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GENERAL CONFERENCE AUTISM SPECTRUM DISORDER

GENERAL CONFERENCE AUTISM SPECTRUM DISORDER. THURSDAY, APRIL 27, 2006 8:30 TO 5:30 RAANANA AMDOCS COMPANY. JAQUELYN McCANDLESS, M.D . WITH JACK ZIMMERMAN, PhD. A BIO-MEDICAL APPROACH TO AUTISM. EVALUATION AND TREATMENT PROTOCOLS BASED ON

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GENERAL CONFERENCE AUTISM SPECTRUM DISORDER

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  1. GENERAL CONFERENCEAUTISM SPECTRUM DISORDER THURSDAY, APRIL 27, 2006 8:30 TO 5:30 RAANANA AMDOCS COMPANY

  2. JAQUELYN McCANDLESS, M.D.WITHJACK ZIMMERMAN, PhD

  3. A BIO-MEDICAL APPROACH TO AUTISM EVALUATION AND TREATMENT PROTOCOLS BASED ON LABORATORY TESTING AND CLINICAL EXPERIENCE

  4. WORLDWIDE ASD EPIDEMIC • FROM 2001-04, 1026% INCREASE IN FULL-DIAGNOSIS ASD SCHOOL AGE CHILDREN PER US DEPT OF EDUCATION. • OVER 2 MILLION CHILDREN IN US HAVE ASD, OVER 6 MILLION HAVE ADD/ADHD, OVER 2 MILLION TAKE RITALIN • INCIDENCE OF CLASSIC 1:10,000 TO ACQUIRED (“REGRESSIVE”) ASD 1:150 • RATIO - BOUS:GIRLS 4:1 for ASD, ADD/ADHD, LEARNING/BEHAVIOR ISSUES

  5. AUTISM CHARACTERISTICS ASD: AUTISM, HFA, ASPERGER’S, PDD, ADD/ADHD • FAILURE TO BOND • LACK OF SOCIAL INTERACTION • AVOIDANCE OF EYE-TO-EYE CONTACT • DIFFICULTIES IN LANGUAGE DEVELOPMENT • REPETITIVE BEHAVIORS “STIMMING”

  6. ASD BIO-MEDICALLY • GENETIC PREDISPOSITION – ALLERGIES, AUTOIMMUNITY, FAMILY HISTORY • WEAKENED IMMUNE SYSTEM, FREQUENT INFECTIONS/ANTIBIOTICS 1st YEAR • GUT INFLAMMATION, PATHOGENS • IMPAIRED NUTRITIONAL STATUS INABILITY TO EXCRETE THEREFORE ACCUMULATE HEAVY METALS IN THEIR BODIES

  7. CAUSATION MODELS • 1) SIMPLY GENETIC? • 2) GASTROINTESTINAL: GLUTEN/CASEIN INTOLERANCE, ENZYME DEFICIENCY, YEAST OVERGROWTH MODEL • 3) TOXIC CHEMICALS/HEAVY METALS –VACCINATIONS, AMALGAMS/FISH • 4) AUTOIMMUNITY, VIRAL MODEL

  8. METABOLIC IMBALANCES IN AUTISM SPECTRUM DISORDER • MULTIPLE NUTRITIONAL DEFICIENCIES • ELEVATED IgG ANTIBODIES GLUTEN/CASEIN • IMBALANCE GUT BACTERIAL FLORA • URINE BACTERIAL/FUNGAL BYPRODUCTS • MYELIN SHEATH INJURY IN BRAIN • EVIDENCE OF IMMUNE IMPAIRMENTS • METHYLATION DISORDERS • ACCUMULATION OF HEAVY METALS

  9. NUTRIENT DEFICIENCIES in ASD • B6 AND MAGNESIUM • ZINC, SELENIUM AND OTHER MINERALS • CALCIUM • VITAMINS A, C, & E • ESSENTIAL FATTY ACIDS • AMINO ACIDS • B-VITAMINS: B1, 2, 3, 5, 12, & FOLATE (FOLINIC ACID)

  10. OVERVIEW BIO-MEDICAL TREATMENTS • 1) RESTRICTED DIET, GF/CF/SF • 2) NUTRIENTS • 3) TREAT GUT PATHOGENS • 4) CORRECTING METHYLATION DYSREGULATION (“Quintet”) • 5) CHELATION: REDUCING TOXIC METALS IN THE BODY • 6) ANTI-VIRAL TREATMENT

  11. HISTORY, PHYSICAL EXAM BASIC GENERAL LAB SCREEN CBC, URINALYSIS SERUM CHEMISTRIES THYROID PANEL IRON PANEL BASICEVALUATION

  12. BASIC DIAGNOSTIC TESTS FOR GUT: URINE ORGANIC ACIDS COMPREHENSIVE STOOL STUDY FOR NUTRIENT STATUS: ORGANIC ACIDS, AMINO ACIDS RBC MINERALS, FATTY ACIDS VITAMIN PANEL

  13. CLINICAL HISTORY: EARLY INDICATIONS OF GUT DYSFUNCTION 1) FAMILIAL DIGESTIVE DIGESTIVE DYSFUNCTIONS 2) INABILITY TO BREAST FEED 3) PERSISTENT COLIC IN INFANCY 4) FREQUENT INFECTIONS (E.G. EAR) LEADING TO FREQUENT ANTIBIOTICS 5) REACTION TO CERTAIN VACCINATIONS

  14. GASTROINTESTINAL PATHOLOGY SYMPTOMS REPORTED BY PARENTS • PERSISTENT DIARRHEA AND/OR CONSTIPATION, BLOATING, GAS AND ABDOMINAL PAIN • SELF-RESTRICTION OF DIET • NIGHT WAKING – REFLUX • GREATER ALLERGIC SUSCEPTIBILITIES

  15. G.I. HEALTH:TREATMENTS PARENTS CAN DO • ELIMINATE SUGARS AND JUNK FOOD FOR EVERYONE IN THE FAMILY • READ LABELS ON FOODS, GET EDUCATED ABOUT TOXINS IN BOTH FOOD AND WATER • GF/CF/SF OR SCD DIET • ENZYMES AND PROBIOTICS • BASIC NUTRIENT SUPPLEMENTATION

  16. G.I. HEALINGTREATMENTS THAT REQUIRE A PHYSICIAN • LAB TESTING FOR GUT PATHOGENS • ANTI-FUNGAL PRESCRIPTIONS RX • ANTI-BACTERIAL PRESCRIPTION RX (CLOSTRIDICA AND OTHER) • SECRETIN, VIT M-B12 INJECTABLES • IMMUNOGLOBULIN, IV OR ORAL, ENDOSCOPY

  17. ANTI-BACTERIALSANTI-FUNGALS NATURALS CAPRYLIC ACID, UVA URSI, GRAPEFRUIT SEED EXTRACT, LAURICIDIN PRESCRIPTIVES: FLAGYL, GENTAMYCIN, VANCOMYCIN, DIFLUCAN, NYSTATIN, NIZORAL, SPORANOX

  18. TREATMENTS BEYOND THE BASICS METHYLATION DETOXIFICATION VIRAL/IMMUNE ISSUES RECENT NEW TREATMENTS

  19. METHYLATION TREATMENT“ QUINTET” 1) GLUTATHIONE (GSH), ORAL, TD, OR IV 150-MG BID ORAL, 125-MG BID TD, 300-600-MG IV 2) ALLITHIAMINE (TD - TTFD) 50-MG BID (COMPOUNDED OR AUTHIA) 3) METHYLCOBALAMIN (INJECTABLE M-B12) CONC 25-MG/ML, 64.5-MCG/KG Q 3 DAYS 4) FOLINIC ACID, 800-MCG TWICE DAILY 5) DMG, 125-MG PER YR OF AGE, ALL IN AM OR TMG, 500-1000-MG TWICE DAILY

  20. METHYLCOBALAMIN • VIT B12 LEAST TOXIC, BEST TOLERATED, H20 SOLUBLE - EXCESSES URINATED OUT WITHOUT HARM. • UPTAKE FROM ORAL INTAKE LOW, PARTICULARLY IN GI INFLAMMATION. • VIT B12 PLAYS KEY ROLE IN GSH STABILIZATION AND KEEPING OTHER ENDOGENOUS ANTIOXIDANTS IN REDUCED STATE. • DIFFICULT TO TEST FOR DEFICIENCY; SERUM LEVELS INADEQUATE AS • MARKER FOR DEFICIENCY. • ULTRA HIGH DOSES MAY REGENERATE NERVES

  21. GLUTATHIONE (GSH) • NATURALLY OCCURING TRI-PEPTIDE FROM CYSTEINE, GLUTATMIC ACID, AND GLYCINE. • PRESENT IN ALL LIVING CELLS, HIGHEST LEVEL FOUND IN LIVER. • WORKS TO INHIBIT FORMATION OF FREE RADICALS, DETOXIFYING HARMFUL COMPOUNDS. • DEFICIENCY INCREASES SENSITIVITY TO THIMEROSAL AND OTHER PRO-OXIDANT AGENTS.

  22. GLUTATHIONE, Cont’d. • VIT C, E, A-LIPOIC ACID (ALA), N-ACETYL CYSTEINE (NAC), SELENIUM, GLUTAMINE, AND SILYMARIN ENHANCE GSH LEVELS BY HELPING BODY MANUFACTURE IT. • VITAMIN B12 HELPS MAINTAIN GLUTATHIONE IN ITS USEFUL REDUCED BIOLOGICAL STATE.

  23. TOXINS DIAGNOSTIC EVALUATION 1) EXPOSURE HISTORY – MOTHER DIET, AMALGAMS, RHOGAM VACCINATION HISTORY 2) HAIR ELEMENTS ANALYSIS 3) RBC MINERALS AND TOXICS 4) METALLOTHIONEIN CELLULAR TEST

  24. TTFD (ALLITHIAMINE) • TTFD IS THIAMINE TETRAHYDROFURFURL DISULFIDE, SYNTHETIC COUNTERPART TO ALLITHIAMINE, A DERIVATIVE OF VIT B1 (THIAMINE) NATURALLY FOUND IN GARLIC. • THIAMINE IS WATER-SOLUBLE, NECESSARY FOR METABOLISM PROTEINS, CARBS, AND FATS • THIAMINE DEFICIENCY IN ALCOHOLISM, MALNUTRITION, USE OF CERTAIN DRUGS • GENTLE CHELATOR FOR ARSENIC, CADMIUM, ALUMINUM, LESS FOR HG • NON-TOXIC, NO PRESCRIPTION NEEDED, TRANSDERMAL CREAM TWICE DAILY

  25. PREPARATION for REMOVING HEAVY METALS • NUTRIENT READINESS: ADEQUATE MINERALS BEFORE AND DURING CHELATION; PROBIOTICS, ENZYMES • GUT READINESS: CHELATION CAN ENCOURAGE PATHOGENS TO GROW, PREPARE AND PLAN FOR THIS • LAB STUDIES: CBC, CHEMISTRY PANEL BEFORE STARTING CHELATION

  26. CHELATION AGENTS • : • DMSA (CHEMET) FDA APPROVED for LEAD REMOVAL IN CHILDREN, HIGH SAFETY INDEX, OTC AS CAPTOMER. NEWLY EFFECRIVE TD FORM, SAME SCHEDULE AS ORAL 3 ON, 11 OFF, Q 4 OR 8 HRS. • DMPS, NOT FDA APPROVED FOR CHILDREN BUT LEGAL FOR COMPOUNDING. SMALL ORAL DOSES EFFECTIVE, SAFE, IV CONTROVERSIAL BUT USED AND EFFECTIVE, NEW TD FORM. • ALA (ALPHA LIPOIC ACID) OTC ANTI-OXIDANT THOUGHT TO CROSS THE BBB, SO NOT TO BE USED UNTIL METAL REMOVAL WITH DMSA HAS PLATEAUED.

  27. IMMUNOLOGY IN ASD • IMMUNOLOGICAL ISSUES IN AUTISM • FAMILY HISTORY IMPORTANT • IMMUNE TESTING AS GUIDANCE FOR TREATMENT

  28. DIAGNOSTIC EVALUATION IMMUNE SYSTEM SPECIALTY LAB Tests, MINIMAL 1) COMPREHENSIVE VIRAL PANEL #3 2) NK CYTOTOXICITY TEST 3) MYELIN BASIC PROTEIN (MBP) PANEL 4) RUBEOLA ANTIBODIES

  29. PREMIER ASD IMMUNE PANEL, ISL • Streptococcal Peptides (M5, M12, M19) (IgG) • Gliadin Peptides Antibodies (IgG, IgM, IgA) • Casein Peptides Antibodies (IgG, IgM, IgA) • Antibodies to Hg Binding Antigen (Fibrillarin) (IgG, IgM, IgA) • Dipeptidylpeptidase (DPP IV) Antibodies (IgG, IgM, IgA) • Anti-Myelin Basic Protein Antibodies (IgG, IgM, IgA) • Anti-Neurofilament Antibodies • Metallothionein (Cellular Level) • NK Cell Activity • Measles Antibodies (IgG, IgM) • VIRAL SCREEN #3: Varicella Zoster Virus (IgG) • Cytomegalovirus (IgG, IgM) • Epstein-Barr Virus or VCA (IgG, IgM) • Herpes Type 1 & 2 Virus (IgG, IgM) • Herpes Type 6 Virus (IgG, IgM) • Immunoglobulins (IgG, IgA, IgM) • $1644, 50% DISCOUNT AS PANEL = $822 PRE-PAID • Blood Required, 2 yellow tops, 1 red top (10 cc in each tube)

  30. MEASLES AND BRAIN VIRAL AUTO-ANTIBODIES IN ASD • SINGH 1998: 70% OF AUTISTIC SERA HAD ANTI-MYELIN BASIC PROTEIN ANTIBODIES, NONE IN NT CHILDREN. • 57% ASD HAD ANTI-NEURON-AXON FILAMENT PROTEIN, NONE IN NT KIDS • HIGHER ANTI-MEASLES ABS THAN NT KIDS, MUMPS AND RUBELLA NOT DIFFERENT FROM NT’S

  31. WAKEFIELD: INFLAMMATORY BOWEL DISEASE IN AUTISM • GUT BIOPSIES, 1998: MEASLES VIRUS DETECTED IN DENDRITIC CELLS AND MATURE LYMPHOCYTES IN 75/91 ASD CHILDREN VS 5/70 CONTROLS WITH LYMPHOID NODULAR HYPERPLAXIA • THOUGHTFUL HOUSE 2005 STUDY CORROBORATES INCREASED RATE OF SWOLLEN INTESTINAL LYMPH GLANDS, INCREASED INTESTINAL LINING INFLAMMATION IN ASD’S WITH BOWEL ISSUES.

  32. IMMUNITY TREATMENTNATURALANTI-VIRALS • LAURICIDIN (ORIGINALLY FOUND IN BREAST MILK & COCONUT, NOW SYNTHETIC (WWW.LAURICIDIN.COM) • OLIVE LEAF EXTRACT, GREEN TEA • LARCH ARABINOGALACTINS • IP- 6 (INOSITOL HEXAPHOSPHATE) • GRAPEFRUIT SEED EXTRACT

  33. PRESCRIPTIVE ANTI-VIRALS • ACYCLOVIR 800MG 3X/DAY (FOR UNDER 30#, 10-12KG) • VALTREX(MAIN ONE I USE) 250MG – 1500MG 2x DAILY, DEPENDING UPON SIZE • ALTERNATE WITH FAMVIR 250MG – 500MG/DAY DEPENDING UPON SIZE

  34. RECENT THERAPY REFINEMENTS • NEW DIETS BEYOND GF/CF/SF: (SCD) SPECIAL CARBOHYDRATE DIET – • (OLD) OXALATE-LOWERING DIET • MB-12 METHYLCOBALAMIN – DAILY HIGH DOSE INJECTIONS NEUBRANDER) • NASAL SPRAY MB-12 + FOLINIC ACID • TD DETOX AGENTS, TD-DMPS, TD-DMSA

  35. RECENT NEW TREATMENTS • PPAR’S (ACTOS) FOR GUT AND BRAIN INFLAMMATION, SHIFTS T2 TO T1 • LOW-DOSE NALTREXONE FOR IMMUNE MODULATION, SOCIABILITY • NASAL MB-12 + FOLINIC ACID • ANTI-VIRAL TREATMENT FOR ALMOST ALL CHILDREN, NATURAL AND/OR PRESCRIPTIVE

  36. ACTOS AND IMMUNE MODULATION FOR BRAIN-GUT INFLAMMATION • PPAR – ACTOS (PIOGLITAZONE), PX FOR PRE-DIABETES, LOWERS GUT AND NEURO-INFLAMMATION, REGULATES LIPID AND GLUCOSE METABOLISM, SHIFTS IMMUNITY FROM T2 HUMORAL (AUTO-IMMUNITY) TO T1 (CELLULAR) . CLINICAL STUDY >300 CHILDREN, DR. BORIS/GOLDBLATT, PROMISING

  37. LOW-DOSE NALTREXONE (LDN) • FDA APPROVED OPIOID ANTAGONIST 1985, BRAND REVIA, ALSO GENERIC USED IN 50 - 150MG DOSES AS OPIOID ANTAGONIST FOR NARCOTIC/ALCOHOL ADDICTION • MUST BE PRESCRIBED AND COMPOUNDED IN CAPSULES OR TRANSDERMAL CREAM

  38. LOW-DOSE NALTREXONE AS IMMUNOMODULATOR • OPIOIDS ALTER BOTH INNATE AND ADAPTIVE IMMUNE CELLS – NK CELLS, MACROPHAGES, IMMATURE THYMOCYTES, T CELLS AND B CELLS • BRIEF BLOCKADE OF OPIOID RECEPTORS ELEVATES B-AND OTHER ENDORPHINS • NORMALIZATION OF PLASMA CHEMICAL PROFILES: ELEVATED NOREPINEPHRINE, ARGININE-VASOPRESSIN, SEROTONIN (BOUVARD, LENSING, PANKSEPP, 1995)

  39. THERAPEUTIC USE IN ASD • USE IN TINY DOSES (1.5 – 4.5MG) • REGULATES MOOD & MODULATES IMMUNE SYSTEM, USE ONCE DAILY BETWEEN 9PM-12AM FOR 2-4 AM ENDORPHIN “RUSH”, LASTS 18 HRS • AS IMMUNOMODULATOR - INCREASES NATURAL ENDORPHINS,SHIFTS T2 (HUMORAL IMMUNITY) TOWARD T1 (CELLULAR) IMMUNITY

  40. ENDORPHINS • NEUROHORMONES - MODIFY NERVE CELL OPIATE RECEPTORS TO NEUROTRANSMITTERS, ANALGESIC • ENKEPHALINS/ENDORPHINS: ALPHA-BETA-GAMMA & SIGMA-ENDORPHIN • STIMULATE ENDORPHIN SECRETION: LDN PHYSICAL EXERCISE TOUCH - MASSAGE/ACUPUNCTURE LAUGHTER CHOCOLATE

  41. BETA-ENDORPHIN ENDORPHIN COLLECTION MICHAEL W. DAVIDSON (NHMFL) FLORIDA STATE UNIVERSITY

  42. TH1-TH2 BALANCE TH1 – CELLULAR IMMUNITY, DIRECTS NK T-CELLS AND MACROPHAGES TO ATTACK ABNORMAL CELLS AND PATHOGENS INSIDE THE CELL TH2- HUMORAL IMMUNITY, CREATES ANTIBODIES TO NEUTRALIZE FOREIGN INVADERS OUTSIDE CELL

  43. HEALTHY IMMUNITY • BALANCED BETWEEN Th1 - Th2, SWITCHES BACK AND FORTH AS NEEDED • INABILITY TO RESPOND ADEQUATELY TO Th1 – CHRONIC INFECTION & CANCER • OVERACTIVE Th2 RESPONSE – PLAYS ROLE IN AUTOIMMUNITY AND ALLERGIES

  44. UNHEALTHY IMMUNITY FAILURE OF THE Th1 ARM & OVERACTIVE Th2 ARM: AIDS CFS (FATIGUE) CANDIDIASIS MULTIPLE ALLERGIES MCS (CHEMICAL) CANCER AUTISM

  45. SUMMARY BIO-MEDICAL TREATMENTS • 1) RESTRICT DIET, GF/CF/SF, SCD • 2) NUTRIENTS • 3) TREAT GUT PATHOGENS • 4) CORRECTING METHYLATION DYSREGULATION (“Quintet”) • 5) DETOXIFICATIOIN: REDUCING TOXIC METALS IN THE BODY • 6) ANTI-VIRAL TREATMENT • 7) ENHANCE IMMUNE SYSTEM

  46. 2nd Edition • 2003

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