One key issue for most people with more severe autism (DSM5 level 3, any DSM3, or just SDA – Strictly Defined Autism) is getting them to fully use their capacity to communicate.
Many such people do learn to talk, but often this is a very matter of fact kind of speech, that is limited to answering questions and making requests.
Often the limiting factor is not vocabulary, grammar or vocalization. Many can put ideas in words on paper, they can sing and read aloud; but something is lacking when it comes to conversation.
You can use behavioral therapy (like Verbal Behavior, VB) and some of the more relevant parts of speech therapy to encourage more extensive speech, but it is a real slog. When you spend less time on 1:1 “speech training”, in order to develop academic school work, you end up with less speech.
I was discussing this with Monty’s assistants, the need to take a step back and refocus on speech as a skill, in addition to regular school work. It is good to be able to master algebra, but in any social situation communication remains number one.
I have long wondered if it is a behavioural problem, a structural brain problem or a treatable biological problem. I do see parallels with how typical people speak foreign languages. For example, if I was on a train in Germany and somebody wanted to talk to me in German, I would keep my answers short and simple; I would not be trying to keep the conversation going. My German is very rusty, but I can read it aloud and yes, I could sing in it. I would not make small talk in German.
I do consider people like Monty, now aged 15 with autism, not to have a first language; silence is their first language and their mother tongue is like a second language. Some readers of this blog are exceptions, but most people are pretty weak in their second language. For them it never becomes intuitive, you have to painfully learn what preposition takes what case and how to decline nouns and conjugate verbs. You can make a strong case that people who do not begin to speak until 4 years old have missed a critical window in how the brain develops and so when language does slowly begin to come, it can never become truly fluent, a bit like my German.
I do have a broader interest in how you acquire language. Monty's big brother is bilingual and also pretty fluent in Russian and German and chatty in French. This all came with minimal effort, but being exposed from birth to two languages and then learning more languages in the conventional way.
Many readers of autism forums ask about what pill can you take to promote speech. I always thought this was rather wishful thinking, in that you cannot target such a specific aspect of someone’s autism. Just like there may be no magic pill for algebra.
Writing before talking?
One idea I had to promote more prolonged “conversation” was to first have Monty write about the subject. I agreed with Monty’s assistants one new exercise, which is to have him write a daily diary of his day and then later on have him retell the day’s events, but without reference to the diary.
It does indeed work, having written about the subject, when later asked to talk about it, there is a much longer and more detailed conversation.
No pills required.
The Ketone BHB
The reason for all the recent posts in this blog about ketones and autism is that perhaps there actually is a “pill” you can take to promote speech.
Our reader Agnieszka in Poland has been experimenting with ketones for some time and since her son responds to most of the things in Monty’s PolyPill, I assume that there is a good chance that anything new that works for her son might also work for Monty.
One area that the ketone BHB seems to help in Agnieszka’s case is promoting speech and BHB does indeed have the very same effect in Monty.
One effect of sulforaphane/broccoli was increased verbalization. If your child is four years old, increased verbalization would be something to celebrate, but by 15 years old you want relevant speech (for some people sulforaphane does indeed produce increased relevant speech). Very encouragingly, BHB seems to deliver an increase in intelligent, relevant, spontaneous speech. These are things that Monty could write but would not say, unprompted.
There are big gaps in the scientific data about ketone supplements in humans. These supplements are only widely available in North America, even though it looks like most commercial products are repackaged from Chinese bulk chemical producers.
It appears that the most effective therapy is a combination of a precursor to ketones (C8) and a salt of the BHB ketone (Sodium, Calcium, Magnesium or Potassium Beta-Hydroxybutyrate).
According to one Chinese bulk producer, the Calcium salt of BHB is not very effective, they recommend Sodium and/or Magnesium.
By using a salt of BHB, you are going to consume significant amounts of sodium, calcium, magnesium or potassium. This may be unwise for some people.
The objective is to raise the amount of BHB in your bloodstream.
You can measure BHB in urine inexpensively, but the more reliable blood testing equipment is more expensive.
The study below evaluated one widely available commercial supplement:-
Figure 1b: mean, standard deviation of D-βHB (mmol/L) level in serum of all subjects () within a time period of 5.5 h after intake of βHB salt mixture (0.5 g/kg BW).
The supplement used was Ketosports KetoCaNa Orange.
In fact the dose of Ca/Na Betahydroxybutyrate was very high, 0.5g per Kg. In the case of a typical adult that might be 40g per day.
That would contain:-
· 23g of BHB
· 2.6g of sodium
· 2.3g of calcium
That is quite a lot of sodium and calcium.
Some products are exclusively Potassium Betahydroxybutyrate, in those for each 23g of BHB you would get 8,700 mg of potassium, which is way too much to take at once. I am amazed it has not been banned.
When it comes to data on the use of C8 MCT oil in humans to produce BHB, we have the following study. The chart they produced is the total of BHB and another ketone, acetoacetate (AcAc), but we can extract the data on BHB itself.
Results: C8 was the most ketogenic test oil with a day-long mean ± SEM of +295 ± 155 µmol/L above the CTL. C8 alone induced the highest plasma ketones expressed as the areas under the curve (AUCs) for 0–4 and 4–8 h (780 ± 426 µmol ⋅ h/L and 1876 ± 772 µmol ⋅ h/L, respectively); these values were 813% and 870% higher than CTL values (P < 0.01). CO plasma ketones peaked at +200 µmol/L, or 25% of the C8 ketone peak. The acetoacetate-to-β-HB ratio increased 56% more after CO than after C8 after both doses.
Conclusions: In healthy adults, C8 alone had the highest net ketogenic effect over 8 h, but induced only half the increase in the acetoacetate-to-β-HB ratio compared with CO. Optimizing the type of MCT may help in developing ketogenic supplements designed to counteract deteriorating brain glucose uptake associated with aging. This trial was registered at clinicaltrials.gov as NCT 02679222.
Plasma concentration and summed daily means (far right) during the metabolic study days for total ketones (β-HB and AcAc) obtained without an added test oil (CTL; ●) or after taking two 20-mL doses of CO alone (▵), C10 alone (□), medium-chain TGs (C8-C10; ★), or C8 alone (⋄). The open arrow indicates when the breakfast plus test oil was consumed; the solid arrow indicates when the test oil alone was consumed without an accompanying meal at midday. Data for metabolic study days on which CO+C8-C10 and CO+C8 were tested are not shown here for clarity, but their AUC data are shown in Figure 2. Values are means ± SEMs; n = 9/point. *Different from CTL, P < 0.05. AcAc, acetoacetate; CO, coconut oil; CTL, control; C8, tricaprylin; C10, tricaprin; β-HB, β-hydroxybutyrate.
Our 2-dose test protocol (breakfast and midday) generated 2 peaks of plasma total ketones throughout 8 h, with the second dose inducing 3.5 and 2.4 times higher ketones with C8 than with CO, respectively. The first dose taken with a meal would be a more typical pattern but resulted in less ketosis that without a meal. One limitation of this study design is that the metabolic study period was only 8 h. A longer-term study lasting several weeks to months would be useful to assess the impact of regular MCT supplementation on ketone metabolism.
In summary, C8 was the most ketogenic MCT tested in this acute 8-h study and its ketogenic effect was significantly higher in the absence of an accompanying meal. Despite a low net ketogenic effect, CO may still be of interest because of its effect on plasma acetoacetate-to-β-HB ratio. With the help of positron emission tomographic imaging and the ketone tracer 11C-acetoacetate (2, 18, 20), it is now possible to investigate the impact on tissue ketone uptake of various ketogenic interventions.
Areas Under the Curve = AUC
Plasma concentration and summed means of 0- to 4-h and 4- to 8-h AUCs for plasma total ketones (i.e., AcAc and β-HB combined) (A) and for the mean AcAc-to-β-HB ratio (B). Bars represent no test oil consumed (CTL) or values after taking 2 doses of CO alone, C10 alone, medium-chain TGs (C8-C10), C8 alone, CO+C8-C10 (50:50), or CO+C8 (50:50). Values are means ± SEMs; n = 9. The AUC for 0–4 h was significantly different from the AUC for 4–8 h under all conditions. Labeled means without a common letter differ (a < b < c < d < e and A < B < C < D < E), P < 0.05. AcAc, acetoacetate; CO, coconut oil; CTL, control; C8, tricaprylin; C10, tricaprin; β-HB, β-hydroxybutyrate.
If we assume AcAc/BHB from C8 oil is 0.8 and that taking C8 without foode gives a total peak ketone (AcAc + BHB) of 0.5 mmol/L in blood. That implies we can approximate peak BHB as 0.28 mmol/L and peak AcAc as 0.22 mmol/L.
The jumbo dose of 23g of BHB produced peak BHB of 0.6 mmol/L in adults.
If the BHB level in blood is linearly related to the dose of BHB supplement, the we might assume that 15ml of Ketoforce produces 0.15 mmol/L (3.9*1.5/23*0.6).
If the Chinese are right that calcium BHB is not effective, then 15ml of Ketoforce likely produces a bit more than 0.15mmol/L., since it contains sodium BHB and potassium BHB.
So we might assume that my 20ml of C8 and 15ml of Ketoforce would produce a peak BHB in the bloodstream of about 0.5 mmol in a 55kg boy and that slightly more is coming from the C8 than the BHB salt.
As you can see from the chart 0.5 is not very much and just at the lower edge of nutritional ketosis. With supplementation 0.5 is the peak level; it will rapidly fall back to the starting level.
So via supplementation we have a brief period of mild nutritional ketosis.
Anyone who has done their homework on Ketones will have come across Dominic D’Agostino. He is a researcher with a big interest in ketones. He has published interesting research and has his own blog on the subject.
I saw his advice that suggested starting with 10ml of C8 and 10ml of KetoForce.
The producer suggests 30ml a day of Ketoforce in adults.
10 ml of Ketoforce contains
· 3.9 g of BHB
· 533 mg of Potassium
· 533 mg of Sodium
Even 500mg of potassium is going increase potassium levels in your blood.
If you happen to be taking bumetanide for autism, you will be losing potassium and likely taking a potassium supplement. Depending on your bumetanide dosage and potassium supplement, you may well be able to make some adjustments and cope with 10 ml of Ketoforce.
Speech and C8/Ketoforce Dosage
Our reader Agnieszka was very scientific and tried different BHB supplements and measured BHB in urine. She found Ketoforce the most effective at producing BHB in urine; speech was one big area of improvement, but not the only one.
I took the advice of Dr D’Agostino, the ketone guru, and combined Ketoforce with C8 in my experiment.
Starting with 10ml of C8 and 10ml Ketoforce, it did produce a marginal change in Monty, but increasing to 20ml of C8 and 15ml of Ketoforce produced a clear increase in spontaneous speech.
Work in progress
Clearly this is a work in progress. Ideally I would want to get all the BHB from C8, since then I do not need to worry about sodium and potassium.
Ketoforce is pretty expensive in the US and very expensive in Europe. C8 is not cheap, but much more reasonable.
Other MCT oils and coconut oil may be cheaper, but are very much less potent, so C8 is the most cost effective MCT oil to produce the ketone BHB.
A naturopathic physician in the US, called Dr Bruce Fife, has written extensively about “reversing autism” with coconut oil; that kind of language will make many people wary. He does suggest the mode of action is calming microglia, which is something BHB should be doing. Regular coconut oil will produce BHB, but you would have to eat a great deal of it. Coconut oil it is not cheap and so it is more cost effective to use C8 oil. The effect of coconut oil (CO) was shown earlier on in this post, in the above line graph, where the triangle represents coconut oil.
Coconut oil, counter intuitively, actually lowers your blood cholesterol, so it actually is a healthy oil, but if it is the ketone BHB you are after, it does not look the best choice.
It is possible that coconut oil does something clever that is unrelated to BHB.
Underlying Mode of Action
By investigating all the modes of action of BHB, this may lead to a more effective therapy. BHB is a signalling molecule and if you know which of its many effects is the key one, you may find an alternative signalling molecule that gives a more potent result.
I have a good effect from C8/Ketoforce, but I would like more of the same; but without the full ketogenic diet and not causing a problem with excess sodium, potassium, calcium or magnesium.
In the coming posts we will look into BHB's other modes of action. It will get quite interesting and we will see how one might even treat psoriasis and Multiple Sclerosis with BHB, because it is an activator of the niacin receptor HCA2. There is a potent HCA2 agonist drug, dimethyl fumarate.
In the coming posts we will look into BHB's other modes of action. It will get quite interesting and we will see how one might even treat psoriasis and Multiple Sclerosis with BHB, because it is an activator of the niacin receptor HCA2. There is a potent HCA2 agonist drug, dimethyl fumarate.
I did a quick search for ketoforce and it was going at 16 ounches in liquid form for 60 US dollars. The first product I tried with my son was KetoOS which never worked because he did not like the taste. There were also the practical and cost considerations as these products were originally designed as a supplement to a ketogenic diet rather than a full replacement.
ReplyDeleteNonetheless, I am intrigued and considering going with the protocol you have suggested. MCT oil does not taste bad and can easily be masked, but I am guessing Ketoforce is some really nasty tasting stuff. Maybe it can be masked in a beverage, but before buying some I was wondering what your opinion on this issue happens to be. Does Monty shrug everytime he takes it, or does it taste acceptable to him?
Tyler, these ketone supplements are very expensive, even more so outside the US/Canada.
DeletePeople do complain about the taste of Ketoforce, but over the years Monty has got used to bad/unusual tastes, and most people do. Broccoli powder in water was the worst and you could see it in his facial expression. He did notice the taste of Ketoforce, but is still happy to drink it.
I put C8 and Ketoforce in 200ml of orange juice and Monty drinks it with a straw. He has been drinking a 200ml concoction every morning for 5+ years. Ketoforce is alkaline and they say take it with an acidic liquid. When you drink via a straw you taste things less. You do need to mix well because the C8 will all float to the surface.
I do wonder if you can achieve a good result with just a larger dose of C8. This would be much cheaper. 40 ml of C8 in orange juice is worth testing.
Some people report GI irritation from C8, so they suggest start with a low dose. Monty was not affected.
Some people report diuresis from ketone supplements. Monty has so much bumetanide diuresis we did not notice this effect.
Whenever you mention potassium supplements for bumetanide, you do not mention which form of potassium. We introduced it into our daughters regime and she has been taking it for 10 days now. We only supplement with bananas so far, 2 every day. tomorrow we will do a blood test to see where her potassium levels are although the test is if questionable worth - in order to get real potassium readings you are supposed to relax yor arm and body during the draw. I do not know of 5 year old children able to do that, so I have the hope that the range values reflect real live children screaming their heads off :-).
ReplyDeleteForgot to add - so far we have seen more attention but not in epic levels. Its more that she is able to communicate her needs better because she is not overwhelmed with all the stuff in her head to the point that she cant filter out the thought she wants to communicate from everything else going on in there. She recently (before the bunetanide) acquired her first sentence ‘I want...’ and she has been using it with much more confidence and creativity (‘I want family’ - last night when she wanted a cuddle). She also told someone her name and allowed a strand of hair to be cut (stuck in a toy car wheels) without any fuss whatsoever. I have the feeling that she has much more confidence and doesnt just give up if a solution doesnt work but tries several in quick succession. That is actually a big thing for her.
DeleteTatjana, you can raise potassium levels with many different products. In many countries doctors use potassium chloride syrup for children. I normally use an effervescent tablet containing potassium citrate. Now that I am using ketone supplements, I get all the potassium from K-BHB (potassium beta-hydroxybutryrate).
DeleteIt is important not to take too much potassium as a supplement at one time. It is rapidly absorbed, unlike potassium from bananas.
Some people get GI problems from certain potassium supplements, so it best to take dissolved in a glass of water.
Hi Peter,
ReplyDeleteI am really pleased to have happened upon Epiphany after 14 years of biomed work with various MAPS docs, functional docs and a really good integrative health specialist. I've been pouring over a lot of your work and have a list to discuss with my team in mid August but when I saw this post about speech I wanted to jump in and tell you briefly about my son.
James is 19, was typically developing in everything except a large motor delay that surfaced around 6 months that was diagnosed as benign hypotonia. He is my fourth kid so I can tell you that his speech and cognition were on target until about 21 months when it started to fade and he slowly became lost in a brain fog and literally started groping for words that had come easily before.
We got good progress from a bunch of things including mito cocktails (later) and chelation and overall lots of dietary and supplement support.
At almost 14 with limited and unreliable speech he learned how to use a letterboard and he quickly became fluent in spelling his thoughts. No touching or guiding the hand or board just verbal prompts to keep him in a rhythm of movement. He has since been tested and verified to be communicating independently so he has had the blessing of being able to attend college and is on track to head to university. His CNS is often under aroused so he is able to sit through long college lectures unlike many of his peers with autism.
All this is good but he longs for speech. He just spelled the other day "I so want to talk easily, like others". So we keep at it. Something shifts day to day that makes it easier and clearer some days and others not. I'd give anything to help with consistent word retrieval and clarity. You nailed it when you had your son write things first for deeper conversation. THat is definitely a key. James spells or writes things on a very complex level but his speech is simple and unreliable.
We did a trial of the keto diet last spring and we did see some improvements in speech and focus but I felt like it was messing with his gut and making him constipated so I dropped it . I did order the C8 oil yesterday and am going to start with that. I'll keep you posted.
Thanks for this fantastic resource.
Brooke
Brooke, that is very interesting.
DeleteI think C8 is a good choice. Since your son is an adult I think you will need 40ml to have any effect.
They say it is best to gradually increase the dose since some people have a GI reaction. It has most effect in producing BHB when given on an empty stomach.
Brooke,
DeleteEating enough fat and vegetables usually eases constipation, but with asd and possible gi issues it could still be a problem for some.
You could try a lower carb diet rather than full keto, e.g. no carbs between meals, one no carb meal a day, less fruit, and so on. Perhaps that would get some of the gains without the side effects.
Aspie2
Hi Peter and All,
ReplyDeleteI should clarify that the main effect of BHB in my son is related to social interactions and affection. His speech problem is severe and complex with factors other than autism involved. While BHB increased his will to communicate, his speech is not functional overall.
Tyler, with regard to KetoForce taste I posted a comment here in 2016 being sure that a child would never swallow it ;-)
Now at first I tried 10 ml and my son indeed was not at all happy to drink it. So I started with really small amount, perhaps 1 ml and gradually increased over a few weeks. That worked very well.
Peter, do you think it also matters what kind of breakfast follows the morning BHB+C8 dose? I wonder if low carb/high fat meal could have any significant impact on transient ketone bodies level? That would be easier than full ketogenic diet.
Also, some other compounds have been suggested to improve ketogenic diet effects or to help with ketosis induction e.g. butyrate or leucine:
https://www.sciencedirect.com/science/article/pii/S175646461730097X
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858534/
What do you think about such ideas to increase short-term ketosis and perhaps reduce costs?
Agnieszka, I expect what you have for breakfast and when you have it may well affect blood BHB levels. I think the longer the gap between BHB/C8 and eating, the better. A lower carb breakfast could help.
DeleteTo reduce costs, the clever idea may be to focus on C8 and buy it in bulk. Food Grade C8 is sold in 10kg containers (so about 11 liters), sometimes it is called Octanoic Acid. It is just a question of getting a supplier willing to sell it to you; usually they would sell to companies.
The price below in Poland is about 200 EUR. It is sold as food grade so it is likely to be no different to what you get paying 40+ EUR for one liter sold as a supplement.
https://www.sigmaaldrich.com/catalog/product/aldrich/w279900?lang=pl®ion=PL
The type of breakfast surely matters. If a no carb breakfast can be eaten, e.g. eggs/cheese with whatever low carb veg/salad is palatable, perhaps cooked in butter/coconut oil/olive oil (omelette with salad?) then i would expect to see as many ketones as above. Some exercise and/or coffee would enhance the effect. Note that it might take the body 2 - 4 weeks to adapt for someone used to burning glucose, but once adapted the extra energy available would seem likely to be useful for an asd brain. There are basic health benefits from reducing carb intake as well.
DeleteAspie2
Hopefully someone will do a simple study measuring BHB in blood and look for the simplest, most cost-effective, method to achieve the medical benefit of BHB without making diet very restrictive. It looks like you do not need BHB to be elevated all day long, as you would have in the ketogenic diet.
DeleteI agree there is benefit from having elevated ketones for just part of the day. I've seen an Israeli study on some factory workers mentioned somewhere, but couldn't find it last time I looked. This is for more general health rather than asd, but I expect the same applies in asd.
DeleteMy belief is that eating carbs mostly eliminates ketones from the blood, there must be something discussing this somewhere. Petro has this post showing that just 40g of carbs can depress FFA levels for hours: https://high-fat-nutrition.blogspot.com/2010/03/butter-insulin-and-dr-davis.html
Aspie2
With such costs of keto-supplements and long-term use perspective, doesn't it make sense to do such study in n=1 way for personal solutions?
DeleteSome questions would still remain for me: if the effect can be seen with transient ketosis, shall we expect further benefit from BHB elevated all day? Is the effect dose-dependent? What about long term safety?
If you are responsible for just one person with autism then n=1 investigation is the way to go. It would be useful for everyone doing n=1, if there was some further basic research based on BHB in humans.
DeleteAt the end of the day you want to know in your n=1, which mode(s) of action of BHB are relevant. Even this may vary.
My suspicion is one important factor in many is HCA2 and for those people there might even be better options than BHB.
Nutritional or pharmacological activation of HCA2 ameliorates neuroinflammation
https://www.cell.com/trends/molecular-medicine/abstract/S1471-4914(15)00021-0
I forgot to say, the Israeli study was on having one carb-free meal per day. Presumably the gain came from a small but noticeable shift towards fat based metabolism.
ReplyDeleteWhen I look at my kids autism, I ‘divide’ it into things that stop her from progressing normally. There is one thing that drives me crazy because it has not yet fallen into the crosshairs of science and is instead being ‘treated’ by audiologists and speech therapists. In my opinion those kinds of experts are like physical therapists, helping your rehab after an injury. Nobody sends you to PT while the knife is still stuck in the muscle, which is why I hate that so many asd kids just get left with that kind of approach. Anyway, the problem my kid has is auditory processing disorder. I will take her to an audiologist to get an official reading as to what is technically wrong, but I believe that to be, with attention issues, her biggest stumbling block. She has started talking a year ago and is able to reproduce any sound you ask her to but mispronounces very short and easy words sometimes, while saying some long ones really well. Her speech therapist has remarked several times, in her own terms, on the fact that she does not hear speech as speech, really. I will not bother with more examples, just wanted to give some info to make the issue understandable. Anyway, have you, Peter, or any other readers here, seen any real scientific research on this type of problem? I have scoured and scoured and its just reviews of existing papers and audiologists measurements but nothing to point towards the source and possible therapies.
ReplyDeleteTatjana, if you want to look at the problem of developing speech in terms of psychology/behaviour, as your speech therapist should, then this takes you to Verbal Behavior, as developed by Skinner.
Deletehttps://en.wikipedia.org/wiki/Verbal_Behavior
If you lived in the US, your speech therapist would have learned about Skinner at College.
In essence Skinner says that to truly understand a word you need to be able to use it 5 different ways (see the link above). This results in an entire teaching methodology around teaching and mastering each word. It is very labour intensive, but it does work for many people.
We did use this approach, but it is clear that correcting biological dysfunctions makes understanding/applying language much easier; in particular how to use all the various pronouns, which proved impossible for my son until Bumetanide.
Old fashioned speech therapy, where they try to correct problems in vocalizing or problems like stuttering, does not really help most people with autism. When you take a broader approach to what speech therapy is, then it becomes very useful.
Thanks for the reply. I looked into the link and phew, despite me being from a linguistics background, if it had not been to for the table, I would have pored over it for hours. Yes, our speech therapist works on attention and communication rather than speech and pronounciation. The only ‘modus’ missing from our daughters verbal communication is the dialogue whete you ask her a question and she replies. everything where she ‘starts’ conversations works (though she still uses single words, she will ask ‘daddy?’ to see where daddy is, tell you that something hurts her, point out a feature of the outside world she ic excited about). Its a big relief for us to know that once she ‘gets’ something, she gets it naturally, as if its never even been an issue. she will use words she knows creatively to tell you what she wants. she did not know the word for outside but knew the word pool (we have one) and would use it when she wanted to go outside, etc. she did not know the word nutella but had seen jelly in a tv show and despite the fact that nobody every spread it in the tv show, she decided that it is spreadable and called nutella ‘jelly’ when she saw it first. this all also points towards her problem being auditory input issues. i am always for correcting the biological disfunction and then working on the rehab. this is why i am looking into this. honestly i do not even know how this receptive speech issue could possibly be solved in a ‘therapy’ way because if sounds dont go in the right way, what can therapy do? its not like you can therapy people out of deafness either.
DeleteMany people exhibit selective hearing. They only seem to hear things they want to hear.
DeleteMy son loves chips/crisps; if I have bought some and put them away in the kitchen he will hear the sound of the packaging and come looking for them. When he was younger and I asked him a question, that was not directly rewarding, he would ignore it.
You can use behavioural therapy to reward your daughter for paying attention, listening and then responding.
In Verbal Behaviour therapy you start with "manding", which is getting the child to make request. Each time she makes request you click the counter and eventually you get to your target of say 200 requests a day. You have to create situations where the child makes requests, for example you pause a video and then the child says "play it" or "more".
So in your case you have to create situations for your daughter to practise replying to you. You use a reward/reinforcer to encourage her to reply promptly. The more she repeats this process, the more instinctive it becomes.
A good behavioural therapist would show you how to do this. It isn't really speech therapy.
Hello
DeleteI always have thought that my daughter (6 years old severely autistic) perceives the speech as noise. This noise really disturbs her. How I can teach her to speak if she covers my mouth and says shhhh almost every time when I try to speak to her or someone in the room?! She can hear a noise long before I can hear it. Sometimes with even 5 minutes before the approach of an ambulance or train, for example. She loves music, but other music upsets her. A lot of her stimming talk is related with the noise that she is perceiving, it is like a cope mechanism. Every therapist and doctor that I have met they do not know any treatment than behavior therapy, which we did and did not work. My daughter can reproduce any sound, and note, makes some demands in one word, pronounces words in three languages, she is able to type on PC words that I dictate by letter, but still non-verbal. Only one speech therapist told me that she can not work with her until we solve this issue. Sometimes I am thinking maybe that is the reason why behavior therapy did not work either.
prada, one thing you can do is see if giving her a potassium supplement, say 200 mg, in a glass of water and see if it makes her more tolerant of sound 20 minutes later.
DeleteThis all relates to hypokalemic sensory overload, which was covered in this blog.
If giving potassium causes a short term improvement then there is likely an ion channel dysfunction (channelopathy) as the underlying problem.
I did this experiment years ago measuring my son's tolerance of his most hated sound (a baby crying).
Peter, I read here on your blog about your success experiment with potassium. I try potassium chloride and citrate powder dissolved in little water and than in her juice. The potassium that I got is 1/8 teaspoon = 365 mg potassium. Only once I succeed to give this dose but spread of all day without any evident effect. I tried to find the potassium from Biofar that you used, bur is not shipped to Canada. I have ordered an effervescent tablet from Doppelherz, but this one has magnesium 300mg et 300 potassium along with B6 (4.2mg) and B12 (5 mcg) and it not here yet. I wonder if it is too much magnesium for one tablet and not too less potassium.?!
Deletehttps://www.amazon.com/gp/product/B0041M8L5O/ref=ppx_yo_dt_b_asin_title_o00__o00_s00?ie=UTF8&psc=1
Past a few months M has begun to eat salt from shaker so the potassium is a big concern here. I am thinking about the potassium gluconate, may be tastes better. Because of her food rigidity we have big trouble to give her supplements or medication. All we give her is in form of drops or powder that we hid in her carrot orange juice. I can give her by force with a syringe but often she makes herself vomit so not a good option. She craves fat also. She loves to eat the left-over oil from cooked chicken or fish. So, I bought Efalex oil for her and she only accepts from syringe without vomiting and fussing. We started it yesterday.
I am thinking of bumetamide, but I read here that deplete potassium and needs a lot of water. M does not drink water, only diluted the juice with it. I will speak at next appointment with her pediatrician, but I know she is not open at any treatment. So am I so scare to try bumetamide without a doctor supervision. A few years ago, I spoke with her about potassium and phosphorus that is missing from Cetrum Junior vitamin that she prescribed to M. She did not agree to supplement her with them. Did you find a doctor that accept bumetamide treatment? I am thinking to find a doctor overseas.
I also thought that my second language and third language are like autism speech in the sense of phrasal verbs, small talks and jokes. I have had difficulty to make friend in these languages too. So, your association of your German language it made perfect sense to me and it is absolute true.
I do not have enough words to express my thanking for your work. I have been here almost every day form the past months. A lot of to digested and not easy stuff for some parents like me. You are so good to put in easy words technical vocabulary. When I find something on google scholar and even it is only the summary of the article, when I came to your blog I find free a lot of stuff.Thank you.
Language and speech are the most central issues in autism, and yet very little seem to be known about it, at least regarding treatment options. Part of this is probably due to the many different reasons why autistic kids struggle to speak:
ReplyDelete-Impaired neurological hearing (not being able to hear speech correctly)
-Verbal apraxia (not being able to use the muscles of the mouth)
-Social anxiety
-Social motivation
-Verbal memory ("loosing the thread" or "on the tip of one's tongue)
-Issues building grammar
-and many other reasons
Having a child who according to statistics has only 10% chance to ever become verbal I surely have looked into this. In my case all the above reasons, except for eventually the ones concerning social behaviour, are very present. Most of these are related to a genetic link between the genes TBR1, FOXP2 and eventually CASK.
The FOXP gene family is directly related to language acquisition (see for example https://en.wikipedia.org/wiki/FOXP2), but mutations in those genes are probably pretty rare and perhaps only associated with language and not autism. Instead, I think that in many ASD cases it is the downregulation of the two others that are responsible. It is also possible that a similar pattern exists for the regulation of the other FOXP genes, I just haven't checked those.
What happens downstream of all this would definitely be interesting, all I know is that it has some vague link to retinoic acid pathways. I also speculate that there is a link to decreased myelination (signals being lost on the way) and neuroinflammation, since my daughters language comprehension goes down to almost zero when she gets a cold.
More practically, I have seen a little bit better language comprehension with Ponstan at early age, but possibly with less effect or fading effect later. Pterostilbene had a small effect, but at the moment that effect is not noticeable and I don't know if it might be correlated to the new tooth that is coming up or if it just faded away.
There is much more to learn, and I will surely post any advancements on this topic.
/Ling
Thank you, I will look into this. We believe to have gotten hold of the neuroinflammation with gcmaf to a good degree but I really want to get rid of this issue because it impacts receptive speech and regardless how well you child advances in any other area, if it cant understand tasks and other people, it will go nowhere. as speech therapists say, if the input is not good, output can’t possibly be good.
DeleteA brief look at the language issue again.
DeleteGiven the importance of the FOXP2 gene in spoken language, I think we can safely regard many language issues in ASD to relate to the triad of cofactors FOXP2+TBR1+CASK. Or, the up/downstream genes. Also, I know that downregulation of any of the three "language triad genes" can lead to language dysfunctions, but it is possible that also upregulation could do the same. I just don't know yet.
Upregulating FOXP2 would be hard, because it doesn't interact with many other genes. It autophosphorylates itself (I guess this could be translated to "use it or loose it"), and some other FOXP genes have impact on it. FOXP2 has one distant promoter which probably isn't investigated yet; it would be very interesting to learn which other gene acts on that site.
The TBR1 gene is upregulated by coordinated AMPA+NMDA activation, and GABAa antagonism by bicuculline. Piracetam sounds like a good option, and I know one anecdotal case where Piracetam helped language issues. It is possible that one or more of the GABAa subunits are involved given that bicuculline upregulates TBR1 - but which ones? It is possible that Gingko could help, as it also is a GABAa antagonist.
For CASK, we could choose anything that enhances the PKA signalling pathway: PDE inhibitors, forskolin, maybe also things that act on dopamin receptor 1.
/Ling
It is also possible that the language problem lies in the up/downstream cascade of the language gene triad.
DeleteUpstreams:
Genes like SATB2 are positively correlated to TBR1.
Here we get positive regulation by BDNF, CNTF and estrogen receptor beta agonism,
unknown regulation of P38/Akt, and negative regulation by insulin.
The genes CTIP2 and Rybp are negatively correlated with TBR1.
The Afa gene also has an (unknown) impact on TBR1.
Downstreams:
The retinoic acid signalling pathway overlaps with the FOXP2 pathway.
The reelin protein (involved in most neurological diseases) is positively regulated by TBR1, and as it seems also by serotonin receptors (some up and some down).
Hypofunctioning NMDArs are implicated, so perhaps D-serine or cinnamon (cinnamon also enhances PKA)
miR-124 is downstreams of FOXP2, and it looks like it needs to decrease to get better verbal memory.
My own experience is that Fisetin + Bacopa together induce syllables in my daughter.
Both act on serotonin receptors, and Bacopa downregulates miR-124 and upregulates reelin if I remember things right. It is possible that it would be enough with just more Bacopa in my case.
/Ling
Up/downstreams of FOXP2, some miRnas well worth looking up:
DeleteFoxp2 is regulated by miR-9 (there are three: miR9-1, 9-2 and 9-3) and by miR-132 (there are two, miR-132-3p and -5p).
Foxp2 regulates miR-124 (as mentioned above) and miR-137 and miR-9 (again - maybe a feedback loop?)
(Source: page 151, "An Introduction to Genetics for Language Scientists", can be found on Internet)
Luteolin can upregulate miR-132 (https://www.ncbi.nlm.nih.gov/pubmed/22916239/)
BDNF stimulates upregulation of miR-132-3p (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049877/)
But, we don't know if miR-132 needs to be up- or downregulated, it can be either depending on the underlying condition. For a review on miR-132, see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5660991/
Some of the miRnas mentioned here are also connected to REST, that we hopefully will learn more about next year.
/Ling
Really, what we would want now is someone explaining the correlation between mitochondrial/energy functions and language, because there is one.
DeleteThere is language regression in autism secondary to mitochondrial disease, but why?
We have reader reports on better language skills from the C8+BHB therapy mentioned in the ketone blog post series.
What about language and folinic acid?
My two best _guesses_ is that this is related to:
a) the function of the AUTS gene, which is downstreams of TBR1+CASK and probably but not confirmed downstreams of FOXP2 too. It has some connections to GLUT4 and OXPHOS.
b) or, that mitochondrial function is related to miR-9 and perhaps REST, so upstreams of FOXP2.
/Ling
Hi Ling!
DeleteHope all is well and that you and your family had a wonderful Christmas!
First, I really like and appreciate the work you've done on the "Language Triad' posts above and the way you've presented the information. Great Work!
Also, I really like how you've drawn the relevant miRNAs into your analysis. I had posted a paper recently that tied social behavior to a cluster of miRNAs, and you've provided some interesting insights into miRNA connections to FOXP2. I think miRNAs will end up being bigger players than people may realize.
I know speech has been a big issue for us (as well as cognitive skills and social interactions), and yes, C8+BHB has easily been the single biggest source of improvement for us, especially in speech.
Interestingly, Dr. Goldenthal's analysis showed that my daughter was on the low end of normal for Citrate Synthase (CS) and below normal in Complex I:CS ratio, but a Mito cocktail didn't necessarily result in noticeable improvement, whereas C8+BHB has made a noticeable improvement.
Hopefully we can put a few key pieces of this puzzle together in 2019.
AJ
P.S. Ling, check out this paper I have been looking over since reading your post and posting my response above:
Deletehttps://www.biorxiv.org/content/biorxiv/early/2018/10/11/439984.full.pdf
And of course, the very important link to the supplemental material:
https://www.biorxiv.org/content/biorxiv/suppl/2018/10/11/439984.DC1/439984-1.pdf
I hope you find this information interesting Ling!
AJ
Thanks AJ for some reading! Two minor additions:
DeleteFirst, that mutated FOXP2 and FOXP1 has some overlapping phenotypes in cognitive disorders and at least FOXP1 is related to ASD. Goes well with the fact that other FOXP genes regulate FOXP2:
(See Figure 1 for quick review)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470686/
Second, FOXP2 directly regulates the MET gene (negatively), and MET is also an ASD gene.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667610/
/Ling
I'm adding some conference abstracts on language here:
DeleteFoxp1 och Foxp2 - ASD and language genes, cooperate:
https://www.abstractsonline.com/pp8/#!/7883/presentation/46436
Ube3a (Angelman) vs CNTNAP2 (ASD model) mutations impair different pathways that improve mice vocalizations - motor skills only vs atypical social behaviour only:
https://www.abstractsonline.com/pp8/#!/7883/presentation/73004
Foxp1 KO in birds disrupts new learning of songs, E/I balance implicated
https://www.abstractsonline.com/pp8/#!/7883/presentation/63837
Songbird research hints that ginsenoside Rh2 can enhance speech learning:
https://www.abstractsonline.com/pp8/#!/7883/presentation/63901
/Ling
I can't understand I missed this article:
DeleteSpeech-Stimulating Substances in Autism Spectrum Disorders
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616660/
It's not really a good review, but it highlights some previously mentioned and trialed stuff by people here.
/Ling
Speech, language and apraxia - down to (some of) the genes around FOXP2:
Deletehttps://pubmed.ncbi.nlm.nih.gov/32622339/
and
https://academic.oup.com/hmg/article/27/7/1212/4819278
Unfortunately it seems "my" gene is a direct interactor with FOXP2, so no intermediates to target. :-/
FOXP2 and it's sidekick miR-3666 seem regulated by all-trans-retinoic acid. Together they eventually modulate the expression of TCF4, possibly of interest to you Peter...
(https://medcraveonline.com/JABB/intronic-mirna-mir-3666-modulates-its-host-gene-foxp2-functions-in-neurodevelopment-and-may-contribute-to-pathogenesis-of-neurological-disorders-schizophrenia-and-autism.html).
/Ling
Ling, thanks that is interesting. It is a subject I would love to fully understand, but nobody does. I would love to write a “how to” post on this subject.
DeleteI think in the world of autism it gets even more complicated.
In English there is a subtle difference between speaking and talking.
Truly non-verbal people cannot speak a single word (no Mum/Mom/Mama/Mummy).
Some autistic people can speak, meaning they can repeat words or sing a song they have learnt or they read aloud; but they do not “talk” much, meaning the act of engaging in communication with others.
Verbal behaviour starts with echoic and then gets more complicated (mand, tact, intraverbal, autoclitic). If your thirsty daughter was to say “water” that would be a mand, a request.
Some people with autism cannot speak and so do not talk. The biology behind this is one category (A).
If a child can speak one word, they can be taught/encouraged to speak more words. This may take a lot of work and it looks like parents do give up.
Some people with autism can evidently speak, but they talk very little, just when they really want someone, or something. The biology behind this is another category (B).
I found BHB and Calcium Folinate seem to have an effect in (B), they promote more complex speech.
I am not sure where I would put sulforaphane (A) or (B); it made my son produce words, but not particularly cleverly.
I think as years pass by speaking/talking becomes a matter of habit and it becomes very hard to get a minimally verbal person to talk.
I know certain genes are linked to a person being non-verbal, but many processes are polygenic meaning a single gene just gives a likelihood rather than a certainty of something happening. With persevering parents, some children who were on a genetic path towards being non-verbal do learn to speak.
Here is another intervention that we've seen on your blog but not related to language/speech:
DeleteFOXP1 suppresses the endothelial NLRP3 inflammasome
The article is on atherosclerosis, and I think we've seen earlier that this is one hereditary inflammatory condition that can predispose for autism in the offspring.
The nice little quote here, that's linked to the heart but probably to some extent to the brain is:
"Simvastatin can upregulate FOXP1 expression"
Now this is interesting, because FOXP1 is implied as a language gene, possibly because it regulates FOXP2 or on it's own:
Just to give a quote on that (I think there is one above among the comments too), here is one from a study on finches (birds are a better model for language issues than mice):
"This study confirms that in multiple songbird species, FoxP1 expression highlights song control regions, and regulation of FoxP2 is associated with motor control of song."
https://jeb.biologists.org/content/216/19/3682
/Ling
wanted to get your opinion on this - is there is anything you can suggest to manage my 13 year old son, high functioning ASD and controlling his sexual impulsitivty. he is very 'curious' about this, as any neuro typical teenage boy is. but he needs to be given direct bounderies and directions on what is appropriate and not. we have tried and most os the time he is pretty compliant but sometimes, and rcently more that in the past, while knowing what's ok, it's like he doesnt really care. Any advice??
ReplyDeleteIf you live in the US, go an see a behavioral therapist (the kind that do ABA for more severe autism) who has/had their own teenage kids. It is a common issue and people who have experienced may kids of this age can give you really useful advice. There are even group workshops for Asperger's teenagers to learn about social behaviour and boy/girl issues.
DeleteIt is all about consistency and not pretending the issue will just go away. A 13 year old can get away with a lot of behaviors that would cause a 23 year old to get into big trouble; so it is important to get things right from the start.
I would go an see an "expert" and ideally have your son attend some of these workshops. My son has been invited to join one.
Peter have you considered that the effect of statins (obviously inhibition of cholesterol production through HMG-CoA reductase inhibtion) could also potentially indirectly increase ketones?
ReplyDeleteThis could also explain why HMB (the anti-catabolic sports supplement) could increase both ketones AND cholesterol.
Have a look at the pathway:
https://en.wikipedia.org/wiki/Beta-Hydroxy_beta-methylbutyric_acid
Could statins through this pathway increase the availability of β-Hydroxy β-methylglutaryl-CoA (HMG-CoA), this is a precursor of Acetoacetic acid and BHB. Basically administrating statins would force the pathway towards endogenous ketone production and thus have HDAC-i properties?
HMB itself has effects on the brain aswell:
Beta-hydroxy-beta-methylbutyrate ameliorates aging effects in the dendritic tree of pyramidal neurons in the medial prefrontal cortex of both male and female rats.
https://www.ncbi.nlm.nih.gov/pubmed/26973106
β-Hydroxy-β-Methylbutyrate (HMB) Promotes Neurite Outgrowth in Neuro2a Cells
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534402/
"Furthermore, HMB increases the expression of brain glucose transporters 1 (GLUT1) and 3 (GLUT3)"
Beta-hydroxy-beta-methylbutyrate (HMB) ameliorates age-related deficits in water maze performance, especially in male rats.
https://www.ncbi.nlm.nih.gov/pubmed/28038406
HMB itself has been shown to cross the BBB.
Aspie1983, statins have numerous good effects that might help someone with autism (or indeed someone with a predisposition to certain cancers). What is surprising is that some people get a behavioural effect within a day. Many of the effects from a statin I think would take longer to take effect.
DeleteI think we will end up concluding something similar with BHB; there are multiple reasons why it may benefitting the same person. It would be nice to know the dominant "good effect", because then you can seek to maximize it, but if BHB gives you no side effects you could just stick with that.
Hello, I enjoyed the article. I am the person who makes KetoForce and developed BHB salts for the market along with Dr. D'agostino. If mineral load is an issue for you than I recommend you try our ketoblitz. It combines BHB free acid with potassium and sodium BHB, thereby delivering BHB at around half the amount of potassium and sodium. It is pH 4.5 with flavor and sweetener and so it tastes well, all you need do is dilute an ounce with about 10 - 12 ounces of water. https://ketosports.com/ketoblitz.html
ReplyDeleteHello Illinois Patrick, for people outside US/Canada your products are very difficult and/or very expensive to acquire.
DeleteIf you sold them through iHerb you would sell far more internationally. They have very cheap shipping and the goods can arrive via the local mail and so avoid a $50 customs clearance admin fee from Fedex/DHL in addition to the expected customs duty and sales tax/(VAT).
I can buy a $55 BHB product on IHerb and my total cost where I live is $85. This is OK.
You could also use Amazon in Europe to distribute it. A tiny company sells C8 this way.
Yes, it would be great to have KetoSports products available in Europe via iHerb. KetoForce sold locally in Poland costs $106 compared to $55 on the US Amazon.
DeletePatrick, can you help me with KetoBlitz ingredients? Its says that KetoBlitz contains Potassium Sorbate and/or Sodium Benzoate, how do I know which one? I need a no-calcium BHB product for a person who cannot tolerate sodium benzoate. To date I found KetoForce increases ketones level most efficiently of several products tried as per Keto Diastix readings.
I would appreciate your insight.
Also, DO NOT drink ketoforce without mixing with an acidic beverage like orange juice. It will taste like sea water. It has a pH of around 10.5. The directions on the bottle instruct the user to do mix with an acidic beverage to bring the pH down to a tolerable level. If you are not doing this then I am sure it is horrific tasting
ReplyDeleteMaybe this is for Tyler. I'm not sure. BCAAs have been a Godsend for us with my young adult son who raged several times a time.
ReplyDeleteWe added phosphorylated serine (Serophos is the brand name) at bedtime (2000 mg) when the escalation started to creep into his nighttime wake (anywhere from 1-3 AM then up for the rest of the night). This did nothing for the nighttime waking but instantly ended the escalation during that time. It seemed to make his daytime mood even better.
I did agmatine for a few days showing nothing positive. I stopped a couple days ago since the short-fused, mini-escalations started to come back.
They are getting worse at this point.
It is so disheartening.
Does the effectiveness of the BCAAs/niagen wear off at some point? Should I be increasing them? (it has been a few wonderful months) Could the phosphorylated serine be doing working against him at this point?
I would appreciate any guidance.
Nancy
Adding a review paper on speech in autism to the stack. It's not the best one I've read (nothing new), but deserves to be mentioned here anyway:
ReplyDeleteSpeech-Stimulating Substances in Autism Spectrum Disorders
https://www.mdpi.com/2076-328X/9/6/60/pdf
/Ling
Apraxia genes paper:
ReplyDeletehttps://www.sciencedaily.com/releases/2020/04/200429105846.htm
(Link to article at bottom)
/Ling
Peter and Ling,
DeleteMy son is 26-mo, and can only speak 1-2 words. The only spontaneous word is "want" (in Chinese). He is, I guess like other Apsies, sensitive to certain music and could recite a few favorite melodies relatively quickly and then signed it every 15-min. Otherwise, he gibberishes a lot that resembles nothing to the mother tongue. He gets irritated very easily and only screams and grunts. HIs voice is coarse. We are obviously very saddened.
If I follow Peter's categorisation, he should be more like a cat. B, but to me, I feel like he has a lot of noises in his head, and only music can go through his ears. I said it because his intra-verbal is very consistent, ie. if we sing a song he likes, but have the lyrics replaced with the pronunciation we want him to imitate, the success rate is like 50%. But a typical shoebox exercise under verbal behaviour, the hit rate is like <1%.
He still mouths objects. No saliva / feeding issues. He sleeps well and poo twice a day normally. He is not a sub-type with GI symptoms. He has good eye contacts, and intention to engage you for simple play. He also engages you to prepare milk (his favorite food).
He stims by touching uneven surface or texture.
Trialing bumetanide and NAC is a very good idea, which you have in process.
DeleteYou might also consider Knut's idea which aims to stop the progression of the disease process. This is only possible in a very young child like yours.
https://epiphanyasd.blogspot.com/2016/06/mefenamic-acid-ponstan-for-some-autism.html
His drug is sold as Ponstan, which is widely used to treat children with a high temperature. It is OTC in some countries and is not expensive.
Knut's deal to commercialize this idea has stalled. There is no doubt he is very clever, but the idea has not been subject to clinical trials.
I think if you trial Calcium Folinate at 1mg/kg and then Bumetanide, you have a good chance that one or both will help with speech.
Tried NAC at 200mg - powder from Thorne. Mixed it with formula, the only plausible way as he doesn't drink orange juice. What a shame. The broccoli powder has a smell that even I find it lingering. May need to give it a pass for now. For younger kid, the drawback is to put them to supplements of different tastes.
ReplyDeleteDo you know if Bumentanide tastes acidic too?
Bumetanide will not be a problem. You can just crush the pill. NAC from the capsule placed in water tastes bad, the powder and effervescent forms taste OK.
DeleteI thought broccoli powder in water tasted disgusting, but my son was happy to drink it. Life is much easier when you know how to swallow pills/capsules.
The supplement Broccomax smells very little, which seems odd to me. You always have the option of fresh broccoli sprouts, which taste fine.
Tung, i use mix my powder capsules with chocolate, basically use typical 70% dark chocolate small piece (size of a button) melt in microwave (make sure not to make it too hot, so couple of trials to find minimal duration/temperature just enough to be able to mix powder with) if mixture is too thick then add some organic agave syrup to help.
DeleteThanks Peter.
ReplyDeleteWith the lockdown of the UK the bumetanide will for sure be delayed unfortunately. Would try mefenamic acid first. It seems mefenamic acid can reduce the effect of diuretics so I can test it until the bumetanide arrives. Hope that mefenamic acid tastes neutral in milk otherwise we have to resort to force-feeding. And not sure the dosage yet. And it is a prescription drug here.
I will try to source the sachet form of NAC which is available here in HKG.
Mefenamic acid doesn't taste much at all. You should always use it together with food/fat though, like yoghurt.
DeleteLook for my old comments on the blog posts about Ponstan here for some reference. I think my initial dose was too high and so could not be sustained for more than 5-6 weeks. (Long term use is bad for the stomach -read up on this so you know the risks). However, within this time it became obvious I had a responder. The effect faded with age.
/Ling
I believe everything is palatable in a spoon of nut/chocolate spread such as nutella. The worst supplement my kid takes is definitely prostaphane which has a burning sensation to it. Everything else is easily taken with the nutspread (we use an organic one with lots of hazelnuts and good fats). This is much easier for me than teaching her how to swallow things and then trying to explain what she can swallow (pills I give her) and what she should not - other pills, small objects etc.
ReplyDeleteHi Peter,
ReplyDeleteCan i ask a quick one? Ketoforce you mentioned, is it this one in the link: https://ketosupplements.co.uk/product/ketoforce-by-ketosports/
thanks
Teymur
Teymur, that is the product, but it is really expensive. You can buy it in the UK online for much less.
Delete