Chapter 12
Treating Yeast in Children with Autism:
Typical Results of Anti-Yeast Therapy
By Dr. Bruce Semon


 Introduction

I am a child psychiatrist and nutritionist who has been treating children with autism using anti-yeast therapy for the past six years.  What follows are some representative cases based on my clinical experience.  The cases I have selected involve children ranging in age from 20 months old to eight years old, all of whom showed significant improvement in the first few weeks and months following anti-yeast therapy.  Their names have been changed to protect their identities.  As you will see, these cases (except in the case of the 20 month old) are not "cures," but they do show the possibility for improvement in children with autism.   Nor is the anti-yeast therapy intended to be the only therapy that a child receives.  I firmly believe, however, that use of the diet and nystatin treatment vastly improves the child's baseline physical functioning, eliminating headaches, stomach and gut pain, and for some children, pain in hands and feet.   By using the anti-yeast therapy, these children have the potential to achieve more in their lives and profit more from the other therapies and education that their parents offer to them.


CASE HISTORIES

 Jon

Jon is a 6-year-old boy who had been diagnosed as autistic at age 3.  He presented for aggressive behavior toward teachers and parents.  Mother stated (on a follow-up visit) that he was hitting her so much that she was black and blue.  He also hit his teachers regularly.  He was kicking, biting and head butting, more so when tired or at transitions.  He had lost language at age 18 months but some language had come back and he could use about 50 words.  Jon had a history of head banging but this symptom had improved after a second set of ear tubes were placed.

Jon had had ear infections since age 1 with four sets of ear tubes being placed.  He had chronic loose stools, eczema on his back and he was not toilet trained. 

He had been placed on Mellaril before coming to see me due to violence against teachers.  The Mellaril did little at low doses (10 mg). Higher doses were too sedating. He was off all dairy.

At the initial visit, Jon did not answer any questions and made little eye contact.  

Jon was started on the anti-yeast diet and nystatin.  Jon returned six weeks later.  His mother reported that his language had blossomed and his aggression had diminished from being constant to being only at transition times and at these times, the aggression was less.  His sleep was improved and mother had stopped his Mellaril.

Jon returned three and a half months later. He was continuing to improve.  He was now toilet trained for urine during the day.  He was not hitting anyone in the family and he was interacting with his brother.

Jon has been treated for about nine months now and he has continued to improve.  At each visit he has more speech and language.  He also benefited from the addition of a low dose of naltrexone (explained below) daily.


 Andrew

Andrew is a 2 and a half-year-old boy who presented with autism.  He had stopped responding to his name at 15 months and had stopped playing with toys.  His hearing was tested at 18 months and was fine.  At 20 months he was referred by a child development specialist to a "birth to three program" for occupational and speech therapies.  He was over active.  He also had rashes, eczema and loose stools.  At the first visit, he ran throughout the room and did not speak.  Parents stated that he could vocalize at the 12-month level.  Andrew was started on the anti-yeast diet and nystatin.

He returned four weeks later and his mother reported he was "more with it".  School people told mother that Andrew was sitting longer with better attention.  His bowel movements had firmed up.  On exam, Andrew was vocalizing more and he sat in one spot on the floor with a pen and paper.  He was no longer overactive.


 Joshua

Joshua is a 20 month old boy who presented for being "crazy" the last few months, ripping things apart and being destructive.  He was up four times per night screaming and yelling.  His mother noted that he had a high tolerance for pain.  He had had frequent antibiotics for ear infections which had sometimes caused diarrhea and he was plagued by frequent hives.  His mother reported that he could understand speech but his expressive speech was behind and that he had lost some words.  He had been an easy infant.  On exam he was unhappy and unsmiling. 
 
Joshua was started on diet and nystatin (but continued on milk).  Two weeks later, his mother noted a huge improvement in how he felt.  He no longer screamed at night.  His activity level was lower.  I noted that in my office he was smiling and playing with toys.  A month later his mother reported that his speech had improved, that more words were coming and he was putting two words together.


 Barbara

Barbara is a three-year-old girl who presented for speech delay.  She had seemed normal until about 18 months when she had a severe vaginal yeast infection.  This infection continued for six months.  At that time her speech stopped developing.  At the interview her parents reported she could say a few words.  I could not discern any intelligible speech.  She was unhappy and screamed occasionally and ran around. 

She was started on diet and nystatin.  She came back three weeks later.  Her parents reported that she was attending better at school and could sit for longer periods of time.  She was having fewer temper tantrums and was saying 4 to 5 words per day.  In my office she said "mama" and smiled.  She played with a toy and was not hyperactive.  


 Steven

Steven is a three-year-old boy who was reported to be normal until age 2.  At 25 months he began screaming and arching his back.  Speech was noted to be delayed.  Before his third birthday, he was diagnosed as autistic.  He had constant loose stools.  He had skin rashes until his parents took milk away a few weeks before the interview.  He had a history of milk intolerance with vomiting and diarrhea.

At his first appointment, Steven had no meaningful speech and he would not sit down.  He moved all over the room. 

He was started on the anti-yeast diet and nystatin.  He returned four weeks later and his parents reported that he was more verbal and was showing some control.  He was having normal bowel movements.  I observed Steven walk around the room, rather than run.  He was responsive to his parents and he smiled and talked appropriately several times with his parents.    


 Ann

Ann is a two and a half year old girl who had not developed much speech.  She was making little eye contact and was screaming regularly.  She had already been diagnosed as autistic by the time she was first seen.  At the time of the first interview, she had no meaningful speech, although she occasionally said single words spontaneously.

She was started on the anti-yeast diet.  Her mother noticed an improvement in speech after only four days on the diet.  She asked for juice, using the word.  She was put on nystatin at this time.  Within a few days, she was putting two words together meaningfully.  By six weeks she appeared at my office naming body parts and saying "I want ..." on a regular basis. She had been involved in intensive in-home applied behavior analysis therapy for several months preceding the anti-yeast therapy.  Her therapists expressed amazement at her progress once she started the diet and nystatin.


 David

David is an eight year old boy who had not developed language by age 3.  He received a diagnosis of autism at age 6.  He had been in an applied behavioral analysis discrete trial program for a year when first seen.  He had made some progress in the behavioral program but his speech was unclear and he would only occasionally speak spontaneously.  At the time he was seen, he responded to "What is your name?" in a whisper, which I could not understand.  He otherwise was non-responsive and made little eye contact.

He was seen six weeks later after being put on diet and nystatin and his mother reported that there was more spontaneous speech.  He could name things more completely.   Before, if a request was made to touch his father, he would touch anyone.  Now he would respond by touching his father.  At this visit, he talked with his mother about going to eat.  His mother told me that he had been taught such phrases in behavioral therapy.  What struck me was that I could understand this time what he was saying.  His speech was much more intelligible.


 Diet and Antifungal Treatment

I use a combination of a special diet and the anti-yeast drug nystatin to treat children with autism.  Dr. Shaw describes nystatin elsewhere in the book, but I will review it briefly. Nystatin is a non-absorbed chemical compound which kills the yeast Candida albicans.  There are no toxic side effects from nystatin and nystatin can be taken for long periods of time.  Although nystatin is a potent anti-fungal medication, it only reaches its maximum effectiveness when combined with a special diet.  Before describing the specific treatment, including the steps to achieving the diet and directions for using nystatin, I will describe how I arrived at the diet.


 Origin of the Treatment

I began treating children with autism in 1991.  My first patient was my son.  He had developed normally until age two and a half and from age two and a half to age four his development slowed.  From age four to four and a half, he lost most of the function he had.  He lost most of his speech and he lost his fine motor skills.  He also began screaming much of the day and he was awake for three to five hours every night.  No doctor had helped us.  We had taken him to some of the best in the Washington, D.C. area.

But, on this early morning day in January 1991, there was to be an insight.  My wife was sitting up with our son, as she had been each night for the previous month, during his waking hours of two to seven AM.  He was staring at something, saying "the lights, the lights."  All of a sudden, it hit her: our son was experiencing a migraine.  He had had a peanut butter sandwich for bedtime snack, a food known to cause migraines, and this was it.
           
I grew up with a strong family history of migraines, and my wife Lori suffered from them occasionally.  Both of us experience what is called an "aura" before the pounding pain of the headache:  flashing lights, dizzying patterns dancing before their eyes.  My father had had several migraines a week when he was in college, until he read an article in a magazine, stating that if one avoided certain foods, the migraines would decrease in frequency.  My father avoided these foods and his migraines diminished considerably.  The list included such foods as chocolate, pickles, salad dressing, bacon, alcoholic beverages, nuts, and aged cheese. I have since seen from other headache clinics similar lists of foods to avoid.  We decided to take away from our son a small list of foods known to cause migraines.
           
We took away chocolate, peanut butter, orange juice, aged cheeses, and some other foods.  The improvement was immediate.  Our son looked and acted as if a weight had been lifted from his head.  Two years later, at the age of six, his headaches completely disappeared unless, by mistake, he ate something we knew was bad for him.  His tactile defensiveness completely disappeared, too.  At the beginning, however, we did not know how far we had to go.

After taking away several foods, we began to see the onset of separate headaches, when we would make a mistake and give him foods we should not have, or when he would eat something that we learned later caused problems.  We saw the headaches set in about three times a week instead of being chronic.  This change only took a few days to see.

Our son's symptoms of what we now know to be autism also began to diminish.  He no longer screamed all the time.  His behavior improved.  He seemed more with us, more engagable.  If he accidentally got into the wrong foods, the screaming began again. 

In the first few weeks, we noted that not all the screaming went away.  We tried to determine what foods were still causing problems.  At the time, I was a research fellow at the National Cancer Institute, in a laboratory concerned with nutrition and cancer.  Using the vast resources of the National Institutes of Health,  I began researching what might be causing our son's problems.  Based on my research, we decided to eliminate vinegar, a staple of our lives.  Our son was a kid who ate ketchup (a significant source of vinegar) on everything, including popcorn, and loved Asian food, sprinkled with rice vinegar. Again, we saw immediate improvement, but knew that we were still missing something.  I had no idea what the relationship was among the foods on the original list.  Around this time, we also found that something in children's pain relievers were causing the headaches to last longer than necessary.  We do not know exactly what that substance is, suspecting many of the additives, including aspartame (Nutrasweet) but we do know that switching to pure acetaminophen, and later to pure ibuprofen, considerably shortened the life of the headaches.  Life for our son improved considerably, but he still suffered considerable pain and still continued to lose his speech.  We heard his last real word for five years in March, 1991.

We got our next break about eight weeks later with the Jewish holiday of Passover.  For this holiday, all food containing yeast, leavening and fermented foods are eliminated.  This holiday lasts eight days.  By about three days into Passover, our son was clearly improving again.  He appeared much more comfortable.  By this time his speech was gone, so we were dependent on how he looked and behaved.  His behavior had improved to the point that he was accepted into a special education speech and language summer program.

After those eight days, though, our son deteriorated.  The screaming intensified.  We had no idea what had happened.  What was in the food that we were now giving again?  We had many snack foods from the health food store, all supposedly healthy.  I read the labels and the one ingredient that I did not recognize was "barley malt."  What was barley malt?" 

Barley malt is a byproduct of beer manufacturing.  Yeast is mixed with barley to split the barley.  Anytime that yeast is allowed to degrade a food, the process is called fermentation.  The liquid part of this fermentation mixture goes off to be made into beer and the solid part is a nice sweet mash, which is then called barley malt or malt extract or simply malt.  Malt is a fermented product.

What was the relationship among items on the list?  Vinegar is literally spoiled wine, so it comes from fermentation.  Barley malt is clearly a product of fermentation.  But what was chocolate and what about nuts?   I went back to my research to find out.  I knew about certain cancer causing chemicals in food.  One is called aflatoxin, a potent cancer causing chemical found in small amounts in peanuts.  Aflatoxin comes from a fungus, called Aspergillus, which contaminates the peanut plant.  Chocolate beans are dried with a fungus.  Now the relationship among the items on the migraine headache list became clear.  They are all products of yeast fermentation or of fungus contamination.  Yeast and fungus contain many similar biochemical pathways, although in general, fungus produce poisons much more potent than yeast can produce.

Something produced by yeast and fungus was wreaking havoc on our son.  We needed to know what it was.   My lab happened to be at the same site where the US Army has its germ warfare labs and there are several people there who work in specialized fermentation.  One research group was right down the hall. They got me started.  The first chemical I found that I thought might be causing a problem is called acetol.  Acetol is a skin irritant and an eye irritant (probably known from research to see if it could be used in cosmetics).  Acetol is in vinegar.  Acetol is also found in maple syrup and in cheese.  I thought I was making progress.  I had found something toxic in vinegar which may be causing problems. The identification of what foods could cause problems for our son was becoming easier.  As I identified what foods contain which chemicals and we took these foods away, our son improved, albeit slowly.

Once we eliminated barley malt, vinegar, and yeast, the improvement was dramatic.  We began to see the light at the end of the tunnel, but little did we know how long that tunnel was.  At the time, simply decreasing his headaches to once a week or once every two weeks, and seeing his behavior improve and his autistic symptoms decrease were major victories.  We had turned the tide before we lost our son Avi altogether.  He was coming back to us, very, very slowly. 

We found, though, that foods were not the only key to our son's puzzle.  We were introduced to a book called The Yeast Connection by Dr. William Crook, about people who have problems with something called Candida albicans. We found a similar list of foods recommended for avoidance.  Could it be that our son had a yeast problem?  Certainly no professional had ever mentioned this, but certainly no professional had been able to help us to this point.  We decided to try treating him with a non-toxic medication called nystatin.  Nobody would prescribe it for us, but fortunately, I have a medical license.

Within a few days of starting on the nystatin, our son made a year's growth in playground development.  He got off the swings and climbed jungle gyms, went down slides, and began to look like a four year old kid again.  He still did not get his speech back, but he was better able to function.

Over the next few years, we were able to refine the diet, gradually eliminating all fermented foods, and, in addition, eliminating casein, gluten and eggs.  He has remained on nystatin.  He is a completely different child than he was in 1991, when he sat for hours screaming or spinning on a swing, making emotional contact with virtually nobody.  He is a happy, healthy child, has been able to tolerate a regular classroom at school since first grade, and began to talk again with the help of significant intensive applied behavioral analysis therapy at home.  Any deviations from the diet bring back autistic symptoms to some extent; some foods are worse than others.  Screaming, aggression, including scratching, kicking, and biting; non-cooperation; lack of progress in school--all of these remind us what life would be like with untreated autism.

I have since treated several other children, only some of whose cases I noted above, with excellent results.  My son, and these children, responded well to being treated with a combination of diet changes and the taking of nystatin.  Why did this regimen help, and what is this regimen?

Although it seemed at first that the diet recommended in The Yeast Connection could have saved us a lot of work, and perhaps could have saved our son's speech had we discovered the book sooner, we found that it did not answer the questions that our son posed to us.  Had we followed that diet, which at the time was the standard for anti-yeast diets, our son still would have been eating many of the foods that we know cause him, and many others, tremendous problems.

The main difference is that in diets based on The Yeast Connection recommend eating a great deal of meat and eliminating most carbohydrates.  The reason for this is that Dr. Orion Truss, who first published the idea that Candida albicans can cause health problems in The Missing Diagnosis, observed that yeast grow well in carbohydrate and not particularly well in protein.  Therefore, he reasoned, one should remove carbohydrate from the diet so the yeast doesn't grow as well.  Subsequently, the standard anti-yeast diet recommends eliminating all sugar and yeast from bread and substitute more meat and fish. However, in my practice, I have found that this diet is not optimal.  The human body is not as simple as a test tube nor is the human diet as simple as culture media for yeast in a Petri plate. 

In my practice I have seen many frustrated patients with many symptoms, ranging from autism to chronic fatigue syndrome to arthritis and fibromyalgia to multiple sclerosis, who had followed these recommendations, eliminating sugar and bread from their diets, probably increased meat and fish, and enjoying few results.  The reason for their lack of results is not their lack of effort, but the fact that the main dietary yeast offenders (vinegar and barley malt) had been left in their diets. In fact, most of the anti-yeast and allergy related cookbooks have vinegar as a staple food and recommend a diet high in animal protein, which is problematic, and nuts, which are thoroughly mold contaminated. Our experience with our son and with my other patients is that this recommendation of using meat and eliminating almost all carbohydrate is wrong. 

When yeast spoils meat, the toxic chemicals formed are worse than those formed by yeast in carbohydrate. In addition, chicken and pigs are fed cottonseed meal which is contaminated with a fungus called Aspergillus.  I speculate that the animals store in their fat the Aspergillus poisons. This technique is a common way for animals to handle poisons.  It is possible that storing the fungus poisons is one reason why yeast sensitive patients should not eat large amounts of meat.  Meat from the right sources and in small quantities is acceptable on the anti-yeast diet, however.  We have found that the easiest meat to eat is veal.  Cattle receive less or no cottonseed meal (other feeds are cheaper) and there is little time for any poisons to accumulate in the calf prior to slaughter.  We found with our son and again with many patients since that a diet of complex carbohydrate is the best for yeast problems.

I left the National Cancer Institute in August of 1991.  A month later I began treating patients for Candida albicans using the dietary principles I developed while working with our son and using the non-toxic anti-yeast drug nystatin.  I found that I could treat supposedly untreatable conditions such as autism, psoriasis, eczema, chronic fatigue syndrome, multiple sclerosis, chronic vaginal yeast infections, attention deficit disorder and refractory depression.  These conditions all respond to treatment of Candida albicans.

I also found that other children with autism responded well to the same treatment as I had given my son.  I have never had a child not respond to the treatment for yeast, when the parents make an effort to follow the treatment.  In fact, the improvement seen with this treatment regimen is often dramatic.  The best explanation for the results for the children described above is that Candida produces compounds which affect the brain and reduction of Candida by diet and nystatin leads to fewer of these chemicals reaching the brain which leads to a reduction in autistic symptoms.


 The Medical Regimen: Diet Plus Nystatin

An overview of the schedule for treatment is helpful to understand that this treatment is a long term process, and a long term treatment.  The first three to four months are spent adjusting to the appropriate diet and level of nystatin. After that, other medications may be introduced, if appropriate.


 Schedule for Treatment:

Preceding treatment, you may wish to have urine testing done using Dr. Shaw's testing.  If so, first see the doctor; order testing, then at return visit, assuming yeast problem, start the following:  

Week 1: Doctor's Appointment. Start diet, Stage I, for 3 days, on 4th day:  start nystatin.   
Week 2: Continue diet Stage I; continue nystatin up to the prescribed maximum dose.
Week 3: Doctor's Appointment to help with questions, assess progress. Continue diet Stage I. Continue
on nystatin.                                                                                   
Weeks 4, 5: Continue diet Stage I; continue nystatin. By week 5 patient should be at full dose.
Week 6: Doctor's appointment. Start diet Stage II if appropriate.
Week 7-9: Continue diet Stage II; continue nystatin.
Week 10: Doctor's appointment; assess progress to determine whether to go to Stage III. Continue diet and nystatin per doctor's instructions.                     
Weeks 11, 12, 13: Continue following doctor's instructions.
Week 14: Doctor’s appointment to assess progress; at this point, patient may consider retesting urine, and/or doing allergy testing for food allergies.
After this point, patient should return to the doctor to evaluate any testing results. Other medications such as naltrexone may be considered.  Patient should continue on the prescribed treatment plan, returning in 4 weeks, then 6 weeks, then 8 weeks, then every 3 months for the first year.


 The Diet

Changing diet is extremely difficult for everyone, including our family.   As my wife often says, if she didn't live with the doctor, she would have a much harder time sticking with the program.   Food has social and emotional contexts as well as nutritional value.  To change diet, you need to have a good reason.  A chance to allow someone with autism to live a "normal" life, to me, is the best reason. Autism is a lifelong condition that can cause tremendous suffering, not only to the person who has autism, but to the person's entire family.  Recognizing these problems, I have tried to make dietary change simpler and more gradual by dividing it into stages.   Some children respond so well to the first stage of the diet that further adjustments are unnecessary.  Other children need more intervention.

STAGE I: Eliminate:

  • Barley malt-a by-product of beer making found in many cereals, crackers, breads and bagels and in many health food snacks.  Substitute:  similar foods that do not contain barley malt.   For example, many breakfast cereals contain barley malt, but others do not   (most General Mills cereals, such as Cheerios and Kix, do not contain barley malt).  Similarly, some brands of pretzels, graham crackers, etc., contain barley malt, but others do not.  When shopping read labels carefully and avoid anything with malt in it.
  • Vinegar- is literally spoiled wine and is very concentrated in toxic yeast products.  Vinegar is found in virtually all condiments, including ketchup and mustard, sauces and salad dressings.  Substitute:  freshly squeezed lemon juice; tomato paste for ketchup
  • Chocolate - Chocolate has two problems.  Chocolate is dried with a fungus.    Chocolate also contains a chemical compound which is similar to one of the yeast products.  Unfortunately, there is no substitute for chocolate.
  • Pickles and pickled foods such as herring, tomatoes, and  pickled peppers (yes, there are such things)
  • Alcoholic beverages and non-alcoholic beer
  • Aged cheese
  • Soy sauce (substitute: sea salt)
  • Worcestershire sauce
  • Anything containing cottonseed oil (The cottonseed plant is often mold contaminated and the products of the mold end up in the cottonseed oil.)
  • Nuts and peanuts
  • Apples and apple products
  • Grapes and grape products
  • Coffee
  • Hot dogs, salami, and other processed meats containing nitrates and/or nitrites.  "Natural" hot dogs can still be eaten at this point.

These foods must be eliminated for 3-4 days prior to starting nystatin according to the schedule listed below.  Continue the diet and nystatin for 4-6 weeks, then consult the doctor to consider whether going to Stage II.

These foods are the most concentrated in toxic yeast and fungal chemicals.  Without eliminating these foods, nystatin will not work well and children will not get much better, even if they are given nystatin.  Apples and grapes contain yeast byproducts that Dr. Shaw has isolated, and in my clinical experience, wreak havoc in a child sensitive to yeast.

STAGE II:  Eliminate all of the above, plus:

  • Baked goods containing yeast, including bread.  Substitute: non-yeast bread (Dr. Semon's
    recipe for Delicious and Nutritious Whole Wheat Bread), but not sourdough bread (this too is highly fermented)
  • Corn and rye - corn and rye are both highly contaminated with mold
  • Vanilla extract - highly fermented; contains alcohol
  • Dried fruits and raisins
  • Concentrated fruit juice
  • Monosodium glutamate (MSG) and aspartame (NutraSweet)
  • Maple syrup
  • Bananas
  • Cut back on all meat and fish except veal
  • Spices such as cinnamon, dried mustard, curry powder, chili powder, cayenne pepper. (All green herbs, fresh or dried, are acceptable.)
  • Mushrooms
  • Soda drinks
  • Cooking oils except safflower oil, soy oil, and olive oil.  Canola oil is acceptable unless a child reacts badly to it.
  • Sugar, including both white and brown.  Substitute: unprocessed honey
  • Margarine - margarine has a host of problems.  The human body does not metabolize it.  Butter, a natural product, is much better for the body, even though it contains cholesterol.
    Substitute: butter
  • Buttermilk

Patients should follow Stage II for a period of four to six weeks, continuing with the nystatin.  After consultation with the doctor, they should consider moving on to Stage III, eliminating gluten and casein (dairy and all grains containing gluten, including wheat, barley, oats, rye, and others.)  Note that there is little information on what is in eggs.  However, they do seem to stimulate food allergies.  Any child with a chronic skin problem should have eggs removed to see if this helps with the skin problem.

STAGE III: eliminating gluten and casein
ELIMINATE all of the above, plus:

  • All foods containing milk protein--butter is acceptable. Butter in small amounts is acceptable because butter is a fat which does not contain the milk protein casein. 
  • All foods containing gluten, including wheat, oats, barley, rye

The transition to a casein/gluten free diet is described elsewhere in this book by Lisa Lewis Ph.D.  The difference between her description and my description is that the diet I recommend also eliminates yeast products and fermented products, so some gluten-free grains, such as corn, which are acceptable on a gluten-free diet, are not acceptable on a yeast free diet.

Patients should follow Stage III for four to six weeks, continuing with the nystatin, then consult the doctor.  At this time, they might move on to Stage IV.  In my experience, only the most severe cases of sensitivity need to continue to Stage IV.  At this point, patients might consider retesting urine by Dr. Shaw, and at this point, they could consider testing for food sensitivity using immunological testing.

STAGE IV. ELIMINATE all of the above, plus:

  • Melons
  • Grapefruit and oranges
  • All meat except veal
  • Yellow onions (leeks are acceptable)
  • Fruits except very fresh fruit in season, such as berries
  • Canned goods - canned goods often contain mold contaminated food, because the canning
    process does not allow for discrimination
  • Fish

ALLOWABLE FOODS on Stage IV:  WHAT CAN WE EAT?
In my practice, I have found that the basic diet, and the best foods to eat, which should form the staple part of your diet unless you have documented food allergies or sensitivities to them, are the following:

  • Beans (kidney, black, garbanzo, Navy, etc.)
  • Brown rice (long grain, short grain)
  • Tomatoes
  • Potatoes
  • Herbs (marjoram, dill, basil, oregano, etc.), including seeds from herbs (dill seed, celery seed, etc.)
  • Butter
  • Safflower oil
  • Green Vegetables (zucchini, broccoli, celery, spinach, kale, lettuce, etc.)
  • Roots, such as parsnips
  • Fresh fruit in season, especially berries
    (you can freeze berries in season for use later in the year)
  • Unprocessed honey

Some people choose to stick with only these foods, rather than eliminating everything else slowly, but I do not advise this.  Most children will not end up at Stage IV.  You may be able to continue eating a variety of foods not on this list.  You don't want to lose that opportunity! 

Even if this restrictive list is where you ultimately will end up, and this is where we have ended up after several years, I do not recommend starting with it, because the change is too drastic for most families, including my own. You will end up failing your child because you simply cannot enforce the diet.  It is much better to implement the diet over the course of several months in a way that enables you to stick with it.  After all, you are the gatekeeper for your child's health and the role model for your children.

This diet is inconvenient.  Remember, though, how inconvenient untreated autism is that led you to seek medical help:  all of the nights of screaming, the extreme sensitivities to touch and chemical substances, and the behavioral issues, all of which I have seen improve more rapidly using the anti-yeast treatment than on any non-biological therapy.


 Is this Treatment Worth the Family's Aggravation for the Sake of My Child?

Changing diet is relatively easy compared with a life in agony.  To my knowledge, I repeat, all children I have treated with the above diet (that is excluding foods containing toxic yeast chemicals) and nystatin have improved.  I have never had a parent come back to me saying they followed the diet and the nystatin, and the child failed to respond.  This response is totally different from the response to many of the medications I have prescribed for children with autism in my psychiatric practice.

The tragedy in waiting to decide about whether you are ready to tackle this diet is that children with autism respond best the earlier and sooner the intervention.  The longer you wait the more function the children lose.   All children I have treated who still have some speech left gain more speech with this treatment.  Once children have lost their speech entirely, there is less hope that speech can come back.


 Using Nystatin

I have heard often from people that they gave nystatin and it was not helpful.  I have found nystatin to be of little benefit without the diet, so these stories do not surprise me.  However, the dose of nystatin is also important.

Dr. Shaw writes elsewhere in this book about the problem of "die-off".  That is when nystatin kills the yeast, it is similar to bursting a water balloon with a pin.  The yeast are like the balloons:  once pricked, they release all of their contents at once, which are these same toxic chemicals that make the patient feel bad to begin with.  The person can feel worse temporarily.   Nystatin can cause some temporary nausea when it is first started but this nausea is not "die-off". This nausea will go away.  To avoid "die-off", Dr. Shaw suggests starting the nystatin dose very low and increasing the dose over a week.  His final dose is much lower than I recommend to patients.

I also recommend starting with a small dose of nystatin, increasing gradually.  Using this strategy combined with the diet, I have never seen this "die-off" with children with autism. When the diet is combined with nystatin, I believe that the yeast do not grow back.  This problem of "die-off" and whether "die-off" can be prevented with the diet described here needs to be tested further.

Another possibility can be seen from some of Dr. Shaw's test results.  He has shown that giving nystatin alone can result in an increase in bacterial byproducts found in the urine.  He suggests that clearing out the yeast may leave room for bacteria to grow and make toxic byproducts.  He suggests treatment for the bacteria also. 

I suspect that my suggested nystatin dosages combined with my suggested diet may prevent the overgrowth of these harmful bacteria but further testing will be needed to confirm this idea. 

I prescribe the nystatin powder, which is the most effective form of nystatin.  I recommend mixing the powder with a small amount of unprocessed honey, enough to dissolve the nystatin (about 1/2 teaspoon).  For convenience, you can mix one day's worth of doses at once in well washed film canisters, and store them in the refrigerator.  These are hermetically sealed.   You can send these premixed doses with your child to school.  Use a chopstick to mix, and a baby spoon to scoop out the nystatin from the film canister.

The important thing is to get the nystatin down to your child's digestive tract, not have it all over their faces, shirts, and your floor.  Especially for the first few days, use anything possible that is acceptable on Stage I of the diet to mix your nystatin, including ice-cream, orange juice, syrup, butter: that is, anything.  Once your child begins to associate taking nystatin with feeling better, giving it will be easier for you, and you can switch to honey.

For those who cannot in any manner get a child to take the nystatin, it does come premixed in a sugar syrup.  This is not optimal, as it is much more dilute than the powdered nystatin and is full of sugar. 

The truly tough (adults) can put the powder on their tongue and wash it down.   Nystatin powder can be pushed into capsules.  Nystatin also comes in pill form.


 Dosing Schedule:

Notes:  An eighth teaspoon of nystatin is about 500,000 units.  When "twice in the day" is recommended, that means spaced evenly--e.g., take one at breakfast and one at dinner.  Three times a day might be breakfast, lunch and dinner.  I recommend taking nystatin after you have eaten something, to avoid possible nausea.

****Week 1
Day 1: 1/16 teaspoon once in the day
Day 2: 1/16 teaspoon twice in the day
Day 3: 1/16 teaspoon three times in the day
Day 4: 1/16 teaspoon four times in the day
Days 5, 6 and 7: 1/16 teaspoon four times in the day

****Week 2  
Day 1: 1/8 teaspoon once in the day, 1/16 three times
Day 2: 1/8 teaspoon twice in the day, 1/16 two times
Day 3: 1/8 teaspoon three times in the day, 1/16 1 time
Day 4: 1/8 teaspoon four times in the day
Days 5, 6 and 7: 1/8 teaspoon four times in the day

***Week 3 (First alternative)-
Day 1: 1/4 teaspoon once in the day, 1/8 three times
Day 2: 1/4 teaspoon twice in the day, 1/8 two times
Day 3: 1/4 teaspoon three times in the day, 1/8 one time
Day 4: 1/4 teaspoon four times in the day
Days 5, 6 and 7: 1/4 teaspoon four times in the day

****Week 3 (Second alternative)-
Day 1: 1/8 tsp. 5 times per day
Day 2: 1/8 tsp. 6 times per day
Day 3: 1/8 tsp. 7 times per day
Day 4: 1/8 tsp. 8 times per day
Days 5, 6, 7: continue at 1/8 tsp. 8 times per day

****Two alternatives are listed for week 3 because many people have a hard time taking 1/4 tsp. at a time.  Smaller amounts are easier to take.


 Other Anti-Fungal Medications

There are both over-the-counter remedies and herbs and other prescription medications that kill yeast.  Dr. Shaw has written about them in this book.   In my experience, nystatin is the most effective and least toxic means to fight yeast.   The problem with the other medicines is that they are absorbed and have toxic side effects.  Both Diflucan and Nizoral can affect the liver.  Thus they can only be given for a short period of time.  Once they are stopped the yeast can grow back. 

Nystatin is a totally natural substance that pharmaceutical companies have harnessed and made a prescription medication.  Nystatin has been available longer than 35 years.  According to all of the literature on it, including the standard PDR (Physicians Desk Reference), nystatin has no known toxic side effects.  Apart from some possible nausea during the first few days, there really are no side effects from nystatin.  It can be taken indefinitely because it is not absorbed into the blood stream.  Nystatin acts only in the intestinal tract. Children with autism must be treated for a long time to allow their brains to recover and develop as much as possible.  Treatment for a few weeks is not sufficient. The only drug which can be used for long periods of time is nystatin.  My son, for example, has been on nystatin for more than six years, with no ill effects.


 How Long Does Treatment Last?

Parents are accustomed to treating problems for a few days or weeks, then stopping treatment.  Usually other people, including some doctors, encourage them to cease treatment to see what happens.  This is unfortunate, because many people never resume treatment, even when they see their child's behavior deteriorate.  They assume that the treatment did not work.   

When treatment is stopped, so do the gains made while on the treatment, and, if you are unlucky, your child may lose all of the gains over time.   Dr. Shaw has tested children for whom nystatin doses are simply reduced and he has shown that toxic yeast chemicals in the urine increase when the nystatin dose is reduced.  Unfortunately, the yeast comes back when nystatin is stopped.  Anti-yeast treatment is a long-term treatment, and it is effective in combating autism.


 How Does the Anti-Yeast Treatment Compare with Standard Psychiatric Medication for
 Children with Autism?

I am a child psychiatrist and have prescribed many medications for children with autism, including Clonidine, Ritalin and others.  Not one of the children on any of these medications has done as well as any of the children on the anti-yeast diet and nystatin.

One medication to consider adding to the diet and nystatin treatment is naltrexone.  This is most effective when combined with the Stage III diet (anti-yeast and free of casein and gluten).   Naltrexone blocks opioids in the brain.  I said above, the opioids from milk and wheat may slow the brain down.  At low doses, naltrexone may help clear the brain of opioids which have already gotten into the brain.  Unfortunately, the doses of naltrexone which have been used in academic studies have been too high, and the studies show that sometimes naltrexone has the opposite effect of what is intended.   These studies also have not combined use of naltrexone with elimination of dairy products and wheat.  In my clinical experience, the best results are obtained from naltrexone if dietary opioids are also eliminated (that is, dairy and wheat), and using a very low dose of 3 to 6 milligrams per day (the pills are 50 milligrams each).  The doses used in studies have been 25 to 50 milligrams per day, and in my experience, those high doses can cause children to have increased pain and headaches.   


 Are There Any Other Natural Substances to Treat Autism?

First, remember that although nystatin is a prescription medication, it is a totally natural substance.

There are many other possible substances advanced to treat autism.  Again, I do not recommend trying any until the Stage III diet, or the most restrictive diet prescribed for your child,  has been in place for at least six months, and with the consultation of your supervising doctor.  Eliminating toxic yeast chemicals from the diet, eliminating casein and gluten, and treating intestinal yeast are the first priorities.  After six months of continuous treatment, parents may wish to experiment with substances.

One herb I have found helpful is called ginkgo biloba.  This herb opens up blood vessels.  There is evidence that blood flow is reduced in the brains of children with autism.  Ginkgo may help reverse this lack of flow.  I think ginkgo may be most helpful when combined with anti-yeast treatment.  The brain may be closing down the blood flow to protect itself from toxic yeast chemicals.  When these are removed, ginkgo may do more good.


 Conclusion

I would advise any parent of a child with autism to try treating their child with diet and nystatin. The presence of yeast chemicals in the urine can be verified using Dr. Shaw's test. Symptoms such as skin problems, diarrhea, constipation, and behavioral problems following antibiotic use also strongly suggest an overgrowth of the intestine with the yeast Candida albicans.  Following Stage I of the diet and using nystatin for two to four weeks will tell you if the treatment is beneficial to your child, with no adverse effects or risk to your child.

I have treated many children with autism who showed significant gains by following the diet prescribed along with the nystatin.  I have designed the dietary regiment to allow for a gradual transition to the yeast-free level of least intervention necessary for your child.  The nystatin-dosing schedule is similarly graduated to provide for the least die-off effect.  Combining the two will yield gratifying results, for you, your child, and your family.