Autism biomedical treatment is a difficult topic to discuss, it is emotional and life altering. I don’t have a child with autism, and thus I approach it from an outside perspective rather than inside. But because it affects 1 in 42 boys and 1 in 68 children, you can’t avoid its reality. Autistic disorders have such a wide spectrum of severity that every case is individual and different. Given its prevalence in children, I will focus on this subset of autistic individuals. Before I get started, it is important that you know that my expertise lies in biochemistry, physiology, immunology, toxicology and nutrition.
I do not plan to address any emotional or social aspects of autism management.
There are many programs available, but this is not my focus and I feel that if the biochemistry and physiology are taken care of first, the many symptoms of autism improve and more focused therapies can be applied to any remaining symptoms.
Medical management of autism is still in its infancy. Management currently consists of speech, occupational and physical therapies. In addition medicines are used to help with “problem behaviors” including depression, anxiety, hyperactivity and obsessive-compulsive disorders. I feel that this is putting the cart before the horse. Let me explain….
If you have read any of my female hormone articles I state that premenstrual syndrome (PMS) isn’t normal and that underlying deficiencies and hormonal imbalances need to be addressed to get remission from these symptoms. For this example let’s use the PMS symptoms of irritability, hostility and/or aggressive behavior. These are also symptoms common in many individuals with autism. What if for women with these symptoms of PMS, instead of addressing root level issues (diet & hormones), we told them that they needed to go to speech therapy to learn to express themselves better, put them in anger management classes to learn ways to cope with stress and gave them drugs to calm down all of their emotions?
While this may be the management choice of some, the better more holistic way is to address the root level problems and then some if not all therapies would not be needed. The same goes for autism.
Root level issues should be addressed first and then other therapies can be addressed more accurately.
This is not easy. Without trying to offend anyone, if you are not willing or able to completely change your lifestyle, you can stop reading now because the holistic method will not work. This is often the case with your own personal health challenges but adding in the complications associated with autistic disorders can make the initial changes even more difficult. The last piece I want to address before we start is that there are some people that say that too many people are trying to “change” their child and should just love them the way that they are. I completely agree.
While it is true, to me that doesn’t mean that you can’t try and protect your child from any unnecessary emotional or physical pain associated with the symptoms of autism. Also as a physician, people come to me in search of help. They come because the child, the parent or the family needs help and it is my job to do what I can. So while I’m not trying to change anyone, I am trying to help. Enough of the rhetoric, let’s get started!
The Physiology of Autism Biomedical Treatments– Simplified
Digestion is more commonly impaired in the autistic population. Inflammation of the digestive tract can be the source of irritability, aggression, and night-time sleep disturbances. Some studies have shown a direct correlation between the amount of intestinal inflammation and the severity of autism. This chronic inflammation leads to “leaky gut” and “leak brain”. Approximately 50% of autistic children suffer from leaky gut. Leaky gut is most frequently caused by gluten intolerance and dysbiosis. Dysbiosis can be caused by a subclinical fungal, bacterial, viral or parasitic infection. The gluten-free/casein-free (GFCF) diet has proved beneficial for many autistic individuals to decrease intestinal inflammation. More importantly small protein particles found in gluten and casein (gluteomorphin and caseomorphin) act as opioid-like stimulants of the brain. Chronic excitatory stimulation of the brain by the opiate receptors affects the temporal region of the brain in charge of a child’s speech and auditory learning. Just as anyone else addicted to the stimulation of opioids, when children come off of gluten and casein, there may be a withdrawal type reaction. They will likely or already do refuse to eat vegetables and other healthy foods. This will fade, they will not starve themselves. Again, many people fail to make it through this lifestyle change.
It first takes believing that autism can be reversed, then once a true belief is in place, motivation to help your child recover becomes much easier.
The GFCF diet is not always needed or necessary; on the other hand, sometimes it is just the beginning of lifestyle changes that can be even more restrictive.
The liver’s main job is detoxification. Some studies show nearly 90% of autistic children can have toxic levels of various chemicals. When the liver is unable to detoxify chemicals, it can produce free radicals that lead to autoimmune disease, allergies and damage to the developing brain. Failure of the liver to detoxify also leads to added sensitivities to chemicals, pesticides, plastics and many other industrial products. Avoidance of certain chemicals found in toothpaste, shampoo and other household items may be necessary.
Nervous System The nervous system is divided into sympathetic (SYM) and parasympathetic (PS). The SYM system is what we refer to as the fight or flight system, the one you would use if you were being chased by a grizzly bear. The PS system is designed to be active during rest and digestion. Most autistic children demonstrate a dominance of the SYM system. Being sympathetic dominant makes a child more hyper and easily agitated. In a healthy population, the SYM system is dormant when not needed and in balance with the PS system. In the autistic population, both the parents and their children exhibit a dominant SYM system which can lead to very stressful situations for both. The PS system is needed not only to digest food, but for the digestive organs to create enzymes and other chemicals. These enzymes and digestive aids are critical to help the body absorb nutrients and without them nutritional deficiencies can develop over time.
One of the neurotransmitters associated with the SYM nervous system is called norepinephrine. Norepinephrine is responsible for vigilant concentration. Autistic children have been found to have higher norepinephrine which could be one of the reasons many exhibit such focused attention to details or even repetitive tasks. Neurotransmitters are made from the basic building blocks amino acids. In autistic children glutamic acid, phenylalanine, asparagine, tyrosine, alanine and lysine have been found to be increased while glutamine levels were lower compared with their peers. Glutamine is used for regeneration and repair of the gut. (Remember leaky gut?) For the excess amino acids, their respective pathways must be assessed in order to determine why they remain so high.
Melatonin is mainly known for being what puts us to sleep at night but it is also a great antioxidant in the brain and also defends against cancer. Many autistic children demonstrate disturbed sleeping patterns and low melatonin. Supplementation of melatonin has been shown to improve sleep patterns up to 80% in children with autism. Sounds like an autistic mothers dream, right? Not so fast! Serotonin deficiency has also been linked to autistic disorders. Serotonin is what melatonin is made out of and 90% of the body’s serotonin is made in the gut.
Serotonin production is impaired when the digestive tract gets inflamed or “leaky”. So in most cases of sleep disturbances we will address dysbiosis with supplementation and/or diet changes and allow the body to create enough serotonin to convert to melatonin. The exception to this rule is in cases where there is enough serotonin but conversion to melatonin is poor.
To get from serotonin to melatonin, a biochemical step called methylation is required.
Methylation defects (inability for the body to do this biochemical step) are a huge topic of research and some even feel they are the key to autism. Some methylation defects are genetic while others are functional, but methylation occurs all throughout the body in many important reactions. Genetic testing is becoming more readily available and affordable to see if this may be part of your solution.
I just mentioned serotonin and its importance in melatonin production, but there is also a condition frequently found in autistic children where the blood serotonin levels are actually high while the brain levels of serotonin are low. Serotonin is important in the regulation of mood, appetite and sleep. SSRIs that allow serotonin to be recycled in the brain are used in ADHD children and used to combat depression, both uses I don’t recommend due to permanent brain damage and impairment of other pathways and cellular receptors. Mercury has also been shown to decrease serotonin, leading to a depressive mood.
Continue to Part 2 for more common physiological disturbances and how to test your “leaky gut” and “leaky brain” at home.
Dr. Anderson provides Scottsdale autism services as well as Mesa autism services. Please contact the office for questions or a free consultation regarding your child.