Articles

Alternative Autism Therapies

By Pete Hueseman, R.Ph.

Autism is a brain development disorder that impairs social interaction and communication skills. Symptoms usually appear during the first three years of life; and four times more often in boys. Autism is the most common of the five disorders that fall under the classification of Pervasive Development Disorders (PPD), which appear in about 1 in 250 births (Centers for Disease Control and Prevention, 2003). As many as 1.5 million American children and adults are believed to have some form of autism, and the rate is growing at 10 to 17% per year, according to government statistics.

Many parents of autistic children are turning to chelation, a therapy used to treat heavy metal toxicity, to rid their children's bodies of mercury. Some physicians advocate the use of transdermal DMPS (2,3-Dimercapto-1-propanesulfonic acid) as a chelating agent that can be spread on the skin to avoid the side effects which often accompany oral medications. DMPS appears to release significant amounts of mercury and other heavy metals into the urine.

DMPS is an antidote for acute and chronic toxic metal poisoning. DMPS belongs to the vicinal dithiol group of chelating agents and has be used extensively in Europe for approximately 50 years. DMPS does not react selectively with a given heavy metal, but mobilizes a wide range of both toxic and essential endogenous metals. The equilibrium constant for the 1:1 DMPS-metal complexes decrease in the following order: Mercury>Silver>methyl mercury>Cadmium>Copper>Lead>Zinc. Because the two neighboring SH groups it has a high affinity for heavy metals that seek sulfur proteins. Once DMPS is bound with a metal, a stable complex is formed. Once complexed, there is a reduction in toxicity of the metal and it becomes unavailable for binding to the sulfhydryl group-containing essential biological components such as enzyme (which would result in functional disorders of the organs and tissues). DMPS complexes with Mercury, arsenic, antimony, bismuth, lead, cadmium, cobalt, chromium, copper, gold, iron, manganese, molybdenum, nickel, osmium, palladium, polonium, rhenium, rhodium, silver, technetium, thallium, tungsten, and zinc. DMPS does NOT react with calcium or magnesium. Even in long-term treatment, DMPS normally does not results in a deficiency of essential elements.

The increased excretion or reductions of blood or plasma levels of the toxic metals are usually used for assessing the clinical efficacy for chelating agents. It would appear however, to be more important to consider the reduced burden of critical target organs and recovery from pathological changes. Thus, the organs can be cleared without any change in the blood level. The danger of redistribution of the heavy metal to critical organs (e.g. brain), which has been demonstrated with other chelating agents must also be taken into account. Animal experiments proved that DMPS does NOT increase the metal level in the brain. DMPS has chelating and antioxidant effects. It has also demonstrated a positive effect in preventing the ototoxic effects of streptomycin, reduced the toxicity of cyanides and exhibited antioxidant and reparative effects in chronic hepatitis.
DMPS is NOT an approved drug in the United States. It is as of this writing, on the list of Bulk Drug Substances that may be used in Pharmacy compounding.

Frequently Asked Questions About DMPS:

Q: Does your doctor have to participate in and IRB to use DMPS?

A: No, IRB participation is not required by the FDA to have your doctor prescribe a compounded DMPS product.

Q: Does DMPS cross over the blood brain barrier?

A: Animal studies indicate it does NOT cross over. It also did not carry metal into the brain of animals.

Q: Should everyone with suspected metal toxicity receive DMPS?

A: Not necessarily. Data from various researchers around the world indicate that some people spontaneously excrete toxic metals once the individual has been removed from exposure. In the prescribing of any drug or compound, a physician must consider the risk/benefit ration and make a decision based upon the clinical and laboratory evidence at hand. Not everyone will benefit from the use of DMPS.

Example of a Treatment Protocol by Dr. Rashid Buttar, DO, FAAPM, FACAM, FAAIM

First 12 Months of Treatment

Initial visit is to establish the patients baseline, history of onset, current/past treatments, drug/nutrient history, possible adverse events that occurred in the last few years of like and answer all questions and concerns. The tests obtained are mandatory to support our treatment rationale, to insure patient safety and to document mobilization of mercury that has previously escaped adequate detection and not been adequately measured in all body compartments concurrently.

The labs would be as listed:

• Standard labs (CBC with differential, chemistry, lipids, thyroid panel, Iron Profile)
  
• CDSA with parasitology- complete diagnostic stool analysis to access the CI tract.
  
• OAT-organic acid test to access balances of metabolites, vitamins, minerals, amino acids, etc.
  
• Metals + minerals (hair, urine (12 hours), fecal, RBC)-Levels accessing various body compartments of toxic metals as well as essential minerals.
  
• Cardiogenomics - access various genetic predispositions including Apo E and MTHF alleles.
  

Transdermal DMPS is a transermal lotion that is simply rubbed in after being applied to the skin. Each drop contains: 1 mg of DMPS and 4 mg of Glutathione. The Glutathione serves to donate the additional sulfhydryl groups to potentiate the metal binding effect of DMPS. Start the Transdermal DMPS at 1.5mg/kg, not to exceed 60 drops, every other day after testing is completed. This represents the normal dose administered every OTHER day. However, when collecting the metal tests (at the beginning, and every 2 months thereafter), administer twice the number of drops. This is called the "CHALLENGE" dose and will ONLY be used when you collect the metal tests.

Therefore, the first dose of the Transdermal DMPS should be double the normal dose (CHALLENGE dose), and each time the tests are due (every 2 months), the Transdermal DMPS dose should also be doubled. The only time it is acceptable to increase above 60 drops is if it is a CHALLENGE dose, which is only used once every 2 months. Regular treatment dose will not exceed 60 drops in anyone. The Urine (12 hours), Fecal and RBC metal toxicity test MUST be done within 24 to 48 hours of the CHALLENGE.

Example: 44 lbs child = 20 kg normal dose = 30 drops every other day, and the CHALLENGE dose would be 60 drops.

Nutritional supplementation is done per the results of the various tests. If slgA level is increased, consider allergy testing and specialized diets such as specific carbohydrate diet or casein/gluten free diet. Detoxify and heal the GI tract using the CDSA as a guide. Supplement with blanket vitamins and minerals and add additional vitamins and minerals as indicated by the test results (OAT and Metals). Vitamins and supplements are administered daily. Minerals should only be administered on the days the Transdermal DMPS is NOT being administered. Urine and RBC mineral levels (from tests) should be relied upon to determine how to replenish mineral stores.

Repeat Standard labs as well as all Metals (hair, urine, fecal, RBC) and OAT every 2 months for the first 12 months and adjust supplementation per test results.
Examples below:
Watch the WBC for transient leukocytosis
Watch Bun/Creat for renal function
Watch Iron levels for iatrogenic depletion

Repeat CDSA with parasitology every 6 months

Cardiogenomics does not need to be repeated although there are those that believe the genetic predispositions may change after adequate interventions. Thus, it is theoretically possible for the cardiogenomics profile to actually improve. However, to date, we have not repeated this test to evaluate the possibility of improvement in the cardiogenomics profile.

Office visits are scheduled every month, with the patient (child) present every OTHER month. Visits are monthly to review the extensive tests collected and implement the necessary changes as a result of testing.

Parents must also video the child for 5 minutes every single month, with a 2.5 minutes of random footage of the child doing what ever the child wants to do. The other 2.5 minutes of video footage is of the child being asked to perform specific tasks, such as answer the phone, say your ABCs, take this plate into the kitchen, etc. These same questions MUST be repeated every month in the same manner, regardless of the child's ability to follow the instructions initially.

The test collection procedure can be complicated and a little intimidating. The doctors nursing staff will spend all the time necessary to explain the correct specimen collection method for each test and they will show you exactly what you will need to do.

After the First 12 Months of Treatment:

After the first 12 months, and improvements have been noticed, testing frequency decreases to the following:

• Standard labs (CBC with duff, Chemistry, lipids, thyroid panel with TSH, Iron Profile) to be done EVERY 2 months. This is the same as previously done during the first 12 months of treatment and is continued in the same manner for safety purposes. THIS IS MANDATORY! If a parent does not continue with this schedule, then NO MORE MEDICATION for the Trandermal DMPS will be authorized. Remember, our rule is DO NO HARM...

• All Metals (Hair, urine, Fecal, RBC) and OAT every 4months (Change from first year of treatment)
  
  
• Repeat CDSA with parasitology every 6 month (same previously).
  
  
• Cardiogenomics does not have to be repeated (same as previously).
  

Continue videotaping every month (same as previously).

Continue to increase the Transdermal DMPS dosage as the child increases in weight. Do not exceed 60 drops every other day. Thus, if a child weighs over 88 lbs, or the patient is an adult, administer ONLY up to a maximum dose, which is 60 drops (60mg) and use every other day. The only exception is when collecting the metal toxicity tests.
Use the CHALLENGE dose on the days when metal toxicity testing samples (urine, hair, fecal, blood) are being collected, and this dose will never exceed 120 drops (120mg).

Possible Complications:

1. Rashes- Generally a rash may appear do to the mobilization of metals and is usually localized to the area of application. These rashes typically occur in only 3% of the patient population using the Transdermal DMPS (made by Bellevue Pharmacy). The rash is transient and usually abates in 2 to 3 weeks. If this occurs rotate sites. If the rash persists, discontinue use and notify the physician who prescribed the Transdermal DMPS. Some individuals may have an allergy. For those patients who persist with a systemic rash, it is most likely do to mercury mobilization and it may become necessary to reduce the dose and/or pre-medicate with by mouth Benadryl and Tylenol prior to treatment.

2. Mineral Depletion- This will be the most common complication that EACH physician must anticipate and monitor closely. Currently, the testing is still being done to figure out which minerals (possibly liquid) to give to children to prevent mineral depletion. It is also wise to consider starting an aggressive 2 week mineral repletion program PRIOR to initiating the treatment with Transdermal DMPS to insure the resolution of any pre-existing mineral deficiencies which are more common than realized.
   

Another treatment option is Glutathione. Glutathione deficiencies are also seen in autistic patients. It has been shown that as Glutathione levels decrease as our bodies age. Moreover, many enviromential toxins can play a role in depleting glutathione levels. Glutathione, also called GSH, is a crucial cell protectant in the body's immune system. It protects the body's tissues as well as the arteries, brain, heart, liver, lungs, and skin from dangerous "free radicals".

Glutathione is a tripeptide composed of the amino acids glutamic acid, cysteine and glycine. Glutathione is found in all cells in the body, in the bile, in the epithelial lining fluid of the lungs, and at much smaller concentrations in the blood. It also protects the tissues of the arteries, brain, heart, kidneys, lens of the eyes, liver, lungs, and skin from free radicals.

The highest concentration of glutathione is found in the liver, making it critically important in the detoxification and elimination of free radicals. Accumulation of these dangerous compounds can result in oxidative stress, which occurs when the generation of free radicals in the body exceeds the body's ability to neutralize and eliminate them. Free radicals are highly reactive compounds created in the body during normal metabolic functions; they can also enter the body through the environment.

Bellevue Pharmacy offers an OTC item called Essential GSH™.
It is an alcohol-free and glycerin-free. It is a convenient and affordable solution for increasing system bioavailability of glutathione--the most powerful antioxidant naturally occurring in all human cells.

Its unique formulation facilitates oral delivery of glutathione into the system via pharmaceutical grade liposomes which also contribute to a much longer shelf life. And because it's in a liquid form, you can vary serving size to your own specific needs.

FAQs

Q:Any side effects or interactions with Glutathione?

A: No side effects or interactions are known to be associated with oral administration of glutathione.

Q:Why does Essential GSH™ have such a sulfurous smell?

A. Essential GSH™ is a biologically active sulfur tripeptide. The Glutathione in Essential GSH™ is encapsulated in liposomes, which minimizes exposure of the sulfur.

Q: Is the Essential GSH™, OK for soy sensitive patients?

A: The soy protein is 100% removed , so it is safe for individuals who have issues with soy products.

Q: Where can we get other forms of Glutathione, for IVs or nebulization?

A:Glutathione can be compounded into various delivery options for a patient such as: ampoules for nebulization (oral or nasally), topical creams, or suppositories. Compounds require a prescription from a licensed prescriber.

Q: Can it be taken on an empty stomach?

A: We suggest take on an empty stomach, but a small amount of food first is okay.

Q: Is refrigeration necessary for this product?

A: It probably will taste better chilled, but refrigeration is an option, room temperature is fine, but keep out of direct sunlight. However, we do ship it with on ice in warm weather, to protect it from excessive heat during shipping in the warmer months and warmer climate areas.

1. Rashid A. Buttar, DO, FAAPM, FACAM, FAAIM
   Vice Chairman, American Board of Clinical Metal Toxicology
   Visiting Scientist, North Caroline State University
   Advanced Concepts in Medicine / Center for Advanced Medicine