http://www.eas.asu.edu/~autism/Summary_of_Montreal.doc

Summary of Montreal’s 3^rd Annual Medical Conference on Autism

By Jim Adams

Note: This is an informal summary based on one person’s notes. There may inadvertently be some inaccuracies in some places.

Walter Spitzer, MD and Lothar Heineman, MD, D.Sc: Epidemiology

Dr. Spitzer discussed the lack of epidemiological studies that could clearly evaluate changes in the incidence of autism. He also discussed several epidemiological studies of MMR, which he feels are inadequate to determine whether or not MMR is a factor in autism.

Therefore, he led the development of a plan on how to carry out a large international epidemiological study on autism. The plan would involve an international group of scientists from 8-9 countries in 3 continents. It would focus on 2 areas: 1) an incidence study of new cases of autism to provide data for a time trend analysis, and 2) a case control study (comparing autism cases with controls) to investigate various possible causes of autism. The plan is fairly well-developed, but the cost for it would be $20-25 million dollars, and they are still searching for funding for it. Due to Dr. Spitzer’s ill health, Dr. Heineman has taken over leadership of the planning effort.

Boyd Haley, Ph.D (Chair of Chemistry at Un. Kentucky): Mercury Toxicity

His work has focused on investigating the toxicity of mercury and other heavy metals on enzymes related to brain function. His work on a variety of toxic metals found that mercury was by far the most toxic element to two proteins, actin and tubulin, that are required for neurite (brain cell) growth. Specifically, thimerosal (the mercury-based preservative in vaccines) was found to be an especially dangerous form of mercury that equally inhibits both tubulin and actin. Aluminum is also added to vaccines, and although it is not very toxic by itself, it greatly enhanced the toxicity of thimerosal. Two oral antibiotics, neomycin and ampicillin, were also found to significantly enhance the toxicity of thimerosal. Thus, he believes that the combination of thimerosal and aluminum in vaccines with oral antibiotics could inhibit brain development, and could be dangerous to infants in the amounts present in thimerosal-containing childhood vaccines. Individual sensitivity would depend on the amount of “protective bio-compounds,” such as glutathione, APO-E, metallothionine, etc.) Infants would be more susceptible, since they have minimal bile production, which is required for excretion of heavy metals.

Genetic susceptibility is also important; for example, variants of one gene result in APO-E proteins having 0, 1 or 2 thiol groups, which are important for removing heavy metals from the brain. People with the APO-E gene for zero thiols would be much more vulnerable to heavy metals. People with that genetic variant are known to be at much higher risk for Alzheimer’s, and hence that gene is also being investigated as a risk factor for autism.

He believes that intravenous vitamin C and glutathione might be an effective alternative to DMSA treatments for removing heavy metals. Vitamin C is a strong antioxidant, so it could donate an electron to Hg+2, converting it to Hg+ which is less strongly bound, and hence might then be more easily removed by glutathione. However, no formal studies have yet been done.

Woody McGinnis, MD: Physical Health in Autism

He focused on gut problems on autism and nutritional interventions. He thinks that four common problems in autism and ADHD are poor nutrition, food intolerance, bacterial/yeast overgrowths, and toxins (such as heavy metals). He reviewed the literature that most autistic children have an inflamed gut, including Horvath’s data (70% have inflammation of their esophagus and/or duodenum ), and Wakefields data. This could be due to sub-optimal nutrient levels, microbial overgrowth, food allergens, or toxins (such as heavy metals). Also, the gut mucosa is very vulnerable to oxidative stress.

The GI injury can cause reduced absorption of essential nutrients (vitamins, minerals, essential fatty acids). The combination of poor digestion and a leaky gut can allow unusual substances to enter the bloodstream, causing food allergies and an opiod effect due to casein and gluten.

He believes that a study of the nutritional status of people with autism is badly needed. He quoted a pilot study by Emar Vogellar that most children with autism suffer from a wide range of deficiencies of vitamins, minerals, and essential fatty acids. He also quoted Waring’s work on sulfate deficiency in autism.

He recommends a GFCF diet, anti-viral agents (such as IVIG), digestive enzymes (especially DPPIV and disachrydase), floral remediation (antifungal, antibacterial, probiotics), secretin (to stimulate digestive enzymes), cod liver oil (for vitamin A, which supports GI membranes, and for EPA which is anti-inflammatory), and Bethanecol (stimulates acid production in the stomach, which helps eliminate yeast/bacterial overgrowths), DMSA and lipoic acid (to remove heavy metals), and zinc (many effects, including protecting cell membranes, decreasing intestinal permeability, increasing stomach acid, and increasing immune function).

In particular, he focused on vitamin/mineral/essential fatty acid supplements, including B6 (as P5P), Mg (glycinate), zinc (as picolinate), calcium, selenium, vitamin A (as cod liver oil), vitamin C, vitamin E, fish oil (EPA, DHA), Evening Primrose Oil.

See www.woodymcginnis.com for more details.

Stephanie Cave, MD, MS: Autism and Immunizations

She discussed the increase in autism cases, and the correlation with increasing numbers of childhood vaccines. She particularly stressed the concerns about thimerosal in vaccines. She gave a comparison with Pink Disease, which involved symptoms similar to autism, and was eventually realized to be due to mercury in teething powders – when mercury was removed from teething powders, there were no new cases of Pink Disease. She pointed out that the DTaP vaccine (the safer form of the DTP vaccine) was used in Japan 15 years before it was used in the US. She discussed concerns re. Hepatitis B vaccine, because the safety tests only followed the infants for 5 days even though plasma immune reactions occurred weeks after the shots. She pointed out that Varivax (chicken pox vaccine) may only last 10-15 years, so people will be vulnerable as adults, when the disease is more serious. Finally, she mentioned several studies that found a 20-50% rise in insulin-dependent diabetes roughtly 3.5 years after new vaccines were administered, including DTP, Hib, MMR, Anthrax, BCG, and Hepatitis B.

She recommends: Use thimerosal free vaccines. Do not vaccinate ill children. Space vaccines where possible (1 month or more apart). Give vitamin C before and after the vaccines. Use DTaP consistently (not DTP). Do not give live viral vaccines to immunodeficient children. Give cod liver oil (vitamin A) daily at the RDA level (about 2500 IU for a young child). Give Vitamin C before and after vaccinations. Delay Hepatitis B until age 4 years. Split MMR into three vaccines, given a year apart. Do not vaccinate sick children. Delay Varicella (chickenpox) until age 4-5 years.

See her book, What Your Doctor May Not Tell You About Children’s Vaccinations, available from amazon.com

Vijendra Singh, Ph.D., Utah State University: Autoimmunity in Autism

He hypothesizes that Environmental Factors (viruses/vaccines/toxins) lead to Immune Dysfunction/Dysregulation, which leads to Autoimmunity to the Brain, which in turn causes Autism. His lab tested antibodies to several viruses, including measles, mumps, rubella, cytomegalovirus, and human herpesvirus-6. Only the antibodies to measles virus was found to be elevated in autism, and it was elevated in 70% of the autism cases vs 0% of the controls. Also, there was a 90% correlation of elevated antibodies to measles with autoantibodies to Myelin Basic Protein (MBP), suggesting that the presence of measles virus caused the body to attack the MBP.

His lab offers 5 major types of autoimmunity tests, including: 1) Brain antibodies (myelin basic protein and neuron-axon filament proteins – MBP is usually elevated in autism), 2) Virus antibodies (measles, mumps, rubella, HHV-6 – measles antibodies are usually elevated in autism), 3) Vaccine antibodies (MMR, DPT – only autistic children have a unique antibody to MMR), 4) Cytokine profile (interleukin-12 and interferon gamma – both are important in causing autoimmune diseases, and sometimes elevated in autism), 5) Antinuclear antibodies – (non-specific antibodies, found in 1/3 of autism).

If autoimmunity markers are found, he recommends treatment with immunoglobulin (IV or oral appear to be equally effective) or sphingolin (an MBP-containing myelin product). Both were shown to reduce or eliminate autoimmunity markers in roughly 8/8 and 2/2 children with autism, respectively, and also lead to a reduction in autistic symptoms, but a formal clinical study is needed. Steroid therapy (Prednisone and/or ACTH) could be considered, but there are only anecdotal reports of it. Plasmapheresis (removes antibodies from blood) has been shown to be more effective than IVIG in certain brain disorders, and may be useful to try in autism.

Bill Walsh, Ph.D. Pfeiffer Labs: Metallothionein and Autism

Dr. Walsh has found an unusually high serum copper: plasma zinc ratio in 503 autism-spectrum patients compared to controls (p<0.0001). Zinc supplementation usually only slightly improves the ratio. This suggests a major defect in metallothionein, the protein that regulates zinc and copper levels. Metallothionein serves many other functions, including distributing zinc throughout the body and working with glutathione in removing toxic heavy metals.

Pfeiffer Lab has developed a 2-stage treatment protocol for normalizing metallothionein. Stage 1 involves pre-loading the body with zinc and related nutrients, and stage 2 involves providing the ratio of amino acids which are the building blocks for metallothionein. These supplements are now being tried by many children with autism under the guidance of their physician, on an experimental basis. These supplements can be ordered from Pfeiffer Lab by a physician (it is important that their protocol of zinc pre-loading be followed). See their web site www.hriptc.org, or call them at (630) 505-0300.

Lisa Lewis, Ph.D. Gluten-Free, Casein-Free Diet

Dr. Lewis discussed her personal experience with her son Sam, and explained how eliminating gluten (wheat and related grains) and casein (dairy) from her son’s diet helped him. She has counseled thousands of families, and estimates that 50-80% of them experience significant improvements when implementing the GFCF diet. The reason is that if the casein and gluten are not fully digested, and if they pass through a “leaky” gut into the blood, then they can attach to opioid receptors in the brain and act like heroin or morphine. Although a double-blind, placebo-controlled trial does not exist, there is good open trial data (http://osiris.sunderland.ac.uk/autism/treat.html), and anecdotal evidence from thousands of families.

The kids most likely to benefit from a GFCF diet are probably those with: early, excessive antibiotic use; late onset autism after normal development; insensitivity to pain; constipation or diarrhea; very limited diet.

Benefits of the diet may include: ability to focus; eye contact; aggression; GI problems; language; sleep; toilet training; behavior.

See her web site www.gfcfdiet.com, and her book Special Diets for Special Kids.

James B. Adams, Ph.D. (Arizona State University) Heavy Metals and Autism

One possible cause of autism could be exposure to heavy metals. For example, lead poisoning is still widespread in the US, with 5% of the children in the US suffering a loss of 5 or more IQ points due to lead poisoning. The symptoms of mercury poisoning are similar to those of autism, and there is a strong synergy between mercury and other heavy metals. One major source of mercury is seafood, and the largest fish (shark and swordfish) have so much mercury that in March 2001 the FDA warned pregnant women not to eat any shark or swordfish, and to limit their consumption of other fish. Another major source of mercury is thimerosal in childhood vaccines. At age 2 months, a typical child receives 60 mcg of mercury, roughly 120x the EPA’s recommended safe level.

His group carried out a small pilot study on 55 children with autism and 50 typical children. They found that mothers of children with autism were twice as likely to consume more than 2 servings of seafood/month, yielding a roughly 3.5x increased risk of autism. More importantly, children with autism had 10 ear infections during their first three years of life, vs 2 for controls. Eight or more ear infections correlated with an 8x relative risk of autism. The reason is that antibiotics seem to almost totally stop the ability to excrete mercury (and probably other heavy metals). They also found that autism families used roughly 2x as much pesticides in their home during pregnancy. Finally, 30% of children with autism exhibited pica (eating non-food items), so that they were exposed to much higher levels of heavy metals.

His group also did DMSA challenge testing of 6 children with autism and 9 typical children. 5 of 6 of the children with autism excreted 5x-700x as much of a variety of heavy metals as the typical children. This is consistent with Bradstreet’s DMSA study, which found that children with autism excreted 5x as much mercury on average.

He also reported on Edelson’s two published studies that found that 89% of children with autism had elevated levels of toxic chemical solvents in their blood, and 100% of them had impaired liver detoxification.

So, he concluded that detoxification of heavy metals and chemicals may be common in autism, that most kids should be tested, and that detoxification may lead to reduction of autistic symptoms.

For more info and a copy of his presentation, see www.eas.asu.edu/~autism

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