The incidence of autism has increased by an alarming rate in recent years. In the early 1980s, the prevalence of autism was roughly 1 in 10,000 children. Today 1 in 150 children develop autism. Rates for Australia have been calculated to be up to 1 in 125 and, in New Zealand, 1 in 100. It has reached epidemic proportions.
The increase in the rate of autism cannot, as some insist, be due solely to better diagnosis. In most children with untreated autism, symptoms usually become worse over time. If the increase in the rate of autism these days is due to better diagnosis, then where are all the young adults with autism now?
Neither can genetics account for the rapid increase in the rate of autism, as genes simply do not change so fast. While genetic factors are involved, the development of autism largely depends on multiple environmental insults. The possibility of improvement and even recovery through modification of the relevant environmental factors therefore becomes a reality.
Defining autism
On the whole, conventional medical practice views autism as purely a psychiatric disorder. However, over the last couple of decades, with new research and understanding, a biomedical approach has evolved which sees autism as a neuro-developmental disorder with impairment of brain function as just one of its symptoms.
In fact autism is the most severe of several Autism Spectrum Disorders (ASD). These disorders can often sound like a jumbled alphabet. The main ASDs are autism, Asperger’s syndrome (AS), Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) and Rett syndrome (RS). Others illnesses belonging to the spectrum include oppositional defiance disorder (ODD) and obsessive compulsive disorder (OCD); some specialists even class attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) as the mildest forms of ASD.
There are several types of autism. In infantile autism, typical neurological development never occurs. Some autistic symptoms are evident from birth while others become obvious as developmental milestones are not reached, particularly with speech.
Regressive autism occurs when initial development is normal and healthy and then at a point, often around 18 months of age, development starts to regress. First signs may be a loss of language skills or eye contact.
High functioning autism (HFA) is a condition where individuals display autistic characteristics, particularly social impairment, but are able to function at close to a normal level in society. They are often very intelligent and sometimes gifted, their symptoms only becoming obvious in social situations where they may be unable to predict or read other people’s emotional responses to events, such as something that has been said. They may appear somewhat disconnected or removed, particularly in situations where there is a lot of sensory stimulation.
Asperger’s syndrome is a pervasive developmental disorder, often referred to as a form of HFA, which is characterised by normal or above-average intelligence and poorly developed social skills with emotional and social development occurring later than normal. Some children previously diagnosed with autism may be re-diagnosed with Asperger’s if they show improvement.
The experience of autism
The symptoms of autism are many and vary between children. Generally, autism is diagnosed before two years of age. Most autism is regressive. Warning signs indicating a medical assessment is needed are:
Other classic symptoms of autism include:
Autistic children are typically very resistant to change, whether it be new foods, clothes, toys, routines or even furniture arrangements. They often become very attached to a particular object. They will often “zone outâ€, staring for hours into space or at running tap water.
Fifty per cent of untreated autistic children never learn to speak; those who do learn much later than normal and often the language that is learnt is used in an unusual way. They often repeat words that have been spoken to them (called echolalia) and incorrectly use pronouns, such as saying “you†instead of “I†or “me†when referring to themselves. They also often have an unusual rhythm of speech and exhibit high-pitched squeals. Autistic children rarely have interactive dialogue with others.
Seventy per cent of untreated autistic children have some degree of mental impairment. Their performance can be very uneven and they may develop what are called splinter skills where they may excel at music or calculating complicated mathematical equations in their head. Ten per cent of autistic children display savant abilities, often with complicated mathematics, music or art, and may then be hailed as prodigies.
Causes of autism
The biomedical paradigm views autism as being a disorder arising from a multi-system breakdown involving metabolic and/or immunologic and/or digestive dysfunction resulting in neurodevelopmental delay and impairment.
Other than the neuro-developmental symptoms listed above, autistic children have many digestive, metabolic and immune dysfunctions in common. Autistic children often suffer from one or a combination of conditions such as asthma, eczema, diarrhoea or constipation, bloating and gas, foul-smelling bowel motions, poor sleep patterns, poor immunity, recurrent ear infections, fussy eating and abdominal pain.
This is due to the fact that they usually suffer from one or more of the following: leaky-gut syndrome, digestive dysfunction, poor dietary choices, nutritional deficiencies, food intolerances or sensitivities, candida, parasitic or bacterial gut infections (or all three) or heavy metal toxicity.
One of the environmental insults that contribute to the development of autism is impaired detoxification pathways, which may result in an overload of toxic or heavy metals. Live viruses and bacteria, the toxic load of the mother prior to and during pregnancy, pre- and post-natal vaccines, heavy metals in air pollution or vaccines, pesticides, overuse of antibiotics and toxic ingredients in water may also impact on a vulnerable child. While none of these factors alone causes autism, a combination may lead to the development of autism in a vulnerable child.
A family history of ASD, allergies, eczema, asthma, depression, schizophrenia, thrush, irritable bowel syndrome, inflammatory gut disorders and/or autoimmune diseases has been noted in children with ASD.
The future with autism
These days, there are many treatment options available due to a better understanding of the disease. As the Autism Research Institute states, “Autism is treatable; recovery is possible.†While avoiding the promotion of false hope, it is important to understand that many parents have recovered their children from autism with a multidisciplinary approach.
Children who receive intervention at an early age are noted to have more favourable outcomes. Early diagnosis and intensive biomedical treatment as well as speech, occupational and behavioural therapies may lead to a typical life. In recent years there has been a significant increase in the percentage of children who are able to enter mainstream schooling and eventually live semi-independently in community settings. However, even with substantial improvements, the majority of those affected by autism remain at least partially impaired in their social and communication abilities.
Biomedical treatment
Leading physicians have now found that autistic children have many common underlying conditions involving the gut and immune systems. These have been shown to lead to the neurological symptoms of ASD. The biomedical approach addresses these factors.
Five key areas in the biomedical approach to autism and ASD
These areas overlap and medications may also be necessary for some children. Dietary intervention is a key aspect of effective treatment for ASD. Hippocrates was right when he said, “All disease begins in the gut.†Autistic children have been shown to have a high level of digestive dysfunction and inflammation, which leads to ASD behaviours. Dietary intervention builds the very important foundations on which medical and bio-medical treatment can be given in a safer, more effective manner. For this reason we will focus on the dietary approaches.
Dietary approaches
The aims of dietary intervention are to:
Dietary intervention restores the functions of digestion, absorption and elimination. The immune system is strengthened, resulting in fewer infections and an improved ability of the body to detoxify itself. Neurotransmitters that affect behaviours, concentration, mood, sleep and addictions are also balanced by resolving the nutritional deficiencies that create an imbalance of these critical brain chemicals. For optimal results, it is important that dietary modification is done concurrently with nutritional medicine, gut repair and detoxification.
Removing allergens
Food allergies and sensitivities need to be addressed. Some children may require a low-phenol/salicylate diet or a low-oxalate diet. The best-known diet for the treatment of autism is the gluten-free casein-free (GFCF) diet, often called the autism diet.
Gluten is the protein found in wheat, barley, oats, rye, spelt, triticale and kamut. Casein is the protein found in all milk and products made from milk. Eliminating these two proteins is an important first step to dietary intervention.
Many children have significant improvement from eliminating gluten and casein. However, for others it has little effect and so a premature conclusion is drawn that diet has no effect on autism. This has done a great disservice to the ASD community. Gluten and casein play only one part in a very big production of dysfunction.
The gluten/casein connection
The main problem with gluten and casein in the diet of children with autism is not actually an allergy or sensitivity issue. The issue is that gluten and casein break down into peptides (clusters of amino acids) which have a very similar shape to opiates, such as morphine. Normally, such peptides are not able to be absorbed through a healthy gut. In an inflamed gut, on the other hand, tiny gaps appear between the cells of the gut wall, resulting in leaky-gut syndrome.
Most, if not all children with ASD have leaky-gut syndrome. These microscopic gaps that develop are large enough to let the peptides through before they have the chance to be broken down into their building blocks of amino acids.
The peptides from gluten and casein are called gluten-exorphine and casomorphin. Due to their opiate structure, they are able to cross the blood-brain barrier and attach to opiate receptor sites. The opiate response results in symptoms such as “zoning outâ€, repetitive behaviour, sleep disturbance, constipation and high pain tolerance.
This opiate response is why many autistic children are very finicky eaters: their diet often consists completely of wheat- and dairy-based foods. In this sense, it is actually an addiction we are dealing with, a solid biochemical reason for demanding these foods. Many parents fear their children will starve if they take gluten and casein out of the diet; however, once these foods are removed in a calculated fashion, the child’s palate tends to open up and they are happy eating a much wider variety of foods.
Other than gluten and casein, other substances that need to be eliminated from the diet are artificial colours, flavours, sweeteners, preservatives and other food additives.
The right bacteria
In many children with autism there is a lack of good bacteria and excess of bad (pathogenic) bacteria in the gut. Diets to correct this essentially focus on removing foods that feed pathogenic microbes in the gut (since pathogenic microbes cause inflammation and immune dysfunction). The diets emphasise the importance of including certain foods which are beneficial for killing off pathogenic microbes. Killing of pathogenic microbes also makes meal times easier as these microbes drive the appetite towards sweet and starchy foods.
The first one to two weeks of making dietary changes can be very challenging for all involved. Once this challenge is overcome, feeding often becomes easier than it has even been before. Rather than eliminate foods from the diet straight away, it is easier to introduce beneficial foods first: in particular, homemade fermented vegetables and fresh young coconut water kefir. These foods are very alkalising (opportunistic microbes in the gut require an acidic environment to thrive) and cleansing. They are also a great source of vitamins and minerals — many times more than raw or cooked vegetables.
Once the gut is healed, many foods that were once proving allergenic may be able to be reintroduced.
Heavy metals
Resolving any heavy-metal toxicity (very common in ASD) is essential in resolving gut dysbiosis. Pathogenic microbes such as candida tend to thrive in the presence of heavy metals. Heavy metals affect brain development and function and interfere with detoxification pathways, leading to further implications.
Chelation is a process whereby a substance is used to bind to certain minerals — in this case, heavy metals — enabling them to be removed from the body via faeces, urine or hair. Many chelating methods are available, both drug based (eg, DMSA, EDTA) and natural (eg, zeolite, footsies, coriander drops, selenium, metal-detox drops, spirulina etc). The method used will depend on which heavy metals are found to have accumulated in the child, and to what degree.
Nutritional supplementation
Nutritional supplementation is required for most ASD children. Some nutrients may be needed early in the process to stimulate certain processes of detoxification and gut repair. Other nutrients will be introduced once initial gut repair has been achieved, as absorption rates will be improved.
Zinc is the most common mineral required with ASD as at least 60 per cent of ASD children have an actual or functional deficiency of zinc. Other nutrients commonly used are essential fatty acids, vitamins B6, B9, B12, magnesium, dimethyl-glycine (DMG) and glutamine, among others. Specific supplementation is tailored to resolve any nutritional imbalances, enzyme dysfunctions and neurological and immune support.
It is important to be aware that some children do very well with some nutrients while others can react to them. For this reason it is important to be guided through the process with an experienced practitioner schooled in the area of ASD.
Since there are so many dietary aspects to ASD, it is highly advisable to consult with a practitioner who understands the principals of the biomedical approach to ASD. Implementing dietary intervention means that all other aspects of biomedical treatment will be much more effective.
A challenge worth taking
Addressing all the factors involved in ASD can be complicated and making changes in the diets and lifestyles of children who are so resistant to change can certainly present a challenge. Thankfully, motivation to stick to treatment is delivered in fits and bursts along the way in the form of breakthroughs — your child has eye contact with you, or can express themselves verbally or say “I love you†for the first time.
Addressing diet, repairing their inflamed, painful digestive tracts and removing toxic substances from their bodies will help their physical, mental and emotional health to thrive, resulting in a more comfortable and liberated life for the child, the family and eventually the community.
Helen Padarin practises at Pymble Grove Health Centre in Sydney, specialising in autism, ASD, AD/HD, eczema, asthma, allergies, gut and immune disorders and stress management. www.pymblegrove.com and www.nourish-ed.com. Ph 02 9418 1388
