Dr. Steve Hinder

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A Psychiatrists View Incorporating
Nutritional Approaches into Clinical Practice for
People with Autism

• Dr. Steve Hinder
• Consultant Psychiatrist
• April 23rd 2008

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Sulphate and Autism

• 10 years ago, very few biological markers
• ? platelet serotonin in 30
• Proxy for reduced serotonin brain function
• Borne out by success of SSRIs and Risperidone
• Rosemary Waring found low sulphate as a marker in
  autistic children
• Pursued links with Allergy Induced Autism group,
  finding migraine in mothers

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• Foods that worsen behaviour contain PHENOLS
• Phenols are metabolized by Sulphation, catalyzed
  by Sulphotransferase enzyme (PST)
• PST is low in migraine

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• RESULTS IN
• AUTISTIC CHILDREN

• Very low Sulphate levels (10 of normal)
• High Cysteine levels
• PST very low in individuals with food reactions
• PST normal in other children

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• CYSTEINE AND SULPHATE VALUES IN AUTISTIC ADULTS
  AND CONTROLS

Mean Cysteine
Mean Free Sulphate
Ratio
Autism (n20)
0.58
0.30
1.93
Severe LD (n10)
1.41
0.91
1.55
Mild LD (n7)
1.57
0.94
1.68
Controls (n60)
0.37
6.34
0.06
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(TMG)
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Gaining New Knowledge
People
Practice

• Autism Research Unit
• Durham conferences
• Allergy Induced Autism
• Hyperactive Childrens Support Group
• Informal networking
• Andrew Wakefield

• Developmental histories
• Taking parents more seriously
• Dietary history
• Immunity
• Vaccines
• Eventually brave enough to give advice !

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OPIATE EXCESS THEORY OF AUTISM

• Reduced crying when isolated
• Decreased pain sensitivity
• Insistence on sameness
• Increased stereotypical behaviour
• Fearlessness
• Abnormal social play
• Unusual body postures
• Changes in eating patterns
• Increase in seizures
• Social withdrawal
• Hyperactivity
• Lack of response to sensory stimuli

All signs of opiate addiction or withdrawal
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EXOGENOUS OPIOIDS

• Intact peptides can cross mucosa
  (Gardner, 1983)
• Gluten and Casomorphin fragments have opioid
  activity
• Peptide peaks in urine of autistic patients have
  opioid activity (Shattock, Reichelt)
• Abnormal intestinal permeability in autism
  (D'Eufemia et al, 1996)
• Effect of gluten and casein-free diets?

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CAUSES OF LEAKY GUTS

• Trauma Cytokines
• Immunodeficiency/Allergy
• Gut flora imbalance or Candida
• Ankylosing Spondylitis or Arthritis
• Low Glycosaminoglycans
• Measles/MMR ?
• ? Learning disability?

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GLYCOSAMINOGLYCANS (GAG's) CANDIDA

• GAG's required for gut wall integrity
• Normally sulphated - produces negative charge
• Lack of sulphate interrupts normal production
• Candida no longer repelled
• Candida very common in autism
• Known to deplete sulphate
• Positive feedback ?

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Recent Trends
- Increased incidence, was 1 in 2000
now 1 in 100 - majority
feel due to better diagnosis and wider
definitions, but significant minority feel
genuinely increasing - Active but odd group now
more prominent ? - Less LD than you would
expect (20 rather than 80) - Children with
autism seem to be making extraordinary progress
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If autism is increasing, what might the cause be
?
- Leaky Gut syndrome - MMR/other vaccines -
Overuse of antibiotics ? Candida or clostridium -
Pesticides or organophosphates - Food additives
(Eg. MSG, Aspartame) - Lowered immunity/increased
autoimmune disease - Mercury toxicity - Unusual
viruses or other infections - Opiate use during
delivery - Chemicals in environment
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A Model for Causation in Autism
EARLY INSULT IN DEVELOPMENT
CANDIDAMMR SULPHATE OTHERS
GENETICALLY DETERMINED LOW DPP IV ?
GENETIC CONDITION
ALTERED OPIATERECEPTORFUNCTION
LEAKY GUT
ALTERED IMMUNITY
CLOSELYINTERACTSWITHSEROTONIN
ALTERED BIOCHEMISTRY
CO-INHERITED WITH OTHER BIOCHEMICAL DIFFERENCES
BRAIN MORE SUSCEPTIBLE TO INSULTS
DRUG TREATMENTS
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Possible causes of autism
Leaky Gut
Biochemical Causes
Cod liver oil/vitamin A Evening Primrose
oil Zinc/minerals Megadose B6 Mg DMG or
TMG Allergies MSG/Aspartame free
Gluten/Casein free Anti-Candida Sulphate
replacement Digestive enzymes Secretin Glutamine
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Gluten/Casein-free

• Combination of both works best
• May be easiest to start with casein, but often
  not enough
• Persevere with casein for at least 2 months ?
• Persevere with gluten for at least 6 months ?
• May get cold turkey, esp. with casein
• Constipation/MMR history suggests gluten
• May previously have craved these substances, or
  avoided
• Sunderland urine test can be non-specific
• May work better in younger children
• May be less effective if clear genetic cause
• Improvement in 40 on combined diet ?
• NEED TOTAL ELIMINATION (in most, but not all)
• Re-exposure can cause severe behaviours

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Sulphate

• No blood test available
• May be low in 90 of children
• Causes diarrhoea if taken orally
• Can try slowly increasing epsom salt baths
• Glucosamine sulphate
• Cranberry juice
• Cut out citrus fruit, apples, vinegar, tomatoes
• Avoid paracetamol
• Overlap with Feingold diet for hyperactivity

Epsom Salts
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Treating Candida

• Suggested by early antibiotic use
• Difficult to test (we all have it)
• NYSTATIN oral drops
• Low sugar
• Capryllic acid other natural products
• Probiotics (acidophilus, Lactobacillus, Bifidus)
• Possibly low yeast diet
• Can get massive die-off reaction

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Essential fatty acids

• Cod liver oil, may be vitamin A, omega 3
• Evening Primrose oil, omega 6 (GLA)
• Flaxseed (Linseed) oil
• Zinc may aid absorption
• Good for hyperactivity/concentration
• May improve eye contact
• Caution with EPO in epilepsy

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Other supplements

• Good evidence for high dose B6, Magnesium
• May tie in with sulphate pathways
• DMG/TMG may have additive effect

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(TMG)
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Other supplements

• Good evidence for high dose B6, Magnesium
• May tie in with sulphate pathways
• DMG/TMG may have additive effect
• Can all improve core social symptoms
• Digestive enzymes promising (CCK connection,
  DPP IV)
• Secretin not yet safe
• Other vitamins/minerals may help
• Glutamine can heal leaky gut?
• Monosodium glutamate/Aspartame important
• MANY OTHER THINGS BEING TRIED (Methyl B12,
  Glutathione)

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Things to consider

• Early treatment probably best
• Interventions can also help ADHD/LD
• Is mercury important?
• Are UK and USA children different? cysteine
  levels seem paradoxical
• DAN protocol Is it humanly possible?
• Dilemma re single versus many treatments, as may
  be synergistic
• Do not take lightly (do have biological action),
  but give dietary interventions a try
• Therapeutic alliance with parents

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