ARI Publication 40 – 2013 Version

Sulfation

Rationale: Sulfate is used for many functions in the body, including detoxification, maintaining the
lining of the gut, and hormone production. Some children with autism have a low level of sulfate in
their bodies due to a variety of reasons, including poor absorption in the gut, excess loss in the
urine, or poor recycling of sulfate by the kidney, or oxidant stress and inflammation can shut down
cysteine dioxygenase, which throttles the cysteine -> sulfate route.

Testing: Blood testing can be used to check for levels of free and total plasma sulfate, and this is
probably the more reliable test. Plasma cysteine can also be informative. (Urine testing of free and
total sulfate may be useful to look for excessive loss of sulfate, but this is only one of several
possible causes of low sulfate in the body, and should not be solely relied on to assess sulfate
status).

Alternatively, since Epsom salt baths are very safe, one could simply try them for up to several
weeks and look for improvements in behavior and functioning (see below).

Treatment:
Tapan Audhya evaluated many different ways to increase plasma sulfate levels in children with
autism who had low levels. The two most effective methods were oral MSM (500-2000 mg
depending on size and sulfate level) and Epsom Salt (magnesium sulfate) baths – 2 cups of Epsom
salts in warm/hot water, soak for 20 minutes, 2-3x/week. A few children did not tolerate MSM, but
Epsom salt baths are generally very well tolerated.

T. Audhya, Role ofSulfation, presentation atAutism/Asperger’s Conference in Anaheim, C4, February
2007.

Many parents and physicians have anecdotally reported that Epsom salt baths were beneficial to
their children. However, there is less experience with MSM for children with autism, and more
research is needed.

Research – Sulfate and Autism
Sulfur is the fourth most common mineral in the body [Chang, 2007]. Most sulfate is produced in
vivo by metabolism of cysteine [Stipanuk et al 2010]. Sulfation is important for many reactions,
including detoxification, inactivation of catecholamines, synthesis of brain tissue, sulfation of mucin
proteins which line the gastrointestinal tract, and more. The measurement of total plasma sulfate
involves many substances in the plasma, including neurotransmitters, steroids, glycosaminoglycans,
phenols, amino acids, peptides, and other molecules.

Low free and total plasma sulfate in children with autism has been reported in three studies
[Waring et al 1997; Geier et al 2009; Adams et al 2011], and is consistent with four studies [Waring
et al 1997; O’Reilly et al 1993; Alberti et al 1999; Horvath et al 2002] which found that children with
ASD had a significantly decreased sulfation capacity compared to controls, based on decreased
ability to detoxify paracetamol (acetaminophen, the active ingredient in Tylenol). The finding of
low plasma sulfate is also consistent with a large study that found high sulfate in the urine of
children with autism [Waring and Kovsra 2000], as sulfate wasting in the urine partly explains low
levels in the plasma.

40