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Showing posts with label Magnesium. Show all posts
Showing posts with label Magnesium. Show all posts

Sunday 8 December 2013

A Hypothesis: Vitamin D, Calcium, Milk, and the Autism Epidemic



by Seth Bittker

My name is Seth Bittker, and I am the father of a boy with ASD.  My son’s development was slow up until about 2 1/2 years of age.  Around this time, his milk consumption increased, and it began crowding out other sources of sustenance.  Within a few months he regressed, and we received an autism diagnosis soon after this.  Stopping his milk consumption was the first step in helping him get better.
Like some other parents of those with ASD children, I noticed that his behavior varies significantly with what he eats.  When he consumes large amounts of calcium fortified foods or beverages, his behavior gets worse: he becomes more autistic in a behavioral sense.  Since milk has a lot of calcium, and calcium fortified foods do as well, it seemed like there might be some connection to calcium and his symptoms.  Later based on a doctor’s recommendation we gave him supplemental vitamin D.  We did not notice much initially, but a few weeks later he developed hives, and he regressed.  Since supplementation with vitamin D increases absorption of calcium, it appeared that the bad reaction to calcium and vitamin D might be connected.  Based on these experiences and others, I eventually inferred that we should keep him on a relatively low-calcium diet and avoid vitamin D supplementation or fortification (milk as well as many other foods in the US are fortified with vitamin D).
I also concluded that my son was different from most others affected with autism as some have suggested that vitamin D deficiency is involved in inducing autism,[1] and he evidently did not have a deficiency based on the vitamin D trial even though vitamin D levels in his blood were relatively low.
But is he really different than others with autism?  If one examines the evidence from a number of genetic syndromes that are comorbid with autism, in many cases the cause is over-active calcium channels (effectively too much intra-cellular calcium).[2]  You can see this by looking at syndromes such as Timothy syndrome, Williams syndrome, and Sotos syndrome, which have high comorbidity with autism and seem to be caused by too much intra-cellular calcium.  In Williams syndrome the connection is through a gene which upregulates vitamin D.[3]  In some of these syndromes is it well known that supplementation with calcium and vitamin D are contraindicated.[4]
In addition there are certain biochemical markers that are typical in autism, and my son seems to have this same biochemical gestalt.  For example two types of immune system cells released by the thymus are called “Th1” cells and “Th2” cells, and Th2 cell levels relative to Th1 cells are much higher in the blood of those with autism than in controls.[5]  As Th2 is associated with extra-cellular immunity, this suggests that those with autism will be prone to allergies,[6] which fits with anecdotal observation.  In addition with autism we see elevated markers for oxidative stress and endothelial damage.[7]  Also those with autism typically have functional deficiencies of magnesium[8] and potassium.  By functional we mean the levels may not be low in the blood relative to controls, but there is a biochemical need for greater consumption.  To see the latter you can give somebody with autism a small dose of supplemental potassium, and the result is generally a reduction in autistic symptoms.  For more on this, see Peter’s work: http://epiphanyasd.blogspot.com/2013/08/potassium-may-play-important-role-in.html.
It turns out that vitamin D skews the immune system to produce elevated levels of Th2 cells.[9]  One can infer that it also produces functional deficiencies of potassium and magnesium as these minerals offset the effect of calcium on calcium channels and vitamin D increases the absorption of calcium.  In addition in high doses vitamin D causes oxidative stress and endothelial damage as we see in autism.[10]

Oral supplementation with vitamin D can cause other consequences as well.  Supplementation with significant doses of vitamin D early in life, results in more cases of allergies, asthma, and dermatitis later.[11]  Asthma, allergies, and dermatitis all feature high levels of Th2 cells like autism.[12]  Is it too much of a stretch to suggest that supplementation with vitamin D early in life, might result in more cases of autism later as well?

On looking at the data we can see that my son as well as most other babies in much of the civilized world received, and in many cases continue to receive, large oral doses of vitamin D starting from birth.  As a baby we gave him vitamin D drops, and he also occasionally received some formula.  Starting at one year of age he consumed increasing amounts of milk (fortified with vitamin D in many countries) as well as children’s multivitamins, which also contained vitamin D.   Here is a graph showing vitamin D content of various beverages:



 
We are giving babies today much more oral vitamin D than they would consume from human milk alone and also much more than they would have consumed in past decades through formula and food sources when vitamin D fortification was more restrained.  In fact based on nutrition data and caloric intake, a baby just out of the womb consuming Similac baby formula today will receive approximately 855 IU per day of vitamin D.[13]  I am 190 pounds.  If we assume that dose should be proportional to weight, which is a good baseline assumption for most vitamins, I should consume 16,245 IU per day of vitamin D.  This is a huge dose, and based on past experience I know it would have a devastating effect on my health.  Why should it not be the same for some subset of babies?
When and where vitamin D consumption by the young is high, is where autism rates are high.  For example, in the United States autism rates are high relative to much of the rest of the world and they rose gradually starting around 1980 as much of the population transitioned to lower fat milks, which increased consumption of vitamin D.[14]  Later rates rose again in the early 1990s as the amount of vitamin D in milk was increased significantly with no change in the label.[15]  Rates continued rising with the popularization of the Sippy Cup starting in the 1995.[16]  They rose further during the 2000s as the Institute of Medicine increased the supplementation recommendations for babies in 2003 and again in 2008.[17]

When looking internationally, the evidence also points to a role for oral consumption of vitamin D in inducing autism.  Cuba for example has extraordinarily low rates of autism.[18]  The Cuban Health Service does not supply vitamin D drops to babies.  Nor do they fortify milk or other foods with vitamin D in Cuba.[19]  The Amish also have very low rates of autism as well.  They do not provide vitamin D drops to babies, and the milk they consume comes straight from cows: no vitamin D is added.[20]  In the United Kingdom rates of autism are lower than in the United States.[21]  Fortification and supplementation are common in the United Kingdom, but at somewhat lower levels than in the United States.[22]
Vitamin D is also used as a rodenticide, and experiments in rats show that it is more deadly to male rats than female rats.[23]  Is it any coincidence that autism strikes many more males than females?  Babies who get most of their sustenance from formula also receive more vitamin D than those who receive vitamin D from human milk.  Not surprisingly autism rates are higher among those who are formula fed.[24]
Vitamin D’s involvement also explains why some with autism benefit from a “casein” free diet as such diets avoid milk, which has high calcium content and is fortified with vitamin D in many countries.  It also explains why low-oxalate diets are beneficial as well as ketogenic diets.  Oxalates cause excess calcium salts to precipitate in the body and ketones effectively remove excess calcium due to acidity.[25]  Both lower the calcium load.  Oral supplementation with vitamin D also explains why some with autism have a favorable reaction to chelation.  Chelation agents remove excess calcium at the same time as they remove other metals.[26]  So they also lower the calcium load.
So the evidence suggests that over-consumption of vitamin D by babies and toddlers may induce autism in a genetically susceptible subset of the population.  This explains the biochemistry of autism as well as the nature of the autism epidemic.  There are a number of other data points that fit with this hypothesis.  If you are interested in this topic, here is an ebook with a lot more detail: http://www.amazon.com/dp/B00GVB46ES.

I want to thank Peter for allowing me to be a guest blogger here, and I also want to thank you for reading this. How do you view this hypothesis?  Do you have observations that are relevant to it?  Are you aware of existing data that would help confirm it or refute it?




[2] For more on calcium channels and autism, please see http://www.autismcalciumchannelopathy.com/Genetic_Factors.html.
[10] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052582/ and Gross, David Ross, Animal Models in Cardiovascular Research, p. 316.
[15] FDA, M-I-92-13.

Monday 2 December 2013

Hypokalemic Autistic Sensory Overload


Hypokalemic Autistic Sensory Overload (HypoASO) is a condition causing distress to autistic people.  Moderately loud sounds, like those around an indoor swimming pool, or shopping mall, can cause an autistic person great irritation, leading to covering their ears, a tantrum, or even self-injurious behaviour (SIB).  The same sensory overload can be caused by light, smell or touch.  

HypoASO is a condition that can be measured and treated.
HypoASO is related to two other conditions Hypokalemic Periodic Paralysis and Hypokalemic Sensory Overstimulation.

HypoASO is an ion-channel disorder triggered by intra/extra cellular concentrations of sodium and potassium.  Calcium may also play a role.  In simple terms, sodium is bad and potassium is good.
Therapy for HypoASO

The therapy for HypoASO is a diet rich in potassium but low in sodium; magnesium will also be beneficial, since it helps maintain the level of potassium.  People with HypoASO need to maintain a high level of potassium in their blood (> 5.0 mmol/L) in order to avoid triggering this ion channel disorder;  this is at the high upper level of the reference range for potassium.   Oral supplements of potassium with magnesium will also prove useful, but need to be spread out throughout the day, for best effect.  Time release tablets should be the most effective.  Very high levels of potassium are dangerous, so care is required.

Testing for HypoASO

Diet should not be changed on a whim.  A simple test can be carried out to check whether the individual is indeed affected by the disorder. 

1.       Find a sound which the person finds disturbing, like a baby crying.

2.       Download a recording of this sound.

3.       Set up a chair in a fixed location in a room with a strong sound system / Hi Fi

4.       Sit the subject in the chair and play the annoying sound at ever greater volume and see at what point the subject reacts strongly (e.g. covers ears)

5.       Repeat the experiment over  a few days to establish a steady base-line volume, at which the subject reacts, (for example volume setting 3, when the amplifier to goes 0-10)

6.       Give the subject an oral potassium supplement (say 250 mg) and wait 20 minutes

7.       Play the annoying sound and measure the volume at which ears are covered.

8.       If the volume is markedly higher than the base-line, you established earlier, then you have established HypoASO

9.       If the subject has an NT sibling, try it on them.  They will most likely show no difference with the potassium and do not have HypoASO



 

Sunday 17 November 2013

Magnesium in Autism and other Neurological/Psychiatric Diseases


You may have my read earlier posts about the surprising role of potassium in autism; in those posts I also noted the importance of magnesium for the body to maintain a sufficient level of potassium.  I had thought I had really finished this subject once and for all.

Last week I was discussing my findings with the Endocrinologist.  She was asking how I could possibly tell whether a new therapy was working, given that I already have others in place.  I thought this was a very good question; I replied that if you only change one thing then you can determine whether a therapy is good, bad or has no effect.  If you are new to autism, you are not aware that the condition has many separate dimensions; it is not just a linear scale from 1 to 10.
A few days ago there was an excellent example.  Monty, aged 10 with autism, has an assistant, Nela, who goes to school with him.  When I asked how he was that day, Nela said that he was not as good as recently; he was not making good eye contact and not answering the teacher’s questions.  I asked more details and then Nela mentioned he had been covering his ears.  Then I had to think what had changed.  No potassium/magnesium supplement at breakfast.  Could it really make such a difference, and so quickly?  The only way to tell was to give K/Mg straight away.  It was like “a curtain had lifted”; Nela’s words not mine.
Rather shocked by this further proof, and since almost nothing has been written about potassium and autism; I thought I would do some digging about the other mineral, magnesium.  I was aware that in autism, people do give magnesium and vitamin B6, but I was unaware about its broader role in other neurological/psychiatric Diseases.
There is a big question about what controls the flow of magnesium across the blood brain barrier (BBB).  It clearly must cross somehow, but it is not a simple process.  Because of this, researchers at MIT tried to find a form of magnesium that would easily cross the BBB, they succeeded in mice; but it is far from clear that their new compound magnesium l-threonate has the same effect in humans. 
From the research, it is clear that most people do not have enough magnesium in their diet and anybody with any kind of neurological or psychiatric disorder should make sure their diet is rich in this mineral.  The rest of this post is really for those who want to know why supplementing Potassium and Magnesium should be good for anybody with ASD.  If you do not feel the need to know why, just go buy your supplements.
All you could ever want to know about the neuroscience of magnesium is available in one place, and for free:-

We have to thank Robert Vink, from Adelaide, Australia and Mihai Nechifor from Iaşi, Romania for this 355 page collection of research papers; if only there was one for potassium.
I made a summary of the parts I found interesting that relate to what I am interested in.  Many of the papers are not too science-heavy and you can skip through them.  
  • Magnesium levels are reduced in acute and chronic brain diseases
  • Extracellular magnesium deficiency induces apoptosis, mainly through increased oxidative stress  



Neuronal apoptosis can be triggered by three main mechanisms:

1)    Lack of growth factors;

2)    Overstimulation of glutamate receptors; and

3)     Oxidative stress.

Magnesium could play a (different) role in each of these signalling pathways.

Brain magnesium decline is a ubiquitous feature of traumatic brain injury and is associated with the development of motor and cognitive deficits.
Experimentally in TBI, parenteral administration of magnesium up to 12 h post-trauma restores brain magnesium homeostasis and profoundly improves both motor and cognitive outcome.

Magnesium has been shown to attenuate a variety of secondary injury factors, including brain edema, cerebral vasospasms, glutamate excitotoxicity, calcium-mediated events, lipid peeoxidation, mitochondrial permeability transition, and apoptosis.

Magnesium therapy has failed in clinical trials. Increase in brain free magnesium concentration seems to be essential to confer neuroprotection, and intravenous magnesium administration only marginally increases CSF magnesium concentration, which suggests that the integrity of the blood—brain barrier and the regulation of magnesium in the cerebrospinal fluid are largely maintained following acute brain injury and limit magnesium bioavailability in the brain.

Calcium and Mg cellular contents classically follow the same pathway – when Mg increased, calcium also increased. This May explain the significant correlation between Erc--Mg and intracellular calcium values as well as the fact that in children who have low intracellular calcium values, Mg therapy increased intracellular calcium levels. It can be hypothesized that a genetic factor, which modulates Na+/Mg2+ exchanger activity, may be important in the regulation of Mg


  




Schizophrenia and bipolar disorders are two of the most severe CNS conditions. Changes in plasma and intracellular magnesium concentration, as well as in other bivalent cations, have been found in both psychoses. Our data, as well as that of other authors, has shown that schizophrenic, paranoid patients admitted in the acute state and without previous treatment, have significantly decreased intracellular magnesium levels compared to healthy subjects. Therapy with haloperidol (a typical antipsychotic) or with risperidone (an atypical antipsychotic) both significantly raised the intracellular magnesium concentration without causing significant changes in plasma magnesium concentration. The increase in intracellular magnesium concentration was positively correlated with the improvement in clinical  symptomatology.
We consider that magnesium acts foremost by reducing glutamate release and by its Action upon NMDA receptors, and results in an augmentation in the activity of the GABAergic systems. Unlike the hypothesis that only implicates zinc deficits in the Pathogeny of schizophrenia, we consider that both intracellular magnesium and extracellular zinc deficits are equally involved in schizophrenia pathogeny.

In patients with untreated bipolar disorder, our data showed a significant decrease In intracellular magnesium concentration and plasma zinc concentration during the manic episode. 

Therapy with mood modulators (carbamazepine and valproic acid) increased total intracellular magnesium and plasma zinc concentrations without having a significant effect on total plasma magnesium concentration. Other data showed that lithium also increases intracellular magnesium concentration. The fact that mood modulators with different mechanisms of action have in common the increase of intracellular magnesium concentration is an argument to consider this augmentation as an important element of their mechanism of action.




 Magnesium in Depression

One 2008 randomized clinical trial showed that Mg was as effective as the tricyclic Antidepressant imipramine in treating Major Depression (MD). Intravenous and oral Mg protocols have been reported to rapidly terminate MD safely and without side effects. Brain Mg deficiency reduces  serotonin levels, and antidepressant drugs have been shown to have the action of raising brain Mg.

Excessive calcium, glutamate and aspartate intake can greatly worsen MD.

We believe that, when taken together, there is more than sufficient evidence to Implicate inadequate dietary Mg as contributing to the cause of MD, and we suggest that physicians prescribe Mg for its prevention and treatment.
Magnesium in autism

In this chapter (21) , a brief overview of pharmacology and genetics of magnesium
transport will be followed by a review of clinical and biological studies of Mg vitamin B6 supplementation in attention deficit/hyperactivity disorder (ADHD) and autism (autistic spectrum disorders family, ASD) in children.

Although no study carried out on a rational basis has been published to date, some experimental and/or clinical works support a positive effect of such therapy in these pathologies.

All the individual observations report a decrease in hyperactivity and a stabilisation of scholarly behaviour with treatment. These data strongly support the need for a controlled study to confirm or invalidate these assumptions.

Magnesium is known to be crucial for brain activity and its involvement in the prevention of neurobehavioural  diseases seems to be established. A  clinical double-blind study with Mg-B6 treatment over placebo cannot be accepted for regulatory and ethical reasons. 

This review brings additional information about the therapeutic role of a Mg-B6 regimen In children with ADHD or ASD/autism syndrome. This effect seems to be associated, At least in part, to a cellular Mg depletion as evidenced by intraeythrocyte Mg measurements.

Children with ADHD or PDD/ASD (pervasive developmental disorders/autistic spectrum disorders), including autism, exhibit low Erc-Mg levels.

Parents frequently showed similar low Erc-Mg values suggesting a genetic defect in Mg transport. Installing a Mg-B6 supplementation for some weeks restored higher intraerythrocyte Mg values and significantly reduced the clinical symptoms of these diseases.


Conclusion

Magnesium turned out to be a surprisingly interesting subject for me.  While it is clear that the science is only partially understood, at least we know that magnesium levels in the diet are important.  In the ideal world you would be able to take a special magnesium molecule that better penetrates the BBB; it does not yet exist for humans.  

Perhaps, in some types of autism, the BBB is compromised enough to allow magnesium to enter more freely. Perhaps this is why some people with ASD respond to Mg + B6 treatment, while others do not. 

Again we learnt that in human biology everything is interconnected.  Low brain Mg lowers serotonin, which is the opposite of what we want.  The thyroid axis is known to play a role in regulation of the Mg metabolism.  When Mg levels increase, so do Ca levels.  Intra/extra cellular levels of all electrolytes in the brain are very important; it is part of the brain's control system. 

The so-called ion channels are how the brain controls itself, when one malfunctions there is likely to be a cascade affecting them all.  We know from Dr Ben-Ari that the NKCC1 transporter is the location of one much malfunction, I suspect there are many others.