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Thursday 11 April 2019

Autism Polypill Version 5










Agnieszka's KetoForce and C8 are new additions, last time it was Tyler's Agmatine as additions to the Full Polypill

I recently updated my autism Polypill. It is now the fifth version, so it is becoming ever more personalized to one specific case of autism.  I added caprylic acid C8 and KetoForce Beta Hydroxybutyrate.
The full Polypill version 5 is here:


I do feel that I am getting near the final version. I already am pretty sure what is going to be added in the sixth version. There are one or two potentially clever ideas in this blog that I have not yet developed.
After my first year of autism research my doctor mother thought the result was good enough to stop, but I persevered and some further improvement did come. She was supportive of the concept but rather surprised it was possible. I think I have now achieved most of what is possible, which took an additional five years.
Having recently been reviewing the expected prognosis in longitudinal autism studies, including the one up to 22 years of age by Catherine Lord in the US, I think the result speaks for itself. In long term studies the remarkable improvement that rarely does occur, takes place by the age of eight. Verbal skills at the age of two is the best predictor of outcome at 19 years old.  I only started with my Polypill at the age of nine, when we were five years into trying to teach prepositions and maths was at the level of struggling with single digit addition and subtraction. Today at 15 years old, maths is at the same level as neurotypical 13-year-old classmates; so, we can say his maths age is 13.
I did suggest years ago to the French Bumetanide researchers that they measure IQ to show the impact of their therapy.
I think that in severe autism, and also Down Syndrome, huge strides forward are possible just by raising IQ.  We saw from the 15-year French study that the entire lower group, representing 80% of the total, had an IQ far less than 70 when they age out of school. An IQ of 70 is the threshold for MR/ID and affects 2.3% of the population.  Many of those French had IQs less than 40. 
Many parents do not like the term Mental Retardation (MR), so they made a nicer term Intellectual Disability (ID), which to me sounds like you might struggle playing chess, rather than dressing yourself and tying shoelaces.
Much MR/ID clearly is treatable.  That makes what is left of autism much easier to deal with. It makes the impact of any expensive 1:1 therapy much more substantial and therefore cost effective.
Recall we also have 81 other types of MR/ID that have been identified and are treatable.


As part of another project, I recently updated an old chart from this blog that shows the change in my autism index over time, including 6 years of the Polypill. I started treatment with Bumetanide on 17 December 2012. That was the sharp drop in the black line, followed rapidly by NAC and Atorvastatin. 


The big spike in the black line is the effect of the summertime allergy “stopping” the cognitive effect of bumetanide and producing the self-injurious behaviour of the same kind as the first big spike in the orange line.
The orange line after December 2012 is my forecast of what would happen, including a spike in bad behaviors likely to be triggered by puberty.
The spike in the black line at 13.5 years was a PANS-like episode that only lasted a couple of weeks, and was immediately treated using prednisone.
Heading towards 16 years old, Monty is still above the blue area, which we could call the “nerd cloud”. This is where you will find all those very mildly autistic, fully verbal people that now receive a medical or educational diagnosis of autism. Back in 1970s, 80s and 90s these were the nerdy kids at your school, who generally got by without any medical diagnosis/label. A small percentage will subsequently have attempted suicide.
On my chart typical development is not zero on the autism scale.
What is “normal” changes, typical kids develop their sense of “cool” group behavior before puberty and this continue until they become parents or just busy and fully employed. Then cool gradually fades and by 30 years old a socially awkward Aspie type really is not so different from a Dad who is juggling his job, commuting and his family obligations. There is no time to be cool.
I think around 18 is the peak difference between an NT young person and an Aspie.  Once the Aspie gets to College/University and meets more fellow Aspies life should get much better.  Find a job in a University or NASA and you will do just fine.
My therapy goal is just to keep heading towards zero on my scale. Entering the nerd cloud would be a great success; all that effort to reach the point many people with today's "autism" start from!
The IQ difference is already overcome. If you can do algebra, your IQ is way above 70.
Optimizing adaptive behaviour is the remaining goal. As the French longitudinal study and Catherine Lord from Cornell University highlighted in their studies, being fully verbal is a big part of enhancing adaptive behavior.  If you can be chatty, many aspects of life and functioning automatically get much easier.
So, in Monty’s case the emphasis has to be on expressive verbal communication, which is his weak point.
Fortunately, the additions in version 5 of the Polypill (Caprylic acid C8 and KetoForce BHB) and the expected additions in Version 6 will target this area. 
I did also write about critical periods and sensitive periods in the treatment of autism. It is clear that while it is never too late to start therapy, the sooner you start the bigger the effect will be. This is another reason why I doubt I will ever get to Version 10 - the clock is ticking.
Time is indeed a great healer, so even just Version 5 for another five years should continue to help Monty close the gap with typical people.
At another visit to the dentist last week when Monty had anaesthetic in his rear lower jaw, which apparently is the most difficult for a dentist treating a person with autism, the dentist was visibly relieved “it was exactly as you said it would be … he was better than my typical patients”.  That is the result of Polypills version 1 to 4 from 2012 to 2119; it is not down to parenting as the dentist believes. We did practise with a syringe and a drill at home, but it really was not needed. Monty understands why the process is necessary and what the steps involved are and so he is happy to sit back and open wide. Ten years ago this was not the case.

According to Catherine Lord at Cornell, based on her longitudinal studies from diagnosis up to adulthood, verbal skills at the age of 2 are the best predictor of outcome at 19 years old. Monty's verbal skills at the age of 2 were zero.

Unfortunately over 60% of the children she followed from 2 years old end up with a very poor outcome in adulthood - severe MR/ID, the adaptive skills of a four year old  and drugged up on psychotropic meds.  As in the 15 year long French longitudinal study of autism we looked at, the measured IQ falls over time. Anyone still think severe autism should not be treated? Perhaps they need their heads examining?

The optimal group of 10% do well, with an IQ shooting up to 111 (average IQ for typical people is 100) and OK with an adaptive functional age of 101 months (8.5 years old). Of them, 63% had a job and the great majority were not on psychotropic meds.  

It appears that in Lovaas' flawed ABA research he selected the kids that completed his trial from this Optimal 10% group. So yes, 50% did great, but they were already on track to do pretty well.  We learned from Dr Siegel that he weeded out the less able kids who did not respond to his therapy during the trial itself. You might think that all his research should now be rescinded.




LA ASD = less able ASD  (62% of the group) have IQ less than 70<70 div="">
MA ASD = more able ASD (38% of the group) with a subset called Optimal = the top 10%








Source: Catherine Lord's Presentation at UC Davis

I always wondered why American Psychiatrists decided to keep relaxing the boundaries of autism. There was no rational reason to do it, because it makes all the data incompatible and so comparisons meaningless. One good reason would be to hide the appalling outcomes of severe autism (DSM3 autism, Strictly Defined Autism etc), by adding more and more much milder autism the overall outcome looks quite acceptable.
Dr Lord is a psychologist and she comments in her presentation that today the prognosis results would look much better, as if that is a good thing. Being of logical engineer origin, I would counter that this is a nonsense. The results today would be exactly the same for those kind of kids; just that a sample in 2019 of 200 kids with newly diagnosed autism would include 100 who would not have been given a diagnosis 25 years ago when Dr Lord started her study. Nobody would have even sent those fully verbal quirky two year olds for evaluation.

For the final word on prognosis, we might recall from this earlier post

that 

"Autistic adults with a learning disability were found to die more than 30 years before non-autistic people."

Time to customize your personalized medical therapy for autism?  If your child was fully verbal at two years old, then you might not need to bother.

Conclusion
My conclusion is that after 480 posts, this blog is now giving a fairly complete picture of autism. The features provided by Blogger/Google make it hard to navigate this blog and the very useful index by label is no longer available. Only a few people have read the entire blog.
It could be reorganized as follows.
  • Prevalence of the many Autisms
  • Prognosis
  • Evidence from clinical trials and case studies that shows improvement is genuinely possible and so it is worth your while to commit serious time to the process
  • Lots of science blah blah 
  • Precision medicine leading to a personalized therapy 
Unfortunately the science blah blah does get very detailed and does lose many people.  Biology is not complicated like math, there is just an awful lot of it and it remains only partially understood, so it changes.  Most people can follow the science, if they are willing to spend enough time, but you need to know that genuine improvement is indeed possible.  Some people are lucky and find their type of autism is similar to someone else's who has already found an effective therapy.
At some point I will get someone to write the java script to make a better index to the blog, so at least I can find things. 
Hopefully Version 6 of the Polpill will include two steps forward.



32 comments:

  1. Version 6 should be your book available for purchase (-:

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  2. Hi Peter
    If you have time to have a look and give your opinion. It is about propionic acid.
    https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/s12906-016-1099-8#Sec9

    ReplyDelete
    Replies
    1. Prada, propionic acid is definitely bad for you and can produce behaviors that look just like autism. If you have the "wrong" kind of bacteria in your gut you can produce too much propionic acid and too little of the "good" butyric acid. This is why some people take Inulin, or just add fiber naturally to their diet.

      Bee pollen and bee propolis are both loaded with interesting chemicals and this is why they have been used for thousands of years for various ailments. One problem is that it is critical what kinds of plants are growing where the bees live, since this influences what is in the pollen and propolis.

      We did see in one paper that propionic acid induced autism is reversible using NAC (N-acetyl cysteine). NAC is not expensive and is seen as safe.

      One interesting component of propolis is CAPE (Caffeic acid phenethyl ester). CAPE has remarkable beneficial properties and it is not expensive to make. I do wonder why CAPE is not developed as a drug, or perhaps as a supplement. CAPE-rich propolis is expensive, while CAPE a chemical is cheap.

      Delete
  3. Not sure if this study has already been mentioned here before.

    https://www.sciencedaily.com/releases/2019/04/190409093725.htm

    "Autism symptoms reduced nearly 50 percent two years after fecal transplant"

    ReplyDelete
    Replies
    1. I should also have highlighted this important part:
      "All of the participants in the study exhibited chronic GI symptoms from infancy, including chronic constipation and/or chronic diarrhea."

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  4. I was about to ask for comment on this study too.

    This is an interesting finding from their previous study on the short-term effect of FMT/MTT published in 2017:

    "Based on the phylogenetic diversity (PD) index, gut bacteria were significantly less diverse in children with ASD than neurotypical controls at baseline."

    And from the recent one:

    "Based on 16S ribosomal RNA (rRNA) gene amplicon sequencing analysis, most participants maintained higher gut microbiota diversity two years after treatment relative to baseline. Interestingly, for many individuals, the bacterial diversity was higher at two years than at the week 18 follow up".

    "Considering low gut bacterial diversity in individuals with ASD and other human disorders, an increase in diversity after MTT may reflect that MTT intervention successfully transformed gut environment into a healthier status and led to a long-term benefit on GI and behavior symptoms.".

    I've read some criticism of that study as being open-label and with conflict of interest.

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  5. Peter -
    Great information, as always. (BTW, I have tried to read every one of your postings - I have learned so much from your blog. Truly grateful for your efforts - and knowledge.)
    QUESTION: Regarding Clemastine...did this not make the cut or is the trial phase just not complete? (I hope its not too forward to ask?)
    Thanks again!
    Ralph

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    Replies
    1. Ralph, I have been using Clemastine for 2 months, but I have never stopped it. Ideally you would stop and see any effect fade away and then restart to see if the same good effect appears. Some potential benefits of Clemastine may need long term continued use, which is why I am not in a hurry to stop.

      Delete
    2. Speaking of Clemastine, I have a question.

      In the corresponding leaflet I read that it can enhance the (sedative) effect of MAO inhibitors. Both Bacopa and Fisetin are MAOis, and I have been a bit vary of combining them since both affect serotonin.
      On the other hand, Clemastine has been used to treat serotonin syndrome. Maybe I am just tired or thinking backwards but I can't make sense of this. Peter or anyone, what does this mean?

      /Ling

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    3. Ling,

      "Concurrent use of monoamine oxidase inhibitors (MAOIs) and sedating H1-blockers (sedating antihistamines) may result in additive sedation, anticholinergic effects, or hypotensive reactions. Consider alternative therapy to antihistamines where possible. If alternative combinations are not available, these medications may be used together with close monitoring. Many non-prescription products for coughs, colds, allergy, hay fever or insomnia contain sedating antihistamines. Patients receiving an MAOI should be counselled that it is essential to consult their healthcare provider or pharmacist prior to the use of any non-prescription products. Patients should also be advised against driving or engaging in other activities requiring mental alertness until they know how this combination affects them."

      You can look at the half-lives of your MAOI supplements. If you give something with a 3 hour half life at breakfast, there is not much left at 6pm.

      You can also look up how potent MAO inhibitors the supplements really are (compared to a drug).

      The important thing is not to give them at the same time.

      Probably best to ask a pharmacist.

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    4. Thank you Peter for making this a little bit more clear to me! ..ahem, what do "anticholinergic effects" look like? Sedation would be very easy to spot, and hypotension can be measured.

      What I still don't get is if clemastine does something to serotonin as it has been used to treat serotonin syndrome together with other drugs. Maybe the reason could be the sedative effect here too?
      While I certainly don't want any sedative effect, I don't want to mitigate the positive effect of other interventions either and I hope clemastine doesn't fiddle with 5HT levels or -receptors.

      /Ling

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    5. Ling, remember that the suggested dose of Clemastine was much lower than the standard dose for allergy. Giving before bedtime means that any drowsiness is no issue, the problem is when you have to take it in the morning. A dry mouth is a common anticholinergic effect. At low doses, Clemastine really should be trouble free for most people. It would not be sold OTC otherwise.

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    6. Dry mouth almost sounds like a feature when you are dealing with drooling. :-)
      Anyway, the trial is started and so far I haven't noticed any of the mentioned side effects.

      Thank you Peter, it is gold worth to have someone like you to ask for advice. Really.

      /Ling

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  6. Hi Peter and Community,

    As many of you know, I would love to trial Bumetanide but haven't been able to for a variety of reasons.

    In the past, I had found that Astaxanthin had NKCC1 impacts, so I trialed that, and I'm not sure in the end I saw any difference through this option, but this could have been due to a variety of reasons.

    I've just done another round of research for NKCC1 inhibitors and / or KCC2 agonists and I've found the following paper that I think could be quite relevant:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142013/

    Based on my read of this, it looks like GCK, the main metabolic product of ginsenoside Rb1, Rb2, and Rc in the intestinal microbiota, appears to both reduce NKCC1 levels and increase KCC2 levels in the brain.

    In the past, I had tried good old regular Panax Ginseng and I didn't see any obvious benefits, but I'm wondering if this could have been due to poor absorption / creation of GCK from Rb1, Rb2, and Rc.

    So I looked into Panax Ginseng options (as the ginseng needs to have Rb1, Rb2, and Rc to be turned into GCK) and I have now found that there is in fact a better version of Panax Ginseng than I had used a couple of years ago - it's called GS15-4, with far better absorption.

    Here is an article from Life Extension on GS15-4:

    https://www.lifeextension.com/magazine/2014/2/Beat-Fatigue-And-Boost-ATP-Production-With-Powerful-Herbal-Duo/Page-02

    I'm curious to trial this.

    Peter and community - are you aware of any experience with GS15-4 or have any thoughts on this based on the above?

    Thanks in advance!

    AJ

    P.S. Peter, are you familiar with STS66? U of Pitt appears to have created a better Bumetanide, but appears to view its utility in stroke as the primary value driver in outlicensing … if they only knew …

    http://www.licensing.innovation.pitt.edu/technologies/04461_na-k-cl-cotransporter-inhibitors

    ReplyDelete
    Replies
    1. AJ, there are many people looking at improving Bumetanide. Much is already known and some is in Ben Ari's original patents, he did not patent just bumetanide for autism, he patented NKCC1 blockers for autism (and Down Syndrome, Parkinson's etc).

      Ben Ari plans an NKCC1 selective drug, so it will not cause diuresis and can be patented. He is not planning a "prodrug" of bumetanide like STS66, because I think that will inevitably also cause diuresis.

      My current interest is in Azosemide, that you also pointed out some time ago. Research suggests it should be "better" than bumetanide and it exists today. It is also included in Ben-Ari's patents.

      I have no experience with GS15-4.

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    2. Hi Peter,

      Hopefully there will be greater recognition of this mechanism of action for ASD, so that kids around the world will have easier access to Bumetanide (or Azosemide), with the right plan to minimize any side effects (e.g. Potassium for hypokalemia).

      I have decided to give GS15-4 a shot, so will keep you and the community posted.

      Have a great night Peter!

      AJ

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  7. I stumbled over a review article on Raloxifene use for schizophrenia:
    https://www.nature.com/articles/s41537-017-0043-3

    Some cut and paste:
    Raloxifene is a selective estrogen receptor modulator (SERM). SERMs have agonistic action on estrogen receptors in the brain and bones, but not in the sex organs. SERMs such as raloxifene and tamoxifen could, therefore, have therapeutic benefits in schizophrenia patients of both sexes without being hazardous to gynecological tissues or having feminizing effects. Currently, raloxifene is the only SERM that is approved for long-term treatment.

    Nine studies were included, investigating 561 patients with a schizophrenia spectrum disorder. Raloxifene was superior to placebo in improving total symptom severity as well as positive, negative as well as general subscales, as measured by the Positive and Negative Syndrome Scale. No significant effects were found for comorbid depression and cognitive functioning.

    /Ling

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  8. Hi peter iam trying to read the 480 posts...in the meanwhile, i have an autistic daughter aged 30 years with this female phenotype: - regressive autism, symptoms appeared after age 24 months, reacted badly to vaccinations with anorexia and insomnia, good articulation but echolalia and repetitive speech, intestinal candida and great improvement at age 7 years with nystatin. severe sleep disturbance from age 5 to age 10, sleep returned normal with an immunomodulator called transfer factor,normal RM, but epileptiform spikes of EEG without clinical seizures..does anyone have a femalephenotype like this?

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  9. Anyone know what the US laws or implications are for administering Bumetanide to my son without doc prescription? I can get from Mexico but don’t want to lose my insurance coverage or get locked up etc.

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    Replies
    1. The best person to ask is your doctor. Several hundred children with autism now take bumetanide in France, so tell the doctor. Some doctors are not willing to prescribe bumetanide off-label for autism but are willing to arrange the blood tests to make sure your child does not suffer low potassium. They are fully aware this is a very safe drug.

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    2. Will try that. He point blank refused to prescribe bumetanide.

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    3. There are MAPS/DAN type doctors in the US who do prescribe bumetanide. You could just phone around and find one close to you.

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  10. Hi, not sure where to leave this comment but curious if you have any experience with or looked into Lialda for autism-related GI issues - particularly constipation, slow movement and underlying microbiome issues? I keep looking and never really see anyone discuss it, but in my opinion for my own issues it does wonders to stimulate natural bowel movements. The mechanism of action has never quite been understood, but recent studies in the last couple years are suggesting evidence that the drug actually produces changes in the person's microbiome, it kills off certain bacterias and promotes others to flourish which seems to heal the gut. Given this is a hot topic for years in the autism community and new to more mainstream science, I find it curious not much is being said about it as to its potential to address some symptoms of autism. Would love to hear your opinion on it after reviewing some of the recent research on its newly discovered method of action. The one thing i can warn about the drug that I discovered is that when it is expelled as waste product through urine it interacts with bleach in the toilet and turns the toilet water a strange color. Freaked me out until I finally found a random case study that explained it.

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    Replies
    1. Mesalazine/Lialda is well known drug used to treat inflammatory bowel disease and ulcerative colitis. These GI conditions are common in people with autism.

      The action of mesalazine is believed to be predominantly topical at the site of inflammation, especially within the colon. The clinical aim is to maximize delivery of the active drug (5-ASA) to the colonic mucosa, while minimizing systemic absorption.

      By controlling GI disease you will very likely improve the symptoms of autism, because the inflammatory signals from the gut have a direct path to the brain, via the vagus nerve.

      Delete
    2. Peter, as I had told you, my son has chronic constipation and nothing works, do you think that mesalazine could be a solution? Here it is super expensive, 100 tablets 500mg, 100 ds.I know that GI disease is critical in my son's autism symptoms and it is becoming worse no matter what he eats or takes. Something very funny about him, he asked me with a serious face:"What do you know about Einstein's polypill?
      Valentina

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    3. Valentina, there are different versions of this drug and they vary widely in price. Salofalk looks much cheaper. This is a drug for ulcerative colitis rather than constipation. I would talk to a gastroenterologist.

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    4. Hi Peter, Valentina, and Dawn,

      As I read your posts, it reminded me of an article I had read recently, so I went looking for it and … here it is:

      https://medicalxpress.com/news/2019-02-see-through-fish-aid-scientists-autism-related.html

      I personally am starting to think that for at least some ASD kids, the GI issues are part and parcel of their genetic mutation (rather than being causative via the gut-brain axis). I also wonder about the chicken and egg relationship between gut microbiome and the GI issues - does the gut microbiome always cause the GI issues or do the GI issues skew the gut microbiome population?

      I don't know if low Serotonin levels in the GI tract is causative in only a handful of or many GI issues for ASD kids, and if it is a contributor to your children Dawn and Valentina, but I wanted to make sure you all saw this. I haven't done any research but wonder if enteric coated 5-HTP may be worthy of a trial?

      AJ

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  11. Roger, Atorvastatin in my Polypill up-regulates PTEN. It also affects the cancer/autism gene BCL2. It also affects Wnt signalling, which is thought to be impaired in much autism.

    People taking atorvastatin (to lower cholesterol) have a lower incidence of RAS-dependent cancers. Ras plays a role in many cancers but also in intellectual disability (ID).

    People with autism who respond to Atorvastatin just need to make a 2 day trial. It shows effect very fast.

    In my son it removes a blockage that seems to stop him doing things he knows how to do and wants to do. The effect is very visible.

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  12. "Optimizing adaptive behaviour is the remaining goal. As the French longitudinal study and Catherine Lord from Cornell University highlighted in their studies, being fully verbal is a big part of enhancing adaptive behavior. If you can be chatty, many aspects of life and functioning automatically get much easier.
    So, in Monty’s case the emphasis has to be on expressive verbal communication, which is his weak point."

    This is where I am at too. I am just not very talkative although SOMETIMES I can be... I like to think that sometimes I can be more chatty that is a sign of what is possible... my state of mind is very inconsistent. I think if I could sustain more chattiness then that would make people more comfortable around me. And lots of missed opportunities of small social interactions which apparently add to quality of life and happiness. I think every interaction is soo much effort to focus on the person and think what to say... and I can get really focused on my work too and ignore everything else. But yea I think ignoring people and not talking (/not having anything to say) is probably my biggest remaining issue.

    Patrick

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  13. Hi.. I learned a lot from your post. Thank you.
    I would like to know your opinion regarding PEA, Palmitoethanolamide, it also helps neuro inflammation it seems. What is your opinion, pls.

    ReplyDelete
    Replies
    1. ss, PEA has been shown to be effective in small Italian studies to treat ASD. It clearly works for some people, but unfortunately not others. There is no way of knowing who will respond without a trial. I do recommend trying it.

      PEA is also widely used in Italy and Spain for neuropathy, here again it works well for some people but not others. There are many causes of neuropathy, just like autism, so it makes sense that it helps only a sub-group.

      It my case it did not help my son's autism, but it did help the neuropathy I had myself. I used PEA myself for several months, until I switched to a tiny weekly dose of DMF (dimethyl fumarate), which is much more practical and is cheaper.

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