Archive for the ‘Diets’ Category

Medical Academy of Pediatric Special Needs 2016 Spring Conference

Sunday, May 1st, 2016

Practitioners, such as myself, find that it is necessary to attend the bi-annual Medical Academy of Pediatric Special Needs conference for two important reasons. First, to listen to experts from all over the world present their knowledge and latest research. Second, to network with, and learn from, other like-minded practitioners.

What I Liked Best
This year, I chose the ADHD path. The workups that were presented tended to be somewhat complex, and perhaps unattainable for many patients. The bottom line was to get a medical evaluation. The differential diagnosis ranges from thyroid to PANDAS. Mostly all agreed that stimulant and psychotropic meds should not be the first line in treatment. One professor spent some time questioning the diagnosis, itself, and how the modern world has contributed to the epidemic.

What I Liked Least
Traveling all the way to Costa Mesa, CA. Course work is 8 hours per day, so no time for Disneyland, etc.

This Year’s Major Focus
Mitochondrial function continued to play a big role in the presentations. The advanced courses involved lots of methylation, detoxification, and energy production diagrams. The newest twist has been the addition of genetic testing to better determine the cause(s) of inadequately functioning biologic pathways. Single nucleotide polymorphisms (SNPs) and ‘epigenetics’ were the buzzwords – how individual genes interact with the environment and within the individual leading to dysfunction and downstream signs and symptoms.

Topics That Were Discussed in Passing
Microarray genetic testing, covering multiple genes, did not play a big part in this year’s talks. Discussions about childhood immunizations underlie a great deal of the members’ conversations; specifically the lack of solid scientific evidence for safety in high risk populations. Attendees are not against vaccinations, by the way. Lyme disease was discussed in general, and as that inflammatory process relates to other infectious-metabolic conditions.

Subjects Not Formally Presented
GcMAF and nagalase levels. Some patients have indicated that a useful, safe supply may become available, so that will help determine future use. As well, chlorine dioxide, hyperbaric oxygen treatment, helminths, medical marijuana, and stem cell therapy were not offered by this year’s presenters.

Conclusion
It is disappointing to return from such conferences without that ‘magic bullet’. Just standing around, listening to Sid Baker speak about how he got interested in autism, or asking him how the ‘ion cleaning’ footpath worked, is worth the price of admission, however. This science started with Dr. Baker, and he continues to be an inquisitive, gentle force for hope, 40 years later.

In the absence of a sufficient population of scientists who are willing and available to address this modern epidemic of childhood developmental problems, this meeting stands as a bastion against the current state of ignorance.

The Autism Diet

Sunday, April 24th, 2016

There are specialty diets for just about every situation, including specific medical conditions. They developed as humans evolved and discovered nourishment that promoted longer, healthier lives.

Some address a particular population; the Feingold diet could be a godsend for ADHD parents. There are plenty of cancer treatment regimens. Paleo is popular. How long did cave men live, about 30 years? Copious cholesterol lowering protocols. And just plain diet diets for people to lose weight. They tend to be trendy like the Coffee Diet or The South Beach Diet.

The Autism Diet(s)
There isn’t really ONE diet that has been shown to work for all, and there are patients who do not respond to any nutritional alteration.
The variety includes:
Gluten Free / Casein Free Diet (GF/CF) – is one of the most popular and often successful. Parents frequently report that eye contact improves, the fog lifts, and some toddlers begin to speak.

Specific Carbohydrate Diet (SCD) – has many success stories. This fairly restrictive protocol makes it difficult to sustain, even for parents who see improvement.

Gut and Psychology Syndrome Diet (GAPS) – an offshoot of SCD. As in other therapies, the aim is detoxification and reduction of inflammation, leading to a abatement of signs and symptoms.

Dr. Udell’s Child Development Center Diet – Blood and urine testing is done first, looking for 1) a significant IgG antibody response to 90+ foods, and 2) the production of morphine from incomplete digestion of gluten and / or casein (leaky gut). Identification of offending fare is explained to the family, which often leads to a successful appropriate dietary intervention.

The Evidence
The diagnosis of ASD is imprecise, confounding the evaluation of any treatment modality. Lack of biomedical markers to identify patients’ level of involvement and response to change represents another significant challenge to the ‘evidence-based-medicine’ crowd.

Solid scientific scrutiny is lacking. However, there have been lots of coincidences where children improve. At least, the child’s stooling patterns may normalize, or toilet training becomes more successful. What’s the harm?

Discussion
There isn’t a great deal of evidence to support the notion that ingesting large amounts of Monsanto’s Round-Up could hurt us, but it is probably not a great idea. There are antibiotics in our food – proven to cause harm –  and the government has failed to respond.

It’s not proof that families seek, it’s change in their child. When a parent says that “After we started the diet, he seemed to wake up and words started coming,” anyone would stop and take note. To the conventional medical community, that is just another nut who probably doesn’t believe in vaccinations.

The criticism that such diets are nutritionally insufficient is spurious. Accurate documentation of somatic growth, plus pre- and post- laboratory testing confirms sufficiency. For those doctors who seem so concerned about this issue, why aren’t you already checking the nutritional status of your picky eaters?

Conclusions
Compliance is paramount for restricted diets to really work, so family resources and the patients’ age need to be considered when the professional recommends. 7+ year-olds (especially male) tend to cheat, lie and steal the yummier, forbidden fare. Likewise, preparing separate meals for a family of 6 can present a major obstacle.

Improvements are generally incremental; so diets might take time, perhaps months, and may need to be kept up for years. Children with ASD are usually sensory diners in the first place, so change is challenging.

Even in the absence of large, perceptible improvements, your healthier child can respond much more efficiently to the other therapies that assist in the journey towards recovery.

Vaccination Redux

Sunday, April 17th, 2016

TheAutismDoctor has been asked to weigh in on the recent media attention regarding the film Vaxxed, which was scheduled, but not shown, at this year’s Tribeca Film Festival.

Robert De Niro, who helped organize the exposition, announced that he has an 18 year-old son with autism, and felt that the point of view presented in the documentary was important enough to explore. However, he decided to pull the film because the controversy is so heated that it deterred the public’s enjoyment of the rest of the event.

Do Vaccinations cause Autism?
The topic has been covered in this venue over 35 times, so I’m fairly certain that another protestation will confer little additional sanity.

Regardless of the volume and frequency with which Jenny McCarthy, Robert De Niro or Dr. Udell voice the opinion that we are not against childhood inoculations, ‘anti-vaccination’ is usually the way that the information is characterized. Opinions are either, “All or none, for or against, pro-science or anti-vaccination, educated or ignorant, healthy or dangerous.” Such points of view offer no middle ground and so this dispute won’t go away any time soon.

Discussion
I posed the following question to the ‘pro-vax’ father of a 6-month old, “You are asked to enter your baby into a formal study in which there are two groups.”

Group A – Present Schedule

Start at birth (Hepatitis B in hospital)
Fever OK (give Tylenol)
Mild illness OK
9 or more components at once OK
Negative previous reaction OK
‘Make up shots’ (for missed doses) OK
Other medical conditions OK
Development not on track OK

Group B – Other factors considered

Wait to begin until infant is clearly healthy
No shots if child is sick
Fewer components at each time
No pretreatment with Tylenol
Medical evaluation if previous problems
Appropriate testing if medically unstable (e.g. frequent infections, premature, GERD, eczema, asthma, abnormal stooling…)

Dad’s answer? “The safe one!” Really? Is that the one that the ‘scientists’ and government say is all right? And by the way, even if a physician might answer the hypothetical by responding, “Group A is perfectly fine,” their partner would probably protest, “Are you crazy? Not my kid!”

When that scenario is too cumbersome to recite, I pose another question. “Which is a more reasonable statement? ALL vaccinations are good for ALL children ALL of the time,” or “SOME inoculations might not be good for SOME toddlers in SOME situations?”

If the answer is the latter, it begs the question, “Which ones, when, under what conditions?”

Conclusion
Childhood vaccinations have been a true victory for modern medicine. They have prevented a variety of devastating diseases suffered by so many for millennia.

This movie, subtitled, From Cover-up to Catastrophe certainly stokes the controversy, as does its outspoken lightning rod, Andrew Wakefield.

No matter how frequently, dogmatic or pedantic the ‘Vaxxers’ pontificate, this polarization will continue until we understand more abut the present autism epidemic. Once that diagnosis is accurately understood and described, ‘real’ science demands independent, prospective, randomized, controlled, double-blind crossover studies of each and every component of the modern protocol to prove safety and efficacy.

The Life Span of Autism

Sunday, March 27th, 2016

LifeSpanLast week, Autistica, a UK “… charity which both funds and campaigns for medical research to understand the causes of autism, improve diagnosis, and develop new treatments and interventions…” released a report that received worldwide attention.

Personal tragedies, public crisis
The urgent need for a national response to early death in autism.

The Report
Based on a recent Swedish study, these points were highlighted:
• Autistic adults with a learning disability are 40 times more likely to die prematurely due to a neurological condition, with epilepsy the leading cause of death.
Those without a learning disability are 9 times more likely to die from suicide.
 Autistic people die on average 18 years earlier than the general population.
For those with autism and learning disabilities, death occurs more than 30 years before their time.

As with any new alarming finding, the media reacted. One report began, “It’s only one study, but the results are disturbing.” That was one of the least sensational interpretations.

Previous literature
Comparative Mortality of Persons with Autism in California, published in 1998, demonstrated that, “Persons with autism are subject to increased mortality risk…”

Research “… to determine which causes of death are more frequent in persons with autism, and by how much, compared with the general population…” was further documented over 15 years ago. The doctors concluded, “… excess mortality was especially marked for persons with severe mental retardation, but life expectancy is reduced even for persons who are fully ambulatory and who have only mild mental retardation.”

Five years ago, another set of authors verified those statistics and recommended, “Various national health care and state developmental disability agency initiatives to reduce risk of mortality are described.”

Likewise, the increased mortality associated with epilepsy (convulsions of various and often uncertain origins) has been previously demonstrated.

The Response
Comments following the story as reported in Science magazine followed various lines of thinking. There was anger directed at doctors, frustration with government failures, exasperation over how long this information has taken to surface, and advice about treatment.

Individuals ‘on the Spectrum’ complained of depression and outrage was expressed by many. An AutismSpeaks vice president explained that, “we need to use caution when interpreting these data…”

Discussion
What is the life span in autism? The most precise answer ought to take into account what kind of autism (genetic, immunologic, metabolic, e.g.), and whether a patient continues to experience co-morbid signs and symptoms. Over-treatment with potent pharmaceutical preparations may contribute to the cause of the increased mortality. Or, caught early with appropriate intervention, the diagnosis can be lost, so ’cause of death’ should parallel the neuro-typical. 

It’s important to get the word out about the ASD epidemic. The media attention to this particular literature, however, is somehow more urgent because of the loss of life; not family and societal costs, nor the numerous qualities that are delayed or absent in the presence of signs and symptoms of autism.

Additionally, certain basic issues, such as improving the general health of those most affected with ASD, proper housing and nutrition shouldn’t require lots of resources to study and implement. Understanding epilepsy, seizure control and psychiatric care will, obviously, take more time.

Conclusion
Autistica appears to be doing valuable work to address this modern epidemic. The recommendations that were made at the conclusion of the report may actually get some traction, especially with the backing of Deutsche Bank.

So, to the extent that this predictable and pre-reported outcome amplifies the need for better answers, media attention to this side of the story should prove helpful.

Speech, Apraxia and Therapy

Sunday, March 20th, 2016
Cortical Humunculus

Cortical Homunculus – Large areas of brain map to oro-motor function and hands

Two major problems facing the youngest patients who are most affected with signs and symptoms of Autism Spectrum Disorder are aggression and speech. These factors shape socialization, the final step in ‘normal’ communication. Therefore, achieving self control and enabling speech is key to reversal.

Aggression
Often, combativeness appears to come from pain. Sensory overload, sinus problems, gastrointestinal discomfort (from reflux to abnormal stooling), infections and headaches can produce a variety of stimming behaviors; including lashing out against self and others. Combined with a short fuse protruding from accompanying sleep difficulties, the resulting picture is often misunderstood by conventional specialists who invoke potent CNS medications, only meant for adults.

So, the first step to successful intervention is the achievement of better health. Modern therapists who recognize this, and refer the children for appropriate diagnosis and intervention, will be rewarded with more attention and compliance.

Speech Apraxia
There is no other more perplexing condition associated with ASD. Almost all vertebrates exhibit the ability to utilize vocal communication. In humans, articulated speech should be a pre-wired state. Parents don’t teach Junior to speak at 12-18 months. He just talks.

Apraxia’ refers to the inability to perform a desired ‘natural’ motor activity, presumably due to difficulties with central nervous system processing. So, neuro-typical individuals do not have ‘trombone apraxia’ because there wouldn’t be a preexisting neural pathway for that activity (unless the person is a prodigy). Research must be targeted at unravelling this mystery. For the great majority of patients, it’s not Autism AND Speech apraxia. It’s autism. Furthermore, I don’t think that those newly minted Autistic Japanese monkeys are ever going to speak.

A scholar.google.com search for medical treatment of speech apraxia in autism returns few specific, well-proven, evidence-based choices. It appears that modern medicine does not understand the cause, or even the site of verbal malfunction in ASD patients, let alone pharmaceutical interventions.

Discussion
By the way, language does not appear to be the problem. It is common to hear parents exclaim that, “Grandpa (from Romania) and Grandma (Haiti) can tell him to do anything.” Additionally, there are patients with speech difficulties who spend hours on the Internet learning other languages, including those not even spoken in the home. Jake, our Practice Administrator’s son, was found practicing Japanese one day!

There is little doubt that the child’s ability to respond to the therapists’ prompts is directly related to the success of intervention. Parents have frequently observed children merely staring into space while the professional works, and may go years without improvement. Or worse, the child becomes belligerent as the S&L person approaches the front door, often leading to violent behaviors.

Conclusion
Biomedical intervention is available for the modern patient to address problems with muscle tone, fog, and processing, in order to better address oro-motor function, and therefore increase chances of successfully addressing this very symptom.

The experience at The Child Development Center of America, and with the doctors who practice under the auspice of Medical Academy of Pediatric Special Needs, has been consistent as far as the ability of methyl-B12 injections, to engender useful speech. When combined with good health and traditional therapies, this could be the best possible advice for confused but determined parents.

A Letter to Autism Researchers

Sunday, March 13th, 2016

The title of a recent article in the Journal of Pediatric Gastroenterology and Nutrition was Evaluation of Intestinal Function in Children with Autism and Gastrointestinal Symptoms. The headlines featured by most of the lay press, “Tests Show No Specific Gastrointestinal Abnormalities in Children with Autism.” Big difference.

The Study
According to the authors:
• There was no difference in the activity of the enzymes that break down key sugars in autistic vs. non-autistic children who are evaluated for gastrointestinal disorders.
• Specific biomarkers of intestinal inflammation were elevated equally in autistic vs. non-autistic children with GI signs and symptoms.
• Biomarkers of a ‘leaky gut’ were not found more frequently in autistic vs. non-autistic patients with similar symptoms.

Discussion
A scholar.google.com search for gastrointestinal problems in autistic children returns >24,ooo results. There are reports of poor oral-motor function, sensory issues of taste and smell, GERD, eosinophilic esophagitis, abnormal gut flora, chronic constipation, chronic diarrhea, alternating constipation and diarrhea, and delayed toilet training.

The authors noted that, “Common problems such as gastroesophageal reflux or constipation may present with atypical symptoms such as stereotypical behaviors, aggression, or self-injurious behaviors. Consequently, gastrointestinal problems that might be easily recognized in a neurotypical child may go undiagnosed in a child with autism.” They concluded, “There is no evidence to support that gastrointestinal disorders cause autism.”

This crystallizes what’s wrong with research in the ASD universe.
There isn’t one kind of autism. Addressing the individual co-morbid conditions frequently allows traditional therapies to take hold.

The diagnosis itself is a collection of signs and symptoms categorized in this manner, especially since the DSM 5.0 has included PDD-NOS and Asperger’s Syndrome under the Autism Spectrum. There are conditions that present primarily with aggressive or disruptive behaviors, genetic variations – large and small, immune system regulation difficulties, central nervous system abnormalities and seizures, significant skin rashes, and probably many more.

It is only a matter of time until a colleague announces to me, “Well, I heard/read/thought that it has nothing to do with the GI system.”

Conclusion
Even when respected professionals, such as Dr. Buie, et.al., research and document important information, it is frequently misunderstood by the general media to dismiss the tragedy of this epidemic.

Helping Pediatricians Understand Autism

Sunday, February 21st, 2016

I publish these ~weekly essays for 4 principle reasons.
1. To learn. This is the main purpose. In order to provide educated answers and advice, it is necessary to delve into all of the science surrounding this epidemic. Basically, the blog is homework, and this venue is often a recording of those literature searches.

2. To teach. Useful treatments are available to alter the course of this possibly life-long condition. The amount of information underlying etiology and diagnosis is dense, and getting more so day-by-day. However, present treatment options are simple to understand and herein made available for all to explore. The situation is clearly made worse by the frequent overuse of conventional medicine.

3. To provide a sense of balance in the polarized, media-drenched world of autism diagnosis and treatment. Nearly 70 million web pages instantly respond when ‘AUTISM’ is googled, with information from The Mind Institute to Quackwatch. These essays are about research, observation and experience.

4. To keep my head from exploding. Sometimes, even with the alarming increase in cases, and all of the effort that the various autism societies put into chronicling the situation, ASD is misrepresented, misunderstood and ignored.

This story is presented for reason #4. Recent events affecting the establishment of a diagnosis that could lead to earlier effective treatments are so garbled by the traditional medical community, I feel compelled to speak out.

The Issue
previous blog detailed my reaction to a ‘US Task Force on Autism’ recommendation against early screening. I noted the following inconsistencies the line of thinking:
There exists incomplete research as to the value of treatment. Should that stop us from trying to treat them, or screening all children?
Potential harm from screening included, “… time, effort, and anxiety associated with further testing.. Behavioral treatments… can place a large time and financial burden on the family.” The burdens of lifelong ASD are considerably greater.
A common theme among most of the parents who are interviewed about the manner in which their child’s autism diagnosis was handled, is the wish that the pediatrician had been more knowledgeable and forthcoming about developmental red flags.
When it comes to all-vaccinations-for-allebolapoisons in our environment, etc., the government has rarely demonstrated reluctance to recommend. When it comes to children’s health, what happened to erring on the side of caution?
The task force VP said, “… of course you should screen if the parent is concerned.” Isn’t that the doctor’s job?

This week, the American Academy of Pediatrics released a ‘Final Recommendation Statement on Autism Screening’. “The AAP stands behind its recommendation that all children be screened for ASD at ages 18 and 24 months, along with regular developmental surveillance.”

They confirmed the Task Force’s belief that early screening could lead to unnecessary concern and expense for the parents. Here’s the thing… THE PARENTS ARE ALREADY WORRIED. Plus, if the doctor is not accurate, THE EXPENSE OF EARLY INTERVENTION IS NEGLIGIBLE, compared to years and years of necessary therapy.

The present line of thinking would be that, if your child is not speaking at, say, 15 months, makes poor eye contact, exhibits low core tone, interrupted sleep, sensory issues and chronic constipation, it’s more worthwhile to wait 3-9 months until making a diagnosis and instituting conventional interventions.

Discussion
So far this month, I have received emails from the FDA, the Florida Department of Health, The CDC and  the American Academy of Pediatrics notifying me of the signs and symptoms, the dangers, treating, reporting and preventing Zika. I haven’t gotten any such warnings for years, regarding ASD. Where is the call for more research on Ebola, e.g., before alarming the public?

“I really don’t know much about autism,” is often a Pediatrician’s response to parents’ questions about the condition. This AAP confirmation of the Task Force’s recommendation is pointless, and only prolongs the professional’s continued ignorance.

This recent formal statement is not merely a letdown to the autism community, it represents a slap in the face.

Reading, Texting, and Arithmetic for Special Needs Children

Sunday, February 14th, 2016

While on summer vacation as a child in the middle of the last century, I would pass booths along the Boardwalk in Atlantic City, NJ, where hucksters would proclaim their ability to accurately evaluate any personality by examining handwriting. Sloppy or tidy text, large or small font, left- or right-leaning, dotting i’s and crossing t’s, for example, were alleged to represent telltale signs about the kind of person you were.

Today, ‘graphology‘ continues to be a skill offered by trained professionals who scrutinize calligraphy to expose weaknesses, point out strengths and certain personality traits. There are even computer algorithms that claim similar results. Information may be used by the legal system and employers to better determine veracity, aptitude, and job success.

History
According to Wiki, the earliest reference appeared in “The Confessions of Saint Augustine” AD 401… For those first lessons, reading, writing and arithmetic, I thought as great a burden and penalty as any Greek.” The original phrase “the Three Rs” came from a speech made in 1795.

Handwriting has thus been included in the necessary skill set that any educated person should possess. Well, it’s the 21st century, and we need to revisit that requirement.

‘Rithmetic
When calculators arrived, they were eschewed by an older generation, who claimed that, “If you were stuck on a desert island without a calculator, what would you do?” Of course, the answer was that, if you were so marooned, you wouldn’t need to cypher, you would need to survive! The point as regards mathematics, is that the concept needs to be understood – that 7 is greater than 5, and that 5 apples do not necessarily equal 5 oranges.

What about memorizing times tables? It’s basically the same issue; there is a larger concept that requires comprehension. If you don’t conceive of 12×12 = gross, you will have a difficult time ordering parts, making a budget, or figuring if you have enough money to buy a Big Mac and fries. Entire skill sets are based on math; from plumbing, to painting, to architecture, to all scientific pursuits. Understanding math is a basic necessary skill, handwriting is not.

Reading
An argument could possibly be made about reading being an archaic competency, as well. After all, computers can now read aloud, and podcasts and audible books are ubiquitous. Such reasoning will certainly rankle traditionalists. I am an avid reader, so believe me, I see holes in this line of thinking.

‘Riting
Most patients who experience fine motor difficulties, whether as a result of their autism, ADHD, dyslexia, dyspraxia, or various other physical challenges, find that they are terrible at handwriting. Practice, Practice, Practice. There is no pill for dexterity. If there were, we would all take them, and learn piano! But, what if you don’t want to learn to play an instrument? Should you be forced to, and will it make you anything but a terrible musician?

When my son taught Special Education to 5 and 6 year-olds, we would speak about the struggle that his students were experiencing as they tried to fit into a conventional academic experience. Later, while trying to instruct 10 and 11 year-olds, however, capitulating to the usefulness of typing became the logical choice. The child’s self-esteem would improve and the frustration of managing this skill would disappear.

Discussion
Watch people use a keyboard nowadays. Some use their thumbs, poke with one digit, stab with two fingers, utilize the old qwerty touch-typing method, point with a stylus, and even talk into a machine that turns voice into text. How well would a 50-something do on a job interview, if thumb-texting were the required skill?

The only ‘C’ that I received throughout my academic experience was for handwriting, when I was in third grade. My cursive was – and still is – nearly unreadable.

You know what? My mom said that I could still be a doctor. She was write right (no thanks to my spell-checker).

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.

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