Woody McGinnis talk - physical
Poor B6-binding, with low or low-normal intracellular magnesium
Low intracellular zinc
Low serum Vitamin A
Low biotic, B1, B3 and B5 function on microbiological assay
Low urinary vitamin C
Low RBCm membrane EPA (derivative omega-3)
Low RBC membrane GLA and DGLA (derivative omega-6)
Elevated RBC membrane archidonic acid (inflammatory)
Elevated casomorfine and gliadomorfine
Elevated urinary yeast metabolites
Elevated IgG to milk
Many autistic children demonstrate:
Low serum selenium (50%0)
Low folate and B12 on microbiological assay
Elevated RBC membrane trans fatty acids
IgG to grains
Elevated urinary bacterial metabolites (50%)
Overly acidic stool
Waring reports low blood sulfate and high urinary sulfate loss (and proteinuria) in most autistic children. For a review of the published studies on the nutritional status of autistic and ADHD children refer to the website.
Current Successful Gut-related Interventions
1. Gluten/Casein-free diets: Key peptidase is produced by the intestinal membrane.
2. Anti-viral agents and IV gamma globulin: May affect chronic intestinal infection.
3. Digestive Enzymes: Multiple choices, including special peptidase and prescription microencapsulated forms.
4. Floral Remediation: antifungal, antibacterial and regular probiotic are mainstay treatment.
5. Secretin: Produced by the small intestine, stimulates digestive enzymes, trophic and stimulates blood flow to the intestine, triggers digestive juices from the pancreas, increases immune levels in bile.
6. Cod liver oil: vitamin A supports gastrointestinal membranes and mucin production. EPA in cod liver oil is anti-inflammatory.
7. Bethanecol: Stimulates all-important acid production by the stomach, tightens gastroesophageal sphincter to stop reflux espohagitis, stimulates digestive enzymes, trophy to pancreas, stomach, small and large bowel mucosa, stimulates definsins release by paneth cells for local immunity, promotes ordered peristalsis.
8. DMSA and Lipoic Acid: Remove heavy metals, which have particularly high affinity for intestine. Mercuric cation at nanomolar concentrations completely inhibits activation of B6 in the intestinal mucosa. Floral alterations may affect heavy metal recirculation and heavy metal levels in the lumen may affect floral composition.
9. Zinc: Last line of defense in protection of cell membrane sulfhydryls from oxidation; inhibits bacterial lipase; lessens intestinal permeability; increases intestinal PGE1 for immune function. Necessary for stomach acid production and vitamin A metabolism.
Strategy: Assure Generous Levels of the Key Nutrients
1. Vitamin B6: Pyridoxal-5-phosphate is activated form.
2. Magnesium: glycinate form most absorbable.
3. Zinc: Picolinate form most absorbable. Dose away from minerals and food which block absorption. Balance with manganese. Warts, stretch marks, flecks subside.
4. Calcium: Assure RDA of about one gram daily plus some require extra.
5. Selenium: Doses up to 200 mcg daily as anti-oxidant and to bind mercury.
6. Vitamin A: Cod liver oil for all behavioral children unless allergic to cod.
7. Vitamin C: Twice-daily dosing rationale; also helps regularize bowel movement.
8. Vitamin E: Important chain-breaking anti-oxidant.
9. Fish Oil: Quiet inflammation with EPA. High EPA/DHA preparations available.
10. Evening Primrose Oil: Good for the gut, growth and immunity.
Particularly Important for Immunity: Zn, Vitamin A, GLA
Management of Nutrition and Gut
History and physical: Dry skin, hair, allergies, thirst, frequent infections and dyspraxia suggest fatty acids; nail flecks and lighter hair for low zinc; indirect gaze for vitamin A; rashes and carbohydrate cravings for fungal overgrowths: abnormal stool consistency and frequency; response to food challenges
Laboratory: Select sensitive lab measurement for nutritional assessment, such as RBC (intracellular) mineral levels, RBC-membrane fatty acids, functional vitamin assay; for key nutrients, treat low-normal lab ranges and do follow-up studies to verify correction. Newer testing modalities such as IgG food allergy blood testing and urinary organic acids are useful.
1. Routine chemistry profile, thyroid, complete blood count and urinalysis
2. Stool studies: culture and sensitivity, parasitology, steatocrit
3. Urinary organic acids
4. Urinary pyrroles: Elevation in twenty-five percent implies primary Zn and B6 need. Off Zn and B6 prior to collection
5. Urinary peptides: Or, empiric trial gluten/casein-free
6. IgG blood test for food allergies
7. RBC mineral levels
8. Sensitive vitamin assay
9. RBC membrane fatty acids
10. Amino acid levels: methionine, taurine, and glutamine very important
11. Heavy metals levels and MELISA for allergic reactivity to metals
1. Principle: If rationale exists for an intervention, continue it unless there is a reason to stop or change it. Nutrients, floral remediation, digestive enzymes and detoxification take time to work and they work together.
2. Combination formulations can be beneficial.
3. Tailored nutritional programs: Include B6 (P5P) and magnesium, zinc, calcium, vitamin C, vitamin E, selenium, cod liver oil and fatty acids. Add one nutrient at a time, sometimes trying lower doses. In the allergy-prone child, start with fish-oil, then balance with evening primrose oil.
4. Assure anti-oxidant coverage before administering oils: Zinc and biotin co-factors for conversion of GLA from EPO.
5. Effective levels of anti-oxidant nutrients
6. Reduce over-all oxidative stress, which is additive.: Avoid exposure to classical allergens such as pets and pollens as associated with hay fever and asthma.
7. Floral remediation: anti-parasitics, nystatin and other anti-fungals and regular probiotics are key. Lactobaccillus GG especially effective for clostridia. Some stool overgrowths may require specific antibiotics; antibiotics generally should be avoided to promote healthy flora.
8. Address food intolerance: Avoid aggravating foods to halt IgG (and IgE) reactivity to food antigens which keeps the bowel inflamed. Gastrocrom, quercitin, EPA (fish oil), vitamins C and E all quiet inflammation.
9. Digestive enzymes with all meals and snacks.
10. Avoid NSAIDS (non-steroidal anti-inflammatory medication) to lessen leaky gut.
11. Glutamine as nutrient for the enterocyte.
12. Decrease toxic burden: Organic food free of insecticides, antibiotics, flavor enhancers, artificial sweeteners, colors, and preservatives. Purified water, clean home and school environments. Assure bowel regularity (fiber, magnesium citrate, vitamin C, Bethanecol) to reduce toxins. The autistic child should eat regularly, several meals per day.
13.Detoxification with DMSA/lipoic acid: precede by nutritional and gut enhancement. Floral influence on metals retention may be significant. Fluctuations in dysbiosis may be related to changes in heavy metals levels.
14. Outcomes: Autistic children respond to improved nutrient status and reduction of microbial overgrowths, aggravating food antigens, ingested toxins and gastrointestinal tissue and reduce inflammation.
Stool mercury levels, or differences in species of mercury in stool are of interest and stool mercury levels are relatively inexpensive. Mercury metabolism and sulfate reduction in the gut flora may be linked, maybe even via mucin degradation. Mercury metabolism in the gut may generate toxic sulfides. Antibiotic exposure may select mercury-resistant flora with detrimental mercury-metabolizing traits. Common mercury methylators include condida, staph, strep and E. coli. Mercury volatilizers may emerge after antibiotic exposure.
Small Bower Overgrowth (SBO), for which either stasis or LNH are risk factors, is diagnosed by hydrogen breath-test, which presents a practical challenge in autistic children. SBO may be diagnosable by other means in autism. Microbial action could produce toxic bile acids metabolites in the feces of autistic children. One known bile metabolite, lithocholic acid, is highly toxic in animals, has not been assayed in autism. Subgroups of autistic children should be evaluated for excess fecal d-lactate production.
About half of incinerator and fossil-fuel mercury fall-out is in salt form, for which gut ha very high binding affinity. This form of inorganic mercury as well as cadmium are concentrated in effluent sludge, used to fertilize food crops. Intestinal biopsy may demonstrate higher mercury or cadmium levels in autism, particularly recent regressions.
There is strong logic for development of a good sequestrant to bind heavy metal in the gut of autistic children.
Submitted by Karen from the autismandenzymes Yahoo Group.
2: November 24, 2001