By Michael Montico, MD
Children diagnosed with autism spectrum disorder (ASD) exhibit repetitive behaviors, have difficulty with communication, and face challenges while socializing with others. While children with ASD exhibit some combination of these signs, it is of utmost importance that we concentrate on treating the underlying causes. The biomedical approach to ASD aims to address the genetic, epigenetic, and biochemical issues that are the underlying causes of our children’s symptoms. Epigenetics is the process by which our DNA expresses itself. This takes place through the activation and deactivation of genes and can be severely impacted by the environment. Insults from the environment lead to multiple biochemical changes epigenetically, in turn leading to changes in the way children with ASD behave. These environmental insults can lead to biochemical changes manifesting themselves as vicious cycles. The biomedical approach to ASD aims to interrupt these vicious cycles in an effort to restore function.
This approach can be summarized as “take away what harms, and give what heals.” In following this approach, we attempt to interrupt the various vicious cycles, including gastrointestinal dysfunction, impaired methylation, faulty detoxification, and immune system dysregulation. Because these children have underlying metabolic problems caused by genetics, epigenetics, and acquired toxicities from the environment, children with ASD improve when we treat these underlying metabolic problems. ASD is emotionally taxing for a parent and tremendously difficult to figure out for a physician; therefore, children with ASD realize the greatest benefit when biomedical interventions are paired with the appropriate behavioral therapies. It’s when we apply the biomedical approach that children with ASD make the greatest strides behaviorally!
Identify Mineral/Vitamin Deficiencies
Addressing vitamin and mineral deficiencies through supplementation is a critical component to restoring health to our children. Many children with ASD are picky eaters with a limited dietary repertoire. Additionally, exclusionary therapeutic diets (gluten-free/casein-free, Specific Carbohydrate Diet, etc.) are core treatment strategies but may amplify the need for nutritional supplementation. These factors, when coupled with a tendency toward poor digestion and inadequate absorption of nutrients from food, can result in nutritional deficiencies.
Common mineral and vitamin deficiencies in ASD children include zinc1,2, vitamin B6 and magnesium,3,4 essential fatty acids (EFAs),5,6,7 vitamin A, vitamin D, and vitamin E, to name just a few. Establishing the correct supplementation protocol for a child’s individual nutritional needs will improve the effectiveness of other biomedical interventions. Supplementation can help reduce the negative effect of the vicious cycles by promoting methylation, improving detoxification, strengthening the immune system, and reducing oxidative stress. Many of my patients’ families report that rates of acquiring new skills and general learning increase once nutritional needs have been successfully addressed.
Despite our general understanding that most ASD children require some type of nutritional supplementation, do not accept a one-size-fits-all approach to this very important intervention. The best way to determine the specific needs of your child is to consult with a physician who performs initial tests to establish a baseline. Be aware that using something that is available as an “over-the-counter” product does not necessarily make it safe for your child or appropriate for your situation.
Addressing your child’s nutritional needs is one of the best ways to establish a firm foundation for other biomedical interventions you may be considering. It can be one of the least invasive and most cost effective ways to start your child’s journey back to health!
Heal the Gut
Dietary changes can be critical in caring for children with autism. At the Holland Center and Clinic, we commonly request the GF/CF diet as an early intervention.8,9,10 Frequently there are many clues in the history and physical exam that will lead us to a specific dietary suggestion. The “opiate theory” suggests that both gluten and casein can have an opiate effect on your child’s brain. Due to faulty digestive enzyme activity in the gut (common in ASD), gluten and casein remain undigested. These undigested particles remain in circulation and can mimic the effects of opiates. It is quite common to review histories of children who consume large quantities of gluten- and casein-rich foods and then exhibit the opiate effect. The enzyme that is often not working properly is DPP-IV (dipeptidyl peptidase-IV). Supplementing specific digestive enzymes can help support digestion, which leads to a decreased inflammatory response to foods. Inflammation in the gut leads to a vicious cycle of altered gut wall permeability and increased reaction toward foods. Enzymes can also have a positive effect on methylation because when methylation is supported, detoxification improves, leading to an overall improvement in the health of your child.
One of the key elements of improving digestive health is restoring balance in the gut. The digestive system is home to healthy bacteria, unhealthy bacteria, and yeast. When these three elements are not in balance, a child may develop dysbiosis. This imbalance causes yeast overgrowth, which leads to behavior problems, aggression, sleep disturbances, and numerous other gut disturbances. Adjustments in diet and supplementation can help control dysbiosis. Unfortunately, the misuse of antibiotics in the medical community has led to many children developing dysbiosis. Fortunately, yeast management through dietary interventions, prebiotics, probiotics (good bugs), and Saccromyces boulardii11 (good yeast) can help crowd out the bad bugs. When necessary, prescription antifungal medications are often incorporated to assist in restoring balance in the gut.
Detoxifying in a Toxic World
The world we live in is toxic, and children with ASD are genetically predisposed to being susceptible to it. Our children are being bombarded daily by chemicals that are affecting their methylation and detoxification pathways.12 This negatively impacts their immune systems, brain function, and overall health.13,14 When the body is under toxic stress, it has to adjust its metabolism to deal with that stress. Methylation is the process by which the body turns its genes on and off. When methylation isn’t functioning properly, it needs to be “rescued” by a healthy detoxification system. When a child’s detoxification system is overwhelmed, the child is perpetually in a vicious cycle of toxicity.
In an effort to reduce the negative effect the environment has on detoxification pathways in ASD, you can start by reducing your child’s toxic load. There are many strategies parents can implement to begin this process, some with relative ease:
- Buy organic foods
- Purify your water source
- Use non-chemical cleaning products
- Avoid pesticides on your lawn
- Avoid flame retardants whenever possible
- Place an air purifier in your child’s bedroom
- Remove bisphenol-A (BPA), phthalates (soft plastics), and other hormone mimicking chemicals.15
In reducing the toxic load, we want to limit the amount of chemicals that may impact a child’s methylation and detoxification pathways. In spite of the best efforts to make healthy choices and live a “green” lifestyle, it is virtually impossible to eliminate all levels of contact with toxins. The primary instruments of this process are the liver, kidneys, and gastrointestinal tract. Fortunately for us, our bodies possess an amazing ability to detoxify. Essentially, we are all exposed to environmental hazards on a daily basis; however, some of us are better prepared genetically to detoxify ourselves. If we can reduce the toxic load and improve methylation and detoxification pathways, there can be dramatic, positive health effects on our children.
We consistently find that children with ASD possess impaired natural detoxification systems resulting in incredibly high chemical body burdens.16,17 We, as parents and physicians, need to implement strategies to reduce our children’s chemical and heavy metal toxicity levels. Some tools in the biomedical approach to ASD that target these issues follow:
- Increasing antioxidant support
- Glutathione therapy
- Vitamin B12 supplementation
- Chelation therapy
- Far infrared sauna
Immunity and Inflammation
There is general consensus among the medical community that systemic inflammation plays a significant role in autism. Of great concern to us is gastrointestinal and neurological inflammation. Any type of chronic inflammation, regardless of its source of origin, can have a negative impact on the brain. When inflammation occurs in the gut, it can lead to an immune system that becomes dysregulated. Inflammation causes a dysregulated immune system, which can lead to allergy, autoimmunity, and chronic infections. The dysregulated immune system can manufacture antibodies against the brain in ASD, causing brain injury.
Fortunately, we have several means at our disposal to address this inflammatory response. For example, Actos is a prescription medication originally used to control blood sugar levels in diabetes. It has also been shown to have anti-inflammatory effects in children with ASD. Spironolactone is most commonly used as a medication to treat high blood pressure. Spironolactone also demonstrates immune modifying properties, in addition to being a potent anti-inflammatory.18
A great deal of discussion recently has centered on the usage of hyperbaric oxygen therapy (HBOT) for autism. HBOT uses increased concentrations of oxygen in an environment with greater than normal atmospheric pressure, leading to a greater amount of oxygen dissolved in the blood than can be achieved under normal conditions. (See also Dr. Lauren Underwood’s article “Understanding the Use of Mild Hyperbaric Oxygen Therapy [mHBOT] as a Treatment Option for Children with Autism” in Issue #34.) Children with ASD often exhibit signs and symptoms of neuroinflammation and brain injury, and oxygen has a healing effect on damaged tissue. So, by increasing oxygen levels, we increase rates of healing. Using high pressure in HBOT allows the oxygen to penetrate deeper into damaged tissues. Ongoing research supports this as an effective, non-invasive treatment option for children with ASD.19,20
The biomedical approach to the treatment of ASD is an effort to restore the biochemical balance in our children. We do this by interrupting one (or more) of the many vicious cycles that may be occurring in your child. While we know ASD has a genetic component, it is an environmental insult that has been the epigenetic culprit causing our current epidemic!21 Gastrointestinal dysfunction, impaired methylation, faulty detoxification, and immune dysregulation are the cycles that need to be addressed. I encourage you to build a relationship with a physician who has been trained using the biomedical approach. Through extensive history, thorough physical examination, and careful laboratory analysis, we can create a comprehensive therapeutic plan for your child. By treating the source of the problem biomedically, we give your child a chance to improve behaviorally. Children with ASD do respond to behavioral intervention, but they do so most successfully when we first restore their health!
1 Yorbik O, et al. Zinc status in autistic children. J Trace Elem Exp Med. 2004;17(2):101-107.
2 Bilici M, et al. Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28(1):181-90.
3 Mousain-Bosc M, et al. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. II. Pervasive developmental disorder-autism. Magnes Res. 2006;19(1):53-62.
4 Mousain-Bosc M, et al. Magnesium VitB6 intake reduces central nervous system hyperexcitability in children. J Am Coll Nutr. 2004;23(5): 545S-548S.
5 Meguid NA, et al. Role of polyunsaturated fatty acids in the management of Egyptian children with autism. Clin Biochem. 2008 Sep;41(13):1044-8.
6 Amminger GP, et al. Omega-3 fatty acids supplementation in children with autism: a doubleblind randomized, placebo-controlled pilot study. Biol Psychiatry. 2007;61(4):551-3.
7 Stevens LJ, et al. Omega-3 fatty acids in boys with behavior, learning, and health problems. Physiol Behav. 1996;59(4-5):915-20.
8 Whiteley P, et al. The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutr Neurosci. 2010 Apr;13(2):87-100.
9 Knivsberg AM, et al. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002;5(4):251-61.
10 Hsu CL, Lin CY, Chen CL, Wang CM, Wong MK. The effects of a gluten and casein-free diet in children with autism: a case report. Chang Gung Med J. 2009;Jul-Aug;32(4):459-65.
11 Erdeve O, et al. The probiotic effect of Saccharomyces boulardii in a pediatric age group. J Trop Pediatr. 2004 Aug;50(4):234-6.
12 DeSoto MC. Ockham’s Razor and autism: the case for developmental neurotoxins contributing to a disease of neurodevelopment. Neurotoxicology. 2009 May;30(3):331-7.
13 Windham GC, et al. Autism Spectrum Disorders in Relation to Distribution of Hazardous Air Pollutants in the San Francisco Bay Area. Environmental Health Perspectives. 2006 September;114(9):1438-1444.
14 Adams JB, et al. The severity of autism is associated with toxic metal body burden and red blood cell glutathione levels. J Toxicol. 2009;2009:532640.
15 Diamanti-Kandarakis E., et al. Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement. Endocrine Reviews 30(4): 293-342.
16 Nataf R, et al. Porphyrinuria in childhood autistic disorder: implications for environmental toxicity. Toxicol Appl Pharmacol. 2006. 214(2):99-108.
17 Geier DA, et al. Biomarkers of environmental toxicity and susceptibility in autism. J Neurol Sci. 2009;280(1-2):101-8.
18 Bradstreet JJ, et al. Spironolactone might be a desirable immunologic and hormonal intervention in autism spectrum disorders. Med Hypotheses (2006), doi:10.1016/j.mehy.2006.10.015
19 Rossignol DA, Rossignol LW. Hyperbaric oxygen therapy may improve symptoms in autistic children. Medical Hypotheses. 2006;67: 216–228.
20 Rossignol DA, et al. Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial. BMC Pediatr. 2009 Mar 13;9(1):21.
21 Deth R, et al. How environmental and genetic factors combine to cause autism: A redox/methylation hypothesis. Neurotoxicology. 2008: 29(1):190-201.