3

You Are What You Don’t Poop: Be Amazed by Enzymes

“Have you fa-a-awted?” When my husband Alan, was in medical school, he had a roommate who nailed their attending physician’s accent and signature line. On hospital rounds, checking on postsurgical patients, he’d sing it loudly from the doorway as he strode into a patient’s room without so much as a hello, his flock of medical students trailing him, startling and often embarrassing the unsuspecting man or woman in the bed.

Anesthesia and opiate pain medications, such as morphine, are notorious for shutting down the bowels and causing opioid-induced constipation (OIC).¹ If you’ve ever had surgery, you may recall that you were not released to go home until you had a bowel movement or at least passed gas; the doctor or nurse checking on you had to be certain that your bowels had awakened from the opiate coma. Or, if you’ve ever been on pain meds like Lortab or Oxycontin, you probably remember how constipated you were.

My husband and his medical school classmates knew the potential problems drugs could cause in the bowels and weren’t surprised by the doctor’s daily query. But they were highly amused by his manner and distinctive accent, which is why “Have you fa-a-awted?” became fodder for late-night antics. In those sleep-deprived days, we thought the impersonation—and the question—was hilarious, and we were always ready for a laugh.

Up to 70 percent of autistic children suffer from chronic constipation,² which can lead to sleep disruptions³ and aggressive behaviors.⁴ Prescription medications that address sleep or aggression issues can be helpful, but most have an undesirable side effect—constipation!⁵ This creates a vicious cycle of more sleep disruption and aggression. Until the bowels are moving on a daily or near-daily basis, not much else can be accomplished.

The GFCF Diet

Most of you will have heard of the gluten-free, casein-free diet—often referred to as the “autism diet” in the same breath—and you’ve either tried it and quit or shied away from it because it’s so challenging. Don’t worry. You don’t have to start this diet, but it is a great tool for GI health if you’re interested. When we first started the GFCF diet with our son Evan, we didn’t understand why it worked. We just knew that it calmed Evan down, like magic. Friends and relatives kept asking us what new medication he had started! It didn’t cure or treat his autism, but it did change his behavior.

        GFCF Diet

GFCF stands for gluten-free, casein-free. Gluten is a protein found in wheat, barley, rye, and spelt. Casein is a protein found in milk and milk products. Following a GFCF diet means eliminating these foods from your child’s diet. That’s challenging when you stop and think about how many foods that includes. Bread, pasta, pancakes, cookies, crackers, to name a very few common (and beloved) foods, are on the “forbidden” list in the GFCF diet, along with milk, ice cream, butter, cheese, cream cheese, and a host of other foods kids (and their parents) love. To learn more about the GFCF diet, including websites, cookbooks, and general tips, see the Helpful Resources section at the end of this book.

As we continued to attend autism conferences, surf the Internet, and question our doctors, we learned that two major food proteins (gluten and casein) were only partially breaking down in our son’s digestive tract and that these partially digested proteins, or peptides, are very similar in structure to morphine—in fact, they are called casomorphins⁶ and gluteomorphin.⁷ Because these peptides can leak out of the GI tract and enter the brain⁸ through the bloodstream, they are classified as neuropeptides. Once in the brain, the opioid neuropeptides can affect mood and cognitive function and affect an area of the brain in the temporal lobes that handles speech and auditory integration. Wow, your child’s favorite foods might be affecting his brain!⁹

The Opioid Effect

Talk about an aha moment! These morphine-like substances were coursing through our son, keeping him in the steady grip of opioids that have the same effects as a powerful prescription painkiller—right down to the constipation and addictive habits. While Evan was eating the same foods the rest of the family consumed, because of his gastrointestinal inflammation and poor intestinal health some of the food was only partially digested. The physiological results were making him act bizarrely.¹¹ A case report published in July 2015 confirms a new clinical entity, “Gluten Psychosis,” which can lead to neuro-psychiatric manifestations in adults and children. It is unrelated to celiac disease or wheat allergy.¹²

I began to understand why traditional methods of discipline were completely ineffective for Evan.

The GFCF diet is controversial, and research studies are mixed, with most failing to show any benefit for ASD. Dr. Susan Hyman at the University of Rochester has led two studies using a handful of autistic children that purport to show the GFCF diet doesn’t have any benefit for ASD. The most recent study states, “we excluded children who had known gastrointestinal disorders, who might have been more likely to respond positively to dietary restriction.”¹³ She excluded those with GI issues from her previous study¹⁴ as well. Apparently, Dr. Hyman is investigating if a GFCF diet affects autism itself, but didn’t investigate if the GFCF diet helps the gastrointestinal issues that affect subsets of autistic children and adults. That’s a fair angle. Dr. Hyman didn’t study autistic children with GI problems, so please do not be misled by the media headlines announcing the GFCF diet has no benefit for those with ASD. Although I do not expect a GFCF diet to cure or treat autism, I do use it quite effectively to help with the gastrointestinal issues of autism.

The opioid effect explains why so many ASD children will eat only a few foods, and in an addictive manner: Macaroni and cheese, pizza, and chicken nuggets are common favorites. These foods are a rich source of opiate-like peptides, making them—to some children with autism—as addictive as narcotic drugs. I have two- and three-year-old patients who want to drink a gallon of milk or more a day or eat “bread sandwiches.” Many of you autism moms and dads reading this know what I’m talking about.

When Alan and I first began following the GFCF diet for Evan, we were skeptical. We weren’t initially aware of all the science behind it, but we couldn’t argue with the astonishing results we saw when foods containing gluten and casein were removed from his diet. His wild rages began to lose their grip on him, he began sleeping more consistently, and his eye contact improved. Even his thought processes became more clear and rational. People who didn’t know he had started a special diet thought he had started a new medication. I was grateful for the improvements, but I wished there were an easier way to get these results. (This chapter will show you how!)

There are some myths concerning gluten and casein and the GFCF diet that should be addressed here.

Why I Stopped Recommending the GFCF Diet to Start

I no longer put my patients on the GFCF diet as a first line of GI support. For years, I did. I wore myself out telling families about the GFCF diet. I conducted workshops, met with parents privately, and gave away hundreds of dollars’ worth of books about how to follow the diet. I cooked and baked delicious GFCF meals to serve at the workshops, eager to show families how good (and simple) the diet could be. I arranged to meet with parents at the grocery store, showing them where the GFCF products were located, giving tips on which ones tasted good and which ones were just plain nasty. I shared recipes and helped people convert their family favorites to GFCF. I printed and gave away instructions for following the diet on a tight budget, even food stamps. I talked until my voice gave out. Let’s just say I gave it my best effort.

There were families who put the work in, implemented the GFCF diet, and were delighted with the improvements they saw in their child. I admire those families to this day. I finally had to admit, however, that of the dozens of families I worked with at any given time, very few children were being put on the GFCF diet. It was just too challenging for their already-overburdened parents.

“Dr. Jae,” parents would say, “this diet makes sense and sounds wonderful, but my child only eats five foods. How am I ever going to do a diet that takes away the few things he’s willing to eat?” Others said they were too stressed out or couldn’t afford it.

Timing Is Everything

I noticed time and again that parents turned away from the entire vibrant health program because of the difficulty this first step, the GFCF diet, presented. Once they determined they couldn’t master the diet, or even get started on it, they gave up and never came back to the clinic.

As the first step of a comprehensive health program, the GFCF diet was being attempted at a time when the child’s behaviors were extremely difficult and parents were mentally worn out. I began to see that parents needed an easier way to calm their children. I needed to give them a simpler way to start the process. If I could get them past the challenge of the diet yet accomplish the same short-term goals of reduced aggression, improved sleep, and daily bowel movements, we could get down to the real work of those beautiful long-term goals: increased language, better social skills, and improved cognition.

         The Role of DPP-IV

DPP-IV is an enzyme that’s made in the lining of the small intestine and breaks down gluten and casein, which are highly resistant to breakdown by other enzymes. This enzyme is suspected to be deficient in some children with autism, either through intestinal damage or less genetic expression, and is sensitive to damage from environmental toxins.

Rumors were circulating on the Internet back then suggesting that autism families could chuck the GFCF diet and just slip their kids some enzyme supplements that contained DPP-IV, an enzyme that breaks down the dietary opioid peptides.¹⁶ It sounded too good to be true. Nothing that easy happens with autism. Ever. I was skeptical. When Dr. Devin Houston, a renowned enzymologist, spoke about enzyme supplements at a local autism conference, I was initially unconvinced. (I hate to admit this now—sorry, Devin!) Were the enzyme companies trying to make money selling autism families a false hope? When I opened my clinic, I was so concerned that enzymes were, at best, a sloppy imitation of the GFCF diet, I suggested them only in extreme cases, when I knew the parents were too overwhelmed to pull off the diet.

Tired families, homes broken by divorce, and single parents with cranky, sleepless children wanted the results the GFCF diet offered, but the plan was just too difficult for most. So, more and more, I began using the enzymes to buy time. Now mom or dad could get started on the child’s Un-Prescription Action Plan right away, rather than spending weeks or months planning and implementing a special diet.

Over time, I created a four-week “step-down” program in which the enzymes were introduced gradually, minimizing the significant withdrawal symptoms that occur when a child is coming off the opioid-producing foods. This approach made it easier on the child, the family, and the school system. The results were so good and the plan so simple, many parents chose to continue with enzyme supplements instead of a GFCF diet. My fears that the enzymes would be a lazy, sloppy imitation of the diet were unfounded. The results were great.

Physiology Is Destiny

As I continued tracking down research data and attending conferences, I learned that over half of children with autism may be deficient in certain digestive enzymes. Their bodies just don’t produce enough of them, making it difficult to digest gluten, casein, lactose, and some carbohydrates and starches.¹⁷ In fact, it’s really good for these kids to take enzymes as a supplement. As time went on, so many families with whom I worked were having such great results with the enzymes alone, I bailed on the diet as a must-do first step. Nowadays, I wholeheartedly recommend the enzyme supplements alone for most of my patients. I feel like a bit of a traitor to the GFCF diet, but it is simply too high-maintenance for most of my stressed-out/in-crisis families. Once the child is out of pain and in a calmer, healthier state, any of the special autism diets are much more doable. The enzymes can be used as a transition to a healthier diet.

How do these enzymes work their magic? Remember, gluten and casein don’t cause autism, but they can form opiate-like substances in your child’s gastrointestinal tract. Opioids dull your child’s cognition and increase difficult behaviors. And opioids cause chronic constipation, which can lead to reflux and night awakenings.

Before enzyme supplements came along, the only way to get the opioids out of a child’s system was to take away the foods that formed them. Now we can break down the opioids using the magic of digestive enzymes. It’s like having an Easy Button! Enzymes break down the partially digested opiate-like “trouble makers” from gluten and casein and, essentially, fake the GFCF diet.

Children with reflux tend to stay very busy, almost hyperactively busy, during the day, trying to keep their mind off of the burn and discomfort of acid reflux. They put off going to sleep for hours, because lying flat makes it worse. Many children will fall asleep sitting up on the couch, or propped up on pillows. This is a clue your child may have reflux.

How do enzymes eliminate constipation, sleeplessness, and aggression?

How is constipation connected to night awakenings? Chronic constipation can contribute to reflux. Think of it this way: If the flow of acid, bile, and food isn’t moving through your gastrointestinal tract toward your hind end, it’s moving in the other direction, up toward your throat! Gastroesophageal reflux disease (GERD) is common among ASD children and adults.¹⁸ Experienced clinicians know that reflux and belly pain are most likely what keeps waking your autistic child throughout the night. During the day, when the child is walking, running, or sitting, gravity helps keep stomach acid where it belongs—in the stomach. There is a muscular sphincter at the top of the stomach that helps keep a lid on things, but it doesn’t always do its job well since these children are prone to low muscle tone. At night, when the child lies down in the horizontal position, the stomach acid can flow up into the throat more freely. It’s the reason children with reflux will put off going to sleep for hours! The burning pain not only delays sleep, but may cause restless sleep or frequent night awakenings.

Constipation contributes to overgrowth of undesirable bacteria and yeast in the gastrointestinal tract (or gut) as well. The longer it takes food to pass through the bowels, the longer it acts as a nutrient source for bacteria and yeast. The bowels are warm, dark, and moist, and they become an incubator for these unwelcome critters. When bacteria and yeast take over the playground, it creates inflammation and pain. Add the discomfort of constipation to reflux, inflammation, sleep deprivation, and chronic pain, and it is not surprising that these children are irritable or aggressive.

First Things First

Many autism doctors, including me, suggest probiotics and antifungals for ASD children to address bacterial and fungal imbalances and infections. But if you give these supplements to a constipated child, the toxic substances produced by dying yeast and bacteria cannot be easily flushed from your child’s body if the bowels are not moving. Your child will absorb these “die-off” products and become quite irritable and edgy. Constipation must be addressed first. Stop and read that sentence again. Circle it, and then highlight it in yellow.

Many autism parents try detoxification or chelation products they find on the Internet. But if you are trying to detox your constipated child, he may be reabsorbing those toxins if he cannot eliminate them through the bowels. Trust me, detox comes much later in the overall plan, if at all.

Quite literally, you are what you don’t poop. The bowels are a major route of excretion and detoxification. That is why you must focus on breaking the constipation before going on to other gastrointestinal interventions such as probiotics and antimicrobials. But I don’t mean you should just rely on laxatives. Once your child is free of chronic constipation and the resulting symptoms, he will probably calm down a lot. In addition, his improved behavior will mean the doctor will be far less likely to suggest psychiatric medications such as risperidone.

This Is Your Child’s Brain on Drugs

What kinds of problems do these opiate-like neuropeptides contribute to? Take a look, and see if you recognize any of your child’s problems in this list:

Social withdrawal

Limited use of language, even if he can speak

Addictive eating patterns

Constipation, or diarrhea and constipation

Reflux

Fuzzy thinking, being “zoned out”

Poor concentration

Poor eye contact

Disrupted sleep patterns

Irritability and aggression

Anger-related issues (easily angered)

Lack of impulse control

Self-injuring behaviors

High pain tolerance

Obviously, these opioid peptides cause lots of symptoms that can make children seem autistic, or more autistic than they really are. Our son Evan had many of the problems on this list; they began to clear up dramatically when we removed the opioid peptides from his diet (which was our best course of action, because we didn’t have the enzymes back then). If he accidently ate wheat or cheese, the bizarre behaviors and anger returned. If you’re skeptical, let me assure you—so was I. But what do you have to lose at this point? Behavioral and educational interventions are great therapies, and your child will need them, but they can’t treat underlying medical conditions in the gut.

Joey’s Story

Frequently Asked Questions About the Enzyme Protocol

Q: My child does not have any of the gastrointestinal problems; no reflux, constipation, or a high pain tolerance. He sleeps just fine and is good- natured. He will eat anything and isn’t picky at all. Can’t I just skip the enzymes? (About one-fourth of my patients raise this question.)

A: I still want you to try the enzymes anyway.

Why? Because I have seen so many children like yours respond to the enzyme protocol. For the price of a bottle of enzymes, you can find out if this approach will help your son or daughter. I have been surprised many times to see improvements in children and adults who did not seem like ideal candidates for the enzyme protocol. Their GI problems might have been present but at such low levels that no one suspected them. If your child has a subclinical opioid effect, he or she could respond well to enzyme therapy. Go ahead and look under that rock! Little Joey’s parents are glad they tried it!

One huge bonus to using enzymes in place of the GFCF diet is that you don’t have to take anything away from your child’s already-limited food choices. As an autism mom, I know how impossible it seems to take away the dairy, pasta, or breads these children demand every day.

Another bonus is that if you do not take away dairy foods and many grain products, you do not have to put back the calcium and other nutrients in the form of vitamin supplements. The vitamin supplement regimens for children using the GFCF diet can be expensive and time-consuming to dole out. Plus, many parents find it very difficult to get so many supplements into their picky eaters.

Here’s another reason I no longer recommend the GFCF diet first: Researching and implementing the GFCF diet is a front-loaded project. Most of the work you’ll put in finding GFCF recipes and foods that your child will agree to eat, stocking your kitchen, checking websites to see if products are GFCF, and so on, is done before and during the early stages of the diet. All of this is a lot of work. Once you get going, the diet is definitely much easier, but many stressed-out families just cannot manage to pull off all of the initial work that goes into starting the diet. Autism parents are some of the smartest, most tenacious people I know, but the chaotic early days make everything harder.

Q What if my child is already GFCF?

A I strongly encourage you to consider the enzymes even when your child is already on a special autism diet.

Why? Over half of these children do not make enough of their own digestive enzymes to properly break down foods.¹⁹ A number of my GFCF diet patients have easily identifiable foods in their bowel movements, foods that have barely undergone any digestion or breakdown. Parents can sometimes tell what their children ate simply by looking at their stools. Even with an organic, gluten-free, casein-free diet, their digestion and absorption may still be impaired. Enzymes increase the efficiency of digestion. Ava, whose story we heard at the beginning of Chapter 1, was GFCF and hadn’t had a bowel movement in years—only “little bits” that slipped out in her diaper at night. After four weeks on the enzymes she, too, was having daily Bristol Type 4 stools and was making progress with toilet-training.

Jon’s Story

Eating Out

Boy, did I miss eating out in the years before we knew about the enzymes. Years ago, when we were using a strict GFCF diet with Evan, we had to practically interview the chef about how foods were prepared in the restaurant’s kitchen and what was on the grill before my child’s food was cooked. At our local Outback restaurant, the owner himself would clean the grill and personally prepare Evan’s meal each time we came. Once we learned about enzymes, however, we could relax and not be so vigilant. If a gluten-free, casein-free child grabs the bread that the waitress set on the table when you aren’t looking, the enzymes are there to save the day. If breaded fish was cooked on the grill before your child’s grilled chicken, enzymes are there to bat cleanup. It certainly makes eating out much less of a hassle!

Some Great Reasons to Use Enzymes for Autism

You can start immediately.

They “fake” the GFCF diet by breaking down opioid-like peptides.

They are far easier to administer than the diet.

They give you time to research the GFCF diet and decide if it will work in your household.

You don’t have to remove foods from your child’s diet.

They eliminate both gluten- and casein-derived peptides.

You don’t have to give as many vitamin supplements as with the GFCF diet.

Enzymes make it easier to eat out in restaurants.

Enzymes are safe, relatively inexpensive, and readily available.

They help decrease GI inflammation.

They provide digestive support.

They minimize the domino effect of poorly digested food and its subsequent sensitivities and allergies.

They improve your child’s nutrition since insufficient enzymes cause poor digestion and absorption.

We can encourage a nice weight gain in undernourished children by using digestive enzymes.

If foods are not broken down, the nutrients remain locked inside. A small number of my patients had such severe gastrointestinal problems they were actually malnourished and had that third-world look of starvation, with a bloated belly and stick-thin arms and legs. Digestive enzymes help “unlock” your child’s food and help him get the nutrition he needs.

Partially digested foods become a source for bacterial overgrowth in our colons. We are constantly fighting dysbiosis (microbial imbalance) in these kids; enzymes ensure there is less undigested food hanging around for bacteria to grow on.

Ready to Start Your Action Plan?

There are four big improvements you should see within the first four to five weeks of using enzymes. You won’t be nearly finished, but you should definitely see significant improvements. Look for the following short-term goals:

1. Reduced aggression and irritability

2. Falls asleep easier

3. Fewer or no night awakenings

4. Daily bowel movements

Some of our long-term goals may begin to show up as well. An increase in language, clarity, and affection as well as eye contact are frequently noted during this early period.

What’s the Catch?

Your child may go through a period of withdrawal from the opioid peptides, and it can get pretty ugly. When I tell parents this, their eyes widen in concern, even alarm, and they immediately want to know how long this spike in behavior is going to last and how bad it’s going to get. The honest answer is: It depends on the child.

Note taped to my fridge: “I’d like a mocha vodka marijuana latte, please!” Humor helps you through the tough times!

A few children may experience no side effects, some may have minor irritability that lasts a few days, a few others may become dramatically more aggressive for several weeks, and the majority are somewhere in between.

Symptoms of withdrawal are temporary and can range from irritability, whining, and some really mean, bad behavior to screaming, hyperactivity, and full-blown violence. Progressing slowly and taking four weeks or longer to implement the digestive enzymes (as described in Chapter 6) will greatly lessen these symptoms.

Here is a general rule of thumb, based on what I see in my practice: The milder your child’s behavior is now, the milder a withdrawal he will likely have.

After the initial spike in difficult behavior has passed, this is truly a thrilling time for families. Finally, some positive results! Teachers and bus drivers are amazed, friends and relatives are all talking about the positive changes, and you are not imagining it. If a child who previously had a vocabulary of a few single words (and who would scream if you touched him) begins to speak in sentences and gives parents hugs and kisses, you are overjoyed. Not every child regains or improves in language, but many do.

Grandparents often tell me with tears in their eyes that they are getting affection from a grandchild for the first time in years. I hear remarks like, “He looks at me now, not through me!” Parents report a strong move in the right direction for sleep and bowel habits as well. Four county school systems have contacted me to learn how we calmed down such aggressive children. These are real improvements in behavior and cognition.

Bonus! After the opioid effect is broken, children often branch out and begin to eat new foods, to the absolute amazement of their parents.²⁰

Three Speeds for Your Action Plan

• “Go!” The basic Un-Prescription Action Plan as we do it in my center (see Chapter 6). This pace is usually neither too fast nor too slow. It takes four weeks to implement the enzymes completely.

• “Slow!” This is a baby-steps plan for families in crisis. It takes twice as long to do each step, minimizing the opioid withdrawal even more.

• “Whoa!” How not to do the plan! A recipe for disaster, usually.

If your child is already gluten- and casein-free, you can introduce the enzymes at a much faster rate (see Chapter 6 for the week-by-week, step-by-step suggestions and variations).

Are Lab Tests Helpful?

The following lab tests are all useful in a number of situations, but none can accurately answer the question of whether your child may respond positively to the enzymes.

Urinary Peptide Test

Not a fan! Some children may test positive for opioid neuropeptides from either casein or gluten, but not both. These families are led astray as they remove only one of the proteins, but not both, from the diet. Remember, this is not about an allergy or sensitivity, but about how similar the two proteins are. With the enzymes, we don’t have to argue this point—the child may have both gluten and casein, and the enzymes will break down both.

Urinary Peptide Test

“Measurement of urinary peptides has not been proven to be clinically useful as a marker for ASDs or as a tool to determine if dietary restriction is warranted or would be effective.”²¹ Children with a negative urinary peptide test may respond very well to a GFCF diet and/or enzymes. Why allocate time and money for this test? It makes more sense to start the diet and/or enzymes right away, and let that be the test.

Allergy Testing

Doesn’t matter. An allergy doesn’t cause an opioid effect. Testing for allergies is a good idea, but it won’t answer the enzyme question for you at this point. (The exception would be if you notice that eating wheat or dairy causes tremendous GI distress or difficult behaviors in your child—but then, do you really need a test to tell you to avoid those foods?)

Celiac Disease Testing

See answer above.

Food Sensitivity Testing

See answer above.

Applied Kinesiology Muscle Testing

See answer above.

NAET (Nambudripad’s Allergy Elimination Technique)

See answer above.

Okay, are you getting the picture? In my opinion, these are all valuable tests in other situations, but all but one are based on some premise of intolerance, allergy, or sensitivity. None of these lab tests can answer the question, Will my child respond to the enzymes?

For those of you who choose to do only the enzymes, you are on your wellness journey. For those of you still interested in one of the special autism diets, the four-week step-down plan of enzymes bought you some time to read about the diet and to see if your child will accept any of the alternate foods and products, so you’ll know if doing a diet is even an option for you.

Guidelines for Using the Enzymes

Which enzyme or blend should I use for my action plan?

When I first opened my practice, we were using pure DPP-IV (dipeptidyl peptidase-4) as our enzyme supplement. Since DPP-IV is the enzyme that digests the opioid peptides from gluten and casein, I knew this enzyme was the key to faking the GFCF diet. But as we have seen, many children with autism are deficient in more than one type of digestive enzyme, including those necessary to digest sugars, starches, and proteins. For this reason, a broad-spectrum blend of digestive enzymes is going to benefit your child the most.

When I switched to a broad-spectrum blend of enzymes, one that would help children digest not only gluten and casein but also fats, sugars, and starches as well, I saw dramatically better results. Parents began calling the office to report amazing changes in their children that we did not see when supplementing with DPP-IV alone. I’ve had new patients tell me they are already using the enzyme approach, yet their child still seemed foggy and constipated to me. A little detective work revealed they were using a formulation that did not contain DPP-IV. So here’s the deal: Your enzyme product needs to be a broad-spectrum formulation and include DPP-IV for the best results. These products are available as capsules, powder, or chewables.

A Note on Time-Release Medications

Most digestive enzyme blends contain an enzyme called cellulase, which will digest cellulose. Cellulose is sometimes employed as the protective time-release coating on prescription medications. For the few medications using pure cellulose as an extended-release coating, cellulase may prematurely release the medicine into your child’s system. In that case, just get a cellulase-free formulation, such as TriEnza by Houston Enzymes. There is no research indicating that cellulase will release the contents prematurely, but I am being conservative here.

If you’re not sure if your child’s prescription is extended-release or if the coating is pure cellulose, ask your pharmacist to check.

We have some great long-term goals we are aiming for. Let’s review them one more time, just for motivation:

These goals are the ones that are nearest and dearest to an autism parent’s heart!

Long-Term Goals

• Increased language

• Improved social skills, like joining the family at the dinner table or joining circle time at school

• Better learning

• More affectionate

• Better cognition

• More imagination

• Less fogginess

• Improved eye contact

• Eating a wider variety of foods

• Decreased sensory issues

• Decreased stimming

• Decreased seizure activity

• Improved immune function

• Fewer colds and runny noses

• Reduced chronic inflammation

• Improved behavior

• Toilet training

• More independent life skills like dressing and bathing

• Able to tolerate things like going to the mall, parties, a fireworks display

Table 3-1 shows you the benefits of enzymes when used alone, and when combined with dietary changes.

Frequently Asked Questions about Enzymes

Here are some common questions and answers on enzymes. Dr. Devin Houston, an enzyme biochemist with thirty years of research experience, has graciously answered some of them. His answers are indicated by his initials, DH.

Q: Are enzymes safe? Is it possible to give too much of the enzymes?

A: Enzyme supplements are most likely the safest products in the dietary supplement arena: You cannot overdose on enzymes, and studies have demonstrated no toxicity, even at extremely high doses. (DH)

Q: Are the enzymes destroyed by stomach acid?

A: These enzymes are acid-stable, which means that they can survive in and actually work in the stomach. (DH)

Q: What if my child is allergic to gluten and/or casein?

A: You should follow the GFCF diet if it is a true allergy, or go gluten-free for celiac disease. You should still give the enzymes with the GF or GFCF diet to aid with digestion.

Q: Can’t I just take these papaya enzymes I have?

A: Papaya enzymes do not contain DPP-IV and will not remove the opioid peptides.

Table 3-1

Q: We use raw milk from our own animals. Can I just depend on the enzymes it naturally contains to do the job, instead of supplementing digestive enzymes?

A: No.

Q: He eats a lot of raw, organic food. Doesn’t that contain enough enzymes to fake the GFCF diet?

A: No.

Q: Can I take the enzymes with medications?

A: Yes, medications are developed to withstand our own digestive enzymes. (DH)

Q: Will my child “get used to” the enzymes, and will his body stop making its own digestive enzymes?

A: No worries!

Q: Can I put them into what I’m cooking on the stove or in the oven? How about the microwave?

A: Enzymes can take temperatures up to about 120° to 130° Fahrenheit but cannot be put into food that is being cooked, baked, or microwaved, as that will destroy them. (DH)

Q: What if I forget to give the enzymes at the beginning of the meal?

A: Go ahead and give them as soon as you remember. Food can stay in the stomach up to an hour and a half or more, so there is still time and opportunity for them to work.

Q: My child says his stomach hurts since we started the enzymes. What’s going on?

A: The enzymes can help clear away any dead layers of cells on the lining of the stomach or intestines, which may expose new, more tender tissue underneath. It is actually beneficial in the healing process for a GI tract that has been inflamed or ulcered. (DH) You may have to go to the kinder, gentler Slow! speed of the enzyme protocol if your child is experiencing this type of stomachache. (JL)

Q: Can the enzymes give him diarrhea or constipation?

A: Different enzyme formulations can either loosen or firm the stools. The enzyme manufacturer will be able to guide you on which formulation to choose. For example, Dr. Houston has a chart that illustrates the effects of his different formulations. Just call the number on your bottle.

Q: We tried the enzymes for a week or two, but it made him worse. I guess the enzymes didn’t work for us.

A: I suspect you were seeing the start of an opioid withdrawal. This is the very time to push forward with the protocol, not quit.

Q: We tried the enzymes for a week or two, but didn’t see any results, so we quit.

A: It is very common not to see any results the first week or two. Some children don’t show any negative side effects. It may be four to six weeks later that you begin to notice your child seems more clear-headed or is looking you in the eye. Perhaps he’s starting to join the family at the dinner table, instead of staying in his room. We don’t always see brimstone and fire with the enzymes; there is that occasional child who simply looks up and quietly begins the journey back to balanced health. If you do the enzymes consistently with every meal and snack for three to four months and see absolutely nothing, then you can drop them in good conscience and continue with the rest of the Basic GI Support Protocol in Chapter 6.

Q: My child is a “grazer” and snacks many times throughout the day. Do I have to give a full dose of the enzymes each time he eats?

A: For grazers, mix the enzymes into a drink, then keep it in the fridge. Shake it up and give him a few sips each time he nibbles a few bites. If kept icy cold, the enzymes will stay active for up to, but no longer than, four hours.

Q: We put the enzymes in a drink, and he says it makes the back of his throat tingle.

A: With certain formulations, such as AFP Peptizyde by Houston Enzymes, it’s normal to feel a tingling or burning at the back of the throat. Use a straw to consume the drink and chase with water.

Q: I gave my child the enzymes, and then he didn’t eat anything. Will this hurt him?

A: No, he will be fine.

Q: How should I store the enzymes?

A: Enzymes can take cold temperatures better than heat. Even freezing them won’t hurt them. Just store them at room temperature. When you bring them on a trip, keep them in your purse or your pocket. A hot car won’t bother them unless temperatures get above 120° to 130° Fahrenheit.

Q: How young is too young to take enzymes?

A: Once a child starts on solid foods, enzymes can be used. Enzymes should definitely not be used when breast-feeding, as there are antibodies and proteins in milk that could be inactivated by enzymes. If the infant is on formulas, enzymes may be used if the infant is having problems tolerating the formula, especially if the formula is soy-based. (DH)