Medical Interventions for Children with Autism Spectrum Disorders, an AutismOne Presentation Re-Cap From Dr. Jerry Kartzinel

We had a wonderful week at AutismOne.  It truly is a time where professionals working with special needs children from many different backgrounds present their clinical findings that improve the life and function of these children and their families.

I had the privilege and pleasure to present not only the co-morbid conditions that many of our children live with from day to day but also many of the medical treatments that are available but so often overlooked by the medical community.  I would like to take the opportunity to summarize my discussion of my medical approach to medical interventions in children with autism.

I usually start my discussion with first, describing the problem: Autism.  Now you may have already had this diagnosis and met some criteria that the physician checked off in the box.  But what does it all really mean?  Basically, autistic behaviors stem from inappropriate responses to every day stimuli.  And the more inappropriate responses the child makes, the more “severe” he or she is on the spectrum.  I used the example of my son Joshua walking on hot gravel in bare feet without making a peep.  He was just fine with that.  But it could also be to sounds, being called, responding to food in a very unusual fashion, and the list goes on and on.

Let’s take a look and some common issues that we MUST take care of if we are ever going to get our children to improve:

  • GUT ISSUES
  • SLEEP ISSUES
  • ALLERGIC ISSUES
  • IMMUNE ISSUES
  • NEUROLOGIC and PSYCHIATRIC ISSUES
  • ENDOCRINE ISSUES
  • INFLAMMATORY AND OXIDATIVE ISSUES
  • TOXIC ISSUES

 

To go along with these issues, here is a partial list of many biological conditions that can attribute to all these issues:

 

Gut Problems:
  • Inflammatory Bowel Disease
  • Reflux Esophagitis
  • Gastritis
  • Dysbiosis
  • Leaky gut
  • Malabsorption

 

Immunologic:
  • Persistent Viral/bacterial Infection
  • Food allergy
  • Recurring illnesses
  • Auto immune
  • Inflammation

 

Neurologic:
  • Seizures/Sensory Issues
  • Low muscle tone- especially trunk
  • Perfusion Defects- SPECT
  • Opiate effect

 

Metabolic/Detoxification Pathway Disruption:
  • Purine disorders
  • Elevated ammonia
  • Omega 3 deficits
  • Sulfation defect
  • Methylation disorders
  • Serotonin/Melatonin deficit
  • Dopamine defect
  • Heavy metal burden
  • Chromosomal issues

One of the metabolic aberrations we find commonly in are clinic is a defect in what is called the “Methylation Pathway” (see www.mendingautism.com for a more comprehensive description).   Problems with this cycle often come with a family history riddled with:

  • Alcoholism                                        
  • Bipolar disease
  • Schizophrenia
  • Depression
  • Attention deficit disorder
  • Autism
  • Constipation
  • Diabetes
  • Cardiovascular disease
  • Thyroid dysfunction
  • Neuro-inflammation
  • Multiple sclerosis
  • Alzheimer’s disease
  • Parkinson’s disease

Now the reason I present the metabolic condition is to demonstrate to the reader that there are specific ways to improve on the biochemistry, and thus, MINIMIZE the impact of this defect:

  • Methyl B 12 appears to work best when given sub-cutaneously, by the parents (this is a prescription).   We tend to add folic acid and N- acetyl cysteine to the injection.
  • TMG or DMG  
  • Folic/folinic acid/leucovorin
  • Glutathione transdermally twice daily is prescribed as well

We then moved from an example of potential metabolic dysfunction to a discussion of Allergies and some of their symptoms.  We like to manage allergies at our office and divide them into 2 broad categories: foods and environmental exposures.  

For food allergies, sometimes referred to as sensitivities, we need to do some lab work to help us figure out what each individual child is sensitive to.  The treatment, as you may surmise, is to remove the foods.  Often, without any testing, we can recommend a TOTAL removal of all dairy containing foods as well as all gluten containing foods.  Again, if the parents are going to remove foods, without testing, next up to remove would be all soy and citrus containing foods.  
For environmental allergies, again, testing would be optimal to obtain, but we may just need to settle on daily treatments of over the counter allergy medications such as zyrtec, claritin, or  even Benadryl.

Next up: The gut!  There is just so much to say here.  It seems the vast majority of children I see in my clinic have significant bowel issues:

  • Constipation
  • Diarrhea
  • Inflammation of the bowel
  • Esophagitis
  • Gastritis
  • Duodenitis
  • Ilieoitis
  • Colitis

That’s a lot of “itis” – but these just denote various areas of the bowel that have inflammation and pain, and must be dealt with.  Further description and management strategies are beyond the scope of this summary, but suffice it to say, we would need the input of the gastroenterologist.  My approach to constipation and diarrhea is presented with detail on my website: www.mendingautism.com.

Yeast is always a big topic and invariably comes up when discussing the bowels.  There is laboratory testing that can be obtained to evaluate not only if yeast is present, but even the types of yeast and relative amount that is present.  Behaviors I see associated with yeast overgrowth include:

  • Giddyness
  • Up at night laughing
  • Bloated belly
  • Flatulence
  • “bakery smell”
  • Climbing
  • Hanging upside down

There are natural treatments one can consider:

  • Monolaurin
  • Oregano
  • Olive leaf extract   
  • Caprylic acid  
  • Berberine (very bitter)
  • Garlic  
  • Biocidin

Next up: the very large topic of supplements.  I was able to give a brief review which I will summarize here:

Primary goals of supplementation:
  • Optimization of Normal Physiology
  • Improve Function of the Immune System
  • Enhance Cognitive Abilities
  • Improve Red Cell Membrane Function
  • Reduction of Autistic Behaviors
  • Improve Gastrointestinal Function
  • Minimize our NEGATIVE genetic influences

 

  • Vitamins: Vitamins are micronutrients that are critical for normal cellular metabolism and function.  They must be consumed regularly as our bodies are not able to synthesize these vital nutrients in sufficient amounts.  Vitamins are required for proper cell signaling, mediators of cell growth, as antioxidants, and even as hormones

 

  • Minerals: The main electrolytes are Sodium, Potassium, Calcium, Magnesium and Chloride. Proper levels of these minerals in the body allow the body to have energy, better muscle and nerve function (including faster stress recovery) and improved function in many other areas.  The so called trace minerals (such as selenium, iodine, chromium, magnesium, molybdenum, just to name a few) need to be replenished daily, ideally through the diet.

 

  • Digestive Enzymes break down the foods that we eat into smaller compounds that can be readily absorbed and put into the blood-stream.  The enzyme class of proteases breaks down proteins to amino acids. The enzyme class of lipase is responsible of breaking down fats to fatty acids, and the carbohydrases break down carbohydrates into simple sugars.

 

  • Omega 3: the fatty acids, maintain the fluidity and stability of cell membranes and protect the body from harmful substances such as bacteria and viruses. They must be obtained through diet or supplementation with EFA-rich food oils. They have an amazing affect on behaviors, mood, focus and concentration.

The last BIG topic I covered, and form many, THE MOST IMPORTANT: SLEEP
(so important I have a very complete articleon sleep at www.mendingautism.com).  In essence, many children have not only problems initiating sleep, but also STAYING asleep (much to their parent’s dismay).  Some simple strategies are outlined here:

  • Melatonin
  • 5-HTP
  • Calcium/magnesium: can really be helpful
  • Vitamin D3
  • GABA
  • Vitamin B6/niacinamide
  • Pantothenic acid (Vitamin B5)Enhances REM sleep)
  • Inositol
  • Herbs: milk thistle, valerian,
  • Chamomile tea

In summary, children who are on the autism spectrum disorder very commonly have medical issues that we can treat.  When we are successful, their autistic issues improve, sometimes modestly, but sometimes very, very significantly! 

 

I would recommend prioritizing what needs to be done:

 

  • Dietary changes: removal of foods not tolerated, going as organic as possible
  • Correcting sleep aberrations
  • Improving bowel function/health
  • Target particular issues:
  • Allergies
  • Inflammation
  • Chronic infections
  • Focus and concentration
  • Language developments…..just to list a few!

 

 

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