Biomedical Treatments for Autism Dr. Suzette Mailloux ND Holistic Medical Clinic

222 Front Street Fairbanks, AK 99701 (907)451-7100

�  Biomedical treatments DO NOT cure autism, however they can greatly improve quality of life

�  Individuals on the autism spectrum have different contributing factors, and different levels of functioning. ASD is composed of multiple disease processes presenting as similar symptoms, therefore different treatments will work for different individuals �  Genetics �  Infections �  Environmental exposures �  Allergies

�  No single treatment will be effective for everyone on the autism spectrum. Many times it takes both testing and trial and error to determine what will help

Genetics

Environmental exposure

Immunological triggers

Autism

Overview 1.  Diets

�  GFCF �  Food allergies and

sensitivities �  SCD/ GAPS �  Low phenol diet �  Improved diet- low

glycemic index/ nutrient dense

2.  Digestion

3.  Sleep

4.  Hormonal imbalance

5.  Nutritional therapies �  B6, Mg, EFA’s, zinc,

probiotics

6.  Methylation support

7.  Environmental toxins �  Avoidance, testing,

chelation

8.  Labwork

9.  How do I use this information?

Possible benefits of special diets

�  Increased speech and/ or language �  Efforts to speak, vocabulary, complexity of

conversation

�  Improved social interaction �  Increased interest in peers, initiation of play, group

tolerance

�  Decreased self stimulation or injurious behaviors

�  Improved digestion

�  Improved sleep and immune function

GFCF- Gluten free casein free �  Most common/ most researched diet

�  A great place to start!

�  Whey and casein are the 2 main proteins in dairy

�  Gluten- large protein made up of many different proteins including gliadin. Found in wheat, rye, barley, spelt �  Contained in many other substances- including personal

care products, stickers

�  Casomorphin/ gliadorphin- opiods that can be formed in the body after eating casein and gliadin

�  Many kids also benefit from removing soy due to gluten- cross reactivity

�  Takes time to notice the benefit. For ASD individuals I suggest removing foods for minimum of 6-8 months

Food allergies and sensitivities �  Very common among

individuals with ASD �  Family history of allergies

�  Food sensitivity testing �  ELISA- genova, great plains, US

Biotek

�  IgG/ IgA/ IgE

�  MRT- mediator release testing is more sensitive

�  Elimination diets- more work, more information

�  For individuals with autism duration is much longer

�  Can exist even if you test negative!

�  Symptoms- rashes, headaches, fatigue, digestive problems, joint pain, irritability, distractibility

�  NAET- Nambudripad’s Allergy Elimination Technique

SCD/ GAPS/ Paleo �  Specific carbohydrate diet: Developed to address

ulcerative colitis. Book- Breaking the Vicious Cycle. �  GAPS (gut and psychology syndrome) developed more

specifically for neurological issues. Includes more fermented foods/ bone broths

�  “Specific carbohydrates” are easier to digest, leaving less for the microbes �  Diet consists mainly of meat, non-starchy vegetables, healthy

fats and certain fruits �  Not casein free, but it is a good idea to avoid dairy until you

know it isn’t an issue

�  Based on the theory that imbalance in microflora along with genetic predisposition causes ASD. �  Incompletely digested carbohydrates stay in the GI tract and

become food for microbes

SCD/ GAPS/ Paleo, cont �  SCD is a good place to start if you have:

�  Diarrhea (though can also help with constipation)

�  Significant gas and bloating �  Family history of inflammatory bowel disease or IBS

�  Tried GFCF without improvement

�  Paleo diet �  Many similarities to SCD �  Grain/ dairy/ legume free �  Can be easier to follow, very popular right now/ more

resources

Low Phenol diet/ Feingold diet �  Developed by Dr. Feingold (pediatrician and allergist) to

reduce hyperactivity in children

�  Naturally occurring phenols are present in all foods �  Avoid synthetic phenols and reduce natural �  Dose dependent- some kids benefit from partial reduction

�  Limiting phenols (ie: salicylates) food dyes/ additives, tomatoes, apples, peanuts, banana, oranges, cocoa, red grapes, milk �  Many alternative fruits and vegetables are lower in phenols

�  Helps when there is limited sulfation in the liver- supporting sulfation also helps �  Epsom salt baths, molybdenum �  Vitamin B6 (Pyridoxal-5-phosphate) can exacerbate

symptoms if used alone

Low Phenol diet/ Feingold diet �  Symptoms: dark circles

under the eyes, red face and ears, hyperactivity, impulsivity, aggression, headache, self- stimming or injurious behavior, insomnia, night waking, inappropriate laughter, poor urinary control

�  If self injurious behavior is present try implementing a low phenol diet, especially if GFCF has not offered relief

Improved Diet �  Low glycemic index,

nutrient dense �  High protein breakfast

�  Vegetables 3-4 servings/ day

�  Fruits 1-2 servings/ day

�  2-3 servings of protein

�  2-3 servings of whole grains

�  Reduce or avoid added sugars/ junk food/ fried foods and other trans fats

�  Avoid additives- preservatives, artificial colors

Digestion �  Constipation- aim for 1-2 bowel

movements daily �  Fiber (ground flax seed or chia

seed for EFA’s), water, magnesium citrate, vitamin C

�  Probiotics

�  Food intolerances- Dairy? �  Enema or colonic hydrotherapy

to retrain bowel

�  Diarrhea �  Identify food intolerances �  Probiotics �  Stress- fight, flight, or freeze

Digestion �  Reflux/ heartburn

�  Symptoms can include: Insomnia, fussiness, gas and bloating

�  Stomach acid support- Betaine HCl, bitters, enzymes

�  Demulcents- slippery elm, marshmallow, throat coat tea, DGL, aloe juice

�  Avoid acid blocking medications- reduced absorption of nutrients

�  Stool analysis- culture for bacteria and yeast, enzyme levels, inflammation, blood

Sleep disturbances �  Investigate possible contributors

�  Sources of pain- digestive tract, headaches, sinus pressure

�  Thyroid function �  Distinguish between difficulty falling and staying

asleep

�  Sleep aids- epsom salt baths, melatonin, magnesium citrate (natural calm drink), herbs (valerian, passiflora, skullcap, chamomile, avena), phosphatidyl serine

�  Weighted blanket or multiple blankets

�  Prescription sleep aids as a last resort- side effects, long term effect on the brain

Sleep Hygiene �  Set sleep schedule that allows for

adequate sleep time for age. Avoid oversleeping, it interferes with the next night’s sleep.

�  Go to bed and get up at the same time each day (including weekends!).

�  The last 1-2 hours before bed is quiet time: reading, calm play, bath. No electronics- tv, phone, ipad, computer.

�  Bedroom should be cave-like. Quiet, dark, cool. Temperature 60-65 degrees is best.

�  Keep pets out of the bedroom

�  If you have problems with waking in the middle of the night have a small protein snack just before bed. This keeps blood sugar steady.

Make a consistent bedtime routine. Bath, book, pajamas, song. Brief enough to be performed nightly. Each step should progress towards the bedroom/ bed.

During the day:

�  No caffeine after noon (or at any time). Remember chocolate has caffeine.

�  Avoid naps for adults and older children

�  Exercise regularly. This decreases the time needed to fall asleep. Most people do better avoiding exercise in the late evening. Relaxing exercise such as yoga can be performed before bed.

�  Aim for light exposure in the early morning. Natural light if possible, or happy light during the winter. Melatonin is suppressed by light and secreted during the darkness.

Hormonal imbalance �  Important to address, especially as children reach puberty and

beyond

�  Chart behavior, see if it relates to menstrual cycle

�  Any symptoms worse the 2nd half of menstrual cycle likely to be related to estrogen/ progesterone balance

�  Irregular menses, excessive menstruation, lack of menses

�  Irritability, insomnia, aggression

�  Easily treated with herbal medicine and nutrition

Nutritional therapies �  Iron- test ferritin for iron stores

�  B6

�  Folate

�  Zinc

�  Magnesium

�  Omega 3

�  Vitamin C

�  Melatonin

�  DMG/TMG

Vitamin B6 �  Pyridoxal-5-phosphate- active form

�  Required to form several neurotransmitters. People with autism may have inability to make active form of B6

�  Relatively high dose is most effective- up to 8 mg/ pound bodyweight (ie: 320 mg for 40 lb child)

�  Potential side effects- irritability, sound and light sensitivity. Side effects can be avoided/ eliminated by adding in magnesium. Peripheral neuropathy at very high doses if other b vitamins are not supplied- take with B complex

�  Researched improvements- improved focus, better eye contact, less self stimulatory behavior, more speech, less hyperactivity

�  Expect improvement within a few days. If no benefit by 4 weeks discontinue or add cofactors

Essential Fatty Acids �  Children with autism may have lower levels of omega 3 fats than

the general population

�  The 2 major omega 3 fats are EPA and DHA �  Best sources are fish oil and cod liver oil. DHA is important for brain

development, EPA is more anti-inflammatory

�  Cod liver oil is a good choice for children- naturally higher in DHA

�  Fish is preferable to flax oil, as flax oil is in the form of ALA and must be converted to EPA/DHA

�  Get as much as possible from diet! Fish, flax seeds, chia seeds, grass fed beef, pasture raised chickens/ eggs

Methylation �  Many biomedical treatments you may have tried or

heard of are supporting methylation. If you are using B12 injections or supplements you are supporting methylation.

�  Many children diagnosed with autism have demonstrated methylation impairment �  Heavy methylation leads to healthy nervous systems

�  Impaired methylation- tongue ties, birth defects, speech delay, autism, ADHD among many others

Methylation support �  What is methylation? Adding methyl group (CH3)

�  Necessary for DNA repair, neurotransmitter functioning, detoxification, immune function, regulating inflammation, producing melatonin/ CoQ10, carnitine, and GLUTATHIONE

�  Requires methyl donors and cofactors: methyl B12/ folate, SAMe, TMG (betaine), DMG, zinc, selenium

�  MTHFR c677t/ a1298c �  Genetic test- standard labs or 23&me

�  Complicated pathway- good to consult with a specialist

�  Homocysteine (blood test) can help to track methylation status

Environmental toxins �  Toxic metals (will go over shortly)

�  Plastics- Avoid #3,6,7. Store food/ water in glass when possible. �  Phthalates- softener. Avoid cling wrap, plastic bags, use

cloth shower curtain �  BPA- receipts, canned food

�  Personal care/ cleaning products �  Fragrance free. No fabric softener/ dryer sheets �  Make your own if possible

�  Organic- does it matter? �  Dirty dozen/ clean fifteen

�  Air quality- forest fires, woodstoves, automobile exhaust (detached garage, pumping gas, etc)

Heavy metal exposure

�  Mercury- amalgam fillings, seafood

�  Lead- paint in older houses, soils near highways/ gas stations exposed to leaded gasoline

�  Antimony- flame retardant clothing and furniture

�  Cadmium- cigarette smoke

�  Uranium- occurs naturally in rock, arms industry

�  Arsenic- shellfish, chicken feed, pressure treated wood (playground equipment/ decks)

�  Reducing exposure is much easier than chelation!

Chelation �  Removal of toxic metals. Most important step is to remove

source of exposure!

�  Follows testing levels of stored body metals through the urine. Blood is only useful for acute exposure. Best is pre and post provocation.

�  DMSA, DMPS, EDTA: IV or oral as directed by specially trained practitioner

�  Chlorella- increases mercury elimination via stool. Watch for GI upset

�  Cilantro- food based is very safe, use caution with supplementation

�  Boosting glutathione activity- Diet- cruciferous vegetables, garlic, onions, brightly pigmented fruits and vegetables

�  Sauna therapy

Plastics

�  Safest: #2, 4

�  Safer: #1,5

�  Least Safe #3 (PVC), 6 (polystyrene), 7 (misc)

�  Phthalates- softener �  Toys, gels, cosmetics, paints, detergents, pesticides,

fertilizers �  Leaches easily into air and water, higher release with

heat and moisture �  Xenoestrogen, lowers thyroid function, increases risk

of obesity

�  Polystyrene- harder plastics, styrofoam �  Releases PAH’s, carbon monoxide, styrene

�  BPA- hard plastics, dental composites/ sealants, food and beverage cans, thermal receipts (very high levels) �  Xenoestrogen, can affect behavior in children

Air Filters �  HEPA- high efficiency particulate air filter

�  Captures 99.97% of particulates �  Filter needs to be changed every 6-12 months �  Affordable option for filtering indoor air

�  Plants! �  Areca palm, lady palm, rubber plant (ficus), dracaena,

phildendron, dwarf date palm, boston fern, peace lily, aloe, spider plant, snake plant, golden pothos, chrysanthemum, rhododendron

•  Proven to remove formaldehyde, benzene, CO, among many others

Pesticide exposure �  Produce wash

�  Environne

�  Homemade �  Soak: In sink full of water add ½ cup vinegar, 2 tbsp

salt. Soak for 15 minutes, then rinse and pat dry

�  Spray: 1 cup water, 1 cup vinegar, 2 tbsp baking soda, 2 tbsp lemon juice: mix ingredients and put into spray bottle. Spray fresh fruits and vegetables generously, let sit for a few minutes then rinse off well.

Potential labwork �  Complete blood count

�  Liver enzymes

�  Kidney function

�  IgG food sensitivity

�  Organic acid testing

�  Heavy metal assessment

�  Amino acids

�  Vitamin D

�  Stool analysis

�  Urinary peptides (assess gliadin and casein breakdown)

�  Methylmalonic acid/ B12

�  Ferritin, iron function studies

�  Thyroid including antibodies

�  Plasma zinc and copper

�  Cholesterol panel

�  Detoxification panel

How do I use this information? �  Diet- start with gluten/ casein

free �  If you have tried without

improvement- was it long enough? Was it strict enough? Can take 8 months for full benefit.

�  If chronic diarrhea- consider specific carbohydrate diet

�  If self injurious behavior- consider Feingold diet

�  The whole family should try!

�  Sleep hygiene- set a sleep routine

�  Labs to request- food sensitivity testing, blood count, ferritin, organic acid urine test

�  Reduce toxin exposure �  Go through cleaning products

�  Avoid plastics

�  Use air filter in home

�  Don’t wear shoes in the house