American Asperger's Association Support Group

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Autism by Ronald Hoffman, M.D.

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1 Autism by Ronald Hoffman, M.D. on Wed Feb 11, 2009 11:36 am


by Ronald Hoffman, M.D.
Autism is a mysterious mental disease that effects 400,000 children in the U.S. alone. It develops insidiously in toddlers after deceptively normal infancies, free of the developmental abnormalities that are early and obvious hallmarks of severe mental retardation or cerebral palsy. Around the age of 18 months or two years, developmental milestones are not attained. Normal communication between parents and children lapses. Autistic children often fail to make eye contact and their speech is rudimentary. They may be prone to explosive tantrums or engage in repetitive mechanical behavior, like rocking or shutting off all the lights in a room again and again. While autism varies in severity, its key features are improper sensory integration, lack of subtlety of emotional expres​sion("flatness" can quickly give way to agitation) and limited communication ability. Autistic children seldom are able to lead independent lives without heavy remedial education, dedicated parental care and sometimes institutionalization and drugs.

No effective drug therapy for autism exists. Medications "take the edge off" symptoms, and parents fervently adhere to various programs of "behavior modification," "sensory integration," and the like, with some encouraging results. And so, it was with great skepticism that physicians and developmental experts responded to the claims of autism pioneer Dr. Bernard Rimland. In the 1970s, he began excitedly publicizing research results that showed autism could be substantially ameliorated with diet changes and nutrients.

A mainstay of his approach was the elimination of sugar and artificial ingredients, coupled with supplementary nutrients, especially B6 and magnesium. To this he later added dimethylglycine (DMG) and treatment for candida (yeast) infection. Many parents attest to the success of his methods, but only recently have new significant strides been made in alternative strategies for autism. Now, results are improved and more consistent. More tests are available to detect abnormal metabolic pathways that can be fine-tuned in autistic kids. Consensus is developing among the growing ranks of physicians who have experience in testing these children. Standardized protocols are being disseminated. The whole approach to autism has finally become less hit-or-miss.

Several events have enabled this quantum leap in our understanding of autism. Researchers have long believed that autism was neurologically "hard-wired" into the brain circuitry of afflicted children. Most guessed that a complex tangle of mixed up switches in the brain were part of the genetic inheritance of autistic kids. But a new model is helping us understand how certain susceptible children may develop autism, why Dr. Rimland’s therapies seem to help some of them, and how we can extend hope and help to still others.

The model arises from medicine’s new understanding of the relationship between the nervous system and the immune system. Traditionally, theoreticians have looked at these two systems as separate and distinct. But current thinking links them—maybe as one continuous network that senses and responds to outside stimuli. For instance, events we perceive with our sensory nervous system—like stress or love—have an immediate negative or positive impact on our immune response. Conversely, events within our immune system like allergic reactions or the fever that occurs with infection have a direct impact on our ability to concentrate, our level of fatigue, or our moods. Autistic children are thought to suffer from "sensory integration" problems. New findings suggest that their immune systems, too, may be suffering from overload.

Studies now reveal that autistic children, while not all alike, suffer from a wide array of immune system and metabolic abnormalities. The vast majority possess blood profiles that show a high state of immune system activation and dysregulation. Many show numerous food allergies, especially to wheat gluten and milk. This accounts for the observation frequently made by parents of autistics that their symptoms seem to "clear" with various elimination diets. Alternately, food allergies can be effectively neutralized with techniques like Enzyme Potentiated Desensitization, which obviates the need for dietary stringency.

Some autistic children develop their symptoms after a series of respiratory infections prompt the use of antibiotics (ear-tubes often are part of this scenario.) Alternatively, some kids appear to deteriorate behaviorally in the wake of an immunization shot. Mothers sometimes swear that they watch helplessly as their kids succumb to a progressive brain-addling disease—as if caused by an unknown germ, toxin, or vitamin deficiency.

Why should some kids be programmed for exquisite sensitivity to environmental or internal factors while others pump M&Ms, Coke and Chicken McNuggets with impunity? The answer may be genetic. Some studies are starting to point to characteristic chromosome abnormalities in autistic children and their families. These are grouped around the gene sequence at a specific location that codes for immunity. Thus autistic kids may be programmed for an immune system meltdown. This in turn initiates an autoimmune attack on critical regions of the brain that govern attention, mood and speech.

The starkest evidence to date for this ambitious theory is new research performed by immunologist Sudhir Gupta of the University of California at Irvine. Noting that many children with autism have faulty immune responses, Dr. Gupta began infusing willing subjects with intravenous gamma globulin, an immune-enhancing "chicken soup" derived from donated blood plasma. Many of the children experienced profound improvements in mood, concentration, and speech. One child even reverted to normalcy and is now attending regular classes and enjoying team sports. Few subjects failed to respond at least partially to this immune "fix," and plans are underway for further testing at the University of California and Harvard Medical School. Other ways to modulate immunity include the use of other medications like Naltrexone and Trental.

Whether or not gamma globulin therapy for autism pans out, the clear message is that factors that affect the immune system are worthy of attention in autism. These include immune-modulating vitamins, minerals and other nutrients like the essential fatty acids; food allergies that "make waves" in the immune system; candida, viruses, and bacteria that trigger immune hyperactivation; and chemicals and heavy metals that disrupt the immune response. In fact, environmental physicians attuned to the adverse effects of chemical insults have documented exposure to paints, pesticides, new furniture and carpeting, or workplace toxicity during the pregnancies of the majority of mothers of autistic children, suggesting that exposure in utero may be a crucial trigger.

Add leaky gut syndrome (inappropriate permeability of the intestinal wall leading to excess absorption of microbial toxins and allergenic food proteins) and faulty liver detoxification of potentially insulting substances, and you have a condition of toxic overload. Recently, research has shown that chemicals produced by yeast and bacteria as well as improperly digested food peptides can mimic the effect of normal neurotransmitters in the brain. The result may be autistic kids "stoned" on a heady mix of internal and external neurotoxins.

Additionally, defects in the metabolic manufacturing chain for helpful brain chemicals (like serotonin, the neurological "juice" that Prozac promotes) are characteristic when amino acid profiles and neurotransmitter levels are studied in autistics. Since B6 and magnesium help repair these defects, this may be part of the reason some autistic kids respond so well to them (a special nutritional formula called "Nuthera" incorporates these nutrients in a palatable form) Alternatively, relief may be obtained with amino acids such as taurine (helpful for seizures) and tryptophan and tyrosine.

Specific tests are the key to guiding and sequencing interventions in autism (see tests). With help from a knowledgeable and experienced practitioner, effective treatment is no longer a matter of pot-luck. Recent conferences of researchers and caregivers in this field have ushered in a new hopeful era of autism therapy. Following the impetus of Dr. Bernard Rimland, the Autism Research Institute convened the first Defeat Autism Now! Conference in Dallas in January 1995. A critical mass has been reached and progress is proceeding apace. It is now time for health professionals, educators, and parents to start paying attention to this promising avenue for amelioration of one of America’s most heartbreaking and challenging medical problems. (For additional information, contact the Autism Research Institute at 619-281-7165.)

Factors that may trigger Autism

• Environmental: Lead, Cadmium, Aluminum, Antimony, Mercury, chemicals (formaldehyde, toulene, etc.)
• Nutritional: deficiency of Calcium, Magnesium, Iron, Vitamin B6 or B1, antioxidant, Glutathione, essential fatty acid, other nutritional
• Metabolic: faulty liver detoxification; hypoglycemia; mold, dust, pollen; amino acid pathway abnormalities; Phenosultotransferase deficiency; "renal leak" syndrome
• Allergic: foods (especially gluten and casein); food coloring, additives
• Intestinal: leaky gut syndrome; malabsorption; Candida overgrowth; incomplete protein digestion; bacterial toxins; parasite infection
• Immunological: vaccinations, viral infections

Therapy for Autism (Partial list)

• Acidophilus,
• antifungals (Nystatin, Diflucan, Sporonox, Nizoral),
• antioxidants,
• amino acids,
• digestive enzymes,
• elimination diets,
• neutralization shots or drops,
• Enzyme Potentiated Desensitization,
• I.V. Immunoglobins or Transfer Factor,
• DMG,
• Vitamin B6,
• Octocosanol,
• Magnesium,
• Inositol,
• herbal antivirals,
• Hyperbaric Oxygen treatments
• Trental,
• Essential fatty acids

Tests that may guide treatment of Autism

• Immune profile (specialized for autism);
• viral titers;
• vitamin, minerals levels;
• food allergy (blood or skin testing);
• anti-gluten or anti-casein antibodies;
• antioxidant levels;
• urine amino acids;
• stool tests (parasites, bacteria, yeast);
• intestinal permeability;
• urine peptides;
• urine organic acids;
• hair analysis;
• liver detoxification profile;
• genetic testing;
• chemical antibodies;
• Candida (blood and skin)

Resource: "Clincial Assessment for Children with Autism and Related Disorders," Autism Research Institute, 4182 Adams Avenue, San Diego, CA 92116

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