Effect of Vitamin/Mineral Supplements on

Children with Autism

James B. Adamsparent of a child with autism

President of Greater Phoenix Chapter of ASAengineering professor at Arizona State University

Research Team

• Jim Adams: organizer; • Richard Fabes: statistician; chair of Human Resources and

Family Development at Arizona State Un.• Carol Johnston: professor of nutrition at Arizona State

University; expert in vitamins and minerals• Raun Melmed, M.D.: developmental pediatrician; co-

medical director of Southwest Autism Research Center• Cindy Schneider, M.D.: co-medical director of Southwest

Autism Research Center• many volunteers from ASA and SARC

Goal of our study:

Determine if vitamin/mineral supplements can reduce some of the symptoms of autism

Why consider vitamin/mineral supplements?

Vitamins and minerals are essential for good health of everyone.The lack of essential vitamins and minerals results in disease - this is the

definition of an “essential vitamin/mineral”Deficiency of Vitamin C: scurvyDeficiency of Vitamin D: ricketsDeficiency of Iron: anemia

High levels of vitamin/mineral intake have been shown to improve health in many cases

Many typical Americans suffer from vitamin/mineral deficiencies: 30% of Americans are deficient in Vitamin Cmany women are deficient in calcium and iron80% of Americans suffer from deficiencies in magnesium and chromium

Why consider vitamin/mineral supplements for people with autism?

1) often restricted diets (“picky eaters”): limited vitamin/mineral intake

2) poor digestion (25% have chronic diarrhea, 25% have chronic constipation); Wakefield’s work shows intestinal problems

limited absorption of vitamins/minerals3) Shaw’s work suggests presence of yeast/bacterial infection in intestine:

fewer “good” bacteria which actually produce several vitamins4) 18 studies demonstrated benefits of vitamin B6/Mg5) 1 study showed vitamin C was beneficial in autism6) Prof. Megson: cod liver oil (with high levels of vitamin A, D, and essential fatty

acids) helped with gaze aversion, behavior7) Dr. Rimland’s set of parent-reported case studies on benefits of vitamins/minerals

Dr. Rimland’s database: self-reported by parents

Supplement # respondents % worse % same % bettercalcium 97 1 41 58vitamin C 220 3 48 49folic acid 226 3 53 44vitamin B6 and Mg 2050 5 49 46zinc 88 6 44 50dimethylglycine 1467 7 52 41niacin or niacinamide 49 8 47 45

Vitamin/Mineral Testing by Dr. Emar Vogelaar

Tested blood levels in 20 children with autismFound low levels of the following vitamins/minerals

in over 50% of childrenA, B1, B3, B5, biotin, selenium, zinc, and

magnesium. Also found that over 50% of the patients had low

levels of essential amino acids and two essential fatty acids (EPA and DGLA).

Why test a multi-vitamin/mineral supplement?

1) Over 20 essential vitamins and minerals, so very difficult to test every one individually

2) Many vitamins/minerals work together:Vitamin B6 and MgVitamin C and bioflavonoidsVitamin D, Calcium, and Magnesium

3) If individual vitamins/minerals help some, perhaps including all the essential vitamin/minerals would help more

4) Despite widespread use, no prior research on effect of multi-vitamin/mineral supplements on people with autism

Thousands of supplements on market;Which to choose?

Criteria:1) want high level of B6 and Magnesium, with some/all B6 in P5P form (other forms may not be well absorbed if yeast infection)2) no copper (too high in most children with autism)3) no iron (not needed in most children)4) high levels of all other vitamins/minerals within safe ranges (especially careful with A, D, K which are fat-soluble and can build up in body)

3 optimal choices, Kirkman’s Super Nu-Thera, Brainchild’s Spectrum Support, and DANplex (all developed for children with autism)

Spectrum Support

Developed by a father of a child with autism; New; previously used by about 100 children with autism;3 levels (I, II, and III) all in liquid form with lemon/lime flavorcontains high levels of all vitamins and minerals except:

no vitamin A; (contains beta-carotene instead)moderate calcium (in case drinking milk)moderate D (so can take with cod liver oil)

sweetened with vegetable glycerin;no artificial colors or flavors; GFCF

VitaminsSSII SSIII %RDI

A (as Carotenes) 6000 IU 7500 IU 200%B1 20 mg 25 mg 2778%B2 20 mg 25 mg 2272%B-3 Niacinamide 20 mg 25 mg 346%B-3 Inositol H. 15 mg 20 mg (above)B-560 mg 85 mg 1545%B-6 (as P5P) 20 mg 35 mg 25,600%B-12 600 mcg 800 mcg 6668%Folic Acid 500 mcg 700 mcg 467%Biotin 60 mcg 100 mcg 400*Choline 60 mg 90 mg *Inositol 60 mg 90 mg *Vitamin C 350 mg 450 mg 1000%Bioflavoinoids 250 mg 400 mg *D-3 200 IU 200 IU 50%E 125 IU 150 IU 750%

MineralsSSII SSIII %RDI

Calcium 280 mg 400 mg 48%Magnesium 325 mg 400 mg 329%Potassium 98 mg 99 mg *Zinc 20 mg 30 mg 400%Manganese 5 mg 8 mg *Chromium 75 mcg 100 mcg *Selenium 75 mcg 85 mcg *Molybdenum 50 mcg 75 mcg *Silica 0 10 mg *

* values not set by US Food and Drug Administration

Other IngredientsSSII SSIII

Betaine 100 mg 200 mgMSM 200 mg 275 mgDMAE 80 mg 90 mgN-Acetyl Cysteine 15 mg 25 mg

trace amounts of many herbs:Ashwaganda Root, Burdock root, Chinese Astralagus Root, Ginkgo Bilboba Leaf, , Gotu Kola Leaf, Gymnema Sylvestre Leaf, Schisandra Fruit, Milk Thistle Seed, Siberian Ginseng, Slippery Elm

Finding Participants

1) Mass mailing to 1000 families with autism in AZ2) Eligibility criteria:• age 2.5 to 7 yrs• diagnosed with autistic spectrum disorder• not taking any other vitamins/minerals (except regular

children’s vitamin allowed)• no changes in any treatments in last 2 months • willing to keep other treatments constant during study

Research Protocol• 3 month study• Half of subjects receive placebo• Half of subjects receive vitamin/mineral

supplement• Dosage is slowly increased to maximum over

first 2 months, then held constant• Double-blind: participants and examiners don’t

know who is getting what until study ends

Eliminated from study: placebo group

Case 1) developed diarrhea 2 weeks into study (had history of frequent bouts of diarrhea); parent stopped “supplement”, but diarrhea continued foranother week;

Case 2) started risperdal 2 weeks into study;

one week later child frequently lost control of bladder and bowels; parent stopped “supplement”; problems continued

Eliminated from study: supplement group

Case 1) Family went on vacation and stopped giving supplement;

Cases 2 and 3) Twins reported occasional vomiting only in evening; supplements given at 9 pm on empty stomach \

Case 4) Child did not take supplement consistently

Final Group of Participants

• Placebo: 7 boys, 1 girl; • Supplement: 7 boys, 1 girl; • Same average age in each group (5.5 years)• Save average severity of autism (moderate)

Testing/Evaluation• Testing at 0 and 12 weeks, including:

– physical exam by medical doctor– blood sample to measure vitamin/mineral level– urine sample to measure vitamin/mineral level

• SARC medical history (150 questions)• Parent reports (100 questions) at weeks 0, 2,

4, 6, 8, 10, and 12• Diet analysis based on 11 daily food logs

Vitamin C results (at end of study)

range averagePlacebo: 0.9-1.4 1.03Suppl. 1.0-2.0 1.33

The difference of 0.3 is statistically significant to 95% confidenceTypical children age 3-17 average=1.3;Below 0.5 is marginal, and below 0.2 is deficient

Data suggests control group had slightly low levels of C, and suggests that supplement did improve level of C in blood

Vitamin B6 levelsPre-study: placebo: 54 ng/ml

supplement: 57Post study: placebo: 65

supplement: 97Typical controls: 35 (22-47 range)

Conclusion: children with autism have significantly elevated B6 levels, and supplement increases them

Explanation: recent study by Dr. Tapan Audhya found that enzyme for conversion of B6 is defective in autism, such that conversion rate is 1/10 of normal

Overall ResultsBased on parent evaluations on final day of study

7 point scale1=much worse2=worse3=slightly better4=same5=slightly better6=better7=much better

Alpha Lipoic Acid Levels

• Autism: average 3.8, range 2.8-6.1• Typical Adult: range 2.3-5

• Thus, children with autism don’t seem to have abnormal alpha lipoic acid levels, although values for typical children (not adults) are needed to be sure

Overall ResultsCategory Placebo Supplement DifferenceSociability 5.1 5.3 +0.1Expr. Language 5.6 5.9 +0.3Rec. Language 4.9 5.8 +0.9Eye Contact 4.9 5.5 +0.6General Behavior4.3 5.1 +0.8Sleep 3.9 5.4 +1.5Stools/Gastrointest. 3.9 5.4 +1.5

Overall 5.1 5.5 +0.4

Sleep and Stool results are statistically significant to 99.5% confidence;Receptive Language and General Behavior are significant at 80% level

Expressive LanguagePlaceboSupplement

Some children improve much more than others

Nobody worse

Supplement seems to help children independent of age

Average Score vs. Age

1

2

3

4

5

6

7

30 40 50 60 70 80 90 100

child's age (months)

aver

age

scor

e

100 Questions

Filled out every 2 weeks by same parentScale of 1 to 5

1=never2=rarely3=sometimes4=frequently5=always

Major Results from Survey by CategoryCategory: placebo change supplement change differenceSleep +0.08 +1.23 +1.18Aggression +0.09 +0.69 +0.60Communication +0.06 +0.52 +0.46Motor Skills +0.02 +0.44 +0.42 Cognitive +0.13 +0.55 +0.42Rep. Behav. +0.24 +0.60 +0.36Daily Living +0.14 +0.46 +0.32Sensory +0.16 +0.45 +0.29Diet +0.12 +0.26 +0.14Social Inter. +0.30 +0.42 +0.12Inappr. Behav. +0.38 +0.43 +0.05Hyperactivity +0.40 +0.39 -0.01

Conclusion: Supplement especially helped sleep, and also general improvement in many other areas

Summary

• Children with autism are low in vitamin C, high in B6 (but need even more B6)

• Multi-vitamin/mineral supplement led to many improvements in the symptoms of autism, especially regarding sleep and GI problems

• Larger study needed, with pre- and post-testing of all vitamin/mineral levels

• See http://www.eas.asu.edu/~autism/ for copy of handout and other information

AcknowledgementsFinancial support from the ASA Foundation, Arizona

State University, ASA-Phoenix and FEAT-TucsonSARC for use of facilities and staffThe families who participated in the studyBrainchild Nutritionals for providing product and

placebo at cost (831) 465-0104

Note: Researchers have no financial link with Brainchild Nutritionals