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HEALTH CONCERN? BioHealth Health Concerns

The Puzzle of Autism-Spectrum Disorders

Contributing Author: Woeller, Kurt D.O.

Kurt WoellerKurt N. Woeller, D.O. is an osteopathic physician who specializes in traditional osteopathic medicine, cranial osteopathy and integrative medicine. His primary focus is treating children with autism-spectrum disorders. He graduated in 1995 from the University of New England, College of Osteopathic Medicine. He currently lives and practices in Temecula, California. Dr. Woeller serves as a clinical consultant for Great Plains Laboratory teaching doctors the latest in biomedical diagnostic testing and treatment protocols for children with autism-spectrum disorders. He lectures nationwide for Great Plains Laboratory, as well independently regarding the benefits of biomedicine for children with autism.

» Website: SUNRISE MEDICAL

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The Puzzle of Autism-Spectrum Disorders (ASD) – Biomedicine as an option for assessment and treatment including with Lyme’s Disease and Borrelia-Related Complex (BRC)

Autism presents a level of complexity from a medical diagnostic and treatment standpoint because of the underlying medical issues affecting this special group of children (see below). Also, the prevailing attitude in traditional circles “that nothing can be done for these kids,” and that behavior, speech and other types of applied cognitive training therapies are the only way to approach an autistic child, doesn’t help. This viewpoint creates confusion and doubt amongst parents looking for real answers to their child’s health concerns.

This same type of closed-minded attitude held by traditional authorities seems to fit the current situation with Lyme’s Disease in the United States today. Current estimates are that 20,000 people are afflicted with Lyme’s Disease every year (1). These are the known cases of tick bites. Most of these people, if treated early enough with appropriate antibiotic therapy such as Doxycycline for 30 days (2), have a great chance for full recovery. A significant number of people suspected of having Lyme’s have no associated or known tick bite, and may present with fatigue, inflammatory arthritis, chronic headaches, muscle and joint pain, and other type of debilitating ailments. If their initial illness was never treated with Lyme-specific therapeutics, the person could go years without assessment until an astute clinician considers Lyme’s as a possible entity. Unfortunately, the current state of affairs for physicians trying to treat patients with chronic Lyme’s by thinking outside the conventional box is very similar to that of physicians such as myself who know that for the majority of children with autism, their condition can be greatly improved through biomedical intervention.

The Lyme’s debate is best summarized by the current situation in Connecticut, where the attorney general has stepped in to intervene between two competing medical organizations’ guidelines – the IDSA (Infectious Diseases Society of America) and the ILADS (International Lyme and Associated Diseases Society). The debate between the two organizations is over how to best treat people who contract the infection each year (1). In short, IDSA’s position is simple – short-term antibiotics for known Lyme’s patients is all that is needed, and there is no need or reason for long-term therapy. However, ILADS takes the position that each patient’s response is different and that longer-term therapies are often necessary. ILADS believes that Lyme’s is much more than an acute illness and adequately needs to be addressed in a more comprehensive fashion. ILADS makes the point that other infectious diseases, such tuberculosis and Q fever, need long-term antibiotic therapy, and that shorter treatments based on the notion of acute illness are inadequate. From my personal experience, ILADS is correct.

What about biomedical intervention for children (or adults) with an autism-spectrum disorder (ASD)? Why is the majority of the medical profession so close-minded about the potential benefits of biomedical intervention? Finally, is the current situation with Lyme’s also affecting a percentage of the autism population? From my position, it certainly is, and the real possibility is that the Borrelia organism and other potential co-infections, i.e., Ehrlichia and Babesia, are other infectious entities that need to be addressed in these children. First, let’s explore the roots of biomedicine for autism and why a comprehensive biomedical approach is necessary.

The Roots of Biomedical Therapy for Autism

The biomedical movement for autism-spectrum disorders (ASD) got its birth from an organization called the Autism Research Institute founded in San Diego, CA by the late Bernard Rimland, Ph.D. (1928–2006). Dr. Rimland had always believed that autism and its related disorders had roots in biological causation, and that they were not just psychological or neurodevelopment disorders. In his early work, Dr. Rimland advocated the use of vitamin B6 and magnesium to help with the cognitive challenges facing autistic individuals.

In a significant number of children who tried this simple therapy, it worked very well, with better eye contact, improved speech, and less hyperactivity, as a few examples of the improvements seen. From there, Dr. Rimland began to collaborate with like-minded physicians using nutrition and targeted vitamin and mineral therapies for their chronically ill patients, some of whom were autistic. These early efforts led to the birth of the Defeat Autism Now (DAN!) organization. From their original meetings in Dallas, Texas in 1995, DAN! has sprung forth into a highly respected group of clinicians and researchers dedicated to researching and treating the various health issues commonly seen in autistic individuals: autoimmune and digestive protein disorders (3, 4, 5, 6), digestive problems including chronic elevated measles antibodies (7), yeast and bacteria overgrowth (8), metabolic disorders including detoxification imbalances and methylation defects (9), heavy metal toxicity (10), and more.

The Defeat Autism Now organization is to be commended for their ongoing dedication to helping unravel the health issues of many autistic children. The DAN! conference, held twice yearly, is an incredible resource of information for parents and doctors seeking answers to the biomedical issues of children with ASD. Of course, the concepts of good diet, and proper immune and digestive function that promote health and vitality are nothing new to the world of natural medicine (and the reader’s of the Townsend Newsletter). For years, natural healers, herbalists, and nutritional laymen have been promoting healthy diets and the removal of toxins as disease prevention. However, the DAN! organization has been able to bring these issues to the forefront of the autism epidemic that we now face. They are an important bridge between the traditionalists who view ASD as a purely neurodevelopmental disorder with no hope for improvement or recovery, much the same way ILADS supports a broader view of Lyme’s disease.

The Puzzle Scenario

There are many questions to be answered regarding the cause and treatment of autism, PDD, and other autism-spectrum disorders (ASD). The solutions are not always simple, the cause is often multi-factorial, and the testing and subsequent treatments are sometimes complicated and expensive. It is important to realize that with everything in medicine, there are no guarantees of absolute recovery from illness, especially with complex disorders involving the nervous system. However, there is reason for hope and enthusiasm regarding the biomedical treatment of children with ASD. Much can be done to help these children reach their full potential, and in my experience many children have had significant mental, emotional, and overall health improvements through specific diagnostic and treatment approaches.

Each child is like a puzzle. The factors influencing a child’s physical health and mental/emotional well-being are many. As mentioned above, the many physical challenges that these children face need to be addressed systematically. A direct approach is prudent and a good diagnostic assessment is necessary. Also, implementing specific targeted therapies, particularly in the beginning, has, in my opinion, done wonders to jump-start the healing process for many ASD patients. However, the puzzle scenario is a real one that creates difficulties with respects to biomedical therapy because each child will not respond positively to every therapy, whereas another child may respond quite profoundly, such as speaking in sentences almost immediately. This can be true even for children harboring Borrelia as a potential contributing factor to their underlying health condition.

LIAF

At a recent think-tank in San Diego hosted by the Lyme Induced Autism Foundation (LIAF – www.lymeinducedautism.com), the discussion centered around the potential link between autism and infection with Borrelia and other co-infections commonly seen in Lyme’s Disease, such as Ehrlichia and Babesia. Input from a number of leading researchers and practitioners in the field of Lyme’s suggest that Lyme’s Disease (Borrelia derived by tick-borne contact) may play a role in autism. However, a more common scenario is likely the Borrelia organism being contacted by other means, such as other insect vectors or trans-placental transfer from an infected mother (11).

In this scenario, the child is not manifesting with Borrelia infection directly from a tick-borne illness (which, in my practice, is almost never mentioned during history taking from parents), but instead has a more insidious infection without classic acute manifestations, as seen commonly in Lyme’s Disease. The think-tank members indicated the need to classify cases of Borrelia-induced illness as something separate from classic Lyme’s Disease (the term generally applied to Borrelia infection contracted via a tick bite).

One term mentioned was Borrelia-Related Complex (BRC), a multi-factorial disorder complicated by Borrelia and other confounding infections, along with a dysregulated immune system that leads to a state of chronic disease. The same pathophysiological manifestation can still exist with BRC, as seen in latent Lyme’s, but BRC is not a Borrelia infection derived via a tick bite.

A research project is underway with assistance from those of us who attended the think-tank and IgeneX laboratory to evaluate how many autism-spectrum children are actually carrying Borrelia infection in their bodies. Estimates at this point range from 40% to 60% (estimate were from the think-tank members from clinical experience), but more conclusive data are needed. The results of this study will go a long way in determining the extent of BRC and autism.

The Biomedical Approach – Incorporates Many Aspects of Medicine

A biomedical approach to autism-spectrum disorders utilizes a wide variety of therapies, diagnostic testing, and at times medication (if needed) to optimize each child’s health potential. I have listed below a brief outline of how I approach a child with ASD. My initial goal is to obtain critical information regarding a child’s underlying health condition while implementing a specific therapy to jump-start the child’s cognitive dysfunction, such as speech delay, attention and focusing problems, and environmental and social awareness. One of the best therapies I have found for these issues is methylcobolamin injections (see discussion below). I separate my laboratory assessment into two different categories – blood and non-blood. For most children, all testing can be done at the same time, but the option for non-blood testing is available in children where blood testing in the beginning stage of assessment may not be appropriate.

Diagnostic Testing (BHD = COREONE Diagnostics, DD = Doctor’s Data, GPL = Great Plains Laboratory, ISL = Immunosciences, Inc.)

 

  • Non-Blood:
    • Comprehensive Stool Analysis (DD or GPL) – evaluates for bacteria, parasitic and yeast overgrowth and infection, as well as markers for digestive immunity and inflammation.
    • Organic Acid Test (GPL) – evaluates for metabolic metabolites of yeast, clostridia bacteria, oxalates, and other functional nutritional deficiencies.
    • Urinary Peptides (GPL) – useful for peptide assessment from wheat (gluten), soy, and casein. (4, 5).
    • Hair Analysis (DD or GPL) – evaluates for the presence of heavy metal exposure and certain mineral imbalances, such as copper, lithium, iodine, molybdenum, and selenium.
    • Porphyrin Profile (Labbio Laboratoire Phillipe – www.labbio.net or Great Plains Laboratory) – urine analysis for porphyrin metabolism. Porphyrins are the building blocks for heme synthesis and imbalances indicate heavy metal exposure and toxicity (13).
  • Blood:
    • Comprehensive Blood Chemistry – including CBC, metabolic profile, liver, kidney, and thyroid assessment.
    • Comprehensive Food Sensitivity – evaluates for elevated IgG levels to common food sensitivities as indicators for immune and physiological stress.
    • Packed Red Blood Cell Analysis – evaluates for mineral depletion, particularly copper, magnesium, selenium, and zinc.
    • Metallothionein Profile (GPL) – evaluates the functional capacity of metallothionein (an indicator of heavy metal detoxification capacity), as well as zinc, copper, and ceruloplasmin imbalances that appear to be an issue for a subset of autistic individuals (12).
    • Viral Panel (BHD, ISL) – evaluates IgG and IgM to common viruses, including CMV, EBV, HHV-I, II, and VI, and Varicella. Measles IgG and IgM may be added separately.
    • Lyme IgG, IgM and Lyme IFA (IgeneX) – evaluates for common band markers for Borrelia burgdefori.

First-line Therapy – Building Block for Success

One of the first therapies I implement for any ASD patient is something called methylcobolamin injection therapy (or methyl-B12) as outlined by James Neubrander, M.D. (14). In my practice, I offer this therapy as first-line treatment to begin the process of supporting methylation defects (15, 16) and cognitive dysfunction for ASD individuals (14). The process is very simple and is outlined extensively on Dr. Neubrander’s website (www.drneubrander.com), with videos to demonstrate how the therapy is done. If a parent can begin methyl-B12 with their child while we are awaiting their laboratory test results, we can in many cases speed up the child’s healing response quite dramatically.

In my experience, methyl-B12 therapy consistently improves the top following five areas for ASD children: attention, eye contact, language improvement – both receptive and expressive, enhanced environmental awareness, and increased willingness to socialize. For some kids, these changes may be subtle at first, while in others, marked improvement can be seen very early on – sometimes within weeks.

My approach is similar to Neubrander’s in that methyl-B12 therapy is implemented for at least five weeks without any other changes to a child’s medication, dietary or supplement program. This scenario usually works out well, as obtaining the above listed test results and then scheduling a follow-up laboratory review with the child’s parents can take three to five weeks. The methyl-B12 injections appear to give the most consistent results (14). Other forms of methyl-B12 are available, such as nasal, oral. or sublingual, but overall response is mixed. Methyl-B12 injections are available only by prescription, but pre-filled insulin syringes are available for ease of administration by either practitioner or parent. For most cases, the parent dispenses the injections every 72 hours basis to begin. The injection is given subcutaneously in the outer upper quadrant of the buttocks, and is virtually painless. Lidocaine cream may be applied to numb the injection site if necessary. For more specifics about this important therapy, reference material from Dr. Neubrander is at www.drneubrander.com and from my resource center’s website, at www.mystillpoint.com.

What is the Bottom Line?

Once you have obtained a child’s test results, you can implement a more detailed treatment program based on the patient’s needs – whether nutritional supplements, dietary intervention such as gluten-, dairy-, and soy-free diets, anti-fungal or anti-bacterial treatment, or specific therapy for Borrelia infection if detected. Prioritizing therapeutic implementation is tricky. In my experience with ASD, if parents have begun methyl-B12 therapy, my next step would be dietary and nutritional supplementation support. Improving digestive function by eradicating or reducing bacteria and yeast overgrowth is also important for long-term success. Once these therapies are in place and you are confident that the child is being supported nutritionally, more direct therapy can be implemented against Borrelia or co-infections, as well as other compounding issues such as heavy metal toxicity, viral loads, etc. At times, all of this will be hard work and requires persistence, consistency. and dedication on your part as a practitioner, along with the help of each parent to overcome the complex health challenges for their ASD child(ren). In the end, the rewards can be gratifying and the outcomes are sometimes miraculous.

The medical issues of many children with an autism-spectrum disorder are an ever-evolving conundrum for physicians and parents. The same can be said for patients dealing with the ravages of Lyme’s Disease. Organizations and physicians unwilling to open their minds to the reality of the health challenges of these patients are already worthless in their ability to help. For those of us left in the battle, we must continue searching for new clues and better ways of implementing what we know works, as well as other potential therapies that may benefit our patients.

My approach is just an example of how to deal with the health complexities of children with autism and other related disorders. Whether or not Borrelia plays a role with a particular child with ASD, a thorough biomedical approach is warranted and extremely helpful for many of these children.

 

  1. Susan J. Landers. Lyme disease debate provokes treatment divide, legal action. AMNews staff. Dec. 25, 2006.
  2. American College of Physicians. Guidelines for laboratory evaluation in the diagnosis of Lyme’s disease. Ann Intern Med. 1997.
  3. Vodjani A, Pangborn JB et al. Infections, toxic chemicals and dietary peptides binding to lymphocyte receptors and tissue enzymes are major instigators of autoimmunity in autism Int. J. Immunopath and Pharmacol 16 no.3 (2003) 189–199.
  4. Knivsberg AM, Reichelt KL, Nodland M. Reports on dietary intervention in autistic disorders. Nutr Neurosci. 2001;4(1):25-37.
  5. Reichelt KL and Kvisbery A-M. Why diet is useful in some autistic children: results so far. Presentation at DAN! Portland Conference, 2003: DAN! Fall 2003 Syllabus 91–99.
  6. Warren RP et al. Deficiency of suppressor-inducer (CD4+CD45RA+) T cells in autism. Immunol Invest. 1990 Jun;19(3):245–51.
  7. Singh VK, Jensen RL. Elevated levels of measles antibodies in children with autism. Pediatr Neurol. 2003 28(4):292–4.
  8. Tabaqchil S. Abnormal intestinal flora: metabolic and clinical consequences. Gastroenterol Jpn.1984 Aug;19(4):351–62.
  9. James SJ, Cutler P, Melnyk S, Jernigan S, Janak L, Gaylor DW, Neubrander JA. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am J Clin Nutr. 2004 Dec;80(6):1611–7.
  10. Bernard S, Enayati A, Redwood L, Roger H, Binstock T. Autism: a novel form of mercury poisoning. Med Hypothesis. 2001 Apr;56(4):462–71.
  11. Lyme Induced Autism Foundation (LIAF) – Think Tank presentations. San Diego, CA. Jan 26-27, 2007.
  12. Walsh WJ et al. Metallothioein and Autism. Pfeiffer Treatment Center, Naperville IL (Oct.2001) 5.
  13. Chemical Injury and Disorders of Porphyrin Metabolism (http://www.mcsrr.org/resources/articles/S5.html)
  14. Myth, Masterpiece or Miracle? James Neubrander, M.D. (www.drneubrander.com)
  15. Molecular Aspects of Thimerosal-induced Autism. Richard Deth, Ph.D. Northeaster University
  16. James J, Cutler P, Neubrander J, et al. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am J Clin Nutr. 2004;80:1611–7.