5

Sh!ts and Giggles: The Antimicrobial Rotation

I’m like a fungus; you can’t get rid of me.
Adam Baldwin

Evan walked out of the bathroom at Sam’s Club with an odd look on his face. “There’s poop on the ceiling.”

My husband came out, an odd look on his face as well. “Get a manager. And buy some clothes for Liam.”

Apparently my middle child had become a diarrhea piñata, the grand finale of diarrhea fireworks, giving the bathroom of our spanking-new Sam’s Club its inaugural christening, but without the traditional champagne. I had no idea poop could exit the human body in a spectacular 360-degree detonation. He had started his first dose of Diflucan that morning.

For far too long, autism families and some health professionals have focused solely on yeast as Public Enemy No. 1 for children with autism, yet there’s more to the story than Candida. Bacterial overgrowth and parasitic infections are ignored in the stampede to treat yeast. My approach addresses all three.

Antimicrobial agents (AMs) are natural supplements and prescription medications that discourage or kill a variety of fungi, bacteria, or parasites. They are part of, or should be part of, the toolbox for individuals with ASD. But misunderstanding, underuse, and even overuse of these agents have created some vicious cycles for our children.

Outdated Approaches to Dysbiosis on the Autism Spectrum

Treatment-wise, it seems a lot of conventional pediatric practices are not yet acting on the emerging scientific support for dysbiosis (a microbial imbalance in the digestive tract) on the spectrum. As we see in Table 5-1, children and adults with ASD aren’t being regularly assessed, treated, or provided support for dysbiosis (pronounced “dis bye OH sis”) in most of the cases I see at my office.

Table 5-1

The Danger of Ignoring GI Problems on the Spectrum

Bindee’s Story

The GI Two-Step

Are you tired of taking three steps forward and then a giant step backward? Do you finally get control of diarrhea, constipation, tummy aches, and a bloated belly, only to see them return worse than before? I’ll share five reasons for the dreaded relapse that often get overlooked and tell you how to get past it and get on with more important things for these children.

This chapter gives you the final piece in the Basic GI Support Protocol, and if you think probiotics are the missing piece, then antimicrobials are the Rosetta Stone.

Relapse Reason 1: Yeast isn’t always the culprit.

Don’t get stuck on treating yeast—it seems that is all some autism parents talk about. There are other possibilities to consider. Time and research are bearing out that individuals on the spectrum may be vulnerable to imbalances in the microbiome,² not just because of yeast, but bacteria and parasites as well. Individuals on the spectrum are candidates for dysbiosis, or microbial imbalance, thanks to:

Genetic differences

Overuse of antibiotics

Extended use of antifungals

Poor hygiene (poor hand washing and hand-to-mouth behavior)

Clostridia difficile, which is a special problem for some on the spectrum³

What are some of the signs and symptoms of a microbial imbalance?

Gas and bloating

Foul breath

Breath that smells like freshly baked bread

Breath that has a “fruity” alcohol smell

Fecal smears in the underwear

Silly giddy behavior

Headache

Fatigue, apathy

Irritability

Brain fog, poor memory

Reflux

Abdominal pain or cramping

Night awakenings

Poor appetite

Weight loss

Nutritional deficiencies

B12 deficiency

Iron deficiency

Sugar and carbohydrate cravings

Carbohydrate intolerance

Fat malabsorption

Diarrhea

Cyclic diarrhea

Eczema

Rashes and hives

Vaginal or urinary tract infections

Fungal infections of skin or nails

Rectal itching

Vaginal itching

Achy muscles and joints

Obviously, most of these symptoms are vague and could be attributed to many things, including allergies, colds, inflammation, or anxiety. I know autism parents who want to “treat yeast” at the first sign of dark under-eye circles in their child, when this could just be a sign of fatigue or even allergies. That’s why it is important to get proper stool testing and not try to treat “yeast” on your own.

How are these infections and imbalances treated? There are natural supplements and prescription medications to control most of these microbes. So why is there a problem? What’s with all the relapse? As usual, the devil is in the details. Using these same tools in the right way can help your child get on with his childhood and leave GI relapse in the rearview mirror.

Relapse Reason 2: Lack of rotation creates havens for bad bugs.

Dr. Sydney Baker brilliantly came up with the prescription “Antifungal Parade” for his autism patients who were struggling with stubborn dysbiosis. It was a breakthrough for restoring GI health at a time when the health challenges of autism were poorly understood. Some doctors implement this strategy but get stuck on using only a couple of antifungals instead of a wide-ranging rotation as originally designed by Dr. Baker.

Relapse Reason 3: You lack a Maintenance Plan.

Countless autism parents express surprise and disappointment when Candida and bacterial overgrowth recur, even though their doctor treated it. Treating a microbial imbalance in the gut microbiome is not like a slow cooker—“fix it and forget it.” Maintenance plans are essential if you want to avoid relapse.

Keeping children on a daily rotation of antimicrobials forever—prescription or over-the-counter—isn’t medically sound, but what to do about the inevitable relapse? I discovered that tapering the antimicrobial agents over time to every other day, then once a week, and eventually transitioning to using them one or two weekends a month was ideal for many children. Some children have to use them every weekend, but the beautiful improvements in health and lack of relapse are worth it. Progressing to a rotating maintenance program helps rest the liver and prevents resistance from developing. When children aren’t struggling with GI relapse, they can enjoy more success at school and in social situations and get more out of therapies. (See Chapter 6 for details.)

Relapse Reason 4: SIBO or small intestine bacterial overgrowth may occur.

Here’s another reason not to assume that everything your child does is due to yeast. Normally, very few bacteria hang out in the small intestine, but our modern lifestyle may set us up for bacterial overgrowth there because:

Chronic use of antacids and proton pump inhibitors for acid reflux reduces protective stomach acid.⁵

A lack of digestive enzymes may leave more undigested food available for bacteria.

Could these lead to a fermentation scenario in the small bowel?

SIBO is when an unusually large number of bacteria grow in the small intestine, whether they are beneficial, opportunistic, or pathogenic.⁶ A comprehensive stool test is more indicative of what’s going on in the large intestine, which makes what’s growing in the small intestine pretty much of a mystery. (There is no direct method of testing for a small bowel overgrowth except perhaps to take a sample from an ileostomy bag.)

As the bacteria feed, they produce hydrogen and methane gases and create all the familiar signs and symptoms of a yeast overgrowth: reflux, bloating and belly pain, gas, belching, fuzzy thinking, and fatigue. Many autism parents and health professionals then double down on their yeast-fighting efforts, all to no avail.

So how can we tell the difference? Ask your autism doctor about the hydrogen (H2) breath test. It’s an indirect method of assessing bacterial overgrowth in the small intestine and may offer some promise.

Your pediatrician should be involved in treating SIBO, as it will require a prescription antibiotic. For those who choose to avoid antibiotics, some experts suggest a selection of natural supplements that support small bowel motility such as Undecylex (a commercial over-the-counter blend), glutamine, and probiotics⁷ may be helpful.

SIBO is an emerging area of research and clinical experience, so stay tuned. See www.siboinfo.com for more information. The take-home message: Not everything is due to yeast.

Relapse Reason 5: There are hidden colonies of microbes.

So far we’ve noted four reasons why GI health relapse happens:

The assumption that it’s always yeast

Creating havens for bad bugs through lack of rotation of antimicrobial agents

Allowing relapse due to lack of a Maintenance Plan

The possibility of SIBO due to overuse of reflux medications and an insufficiency of digestive enzymes

So what’s left?

Biofilm.

If you haven’t heard of it, you will. Biofilm has been an active area of research for a number of years now and is emerging as of possible importance to autism spectrum disorder. Biofilm is a protective polysaccharide matrix manufactured by microbes, both beneficial and pathogenic, in the GI tract and elsewhere in the body.

Taking shelter in a biofilm is like taking cover in a nuclear bunker. Dental plaque is a biofilm and is a great example of just how tough and persistent this stuff is. Biofilms are made in nature and create problems in industrial and hospital settings as well.

Biofilm provides shelter to microbes from the following threats:

Dislodgement

Attack by other microbes

The host immune system, both humoral and cell-mediated

Prescription antibiotic, antifungal, and antiparasitic agents

Botanical or “natural” antibiotic, antifungal, and antiparasitic agents

Microbes protected by biofilm are up to 1,000 times more resistant to antimicrobials than the free-floating planktonic form. This means powerful agents like fluconazole, nystatin, amoxicillin, or olive leaf extract go right over the biofilm, while bacteria and yeast shelter safely within the matrix, untouched and very much alive. And when our immune system tries to attack the biofilm, it can end up damaging our surrounding body tissues with no damage to the pathogens.

Free-floating or planktonic bacteria travel alone, are unprotected, and aren’t known to communicate or cooperate with other microbes. The gene expression in bacteria and fungi associated with biofilm is different from that of planktonic microbes. Through chemical signals and quorum sensing, certain suites of genes are up-regulated or down-regulated. For example, for microbes residing within the biofilm, the genes for antibiotic resistance and making the components used in the matrix are up-regulated. Genes for motility are down-regulated. What’s fascinating (creepy, really!) is that microbes in a biofilm actually communicate and are assigned specific metabolic jobs. It’s like an entire city within the biofilm, complete with communication and public works departments.

Gastrointestinal relapses are about as welcome as thunder and lightning at a picnic, and biofilm may be responsible. Your efforts at reducing and eliminating yeast and other pathogens may be effective, but only for the free-floating microbes. The ones in the biofilm simply wait for you to stop using antimicrobials; the colonies then mature, rupture, and reseed the gut with a new wave of bad guys.

There are relatively new products and protocols on the market designed to break open and degrade biofilms. (InterFase Plus by Klaire Labs and Serralase by ProThera are two; Biofilm Defense by Kirkman Labs is another.) This leaves the microbes open to attack, and we often see new leaps in health, cognition, and clarity when a biofilm protocol is used.

Does everyone need to treat biofilm? In my clinical experience—no. I only use biofilm strategies when relapse is persistent and severe. I can almost always achieve vibrant health and good gut control using just the Basic GI Support Protocol and a wide-ranging antimicrobial rotation. So why do I even mention biofilm? So you’ll understand why microbial imbalance can return again and again, and understand the importance of a light maintenance rotation to check the growth of any new seeding of the gut from down in the biofilm. I’m not sure it is healthy to completely eradicate biofilm—after all, even beneficial bacteria produce it—so don’t set that as a goal unless clinically indicated. Maintenance is the message here.

Should You Use Natural or Prescription Antimicrobials, or Both?

Systemic antifungals like fluconazole and ketoconazole circulate in the whole body and can adversely affect the liver, the blood chemistry, the heart, and other body systems, and you may need to run blood tests to monitor for adverse effects (see Table 5-2). These helpful prescription agents weren’t meant to be used for months and years on end. The prescription is hard on the liver, the blood draw is hard on the child, and the expense of it all is hard on the wallet. Yet the children seem unable to come off the prescriptions without the Candida coming back. Even worse, some patients on these drugs aren’t being monitored with blood tests at all. I keep wondering, “What’s the plan here?”

Drawbacks of prolonged treatmentwith prescription antifungals

Table 5-2

Other antifungal and antimicrobial agents such as nystatin, oral amphotericin B, and a wide array of botanicals stay in the GI tract, don’t enter the general circulation, and therefore don’t affect the liver. Also, no blood draws are needed. These products are fine to use in rotation.

Depending on the style and preference of your doctor, good results can be obtained using both prescription and natural agents. With care, both can form the foundation of a safe and effective maintenance program to put an end to the dreaded GI relapse. Just be sure to use systemic prescriptions on a short-term basis only.

A Special Tool for Autism— The High Priest of Yeast

I always tell patients that the beneficial yeast Saccharomyces boulardii, or “Sac b” as we call it, is my favorite supplement for many reasons. It is widely available, inexpensive, helps heal the gut,⁸ stimulates the immune system in a positive way,⁹ has antifungal properties,¹⁰ and curbs H. pylori¹¹ and Clostridia difficile.¹² Sac b has been shown to be helpful in children with autism, and it can be a real gem in your quest for vibrant GI health in your son or daughter with autism.¹³

It completes the trilogy of supplements that make up my Basic GI Support Protocol, and I usually get a lot of bang for the buck with this wonderful tool. It doesn’t permanently colonize the gut in healthy individuals —another visiting angel—but it’s useful for its many actions. Let’s look at the amazing benefits of this powerful nonpathogenic yeast in Table 5-3.

How long to use S. boulardii? I advise my patients to use it for about one month, and then go on to an antimicrobial rotation. Don’t throw away what’s left in the bottle; just put the S. boulardii into the lineup for the weekly rotation. (See Chapter 6 for details on the Antimicrobial Rotation.)

Figure 5-3

S. boulardii has not been shown to cause a blood-borne infection in healthy individuals; however, it should not be used in immunocompromised patients, critically ill individuals, or those who have a central vascular catheter. It is a yeast, so I don’t use it in patients who have a prominent yeast allergy or sensitivity.

How the Un-Prescription for Autism Approaches Dysbiosis

The Un-Prescription Action Plan for autism brings rotation, rotation, rotation and a long-term maintenance plan to the table. Using natural, over-the-counter supplements, the plan addresses yeast, bacteria, and parasites; it restores and supports GI health; and it avoids the dreaded relapse. It’s how I achieve and maintain GI health for my patients.

A lot of the children I see have used countless rounds of antibiotics in the fight against recurring ear infections. In Chapter 4, we saw that antibiotics often ransack the neighborhoods and “real estate” of the gastrointestinal system and create gut ghettos. And we learned the wisdom of making sure the neighborhoods were rehabilitated by supplying them with good, hardworking citizens in the form of probiotics.

Now we’ve learned that even in the best of neighborhoods, security guards are often necessary to keep order and clear out any bad guys. I like to think of a gentle rotation of antimicrobials as the friendly neighborhood police officers walking their beat. Once you have balanced your neighborhood, you don’t need a SWAT team, just a light security detail to keep things in order. Think of it as the “Yeast Police”!

If your child has had “too many antibiotics to count,” or even just a few, plan on starting a Basic GI Support Protocol now. Antibiotics are often necessary for various childhood ailments, but probiotics and antifungals should be used each and every time to restore balance to the GI tract.

Even doctors who understand that autism patients are prone to dysbiosis get stuck on the prescription pad, keeping young children on prescription antifungals for years. Remember, the goal is not to eradicate yeast, but to rehabilitate the microbiome. I have discovered that balance can be restored without the use of prescription antifungals or antibiotics at all. Save those big guns for special cases (like Bindee’s story).

What’s in Your Toolbox?

What are these antimicrobials (AMs), and are they in your toolbox? There are prescription ones such as nystatin, fluconazole, ketoconazole, and oral amphotericin B. There are natural herbs and extracts that have antifungal, antibacterial, and antiparasitic properties. In Chapter 6, you’ll find a long list of some of the widely available ones that I use at the office to support GI health. I use many of the same ones that laboratories use when testing stool samples.

None of the antimicrobials I’ve listed in Chapter 6 are appropriate for infants or toddlers with the exception of S. boulardii. If, despite working with your child’s pediatrician, your infant is still prone to diaper rash or oral thrush, rely on high-potency infant probiotics designed to make it through the stomach acid to support microbial balance. Clean the diet of excess sugar and carbohydrates. The Specific Carbohydrate Diet (see Helpful Resources) is an excellent choice.

You’ll find out how to do an Antimicrobial Rotation and set up a Maintenance Schedule in Chapter 6. Your organizer is crucial here—enter all antimicrobials with dates and dosages used. It’s really helpful if you also track the signs, symptoms, and behaviors at the same time. Tables 5-4 and 5-5 will remind you of our short-term and long-term goals.

Short-term goals for antimicrobial support

Table 5-4

Table 5-5

Side Effects and Discussion of Microbial Die-Off Reactions

Autism is part of my family life. So I understand the fragile family dynamic that must be taken into account when designing health support protocols. I get better compliance and results when I design conservative protocols that put the entire family through less stress and frustration. It takes a little longer, but compliance and lasting results are worth it. Many families would have stopped antimicrobials altogether after the Sam’s Club experience. What good is a protocol if the family quits the entire health journey?

You often have to walk through the fire to get to the other side when using antimicrobials. When yeast, bacteria, and parasites die, their toxin load gets dumped into the GI tract. This microbial death is called the die-off. Even though you’ve gotten your child’s bowels moving daily, these toxins will still be absorbed into the bloodstream. It’s like an oil tanker sinking in the ocean and the payload of oil gushing out to pollute the water. You will definitely see some side effects when you start antimicrobials.

Interpreting the side effects of microbial die-off might feel like taking a test you haven’t studied for. Table 5-6 shows us what to look for.

As with the enzymes and probiotic protocols, you can use a regular antimicrobial protocol, go slow, modify it for the school or daycare calendar, and of course, there is always a way to go about it completely WRONG! (See Chapter 6 for specific protocols.)

Tips for Minimizing and Handling a Microbial Die-Off

Work with your doctor.

Do not use antimicrobial agents in a constipated child. Big boom!

Table 5-6

Don’t start while on vacation or right before an important event (antimicrobial support can be a messy business).

Start on a Friday to avoid fireworks during the week.

Start low and go slow with the dosing.

Give with food if you have to, but on an empty stomach is best.

Drink plenty of fluids.

Take milk thistle to help support the liver during treatment. The liver processes the metabolic by-products of microbial death.

In the case of a severe die-off, you should work with your doctor and use your “mom or dad intuition.” Back down on the frequency or the dose. Just give ¼ to ⅓ of a child’s dose every other day, or even every third day. During the school year, I encourage parents to treat more actively on weekends and over school breaks such as Thanksgiving or Christmas.

Wait at least two hours after you give the AMs, and then give acacia fiber or activated charcoal to absorb the by-products of microbial death.

No spanking for die-off behaviors. You must draw the line and have consequences, but they should be short and nonphysical. These are predictable side effects, not a spoiled child having a tantrum.

Nausea/vomiting is not common, but it can happen when there is a toxin dump into the child’s system. Just cut back on the dose and/or frequency and keep going if you can. Or take a short break and try again at a much reduced dose. You may have to do heavy probiotics for a while before retrying.

Brace yourself: Can you say C-R-A-N-K-Y? If your child is mild-mannered and dreamy, you will likely only see things like irritability and whining, easy frustration, or a little extra hitting with siblings. But, if your child is aggressive and destructive to begin with, brace yourself. You may see holes in the wall and have some furniture flipped over. You may have to have younger siblings stay with grandparents or they will bear the brunt of the physical aggression. Hair pulling, screaming, anger, you name it, we see it. If the reaction is this strong, check with your doctor and reduce the dose and frequency until your child can tolerate the full dose. It may last a day or two, it may last for weeks—there is no way to predict.

Try brushing and other calming sensory techniques. (Ask your occupational therapist.)

Swinging.

Water play in a warm bath.

Exercise.

Keep busy! Go on lots of walks to the park.

Try GABA and magnesium supplements (see Week 3 in the Chapter 9 Online Action Plan for calming strategies).

Know when not to give up. Even if the die-off reaction is too nasty, he gets too mean, and you just can’t take it, don’t quit. Just use your “parent radar,” cut way back on the dose, and give it every other day or even every third day. I had one parent tell me that her son got so mean and irritable on Week 2 that she just threw everything away. She was so rattled that she forgot that she could adjust the dose and control the microbial die-off side effects. She tried it again, taking twice as long to introduce it, and was able to get through the die-off process and achieve good results.

Make it yours. It’s okay to spread out the support protocol over two to three months. I remind parents that your child didn’t get that way overnight, and he isn’t going to dig his way out of it overnight. Yes, we are all anxious for results, but sometimes it is easier on the child as well as the family to restore balance in a slower, more controlled fashion.

Stool Testing

It’s always a good idea to start with a stool test. (Because guessing isn’t smart and the Internet isn’t always right.) When should you do a stool test?

When a child eats a sufficient amount of food, but appears malnourished

In cases of failure to thrive

If your child suffers from chronic diarrhea, or the bouquet of his bowel movements brings tears to your eyes

In cases of cyclical diarrhea and GI symptoms, which may indicate a parasitic infection

If your child is in reasonably good health, it’s reasonable to start by giving the Basic GI Support Protocol a trial for a few months. If his GI issues straighten out, you’re fine. If not, it’s time to test.

What Kind of Stool Test Should You Have Done?

There are stool tests and then there are stool tests. Some tests just give you the basic facts about bacterial, fungal, or parasitic infections. Others give digestion and absorption markers, inflammation markers, and information on commensal bacteria, opportunistic and pathogenic bacteria, fungi, parasites, and beneficial short-chain fatty acids. Comprehensive stool testing generally reflects what is going on in the large bowel or colon. See Week 31 in the Chapter 9 Online Action Plan for more information, as well as the Helpful Resources section for suggestions on laboratories.

At the same time, get an Organic Acids Test (OAT). This is thought by some to be an indirect indicator of what is going on in the small intestine, as well as a reflection of metabolic and nutritional status. I like to combine stool testing with the OAT and the amino acids test (both are urine tests) for nutritional factors to help me design a thorough support plan for my patients. See Week 32 in the Chapter 9 Online Action Plan for more information.

Occasionally, I’ll have a patient whose stool test is nearly pristine (colon), but whose OAT test shows strong markers for bacterial overgrowth (small bowel). Since our children with autism are often on long-term medications that reduce stomach acid and the natural protection against infection it provides, I suspect they may have a small intestine bacterial overgrowth. Although there is a breath test available to confirm SIBO, it doesn’t provide clues to the types of bacteria involved. Discuss the possibility of SIBO with your child’s doctor.

“I Read It on the Internet”

The Internet is brimming with helpful information, but there is some dangerous misinformation out there as well. I cringe sometimes when I eavesdrop in an autism chat room, as the discussions there seem to think that treating yeast is the answer for everything.

I have had patients ask me about the “saltwater flush” or the “lemonade fast” they read about on the Internet as a way to treat yeast or break down biofilm. No. Hell no! I don’t even put the word “fast” and “child” in the same sentence, unless I’m chasing him. These are dangerous ideas. You should ask about the science, research, and clinical observations on any treatment, even ones your doctor suggests. Yeast does pose significant problems for those on the spectrum, but as you saw in Chapter 1, there are many other health challenges that explain signs, symptoms, and behaviors on the autism spectrum. So don’t overtreat for yeast and miss other important areas of health support.

Some protocols don’t play well with others. This is true of treating a known fungal overgrowth and also trying to detox or “chelate” at the same time. Any form of detox enhances the growth of yeast and must wait until ironclad gut control is achieved. One of the most common mistakes that I see autism parents (and many autism doctors) make is to start chelation or detox protocols while still trying to get control of dysbiosis in the GI tract. The child ends up in a yeasty, rashy, irritable mess, and the family often quits everything in confusion and anxiety.

Patience, patience! Go about restoring health on the autism spectrum one careful, conservative step at a time. I used to test for metals and toxins on the first visit. Now, with clinical maturity, I know if I wait a year or two to test the body’s detox status and focus instead on restoring health and balance, the vast majority of my patients will naturally begin to flush toxins from their system so that no detox support is needed. Read that sentence again.

Rule of thumb: If you save detox for last, you probably won’t even need it. Your child’s body will naturally begin to flush itself of toxins and metals as health and balance are restored.

The signs and symptoms of parasitic infections can be vague, and many people become convinced they have “parasites” and begin treating with ideas they got off the Internet. Long strips of intestinal mucosa can slough off from these “treatments” and appear as “parasitic worms.” The individual takes this as proof that he has parasites and redoubles his efforts at treating parasites, usually with no medical oversight. I had one patient who had treated himself for “parasites” for years. I sent off the “parasites” to a lab, only to discover they were actually long strips of intestinal wall tissue that his harsh home parasite treatments were sloughing off his intestines.

Another gentleman in his thirties severely damaged his health after years of chelating himself for metals and toxins. He would lie on the couch for several days after each chelation, exhausted and ill. He felt the health problems caused by his “metal poisoning” cost him his marriage. He never felt well, and his gut could only tolerate a few foods. Only after I ran tests that did not indicate a high level of metals in his body or impaired detox status did he begin to change his thinking. He has enjoyed much better health since he stopped trying to detox himself without medical oversight and focused instead on restoring and balancing health.

Frequently Asked Questions About Antimicrobials

Q: Does the Saccharomyces boulardii have to be refrigerated?

A: It does not have to be refrigerated, but it will last longer if kept in a cool place or refrigerated.

Q: Do the herbal AMs have to be refrigerated?

A: No.

Q: Can I take the antifungals and antimicrobials with the probiotics?

A: This is an area where there isn’t much research to guide us, so to be conservative, I suggest taking antimicrobials in the mornings when the stomach is empty from its overnight fast. This gives the AMs direct access to microbes and fungi without food getting in the way. I give the probiotics with the last meal of the day.

Q: My child is too young to take these AMs (or refuses these bitter AMs). Is there anything else I can do?

A: Yes, double up on probiotics, rotate among different probiotic blends, and use a diet low in carbs and sugars. The Specific Carbohydrate Diet or the Body Ecology Diet work beautifully. (See this book’s Helpful Resources section.)

The take-away message: Always start low, go slow, and use your parent radar to decide if it’s okay to go on to the next step in any protocol.

Ready to put some voodoo on that doo-doo? I know you can’t wait to get started with specific strategies for supporting vibrant health for your son or daughter on the autism spectrum.

On to Chapter 6!