Download Defeat Autism Now! ~ Fall 2008

Defeat Autism Now! ~ Fall 2008
Optimal Health Initiatives, LLC
Nancy O’Hara, MD and Gail Szakacs, MD
150 Danbury Road , Wilton, CT 06897
Phone: 203.834.2813 Fax: 203.834.2831
HBOT NEWS
It is our pleasure to introduce Shannon Claussen as the new Hyperbaric Technician at Optimal Health Initiatives.
She is looking forward to assisting you with all your hyperbaric needs.
Hyperbaric Oxygen Therapy is one of the biomedical interventions used to treat various conditions present in a
child with ASD.
“Hands down HBOT was the single most effective treatment for our
child, specifically in the areas of language and relatedness.”
- Lisa, mother of Charlie
What is Hyperbaric Oxygen Therapy?
Hyperbaric Oxygen Therapy (HBOT) involves inhaling oxygen (up to 100% oxygen) at greater than 1
atmosphere (atm) in a pressurized chamber. The pressure “forces” oxygen into the blood and increases oxygenation to
the entire body. Research has shown improvements with HBOT in children on the Autism Spectrum who have gut and
brain inflammation, cognitive impairments, anaerobic bacteria overgrowth, and detoxification issues.
“Numerous studies document oxidative stress and inflammation in
individuals with autism; both of these conditions have demonstrated improvement
with HBOT, along with enhancement of neurological function and cognitive
performance.” Please see link below for the full article.
http://www.biomedcentral.com/1471-2431/7/36
Additional Links:
www.hbotreatment.com
Please visit the HBOT section of our website at www.drohara.com where you will find graphs, charts,
testimonials, and study results, including; The Results of 30,000 Hrs. of Hard and Soft Chamber HBOT-The 20 Most
Common Parental Observations. Please be patient with us, as this is a new section of our website and will take some
time to be completed. We apologize in advance for any inconvenience.
Contact Shannon at 203-834-2813 x 18 with any questions or to request a HBOT packet.
* PATIENT UPDATE FORMS*
*REQUIRED BEFORE ALL CONSULTATIONS*
It is a requirement before all office and phone consultations. We request that you email the form one week prior to your
consult date. You can even simplify the process by saving it on your computer and making any adjustments as needed
before each appointment.
The process will make your consult much more productive and ultimately save you time and money.
Thank you for your cooperation!
Information from the fall Defeat Autism Now! Conference in San Diego
MIND THE GUT
Several speakers at the recent Defeat Autism Now! Conference in San Diego spoke about the guts of our kids –
gut bugs, biofilms, clostridia, PANDAS and strep. We recommend continuing to treat the gut inflammation,
dysbiosis and malabsorption that our kids experience. Here are some of the GUT PEARLS (as discussed by Dr.
Robyn Cosford, Dr. Anju Usman, Dr. Derrick McFabe, Dr. Andy Wakefield and Dr. Sue Swedo):
How can dysbiosis (too many bad germs and
not enough good germs) hurt my child?
(Controlled study of kids with ASD vs. controls
(Robyn Cosford))
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Our kids with ASD have more strep and
enterobacter and less beneficial E coli
As Ecoli levels drop and enterobacter and strep
increase, we see more fat and protein
malabsorption, acidic pH, increase production
of ammonia and deconjugation of bile acids;
we also see associated cognitive dysfunction
Similar patterns seen in those with Celiac
Disease and Chronic Fatigue Syndrome
At risk kids have recurrent infections, reflux,
nocturia, family history of strep infections;
when treating these gut bugs, beware of
herxheimer (die-off type) reaction
Management includes organic diet,
phytonutrients, mucolytic enzymes, probiotics,
xylitol, antimicrobials (herbals include
artemesia, OOO, OLE, garlic)
How can gut bugs control behavior? (research by
Dr. Derrick McFabe)
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Bugs produce SCFA, like Proprionic acid (also a
common preservative in wheat and dairy
products and byproduct of bacterial/clostridial
metabolism)
Bugs produce abnormal gut inflammation and
permeability
Proprionic acid is increased with B12 problems
and biotin deficiencies
Proprionic acidemia causes carnitine depletion,
mitochondrial problems, accumulation of SCFA,
impaired methylation and sensitivity to
metabolic stress
Injecting Proprionic acid into rat brains causes
reversible repetitive behavior and induces
hyperactivity, ritual turning, object fixation and
sterotypies
Treating Clostridia with Flagyl in children with
regressive ASD can cause temporary remission
when we get rid of these bugs
Why Do Our Kids Have Colitis (Gut Inflammation)? (Autistic Enterocolitis presented by Dr. Andy
Wakefield)
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Timing of exposure determines risk (delay DTaP by 2 months, decreased rate of asthma by 50 %)
Children with ASD have lymphopenia (low white blood cell count (CD4 depletion)); this leads to the body
trying to increase lymphoid tissue which then leads to lymphoid hyperplasia (swollen glands) in gut and then
translocation of gut bacteria out of gut into systemic blood
IL10 and TGFbeta are the aspirin of immune system; they regulate and stop other parts of immune system;
IL10 and TGFbeta are very low in ASD (Ashwood) leading to autoimmunity and allergic disease
So T cell expansion (lymphoid hyperplasia) not regulated by T cell regulation (IL10 and TGFbeta) and kids
develop colitis
Thimerosal induces apoptosis of T cells/lymphopenia (Glutathione (which is low in kids with ASD) is
protective)
Children who received high titer measles vaccine at 6 months of age (in Haiti, Peru, Senegal) developed long
term lymphopenia; lymphopenia may follow measles infection or vaccination
Earlier exposure to MMR vaccination associated with increased risk of ASD (50% increased risk);
DeStefano Pediatrics 2004, 113, 259-266
Information from the fall Defeat Autism Now! Conference in San Diego
What is Biofilm? (presented by Robyn Cosford and Anju Usman)
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Collection of microbial communities enclosed in matrix of negatively charged polysaccharide substance held
together with calcium, magnesium and iron
Matrix protects against phagocytosis, antibiotics, immune modulation and antimicrobials
Also outer membrane proteins of matrix not expressed on outer layer (but rather internalized into biofilm) and
therefore not recognized by immune system
Consider biofilm if recurrent or persistent dysbiosis, recurrent otitis, sinusitis, dental caries, initially do well with
antifungals and then no response, stool and urine cultures negative but does well on antifungals or antibiotics
Treatment includes probiotics and prebiotic (symbiotic = combination of probiotics and prebiotic), EDTA
(enhances affect of antifungal or antibiotic), iron chelating compounds, mucous degrading enzymes
o Lactoferrin retains motility in bacteria and does not allow it to form biofilm aggregates (especially
pseudomonas – serratiopeptidase also helps)
o Fibrinolytic enzymes help to break down staph
o Chitosan (derived from shellfish) – has NAG and thins biofilm, especially strep
Biofilm Treatment protocol (very long process – may be years; average 4-6 months; improvements seen in weight gain,
behavior (including PANDAS, OCD and tics), and stools)
Step 1 – Lysis/detachment of biofilm (on empty stomach)
o Enzymes (mucostop, lumbrokinase, nattokinase, serratiopeptidase, SPS30, papaya or pineapple)
o Oral DisodiumEDTA or Apple Cider Vinegar
o Lactoferrin (do not do if very sensitive to dairy)
o NAG (N-Acetyl Glucosamine)/Chitosan
Step 2 – microbial killing (antifungals/antibiotics – give 15 minutes later and can give with other meds; often start with
herbals)
o Agent varies with microbiologic growth (bacteria, fungus)
o Die off often occurs at Day 21 (includes irritability, aggression, hyperactivity, sleeplessness, skin rash and
fever)
Step 3 – clean up (like a toothbrush – a few hours after step one but can be at night)
o Charcoal, fiber, modified citrus pectin, alginates, brown algae
Step 4 – rebuilding and nourishing gut lining
o Probiotics, prebiotics, fermented foods
o Diet – SCD or at least high antioxidant (high ORAC value- Acai, noni, goji), low sugar and low AGE
(advanced glycation end-products such as brown, fried or heated at high temps like French fries, cake,
dark sodas, donuts)
o Supporting nutrients include xylitol, aloe, EFAs, slippery elm, marshmallow, ginger, colostrum
What is PANDAS? (Pediatric Autoimmune Neurologic Disorder Associated with Strep; as researched and presented
by Dr. Sue Swedo)
o Symptoms of PANDAS can include choreiform movements, emotional lability, personality change,
fidgetiness, separation anxiety, irritability, impulsivity, enuresis, depression, cognitive and handwriting
changes, compulsive rituals, aggression or self-injurious behavior
o Symptoms much improved on PCN or Zithromax prophylaxis
o Treatment with plasmaphoresis (decreases titers, antineural antibodies) or IVIG (internal plasmaphoresis
– recognize child’s antibodies as foreign and pulls them out); treatment (1 gram over 2 days) will work in
first course (decreased OCD symptoms by 45% in one month (no change in placebo group)); if not, then
will not work
o Criteria for PANDAS
ƒ Presence of OCD and/or tic disorder
ƒ Prepubertal onset
ƒ Episodic course of symptom severity (relapsing and remitting)
ƒ Association with neurologic abnormalities
ƒ Temporal relationship between symptom exacerbations and strep infection
Information from the fall Defeat Autism Now! Conference in San Diego
Information for SLOW or NON-RESPONDERS (Dr. Bradstreet and Dr. Rossignol)
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Consider and evaluate potential missing links:
o subclinical seizures
o persistent oxidative stress
o low serotonin and/or clostridia issues for stimming and/or OCD
o consider other sources for chronic strep (chronic sinusitis, which may be the reason tonsillectomy does not
always cure chronic strep/PANDAS)
o germs may be trapped in biofilm
o vitamin D deficiency
o Disruptive sleep with little or no REM can affect ability to retain information
o Paradoxical reactions to medications may have to do with neurotransmitter dysregulation
Treatments to consider:
o Galantamine (inflammation, aggression, behavioral dyscontrol, and inattention)
o Transdermal Nicotine (attention).
o Galantamine and Nicotine have synergistic effect on blocking microglial activation (which leads to neuroinflammation).
o Intranasal Oxytocin (anxiety, self-stimulatory behaviors).
o Intranasal Secretin (help with stress regulatory peptides, behavior, gut)
o Minocycline (inflammation)
o Spironolactone (anti-androgen and anti-inflammatory effects; one study showed it as a protective antidote
against acute organic mercury poisoning in rats)
o 5-HTP (self-stimulatory behaviors, OCD, sleep, mood regulation)
o Curcumin (inflammation)
o Phosphatidylcholine (inflammation, detoxification)
o Melatonin (antioxidant, sleep)
o TSO (immune regulation)
o Low Dose Naltrexone = LDN (self-abusive behaviors, inflammation/immune dysregualtion)
o Revisit Diet
o Namenda = Memantine (language, social behavior, and self-stimulatory behaviors)
o Vitamin D3 (see separate vitamin D section)
o Antioxidants (decrease oxidative stress/free radical damage and promote detoxification)
o Steroids in combination with certain antimicrobial therapy for CNS infections (Fitch)
o HBOT (inflammation, detoxification, some gut germs, cognition, communication)
o Neurofeedback (processing, anxiety, OCD and stimming type behaviors)
Seizures
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Study by Sue Swedo found that up to 60% of otherwise non-responding children with ASD had abnormal overnight
EEG
o Recommended work-up may include prolonged EEG
o SPECT Scan or functional MRI
o Consider Brain Mapping
Found sleep problems with decreased sleep efficiency, prolonged latency to REM and decreased total time of REM
o Consider Aricept (Donepezil) to treat sleep abnormalities (often 2.5 mg; but may range from 1.25-5 mg); may
also help with speech, word retrieval
o Consider trial of minocycline (inhibit NF Kappa B; to treat inflammation in CSF); concern about teeth
staining
o Consider other anti-inflammatory agents to promote stem cell proliferation (HBOT, curcumin), antiglutamates (Namenda, Rilutec), and mitochondrial catalysts (L carnitine, acetyl L carnitine, uridine, tyrosine,
EFAs, phosphatidylserine)
Information from the fall Defeat Autism Now! Conference in San Diego
INFLAMMATION and IMMUNE DYSREGULATION
(Judy Van de Water, PhD)
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Depletion of adaptive immunity affects
learning behavior in mice (Anna Brynskikh)
Study by Luke, Van de Water, et al – shows
association between immune dysfunction and
behavioral issues in Autism
Ongoing study – have found specific
antibodies to fetal brain proteins in the blood
of a subset of mothers with autistic
children (seen more frequently in regressive
autism)
Study in Journal of Neuroimmunology
(Ashwood, Van de Water, et al) showed low
TGF-beta levels (involved in repair and
neurodevelopment) correlated with increased
severity of behavioral changes
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(Andrew Wakefield, MD)
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If DTaP vaccine delayed 2 months, the risk of Asthma
decreases by half
White blood cells (WBCs) are low in the blood, but high
in the periphery. Most of the peripheral immune system
is in the gut.
Serologic markers of IBD: CBir1 (target antigen
Clostridiaal flagellin protein), Perinuclear ANCA (target
antigen colonic bacteria), ASCA IgG and IgA (target
antigen S. cerevisae)
Early infectious exposures may lead to immune-mediated
inflammatory response following an acquired loss of
immunological tolerance to luminal antigens
Patterns include abnormal immune response against own
gut microbes and an age-related rise in immune response
for certain microbes
Autistic enterocolitis is more like Chron’s
There may be a change in intestinal disease and serologic
status over time.
Emphasis on other aspects of IMPAIRED DETOXIFICATION (Dr. Rossignol and Dr. Bradstreet)
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Further evaluation beyond porphyrins and chelation challenges:
o Urine 8-OH-G RNA
o Plasma cysteine and sulphate
o Other mitochondrial markers (total/free carnitine, plasma ammonia, plasma lactate, total CK)
o Water analyses and other testing if ongoing toxic exposure
Treatment options beyond chelation:
o Prevention, prevention, prevention
ƒ Diet – organic, fresh, special
ƒ Avoid plastic containers
ƒ Avoid acetominophin
ƒ Be aware of toy recalls
ƒ Evaluate all household cleaning products and cookware
ƒ Review all aspects of environment
o Adequate antioxidant intake – including fat-soluble ones that may be more effective
o Increase glutathione levels with supplements such as glutathione, N-Acetyl Cysteine (NAC), Vitamin C,
Vitamin E, Milk Thistle, TMG, Methylcobalamin, Folinic Acid, and Alpha Lipoic Acid (ALA)
o Ensure adequate mineral support
o Far Infrared Sauna
o HBOT
Information from the fall Defeat Autism Now! Conference in San Diego
Information about possible role of Vitamin D in Autism (Dr. Cannell)
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Increased Autism prevalence coincides with medical advice to avoid sun over past 20 years
Some animal studies show vitamin D deficiency during gestation dysregulates proteins associated with
brain development
Calcitrol (activated vitamin D) down-regulates inflammatory cytokine production in the brain
It has been reported that estrogen has a positive effect on calcitrol levels and thus may protect developing
female brains
Calcitrol raises seizure threshold (and thus may be protective)
Ongoing research about medications that may interfere with Vitamin D
Other studies that question any link between Vitamin D deficiency and Autism
Diagnosis depends on Vitamin D 25-OH levels; deficiency generally defined as < 40 ng/ml, but may vary
slightly according to reference ranges of different labs.
Treatment:
o Vitamin D3 (also known as colecalciferol).
ƒ Goal level for treatment is at least 40 ng/ml year round.
ƒ Since Vitamin D is a fat soluble vitamin, levels must be monitored routinely when being
supplemented with Vitamin D.
ƒ Amount of D3 needed varies with body weight.
o Sunlight
ƒ Total of 15 minutes of sunlight provides approximately 10,000 IU. Usually only one or two
exposures per week are needed to maintain adequate levels.
ƒ Risks for sun exposure still exist and need to be factored in
NEWS FROM LORI CODA
Lori Coda offers:
• Neurofeedback (brain exercise in self-regulation that can address ADHD, learning disabilities, language delays,
processing issues, anxiety, depression, and migraines)
o We are exploring the use of brain mapping (QEEG) in our office and how it can help direct Neurofeedback
Therapy in your individual child.
o More info on brain mapping will be available in early 2009.
• Behavioral consults
• Educational consults (how to navigate your educational system)
• Listening therapy programs
There are a limited number of spaces available for Neurofeedback. Please contact Lori to discuss availability.
Lori Coda has been in the field of Special Education for 22 years. She has an undergraduate degree in Psychology, a master’s
degree in Special Education, and post-masters training/ certification in TEACCH, Social Skills, Therapeutic Listening and
Neurofeedback. Please contact Lori at 203-834-2813 x 15 or by email at [email protected] to find out more information
on these therapies and services.
Upcoming Events
Dr. O’Hara will be speaking at the following conferences:
April 15-19, 2009Atlanta, GA
May 15-16, 2009 Boston, MA
May 20-24, 2009 Chicago, IL
Defeat Autism Now! Conference
Autism Conference
Autism One
Happy Holidays!
Nancy, Gail, Vicki, Lauren, Lori, Barb, Betsy, Deidrea, Shannon, Patti and Traci
Please visit our website: www.drohara.com
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