Biomedical Treatment Options for Autism Spectrum Disorders (ASD) Phillip C. DeMio, MD Seven Hills,...

Biomedical Treatment Options for Autism Spectrum

Disorders (ASD)Phillip C. DeMio, MD

Seven Hills, OH 216-901-0441

Worthington, OH614-436-2036

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)

– 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 restrictionYeast –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 ASDNutritional 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) – Diet and probiotics– Antimicrobials– Supplements– Herbal– 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