Polly: Don Pangborn is an expert in amino acid profile interpretation and is a consultant for the Great Smokies Laboratory and other companies. He recently gave a lecture at the DAN! 2000 Conference on the subject of a protein/enzyme called DPP IV.  DPP IV helps us digest casein and gluten. However, DPP IV has many different functions in the body besides digesting gluten and casein. This protein is known to influence T cells of the immune system. It is also a binding protein for purine, and adenosyl deaminase. Because of this, a problem with DPP IV can throw off the immune system, the amino acid profile, and methylation. The interference with DPP IV may even be implicated in the children’s reaction to secretin.
What could cause a problem with DPP IV?
4. Peptides made by abnormal intestinal flora
8. Certain antibiotics
The above substances interfere with DPP IV through different mechanisms. Depending on which of the above substances is present, and a person’s individual biochemistry, you will get different manifestations of the problem.
Notice that zinc interferes with DPP IV. Hence an arbitrary zinc supplement would be detrimental if not needed. However, many of these kids have low zinc, and it is very important that it is supplemented in these cases. Zinc should not be taken with food or it could interfere with digestion.
Many of the autistic have high levels of pesticides and solvents in their bodies. This would interfere with DPP IV. (Is the high level of pesticides and solvents due only to exposure, or is it also due to an impaired ability to remove these poisons?)
To improve methylation when this DPP IV is hampered, these nutrients might be helpful: trimethyl- glycine (TMG), B6, folic acid, B12, magnesium and serine. Glycine may also be useful since the body creates serine from it. However, folic acid is needed for this conversion of glycine to serine. (Folinic acid is an active form of folic acid and is a better choice. Here is one of many places where you can purchase it: http://www.integratedhealth.com/hpdspec/folinic.html phone 800-228-4265) A supplement of a little methionine or S-Adenosyl-Methionine (SAMe) may help, however, Dr. Pangborn said that it is not clear at this point whether the addition of large doses of methionine or SAMe will help or harm.
There are at least three products on the market that are specifically designed to help digest gluten and casein. They are marketed for those with ADD/ADHD as well as for those with autism. One is called is called DPP IV Forte and is available from Kirkman Labs, website http://www.kirkman.com, or phone 800-245-8282. Another one is called Serenaid, and is made by Klaire Labs. See http://www.serenaid.com, phone (509) 946-1695 or http://www.klaire.com phone 800- 533-7255 or (208) 665-1882. The inventor of Serenaid has a new product called Peptizyde. Peptizyde is available from Houston Nutraceuticals, website http://www.houstonni.com and phone (866) 757-8627 or (510) 549-4548.
It is strongly recommended that you first start on the gluten and casein free diet before trying these digestive aids. It could make things worse instead of better if you add the digestive aid before starting the diet. Even those who have first put the child on a gluten and casein free diet have sometimes noticed an initial problem with adding the DPP IV. Thirst, bedwetting, more stimming, or loose stools. One can only speculate as to the reason. It might be breaking up stored peptides or it might be affecting the immune system. After a while on these enzymes, some parents have been able to reintroduce gluten and casein foods.
Please be aware that these particular digestive enzymes are made using a mold called Aspergilus. There is a chance of an allergic reaction, especially a breathing problem. When trying anything, please start with small doses, be observant, and get as much information as possible about it. Also, these kids need the whole Autism Interventions 19 array of pancreatic enzymes due to their digestive difficulties. So you can’t just focus on the DPP IV enzyme.
If you put your growing child on a milk-free diet, it is particularly important to provide another source of calcium. Dr. Shaw has mentioned that some of the autistic will end up with eye pain when low on calcium. A few have poked out their eyes in an attempt to relieve the pain. Calcium is in particular demand in a child whose bones are growing. It is also needed to keep the parathyroid hormone in check. If the parathyroid hormone is elevated, this causes calcium to be taken up by the cells, and this interferes with energy production. Many people have reported improvements in the child when they give the child a calcium supplement.
One other curious thought. In the intestines, you must have the DPP IV available to break down and transport / absorb proline-containing peptides. Hence, anyone with low DPP IV may not be getting enough proline from their food. Especially, people in the US, in their stressful life, no longer bother to cook their soup bones and are thus already eating a diet deficient in proline. However, this doesn’t necessarily mean that a blood test will show low proline because proline can be synthesized from other amino acids, like ornithine, alpha ketoglutaric acid, and glutamate. It just means that without proline in the diet, the body will be working hard to make up for such a deficit and dietary imbalance.
In healthy people, eating gelatin should eventually increase the amount and activity of the DPP IV enzyme in the intestines.  However, when gelatin is given to a person where the DPP IV enzyme has been poisoned, all the dynamics are thrown off. There are some reports of autistic children not tolerating gelatin. There is no clear answer here. However, one wonders if the gelatin is creating a demand for additional DPP IV enzyme that cannot be met. In this situation, it seems logical to use a supplement of the DPP IV enzyme to increase the tolerance to proline rich foods, like gelatin and colostrum.
Polly: According to Dr. Kalle Reichelt, soy proteins sometimes cross react with antibodies against casein. Hence, there is concern that soy protein might inhibit the breakdown of opioids and thus increase the deleterious effect of milk casein on autism and attention deficit. Even if you have your child on a strict no casein/no gluten diet, it might take as much as a year for the offending peptides to clear. Hence, soy protein used during this first year might be particularly problematic. (See the article entitled “Food allergy vs intolerance, soy and autism” at this website: http://www.GFlinks.com/reichelt.html.) Some advocate a little fermented soy. That might be okay in limited quantities. Yet since soy has phytoestrogens (phenols), it doesn’t seem like a good food for anyone with phenolsulfotransferase (PST) problems, which includes most of the autistics and many of those with ADD.
See http://www.mercola.com, http://www.soyonlineservice.co.nz and http://www.westonaprice.org/soy_alert.htm.