Data, IL, 800 323 2784
  • MetaMetrix, GA, 800 221 4640
• Complete Stool Analysis
  • Great Smokies, NC, 800 522 4762
  • Meridian Valley Lab, WA, 253 859 8700
• Soil-Based Organisms
  • (one of numerous distributors) 561 748 2478

• Emerson Ecologics, 800 654 4432, Will Request Name of Physician
• National Ecological Environmental Delivery Syst (NEEDS), 800 634 1380
• Klaire Labs, 800 533 7255
• Tyler Encapsulations, 800 869 9705, Needs One-Time Doctor Authorization
• Kirkman Vitamin Company, 800 245 8282
• Efamol Nutrition, 617 261 4440

Compounding Pharmacies

• College Pharmacy, 800 888 9358
• Wellness Health, 800 227 2627
• Women's International Pharmacy, 800 279 5708