Autism Spectrum Disorder
Chances are you have a loved one or know someone whose loved one has been diagnosed with Autism Spectrum Disorder (ASD). The occurrence of ASD has been increasing in the past two decades. Between 2000–2012 the prevalence of ASD increased from 1 in 150 children to 1 in 68 children. In a study released in 2015, the rate had increased to 1 in 45 children [1] Some believe the increase is due to better detection and/or changes in the questionnaire that is being used. Others believe that this increase is due to other factors.
Here is a link to the DSM V Diagnostic Criteria for the diagnosis of ASD. [3] Just a cursory glance through the diagnostic criteria helps to explain the emotion and sensitivity surrounding this topic.
What Is Allostasis and Allostatic Load?
What are some common symptoms and complaints seen with ASD? Often the child will present with various behavior and social issues like poor eye contact, repetitive movements, etc. It is also common for there to be problems with learning and reaching developmental milestones. These are the issues that are most obvious to an outside observer. However, most parents of children diagnosed with ASD also notice many other issues. These children often have stomach/gastrointestinal issues, immune system issues and problems with detoxification. This information suggests that ASD may be a body disorder that is affecting the brain. This is something Martha Herbert, MD and Pediatric Neurologist from Harvard has suggested. She sees the issue as one of allostatic load. [4]
Allostasis refers to the adaptive processes the body uses to maintain homeostasis in response to stress. Allostatic load refers to the total load on the body in responding to those stressors and the in using adaptive processes to do so. These concepts are a new interpretation of Hans Selye’s General Adaptation Syndrome that was discussed previously here. [5] If the allostatic load exceeds the body’s ability to respond, it is termed allostatic overload and predisposes the body to disease. [6] So, maybe children diagnosed with ASD are experiencing allostatic overload that is playing a part in the symptoms and issues they are facing. What would happen if we decreased that load so that it was no longer an overload? Maybe some of the symptoms would decrease or cease and their bodies would have the resources to manage their allostatic load appropriately.
Where Does Functional Medicine Fit In?
Functional Medicine provides a means and a framework to decrease allostatic overload. You may be wondering though, what sort of stressors could a young child be under that would lead to allostatic overload. There are at least 7 key areas/body systems that could be affected by a variety of stressors. Those areas include:
- Gastrointestinal Dysfunction
- Nutrient Deficiencies
- Inflammation
- Detoxification Issues
- Mitochondrial Issues/Oxidative Stress
- Immune System Dysfunction
- Genetics/Epigenetics
Functional Medicine is designed to look at all of the body systems and how they interact to function as a whole. Specific testing is performed to detect abnormalities in these areas and to assess each person’s individual biochemistry. Depending on the client’s issues and needs, the testing may include blood work, stool sample, saliva and/or urine testing. In looking at the whole person through this lens, the specific diagnosis is not the primary driver of care. Instead, the specific cause/contributing factor for the dysfunction is identified and the appropriate steps are taken in response to those findings. By doing so, the load on the body is decreased and overall health improves.
Let’s begin to look more closely at each of those 7 areas and how they intertwine.
Gastrointestinal Dysfunction
Gastrointestinal (GI) symptoms are a common complaint of children with ASD and their parents. Studies have shown alterations in the bacteria in the gut of children with ASD versus controls. Qinrui et al. 2017 looked at the specific interactions between the Central Nervous System (CNS) and GI tract (i.e. Gut-Brain Connection) and the role of the gut microbiota with the CNS and ASD. [7] Buie et al. 2010 showed that patients with ASD and GI symptoms tend to display behavioral symptoms like anxiety, self-injury and aggression. [8] It also appears that many children with ASD also have alterations in the yeast located in their gut, especially Candida albicans. This can result in issues with absorption of minerals and yield a higher release of toxins. [7] This result shows a connection between multiple body systems. The GI dysfunction is leading to decreased absorption of minerals which could result in nutrient deficiencies. There is also an increased release of toxins that could be an issue if the detoxification system is already maxed out.
Another possible source of GI dysfunction is Intestinal Permeability or leaky gut. The basic premise is that when you eat certain foods, such as wheat/gluten, it is able to pass out of your gut and circulate around your body. Studies have found higher levels of Intestinal Permeability in those with ASD versus those without. [9] This study also showed that many children with ASD also have issues with constipation and diarrhea. This can lead to poor nutrient absorption due to a faster than normal bowel transit time (i.e. diarrhea) or poor detoxification due to a decreased in excretion of toxins via stool (i.e. constipation).
The other issue with Leaky Gut is that this can lead to increased circulating lipopolysaccharides (LPS), otherwise known as an endotoxin. This endotoxin, can circulate around the body and initiate an immune response. The use of NSAIDs, like Tylenol and Advil, long term can increase Intestinal Permeability and gut inflammation. [10] This shows a correlation between GI dysfunction and inflammation as well as GI dysfunction and the immune system.
Nutrient Deficiencies
Nutrient deficiencies can occur for many different reasons. The Qinrui et al. 2017 study showed that there could be mineral deficiencies found in children with ASD due to an overgrowth of yeast in the gut. [7] Low levels of folate and vitamin B12 have been found in children with ASD. [11] These vitamins also play a role in methylation and the production of glutathione. Glutathione is considered to be the master antioxidant of the human body. Low levels of folate and vitamin B12 can lead to decreased levels of glutathione. Low levels of glutathione are associated with increased oxidative stress/damage and increased inflammation in the brain of those with ASD. [12] Glutathione also plays a role in detoxification. If glutathione levels are low, then detoxification will be hampered which could result in a buildup of toxins. [13] Now we see a connection between nutrient deficiency and detoxification, nutrient deficiency and oxidative stress and nutrient deficiency and inflammation.
That Is All For Now
We have covered a good bit of ground regarding some possible issues people with ASD may be dealing with. We have also seen how many different body systems influence each other and may affect each other. However, we should not assume this occurs only with ASD. According to the allostatic load model, this may be the issue with all chronic diseases. We will discuss Inflammation, Detoxification, Mitochondrial Issues/Oxidative Stress, Immune System Dysfunction and Genetics/Epigenetics in future articles.
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Disclaimer:
This article is for educational use only. Nothing contained in this article should be considered, or used as a substitute for, medical advice, diagnosis or treatment. This article does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. Always seek the advice of a physician or other qualified health care provider with any questions regarding personal health or medical conditions. Never disregard, avoid or delay in obtaining medical advice from your doctor or other qualified health care provider because of something you have read in this article. If you have or suspect that you have a medical problem or condition, you should contact a qualified health care professional immediately. If you are in the United States and are experiencing a medical emergency, you should dial 911 or call for emergency medical help on the nearest telephone.
References/Citations:
- https://www.cdc.gov/nchs/data/nhsr/nhsr087.pdf
- https://www.cdc.gov/ncbddd/autism/data.html
- https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
- http://www.marthaherbert.org
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1197275/
- https://www.ncbi.nlm.nih.gov/pubmed/12614627
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408485/
- https://www.ncbi.nlm.nih.gov/pubmed/20048084
- https://www.ncbi.nlm.nih.gov/pubmed/20683204
- Sigthorsson G, Tibble J, Hayllar J, et al. Intestinal permeability and inflammation in patients on NSAIDs. Gut 1998;43:506–511.
- Low folate and vitamin B12 nourishment in common in Omani children with newly diagnosed autism. Al-Farsi, Yahya M. et al. Nutrition , Volume 29 , Issue 3 , 537–541
- https://www.nature.com/articles/tp201261#rightslink
- https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-9-35
