From: Saji. M. Idicula To: [email protected] Sent: Saturday, December 17, 2005 10:26 PMSubject: [DAN-India] DAN Workshop at Bangalore -Topics covered
BIOMEDICAL APPROACHES FOR THE TREATMENT OF AUTISM
By Dr. Karima Hirani MD MPH, Los Angeles.
Workshop at Bangalore on 18th Dec. 2005
Brought to you by Autism India Network www.AutismIndia.net
Topics covered are:
WHAT IS DAN?
Defeat Autism Now
History of DAN
Bernard Rimland PhD www.autism.com/ari
Autism Epidemic=Epidemic of Toxic children
From 1975-1995, the cancer rates in children rose 20%
Asthma among U.S. preschool children grew 160% from 1980 to 1994
1/6 children in the U.S. has been diagnosed with a developmental disorder or behavioral problem(ieADD)
Autism Epidemic
15 years ago the incidence of autism was 4-5/10,000
Today, the incidence is 1/166
A stunning increase of over 1000%
The assault of environmental toxins
Air
Food
Vaccines
Result: more sick children and adults, more children with autism
Autism and the Environment:Exploring a connection. www.healthytomorrow.org (get the video)
Biomedical approach
Diet
B12 shots
Supplements
Food allergies and avoidance
Testing
Treating GI related problems
Heavy metal detoxification
Being open to trying new promising therapies
Section One: Gluten-Free/Casein-free (GFCF) Diet
There is research that suggests the diet can help many children
You can try it on your own
Suggested reading for beginners: “Special Diets for Special Kids” by Lisa Lewis
What is Gluten?
Protein: wheat, oats, rye, barley, bulgur, durum, kamut, and spelt
Also found in food starches: semolina, couscous, malt, some vinegars, soy sauce, flavorings, artificial colors, hydrolyzed vegetable proteins
What is Casein?
Protein found in milk and milk products like
cheese, butter, yogurt, ice cream, whey and most brands or margarine, and some non milk products such as soy cheese, hot dogs, and tuna fish, in the form of caseinate. Goat’s milk products also contain casein.
Enzyme Link
DPPIV an enzyme that breaks down casein and gluten in the GI Tract.
Not working well in these kids
Theory: it has been damaged by mercury
Casein and Gluten are converted into opiate like molecules
Opiate like effect in behaviours
Immune dysregulation
The immune system is effected
The body develops abnormal responses to foods which can result in:
Food allergies
Leaky Gut
Leaky Gut
An abnormal or unfavorable increase in intestinal
permeability
The intestinal lining is supposed to be the barrier between the GI tract and the blood stream
It is now possible for incompletely digested proteins and/or other by-products to “leak” through this lining, leak into the blood stream and effect the immune system in a negative way
How to treat Leaky Gut
The GFCF diet: # 2 on list of most effective biomedical treatments
Excellent websites for beginners:
www.GFCFdiet.com
www.Autismndi.com(autism network for dietary intervention)
How to get started on the diet
Meat, eggs, vegetables, nuts, fruits, use grains other than those mentioned.
Rice, potato, nut milk instead of cows milk
Rice/millet/potato/corn bread instead of wheat bread or wheat chapatis
Ordering GFCF foods on-line
Miss Robens www.allergygrocer.com
1800-891-0083
Kinnikinnick www.kinnikinnick.com
877-503-4466
Note: beware of sugar content in these foods
How to heal leaky gut
Avoid sugars
No sodas
All juices should be 100% juice and diluted
Learn to make desserts using natural sugar substitutes if possible ie, stevia, xylitol
How to heal leaky gut
Avoid refined carbs ie, white rice, pasta,
Try to encourage whole foods
Avoid fatty foods
Enzymes
Supplements
Avoid allergenic foods
Cleanse the gut of toxins(detoxification)
How to determine if your child has food allergies
Testing by blood (IgG antibodies)
Allergy elimination diet (by Dr. Doris Rapp)
#4 on the list of most effective biomedical interventions
Detoxification
Methylation and Sulfation
Two natural ways the body gets rid of toxins
ASD children often are lacking in the nutrients needed to promote these biochemical reactions
Methylation
Turns genes on and off
Involved in neurotransmitter synthesis
DNA and RNA synthesis
Detoxification
Methylation
B12 shots # 3 on the list of most effective biomedical interventions
Methyl B12 (not Cyano B12)
Extremely safe, non toxic
Must be injectable, subcutaneous
Given 2 times a week
DAN doctor must prescribe it for you
60-70% of children have shown improvement
A word about B12
Why injectable and not oral?
Strict vegetarians can be B12 deficient
Germs in the gut make B12 but not the useful kind
B12 levels in the blood are falsely elevated and of the un useful kind
Injectable B12 must be kept away from sunlight and not exposed to air
Adverse Reaction to Methyl B12
Hyperactivity
Consider Taurine supplementation
Try DMG
Try TMG
Try Folate
Stop methionine or SAM
MethylB12 and Dr. Neubrander
For more detailed information, go to www.drneubrander.com
Note: I don’t follow all his recommendations
Summary
Start the GFCF diet
Reduce sugars in the diet
Work on Food allergies
Start the B12 shots (needs a prescription)
Section Two: Supplements:
4 general rules
Always start with a low dose
Discontinue if there are adverse effects
Introduce supplements one at a time with the exception of B6 and magnesium
Keep records
Supplements: How to administer
Many are in capsules, so you must open them and disguise in the child’s food or liquid or give via a syringe diluted with liquid
Some are in liquid
Some are tablets, so you must crush if child cannot swallow
Supplements: Phase One
Digestive enzymes
#6 on list of most effective
Contains the DPPIV enzyme to help digest casein and gluten
Helps digest other proteins, fats, carbohydrates
2 with each meal and 1 with a snack
Must open capsule and mix in liquid or food, unless the child will swallow
Digestive Enzymes
Many brands available
I like the Isogest formulation=new disacharidase containing
Helps heal leaky gut
Ensures proper digestion of all foods
Adverse Reaction to Digestive Enzymes
I have rarely encountered this
Worsening of autistic traits, hyperactivity, and irritability
This is almost always temporary
Possibly due to a period of opiate-like withdrawal which may last 5-10 days or longer.
Melatonin
#5 on the list of most effective
The highest benefit score of any single oral nutrient
Hormone like substance made in the body by methylation from serotonin
Helps regulate circadian rhythm, sleep,intestinal motility, and increase antioxidation
1-2mg at bedtime may help with sleep and behaviour
Melatonin: Adverse reactions:
Disturbed sleep instead of better sleep.
If this occurs try a time-released formulation or discontinue it
Vitamin B6/P5P
B6 must be converted to P5P(Pyridoxal 5-Phosphate to be active
Studies show that autistics have slow conversion to P5P
B6 needs in autism can greatly exceed the government recommended amounts
21 of 22 consecutive clinical studies have shown beneficial effects for autistics with doses much larger than RDA of B6
Optimal dose is about 8mg/pound body weight per day
Do not exceed 500mg/day
Benefits are more favorable when magnesium is used with B6
B6: Adverse Reactions
Irritability, hyperactivity
Worsening of behaviours and autistic traits
We know of 5 possible reasons why:
B6 given without adequate food
Zinc is severely deficient
Amino acid levels may be deficient
An impure grade of B6 is used
Magnesium is required when B6 is used
Magnesium
Important for energy delivery in cells
Helps convert methionine to SAM
Helps with sulfation which is low in autistics
Optimal dose is 4mg/pound body weight or more
Adverse reaction:loose bowels/diarrhea
Reduce dose if this occurs
B6 with Magnesium
Give together
Give with food
Almost 50% of autistic patients benefit
Start these early in the nutritional intervension
Taurine
Synergistic with magnesium
Magnesium sparing
Needed for bile salt formation which assists absorption of essential fats, vitamins A,D,E
Powerful antioxidant
This supplementation should be in place before trying TMG
I normally check levels and only prescribe if low
Taurine
100 to 250mg/day for 2-5 year olds
250-500mg/day for 6-12 year olds
Can be helpful in seizure disorder
Adverse reactions quite uncommon
Vitamin C
Can keep stools loose and bowels regular (20mg/kg body weight per day)
Supplementation has a high benefit ratio (20:1) for autistics
Several documented metabolic functions which could be important in autism
neutralizes harmful oxidants and can regenerate vitamin E
results in harmless radicals and easily recycled
required for efficient formation of L-carnitine, amino acid that is carrier of fatty acids into cells for energy
helps convert folic acid to folinic acid which is beneficial in autistics
Very good food sources: broccoli, collards, horseradish, kale, parsley, turnip greens, black currant and guava
Moderate sources: citrus, strawberry, papaya, beet, greens, cauliflower, cabbage, chives, watercress, mustard greens and spinach
250mg/day for body weight less than 50 pounds
500mg/day or more for kids 50-100Lb
Note: most health food stores Vitamin C is corn based and a lot of autistics are allergic to corn. So use a non corn source if possible
Averse reactions: loose stools. Reduce amount if this occurs
Zinc
Low in many autistics and can be difficult to normalize cellular levels by supplementation
85% autistics show a high copper:zinc ratio in
blood
Assists in digestion, methylation, immune response
Supplementation helps autistics accept changes in their diet
Zinc assimilation depends on GI conditions, form of supplement and assisting nutrients
Effective supplemental forms: citrate, picolinate, gluconate, aspartate
Can be beneficial in autistics when introduced at an early stage of intervension
Do not give with meals, or with calcium, iron or folate
Start with low dose 5mg/day for a small child and may go up to 35mg/day for a 100 pound child
Adverse reactions:worsening of behavior is usually due to the substance that the zinc is combined with. Try a different form (ie picolinate instead of citrate
Molybdenum to lower high copper
If molybdenum deficiency is present, then copper can be retained excessively in the cells.
25-250micrograms per day is used.
Try sodium molybdate form
Good food sources: buckwheat, lima beans
Calcium
Low levels have been postulated for a subset of autistics per urine levels
Supplementation is behaviorally beneficial for 35%
Diets that are casein free will significantly increase the need for calcium
Necessary for bones, teeth, cell signaling and hormonal messenger activities
Calcium carbonate is a good form for supplementation when combined with another more soluble form.
Carbonate form is 40% calcium by weight versus 20% for most citrates
Vitamin D should be part of the supplement
How much to give? 600mg-1200mg per day
Best given with meals away from zinc
Vitamin A
Supplementation has a high benefit ratio with autistics
Enhances immunity
May be helpful in cases of persistent GI Measles
Almost always low in blood testing I have done
I recommend any where from 5,000-10,000 iu per day in the form of retynl acetate.
Betacarotene is a provitamin A but is not always converted as needed to
Adverse reactions: acute toxicity from hypervitaminosis A is rare: headache, nausea,vomiting, dizziness or vertigo, blurred vision, dry scaly skin at the back of the neck
Vitamin D
I usually supplement if blood levels are low
Usually present in most calcium supplements and in cod liver oil
Unless levels are low, further supplementation is usually not necessary
Cod liver oil
50% of autistics derive benefit
Natural source of vitamin A and D
In my opinion, there is not enough vitamin A that is needed in these kids
¼ teaspoon given to infants contains 1250 iu vitamin A and 2/3 teaspoon given to 10+ year old is
only 3330 iu of vitamin A
Cod liver oil Adverse reactions:
Allergic like sensitivity to palmitic acid or palmitate. Switch to another form ie synthetic Vitamin A acetate
Note: when using codliver oil, always use a brand that guarantees no mercury ie Nordic Naturals, Metagenics
Fatty Acids
#7 most effective biomedical intervension
Make up cell walls or membranes
Responsible for fluidity of membranes and ensuring proper flow across membranes of nutrients
Examples are DHA, EPA, ALA,
Essential, our bodies do not make them
I typically measure these in all my kids
Omega-3: DHA and EPA 20-60mg per kg body weight(note: if already using codliver oil you may not need to give this)
Omega-3 ALA found in flax seed. I recommend 1-2 tablespoons a day, less if using canola oil to cook with
Omega 6: LA found in canola oil or sunflower seeds. I recommend 1-2 tablespoons a day
Omega 6 : GLA found in evening primrose oil. I recommend 120-200mg per day(2 capsules)
Be sure to supplement with taurine, digestive enzymes
Fatty Acids:Adverse Reactions
Uncommon, and usually related to spoilage.
Smell the oil if rancid, throw it away
Check expiration date
Omega 3 oils need to be refrigerated after opening
Giving too much all at once can cause gas or diarrhea
Probiotics
Friendly bacteria found in the GI tract
Helpful against bad bacteria
Saccharomyces boulardii, a good yeast that kills the bad yeast, then leaves
Lactobacillus rhamnosis is beneficial, but requires refrigeration
Make sure they are dairy free
Won’t implant and flourish if the following have not been attended to:
removal of food intolerances
maldigestion
constipation
intestinal acidity(pancreatic dysfunction)
deficient bile production
Large daily doses will show beneficial effects. I prescribe 30-60 billion organisms 2 times a day
Try Kirkman’s Multiflora Spectrum
Good brands need refrigeration
Always needed like digestive enzymes
Probiotics:What do they do?
Predigest sugars and proteins that could be hard for us to deal with, ie lactose
Produce vitamins for us: B vitamins
Produce natural antibiotics that inhibit growth of bad bacteria
Reduce toxicity in the intestine
Probiotics: 5 recommended strains
1.Saccharomyces boulardii -yeast that kills other yeast like candida.
Needs to be refrigerated
Does it’s job and leaves
Killed by prescription antifungals
I usually prescribe this after stool test or urine organics reveals presence of yeast
Clinical clues of yeast:
Chronic diarrhea, constipation, Gas/Bloat/Abdominal pain, tired, decreased cognition, worsening behaviour with chelation
I prescribe 1 pill 3 times a day preferably b/w meals
Die Off Reaction
Can be seen with use of saccharomyces boulardii or other probiotics.
As the pathogenic bacteria or yeast are dying, they will give off toxins to which the child can react to.
Symptoms: headache, hyperactivity, temporary diarrhea, stimming and irritability. If they occur at all, they should resolve in a week or so.
2. Lactobacillus Rhamnosus
Similar to famous Lactobacillus GG but without any casein.
In the right conditions, it will implant and colonize lower part of small intestine vigorously
Survives normal stomach acidity
30-60 billion organisms per day
Needs refrigeration
3. Lactobacillus Acidophilus
“old reliable”, must be dairy free, refrigerated
Produces an antibiotic that kills pathogens in food
Can stop or decrease diarrhea due to pathogens
Most strains survive stomach acid
4. Bifidobacteria
Also produces an antibiotic
Colonizes the large bowel like acidophillus
Complements acidophillus
Help balance the acid-base balance in the bowel
Reduces putrefaction, Refrigerate
5. Streptococcus thermophilus
Does not implant and colonize, but helps others to
do so.
Makes enzyme lactase, digests lactose, then produces lactic acid which usually improve environment for acidophillus and bifidobacter
Probiotics Adverse Reactions
Die Off reaction-not every kid gets this, in my experience, not very common.
Lower dose of probiotic or try activated charchoal
Double check to see if it is dairy free
Die off Reaction – How to Treat
Activated charchoal given 1 pill up to 3 times a day.
Acts as a sponge, soaks up the toxins given off
Do not give with a meal/sacc. Boulardii/other supps. It will soak all these up
Dimethylglycine(DMG)
Provides chemical parts for folate to do its many jobs
For autism, relatively high doses can have positive results for speech and eye contact
Start with low trial dose
Once tolerating the DMG, may triple the dose.
Start at 125mg 3 times a day for about a month
Then increase to 375mg 3 times a day. If no significant improvement in language or eye contact then go back to lower dose or try TMG
DMG Adverse Reactions
Stimming or hyperactivity
May be due to folate deficiency
Supplement with folinic acid and B12
800mcg of folinic acid 3 times a day give along with the DMG
Trimethylglycine(TMG)
Helps methylate homocysteine to make methionine, then it becomes DMG
Can help with speech and eye contact
Do not confuse with Betaine-HCL
Start Taurine first, then add TMG
TMG vs DMG
Wise and safe to start with DMG first
If no benefit was derived with high dose of DMG, then try DMG with folate/B12 first.
If no benefit from DMG with folate/B12, then switch to TMG
TMG can deplete cysteine and hence Taurine and Glutathione which can be detrimental
44% of parents have reported benefit
Large doses are needed as with DMG
Adverse response to TMG? Make sure Taurine was started first.
If no benefit from TMG then try TMG with folate/B12
Creatine
Important in cellular communication
70% or SAM’s methylation is used to produce it.
Deficiency can coincide and be causative of expressive speech defecit
Mercury inhibits phosphorylation of creatine. Therefore, if it doesn’t work initially, try it later on.
Clues to creatine insufficiency
Low muscle mass(hypotonia) and history of floppy baby
Low serum creatine
Low urine creatinine
Hi ornithine in amino acid analysis
Large therapeutic amounts needed
300-1000mg/kg body weight per day in divided doses
Adverse reactions: ask if the product is pure, are you detoxing(mercury) at the same time? If so then consider stopping temporarily
Note: I have not been using this product in my practice yet
Amino Acids
Blood testing reveals that many autistics are low in these
Address diet, digestion and intestinal dysbiosis first before supplementation
Some pharmacies can customize the amino acid formula based on deficiencies
Supplementation objective is to form a pool of amino acids that can be used to make creatine, serotonin, melatonin, glutathione to name a few
Wait to use until after Gut issues have been addressed.
Kirkman makes a good blend of the amino acids found to be commonly low
Amino Acids-Adverse Reactions
Ask, is gut dysbiosis present?
Ensure adequate B Vitamin intake
Ensure adequate mineral intake
Note: SAM and methionine are often poorly tolerated in autism regardless of the levels in blood/urine
Folate
B vitamin very important for methylation and regeneration of SAM
For autism, folinic acid is the most versatile supplement form
You can try FolaPro(5-meTHF) the active form of folate, but if no benefit, then stick to folinic acid
Glutathione(GSH)
Small protein, very very important in detoxification, immune enhancement
In autism, GSH is low
Occasional adverse reaction to supplementation occurs(I have rarely seen this)
TMG and folinic acid can enhance its activity
Glutathione(GSH)
Oral supplementation is definitely beneficial (the kind used may be important)
I use it in my practice a lot for immune enhancement
400mg-800mg of reduced L-glutathione(recancostat brand by Tyler)
Carnosine
Dietary peptide contains histadine and beta-alanine (found in meat and fish)
Can reduce seizures and improve speech
Problems with its use have occurred.
Supplement with 600-1200mg per day, take with Zinc, Magnesium, Taurine, B6
Other important nutrients
Vitamin E 200-400iu per day(metagenics brand)
B complex 50-100mg per day(kirkman’s 1 teaspoon per day)
coQ10 50-100mg
L-carnitine 500-1000mg per day on empty stomach
Mineral complex (kirkman’s mineral 1 pill 1-2 times a day) or elyte liquid trace minerals one dose 2 times a day www.emersonecologics.com for Elyte
First Tier Supplements, while the GFCF diet is introduced
Digestive enzymes
B6/magnesium
Taurine
C and E
Zinc
Calcium
Vitamin A
Cod-liver oil/fish oil
Melatonin
B Complex
Mineral complex
Next step Treating dysbiosis
Milk thistle (liver support) 200mg-400mg per day
Probiotics
S. boulardii
Activated charcoal if needed
Second Tier options during mercury detoxification
More vitamin C
Glutathione
coQ10
DMG/TMG
B12 injectable, folinic acid
creatine,
L-carnitine
L-carnosine
Amino acids
Carnosine
Be wary of use if:
Levels are already high in the amino acid analysis
Taurine is high in the urine amino acid test
Taurine is low in the blood amino acid test
Zinc is deficient in the blood
Creatine is low in the blood
Section Three: Testing
Can be very beneficial if one has the financial resources and the means
Baseline Testing: I do on all children in my practice
Complete blood count(CBC)
Chemistry (liver, kidney function, electrolytes)=Chem Panel
Iron levels and storage
Baseline hair analysis (GSDL)
Comprehensive parasitology (stool test) GSDL
Food allergies (ImmunoLabs)
Testing
Ion Panel (includes amino acids, fatty acids, antioxidant levels, oxidative stress analysis, red blood cell minerals, urine organic acid testing) this panel is very comprehensive and cost effective(metametrix)
Thyroid panel
Tests that can easily be done in India:
CBC, chem panel, thyroid, iron and ferritin.
Tests that may be difficult to do but should be attempted to obtain: all the rest, especially the comprehensive parasitology
Web Addresses of the Specialty Labs
www.GSDL.com
www.Doctorsdata.com
www.immunolabs.com
www.metametrix.com
The above labs may be able to send to your doctor the kits to draw the blood/urine/stool and then you can send back
What if you cannot get specialty tests done
Get the basic tests that can be easily done in India.
Get started on the diet and first tier supplements.
When appropriate, ask your doctor to get you methyl B12 injectable. I use on average 2000mcg per shot subcutaneous 2 times a week.(www.MCGuff.com). 10ml bottle can last more than 3months
Heavy Metal Detoxification
#1 most effective therapeutic treatment according to DAN and me too!
Does this implicate the childhood vaccines containing thimerisol (mercury)?
Mercury injures methylation which could lead to widespread consequences
The transdermal route of detoxification is very promising
Heavy Metal Detoxification
Read “Treatment options for Mercury/Metal Toxicity in autism and related developmental disabilities:consensus position paper” February 2005. www.autism.com/ari
DMPS as a therapeutic agent
Been in active use for over 50 years
Long track record of safety
Originally used intravenously and orally(limited absorption)
Most recently available in a transdermal form thanks to dr. Buttar
Considered to be more potent than dmsa(another chelating agent)
Transdermal DMPS
Applied every other day with the rest day used to replenish with minerals
Common side effects:
behavioral which respond to improving gut flora and function or enhancing trace mineral intake
occasionally liver enzymes may go up but promptly come down with milk thistle or GSH
Kidney toxicity is not considered to be a risk for dmps.
Most commonly we see a depletion of minerals. Therefore it is very important to replenish minerals and where possible test for RBC minerals at a minimum every 2 months
(Metametrix Labs).
Is your child a candidate for heavy metal detoxification?
Common laboratory evaluation to determine body burden of mercury and other toxic metals are not always reliable.
The best test is to try the TD-DMPS
You must go to a trained doctor to obtain this and he/she should monitor the child
TD-DMPS
Where to get it from: AMT pharmacy
Be careful of other pharmacies
When to start heavy metal detoxification?
Once the Gut is clean, i.e. child is on the GFCF diet, enzymes, food allergy avoidance, probiotics etc.
What if I cannot obtain TD-DMPS
If cost is an issue, this may be overcome stay tuned.
Try all other recommendations in the mean time especially diet, methyl B12, supplements
Other Heavy Metal Detoxification options
DMSA: oral or TD
EDTA: oral/suppository/iv
Natural ones: be careful
Bottom Line: I have had the most success with TD-DMPS, some docs are using TD-DMSA with equal results. So TD (topical) seems to be the best route for now.
Vaccines
Thimerosal(mercury) in vaccines
Websites to determine content
http:/www.vaccinesafety.edu/thi-table.htm
http:/www.fda.gov/cber/vaccine/thimerosal
Most vaccines in U.S.A as of 2004 are free of thimerosal.
Read Stephanie Cave’s book “Children’s Vaccinations-what Your Doctor May Not Tell You”
Section Four: Clinical Approach to Common Problems in Autism
Protein deficiency: Rice protein powder directly into their drink. www.nutribiotics.com. Under 3 years, 1 gm per 2 pounds body wt. If 4-6 years, 1 tablespoon daily. 7-10 years, 1 ¾ tablespoon daily. 10+ years old, 2 tablespoons per day.
Constipation
Benefiber (guar gum) 1 teaspoon in juice or water
3 times a day
Prune juice
Magnesium(milk of magnesia)
Vitamin C high dose
Oxypowder(oxypowder.com) high dose magnesium and germanium
Fruit-eze(www.fruit-eze.com)
Prescription laxatives(miralax)
Diarrhea
Colostrum (transfer factor)
Probiotics-see supplements section(this includes s.boulardii)
Digestive enzymes
Biocidin 1 drop per 10 pounds body weight(www.drhoffman.com)
GFCF diet if already on it, suspect a leak.
Xray of abdomen (as it could be a sign of constipation)
Do the comprehensive parasitology test
Self-Abusive Behaviors and Rage, impulsivity, disinhibition
Suspect GFCF leak
Inositol 1-6 gm 3 times a day
Chromium 100-200mcg per day(in the mineral formula)
Taurine up to 10gm per day
GABA up to 10 gm per day
Low sugar/carb diet
Eliminate Artificial colors
Heavy metal detoxification
Low dose Naltrexone(prescription)
Consider Risperidal(prescription drug)
Poor Sleep
Melatonin 1-3mg at bed can split it up twice daily(may be drowsy initially in the day time)
Taurine 1000-4000mg at bed
GABA 1000-5000mg at bed
DMPS
TMG day time dose
Magnesium 400-800mg at bed
5htp 50-100mg at bed
Naltrexone (prescription)
In Closing
There are many new Therapies on the horizon. Find a DAN doctor
The biomedical approach must be balanced with behavioral therapies
Don’t give up
Letters from families of recovered children (patients of mine)
Brought to you by Autism India Network. www.AutismIndia.net
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