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The Sunderland Protocol:
logical sequence of biomedical interventions for the treatment of autism and related disorders.
Paul Shattock & Paul Whiteley
Autism Research Unit, School of Science, University of Sunderland, Sunderland. SR2 7EE.
We have a number of occasions, presented and discussed the theoretical underpinning of many interventions used in the treatment of autism (Shattock 1990, 1991). These are largely based on the pioneering work of Dohan (1996), Panksepp (1979) and Reichelt (1981) followed by lending Cade (1990). The effectiveness of some of these interventions is proven but for others indices are still anecdotal and not scientifically validated (and in some cases it is probably not possible to perform such validation). In most cases the intervention was introduced by chance or randomly when a parent (or guardian) has discovered a particular therapy hearsay, through a newspaper or magazine or through an Internet discussion. Sometimes parents have stopped interventions they considered ineffective or is continued or not they get results.
In other cases, professionals have suggested taking many supplements and more and more are added as and when. Parents and guardians are not competent in this area or do not understand the technical side of chemical nomenclature. The worst case was a girl who was taking 70 different supplements. In fact, it was not exactly true since his multi-vitamin tablets contained the B6 and she also took the B6 separately and Pyridoxine tablets (which are of B6).
It is quite understandable that a parent wants to try everything to help her child, but it is also desirable to know the factors that help a particular child and what does not help. It is possible, course, one or more supplements are harmful to the health of the child. It is not possible to generalize on the matter because all children with autism are different from each other and also from their peers with no symptoms. To avoid overmedication we suggest the following protocol, which should assess each intervention for each child. Each element should be treated with the same respect as any biomedical intervention using a drug specifically prescribed or as part of a course of therapy. These interventions generally do no drug, however we recommend which are treated with equal respect and used experimentally a time-delimited, with all precautions taken.
If they are successful they can be useful if they are not they should, for now at least, be abandoned. Ineffective therapy can always be revisited later, or may be, when problems arise and different development when metabolic or physiological status will be changed due to another intervention or age. We are seeking a therapeutic benefit and if the negative effects are too significant to continue can hardly be justified. It is difficult to justify a very intensive therapy or restrictive if substantial profits are not highlighted. In all cases, these interventions must be made within the context of a comprehensive treatment plan including the educational and social development. This type of intervention can not substitute for a proper education but rather aim to make the subject more responsive to the educational process.
Figure 1:
"CEASE FIRE" - Remove the source of aggression
1. CASEIN (3 weeks)
2. GLUTEN (3 months)
PRELIMINARY AGREEMENT
(Corn, Soybeans, Tomatoes, Eggplant, Beef. Etc.)
4. TESTS
(Vitamins, Minerals, Amino Acids, Allergies - IgG, IgE)
appropriate supplements (Zn, Ca, Mg, Mb, Vit. A, C, B 1, B 3, B 6 , B 12 )
5. ORGANISMS PATHOGENIC
(Candida; Other)
ACTIVE RECONSTRUCTION
6. PROBLEMS sulphate
(Magnesium Sulfate - Internal / External; MSM)
7. ENZYMATIC ACTIVITY
(HCl
8. FATTY
(primrose oil, fish oils, cod liver oil (Vitamin A), linseed oil)
9. L-GLUTAMINE
(Correct deficiencies, intestinal nutrients)
10. SUPPLEMENTS D'ENZYMES
(Bromelain; SerenAid; EnZymAid)
DIVERS
11. 5-HYDROXY TRYPTOPHAN
12. REGIME SANS COLORANT
13. REGIME SANS SALYCILES
14. MEGADOSE B 6 & Mg
15. DIMETHYLGLYCINE (DMG)
16. SECRETINE
We suggest to introduce an intervention at a time and evaluate the therapeutic benefit for each individual. Then there are the continuation or discontinuation. Like ancient Gaul, our protocol is divided into three. Using a military metaphor: we are conducting a battle and we should seek peace. There are three steps to establish a viable and permanent peace.
A. Cease fire;
B. Identify problems and find common cause;
C. Rebuild.
We envision solving these problems exactly the same way.
Stage A, "Cease Fire": The experience and the opioid excess theory of autism suggests that the first step in treating autism should be removing the source these peptides. We do not suggest that this explains everything, but it is an appropriate first step. Since the source of the attack almost always include casein and gluten, they must be removed from the diet. It is possible that parents, guardians or professionals or the subjects themselves have an analysis performed to detect these substances. The test is known as urinary peptide but there are other methods.
Although these tests provide valuable information when used in conjunction with clinical data, it is worthwhile in all cases to consider the exclusion of these proteins in the diet. We met with autistic individuals in whom the tests indicated no abnormal levels of urinary peptides (or indolyl acryloyl glycine, IAG), in fact their peptide profiles appeared normal in every way, yet the subject was clearly autistic. We met with such topics that they react positively to the removal of casein and gluten from the diet. It is possible that these subjects digest peptides in an abnormal manner but that these components are not detected by our systems. It is possible that although the urinary levels are normal, the quantities crossing the blood-encéphalée and reaching the central nervous system are high. We also encountered some cases, fortunately very infrequent, and the problem seems to be due to hypoxia or anoxia at birth or during the early days. In these cases, be caused little damage to the cerebellum being very fragile development. These parts work but may therefore be affected by even a normal level of peptides derived from food via the blood.
Whatever the mechanisms involved or the results of biomedical testing, we suggest that you consider first the withdrawal of all dairy products.
1. Remove the casein
The effects of removing milk products can often be found quickly. Depending on the subject's age, it can range from 2-3 days (for younger children) or 10-14 days in adults although usually it is faster. We generally suggest a trial period of 3 weeks in first. Lucarelli (1995) found that 66% of those tested were in this type of intervention, although we have no firm data to confirm this view, our experience suggests that more or less corresponds to reality. Of course, there may be a time when side effects are visible but at the end of the third week the situation should be clear.
Any effect of lack lasts a relatively short time but can be quite severe, especially among young children. For this reason we prefer another separate removal of the two components, gluten and casein, for this protocol. We found that the elevation of beta-casomorphin (1-7) quickly disappears from urine profile after removal of dairy food (a few days). We assume that this is the result of the dramatic effects of withdrawal identified.
We also observed that many children with a better level of functioning withdrew themselves dairy products from their diet anyway. Since the peak elevation disappear so quickly, it is highly likely that subjects are able to detect the difference produced by abstinence from dairy products. Many Asperger's, for example, complain of confusion or difficulty concentrating when they drink milk. They avoid milk but rationalize it by saying they "hate milk" or are "sticky". On the other hand some children clearly use milk as a drug and drink in what is generally considered large quantities. A child of three years, for example, who drinks two pints of milk a day is not unusual for this group. The cultures of Western Europe are borrowed from the idea that milk is wonderful and essential in the diet. Dietitians, nurses and orthodox medical practitioners are not easily convinced that milk is not intended for human consumption and that in many cases is undesirable and inappropriate. There was an increased incidence of autism among immigrants in Sweden (Gillberg 1996) compared to the indigenous population. There are several theoretical explanations but one of them involves the consumption of foods for which subjects are not genetically equipped in terms of enzymes or metabolic capacity of assimilation. The absence of the enzyme lactase in the original subjects Africa and the disappearance of enzymes that digest casein in individuals of Chinese descent around the age of 12 years are well documented examples of this phenomenon.
We summers very impressed by the number of parents, especially mothers, who took the initiative, often against the advice of professionals, to remove the dairy feeding their child. Clearly, these parents have felt intuitively that their child's reaction to dairy products was abnormal. Vomiting of milk (cow), eczema, particularly behind the knees and in the hollow arm, funny white bumps under the skin in early childhood, runny or ear infections, sometimes requiring the installation of pipes, constipation and / or diarrhea from the very young child and breathing problems resembling asthma can all be signs of a problem digesting casein.
After three months of suppression of casein it is useful to take stock of the situation. Clearly, in cases where improvements are apparent, the intervention must be continued. When we saw no improvement, it is difficult to justify the continuation of the removal, but most parents consider the difficulties inherent in this type of intervention are not so annoying that they can not continue. This must be a personal choice. Since the withdrawal of milk products is relatively simple, it also helps parents prepare for the rigor necessary for the removal of gluten. Of course, many people prefer to remove both the food at the same time and that's fine, but we still strongly recommend separating the two elements for children under 4 years because of the potential severity of the effect of lack. However, we still recommend that you test the role of milk soon after implementing the plan.
2. Gluten withdrawal
As previously indicated, requires the withdrawal of gluten proteins (prolamins) of a number of cereals, especially wheat, barley, rye and oats . Given the composition of the Western diet and its dependence on cereals, it is not easy, but most do without too much difficulty. The spikes in the urinary profiles that we (correctly or incorrectly) ascribe to gluten lasts much longer than casomorphins. In our test (Whiteley 1999) there were only 26% reduction in urinary levels after a period of 5 months. This can be explained by the storage capacity of the peptide in body tissues and may be, only partial compliance by the regime in some cases. The body is unable to decompose and release mechanisms in the urine (as we assume) overloaded by the amount of peptides. In other cases, the body has little option but to store them, probably in the adipose tissue. When food sources are removed, these stocks are declining as quickly as possible, but gradually as the child / person grows, the amount stored will, in absolute terms, more important and the time required for their removal will be greater.
It is very rare for this reason that the parent or the person affected is identified the role of gluten as the benchmark for milk. There is always some degree of environmental products containing gluten, and we know of no person with autism who has refused to gluten products in the same way they avoid milk and dairy products. It is strange that we are so attached to what is essentially the seed of an obscure type of grass. It is possible that the production of opioids is one of the elements its acceptance as a staple food in many countries.
While this may happen, the withdrawal of gluten does not usually dramatic effect. Except in very young children, whose results are visible quickly, do not generally expect changes before 3 or 4 weeks, therefore we suggest that the withdrawal be for a period of three months . Then it is appropriate to take stock of progress. We know a number of cases where dramatic improvements have occurred 7-9 months after the beginning of the plan, and one case (Reichelt, personal communication) these improvements have taken place two years after starting a strict diet. As previously mentioned, the disappearance of gluten peptides is more progressive than casomorphins. Therefore the effects of lack tend to be milder in severity, but more prolonged, especially in adults.
The Norwegian Studies Have Been going on for The Longest Period of Time (Knivsberg 1995) And They Always Have Proposed removal of gluten as well as "casein. Interestingly, They Observed a Phenomenon We Have Also Noted in Subjects Who Have Used this approac h Where the casein and gluten are removed simultaneously. There Is an initial rapid Withdrawal Period and improvement. This tend to Be Followed by a period "where not at all and Much Happens Often parents begin to wonder if Their initial improvement com ments Were a result of self-delusion. After A Further Period of Time, Other Improvements APPEAR Sometimes after a second set of Withdrawal Symptoms. We Believe That Biphasic this pattern is Due To The sequential effects of casein and gluten Then remove the From The diet.
The Norwegian studies are the oldest (Knivsberg 1995) and have always suggested the withdrawal of gluten as casein. It is interesting to note the observation of a phenomenon that we also noticed in patients who opted for remove gluten and casein simultaneously. There is a period of rapid detoxification and improvement. This tends to be followed by a period where not much happens and the parents wonder if their observation of immediate improvement was not an illusion. After a period of time more important, other improvements are felt, may from time after a second period of withdrawal symptoms. We believe that this process is the dual-phase effects of sequential removal of casein and the withdrawal of gluten from the diet.
Stage B "identify problems"
We believe that these peptides are the agents (source of aggression) that are directly responsible for causing the symptoms but there may be other agents who have a serious impact on the whole. In some cases, the gluten and casein seem to be the only elements, but in other cases there are clearly other factors involved. The relative involvement of these peptides (gluten and casein) is very wide and can hide other factors. Only after the main source of aggression, gluten and casein, was removed from power the smoke to dissipate enough to allow us to detect other elements causatives that are largely food-borne.
It is desirable to keep a diary of foods in all cases before, during (and after?) Any intervention but this is doubly important after the gluten and casein is removed, because only this long as we can determine the role of other dietary factors. It is interesting to note that the APNA (Association de Padres de Ninos autism) for several years provided its members with such a journal in which they can record the daily diet as well as the behavior and performance of the child. Many parents use these newspapers and noted that consumption of a particular food is often linked to degradation behavior, sleep and performance. Without having a specific newspaper, these foods would probably not have been identified. The reaction to certain foods tend to be personal but certain foods often cause problems identifiable groups of people. Eggs, tomatoes, avocados, eggplants, red peppers, soybeans, corn officers are frequent, while beef, pork, rice and potatoes are rarely involved. If a particular food seems suspect, it should be removed from the diet for a trial period of about two weeks and the effects should be noted. We agree to think that this method is very empirical, but that's all we can do right now. It may, however, often pick up clues by observing the subject.
The special food for children with autism are well known and often they restrict the foods they will eat only a few of them. These are mostly large quantities of foods that can harm them just as we described above, but some of these foods are completely avoided. If a child has a problem with food, he or she is actively avoid it or otherwise use it more or less like a drug. The situation is the mirror of what is encountered in adults with a history of alcohol abuse. Either they continue to abuse it or they avoid it like the plague. When the main culprits are removed from the diet (gluten and casein) the parent or guardian must pay attention to the possibility of transfer to other potentially hazardous foods. On several occasions we have seen children who hate milk and yet suddenly in demand when gluten is withdrawn from their diet.
Seroussi (2000) described how she discovered the negative effects of corn for her son after a strict removal of gluten and casein from the diet. Generally, when the harmful foods are removed, the power of the child expands and he accepts that he was refusing food in advance. If the power remains limited, this may be an indication (but not certainty) that the food is always bad party food. The same result is observed if a child accidentally consumes again a bad diet. This may be, for example, the contents of a particular brand of beans prepared with composition is changed without notifying the consumer, in addition to gluten. The child's behavior may change but it also tends to reduce its supply which can reappear. We stress again the fact that the removal of basic components of food are likely to result in a reduced intake of vitamins and minerals and other essential nutrients. A good supplement, balanced, should be implemented. We must do better with the help of a trained professional who knows what kind of approach. In case of inadequate intake of essential nutrients, the metabolic processes of digestion and absorption will under no circumstances be held properly.
3. Tests
At this stage it may be appropriate to conduct further tests. There is no doubt that many of our children have abnormal levels of minerals, vitamins, and other items. However, actual results are often obscured by the smokescreen that is the consumption of gluten and casein. Only now, after the withdrawal of these sources of dietary protein aggressive that meaningful tests can be performed. On some occasions, parents have sent us the results tests on the Statute of minerals and vitamins (in hair or blood) before and after removal of gluten and casein. The results were very forward outside of the standard in effect, and the results after the exclusion of harmful proteins showed a return to the norm. We interpreted this as an indication that the bowel function was partially restored by removal of these elements, the vitamins and minerals from food were now absorbed as they should but it can, of course, be other mechanisms involved.
We always suggest that any person starting a diet ensures adequate intake of vitamins and minerals and for this reason we suggest to involve a qualified dietitian or someone with equivalent training. We suggest taking a dietary supplement multi-vitamin and multi-mineral balance to ensure adequate levels. If these tests are done before the diet, severe deviations from the standard may be evident and remedial action in the form of a very unbalanced may be initiated inappropriately. It is probably best to wait this time.
There are some common rules. Some children have high calcium and low magnesium and the remedy is obvious. Others have very high levels of toxic substances, such as aluminum. The addition of zinc supplementation can correct this situation. Zinc supplementation in all cases is probably desirable that it is necessary for both normal metabolic reactions. There is no rigorous scientific studies demonstrating its effectiveness in improving the symptoms of autism but there are many anecdotal reports that confirm its effectiveness. Waring (2000) indicated that the addition of minute doses of molybdenum has dramatic effects on the correction of abnormalities on the level of sulfates and sulfites.
We also observed that allergies classic "disappear" frequently when gluten and casein are removed from the diet. At the same time, certain allergies and real underlying revealed. We believe, therefore, that the most appropriate time for testing is after the withdrawal of the main offensive foods. If allergies are suspected, it is useful to consider some interventions. We met many people who have conducted tests using a test VEGA (the skin) prior to any intervention. These tests usually show 30 or 40 allergies but after removal of gluten and casein, these numbers drop dramatically. In some cases, children are deprived of food allergens as indicated by tests done before surgery and who have no clinical value.
Laboratories based in hospitals are testing in general levels of antibodies in the blood (particularly IgE) to indicate "allergies" to certain foods. In Britain, the results of these tests are not always communicated to parents. Traditionally they use a notation 0 to 4 (4 being the highest level). Levels 0 and 1 are fairly common and are generally ignored while higher levels must be taken seriously. Understand that these levels are nothing other than a photograph at some point and it may be appropriate to consider removing from the food to give it a try at some future time.
We believe that the real meaning of those allergies has been widely underestimated in the past and that research should be directed to this sector. Avoiding allergens is an obvious therapy, but there may be other alternatives. The EPD (enzyme potentiated Desentitisation, Desensitization by enzymes) is a technique used by a limited number of practitioners who think it is effective. This has not been rigorously evaluated and American practitioners were censored for its use. We believe that there are considerable benefits, and in all cases, feedback from practitioners has been modest.
We would emphasize that although we do not believe that conventional allergy to casein or gluten is heavily involved in most cases of autism, it is important to check this possibility before the withdrawal of these foods. These tests are of course no value once the food has been removed from food for a certain period. It is always a shame that doctors ask parents, even if with reason, to reintroduce gluten and casein to perform these tests. Although these reintroductions almost invariably result in a deterioration of performance and capabilities of the subject, just as invariably tests have given negative results. For this reason, we recommend to test the allergy to gluten and casein (but not other allergies) before the introduction of a scheme to exclude them.
4. Intestinal parasites
For many years, an association between autism and yeast parasites was observed and recorded, and yet the nature of this relationship remains uncertain. The fact that the two conditions co-exist does not necessarily mean that one causes the other. The cause and effect could be reversed, but it could also be a mechanism underlying causes both phenomena. We have frequently observed the disappearance of a parasitic infection apparent when gluten and casein were removed from the diet. And interventions recommended below, for the treatment of candidiasis are not necessary. For this reason, we prefer to act against the parasites at this stage rather than, as some therapists, early intervention. For several years, we thought that parasitic yeasts such as Candida, multiplied due to the weak immune system, which was itself the result of the action of opioid peptides food. This colonization by yeasts may well be promoted through an inappropriate use of antibiotics in infancy. For example, it is known that many Children with autism have many ear infections. It is likely that they are at least initially the result of problems caused by the milk, yet they are treated with antibiotics. These powerful antibiotics are used routinely and sometimes with great regularity in some children. Of course they kill bacteria while the role of these in the outbreak of ear infections is minimal. Unfortunately they also kill intestinal bacteria and allows the development of yeast and other organisms more like parasites. Thus, the use of antibiotics encourages the growth of parasites of this type. If the yeast are present, they can increase the permeability of the intestinal wall, especially when rates are low in sulfates. Shaw conducted a study on yeast and applied for a number of mechanisms by which yeast products could have a more direct influence and we must refer the reader interested in his work (Shaw 1998) for more information. Recently (Shaw 2000), he suggested that yeast may be responsible for the production of substances that can form complexes with enzymes (such as Di-Peptyl Peptidase IV) which should, under normal circumstances, digest peptides derived Food. There is certainly some logic in these ideas but there is no immediate formal proofs.
mechanisms have or have no influence, but it is clear that some parents think they see benefits in treating these infections yeast. Unfortunately there is no published data to confirm comments but numbers of behavioral improvements following the use of antifungal product such as Nystatin suggest that these observations should be taken seriously. It has been suggested that the Nystatin acts through another mechanism, such as reducing the permeability gut. This is indeed possible, but again, there is no data and this would not explain the benefits achieved by other anti-fungal Diflucan like.
yeasts thrive on sugar (sucrose and others), too many parents have tried to control the yeast by limiting or eliminating dietary sugars completely. In addition, some parents have gone further and have eliminated foods containing yeast. Other parents have tried to control the yeast infection by supplementing with high doses of beneficial bacteria normally found in intestine. Products containing acidophilus or bifidus are used for this purpose as well as "anti-yeast" as the natural seed oil or garlic reason (although the latter may have its own consequences!).
There are a number of tests to detect yeasts. This may require examination of stool (to find direct evidence of infection), blood (for the antibodies or antibody-antigen) or urine (for yeast metabolites absorbed through the gut ). Each test has its strengths and none is without weakness. Many parents think it is easier to assume an infection and try a treatment in the form of supplementation. However, the Nystatin is a prescription drug and medical it is unlikely that doctors prescribe without prior testing or for other reasons.
5. Other intestinal parasites
Life of intestinal parasites is not always easy and their survival depends not only food they get but also their ability to survive against the body's defense mechanisms. The production of substances that reduce the ability of the immune system would greatly improve the chances of survival of each organization. Only a parasite very "stupid" would produce chemicals that would turn against their host since its own chances of survival depend on the survival of the host organism. Opioid peptides are perfect for this task since it reduces the strength of the immune system but can not, under normal circumstances, be absorbed. However, we know that people with autism have an exaggerated intestinal permeability and that problems may accumulate.
It is known that certain organisms and protozoa to produce these substances and we suspect, although it is not demonstrated that bacteria use the same mechanisms. Nobody really thinks that "the worms are the cause of autism" but they could exacerbate the situation, particularly in our subjects that may be particularly susceptible to such infections because their immune systems are already low. A theory on the existence of a substance containing an unusual type of dermorphin, which we previously referred to, suggesting they are derived from bacteria (anaerobic bacteria can be as clostridia) seeking to increase their chances of survival by this means. Although there no evidence to confirm this possibility, it is possible that the same virus or candida use a similar mechanism. In all cases, it seems important to normalize the intestinal flora as much as possible using diet and appropriate medication.
[See article on abnormal gut flora and new search ]
gluten-free diet (yet)
The nature of the intestinal flora depends on a lot of food. A restrictive diet such as the one selected by many people with autism may favor certain bacteria at the expense of others. For example, a diet rich in corn little foster Clostridia then they would be almost absent if the rice was the only carbohydrate present in food. Interest in this relationship is new and it clearly requires a more detailed investigation.
Stadium C. The reconstruction phase
The ultimate goal of these interventions must be to make possible a diet as close as it can from the normal. If, for example, we can reduce harmful levels of peptides in the gut and decrease the permeability of the intestinal membrane and / or the blood-encéphalée, we can minimize the risk of damage. This is the purpose of elements of the "reconstruction phase".
6. Sulfotransferases and food phenolic
The interest on this subject came to the observation of parents. Parents have reported that specific foods lead to abnormal behavior in their children. These foods, such as apple juice, citrus, chocolate and paracetamol are precisely those which are known to cause migraines in susceptible individuals. The Parents also noted the frequency of migraine among relatives of autistic children. These observations made by parents have led them, without training in these areas, consult books of biochemistry. They noted that some enzymes tend to function sub-optimal for people suffering from headaches and wondered if the same situation was relevant to autism. They asked Rosemary Waring, a researcher experienced in this field, to test a group of autistic children. The results were published some years ago (1997) and have been replicated and extended only recently dramatically by Alberti (1999) and recently by Waring itself (2000a).
Apparently sulphotransferase systems are operating sub-optimally in autism. This has certain consequences, including the metabolism of classical neurotransmitters, assimilation and metabolism of bile pigments of disturbed bilirubin and biliverdin, reduced action of the hormone CCK resulting in reduced secretion of bile and biliary tract to the intestines. This could lead, again, reduced absorption of some vitamins and other nutrients in the gut, reduced activity of gastrin in the stomach, resulting in reduced production of stomach acid, mucus and pepsin in the stomach, and may be a reduced production of secretin and absorption of vitamins further downstream.
The greatest importance is perhaps for the intestinal permeability. The intestines are covered with a thin layer of mucoproteins. This layer, as it contains important immunoglobulins (particularly IgA class) provided lubrication and protection to the intestinal wall during the passage of food through the alimentary canal. These mucoproteins be sulfated so they are continuous, protective and effective. If they are not sulfated, proteins come together and leave exposed material intestinal peptide transport to the tissues is encouraged.
The role of sulfation could well be a pivotal factor in causing autism, yet it is still poorly understood and has received scant attention. The role of sulfate in the immune system, hormones and effectiveness in maintaining the integrity of intestinal function, kidney function and detoxification systems deserves much greater attention than it receives now. Owens (1998) drew attention to the importance of sulfation to chemical bodies called GAGs (glucosyl acetylglucosamine), which has enormous significance for many functions of brain development. Processes including inflammation, such as those that may result from infection can be acquired naturally or through vaccination program, will result in the removal of GAGs containing sulphates of the intestinal barrier. Owens suggests that these GAGs are the main reservoir of sulphates in the body. Thus, any inflammatory process will result in an inevitable depletion of sulfate. Waring (2000b) also presented data indicating that the conversion of sulfites to sulfates is severely inhibited after vaccination of adult students against hepatitis B.
sulfate ions are only weakly absorbed through food but absorbed through the skin. This explains the rationality of the use of magnesium sulphate in the bath of autistic children. Some parents have experienced the "patches" home-prepared, containing crystals of magnesium sulfate. The intention is that small amounts of salts are absorbed through the skin on a continuous basis. Alternatively, MSM (Methyl sulphonyl Methane) can be given orally in an attempt to increase blood levels of sulfates. Efficacy has not yet been proven through clinical tests appropriate but anecdotal evidence is impressive.
7. The Betaine Hydrochloride (Tri-Methyl Glycine)
As for the enzymes mentioned above, the Tri-Methyl Glycine (TMG) is used for many years in the treatment of hyperactivity, although mode of action is unclear. This supplement will act slowly producing hydrochloric acid, thus increasing the acidity of the stomach. It seems that people with autism do not have enough stomach acid (achlorhydria) and therefore the stomach enzymes to act adequately digest protein. It is perhaps also significant that secretin is produced in the intestines after the stomach acid. So if there is acid deficiency, the level of secretin produced could be sufficient.
[See article on Famotidine (Pepcid AC) and autism ]
As with DMG (Di-Methyl Glycine), it is possible that each action depends on completely different mechanisms. The role of DMG and TMG in the metabolism of cysteine is well known. Alternatively, they may have a direct role in neurotransmission or act as a source of glycine, which is always asked by the body. We believe that because these products may have, or not at all, indications and cons have long been used they should be considered at this point.
8. Fatty acids (fats and oils)
Many believe erroneously that fats are acting only as a system of energy storage or as packing material. The very important role in fat metabolism and Development of the body is known only recently. More is known about the role of fatty acid metabolism in maintenance of membrane permeability through the body. Interesting data have been published (Kane, 1999 and Cosford 2000) but currently there is no global consensus on significant items and those who do not. At this point, we hesitate to give certainty on the appropriate interventions and we suggest that those interested in the subject gets advice from someone else until the positions are clearer. Although formal evidence is lacking, it appears there are abnormalities in the fatty acid content in the blood as in related forms and there is no agreement as to whether circulating levels reflect honestly the situation of the membranes. Given the instability of the membranes and the fact that tests are rarely carried out immediately after collection, we must still cast doubt on the reliability of all sample except those made with the utmost care.
Many windy the merits of linseed oil, oil, cod liver oil olive leaf and many others but for a variety of reasons. The evidence accumulates indicating that any intervention must use a balanced approach of Omega 3 and Omega 6 rather than high doses of one of two forms. One element that seems to be universal agreement is the use of oil Primrose. Profits may be the consequence of its acid content incorporated into the structure of prostaglandins required to maintain intestinal integrity. (Even here, it is suggested to avoid it if at risk of epilepsy). Kane's research is controversial, and his explanations are not accepted by everyone but there is general agreement on the sequence of use of fats and oils it offers.
Primrose Oil; It consists largely of Gamma Linoleic Acid, an acid Omega 6. There are other sources, the richest of gamma linoleic acid oil as jam, but they say it is less well tolerated than Primrose oil. We are unable to comment the above. It is probably wise to saturate with it before attempting to restore balance in Omega 3 oils such as with fish oils. The fish oil as cod liver oil has the advantage of including vitamin A, which certainly lacks in autism (Megson 1999).
Flax oil, rich in Omega 3. The goal, in our opinion, these fatty acid intake is to ensure that the membranes of intestinal cells and the barrier is permeable encephalomyelitis hématée until an appropriate degree. The level of cholesterol is important for that. Although there is currently an anti-cholesterol, I must admit that this is an important component of these membranes and some have advocated to ensure adequate levels of fatty acids that are converted by the body cholesterol.
9. Amino acids
A number of diseases can be the result Direct irregularities in the amino acids. The histidianémie, phenylketonuria; homocysténurie and the others may be involved in causing symptoms. Tests to verify that this problem is absent should be performed routinely. There is considerable anecdotal evidence indicating that certain amino acids are beneficial for people with autism. The lack of evidence but supplementation should be considered and in all cases their use will probably no negative effect. L-Glutamine is very appreciated by many parents even though its precise mode action is unknown. It is currently used in medicine to encourage growth of the mucous membranes and improve intestinal absorption. It has been suggested that glutamine levels in the blood are low in people with autism so supplementation may be beneficial.
The 5HTP (5-Hydroxy Tryptophan) is a metabolite of the amino acid tryptophan and is used in the formation of serotonin. It is possible that serotonin levels, or where necessary, are low and supplementation with 5HTP. Many people think that this is the case although, again, the evidence its efficacy in autism is lacking. (The theoretical concepts are described by Shattock (1999).)
10. Enzyme supplements
If the peptides in the stomach are not digested properly, it may be the result of an insufficient level of the enzyme peptidase. For many years, parents of hyperactive children use enzymes (orally) to improve the problem. Many products are marketed. Some of the plant enzymes are particularly effective and we know that many parents believe that the enzyme from pineapple, bromelain, gives beneficial results. Bromelain has a special advantage over other natural enzymes as it is known to break the links tyrosine-glycine, which are critical to the opioid activity of most of these biologically active peptides. Many products contain the enzyme "papain" which is also a plant enzyme. However, it seems that some people are allergic to that substance. A product specially made for people with autism is now marketed (SerenAid). It contains the peptidase from a variety of sources and has been specially formulated to operate in environments of stomach acid. The peptides will be digested and will not be available to be absorbed in the lower intestine.
manufacturers do not claim that SerenAid be used alone, but want it to be added to other dietary intervention. Many parents use it regularly with meals. No formal test has been published but it is possible that this is done in the future.
Stage D - Other operations
The following interventions have been placed near the end of the protocol for various reasons. The implementation of plans or colorless without salicylates, although theoretically possible and feasible by experimentation in vitro (Waring 1999) is not easy to do and parents trying these diets are fairly strict hard to justify their action orthodox physicians. Similarly, the use of secretin, at this stage is experimental rather than routine. As new versions become available, and purer than proof of its safety and effectiveness appear this may well change. Even the mega-doses of vitamin B6 are frowned upon as there are theoretical risks associated with its use. The use of DMG has not attracted such criticism, but since we do not know the reason for its efficiency we have no possibility to allocate a place in our protocol.
11. 5-HTP (5-hydroxytryptophan)
The mechanism we have proposed implies a pivotal role Indole Acrylic Acid (I.Acr.A) which is a metabolite of the unusual amino acid tryptophan and immediate precursor of indole acrylic Glycine (IAG) which we noted the presence in abnormal amounts in the urine of people with autism. We suggested that differences in the standard for this metabolism may be a consequence of partial inhibition of the enzyme tryptophan hydroxylase. This is the enzyme responsible for converting tryptophan to 5-HTP (5-hydroxytryptophan) which is then converted to 5-hydroxytryptamine (5-HT or serotoninergic). Thus, inhibition of the enzyme tryptophan hydroxylase resulting in an increase of I. Acr.A potentially dangerous and a reduced level of serotonin available in the body. The obvious remedy is to supplement tryptophan but it is also problematic. First, if the enzyme activity is diminished as we propose, tryptophan can be converted to I.Acr.A is not desirable. Secondly, tryptophan is only available by prescription in most of the world.
ban the sale of free tryptophan is unusual and controversial given the history of this product, but in all cases, the use of 5-HTP seems more appropriate. Again, the information on its effectiveness is anecdotal, but its use is both logical and probably without side effects.
12. Phenol-free diet (pigments)
It seems that the sub-activity depends on the sulphotransférase low sulphate plasma rather than a real deficiency of the enzyme. Thus, any food or requiring the use of sulfate ions during its metabolism will worsen the situation. These foods included apple juice, citrus juices, chocolate and paracetamol. In fact, any chemical containing a high proportion of phenolic groups have that effect and will worsen the problem mentioned above. Many dyes, natural or synthetic, have phenolic groups. For this reason, some doctors recommend the removal of all colored food diet. Of course, interventions have long been known (Feingold diet) the widely advocated removal of synthetic dyes, especially those beginning with the letter E. Part of the negative publicity for these products is that we find disagreeable these unnecessary additions to our food, but for some people they are important. Except in isolated cases, we have not seen a big difference for people with autism when colored foods are removed unless other elements mentioned above will be used also.
Some (maybe most) do not react to these foods, including paracetamol, but there are individuals who should avoid these products. Again you must check the effects for each individual.
13. Salicylate free diet
Since Feingold's regime people are aware that foods containing high levels of salicylates may cause problems for people with autism. Salicylates (including aspirin) are used clinically for their anti-inflammatory, antipyretic (temperature drop) and painkillers. These effects are achieved by blocking the action of enzymes COX1 and COX2. These enzymes cause inflammation but are also necessary for the production of certain prostaglandins essential for maintaining the integrity of the intestine. Drugs like aspirin, which inhibit COX1, have serious side effects on the intestines and increase intestinal permeability, particularly in susceptible individuals. Some parents find it justified to avoid these foods such as almonds and other foods containing salicylates. For others the problem does not arise.
14. Mega-doses of Vitamin B6 and Magnesium
Very high levels (500-1000 mg / day) of vitamin B6 (balanced with magnesium and other B vitamin) are recommended and many claim the benefit of their use. There are theoretical risks and some have tried, both in the U.S. than in GB, to limit its availability. However, I am not aware of a person who had to suffer the side effects described in the literature.
15. Di-Methyl Glycine (DMG)
The Di-methyl glycine appears safe, and in some cases, useful, but, again, the observation of encouraging parents and some professionals have not yet been confirmed by clinical observations.
[ See article on the DMG here ]
16. Secretin
Although not strictly speaking a dietary intervention, we must mention the secretin, a hormone. Secretin has recently received much publicity. The rationale for its use comes from its ability to stimulate the pancreas to produce the enzyme peptidase (Horvath 1998). The preliminary test results are ambiguous and we are awaiting clarification. However, a discussion on this subject goes beyond the purpose of this presentation.
Other supplements
There is a plethora of substances that while not strictly speaking of drugs, in a legal sense, have actions that push the barriers of what should be considered a "nutritional supplement" and are sold as such. For example, Ginkgo (biloba) has been widely used for its action to increase blood flow, and thus the oxygen supply to the brain. Ginger, licorice and other natural products are also used for their effect on the gastrointestinal inestinal and may have a place when more information becomes available. Although not dietary supplements, the use of chelating agents should be considered at a time. Since considerable time voices were raised against the potential adverse effects of mercury in autistic children. Indeed, there are close parallels between the known effects of mercury and autistic symptoms. Evidence began to appear suggesting that people with autism have more mercury. This becomes apparent only when chelating agents are used to chelate heavy metals from the body. Research is being conducted to test these hypotheses and at this stage we believe that a discussion regarding the use of chelating agents is not appropriate. Potential side effects are unacceptably high for a self-medication and this type of treatment should be tested under the supervision of a qualified physician. This clearly calls for more attention.
Conclusions
interventions including diet avoiding certain components or taking dietary supplements are increasingly used for the treatment of autism and many other conditions. Western cultures are very oriented towards the use drugs, synthetic and often very powerful, used to treat symptoms for a particular problem that interferes with quality of life of the affected individual. This approach is acceptable only to a certain extent. Parents and guardians are becoming more interested in processes that are underlying the symptoms and by intervening to help minimize it. Of course, predisposition, the fragility, the source of autism remain but the causative factors in minimizing it is possible to improve the problem.
Many interventions are recommended, and at first glance they may occur, particularly for professionals not interested, as a cluster of ideas without substance. Most of these interventions have been designed and developed by perseverance and good sense. Mechanisms that appear reasonable, logical and justifiable, were established. These interventions are integrated and can be used to form plans for each individual. They offer the practitioner an opportunity to intervene so promising in the knowledge that the scientific evidence accumulates. Professionals who do not consider these responses may be missing the boat and do not meet the needs of their customers. We résumé notre protocole (version 2000) dans le tableau joint.
Références
Alberti A., Pirrone P., Elia M., Waring RH and Romano C. (1999) "A sulphation deficit in autistic children: a pilot study" Biological Psychiatry, 8, 420-424.
[View Abstract]
Cade R., Wagemaker H., Privette M., Fregly MJ., Rogers J., Orlando J. (1990) "The effects of dialysis and diet on schizophrenia" Psychiatry: A World Perspective, 3, 494-500.
Cosford R. (2000) "Vaccination, Early Infections; Antibiotic Use and the connection with Gastrointestinal Dysbiosis and Autism in Children" Lecture at Autism-Europe Congress, Glasgow, May 2000.
Dohan FC. (1966) "Cereals and Schizophrenia - data and hypothesis" Acta Psychiatrica Scand., 42, 125-
D'Eufemia P., Celli M., Finocchiaro R. (1996) "Abnormal intestinal permeability in children with autism" Acta Paediatrica, 85,1076-1079.
Gillberg IC., Gillberg C. (1996) "Autism in immigrants: a population based study from Swedish rural and urban areas" J. Intell. Disability Research. 40 24-31.
[View Abstract]
Horvath K., Stefanotis G., Sokolski KN. (1998) "Improved social and language skills after secretin administration in patients with autistic spectrum disorders." J. Assoc Academic Minority Physicians, 9, 9-15
[View Abstract]
Kane P. (1999) Lecture at American Academy of Environmental Medicine Conference. Coeur d'Alene, October 2000.
Knivsberg AM., Reichelt KH., Nodland M. (1995) "Autistic syndromes and diet: a follow-up study" Scand. J. Educat. Res., 39, 223-236.
Lucarelli S., Frediani T., Zingani A., Ferruzzi S. et al. (1995) "Food Allergy and infantile autism" Panminerva Medica 37 (3) 137-141.
Megson M. (1999) Lecture presented at the Defeat Autism Now conference, Cherry Hills, New Jersey, September 1999.
Murch SH., Macdonald TT., Walker-Smith JH., Levin M., Lionnetti P., Klein NJ (1993) "Disruption of sulphated glycosaminoglycans in intestinal inflammation." Lancet (1993), 711-714.
[View Abstract]
Owens SC. (1998) "Exploration of the New Frontier between Gut and Brain: A look at GAGs, CCK and Motilin" in "Psychobiology of Autism: Current Research and Practice" Conference held at University of Durham published by Autism Research Unit, University of Sunderland, 45 - 70.
Panksepp J. (1979) "A neurochemical theory of autism." Trends in NeuroScience, 2, 174-177.
Reichelt KL., Hole K., Hamberger A., Saelid G., Edminson PD., Braestrup CB., Lingjaerde O., Ledaal P., Orbeck H. (1981) "Biologically active peptide-containing fractions in schizophrenia and childhood autism." In: Martin JB., Reichlin S., Bick KL (Eds ). Neurosecretion and Brain Peptides, Raven, New York 627-643.
Serroussi K. (2000) "Unraveling the Mystery of Autism" Simon and Schuster, New York, USA
Shattock P., Kennedy A., Rowell F., Berney TP. (1990) "Role of neuropeptides in autism and their relationships with classical neurotransmitters" Brain Dysfunction, 3, 328-345
Shattock P., Lowdon G., (1991) "Proteins, peptides and autism Part 2: implications for the education and care of people with autism" Brain Dysfunction, 4, 323-334.
Shattock P. (1999) "Environmental factors in the causation of autism" Proceedings from the conference "From Research into Practice" held at the University of Durham April 2000, published by the Autism Research Unit, University of Sunderland. 163-174
Shaw W. (1998) "Biological Treatments for Autism and PDD" Published by the Author, Kansas, USA
Shaw W. (2000) Lecture at Autism Europe Congress, Glasgow, May 2000.
Waring RH., Ngong JM., Klovrza L., Green S., Sharp H. (1997) Biochemical parameters in autistic children. Developmental Brain Dysfunction, 10, 40-43
Waring R.H. (2000a) Biochemical Parameters in Autism. J.Nutritional and Environmental Medicine 10 25-32.
Waring RH. (2000b) "Sulphation in Autism" Lecture at Autism Europe Congress, May 2000.
Whiteley P., Rodgers J., Savery D., Shattock P. (1999) A gluten free diet as intervention for autism and associated disorders: preliminary findings Autism: International Journal of Research and Practice, 3, 45-65.
Copyright 2000 Paul Shattock and Paul Whiteley.
From Proceedings of Conference held at the University of Durham, April 10th 2000
Traduction : Martine F., l'original anglais se trouve à l'url : http://osiris.sunderland.ac.uk/autism/durham2.htm
