Transcript Overall treatment by Dr. W Shaw

The Plaza,
Kansas City, MO
Comprehensive Treatment
Autism/ADHD
William Shaw PhD
The Plaza, Kansas City
Autism: divergent views
• Viewpoint one: Autism is a neurological
disorder due to primarily genetic causes.
• Treatment is behavioral therapy and
neuropharmacological therapy.
Autism: divergent views
• Viewpoint two : Autism is a systemic disorder in
which brain function is also affected due to toxic
exposures, nutritional deficiencies, vaccine
overuse or vaccine abuse, gastrointestinal
dysfunction, food allergies, and genetic
vulnerabilities. Treatment is directed to reduce
and/or remove toxic chemicals, restore nutritional
balance, restore beneficial flora, and remove
foods that are not beneficial to the individual.
Behavioral therapy helps to recover functions
lost during suboptimum physiological state.
Thalidomide
 Introduced in 1956 as
sedative (sleeping pill) and to
reduce nausea and vomiting
during pregnancy
 “Completely safe”
 Withdrawn in 1961-5 years too
late for many children
 Discovered to be a human teratogen
causing absence of limbs or limb
malformations in newborns
 5000 to 7000 infants effected
 Resulted in new drug testing rules
The causes of autism
• Although autism appears to be
multifactorial, could there be a single
factor that is much more important than
others as in the case of thalidomide?
• Autism is more difficult to diagnose since
children don’t have missing arms and legs
Symptoms of autism/PDD
Pervasive developmental disorder
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Lack of speech: expressive and receptive
Stereotypical or odd behavior
Social deficits
Hyperactivity/hypoactivity
Poor focus and concentration
Reduced pain and danger perception
Poor eye contact
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Symptoms
Sleep disturbance
Eye pain, eye touching
or poking
Hyperactivity, excessive
laughing
Spaced out, no
sensitivity to pain, diet
high in milk and wheat
Frequent urination of
small amounts of urine
Head banging, hand
biting
Underlying causes
• Melatonin, iron deficiency
• Severe calcium deficiency
• GI candida, lead toxicity
• High concentration of
opiate peptides from milk
and wheat
• Oxalate stones in urinary
tract
• Severe GI pain
Symptoms
• Bending over sofa with
pressure against
stomach
• Walking on toes
• Excessive drooling
• Extremely violent
behavior, kicking,
screaming, destructive
• Looking at things by
sideways glance
Underlying causes
• GI discomfort, pain
• Oxalate deposits in
soles of feet, selenium
deficiency
• Mercury toxicity
• Clostridia overgrowth
• Vitamin A deficiency
Comprehensive Biochemical
Testing
• Organic acid test •
for genetic disease, •
toxics, and yeast
and bacterial
•
byproducts
• Yeast culture and •
sensitivity
• Cholesterol profile •
• Heavy metals
• Iron stores-ferritin •
•
Copper/zinc profile
Comprehensive
IgG food allergies
Comprehensive
inhalant allergies
Immune system
deficiencies
Amino acids and
fatty acids
Strep antibodies
Vitamin D
Reasons to give supplements
for autism, ADHD and PDD
• Malabsorption due to lack of digestive enzymes
or abnormal gastrointestinal flora
• Dietary deficiencies due to special restricted diet
• Need for higher than normally recommended
nutrients due to abnormal metabolism or inborn
errors of metabolism (genetic vulnerability)
• Help to detoxify toxic chemicals from
environment or infections
Parental Rating of Various Nutrients for
Autism compared to drugs
5.5
5.9
8.8
9.9
niacin or niacinamide
Dimethylglycine
Zinc
B-6 and magnesium
Folic acid
Vitamin C
Calcium
Haldol
Stelazine
Hydroxyzine
Prozac
Depakene
Benadryl
Prolixin
Buspar
Mellaril
Naltrexone
Clonidine
Antifungal
16.5
18.2
56
1
1
1.1
1.1
1.1
1.2
1.3
1.3
1.3
2.1
2.7
12.9
0
10
20
30
40
Better:Worse ratio
50
60
Why is the brain so susceptible to
oxidative stress ?
Why the brain is a free-radical
target
•The brain does not have adequate
stores of antioxidants
•The brain has so much iron that it leads to
significant production of free radicals that
cause significant peroxidation of the fats
in the cell membrane
•The brain has a very limited capacity to
regenerate after being damaged.
Why the brain is a free-radical
target
•The brain has a very high percentage of
essential fatty acids, that can be damaged by
free radicals
•The brain requires a tremendous amount of
the total oxygen used in the body,
approximately 20% of the total oxygen.
Dolske MC, Spollen J, McKay S, Lancashire E,
Tolbert L. A preliminary trial of ascorbic acid as
supplemental therapy for autism. Prog
Neuropsychopharmacol Biol Psychiatry. 1993
Sep;17(5):765-74.
• 30-week double-blind,placebo-controlled
trial of the effectiveness of ascorbic acid
(8000 mg/70kg/day) for autistic children
• Pacing, rocking, flapping, and whirling
behaviors responded especially well to this
high dose vitamin C regimen.
Eur Child Adolesc Psychiatry. 2006 May 13;
Treatment of ADHD with French maritime pine bark
extract, Pycnogenol.
• Results of double-blind placebo study show that
1-month Pycnogenol administration caused a
significant reduction of hyperactivity, improves
attention and visual-motor coordination and
concentration of children with ADHD.
• In the placebo group no positive effects were
found.
• One month after termination of Pycnogenol a
relapse of symptoms was noted.
The plasma zinc/serum copper ratio as a biomarker in
children with autism spectrum disorders. Scott Faber et al
Biomarkers March 11,2009
The Children's Institute, Pittsburgh, PA, USA
• A retrospective review of plasma zinc, serum copper
and zinc/copper was performed on data from 230
children with autistic disorder, pervasive developmental
disorder-NOS and Asperger's syndrome.
• The entire cohort's mean zinc level was 77.2 mcg/dl;
mean copper level was 131.5 mcg/dl, and mean Zn/Cu
was .608, which was below the 0.7 cut-off of the lowest
2.5% of healthy children.
• The plasma zinc/serum copper ratio may be a
biomarker of heavy metal, particularly mercury, toxicity in
children with ASDs.
Destruction of vitamin C by
free copper or iron ions
without SOD
Ascorbate (Vitamin C)
Cu Cu Cu Cu
Cu Cu Cu Cu
Cu Cu
Free copper has as much SOD
activity as SOD
Dehydroascorbate
Zinc deficiency
Severe zinc deficiency
Physical
symptoms
•Skin rash
•Poor
appetite
•Frequent
infections
•Nail white
spots
Children With Autism: Effect of Iron Supplementation on
Sleep and Ferritin. J.Pediatr Neurol.2006.11.004. Cara F.
Dosman MD,
• 33 children with autism in study.
• 77% had restless sleep at baseline, which
improved significantly with iron therapy,
• 69% of preschoolers and 35% of school-aged
children had insufficient dietary iron intake.
• Mean ferritin increased significantly (16 μg/L to
29 μg/L), as did mean corpuscular volume and
hemoglobin, suggesting that low ferritin in this
patient group resulted from insufficient iron
intake.
Need for calcium and/or vitamin
D supplementation in autism
• Because of milk and dairy restriction many
children with autism or ADHD may be
calcium deficient and may also be vitamin
D deficient due to lack of milk and or not
enough sun exposure
• Most children after 2 years of age need
1000 mg per calcium
Need for calcium and/or vitamin
D supplementation in autism
• Need for calcium in autism is critically
needed for strong bones and teeth
• Special need in autism due to eye
poking behavior associated with calcium
deficiency, milk-free diet
• Over 20 children with autism have
poked out own eyes.
Cannell JJ. Autism and vitamin D. Med Hypotheses
2008;70:750-759.
• Children with rickets have hypotonia, decreased activity,
developmental motor delay, listlessness, failure to thrive,
and other autistic
• Children with the Williams syndrome , some of whom
have greatly elevated calcitriol levels for several months
in early infancy, have remarkable sociability,
overfriendliness, empathy, and willingness to initiate
social interaction, strikingly the opposite phenotype of
autism.
• A placebo controlled three-month study of 20 autistic
children found multivitamins with low doses of vitamin D
(150 units or 3.75 mcg) significantly improved sleep and
gastrointestinal problems
Recommended daily doses of essential
minerals; more needed in deficiency
Age
in yrs
Amount
of calcium
Amount of
magnesium
Amount of
zinc
1-4
800 mg
100 mg
2.5 mg
5-10
800-1000 mg
200 mg
5 mg
>10
800-1200 mg
350-450
15 mg
J Am Coll Nutr. 2002 Feb;21(1):14-21. Lithium:
occurrence, dietary intakes, nutritional essentiality.
Schrauzer GN.
• Low lithium intakes from water supplies were
associated with increased rates of suicides,
rape, homicides and the arrest rates for drug
use and other crimes.
• The available experimental evidence now
appears to be sufficient to accept lithium as
essential; a provisional RDA for a 70 kg adult
of 1,000 micrograms/day is suggested.
Toxic Metals and Essential Minerals in the Hair of
Children with Autism and their Mothers
J.B. Adams1; C.E. Holloway1; F. George2; D. Quig3
• The levels of 39 toxic metals and essential minerals in hair
samples were determined for children with autism spectrum
disorders and a subset of their mothers compared to
controls.
• Iodine levels were 45% lower in the children with autism
(p=0.005).
•
Lithium levels were 30% lower (p=0.04) in the younger
children with autism . The mothers of young children with
autism had especially low levels of lithium.
What if
water is
too
pure?
Hair elements test profile –autism-
Clinical usefulness of high
dose vitamin-B-6 in autism
• V. E. Bonisch, reported in 1968 that 12 of
16 autistic children had shown
considerable behavioral improvement on
high dosage levels (100 mg to 600 mg per
day) of vitamin B6.
• Three of Bonisch's patients spoke for the
first time after vitamin B6 was
administered in this open clinical trial.
Improvements in autism noted
with vitamin B-6 megadose
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Better eye contact
Less self-stimulatory behavior
More interest in the world around them
Fewer tantrums
More speech
Some children spoke for first time
Less aggressive behavior
Benefits of different
fats in autism and
ADHD
What are omega-3 and 6 fatty
acids
Vancassel S, et al Plasma fatty acid levels
in autistic children. Prostaglandins Leukot
Essent Fatty Acids 2001;65(1):1-7.
• Total omega-3 fatty acids 20% lower than
control group with mental retardation
• One omega-3 fatty acid (DHA) was 23% lower
than control group
• This deficiency has also been found in
schizophrenia,attention deficit, and Rett’s
syndrome
• 20% of dry weight of brain is polyunsaturated
fatty acids
JG Bell et al Prostaglandins Leukot Essent
Fatty Acids. 2004 Oct;71(4):201-4. Essential
fatty acids and phospholipase A2 in autistic
spectrum disorders.
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Benefits of omega-3 supplementation
Less aggression
Less hyperactivity
Improvements in sleep
Improvements in speech and
behavior
• Improved ability of the child to concentrate
High cholesterol in children is
associated with decreased mortality
Child
mortality
rate in
different
countries
57.5% of ASD
children
are below this
value (<160)
Serum cholesterol mg/dL
The Great Plains Laboratory cholesterol study
Of children with autistic spectrum disorder
9
Number of patients in group
8
7
6
5
4
Low cholesterol 57.5%
Cholesterol in children with
Extremely
low
autistic
spectrum
disorder
cholesterol 17.5%
3
2
1
0
0-20 2140
4160
61- 81- 101- 121- 141- 161- 181- 201- 221- 241- 261- 281- 301- 321- 34180 100 120 140 160 180 200 220 240 260 280 300 320 340 360
Range of Cholesterol Results-mg/dL
Other new reports of cholesterol
supplements in autism-Case 1
• Neurologist:
• Marked reduction in anxiety in 17 year old
girl with autism.
• In addition, the girl had normal menstrual
periods for the first time.
Other new reports of cholesterol
supplements in autism-Case 2
• A woman called to say that her son is
significantly less aggressive when on just
one capsule (250 mg) of Cholesterol.
• He stopped head banging and being
aggressive toward others. In addition,
after a couple of months on the product,
her son started to spell for the first time.
• She stopped it for one week and his
aggressiveness came back so she is a
believer.
Other new reports of cholesterol
supplements in autism-Case 3
• I wanted to let you know that my son’s cholesterol went
up 20 points to 131 after taking cholesterol supplements
for a month. He is improving wonderfully. However, the
proof is in way more than the numbers. Babbling is back
and he is watching my lips when I talk to him. He
understands and follows verbal commands. He learned
to give himself a drink from a cup (I used to give him a
bottle) during the first month on sonic, two weeks ago he
learned to climb stairs and yesterday he fed himself with
a spoon. Best of all, he is happy now! He smiles and
laughs -- with people!!! At 12 months of age my son
would be best described as catatonic, rather than autistic
-- he was extremely severe.
Other new reports of cholesterol
supplements in autism-Case 4
• My son's cholesterol number came back at
106, the lowest our DAN's office had seen.
We have been on cholesterol
supplementation for 2 days and my son
has been making great eye contact and
been very interested in connecting with
me. I haven't done anything else new in a
while so I am pretty excited that this might
be doing something.
Other new reports of cholesterol
supplements in autism-Case 5
• “Cholesterol supplementation raised my son's
cholesterol level from 117 to 159.
• We have to give him 5 capsules/day to maintain
that cholesterol level but we had a dramatic
decrease in his aggression at school overnight
when we started it.
• His teachers and therapists all asked us what we
were doing.
• He is allergic to eggs, but we couldn't have given
him enough eggs to make a difference anyway.
It was a amazing for us.”
Dosing of eggs or cholesterol
• Determine total cholesterol
• If 160 or more,the patient doesn’t need more
cholesterol
• Subtract patient’s cholesterol from 160 mg/dL,
then divide by 10 to determine daily dose of
cholesterol in 250 mg capsules or eggs
• If patient’s cholesterol is 100,160-100=60
• 60/10=6=number of eggs or 250 mg cholesterol
capsules per day
• One average egg=250 mg cholesterol
Abnormal
Gastrointestinal
Flora in autism
Candida Overgrowth of
Esophagus
Normal Intestine
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**
After Antibiotics
Stool Yeast and Urine Organic Acids in
Child With IgA Deficiency and Autism
before therapy
arabinose in
urine*
*mmol/mol
creatinine
341
after therapy with
antifungals
51
normal range
0-115
Candida
parapsilosis
stool
4+
none
detected
0-1+
Symptoms Improved by Antifungal
• Increased focus and concentration
• Improved receptive and expressive language
• Reduced bowel symptoms
• Increased eye contact and socialization
• Reduced self-stimulatory behavior
• Reduced aggressive and self-abusive
•
•
behaviors
Reduced Candida symptoms such as thrush
Reduced skin rashes
Prescription Antifungals
• Nystatin-Mycostatin-very little toxicity
• Amphotericin B
• Fluconazole-Diflucan
• Itraconazole-Sporanox
• Ketoconazole-Nizoral
• Terbinafine-Lamisil
Over the Counter Antifungals
• Caprylic Acid,
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caprylates
MCT oil
Coconut oil
Garlic
Oregano
• Aloe vera (oral)
• Goldenseal
• Pau d’arco
• Grapefruit seed
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•
extract
Tanalbit
Candex (cellulase
enzymes)
Candida defense formula
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Biotin
Zinc undecylenate
Oregano leaf extract
Pau d’arco
Sodium caprylate
Berberine
Cinammon bark extract
Ginger root
Grapefruit seed extract
Side Effects Associated with the
Yeast “die-off” Reaction
• Lethargy(tiredness)
• Fever
• Increased stereotypical behavior
• Increased hyperactivity
• Nausea,vomiting
• Alka-Seltzer Gold neutralizes some of the
toxic acids produced
Clostridia
Bacteria
and Autism
Endoscopy of Colon of Patient with Mild
Clostridium Difficile Overgrowth
Endoscopy of Colon of Patient with
Severe Clostridium Difficile Overgrowthpseudomembranous Colitis
J Child Neurol 2000 Jul;15(7):429-35
Short-term Benefit from Oral Vancomycin
Treatment of Regressive-onset Autism
Sandler RH, Finegold SM, Bolte ER, Buchanan CP, Maxwell
AP, Vaisanen ML, Nelson,MN, Wexler HM
11 children with regressive-onset autism were
recruited for an intervention trial using vancomycin.
• A clinical psychologist blinded to treatment
status..noted improvement in 8 of 10 children
studied.
• “…these results indicate that a possible gut florabrain connection warrants further investigation”
Properties of Clostridia Bacteria
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•
Strict anaerobe-dies when exposed to oxygen
Causes tetanus,diarrhea, and botulism (food
poisoning)
Forms spores that are highly resistant to heat
and antibiotics
About 100 species of Clostridia in GI tract
Controlled by vancomycin, metronidazole,
and Lactobacillus acidophilus GG
2000.00
HPHPA
(MMOL/MOL CREATININE)
1800.00
1600.00
1400.00
1200.00
1000.00
800.00
Male
control
infants
Control
Males
2-13 yr
Autistic
males
2-13 yr
N = 211
600.00
N = 30
400.00
200.00
N = 14
0.00
CONTROL
MALE
INFANTS
CONTROL
MALE
CHILDREN
2 - 13 YRS
AUTISTIC
MALES
2 - 13 YRS
Structure of 3-(3-hydroxyphenyl)3-hydroxypropionic acid
CHOHCH2COOH
HO
phenylalanine
phenylalanine
hydroxylase
CH2CHCOOH
CH2CH2COOH
NH2
HO
microbial
microbial
CH2CHCOOH
NH2
CH2CH2COOH
NH2
HO
phenylpropionic
acid
microbial
NH2
CH2CHCOOH
tyrosinetyrosine
hydroxylase
NH2
microbial
m- tyrosine
HO
3-hydroxyphenylpropionic acid
human beta-oxidation
HO
CH2CHCOOH
NH2
tyrosine hydroxylase
HO
CHOHCH2COOH
HO
3,4-dihydroxyphenylalanine
DOPA)
dopamine
norepinephrine
HO
CH2CHCOOH
HO
NH2
3-(3-hydroxyphenyl)
-3-hydroxypropionic
acid HPHPA
DOPA analog
human beta
oxidation enzymes
dopamine analog
COOH
norepinephrine analog
HO
glycine
3-hydroxybenzoylglycine
3-hydroxybenzoic(3-hydroxyhippuric)
acid
Effect of anti-Clostridia therapy on urine
excretion of HPHPA* in woman with
depression and chronic fatigue
Before treatment
After treatment
patient
1444
normals
0-150
13
0-150
Effect of anti-Clostridia therapy on urine
excretion of HPHPA* in young woman
with acute psychosis
During acute
psychosis
After treatment
( depressed)
patient
7489
673
normals
0-150
0-150
*mmol/mol creatinine (patents pending)
Treatments for Clostridia
Bacteria
• Vancomycin
• Flagyl (metronidazole)
• Lactobacillus acidophilus GG
• (Only probiotic patented for use in
•
control of Clostridia)
Saccharoyces boulardii-occasionally
causes hypoglycemia-cannot be used
with antifungal agents
Bacteriologist Elie Metchnikoff in his
laboratory
"Etudes sur la
flore intestinale.
1er mémoire :
Putréfaction
intestinale "
Ann. Inst.
Pasteur Paris,
22, pp. 929-955.
William Shaw Ph.D, in his laboratory
Field trip to the Amazon rainforest
Pyrethrins-common insecticide
Pet shampoo: Contain pyrethrins
and piperonyl butoxide, inhibitor of
cytochrome P-450
I. Hertz-Picciotto, et al Public Health Sciences
and the M.I.N.D. Institute, University of
California at Davis, International Meeting for
Autism Research (IMFAR) Household
Pesticide Use in Relation to Autism, May 2008
• Mothers exposed to pet shampoos (almost
all pyrethrins) were twice as likely to have
a child with autism.
• The worst exposure time was the second
trimester.
Pesticide Application
E. Guillette et al, "An Anthropological Approach to the
Evaluation of Preschool Children Exposed to Pesticides in
Mexico," ENVIRONMENTAL HEALTH PERSPECTIVES
106: 347-353,1998.
The pesticide-exposed children
● Far less physical endurance in a test to see how long they
could keep jumping up and down
● Inferior hand-eye coordination
● Could not draw a simple stick figure of a human being,
which the nonexposed children could readily do.
E. Guillette et al, "An Anthropological Approach to the
Evaluation of Preschool Children Exposed to Pesticides in
Mexico," ENVIRONMENTAL HEALTH PERSPECTIVES
106:347-353,1998.
"Some valley (pesticide-exposed) children
were observed hitting their siblings when they
passed by, and they became easily upset or
angry with a minor corrective comment by a
parent. These aggressive behaviors were not
noted in the [pesticide-free] foothills
[children]."
Eric M. Roberts, et al Maternal Residence Near
Agricultural Pesticide Applications and Autism
Spectrum Disorders among Children in the
California Central Valley Environ Health Perspect.
115(10): 1482–1489, 2007
• Children exposed to pesticides called
organophosphates used to kill insects had more
than twice the risk of developing pervasive
developmental disorder (PDD).
• For organochlorines,there was 7X autism rate
• Mothers exposed to such pesticides were also
likely to have shorter pregnancies and their
children to have impaired reflexes .
Reduced ability to detoxify pesticides in
autism. Life Sciences 78 (2006) 2244-2248
PON1
Enzyme
activity
Autism
Controls
Autism rates in Texas
1990-1993
1998-2001
Comparison of autism rates and industrial
pollution in Texas
Autism rate1998-2001
Pounds of industrial
toxic release
Victim of mercury toxicity
Hair mercury values in Minamata
bay victims
• Values of hair mercury were all elevated.
Most of those who died were extremely
elevated(500-1000 ppm)
• 1787 people died
• Great Plains has tested some people in
this range who used a beauty cream with
mercury
Effect of mercury dose on
autism incidence in the USA
Environmental mercury release, special education rates,
and autism disorder: an ecological study of Texas
Raymond F. Palmer, et al
• There has been a significant increase in the
proportion of children in special education and
autism associated with mercury released into
the environment.
• For every 1000 lb of mercury liberated into the
environment, there has been a 43% increase in
the rate of special education students and a
61% increase in the percentage of students
with autism.
Acceptable Childhood Blood Lead Levels
Blood Lead (ug/dl)
60
60
50
40
30
20
40
30
25
20
15
10
10
2
0
CDC CDC CDC CDC WHO EPA CDC CDC
1960 1973 1975 1985 1986 1986 1990 2006?
Agency and Year
Lead increases death from many
diseases
Hair metals in boys with autism
n=40 boys per group, age matched
Median
Autism
Mcg/g
hair
8
6
4
2
0
Uranium Mercury
Lead
Autism 9:290-298,2005
Median
Normal
Mcg/g
hair
Comprehensive Biochemical
Testing
• Organic acid test •
for genetic disease, •
toxics, and yeast
and bacterial
•
byproducts
• Yeast culture and •
sensitivity
• Cholesterol profile •
• Heavy metals
• Iron stores-ferritin •
•
Copper/zinc profile
Comprehensive
IgG food allergies
Comprehensive
inhalant allergies
Immune system
deficiencies
Amino acids and
fatty acids
Strep antibodies
Vitamin D
Nutritional Treatment
Autism/ADHD
William Shaw PhD
The Plaza,
Kansas City, MO
Thank You!
The Plaza, Kansas City