It has been
a long time since I added anything new to my autism Polypill. This is the
combination of therapies that consistently, and materially reduce the symptoms
of autism in Monty, now aged 13 with ASD.
As regular
readers will be aware, due to the heterogeneous nature of autism, what works
wonders for one person with autism may be totally ineffective, or even make
matters worse, in another person with a different type of autism.
However,
once you have found one therapy that is effective you have an opportunity to
identify the underlying biological dysfunction that you have stumbled upon,
without the need for any fancy genetic or metabolic testing. Then you can look for other therapies for
that dysfunction and other people who fall into that sub-group of autism and
see what else works for them.
I am
surprised how many people do respond to some of the therapies I am highlighting
in this blog.
Time to update?
I had been
expecting to add the Biogaia Protectis probiotic bacteria to the Polypill. It does indeed work in Monty and in other
readers, but prolonged use does have a problem, at least in some people. The behavioral effects fade and, in our case,
it switches from suppressing allergy to promoting allergy.
The person
who originally told us about Biogaia for autism uses the more potent Biogaia
Gastrus, which contains the Protectis bacteria and a second one. She uses a high dosage and uses it three
weeks on and one week off.
Like some other readers found, Monty
had an immediate negative reaction to the second bacteria in Biogaia
Gastrus. We are users of Biogaia
Protectis, but not every day.
A long time ago I proposed the flavonoid
Tangeritin/Sytrinol as a safe PPAR gamma agonist that is also a P2Y2 receptor antagonist.
Research studies have shown that the flavonoids Tangeritin and kaempferol are antagonists at P2Y2 receptors and may be of interest as potential anti-inflammatory
drugs. Robert Naviaux, from the University
of California at San Diego, believes that antipurinergic therapy is a key potential strategy to treat autism and
also chronic fatigue syndrome
and fibromyalgia.
The broccoli sprout powder already in
the Polypill is a rich source of kaempferol.
Tangeritin/Sytrinol has been shown to
have sufficient bioavailability to reduce the level of cholesterol in people
with high cholesterol.
KBr
The most
likely contender to enter the Polypill for everyday use is potassium bromide
(KBr), it does seem to tick all the boxes.
·
It
works
·
It
continues to work after longer term use
·
Mode
of action is understood
·
Safety
record is very well understood
·
Effective
at a low dosage
·
Not
expensive, about 30 cents a day. Much
less if you use bulk KBr.
KBr should
be effective in people who respond to bumetanide, since they both reduce
intra-cellular chloride levels, but by different mechanisms.
In people
who stop responding to bumetanide, I think KBr might be a good choice. In responders to bumetanide, increasing
inflammation due to an unrelated condition, may further reduce the expression of the
KCC2 transporter that lets chloride exit neurons. So the inflammation increases
the level of intracellular chloride and wipes out the benefit that was being
produced by the bumetanide. The effect
of the KBr will be to reduce chloride again, this time by substitution with the
relatively inert bromide.
It is also possible that some people with severe autism do not respond to bumetanide because their chloride level is so high that bumetanide is not sufficiently potent. In those people the additive effect of KBr might just tip the balance.
In some
countries bumetanide tablets include potassium chloride (KCl) to compensate for
potassium lost in diuresis. The cleverer
thing in autism would be to add KBr, since you benefit from the K+
and the Br-.
Due to the
very long half-life, you need to take a low dosage of KBr for 4 to 6 weeks
until you reach the peak level of Br- in your body. Only then can you judge whether you are a
responder or not.
What I am considering
the autism dose (8mg/Kg) is far lower than the dose used for intractable
pediatric epilepsy (30-50mg/Kg), specifically to avoid the known side
effects. The main side effect at high
doses is bromo-acne. Children with intractable epilepsy opt for some facial spots
over seizures.
Quite
possibly a higher KBr dosage would be even more effective in autism, but then
you will for sure be dealing with bromo-acne.
Summertime Add-ons
One
conclusion from the gene studies is that often in autism and schizophrenia
there are variances in the genes linked to the immune system. So the immune–related
therapies that help Monty a great deal during spring and summer may indeed be
applicable to a substantial sub-group of autism. For others they are likely to be ineffective.
I am hopeful
of yet another step forward this summer using the amino acid L-histidine. Histidine is very closely related to histamine
and you might think that would be the last thing that could help in those prone
to allergy-driven autism flare-ups.
However in an earlier post we saw that there is a paradoxical effect
when raising the level of histidine, inhibits the release of histamine
from mast cells. We also saw that
histidine has an inhibitory effect on mTOR, one of the suggested common core autism
pathways that was highlighted yet again in the gene studies.
L-histidine, is an
essential amino acid that is not synthesized in humans. You have to eat it.