Vitamin A Article - Dr. Baker & Dr. McCandless

[Guest guest]

CLARIFICATION ON THE VITAMIN A ISSUESidney Mac Baker, M.D. and Jaquelyn McCandless, M.D.Internet posting on an autism parent-support list has revealed some potentiallyharmful misunderstanding on some parents’ part concerning the use of Vitamin A.The speculation that Vitamin A may benefit children with persistent measlesvaccine virus problems as has been shown for hospitalized children with acutewild measles infections has led to some parents using the mega-dosing regimewith or without medical supervision with variations of dosing and agents. Arecent post from a parent who was giving mega-doses to her child for 4 days in arow wanted to know if she should increase the dose even more, even though herchild was showing alternating lethargy and hyperactivity, because he hadn’t yetgotten what she called the “measles” rash. She stated that she had gotten thisfrom another parent, who believed you would not have effectiveness until you gotthe rash. The parent was contacted immediately and told to stop all Vitamin A,and the list was given all pertinent information about the Vitamin A issue. (Her child is fine now). We felt it wasimportant enough to alert all of you in the DAN! community of our position onthis treatment.Background: (Dr. Baker) In the spring of 2002, measles virus was reliablyreported to be present in the spinal fluid of some autistic children who hadpreviously demonstrated measles vaccine virus in the lymphoid tissue of theirdigestive tracts. The alarm of this finding increased our incentive to come upwith ideas upon which well-informed parents might base safe private decisionsfor their children pending a shift in public policy to address the measles virusissue. The gap between the urgency of private decisions in regard to this issueand the resistance to the very idea on the part of those responsible for publicpolicy suggested that it might be many years before speculations about treatmentof individual children with atypical presence of MV might be resolved byresearch in groups of children.Very high doses of vitamin A palmitate (400,000iu per day for two consecutivedays) is the only measles specific treatment for children with active acutemeasles. This common childhood infection may involve a sometimes fatalinflammation of the lungs (pneumonia), inflammation of the brain (encephalitis)as well as other complications that befall very sick children. Other anti-viraltreatments have not been shown to work in measles. A discussion at the DAN!Think Tank in May of 2002 in Boston led to a consensus that some form of VitaminA treatment would be worthy of consideration. Guidelines for such treatment werepublished in Biomedical Assessment Options For Children with Autism and RelatedProblems, by Pangborn, J and Baker, SM, published by the Autism ResearchInstitute, 4182 Avenue, San Diego, DA 92116 October 2002 Edition, pages216-220.The chronic nature of the possible measles problem in a subgroup of children inthe autism spectrum led me (SMB) to consider that a lengthy treatment thatpushed Vitamin A levels toward the high end of the safe range would make sensein that it answered the need of parents to observe their children over a periodof a few weeks or longer to judge progress if any should occur and it gave timefor monitoring a slow increase intake to avoid surprises of toxicity. My ownexperience with this approach in my patients did not yield positive results.Meanwhile Dr. McCandless, inspired by Binstock’s and my literature searchshowing this to be effective in children with wild measles and also as reportedfrom English parents with 2-day high dosing, began suggesting that parents whofit certain criteria might try the two-day protocol, followed by maintenancedoses only for at least 6 months before doing any more mega-doses. Herpreliminary clinical study of salivary secretory IgA rubeola antibodies done with Dr. Ari Vojdani at Immunosciences has revealed anelevated level in 14 of 32 children tested. Those with very high levels weresome of the best responders to this protocol, and other positive feedbackstarted coming in from parents doing the protocol. Another study is almostcompleted checking both the serum IgG rubeola antibody level as well as thesecretory IgA salivary antibody level to see how these two correlate along withclinical assessment and reports.Seizing upon the positive implications of those reports and guided by thesimplicity and safety of that approach (for which safety has been documented instudies of both well-nourished and undernourished children) I took the positionthat this approach might form the basis for clinical observations that couldbenefit children. Unfortunately, there are no generally available tests toreliably measure Vitamin A levels in the body; the assessment is primarilyclinical observation. Signs of toxicity are a “scruffy” rash around the neck,headache, nausea, vomiting, lethargy, and excessive unusual hyperactivity. Thefew parents reporting whose children have shown any of these responses havestopped with no sequelae. Most reports have been very positive with some showingremarkable benefit. It is important to emphasize that this is not a treatmentfor autism generally (though the RDI is probably very low for Vitamin A) butonly for those suspected of having measles in their systems. The risks at this time do not seem to be from the protocol itself, butfrom misunderstandings such as related above. High doses should not be givenuntil a skin rash is produced, for that is one sign of Vitamin A poisoning!Based upon existing medical literature, two (2) days of high dose vitamin A inthe range of 200,000-400,000iu of Vitamin A Palmitate is the only way ofproceeding that appears to be safe. Any further exploration of high-dose VitaminA therapy must be carried out with close medical supervision. Based on thebelief that children with active measles in their gut or brain are probably lowor depleted in Vitamin A, the criteria as outlined by Dr. McCandless for herpatients for launching into this pilot study are three or more of the following:-History of regression after MMR (particularly in those children who had animmediate and strong negative reaction to the vaccine or booster).-Persistent gut problems in spite of all recommended treatments.-More than slightly elevated IgG serum rubeola levels.-Elevated anti-myelin basic protein (MBP) and anti-neurofilament antibodies(indication of autoimmune reaction).-Elevated secretory salivary rubeola IgA antibodies.-Needless to say, endoscopy showing ileal lymphoid hyperplasia with vaccinestrain measles by PCR, or measles in CSF studies.Sidney M. Baker, M.D. Jaquelyn McCandless, M.D. 3/21/2004