A number of years ago, some of our community members asked me about Asperger's and Autism and how they might fit with sugar sensitivity. Ironically, I was thinking about Autism because of a rescue dog.[some of my more intriguing thoughts have come from that path]. Those reflections prompted me to do a fair amount of research on the topic. When I reread this article, I was fascinated to see that I wrote earlier was really on target and very helpful. I want to go back and revisit this and see what has been written since. I am thinking about developing a series of special reports so this update can be one of them.

Back to the dog. I got a gorgeous rescue golden retriever named Delilah. Her people gave her up because she was a *behavioral problem*. I took her and then observed her for a couple of weeks. She would not connect, made no eye contact, and spent her days immobile with her head under the bed. She collected all the dog toys and hoarded them with her there under the bed. She could not cope with new experiences. She was stubborn, willful and terrified of rain and thunder. I worked with her behaviorally for 6 months with no change made.

Eventually, I took her to a homeopathic vet to see if he might offer some perspective. We met for an hour. He said, *I think she is autistic.* He had a remedy for her, but had to order it and said it would take 2 weeks. I figured while I was waiting, I would play with her food and see what happened. I did and in 3 days, this dog was transformed. She connected, she started wagging her tail, she started to play with the other dogs. Six months more and she was in a loving home being funny and loving. She is at times a little quirky, but they adore her and see her as a normal dog. The transformation got my attention.

Science is still learning what autism is or how to treat it. Basically, researchers admit that they are trying stuff to see if it makes any difference. And of course, each field will believe that their way is the best way.  As I started reading the literature, I found some intriguing connections. I focused on children because the parents had asked for help.

Autistic children generally have high levels of serotonin in their blood platelets, but low levels of *free* serotonin. This means that somehow the serotonin that is in the blood gets bound to the platelets but extra does not float around. This may mean high serotonin in blood cells, but low serotonin in brain.

One study suggests that this early high level could have an impact on the infant brain. Small babies do not have a formed blood-brain barrier; so high levels of serotonin could cross over and *knock out* or overload the brain. This would mean a dysfunction in the serotonin receptor system. Fewer receptor sites, or impaired receptor binding, could account for the strange combination of no impulse control and obsessive brain lock we see in autistic children. At any rate, think of impaired serotonin function in your children. It is complex and not really clear, but there is no question that serotonin in some form is implicated.

Research also comments on the fact that autistic children have high beta-endorphin levels. The literature does not reference baseline beta-endorphin but talks about an exaggerated stress response. Measuring beta-endorphin evokes stress, so the high levels they see may be a function of the exaggerated stress reaction. Stress evokes BE, and generally serotonin modulates the spike. If the serotonin system is impaired, there could be nothing to tone the beta-endorphin spike down so there would be a constant spiking and crashing. Higher BE levels are associated with difficulty in bonding. BE is designed to kill pain, it creates *numb*. This can be life saving in a crisis, but it does not bode well for bonding. Children treated with a BE blocker actually had fewer autistic symptoms. Researchers used a drug called Naltrexone that sits in beta-endorphin receptor sites and does not allow the heightened BE reaction to charge the system. But it does nothing to heal it. I began thinking, what about food? What do we know and how might we design a food program for your kids. The variables we are working with:

OK, this simplifies the task. Here's what we want to do:

What does this mean in terms of food?

Increase the protein to make sure that the brain has the amino acids it needs to make serotonin in the brain factory. This means regular and consistent protein. And yes, I know that most of your children only want to eat carbs. Identify what proteins your kids are willing to try and use those creatively.

Give your children a children's formula of fish oil. Check the DHA formulation we have in the store. I love Nordic Naturals Products and think they are safe and very appropriate for your children.

Ultimately, you will want to move your kids to a food plan that has no wheat, no hard-core dairy (whey protein powder is ok because it does not have casein), and no sugar.

Wheat and dairy contain opioid peptides and raise BE levels more. Sugar does the same. Obviously you will not do all of this at once. But you can take out things like soda and move incrementally towards the goal. It make take a while, but at least you can understand the big picture.

Now, at this point, you are probably either laughing or recoiling in horror. You may be thinking, "Kathleen, that is a joke, my child only eats 2 things." I realize we have some major logistics to get through. I am very pragmatic. But, if you knew that changing your child's food would create a profound improvement, wouldn't you want to at least try? I know you have spent thousands of dollars and have tried 100 other things. We have nothing to lose. Let's share and do problem solving together.

And, of course, it is critical that YOU do the steps. You cannot even think of making these changes with your child unless you are totally steady. Let's do it together. 

And here are the citations. All of the abstracts are on Pub Med if you want to read them. Go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

Akbari, H. M., H. K. Kramer, et al. (1992). "Prenatal cocaine exposure disrupts the development of the serotonergic system." Brain Res 572(1-2): 57-63.

Anderson, G. M., D. X. Freedman, et al. (1987). "Whole blood serotonin in autistic and normal subjects." J Child Psychol Psychiatry 28(6): 885-900.

Anderson, G. M., A. W. Zimmerman, et al. (2004). "Autism clinical trials: biological and medical issues in patient selection and treatment response." CNS Spectr 9(1): 57-64.

Blum, I., Y. Vered, et al. (1992). "The influence of meal composition on plasma serotonin and norepinephrine concentrations." Metabolism 41(2): 137-40.

Buitelaar, J. K. (2003). "Why have drug treatments been so disappointing?" Novartis Found Symp 251: 235-44; discussion 245-9, 281-97.

Bursztejn, C., P. Ferrari, et al. (1988). "["[Metabolism of serotonin in autism in children]." Encephale 14(6): 413-9.

Cazzullo, A. G., M. C. Musetti, et al. (1999). "Beta-endorphin levels in peripheral blood mononuclear cells and long-term naltrexone treatment in autistic children." Eur Neuropsychopharmacol 9(4): 361-6.

Chugani, D. C. (2004). "Serotonin in autism and pediatric epilepsies." Ment Retard Dev Disabil Res Rev 10(2): 112-6.

Cook, E. H., Jr., R. C. Arora, et al. (1993). "Platelet serotonin studies in hyperserotonemic relatives of children with autistic disorder." Life Sci 52(25): 2005-15.

Hollander, E., A. Phillips, et al. (2005). "A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism." Neuropsychopharmacology 30(3): 582-9.

Humble, M., S. Bejerot, et al. (2001). "Reactivity of serotonin in whole blood: relationship with drug response in obsessive-compulsive disorder." Biol Psychiatry 49(4): 360-8.

Leboyer, M., A. Philippe, et al. (1999). "Whole blood serotonin and plasma beta-endorphin in autistic probands and their first-degree relatives." Biol Psychiatry 45(2): 158-63.

McBride, P. A., G. M. Anderson, et al. (1989). "Serotonergic responsivity in male young adults with autistic disorder. Results of a pilot study." Arch Gen Psychiatry 46(3): 213-21.

McCauley, J. L., L. M. Olson, et al. (2004). "Linkage and association analysis at the serotonin transporter (SLC6A4) locus in a rigid-compulsive subset of autism." Am J Med Genet B Neuropsychiatr Genet 127(1): 104-12.

Moore, M. L., S. F. Eichner, et al. (2004). "Treating functional impairment of autism with selective serotonin-reuptake inhibitors." Ann Pharmacother 38(9): 1515-9.

Mulder, E. J., G. M. Anderson, et al. (2004). "Platelet serotonin levels in pervasive developmental disorders and mental retardation: diagnostic group differences, within-group distribution, and behavioral correlates." J Am Acad Child Adolesc Psychiatry 43(4): 491-9.

Nabi, R., F. J. Serajee, et al. (2004). "Association of tryptophan 2,3 dioxygenase gene polymorphism with autism." Am J Med Genet 125B(1): 63-8.

Nader, R., T. F. Oberlander, et al. (2004). "Expression of pain in children with autism." Clin J Pain 20(2): 88-97.

Nagamitsu, S., T. Matsuishi, et al. (1997). "CSF beta-endorphin levels in patients with infantile autism." J Autism Dev Disord 27(2): 155-63.

Palermo, M. T. and P. Curatolo (2004). "Pharmacologic treatment of autism." J Child Neurol 19(3): 155-64.

Ross, D. L., W. M. Klykylo, et al. (1987). "Reduction of elevated CSF beta-endorphin by fenfluramine in infantile autism." Pediatr Neurol 3(2): 83-6. Sandman, C. A. (1988). "Beta-endorphin disregulation in autistic and self-injurious behavior: a neurodevelopmental hypothesis." Synapse 2(3): 193-9.

Scifo, R., M. Cioni, et al. (1996). "Opioid-immune interactions in autism: behavioural and immunological assessment during a double-blind treatment with naltrexone." Ann Ist Super Sanita 32(3): 351-9.

Sodhi, M. S. and E. Sanders-Bush (2004). "Serotonin and brain development." Int Rev Neurobiol 59: 111-74.

Spivak, B., P. Golubchik, et al. (2004). "Low platelet-poor plasma levels of serotonin in adult autistic patients." Neuropsychobiology 50(2): 157-60.

Tordjman, S., G. M. Anderson, et al. (1997). "Plasma beta-endorphin, adrenocorticotropin hormone, and cortisol in autism." J Child Psychol Psychiatry 38(6): 705-15.

Tordjman, S., C. Antoine, et al. (1999). "[Study of the relationships between self-injurious behavior and pain reactivity in infantile autism]." Encephale 25(2): 122-34.

Vered, Y., P. Golubchik, et al. (2003). "The platelet-poor plasma 5-HT response to carbohydrate rich meal administration in adult autistic patients compared with normal controls." Hum Psychopharmacol 18(5): 395-9.

Whitaker-Azmitia, P. M. (2005). "Behavioral and cellular consequences of increasing serotonergic activity during brain development: a role in autism?" Int J Dev Neurosci 23(1): 75-83.

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Willemsen-Swinkels, S. H., J. K. Buitelaar, et al. (1996). "Plasma beta-endorphin concentrations in people with learning disability and self-injurious and/or autistic behaviour." Br J Psychiatry 168(1): 105-9.