by John C. Pittman, MD, and Mark N. Mead, MSc
Are mercury, lead, and other toxic metals likely culprits in classic autism, ADHD, Asperger Syndrome, and other Autism Spectrum Disorders (ASDs)? Can yeast overgrowth and intestinal imbalances have a substantial impact on many ASDs? Do kids with ASDs often suffer from an inability to detoxify toxic compounds? Can these children benefit from therapies aimed at removing these toxic factors and correcting the underlying biological problems?
The answer to all these questions, based on our clinical experiences and training at the Autism Research Institute, is a resounding yes. But if this is the case, why is there so much disagreement among pediatricians and public health scientists? The reason: Much of the population-based research to date has focused on the more superficial aspects of ASDs, and in doing so has helped engender the misunderstanding that such toxic factors as mercury and fungal toxins are of little relevance to the child with autism.
Of Detox Defects and Vulnerable Brains
A recent study, published in a 2010 issue of Acta Neurobiologiae Experimentalis, found that individuals diagnosed with ASD had blood mercury levels that were approximately double those observed in non-ASD individuals. However, closer examination of the data revealed a threshold blood mercury level below which no autism was seen. Specifically, the total blood mercury level did not increase the odds of having autism until it was greater than 26 nmol/L (>5.2 μg/L). Individuals with a blood level higher than 26 nmol/L were three times more likely to be diagnosed with autism than individuals whose blood level was lower than 26 nmol/L.
These findings, which come from the Institute of Chronic Illnesses, Inc., in Silver Spring, Maryland, are consistent with multiple studies showing increased levels of mercury in the teeth and brains of children diagnosed with an ASD relative to non-ASD kids. Several studies also found increased mercury in the urine and fecal samples following chelation therapy, as well as associated urinary porphyrins among ASD individuals relative to the control groups. Moreover, a 2009 report in the Journal of Toxicology demonstrated a strong relationship between the severity of autism and the relative body burden of toxic metals.
Now, some scientists may reasonably argue that blood mercury levels are not consistently linked with ASDs, and they would be correct. However, blood mercury levels do not reflect chronic exposures or tissue levels—only acute exposures, for example, from industrial accidents, eating mercury-laden fish, or off-gassing from dental amalgams. The metals that accumulate from pre- and post-natal exposure are not reliably detected by a blood test, only by a combination of urinary porphyrins and urinary mercury following administration of metal-binding agents. Doctors who have studied heavy metal toxicology understand this.
Also seemingly paradoxical is the finding of lower hair levels of mercury in very young children with ASDs. This suggests that ASD kids are unable to excrete the mercury that has accumulated in their bodies. Indeed, we find that virtually all children with autism show measurable defects in their detoxifying capacity. These defects render the children unable to eliminate or neutralize many brain-toxic factors such as lead, mercury, and pesticides—and more prone to the brain-injuring effects of inflammation and oxidative stress. Many of these kids also have immune system imbalances that keep ther brains inflammed as well as rendering them even more susceptible to harmful bacteria and other microbes and their toxins.
The implications of this complex profile of susceptibility are profound. These children are like the proverbial “canaries in the coal mine”—far more vulnerable to the pollutants that other children’s bodies handle with ease. If you’re not taking into account the detoxification and immunologic problems commonly found in autistic children, then population-based comparisons of exposure levels have less relevance.
Deficiencies in key nutrients and metabolites that support detoxification pathways also are extremely common among children with ASDs. For example, many of these kids show low glutathione or its metabolites in their blood and urine. Since glutathione is the core detoxifying molecule in our cells, this deficiency greatly limits the child’s ability to process and eliminate mercury and other toxicants from the blood. Those children who are genetically less capable of detoxification, or whose detox mechanisms are overwhelmed with other toxins, are far more prone to toxic overload—and thus to the neurologic and behavioral problems linked with ASDs.
Developmental Delay or True Treatment Effect?
Another common criticism you will hear of doctors who are using this innovative approach is that autism is a condition of developmental delay, and that at least some of these children—possibly 5 to 19 percent—will go on to develop and function fairly well. Without conducting randomized controlled trials, these critics say, you never can know whether the development and improvement of symptoms would have occurred anyway with time, or whether the improvement could simply be attributed to behavioral and occupational therapy.
Going further, the critics contend that the single-person level of observation can be very deceiving, and that you can easily be fooled into believing that what you are observing is a real benefit versus something that might have happened by chance.
Here’s the main problem with this view, and perhaps the most profound myth-busting truth of all. You cannot be fooled by what you’re seeing when improvements occur on the integrative treatment program, and then those same improvements vanish if the child goes off the program. If your child quickly gets worse every time they go off their program, and then improves again every time they go back on, this is clearly due to the treatment. This is what separates clinical trials from case-by-case observations in the clinical setting, and it is incredibly important in the context of ASDs, since every case is so different and requires a high degree of individual tailoring based on testing results.
Let’s take the example of intestinal candidiasis, or yeast overgrowth. When children with ASDs are treated for an obvious yeast overgrowth, at some point they begin to show a dramatic improvement in their behavior—showing great eye contact, communicating well or even animatedly, becoming more peaceful and attentive. When they go off the anti-yeast treatment, their behavior can spin wildly out of control again.
Another example: Many children are sensitive to gluten. Take them off gluten-containing foods for three weeks, then reintroduce those foods and watch what happens. Very often there will be some improvement in behavior during the time off gluten, but if the child has an underlying intestinal infection or yeast overgrowth situation, that must be resolved first.
Our approach at the Carolina Center for Integrative Medicine addresses the problems that are common to virtually all children with ASDs, including detoxification weaknesses, toxic overload, nutritional deficiencies, and intestinal imbalances such as yeast overgrowth. Various nutrient deficiencies have been documented in children with ASDs, and targeted nutritional strategies are often very helpful and again make other strategies more effective. In addition, we help identify certain “trigger” foods, such as casein-containing dairy products, wheat and other gluten sources, sugar, chocolate, preservatives, and food colorings.
As implied in the mention of gluten and yeast (see above), proper sequencing of the treatments is part of the art of medicine when it comes to helping kids with ASDs. For example, the full benefits from heavy metal detoxification and hyperbaric therapy (pressurized oxygen) are only likely to occur when the GI tract problems are addressed first. Children undergoing this integrative approach may show rapid improvement in language and social skills, as well as better sleep, moods, and overall disposition.
The medical-scientific community is beginning to wake up to the power of this perspective. In November 2009, the American Academy of Pediatrics, Autism Speaks, and the North America Society for Pediatric Gastroenterology, Hepatology and Nutrition, hosted a symposium of researchers and physicians to address GI problems seen in children with ASDs. The symposium was intended to raise awareness among specialists about GI disorders in autism and to educate doctors about new treatment strategies for ASDs.
Overcoming Autism: A Success Story
When it comes to harnessing the power of this integrative approach, one of the keys to therapeutic success is catching ASDs at an early age, when there is still sufficient neuro-plasticity or brain plasticity. The term plasticity refers to the central nervous system’s ability to change neurons and neuronal pathways, and ultimately to re-organize entire neural networks. A good example of this early-life therapeutic advantage is the story Mike Simpson, now age 5, who was diagnosed in November 2006 with autism. At the time of his diagnosis, several physicians had told Mike’s parents, John and Suki Simpson, that no treatment options existed and that recovery was impossible.
Mike’s pediatrician referred the parents to the state’s behavioral intervention program. Although they found the program somewhat helpful, it clearly was only a start, and his behavior remained that of a child with classic autistic disorder. “At the time, Mike did not respond to his own name,” Suki Simpson recalls. “He was unable to sit in a chair or by a table, and he could not focus on any activity for any extended period of time.” Due to these limitations, it seemed unlikely that he could reasonably benefit from the behavioral program.
In his first year of life, Mike appeared to be deaf because he would not respond to his name, nor did he react to loud noises, such as the doorbell ringing or a car horn honking. Testing revealed that his hearing was fine. In fact, as the parents later learned, Mike was quite sensitive to sound—but was not responding because he was tuning the sound out due to the pain it caused. This phenomenon is fairly typical among children with autism.
One glance at Mike’s diet at the time might have provided some insight into his behavioral issues. From the moment he began eating solid foods, according to the Simpson parents, he seemed to constantly crave carbohydrate items such as crackers, pizza, chicken nuggets and Cheerios. His diet as a whole was quite limited, and he invariably shunned new foods. The parents began to wonder whether his diet might have something to do with the abnormal behaviors he was exhibiting.
“We began to speculate about how nutrition could be impacting Mike’s body and mind,” says John Simpson. “Perhaps his limited diet was giving him headaches, or perhaps he lacked the nutrition needed for normal brain function. Perhaps he was unable to sleep because his stomach was upset, or he was not eating well because the food did not taste good to him. These kinds of questions prompted us to begin looking into alternative approaches to autism.” As the parents looked further, they came to believe that a “leaky gut” and possibly other digestive problems, along with poor nutrition, could be fueling Mike’s abnormal behaviors.
When Mike turned age two in the spring of 2007, the parents placed him on a gluten-free, casein-free (GFCF) diet—a diet free of cow’s milk, wheat and most other grain products. “Immediately, we saw several of his behaviors improve,” Suki Simpson says. “Soon afterward, we added digestive enzymes as supplements to his diet six months later. This led to small but continual improvements in his focus and communication, including his very first ‘Mama.’ That was immensely exciting. We realized then that there had to be an underlying biological reason for his behavioral symptoms.”
In December 2007, after an Internet search of physicians listed in the Defeat Autism Now! (DAN!) directory, the parents sought my expertise and scheduled an office visit with me at the Raleigh-based Carolina Center for Integrative Medicine. (Much of the Carolina Center’s approach to autism is adapted from the DAN! program. To help decide which supplements and which parts of the program to emphasize, we recommend individualized, in-depth clinical and laboratory testing.)
After an extensive evaluation that included laboratory testing to look for signs or markers of hidden infection, I determined that Mike had an overgrowth of Candida yeast and bacteria in his intestines. The first treatment priority was to reduce the yeast levels in order to improve his digestive function health. In addition to pharmaceutical and herbal anti-fungals, Mike received specific supplements aimed at killing disease-causing organisms, as well as replacing those microbes with beneficial bacteria.
Our second effort was targeted towards vitamins and other nutrients his body lacked, and were intended to help him feel and function normally. At the same time, the parents also elected to have him start hyperbaric therapy, involving the use of pressurized oxygen to activate neurons in his brain. Children undergoing hyperbaric therapy often show rapid progression in language skills and the expansion of their vocabulary, as well as a range of behavioral improvements. Later in his treatment, Mike received an antiviral medication called Valtrex, which is thought to work as a brain anti-inflammatory agent. Recent research, all published in peer-review medical journals, has highlighted the benefits of this integrative medical approach. For some excellent summaries of this research, see the August and December 2002 issues of Alternative Medicine Review, as well as the February 2008 Journal of Alternative & Complementary Medicine.
The multi-pronged treatment—including anti-microbial therapy, physiological rehabilitation, and nutritional and behavioral interventions—led to rapid and dramatic improvements. Within four months, Mike not only knew his own name and made good eye contact, he also began speaking the name of everyone with whom he was coming into contact on a daily basis. He could speak in full sentences and quickly developed a huge vocabulary. He could count to 40, and his ability to recite the alphabet, identify letters, and put letters together was that of a first grader. To his parents’ delight, Mike became very sociable, talkative and interactive, singing songs and playing games like tag and Hide-and-Seek. He made friends easily at school, and it was very clear to his teachers that he had a keen ability to learn.
“If we had not seen it happen before our own eyes, we would not have believed it to be possible,” says Suki Simpson. “Recovery from autism is possible. In the beginning, teaching Mike was like driving down a dead end street. Today, we are cruising along a highway with interaction in both directions.” Suki adds that Mike has been thriving both socially and intellectually in a mainstream classroom at their local elementary school. “He has lots of friends,” she says. “And he talks with them and us all the time. We couldn’t be happier with his complete turnaround, and for that, we give credit to the Carolina Center’s approach.”
In short, there is now light at the end of the tunnel. At this writing, we have seen hundreds of children with ASDs go from having all types of aberrant behaviors to becoming playful, sociable, and communicative. Many of them have gone from extreme isolation to being mainstreamed in a normal school, performing just as well as their peers, sometimes even ending up at the top of their class. Yes, behavioral interventions such as speech therapy, occupational therapy, and Applied Behavior Analysis still have an integral role to play, but very often the results they achieve are limited. By addressing the underlying biological issues, autism and other ASDs can be greatly improved. And in some cases, as we saw with young Mike Simpson, autism and ASD symptoms may disappear altogether.
John C. Pittman, MD, is the Medical Director of the Carolina Center for Integrative Medicine in Raleigh, NC, and is certified by the American Board of Clinical Metal Toxicology. Mark N. Mead, MSc, serves as the Center’s Nutrition Educator and Integrative Medicine Research Consultant.
For more information, please visit our website: www.carolinacenter.com
Key scientific references:
Rossignol DA. Novel and emerging treatments for autism spectrum disorders: a systematic review. Ann Clin Psychiatry. 2009;21(4):213-36.
Bradstreet JJ, Smith S, Baral M, Rossignol DA. Biomarker-guided interventions of clinically relevant conditions associated with autism spectrum disorders and attention deficit hyperactivity disorder. Altern Med Rev. 2010;15(1):15-32.
Landrigan PJ. What causes autism? Exploring the environmental contribution. Curr Opin Pediatr. 2010; 22(2):219-25.
Adams JB, Baral M, Geis E, Mitchell J, et al. The severity of autism is associated with toxic metal body burden and red blood cell glutathione levels. J Toxicol. 2009;2009:532640.
Adams JB, Baral M, Geis E, Mitchell J, et al. Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A--medical results. BMC Clin Pharmacol. 2009;9:16.
O'Hara NH, Szakacs GM. The recovery of a child with autism spectrum disorder through biomedical interventions. Altern Ther Health Med. 2008;14(6):42-4.
Kidd PM. An approach to the nutritional management of autism.
Altern Ther Health Med. 2003;9(5):22-31
Kidd PM. Autism, an extreme challenge to integrative medicine. Part 2: medical management. Altern Med Rev. 2002;7(6):472-99.
Kidd PM. Autism, an extreme challenge to integrative medicine. Part: 1: The knowledge base. Altern Med Rev. 2002;7(4):292-316.