-IBIS-1.7.0-
tx
mental/emotional
autism
Nutrition

dietary guidelines

therapeutic foods:
• foods that tonify the Heart
• foods that tonify the Liver
• foods that calm the Shen (Spirit)
• foods that open channels


supplements

Magnesium, 10-15 mg per 2.2 pounds of body weight: Most research on the use of nutrient supplementation with autistic children has combined high doses of magnesium and vitamin B6 over periods lasting more than three months. The dose levels of magnesium usually employed would normally be expected to cause diarrhea in most people. The supervision of a nutritionally-trained healthcare professional would be advisable in the treatment of autism with these nutrients at the recommended levels. (Findling RL, et al. J Autism Dev Disord 1997 Aug;27(4):467-478; Kleijnen J, et al. Biol Psychiatry 1991 May 1;29(9):931-941; Martineau J, et al. Biol Psychiatry 1985 May;20(5):467-478; Martineau J, et al. Dev Med Child Neurol 1989 Dec;31(6):721-727; Pfeiffer SI, et al. J Autism Dev Disord 1995 Oct;25(5):481-493)
Vitamin B6, 30 mg/kg (toxic dose), usually combined with Magnesium. Numerous studies have examined the apparent beneficial effects of Vitamin B6 supplementation upon the nervous system in autistic children but Pfeiffer and Findling have recently disputed these conclusions. In the positive uncontrolled and double-blinded trials, children were typically given doses of B6 ranging from 3.5 mg to nearly 100 mg for every 2.2 pounds of body weight; some researchers recommended threapeutic levels of 30 mg per 2.2 pounds of body weight. It is generally assumed that such levels will inevitably damage the nervous system even though such toxicity was not reported. Clearly any use of vitamin B6 at these levels for treatment of autism needs to be under the supervision of a nutritionally-trained physician. (Findling RL, et al. J Autism Dev Disord 1997 Aug;27(4):467-478; Kleijnen J, et al. Biol Psychiatry 1991 May 1;29(9):931-941; Martineau J, et al. Biol Psychiatry 1985 May;20(5):467-478; Martineau J, et al. Dev Med Child Neurol 1989 Dec;31(6):721-727; Pfeiffer SI, et al. J Autism Dev Disord 1995 Oct;25(5):481-493)


footnotes

Findling RL, Maxwell K, Scotese-Wojtila L, Huang J, Yamashita T, Wiznitzer M. High-dose pyridoxine and magnesium administration in children with autistic disorder: an absence of salutary effects in a double-blind, placebo-controlled study. J Autism Dev Disord 1997 Aug;27(4):467-478.
Abstract: Several reports have described salutary effects such as decreased physical aggression and improved social responsiveness being associated with the administration of high doses of pyridoxine and magnesium (HDPM) in open-labeled and controlled studies of patients with autism. Despite this fact, this intervention remains controversial. A 10-week double-blind, placebo-controlled trial was undertaken to examine both the efficacy and safety of HDPM in autism. Twelve patients were enrolled, and 10 patients (mean age 6 years 3 months) were able to complete the study. HDPM at an average dose of 638.9 mg of pyridoxine and 216.3 mg of magnesium oxide was ineffective in ameliorating autistic behaviors as assessed by the Children's Psychiatric Rating Scale (CPRS), the Clinical Global Impression Scale, and the NIMH Global Obsessive Compulsive Scale. Furthermore, no clinically significant side effects were noted during HDPM administration. A trend for a transient change on the CPRS was found that was possibly due to a placebo response. This study raises doubts about the clinical effectiveness of HDPM in autistic disorder.

Jonas C, Etienne T, Barthelemy C, Jouve J, Mariotte N. [Clinical and biochemical value of Magnesium + vitamin B6 combination in the treatment of residual autism in adults]. Therapie 1984 Nov-Dec;39(6):661-669. [Article in French]

Kleijnen J, Knipschild P. Niacin and vitamin B6 in mental functioning: a review of controlled trials in humans. Biol Psychiatry 1991 May 1;29(9):931-941. (Review)
Abstract: Fifty-three controlled trials of the effects of niacin, vitamin B6, and multivitamins on mental functions are reviewed. The results are interpreted with emphasis on the methodological quality of the trials. It turns out that virtually all trials show serious short-comings: in the number of participants, the presentation of baseline characteristics and outcomes, and the description of changes in concomitant treatments. Only in autistic children are some positive results are found with very high dosages of vitamin B6 combined with magnesium, but further evidence is needed before more definitive conclusions can be drawn. For many other indications (hyperactive children, children with Down's syndrome, IQ changes in healthy schoolchildren, schizophrenia, psychological functions in healthy adults and geriatric patients) there is no adequate support from controlled trials in favor of vitamin supplementation.

Lelord G, Callaway E, Muh JP. Clinical and biological effects of high doses of vitamin B6 and magnesium on autistic children. Acta Vitaminol Enzymol 1982;4(1-2):27-44.
Abstract: In 1973 Rimland reported that some autistic children responded favorably to high doses of vitamin B6. Since this finding, different studies were performed to identify apparently B6 responsive subjects and to critically evaluate clinical and biological B6 responsiveness. Magnesium was included because large doses of B6 might increase irritability. 44 patients (mean age 9.3 years) were examined. All selected children had marked autistic symptoms. The children received a complete diagnostic work-up, including psychiatric, psychological, neurological and medical evaluation. Clinical data were scored using an estimate of global clinical state and numerical rating on a 18 item scale (Behavior Summarized Evaluation). In a first open trial 15 out of 44 children exhibited moderate clinical improvement with worsening on termination of the trial. Thirteen responders and 8 non responders were re-tested in a 2-week crossover, double-blind trial and the responses to the open trial were confirmed. Biochemical data analysis revealed that a significant decrease in urinary homovanillic acid (HVA) levels was observed during B6-Mg administration. During B6-Mg treatment, middle latency evoked potentials exhibited a significant increase of amplitude.

Lelord G, Muh JP, Barthelemy C, Martineau J, Garreau B, Callaway E. Effects of pyridoxine and magnesium on autistic symptoms--initial observations. J Autism Dev Disord 1981 Jun;11(2):219-230.
Abstract: In an open trial, a heterogeneous group of 44 children with autistic symptoms were treated with large doses of vitamin B6 and magnesium. Clinical improvement with worsening on termination of the trial was observed in 15 children. Thirteen responders and 8 nonresponders were retested in a 2-week, crossover, double-blind trial, and the responses to the open trial were confirmed.

Martineau J, Barthelemy C, Cheliakine C, Lelord G. Brief report: an open middle-term study of combined vitamin B6-magnesium in a subgroup of autistic children selected on their sensitivity to this treatment. J Autism Dev Disord 1988 Sep;18(3):435-447.

Martineau J, Garreau B, Barthelemy C, Callaway E, Lelord G. Effects of vitamin B6 on averaged evoked potentials in infantile autism. Biol Psychiatry 1981 Jul;16(7):627-641.
Abstract: In autistic children, averaged evoked potentials have been reported to have lower amplitudes and shorter latencies than those of normal children. Also, moderate clinical improvement has been observed in some autistic children after treatment with vitamin B6 and magnesium. We have studied biochemical and electrophysiological effects of vitamin B6 and magnesium in 12 autistic children and in 11 normal children. During treatment of the autistic children with B6, an increase of amplitude of middle-latency evoked potentials and a decrease of urinary homovanillic acid were found. The reverse was noted in the normal subjects.

Martineau J, Barthelemy C, Roux S, Garreau B, Lelord G. Electrophysiological effects of fenfluramine or combined vitamin B6 and magnesium on children with autistic behaviour. Dev Med Child Neurol 1989 Dec;31(6):721-727.
Abstract: The authors compared the effects of fenfluramine or combined vitamin B6 and magnesium treatment on the evoked potential conditioning of 12 children whose autistic behaviour had improved clinically following treatment. The children who were clinically sensitive to combined vitamin B6 and magnesium developed a conditioning phenomenon and the fenfluramine-sensitive children showed an enhancement of the Cz evoked response amplitude. Results are discussed with reference to behaviour modifications observed during treatment.

Martineau J, Barthelemy C, Lelord G. Long-term effects of combined vitamin B6-magnesium administration in an autistic child. Biol Psychiatry 1986 May;21(5-6):511-518.

Martineau J, Barthelemy C, Garreau B, Lelord G. Vitamin B6, magnesium, and combined B6-Mg: therapeutic effects in childhood autism. Biol Psychiatry 1985 May;20(5):467-478.
Abstract: This article reports the behavioral, biochemical, and electrophysiological effects of four therapeutic crossed-sequential double-blind trials with 60 autistic children: Trial A--vitamin B6 plus magnesium/magnesium; Trial B--vitamin B6 plus magnesium; Trial C--magnesium; and Trial D--vitamin B6. Therapeutic effects were controlled using behavior rating scales, urinary excretion of homovanillic acid (HVA), and evoked potential (EP) recordings. The behavioral improvementobserved with the combination vitamin B6-magnesium was associated with significant modifications of both biochemical and electrophysiological parameters: the urinary HVA excretion decreased, and EP amplitude and morphology seemed to be normalized. These changes were not observed when either vitamin B6 or magnesium was administered alone.

Pfeiffer SI, Norton J, Nelson L, Shott S. Efficacy of vitamin B6 and magnesium in the treatment of autism: a methodology review and summary of outcomes. J Autism Dev Disord 1995 Oct;25(5):481-493. (Review)
Abstract: Pauling's orthomolecular hypothesis appeared in 1968, stating that some forms of mental illness and disease are related to biochemical errors in the body. Vitamin therapy is believed to be a means of compensating for such errors. There have been few empirical studies on vitamin therapy in individuals with autism. This article presents a critical analysis of the 12 published studies located through an extensive computerized search. Studies were systematically evaluated to provide an objective assessment of empirical evidence supporting the efficacy of vitamin treatment. The majority of studies report a favorable response to vitamin treatment. However, interpretation of these positive findings needs to be tempered because of methodological shortcomings inherent in many of the studies. For example, a number of studies employed imprecise outcome measures, were based on small samples and possible repeat use of the same subjects in more than one study, did not adjust for regression effects in measuring improvement, and omitted collecting long-term follow-up data. Recommendations are offered to assist researchers in designing future investigations.

Rimland B. Controversies in the treatment of autistic children: vitamin and drug therapy. J Child Neurol 1988;3 Suppl:S68-72. (Review)
Abstract: A survey of approximately 4,000 questionnaires completed by parents of autistic children provided ratings on a variety of treatments and interventions. Among the biomedical treatments, the use of high-dosage vitamin B6 and magnesium (n = 318) received the highest ratings, with 8.5 parents reporting behavioral improvement to every one reporting behavioral worsening. Deanol (n = 121) was next most highly rated, with 1.8 parents reporting improvement to each one reporting worsening. Fenfluramine (n = 104) was third, with a ratio of 1.5:1. Thioridazine hydrochloride (Mellaril), by far the most often used drug on the list (n = 724), was fourth with a helped-worsened ratio of 1.4:1. The research literature on the use of vitamin B6-magnesium is briefly reviewed, and mention is made of recent findings regarding high-dosage folic acid in autism and biotin in Rett syndrome.

Rimland B. High dose vitamin B6 and magnesium in treating autism: response to study by Findling et al. J Autism Dev Disord 1998 Dec;28(6):581-582.

Rimland B, Callaway E, Dreyfus P. The effect of high doses of vitamin B6 on autistic children: a double-blind crossover study. Am J Psychiatry 1978 Apr;135(4):472-475.
Abstract: The authors used data from an earlier nonblind study to identify 16 autistic-type child outpatients who had apparently improved when given vitamin B6 (pyridoxine). In a double-blind study each child's B6 supplement was replaced during two separate experimental trial periods with either a B6 supplement or a matched placebo. Behavior was rated as deteriorating significantly during the B6 withdrawal.