GENERAL CONFERENCE AUTISM SPECTRUM DISORDER

GENERAL CONFERENCEAUTISM SPECTRUM

DISORDER

THURSDAY, APRIL 27, 20068:30 TO 5:30

RAANANA

AMDOCS COMPANY

JAQUELYN McCANDLESS, M.D.

WITH

JACK ZIMMERMAN, PhD

A BIO-MEDICAL APPROACH TO AUTISM

EVALUATION AND TREATMENT PROTOCOLS

BASED ON

LABORATORY TESTING AND CLINICAL EXPERIENCE

WORLDWIDE ASD EPIDEMIC

• FROM 2001-04, 1026% INCREASE IN FULL-DIAGNOSIS ASD SCHOOL AGE CHILDREN PER US DEPT OF EDUCATION.

• OVER 2 MILLION CHILDREN IN US HAVE ASD, OVER 6 MILLION HAVE ADD/ADHD, OVER 2 MILLION TAKE RITALIN

• INCIDENCE OF CLASSIC 1:10,000 TO ACQUIRED (“REGRESSIVE”) ASD 1:150

• RATIO - BOUS:GIRLS 4:1 for ASD, ADD/ADHD, LEARNING/BEHAVIOR ISSUES

AUTISM CHARACTERISTICS

ASD: AUTISM, HFA, ASPERGER’S, PDD, ADD/ADHD

• FAILURE TO BOND• LACK OF SOCIAL INTERACTION• AVOIDANCE OF EYE-TO-EYE CONTACT• DIFFICULTIES IN LANGUAGE

DEVELOPMENT• REPETITIVE BEHAVIORS “STIMMING”

ASD BIO-MEDICALLY

• GENETIC PREDISPOSITION – ALLERGIES, AUTOIMMUNITY, FAMILY HISTORY

• WEAKENED IMMUNE SYSTEM, FREQUENT INFECTIONS/ANTIBIOTICS 1st YEAR

• GUT INFLAMMATION, PATHOGENS• IMPAIRED NUTRITIONAL STATUS

INABILITY TO EXCRETE THEREFORE ACCUMULATE HEAVY METALS IN THEIR BODIES

CAUSATION MODELS

• 1) SIMPLY GENETIC?

• 2) GASTROINTESTINAL: GLUTEN/CASEIN INTOLERANCE, ENZYME DEFICIENCY,

YEAST OVERGROWTH MODEL

• 3) TOXIC CHEMICALS/HEAVY METALS –VACCINATIONS, AMALGAMS/FISH

• 4) AUTOIMMUNITY, VIRAL MODEL

METABOLIC IMBALANCES IN AUTISM SPECTRUM DISORDER

• MULTIPLE NUTRITIONAL DEFICIENCIES• ELEVATED IgG ANTIBODIES

GLUTEN/CASEIN• IMBALANCE GUT BACTERIAL FLORA• URINE BACTERIAL/FUNGAL BYPRODUCTS• MYELIN SHEATH INJURY IN BRAIN• EVIDENCE OF IMMUNE IMPAIRMENTS• METHYLATION DISORDERS• ACCUMULATION OF HEAVY METALS

NUTRIENT DEFICIENCIES in ASD

• B6 AND MAGNESIUM

• ZINC, SELENIUM AND OTHER MINERALS

• CALCIUM

• VITAMINS A, C, & E

• ESSENTIAL FATTY ACIDS

• AMINO ACIDS

• B-VITAMINS: B1, 2, 3, 5, 12, & FOLATE (FOLINIC ACID)

OVERVIEW BIO-MEDICAL TREATMENTS

• 1) RESTRICTED DIET, GF/CF/SF• 2) NUTRIENTS• 3) TREAT GUT PATHOGENS• 4) CORRECTING METHYLATION

DYSREGULATION (“Quintet”)• 5) CHELATION: REDUCING

TOXIC METALS IN THE BODY• 6) ANTI-VIRAL TREATMENT

BASIC EVALUATION

• HISTORY, PHYSICAL EXAM

• BASIC GENERAL LAB SCREENCBC, URINALYSIS

SERUM CHEMISTRIES

THYROID PANEL

IRON PANEL

BASIC DIAGNOSTIC TESTS

FOR GUT:

URINE ORGANIC ACIDSCOMPREHENSIVE STOOL STUDY

FOR NUTRIENT STATUS:ORGANIC ACIDS, AMINO ACIDSRBC MINERALS, FATTY ACIDS VITAMIN PANEL

CLINICAL HISTORY: EARLY INDICATIONS OF GUT

DYSFUNCTION

1) FAMILIAL DIGESTIVE DIGESTIVE DYSFUNCTIONS

2) INABILITY TO BREAST FEED

3) PERSISTENT COLIC IN INFANCY

4) FREQUENT INFECTIONS (E.G. EAR) LEADING TO FREQUENT

ANTIBIOTICS

5) REACTION TO CERTAIN VACCINATIONS

GASTROINTESTINAL PATHOLOGY SYMPTOMS REPORTED BY PARENTS

• PERSISTENT DIARRHEA AND/OR CONSTIPATION, BLOATING, GAS AND ABDOMINAL PAIN

• SELF-RESTRICTION OF DIET

• NIGHT WAKING – REFLUX

• GREATER ALLERGIC SUSCEPTIBILITIES

G.I. HEALTH: TREATMENTS PARENTS

CAN DO

• ELIMINATE SUGARS AND JUNK FOOD FOR EVERYONE IN THE FAMILY

• READ LABELS ON FOODS, GET EDUCATED ABOUT TOXINS IN BOTH FOOD AND WATER

• GF/CF/SF OR SCD DIET• ENZYMES AND PROBIOTICS• BASIC NUTRIENT SUPPLEMENTATION

G.I. HEALING TREATMENTS THAT REQUIRE

A PHYSICIAN

• LAB TESTING FOR GUT PATHOGENS

• ANTI-FUNGAL PRESCRIPTIONS RX

• ANTI-BACTERIAL PRESCRIPTION RX (CLOSTRIDICA AND OTHER)

• SECRETIN, VIT M-B12 INJECTABLES

• IMMUNOGLOBULIN, IV OR ORAL, ENDOSCOPY

ANTI-BACTERIALSANTI-FUNGALS

NATURALSCAPRYLIC ACID, UVA URSI, GRAPEFRUIT SEED EXTRACT, LAURICIDIN

PRESCRIPTIVES: FLAGYL, GENTAMYCIN, VANCOMYCIN,

DIFLUCAN, NYSTATIN, NIZORAL, SPORANOX

TREATMENTS BEYOND THE BASICS

METHYLATION

DETOXIFICATION

VIRAL/IMMUNE ISSUES

RECENT NEW TREATMENTS

METHYLATION TREATMENT

“ QUINTET”1) GLUTATHIONE (GSH), ORAL, TD, OR IV

150-MG BID ORAL, 125-MG BID TD, 300-600-MG IV

2) ALLITHIAMINE (TD - TTFD)50-MG BID (COMPOUNDED OR AUTHIA)

3) METHYLCOBALAMIN (INJECTABLE M-B12) CONC 25-MG/ML, 64.5-MCG/KG Q 3 DAYS

4) FOLINIC ACID, 800-MCG TWICE DAILY5) DMG, 125-MG PER YR OF AGE, ALL IN AM

OR TMG, 500-1000-MG TWICE DAILY

METHYLCOBALAMIN• VIT B12 LEAST TOXIC, BEST TOLERATED, H20

SOLUBLE - EXCESSES URINATED OUT WITHOUT HARM.• UPTAKE FROM ORAL INTAKE LOW,

PARTICULARLY IN GI INFLAMMATION.• VIT B12 PLAYS KEY ROLE IN GSH STABILIZATION

AND KEEPING OTHER ENDOGENOUS ANTIOXIDANTS IN REDUCED STATE.

• DIFFICULT TO TEST FOR DEFICIENCY; SERUM LEVELS INADEQUATE AS

• MARKER FOR DEFICIENCY.• ULTRA HIGH DOSES MAY REGENERATE NERVES

GLUTATHIONE (GSH)• NATURALLY OCCURING TRI-PEPTIDE

FROM CYSTEINE, GLUTATMIC ACID, AND GLYCINE.

• PRESENT IN ALL LIVING CELLS, HIGHEST LEVEL FOUND IN LIVER.

• WORKS TO INHIBIT FORMATION OF FREE RADICALS, DETOXIFYING HARMFUL COMPOUNDS.

• DEFICIENCY INCREASES SENSITIVITY TO THIMEROSAL AND OTHER

PRO-OXIDANT AGENTS.

GLUTATHIONE, Cont’d.

• VIT C, E, A-LIPOIC ACID (ALA), N-ACETYL CYSTEINE (NAC), SELENIUM, GLUTAMINE, AND SILYMARIN ENHANCE GSH LEVELS BY HELPING BODY MANUFACTURE IT.

• VITAMIN B12 HELPS MAINTAIN GLUTATHIONE IN ITS USEFUL REDUCED BIOLOGICAL STATE.

TOXINS DIAGNOSTIC EVALUATION

1) EXPOSURE HISTORY – MOTHER DIET, AMALGAMS, RHOGAM VACCINATION HISTORY

2) HAIR ELEMENTS ANALYSIS

3) RBC MINERALS AND TOXICS

4) METALLOTHIONEIN CELLULAR TEST

TTFD (ALLITHIAMINE)• TTFD IS THIAMINE TETRAHYDROFURFURL

DISULFIDE, SYNTHETIC COUNTERPART TO ALLITHIAMINE, A DERIVATIVE OF VIT B1 (THIAMINE) NATURALLY FOUND IN GARLIC.

• THIAMINE IS WATER-SOLUBLE, NECESSARY FOR METABOLISM PROTEINS, CARBS, AND FATS

• THIAMINE DEFICIENCY IN ALCOHOLISM, MALNUTRITION, USE OF CERTAIN DRUGS

• GENTLE CHELATOR FOR ARSENIC, CADMIUM, ALUMINUM, LESS FOR HG

• NON-TOXIC, NO PRESCRIPTION NEEDED, TRANSDERMAL CREAM TWICE DAILY

PREPARATION for REMOVING HEAVY METALS

• NUTRIENT READINESS: ADEQUATE MINERALS BEFORE AND DURING CHELATION; PROBIOTICS, ENZYMES

• GUT READINESS: CHELATION CAN ENCOURAGE PATHOGENS TO GROW, PREPARE AND PLAN FOR THIS

• LAB STUDIES: CBC, CHEMISTRY PANEL BEFORE STARTING CHELATION

CHELATION AGENTS• :

• DMSA (CHEMET) FDA APPROVED for LEAD REMOVAL IN CHILDREN, HIGH SAFETY INDEX, OTC AS CAPTOMER. NEWLY EFFECRIVE TD FORM, SAME SCHEDULE AS ORAL 3 ON, 11 OFF, Q 4 OR 8 HRS.

• DMPS, NOT FDA APPROVED FOR CHILDREN BUT LEGAL FOR COMPOUNDING. SMALL ORAL DOSES EFFECTIVE, SAFE, IV CONTROVERSIAL BUT USED AND EFFECTIVE, NEW TD FORM.

• ALA (ALPHA LIPOIC ACID) OTC ANTI-OXIDANT THOUGHT TO CROSS THE BBB, SO NOT TO BE USED UNTIL METAL REMOVAL WITH DMSA HAS PLATEAUED.

•

IMMUNOLOGY IN ASD

• IMMUNOLOGICAL ISSUES IN AUTISM

• FAMILY HISTORY IMPORTANT

• IMMUNE TESTING AS GUIDANCE FOR TREATMENT

DIAGNOSTIC EVALUATION IMMUNE SYSTEM

SPECIALTY LAB Tests, MINIMAL

1) COMPREHENSIVE VIRAL PANEL #3

2) NK CYTOTOXICITY TEST

3) MYELIN BASIC PROTEIN (MBP) PANEL

4) RUBEOLA ANTIBODIES

PREMIER ASD IMMUNE PANEL, ISL Streptococcal Peptides (M5, M12, M19) (IgG) Gliadin Peptides Antibodies (IgG, IgM, IgA)   Casein Peptides Antibodies (IgG, IgM, IgA) Antibodies to Hg Binding Antigen (Fibrillarin) (IgG, IgM, IgA)   Dipeptidylpeptidase (DPP IV) Antibodies (IgG, IgM, IgA)   Anti-Myelin Basic Protein Antibodies (IgG, IgM, IgA)   Anti-Neurofilament Antibodies Metallothionein (Cellular Level) NK Cell Activity   Measles Antibodies (IgG, IgM) VIRAL SCREEN #3: Varicella Zoster Virus (IgG) Cytomegalovirus (IgG, IgM) Epstein-Barr Virus or VCA (IgG, IgM) Herpes Type 1 & 2 Virus (IgG, IgM) Herpes Type 6 Virus (IgG, IgM) Immunoglobulins (IgG, IgA, IgM) $1644, 50% DISCOUNT AS PANEL = $822 PRE-PAID Blood Required, 2 yellow tops, 1 red top (10 cc in each tube)

MEASLES AND BRAIN VIRAL AUTO-ANTIBODIES IN ASD

• SINGH 1998: 70% OF AUTISTIC SERA HAD ANTI-MYELIN BASIC PROTEIN ANTIBODIES, NONE IN NT CHILDREN.

• 57% ASD HAD ANTI-NEURON-AXON FILAMENT PROTEIN, NONE IN NT KIDS

• HIGHER ANTI-MEASLES ABS THAN NT KIDS, MUMPS AND RUBELLA NOT DIFFERENT FROM NT’S

WAKEFIELD: INFLAMMATORY BOWEL DISEASE IN AUTISM

• GUT BIOPSIES, 1998: MEASLES VIRUS DETECTED IN DENDRITIC CELLS AND MATURE LYMPHOCYTES IN 75/91 ASD CHILDREN VS 5/70 CONTROLS WITH LYMPHOID NODULAR HYPERPLAXIA

• THOUGHTFUL HOUSE 2005 STUDY CORROBORATES INCREASED RATE OF SWOLLEN INTESTINAL LYMPH GLANDS, INCREASED INTESTINAL LINING INFLAMMATION IN ASD’S WITH BOWEL ISSUES.

IMMUNITY TREATMENT NATURAL ANTI-VIRALS

• LAURICIDIN (ORIGINALLY FOUND IN BREAST MILK & COCONUT, NOW SYNTHETIC (WWW.LAURICIDIN.COM)

• OLIVE LEAF EXTRACT, GREEN TEA

• LARCH ARABINOGALACTINS

• IP- 6 (INOSITOL HEXAPHOSPHATE)

• GRAPEFRUIT SEED EXTRACT

PRESCRIPTIVE ANTI-VIRALS

• ACYCLOVIR 800MG 3X/DAY (FOR UNDER 30#, 10-12KG)

• VALTREX (MAIN ONE I USE) 250MG – 1500MG 2x DAILY, DEPENDING UPON SIZE

• ALTERNATE WITH FAMVIR 250MG – 500MG/DAY DEPENDING UPON SIZE

RECENT THERAPY REFINEMENTS

• NEW DIETS BEYOND GF/CF/SF: (SCD) SPECIAL CARBOHYDRATE DIET –

• (OLD) OXALATE-LOWERING DIET

• MB-12 METHYLCOBALAMIN – DAILY HIGH DOSE INJECTIONS NEUBRANDER)

• NASAL SPRAY MB-12 + FOLINIC ACID

• TD DETOX AGENTS, TD-DMPS, TD-DMSA

RECENT NEW TREATMENTS

• PPAR’S (ACTOS) FOR GUT AND BRAIN INFLAMMATION, SHIFTS T2 TO T1

• LOW-DOSE NALTREXONE FOR IMMUNE MODULATION, SOCIABILITY

• NASAL MB-12 + FOLINIC ACID

• ANTI-VIRAL TREATMENT FOR ALMOST ALL CHILDREN, NATURAL AND/OR PRESCRIPTIVE

ACTOS AND IMMUNE MODULATION FOR BRAIN-GUT

INFLAMMATION • PPAR – ACTOS (PIOGLITAZONE), PX FOR

PRE-DIABETES, LOWERS GUT AND NEURO-INFLAMMATION, REGULATES LIPID AND GLUCOSE METABOLISM, SHIFTS IMMUNITY FROM T2 HUMORAL (AUTO-IMMUNITY) TO T1 (CELLULAR)

. CLINICAL STUDY >300 CHILDREN, DR. BORIS/GOLDBLATT, PROMISING

LOW-DOSE NALTREXONE (LDN)

• FDA APPROVED OPIOID ANTAGONIST 1985, BRAND REVIA, ALSO GENERIC USED IN 50 - 150MG DOSES AS OPIOID

ANTAGONIST FOR NARCOTIC/ALCOHOL ADDICTION

•

• MUST BE PRESCRIBED AND COMPOUNDED IN CAPSULES OR

TRANSDERMAL CREAM

LOW-DOSE NALTREXONE AS IMMUNOMODULATOR

• OPIOIDS ALTER BOTH INNATE AND ADAPTIVE IMMUNE CELLS – NK CELLS, MACROPHAGES, IMMATURE THYMOCYTES, T CELLS AND B CELLS

• BRIEF BLOCKADE OF OPIOID RECEPTORS ELEVATES B-AND OTHER ENDORPHINS

• NORMALIZATION OF PLASMA CHEMICAL

PROFILES: ELEVATED NOREPINEPHRINE, ARGININE-VASOPRESSIN, SEROTONIN (BOUVARD, LENSING, PANKSEPP, 1995)

THERAPEUTIC USE IN ASD

• USE IN TINY DOSES (1.5 – 4.5MG)

• REGULATES MOOD & MODULATES

IMMUNE SYSTEM, USE ONCE DAILY BETWEEN 9PM-12AM FOR 2-4 AM

ENDORPHIN “RUSH”, LASTS 18 HRS

• AS IMMUNOMODULATOR - INCREASES NATURAL ENDORPHINS,SHIFTS T2

(HUMORAL IMMUNITY) TOWARD T1 (CELLULAR) IMMUNITY

ENDORPHINS• NEUROHORMONES - MODIFY NERVE

CELL OPIATE RECEPTORS TO NEUROTRANSMITTERS, ANALGESIC

• ENKEPHALINS/ENDORPHINS: ALPHA-BETA-GAMMA & SIGMA-ENDORPHIN

• STIMULATE ENDORPHIN SECRETION:LDNPHYSICAL EXERCISE

TOUCH - MASSAGE/ACUPUNCTURE LAUGHTERCHOCOLATE

BETA-ENDORPHIN ENDORPHIN COLLECTION

MICHAEL W. DAVIDSON (NHMFL)

FLORIDA STATE UNIVERSITY

TH1-TH2 BALANCETH1 – CELLULAR IMMUNITY,

DIRECTS NK T-CELLS AND MACROPHAGES TO ATTACK

ABNORMAL CELLS AND PATHOGENS INSIDE THE CELL

TH2- HUMORAL IMMUNITY, CREATES ANTIBODIES TO

NEUTRALIZE FOREIGN INVADERS OUTSIDE CELL

HEALTHY IMMUNITY

• BALANCED BETWEEN Th1 - Th2, SWITCHES BACK AND FORTH AS NEEDED

• INABILITY TO RESPOND ADEQUATELY TO Th1 – CHRONIC INFECTION & CANCER

• OVERACTIVE Th2 RESPONSE – PLAYS ROLE IN AUTOIMMUNITY AND ALLERGIES

UNHEALTHY IMMUNITY

FAILURE OF THE Th1 ARM & OVERACTIVE Th2 ARM:

AIDS

CFS (FATIGUE)

CANDIDIASIS

MULTIPLE ALLERGIES

MCS (CHEMICAL)

CANCER

AUTISM

SUMMARY BIO-MEDICAL TREATMENTS

• 1) RESTRICT DIET, GF/CF/SF, SCD• 2) NUTRIENTS• 3) TREAT GUT PATHOGENS• 4) CORRECTING METHYLATION

DYSREGULATION (“Quintet”)• 5) DETOXIFICATIOIN: REDUCING TOXIC

METALS IN THE BODY• 6) ANTI-VIRAL TREATMENT• 7) ENHANCE IMMUNE SYSTEM

• 2nd Edition

• 2003