1. Biomedical Treatment Options for Autism Spectrum Disorders (ASD)
Phillip C. DeMio, MD
Seven Hills, OH
Worthington, OH
© Phillip C. DeMio, MD 05/05

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

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

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

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

30. 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

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