6/2/2016. Biomedical Diets Which One and Why? Content Disclaimer. Lecture Overview

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1 Biomedical Diets Which One and Why? Copyright 2016, Kurt N. Woeller, D.O. and Educational Resource Association. This material may not be reprinted, distributed or used without permission. 1 Content Disclaimer The material contained within this document/presentation is not intended to replace the services and/or medical advice of a licensed health care practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes only. Kurt N. Woeller, D.O. (or associates) does not accept legal responsibility for any problems arising from experimentation with the information described herein. Any application of suggestions set forth in the following portions of this document/presentation is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes, medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility and should be discussed with your (or your child s) personal physician first. 2 Lecture Overview The role of IgG food reactions in autism Highlighting the Food IgG Test The neurochemical influence of urinary peptides The Specific Carbohydrate Diet (SCD) A significant step-up from GFCF Its role in Inflammatory Bowel Disease intervention GAPS Diet A more comprehensive program than SCD The Issue with Phenols & Salicylates, etc. Feingold & Failsafe The Low Oxalate Diet Resources 1

2 Support Documents For Module #5 Overview of Autism Diets (pdf) Great Plains Laboratory Oxalate Article (pdf) Lecture slides (pdf) Lecture slides: note taking (pdf) The Roadmap Biomedical Intervention For Autism Autism Assessment Signs & Symptoms Lab Testing Dietary Intervention Foundational Supplements Digestive System Treatment Methylation Other Interventions GFCF Diet, Food IgG Elimination, SCD, GAPS, Failsafe, etc. Starter Packets multivitamin/mineral, EFAs, Cal/Mag, etc. Candida, Clostridia Treatment, etc. Diet MUST start with diet Dietary modification plays a key role in autism intervention. Without a healthy diet and the removal of toxic and reactive foods, the ability to significantly help your will be compromised. 6 2

3 Food IgG Testing Differences Between IgE and IgG Food Reactions IgE Releases histamine Tested by skin pricks Anaphylactic shock Symptoms immediate Most common allergy test. Clinical usefulness mainly with allergic reactions, hives, sneezing, etc. IgG Does not usually release histamine. No immediate skin prick reaction. No anaphylactic shock Symptoms may be delayed Most common sensitivity test High clinical usefulness for chronic illnesses, psychiatric diseases. Unpublished internal data from The Great Plains Laboratory 250 IgG casein mg/l normal autism 3

4 R Cade et al. Autism and schizophrenia: Intestinal disorders. Nutritional Neuroscience 3: 57-72,2000. Depts. of Medicine, Physiology, Psychology, and Psychiatry, University of Florida, USA. Abnormal peptides in both patients with autism and schizophrenia. High titers of IgG antibodies to gliadin(wheat) found in 87% of patients with autism and 86% of patients with schizophrenia. High titers of IgG antibodies to bovine casein found in 90% of patients with autism and 93% of patients with schizophrenia. A gluten and casein free diet caused significant improvement in 81% of patients with autism within 3 months. Urinary Peptides 4

5 Urinary Peptide Great Plains Laboratory History of Milk Problems (not lactose, but casein) Main Point: A1 (beta-casein), A2 (beta-casein), B casein A few thousand years ago European dairy cows carrying the A2 beta-casein mutated to A1. This change in gene coding switched proline (pro) in A2 to histidine (his) in A1 (B-casein found in Jersey Cows, and is a subtype of A1) : When peptide is acted upon by digestive enzymes there is a release of a morphine-like chemical (aka. casomorphin) that can have opiate activity as well as interfere with serotonin metabolism. 5

6 Childhood Autism Rating Scale (CARS) Measuring the amount of casomorphin in urine and severity of autism 6

7 Gluten and Casein-Free (GFCF) Clinical Improvements Observed: Better bowel function, i.e. less constipation and/or diarrhea. Improved skin tone, reduced rashes, i.e. eczema Improved sleep, mood, and emotional volatility Improved pain tolerance, decreased self-injurious behavior. Improved language, eye contact, focusing/attention Increased appetite for other foods. Trial Diet: 100% - no infractions and done minimally for at least 3 months. Start with casein 1 st for 3 weeks, then start to eliminate gluten. Combining Food IgG and Urinary Peptide Tests 7

8 Dairy 8

9 Specific Carbohydrate Diet Specific Carbohydrate Diet (SCD) The Specific Carbohydrate Diet is predicated on the understanding that Ulcerative Colitis, Crohn's Disease, Irritable Bowel Syndrome, and gluten therapy resistant Celiac are the consequence of an overgrowth and imbalance of intestinal microbial flora. By altering the nutrition we take in, we can effect the constitution of our intestinal flora, and bring it back into balance, healing our digestive tracts and restoring proper absorption. Source: SCD History Developed by a Dr. Sydney Haas as an attempt to help children suffering from Celiac disease, many of whom where dying. In the early 50 s, Dr. Haas wrote a book called Management of Celiac Disease. Dr. Haas diet also became useful for sufferers of Chron s Disease, Ulcerative Colitis (UC), Irritable Bowel Syndrome, diverticulitis, chronic diarrhea, etc. Elaine Gottschall, a mother of an 8 year suffering from UC, sought guidance from Dr. Haas who placed her child on his SCD. She went on to obtain post-graduate degrees in biology and worked in the areas of nutrition and cell science. Helped to spread the word about the benefits of SCD. Her first self-published book was Food and the Gut Reaction. 9

10 Diet Used Primarily To Help Inflammatory Bowel Diseases and Pathogen Overgrowth Disorders Overgrowth of intestinal flora, particularly in the small intestine, leads to toxic byproducts, i.e. methane, hydrogen, carbon dioxide, lactic acid through fermentation causing mucosal damage. Neurochemical influences can occur from these byproducts, i.e. lactic acid. Imbalance leads to worsening microbial overgrowth Brush border and microvilli function are compromised. Enzyme function is compromised Digestive nutrient absorption is compromised The Diet The SCD is based on the principle that selective carbohydrates (monosaccharides) require minimal digestion and absorption leaving less available for bacteria and yeast fermentation. Monosaccharides (single sugars) fructose, glucose, galactose Looks to eliminate all complex starches (disaccharides) which comprise two sugars. Ex: sucrose, lactose, and maltose: Sucrose a combination of glucose and fructose. Found as various forms of sugar commonly used in processed foods. Lactose milk sugar as a combination of galactose and glucose Maltose combination of two glucose molecules. It is produced when amylase breaks down starch, i.e. barley. Maltose is found in may sweetened beverages, beer, cereal, pasta, potatoes and in many processed products. The Diet (continued) The SCD diet relies heavily on specially home prepared yogurt that is fermented for at least 24 hours. This fermentation allows for lactose (disaccharide) to breakdown into galactose (monosaccharide). In Autism, because of the extensive problems with dairy, cow derived yogurt is discouraged for at least the first 12 months of the SCD diet. Only dairy product allowed is Ghee (which does not include lactose or casein). Goat yogurt advocated instead Specific dietary recommendations for autism are found at 10

11 SCD Resources Breaking The Vicious Cycle: Main website for Specific Carbohydrate Diet for individuals with inflammatory bowel disease, irritable bowel, Celiac, and other chronic digestive problems Pecan Bread: Main website for children, including autismspectrum kids - GAPS Diet Gut and Psychology Syndrome Diet The Gut and Psychology Syndrome Diet has its foundation from the Specific Carbohydrate Diet (SCD) created by Dr. Sidney Valentine Haas to heal digestive disorders. In addition, it provides supplement, detoxification, and lifestyle changes as a way to maximize the overall health benefits. Source: 11

12 General Supplements General supplements recommended for the GAPS diet: 1. Therapeutic strength probiotic (at least 8 billion organisms per gram) GAPS primarily promotes Bio-Kult probiotic. 2. Digestive enzymes primarily with Betaine HCL. 1. With children need to be cautious if cannot swallow capsule or tablet 2. Can use combination enzymes: protease, lipase, and sucrase 3. Essential fatty acids 1. Omega-3/omega-6 2. Cod Liver Oil to supply vitamin A, vitamin D, EPA, and DHA 4. Vitamin A in the form of Cod Liver Oil is recommended 5. Vitamin & mineral supplement try to keep supplements to a minimum, but multivitamin/minerals okay to use. Starter Packets Spectrum-mate powder 1 scoop or teaspoon (adults or kids > 4 years of age). Less than 4 years of age ¼ to ½ scoop or teaspoon daily. Cod liver oil one teaspoon daily to start. Calcium chewable w/magnesium 1 to 4 tablets daily (children > 8 years to adults 4 tablets, children greater than 1 year of age to 7 years 3 tablets daily). Package contains approximately 2 to 3 month supply Spectrum-mate capsules 6 capsules daily (adults or kids > 4 years of age). Less than 4 years old use 1 to 3 capsules daily. Cod liver oil one teaspoon daily to start. Calcium chewable w/magnesium 1 to 4 tablets daily (children > 8 years to adults 4 tablets, children greater than 1 year of age to 7 years 3 tablets daily). Starter Packets Package contains approximately 2 to 3 month supply 12

13 Digestive Support 1 to 4 capsules with meals 1 to 2 capsules at the start of meals Amylase, Protease, Lipase, etc. does not contain HCL Betaine HCL and Pepsin NOT to be used if cannot swallow capsules. Zyme-Prime Chewables 2 to 4 chewable tablets with meals Bio-Kult Contains a wide variety of organisms: B. bifidum B. brevis B. longum L. acidophilus L. plantarum L. rhamnosus NOTE: does contain small amounts of soy and milk in trace amounts. Also, contains S. thermophillus. 13

14 Similarities Between SCD and GAPS Removal of all starches and complex sugars Only allows monosaccharide carbohydrates found in honey and fruit sugar and non-starchy vegetables. Both have introductory diets that are highly recommended to start with, particularly for individuals with severe gut issues and sensitivities. Upwards of 2 years or more is recommended Differences Between SCD and GAPS SCD Specifically developed for people suffering with bowel issues, i.e. IBD Main goal is to reduce inflammation, heal the gut, and reduce opportunistic pathogens. Is a diet only Will allow dairy from the beginning, i.e. yogurt, but with autism is not recommended. Can start with special fermented yogurt. Specialized and restrictive supplements GAPS Developed for people suffering from behavioral, cognitive, and mood issues whether or not they have bowel issues. GAPS is a dietary program based heavily on SCD, but overall is a 3 part program based: diet, detoxification, supplements. GAPS recommends everyone start casein-free. Strong emphasis on broths and fermented vegetables. Tends to freely allow more supplements, and higher dose probiotics that are often prohibited with SCD. Feingold & Failsafe 14

15 Feingold Diet Diagnostic program to see if certain foods or food additives lead to physical or behavioral problems. Focuses primarily on Salicylates and Phenols. Dyes (ex: red 3, red 40, blue 2) Artificial flavors, i.e. vanillin Artificial sweeteners, i.e. aspartame 3 Preservatives: BHA, BHT and TBHQ What Can Be Helped short list ADHD Aggression Asthma Autism Bed-wetting Bipolar/mood swings Conduct disorder Depression Dyslexia Eczema-hive Vision problems GI issues Headaches, migraines Learning difficulties OCD Sleep problems Speech issues Tics, Tourette s Violent behavior Source: What Are Salicylates? Salicylates are a group of chemicals related to aspirin They occur naturally in plants for protection against disease, and act as natural pesticides. There are many varieties of salicylates: Acetylsalicylate acetylsalicylic acid Ethyl Salicylate Isooctyl salicylate Methyl Salicylate Monosodium salicylate Octyl Salicylate Phenyl Salicylate Salicylic Acid 15

16 The Challenge In Avoiding Salicylates There are many varieties and don t always know which ones will cause problems. Amount of salicylates can vary from among different fruits or vegetables, and which part of the plant is being used (seeds, pulp, peel). Levels can change in plants from season to season, and region in which it grows. Organic fruits and vegetables may contain more natural salicylates. Cooking can change salicylate levels Tolerance to salicylates in food can change overtime with avoidance. What About Phenols? Class of chemical compounds where a hydroxyl group (-OH) is bonded directly to an aromatic hydrocarbon. Can be produced industrially Can be produced naturally from plants and microorganisms. Estrogen, Serotonin, Dopamine are phenols. L-Tyrosine is a phenol Benzene Quercetin Structure of 3-(3-hydroxyphenyl)- 3-hydroxypropionic acid (HPHPA) CHOHCH 2 COOH Hydroxyl group HO 3 2 Propionic acid Phenyl group 16

17 Structure of 4-cresol (methylphenol) Phenyl group 5 6 HO Hydroxyl group CH3 Phenol-Sulfur-Transferase (PST) PST is necessary to oxidize sulfur compounds, i.e. foods with phenols, salicylate, amines, including various hormones (estrogens) and neurochemicals (serotonin, norepinephrine). Inadequate function of PST allows for sulfur compounds to buildup in the body leading to a host of physical problems such as sleeping difficulties, night sweating, excessive thirst, reddened ear, facial flushing, etc. Mental problems happen too. Autism is often found to have low serum sulfate and high urine sulfate. Generally, inadequate sulfate available for optimal PST activity Low phenol diets can help take pressure off of the PST system Also, nutrients such as vitamin C, N-acetyl-cysteine (NAC), and glutathione can aide in phenol metabolism. Some Remedies To Help With Phenol Sensitivity Molybdenum 50mcg to 100mcg daily No-Fenol Enzyme 1 capsule with phenolic food or meals. Epsom Salt creams and baths 17

18 Epsom Salt (magnesium sulfate) Cream Bath 1 to 2 cups of epsom salts in bathwater. Let child sit in bathwater for at least 20 minutes. Can do once to twice daily. 3 to 7 days per week Apply 1 or more grams to skin 2 to 3 times daily. Failsafe Diet Free of Additives, Low in Salicylates, Amines, and Flavor Enhancers. Term coined by Sue Dengate (from the Food Intolerance Network in the United Kingdom) for the comprehensive low chemical and low reactive food exclusion program from the Royal Prince Alfred Hospital in Sydney, Australia. The Failsafe diet is designed to treat intolerances and sensitivities to chemicals in foods not allergies. Diet has been around since the early 80 s, but not well known outside Australia. Considered to be a more advanced diet than the traditional Feingold Diet, which Failsafe advocates consider to be incomplete and outdated. What Is Eliminated Through The Failsafe Diet? Approximately fifty artificial food additives including colors (like tartrazine, sunset yellow), flavors, preservatives and antioxidants (sulphites, nitrates, benzoates, sorbates, parabens). Salicylates (aspirin) and polyphenols (natural flavors, colors and preservatives) found in a wide range of fruits and vegetables. Neurotransmitters in food: free glutamates (MSG) and amines (histamine, serotonin, dopamine, phenylethylamine, tyramine and others) found in aged proteins and fermented foods like cheese, chocolate, game, and hung meat. Aromatic (strong smelling and tasting) chemicals found in perfumes, cleaning products, commercial cosmetics, and scented and colored toiletries, especially mint and menthol products. Some pharmaceutical drugs, including aspirin, NSAIDS and other COX II inhibitors including ibuprofen, and the methyl-salicylates found in decongestants and anti-inflammatory creams. Source: 18

19 Common problems seen with chemical sensitivities in children Dark circles under eyes, red cheeks and ears. ear infections, asthma, sinus problems. Diarrhea and digestive discomfort. hyperactivity, impulsivity, and aggression. Inappropriate laughter Bed wetting and day wetting Dyslexia Hives Headaches, head banging/self-injury. Impatience, short attention span. Difficulty falling asleep, night walking for several hours, inappropriate. Sensitivity to noise/lights/touch. Speech difficulties, tics and some forms of seizures. Failsafe Diet - basics Diet is mainly composed of fresh (non-vacuumed packed or hung meat), chicken, white fish, eggs, fresh dairy products (if tolerated, such as yogurt, cottage cheese, milk, and butter), some grains (if tolerated), peeled potatoes, beans and legumes, peeled pears, certain green vegetables. Heavy flavors, additives, exotic fruits, vegetables, and spices are not allowed. Failsafe Diet is an elimination/challenge test. Failsafe Diet - basics Diet must be treated as a scientific experiment The diet must be followed strictly. If not followed directly as outlined by the Failsafe program inconsistent results will be seen. Generally, it takes 2 to 4 weeks for results to be seen, sometimes upwards of 3 months may be needed. Once an individual is feeling well on the diet, or a parent notices positive physical and/or behavioral changes with their child they can begin the challenge phase of the diet. This involves testing each food or chemical individually 19

20 Amines Found naturally in some fruits and vegetables, as well as meats, alcohol, and dairy products, i.e. cheese from bacterial degradation. The amine content of food is variable and hard to quantify. Amines are derivatives of ammonia wherein one or more hydrogen atoms are replaced by a substitute group attached to the nitrogen atom. Glutamates Glutamic acid L-glutamate Monosodium glutamate Disodium glutamate 20

21 Main Difference Between Feingold and Failsafe Programs The main difference between these two programs: Feingold focuses on removing phenol and salicylate foods. Failsafe focuses on removing phenol, salicylates, amine and glutamates. Which includes certain medications, toiletries, cosmetics, perfumes, scented products, essential oils, and lotions. The Failsafe Program is a more advanced and comprehensive approach to elimination of potential offending foods and non-food substances. X Mark 21

22 Kidney Oxalate Crystals in Brain Oxalate crystal in meninges Oxalate Crystal in Nerve Tissue 22

23 Thyroid Oxalate Accumulation Oxalates and Autism Oxalate Resources and Additional Research Susan Owens, Ph.D - founder of Independent biomedical autism researcher found that some children with Pervasive Developmental Disorder (PDD) and Autism improved with a Low Oxalate Diet (LOD). Urine oxalate levels in children on the autismspectrum: In a 116 children (100 autism, 16 neurotypical), 36% of the autistic children had oxalate levels greater than 90 mmol/mol creatinine - the value consistent with a genetic hyperoxaluria. None of the neurotypical children had values this high None of the ASD kids had either glyceric or glycolic elevated on their OATs. 23

24 Comparison of Urine Oxalate in Autistic-Spectrum and Neurotypical children 700 oxalate mmol/mol creatinine t-test p <10-16 Oxalate above 90 is consistent with genetic hyperoxaluria Autistic Spectrum N=100 Normal Children N=16 Mean value for autism at 90.1 is at the lower cut-off for genetic hyperoxaluria. Correlation Between Urine Arabinose and Oxalate 800 Oxalate mmol/mol creatinine R= Arabinose mmol/mol creatinine 24

25 Ascorbic acid Some Oxalate Levels Can Be Extremely High Likely soy consumption Arabinose 25

26 4 year old girl Glycolic Very Low Vitamin B6 8 Year Old Boy 26

27 2 Year Old Girl Observed Benefits of Low Oxalate Diet Improved fine and gross motor skills. Improved handwriting skills Improved counting ability Increased receptive and expressive language ability. Increased imitation and socialization skills. Decreased rigidity Improved cognition More imaginative play Less self-abusive and aggressive behavior. Decreased bed-wetting and urinary accidents. Improved physical energy and lessened fatigue. Less sleep problems Other Factors Possibly Related to High Oxalate in Autism Craving high oxalate foods Behavior problems with glycine supplements such as Dimethylglycine (DMG) or Trimethylglycine (TMG), or even Magnesium Glycinate. Odd or negative behavior reactions on calcium supplements. Negative behaviors while on laxative products that contain polyethylene glycol (PEG) such as Miralax. Negative behavior after consuming high oxalate foods. 27

28 General diet recommendations: Adults following a low oxalate diet should be between 40mg to 60mg of oxalate consumption (maximum) a day on a 2000 calorie diet. Great resource for information about Low Oxalate Diet (LOD). Yahoo support group for people implementing LOD. Food list and recipes FAQ and Research section PDF available in Document Section for Module #5 28

29 Treating High Oxalates Beyond Dietary Intervention Other Support Vitamin B6 Probiotics Calcium + Magnesium Treat Yeast Diet Remove Oxalates SLOWLY from the Diet 5-10% per week For high oxalate patients, this could take a couple months or more. Removing them quickly can cause dumping symptoms, pain, and can overwhelm the system. Julie Matthews Nourishing Hope 29

30 Oxalate Dumping Sandy or grainy stools Pain with urination Urinary urgency Irritability, moodiness, etc. Potty accidents Painful bowel movements Possible rash red bumps on skin, hives, may be itchy. Yeast flare Cooking to Reduce Oxalates While cooking can reduce oxalates Reduction from boiling and soaking it reduces soluble oxalate by approx. 50%, and discarding the water. Roasting at high heat for 30 minutes can reduce oxalates in tubers (potatoes, sweet potatoes). However, this is not enough to make extremely high oxalate foods low enough to consume for a low oxalate diet. For example, extremely high oxalates: beets, sweet potato, spinach, Swiss Chard, and amaranth reduced by 50% will still be very high. Although, cooking can help get medium/high vegetables (12-20 mg) into an acceptable range. Julie Matthews Nourishing Hope Low Oxalate Diet Experience and Length of Diet Typically, people that need a low oxalate diet because of endogenous production, and those who have had high oxalates for years, will likely benefit from a long-term diet strategy of low oxalate. The body can still be dumping oxalate a year or more after the source of high oxalate is gone. Unlike other diets, where when you remove a food you see a positive result - with low oxalate, when you remove foods, you might see a negative result at first (from dumping). If you go slowly enough, you may see relief and benefit right from the start. Julie Matthews Nourishing Hope 30

31 Supplement Support for High Oxalates Calcium/Magnesium Citrate 1 to 2 capsules before meals to help prevent oxalate absorption. Capsules can be swallowed or opened up and mixed into food or drink. Cal/Mag Citrate 600mg each of Calcium and Magnesium Citrate. Binding Oxalates in Gut 31

32 Calcium Chewable w/magnesium 1 tablet with meals containing low to medium oxalates. 2 tablets with meals containing high oxalates. 1 tablet = 247 mg of calcium citrate & 50 mg of magnesium citrate High Dose Probiotics 1 to 2 capsules daily (two capsules = 225 billion organisms) ½ to 1 packet (one packet = 225 billion organism) Probiotics Helps to control Candida and destroy oxalates in the digestive tract, i.e. VSL#3, Pro-Bio Premium. Lactobacillus acidophilus and Bifidobacterium lactis have oxalate degrading enzymes. ProBio Premium, Ther-Biotic Complete, ProBiotic Support Formula all contain L. acidophilus and B. lactis. VSL#3 contains L. acidophilus, but not lactis. Probiotic Infant Formula contains B. lactis, but not L. acidophilus. ALL available from New Beginnings Nutritionals 32

33 Vitamin B6 Pyridoxine HCL Helps in oxalate metabolism enzyme function. Dosing suggestion is 100mg daily for adults. 25mg to 100mg daily for children. Additional Supplements Epsom Salt Baths 1/2 to 2 cups in bathwater - 3 to 7 times weekly. Epsom Salt Cream apply 1 gram 2 to 3 times daily. L-Arginine 500mg to 1000mg daily. Need to watch for underlying viral herpes viral problems, i.e. blisters. General Rule of Thumb Consume ½ body weight in ounces of pure water daily. For example, a 40lbs. (18kg) child should drink approx. 20 ounces of fluids daily, or 0.59 liters. 1 fluid ounce = liters Adjust consumption with increased activity. Hydrate 33

34 What About Vitamin C Supplementation? Vitamin C can break down to oxalate, but estimates are that at low levels of oxalate this system is saturated. A number of studies show little to no correlation with moderate amounts of ascorbic acid and oxalate problems: 85K women had no relation to kidney stones and ascorbic acid. Great Plains Laboratory (GPL) found zero correlation between urinary oxalate and vitamin C. The vast majority of ascorbic acids on the Organic Acids Test from GPL show low to low normal Vitamin C. Additional Factors Regarding Vitamin C and Oxalate Free copper accelerates vitamin C breakdown to oxalates. High percentage of kids on the autism-spectrum tend to have high free copper. Low Oxalate Diet advocates recommend small amounts of ascorbic acid, i.e. 200mg to 400mg daily. This is typically the dosing range I use for kids when oxalate levels are high and vitamin C level is low. Some websites for kidney stone patients recommend no more than 2000mg daily. Resources 34

35 Specific Carbohydrate Diet

36 Feingold Diet Failsafe Diet Julie Matthews, CNC 36

37 Module #6 Topic What You Need To Know About Methylation and How To Get Started: What is methylation and why is it so important in autism? What methylation supplements do How to get started with methylation support The important role of Methyl-B12 Thank You Kurt N. Woeller, D.O