Abstract

The treatment of Autistic Spectrum Disorders is helped by trying to understand the underlying causes. Many differing causes have been suggested including food allergy, infections, brain damage, poisoning, metal deficiencies, vaccine damage and vitamin deficiencies.

Studies of brain circulation suggests that there is an impairment of activity over the fronto-parietal areas, which would be expected to limit function in speech, perception and co-ordination and motor skills.

Selection of treatment depends on the recognition of the underlying cause, which appears to be a heritable failure of the immune system and the metabolic effects of that failure. This is supported by twin and family studies, as well as direct evidence from the children.

Signalling hormones from the disturbed immune system interfere with brain cell function, and due to deficiencies in the immune system responses to common antigens are reduced, reflecting low T cells and in turn lower production of antibodies.

Deficiencies of metals such as Zinc and Magnesium compound this, because much of immune cell activity is dependent upon them.

Phenol sulphyltransferase (PST) deficiency leads to poor detox management; toxic Sulphite is not converted to sulphate. In the presence of Sulphite, acquisition of immune tolerance is disturbed.

Treatment in this programme is directed towards restoring normal gut function, using complex homeopathic medicines and probiotics. Improvement in liver function is achieved by reducing the load on PST by diet, and by replacing minerals in deficiency. Gut function is impaired by mineral deficiency so re-absorption of toxic metabolites and food substances is reduced by using active laxatives.

Twenty children were diagnosed using DSM protocols in clinics in India, Pakistan, USA, UK, Egypt, UAE and Saudi Arabia.

Results from these 20 treated children showed that 15 had Sulphite in the urine, before treatment, but after six months of treatment there was a complete absence of Sulphite in 60% and a significant fall in 13%. This was associated with positive behavioural changes including reduced hyperactivity, more referring gaze, better social interaction, faster speech acquisition, better use of computational skills, improvements in perceptive development, and improved hand eye co-ordination.

Physical symptoms such as night sweats were reduced. There were fewer attendances for ENT and URTI problems. Weight and height increased reflecting improved bowel function, diarrhoea and constipation resolved and continence improved.

Confounders include behavioural intervention, concurrent drug treatment, drug interactions, and placebo response.

Complementary Medicine in Autistic Disorders: Results from the Application of a Working Hypothesis

The results of treatment applying the working hypothesis outlined below suggest that management of the underlying biochemistry and immune disorder can be associated with improvement in functional activity and behaviour. To treat these conditions requires some understanding of the underlying disorders, and management of these appears to offer some help. The use of complementary medicines can be helpful in the biochemical management of autistic spectrum disorders.

Over 200 autistic children have attended my practice, their progress is being monitored and they are in various stages of recovery. This paper refers to a group of 20 children in 1997-1998 who were entered into the study simultaneously and followed up together over a period of six months.

What is the cause?

There is no single answer. The search for an effective treatment has been undermined by the desire to find a single effective treatment. To date there has been none.

Amongst suggested causes has been food allergy, (Egger 1985) candida infection (Shaw 1996) suggesting an incompetent immune system. Immune cell loss, with inadequate numbers of lymphocytes and poor immunoglobulin production supports this (Gupta 1998). A form of poisoning has been suggested when children with lead poisoning were seen to have significant
behavioural changes (Marlow 1983). Other heavy metals such as mercury will produce changes in behaviour and mental retardation. (Rea 1996) Brain mapping by Egger has shown that fronto parietal circulation is impaired, consistent with poor speech development and perceptive disorders leading to poor communication. Motor development and co-ordination function is also impaired with evidence of poor hand eye co-ordination and a likely sensory ataxia.

How do we make a choice in treatment ?

Treatment in all medical activity should be directed towards the underlying causes of illness. It is no good for example treating the symptomatic cough of bacterial pneumonia whilst ignoring that the underlying infection will respond to antibiotic treatment

What is the underlying cause?

There seems to be a heritable failure of the immune system complicated by the metabolic effects of that failure.

Twin studies are helpful, showing a concordance in identical twins of close to 70%. (Bailey 1995) In my own practice I have a number of identical twins with autism. It is important to recognise, however, that despite being identical, the severity of autism appears to be different in each of the children reflecting some environmental effects upon the gene expression.

Indirect evidence of immune incompetence is indicated by family histories where there is an increased incidence of atopy, (asthma and eczema), irritable bowel, particularly in the mother, autoimmune conditions such as SLE, and immune arthritis such as Rheumatoid Arthritis. Grandparents frequently have a strong history of multiple joint arthritis. In my own practice I have children with parents with Crohns disease, which is more than I would expect.

The concentration of the gene pool for atopy together with dietary changes suggests that the risk of developing autistic spectrum disorders is likely to be increasing with over 4 million atopic individuals in the population at present.

Direct evidence in the child includes glue ear, with recurrent Otitis media events, having numerous courses of antibiotics, recurrent upper respiratory tract infections are common and food reactions have been noted frequently by parents discovering their child reacts badly, with deterioration in symptoms, on exposure to common foods such as wheat, or milk There is frequently a history of persistent diarrhoea with episodic constipation.
(Goodwin 1971) (Mann 1998)

What is Immune incompetence?

Studies have focused upon three areas, the signalling link between immune cells, the presence of immune cells and the production of immunoglobulins.

The immune system signals between its parts by the use of interleukins which are numbered peptides and which have specific inflammatory and pro-inflammatory activity. Il 2, Il6 and Tumour necrosis factor are particularly raised in concentration indicating an active immune process. Biopsy of the bowel has shown a failure of white cell activity
suggesting an interference in antigen (foreign body) consumption. Interleukins can interfere with brain cell function. Tumour necrosis factor impairs astrocyte cell membrane function with evidence of calcium channel failure which is incidentally dependent upon Magnesium. (Koller 1996)

Lymphocytes are grouped into T and B cell types. T cells effectively run the immune system and have different numerical classification prefixed CD. CD4, helper cells, have been shown to be low in 7 out of 45 children and in the same children CD8 killer cells are low in 16 out of 45. (Gupta 1997)(Gupta 1998)

As a result of this, it would be expected that the production of immune responses to challenge would be adversely affected. The response to Mumps was reduced in 29 out of these 45, to candida by 12 out of 45 and tetanus by 16 out of 45. In my own practice a child being monitored for immune status lost his immunity to tetanus over a six-month period.

What else is low?

Frequently Zinc, and this has importance in both the immune system and in healing. There are over 150 enzyme processes dependent on Zinc. (Mann 1998)

It is a co-factor in immune enzymes; Thymulin for example favours T cell activity, with differing concentrations helping both CD4 and CD8 cells. This will thus affect resistance to infection. (Prasad 1998)

Zinc is involved in cell repair. It has a positive effect on the migration of epithelial cells. Topical zinc was used for many years to promote wound healing. Over 90% of atopic individuals are short on Zinc.

In the digestive tract Zinc has direct effects on taste and smell. For many years until sophisticated laboratory tests were available, detection of Zinc deficiency involved a simple taste test; the patient was given a strong tasting substance, no taste was recognised. Zinc was then given and the test repeated; the successful recognition by taste and smell confirmed
the Zinc deficiency that had been present. Autistic children appear to enjoy very strongly flavoured foods. Zinc is also important in fat metabolism. (Mann 1998)

Poor Zinc levels appear to be related to increase in gut infection. Diarrhoea exacerbates zinc depletion since it is very rich in Zinc. The normal pancreas secretes a Zinc rich digestive juice. Homeopathic VEGA machine testing frequently shows the pancreas as a stressed organ. It is possible that Secretin given therapeutically causes large amounts of digestive juices to be made which by virtue of the amount of Zinc present has a protective effect on the gut and will help in gut healing. The
peptidase enzymes which are responsible for the breakdown of casein and gluten in the bowel are both zinc dependent. (Reichelt 1994) Zinc has been shown to be of value in behavioural disorders. (Lewith 1996) Magnesium is particularly important in cell membrane and pump activity, and is important in ATP management. It is of proven value in behavioural
disorders. (Pfeiffer 1995) Liver function is reflected in detoxification metabolism; a specific area of interest is the enzyme system phenol Sulphyl transferase (PST). This group of enzymes is the principal route through which excess neurotransmitters are broken down such as adrenaline. A deficiency in this enzyme system is frequently associated with hyperactivity and attention deficit. (O'Reilly 1993) It was thought at one time that this may be an indicator for autism but has been shown to be obtunded in schizophrenia, irritable bowel, migraine and asthma. In the presence of an incompetent
PST enzyme system there is a reduced level of immune tolerance.

Detoxification depends on centrilobular access in the liver via the portal vein. The release of interleukins from the gut may produce a mild hepatitis with limitation of uptake of substrate into the centrilobular areas where the detox enzymes are concentrated. Thus in addition to an absolute deficiency of PST, which may be exacerbated by food substances such as Tartrazine which interferes with PST activity and Molybdenum (co-factor) deficiency there is a relative deficiency caused by access problems.

A ready measure of this enzyme system's competence is the presence of Sulphite in the urine.

Can this enzyme failure be treated?

By reducing the level of gut disturbance and consequent release of interleukins, the access to the centrilobular area of the liver should be increased. If foods are excluded which load this enzyme system and possibly impede its effectiveness then more enzyme should be available to break down catecholamine. Removing food substances that have a similar basic structure to adrenaline-like compounds would be expected to help.

Did all children achieve the same recovery level?

Children were at different ages, and the disease process had been present for different periods and in different degrees of severity.

Infections and gut function improved. There was a reduction or absence of night sweats. Attendances for ENT and URTI were reduced. Weight and height increased consistent with bowel function improvement. Continence improved with absence of diarrhoea and constipation.

Confounders

Amongst the group were children receiving Lovaas therapy. One of the children had been managed with a combination of Ritalin, Phenergan and Haloperidol producing Akathisia a recognised side effect of Haloperidol excess. Removal of these medicines led to a rapid resolution of the akathisia and agitation caused by Phenergan. Hyperactivity is a recognised
side effect of Phenergan in children.

The possibility of placebo effects must always be borne in mind, especially in autism where because of the severity of this illness parents are desperate to find improvement. An example of this is eye contact, which when relied upon as a marker for clinical improvement can be misleading. Avoidance of eye contact in some societies is a sign of deferential respect.

Conclusions

The results of the treatments on these 20 children, taken together with the emerging results from a larger number of children, suggests that this treatment and the working model are worth pursuing, especially considering the speed and economy with which the improvements are achieved. Clearly controlled trials are needed, but these early results are promising and consistent with other developments in the field.

TABLE ONE (text format)

(Patient Registration Number)(D-Glucaric acid, July97, Oct97, Feb98)(Sulphite, July97, Oct97, Feb98)
(N.B. D-Glucaric acid, Borderline >8.5, Increased >12.5, Marked >30, Sulphite, Target Zero)

11423 14.4 4.1 6.0 2.5 4 1.5
11434 6.0 2.4 4.7 nil nil nil
11436 20.6 5.7 10.7 18.5 6 nil
11418 18.3 9.2 8.4 10.5 nil 2.5
11422 9.8 3.4 10.2 7 1 nil
11405 4.0 2.7 5.2 5 4 nil
11413 7.2 4.9 3.8 nil 1.5 2.5
11431 2.9 7.6 2.9 4 nil nil
11649 10.4 3.2 3.7 1 1 nil
11432A 6.2 2.8 3.8 4 3 nil
11432Ai 15.2 1.4 2.8 16 2.5 4.5
11410 12.9 6.4 16.8 16 1 .5 nil
11417 11.3 5.1 8.9 nil nil nil
11428 7.6 9.2 11.7 16 nil nil
11433 4.8 2.5 - nil nil -
11435 12.7 4.5 4.1 5 nil nil
11411 4.5 7.9 10.2 1 3 1.5
11408 11.4 5.0 10.6 1 3 1.5
11416 7.8 3.1 4.2 9 2 3.5
11421 18.2 4.7 4.0 2 7 nil

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Additional Source Material

Autism Research Institute 4182 Adams Avenue San Diego California CA92116
Baker and Pangbourn:Clinical Assessment Options For Children with Autism and related Disorders DAN Conference January 1995
Passwater and Cranton (1983)Trace Elements,Hair Analysis and Nutrition, Keats Publishing Inc ISBN 0-87983-265-7

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Revised: September 07, 2000 .
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