Archive for the ‘Diets’ Category

Concerns About Nutrition in Restricted Diets

Sunday, January 31st, 2016

Achieving an Optimal Medical Outcome
A Play in 3 (very short) Acts
By Brian D. Udell, MD

CHARACTERS

Dr. Udell Medical Director of Pediatric Special Needs Practice. Forty years of experience. Doesn’t take any crap. Prone to voicing his opinion.
Mom A great mother who tries to listen to all the professionals, research the ‘net, and get the best care for her child. Seeking another opinion from Dr. Udell.
Bobby – the kid Beautiful 4 year-old child with autism. Speech apraxia and social isolation are the most significant problems.

SETTING
The Child Development Center of America, in Davie, Florida. Typical tropical rainstorm on the outside. While the child is being observed via cameras in the playroom, a discussion ensues in Dr. Udell’s medical office.

TIME
The present.

ACT 1
MOM
I came to see you because the doctors over at the hospital want to put a gastric feeding tube into my child. He got sick with intestinal blockage 3 months ago, then pneumonia 2 months ago, and now he won’t eat anything but Pediasure. Also, we have to give Miralax all of the time, or Bobby won’t poop for 3 or even more days.

Dr. UDELL
Do any of the doctors know that Bobbly has autism?

MOM
Well, I guess so. But they are all worried about his nutrition. Without the Pediasure, he won’t eat anything. He wasn’t growing and we are all scared. But, I don’t want to put a tube into my child.

(Dr. UDELL performs a physical examination and goes over the chart containing information from previous visits.)

Dr. UDELL
I see here that the child is really intolerant of casein. Also, our notes reflect that there was some variable response to biomedical protocols. What happened with that?

MOM
We did everything that we could to get him to eat. Especially after he got sick recently, this was the only was to make sure that he was fed. At least now, he drinks the Pediasure – just won’t eat anything else.

ACT 2
Bobby enters. He makes pretty good eye contact with his mom, mostly ignores the doctor, says some words that make sense and are very clear (“go home”), and others that are unitelligible. Echolalia and scripting. Then, back to the playroom. The staff interacts with him, but mostly he wanders by himself, with occasional hand flapping.

Dr. UDELL
Is he getting Speech and Language Therapy?

MOM
The insurance… we’re waiting for that.

ACT 3
(Dr. Udell seems upset. He closes the door, slowly raising his pitch, and pointing his fingers.)
Everything that you have told me, and everything I know about your child tells me that all his problems are really one problem – Autism. Somehow his immune system and his gut are involved. Nutrition is surely a factor.

(Dr Udell’s voice more sympathetic now.) You are a great mom. What these doctors are suggesting is not only un-helpful, it could lead to permanent problems. Where does this cycle of Pediasure and Miralax for constipation lead to? Abilify for stimming and Adderall for hyperactivity.

(Dr. Udell sounding more authoritative.) The main deficit is speech. At this crucial time in your child’s less-than-5-year-old development, whatever you do from this point forward, ought to be focused on improving communication, especially producing useful speech. And, Bobby even exhibits occasional flashes of that skill… he’s in there!

To the extent that addressing gut and nutritional issues advances that goal, we should capitalize on our ability to pursue. But… THE BRAIN TRUMPS THE GUT. The child will reach the age of ten or twenty – either bigger or smaller. But, will he talk?

(Dr. Udell’s right finger pointing in the air). To prove my point, I offer the following scenario: A doctor says, “I have a pill that will definitely increase the chances that useful language will emerge, but it may result in a loss of a few pounds in weight or inches in final height. Otherwise, there are no other significant risks. And, it will take time, effort, and resources. It may seem that the child is starving, but we will make sure that doesn’t happen.”

Or, the family could be satisfied with a rubber tube that pumps fake milk into a child’s stomach, assuring nitrogen balance and optimal growth. The child’s autism? That’s not their problem – and, anyway, there’s little that can actually be done, other than conventional therapies and take your chances.

(Dr. Udell seems really upset.) There really is no in-between. ASD is associated with gastrointestinal issues, including oro-motor functioning, sensory processing, GERD, and constipation. And, there are no pickier eaters than those who suffer from restricted interests and repetitive behaviors.

Whatever it takes to achieve some minimal nutritional support, a way can usually be found to address the lack of interest in real food. And, it starts with a speech and language professional who understands that feeding therapy is the most basic part of the patient’s issue. If it takes 3 or more months of slowly introducing necessary supplements, medications, and yes, even foods, that’s OK. Because communication – not nutrition – is the paramount issue of that period in the child’s recovery. (Dr. Udell is standing, and breathing rapidly).

EPILOGUE
Nearly 30 years ago, as a practicing neonatologist, I introduced the first computer program for feeding tiny babies. As a pediatrician treating infants who were suffering from cocaine addiction, poor prenatal care, and even HIV/AIDs, our NICU was responsible for working with nutritionists, nurses and parents to best address dietary needs in very sick newborns.

So, as the epidemic of signs and symptoms that are presently called Autism Spectrum Disorder evolves, my perspective on the topic of achieving optimal nutrition has advanced and adapted to meet the needs of each individual patient.

Antibiotics and Autism, too

Sunday, January 17th, 2016

One of my most re-tweeted essays is The Law, Antibiotics, and Autism, which is a discussion involving a recent Federal Court ruling. The final verdict was that, even though antibiotics in our food are admittedly harmful, the LAW’s hands are tied, and the practice would continue.

The evidence shows that resistant strains of bacteria are being created due to the addition of bug-killers in animal feed. Tweeters questioned my jump to the association with autism.

Is there any association
between antibiotics and ASD?

Evidence
More than 10 years ago, a proposed mechanism was offered as evidence that demonstrated increased antibiotic treatment in “… 206 children under the age of three years with autism… A significant commonality was discerned and that being the level of chronic otitis media.”

A well-researched paper entitled Microbiology of regressive autism concluded, “This shows that penicillins and cephalosporins… have a major impact on the normal bowel flora and therefore might well predispose subjects to overgrowth of such organisms … of particular importance for autism…”

There is even information (animal and human) that microbes in the mother’s G-I system affect the developing fetus.

Mostly, however, the overwhelming evidence is the preponderance of children with signs and symptoms of ASD who offer histories consistent with multiple trips to the doctor, and suffer from a myriad of gastrointestinal ailments, which seem to respond to probiotics, anti-fungals, and targeted antibiotics.

Discussion
Women who are pregnant, or thinking about becoming so, should try to avoid all pharmaceutical agents, unless absolutely necessary.

Doctors should take note of this and make every reasonable effort to avoid the knee-jerk response to prescribe a ‘z-pack’, or 10 day course of amoxicillin, at every turn.

Conclusion
Once it became established that antibiotics in the food chain cause harm, it shouldn’t really matter exactly what havoc they wreak, for the FDA to protect us. If medication gets into the livestock, it pretty much gets into mother’s milk and your kid’s chicken nuggets.

However, autism is the epidemic that hundreds of thousands of parents are facing. While an increased rate of two variables doesn’t prove a relationship, common sense dictates caution, at least, in their continued indiscriminate use.

Top Autism Stories of 2015

Tuesday, December 29th, 2015

An end-of-the-year GoogleScholar.com search for publications using the term AUTISM returned ~ 58,000 entries:
√ Treatment = 32,000 results
√ Diagnosis = 19,000 items
√ Cause = 19,000 records
√ Prevention = 10,000 entries

Here are the stories that represent this year’s salient research and experience (according to TheAutsimDoctor, at least):

December
Reduced GABAergic Action in the Autistic Brain
Evidence of this neurotransmitter showing reduced activity in the autistic brain. The supplement form is not able to cross into the brain However, it is sometimes helpful as a calming agent, though the opposite effect also occurs.

Cell cycle networks link gene expression dysregulation, mutation, and brain maldevelopment in autistic toddlers
“Further underscoring the prenatal origins of ASD, researchers… describe for the first time how abnormal gene activity… may underlie abnormal early brain growth in the disorder.”

Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children
This is a BIG DEAL, to be discussed in a future posting.

November
Transcranial Direct Current Stimulation Treatment in an Adolescent with Autism and Drug-Resistant Catatonia
A possible new (and really expensive) treatment for ASD?

October
Oxytocin ‘Love Hormone’ Nasal Spray Shows Promise in Kids With Autism
Previously reviewed here.

EARLY SCREENING OF AUTISM SPECTRUM DISORDER: RECOMMENDATIONS FOR PRACTICE AND RESEARCH
Someone at the American Academy of Pediatrics gets it.

September
Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder
This research bears out my experience as a neonatologist; the type of birth, per se, does not appear to lead to ASD.

August
Draft Recommendation Statement
Autism Spectrum Disorder in Young Children: Screening
A formal recommendation not supporting a toddler screen for ASD! Discussed in depth here.

A New Interactive Screening Test for Autism Spectrum Disorders in Toddlers.
But, if a screen is used, here is a better mousetrap.

An Autism-Linked Mutation Disables Phosphorylation Control of UBE3A
How gene function/malfunction can lead to downstream CNS processing errors.

July
A Mechanistic Link between Olfaction and Autism Spectrum Disorder
Patients don’t have Sensory Processing Disorder AND autism. Until it’s called something else, the condition is ASD.

Long-Term Outcomes of Early Intervention in 6-Year-Old Children With Autism Spectrum Disorder
“This is the first study to examine the role of early… behavioral intervention initiated at less than 30 months of age in altering the longer-term developmental course of autism.”

June
Autism risk associated with parental age and with increasing difference in age between the parents
If this is more than a mere association, it provides evidence of the environment interacting on genes (epigenetics).

May
Heritability of Autism Spectrum Disorder in a UK Population-Based Twin Sample
Nature > Nurture study.

April
Long-Term Outcomes of Early Intervention in 6-Year-Old Children With Autism Spectrum Disorder
Yes, Virginia, early detection and intervention DOES matter.

Prediction of autism by translation and immune/inflammation coexpressed genes in toddlers from pediatric community practices.
A comment from the New England Journal of Medicine: “A Blood Test for Predicting Autism?
It can’t be used for diagnosis just yet, but its findings may form the foundation for a more predictive test.”

Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism
Another study proving that ALL vaccinations, given at ANY age, in ANY combination, are good for ALL children, ALL of the time. Lies, damn lies, and statistics.

March
Autism Spectrum Disorder and Particulate Matter Air Pollution before, during, and after Pregnancy: A Nested Case–Control Analysis within the Nurses’ Health Study II Cohort
Higher maternal exposure to toxins during pregnancy, particularly in the last few months, were associated with greater odds of a child having ASD.

The autism-associated chromatin modifier ​CHD8 regulates other autism risk genes during human neurodevelopment
Discussion of epigenetics – how the environment works on genes.

Common polygenic risk for autism spectrum disorder (ASD) is associated with cognitive ability in the general population
It’s not news to the ASD community… “Autism Genes Found to Be Associated with Brighter Minds

February
Shorter spontaneous fixation durations in infants with later emerging autism
Even the youngest children may demonstrate high risk signs. 

A Pilot Proteomic Analysis of Salivary Biomarkers in Autism Spectrum Disorder
An important step in diagnosing and treating any condition, is to have reproducible lab tests to assess risk, degree of involvement, and efficacy of intervention(s).

January
Explaining the Increase in the Prevalence of Autism Spectrum Disorders
The Proportion Attributable to Changes in Reporting Practices
It’s merely reassignment of diagnosis. NOT.

Is the U.S. Prepared for a Growing Population of Adults With Autism?
Since we aren’t prepared for the present growth of children on the spectrum, how could it be possible that future resources will be available?

Conclusion
Promising Forecast for Autism Spectrum Disorders
This editorial, which appeared in a respected medical journal, crystalizes the differences between what pediatricians think they know about ASD, and what parents actually experience. In practice, progress seems anemic and glacial. Autism is rocket science, mired in a political, emotional, and financial morass.

The top autism stories of 2015 are not enough. We need to recognize the epidemic, publish more information that assures vaccine safety for susceptible populations, address causes, safe and effective treatments, possible preventions, and how to address the aging of the autism population. Affected families just need more of everything.

As always, readers are invited to share their thoughts about this research,
and any other scientific papers 
that should be included.

Get Your Child Off the Couch and Out of the House

Sunday, December 13th, 2015

I watched a tv commercial recently, recommending that families should play outdoors for at least an hour a day. “The NFL PLAY 60 Challenge teaches educators and children to integrate health and fitness into daily classroom lessons.”

What a great idea! It shouldn’t even be necessary, since most of us grew up playing outside, until our mothers called us home for dinner – by screaming our names (no cell phones).

Outdoor play is part of a healthy existence that has, somehow, been moved lower down on kids’ to-do-list. Academics, homework, tutoring, therapies, digital devices, etc., have become top priorities, even in the youngest, and especially for special needs children.

There are a variety of questions and theories about the cause of the increase in childhood developmental abnormalities in this century. To be sure, there are poisons galore that have exploded into our air, food, and water. Perhaps just as importantly, or in some cause-and-effect manner, healthy outdoor play has dwindled in modern childhood, and deserves exploration as one of the possible associations, because treatment is so simple. Get off the couch!

Causes and Effects

Digital devices
These alluring products have taken over the lives of many, as young as the second year of life, for prolonged periods. There are two primary problems – lack of socialization and imagination. To be sure, there are educational and other apps that may be able to successfully address certain behaviors or educational weaknesses. Mostly, however, i-stuff shuts out the world and is subject to repetitive play that rarely generalizes to useful real-world skills.

Medications
Often, anti-anxiety and stimulant preparations are prescribed too easily and frequently, and rarely address the root cause(s) of a child’s difficulties. The side effects may include listlessness, poor diet or unraveling (as the med wears off) that makes after-school-play a chore. Drug ‘vacations’, during holidays, vacations, and even weekends can mitigate some of those problems.

Nutrition
Undernourished or overweight individuals are less likely to achieve in outdoor sports. Picky eaters, low vitamin D, high or low cholesterol, iron-deficiency anemia, and thyroid problems are often diagnosed at The Child Development Center of America. Children who experience such metabolic abnormalities may display a lack of normal desire to leave their indoor environment and socialize. A vicious cycle ensues, with even lower energy, leading to more resistance to physical activities.

Yeast
Fungus in the gastro-intestinal system is a prevalent problem, at least in the special needs population. Constipation leads to slowing down the entire body ecosystem, making outdoor play a chore. Less activity can further deteriorate the situation. Warm, wet, dark, stationary places (a non-motile gut) make an excellent home for yeast, which robs nutrition, alters the immune system, and creates toxic byproducts. In addition to probiotics, healthier foods, and anti fungal preparations, adequate muscle activity will push the food along.

Sleep
Perhaps created by a child’s internal constitution and altered biorhythm, or due to any combination of the formerly-mentioned medication, nutrition, and gut micro-biome disturbances, lack of adequate sleep can be a major factor in a cyclical pattern of decreased activity and less desire and/or ability to fall asleep.

Socialization
Mingling with others and exploring the world breeds increased desire to expand our universe. Playing at home with family is great, but the outdoors is where kids have frolicked for all generations and in all locales. Our complicated world forces adults to work more, experience increased stress, and have poor health habits. We shouldn’t be foisting that condition on the children, as well.

The NFL has experienced and/or created a number of poorly handled issues, such as concussions, player lifestyles, recruiting and gambling. This effort needs to be applauded because the advice – to play outdoors at least 60 minutes per day – should be heeded.

Going Beyond Biomedical ADHD Treatments

Sunday, November 29th, 2015

Message from TheAutismDoctor.com Mobile Site:
11.29.2015 “Dr. Udell, my six year old grandson has autism. He was diagnosed right after his 2nd Birthday. He is in a special needs kindergarten class and has speech, occupational, and physical therapy regularly. He is non verbal. For the last week he has had some terrible meltdowns that last almost all day. We have tried everything. He is on rispiridone and guanficin. He kicks screams cries and had multiple bruises on his arms from this. His pediatrician told my daughter to take him to the er and have him put into an in patient facility to be seen by a psychologist. Putting him in a “home” is not an option!!! We live in <<deleted>> and cannot find anyone to help my precious grandson…”

November seems to bring unusually dramatic challenges to the more developmentally neuro-diverse. It is a most likely time for caregivers and teachers to complain about lack of focus and attention, fidgeting, daydreaming, easy distractibility, opposition, negative and/or aggressive behaviors.

Here are some of the questions, posed to families at The Child Development Center, which readers may find useful (or not).

Has anything changed in the family?
Fitting in to a more rigorous schedule is quite disruptive to the repetitive-behaviors-restricted-interest (incorrectly referred to as OCD) crowd, especially if there have been changes in family dynamics and living situations. Obviously, life happens, and there is little that can be done. It takes love, time, patience, ABA, other therapies, and a medical evaluation, to determine the best next step.
Treatment with stimulant or anti-anxiety medication should be the last, not first, remedy. Pursuing a less chemical route is helpful because the parent can feel that they have left no reasonable ‘stone unturned’. Moreover, if / when medication is required, dosage may be more manageable.

What has changed at school?
Pre-K to K, K to 1st, 2nd and 6th grade, seem to require the most maturational skills. Large gaps in socialization, and / or unusual behaviors will set that child apart. The ability of the intelligent youngster to perceive their shortcomings can be even more frustrating, leading to a downward spiral in cooperation.
Difficulties include out-of-the-ordinary problems with homework, digital devices, getting to sleep, sleeping, staying asleep, (not) getting ready in the morning, not caring, listening or following directions, and / or poor grades and aggression at school.
If the parent of a child who is older than ~6 years uses those behaviors as measuring sticks, it could be worthwhile to speak with a qualified practitioner about ‘doing a workup‘ and prescribing meds.

Has ‘The DIET’ has been slipping?
Strangely, the customary first step when observing a toddler’s improvement is related to a change in diet, yet it is one of the last things that families think of when things are unravelling. Parents will frequently find an increase in cooperation and concentration by merely re-starting a previously successful one, or giving a trial to The Feingold Diet (Quackwatch.com‘s opinion notwithstanding).
Also, think YEAST. If the child responded previously to anti-fungal intervention, perhaps it is worth giving that another try. It’s safer/more useful/less addictive/and less expensive than Risperdone or Adderall.

Any Recent Illness?
It takes more time for a child with immune system issues, such as ASD and perhaps ADHD, to recover from a cold, ear or sinus infection. They usually receive an antibiotic or two, maybe steroids, and lots of tylenol. That seems to be sure to take the clock back, a bit, on optimal health. Strong probiotics can help address that deficiency.
A more in-depth examination of the child’s constitutional state may reveal simple, safe and useful supplements, or milder medications to improve mitochondrial functioning.

Get Sleep Under Control.
Nothing can be more effective for ameliorating the signs and symptoms that we call ADHD than a good night’s sleep, every night. Don’t forget about the more natural sensory improvements that may come from massage, warm baths, or essential oils.
Melatonin is useful to decrease sleep latency (the time it takes to fall asleep) though it may not hold throughout the night. Occasionally, 5-hydroxy-tryptophan may lengthen the rest. Sometimes, it may even be necessary to add an antihistamine, such as Benadryl. It is less risky/harmful/expensive than a drug, such as clonidine.

Conclusions:
There are definitely families who have found that the best and most lasting improvement has been due to a (some combination of) pharmaceutical preparation(s). Indeed, medications seem to help with school in non-ADHD patients, as well.

Alternatively, as experienced by the family in this email, many parents have been frustrated by the medications, because the child became too ‘stoned’ or more combative.

Socialization will enable maturation to turn on self-control. It’s that switch that no one, including the child, seems to understand. “To medicate or not?” is a decision between the parents, the doctor, and perhaps, the child as well, and should not be the school’s decision, based solely on compliance.

Finally, our response to email requests, such as the one that was presented, is to recommend a local MedMaps.org practitioner, or to ask the family to undertake at least one visit to sunny South Florida, so the child can be properly assessed.

Some Thoughts on Alternative Medical Alternatives to Autism

Sunday, November 22nd, 2015

Dr. Udell & Vicki Martin RN


This month’s Autism Society of Broward Speaker Series featured autism expert, Ms. Vicki Martin, who gave an interesting and thorough discussion assessing the medical causes of behavior in ASD, and my talk covering some of the latest biomedical treatments for autism.

Purpose – Improve our Understanding of the Range of Treatment Possibilities
Doctors get questions about these more-than-off-label treatments quite often, so it’s necessary to be current about the literature in order to give a learned response. It’s like homework.
I have an opportunity to give something back to The Autism Society of Broward. It has been my pleasure to have served on this Board for over 6 years. This not-for-profit (and, trust me, we have very few $) organization brings services, such as yoga, sensory-friendly movies, and golfing, etc., to the family level.
Public speaking is always a networking opportunity. There are parents who may not know about The Child Development Center of America and how simple protocols may improve outcomes, especially when they are combined with the traditional therapies. Attendees ask questions and learn about our medical practice.
It’s fun to discuss these topics, and more interesting than reviewing epidemiological data that questions whether autism is an epidemic.

Topics of Discussion
These were not necessarily chosen because they are truly the most recent or popular, but mostly because they have been hyped a great deal, lately, by social and other media.

Cannibidiol
Improvements have only been accurately documented, so far, in ASD patients with seizures. Any other use of the product at this time is purely trial-and-error, and the safety of hemp oil extract safety in children has yet to be proven. To the extent that patients may be able to take equivalent dosing, more information will emerge. The myriad of patients who try it, however, complicates evaluation about efficacy.

Helminth Therapy
While this unusual treatment of administering live organisms to successfully restore-reset immune function has been documented in adults with specific conditions, as concluded in a recent review, “Studies are neededto move helminth-related interventions that show promise in animals, and in phase 1 and 2 studies in human beings, into the therapeutic development pipeline.”

Chlorine Dioxide (CD)
Following up on that ‘worms or elimination of worms?’ question was a discussion about Chlorine Dioxide (CD) treatment. I ain’t sayin’ that it cannot/does not work in some individuals, but there are problems.
1. The science is weak and contradictory. There is no supporting research for terms, such as “Parasitological Vaccinosis.”
2. The main proponents, so far, are, the mother of an affected child, and scientist with questionable credentials.
3. Treatment can be risky.
4. Treatment involves a fair amount of resources; including frequent administration (every hour, sometimes), adjustment of dose, and which specific sites on the body to administer a dose (systemic, eyes, ears, rectum, etc.).

Oxytocin
This peptide, which is produced in the brain, has been called the ‘love hormone’, and has been shown to be deficient in some patients with ASD. Animal models have demonstrated improvement, though humans haven’t responded the same way.

The most recent prospective, controlled, double-blind crossover study that involved 31 patients, demonstrated improvement. This has not necessarily been the experience at The Child Development Center of America, where it has been used for over 4 years, yet only a handful of parents continue to administer the product.

Transcranial Magnetic Stimulation
This type of mechanical device has been used for over a decade outside of the US, but has recently received FDA approval as a device for “major depression in adults who failed to improve on medication.” This is an expensive treatment option, in the range of $6,000 – $12,000 or more, and requires daily 1/2 hour treatments.
Adverse effects are listed as fainting, possible seizures, pain or discomfort, mania, changes in cognition, and transient hearing  and memory loss.

A recent review stated, “Though preliminary data suggests promise, there is simply not enough evidence
yet to conclusively support the clinical widespread use of TMS in ASD,
neither diagnostically nor therapeutically.”

Essential Oils
There is a paucity of literature to support the use of these products for patients who exhibit signs and symptoms consistent with ASD. On the other hand, they are relatively safe, have been around since the beginning of civilization, and do not cost a great deal to try. Furthermore, there are many studies demonstrating improvement in processing with occupational therapy and other ‘sensory diets’.

As in many of the other treatments, this has demonstrated the least improvement in our most apraxic and/or disruptive individuals.

Conclusions
Present medical therapies are woefully inadequate.
Many treatment options have been offered, but few have undergone sound scientific scrutiny.
Parents, desperate to help their non-typically developing child will be tempted to pursue less-than-helpful, less-than-safe protocols.
For the lesser affected patients, many forms of treatment will help.
For the most affected patients, such protocols offer only spotty improvements.
More research is needed. Physicians, who are in the best position to understand the complicated science, must understand the variety of presentations of autism and the myriad of treatment options in order to give families the best advice.

Doctors Failing to Understand Autism

Sunday, November 15th, 2015

When faced with the unknown or uncertain, physicians will often rely on language that, while sounding scientific and medical, just restates the obvious or says nothing helpful at all.

“I’m not aware of any literature on that topic.” Does that mean that the clinician has read everything and there isn’t any, or is the doctor displaying ignorance? A better answer would be, “Let me read about that and I will get back to you.”

“I don’t want to give you a diagnosis at this time.” It’s not up to the physician to decide. At least,  there could be a presentation of possible diagnoses, with the statement about a workup and interventions that the parent can initiate.

“It’s eczema. I’ll prescribe a steroid cream.” What is causing the skin rash? And, steroids will temporarily clear up any skin condition.

A 3-year-old wanders in circles and does not play with other children. “It looks like your child has developmental delay.” Stating the patently obvious is a frequent technique to deflect the physician’s lack of knowledge. The oncologist wouldn’t just say, “It’s a lump.”

“It’s not speech apraxia.” If a toddler wants to communicate and cannot say any intelligible words, that IS the name for that symptom. The converse situation occurs when the professional says that child has autism AND speech apraxia. It’s autism.

“I’d like you to come back in 6 months to see how the child is doing.” If that is the only reason that the doctor has for your return, he should be paying YOU for the visit.

“It’s not autism, I’d say more like PDD-NOS (pervasive developmental delay – not otherwise specified).” The DSM 5.0 has been published. The medical establishment has spoken. If a child exhibits repetitive or unusual behaviors and has communication delay, it’s Autism Spectrum Disorder.

“Those special diets are risky and can lead to nutritional deficiencies.” How about checking nutritional status with some appropriate lab testing? Better, check is as part of the initial workup, especially in picky eaters.

“He’s a boy… You speak two languages… She’s spoiled… Your grandfather was that way, etc.” We are in the midst of an epidemic. The child should be thoroughly evaluated for ASD.

“Studies have not shown significant results.” That depends on what research the practitioner chooses to read and believe. And, whether a treatment is worthwhile is best determined from the parents’ point-of-view.

“We can give medication to get rid of those ‘stims’.” One, repetitive behaviors are often communication, so reprimands may cause even more frustration. Two, those drugs are potent and have serious side effects.

“We can give medication for that anxiety.” One, nervousness is frequently appropriate. The affected child is concerned about not having the skills to join the group. Simply depressing the child’s response is not necessarily a good thing. Two, those drugs are potent and have serious side effects.

“We can give… Miralax for constipation… Zantac for refluxantibiotics for everything.” How about a thorough evaluation of why?

“It’s not anything to be concerned about.” The number one lesson that any pediatrician should learn is, “Listen to your mother(s)!” Worrying is part of their job. The child’s physician should perform an appropriate evaluation.

“Those ‘autism doctors’ are just quacks who will waste your time and money.” The parents can see progress for themselves. Families will continue to search for answers when traditional therapies alone do not seem sufficient.

The parents of today’s children who show signs and symptoms consistent with the epidemic of ASD are often more well-read than the doctor. These questions should spark interest on the professional’s part to offer more than lip-service to such a serious situation.

A Brief Discussion of Mitochondrial Function and Autism

Sunday, November 8th, 2015

Previously only of interest to researchers and a few doctors, this topic has become a popular subject to families of children affected with signs and symptoms that are grouped as Autism Spectrum Disorder.

Click to see the action…

The amount of information is dense, complicated by the myriad of bodily processes that are involved. Genetics, energy production, chemical reactions, membrane potentials and movement along the electron transport chain are basic to the understanding of these cellular organelles, called mitochondria.

Learning normal cell anatomy and function is a prerequisite to understanding what can go wrong and why.

There are discrete diseases of mitochondria, in which the specific steps involved in making energy don’t perform correctly. Additionally, there are numerous conditions caused, or exacerbated by, mitochondria functioning in some imperfect fashion, including autism.

Considering that mitochondria are the cells’ batteries, suboptimal functioning results in symptoms that reflect the particular organs that are affected.

Poor motility in the smooth muscles in the gut, e.g., could lead to reflux, or constipation and possible yeast overgrowth.
Weakness in the skeletal muscles may lead to poor core tone, developmental delays such as unusual or absent crawling, and eventually strength and energy as well.
Organs, such as the liver, that detoxify and so require a great deal of energy would not function optimally. A vicious cycle could ensue, as power stores become even more taxed. Additional potentially harmful substances would likely be less tolerated.
Throughout the nervous system, constant communication is necessary for proper perception. Affected individuals could exhibit various unusual sensory issues. Likewise, perhaps, there might be disturbances of motor function leading to atypical movements.
Poor energy function in the brain, which has to manufacture and reabsorb neurotransmitters, make electricity, grow new brain and prune the older, may lead to difficulty processing signals; therefore memory or focus would appear inadequate.

Diagnosis
With an increased index of suspicion after a thorough history and physical examination (including the family history and review of systems – other than the chief complaint), a physician may decide whether to pursue laboratory and other appropriate testing.

Treatments
Specific mitochondrial diseases are best addressed with diet and necessary medication, depending on the primary signs and symptoms and the affected organs.
In patients with ASD, in whom research has demonstrated low reduced-to-oxidized glutathione levels (GSSH/GSH), vitamins and supplements that address that situation, such as methyl B12, folate, SAMe (S-Adenosyl-methionine), cysteine and glutathione have led to improvement.
Mitochondrial ‘cocktails’ and supplements are popular; much of the work has been described here by Dr. Richard Frye.

Conclusion
The complexity of this topic is daunting, with much more research needed by universities and other scientific institutions. Armed with 21st century knowledge about mitochondria, doctors need to learn as much as possible, so that parents don’t have to figure all of this out on their own.

Top 10 Reasons Why Autism Remains a Mystery

Sunday, October 18th, 2015

As regards the explosion of individuals who are diagnosed with autism, progress  seems agonizingly slow. It is the parents of affected children who are leading the way, and traditional explanations are, literally, the thinking of the last century. Why is information about prevention, cause and treatment so sparse?

Researchers are still debating the existence of an Autism Epidemic. Why should it matter whether there are more affected individuals because of reason “A” or reason “B”? That confusion holds up funding for studies, however.

Professionals continue to argue about the ‘when, how, and who’ of assigning an accurate diagnosis, which impedes trials seeking to explore prevention or treatment.

The likelihood of discovering a ‘magic bullet’ is low. There will probably need to be multiple treatments for the signs and symptoms documented in the DSM 5.0, depending on the myriad of causes and presentations.

There are no practical, accepted biomarkers for diagnosis. This is especially important in order to evaluate treatments(s) in an acceptably objective manner. This discovery alone could significantly advance research.

Surrounding the topic of ASD are highly charged issues, such as vaccinations, or complicated treatments, such as HBOT and chelation. Rather than stimulate further investigation, the situation appears to impede conventional researchers from documenting efficacy (or the lack thereof) in such controversial interventions.

Successful treatments of the various co-morbidites displayed by autistic patients, such as those offered at The Child Development Center of America, which combine biomedical and conventional protocols, are frequently viewed with skepticism, at best. These protocols deserve the attention of the medical establishment.

 We drink red G-2 and it comes out yellow.
Ever wonder where the red goes?
(hint… it’s not digested)

Proven associations, such as toxins, poisoned food and the environment, are not popular areas for discussion. Preventive measures receive little promotion or even acknowledgment. Cleaning up can be accomplished, at a cost. This involves not only public education and policy making, but personal choices, as well.

Antibiotics and steroids continue to be overprescribed by doctors, and are requested or too readily accepted by patients. There is a price to be paid for taking strong pharmaceuticals for every ‘cold’ or rash.

Research findings that implicate genetic variations imply feelings of futility about the plausibility of successful intervention. “If it’s genetic, we can’t fix it.” But, every day there are new discoveries about personalized medical treatments for autoimmune conditions or cancer, for example. Tiny chromosomal errors are not insurmountable.

Tools for early diagnosis and intervention, already proven successful, continue to elude the pediatrician’s black bag. Psychiatrists and neurologists, likewise, employ old-fashioned thinking and potent, risky medications that are barely and rarely effective.

In order to take autism research and treatment into the 21st century, organizations that are responsible for actually providing answers need to address these concerns and get serious about forming a unified and thoughtful approach to this medical puzzle.

Patient Testimonials about Biomedical Autism Treatments

Sunday, October 4th, 2015

Every so often, my beautiful and patient wife, Jackie, reminds me that the service websites that she searches contain letters and feedback from clients. “It’s not just advertising,” Jackie points out, “there are key comments that help me make my decision.”

In the spirit of helping other potential families decide about providing biomedical interventions for their non-typically developing children, here is some recent correspondence concerning the work at The Child Development Center of America. (names changed)

Letter from a teacher:
♥ …Also, just wanted to let you know-Billie is doing AMAZING! Therpist2 is wonderful with him. Therpist1 was lovely and worked well with Billie, however, Therpist2 has been getting him to do things that I did not see last year at all. He is trying to communicate more with me and with the other students. Billie is happy and engaged in learning when Therpist2 works with him. She is a lovely lady and so good with him. I am so pleased with what he is doing in class. Tomorrow we are going to show his science project during class – he did a great job on the assignment.
Therpist2 and I were brainstorming ideas for Billie to participate in the event at the end of the year….
Posting on Facebook:
♥ Doctors don’t know everything.
In February of 2011, the lead neurologist… told us that our oldest son (then 2.5 years old) would only continue to regress to the point where he’d become so aggressive we’d have to medicate him (which he showed no aggression at the time) and that he threw up every day bc he was autistic, cried all night bc he was autistic, and while he didn’t have a crystal ball, he said he’d probably eventually need to be institutionalized. He said he was 100% confident in his diagnosis.
Through reading and research, a second opinion and holistic approach guided by Dr Brian D Udell, extensive tests on food sensitivities and bacteria imbalances (due to antibiotic abuse from his previous pediatrician) a radical change in diet, faith and determination we reversed that diagnosis and restored his health.
Emails:
♥ Fabio is responding well to the B12 shots. We are at 0.08ml three times a week for two weeks now and he is doing well. The better days are the days of the shot, then 2nd and 3rd day in between shots, he gets a little silly and extremely sensitive at the mouth area (he puts all his fingers in his mouth). Would it be ok to give him a shot every other day? I feel the effect of the shot wears out the days in between and as a result we see the silly behavior and sensitivity…
♥ Hi Dr. Udell, just wanted to show you an example of a good day for Bobby outside of all the movement you constantly see in your office… On a different (positive) note, see pic below at the School Award Assembly. Bobby walked up from the back of the cafeteria and up the ramp on to stage by himself, waited for all the other kids to get in position for pic and walked down. Huge difference from last year, he had someone with him the whole time. It was great to see all that independence growth from one year to the next!
♥ I just wanted to give you my perspective on what I am observing with Pat so you can understand why I am so adamant about increasing her dose back to the 3cc’s on Fluconazole.  She was a straight A student last year on this dose and is now struggling this school year.  I don’t know what it is about this medication but, it is magic for Pat and keeps her focused and on track.
Thanks for your help…
♥ Hi Dr. Udell. I wanted to update you on Darien’s behavior, constipation and my opinions on the Diflucan. We last saw you Sept 15.
On Sept 16, his behavior got him sent home from preschool for the day.
He was miserable Sept 17-19, constantly repeating “you didn’t say something?” and “nothing hurts?” And having tons of outbursts. The 19th was the worst. I took him to a first visit with his new play therapist and he was screaming and throwing things.
I started the Diflucan on Thursday the 18th. Stating Saturday the 20th, I have had my kid back again. He has been happy. The sensory stuff is still there but very toned down from last week. Overall, I have seen a HUGE improvement this week.  Huge…
♥ We are out of probiotics and have been for a week. We have noticed an increase in crying and pain with Robert. He also had loud farts with terrible smells.
♥ Jose is doing good. He pooped with the magnesium…
♥ I wanted to share this with you, it is about Henry and his horse riding therapy. He is doing a little better every day. Thank you for being part of our journey.
♥ Just some pics of Stan…he really is doing so much better with the htp. (5-hydroxy-tryptophan)
♥ Hello from Nassau! Sheena has been doing quite well since our visit. The Benefiber is WORKING !!!! She has a poop most days. It is formed but not hard, just pointy! … So she is doing well and we are grateful. Take care and see you in May.
Tweets:
♥ From a non-profit foundation “dedicated to providing …children in foster care with enriching activities, opportunities and experiences.” Here’s a great resource for all of us! “10 things every pediatrician should know about children in foster care”
♥ From Dr. Robert Melillo, author of Disconnected Kids, many tweets about “10 Things All Pediatricians Should Know About Autism” and “The Law, Antibiotics, and Autism“.
Comments about this blog:
♥ Everything is very open with a very clear clarification of the issues.
It was definitely informative. Your website is very useful.
♥ I like the valuable info you provide in your articles.
I will bookmark your blog and check again here frequently.
I am quite sure I will learn a lot of new stuff right here! Good luck for the next!
♥ I read a lot of interesting articles here. Probably you spend a lot of time writing.
Patient services:
♥ Hi Dr Udell, Karen & all your wonderful staff… for your help in the process of getting Maria switched to a bus that has AC/Heat capability… We are so thankful to God for good people like you guys that care and have helped us in the journey of advocacy for our little ones so that they can have all the resources available to be able to become functional & exceptional adults someday…I demanded that they read the letter & reviewed the case again that they realized their mistake & even apologize for their ignorance. Maria can finally resume classes & continue to enjoy learning her ABCs. Thank you again, very much, for ALL THE WONDERFUL WORK YOU DO!
♥… We are just so eager to get his little gut ready for the LDN and B12 shots……again thank you for everything!!  Our regards to the whole staff….they are awesome. You definitely give parents hope…by taking the time answer all of our questions and concerns….we are so thankful…..you are amazing!!

Website inclusions:
♥ GraciesAutism
♥ Jacob Velazquez, pianist

Conclusion:
Perhaps, I’m just ‘preaching to the choir’. For years, reknowned ABA guru, Dr. Doreen Granpeesheh, has spoken about the improved outcome when parents combine ABA with biomedical techniques. Similarly, prominent researcher, Dr. Martha Herbert, has emphasized the whole body conditions that can be addressed in this manner.

By combining the time-tested improvements from ABA, OT, PT and S&L therapies, plus other emerging techniques, doctors can learn to successfully treat children diagnosed with ASD.

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Brian D. Udell MD
6974 Griffin Road
Davie
FL 33314
Office phone – 954-873-8413
Fax – 954-792-2424

Email bdumd@childdev.org
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