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.
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.
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.