INTERVENTIONS/THERAPIES: MEDICAL AND BIOMEDICAL
There are many medical and biomedical approaches in treating autism spectrum disorders. We will identify different methods used to treat individuals with ASD. THE CONTENT IS NOT INTENDED IN ANY WAY TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH PROVIDER WITH ANY QUESTIONS YOU MAY HAVE REGARDING A MEDICAL CONDITION.
USAAA does not recommend any one particular intervention or therapy. Most therapies are applicable through adulthood and not limited to young children. While early intervention is highly recommended, many adults (both young and older) have improved from many of the interventions listed in this section.
By recognizing the highly individual and diverse nature of treatment and services, USAAA offers information and education that reflects a variety of views and practices regarding these interventions and resources to allow maximum choice and benefit for the ASD community.
One of the most important decisions in treatment is choosing a physician. Selecting a physician can be very difficult. This topic is discussed in the Parent/Practitioner Program: Monitoring and charting your child's development or your own if your are an adult with ASD; How to choose a physician; Respecting your doctor and earning your doctor's respect; Ten steps to effective listening; Interviewing and negotiating with your health care practitioner.
Research has shown that many children and adults, with autism spectrum disorders, endure multiple medical problems. Coexisting medical problems such as anxiety and seizure disorders should be addressed with your health care provider. Physicians will refer to this topic as Comorbidity (the presence of one or more disorders or diseases in addition to ASD).
The Biomedical Concept
Biomedical approaches are based on scientific research that identify underlying causes which include metal toxicity, nutritional deficiencies, gastrointestinal problems and other issues. In other words, the physician treats the whole body. Dr. Phillip C. DeMio, MD, provides "An in Depth Look Into Dietary Interventions and Digestive and Gastrointestinal Problems" from a recent USAAA conference presentation.
Dr. DeMio explains the Biomedical concept: "As espoused by Dr. Bernard Rimland more than 40 years ago, persons with Autism Spectrum Disorders (ASD) have a bona fide medical disease, not a psychiatric disorder. ASDâ€™s do not result from bad parenting, nor do they â€śjust happen.â€ť Underlying medical abnormalities in metabolism, gastrointestinal/nutritional function, the detoxification system, and immunology all as a group lead to a severe lack of normal brain support with resultant abnormal behaviors that we know as ASDâ€™s. Just as the person with a head injury from a car accident acts abnormally and has deficits in language, so it is that ASDâ€™s, too, have a biological medical basis as to why they occur."
"The vast majority of persons on the Autism Spectrum (ASD) who make significant gains from biomedical treatments will require care that addresses the triad of dietary intervention, digestive/gastrointestinal problems, and detoxification techniques. Practical implementation of treatment programs will be given, including such diets as gluten-free/casein-free, specific carbohydrate, low oxalate, pigment restriction (e.g., phenols and salicylates), and others. Particular situations in which one diet would be chosen over another will be highlighted. Pitfalls must be avoided in order to foster greater ease of implementation, success (symptom control), and reduction in the complications that can occur with each diet. Digestive and gastrointestinal (GI) topics will touch upon overgrowth of yeast and other dysbioses (abnormal GI germs), leaky gut, abdominal pain, chewing problems, swallowing difficulties, acid reflux, diarrhea, constipation, malabsorption of nutritional substances, and how these all connect to symptoms in our children and adults with spectrum disorders."
Dr. DeMio's presentation "Beneficial Interventions and Critical Health Challenges in ASD"can be downloaded from the USAAA conferences at USAAA TV.
"The gluten-free casein-free diet is a mainstay for many ASD patients, and is often the first diet attempted on the journey to help your family member or patient. The major theory is that of false endorphins (based on poor digestion and intestinal barrier dysfunction [so-called leaky gut]), with the potential of sweeping benefits from immunologic to cognitive, and back full circle to the GI tract. This is the theory that best explains the clinical and lab response, though allergy and excitotoxicity probably play a role. Thus gluten foods, namely anything derived from wheat, barley, oats, or rye, (i.e., many staples) is excluded from the diet, as is anything from a dairy source (milk, butter, yogurt, ice cream, etc.). A withdrawl can occur, so the diet is usually implemented no faster than over a 3 week period. Benefits are expected in a few weeks but may continue to manifest over some months. Yeast control must simultaneously be done to improve success of the program.
Carbohydrate-restrictive diets can be from a gamut that excludes all carbs (starch and sugar) in an effort to circumvent difficulties in digestion that lead to residual food particles that feed yeast, some bacteria, and other disease-producing germs. The specific carbohydrate diet, invented and practiced beginning about sixty years ago by Dr. S. V. Haas, and more recently espoused by the late Elaine Gottschall, restricts carbs that are hardest to digest, so that most tree fruits, nuts (sometimes blanched), and most legumes and nonstarchy garden vegetables are allowed. Probiotics are controversial here, as is dairy, so that subgroups of the diet are accepted by some practitioners and support groups, while others shun them and have their own variants revolving around these differentials. Complications can include bacterial (â€śputrefactiveâ€ť) shift, often some months into the diet.
Oxalates are largely found in plant foods. These are substances that can sequester minerals, both toxic, e.g. mercury, and essential, e.g. zinc, i.e., the body can neither properly detoxify heavy metals nor utilize nutritive minerals because the oxalates â€śfreezeâ€ť them in the body. High oxalate foods are often those that we give our kids when implementing some of the other diets discussed here, so that the oxalate issue may emerge in the midst of a treatment program. Unlike some diets, this is not so often an â€śall-or-noneâ€ť diet, as steady improvement frequently occurs with further and further reduction in dietary oxalates. Also, the GI tract can be used as a blocker and demolition area to further help with the problem of oxalates, eg with divalent cation trickles and certain probiotics.
Pigments in foods can cause symptoms in our patients. A major group is that of phenols and salicylates, which includes a varied group of highly colored and sometimes colorless but spicy flavors in foods. These are in both synthetic groups (which are often the worst at producing symptoms) and in natural forms, eg red, purple, and some green fruits. These can all tax the sulfation system, which is often lacking in our ASD patients. Some of these substances also foster imbalances of toxic and essential metals in the body. Natural foods that are chopped and cooked can reduce the load, as can some enzymes. Other pigment-related diets include Sarahâ€™s diet, which avoids carotenes, eg orange, yellow, red, purple, and sometimes green pigments, mostly in vegetables. Again, as we move away from one food on a special diet, we may increase carotenes. They are also in many supplements that are commonly given to our kids, so these may need modification.
Enzymes: these can, in a small number of patients, substitute for some of the above diets. More often, though, when enzymes help, they do so in conjunction with a completely implemented diet. Enzymes, too, can have undesired (â€śsideâ€ť) effects, eg regression by release of toxic peptides, diarrhea, and constipation. Therefore enzymes, like any other treatment can play an important role in a whole program and may help many persons while not being as helpful to others.
Digestion and gastrointestinal issues: From chewing difficulties to swallowing abnormalities to reflux to constipation to diarrhea (often after vaccines in the first day of life), the GI tract is often where parents first notice problems in children even â€śbeforeâ€ť their ASD cognitive issues are apparent. Yeast is a pathologic (symptom-causing) microbe in the GI tracts of our kids, and is present in the overwhelming majority of cases. Many patients have bacteria that can add to the symptoms, or will later emerge. Due to the above or other problems, many ASD patients suffer from frequent abdomen pain, which can for them (as with anyone) make their lives miserable, and, more specifically, lead to interruption in the benefits of school, play, and therapies. â€śLeaky gutâ€ť can allow entrance of toxic byproducts and metals excessively into the body, leading to cognitive changes. Inability to completely uptake nutrition from the diet can ensue when the GI tract is a battleground, leading to deficiencies in the face of an otherwise healthy diet.
Other biomedical interventions include Hyperbaric Oxygen Therapy, Methyl B12, anti-viral and anti-fungal treatment, Magnesium and B6, and others that are discussed in Dr. DeMio's and Dr. Kartzinel's presentations.
To understand the dynamic category of nutritional supplements, the Physiciansâ€™ Desk Reference (PDR) for Nutritional Supplements creates an invaluable reference for consumers and health care professionals. You will discover which benefits are clinically verified and which remain speculative. The PDR includes potential side effects and interactions to the very real dangers of toxicity and overdose of these products.
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