I have talked before about serotonin levels within kids with special needs, particularly those on the Autism spectrum. I have also talked about how serotonin has an influence on learning, on brain function, on mood, on states of happiness. That is the reason why many individuals are given medications like Prozac or Paxil or Zoloft, these things are called serotonin reuptake inhibitors because for many people in our society, serotonin becomes depleted and people become depressed. Now for kids on the Autism spectrum, what appears to be happening with many of them is that they can’t convert serotonin into its more active form and that has adverse effects on many of the overall core issues we see in Autism from self stimulatory behavior to language issues to eye contact problems to behavioral problems.

There is an enzyme in the brain called MAO-A (monoamineoxidase A) that seems to be one of the problem areas. MAO-A which helps with this conversion of serotonin into its active form is not working appropriately. Now there is actually a therapy called reserpine, reserpine is from an Indian herb. This has been shown in the past to be used with individuals on the Autism spectrum even dating back into the ‘50’s where reserpine was used to help boost the levels of MAO-A and to help essentially with many of the core issues we see in Autism. There is actually a therapy called Respen-A which is a patch, it is a homeopathic derivative of reserpine which is showing some good benefit with respects to many of these core issues, the eye contact, the focusing, the attention, the self stimulatory, the sensory seeking behavior, the language problems that are so common.

So the complexities of brain chemistry are being unfolded more and more as research goes on into the complexities of Autism. But that is one particular area that is of great interest is this link between serotonin, is the link between MAO-A activity and the potential use of this Respen-A as one therapy that can help in this area.

Let’s talk a little bit about the differences between gluten sensitivity and Celiac disease. Now for most of the kids on the Autism spectrum we talk about the gluten and casein free diet as a primary diet to help reduce some of the inflammatory proteins that are found in gluten. Gluten is found in wheat and casein is found in dairy. But we know that these foods also have a drug like effect on many kids because they have something called peptides. Peptides are small amino acid chains that can influence brain chemistry adversely.

So gluten sensitivity is actually having an intolerance in the body to the gluten protein found in the wheat. Celiac disease is a form of gluten sensitivity except that with Celiac disease it is actually a genetic disorder where you truly lack the ability to breakdown the specific proteins found in wheat, one of them being gluten, another one is something called gliadin. Gliadin is actually a subfraction of gluten and it is an inflammatory protein in individuals with Celiac disease where they lack the specific enzymes that allow them to process that protein in the digestive tract. Then it creates an autoimmune reaction, auto meaning self, immune reaction in the gut and that leads to an inflammatory type process and essentially over time it starts to wear away at the surface lining of the gut. What I often tell people is you can have a gluten sensitivity and not Celiac disease but if you have Celiac disease, you have gluten sensitivity. Everyone with Celiac disease has a gluten sensitivity but not everybody who has a gluten sensitivity has Celiac disease.

Testing for it can be somewhat complicated. You can do an IgG food sensitivity profile and look for reactions to gluten, to look for reactions to gliadin and even to look for reactions to the entire wheat complex if you will. That only identifies a sensitivity reaction. The Celiac disease tests are more in-depth. You can do IgA as well as IgG reactions to gliadin. You can do an IgA reaction which is an immune test for something called transglutaminase. There is also something called reticulin antibodies. Many times to get a confirmatory diagnosis, some gastrointestinal doctors will also put a scope down into the intestinal system and take biopsy samples of different parts of the intestinal tract to see if there are cellular changes specific to Celiac disease. So it is a little bit more in-depth getting a diagnosis of Celiac disease as opposed to getting a diagnosis of gluten intolerance. The treatment for it is essentially the same and that is the avoidance of gluten proteins. I just wanted to make you aware that there is a distinction between gluten sensitivity and Celiac disease. With kids on the spectrum it is one of those things that we make a common recommendation for because we know it helps so many of them, not only from a digestive standpoint but from a cognitive standpoint.

Let me talk a little bit about regression particularly now that the holidays are over with, regression after the holidays. I have seen a few kids in my practice where regression is really hitting them pretty hard and obviously it is very disturbing for their family. Kids who were doing pretty well, language, eye contact, socialization and things seemed to be on the mend, improving and now all of a sudden we have a child who has regressed, they’ve lost eye contact, they’ve lost language, they are doing more self stimulatory behaviors, their sensory seeking has increased, what could be going on?

Well a couple of things particularly after the holidays, first thing I’ll always want to find out about is dietary infractions that may contribute to regression. Have there been any infractions with the diet whether it is gluten that they were not eating that they got over the holidays or dairy that they were not eating that they got over the holidays. Is that a possible trigger for regression? If not, another avenue is sugar, kids just naturally being exposed to more sugar and artificial ingredients through the holidays whether it is being at a friend’s house, parties at school, wherever it may be, that can also contribute to regression. Sometimes just a change in diet can bring on some of these regressive behaviors. Usually, particularly too if your child has any sort of yeast sensitivity, increasing sugars in their diet sometimes bring a worsening in yeast and obviously that can lead to eye contact problems and self stimulatory behaviors and sensory issues associated with regression.

Sometimes just the change in routine, as school is getting out, we’re now on to the holidays, there is a lot of excitement, people are traveling, sometimes that change can disrupt the normal routine for a child and that can cause regression with some kids. Also, transitioning back into school, if your child is of school age where they have been off for a couple of weeks over the holidays, now they are being transitioned back into school and that can contribute to regression. Or their therapies are starting up again so things are a little bit altered that way, maybe they are feeling overwhelmed and that is causing regression. There can be a combination of these things happening to cause regression. But sometimes you just simply have to look back and find out what changed in their environment, what changed in their routine and what may be changed in their diet that may have contributed to some of the regressive patterns that you are currently seeing with your child.

I am often asked the about the difference between a medication such as Nystatin and a medication such as Diflucan and their effects on yeast and what are some of the things you need to be aware of when using these medications. Both Nystatin and Diflucan are considered antifungals which mean they have an eradication or inhibiting or killing effect against yeast organisms, specifically candida.  We know that candida is a big problem for many kids on the spectrum. We commonly treat using Nystatin and/or Diflucan to lower the levels of candida to bring on improvement in behavior. We know yeast can increase stimming behaviors, silly, goofy and giddy behaviors, and other negative behaviors. Nystatin is considered a local antifungal.  It inhibits the overgrowth of colonies of yeast that line the digestive system. There is no significant absorption of Nystatin into the bloodstream so it can be taken long term with no major concern.  It can be taken for months or years in many cases. Think of Nystatin like Pepto Bismal, Pepto Bismal coats the stomach and Nystatin coats the inner lining of the digestive tract.  Because it coats the lining of the digestive tract, generally we need to take it several times a day to keep that coat in place.  So, 3, 4 or even 5 times a day is ideal, even though that is difficult to do. Minimally 3 times per day, preferably 4 and Nystatin becomes quite effective. In comparison, Diflucan is considered a systemic antifungal which means when you take it orally it will be absorbed into the blood stream within about 2 hours. It also has a local effect in the digestive system as well but it is absorbed into the body and is metabolized in the liver. So there is the potential for risk of liver stress with long term use.  So if your child is taking Diflucan you will want to run blood work every 6 – 8 weeks in my experience to check for liver stress.  What you can do with Diflucan is you  can take it for a short time like 2 weeks, 3 weeks or 4 weeks and then take a couple week break and cycle back to it and in many cases that works well. There are other medications that fall into the same category as Diflucan called Nizoral, Lamisil and Sporonox. The primary ones I use in my practice are Diflucan and Nizoral and both are systemic and so with use over a prolonged period of time, you do need to check liver enzymes function. Nystatin really doesn’t need to have the liver function tests because it just stays in the GI tract.  As a recap, both Nystatin and Diflucan are antifungal medications. Nystatin has a local effect with minimal systemic absorption, if at all. Diflucan is a systemic antifungal so you do need to do liver tests to check for liver function periodically.

What are probiotics and what do they do? A probiotic by definition is something that helps to promote life. This is the normal bacteria in our digestive tract. Many people don’t realize that our digestive tract harbors billions and billions and billions, if not trillions of bacteria and sometimes yeast that are health promoting to our body. They have a regulating effect on our immune system, they help us assimilate vitamins and nutrients from our foods and are absolutely necessary for us to survive. Probiotics are supplements that help provide some of the normal bacteria, called flora, for our overall health. We know that taking certain drugs like antibiotics can deplete a certain percentage of the normal flora. So probiotics are supplements that can be used to build back up the normal flora levels. We commonly use probiotics for kids on the spectrum to improve their digestive health and improve their overall immune function by giving probiotics. There are a wide variety of probiotics. The two that you have probably heard of bacteria wise are acidophilus and bifidobacter. We know that Acidophilus is a bacteria that generally resides in the small intestine and bifidobacter usually resides in the large intestines. They are both very important for keeping a balance of healthy bacteria in the gut. When you give a multi spectrum probiotic, an example would be the Probiotic Support Formula from New Beginnings or Therbiotic complete from Klaire labs, those are a multi-flora probiotics. They are generally health promoting, they give a wide variety of normal bacteria, sort of like a multi-vitamin for your child’s digestive system. There are other types of Probiotics that are more treatment specific like Culturelle. Culturelle is a specific type of bacteria called acidophilus GG and it has a specific affinity for clostridia bacteria. Clostridia bacteria is pathogenic and it does cause problems in the body and for kids on the spectrum. Culturelle is very target specific for colostridia. There is another probiotic called VSL #3. VSL #3 is a very high potency lactic acid producing probiotic that is very helpful for breaking down oxalates. Oxalates are organic compounds that we get through our foods, they can cause mineral depletion in the body and in some people when they are absorbed in high amounts over prolonged periods of time can lead to kidney stones. So VSL #3 is very oxalate specific. Threelac is another type of probiotic and its effects are more antifungal, it tends to attack more yeast. So you think of Threelac as something that you would be using as an anti-yeast treatment. There is another type of probiotic that is commonly used called Saccharomyces boulardii. Saccharomyces boulardii is actually a yeast so it may not fall into the classic definition of a probiotic because it is not something that is essential for our health and well being but it can be used as a remedy to help attack and eradicate Candida. It also does help to attack clostridia. Saccharomyces boulardii is a more treatment specific type of probiotic. Probiotics are very important supplements for interventions for your child, especially in respects to digestive health and come as both broad spectrum probiotics and treatment specific probiotics.

One of the first things I ask parents in my practice is about how their child is sleeping. If your child is not sleeping, that generally means mom and dad are not sleeping which leads to exhaustion, frustration and a breakdown of the family unit. Sleeping is very important and children should be sleeping between 8 and 12 hours per night. Some children sleep very little, 1 -2 hours per night or have very erratic sleep patterns. Some questions to ask are does your child go to sleep easily? Does your child have difficulty falling asleep. If they do go to sleep easily, do they wake up in the middle of the night? If they wake in the night, what are they doing when they wake up? The most desirable pattern is a child who falls asleep between 20 and 30 minutes of going to bed and who sleeps through the night. Many times you can have a child with a combination of sleep problems, who has a hard time falling asleep and wakes up in the middle of the night as well. If you have a child that wakes at night, you need to be aware of what they are doing. Are they coming into your room? Are they agitated? Are they talking to themselves? Are they playing? Are they stimming? Are they goofy, giddy or silly? These things can tell us what may be going on medically and biomedically that we can intervene with to treat sleep issues in Autism. If you have a child that wakes up at 2 am or 3 am and is goofy, giddy or silly, you may have a child with an underlying yeast problem. If your child is waking up and is agitated it could be an underlying bacterial problem or even possibly an underlying seizure disorder. Your child could have a food allergy or sensitivity as well that is making sleep problematic. A very simple remedy for sleeping problems in Autism is melatonin. Melatonin is a hormone that is secreted by the pineal gland in the brand. It is the molecular equivalent to darkness. Melatonin is secreted when it gets dark and helps our brain go to sleep and sleep through the night. A dose as low as 1 mg 20 – 30 minutes before bed can work wonderfully for a child who has a hard time going to sleep. Or you can give a dose at bedtime to help keep them asleep. Or you can give melatonin in the middle of the night, 1 – 3 mgs to help them go back to sleep. The typical dose is 1 mg for a child who just starts using it, you can even start with a ½ dose for the first time. Some children need 2 mg – 3 mg, I have even recommended up to 4 mgs. I recommend New Beginnings Nutritionals and they carry a 1 mg melatonin. There can be other issues that contribute to sleep disturbances but melatonin can be an easy, natural remedy for sleep issues and autism. I cover more information on Autism and sleeping issues but melatonin can be a very easy remedy to sleep issues in Autism.

Magnesium Sulfate, aka. Epsom Salts have been around for a long, long time. We’ve used them for aches and pains, join aches after vigorous exercise or for a child who is feeling sick. When they have a cold or the flu, a nice warm bath with Epsom salts makes them feel better. Epsom salts has also been a remedy for constipation. You can take a can a little Epsom salts to help flush the bowels. As it turns out, Epsom salts are also a nice remedy for some children on the Autism spectrum. Epsom salt is magnesium sulfate. Magnesium is a mineral that is very relaxing to the body. Many people, particularly in the United States, have a deficiency in magnesium levels. That can contribute to sleeping problems, behavioral issues, cramping muscles and a tendency to just not feel well over all. Magnesium can be absorbed and can cause relaxation. If it is swallowed in bath water it can be beneficial for kids with constipation. The other component to Epsom salt is sulfate. Sulfate is commonly deficient in children with Autism. We can measure serum sulfate levels which most of the time are low. The biochemistry with kids on the Autism spectrum is quite unique and there are various deficits that happen where the sulfur chemistry becomes depleted. This is important because sulfur chemistry is deeply connected to detoxification. The detoxification system in our body is critical to rid the body of toxins and for many kids we know that toxicity is a big problem. Simply adding Epsom salts to your child’s bath can be a nice remedy not only to add magnesium but to add extra sulfate to their system as well. Normally you can add between 1 and 2 cups of Epsom salts. If you have never done Epsom salts, I would recommend 1/2 cup to their bath water for the first night. Some kids may have sensitive skin and may have some slight irritation but each night thereafter you can slowly increase the amount of Epsom salts depending on their reaction. On Average most kids in my practice use between 1 ½ to 2 cups of Epsom salts nightly, on occasion I have recommended 3 cups or more depending on their size and tolerance. Epsom salts is a nice remedy to add to your child’s bathwater at night, it can have a calming effect. Another thing to consider with respects to Epsom salts is that some kids have reactions to phenols. Phenols are chemicals in certain foods like dark fruits and vegetables. Phenol reaction for most kids can manifest as hyperactivity, irritability, agitation and a sense of being over excited with respects to behavior. We know that phenol sensitivity can also lead to headaches and psychiatric issues. A good example is artificial food colors. If you have seen your child have a behavioral problem after eating an artificial color you are likely seeing a phenol response. The chemical in the body that helps process phenols is sulfate. Through the sulfur chemistry system, if we add Epsom salts to the bath water at night we can start to increase the sulfate system in the body, improve the efficiency of sulfur chemistry and many times phenol sensitivities can be diminished. Think of Epsom salts as one biomedical remedy for your child simply by getting some Epsom salts from your local drugstore and adding it to their bath water on a nightly basis.

What is a biomedical approach to Autism?  The majority of individuals on the Autism Spectrum whether it is a child, teenager or adult are dealing with some underlying medical conditions.  These conditions can range from digestion problems, hormone imbalances, metabolic problems, biochemical imbalances, food sensitivities, heavy metal toxicity or a combination of those things.  What we do as physicians is run various medical, diagnostic tests that you may be able to get from a regular lab.  We are looking at things like complete blood count, iron levels, thyroid problems, and cholesterol levels.  But many times we do need to use specialized tests to look at immune function, heavy metal toxicity, genetic imbalances, biochemical imbalances, etc.  When we put all of that information together and implement various therapies, many times individuals respond tremendously.  We see better eye contact, better focusing, better behavior, more ability to learn and comprehend and the ability to become more environmentally aware.  And for some individuals they can lose their Autism diagnosis and move off of the spectrum.  Other kids may just improve overall but they still may fall somewhere on the spectrum but there are more integrated with their family, happier and more aware.  Children on a biomedical treatment plan for Autism can learn, integrate and socialize better.  The biomedical approach to Autism is very comprehensive, it is not just one thing but a combination of things.  Learn more about the biomedical approach to Autism and understand that it is a comprehensive medical system.  The things we do like testing and treatments are rooted in science have been clinically studied as well as has been studied through research facilities.  There is a tremendous amount of hope and healing that can happen for your child.  There are many biomedical treatments and assessments that can help your child on their path to recovery from Autism.