Nutritional Supplement Use for Autistic Spectrum Disorder
by Jon B. Pangborn, Ph.D.
A Summary
Table of Contents
Prerequisite Strategies ............................................................................................................................... 3
Strategies and Priorities for Use of Nutritional Supplements for ASD .............................................. 3
Six Rules for Trial/Use of Nutritional Supplements ............................................................... 3
A Dozen Don’t/Dos ..................................................................................................................... 3
Supplement Intervention Schedule ......................................................................................................... 4
Preliminaries and Prerequisites .................................................................................................. 4
Initial Tests ..................................................................................................................................... 4
Tier Explanations .......................................................................................................................... 5
Technical Information on Nutritional Supplements (omitted)............................................................ 6
Nutrient Descriptions and Use Information .......................................................................................... 6
Alpha-ketoglutaric acid................................................................................................................ 6
Amino acids (except taurine) ...................................................................................................... 7
L-Carnitine ..................................................................................................................................... 7
Carnosine ....................................................................................................................................... 7
Creatine .......................................................................................................................................... 7
Digestive Enzymes........................................................................................................................ 8
DMG, TMG .................................................................................................................................... 8
Fatty Acids ..................................................................................................................................... 9
Glutathione .................................................................................................................................... 9
Herbals.......................................................................................................................................... 10
Anti-yeast/fungal .......................................................................................................... 10
Olive leaf extract ............................................................................................... 10
Pau d’Arco ......................................................................................................... 10
Goldenseal.......................................................................................................... 10
Saccharomyces boulardii (probiotic) .............................................................. 10
caprylic acid ....................................................................................................... 10
calcium caprylic ................................................................................................ 10
Antibacterial Herbals..................................................................................................... 10
Oregano .............................................................................................................. 10
Thyme ................................................................................................................. 10
Goldenseal.......................................................................................................... 10
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Antioxidant/Anti-inflammatory Herbals .................................................................. 10
Turmeric (curcumin) ........................................................................................ 10
Silymarin (from milk thistle) ........................................................................... 10
Cognitive Improvement Herb ...................................................................................... 10
Bacopa................................................................................................................. 10
Melatonin ..................................................................................................................................... 10
Minerals and Elements ............................................................................................................... 11
Calcium............................................................................................................................ 11
Iodine and thyroid support .......................................................................................... 11
Magnesium ..................................................................................................................... 12
Selenium .......................................................................................................................... 12
Zinc .................................................................................................................................. 12
Probiotics ...................................................................................................................................... 13
Taurine.......................................................................................................................................... 13
Vitamins ....................................................................................................................................... 14
B-vitamins and folate..................................................................................................... 14
B1 Thiamine ....................................................................................................... 14
B2 Riboflavin ..................................................................................................... 14
B3 Niacin ............................................................................................................ 14
B6 Pyridoxine .................................................................................................... 14
Pantothenic Acid ............................................................................................... 14
B12 Cobalamin................................................................................................... 14
Folic Acid, Folate............................................................................................... 14
Vitamin A ........................................................................................................................ 15
Vitamin C ........................................................................................................................ 15
Vitamin D ........................................................................................................................ 15
Vitamin E......................................................................................................................... 16
Supplements to be Wary of .................................................................................................................... 16
Also Consider (not from Pangborn’s book)......................................................................................... 16
Chromium .................................................................................................................................... 16
Alka Seltzer Gold ........................................................................................................................ 16
Biotin ............................................................................................................................................. 16
Choline, phosphatidylcholine, or GPC (Glycerophosphocholine) ...................................... 16
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Nutritional Supplement Use for Autistic Spectrum Disorder
by Jon B. Pangborn, Ph.D.
A Summary
Prerequisite Strategies
Prerequisite Strategy 1: Remove/avoid potentially toxic chemical stressors
Organochlorides - the beginning of acquired ASD
Organophosphate toxicants
Other toxicants of concern
Purifying your living space, food, and drink
Prerequisite Strategy 2: Remove/avoid infectious stressors
Yeast overgrowth [anti-fungal medications, low sugar diet]
Bacterial dysbiosis and excessive use of antibiotic medications
Killing persistent pathogens naturally
Prerequisite Strategy 3: Fix the diet
Prerequisite or Concurrent Strategy 4: Relational Therapy and Special Education
Strategies and Priorities for Use of Nutritional Supplements for ASD
Six Rules for Trial/Use of Nutritional Supplements
1. Use the purest, highest-grade nutritional supplements available.
2. Coordinate supplement trials with the other interventions such as diet trials and
medical procedures that your doctor may have underway.
3. Always start with a low amount.
4. Discontinue the supplement if there are adverse effects, except in a few cases, such as
digestive enzymes or perhaps probiotics, where “worse” may precede “better.”
5. Introduce new supplements one at a time with few exceptions. B6 and magnesium
together is such an exception.
6. Keep records religiously.
A Dozen Don’t-Dos
1. Don’t start two or more different intervention trials at the same time.
2. Don’t begin with detoxification interventions.
3. Hold off on sophisticated metabolic manipulations until later.
4. Don’t use vitamin B12 in any form as a separate supplement until you already have
L-carnitine in use (acetyl-L-carnitine).
5. Don’t use amino acid supplements (except taurine) until intestinal health has been
addressed and dysbiosis has been remedied.
6. Don’t supplement vitamin B6 without also supplementing magnesium.
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7. Don’t use supplements that metabolize homocysteine to methionine (such as TMG or
DMG) without having taurine in use.
8. Don’t rely on laboratory tests of urine analytes for guidance on supplementation
when analytes are ratioed to creatinine and creatinine itself is subnormal.
9. If your ASD individual has excessive urine levels of oxalate, be sure that calcium and
lipase (a digestive enzyme) are supplemented, as well as taurine, vitamin B6, and
magnesium.
10. At supper or in the evening, don’t give supplements that contain phenylalanine,
tyrosine, or histidine, and don’t feed high-protein meals late in the day.
11. Don’t use cysteine, cysteine, or alpha-lipoic acid as nutritional supplements except
under medical supervision and with periodic checks of intestinal yeast content.
12. Don’t use N-acetylcysteine unless it is certified to be the reduced, active form, and
then do periodic checks of intestinal yeast content.
Supplement Intervention Schedule
Preliminaries and Prerequisites
Diagnosis of ASD
Find a qualified doctor or physician assistant
Find a qualified nutrition counselor
Record patient and family histories
Environmental cleanup
Diet cleanup
Arrange for relational therapy
Initial tests
Physical exam
Blood chemistry, CBC
Thyroid markers
Urinalysis
Stool analysis including digestive and inflammation markers, microbiology, mycology
and parasitology
Blood ammonia?
Other doctor-ordered tests
metric tests of autism severity
4
Tier Explanations
TIER 1, Basic for ASD, CF (Casein-free) Trial
6 weeks
Digestive aids (enzymes)
Alpha-ketoglutarate if ammonia is elevated
Activated charcoal (use as needed)
Calcium, magnesium, multiminerals?
Taurine
L-carnitine
Multivitamins: B complex, folate, A, C, D, E
Melatonin
Omega-3 Fatty acids
TIER 2, Intestinal Cleanup, GF (Gluten-free) Trial
12-16 weeks
Continue Tier 1 supplements, plus
Herbal antibiotics: oregano, thyme
Activated charcoal
Probiotics & S. boulardii
Turmeric, silymarin
More antioxidant nutrients?
Zinc
Carnosine, esp. with seizure cases
TIER 3, Healing Period, Carbohydrate check, Gut check
Try or continue Low Oxalate Diet?
More Omega-3 fatty acids
Continue Tier 1 supplements; perhaps more L-carnitine
Continue but reduce Tier 2 supplements to maintenance levels for intestinal health
If oxalate was high initially, retest now. If still high, check fat content of stool with new
stool analysis;
Recheck intestinal flora and digestive markers
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TIER 4, Detox and Antioxidant Brigade
Choose and stay on most beneficial diet
Detoxification therapies - chelation, saunas, sulfate baths
Clean environment is essential
Continue supplements as in Tier 3, plus
Extra vitamin C
Glutathione, NAC
Extra taurine
Magnesium malate
CoQ10
Watch out for reoccurance of dysbiosis
TIER 5, Special Metabolic Measures
Continue diet
Continue supplements as in Tier 3
Continue Tier 4 detox and antioxidant supplements at reduced or maintenance levels,
plus:
Creatine
Amino Acids
DMG or TMG, folinic acid
Methylcobalamin (B12)
Carnosine (may have been tried in Tier2)
Bacopa
Technical Information on Nutritional Supplements (omitted)
Nutrient Descriptions and Use Information
1 pound = about .454 kilograms (multiply your child’s weight in pounds by .454 to find out how
many kilograms they weigh)
doses indicated are per day
Alpha-ketoglutaric acid
If ammonia excess is the problem, 50-200 mg per kg body weight - Tier 1
Other problems, 25-100 mg per kg body weight
Divided doses with meals works best
Do not use unbuffered alpha-ketoglutaric acid
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Amino acids (except taurine)
An amino acid supplement is a Tier 5 item
Never begin nutritional intervention with amino acid supplements, except taurine
Our bodies are supposed to break food down into amino acids
Amino acid test will show deficiencies
balanced blends are generally safe in amounts suggested by the manufacturer
Pangborn formulated a blend specific to ASD (see page 53)
Don’t use if there’s hyperammonemia (elevated ammonia in the blood)
Adverse responses are possible, and some unusual metabolic conditions are
contraindications for amino acids
L-Carnitine
Tier 1, perhaps more in Tier 3
Can be supplemented quite effectively
Diagnosis of autism is sufficient to warrant trial use of L-carnitine
Never use D,L-carnitine
Acetyl-L-carnitine is an excellent form
50 mg per kg of body weight - more than 1140 mg/day at the discretion of a doctor
Goes well with meals
Can be sprinkled on prepared foods or dissolved in drinks - it is water soluble
Carnosine
Tier 2, may try again in Tier 5
Enhances muscle mass, alleviates autistic traits in some ASD children, especially those
with seizure conditions
Make sure carnosine is not excessive per plasma or urine amino acid analysis
Histidine deficiency could indicate benefit from carnosine supplementation
Children 3-5 years old - 400-600 mg
Children 6-12 years old - 600-1200 mg
Adverse effects are possible, sometimes help then relapse
Creatine
It’s a Tier 5 supplement because toxicants can interfere with it
Indications of need include low muscle mass/strength, hypotonia, “floppy baby
syndrome” in infancy, dystonic-hyperkinetic movement disorder (sometimes),
seizures (sometimes), language delay, deficient expressive speech, x-linked
mental retardation (sometimes), autism (sometimes)
Relatively large, therapeutic amounts of oral creatine are needed to be effective
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300-1000 mg per kg body weight, in divided servings
One study used 350-2000 mg per kg in adults with no serious side effects
Be sure to get this supplement from a reputable supplier - at high doses impurities can
add up
Notable improvement in 5-10% of children with ASD following creatine
supplementation
Digestive Enzymes
Tier 1 supplement
Diet adjustment and digestive enzymes are the best ways to start nutritional
intervention for at least 60% of those with ASD
No good lab tests to tell which enzymes are needed
Best bet is comprehensive enzyme supplement that includes proteases, peptidases,
amylases, disaccharidases, and lipase
Best taken at the beginning of each meal
How much depends on how much food is eaten, not how big the person is - follow
instructions on the label or from your health care professional
Expect to have a period of “worse before better” - adverse symptoms usually appear
after a day or two of use, and may continue for 1-2 weeks
A capsule of activated charcoal, 3 times a day (away from meds and supplements) may
help with adverse symptoms from “die-off”
Dimethylglycine (DMG), Trimethylglycine (TMG or betaine)
Tier 4 or preferably Tier 5
DMG and TMG are of value to those with ASD who can derive benefit from increased
methylation of homocysteine to form more methionine.
When one or the other works, parents report improved verbal communication
Start with DMG, then try TMG
Some DMG and TMG supplements contain added folate (or folinic acid) and vitamin
B12 - some individuals may need those
Dosage tables on page 74
DMG: 125-1300 mg or higher, depending on body weight
TMG: 150-2000 mg or higher, depending on body weight
Do not use betaine hydrochloride, betaine HCl, pluchine, or trimethylglycine
hydrochloride
If you have an adverse reaction to TMG, try it again after adding taurine for a week or so
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Fatty Acids
End of Tier 1, add more in Tier 3
Cell walls and membranes around cell parts are composed of fatty acids
A common abnormality in autism is a depressed level of omega-3 fatty acids, especially
DHA
Most infants and children with ASD benefit from Omega-3 fatty acid supplements
Lab tests of red blood cell fatty acids are indicative of need, but not conclusive
Before using fatty acid supplements, add taurine and maybe glycine
Dosage: 20-40 mg per Kg of body weight
Beware, often the omega-3 portion of a capsule is only 25-30% of entire capsule
Refrigerate supplements, and make sure they are fresh by breaking capsule and
smelling; respect expiration dates
Make sure supplements are mercury-free
Start with one capsule/day and work up to desired amount
Too much can cause intestinal or bowel symptoms in some people, such as gas
Glutathione
Tier 4, after the intestinal tract is cleaned up and contains a populace of normal and
friendly flora, and when it’s time to do detox (or use IV glutathione)
Frequently people with autism don’t have enough glutathione, and too much of it is in
the inactive, oxidized form
Can be measured by lab tests
In Pangborn’s opinion, ASD alone warrants trial use of glutathione
Ages 2-4, 50-150 mg oral glutathione
Ages 5-10, 100-250 mg oral glutathione
Age 11+, 100-300 mg oral glutathione
Also, TMG and folinic acid supplements raise glutathione levels
Use reduced L-glutathione, GSH, with no significant amount of oxidized glutathione,
GSSG (5% is too much)
Over time, some GSH users develop yeast, and regular use of anti-yeast supplements is
recommended
If insulin-dependent condition, consult doctor
If cystinuria (renal wasting of cystine), risk of renal cystine stones
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Herbals
Be sure to get herbals from reputable sources, as purity is an issue
Get them in capsule form to avoid powerful flavors and aromas
Anti-yeast/fungal (Tier 2 and beyond)
Olive leaf extract - 200-400 mg in divided doses ages 5-12, less for younger
Pau d’Arco - 200-400 mg for ages 5-12, less for younger
Oregano
Goldenseal
Saccharomyces boulardii (probiotic)
caprylic acid - 25-100 mg orally
calcium caprylic
Antibacterial Herbals (Tier 2 and beyond)
Oregano - 250-500 mg for ages 5-12, less for younger, 500-1000 mg for teens and
adults
Thyme - Same doses as Oregano
Goldenseal - 100-200 mg for ages 5-12, less for younger, 200-400 mg for teens and
adults
Antioxidant/Anti-inflammatory Herbals (Tier 1 and beyond) (Tier 2?)
Turmeric (curcumin) - 200 mg 3xday for ages 5-12, less for younger, 200-400 mg
3xday for teens and adults
Silymarin (from milk thistle) - extracts should be 60-80% silymarin - 50-100 mg
2xday for ages 5-12 years, less for younger, 100-200 mg 3xday for teens
and adults
Cognitive Improvement Herb - Bacopa
Tier 5
extract should include bacosides A and B
20-40 mg of bacosides A and B for ages 5-12
20 mg for younger
40-80 mg for teens and adults
Melatonin
Tier 1
Many parents report it helps sleep and behavior
Effective daily amount is quite variable from one individual to another, from ½ mg to 5
mg, but usually 1 to 2 mg sufficient - use trial and error
If you use the time-release type, don’t break, crush, or dissolve the tablet
You must keep the child’s bedroom dark and quiet - light causes the body to begin
destroying the melatonin
10
too much can produce an opposite effect
may need to add taurine before adding melatonin, or may need to wait until Tier 4 or 5
avoid high-protein meals before bedtime, get diet and digestion in shape
Elements and minerals
Calcium
Tier 1
600-900 mg supplemental calcium is needed when a casein-free diet is used,
some can be from food
Digestive enzymes that include lipase may increase uptake of dietary fats and
calcium
Best time to give is supper, lunch, breakfast, in that order, in divided doses, such
as supper 300 mg, lunch 200 mg, breakfast 100 mg
Often has a calming effect
Don’t give a lot of calcium at the same time as zinc
(Pangborn discusses different forms of calcium)
Iodine and thyroid support
Iodine is used exclusively for formation of thyroid hormones
If ASD individual needs iodine or thyroid hormone supplementation, has to be
done before healthy intestinal flora can thrive
Indications of need include abnormal thyroid tests, subnormal basal body
temperature, periodic regrowth of intestinal yeast despite various antiyeast measures, low iodine according to hair element analysis, living in
an area known to be contaminated with perchlorate, or living near a
military base where solid-fuel rockets have been fired
If hypothyroid condition, then dr will probably prescribe hormone
supplementation
If using lithium at pharmacologic doses, consult dr before using iodine
Use potassium iodide
Too much is just as bad as not enough, so seek nutritional advice
Recommended amounts of dietary iodine are 50-150 mcg (NOT mg), depending
on age
Don’t give iodine if there’s autoimmune thyroiditis or cystic fibrosis
Pangborn very strongly favors use of a multi-vitamin/multimineral containing
iodine, over a stand-alone iodine supplement
Symptoms of iodine overdose include acne flare-ups, skin rash, numbness and
tingling in hands and feet, and headache
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Magnesium
Tier 1, magnesium malate in Tier 4
Deficiency occurs when taurine is deficient or after toxicant exposures
Need is determined by lab tests, especially element levels in blood cells
Symptoms consistent with magnesium insufficiency include
Muscle twitches (not tics of Tourette’s Syndrome)
Constipation
Muscle cramps, “tight” muscles
Anxiety, panic attacks
Insomnia
Limited physical endurance
Numbness or tingling in fingers, hands, toes, feet
Multiple chemical sensitivities, inflammation
If lithium is given by prescription, consult dr before giving magnesium
Give magnesium when vitamin B6 is used
Magnesium malate can be especially beneficial for ASD, but other good forms
too
Best time to give is with calcium at supper
Has a calming effect
3-8 mg per kg of body weight
If causes loose stools, reduce the amount
Selenium
Selenium deficiency is uncommon in the ASD population
lab tests can show deficiencies
Pangborn prefers seleno-L-methionine
Dosage is 20-50 mcg/day (NOT mg/day), depending on age
Pangborn favors multivitamin/multimineral supplements with selenium
included
Zinc
Tier 2
Dozens of metabolic processes depend on zinc
blood cell or plasma analysis (against a correct reference range) will indicate
whether zinc levels are subnormal
symptoms of zinc deficiency include: diminished acuity of taste and smell, poor
appetite, pica, slow visual adaptation to darkness, growth retardation,
skin rash, suppressed immune response, slow wound healing, and ataxia
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zinc citrate is a good form, but there are other good forms
avoid zinc picolinate, zinc aspartate, and zinc sulfate
Best given away from meals, but with 15-30 mg, not a problem
Evening is a good time, but not when relatively large amounts of calcium are
also given
Dosages are 5-45 mg/day, depending on body weight
Sometimes it’s very difficult to correct a zinc deficiency with supplements Pangborn gives ideas on things that might help
If adverse reaction, try a different form of zinc
Probiotics
Tier 2
These are friendly bacteria
Indications of need:
when you change the diet
when you start to use digestive enzymes
when a stool analysis shows imbalanced or pathogenic flora, or maldigestion
when a lab report on intestinal permeability shows excessive transfer of test
substances into the blood (“leaky gut”)
when chemical markers consistent with intestinal dysbiosis are high in urine per
a lab report
chronic or frequent diarrhea or constipation
during any detox treatment
while using antibacterial herbal supplements such as thyme or oregano
during and after use of antibiotic medications
sprinkling on food to be eaten right away works okay, but giving it between meals
washed down with lots of water works better
Pangborn does not recommend enteric coated supplements for ASD
Often symptoms will get worse before better due to die-off of bad flora - if so, give
activated charcoal between meals
Start gradually and work up to full dose (per doctor or label) over 2 weeks
Taurine
Tier 1, extra taurine in Tier 4
Taurine is really important and likely to be helpful
Works especially well with breakfast
100-250 mg for ages 2-5
250-500 mg for ages 6-12
13
500-1000 mg for teens and adults
Don’t go above 2000 mg
adverse responses are very uncommon (rare) at these doses
Intolerance can occur in hyperkalemia (excessive blood potassium), Addison’s disease,
and insulin deficiency if gram quantities are used continuously
start at a low level and work up
Vitamins
General rule, do not exceed daily serving amount (not RDI) on label without conferring
with your doctor or nutritional counselor
B-vitamins and folate
Tier 1
B1 Thiamine, B2 Riboflavin, B3 Niacin, B6 Pyridoxine, B12 Cobalamin, Pantothenic acid,
Folic acid
Pangborn likes B-complex supplements, because the B vitamins work best taken
together
Thiamine - 10-25 mg is plenty when the rest of the vitamin team is present
Riboflavin - 5-50 mg is appropriate - toxic levels are unknown if kidney function is
normal
Niacin - 20-100 mg of total nicotinamide and/or inositol nicotinate, but not more
B6 is the grandfather of nutritional supplements reported by parents and many
clinicians to improve autistic traits and behaviors - 21 out of 22 studies show
beneficial outcomes, must give magnesium with B6
10 kg body weight,
25 mg B6+P5P,
15 mg additional magnesium
20-30 kg body weight, 50 mg B6+P5P,
30 mg additional magnesium
40+ kg body weight, 100 mg B6+P5P,
60 mg additional magnesium
Pantothenic Acid - toxicity or overdose not an issue
Cobalamin
Tier 5
methylcobalamin or cyanocobalamin
virtually no toxicity with regular supplements, even at high levels
50-1,000 mcg/day with oral supplements
Folic Acid, Folate Tier 5
Folinic acid usually more helpful than folic acid or methylTHF
but if genetic test shows MTHFR weakness, then methylTHF might be helpful
400 mcg of folinic acid or folinic+folic acids for ages 5+ is enough
14
half that for 2 year olds
Should use vitamin B12 at the same time
Vitamin A
Tier 1
Two forms - retinal and beta-carotene - the body turns beta-carotene into retinal
necessary for good vision [eye contact]
helps decrease infection and inflammation
Give as cod liver oil or in multivitamin products
Give any time of day
Don’t forget to supplement taurine
Use a multivitamin that provides 3000-5000 IU via a mixture of retinal (30-60%) and
beta-carotene (60-30%) for ages 5+. Half that for ages 3-5. If need more, use cod
liver oil certified mercury-free.
Adverse responses are unlikely, but start with low amount and work up
long half-life of 3-6 weeks, so adverse reactions take long time to show up and disappear
Vitamin C
Tier 1, more in Tier 4
Less than 50 lbs body weight, 250 mg
50-100 lbs body weight, 500 mg or more
100 lbs+ body weight, at least 500-1000 mg
Usually not more than 2000 mg except for short periods of time, as for constipation
breakfast and/or lunch are best times, to avoid potty trips at bedtime
Give at different times/meals from vitamin B12
loose stools are often due to too much of the laxative-acting supplements: magnesium,
citrates, phosphatidylcholine, herbals, vitamin C
most vitamin C is corn-based; those allergic to corn should use one that is not
use multi-element buffered vitamin C when amounts over 500 mg are used
Vitamin D
Tier 1
Every person with autism/ASD should get a supplemental vitamin D in an amount at
least equal to the recommended servings for their age
ages 1-2, 50-100 IU
ages 3-10, 100-200 IU
ages 11+, 200-400 IU
15
A vitamin D analysis (blood) is advisable, except that a “normal” blood level may not
actually be adequate when oxidant stress with inflammation is a persistent
condition
Hypervitaminosis D (too much D) is rare
Don’t exceed 400 IU for ages 3-10 years, or 1200 IU for adults
Use the D3 cholecalciferol form
If using a stand alone supplement, then give with calcium at supper
Problems with D for people with poor kidney function, or who have elevated blood
calcium levels
Vitamin E
Tier 1
Has antioxidant and tissue-protective properties
may be included in multivitamin, but additional E is often beneficial
give stand alone E at supper
15-100 IU/day, depending on age
If tolerated, you may try a “natural” product that includes additional tocopherols
Most natural E is from corn, those allergic to corn may have adverse reaction, but quite
uncommon
Too much E can cause slowed blood clotting (nosebleeds), and other problems
Supplement Products to Be Wary of
N-acetylcysteine (NAC)
S-adenosylmethionine
Alpha-lipoic acid
Cycloserine
Cysteine
Cystine
5-hydroxytryptophan
Methylsulfonylmethane (MSM)
Also consider (not from Pangborn’s book)
Chromium - for sugar craving
Alka Seltzer Gold - for acidity/to prevent fungal infections
Biotin - prevents yeast
Choline, phosphatidylcholine, or GPC (Glycerophosphocholine)
16