ENCEPHALOPATHIES including AUTISTIC SPECTRUM DISORDERS and
PDD
Although the diagnostic criteria and the
dependence on behavior modification strategies might lead one to believe that
autism, PDD, and Aspberger’s have psychological origins, there is greater
evidence for physiologic causes. One
study showed stunted branches in the nerve cells of an area of the brain called
the hippocampus. Many of the children
have enlarged craniums (skulls) and there may be a correlation to a certain
gene mutations (Apo E4, Glutathione, etc).
It is not clear if there is a single causative abnormality exacerbated
by a variety of factors or if there are multiple causative factors with a
common clinical outcome. For now my
suggestions are 1) optimize physiologic processes; 2) modify and strengthen
appropriate behaviors; and 3) be diligent in searching for possible underlying
causes.
Causative and/or Exacerbating factors
DIETARY FACTORS: Food additives,
impaired simple carbohydrate (glucose) metabolism, and food
allergies/sensitivities. The most common
intolerances are gluten-containing grains (Wheat (durum, semolina, kamut,
spelt), rye, barley, triticale, etc) and casein (a milk protein). Healing the intestines is a by-product of
proper diet. Many parents are finding
the Specific Carbohydrate Diet an excellent guideline to heal the intestines,
improve behavior, and provide balanced nutrition.
SENSORY
INPUT IMPAIRMENT: Chronic fluid retention in the middle ear -
children with moderate to severe hearing loss tend to have impaired speech and
language development, lowered general intelligence scores and learning
difficulties. Visual abilities such as
integration, tracking, etc. play a significant role.
NUTRIENT
DEFICIENCIES:
Almost any nutrient deficiency can impair brain function. Iron deficiency is the most common nutrient
deficiency in American children and is associated with marked reduction in
attentiveness, less complex or purposeful, narrower attention span, decreased
persistence and decreased voluntary activity.
Correction of even subtle nutritional variables exerts a substantial
influence on learning and behavior. Zinc and sulfur are also commonly
insufficient.
TOXIC
ELEMENT EXPOSURE:
There is a strong relationship between childhood learning disabilities and body
stores of heavy metals, particularly lead.
Copper toxicity with elevated ceruloplasmin levels has been considered
of possible significance since catecholamine-synthesizing enzymes are activated
by copper. Aluminum interferes with the
citric acid cycle (alpha-ketoglutarate) and thereby reduces energy production
from foods. This has been shown to influence
mood, energy levels. Antimony interferes
with monoamine oxidase and cholinesterase. Mercury is not uncommonly involved.
CANDIDA OVERGROWTH: there is a substantial amount of clinical
observations that support the effect that byproducts of bowel Candida and/or
other fungi overgrowth have on the nervous system and behavior. Gastrointestinal health plays a key role in
many chronic illnesses. This is worth
looking into for all children with developmental or behavioral concerns.
DISORDERED
AMINO ACID METABOLISM: serotonin
metabolism may be an avenue of exploration based on the occasional response to
SSRI's like Prozac. Experts estimate
that 25-30% of children with PDD have elevated serotonin blood levels and low
brain levels. The source is thought to
be from an inflamed GI tract, food reactivities, and/or malabsorption. The effects could be manifested as light,
sound, and external stimuli hypersensitivity.
The metabolism of sulfur amino acids are often abnormal with low levels
of cystine and cystathione which in turn could reduce the body's ability to
perform Phase II detoxication and allow toxic by-products to accumulate in the
brain. Methylation plays an important
role in brain function and is an area that shows promise in developmental and
behavioral dysfunction.
IMMUNE DYSREGULATION: It is not
uncommon for the onset of autism to occur after a viral episode or an
immunization. There is ongoing work that
suggests the abnormal response to measles and rubella vaccination (part of MMR)
plays a role. Synergistic toxicity of
the mercury preservative may occur in certain children, which explains why the
reaction does not occur in all children.
Preliminary studies using immune modification therapies show very
promising improvements in at least certain autistic children.
¨ DISORDERED FATTY ACID METABOLISM: Data suggests very
long chain fatty acids (VLCFA) are disproportionately elevated in many children
with autism and indicate a deficiency in peroxisomal b-oxidation. This in
turn leads causes an accumulation of VLCFA, which is toxic to the nervous
system. In my experience, supplying the
essential fatty acids (omega-3 and omerga-6) in the right proportions provides
some of the most satisfying responses.
Diagnostic
Considerations
Food Sensitivities - There are many ways to try to assess food
hypersensitivity. Each has
limitations. Allergy skin tests are
rapid, inexpensive, accurate, and can be helpful when positive but do not
include non-IgE mediated immune reactions to foods or other ingested
agents. Blood tests include RASTs and
ELISA methods to detect allergies caused by IgE or IgG antibodies. Drawing blood is required, they can be
expensive, and are considered controversial in terms of their significance but
have the advantage of having a wider array of foods available than skin
tests. There is evidence IgG type blood
tests only indicate recent or recurrent intake rather than allergic or
hypersensitivity reactions. Other
immunologic tests include the ELISA/ACT that reportedly reveals other type of
immune reactions including those due to IgA, IgM, Immune Complexes, and/or T
cells. The test is expensive and
specific. When the foods/items found to
be reactive on ELISA/ACT are avoided, improvement in those conditions related
to an immune reaction has been shown in scientific studies and have been
observed in my practice. None of the
above procedures identifies foods/items causing metabolic reactions that have
no immune basis. Muscle tests or other
Applied Kinesiology techniques can be of help but are dependent on the skill of
the tester and are considered invalid by most medical doctors. Electromagnetic and resistance type equipment
uses a similar basis for finding intolerances and remains dependent on the
skill of the tester, the device being used, and is controversial. A diet diary with food avoidance of
“high-risk” foods or by use of defined rotational diets often provides the most
convincing information. Even if the lab tests are negative, your child may
still have reactions to a particular food - the reactions may not even involve
the immune system directly. For this
reason, gluten and casein are always suspect because of their metabolic effects
in addition to any immune reactions they may trigger. 100% avoidance and monitoring is the only way
to be certain of food's effect on your child.
Sensory Input
Impairment
- audiometry and tympanometry are simple, inexpensive, and readily
available. More sophisticated testing
with neural mapping of hearing and visual input may also be worthwhile. Functional vision problems should be
evaluated by a Developmental Optometrist as vision is more than simply having
20/20 eyesight. It is a complex process
involving over 20 visual abilities and more than 65% of all the pathways to the
brain. Nearly 80% of what a child
perceives, comprehends and remembers depends on the efficiency of the visual
system.
Nutrient
Deficiency
- can be detected by a few symptoms such as peculiar food intake habits and a
few physical findings suggestive of mineral imbalances. Common laboratory tests of the blood, urine,
and hair can also give insight into the nutritional needs and metabolic status
of the individual. Unfortunately, most
medical doctors are not as familiar with these tests as they are with the
routine lab evaluations.
Heavy
metal evaluation
- Hair analyses are a simple and inexpensive screening tool for heavy
metals. When collected properly, hair
samples give a reliable indication of heavy metal burdens. A urinary provocation challenge is a more
sensitive test and involves a timed 6 or 24 hour urine collection after giving
a chelating agent such as DMSA or NDF Mier Drops that chelates heavy metals
into the urine.
Immunologic
Assessment
- initially includes looking for deficiencies, abnormal responses to
immunizations, high levels of viral antibodies or replication, and evidence of
yeast overgrowth...
Structural
Abnormalities
- some children with autism have disorders detectable through imaging
studies. If there is any suggestion of
injury, seizure activity, etc. a full diagnostic evaluation should be
performed.
Management Approaches
Dietary
Recommendations
- for all children limiting simple processed carbohydrates (sugar, candies,
sweets, etc.) is required without exception.
Specific foods based on tests or observation at home plays a critical
role in nearly every case successfully managed.
Some fats should be avoided by autistic children based on the work at
the Bio Body Centre: mustard, peanuts
(including peanut butter and peanut oil), canola oil, hydrogenated vegetable
oil, garlic and garlic oil/salts, and margarine. Appropriate alternatives include extra virgin
olive oil, organic raw butter, and flax oil.
Because aspartame (NutraSweet®, Equal®) is a neurotoxin, it must be
avoided by everyone. Gluten
and casein avoidance seems to be critical for the vast majority of
patients and therefore is mandatory.
Nutritional
Supplementation
- A U.S.D.A.’s report on the vitamin and mineral status of Americans eating a
standard Western diet showed marked and widespread nutrient deficits without
overt signs of malnourishment or disease. Based on this data and my own
nutritional evaluations of children with autism and other learning
difficulties, specific and individualized supplementation is nearly always
required. Zinc, sulfur, fatty acids, neurotransmitters,
and methylation are common areas that warrant specific attention.
Detoxication - of heavy metals or
organic toxins may provide dramatic improvement. This is my opinion provides the most
consistent benefit of any intervention we offer. Reducing Candida or bowel bacterial overgrowth
also helps. Glutathione, both a nutrient and a detoxification agent, is often
associated with remarkable improvements.
Unfortunately, intravenous glutathione is much more effective than any
other form (oral, inhaled, and transdermal) we have tried.
Behavioral
Interventions
- although autism is not a behavioral problem, programs involving discrete
trials and sensory input benefits many autistic children and can be an adjunct
to other biological therapies.
Neuronal
Pathway Stimulation
- stimulation of the nerve cells may be accomplished by fibroblast growth
factor (FGF), neural trophic products, certain phosphatides, and perhaps
masking (which I do not recommend).
Secretin – is available for IV administration. Secretin receptors in the brain (pituitary
and pineal especially) are of unknown function, but do increase brain blood
flow on SPECT scan. Increased secretion
seen after a steak meal or with HCl but in IBD, vagotomy, and with
anti-cholinergics there is reduced responsivity to Secretin (not insulin). Treatment for hyperthyroidism increases Secretin
levels. Duodenal extracts may provide
some support for Secretin production.
Feb
2006
