Bio Medical Approach to Autism

8/7/2019 Bio Medical Approach to Autism

1/67

2007 Dr. Irfan Qureshi, ND 1

The Biomedical Approach

to Autism:

The Gut-Brain Connection

Dr. Irfan Qureshi, ND

Pacific Highway Natural Medicine

15245 International Blvd., Suite 210Seattle, Washington 98188

Phone: (206) 923-7600

Email:[email protected]


2/67


Naturopathic Medicine Philosophy and Scope of Practice

A discipline of medicine requiring a doctorate level educationsimilar to degree programs in allopathic medicine

A holistic system of medicine encompassing diet therapy,lifestyle changes and therapeutic nutrition.

In a number of states in the US, Naturopathic Physicians arelicensed to practice as Primary Care Physicians

Naturopathic Physicians stress treatments that are natural tohelp with chronic conditions, such as diet and lifestylechanges, herbal medicine and nutritional supplementation;however, they also can prescribe drugs, when necessary.

Aim is to address the cause of the illness and not just treat thesymptoms.


3/67


Dr. Irfan Qureshi, ND Pre-med. BSc Microbiology (University of Washington)

Doctor of Naturopathic Medicine (Bastyr University)

Licensed Primary Healthcare Physician, State of Washington,

USA

In practice since 2003 in Singapore and Washington State

Special areas of interest include natural alternatives for Autism,

Attention Deficit Disorder, Diabetes and other chronic diseases

Specifically:

Gastrointestinal health in Autism and other developmental

disorders

Autoimmune disorders

Clinical nutrition


4/67


Objectives of the Talk

To develop an understanding of the

Biomedical approach to Autism (especiallyas it relates to gut health)

How to measure progress

To understand how to get started

Individualized therapy

How to decide if you should try it


5/67


Autism on the rise There has been a disturbing trend over the last 2

decades

Incidence in the past was always cited as nearly 1 in2000 individuals

Evidence is that the incidence has increased to 1 in200, with the incidence in some areas even higher!

No one definitive cause for this condition that hasbeen identified.

An autism epidemic? No decrease in cases in sight.


6/67


Overt Signs and Symptoms of

impaired digestion

Gas and bloating

Belching Heartburn

Acid Reflux

Nausea/vomiting Constipation

Diarrhea


7/67


Hidden Signs and Symptoms of

Gut disturbance

Behavioral changes

Dazed sensation

Food reactions Toe Walking (a sign of constipation)

Asthma

Skin rashes

Headaches Attention deficits

History of chronic infections

Impaired immune function


8/67


Evidence of poor intestinal health

in Autism Food Allergies

Dysbiosis (Imbalance) of bacterial flora in intestines

Candida and Clostridium overgrowth in the gut Increased intestinal permeability Leaky Gut

Syndrome

Opioid-receptor effects of milk and wheat proteins(casein and gluten)

Oxidative damage of intestinal tissues

Abnormal immune function

Increased levels of heavy metals

Impaired detoxificationand increased toxic load


9/67


Autism: The Biomedical Approach Aims to correct the underlying abnormalities seen

in Autistic patients.

Treatment consists of: Dietary modification

Removal of food allergens and sensitivities from the diet

Decrease sugars and processed foods

Targeted nutritional supplementation Determined by results of functional physiological testing of

stool, blood, and urine

To improve gut health

Reduce toxic burden


10/67


Autism: The Biomedical Approach Treatment targets the following areas:

Food Allergies

Reducing Free Radical damage

Improving Digestive Function Rebuilding intestinal mucosa and correcting Leaky

Gut

Correcting bacterial imbalances

Eliminating intestinal pathogens (Candida and

Clostridia) Removing toxins and improving detoxification

systems

Stimulating immune function


11/67


Food Allergies A number of autistic kids have been shown to have one or more

significant food allergies.

Dramatic improvement can be seen in many cases upon eliminationof allergic foods from the diet. Lucarelli S, et al. Food allergy and infantile autism.Panminerva Med. 1995 Sep;37(3):137-41.

The majority of problematic food allergies are the delayed-onsettype (IgG), taking hours to days to occur.

Immediate reactions are easier to identify and eliminate becausethey have a fast onset (IgE antibody). (Skin prick testing identifiesonly these type, and is better for environmental sensitivities)

The blood testing screens multiple foods for reactions based on bothimmediate and delayed onset (IgG and IgE antibody reactions).

Major allergens may be dairy, wheat, soy, eggs. Other foods canalso be reactive.


12/67


Gluten and Casein defined Gluten is a protein component of grains. The following grains

contain gluten: Wheat (durum, semolina)

Rye

Barley Spelt

Triticale

Kamut

Farina

Oats (controversial)

Casein is a protein derived from dairy products: Includes milk, butter, cheese, yogurt, ice cream, etc.

Goats milk has casein, but it may or may not be reactive(controversial). Elliott RB, Harris DP, Hill JP, Bibby NJ, Wasmuth HE. Type I (insulin-dependent) diabetes mellitus and cow milk: casein variant consumption. Diabetologia 1999Mar;42(3):292-6


13/67


The Role of Gluten and Casein inautism

Opioid-like effects

Food Allergies

Free-radical damage to gut cells

Leaky Gut syndrome


14/67


Opioid effects of gluten and casein These are not food allergies and are not

necessarily immune-mediated reactions.

Many food proteins are known to exert

opioid-like effects on the brain. Teschemacher H.Opioid receptor ligands derived from food proteins. CurrPharm Des. 2003;9(16):1331-44.

These proteins attach to receptors in the brain.They are nearly identical in structure tonatural opioid-binding peptides. (Can have

morphine-like effects) The proteins enter the blood circulation in

incompletely digested forms (due to digestiveenzyme deficiencies and leaky gut) and

potentially cause changes in mood and brainfunction.


15/67


Opioid effects of gluten and casein

These effects may be responsible for autistic childrenseemingly being dazed.

Components of gluten and casein have been found in

abnormally high levels in the urine of autistic patients.Reichelt, et al. Gluten, milk proteins and autism: dietary intervention effectson behavior and peptide secretion. J Appl Nutrition 1990; 42(1):1-11.;Shaw, William, Ph.D. Biological Treatments for Autism and PDD. Overland

Park, KS: 2002.

Studies show that elimination of gluten and caseinfrom the diet has improved behavior in autisticchildren.Knivsberg AM, Reichelt KL, Hoien T, Nodland M. Arandomised, controlled study of dietary intervention in autistic syndromes.

Nutr Neurosci. 2002 Sep;5(4):251-61.

Important to remember that autistic children can haveboth allergies AND sensitivities to wheat and dairy.


16/67


Leaky Gut Syndrome The normal intestinal barrier

Tight junctions between cells do notnormally allow the entry of large

molecules into the bloodstream. Leaky gut develops when these tight

barriers between cells are compromisedand loosen up due to cell injury

This shriveling allows the passage oflarge molecules (especially food

particles such as casein and gluten)into the bloodstream.

These large molecules are incompletelydigested food proteins (possibly due todigestive enzyme deficiencies ordysfunctions)


17/67


Leaky Gut Syndrome Causes of increased intestinal

permeability include: Allergenic foods causing

inflammation of cells Incompletely digested food

proteins (gluten/casein, etc.)

Medications such as antibiotics,steroids, aspirin (irritate lining,

causing imbalance in bacterialflora)

Other potential causes includeheavy metals, yeast and bacterialovergrowth, and components ofvaccines


18/67


Leaky Gut Syndrome Evidence of intestinal problems in Autism

and ADHD Chronic nonspecific diarrhea is associated with

attention deficit disorder in childhood

There is a relationship between the presence ofADHD and greater severity of irritable bowelsyndrome. A significant number of ADHDindividuals also had IBS. Wender PH, Kalm M.

Prevalence of attention deficit disorder, residual type, and otherpsychiatric disorders in patients with irritable colon syndrome. AmJ Psychiatry. 1983 Dec;140(12):1579-82.

There is mounting evidence of impaired

intestinal permeability in autistic childrenshowing intestinal signs such as gas, bloating,diarrhea, reflux and constipation. White JF. Intestinalpathophysiology in autism. Exp Biol Med (Maywood). 2003

Jun;228(6):639-49.


19/67


Leaky Gut SyndromeEvidence of Intestinal problems (contd) Abnormal intestinal permeability (or leaky

gut) was even found in 43% of autisticchildren showing no intestinal signs orsymptoms. D'Eufemia P, et al. Abnormal intestinal

permeability in children with autism. Acta Paediatr. 1996

Sep;85(9):1076-9.

57% of patients with neurological dysfunction(including Autism and ADD patients) wereshown to have antibodies to gluten (acomponent of wheat and other grains.) LahatE, etal. Prevalence of celiac antibodies in children with neurologic

disorders. Pediatr Neurol. 2000 May;22(5):393-6.

A unique type of enterocolitis (infection of thecolon) was found in 93% of individuals withdevelopmental disorders. Wakefield AJ, et al.Enterocolitis in children with developmental disorders. Am JGastroenterol. 2000 Sep;95(9):2285-95.


20/67


Casein:

A role in Pain suppression and

Self-injurious behavior

Many autistic individuals commonly displayself-immolating behavior

Self-injurious

Head banging Scratching to the point of bleeding


21/67


Casein:

A role in Pain suppression and SIB Casein has analgesic effects

Casein is a food hormone that elicits opioid effects on opioidreceptors in the brain. Teschemacher H, Koch G, Brantl V. Milk protein-derived opioid receptorligands. Biopolymers 1997;43(2):99-117

In animals, casein was shown to greatly increase the pain thresholdcompared to controls. These researchers concluded that one derivative of casein showed pain-

relieving activity 1000x more potent than morphine. Ruthrich HL, Grecksch G, Schmidt R,and Neubert K. Linear and cyclic beta-casomorphin analogues with high analgesic activity. Peptides 1992 May-Jun;13(3):483-5

Beta casomorphin, the casein derivative found in high quantities incows milk, causes a decreased response to pain. This protein causes

behavioral changes. BlassE

M, Blom J. Beta-Casomorphin causes hypoalgesia in 10-day-old rats:evidence for central mediation. Pediatr Res 1996 Feb;39(2):199-203

Researchers studied 8 children for the presence of casein derivatives inthe brain. Casein derivatives were found in 19 different functionally-relevant areas of the brain. These proteins can play a role in theregulation of many physiological processes. Pasi A, et al. Beta-Casomorphin-immunoreactivity in the brain stem of the human infant. Res Commun Chem Pathol Pharmacol 1993 Jun;80(3):305-22.


22/67


23/67


Gluten:Direct harm to the intestines Components of gluten can harm the intestines through a

variety of mechanisms.

Studies have shown that components of gluten can causedeath (apoptosis) of intestinal cells in gluten-sensitive

patients. Giovannini C, Matarrese P, Scazzocchio B, Vari R, D'Archivio M, Straface E,Masella R, Malorni W, De Vincenzi M. Wheat gliadin induces apoptosis of intestinal cells via anautocrine mechanism involving Fas-Fas ligand pathway. FEBSLett. 2003 Apr 10;540(1-3):117-24.

Gluten activates enzymes in the intestines that cause thebreakage of tight junctions between intestinal cells. Leaky Gut. Clemente MG, De Virgiliis S, Kang JS, Macatagney R, Musu MP, Di

Pierro MR, Drago S, Congia M, Fasano A. Early effects of gliadin on enterocyte intracellularsignalling involved in intestinal barrier function. Gut. 2003 Feb;52(2):218-23.


24/67


Gluten:

Direct harm to the intestines Gluten causes an abnormal immune response with the activation of high levels of

inflammatory substances and white blood cells. Leads to active inflammation in theguts. Westerholm-Ormio M, Garioch J, Ketola I, Savilahti E. Inflammatory cytokines in small intestinal mucosa of patientswith potential coeliac disease. Clin Exp Immunol. 2002 Apr;128(1):94-101.

Some gluten-sensitive patients have been shown to have low levels of enteropeptidaseenzymes (responsible for digesting gluten protein) in their intestines.

Giving digestive enzymes resulted in near normalized growth. Moroz SP, Hadorn B,Rossi TM, Haworth JC. Celiac disease in a patient with a congenital deficiency of intestinal enteropeptidase. Am JGastroenterol. 2001 Jul;96(7):2251-4.

Gluten causes flattening of the villi in the intestines of gluten-sensitivepatients.

Villi are the projections on intestinal cells that allow absorption of nutrientsfrom foods.

This results in decreased absorption and documented nutritional deficiencies.

The villi return to their normal shapes after gluten removal, and the nutritionaldeficiencies are corrected.


25/67


The Gut-Brain Connection:The link between digestion and behavior

The Gut is our second brain, also known as theenteric nervous system. Both the brain and the gut

develop from the same tissue in the fetus. There is a network of nerves and neurotransmitters in

the tissue lining the gut that are directly linked to thebrain.

The digestive organs can operate independently fromthe CNS. In people who are brain-dead, the stomach

functions properly. Evidence suggests that emotions and feelings are

intimately associated with bowel function. Exampleis Irritable Bowel Syndrome, where stress andemotions can cause digestive symptoms.


26/67



Many autistic children develop intestinal symptoms at thesame time they are losing acquired skills such as language.This shows that gut health can have a major impact ondevelopment of sensory skills. Mcmillin DL, et al. The Abdominal Brain andEnteric Nervous System. J Alt and Compl Med. 1999; 6:575-586.

One study looked at 12 autistic children with a history ofnormal development followed by a loss of acquired skills. Allof them had developed diarrhea and abdominal pain. Wakefield AJ,et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmentaldisorder in children. Lancet 1998; 351:637-641.

The gut, like the brain, has opiate receptors. Drugs likemorphine act on the brain, but also on the gut, to cause

constipation by binding to the opiate receptors.(http://immune.altmedangel.com/gutbrain.htm) Casein and gluten proteins can similarly bind to the gut opiate

receptors, causing digestive complaints.


27/67



Neurological dysfunction in ADD and Autism may be explainedby allergies to foods and additives (as in the case of gluten). LahatE, etal. Prevalence of celiac antibodies in children with neurologic disorders. Pediatr Neurol. 2000May;22(5):393-6.

Wheat gluten component was shown to have high opioid activity.Bound receptors as well as a dose of morphine. Huebner FR, Lieberman KW,Rubino RP, Wall JS. Demonstration of high opioid-like activity in isolated peptides from wheat gluten hydrolysates.

Peptides. 1984 Nov-Dec;5(6):1139-47.

A group of adults with dementia were later found to be sensitive togluten. GF diet improved cognitive activity in some patients. CollinP, Pirttila T, Nurmikko T, Somer H, Erila T, Keyrilainen O. Celiac disease, brain atrophy, and dementia.Neurology. 1991 Mar;41(3):372-5.

A significant number of adults with migraines may have glutensensitivity. Gluten-free diet improved symptoms in majority ofcases. Gabrielli M, Cremonini F, et al. Association between migraine and Celiac disease: results from apreliminary case-control and therapeutic study. Am J Gastroenterol. 2003 Mar;98(3):625-9.


28/67



Study showed that gluten sensitivity can causeataxia (problem with coordination and walking) . Gluten caused inflammation and damage to the

cerebellum, the spinal cord, and to peripheral nerves in agroup of gluten-sensitive patients.Hadjivassiliou M, Grunewald RA, et al.Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet. 1998Nov 14;352(9140):1582-5.

Clinical evidence of an association between glutenand schizophrenia. Schizophrenics showedimprovement on a GF diet.Ross-Smith P, Jenner FA. Diet (gluten)and schizophrenia. J Hum Nutr. 1980 Apr;34(2):107-12.

Interestingly, there is a subgroup of autistic children whodevelop schizophrenia.Petty LK, Ornitz EM, Michelman JD, ZimmermanEG. Autistic children who become schizophrenic. Arch Gen Psychiatry. 1984Feb;41(2):129-35.


29/67


Determining the need for CFGF diet Signs and symptoms- Digestive symptoms indicate the presence of one or

more food sensitivities. Researchers have observed that children who exhibit autistic signs near the

time of birth are more sensitive to casein.

Children exhibiting signs only after the age of 2 are usually moresensitive to gluten.

Self-injurious behavior and clear digestive signs and symptoms maybe enough to warrant a trial on the diet.

Urine Testing Detects the levels of casein and gluten in the urine.

Elevated levels suggest the need to go on the diet. Eliminating gluten andcasein lowers the amount of these proteins in the urine.

Research has shown lowered levels correlate to behavioral improvement.

Advantage of testing:

May be able to determine whether gluten or casein or both areproblematic.

Testing is only valid prior to beginning CFGF diet!!


30/67


Urinary Test for Casein and Gluten Available from Great Plains Laboratory (USA)

Relatively simple specimen collection 5 ml. or more of firstmorning urine (ideally).

Sample reports

Patient 1: Results indicate elevated casein and gluten in urine.

Patient 2: Results show elevated gluten, but normal levels of casein.


31/67


Outcomes Many researchers recommend removing one food at a time.

Start by eliminating casein (dairy products) If individual is casein sensitive, results should be seen in 7 to 10

days.

Continue for 3 weeks to be sure of its benefits. If beneficial,continue further.

Casein is a major culprit in constipation. 50% of autistic children have constipation.

Second, eliminate gluten (wheat and other grains) Gluten elimination takes longer to produce results

Trial should be done for 3 months to determine effectiveness. Ifeffective, continue the diet.

***There are some reports of benefit seen only after 6months or longer on the diet.***


32/67


Cumulative effects of opioids The effects of gluten and casein are mediated by

the concept of Total Load

This means that in order for gluten and casein to

have an effect on the brain, a majority ofopiate receptors need to be boundsimultaneously.

Reducing the total body burden by eliminatingthese foods eliminates the opioid effects.

Eliminating these foods for 4-6 months as muchas possible is a good idea.

Thereafter, the person maybe able to have somecasein and gluten-containing food (on a rotation

basis, once every 4-5 days) without problems.Supplemental enzymes can help


33/67


The Bottom Line Be as strict as possible on the diet!!

But you will see benefit even if not 100%compliant!

A trial on the diet is certainly worthundertaking.

80% of the cases have shown benefit onthe diet in research trials and in practicalexperience.


34/67


Cautions and Considerations Gluten and casein-containing foods are feel good foods

because of their opioid effects.

Withdrawal symptoms may be seen (but not in all cases), suchas strong cravings for these foods. Yeast and bad bacteria (often seen as an issue in autism) thrive on

these foods, and this is one reason autistic people crave these foods. Increased irritability is a common symptom.

Withdrawal will last a maximum of 1 to 2 weeks and will diminishafter that. Withdrawal is less severe with casein (observation)

Withdrawal symptoms may be avoided by removing only one foodgroup at a time.

Beneficial side effects include improved presence of mind,concentration, behavior, diminished self-immolation, drasticallyimproved digestive function and more!


35/67


Nutritional Deficiency with CFGF In many autistic children, wheat and dairy form a significantpart of the diet. Autistic patients tend to be finicky eaters, with a limited diet.

One reason may be the feel good effects of wheat and dairyproducts. People feel good when eating these foods.

Removal of these foods can pose a problem with nutrition Dairy is the major source of Calcium in many of these children

It is important to seek help from knowledgeable professionals whenconsidering the CFGF diet

Adequate supplementation may be needed to prevent vitamin andmineral deficiencies

Professionals can help to properly guide the implementation of the diet.

Interestingly, experience shows that when patients go on aCFGF diet, their dietary choices tend to significantly broaden. Other good sources of Calcium in the diet include green leafy

vegetables, fish, seafood (beware of high levels of mercury and otherheavy metals), beans, nuts and seeds.


36/67


CFGF is not the Complete Story Other Dietary factors

Eliminating sugars and simple carbohydrates to

control yeast and bacteria overgrowth

Eating a healthy well-rounded diet high in

nutrition

Increasing fiber intake and water consumption

to remove toxins Testing for and removing other food allergens


37/67


CFGF is not the Complete Story Correcting Leaky Gut and Digestion

An integral part of the biomedical approach

Intolerances to Casein and Gluten are a result of LeakyGutand poor digestive health

Research in patients on a GF diet showed that there wasstill an imbalance in the bacteria of the intestines. Patientsstill had digestive symptoms. The overgrowth of harmful bacteria and yeast persisted even

months into the GF diet. Tursi A, Brandimarte G, Giorgetti G. High prevalence ofsmall intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal

symptoms after gluten withdrawal. Am J Gastroenterol. 2003 Apr;98(4):839-43.

Treating Leaky Gut and related issues can improve theeffectiveness of the diet Reduces reactions to food allergens

Dietary measures can be relaxed when the guts are healed.


38/67


Intestinal bacterial imbalance Decreased amounts of beneficial bacteria seen in autistic

patients. Allows for overgrowth of harmful bacteria and yeast

Can be due to chronic use of antibiotics and other medications,as well as dietary factors (high intake of refined foods, sugars)

Antibiotics are frequently given for ear infections inchildhood. Overuse and unnecessary use of antibiotics leadsto a number of problems

Autistic children tend to have a number of ear infectionsduring childhood Physicians treat with (and parentsrequest!) antibiotics.

Earlier incidence of ear infections was correlated to thedevelopment of autism spectrum disorders. In autisticchildren, frequency of ear infections also correlated withseverity of autism. (Konstantareas M and Homatidis S. Ear infections inautistic and normal children. J Autism and Dev Dis 17:585, 1987.)

Stool tests of autistic patients frequently show no or lowlevels of growth of L. acidophilus and Bifidobacterium

species.


39/67


Candida and Clostridium Candida overgrowth of the intestinal tract iscommon in autistic individuals, as shown byincreased yeast byproducts in the urine. Shaw, William,

Ph.D. Biological Treatments for Autism and PDD. Overland Park, KS: 2002

Antifungal treatment has also been shown todecrease the amount of these yeast byproductsand improve autistic symptoms.

Chronic or frequent antibiotic usage allowsCandida overgrowth of the intestines by killingoff normal beneficial bacteria. Samonis G, et al. Prospective

evaluation of the impact of broad-spectrum antibiotics on the yeast flora of thehuman gut. Eur J Clin Microbiology & Inf Dis 13:665-7, 1994.

Some antibiotics have actually been shown topromote yeast growth. Kasckin P. Some aspects of the candidosisproblem. Mycopathologia et Mycologia applicata. 53:173-181, 1974.


40/67


Candida and Clostridium Intestinal overgrowth of Clostridium bacteria has also been

identified in some children with autism. Many have highlevels of a metabolite of Clostridium in their urine. Shaw,William, Ph.D. Biological Treatments for Autism and PDD. Overland Park, KS: 2002

Various Clostridium species cause diseases such as tetanus,gangrene, diarrhea and botulism.

The DPT vaccine may cause a low level tetanus infection inautistic children. Shaw, William, Ph.D. Biological Treatments for Autism andPDD. Overland Park, KS: 2002.; Crone N and Reder A. Severe tetanus in immunizedpatients with high anti-tetanus titers. Neurology 42: 761-764, 1992.

Decreased levels of beneficial intestinal bacteria can lead toan overgrowth of Clostridium following the use ofantibiotics. Clostridium species are resistant to a number of

antibiotics. Finegold S. Anaerobic infections and Clostridium difficile colitisemerging during antibacterial therapy. Scand J Inf Dis Suppl 49: 160-164, 1986. Clostridium species produce a potent neurotoxin that can lead

to sensory hypersensitivity, which may help explain sometraits of autistic children.


41/67


Intestinal oxidative damage Oxidative Stress is cellular injury resulting from free-radical

generation that exceeds available antioxidants.

The interplay of genes, nutrients and toxins

determines the level of oxidative stress. Free-radicals are highly-reactive molecules which damage

cells by oxidizing fats, proteins and DNA.

Some free-radicals are a product of energy metabolism

Environmental toxins (heavy metals such as

mercury, pesticides) are either free-radicalsthemselves, or lead to the generation of free-radicals in the body (as do infections and foodallergies).


42/67


What Increases Free-Radicals?Smoking, pollution, ozone

Heavy metals

Inflammatory cytokinesInfections, allergies

Oxidized foods, food additives

Dirty foods (insecticide, herbicide)

Depleted anti-oxidant defense


43/67


Antioxidants as free radical scavengers


44/67


Free Radical damageHealthy cells

Delinearization of FFAs affects

cellular communication and transport


45/67


Immune System abnormalities Candida interfering with immune function

The immune system of Candida-infected individuals producesantibodies against Candida proteins that are involved in reproduction.Vojdani A, et al. Immunological cross-reactivity between Candida albicans and human tissue. J ClinLab Immunol 48: 1-15, 1996.

Alpha-gliadin (a part of gluten) from wheat is similar in structure to aCandida reproductive protein. Antibodies produced against yeast may

be tricked into reacting against wheat. Theoretically, this may be onereason autistic individuals react to wheat. Shaw, William, Ph.D. BiologicalTreatments for Autism and PDD. Overland Park, KS: 2002

Increased WBCs in the colon Intestinal analysis performed in 21 autistic children showed increased

numbers of white blood cells, indicating an inflammation or infectionof the intestines. These white cells seem specifically targeted againstthe cells of the intestinal walls. This points to gut wall dysfunction inautistic individuals. Furlano RI, et al. Colonic CD8 and gamma delta T-cell infiltration withepithelial damage in children with autism. J Pediatr. 2001 Mar;138(3):366-72.


46/67


Immune System abnormalities Immune proteins (Ig) have been found to be deficient in

autism.

In one study, 20 % of autistic children had IgA antibody

deficiency; 8% lacked it completely; none of the controlshad IgA deficiency. 20% also showed deficiency of IgG.Gupta S, et al. Dysregulated immune system in children with autism. Beneficial effects of intravenous immuneglobulin on autistic characteristics. Autism Develop Dis 26: 439-452, 1996.

Deficiencies of proteins lead to low immune function inability to fight off infections.

IgA is the major class of immune globulin associated with

intestinal tissue. A deficiency of IgA means low gutimmunity, predisposing to local inflammation, infection andallergies.


47/67


Putting it all together: A vicious cycle?

Ear infections/Lung Infections

Antibiotics kill beneficial bacteria

Allow overgrowth of yeast

Promote Clostridium growth

Development of Leaky Gut

Release of toxins

Entry of toxins

Entry of opioid food proteins

Impaired detoxification

Food Allergies and sensitivities

Sugars feed Candida/Clostridium

Food allergens inflame intestines

Impaired Digestion/

Enzyme deficiencies

Improper breakdown of foods

Vaccines DPT and MMR

Mercury damages gut cells

Organisms produce chronic infections

Binding of opioid foods, toxins to brain

Behavioral changes

Hypersensitivity


48/67


Relevant Laboratory Assessment CBC +Chem panel

a way of determining general health status andgathering information about vitamin and mineraldeficiencies, liver function, etc.

Serum Homocysteine indicator of methylation status for DNA repair and

detoxification indirectly assesses need formethylation cofactors such as B6, folic acid, B12 andDMG/TMG.

Methylmalonic acid (MMA) Measure of vitamin B12 deficiency


49/67


Relevant laboratory assessment Food Allergy Assessment

Multiple Options

IgG + IgE Antibody Assessment (blood test).

Identifies immediate and delayed food reactions.

Intradermal Testing

Food Elimination and Challenge.

Intestinal Permeability Studies.

Testing for leaky gut

Lactulose/Mannitol urine concentrations are measured.

Patient drinks a solution of two sugars and collects urine for next 6 hours

Mannitol is a small molecule and is normally absorbed; Lactulose is a large

molecule and is not normally absorbed.

Elevated concentration of Lactulose in the urine means Leaky Gut is

present.


50/67


Relevant laboratory assessment Comprehensive Digestive Stool Analysis.

Assesses Microbiology, Digestion, Yeast Infection, Absorption /Malabsorption

Assess gut bacterial balance.

Measures levels of Lactobacillus and Bifidobacterium in theintestines.

Gives us information on the presence of Candida and pathogenicbacteria and how they affect gut health.

Urinary Peptide Test Checks for excretion of gluten and casein peptides in the urine

Elevated levels of these proteins correlates with them having opioid-like effects in children.


51/67


Relevant laboratory assessment Organic Acid Testing (OAT panel)

This tests for byproducts of yeast and bacteria.

Urine collection. Good for picking up systemic infection with Candida

Also useful for testing for the presence of Clostridiumin the intestines

Helpful for distinguishing Candida from Clostridia

overgrowth, or presence of both simultaneously. Also tests for certain nutrient and vitamin deficiencies.


52/67


Relevant laboratory assessmentNot all tests will be positive in all cases of

autism.

Tests serve as a guide towards

implementation of the protocol

They help to identify areas of focus for

therapeutic intervention.


53/67


Therapeutic Nutritional protocol The goal is to correct underlying digestive

imbalances to: Improve absorption and assimilation of nutrition

Reduce food sensitivities

Impact the physiology of mental function and behavior


54/67


Treatment targets and principles Dietary Modification

Reducing oxidative damage

Improving Digestive Function Rebuilding intestinal mucosa and correcting Leaky

Gut

Correcting bacterial dysbiosis

Eliminating intestinal pathogens (Candida and

Clostridia)

Removing toxins

Stimulating immune function


55/67


Dietary Modification This is assessed by Food Allergy testing

and Urinary Peptide testing.

Based on the above results, avoidance ofpotentially allergenic foods for the durationof protocol.

If urinary peptide test is positive, avoidanceof gluten and casein is important for theduration of protocol.


56/67


Reducing Oxidative Damage Increase dietary intake of foods rich in

antioxidants

Good quality, high-potency multiple

vitamin and mineral formula

Additional antioxidant supplements on a

rotation basis

A, C, E, Zinc and Selenium


57/67


Improving Digestive function Dietary avoidance of any potential food

allergens as determined by testing.

Acid-stable fungal-sourced digestive

enzymes

Hydrochloric acid(determined by CDSA)

These improve the breakdown of foods and

increase the absorption of nutrients.


58/67


Correcting Leaky Gut / Rebuilding

intestinal tissue

Nutrition for intestinal cell repair and

rebuilding:

L-Glutamine and other Amino Acids

Gamma-oryzanol (rice bran)

Phosphatidylcholine

Essential fatty acids (combination product

containing both omega 3 and omega 6 oils)


59/67


Correcting Intestinal Bacterial

BalanceAim is to restore beneficial bacteria that normally

colonize the intestines. These bacteria aid in thedigestion of our foods and increase the absorption ofour nutrients.

Probiotics (containing Lactobacillus andBifidobacterium species)

Fructooligosaccharides (FOS) food for the

beneficial bacteria. Promotes growth ofBifidobacterium while inhibiting growth of yeastsuch as Candida


60/67


Eliminating Candida and Clostridia

overgrowth Assessed by the CDSA test and organic acids. Can

vary from individual to individual.

Diet should be low in sugars, simple carbohydrates,alcohol and processed foods. These foods can feedthe yeast.

Various treatments based on type of pathogens

Herbs/ Drugs to control Candida

Products containing Caprylic acidand Oregano oil. Nystatin and other antifungals

The most effective treatment forClostridium hasbeen the use ofProbiotics. Shaw, William, Ph.D. Biological Treatmentsfor Autism and PDD. Overland Park, KS: 2002


61/67


Removing intestinal toxins Increase all sources of dietary fiber.

Candida and other pathogens release toxins

in die-off reactions. These toxins can

further injure the intestinal mucosa.

Fiber binds the toxins in the GI tract and

aids in their removal through the stools.


62/67


Improving Detoxification through

Enhanced Methylation

Depending on results of lab tests for

homocysteine and MMA:

Methyl-B12

Vitamin B6

Folic/ folinic acid

Dimethylglycine / Trimethylglycine

Magnesium


63/67


Monitoring of Therapy Two methods to monitor improvement Clinical/observational (Physician, parents)

Monitoring of behavioral improvements throughout the treatment periodand thereafter.

Customized assessment questionnaires for individual children.

Monitoring improvement over time of gastrointestinal signs andsymptoms (reductions in gas, bloating, constipation, reflux, diarrhea,etc.)

Questionnaires and food diaries ATEC (Autism Treatment Evaluation Checklist) scores (ARI website)

To establish a baseline and to monitor progress

Objective To monitor improvements in physiology Initial assessment followed by reassessment of laboratory measures canbe done (Food allergy, Intestinal permeability, CDSA) to determinephysiological changes.

Signs of improvement are reduction of intestinal permeability, improveddigestive function, idealization of intestinal bacterial balance andreduced number of food allergies.


64/67


Practical issues of implementation

specific to Autism

Collection of test samples for laboratory

assessment: blood, urine and stool.

Sensitivity to taste of supplements, ability toswallow capsules.

Determining correct dosages of supplements

based on age and body weight.


65/67


Remarks Proper treatment of Autism using the biomedical

approach entails finding the cause of the problem.

Correcting digestion provides a foundation for

optimizing health.

Avoid using the shotgun approach to nutrition,

as it may do more harm than good.

Many doctors treat with this approach, rather than

performing the necessary testing (out of ignorance??)

The laboratory testing helps to customize therapy.

The road toHealth is paved with goodIntestines -Unknown


66/67


67/67

Results of GFCF Survey 2002Respondents Average age at

diet start

Average time spent

on diet

Average change in

ATEC score

Dramatic 11.5% (16) 3.0 years 18 months -85 (82 %)

Excellent 29.5% (42) 3.3 years 13 months -54 (62 %)

Good 27% (37) 4.7 years 8 months -28 (38 %)

Moderate 22.6% (31) 4.4 years 7 months -12 (16 %)

No result 5% (7) 5.7 years 1 month 0

Regression 4.4% (6) 5.5 years 7 months +5 (16 %)

Bio Medical Approach to Autism

Documents