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GENERAL CONFERENCE
AUTISM SPECTRUM
DISORDER
THURSDAY, APRIL 27, 2006
8:30 TO 5:30
RAANANA
AMDOCS COMPANY
JAQUELYN McCANDLESS, M.D.
WITH
JACK ZIMMERMAN, PhD
A BIO-MEDICAL
APPROACH TO AUTISM
EVALUATION AND TREATMENT
PROTOCOLS
BASED ON
LABORATORY TESTING AND
CLINICAL EXPERIENCE
WORLDWIDE ASD EPIDEMIC
• FROM 2001-04, 1026% INCREASE IN FULLDIAGNOSIS ASD SCHOOL AGE CHILDREN PER
US DEPT OF EDUCATION.
• OVER 2 MILLION CHILDREN IN US HAVE ASD,
OVER 6 MILLION HAVE ADD/ADHD, OVER 2
MILLION TAKE RITALIN
• INCIDENCE OF CLASSIC 1:10,000 TO ACQUIRED
(“REGRESSIVE”) ASD 1:150
• RATIO - BOUS:GIRLS 4:1 for ASD, ADD/ADHD,
LEARNING/BEHAVIOR ISSUES
AUTISM CHARACTERISTICS
ASD: AUTISM, HFA, ASPERGER’S,
PDD, ADD/ADHD
• FAILURE TO BOND
• LACK OF SOCIAL INTERACTION
• AVOIDANCE OF EYE-TO-EYE
CONTACT
• DIFFICULTIES IN LANGUAGE
DEVELOPMENT
• REPETITIVE BEHAVIORS “STIMMING”
ASD BIO-MEDICALLY
• GENETIC PREDISPOSITION – ALLERGIES,
AUTOIMMUNITY, FAMILY HISTORY
• WEAKENED IMMUNE SYSTEM, FREQUENT
INFECTIONS/ANTIBIOTICS 1st YEAR
• GUT INFLAMMATION, PATHOGENS
• IMPAIRED NUTRITIONAL STATUS
INABILITY TO EXCRETE THEREFORE
ACCUMULATE HEAVY METALS IN THEIR
BODIES
CAUSATION MODELS
• 1) SIMPLY GENETIC?
• 2) GASTROINTESTINAL: GLUTEN/CASEIN
INTOLERANCE, ENZYME DEFICIENCY,
YEAST OVERGROWTH MODEL
• 3) TOXIC CHEMICALS/HEAVY METALS –
VACCINATIONS, AMALGAMS/FISH
• 4) AUTOIMMUNITY, VIRAL MODEL
METABOLIC IMBALANCES IN
AUTISM SPECTRUM DISORDER
• MULTIPLE NUTRITIONAL DEFICIENCIES
• ELEVATED IgG ANTIBODIES
GLUTEN/CASEIN
• IMBALANCE GUT BACTERIAL FLORA
• URINE BACTERIAL/FUNGAL BYPRODUCTS
• MYELIN SHEATH INJURY IN BRAIN
• EVIDENCE OF IMMUNE IMPAIRMENTS
• METHYLATION DISORDERS
• ACCUMULATION OF HEAVY METALS
NUTRIENT DEFICIENCIES in
ASD
• B6 AND MAGNESIUM
• ZINC, SELENIUM AND OTHER
MINERALS
• CALCIUM
• VITAMINS A, C, & E
• ESSENTIAL FATTY ACIDS
• AMINO ACIDS
• B-VITAMINS: B1, 2, 3, 5, 12,
& FOLATE (FOLINIC ACID)
OVERVIEW BIO-MEDICAL
TREATMENTS
•
•
•
•
1)
2)
3)
4)
RESTRICTED DIET, GF/CF/SF
NUTRIENTS
TREAT GUT PATHOGENS
CORRECTING METHYLATION
DYSREGULATION (“Quintet”)
• 5) CHELATION: REDUCING
TOXIC METALS IN THE BODY
• 6) ANTI-VIRAL TREATMENT
BASIC EVALUATION
• HISTORY, PHYSICAL EXAM
• BASIC GENERAL LAB SCREEN
CBC, URINALYSIS
SERUM CHEMISTRIES
THYROID PANEL
IRON PANEL
BASIC DIAGNOSTIC TESTS
FOR GUT:
URINE ORGANIC ACIDS
COMPREHENSIVE STOOL STUDY
FOR NUTRIENT STATUS:
ORGANIC ACIDS, AMINO ACIDS
RBC MINERALS, FATTY ACIDS
VITAMIN PANEL
CLINICAL HISTORY:
EARLY INDICATIONS OF GUT
DYSFUNCTION
1) FAMILIAL DIGESTIVE DIGESTIVE
DYSFUNCTIONS
2) INABILITY TO BREAST FEED
3) PERSISTENT COLIC IN INFANCY
4) FREQUENT INFECTIONS (E.G. EAR)
LEADING TO FREQUENT
ANTIBIOTICS
5) REACTION TO CERTAIN VACCINATIONS
GASTROINTESTINAL
PATHOLOGY SYMPTOMS
REPORTED BY PARENTS
• PERSISTENT DIARRHEA AND/OR
CONSTIPATION, BLOATING, GAS AND
ABDOMINAL PAIN
• SELF-RESTRICTION OF DIET
• NIGHT WAKING – REFLUX
• GREATER ALLERGIC
SUSCEPTIBILITIES
G.I. HEALTH:
TREATMENTS PARENTS
CAN DO
• ELIMINATE SUGARS AND JUNK FOOD FOR
EVERYONE IN THE FAMILY
• READ LABELS ON FOODS, GET EDUCATED
ABOUT TOXINS IN BOTH FOOD AND WATER
• GF/CF/SF OR SCD DIET
• ENZYMES AND PROBIOTICS
• BASIC NUTRIENT SUPPLEMENTATION
G.I. HEALING
TREATMENTS THAT REQUIRE A
PHYSICIAN
• LAB TESTING FOR GUT PATHOGENS
• ANTI-FUNGAL PRESCRIPTIONS RX
• ANTI-BACTERIAL PRESCRIPTION RX
(CLOSTRIDICA AND OTHER)
• SECRETIN, VIT M-B12 INJECTABLES
• IMMUNOGLOBULIN, IV OR ORAL,
ENDOSCOPY
ANTI-BACTERIALS
ANTI-FUNGALS
NATURALS
CAPRYLIC ACID, UVA URSI,
GRAPEFRUIT SEED EXTRACT,
LAURICIDIN
PRESCRIPTIVES: FLAGYL,
GENTAMYCIN, VANCOMYCIN,
DIFLUCAN, NYSTATIN, NIZORAL,
SPORANOX
TREATMENTS BEYOND
THE BASICS
METHYLATION
DETOXIFICATION
VIRAL/IMMUNE ISSUES
RECENT NEW TREATMENTS
METHYLATION TREATMENT
“ QUINTET”
1) GLUTATHIONE (GSH), ORAL, TD, OR IV
150-MG BID ORAL, 125-MG BID TD,
300-600-MG IV
2) ALLITHIAMINE (TD - TTFD)
50-MG BID (COMPOUNDED OR AUTHIA)
3) METHYLCOBALAMIN (INJECTABLE M-B12)
CONC 25-MG/ML, 64.5-MCG/KG Q 3 DAYS
4) FOLINIC ACID, 800-MCG TWICE DAILY
5) DMG, 125-MG PER YR OF AGE, ALL IN AM
OR TMG, 500-1000-MG TWICE DAILY
METHYLCOBALAMIN
• VIT B12 LEAST TOXIC, BEST TOLERATED,
H20 SOLUBLE - EXCESSES URINATED
OUT WITHOUT HARM.
• UPTAKE FROM ORAL INTAKE LOW,
PARTICULARLY IN GI INFLAMMATION.
• VIT B12 PLAYS KEY ROLE IN GSH
STABILIZATION AND KEEPING OTHER
ENDOGENOUS ANTIOXIDANTS IN
REDUCED STATE.
• DIFFICULT TO TEST FOR DEFICIENCY;
SERUM LEVELS INADEQUATE AS
• MARKER FOR DEFICIENCY.
• ULTRA HIGH DOSES MAY REGENERATE
NERVES
GLUTATHIONE (GSH)
• NATURALLY OCCURING TRI-PEPTIDE
FROM CYSTEINE, GLUTATMIC ACID,
AND GLYCINE.
• PRESENT IN ALL LIVING CELLS,
HIGHEST LEVEL FOUND IN LIVER.
• WORKS TO INHIBIT FORMATION OF
FREE RADICALS, DETOXIFYING
HARMFUL COMPOUNDS.
• DEFICIENCY INCREASES SENSITIVITY
TO THIMEROSAL AND OTHER
PRO-OXIDANT AGENTS.
GLUTATHIONE, Cont’d.
• VIT C, E, A-LIPOIC ACID (ALA), NACETYL CYSTEINE (NAC), SELENIUM,
GLUTAMINE, AND SILYMARIN
ENHANCE GSH LEVELS BY HELPING
BODY MANUFACTURE IT.
• VITAMIN B12 HELPS MAINTAIN
GLUTATHIONE IN ITS USEFUL
REDUCED BIOLOGICAL STATE.
TOXINS DIAGNOSTIC
EVALUATION
1) EXPOSURE HISTORY – MOTHER DIET,
AMALGAMS, RHOGAM VACCINATION
HISTORY
2) HAIR ELEMENTS ANALYSIS
3) RBC MINERALS AND TOXICS
4) METALLOTHIONEIN CELLULAR TEST
TTFD (ALLITHIAMINE)
• TTFD IS THIAMINE TETRAHYDROFURFURL
DISULFIDE, SYNTHETIC COUNTERPART TO
ALLITHIAMINE, A DERIVATIVE OF VIT B1
(THIAMINE) NATURALLY FOUND IN GARLIC.
• THIAMINE IS WATER-SOLUBLE, NECESSARY FOR
METABOLISM PROTEINS, CARBS, AND FATS
• THIAMINE DEFICIENCY IN ALCOHOLISM,
MALNUTRITION, USE OF CERTAIN DRUGS
• GENTLE CHELATOR FOR ARSENIC,
CADMIUM, ALUMINUM, LESS FOR HG
• NON-TOXIC, NO PRESCRIPTION NEEDED,
TRANSDERMAL CREAM TWICE DAILY
PREPARATION for REMOVING
HEAVY METALS
• NUTRIENT READINESS: ADEQUATE
MINERALS BEFORE AND DURING
CHELATION; PROBIOTICS, ENZYMES
• GUT READINESS: CHELATION CAN
ENCOURAGE PATHOGENS TO GROW,
PREPARE AND PLAN FOR THIS
• LAB STUDIES: CBC, CHEMISTRY PANEL
BEFORE STARTING CHELATION
CHELATION AGENTS
•
:
• DMSA (CHEMET) FDA APPROVED for LEAD
REMOVAL IN CHILDREN, HIGH SAFETY INDEX,
OTC AS CAPTOMER. NEWLY EFFECRIVE TD
FORM, SAME SCHEDULE AS ORAL 3 ON, 11 OFF, Q
4 OR 8 HRS.
• DMPS, NOT FDA APPROVED FOR CHILDREN BUT
LEGAL FOR COMPOUNDING. SMALL ORAL
DOSES EFFECTIVE, SAFE, IV CONTROVERSIAL
BUT USED AND EFFECTIVE, NEW TD FORM.
• ALA (ALPHA LIPOIC ACID) OTC ANTI-OXIDANT
THOUGHT TO CROSS THE BBB, SO NOT TO BE
USED UNTIL METAL REMOVAL WITH DMSA HAS
PLATEAUED.
•
IMMUNOLOGY IN ASD
• IMMUNOLOGICAL ISSUES IN AUTISM
• FAMILY HISTORY IMPORTANT
• IMMUNE TESTING AS GUIDANCE FOR
TREATMENT
DIAGNOSTIC EVALUATION
IMMUNE SYSTEM
SPECIALTY LAB Tests, MINIMAL
1) COMPREHENSIVE VIRAL PANEL #3
2) NK CYTOTOXICITY TEST
3) MYELIN BASIC PROTEIN (MBP)
PANEL
4) RUBEOLA ANTIBODIES
PREMIER ASD IMMUNE PANEL, ISL
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Streptococcal Peptides (M5, M12, M19) (IgG)
Gliadin Peptides Antibodies (IgG, IgM, IgA)
Casein Peptides Antibodies (IgG, IgM, IgA)
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Antibodies to Hg Binding Antigen (Fibrillarin) (IgG, IgM, IgA)
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Dipeptidylpeptidase (DPP IV) Antibodies (IgG, IgM, IgA)
Anti-Myelin Basic Protein Antibodies (IgG, IgM, IgA)
Anti-Neurofilament Antibodies
Metallothionein (Cellular Level)
NK Cell Activity
Measles Antibodies (IgG, IgM)
VIRAL SCREEN #3: Varicella Zoster Virus (IgG)
Cytomegalovirus (IgG, IgM)
Epstein-Barr Virus or VCA (IgG, IgM)
Herpes Type 1 & 2 Virus (IgG, IgM)
Herpes Type 6 Virus (IgG, IgM)
Immunoglobulins (IgG, IgA, IgM)
$1644, 50% DISCOUNT AS PANEL = $822 PRE-PAID
Blood Required, 2 yellow tops, 1 red top (10 cc in each tube)
MEASLES AND BRAIN VIRAL
AUTO-ANTIBODIES IN ASD
• SINGH 1998: 70% OF AUTISTIC SERA
HAD ANTI-MYELIN BASIC PROTEIN
ANTIBODIES, NONE IN NT CHILDREN.
• 57% ASD HAD ANTI-NEURON-AXON
FILAMENT PROTEIN, NONE IN NT
KIDS
• HIGHER ANTI-MEASLES ABS THAN NT
KIDS, MUMPS AND RUBELLA NOT
DIFFERENT FROM NT’S
WAKEFIELD: INFLAMMATORY
BOWEL DISEASE IN AUTISM
• GUT BIOPSIES, 1998: MEASLES VIRUS
DETECTED IN DENDRITIC CELLS AND
MATURE LYMPHOCYTES IN 75/91 ASD
CHILDREN VS 5/70 CONTROLS WITH
LYMPHOID NODULAR HYPERPLAXIA
• THOUGHTFUL HOUSE 2005 STUDY
CORROBORATES INCREASED RATE
OF SWOLLEN INTESTINAL LYMPH
GLANDS, INCREASED INTESTINAL
LINING INFLAMMATION IN ASD’S
WITH BOWEL ISSUES.
IMMUNITY TREATMENT
NATURAL ANTI-VIRALS
• LAURICIDIN (ORIGINALLY FOUND IN
BREAST MILK & COCONUT, NOW
SYNTHETIC (WWW.LAURICIDIN.COM)
•
•
•
•
OLIVE LEAF EXTRACT, GREEN TEA
LARCH ARABINOGALACTINS
IP- 6 (INOSITOL HEXAPHOSPHATE)
GRAPEFRUIT SEED EXTRACT
PRESCRIPTIVE ANTI-VIRALS
• ACYCLOVIR 800MG 3X/DAY (FOR
UNDER 30#, 10-12KG)
• VALTREX (MAIN ONE I USE) 250MG –
1500MG 2x DAILY, DEPENDING UPON
SIZE
• ALTERNATE WITH FAMVIR
250MG – 500MG/DAY DEPENDING
UPON SIZE
RECENT THERAPY REFINEMENTS
• NEW DIETS BEYOND GF/CF/SF: (SCD)
SPECIAL CARBOHYDRATE DIET –
• (OLD) OXALATE-LOWERING DIET
• MB-12 METHYLCOBALAMIN – DAILY
HIGH DOSE INJECTIONS NEUBRANDER)
• NASAL SPRAY MB-12 + FOLINIC ACID
• TD DETOX AGENTS, TD-DMPS, TD-DMSA
RECENT NEW TREATMENTS
• PPAR’S (ACTOS) FOR GUT AND BRAIN
INFLAMMATION, SHIFTS T2 TO T1
• LOW-DOSE NALTREXONE FOR IMMUNE
MODULATION, SOCIABILITY
• NASAL MB-12 + FOLINIC ACID
• ANTI-VIRAL TREATMENT FOR ALMOST ALL
CHILDREN, NATURAL AND/OR PRESCRIPTIVE
ACTOS AND IMMUNE
MODULATION FOR BRAIN-GUT
INFLAMMATION
• PPAR – ACTOS (PIOGLITAZONE), PX FOR
PRE-DIABETES, LOWERS GUT AND NEUROINFLAMMATION, REGULATES LIPID AND
GLUCOSE METABOLISM, SHIFTS
IMMUNITY FROM T2 HUMORAL (AUTOIMMUNITY) TO T1 (CELLULAR)
. CLINICAL STUDY >300 CHILDREN, DR.
BORIS/GOLDBLATT, PROMISING
LOW-DOSE NALTREXONE (LDN)
• FDA APPROVED OPIOID ANTAGONIST
1985, BRAND REVIA, ALSO GENERIC
USED IN 50 - 150MG DOSES AS OPIOID
ANTAGONIST FOR NARCOTIC/ALCOHOL
ADDICTION
•
• MUST BE PRESCRIBED AND
COMPOUNDED IN CAPSULES OR
TRANSDERMAL CREAM
LOW-DOSE NALTREXONE AS
IMMUNOMODULATOR
• OPIOIDS ALTER BOTH INNATE AND
ADAPTIVE IMMUNE CELLS – NK CELLS,
MACROPHAGES, IMMATURE
THYMOCYTES, T CELLS AND B CELLS
• BRIEF BLOCKADE OF OPIOID RECEPTORS
ELEVATES B-AND OTHER ENDORPHINS
• NORMALIZATION OF PLASMA CHEMICAL
PROFILES: ELEVATED NOREPINEPHRINE,
ARGININE-VASOPRESSIN, SEROTONIN
(BOUVARD, LENSING, PANKSEPP, 1995)
THERAPEUTIC USE IN ASD
• USE IN TINY DOSES (1.5 – 4.5MG)
• REGULATES MOOD & MODULATES
IMMUNE SYSTEM, USE ONCE DAILY
BETWEEN 9PM-12AM FOR 2-4 AM
ENDORPHIN “RUSH”, LASTS 18 HRS
• AS IMMUNOMODULATOR - INCREASES
NATURAL ENDORPHINS,SHIFTS T2
(HUMORAL IMMUNITY) TOWARD T1
(CELLULAR) IMMUNITY
ENDORPHINS
•
•
•
NEUROHORMONES - MODIFY NERVE
CELL OPIATE RECEPTORS TO
NEUROTRANSMITTERS, ANALGESIC
ENKEPHALINS/ENDORPHINS: ALPHABETA-GAMMA & SIGMA-ENDORPHIN
STIMULATE ENDORPHIN SECRETION:
LDN
PHYSICAL EXERCISE
TOUCH - MASSAGE/ACUPUNCTURE
LAUGHTER
CHOCOLATE
BETA-ENDORPHIN
ENDORPHIN COLLECTION
MICHAEL W. DAVIDSON (NHMFL)
FLORIDA STATE UNIVERSITY
TH1-TH2 BALANCE
TH1 – CELLULAR IMMUNITY,
DIRECTS NK T-CELLS AND
MACROPHAGES TO ATTACK
ABNORMAL CELLS AND
PATHOGENS INSIDE THE CELL
TH2- HUMORAL IMMUNITY, CREATES
ANTIBODIES TO NEUTRALIZE
FOREIGN INVADERS OUTSIDE CELL
HEALTHY IMMUNITY
• BALANCED BETWEEN Th1 - Th2,
SWITCHES BACK AND FORTH AS
NEEDED
• INABILITY TO RESPOND
ADEQUATELY TO Th1 – CHRONIC
INFECTION & CANCER
• OVERACTIVE Th2 RESPONSE –
PLAYS ROLE IN AUTOIMMUNITY
AND ALLERGIES
UNHEALTHY IMMUNITY
FAILURE OF THE Th1 ARM &
OVERACTIVE Th2 ARM:
AIDS
CFS (FATIGUE)
CANDIDIASIS
MULTIPLE ALLERGIES
MCS (CHEMICAL)
CANCER
AUTISM
SUMMARY BIO-MEDICAL
TREATMENTS
•
•
•
•
1)
2)
3)
4)
RESTRICT DIET, GF/CF/SF, SCD
NUTRIENTS
TREAT GUT PATHOGENS
CORRECTING METHYLATION
DYSREGULATION (“Quintet”)
• 5) DETOXIFICATIOIN: REDUCING
TOXIC METALS IN THE BODY
• 6) ANTI-VIRAL TREATMENT
• 7) ENHANCE IMMUNE SYSTEM
• 2nd Edition
• 2003