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By Anil Minocha MD, author of Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
Autistic spectrum disorders include behavioral disorders like autism, Asperger's syndrome, Rett syndrome and Pervasive Developmental Disorders Not Otherwise Specified (PDD-NOS).
- While our knowledge about these entities continues to advance, the treatment of such children has been mired in controversies and present a huge challenge to the parents.
- A recent systematic review of medical treatments concluded that while a variety of medical treatments are being used in practice "strikingly little evidence exists" to support benefit for most treatments
Is It Leaky Gut or Leaky Gut Syndrome?
Hypothesis underlying comprehensive autism treatment:
An underappreciated is the pivotal role that leaky gut syndrome or increased intestinal permeability, alterations in gut/intestinal bacteria and nutritional impairments play in the initiation as well as sustaining the manifestations of autism/ASD in an otherwise genetically predisposed subject.
The clues about dietary manipulation also come from our studies of tribes continuing to practice old dietary patterns of paleolithic or old stone age where the modern day diseases are unheard of despite high meat, fruit (fructose) and starchy food consumption. The key is to look at not what was included but what was absent in those diets. Grains were conspicuous by their absence. Milk was not as used either.
It is always a huge challenge to crystallize a therapeutic formula for so many diverse and many might argue poorly understood disorders into a small article. Below is my attempt to offer some of the options that may be tried singularly or in combination realizing that not everything works in everyone.
Because multiple factors are likely involved in causing/manifesting these disorders, a combination natural/holistic approach may have better chance of success than just using one single remedy.
Of note: My opinions are based on the combination of scientific evidence in the context of risk versus benefit. For example, some data indicates that micronutrient supplementation is superior to medical therapy for treatment of autism.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
The 12-elements of this approach are as follows:
1. Melatonin: Patients with autism/ASD tend to have disordered circadian rhythms and low blood melatonin levels. Abnormalities of urinary metabolite levels have been correlated with impaired behavioral and communication skills. Some experts suggest that low melatonin levels may be a risk factor for autistic spectrum disorders including autism. Multiple studies have documented that melatonin supplementation modulates body circadian rhythms and improve sleep abnormalities with minimal side-effects.
2. Tetrahydrobiopterin (BH4): Examination of the fluid surrounding the brain and spinal cord i.e. CSF reveals that tetrahydrobiopterin (BH4) levels are lower in kids with autism as compared to controls. Evidence indicates that administration of 1-3 mg/kg/day significantly improves language, social skills, vocabulary etc.
3. Vitamin C: Scurvy has been reported in autistic kids. A placebo controlled (randomized, double blind)study demonstrated that ingestion of 8g/70kg body weight per day over 30 weeks significantly improves severity of symptoms in autistic kids.
4. Correcting intestinal and nutritional dysfunction: Increased intestinal permeability and dysbiosis have been implicated in causing autistic spectrum disorders like autism. Measures to optimize the gut imbalances include:
- Probiotics and prebiotics: Be mindful, not all probiotics are created equal. Probiotics are like antibiotics, one may not substitute for other. Also most of the popular yogurts available in market even when include live cultures do not provide much probiotic benefit.
- Vitamin D supplementation: Evidence suggests that vitamin D strengthens barrier function and reduces the intestinal hyperpermeability or leaky gut Vitamin D receptors are present in brain. In addition, vitamin D affect neurotransmitters. Low maternal vitamin D level is a risk factor for infantile autism. There is controversy over what the "normal" levels are. Many experts believe that the lower limit of "normal" is too low and may be missing out on people that may benefit from vitamin D supplementation.
- Turmeric, the all-round golden herb/spice: It has antimicrobial, antiinflammatory and antioxidant properties, all of which have potential to impact dysbiosis and leaky gut.
- Dietary modifications including trial of elimination diet. In addition, eat your foods organic while avoiding cnned processed food.
- Chew very well or better still, eat shredded or finely cut salads. Cut your food in plate and not rely on chewing to accomplish that. Smaller pieces are easier to digest and undigested foods are easier to expel by gut's housekeeper function via migrating motor complexes.
- Avoid frequent snacking between meals in order to allow gut's fasting motility pattern to take care of cleansing/housekeeping function.
- Multivitamin/minerals supplements
- Digestive enzymes: Limited data indicates benefit from digestive enzyme supplementation.
Wall Street Journal Best Seller Dr. M's Seven-X Plan for Digestive Health
5. Carnosine (Beta alanyl L-histadine): It is an endogenous combination of two amino acids and is concentrated in brain and muscle tissues. A double blind placebo controlled trial found that 800 mg per day of L-carnosine administered for 8 weeks significantly improves behavioral abnormailities including social interactions and vocabulary in kids with autistic spectrum disorders.
6. L-carnitine: Mitochondrial abnormalities are common in autism/ASD. Biomarkers of mitochondrial dysfunction include carnitine and lactate. I have discussed the beneficial role of L-carnitine and I have discussed this elsewhere in another blog posting.
8. Polyunsaturated fatty acids (PUFA): PUFA are involved in multiple processes in nervous system function.They may be a critical element at the mind-body interface!PUFA deficiency/imbalance has been seen in multiple behavioral/devlopmental disorders including attention deficit disorder (ADD/ADHD), autisctic spectrum disorders, dyslexia, depression etc. PUFA deficiency has been implicated in poor reading and spelling skills as well as memory dysfunction. Kids with behavioral disorders who also have lower PUFA levels tend to exhibit more hyperactivity, temper dysregulation, and learning problems as compared to similar kids with higher PUFA levels.
9. Yoga: A 10-month study of yoga integerative therapeutic program of 5-weekly sessions coupled with practice at home demonstrated that the intervention resulted in improved imitation skills as well as sociocommunicative behaviors including playing patterns with peers.
10. Massage: A recent systemetic review and metaanalysis published in the Journal of Clinical Psychiatry found several studies documenting beneficial effect on autistic behaviors in kids with ASD. Massage appeared to benefit sensory profile, communication attitudes, adaptive behavior, learning and social skills. However, studies had limitations and authors recommended more rigorous trials. Based on evidence, Qigong massage may be a preferred option among various massage options.
Is It Leaky Gut or Leaky Gut Syndrome?
11. Music/art therapy: Studies of MRI scans reveal that there are functgional and dysfunctional brain circuits underlying emotional processing of music in autistic spectrum disorders. However, ability to process perceptual and emotional aspects of music appears to be preserved. Many kids with ASD enjoy music based activities and interactions with others. Several studies have investigated the role of music therapy in autistic disorders. A Cochrane Database review in 2006 found 3 studies that demonstrated the benficial effect of music in verbal and gestural communicative skills over short term.
12. TLC: Lots of tender loving care and understanding in addition to learning based programs, and mind body therapies like cognitive behavioral therapies. Difficult cases may opt for less well studied options like acupuncture, biofeedback etc.
Beyond my 12-point plan
Other potential remedies that may be encountered in practice inlude:
- D-ribose
- Piracetam: It is considered a brain-booster by many. Limited evidence supports its use. However availability issues abound especially in the U.S.
- Vitamin B12 and folic acid: Evidence suggests that tissue levels of these vitamins may be lower in kids with autism/ASD. There is some weak evidence supporting the use of their supplementation helps improve behavioral and speech dysfunction.
- Tryptophan and 5-Hydroxytryptophan: Decreasing tryptophan levels in blood by depleting tryptophan from diet results in exacerbation of symptoms in kids with autism.
- Medical treatments that are tried include acetylcholinesterase inhibitors (rivastigmine, donepezil), naltrexone, alpha-2-adrenergic agonists (clonidine, guanfacine), hyperbaric oxygen, antiinflammatory and immune-modulating agents, oxytocin, cyproheptidine, histamine-2 blockers (famotidine), antibiotics, chelation etc.
Is It Leaky Gut or Leaky Gut Syndrome?
Caveat: My thoughts above should be viewed in the context that I am a gastroenterologist and nutritionist. I am not a pediatrician or psychiatrist. It is never a good idea to treat based on what is written on internet. Always talk to your doctor!
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