Recent advances in autism treatment

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  • Numerous heavy metals which are toxic the most toxic are lead,mercury,cadmium,arsenic,aluminium,antimony,tin,nickel,thallium as well as ones that are essential but dangerous in excess namely Iron and copper which we will discuss later
  • When they enter the bodythey go thro a chemical biological processcalled oxidation and form free radicals.It is now indisputed that free radical damagecontributes significantly to the degeneratuve process of ageing.Act akin to sparks in a fire damagingcells and resulting in the diseases so often reffered as the ageing diseases.when cells are damaged they no longer function properly resulting in damage to the tissues andfinally to the organs of the body.Symptoms may not appearfor yearsas the body stores these toxins in various tissues.Bones and fatty deposits.Symptoms of chronic metal toxicity are therefore insidiousand non specifucand include fatigue,malaise and increased susceptility to infections.Excessive free radical activity cannot be avoided in todays environment.When this dagenerative process happens to the cells in your body you can easily see why you do not have the energy you should.You don’t repair as well as u used to,u get older more quickly and u wear out much faster than you want.When this process affects your blood vessels u develop circulatory problems leading to poor skin texture etc etc
  • Antioxidants in diet and producedin the body during the course of normal metabolism protect us by preventing these heavy metals from becoming oxidated and behaving as free radicals. Exaplles of antioxidants are etc etc.So a diet rich in these is advised.
  • For Example
  • Diet supplementation skinn release etc are all useful methods for dealing with heavy metals.Over time these natural processesare unable to defend us resulting in the diseases already mentioned
  • Recent advances in autism treatment

    1. 1. Recent Advances in the treatment of Autistic Spectrum Disorders
    2. 2. By the end of 7 months Smile back at another person Respond to sound with sounds Enjoy social play Red Flags • No big smiles or other warm, joyful expressions by six months or thereafter • No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
    3. 3. By the end of 12 months Use simple gestures Imitate actions in their play Respond when told “no” Red Flags • No back-and-forth gestures, such as pointing, showing, reaching, or waving bye • Not answering to one’s name when called • No babbling – mama, dada, baba
    4. 4. By the end of 18 months Do simple pretend play Point to interesting objects Use several single words unprompted Red Flags • No single words by 18 months • No simple pretend play
    5. 5. By the end of 2 years (24 months) Use 2- to 4-word phrases Follow simple instructions Become more interested in other children Point to object or picture when named Red Flags • No two-word meaningful phrases (without imitating or repeating) • Lack of interest in other children
    6. 6. Red Flag: Any loss of speech or babbling or social skills Regression at any age is cause for immediate referral
    7. 7. The emergence of a new autism model Older model • Genetically determined • Brain based • Hard-wired • Treatable but not curable Is autism a BRAIN DISORDER? Newer model • Environmentally triggered • Genetically influenced • Both brain and body • Metabolic abnormalities play big role • Treatable and recovery possible OR is it A DISORDER THAT AFFECTS THE BRAIN?
    8. 8. Topics AUTISM is A Medical condition . It is not a mental Disorder As such it is preventable Treatable . 8
    9. 9. Treatment Goals  Minimize core features and associated deficits  Maximize functional independence and QOL  Alleviate family stress Educational intervention Developmental Therapies  Communication  Sensory, fine motor, gross motor Behaviorally Based treatments  Core and associated symptoms  Social skills Medical or biologic treatments Support family in home and community
    10. 10. ABA (Applied Behavioral Analysis) General behavioral teaching approach involves reinforcement and consequences to shape behavior All of our parents used it! Involves the A, B, C’s Not airway, breathing circulation Antecedent Behavior Consequence
    11. 11. Speech/Language Therapy Behaviorally based/ intensive structured teaching  E.g., Verbal Behavior Augmentative strategies  Sign language  PECS  Aided augmentative/ alternative system(s) Decrease non-communicative language Developmental-pragmatic approaches  appropriate use of language in social situations  e.g., SCERTS  Social skills training
    12. 12. Adjunct to educational, developmental & behavioral treatments So far no evidence of impact on core symptoms Evidence supporting is variable Toolkit – handouts for MD & families Treat target symptoms  Stereotypies  Withdrawal  Obsessions  Irritability  Hyperactivity  attention span  self-injurious behavior  Aggression  sleep
    13. 13. Mind-body Medicine Yoga Music Therapy Manipulative and Bodybased Chiropractic Massage/Therapeutic Touch Auditory Integration Energy Medicine Transcranial & magnetic stimulation Biologically Based Most commonly used ~ 50% - biologically based 30% - mind body 25% - manipulation/ body based ** Most use > 1 modality
    14. 14. Immune Supplements B6/Magnesium, B12 DMG/ TMG Vitamin A, Vitamin C Folate Omega 3 Fatty Acids Elimination Diets Casein/ gluten free Off-label medications Secretin  Antifungal therapy  Immunotherapy, steroids  Antibiotics/Antivirals  Stem cell transplantation Immunization- related  With-hold immunization  Chelation Hyperbaric oxygen therapy (HBOT) Always others coming along…
    15. 15. One of most commonly used CAM treatments Hypothesis : Exogenous opiate-like peptides = false neurotransmitters Evidence – most non-blinded; few RCT emerging, no differences Requires elimination of ALL dairy products (not “GFCF except for ice cream…”) & elimination of barley, rye, oats & wheat products Potential deficiencies Inherently deficient in calcium, vitamin D B vits, Iodine, others may be lower in substitute products Weight typically adequate, monitor Fe status
    16. 16. Another approach to therapy Dealing with the yeast overgrowth. Dealing with the leaky gut. Heavy metals and their effects. Chelation. Methylcobalamin. 16
    17. 17. with before dealing with the heavy metal issue There are 3 main issues common to all autistic Children 1. Yeast Overgrowth 2. Leaky gut 3. Heavy Metal Accumulation 17
    18. 18. Yeast Overgrowth Yeast overgrowth leads to poor absorption of necessary vitamins, minerals & esssential nutrients. It is normal to have a small amount of yeast in the GI tract. Autistic children however have abnormal amounts, usually leading to poor absorption of essential nutrients and the leakage of toxic substances into the bloodstream which should not be absorbed. 18
    19. 19. How do we treat the Yeast overgrowth & Leaky gut syndrome  Nutrition/Antioxidants in food and metabolised in the body  Vitamins A, B Complex, C, E, B12 , B6, Folic Acid, Niacin  Essential Fatty Acids These are extremely important. They are a most powerful anti-inflammatory agent.  Co-Enzyme Q10,DMG  Trace elements – Magnesium, Selenium, Chromium, Zinc  Probiotics  Reduced L glutathione,N Acetyl cysteine, Alpha-Lipoic Acid  Anti-fungals medications.  Herbal Products, 19
    20. 20. and where do they come from Lead – petrol, paint, batteries, certain water mains Mercury – fillings in teeth, fish, paint, numerous appliances such as mercury thermometers, nasal sprays and eye drops, certain vaccines. Cadmium – Cigarettes, tyres, metal platings Arsenic – Pesticides, chicken feeds, rice, treated wood 20
    21. 21. and where do they come from Aluminum – Cooking wares, aluminum foil, antacids, certain vaccines, canned drinks/foods Antimony – Carpets, flame retardant clothes Iron Copper 21
    22. 22. Heavy Metals – how are we protected against these free radicals  Diet /nutrition– “let food be your medicine       and let medicine be your food”- Hippocrates Supplementation Skin release Good kidney eliminations Good bowel eliminations Exercise Healthy lifestyle 22
    23. 23. What are the effects of these toxic metals overload They are oxidised to form free radicals resulting in the destruction of cells, They affect organs ,interfere with enzyme systems, inhibit prostaglandin formation. Weaken the immune system, inhibit the proper functioning of cells, contribute to gastrointestinal problems, and are carcinogenic. 23
    24. 24. What Chelation agents are there 1. EDTA-Ethylene diamine tetra acetic acid 2. DMSA(dimercocaptosuccinic acid) 3. DMPS(dimercaptopropanesulfonic acid) 4. TTFD Transdermal Allithiamine 24
    25. 25. How are they used EDTA is effective only intravenously.It is used in adults in the form of MG EDTA for Heart Disease,Circulatory disorders,neurological disorders, and the chronic degenerative diseases. DMSA (dimercocaptosuccinic acid) DMPS(Dimercaptopropanesulfonic acid) TTFD/allathiamine (active form of B1) 25
    26. 26. EDTA and its safety Given according to ACAM protocol millions of chelations in past 30 years no recorded death. Doctors licensed in western Canada since 1997 No serious ADRS NIH conducting $30 million clinical trial on 2,300 patients no serious adrs NIH 800,000 I.V EDTA chelations in U.S. alone no serious ADRS Not suitable for ASD children 3 hour i.v. inneffective in chelating mercury Powerful chelator of all other toxic heavy metals 26
    27. 27. Metal Dertoxification in Auistic children DMSA is the most widely used , convenient, safe , and given orally. It is a good chelator of Mercury, Lead and Cadmium. Dmps May be given intravenously. A good chelator of mercury,often used as a provovative agent, usually given in oral form 27
    28. 28. Chelating With the oral chelators  DMSA is given orally according to the Dan protocol 10mg/kg body weight/3times daily for three days on and 11 days off.  Repeat Full Blood Count and Blood chemistry tests at 3 to 4 month intervals.  Mobilization and excretion of the heavy metals produces a shift in the equilibrium between the various compartments of the body. This exerts an almost magnetic effect on metals in depots which are not directly accessible to the chelating agent. The body attempts to restore an equilibrium between the depots again. The heavy metals will then migrate partially into compartmenst where it is accessible to the chelating agent. 28
    29. 29. Advantages of DMSA over DMPS  DMSA more widley used therefore greater experience with its use and well established safety profile.  Well established in the DAN protocol.  No well established oral DMPS protocol.  DMPS used more in acute poisoning with Lead, Mercury, Arsenic etc.  DMSA is more effective in removing Mercury from the brain, particularly when combined with Alpha Lipoic Acid. 29
    30. 30. Disadvantages of DMSA oral therpay  DMSA may feed into the yeast/leaky gut/Gastrointestinal problems.  DMPS is not as severe on the gastrointestinal problems  DMPS used by some physiciansina once weekly dosage of 100 mg per week  Is over 50 % absorbed 30
    31. 31. Methylcobalamin and pharmacology Metylathion is the process by which a single Carbon atom is transferred from a Methyl donor to another molecule.This process is essential to life itself. Dr. Richard Deth of Boston believes that Thiomersail interferes with the Metylathion process in converting Vitamin B12 to Metylcobalamin. In many cases Autsim can be treated effectively by the Administration of Metyl B12 to augment the Metylathion capacity. 31
    32. 32. Biosynthesis of Active Methylcobalamin The low levels of Glutathione in autistic children will adversely affect their ability to detoxify and protect against heavy metals such as Thiomersal. 32
    33. 33. Impaired Methylation As impaired Methylation is important in Autism, the administration of Methylcobalamin should bring about an improvement. Dr. James Neubrander has found significant improvement with injections of Methylcobalamin by giving the Methylcobalamin every 3 days. Improvements were noted in Attention, language ability and social skills. 33
    34. 34. How is Methylcobalamin given? Dosage recommendation is 65 micrograms per Kilogram Bodyweight every 3 days. This means that as much as 1250 micrograms is present in 0.05ml The needle 30 gauge 3/10 Ultrafine BD insulin. It may be given by the parent while the child is sleeping. It is inserted into the buttock at a 30 – 45 degree angle just under the skin. 34
    35. 35. Adverse effects 1. Stimming 2. Hyperactivity  Should these effects occur one does not necessarily stop the treatment.  If Adverse effects are tolerable the treatment should continue 35
    36. 36. Concentrated Metylcobalamin by Injection Metylcobalamin is the active Co-enzyme element of B12 B12 is present in the brain and central nervous system as Metylcobalamin & is Non toxic. It is known that Metylcobalamin metabolism is impaired in the Autistic child. Much information on this is available for Dr. Neubrander. 36
    37. 37. Typical Naturopathic Treatment Plan Heavy Metal Toxicity Gastrointestinal Health Wheat (gluten) and milk (casein) free diet Candida diet (sugar, arabinose, tartaric acid) Hypoallergic diet to prevent autoimmunity Anti-inflammatory diet to control inflammation Supplements including EFA, probiotics, glutamine, MCT Asses presence of heavy metals Investigate heavy metal exposure Undergo chelation therapy for removal of heavy metals Brain Chemisty Evaluate levels of Glutamate/GABA, serotonin and dopamine
    38. 38. Nutrition Why does food matter? Opium, gluten and milk in Autism Breakdown of gluten and casein by secretions of the pancreas and the intestines create peptides (small proteins) that are similar in structure to endorphins (the body’s natural pain killer). These peptides have opiate-like qualities. Normally, these peptides are degraded and excreted with little effect. In autistic patients, these peptides can lead to reduced brain electrical activity and thus altered behavioural changes. This activity is improved by naltrexone administration (an opioid antagonist) therefore proving opioid action. Much anecdotal evidence exists of significant improvement in autistic symptoms when milk and wheat are eliminated from the diet. A study using 15 autistic children correlated significantly increased urine exorphin level with autistic spectrum patients. Elimination of milk and gluten from the diet resulted in improvement of social, cognitive and communications sills, commensurate with reduction of urinary exorphin level. Knivsberg et al, 1990
    39. 39. Treatment  Atypical antipsychotic, Abilify (Aripiprazole) oral formulation was approved November 24, 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years.  Data based on two 8 week, randomized, placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I).
    40. 40. Multi dimensional approach It should be remembered that improving Methylation capacity is only one component of the multi dimensional approach in the treatment of Autism. Gluten Casein free diet Nutritional supplementation Chelating Behavioural therapies Pharmacotherapy 41

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