Dr. Paul Hardy talk EFAs

Dr. Paul Hardy
Behavioral neurologist in Massachusetts

drhardy@hardyhealthcare.com


[These notes were passed out and are not in the conference book]
[first preliminary talk]
On the Road to Damascus:
Thou shall question thy pediatrician
He works with:
Co-factors for neurotransmitters
Glycine
Says he does not like the term "alternative medicine"
Maybe Complementary medicine,
Or Functional medicine,
Or Hippocratic medicine
But what is alternative medicine ? There is no "alternative biochemistry", there is only one field of biochemistry. You study it the same way and it works the same way no matter what you want to use it for. So he prefers other terms.

Ppars substances that come from the omega 3 fatty acids and .[sorry lost here]Ppars get altered depending on how much exercise and carbos the body gets. And the cells become more sensitive to insulin levels and glucose and this can reduce obesity. [sorry, I don't have any idea what this relates to]

Slide 1: EFAs in Autism [the main talk]

- 1997 DAN in San Diego
Dr. B.J. Stordy from England spike about ADD and ADHD > Efalex
- 1999 DAN in Cherry Hill
Dr. L. J. Stevens on ADD and ADHD
- 2000 DAN think Tank Meeting
Dr. J. Gordon Bell presented data on one child
Notes: There is lots of anecdotal evidence of EFA helping apraxis/dyspraxia and autism.

2. Bipolar Disorder in Childhood (?DPP-NOS)
- Hypothesis: A subset of the ASD consists of children with early onset and severe Childhood Bipolar Disorder (Manic-Depressive Disease)?
-- G. Robert Delong, MD MGH & Duke
--Ira Lott, MD & P.M. Hardy, MD EKS Center
-Joseph Biederman, MD et all at MGH
--High co-morbidity with ADD/ADHD

Notes: Many symptoms disappear within several months of starting essential fatty acids there is a yahoo group for this - Bipolar Disorder in childhood.

3. Slide showing cover of book The Bipolar Child
Notes: Hypothesis there is a subset of individuals on the autistic spectrum which may consist of children with early onset and severe Childhood Bipolar Disorder (manic-depressive disease).  Your diagnosis in some areas will vary depending on where you live/by regional preferences. A doctor in NY may say PDD, one in the Midwest may say bipolar.

4. Bipolar Disorder in Childhood
- Rapid cycling mood swings "the Jekyll and Hyde Syndrome:
- Sleep disorder
- Positive family history
- Rages and explosive temper tantrums
- Marked irritability
- Oppositional behavior
- Distractibility
- Hyperactivity
- Impulsivity
- Restlessness/fidgetiness
- Silliness, giddiness, goofiness
- Racing thoughts
- Aggressive behavior
- Self-injurious behavior
- Carbohydrate craving, binging
- Risk-taking behaviors
- Tics, OCD
- Hyper sexuality

Notes: These are the symptoms used to diagnose bipolar disorder in childhood especially the top three:
Rapid cycling mood swings the Jekyll and Hyde syndrome
Sleep disorder hard to get to sleep, inconsolable
Positive family history this is often hard to dig up because people are reluctant to blurt it out to strangers often takes digging deep into the family tree
Also, the giddiness silliness, laughing hyena there is rapid cycling of moods
Traditional bipolar is difficult to treat with conventional medicine.

5. What are Essential Fatty Acids (EFAs)?
-"Essential" because the body cannot make them and they must come from our diet.
- Importance and biochemistry Dr. Andrew Stoll

Notes: Highly recommended Andrew Stoll's book The Omega 3 Connection "Essential" because the body cannot make them and they must come from our diet. Fats that Heal, Fats that Kill is another book.

6. Why are Omega-3 EFAs Important?
- Essential because they are needed for:
--Normal brain development
---Membranes and cell integrity
---Neuroltransmitters, "Second messengers"
-- a healthy immune system
-- a healthy cardiovascular system
-- a healthy gastrointestinal tract

7. Role in Normal Brian Function
60% of solid brain weight is from lipid
- phospholipid
- sphingolipid
- ganglioside
- cholesterol

8. Role in Normal Brain Function Brain phospholipids:
- Stabilize neuronal membranes
- Regulate ion exchange
- Incorporate membrane proteins
- Regulate membrane receptors and second messengers

9. Omega-3 EFA & Receptor Functions
- Deficient n-3 leads to decreased DHA in frontal cortex and striatum
- DHA replaced with DPA (n-6 form)
- Accompanied by 55% decrease in dopamine
- 13% decrease in dopamine D2 receptor binding (Delion)

**Farquharson, Lancet, 1992

10. EFA and Receptor Function High sunflower oil diet (n-6)
- increased norepinephrine release
- increased alpha0adrenergic sensitivity
- beta-adrenergic binding
- coupling to adenylate cyclase

**Semafuco, J Cardiovasc Pharm, 1989

11. Human Evolution and EFAs
- Homo sapiens evolved out of the Africa's Rift Valley,
- "Paleolithic/Aboriginal Diet" is perhaps the "gold standard" diet.
- Wild foods contain a better ratio of EFAs: corn fed animals or farm raised fish are poor sources of Omega 3's.
- Brain development, size, and intelligence directly related to EFAs primarily Omega-3
Notes: In Andy's book, human evolution and EFAs, the Paleolighic/aboriginal diet is perhaps the gold standard diet. Wild foods contain a better ratio of EFAs corn feed animals or farm raised fish are poor sources. So know the true source of your meat, whether it is wild feed or a commercial feed.

12. Twentieth Century Knowledge and Supplementation
- For generations mothers gave their children cod liver oil until the era of "modern pediatrics" in the 1960s
- why this practice stopped is not clear

13. GI Problems in Autism Significant
- In the last 100 years, the brain size has decreased 10%. Up to 40% of ASD children have clinically significant GI dysfunction.
-Maldigestion protein, fat, and carbohydrate not properly broken down so that it can be absorbed across the gut wall.
-Malabsorption Intestinal wall not functioning properly.
--Leaky gut things get into the blood stream which should not (peptides)
--Important nutrients never get in and are excreted in the stool.

14. Diets of Children with ASD Often extremely limited
-Cravings for dairy, wheat, sugar
- Chicken McNuggets: 11 gms total fat, 3 gms saturated
- French fries: "medium" 22 gms Total fat, 4 gms saturated
- Peanut butter & jelly
- Other junk foods
- Severe Lack of Omega-3 EFAs in the Diet!!!

15. Multiple Nutritional Deficiencies May Make It Difficult to Metabolize and Utilize EFAs
[Here are a list of the important vitamins and minerals that are needed for the metabolism of EFAs]
Vitamins: B3 (niacin, B5 (panothenic acid), B6, Folic Acid, A, C, E
Minerals: Zn, Mg, Calcium, Iron, Selenium

16. Clinical Symptoms and Signs of EFA Deficiency
- dry, flaky, and/or scaly skin
- dandruff
- dry, lifeless, straw-like or unmanageable hair
- small, hard, white bumps on outer arms, elbows, thighs or buttocks
- easily broken fingernails,
- excessive thirst
- frequent urination
- bedwetting
- hyperactivity
- frequent or excessive temper tantrums
- asthma, hay fever, eczema, hives
- frequent stuffy, runny, and/or itchy nose

17-21. Showed a serious of slides showing what malnutrition can look like.  Protruding diaphragm on child protruding above the navel need EFAs
Emaciated adult 
Osteoporosis rashy blister bumps around a child's mouth, at the corners mainly -
Sores on mouth chelosis severe nutritional deficiencies
Notes: Far more nutritional studies in the areas of animal science/veterinary medicine than in people.

22. Amino Acid Deficiencies
slide showing what an amino acid deficiency test might look like.
Notes: He said he required labs test for families whenever it was financially possible, when they had insurance, because this information was helpful for the doctors records.

23. EFA Deficiencies
another slide showing test results, but too small to actually read.
Notes: Time and time again there was a marked deficiency in the ALA, EPA DPA, DHA - Omega 3 acids.

24-28. Talked about some cases from a Study of EFA Deficiency in Autism with 50 children who fill the DSM-IV criteria for PDD. There were 41 males, 9 females, and about the age of 9.  One child have a bedwetting problem and within 3 weeks of EFA and B-complex/mag a 12 year old chronic wetter stopped. Since the Atlanta meeting, the child decided he didn't want to take supplements anymore. He deteriorated noticeably even becoming psychotic and so returned to supplements.

Another case: person improved very dramatically with high EFA doses (CLO) even though metal toxic. Basically, Omega 3 therapy can be started and effective at any age.

29. Limitations of this Pilot Study
- retrospective review
- no control group
- GSL references ranges may be problematic
- Outcomes thus far is only anecdotal
- ?Role of pre-treatment with Vitamins and minerals

30. Implications of this Pilot Study
1. This is an area of research that demands attention and funding.
2. There appears to be a marked deficiency in Omega-3 EFAs in ASD.
- consistent with several other observations
3. Suggests a pathophysiology in neuronal function.
4. Suggests a pathophysiology in immune function.

31. Implications of this Pilot Study
1. Early recognition and treatment is extremely important
2. Treatment at any age can be helpful it is never too late for some benefit.
3. Implications for Pregnancy need to be seriously considered.

32. ?Pregnancy!
- Baby formulas in this country do not contain any EFA!!
-Similac, ProSobee, SMA, Carnation Good Start
- Breast milk composition is dependent on mother's dietary intake
[3 references]

33. 25 year old medical nursing student with a 23 year old brother with autism [I don't remember what this slide was about at all]

34. Testing for EFA Deficiency
What tests?
- Redblood cell membranes
-- one tube of anti-coagulated blood
-- Representative of most cells in the body.

35. Testing for EFA Deficiency
Is this necessary?
- No. clinical symptoms and signs can be enough.
--basically assume that 90% of children with ASD are deficient.
--Can't hurt "nutritional insurance" benefit far outweighs the risk of harm
- Preferable to guide treatment
--may help with the choice of supplements and maximize outcome
--may reduce the chance offside effects ?hyperactivity/mania?

Notes: There is a role for testing at times. He feels more and more that this is less necessary.

36. Testing for EFA Deficiency lists several labs

37. Pretreatment to maximize benefit and reduce side effects
- pretreatment with key vitamins & minerals
- pretreatment of yeast overgrowth?
--yeast love/food on EFAs > sugars
--Yarrolvia lipolytica especially

38. Treatment
Safety Concerns
- minimal really quite safe
-cold liver oil you are limited by vitamin A toxicity
Side Effects
- diarrhea, "repeating," body odor, hyperactivity!!!
- less than 10% in my experience
- probably not more than placebo
Duration of Treatment
- months to years

39. Treatment
Natural EFA oils readily available
Concentrated fish oil
Col liver oil
Flax seen oil
Borage oil
Evening primrose oil
Concentrations of Omeg-3s confusing variables: grams and mgs, not pills, capsules, gel caps, teaspoon, tablespoons

40. Other Sources of Supplementation
The Omega eggs that you buy in the grocery store. The chickens are fed a special feed.
- six times more vitamin E than an "ordinary egg" 6 vs. 1 IU
- eight times more DHA: 150 mg vs. 18 mg

41. OmegaBrite
- highest concentration of EPA available
- nitrogen encapsulation
- 7 to 1 ratio of EPA to DHA
- 3 capsules/day = EPA 1125 mgs and DHA 165 mgs

42. Other Sources of Supplementation
Commercially blended products
- Efalex for ADD/ADHD 2 capsules/day
---evening primrose oil 200 mgs
---DHA 120 mgs
---AA- 10.5 mgs
---Thyme oil 2 mgs
-Nordic Naturals

43. Dosing in Pregnancy
- Up to 3.5 grams per day of EPA in research studies have been safely given
- Eskimo women traditionally consume up to 400 grams of seal and fish per day = 14 grams of EPA and DHA per day
- DHA and AA more important in the developing brain

44. Follow-up Evaluation [these are the things they are looking at]
- clinical observation
- laboratory testing
- vitamin A levels
- behavioral outcome evaluation

45. "It's supposed to be a secret, but I'll tell you anyway. We
doctors do nothing. We only help and encourage the doctor within."
-Albert Schweitzer, MD

Negative Behavior and Supplements
This is general commentary I derived from the talks. People on the enzyme board have mentioned hyperactivity sometimes when they start enzymes. This is also characteristic of beginning the GFCF diet. Several presenters mentioned this when starting any of several supplements. Glutamine was mentioned as being quite good for gut healing. However, if you see the hyper/negative behavior, then stop immediately. Go back to focusing on general nutrition and more gut healing first with a nutritious diet, probiotics and maybe enzymes. Then later resume the glutamine.

Dr. Walsh said the same when trying to add zinc to balance the excessive copper (Amber mentioned this earlier). If a person reacts badly to the zinc, back off on the dose and go slower. This indicates the copper is being dumped into the body too quickly and the body cannot detox fast enough.

We see the same with Epsom salts. Sometimes the child will react badly to a Epsom salt bath, so lower the amount of salts and continue and the child will improve.

Dr. Baker said it also happens commonly with yeast treatments. The child may become hysterical while "on" the treatment but this is the yeast die-off/toxin reactions. He said one client went through three rounds of outlandish bad behavior. They also saw this accompanied by improvements so they continued. Eventually the yeast was in balance and the child showed remarkable improvement.

Dr. Holmes said the same with chelation. Look for negative behavior with the "on" cycles. If the negative behavior continues through to the "off" cycles, then you have a bug problem and need to stop chelation and deal with that first. If is it just during the "on cycles, it indicates detox of metals.

So this seems to be a very common part of the healing process. I just wanted to throw this out because it is always worrisome to see someone going through a bad time. It seems to be a tricky issue when starting a therapy of evaluating if it is a true intolerance and should be stopped, or withdrawal/die-off/detox and should be continued? The general consensus seems to be 1)back off and go slower if possible, or 2) let the bad stuff run a few days and see if the negative behavior improves after time. After a few days, stop and re-evaluate.

This is consistent with what we have seen with the strong protease products. If negative reactions occur, either stop or reduce the dosing on the proteases and build up slowly. The general all-purpose enzyme products don't seem to produce these effects. Here is an excerpt on such reactions by Jon Pangborn from the SerenAid enzyme study.

"This brings up the question of what happens when digestion starts to work better, malabsorption decreases, and the food supply to the gut flora is normalized. Quite simply, some of the alien residents die off. Unfortunately, die-off releases toxins and allergenic substances that can provoke allergic like symptoms. This is like detoxification. With better digestion of food, the body can clear itself, and there is a period of time, sometimes lasting a few weeks, during which bowel irregularity or allergic like symptoms may occur. These were observed for some of the 55 children tested in the preliminary trails of the enzyme that were supervised at five medical practices. These presentations included more frequent bowel movements, increased irritability, increased / decreased appetite, hyperactivity and more compulsive behaviors. Usually these presentations ceased before the third week of testing."

Submitted by Karen from the autismandenzymes  Yahoo Group.

4: November 26, 2001