autism â€" a primary-care biomedical perspective

03/20/03 John L. Kucera, MD

Autism – A Primary-Care Biomedical Perspective


Autism – A Primary-Care Autism – A Primary-Care Biomedical PerspectiveBiomedical Perspective

• Family Medicine PracticeFamily Medicine Practice• Preventive / Nutritional Medicine FocusPreventive / Nutritional Medicine Focus• Toxic Metals Issue–Lead in Paints, Toxic Metals Issue–Lead in Paints,

Gasoline, bullets, pottery, waterpipes, Gasoline, bullets, pottery, waterpipes, batteriesbatteries

• Focus on Lead poisoning by Focus on Lead poisoning by physicians, especially pediatriciansphysicians, especially pediatricians

• Lead—possible cause of autism Lead—possible cause of autism (Cohen. (Cohen. American Journal of Diseases of American Journal of Diseases of

ChildrenChildren, 1976), 1976)


Autism – A Primary-Care Autism – A Primary-Care Biomedical PerspectiveBiomedical Perspective

• Toxicity of Mercury in Some AdultsToxicity of Mercury in Some Adults– Amalgam fillings—mercury, tin, etc.Amalgam fillings—mercury, tin, etc.– Fish—pregnancyFish—pregnancy– Largely ignored by physicians, dentists and Largely ignored by physicians, dentists and

public health officialspublic health officials

• Potential Mercury Toxicity of Some Potential Mercury Toxicity of Some VaccinesVaccines– ThimerosalThimerosal– Aluminum, formaldehyde – Synergistic Aluminum, formaldehyde – Synergistic

Toxicity?Toxicity?


Toxicity of MercuryToxicity of Mercury

• ““Methyl Mercury exposure is a Methyl Mercury exposure is a widespread and persistent problem in widespread and persistent problem in the environment and may cause the environment and may cause neurological problems in 60,000 neurological problems in 60,000 children born in the U.S. each year.” children born in the U.S. each year.” -- --National Academy of Science (USA, National Academy of Science (USA, 7/2000)7/2000)


““Autism Spectrum Disorder”Autism Spectrum Disorder”

• Not one disorder, but a group of disordersNot one disorder, but a group of disorders• Vary widely in presentation; similarities existVary widely in presentation; similarities exist• Many known distinct genetic defects Many known distinct genetic defects • Similar effects on neurons of particular areas Similar effects on neurons of particular areas

of brainof brain– Purkinje neurons in cerebellum often affectedPurkinje neurons in cerebellum often affected– Amygdala damage in Fragile X Syndrome and in Amygdala damage in Fragile X Syndrome and in

other autistic individuals and in mercury toxicityother autistic individuals and in mercury toxicity


““Autism Spectrum Disorder”Autism Spectrum Disorder”

• Many known genetic disorders, but Many known genetic disorders, but very rarevery rare

• Cannot account for dramatic increase Cannot account for dramatic increase in ASDin ASD


Autism: A Unique Type ofAutism: A Unique Type ofMercury PoisoningMercury Poisoning

• Bernard, Enayati, Binstock, Roger, Redwood, McGinnisBernard, Enayati, Binstock, Roger, Redwood, McGinnis•

• Medical Hypothesis, 2001Medical Hypothesis, 2001

• available on Autism Research Institute Website:available on Autism Research Institute Website:• www.autism.com/ariwww.autism.com/ari• And on Defeat Autism Now Website: And on Defeat Autism Now Website:


Autism & Mercury PoisoningAutism & Mercury Poisoning

• Psychiatric Traits Psychiatric Traits (Bernard, et. al.)(Bernard, et. al.)

– Social withdrawal, shynessSocial withdrawal, shyness– Anxiety, obsessive/compulsive traitsAnxiety, obsessive/compulsive traits– DepressionDepression– Irritability, aggression – severe temper Irritability, aggression – severe temper

tantrumstantrums– Impaired face recognitionImpaired face recognition– Paranoid/psychotic thoughts and behavior Paranoid/psychotic thoughts and behavior



• Speech/Language/Hearing Deficits Speech/Language/Hearing Deficits (Bernard, et. al.)(Bernard, et. al.)

– Speech loss, delay or failure to developSpeech loss, delay or failure to develop– Dysarthria, slurred or intelligible speechDysarthria, slurred or intelligible speech– Echolalia, voice differentiation with other Echolalia, voice differentiation with other

soundssounds– Sound sensitivitySound sensitivity– Hearing lossHearing loss– Poor performance on language testsPoor performance on language tests



• Sensory Abnormalities Sensory Abnormalities (Bernard, et. al.)(Bernard, et. al.)

– Paresthesias in and around mouth & Paresthesias in and around mouth & extremitiesextremities

– Abnormal sensitivity to painAbnormal sensitivity to pain– Touch aversionTouch aversion– Proprioceptive (position sense) difficultyProprioceptive (position sense) difficulty


Autism & Mercury PoisoningAutism & Mercury Poisoning• Motor Disorder Behaviors Motor Disorder Behaviors (Bernard, et. al.)(Bernard, et. al.)

– Flapping, jumping, spinning, jerkingFlapping, jumping, spinning, jerking– Poor eye-hand coordination, handwritingPoor eye-hand coordination, handwriting– Abnormal gait, posture / clumsy / toe walkingAbnormal gait, posture / clumsy / toe walking– Chewing/swallowing problemsChewing/swallowing problems– Unusual posturesUnusual postures– Increase in cerebral palsy; hyper- or Increase in cerebral palsy; hyper- or

hypotoniahypotonia– Incontinence / toilet training difficultiesIncontinence / toilet training difficulties– Autonomic disturbances: excessive sweating, Autonomic disturbances: excessive sweating,

poor circulation, elevated heart ratepoor circulation, elevated heart rate



• Mental Impairments Mental Impairments (Bernard, et. al.)(Bernard, et. al.)

– Borderline or retarded intelligence on Borderline or retarded intelligence on previously normal appearing personspreviously normal appearing persons

– ““Reversible” mental retardation in some Reversible” mental retardation in some casescases

– Poor concentration / short attention spanPoor concentration / short attention span– Difficulty with multiple/complex commandsDifficulty with multiple/complex commands– Deficits with abstract/conceptual thinkingDeficits with abstract/conceptual thinking



• Other Unusual Behaviors Other Unusual Behaviors (Bernard, et. al.)(Bernard, et. al.)

– Stereotyped sniffingStereotyped sniffing– HyperactivityHyperactivity– Insomnia: sleep disturbancesInsomnia: sleep disturbances– Eating/feeding disorders: food aversion / Eating/feeding disorders: food aversion /

narrow food preferencesnarrow food preferences– Unprovoked / prolonged cryingUnprovoked / prolonged crying– Self-injurious behaviorSelf-injurious behavior– Masturbatory tendenciesMasturbatory tendencies– Grimacing / staring spellsGrimacing / staring spells



• Visual Impairments Visual Impairments (Bernard, et. al.)(Bernard, et. al.)

– Limited or lack of eye contactLimited or lack of eye contact– Gaze abnormalitiesGaze abnormalities– ““Visual impairments”Visual impairments”– Light sensitivityLight sensitivity– Blurred visionBlurred vision– Constricted visual fieldsConstricted visual fields



• Gastrointestinal Problems Gastrointestinal Problems (Bernard, et. al.)(Bernard, et. al.)

– Diarrhea and/or constipationDiarrhea and/or constipation– Abdominal discomfortAbdominal discomfort– Anorexia, poor appetiteAnorexia, poor appetite– Lesions of ileum & colonLesions of ileum & colon– Increased intestinal permeability (“leaky Increased intestinal permeability (“leaky

gut”)gut”)– Inhibition of endopeptidase enzymes Inhibition of endopeptidase enzymes

(especially dipeptidyl peptidase IV) needed (especially dipeptidyl peptidase IV) needed for breakdown of casein and glutenfor breakdown of casein and gluten



• Biochemical Abnormalities Biochemical Abnormalities (Bernard, et. al.)(Bernard, et. al.)

– Sulfate deficiencySulfate deficiency– Purine / pyrimidine metabolic errorsPurine / pyrimidine metabolic errors– Tyrosine depletionTyrosine depletion– Glutathione deficiency, necessary for liver Glutathione deficiency, necessary for liver

detoxification of heavy metalsdetoxification of heavy metals– Mitochondrial dysfunction, especially in Mitochondrial dysfunction, especially in

brainbrain



• Immune System Abnormalities Immune System Abnormalities (Bernard, et. (Bernard, et. al.)al.)

– Increased incidence of allergies & asthmaIncreased incidence of allergies & asthma– Autoantibodies to myelin basic proteinAutoantibodies to myelin basic protein– Increased Th2 subset of lymphocytesIncreased Th2 subset of lymphocytes– Reduced Natural Killer T-Cell functionReduced Natural Killer T-Cell function


Autism & Mercury PoisoningAutism & Mercury Poisoning• Central Nervous System Lesions Central Nervous System Lesions (Bernard, et. al.)(Bernard, et. al.)

– Selective damageSelective damage– Purkinje and granular cellsPurkinje and granular cells– Pathology in amygdala and hippocampusPathology in amygdala and hippocampus

• Unable to synthesize glutathioneUnable to synthesize glutathione• Social avoidance, lack of facial expression, lack of Social avoidance, lack of facial expression, lack of

eye contact, motor stereotypic behaviorseye contact, motor stereotypic behaviors

– Neuronal disorganizationNeuronal disorganization– DemyelinationDemyelination– Brain stem damage – peripheral Brain stem damage – peripheral

polyneuropathypolyneuropathy– Seizures, subtle seizure activities, abnormal Seizures, subtle seizure activities, abnormal

EEGEEG


Autism: A Unique Type ofAutism: A Unique Type ofMercury PoisoningMercury Poisoning

Bernard, Enayati, Binstock, Roger, Redwood, McGinnisBernard, Enayati, Binstock, Roger, Redwood, McGinnis

Medical Hypothesis, 2001Medical Hypothesis, 2001

available on Autism Research Institute Website:available on Autism Research Institute Website:

www.autism.com/ariwww.autism.com/ari

And on Defeat Autism Now Website: And on Defeat Autism Now Website:


Autism, Mercury and VaccinesAutism, Mercury and Vaccines

• Thimerosal—until 2001, in many Thimerosal—until 2001, in many vaccinesvaccines– Antibacterial, antifungalAntibacterial, antifungal– Used as a “preservative”Used as a “preservative”– Removed from animal vaccines years agoRemoved from animal vaccines years ago– Banned from most over-the-counter Banned from most over-the-counter

products in 1998, but left in vaccinesproducts in 1998, but left in vaccines– Vaccine requirements for children birth to Vaccine requirements for children birth to

age 2 increased from 8 in 1980 to 22 in age 2 increased from 8 in 1980 to 22 in 20012001

– Children could have received >100x EPA Children could have received >100x EPA safe daily dose in vaccines given one daysafe daily dose in vaccines given one day


Autism, Mercury and VaccinesAutism, Mercury and Vaccines• Mercury binds to sulfhydryl groups on proteinMercury binds to sulfhydryl groups on protein• Can be structural proteins or enzymesCan be structural proteins or enzymes• Loss of structural integrity or enzyme function Loss of structural integrity or enzyme function

• Thimerosal destroys tubulin & actin in neuronsThimerosal destroys tubulin & actin in neurons• Thimerosal is potent inhibitor of many critical Thimerosal is potent inhibitor of many critical

enzymes involved in cellular metabolismenzymes involved in cellular metabolism• Synergistic effect with aluminum and other Synergistic effect with aluminum and other

chemicals in vaccine mixture chemicals in vaccine mixture Boyd Haley, Ph.D., 7/01Boyd Haley, Ph.D., 7/01



• Complicating FactorsComplicating Factors– Infant's hepatic detoxification function not Infant's hepatic detoxification function not

fully developedfully developed– Multiple toxic mechanisms of mercury, Multiple toxic mechanisms of mercury,

including to immune system, may including to immune system, may contribute to vulnerability to other contribute to vulnerability to other substances, including vaccines substances, including vaccines withoutwithout thimerosal (MMR)thimerosal (MMR)



• Thimerosal Study – Centers for Disease Thimerosal Study – Centers for Disease ControlControl– Screened 110,000 patients for Speech delay, Screened 110,000 patients for Speech delay,

Neurodevelopmental Disorders, ADDNeurodevelopmental Disorders, ADD– Official Conclusion: No link to AutismOfficial Conclusion: No link to Autism– Primary Investigator says opposite:Primary Investigator says opposite:

• ““This screening suggests a possible association This screening suggests a possible association between certain neurological disorders and between certain neurological disorders and exposure to mercury from thimerosal-containing exposure to mercury from thimerosal-containing vaccines before the age of six months.” --vaccines before the age of six months.” --Dr. Thomas VerstraetenDr. Thomas Verstraeten


Autism—TestingAutism—Testing

• Basic Biochemical testingBasic Biochemical testing– Establish baseline before interventionsEstablish baseline before interventions– Liver/renal function – treatments can affectLiver/renal function – treatments can affect– Complete blood chemistryComplete blood chemistry

• CLUES: low bicarbonate (CO2): acidic stressCLUES: low bicarbonate (CO2): acidic stress• Low protein: inadequate intake or Low protein: inadequate intake or

absorptionabsorption• High protein: enzyme deficienciesHigh protein: enzyme deficiencies• Low normal AST/ALT: Zinc deficiencyLow normal AST/ALT: Zinc deficiency


Autism—TestingAutism—Testing• Other labsOther labs

– CBCCBC– Thyroid functionThyroid function– Ammonia levelAmmonia level– ANAANA– Immunoglobin Levels (IgG, A, M, E)Immunoglobin Levels (IgG, A, M, E)– Myelin Basic ProteinMyelin Basic Protein– Serum Copper, Plasma Zinc for Copper/Zinc Serum Copper, Plasma Zinc for Copper/Zinc

ratioratio



• Organic acids—urine Organic acids—urine – Metabolic waste (like analysis of engine Metabolic waste (like analysis of engine

exhaust)exhaust)– Metabolites of carbohydrates, proteins and Metabolites of carbohydrates, proteins and

fatsfats– Waste products of yeast, bacteriaWaste products of yeast, bacteria– Kreb's Cycle IntermediatesKreb's Cycle Intermediates



• Organic acids—urine Organic acids—urine – Indicators of Mitochondrial DysfunctionIndicators of Mitochondrial Dysfunction

• Partial blocks in Kreb's Cycle—increase Partial blocks in Kreb's Cycle—increase intermediatesintermediates

• Uncoupling of oxidative phosphorylation for Uncoupling of oxidative phosphorylation for energyenergy

– Elevated fatty acid metabolitesElevated fatty acid metabolites– Elevated lactateElevated lactate– Elevated hydroxymethylglutarateElevated hydroxymethylglutarate



• Comprehensive Stool Analysis—Comprehensive Stool Analysis—ImportanteImportante– Identifies beneficial bacteria, potential Identifies beneficial bacteria, potential

pathogenspathogens– Identifies yeast and parasitesIdentifies yeast and parasites– Measures digestive and absorptive function Measures digestive and absorptive function

of gutof gut– Measures indicators of inflammation and Measures indicators of inflammation and

immune functionimmune function– Measures markers of Intestinal healthMeasures markers of Intestinal health



• Comprehensive Food Allergy PanelComprehensive Food Allergy Panel– Uncovers unknown food sensitivitiesUncovers unknown food sensitivities– IgE and IgGIgE and IgG– Better to wait until initial treatment Better to wait until initial treatment

completedcompleted


Autism--Testing Autism--Testing

• Toxic and Essential Mineral ScreeningToxic and Essential Mineral Screening– Serum—useful only for very recent high Serum—useful only for very recent high

exposureexposure– RBC—good only for exposure in prior 3-4 RBC—good only for exposure in prior 3-4

monthsmonths– Hair metals–reliable only if ability to detoxify Hair metals–reliable only if ability to detoxify

intact, but unreliable for infants and children intact, but unreliable for infants and children with immature or impaired detoxificationwith immature or impaired detoxification

– Fecal—more useful if recent Fecal—more useful if recent exposure/ingestion or after beginning exposure/ingestion or after beginning chelationchelation



• Toxic and Essential Mineral ScreeningToxic and Essential Mineral Screening– Urine Challenge—controversial; best available Urine Challenge—controversial; best available

tool for assessing body burdentool for assessing body burden– Unchallenge urine--unreliable as indicator of Unchallenge urine--unreliable as indicator of

mercury exposure mercury exposure (Arch Environ Health 6:480-3, 1963(Arch Environ Health 6:480-3, 1963

– Pre-challenge urine baseline unnecessaryPre-challenge urine baseline unnecessary– Challenge (provocative) agents vary in Challenge (provocative) agents vary in

affinities for each toxic metal and nutrient affinities for each toxic metal and nutrient mineralmineral

• DMSA (meso-2, 3-dimercaptosuccinic acid)DMSA (meso-2, 3-dimercaptosuccinic acid)• DMPS (sodium 2,3 dimercaptopropane-1-sulfonate)DMPS (sodium 2,3 dimercaptopropane-1-sulfonate)



• DMSA—Rx DMSA—Rx ChemetChemet (Sanofi (Sanofi Pharmaceuticals), Pharmaceuticals), SuccimerSuccimer (Thorne), (Thorne), DiSulfhydrylDiSulfhydryl (Kirkman) (Kirkman)– Sulfur-thiol, forms stable complex with metalsSulfur-thiol, forms stable complex with metals– FDA approvedFDA approved– Long-term experience in US with pediatric lead Long-term experience in US with pediatric lead

toxicity toxicity (Safety and efficacy of DMSA in children with elevated blood (Safety and efficacy of DMSA in children with elevated blood lead concentrations. J Toxicol Clin Toxicol 2000; 38(4):365-75) lead concentrations. J Toxicol Clin Toxicol 2000; 38(4):365-75)

– Majority (40-60%) remains in intestine (little or Majority (40-60%) remains in intestine (little or no chelation of toxic metals); excreted in feces no chelation of toxic metals); excreted in feces

– Three-day dosing before urine collectionThree-day dosing before urine collection


Autism--TestingAutism--Testing• DMPS--Dimaval (Heyl); generic available DMPS--Dimaval (Heyl); generic available

via compounding pharmaciesvia compounding pharmacies– Rapidly absorbed orally, peaking in 4 hoursRapidly absorbed orally, peaking in 4 hours– Majority (45-60%) excreted in urine; rest in Majority (45-60%) excreted in urine; rest in

fecesfeces– Appears to have greater affinity for lead and Appears to have greater affinity for lead and

mercury than arsenic and cadmiummercury than arsenic and cadmium– Extensively researched in Europe for safety Extensively researched in Europe for safety

and efficacyand efficacy– Challenge test is Challenge test is one-timeone-time oral dose (50-250 oral dose (50-250

mg) followed by 6-hr collection (one-time mg) followed by 6-hr collection (one-time collection OK)collection OK)


Autism TreatmentAutism Treatment

• ““The pathetic fact is that the standard The pathetic fact is that the standard of care in America for a child with of care in America for a child with 'autism' is no care at all – other than a 'autism' is no care at all – other than a diagnosis by a psychiatrist after diagnosis by a psychiatrist after behavioral observations, and a behavioral observations, and a prescription for psychotropic prescription for psychotropic medications.” medications.”

• --from Don't GIVE UP – Matthew's Story--from Don't GIVE UP – Matthew's Story

• by Liz Birt and Maurice Lopezby Liz Birt and Maurice Lopez

• MotheringMothering, May-June, 2000, May-June, 2000


Autism Treatment – DietAutism Treatment – Diet

• Casein-free, Gluten-free DietsCasein-free, Gluten-free Diets– Decrease opioid-peptides into circulationDecrease opioid-peptides into circulation

• Improves cognitive / behavioral functionImproves cognitive / behavioral function• Improves gut motilityImproves gut motility

– Decrease allergic reactionsDecrease allergic reactions–


DietDiet

• Casein RestrictionCasein Restriction– All dairy productsAll dairy products

• Cow's milk, goat's milk, buttermilkCow's milk, goat's milk, buttermilk• YogurtYogurt• ButterButter• CheeseCheese• Whey Whey • CaseinatesCaseinates• All foods with dairy products, caseinAll foods with dairy products, casein• Reading labels necessary but not always Reading labels necessary but not always

accurateaccurate


DietDiet

• Casein RestrictionCasein Restriction• Milk/casein-free substitutesMilk/casein-free substitutes

– Rice, potato, soyRice, potato, soy– Dairy-free cheeses, yogurts, margarinesDairy-free cheeses, yogurts, margarines– Comprehensive IgG food allergy testing very Comprehensive IgG food allergy testing very

helpfulhelpful Uncovers unknown food allergies (e.g., eggs)Uncovers unknown food allergies (e.g., eggs) Reveals many foods to which child is NOT Reveals many foods to which child is NOT

allergicallergic Helps in expanding food options safelyHelps in expanding food options safely


DietDiet• Gluten (or gliadin) Restriction—more difficultGluten (or gliadin) Restriction—more difficult

– Wheat and most grains:Wheat and most grains:– Barley, Kamut, Oats, Rye, Seminola, Spelt, Barley, Kamut, Oats, Rye, Seminola, Spelt,

TriticaleTriticale– Most bakery, cereals and prepared foodsMost bakery, cereals and prepared foods– Often “hidden” in dressings, flavorings, spices, Often “hidden” in dressings, flavorings, spices,

etc.etc.– Reading labels necessary but not always accurateReading labels necessary but not always accurate– Not always noted on list of ingredientsNot always noted on list of ingredients– Contamination in manufacturing or packaging Contamination in manufacturing or packaging

equipment/materialsequipment/materials– Contamination at home—kitchen utensils, etc.Contamination at home—kitchen utensils, etc.


DietDiet

• Gluten/grain alternatives:Gluten/grain alternatives:– Corn—may have allergen (corn 'gluten')Corn—may have allergen (corn 'gluten')– Soy—may have allergen or sensitivitySoy—may have allergen or sensitivity– LentilsLentils– PotatoPotato– RiceRice– Legumes (bean flours, e.g., garbanzo)Legumes (bean flours, e.g., garbanzo)– Comprehensive IgG food allergy testing Comprehensive IgG food allergy testing

helpful (helpful (necessarionecessario))


DietDiet• Guidelines for dietary, nutritional interventionGuidelines for dietary, nutritional intervention

– Be willing to experimentBe willing to experiment– Observe closely for positive or negative reactionsObserve closely for positive or negative reactions– A “negative” reaction is not always bad—may be A “negative” reaction is not always bad—may be

sign of new or recovered brain function, “sensory sign of new or recovered brain function, “sensory overload” or “withdrawal”overload” or “withdrawal”

– If no obvious improvement after reasonable trial, be If no obvious improvement after reasonable trial, be willing to stop the treatment—again observe!willing to stop the treatment—again observe!

– Consider retrials laterConsider retrials later– Record responsesRecord responses / /datesdates of trials ( of trials (muy importantemuy importante))


DietDiet

• ResourcesResources– ““Special Diets for Special Kids”--Lisa Lewis, Ph.DSpecial Diets for Special Kids”--Lisa Lewis, Ph.D– ““Unraveling the Mystery of Autism and Pervasive Unraveling the Mystery of Autism and Pervasive

Developmental Disorder”--Karyn SeroussiDevelopmental Disorder”--Karyn Seroussi– Website: www.gfcfdiet.comWebsite: www.gfcfdiet.com– Autism Network for Dietary Intervention Autism Network for Dietary Intervention

newsletter, newsletter, The ANDI News, POBox 77111, The ANDI News, POBox 77111, Rochester, New York USA 14617-0711. E-mail:Rochester, New York USA 14617-0711. E-mail:

– [email protected]@aol.com


Mercury/Heavy Metal Mercury/Heavy Metal DetoxificationDetoxification

• Throughout treatmentThroughout treatment– Appropriate nutritional supportAppropriate nutritional support– Appropriate monitoring testsAppropriate monitoring tests

• See DAN! Consensus PaperSee DAN! Consensus Paper

– Monitor for side effects and benefitsMonitor for side effects and benefits


Mercury/Heavy Metal DetoxificationMercury/Heavy Metal Detoxification

Defeat Autism Now! (DAN!)Defeat Autism Now! (DAN!)Mercury Detoxification Consensus Mercury Detoxification Consensus

GroupGroup

Position PaperPosition Paper

Available online: dan.com; Available online: dan.com; autism.com/ariautism.com/ari



• Pre-treatment testingPre-treatment testing– see DAN! Consensus papersee DAN! Consensus paper

• Locate toxic metal sources and stop Locate toxic metal sources and stop exposureexposure– Food, drinks, toys, clothing/bedding (antimony), Food, drinks, toys, clothing/bedding (antimony),

wooden playground equipment (arsenic)wooden playground equipment (arsenic)

• Correct as much as possible:Correct as much as possible:– Intestinal dysbiosisIntestinal dysbiosis– Intestinal permeability (leaky gut)Intestinal permeability (leaky gut)– Nutritional derangementsNutritional derangements


Intestinal DysbiosisIntestinal Dysbiosis

• Dietary TreatmentDietary Treatment– Sugar restrictionSugar restriction– No milk and dairy—lactose promotes No milk and dairy—lactose promotes

CandidaCandida– Avoid mold and yeast-containing foods Avoid mold and yeast-containing foods

(cheeses, dried fruits, peanuts, alcoholic (cheeses, dried fruits, peanuts, alcoholic drinks, juices, some B-vitaminsdrinks, juices, some B-vitamins

– Address food allergiesAddress food allergies– Pancreatic enzymes (proteases)Pancreatic enzymes (proteases)


Intestinal DysbiosisIntestinal Dysbiosis• Attempt to eradicate potential pathogens seen Attempt to eradicate potential pathogens seen

on Stool Analysis on Stool Analysis and/orand/or Organic Acid Testing Organic Acid Testing• YeastYeast

– Nystatin—safe; start low dose to prevent (“die-off”)Nystatin—safe; start low dose to prevent (“die-off”)– Probiotics—1-10 billion L. acidophilus, B. bifidum/d.Probiotics—1-10 billion L. acidophilus, B. bifidum/d.– Saccharomyces boulardiiSaccharomyces boulardii– Natural agents against CandidaNatural agents against Candida

• Caprylic Acid (enteric-coated, time-release)Caprylic Acid (enteric-coated, time-release)• Oregano Oil (100x more potent than caprylic acid)Oregano Oil (100x more potent than caprylic acid)• Berberine (goldenseal)--broad-spectrum activity against Berberine (goldenseal)--broad-spectrum activity against

fungi including fungi including C. albicans, pathogenic bacteria, protozoaC. albicans, pathogenic bacteria, protozoa• GarlicGarlic


Intestinal DysbiosisIntestinal Dysbiosis

• Treat parasites and pathogenic Treat parasites and pathogenic bacteriabacteria– Try natural options firstTry natural options first– Sulfamethoxazole/trimethoprimSulfamethoxazole/trimethoprim– Metronidazole (antifungal and antiparisitic)Metronidazole (antifungal and antiparisitic)– Yodoxin (antifungal and antiparisitic)Yodoxin (antifungal and antiparisitic)



• DMSA–most commonly usedDMSA–most commonly used– Usually oral dosing; can be rectalUsually oral dosing; can be rectal– About every 8 hours; do not interrupt sleepAbout every 8 hours; do not interrupt sleep– Usually given for 3 days, then eleven days Usually given for 3 days, then eleven days

offoff– Re-check CBC, biochemical profile and Re-check CBC, biochemical profile and

urine metal challenge after two or three urine metal challenge after two or three cyclescycles

– Not effective for aluminum chelationNot effective for aluminum chelation



• DMPS—usually reserved for DMPS—usually reserved for persistently elevated mercury or other persistently elevated mercury or other metalsmetals– More rapid chelatorMore rapid chelator– More effective chelator of mercuryMore effective chelator of mercury– Can be used for challenge test after DMSA Can be used for challenge test after DMSA

treatmenttreatment


Mercury/Heavy Metal Mercury/Heavy Metal DetoxificationDetoxification

• PrecautionsPrecautions– Supplement trace mineralsSupplement trace minerals

• Chelators bind with nutritional minerals, tooChelators bind with nutritional minerals, too

– Make sure bowels movingMake sure bowels moving• Some metals cleared through gutSome metals cleared through gut• Increase fiber—e.g., psyllium at bedtimeIncrease fiber—e.g., psyllium at bedtime• Laxatives, if necessary—try Laxatives, if necessary—try Cascara sagradaCascara sagrada or or

sennasenna

– Support, protect liver—major detoxifying Support, protect liver—major detoxifying organorgan

• GlutathioneGlutathione• Extra Vitamin C and EExtra Vitamin C and E• Milk thistle (Milk thistle (Silybum marianumSilybum marianum), silymarin ), silymarin

flavonoids-- 50-250mg up to three times dailyflavonoids-- 50-250mg up to three times daily


Case StudiesCase Studies

autism â€" a primary-care biomedical perspective

Health & Medicine

defeat autism

autism spectrum disorder

lead poisoning

poor circulation

amygdala damage

poor eyehand coordination

genetic disorders

visual impairmentsbernard