Chapter 11
The Use of Vitamin B6, Magnesium, and DMG in the
Treatment of Children and Adults with Autism
By Dr. Bernard Rimland

The following information is condensed from articles appearing in the Autism Research Review International, the newsletter of the Autism Research Institute.  The original articles, including summaries of and literature references to the 18 studies of vitamin B6 in autism, as well as to other studies referred to below, are available on request from the Autism Research Institute, 4182 Adams Avenue, San Diego, CA  92116.

 Vitamin B6 (and Magnesium) in the Treatment of Autism

From the Autism Research Review International, Volume 1, No. 4:
All 18 studies known to me in which vitamin B6 has been evaluated as a treatment for autism have provided positive results, and no significant adverse effects have been reported in any of the studies. This is a rather remarkable record of efficacy and safety, since the many drugs that have been evaluated as treatments for autism have produced very inconsistent results; and all drugs pose a risk of serious side effects. If a drug shows positive results in about half of the evaluation studies, it is considered a success and the drug is then advocated for use with autistic patients. However, despite the remarkably consistent findings in the research on the use of vitamin B6 in the treatment of autism, and despite its being immeasurably safer than any of the drugs used for children with autism, there are at present few practitioners who use it or advocate its use in the treatment of autism.  The reasons are obvious: most physicians know little about vitamins and have no economic incentive to recommend a substance that does not require a physician's prescription.

Research on the use of vitamin B6 with children with autism began in the 1960s. In 1966 two British neurologists, A. F. Heeley and G. E. Roberts, reported that 11 of 19 children with autism excreted abnormal metabolites in their urine when given a tryptophan load test. Giving these children a single 30 mg tablet of vitamin B6 normalized their urine; however, no behavioral studies were done. A German investigator, V. E. Bonisch, reported in 1968 that 12 of 16 children with autism had shown considerable behavioral improvement when given high dosage levels (100 mg to 600 mg per day) of vitamin B6. Three of Bonisch's patients spoke for the first time after the vitamin B6 was administered in this open clinical trial.

After my book Infantile Autism was published in 1964, I began receiving hundreds of letters from parents of children with autism throughout the United States, including a number who had tried the then-new idea of "megavitamin therapy" on their children with autism. Most had begun experimenting with various vitamins on their children with autism as a result of reading books by popular nutrition writers. I initially was quite skeptical about the remarkable improvement being reported by some of these parents, but as the evidence accumulated, my interest was aroused. A questionnaire sent to the 1,000 parents then on my mailing list revealed that 57 had experimented with large doses of vitamins. Many of these had seen positive results in their children. Intensive study of the medical literature convinced me the vitamins were safe.  As a result, I undertook a large-scale study, on over 200 children with autism, of megadose quantities of vitamin B6, niacinamide, pantothenic acid, and vitamin C, along with a multiple-vitamin tablet especially designed for the study. The children were living with their parents throughout the U.S. and Canada.  We required that each child be medically supervised by the family's own physician. (Over 600 parents had volunteered for the study, but most could not overcome their physicians' skepticism.)

At the end of the four-month trial it was clear that vitamin B6 was the most important of the four vitamins we had investigated, and that in some cases it brought about remarkable improvement. Between 30% and 40% of the children showed significant improvement when the vitamin B6 was given to them. A few of the children showed minor side effects (irritability, sound sensitivity and bed-wetting), but these quickly cleared up when additional magnesium was supplied.  The magnesium not only eliminated the side effects, it often brought about even more improvement in speech and behavior. 

Two years later two colleagues and I initiated a second experimental study of the use of megavitamin therapy on children with autism, this time concentrating on vitamin B6 and magnesium. My co-investigators were Professors Enoch Callaway of the University of California Medical Center at San Francisco and Pierre Dreyfus of the University of California Medical Center at Davis. The double-blind placebo-controlled crossover experiment utilized 16 children with autism, and again produced statistically significant results. For most children dosage levels of B6 ranged between 300 mg and 500 mg per day. Several hundred mg/day of magnesium and a multiple-B tablet were also given, to guard against the possibility of B6-induced deficiencies of these other nutrients.

In both studies the children showed a remarkably wide range of benefits from the vitamin B6. There was better eye contact, less self-stimulatory behavior, more interest in the world around them, fewer tantrums, more speech, and in general the children became more normal, although they were not completely cured.

People vary enormously in their need for B6. The children who showed improvement under B6 improved because they needed extra B6. Autism is thus in many cases a vitamin B6 dependency syndrome.

After completing his participation in our study, Professor Callaway visited France, where he persuaded Professor Gilbert LeLord and his colleagues to undertake additional B6/magnesium research on children with autism. The French researchers, although skeptical that anything as innocuous as a vitamin could influence a disorder as profound as autism, became believers after their first, reluctantly undertaken, experiment on 44 hospitalized children. They have since published a number of additional studies evaluating the use of vitamin B6, with and without additional magnesium, on children with autism and adults. Their studies typically used as much as a gram a day of vitamin B6 and half a gram of magnesium.

LeLord and his colleagues measured not only the behavior of the children with autism, but also their excretion of homovanillic acid (HVA) and other metabolites in the urine. Additionally, they have done several studies in which the effects of the vitamin B6 and/or the magnesium on the brain electrical activity of the patients was analyzed. All of these studies have produced positive results.

LeLord et al. recently summarized their results on 91 patients: 14% improved markedly, 33% improved, 42% showed no improvement, and 11% worsened. They noted that "in all our studies, no side effects were observed." Presumably, no physical side effects were seen.

Several studies by two groups of U.S. investigators, Thomas Gualtieri et al., at the University of North Carolina, and George Ellman et al., at Sonoma State Hospital in California, have also shown positive results on autistic patients.

While no patient has been cured with the vitamin B6 and magnesium treatment, there have been many instances where remarkable improvement has been achieved. In one such case an 18-year-old autistic patient was about to be evicted from the third mental hospital in his city. Even massive amounts of drugs had no effect on him, and he was considered too violent and assaultative to be kept in the hospital. The psychiatrist tried the B6/magnesium approach as a last resort. The young man calmed down very quickly. The psychiatrist reported at a meeting that she had recently visited the family and had found the young man to now be a pleasant and easy-going young autistic person who sang and played his guitar for her.

Another example: a frantic mother phoned me to ask for information on sheltered workshops in her city, since her 25-year-old autistic son was about to be expelled for unmanageable behavior. I knew of no alternate placements for the son, but I suggested that the mother try Super Nu-Thera, a supplement containing B6, magnesium and other nutrients. Within a few weeks she called again to tell me excitedly that her son was doing very well now and his piecework pay had risen dramatically from the minimum pay of $1.50 per week to $25 per week.

In view of the consistent findings showing the safety and efficacy of the nutrients B6 and magnesium in treating autistic individuals, and in view of the inevitability of short and/or long-term side effects of drug use, it certainly seems that this safe and rational approach should be tried before drugs are employed.

 Vitamin B6 in Autism: The Safety Issue

From the Autism Research Review International, Volume 10, No. 3:
There is no biological treatment for autism which is more strongly supported in the scientific literature than the use of high dosage vitamin B6 (preferably given along with normal supplements of magnesium). Eighteen studies have been published since 1965, showing conclusively that high dose vitamin B6 confers many benefits to about half of all the children with autism and adults on whom it has been tried. While B6/magnesium is not a cure, it has often made a big, worthwhile difference.

Included among the 18 studies are 11 double-blind, placebo-crossover experiments, 8 experiments in which abnormal substances appearing in the urine of children with autism have been normalized by the B6, other studies in which brain waves have been normalized, and a wide range of other improvements: 18 consecutive studies showing megadose B6 to be effective and no studies failing to show that megadose B6 is effective. No drug even comes close.

None of the studies of B6 in autism have reported any significant adverse effects, nor would any significant adverse effects be expected. I conducted an intensive analysis of the literature on B6 safety before embarking on my first study of B6 in the late 1960s. A review published in 1966 by the American Academy of Pediatrics confirmed my own conclusion: "To date there has been no report of deleterious effects associated with daily oral ingestion of large doses of vitamin B6 (0.2 to 1.0 grams per day)."

Tens of thousands of people, including thousands of children with autism and adults, took large doses throughout the '60s, '70s, and beginning '80s with no reported signs of any adverse effects. However, in 1983, a paper by Schaumburg et al. reported significant, though not permanent or life-threatening side effects in 7 patients who had been taking 2,000 mg to 6,000 mg per day of B6. The side effects, peripheral neuropathy, were numbness and tingling in the hands and feet -the sensation one gets when one's hand or foot "falls asleep." The foot numbness in some cases interfered with walking. These patients were not taking magnesium, the other B vitamins, nor any of the other nutrients that should be taken if one is taking large amounts of B6. It is at least possible that the adverse reactions were due not to B6 "toxicity" but to deficiencies of magnesium and the other B vitamins induced by taking large amounts of B6.  It is also possible that the problem was caused by a contaminant in the B6, rather than by the B6 itself.

It should be noted that the Schaumburg study covered only 7 patients and had 7 authors from several major medical centers throughout the United States. It would seem that a national search had been done to locate these patients, once the first case had been identified.

In the ensuing years, a few other patients have been reported in the literature who showed similar symptoms of peripheral neuropathy.

In my own experience, covering almost 30 years, and many thousands of children with autism and adults, I have, to the best of my knowledge, encountered only four cases of peripheral neuropathy. In these cases the numbness in the hands and feet was noticed by the parents, who reported that the child would: a) shake the hands as though to try to get the circulation back, b) have difficulty in picking up objects, such as bits of food, or c) have difficulty walking, because of numbness in the soles of the feet. When the B6 was discontinued, or the dosage was markedly reduced, these symptoms went away very quickly and completely.

Some individuals may be exceedingly sensitive to larger than normal amounts of B6. These cases are very few and far between, and discontinuing the B6 seems in all cases thus far to resolve the problem.

If you contrast these findings with the findings reported on a daily basis on the drugs that are used for autism, it becomes instantly clear that the B6 is immeasurably safer. There has never been a death or serious illness associated with ingestion of even very large amounts of B6. Deaths and permanent disability from prescription drugs are commonplace.

My own son, now 40, has been taking about 1 gram per day of B6 (along with 400 mg of magnesium, and other nutrients) for some 30 years. If there is a healthier person in North America, I would be surprised. Mark's only physical problem to date occurred in his early 20s, when a dentist found one small cavity in one tooth.

Despite the extraordinary safety of B6, I have been told, over the years, by thousands of parents, that their physicians have warned them against giving their children high doses of B6, because of the supposed risks involved. It is unfortunately very typical of most of the medical establishment (which of course makes its money by prescribing drugs) to denigrate and exaggerate the dangers of taking nutritional supplements.

A case in point: recently the national news media gave heavy coverage to a paper from the University of Michigan which warned the public against the dangers of taking vitamin B6. This report was given national television coverage, and we received a number of alarmed inquiries in our office from parents who were frightened by the warning, "B6 is toxic!"

When I read the study, I was truly appalled. The authors, from the University of Michigan Medical School, were supposedly investigating the value of vitamin B6 in the treatment of carpal tunnel syndrome (a painful malady of the wrists, which has become very common in recent years, and is usually considered a repetitive motion injury). The conventional treatment is surgery, which is often ineffective, as well as being disfiguring, expensive, and painful. There are a number of well-documented reports that high doses of vitamin B6 successfully treat carpal tunnel syndrome, in the majority of cases, so that over a six-week period people who were scheduled for surgery no longer need such drastic treatment.

The Michigan researchers had not given even one milligram of B6 to even one of their subjects (not patients)! Their warning was based primarily on the 1983 Schaumburg report. Further, they had not included even a single subject who actually had carpal tunnel syndrome! They did blood and nerve conduction studies on people who were "potentially" at risk for carpal tunnel syndrome, but did not in fact have carpal tunnel syndrome. The anti-vitamin B6 bias in the report is very evident when you read, in their review of research, that "several" studies have reported B6 to be effective in treating carpal tunnel syndrome, while "numerous" reports have failed to confirm the finding. If you look at the actual references in their study, you will see that there are 12 favorable reports, and only 7 negative reports. So, to them, "several" equals 12 and "numerous" equals 7!

The University of Michigan study, with its highly publicized and totally irrelevant conclusions, is certainly one of the worst and most appalling studies I have ever read. Alan Gaby, M.D., author of The Doctor's Guide to Vitamin B6, referred to it as a "disgusting" display of bias, and I certainly agree with that assessment.

Nothing is perfectly safe, but B6 is exceptionally safe, particularly when compared to the alternative, drugs, which are infinitely more likely to cause severe illness, injury, and even death. An autistic person will improve on high dosage B6 only if that person's body requires extra B6. The benefits of B6 often start within a few days. If no benefits are seen in three to four weeks (in about 50 percent of cases), or if any signs of peripheral neuropathy appear (very rare), stop giving the B6.

A 1995 paper by Ellis and McCully reported that elderly patients who had been taking 100-300 mg per day of B6 for some years experienced only 27% the risk of heart disease, and among those who died of a heart attack, the average age at death was 84.5- eight years longer life than control group patients from the local area. In a 1993 study of epileptic newborns, Pietz found 300 mg of B6/kg/day-18 times the dosage used in autism-to be superior to seizure drugs. And B6, in amounts as high as 50 grams per day, is used as an antidote for victims of certain poisons. Is vitamin B6 toxic? Hardly!

 Dimethylglycine (DMG), a Nontoxic Metabolite, and Autism

From the Autism Research Review International, Vol. 4, No. 2

DMG is a rather sweet-tasting substance that was described in a recent article in the Journal of Laboratory and Clinical Medicine (1990, 481-86) as a "natural, simple compound with no known undesirable side effects." The article did not pertain to the use of DMG in autism, but instead described an experiment in which DMG was used to try to enhance the function of the immune system of laboratory rabbits. It worked-the immune systems of the animals given DMG showed 300% to 1,000% better response to infection than the controls.

DMG is readily available in many health food stores. It is legally classified as a food. It does not require a prescription. It is manufactured by several companies, and comes in various forms, most commonly in tiny foil-wrapped tablets about 1/3 the size of an aspirin.

The taste is pleasant and children chew the tablets readily. At about 25 cents per tablet, the cost is minimal, since only one to eight tablets a day are usually taken (eight for adults). "So far so good," you may be saying, "but what does this have to do with autism?"

In 1965, two Russian investigators, M. G. Blumena and T. L. Belyakova, published a report showing considerable improvement in the speech of 12 of a group of 15 mentally handicapped children who had not been able to use speech to communicate. The children had been treated with a substance variously known as calcium pangamate, or pangamic acid, or "vitamin B15." In addition to enriched vocabulary, the children began to use simple sentences, their general mental state improved, and there was better concentration and interest in toys and games. Subsequent research has shown the essential factor in calcium pangamate to be DMG.

Soon afterward psychiatrist Allan Cott visited Moscow and brought back a small supply of pangamic acid, which he tried on a number of children in his practice, some of whom were autistic. Many of Cott's patients responded in the same way the Russian children had. One mother wrote, "It's the most exciting thing I've ever experienced. He was repeating words and he answers questions now!."

At about this time pangamic acid, or B15, entered the U.S. market. Chaos ensued. Every manufacturer touted his product as "the original Russian formula." There were at least four different formulas on the market, partly, it is believed, as a result of deliberate deception and obfuscation on the part of the Russians. DMG, in small amounts, was a component of some of the formulas. The FDA stepped in and lengthy legal battles ensued. One outcome is that the term B15 was outlawed. (Although DMG resembles the B vitamins in many ways-it is found in the same foods, for example--there are no known overt symptoms characteristic of a DMG deficiency.)

The significant outcome of the legal battles is that the sale of DMG is now permitted, as long as it is not referred to as a vitamin, and as long as it is sold as a food and not a drug.

I have been following the pangamic acid-DMG situation for almost 25 years. I have mentioned it in some of my lectures, and told parents and professionals about it in conversations and correspondence. Always I would ask, "If you try it, please let me know what results you see, even if no improvement is found."

I am now so firmly convinced that DMG is helpful to a substantial proportion of children with autism and adults that I have decided to "go public" in the Autism Research Review International -to tell people about it freely and openly, so they may try it if they wish.

Some who hear of this boldness may be aghast: "Where are the double blind placebo-controlled scientific studies showing it to be effective in autism?" they will ask. My reply is simple. "There aren't any, and none are needed." There are, of course, numerous double blind non-autism studies of DMG in the scientific and medical literature, using not only humans, but many kinds of laboratory animals, often given very large amounts of DMG. As noted earlier, no adverse side effects have been found with even massive intakes of DMG. (I say "intakes" rather than "dosages" because "dosage" implies that DMG is a drug, which it is not.)

Since no company has the exclusive right to make DMG, competition keeps the price-and profits-down. Thus there is almost no chance that anyone will sponsor a $200,000 double blind study of DMG on children with autism. A parent can buy 30 tablets for about $8.00. That is a sufficient supply, even for an adult given five or more tablets a day, to determine, in most cases, if it will be helpful. If it is felt to be helpful, fine. If not, you have wasted $8.00 (except for the boost given to the immune system).

To help the parents receive unbiased input, I usually tell them to refrain from mentioning to teachers, grandparents and others in the child's environment that DMG is being tried. I have numerous letters in my files saying, "Johnny's speech therapist says he has made more progress in the last two weeks than in the last six months. As you suggested, we had told no one at his school that we were trying DMG."

I am 100% in favor of double blind studies on drugs with considerable potential for harm, such as fenfluramine, Haldol, or the like. However, it doesn't make sense to insist on such refinements before trying a perfectly safe substance such as DMG, apple pie, or chicken soup.

If DMG is going to work, its effects will usually be seen within a week or so, though it should be tried for a few weeks or a month before giving up. In some cases dramatic results have been seen within 24 hours: A Los Angeles mother was driving on the freeway, three-year-old Kathy in the back seat, five-year-old mute autistic son Sammy in the front. DMG had been started the day before. Kathy began to cry. Sammy turned and spoke his first words: "Don't cry, Kathy." The mother, stunned, almost crashed the car.

A similar case: A Texas mother secured her six-year-old mute autistic daughter in the front seat, then, before driving off, turned to tell her husband, "I'll drop Mary at the babysitter's house first." Mary, on DMG for two days, startled her parents with her first words: "No! No babysitter!"

Although speech is the most notable positive change in those children helped by DMG, behavioral improvement is also often reported. One father gave his son one DMG tablet per day without mentioning it to the school. He later requested a copy of the school's detailed record of his son's day-by-day behavioral transgressions. The correlation between outburst-free days and the use of DMG was unmistakable.

An article in the New England Journal of Medicine (October 1982) reported that a 22-year-old mentally retarded man who had 16 to 18 seizures per week on standard anticonvulsants, experienced only three seizures per week while on DMG. Two attempts to remove the DMG dramatically increased seizure frequency.

Last year I sent information on DMG to Lee Dae Kun, Director of the Pusan (Korea) Research Center on Child Problems. He tried the DMG on 39 children with autism, ages three to seven, for three months, with the following (summarized) results:
Benefits seen:
Yes: 31 (80%)   No: 8 (20%)
(Improved speech, eating, excretion, willingness, etc.)
8 children had difficulty sleeping for weeks 1 and 2.
6 children became more active for weeks 1 and 2.

Lee Dae Kun wrote that the parents, usually skeptical, saw the improvements clearly. He concluded that DMG is very beneficial for children with autism, even if it is not a cure.

Information about the use of DMG with older persons is also encouraging. One mother of a 26-year-old who squeezed things (people, TV sets, etc.) very hard when frustrated, tried DMG, quite skeptically, to see if it would stimulate his very sparse speech. It didn't, but brought remarkable improvement in his frustration tolerance. "Even my husband, who was even more skeptical than me, now is a believer," she wrote.

DMG certainly doesn't always help, and it certainly is not a cure, but it is certainly worth trying, in my humble opinion. If you try it, let me hear from you.