Biomedical Treatment Options for Autism Spectrum Disorders (ASD) Phillip C. DeMio, MD Seven Hills, OH 216-901-0441 Worthington, OH 614-436-2036 www.drdemio.com © Phillip C. DeMio, MD 05/05

What is Autism? It’s, well, you know… Can seem almost abstract To the “rescue”: DSM and the Psychiatric definition. Initially (1938) a breakthrough. Now generally includes: autism, PDD’s, ADD/ADHD, and Asperger’s syndrome Ignores biology and undeniable physical signs and symptoms by calling autism a mental disorder Now obsolete (and dare I say prejudicial) © Phillip C. DeMio, MD, 05/05

Redefining Autism A combined disorder of: Gastrointestinal/Nutritional system Immune system Metabolism Toxicologic (detoxification) pathways These result in specific neurologic findings that are not behavioral (cognition, speech, motor, cerebellum, cranial nerves, (eg. swallowing), sensory integration, etc.) Medical (not mental!) © Phillip C. DeMio, MD, 05/05

Redefining Autism (continued) Therefore, ASD includes: Autism, PDD’s, ADD/ADHD, Asperger’s Syndrome, and … OCD, RAD, tics, comorbid developmental illnesses, shadow syndromes, and … Bipolar/affective disorders, schizophrenia, allergy, asthma, autoimmune diseases, fibromyalgia, some dementias © Phillip C. DeMio, MD, 05/05

Gastrointestinal Issues in ASD Swallowing dysfunction Tactile sensory integration disorder (defensiveness, textures) Heightened taste sensitivity Motor planning problems (stuffing, laryngeal penetration) Leads to choking/gagging, leakage, expectoration GERD and upper GI dysmotility Almost always dysbiosis of yeast and others (immune connection) © Phillip C. DeMio, MD, 05/05

Gastrointestinal Issues (continued) Inflammation, mucus production, villous denusion Poor digestion, malabsorption, barrier dysfunction (“leaky gut”), and low bile flow (detoxification connection) Enterocolitis in autism with measles virus (vaccine connection) Endoscopic abnormalities Association with antibiotics Diarrhea (dysbiosis and malabsorption) Constipation!! (connection to diet, yeast, and metabolism) © Phillip C. DeMio, MD, 05/05

The Immune System in ASD Immune deficiency: Severity and frequency of infections (respiratory, GI, brain) Altered response to treatment (antibiotics, steroids) Association with dysbiosis and yeast (dietary connection, antibiotics) Allergy/asthma Aeroallergiens Food sensitivity (immunologic, toxic (gluten/casien, phenols, carotenes)) Steroid connection (yeast and dysbosis) Autoimmunity Thyroid Brain (GABS, PANDAS, OCD, tics, Hg) GI (like IBD) Opiate receptors (diet connection) © Phillip C. DeMio, MD, 05/05

Toxicity in ASD Mercury Vaccines Dental Diet/other Mercury is very toxic Brain Immune system GI tract Metabolism “No matter what the cause…” (even when Hg and others are detected, controversy remains) © Phillip C. DeMio, MD, 05/05

Toxicity in ASD (continued) Chelation and minerals treat Hg toxicity Simultaneous diagnostic information and treatment (essential and multiple toxic minerals) Useful in treatment of ASD Clean up the diet and the home Other toxins Testing is difficult Treatment overlaps with that for heavy metals, especially glutathione Clean up diet and home © Phillip C. DeMio, MD, 05/05

“Genetic” Cause What is genetic disorder? Can genes be damaged after conception/birth? What do tests tell us?

Metabolic Abnormalities in ASD Many fundamental B-vitamin – mediated pathways have been seen to be in disarray, eg. Krebs cycle and other mitochondrial pathways Methylation abnormalities: B-12 Folate (MTHFR) Transulfuration (homocystine, SAM, sulfate, and glutathione) Connects with muscle tone, cognition, and intrinsic detoxification, to name a few. © Phillip C. DeMio, MD, 05/05

Treatment of ASD Based on: Defining concepts of ASD as biological Results of tests Patental decisions: Ability to implement Commitment (not judgemental) Practitioners should work together without forcing parents/patients to choose “either or”. © Phillip C. DeMio, MD, 05/05

Tests in ASD Purposes: Serve as baseline Toxic metals Nutritional metals Detoxification systems Integrity of baseline metabolism and organs (liver, kidney, hematologic, nutritional, and others) Allow physician to follow course of treatment Goals for improvement (clinical, correlates) Preempt “side effects” © Phillip C. DeMio, MD, 05/05

Biomedical Treatment of ASD A word about psychoactive drugs I am not against the use of these drugs in managing ASD For most cases, other options in my opinion should be implemented first It should never be “either or” They do have their own toxicities and excipients (constipation, amotivational (therapy), metals, starch, sugar, colorings) The ideal: reduce or eliminate the drugs © Phillip C. DeMio, MD, 05/05

Biomedical Treatment (cont.) Dietary Intervention Goals: Address malnourishment (common) Address foods that are often toxic to kids and adults with ASD Address dysbiosis , leaky gut, and bowel function Must be part of a comprehensive program Many types; not all of them need be done in every child nor is it practical to do so. Layers They include: GF/CF, CSYF, sugar/carbohydrate restrictive, phenols/salicylates (and synthetic), carotene avoidance, whole foods © Phillip C. DeMio, MD, 05/05

Diets in ASD Gluten-free, casein-free (gf/cf) Pathophysiology Two diets usually done simultaneously (or in close tandem) Pathophysiology Exorphin peptide concept Involves incomplete digestion of grains and/or dairy proteins Concurrent intestinal barrier dysfunction Adverse effects occur at wide spread receptor sites © Phillip C. DeMio, MD, 05/05

Diets in ASD (continued) Testing (gf/cf diet) Dietary trial (sorry, there doesn’t seem to be a lowest threshold above zero) Urine peptide test Follow-up clinical A word about enzymes. Peptidases (DPPIV, Bromelain) Sounds good, but… Toxicity Mucosal Actual release of toxic peptides Fungal derivation (rarely a problem) © Phillip C. DeMio, MD, 05/05

Diets in ASD (continued) Pragmatics (gf/cf diet, cont’d) Not the same as celiac diets Lots of work for what many parents see as an unknown Sugar Sucrose/lactose/maltose, other disaccharides Yeast dysbiosis (not “a stimulant”) Enzymes a help Antimicrobials: with a whole program when off sugar for good © Phillip C. DeMio, MD, 05/05

Diets in ASD (continued) Carbohydrate restricting diets Define (grain, peanut, soy and root starch vs. tree nuts and legumes) Sugars: monosaccharides but… (many persons grow yeast on some monosaccharides) Examples of the above starches and sugars Bottom line: Some kids lose weight Not necessary nor helpful in every child Shifts to putrefaction Whole foods, carbohydrate, moderation, and enzymes are where to start. © Phillip C. DeMio, MD, 05/05

Diets in ASD (continued) Pigment Restrictions Phenols/salicylates Define Synthetic versions (supplements, foods, etc) No test available Treat by trial and enzymes Carotene restriction Yeast –related diets Complex on paper (live or dead yeast, fermented products, food additives, baked goods, alcoholic beverages) Simple to implement for most people Sugar (refined and fruits (fresh vs. dried)) © Phillip C. DeMio, MD, 05/05

Diets in ASD (continued) Allergy Elimination Re: IgE-mediated (describe) Otherwise this will be quick (unless you have gone through lots of treatment, and your child is now ready) Tests can show many positives (“yes, it’s allergy”) to foods that the child doesn’t react to (GI basis), as well as to true allergens. Cross reactive advice is too broad Yeast is an early cause of the above Diets will be too restrictive in early treatment of other issues Rotation/elimination (more accurate than tests, more cumbersome) © Phillip C. DeMio, MD, 05/05

Diets in ASD (continued) Whole foods Defined “easier and harder” Scratch cooking Not much to do/add Child’s refusal GI digestion issues Spoilage and organic foods © Phillip C. DeMio, MD, 05/05

Biomedical Treatment of ASD Nutritional Supplements Thousands of types, so where do you start? They must be clean (gf/cf, metals, dyes) Based on malnourishment, test results, and studies/experience with children on the spectrum Common supplements Probiotics Minerals (zinc!) Oils Various B vitamins Re: methylation/trans-sulfuration “Side effects” © Phillip C. DeMio, MD, 05/05

Biomedical Treatments in ASD (cont.) GI Treatment: Dysbiosis & Barrier Dysfunction Fighting yeast Diet and probiotics Antifungals Drugs Supplements Herbal Bacterial (putrefactive) Antimicrobials Antibiotics © Phillip C. DeMio, MD, 05/05

Biomedical Treatment in ASD (cont.) Parasites (cyclospora & giardia) Barrier dysfunction Treating the above Diet and antimicrobials Immune stimulants Cromolyn, bioflavones Classic drugs © Phillip C. DeMio, MD, 05/05

Biomedical Treatment in ASD (cont.) Chelation Based on history, exam, and testing Part of a whole program Musical chairs with sulfur Topical vs. oral vs. IV Must supplement “Side effects”: metabolic, cognitive © Phillip C. DeMio, MD, 05/05

Immunologic Treatments for The Spectrum IV/OIg/Others Actos® LDN Other Treatments

Hyperbaric Oxygen in ASD About HBOT Types One size fits none with our kids! Vascular GI Immune Other “Side” Effects

Far Infrared Treatment (FIRS) A detox and metabolic treatment Discuss mechanisms Pragmatics

Biomedical Treatment in ASD (cont.) Follow-up Observe closely Modify based on clinical response (parents, other practitioners) Follow-up tests © Phillip C. DeMio, MD, 05/05

Biomedical Treatment of ASD (cont.) Discussion with Q & A © Phillip C. DeMio, MD, 05/05