Child Psychiatry Day April 7, 2011
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1 Child Psychiatry Day April 7, 2011 Naturopathic Insights Into ASD: Etiology, Diagnosis and Treatment Presented by: Caroline Meyer, ND
2 Naturopathic Medicine: Principles Naturopathic medicine is natural health care provided according to the following principles: 1) First, to do no harm, by using methods and medicines that minimize the risk of harmful side effects; 2) To treat the causes of disease; 3) To teach the principles of healthy living and preventative medicine; 4) To treat the whole person through an individualized approach; 5) To support the natural healing power of the body.
3 Naturopathic Medicine: Training In Ontario, all licensed naturopaths must complete a 4 year full-time program at a regulated naturopathic college In this program, naturopathic students study basic medical sciences, pharmacology and natural treatment modalities In the fourth year of study, students complete an internship at the College clinic, treating a variety of patients There are focus shifts at the College clinic including two pediatric shifts
4 Naturopathic Medicine: Licensure To be licensed to practice naturopathic medicine in Ontario, a naturopath must not only complete the 4- year program but also pass a set of licensing exams which are set by a North American-wide organization In Ontario, the College of Naturopaths has been established and is developing regulations under HPRAC Naturopaths are also required to complete continuing educational hours on ongoing basis NDs work in collaboration with other medical practitioners and make referrals when necessary
5 Naturopathic Medicine: Treatment Modalities All licensed naturopaths are trained in the following treatment modalities: Nutrition and Nutraceuticals Lifestyle Counselling Botanical Medicine Asian medicine, including acupuncture Physical medicines, including hydrotherapy and spinal manipulation Homeopathy
6 Naturopathic Insights into Etiology Clinically, naturopaths observe that children with ASD often have imbalances in these systems: Neurological Gastrointestinal & Metabolic Immunological Behavioural & Psychological Possibly Hormonal
7 Naturopathic Insights into Etiology: Vaccinations In the naturopathic community, there is a wide range of opinions on a causal link between childhood vaccinations and onset of ASD Current scientific research does not support such a link At the same time, some evidence indicates that children with ASD do metabolize mercury and lead differently than neurotypical kids (Woods JS, Armel et al. 2010)
8 Naturopathic Insights into Diagnosis of ASD Naturopaths primarily rely on the diagnostic criteria of the DSM IV-R for ASD Additional testing for metabolic, immune and digestive imbalances is also done for certain children with ASD These tests include: IgG/IgE food allergy/sensitivity serum testing, organic acid testing, provoked urine or hair analysis tests for presence of heavy metals/toxic elements
9 Naturopathic Insights into Diagnosis of ASD Although there remain concerns about its reliability, a recent review by Mullin GE, Swift KM, Lipski L et al (2010) determined that IgG serum testing do closely correlate with patients symptoms Another study by Evans C et al (2008) found significant differences in urinary metabolites btn neurotypical children and children with ASD, suggesting that organic acid testing may prove to be useful in determining metabolic imbalances and thus directing treatment choices
10 Naturopathic Insights into Treatment of ASD Based on the naturopathic principle of individualized treatment, there are no set protocols for the treatment of ASD However, certain natural treatment interventions are commonly used including vitamin B6 with magnesium, methycolbalamin, melatonin, vitamin C, essential fatty acids and casein-free/gluten-free (CF/GF) diet. Almost all of the above interventions have Grade C level of evidence
11 Naturopathic Insights into Treatment of ASD: Dietary Interventions There are many different diets that parents try with children on autistic spectrum, including: Casein-free/Gluten-free (CF/GF) Diet Specific Carbohydrate Diet Anti-yeast Diet Low Glycemic Diet Low Oxalate Diet
12 Naturopathic Insights into Treatment of ASD: CF/GF Diet Clinically, I have seen dramatic improvements in repetitive behaviours, language and social interaction skills with CF/GF diet Usually, it takes a 3 week trial for the caseinfree part, and up to 3 months to detect change with avoidance of gluten In recent systematic review by Rossignol DA (2009), elimination diets have shown promising results in treatment of ASD
13 Naturopathic Insights into Treatment of ASD: Vitamin B6/Mg Vitamin B6 (pyridoxine) is important cofactor in amino acid metabolism and health of neurological system Magnesium is important cofactor in many reactions in body, including neurotransmitter function and detoxification; also smooth muscle relaxant
14 Naturopathic Insights into Treatment of ASD: Vitamin B6/Mg Although they have been used since 1980s for treatment of ASD, there are conflicting studies on efficacy of using pyridoxine with magnesium (Murza KA, Pavelko SL, et al, 2010) Clinically, with adminstration of B6, in combination with magnesium, often will see significant changes in behaviours (less stimming, more eye contact)
15 Naturopathic Insights into Treatment of ASD: Methylcolbalamin Clinically, using subcutaneous injections of methylcolbalamin is one of the most exciting emerging treatments for ASD Methylcolbalamin is a methyl donor that increases levels of reduced glutathione (an important antioxidant) which also crosses the BBB more readily than other forms of Vitamin B12 Administration of methyl B12 does not treat a deficiency but rather, people with ASD seem to have a higher need for this substance
16 Naturopathic Insights into Treatment of ASD: Methylcolbalamin Within treatments, can see improvement in acquisition of language, improved attention and eye contact Typical dose is 65mcg/kg given every 3 days Recent open-label trial by James SJ, Melnyk S, Fucha G et al, (2009) found that reduced glutathione levels increased after methylb12 treatment of children with ASD
17 Naturopathic Insights into Treatment of ASD: Correcting oxidative stress Vitamin C is a potent antioxidant and immune tonic, which also helps to convert dopamine to norepinephrine Vitamin C is commonly used to reduce oxidative stress which has been shown to be higher in children with ASD compared to neurotypical children (McGinnis, 2004 & James SJ, Cutler P et al, 2008)
18 Naturopathic Insights into Treatment of ASD: Additional Options Melatonin has been shown to improve sleep latency and overall sleep quality in children with ASD who also have insomnia Probiotics have been shown to balance innate immunity in general pediatric population and are commonly used in children with ASD (Adams JB et al, 2011) Essential fatty acids (EPA/DHA) also commonly used to reduce inflammation and nourish neurological system
19 Naturopathic Insights into Treatment of ASD: Typical Naturopathic Treatment Protocol 1) Nutrition/Diet: Shift diet to one based on whole foods; after this regimen is established for month, switch over to casein-free diet for 3 weeks followed by casein-free plus gluten-free diet for a trial of 3 months
20 Naturopathic Insights into Treatment of ASD: Typical Naturopathic Treatment Protocol 2) Supplements: Start with liquid B-complex; Vitamin C; calcium/magnesium; cod liver oil Start methylcolbalamin injections on second or third visit for a trial of 12 treatments. 3) Visit Frequency: Typically, see patients every 3 to 4 weeks, often for a period of several months to a few years
21 Naturopathic Insights into ASD: Conclusions 1) Naturopathic medicine views ASD as a complex condition involving imbalances in several body systems 2) There are many promising natural treatment options for ASD, but almost too many choices that can lead to confusion for patients, families and practitioners 3) The role of NDs is to push the envelope of EBM treatments-- in a responsible way-- in order to help patients and families affected by ASD choose the most effective interventions.
22 References Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA. (2011). BMC Gastroenterol. Mar 16; 11(1): 22. Careaga M, Van de Water J, Ashwood P. Immune dysfunction in autism: a pathway to treatment. (2010). Neurotherapeutics. 7: Evans C, Dunstan RH, Rothkirch T, Roberts TK, Reichelt KL, Cosford R, Deed G, Ellis LB, Sparkes DL. (2008). Altered amino acid excretion in children with autism. Nutr Neurosci. Feb; 11(1):9-17. Gannage J. (2010). Integrative autism treatment: fortelling medicine s future. JOM. 25(4):
23 References James SJ, Melnyk S, Fucha G, Reid T, JerniganS, Pavilov O, Hubanks A, Gaylor DW. (2009). Efficacy of methylcolbalamin and folinic acid treatment on glutathione redox status in children with autism. Am J Clin Nutr. Jan; 89(1): James SJ, Cutler P, Melnyk S, Jernigan S, Janak L, Gaylor DW, Neubrander JA. (2004). Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am J Clin Nutr. Dec; 80(6): Jyonouchi H, Geng L, Ruby A, Zimmerman-Bier B (2005) Dysregulated innate immune responses in young children with ASD: their relationship to GI symptoms and dietary interventions. 51(2):
24 References Kidd PM. (2002) Autism, an extreme challenge to integrative medicine: part I. Altern Med Rev. 7; Kidd PM. (2002) Autism, an extreme challenge to integrative medicine: part II. Altern Med rev. 7: McGinnis WR (2004). Oxidative stress in autism. Altern Ther Health Med. Nov-Dec; 10(6): Mullin GE, Swift KM, Lipski L, Turnbull LK, Rampertab SD. (2010). Testing for food reactions: the good, the bad and the ugly. Nutr Clin Pract. Apr; 25(2):192-8.
25 References Rossignol DA. (2009) Novel and emerging treatments for autism spectrum disorders: a systematic review. Ann Clin Psychiatry. Oct-Dec; 21(4): Woods JS, Armel SE, Fulton DI, Allen J, Wessels K, Simmonds PL, Granpeesheh D, Mumper E, Bradstreet JJ, Echevarria D, Heyer NJ, Rooney JP. (2010). Urinary porphyrin excretion in nuerotypical and autistic children. Enivron Health Perspect. Oct; 118(10):
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