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Getting a Handle on all the Supplements
As you may already know, those of us treating our autistic kids biomedically end up giving them lots of nutritional supplements. This is partly because their guts are in such bad shape that they cannot absorb nutrients well, and partly because so many of their body systems aren't working well. The idea is to get enough of what the body needs to absorb where it needs to go, so that the body can slowly start functioning better, and eventually pick up some of the work itself and need less help. Also, to heal the gut itself, so that it can absorb nutrients better from food, supplements and all.

This whole supplementation thing can seem like a bewildering maze when you first start looking into it. This is a piece I wrote in response to this overwhelm and confusion, expressed by a mom on one of the email lists I read. TINY DISCLAIMER: I work for Brainchild nutritionals and my son has taken their vitamin and mineral supplements for five years now.

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Don't despair, this will all come together for you. It just takes some time, planning and most of all, patience. There aren't all that many basic types of supplements we need to give these kids, as a foundation. After you've started the basics, you can start reading and learning about all the other kinds, and start to make intelligent decisions about which ones are worth pursuing for your particular child.

The Basics
Here's how I like to break down the basic supplement list for parents when I talk to them:
1. Vitamins and minerals
2. Fatty acids (i.e. fish oil)
3. Probiotics
4. Digestive Enzymes

That's really it. There are a hundred different variations within each, but that's the basic list. First and probably the most important rule: only try or change one new thing at a time.

Everybody Say it with me: ONLY TRY OR CHANGE ONE NEW THING AT A TIME

So this means, if you increase the dose of one supplement, don't change ANYTHING else for a few days. If you start a new supplement, keep everything else the child is taking exactly the same as before. Only ONE change at a time. This might sound simplistic, but you'd be surprised how tempting it can be to mess with several things in the same few days, and then you have no idea what's up when the child starts climbing the walls!

For enzymes and targeted vitamins/minerals, you'll want to give a good while for your child to get used to and settle into a good dosage of them. This shouldn't be rushed. For each of these, I'd plan on it taking six weeks, possibly longer. I know that sounds like a long time, and it could go faster, but I wouldn't plan on it. Getting these well started will pay off for you. You'll want to start at a low dosage and watch your child carefully, moving up when you think he's ready to, and being ready to back off again or change your plan and slow down if he's not.

With Brainchild's (the multivitamin/mineral supplements I'm most familiar with), it seems to go easiest if people start with minerals only, let the child get a little bit settled on those, then start vitamins, low and slow, being prepared to just stay at a low dose if needed. It takes longer than just plunging in, but I think it's the most smooth way to introduce them - easiest on the child, and on you. I know there's a similar period for enzymes, which I'm not as familiar with, as we're still experimenting with enzymes and haven't quite hit the 'right' combination for my son yet.

If the first product you try in any category doesn't seem like a winner for your child, try a different brand - these lists are a great place to find alternatives. If still no luck, try to think about what might be keeping his body from being able to use these supplements, and/or get a little testing done that might help figure out what else might need to be in place to help his body along. We find with Brainchild's that some children have difficulty tolerating them at first, but after their body starts working better from absorbing some nutrients at a very low dosage, they are able to move to full dose and have good results. It just really takes patience, in this case.

My own rule of thumb for starting new supplements is as follows:
- With most other supplements, you can plan on a week or two startup period. Get your foundation (1-4 above) well established before you let yourself get sucked in by other things.
- General rule is to start each new supplement at 1/4 of the full dose you have in mind - or even less if your child seems extremely sensitive.
- After 3 days or so, if all is well, go up to 1/2 dose, then full dose in another few days. Watch the child closely for signs you need to slow down or that the child can't tolerate it.
- Take notes about when you started what and at what dose. Include any changes you observe in digestion, behavior, sleep, appetite, skin color and so on, and note any time you change the dosage or add anything, and any unusual events in the child's life that might help clarify.
- Have a written plan ahead of time and stick to it, don't try to rush or stop and start lots of things all over the place, or you won't know what's helping and what isn't.
- If you see a little loose stools when starting new supplements, don't worry - this is the most common problem and will probably settle down in a couple days. Just stay at the dose you're at until things settle down.

Methylation
After you have the basic 4 types of supplements above started, there are a few more you may want to look into:
- Methyl B12 shots (yes, it must be in injection form -- takes a prescription from a doc). Dr. Neubrander is the doc who developed these - you can find information about them at www.drneubrander.com/page1.html
- Folinic Acid (Folacal by Thorne is what most of us use). This is a 'doctors' office' brand, but you can buy it at a number of online stores, my current favorite is www.illnessisoptional.com
- TMG or DMG, increase to approx 1 gram a day. You can buy this lots of places, and it's easy to give. The other names of TMG are trimethylglycine or anhydrous betaine.

All three of these are methylation/sulfation support, part of Jill James' and Dr. Deth's protocol, and seem to help most kids some, and some kids quite a lot. These were being talked about a lot at DAN! this time. Here's where to find links of their 2004 DAN conference talks: www.autism.com/ari then go to Defeat Autism Now link, then DAN! 2004 Conference, and you'll find a list of presentations.

Yeast (candida)
In this process somewhere, you need to deal with yeast. If you're working with a doctor, this will be one of his/her first goals. If not, you may next want to try to determine if the child has yeast, and treat for it. You can read my journal on Rotating Natural Antifungals for more on that.

Heavy Metals, i.e. MERCURY
The large majority of our children seem to have a lot of heavy metals in their bodies, which can affect brain function, energy production, and many other areas. Once the yeast is under control, it's time to start getting rid of the heavy metals. See, this isn't that complicated, is it? Just expensive, and time consuming, and inconvenient, and... well, ok, maybe a little complicated.

When you get to this point, it's time to find a doctor you can trust to oversee this for you. You can check my list of doctors, and also ask other parents who they've used. That's the best way to find a good doctor for your needs.

Trying Other Supplements
As you go, you'll have well-meaning people of all kinds, like your doctor, your healthfood store clerk, other moms you talk with, and plenty of others, suggest other possible supplements to you. The list will get long. As you're considering each one, there are some good things to check out before even considering trying it:

1. Make sure it's safe - be sure it contains no heavy metals, artificial sweeteners or colors or preservatives or anything your child is allergic to. Our kids are generally quite sensitive to these kinds of things.

2. Start to think about what 'kind' of a thing it is -- is it a vitamin? a mineral? an amino acid? a nutritional supplement? a hormone? what is it supposed to help? Do you have any evidence (test results, observations, etc.) that your child's body needs this kind of help? Are you already giving a similar 'kind' of supplement, intended to do the same thing? Try to reason it through. This will get easier as you learn more.

3. Try to find a mom or two or ten, who really think it helped kids similar to yours -- there are a thousand things you could try... it will start to get easier as you keep reading and asking questions to tell which are worth your time/energy.

4. If you do decide to try it, look at the other things you have in mind, and put them in a logical sequence, one at a time. Write down which you are trying, when you start, what dosage and what you see. Don't jump the gun and start lots of things at the same time.

Important Books for your Supplementation Education
A couple of useful books: I very strongly recommend buying and reading Children with Starving Brains, by Dr. Jaquelyn McCandless, ISBN 1-883647-09-6. This is the best book out there on Autism and Biomedical Treatment thereof. This book will start getting you used to managing your child's supplementation and health, and using your brain to figure out what might help your individual child

Another good book to get a copy of for reference purposes is The Encyclopedia of Nutritional Supplements, by Michael Murray. ISBN 0-7615-0410-9. I found a copy on ebay for cheap, recently, as I think this edition is a few years old, it's still plenty useful -- tons of information on the suggested and optimal doses of each nutrient, side effects, most absorbable forms, pros and cons, etc.

Hope this is helpful and not just more fog for you!

Terri