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Autism: A Spectrum of Improvement
Steve Blake, ScD
My goal in writing this book is to present
safe methods to improve behavior in
autism spectrum disorder individuals.
The therapies presented here are chosen
because there are clinical studies in
medical journals verifying their effectiveness.
I hope to help readers understand some of
the dietary factors that may improve behavior.
It may be wise to avoid foods that increase
undesirable behavior. It may be wise to add
certain nutrients to improve behavior.
I understand that it may be difficult to
change the diet of someone who dislikes change.
The helpful therapies that I present may
not be used by medical doctors because
they are not medicine. Finding safe, effective
nutritional therapies is my passion.
Please let me know how your child improves.
Thank you, Steve Blake
If all of these safe therapies worked as well as they did in the clinical trials, there would be a chance of a 98.8% improvement in autistic symptoms. This would be wonderful, but, in any one child, improvement is likely to be less.
Please see below for the table of contents
and the scientific references.
Table of Contents
Table of Contents 3
Table of Figures 11
A Spectrum of improvement 13
A dairy-free diet (30% improvement) 13
Omega-3 fatty acids (33% improvement) 15
A gluten-free diet (57% improvement in communication) 15
Magnesium & vitamin B6 (47% improvement in communication) 16
Vitamin D (25% improvement) 17
Tryptophan is needed for brain serotonin 18
Digestive enzymes (50% improvement) 18
Vitamin C improved autistic symptoms 19
Antioxidants including glutathione are low in autism 19
Coenzyme Q10 (21% improvement in communication) 19
Melatonin improved sleep and behavior in autism 20
Nutrients can be low in autism 20
Vitamin B12 (10% Improvement) 21
Vitamin A is low in autism and supplementation improves symptoms 22
Folate can be low in autism and supplementation improves behavior in nine out of ten cases 22
Multivitamins for autism 23
Broccoli sprout extract (34% improvement in behavior) 23
Zinc supplements (7% improvement) 23
Mercury contributes to permeability of intestine and blood-brain barrier 24
Non-nutrient therapies 24
Understanding Autism 25
Accompanying autism 26
The autism spectrum 26
Prevalence of autism spectrum 27
Brain changes in autism 28
Contributing causes to autism spectrum disorder: 29
Genes and epigenetics 29
Pregnancy factors that increase the risk of autism 30
Epilepsy is more common in autism 30
Glutamate, excitotoxicity, and seizure 31
Testing for Autism 32
Ritvo-Freeman Real Life Rating Scale 32
Behavioral Summarized Evaluation-BSE 32
Childhood Autism Rating Scale (CARS) 33
Autism Treatment Evaluation Checklist 34
Documenting autism 34
What can we do to improve behavior? 36
Behavior ratings by parents 36
A checklist for a broad approach 37
Healthy lifestyles 39
Drugs for autism 39
Selective serotonin reuptake inhibitors 40
Tegretol and Depakene 41
Serotonin, Vitamin D, and Tryptophan 42
Tryptophan, serotonin and autism 42
Tryptophan is required for serotonin in the brain 43
Tryptophan and serotonin in the body and in the brain 43
Tryptophan sources 44
Vitamin D increases serotonin in the brain 44
Vitamin D is Low in autism 45
Vitamin D, serotonin and diarrhea 45
Vitamin D deficiencies and supplements 46
Lower vitamin D improved the CARS score 46
Vitamin D supplementation improved behavior in 80% of ASD children 47
Vitamin D upper limits for children 49
Estrogen, vitamin D, and serotonin in autism 50
Vitamin D improved autism 50
A clinical trial of vitamin D for autism 51
Kynurenine and quinolinic acids 52
Vitamin D, glutathione, and nerve growth factors 53
Autism, Vitamin B6, and Magnesium 55
Magnesium and vitamin B6 for neurotransmitters 55
Difficulties converting vitamin B6 to its active form 55
Magnesium and B-vitamins improved behavior 56
Autistic children were low in magnesium 56
Magnesium & vitamin B6 improved behavior 57
Autism and minerals 59
Inflammation in Autism 60
Inflammatory cytokines in autism 60
Inflammation can trigger autoimmunity 60
Inflammation and oxidation 60
Inflammation and coagulation 61
Gastrointestinal Problems, Intestinal Permeability, and Gluten/Casein Free Diets 62
Diet can be the first step 62
Gastrointestinal problems are common in autism 62
Excess serotonin can increase diarrhea 63
About half of autistic children have excess intestinal permeability 63
Testing intestinal permeability 64
Causes of leaky gut 64
Opiate exorphins in the brain from leaky gut 65
Protein-digesting enzymes and autism 66
Exorphins and serotonin may be key factors in autism 66
Indifference and exorphins from wheat and dairy 67
Immunity and exorphin peptides from wheat and dairy 67
Inflammation may increase exorphin peptides 68
Leaky intestines and blood-brain barrier 68
Exorphins and neurotransmitter systems in the brain 69
Opioid peptides in autistic urine 69
Gluten and casein free diet improved behavior 70
Gluten and casein free diet may take 6 months 71
One year gluten/casein-free diet improved behavior 71
A gluten/casein free diet improved behavior and reduced urinary peptides 72
A one year gluten/casein diet improved behavior 72
Nutrition on a gluten and casein free diet 74
Gluten/Casein diet improved 81% of ASD children 74
Gluten/Casein free diet for ASD children with GI symptoms 75
Gluten free diet & GI symptoms 76
Removing dairy and allergens improved behavior 77
Elimination diets 77
Dairy casein and inflammatory bowel disease 78
Dairy casein can cause intestinal bleeding in infants 79
Beta-Casomorphin-7 correlates with symptom severity 79
Beta-Casomorphin-7 lowers glutathione 80
Exorphins and social indifference 82
Opioid peptides from milk & wheat 83
Fiber reduces intestinal inflammation 83
Digestive enzymes improved ASD behavior 84
Digestive enzymes improved behavior in 50-90% of cases 84
Oxidation and Autism 87
Oxidation and inflammation in autistic brains 87
Higher oxidation correlates with worse symptoms 87
Glutathione is reduced 37% in autism spectrum disorder 88
Decreased glutathione correlates with worse autism 88
Low vitamin E and vitamin C in autism 89
Vitamin E was only half as much in autistic children 90
Vitamin C improved symptoms in ASD 91
Oxidative damage and effect on behavior 92
Autism, oxidation, and malondialdehyde 93
Cellular oxidation is higher in the autistic brain 94
Antioxidants and mitochondrial dysfunction 94
Vitamin B, C, D, and E can help reduce oxidation 95
Antioxidants were low and needed in autism 95
More antioxidants are needed in autism 96
Glutathione and other liver support nutrients 96
Coenzyme Q10 protects the brain and improves energy 97
Coenzyme Q10 improved communication and sleep 97
Melatonin is antioxidant and anti-inflammatory 98
Melatonin improved sleep and behavior in autism 99
Melatonin reduced cognitive decline and improved sleep 99
Nutrition and Autism 100
Nutrients consumed by autistic children 100
10% Improvement with vitamin B12 101
Vitamin B12 is only one-third of normal in autistic brains 101
Vitamin A is low in autism and supplementation improves symptoms 103
Cow’s milk damages the human folate receptor 103
Folate can be low in autism and supplementation improves behavior in nine out of ten cases 104
Food additives, colorings, sweeteners, preservatives 104
Multivitamins for autism 105
Autism and Fever 106
Fever and heat shock proteins 106
Sulforaphane, a 34% improvement in behavior 107
Sulforaphane is protective of the brain in autism 108
Autism and Environmental Pollutants 109
Bisphenol A and autism 109
Autism and heavy metals 110
Zinc supplements 110
Zinc supplements improved behavior seven percent 111
Zinc was low in autism 111
Pesticides and autism 112
Inner city pesticides and pervasive development disorder 113
Air pollution and autism 114
PCBs and PBDEs in autism 115
44% of autistic children have high lead levels 117
Plastics and autism 118
Flooring material and autism 119
Autism and Mercury 121
Mercury in vaccines can cause brain cell death 122
Thimerosal damages the brain at very low concentrations 123
Mercury contributes to the permeability of intestine and blood-brain barrier 123
Ethylmercury is a mitochondrial toxin 124
Ethylmercury Thimerosal 124
Ethylmercury can cause autistic behavior 125
Glutathione, cysteine, or n-acetylcysteine supplementation for mercury 125
Flu vaccines, Thimerosal, and development disorders 126
Increased Risks of autism with Thimerosal 127
Vaccines with Thimerosal exceeded US EPA guidelines 128
Omega-3s and Autism 130
Omega-3 fatty acids were low in autism 130
Omega-3s for autism 130
88% of autistic children taking omega-3s improved 33% 133
More Therapies for Autism 134
Horseback therapy 134
Massage for autism 134
Calamus for autism 135
Iron deficiency is common in autism 135
Safe autism treatments 136
A Case-Control Study Evaluating the Relationship Between Thimerosal-Containing Haemophilus influenzae Type b Vaccine Administration and the Risk for a Pervasive Developmental Disorder Diagnosis in the United States, Geier et al., Biol Trace Elem Res (2015) 163:28-38.
A gluten-free diet as an intervention for autism and associated spectrum disorders: preliminary findings, Whiteley et al. Autism 1999 Vol3(1) 45-65.
A key role for an impaired detoxification mechanism in the etiology and severity of autism spectrum disorders, Alabdali et al., Behavioral and Brain Functions 2014, 10:14.
A preliminary trial of ascorbic acid as supplemental therapy for autism Dolske et al., Progress In Neuro-Psychopharmacology & Biological Psychiatry 1993 Sep; Vol. 17 (5), pp. 765-74.
A Randomized, Controlled Study of Dietary Intervention in Autistic Syndromes. Knivsberg et al., Nutritional Neuroscience, 2002 Vol. 5 (4), pp. 251-261.
Aberrant tryptophan metabolism: the unifying biochemical basis for autismspectrum disorders? Schwartz, Biomarkers Med. (2014) 8(3), 313-315.
Abnormal intestinal permeability in children with autism, Eufemia et al., Acta Paediatr 1996;85:1076-1079.
Abnormally High Plasma Levels of Vitamin B6 in Children with Autism Not Taking Supplements Compared to Controls Not Taking Supplements, Adams et al., J Alt Compl Med Volume 12, Number 1, 2006, pp. 59-63.
An overview on traditional uses and pharmacological profile of Acorus calamus Linn. (Sweet flag) and other Acorus species, Rajput et al., Phytomedicine 21 (2014) 268-276.
Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders, Croen et al., Arch Gen Psychiatry. 2011;68(11):1104-1112.
Autism and phthalate metabolite glucuronidation, Stein et al., 2013.
Autism spectrum disorder prevalence and proximity to industrial facilities releasing arsenic, lead or mercury, Dickerson et al., SciTotal Environ. 2015 December 1; 536: 245-251.
Autism, An Extreme Challenge to Integrative Medicine, Part 1: The Knowledge Base, Kidd, Alternative Medicine Review Volume 7, Number 4 2002.
Autism: Pathophysiology and Promising Herbal Remedies, Bahmani et al., Current pharmaceutical design 22.3 (2016): 277-285.
Autistic children display elevated urine levels of bovine casomorphin-7 immunoreactivity, Sokolov et al., Peptides 56 (2014) 68-71.
Biochemical and molecular basis of thimerosal-induced apoptosis in T cells: a major role of mitochondrial pathway, Makani et al. Genes and immunity 3.5 (2002): 270-278.
Blood-brain barrier and intestinal epithelial barrier alterations in autism spectrum disorders, Fiorentino Molecular Autism (2016) 7:49.
Can the Pathophysiology of Autism be Explained by the Nature of the Discovered Urine Peptides? Reichelt et al. Nutritional Neuroscience, 2003 Vol. 6 (1), pp. 19-28.
Casein: A Milk Protein with Diverse Biologic Consequences, Miller et al., Exp Biol Med (Maywood) 1990 195: 143.
Clinical improvement following vitamin D3 supplementation in Autism Spectrum Disorder, Feng et al., Nutritional Neuroscience 2017 VOL. 20 NO. 5.
Coenzyme Q10 Depletion in Medical and Neuropsychiatric Disorders: Potential Repercussions and Therapeutic Implications, Morris et al., Molecular neurobiology 48.3 (2013): 883-903.
Decreased Brain Levels of Vitamin B12 in Aging, Autism and Schizophrenia, Zhang et al., 2016 PLoSONE 11(1): e0146797.
Does Nutritional Intake Differ Between Children with Autism Spectrum Disorders and Children with Typical Development? Herndon et al., J Autism Dev Disord (2009) 39:212-222.
Early Intervention with a Parent-Delivered Massage Protocol Directed at Tactile Abnormalities Decreases Severity of Autism and Improves Child-to-Parent Interactions: A Replication Study, Silva et al., Autism research and treatment 2015.
Effect of a Dietary Intervention on Autistic Behavior, Knivsberg et al., Focus on autism and other developmental disabilities, Volume 18, number 4, winter 2003.
Effect of gluten free diet on gastrointestinal and behavioral indices for children with autism spectrum disorders: a randomized clinical trial, Ghalichi et al., World J Pediatr2016;12(4):436-442.
Effectiveness of the gluten-free, casein-free diet for children diagnosed with autism spectrum disorder: Based on parental report, Pennesi et al., Nutritional Neuroscience 2012 VOL. 15 NO. 2.
Elimination diets-efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder, Ly et al., Eur Child Adolesc Psychiatry (2017) 26:1067-1079.
Environmental Chemical Exposures and Autism Spectrum Disorders: A Review of the Epidemiological Evidence, Kalkbrenner et al., Curr Probl Pediatr Adolesc Health Care. 2014 November ; 44(10): 277-318.
Environmental toxicants and autism spectrum disorders: a
Enzyme-based therapy for autism spectrum disorders-Is it worth another look? Brudnak et al., Medical Hypotheses (2002) 58(5), 422-428.
Epigenetic effects of casein-derived opioid peptides in SH-SY5Y human neuroblastoma cells, Trivedi et al., Nutrition & Metabolism (2015) 12:54.
Estrogen receptor-b regulates human tryptophan hydroxylase-2 through an estrogen response element in the 5 0 untranslated region, Hiroi et al., J Neurochem 2013;127(4):487-495.
Evaluation of whole blood zinc and copper levels in children with autism spectrum disorder, Craciun et al., Metabolic Brain Disease 31.4 (2016): 887-890.
Examination of vitamin intakes among US adults by dietary supplement use, Bailey et al., (2012) J. Acad. Nutr. Diet 112, 657-663, e654.
Folate receptor alpha autoimmunity and cerebral folate deficiency in autism spectrum disorders, Rossignol et al., Journal of Pediatric Biochemistry 2.04 (2012): 263-271.
Food allergy and infantile autism, Lucarelli, et al. Panminerva Medica 37.3 (1995): 137-141.
How nutritional status, diet and dietary supplements can affect autism. A review, Kawicka et al., Rocz Panstw Zakl Hig 2013;64(1):1-12.
Identifying autism from neural representations of social interactions: neurocognitivemarkers of autism. Just et al. PloSone 9.12 (2014).
Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6 II. Pervasive developmental disorder-autism, Mousain-Bosc et al. Magnesium Research 2006; 19 (1): 53-62.
Integrative approaches to caring for children with autism, Klein et al., Current problems in pediatric and adolescent health care 46.6 (2016): 195-201.
Iron deficiency in Autism and Asperger Syndrome, Latif et al., Autism 2002, 6, 103-114.
J. Autism Dev. Disord. 43, 2677-2685.
Level of Trace Elements (Copper, Zinc, Magnesium and Selenium) and Toxic Elements (Lead and Mercury) in the Hair and Nail of Children with Autism, Priya et al., BiolTrace Elem Res (2011) 142:148-158.
L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications, Richard et al., International Journal of Tryptophan Research 2009:2 45-60.
Melatonin for sleep in children with autism: a controlled trial examining dose, tolerability, and outcomes. Malow et al. Journal of autism and developmental disorders 42.8 (2012): 1729-1737.
Metabolic biomarkers related to oxidative stress and antioxidant status in Saudi autistic children, Al-Gadani et al., Clinical Biochemistry 42 (2009) 1032-1040.
Neurodevelopmental disorders following thimerosal-containing childhood immunizations: a follow-up analysis, Geier and Geier, International journal of toxicology 23.6 (2004): 369-376.
Nuclear Factor-Kappa B and Other Oxidative Stress Biomarkers in Serum of Autistic Children, Abdel-Salam et al. Open Journal of Molecular and Integrative Physiology, 2015, 5, 18-27.
Nutritional Impact of a Gluten-Free Casein-Free Diet in Children with Autism Spectrum Disorder, Mari-Bauset et al., J Autism Dev Disord (2016) 46:673-684.
Omega 3 Fatty Acid Treatment in Autism, Meiri et al., Journal of child and adolescent psychopharmacology. Volume 19, Number 4, 2009.
Oxidative stress-related biomarkers in autism: Systematic review and meta-analyses, Frustaci et al., Free Radical Biology and Medicine 52 (2012) 2128-2141.
Peptides and Exorphins in the Autism Spectrum, Tveiten et al, Open Journal of Psychiatry, 2014, 4, 275-287.
Peptides-role in autism with emphasis on exorphins, Reichelt et al., Microbial Ecology in Health & Disease 2012, 23.
Plasma membrane coenzyme Q: evidence for a role in autism, Crane et al., Biologics: Targets and Therapy 29 May 2014.
Prenatal phthalate exposure is associated with childhood behavior and executive functioning, Engel et al., 2010 Environ. Health Perspect 118, 565-571.
Randomized Controlled Trial of Therapeutic Horseback Riding in Children and Adolescents With Autism Spectrum Disorder, Gabriels et al., J Am AcadChild AdolescPsychiatry. 2015 July ; 54(7): 541-549.
Randomized controlled trial of vitamin D supplementation in children with autism spectrum Disorder, Saad et al., Journal of Child Psychology and Psychiatry (2016).
Randomized, Placebo-Controlled Trial of Methyl B12 for Children with Autism, Hendren et al. Journal of child and adolescent psychopharmacology 26.9 (2016): 774-783.
Redox Regulation and the Autistic Spectrum: Role of Tryptophan Catabolites, Immuno-inflammation, Autoimmunity and the Amygdala, Anderson et al., Current Neuropharmacology, 2014, 12, 148-167.
Role of NAD+, Oxidative Stress, and Tryptophan Metabolism in Autism Spectrum Disorders, Essa et al., International Journal of Tryptophan Research 2013:6 15-28 (Suppl1).
Role of NAD+, Oxidative Stress, and Tryptophan Metabolism in Autism Redox Regulation and the Autistic Spectrum: Role of Tryptophan Catabolites, Immuno-inflammation, Autoimmunity and the Amygdala, Anderson et al., Current Neuropharmacology 2014 12 148167.
Role of neuropeptides in autism and their relationships with classical neurotransmitters. Shattock et al., Brain Dysfunct 1990;3:328-345.
Role of Zinc Supplementation on Metallothionine System and Cognitive Motor Performance in Children with Autism, Elnahry et al., International Journal of ChemTechResearch 2017 Vol.10 No.5, pp 503-512.
Role of Zinc Supplementation on Metallothionine System and Cognitive Motor Performance in Children with Autism, Elnahry et al., International Journal of ChemTechResearch 2017 Vol.10 No.5, pp 503-512.
Sulforaphane treatment of autism spectrum disorder (ASD), Singh et al., PNAS October 28, 2014 vol. 111 no. 43.
Sulforaphane treatment of young men with autism spectrum disorder, Singh et al., CNS & Neurological Disorders-Drug Targets 15.5 (2016): 597-601.
Targeting the mitochondrial electron transport chain in autism, a systematic review and synthesis of a novel therapeutic approach, Ghanizadeh et al., Mitochondrion (2012).
The Gluten-Free, Casein-Free Diet In Autism: Results of A Preliminary Double Blind Clinical Trial, Elder et al, Journal of Autism and Developmental Disorders, Vol. 36, No. 3, April 2006.
The Interplay Between Fiber and the Intestinal Microbiomein the Inflammatory Response, Kuo, Advanced Nutrition 4: 16-28, 2013.
The Role of Heavy Metal Pollution in Neurobehavioral Disorders: a Focus on Autism, Gorini et al., Rev J Autism Dev Disord (2014) 1:354-372.
The role of mercury in the pathogenesis of autism, Bernard et al., Molecular Psychiatry (2002) 7, S42-S43.
The ScanBrit randomized, controlled, single-blind study of a gluten-and casein-free dietary intervention for children with autism spectrum disorders, Whiteley et al., Nutritional Neuroscience 2010 Vol13 No 2 87.
The varied rate of response to dietary intervention in autistic children, Klaveness et al., Open Journal of Psychiatry, 2013, 3, 56-60.
Thimerosal in Childhood Vaccines, Neurodevelopment Disorders, and Heart Disease in the United States, Geier et al. Journal of American Physicians and Surgeons Volume 8 Number 1 Spring 2003.
Thimerosal Neurotoxicity is Associated with Glutathione Depletion: Protection with Glutathione Precursors, James et al., NeuroToxicology26 (2005) 1-8.
Toxicity and Fate of Heavy Metals with Particular Reference to Developing Foetus, Agrawal, Advances in Life Sciences 2012, 2(2): 29-38.
Tryptophan status in autism spectrum disorder and the influence of supplementation on its level, Kaluzna-Czaplinska et al., Metab Brain Dis (2017) 32:1585-1593.
Vitamin A improves the symptoms of autism spectrum disorders and decreases 5-hydroxytryptamine (5-HT): A pilot study, Guo et al., Brain Research Bulletin Volume 137, March 2018, Pages 35-40.
Vitamin D hormone regulates serotonin synthesis. Part 1: relevance for autism, Patrick and Ames, The FASEB Journal 28, 2398-2413 (2014).
Vitamin D is an Adjuvant Therapy for Egyptian Children with Autism, Al-Aasy et al., PediatrTher2017, 7:3.
Vitamin D status in autism spectrum disorders and the efficacy of vitamin D supplementation in autistic children, Saad et al., Nutritional Neuroscience 2016 VOL. 19 NO. 8.
Vitamin D, Neurosteroids and Autism, Macova et al, Physiol. Res. 66 (Suppl. 3): S333-S340, 2017.
Vitamin/Mineral Supplements for Children and Adults with Autism, Adams, Vitamins Minerals 2015, 4:1.
Zinc Status in Autistic Children, Yorbik et al., Journal of Trace Elements in Experimental Medicine 17:101-107 (2004).