A Bio-Medical Treatment Approach to Autism Spectrum Disorder, Including Heavy Metal Detoxification By JAQUELYN McCANDLESS, M.D.
Certified by American Board of Psychiatry & Neurology

Bio-Medical Evaluation
Vaccinations and Mercury Poisoning
Testing for Brain Mercury
Mercury Detoxification
Importance of Nutrient Program
Role of Doctors and Parents In This Treatment Approach

(Note: This has been excerpted from the recently published book: CHILDREN
with STARVING BRAINS - A Medical Treatment Guide for Autism Spectrum
Disorder by Jaquelyn McCandless, M.D.) This article is being written for
parents (and their doctors!) who want to have their children bio-medically
evaluated for developmental or learning delays. It is an attempt to provide
a brief summary of current information gleaned from my own practice,
current research studies, and what I have learned from autism conferences
and reports of other clinicians working with this population of children.

General: Developmental disabilities such as autism (ASD), attention deficit
hyperactivity disorder (ADHD), dyslexia and uncontrollable aggression
currently affect an estimated 12 million children under age 18 in the U.S.
- almost one child in five. A recent report by a group of physicians states
that millions of children in the U.S. exhibit learning disabilities,
reduced IQ and destructive, aggressive behavior because of exposures to
toxic chemicals. This report published by Greater Boston Physicians for
(l) links toxic exposures during early childhood, or even before birth, to
lifelong disabilities. The report states that one million American children
currently live with blood lead levels above the threshold recognized by
U.S. Environmental Protection Agency as affecting behavior and cognition.
Millions more would be added to this list if EPA thresholds were updated to
take account of the most current research on the effects of lead, mercury
and other heavy metals in children. The authors note that even at extremely
low doses mercury exposure produces impairments in language ability,
attention, and memory. In addition to the heavy metals, studies show that
some 20 million U.S. children under age 5 eat an average of eight different
pesticides on their food daily.

Autism Spectrum Disorder (ASD) is a very complex disease affecting multiple
major physiological systems. Psychological and genetic etiologies have been
researched for many years with applied behavioral analysis techniques the
only officially recognized treatment for autism other than drugs for
behavior control. There appears to be a genetic factor operating shown by
high incidence of affected siblings, high frequency of autoimmune disorders
in the mothers and other close relatives, and patterns (but not invariably)
of genetic markers in research studies. However, the understanding of how
genetics contribute to autism is still not known. Infectious (viral,
bacterial, and fungal) etiologies have all been proposed, as many children
show immune impairment from very early on. No one doubts the presence of
immune dysregulation in our developmentally delayed children, but more and
more clinicians who are working in this area are starting to feel that
toxins of various kinds may be the etiological triggers that start the
immune impairment in the first place, particularly toxic vaccinations
injected into infants with immature immune systems.

Bio-Medical Evaluation: The first step in a bio-medical evaluation consists
of a thorough family and child health history/interview. Then screening
diagnostic lab tests are done to determine what bio-medical issues need to
be addressed including whether heavy-metal toxicity is present. A basic
blood count, metabolic chemistry, urinalysis and thyroid panel is obtained
as a base-line for all children. Special tests are obtained according to
symptoms and history of the child, and often include: tests for immune
impairment; presence and levels of viruses and fungi involving both urine
and stool studies; and IgG food sensitivity and amino acid panels as well
as RBC essential mineral tests to direct proper nutrition. Some of these
are blood tests. I am not currently accepting patients with autism whose
parents are not willing to get them stabilized on a GF/CF (gluten and
casein free) diet prior to their evaluation. In my opinion, these children
have irritated intestines even if it has not reached the point of "leaky
gut." They need copious probiotics and elimination of sugar intake in order
to help the near-ubiquitous gut infections heal. Anti-fungals may sometimes
be needed per testing as an early step in treatment; we know now that
chelation efforts fail if we try to administer chelating agents to inflamed
guts - the yeasts flourish on those agents and they cannot do their job of
chelating the mercury. Many children have sensitivities to other foods as
well as casein and gluten, and those must be avoided or rotated according
to degree of sensitivity.

Vaccinations and Mercury Poisoning: A relatively recent development in
autism studies has arisen from the observation and sharing through internet
and other support groups by parents that their children became autistic
after vaccinations, notably the triples, DPT and MMR. There certainly have
been isolated incidents of vaccine injuries for many years with little
support from the medical profession or the vaccine makers, who have
protection against injury suits. As a consequence of the increasing
frequency of ASD and the worldwide sharing of information, parents as well
as clinicians have been made aware that some vaccines our children have
been receiving have neurotoxic levels of thimerosal, a mercury
preservative. It appears that the cumulative level of mercury in required
vaccines has reached toxic levels for a growing number of children. Mercury
in its organic form is not toxic, but it is lipophilic and drawn to the
brain, which is mostly fat, becoming oxidized into the very toxic inorganic
form there. This inorganic form causes interference with the enzyme systems
that allow proper nutrition and conduction to take place across the brain
cell membranes. Since 1991 (which happens to be the year Hepatitis B began
being mandated for all newborns), the increase in the incidence of autism
has been phenomenal and reported in very clear statistics from the U.S.
Dept. of Education (2). The number of children 6-11 served under IDEA, Part
B for autism rose from 3,046 in 1991-92 to 27,323 in 1997-98, a 785%
increase. Such increase cannot be due to genetics, though there seems to be
a genetic predisposition that makes a certain subset of children more
sensitive to heavy metals and other toxins. National statistics for the
last two years show a continuing rise in the incidence of autism, estimated
currently to be 1 per 150-250 children.

It is well known that the gastrointestinal tract is extremely susceptible
to mercury injury. Since 60-70% of our immune function is located in the
gut, toxic exposure predisposes the child to immune impairment very early
in life, particularly when the toxic-laden vaccines are administered to
newborns whose immune system is undeveloped. I consider any child who has
four or more ear infections in their 1st year as immune-impaired with
accompanying multiple courses of antibiotics contributing to gut pathogen
overgrowth. Intestinal dysbiosis, usually candida, intractable diarrhea (or
constipation), and subsequent inability to tolerate the large peptides
contained in wheat and milk is very common in these children. We have found
that almost all of them benefit by a gluten and casein/free diet.
Persistent brain viruses may be indicated by viral titers, brain studies,
and positive response to anti-viral treatment. The earlier the toxic injury
the more severe the effects on the brain and immuno-endocrine systems. In
utero, the infant is subjected to mercury as well as other toxins by what
the mother eats (especially contaminated fish), by the mercury vapor given
off each time she chews if she has amalgams in her mouth, and ubiquitous
environmental toxins she breathes. It is known now that it is detrimental
for the expectant or nursing mother to have amalgam work done (placed or
removed), as mercury crosses the placenta, with toxin accumulating in
breast milk 8X the level in the mother.

Many parents have reported that their children became autistic soon after
receiving their MMR immunization, usually between 14 and 18 months of age
after what appeared as normal development, with many children already
having age-appropriate language before their shot and losing all language
afterwards. Though MMR does not contain mercury, if a child's immunity has
been compromised by previous toxic insult, it appears that his or her
immune system cannot then handle the triple-virus challenge in a sizable
number of children. The majority of children have immune systems that can
apparently deal with the amount of mercury they receive either from the
mother or in vaccinations. However, the exponential rise in the incidence
of autism, ADHD, and other developmental delay and learning problems in
children in recent years seems to indicate that a sizable number of
children have brain toxicity very likely through their vaccinations or
mothers' amalgams.

When a congressman's (Dan Burton of Indiana) healthy five-week-old
granddaughter almost died within hours of her Hepatitis B injection, a
congressional investigation into vaccine injury was finally opened in July
2000. At least fifty-seven newborn babies had already officially been
reported to have died shortly following the Hep B, which very probably is
an underestimation, since many "crib deaths" may actually be post-vaccinal
reactions. As a result of this investigation and parents' outcries,
vaccination reform is in the works right now, with thimerosal being
replaced by non-toxic preservatives in Hep B for newborns and other new
vaccines. The AMA, CDC, IOM, or vaccine-makers are still not admitting any
responsibility for the toxic levels of thimerosal in the vaccines, but they
have recently admitted it may be plausible, and have agreed to fund several
studies on the issue. Tragically, thimerosal was still present in doctors'
supplies until late in 2001, which they were allowed to administer until
used up and/or the new vaccines were more readily available. Amalgam dental
reform is also being sought, but the ADA is as adamant about the safety of
amalgams as the AMA is about mercury in vaccinations. Reigning paradigms
are very difficult to give up, and most traditional doctors and dentists
are resistant to even learning of many recent studies documenting the
extreme neurotoxicity of mercury.

Testing for Brain Mercury: It is clear that if there is a genetic factor
for immune dysfunction (e.g. mother with autoimmune disease, other affected
family members, etc.) and/or the toxic load is too heavy and/or the immune
system is too immature at the time of toxic input, cognitive impairment may
result. It is also clear that there is a striking resemblance between
autism and mercury poisoning. (3) In adults, poisoning seems to show its
effects in generally impaired immunity, with chronic fatigue syndromes,
multiple sclerosis, and autoimmune and other diagnostically puzzling
illnesses now suspect as possible mercury poisoning. Mercury in even minute
amounts is the most neurotoxic element on the planet next to plutonium.
Many doctors do not realize the extent of this toxic problem, and do not
understand that blood, urine, hair, or stool tests do NOT usually reveal
the presence of mercury in the brain. If tests are positive, they probably
indicate recent exposure (30-60 days) and are revealing body or organic
mercury, which is non-toxic unless the exposure is great, and can often be
handled by the immune system. If tests are negative that does not mean
there is no brain mercury. The blood-brain barrier which is usually
protective to the brain prevents the mercury coming out into the body
excretions and hair without a chelating agent, so if poisoning is present
it is a lifetime affair if not treated (25-30 years is the half-life for
inorganic mercury).

Mercury Detoxification: A physician-mother of an autistic child, Amy
Holmes, M.D. of Baton Rouge, LA has been exploring the testing and
treatment for mercury poisoning in autistic spectrum children for several
years. She is a leading practitioner of oral chelation for children who
show evidence of brain mercury and one of a group of physicians who is
pioneering a new direction in medical detoxification of children based on
careful attention to testing and nutrient/mineral supplementation. She and
her group are working with around 800 patients (and a long waiting list) in
treatment for heavy metal toxicity; her own autistic son who was non-verbal
at four years of age is totally off the spectrum and normal in most ways
after two years of chelation. Previous chelation protocols for children
have not been adequately defined and effective to our knowledge, especially
since what we're seeing in these epidemic proportions is a newly defined
syndrome called "regressive" or "late onset" autism. Dr. Holmes
participated in a group of 26 toxicity experts who convened for three days
in February of 2001 to devise a Consensus Position Paper for Mercury
Detoxification of Autistic Children (4). Though specifics of dosages,
timing, and nutrients vary, this protocol offers safe and effective
guidelines for practitioners who are ready to enter this pioneering new
treatment mode. This approach has given new hope to thousands of parents
for a disorder that has been considered a psychiatric illness and basically
untreatable (except for applied behavioral analysis) rather than what it
is: a treatable medical illness.

The improved hair analysis test is a good inexpensive preliminary screening
for revealing abnormalities in essential minerals and other heavy metals,
from which we can deduce the presence of mercury because of its known
effects on other elements not protected by the blood brain barrier.
Doctors' Data laboratory has the largest data base in the world on hair
analyses, and this is the lab from which I order hair tests. By study of
these findings and corroborating tests it can be inferred in a majority of
cases whether mercury or other heavy metal poisoning exists and whether
chelation might be useful. A challenge test with a chelating agent and
urinary analysis of the metals pulled out is helpful to convince doctors
and insurers unfamiliar with chronic mercury poisoning. If tests indicate
heavy metal toxicity is present, we have to make sure the gastrointestinal
tract and liver are functioning adequately before starting the chelation
process. Since early immune injury sets the children up for low resistance
to pathogens in general, some practitioners want to address the viral
infections if titers are elevated, along with anti-fungal treatment. Others
prefer to do the chelation first to see if the body's improved immune
system can handle the viruses without anti-viral medications, since the
available drugs strong enough to actually kill viruses are too toxic for
our children, and the ones we do have are estimated to be about 30%
effective at lowering the viral load to the point where the child's immune
system can keep the infection controlled. However, we have discovered we
cannot wait to treat the gut pathogen overgrowth; we learned the hard way
that chelation appears to be less effective or even ineffective in children
with heavy fungal infestation. Since anti-fungals and anti-virals as well
as the chelating agents can be sometimes stressful to the liver, the
sequence of treatment depends on the doctor's experience and preferences
and on the general health and lab tests of the individual child.

Importance of Nutrient Program: A good nutrient program specific to each
child is always implemented from 2-4 weeks prior to chelation to make sure
there will be no depletion during the detox program, as some of the good
minerals may be excreted along with the heavy metals. Once the nutrient
program is in place, the gut is in good health, and lab values show
adequate kidney and liver function, we begin the oral chelation process
with properly spaced doses (per child's weight) of dimercaptosuccinic acid
(DMSA), present recommendation being two week cycles of 3 days on and ll
days off. If amalgams are in place they must be removed prior to chelation,
and should be removed from ALL children nevertheless in my opinion. Our
testing reveals that other toxic heavy metals are often removed in the
chelation process also. Then, with regular testing finally showing little
or no body mercury being excreted, and not until then, alpha-lipoic acid
(ALA) is added (oral or transdermal), this being the only known chelating
agent other than cilantro (which is difficult to quantify and administer
reliably), which crosses the blood-brain barrier to remove brain mercury.
Treatment can take 6 months to 2 or more years depending on how much and
how long mercury has been in the brain and/or on other factors as yet

The nutrient/mineral reinforcement as preparation and careful replacement
during chelation must be accompanied by avoidance of any further known
contamination from the environment or from foods or medicines (and
especially vaccines with thimerosal!) Mono-vaccines are preferable to the
triples, and parents must start insisting on these in order to get the
physicians and vaccine makers to comply. Finally, no child should ever be
vaccinated while ill in any way, and if other children in the family have
developmental delay, the question of vaccines has to be very carefully
considered and all the latest vaccine information obtained before
proceeding. Titers may need to be checked to make sure there is a need for
boosters. Needless to say, this bio-medical treatment does not obviate the
need for ongoing educational and rehabilitation training to compensate for
any delay present to fill in the missing elements of each child's development.

Role of Doctors and Parents In This Treatment Approach: This kind of
extensive evaluation, diagnostic tests with proper interpretation, and
dedicated follow-up with chelation dosages and nutrient management make
detoxification challenging for both physician and parents, not to mention
the child. Responsible lab testing, assessment of pre-chelation blood and
chemistry status, ever-changing medication needs, requirement for periodic
testing to check amount of mercury being removed and an ongoing
relationship between parent(s) and physician are all important to this
process. The professional effort and time required make this process
unattractive to many busy pediatricians and HMO groups; many professionals
take it on only after encountering these developmental disorders in their
own loved ones. Health insurance payment is variable and many tests will
not be covered (insurance reform is important as well as vaccine reform to
help parents pay for the treatment of this very complex disease). Parents
must fight to get coverage, and sometimes threatening litigation with a
willingness to follow through is the only way proper coverage may be

It is very important for parents to be informed so they can intelligently
participate in these medical decisions especially since they are doing the
long-term administering of these treatments and know their children and
their children's health history and response pattern better than any
physician could. They should also be advised to keep copies of all their
lab reports and understand as much as possible every medical intervention
given their child. So many parents who totally trusted their doctors and
our health system have now become disenchanted with the system, and realize
they are their child's best advocate and often have to educate their
doctors about this new kind of disorder and new treatments.

Chelation is associated in many people's minds with elderly people getting
hours-long daily IV treatment for arteriosclerosis, and many doctors are
not yet aware of safe oral chelation treatment for children except for lead
poisoning, a very prevalent and serious toxicity problem but with a much
different protocol. When parents first present the idea of mercury toxicity
and chelation to their doctors, many of my colleagues are reluctant to look
into it, considering it "alternative" or "fringe" medicine. I strongly
believe it is one of the most important pieces of the autism-ADHD spectrum
puzzle yet discovered, tying together many of the disparate
gastrointestinal, neurological, endocrinological, and immune-deficiency
symptoms in these children. It is especially important since we can safely
and effectively provide treatment if the proper evaluation indicates there
is toxicity present. Often younger children improve with the pre-chelation
nutrient program, diet, and probiotics remarkably and quickly so, lending
credence to what is known about heavy metals' effect of diminishing the
ability of body and particularly brain cells to take in proper nutrients
for optimal functioning. Obviously younger patients have a better chance of
being cured of permanent brain damage, but older children are often showing
much benefit from this process also, particularly if treated prior to

One of the side effects of oral chelation for some children is a heightened
susceptibility to yeast overgrowth activated by the sulfur compounds that
are part of the chelating agents. For those children who prove to have such
immature or impaired gastrointestinal tracts that these infections and
treatments interfere or delay our chelation efforts, I have begun exploring
and putting into effect an alternative to DMSA chelation for some children
who on testing show disturbed metal metabolism. I may start out with this
protocol for those children who are having severe yeast infections prior to
even starting DMSA chelation. This is a perhaps slower but more "natural"
detoxification program in the form of a nutrient protocol designed by Dr.
William Walsh at Pfeiffer Clinic in Illinois called the metallothionein
promotion protocol. (5)

Detoxification treatment knowledge is still in the early stages, with
protocols changing as our clinical experience dictates. Still, the critical
time factor for our children being helped makes it imperative to proceed as
quickly as possible with what we already know as long as we do not harm
them. At this early stage, we may be testing much more than we may need to
later on as we know more, but we are still fine-tuning this protocol so
precautions are taken very seriously.

Summary: In summary, I feel that all children who have serious attention,
behavior, and learning problems should be given a bio-medical evaluation
including a heavy metal toxicity work-up. These children are medically ill
and their brains are starving. I urge parents to become informed and
doctors to become interested enough to educate themselves on bio-medical
approaches to this disorder now reaching epidemic proportions. A
well-functioning immune system is the primary key to good health.
Ever-increasing toxins all over the world now require all of us to become
aware of this exposure and avoid environments, foods, and medical
treatments especially vaccinations and excessive antibiotics that will
impair our immunity. Increased awareness at the personal and parental level
is essential and will hopefully eventually influence governments to expand
their awareness of the connection between increased toxins and impaired
immunity. It is clear that immune system health through enlightened
nutrition and education about elimination/avoidance of toxins is the
medicine of the present and the future.

Greater Boston Physicians for Social Responsibility, May 2000) or paper copy, 617-497-7440
(2) Autism numbers from US Dept. of Education, 21st Annual Report to
Congress on the Implementation of Individuals with Disabilities Education
Redwood, Roger, Binstock comparing mercury poisoning and autism, Autism
Research Institute's website:
(5) Metallothionein and Autism; Booklet published by Pfeiffer Treatment
Naperville IL, October 2001