Q & A

These are a sample of the questions Dr. Volpe receives on a daily basis.

Could you please give me an update on the use of vitamin A and other antiviral agents in the treatment of autism?

There is a great deal of evidence linking several classes of viruses with autism. Research conducted in England by Andrew Wakefield, MD identified a chronic form of the measles virus growing in the lymphatic tissue of the small intestine of autistic children. Since none of these children had measles, it is clear that this virus originated from vaccines. If the virus is found in the small intestine it is likely that it also resides in other parts of the body, conceivably including the brain.

Vaccines employ weakened forms of viruses to trigger an immune response that renders the individual immune to a disease. It is believed that this does not happen as planned in at least some children who later develop autism because of an immature immune system. Instead the virus in the vaccine is able to replicate and grow in the body, eventually causing trouble.

Other viruses related to herpes have also been found to be prevalent in some children with autism and ADHD. These viruses include Epstein Barr virus (EBV), human herpes virus 6 (HHV6), and cytomegalovirus (CMV). Exposure to these viruses is very common among children, and random blood tests often yield positive results. The unusual finding in children with autism is the very high antibody counts that are often found and that indicate an active disease process.

At the present time we can’t determine precisely the role of viruses as causative agents in autism or ADHD. It is also hard to establish the interaction, if any, between viruses and other common troublemakers (including yeast and mercury) although they may be synergistic, possibly causing viruses to be activated by these other factors. We do know from numerous parent and practitioner reports that antiviral therapies are associated with clinical improvements in some of these children, possibly as many as a third.

Vitamin A therapy is used in children with autism primarily as a treatment for chronic measles. In the most recent version of the Defeat Autism Now (DAN) manual, Dr. Sid Baker referenced 33 studies showing that vitamin A is effective and safe in various conditions associated with measles.

This vitamin has also been found to reduce the rate of complications from measles in undernourished children, thus dramatically cutting the death rate associated with this disease. Benefits were also documented in well-nourished individuals, and indicate that vitamin A should really be given to every child with acute measles.

However, no studies were performed on autistic children who seem to have a chronic form of this virus, and the use of vitamin A in this context is still a matter of speculation that is supported primarily by reports of positive outcomes.

Various protocols of vitamin A administration have been tried and Dr. Baker initially recommended starting with a low daily dose and building it up gradually while screening for possible toxicity. Experience has shown this approach to be ineffective and the preferred protocol now involves a very high dose (400,000 IU) given once a day for two consecutive days only. This method seems to deliver a deadly blow to the virus not achieved with the gradual approach.

Numerous studies performed on large numbers of children confirm the safety of this high-dose protocol. Because the dose involved is hundreds of times higher than normal intake it should be administered only under medical supervision.

There is also no clear way to prescreen children for this therapy. Blood levels of vitamin A are not helpful. Regression after receiving the MMR vaccine might be a more useful indicator, as may be chronic diarrhea or other intestinal complaints that possibly indicate the presence of chronic measles. While antibodies to measles are expected in vaccinated children, extremely high levels of these antibodies in blood can raise suspicions of a chronic infection.

While possibly effective for measles, vitamin A doesn’t appear to help with the chronic herpes-like viruses discussed above. These viruses can be addressed either with antiviral medications, supplements or a combination of both. I am not an expert on antiviral medications and will not discuss them here. These medications are nevertheless a valid option and are available to my patients through the physician with whom I am associated.

Supplements also offer valid and not necessarily less effective options. Certain antiviral herbs and especially herbal combinations have been shown to have significant inhibiting effects on viruses (including EBV, HHV6 and others) while being virtually non-toxic. Some of these herbs work by stimulating the immune system and can be of benefit also for yeast and bacterial control. Herbal medications are often considered less effective than drugs in our society, but this view is inaccurate. In many cases they are simply better than drugs.

Other supplements with anti-viral properties include the trace elements selenium and lithium. Although lithium is considered a prescription drug for bipolar disorder with significant side effects, tiny amounts of lithium may be essential for human health. Supplement doses of 500 mcg to 5 mg have been associated with significant health benefits and no side effects or toxicity.

These nutritional doses of lithium can stimulate the growth of gray matter in the brain (Lancet 2000;356:1241-1242), protect brain cells from toxins (Neuropsychopharmacology 2000;23(S2):S39), and inhibit viral replication (Pharmacotherapy 1996;16(6):1070-1075 and others).

Finally, the natural antiviral supplement Monolaurin can be effective, although it is a little more challenging to administer because of taste and the large amounts needed to achieve optimal results. Monolaurin contains lauric acid, a fatty acid extracted from coconut oil. Using organic coconut oil for cooking can also provide some of the same benefits and is therefore recommended. A complete review of monolaurin research with detailed references can be found at www.lauricidin.com

You often recommend the Specific Carbohydrate Diet (SCD). Could you please comment on the list of allowed and forbidden supplements for this diet I have seen on the Internet?

Answer: As I have frequently said, the SCD is a useful diet that should be considered for children and adults who have digestive and other health issues. Like any diet, it is not perfect and should be customized based on each individual’s specific needs and circumstances.

The Specific Carbohydrate Diet is described in a book written by Elaine Gottschall entitled “Breaking the Vicious Cycle.” Ms. Gottschall did not invent the diet – she just wrote about it and made it easier to follow by developing many excellent recipes.

Ms. Gottschall was always very clear in stating that she is not an expert on dietary supplements, and that only doctors and nutritionists are qualified to make decisions or give advice in this area.

However, in recent years various SCD websites have made thousands more people aware of this diet and able to benefit from it. Many of these people simply didn’t have a doctor or nutritionist who would work with them and asked Ms. Gottschall for advice on supplements. I believe her intention when she put together her supplement recommendations was simply to give people who are working alone some basic guidance.

Her list doesn’t imply at all that “forbidden” supplements cannot be used or are harmful, just that she doesn’t recommend taking them without professional supervision. In fact, the “forbidden” list contains many of my favorite products, including some that have been very helpful for my patients in conjunction with the SCD or similar diets. If you are working with a qualified healthcare professional, you should not concern yourself with such general recommendations but stick with what helps in your unique circumstances.

I recently read the book “Enzymes for Autism and Other Neurological Conditions.” Have you read this book, and what is your opinion of diet change versus the use of enzymes in autism and ADHD? Finally, are Houston Enzymes really better than those from Kirkman or other companies?

These are truly excellent questions, ones that have led me to do more research and fine-tune my own understanding of enzyme therapy and diet. Questions like these help me become a better practitioner.

First of all, let me stress that I have no financial ties to Kirkman Laboratories, Houston Nutraceuticals or any other supplement company. My only loyalty is to those who choose to trust me for advice. I only recommend products that I feel are the very best of their kind, regardless of the manufacturer.

I recently read the book you mention and although it tells an interesting story I can’t say I would recommend it, primarily because the author makes too many inaccurate and misleading statements and doesn’t seem to really understand the goals of dietary intervention.

For many parents, including the author, diet change is viewed as an imposition rather than a path to health. Replacing ice cream, cookies, cakes, breads, and donuts with gluten- and casein-free versions of the same foods rather than choosing to serve and eat cleaner and more nutritious foods does not help a child’s system heal. Also, if your mindset is that you are just trying to replace junk foods with like-tasting gluten- and casein-free versions, chances are you will find the search/substitution game endlessly frustrating.

Because some children (and often their parents) are strongly addicted to these types of foods and because our society values them as part of a “normal” childhood, the whole process of substituting on a limited basis or eliminating them altogether seems unthinkable to many. It’s just so much easier to pop a few enzyme pills.

The only way you can see things differently is if you realize that children in this country are growing up on a terribly impoverished and nutrient-depleted diet, loaded with synthetic chemicals and dyes, sugar, stimulants and other non-foods with virtually no redeeming qualities.

This is a major contributing factor to the unprecedented crisis in children’s health, with the highest rates ever recorded of ear infections, asthma, allergies, obesity, diabetes, plus increasing numbers of an array of neurological conditions like autism, ADHD, depression, and bipolar disorder.

Brains need nourishment like any other organ, and this nourishment must come first and foremost in the form of pure natural foods. If a child’s brain, digestive and immune systems have been hurt because of exposure to mercury or other toxins, doesn’t it make sense that the first step in promoting recovery should be to ensure the best nourishment possible?

This is why I recommend that parents start out by focusing on a slow and gradual transition to a diet made up of natural whole foods, organic whenever possible. This is by far the most important and most valuable first step, although it can be difficult and patience is a must.

Gradually shift your focus. Only use the healthiest oils; the brain needs good fats. Eliminate processed junk foods one at a time. I often advise parents to replace really bad junk food with less-bad junk food as an interim step. As another interim step, vegetables can be pureed and hidden in hamburger meat and there are many tricks that I have learned over the years – often from parents – to help “supercharge” a child’s diet. Foods I call super-foods are packed with vitamins, minerals and fatty acids. Freshly ground flax and sesame seeds, kelp, raw nuts, whole grains are just a few of them. These can be added to drinks or used in baking. Anything out of a box or can should be gradually phased out; foods like this are just not good enough for children whose brains need to heal!

Once these steps have been achieved, at least partially, avoiding gluten and casein becomes a minor adjustment because you are no longer relying on packaged foods that always contain these ingredients. You might be surprised along the way to discover how many gluten-free flours can be used to make breads, and actually one of the most delicious breads I have ever tasted contains no grain at all (see Recipes in Newsletters).

The rationale for eliminating gluten and casein is that these foods are poorly tolerated and stress the digestive system, thus preventing or delaying recovery. Most of these foods are highly processed and loaded with sugar and other additives, so they are not beneficial to begin with and there isn’t much of a nutrient loss in giving them up. The key is to replace them with nutritious substitutes, avoiding non-foods like potato milk. Enzymes can also help in a transition and can help promote digestive recovery, but there’s one thing enzymes can’t do, and that’s turn junk food into health food!

Most children will improve, some dramatically, with these dietary changes, but if improvements are disappointing, this should not be a reason to go back to old habits. What exactly was healthy about those old habits? Instead this should give us incentive to look for a better approach. For example, some children have a tendency to develop new sensitivities to foods they eat frequently and do best temporarily on a rotation diet, where foods are rotated every four days.

Another diet program that has been tremendously beneficial for many children is the Specific Carbohydrate Diet (SCD). This diet is described in the highly recommended book “Breaking the Vicious Cycle” by Elaine Gottschall. The book also explains why this diet can be so beneficial, and provides an array of wonderful and kid-friendly recipes.

The SCD contains some casein and is not suitable for those who are strictly allergic to dairy, but it avoids all grains and other starches like potatoes, thus removing an enormous source of stress for the digestive system. The types of casein allowed are highly specific and are significant sources of so-called “lactic acid bacteria” that plays a major role in promoting intestinal health. Because they can be helpful, I recommend that all kids (even those not going on the full diet program) try these foods after a period of strict casein elimination. To the extent that enzymes can be used to help tolerate these healing foods, I am clearly in favor of it.

Enzymes should also be tried because they can make a major difference, not only in digestion, but also in every aspect of behavior, attention span, eye contact and so on. Response to enzymes is very variable and while some children will not tolerate them at all, others will benefit to varying degrees.

An important point is that enzymes should be dosed according to need. Every child will need a different amount of enzymes with meals depending on how healthy or unhealthy his/her digestive system is and sometimes enzymes can also help when taken between meals. If a small dose doesn’t help, try giving a little more and keep increasing the dose slowly until you become sure they don’t help at all or you reach the maximum benefit.

Finding the optimal formulation for each child can also be a decisive factor, and if a certain product doesn’t seem to help, I recommend trying a different one. Labels can also be misleading, and I have seen cases where the newest and most comprehensive formulas did not help as much as simpler, “antiquated” products.

As long as your child isn’t allergic to the enzymes, they won’t hurt. Nor will the body suddenly forget how to make its own enzymes. They’re also not meant to be taken forever, but for an interim period, maybe even a few years, they can give the body a break and a chance to heal.

The original project to develop enzymes specifically formulated for children with autism or ADHD was started by a group of Defeat Autism Now! (DAN) scientists almost ten years ago, and eventually led to the formulation of a product named Serenaid that is still produced under a patent owned by Klaire Laboratories. This product is the only one ever patented and this is a clear indication that other products were not as innovative or unique.

More research led to the development of a second-generation product called Enzym-Aid, this time produced by Kirkman Laboratories. Still more research and the availability of newer and more efficient enzymes led Kirkman to launch a variety of new formulas in the past few years, particularly a broad-range supplement called Enzym-Complete with DPP-IV and a more narrow-range protein-digesting enzyme called Peptidase Complete.

These new products were innovative in two major ways. First, they incorporated new protein-digesting enzymes, particularly one called DPP-IV, found to be specifically deficient in many autistic children. They also incorporated a new understanding that these children’s digestion of fat and carbohydrates was also often impaired.

Many parents feel strongly that the products from Houston Nutraceuticals are better and have become extremely active advocates for these products. Unfortunately, much of this enthusiasm seems to be misguided and based on claims that these products enable children to tolerate junk food better.

After analyzing and comparing labels, and speaking with technicians who work in the field of enzyme production and formulation, I cannot find any clear advantage to the Houston products over those from Kirkman. I have also not personally observed widespread incremental benefits from using the Houston products. At the same time it is clear to me that the Houston enzymes are safe and can be tried – but appropriately, within the context of a health-enhancing diet and supplement program.

One of the Houston enzyme products, called No-Fenol, led to a great deal of controversy concerning its safety when first introduced. Although Houston claimed it represented a major innovation, in reality it did not. Virtually identical products had been available for years from various manufacturers, including Enzymedica.

So-called phenol sensitivities are common in individuals with autism and ADHD and manifest as reactions, sometimes severe, to common fruits and their juices. The enzymes contained in No-Fenol do nothing to eliminate or digest phenols, but help digest the fibrous cell walls found in plant foods. When children digest fruits better, phenols become less of a problem and this is a perfectly legitimate use of digestive enzymes.

An interesting benefit of these products is that they can also help control intestinal yeast overgrowth if taken on an empty stomach because many yeast cells have the same fibrous cell walls as plants. It is not clear if the enzymes can actually kill yeast cells, but they can weaken them making them more vulnerable to other interventions.

Recently Kirkman also launched a similar product called Phenol Assist, which may actually be a slight improvement over the Houston version. Any original doubts regarding the safety of these products should be dispelled by this time. They present no risk whatsoever and can be used as both an adjunct for yeast control and as digestive aids for raw fruits and vegetables.

I have been reading many reports about how daily injections of vitamin B-12 in the methyl form help autistic and PDD children achieve better eye contact and speech. What is your opinion on this and would you recommend this therapy for my child?

I have read these same reports and, as you know, I am interested in exploring any avenue that may prove beneficial for children as long as it is safe.

I have no doubt as to the safety of methyl-B-12 injections, but I wonder if this aggressive approach is absolutely necessary in all cases. For example, the improvements that are being reported in eye contact and speech are not unlike improvements I have been seeing for a long time with diet change and targeted supplementation without any injections at all.

In addition, some doctors are using vitamin B-12 as a cream that is absorbed through the skin. Although I was skeptical at first about whether methyl-B-12 a water-soluble vitamin could truly be absorbed through the skin, I hear from reliable sources that absorption does take place.

Injections may still be a more efficient means of delivery. The good news is that these injections generally don’t hurt and some parents are giving them with tiny diabetic syringes to children while they’re asleep and the injections don’t even wake them up.

I have also followed with great interest the work of Dr. Jacquelyn McCandless. Dr. McCandless wrote a highly recommended book, “Children with Starving Brains,” and she is using methyl-B-12 injections as a part of a protocol that includes allithiamine cream and glutathione cream. Allithiamine was discussed earlier in this newsletter and glutathione is a major detoxifier, often deficient in children with autism and related disorders, that is very efficiently absorbed through the skin.

Dr. McCandless has reported that this protocol can be a powerful way to eliminate toxic metals from the body. She has found that children who had been on DMSA chelation for mercury and were no longer excreting any toxic metals with the DMSA began to excrete more toxic metals when they started taking this combination of nutrients. Not only this, but they suddenly experienced major breakthroughs in their recovery. As a result of reports like hers I am considering recommending this protocol as a more natural alternative to DMSA for mercury or other toxic metals or, alternatively, as a follow-up to DMSA.

As I age I am finding that my perspiration odor keeps getting worse. Is this normal and what can be done to correct it?

Even though perspiration happens on the outside of the body, it reflects what is going on the inside. The more toxic the inside the more unpleasant the odor you are likely to experience. There are various reasons why this happens increasingly in our older years. One reason is that our body’s ability to produce digestive enzymes declines as we age. As we produce fewer enzymes, more food remains undigested. Undigested food tends to putrefy and produce noxious odors.

A simple approach that can help in the short-run is to take chlorophyll as a supplement. Chlorophyll acts as a mild internal cleanser and deodorant. It can be found as a liquid concentrate at health food stores and is also contained in all green foods. Juicing green foods like parsley, wheat grass or even broccoli concentrates the chlorophyll in these foods, so drinking this type of juice can be particularly helpful.

To achieve a more permanent solution to this problem I recommend that you start by doing a stool test called a digestive stool analysis. This test is available from many specialized laboratories and my favorite one is Doctor’s Data.

I feel that everybody should do this test at least once as they age (I do it once a year). This test not only gives you information about your ability to digest the food you eat it also tells you about your intestinal health. Although this test cannot tell you whether you have colon cancer or not, it can identify risk factors for this and other dreaded diseases and is therefore a truly preventative measure.

Once you do this test you will be able to start correcting the problems it brings to light. For example you might find that you are particularly deficient in a type of enzyme, or that you have an overgrowth of unhealthy bacteria or yeast. You then can begin to focus on changing your diet and taking the right supplements to produce better intestinal health and ultimately less perspiration odor.

I have been hearing many good things about coral calcium. What is your opinion about this supplement and do you recommend that I take it and give it to my child?

The truth is that I have been reading the same reports and, although I was skeptical all along, I knew very little about coral calcium until I decided to do some research on this topic.

If you want to sell a calcium supplement and really make some money, you’d better find a catchy name and make some bold claims even if you can’t substantiate them. In a nutshell, this was my original thought and I must say I haven’t seen anything to change my mind.

Coral calcium is extracted from coral reefs near Okinawa, Japan and the health claims stem from the fact that Okinawans enjoy long healthy lives and apparently consume some of these coral extracts. The fact is that we have seen this type of marketing many times before and in all likelihood the Okinawans’ good health has more to do with their active lifestyle and traditional diet than coral calcium.

A closer look reveals that coral calcium is made primarily of calcium carbonate. This is the same type of calcium found in limestone and the antacid Tums. Although there is nothing specifically wrong with calcium carbonate, it is known to be very poorly absorbed, with absorption rates as low as 5%, especially in aging individuals. Other forms of calcium, including calcium citrate, far outperform the absorption of calcium carbonate.

One claim that is made for coral calcium is that it can raise blood pH making the body more alkaline. However, pH is determined by a complex set of factors and we can’t state either that raising pH is always desirable, or that calcium will predictably raise pH. In fact, within different ranges calcium can either increase or decrease alkalinity. One good place to start to assess pH balance of the body is to obtain a comprehensive blood chemistry, something that can be done with minimal expense.

The most outrageous claim I read was that coral calcium can extend life. I’ll let you be the judge of that one. To read all about these claims you can visit www.coral-calcium-supplement.com or www.coral-calcium-supplement.net.

My (autistic) child is making marked improvements recently, especially in language, both receptive and expressive. He is more interested in his surroundings and is wanting to work in his therapy sessions. He is also more interested in trying new foods and has taken a liking to baked squash, of all things!

Interestingly, these things improved dramatically the day we began the panthethine (as you can see we are still introducing some of the supplements you recommended going extremely slowly). Please remind me what pantethine is. Could you also please tell me your opinion of buckwheat in a gluten-free diet?

Thank you for the good news! I see more and more with so many kids that when parents have taken the time to introduce the supplement program gradually over a few months, you start a positive cycle like this one where the nutrients really “kick in” and build on one another.

However, I encourage you to continue going very slowly. This approach respects your child’s unique metabolism and gives him a chance to let us know what he needs (not what we think he needs).

The fact that the improvement came after you introduced the pantethine may be purely coincidental. Pantethine is an activated form of vitamin B5 and, like all B vitamins, it plays numerous roles and acts synergistically with other vitamins and minerals. One reason I like pantethine is that is promotes the synthesis of phospholipids and neurotransmitters that are critical for healing the brain. It also helps the body produce certain amino acids that detoxify ammonia.

Buckwheat is very safe. It is not a grain at all but a member of the rhubarb family. The only problem with buckwheat is that it has a very strong taste if eaten alone and is therefore often blended with other flours (most commonly wheat). However, it could be mixed with gluten-free flours or nut flours. If you find some good recipes, let me know!

My dentist wants to give me fluoride treatment. I wanted to check with you to see what your thoughts are about the safety of fluoride, and if there are any natural alternatives to strengthen teeth.

I am very much opposed to fluoride. It is a toxic byproduct of aluminum production. Instead of disposing of it, industry managed to convince our government that it’s good for us and should be added to our drinking water and supplied in dental treatments.

The research on the benefits of fluoride is, at best, insubstantial. Too much fluoride can actually weaken teeth and cause a yellow discoloration of tooth enamel. In addition, there is a great deal of suspicion that fluoride may weaken bones and may even be toxic to the brain.

Actually, fluoride is promoted not to strengthen teeth but to prevent cavities. Well, by far the most effective way to do this is to avoid sugar! Another well-kept secret is xylitol gum. Xylitol tastes just like sugar but cannot be digested and does not cause the same problems as sugar. In addition, xylitol helps clear bacteria from teeth. This is the same kind of bacteria that cause tartar build up and eventually cavities. Since I started to chew this gum, dental cleaning at my dentist’s office has become much easier and faster and I keep getting compliments on how clean I keep my mouth!

I have a nutritional question for you: what is your opinion of ghee with the casein-free gluten-free diet?

Fat is actually one of the most critical ingredients when it comes to healing of the brain. Consider that a full 60% of the dry weight of the brain is fat and the connections between nerve cells are protected by myelin, a largely fatty substance.

The two most prevalent fats in the brain are arachidonic acid and DHA from fish oil. Arachidonic acid is found in meat fat and butter, but not in margarine or commercial vegetable oils. These oils may contain altered forms of arachidonic acid that do more harm than good to the brain.

As a result, there can be a benefit to reintroducing butter even in a casein-free diet. The amount of casein in butter is minimal and can often be tolerated without a problem even by individuals who are highly sensitive to milk and other dairy products. A hidden problem can be the yellow dye that is commonly added to butter and is often not easy to detect on the label.

If butter is not tolerated, or if you prefer to avoid it, ghee is an equally good choice. Ghee is butter from which all the milk solids have been removed. The main advantage of ghee is that it tolerates high heat and can be used for frying, but unfortunately it is harder to find and expensive. I have also been told that all of the ghee from Asian food stores is laced with hydrogenated vegetable oil (margarine) and should be avoided. If you are going to buy ghee or butter I recommend that you pick the organic type from a health food store.