Celiac Disease Presenting as Autism

The Journal of Child Neurology published a special article online June 29, 2009 (published ahead of printing) entitled “Celiac Disease Presenting as Autism.” The article is a case study of a 5-year-old boy diagnosed with autism and celiac disease.

The boy was described as “an increasingly picky eater and would reject food on the basis of taste, smell, or appearance.”  He had severe language problems, as well as gastrointestinal symptoms including bloating, belching, abdominal pain, nausea, vomiting, and diarrhea.  He had deficiencies in fat-soluble vitamins (vitamins A, D, and E) and fatty acids (omega 3, omega 6, saturated fat), as well as low coenzyme Q10 and folate.

Upon being assessed and diagnosed with celiac, the boy was put on a gluten-free diet and nutritional supplementation based on deficiencies.  "Fruits and vegetables were juiced to make nutrients easier to absorb, and fat-soluble vitamins, omega 3 fatty acids (in the form of cod liver oil), omega 6 fatty aids, and folic acid were given as supplements.”  According to the published article, "The patient's gastrointestinal symptoms rapidly resolved, and signs and symptoms suggestive of autism progressively abated." 

“Within 1 month, the boy’s gastrointestinal symptoms were relieved and his behavior had changed dramatically.  The mother excitedly reported that for the first time, her 5-year-old boy became progressively more communicative and told her that he loved her.  Within 3 months, his functioning had improve so much that he no longer required an individualized leaning program and was able to enter a normal classroom with no aide.”

The authors of the article postulate that nutrient deficiencies caused by malabsorption from celiac disease caused the symptoms of autism, as they stated, “This case is an example of a common malabsorption syndrome associated with central nervous system dysfunction and suggests that in some contexts, nutritional deficiency may be a determinant of developmental delay.  It is recommended that all children with neurodevelopmental problems be assessed for nutritional deficiency and malabsorption syndromes.”

Genuis SJ, Bouchard TP. Celiac Disease Presenting as Autism. J Child Neurology Online First. Published on June 29, 2009 as doi:10.1177/0883073809336127

Autism, Vaccines and the CDC: The Wrong Side of History

Robert F. Kennedy, Jr. and David Kirby

Posted January 27, 2009 | 04:05 PM (EST)  From Huffington Post

Even as the evidence connecting America's autism epidemic to vaccines mounts, dead-enders at the Centers for Disease Control (CDC) -- many of whom promoted the current vaccine schedule and others with strong ties to the vaccine industry -- are trying to delay the day of reckoning by creating questionable studies designed to discredit any potential vaccine-autism link and by derailing authentic studies. 

On January 12, a cadre of mid-level health bureaucrats left over from the Bush administration ignored Federal requirements for advance notice in order to vote to quietly strip vaccine research studies from funding allocated by Congress in the Combating Autism Act (CAA) of 2006. Members of Congress had said that this money should be used to study the vaccine-autism connection.

These rogue bureaucrats -- members of the Interagency Autism Coordinating Committee -- held an unannounced vote to remove previously approved vaccine studies from funding under the CAA. Nearly all of the "Federal" members of the panel voted to remove the two studies, whose estimated cost was $16 million - or 1.6% of the billion dollars authorized by Congress for autism. The panel's civilian members, in contrast, voted nearly unanimously to retain the funding.

IACC's action to halt vaccine-autism research flies in the face of congressional intent. The bill's authors clearly stated that vaccine research should be funded. Even the esteemed Institute of Medicine has condemned CDC's methods. In 2005, an IOM panel condemned CDC for its "lack of transparency" in vaccine-autism research. 

The bureaucrats responsible for this scandal are on the wrong side of history and it's hard to not attribute an obstructionist motive to their act since vaccine-autism research has already entered the realm of mainstream science. Serious scientists (except those tied to the vaccine industry) no longer debate whether vaccine-autism research should be done, but rather how it should be done, and by whom.

And Congress concurs: "I want to be clear that ... no research avenue should be eliminated, including biomedical research examining potential links between vaccines, vaccine components, and autism,pronounced Sen. Mike Enzi (R-WY), Chairman of the H.E.L.P. Committee at the bill's passage. Sen. Chris Dodd (D-CT) said the bill should fund "environmental research examining potential links between vaccines, vaccine components and autism. And last week, Dodd called the potentially illegal maneuver to shut down vaccine research, "contrary to the spirit of the bill."

These days, being opposed to vaccine-autism research puts one outside of the "mainstream" (and let's be clear, supporting such research in no way makes one "anti-vaccine" -- that charge is a tired, diversionary charade -- an ugly lie perpetrated by vaccine industry allies and their blind supporters.)

Recognizing this fact, the vaccine industry and its CDC allies have continued to fund a series of deceptive and badly flawed studies designed to dispute the connection between vaccines and the epidemic of pediatric neurological disorders. The latest of these is the controversial Italian study released this week intended to allow Thimerosal's defenders to argue that the preservative is safe. The study comparing two groups of Italian children, who received a moderate level of Thimerosal vs. a moderately higher level, is so poorly designed it could only find one child in 1400 who tested with autism. The researchers did not include in the study the records of children who received no Thimerosal. For years, a cadre of vaccine officials at CDC has vigorously opposed funding for epidemiological studies that include both vaccinated and unvaccinated cohorts that might give us useful information about causation.

The evidence of a potential link between vaccines and autism is now so compelling that every national autism organization firmly supports research into vaccination as a possible trigger for the disorder, including Autism Speaks, the world's largest, most well funded, well connected mainstream group.

Autism Speaks was co-founded by Bob Wright, former CEO of NBC-Universal, former Vice Chairman of General Electric. Autism Speaks, a staunchly pro-vaccine group, supports vaccine research. Its statement on the issue is right down the middle.

Why has vaccine-autism research gone mainstream? The reasons are many: (read more at The Huffington Post)

Cholesterol Levels May Not Measure Cardiac Risk

After writing about the inaccuracies of using cholesterol as the primary marker for heart disease in “Saturated Fat and Animal Fat—Further Vindication”, I came across this article from HealthDay discussing a recent study of cholesterol levels and heart disease.  This is further support for why simply lowering cholesterol numbers is not the answer to heart disease.  In the study, “Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines,” from American Heart Journal, researchers found that almost 75% of patients hospitalized for heart attacks had cholesterol levels that fell within normal healthy guidelines.  While Fonarow, the lead researcher on the study, states in an interview, “Cholesterol is only one part of the heart risk picture,” in the study he concludes “These findings may provide further support for recent guideline revisions with even lower LDL goals.”

I continue to contest that cholesterol should not be the only and may not be the best indicator of heart disease risk, and that lowering the guidelines may not be the answer.  (Also, please notice the financial disclosures at the bottom of the study and the numerous pharmaceutical companies that contributed.)

Here's the article from HealthDay on the study:

Cholesterol Levels May Not Measure Cardiac Risk
Normal readings showed up in many who had heart attacks, study shows

Posted January 16, 2009

By Ed Edelson
HealthDay Reporter

FRIDAY, Jan. 16 (HealthDay News) -- Nearly three-quarters of patients hospitalized for heart attacks had cholesterol levels indicating they were not at high risk for cardiovascular trouble, a new, nationwide study shows.

The finding points to the possibility that current guidelines on cholesterol levels should be changed, said study author Dr. Gregg C. Fonarow, a professor of cardiovascular medicine and science at the University of California, Los Angeles. His report appears in the current issue of theAmerican Heart Journal.

"The LDL cholesterol range at which people have heart attacks shouldn't be regarded as normal," Fonarow said.

LDL cholesterol, the "bad" kind, collects to form plaques that can eventually block arteries. Guidelines compiled by the U.S. National Heart, Lung and Blood Institute set an LDL cholesterol blood level target of 130 milligrams per deciliter for people with no cardiovascular disease or diabetes and 70 for those at high risk because of factors such as obesity, smoking and high blood pressure.

But the study of nearly 137,000 Americans hospitalized for heart attacks between 2000 and 2006 found that about 72 percent had LDL levels below 130 on admission, while 17.6 percent had LDL levels below 70.

"People with LDL cholesterol levels in the 100 to 130 range may feel they are at low risk," Fonarow said. "In this study, there was nothing normal about having an LDL reading of 100."

The study also looked at levels of HDL cholesterol, the "good" kind that helps prevent artery blockage. Current guidelines recommend an HDL level of 60 or higher, but the study found levels below 40 in 54.6 percent of the heart attack patients.

Only 1.4 percent of patients met the recommendation for both an LDL level of 70 or lower and an HDL reading of 60 or higher, Fonarow noted.

The current National Cholesterol Education Program guidelines were first set in 2001, and were updated in 2004. The NHLBI is expected to review those guidelines in the near future, Fonarow said.

"My opinion, based on the totality of the evidence that has come out, is that it is likely that there will be important revisions to the guidelines, but that should be determined by the individual advisory groups that will be writing them," he said.

In its update of the guidelines, the NHLBI called for more use of measures such as physical activity and weight loss to reduce the risk of heart attack and other cardiovascular problems.

Cholesterol is only one part of the heart risk picture, Fonarow said. Risk climbs higher with age, especially for men and for those with close relatives who have had cardiovascular conditions.

"The good news is that as much as 80 percent of the risk factors are under individual control and are modifiable," Fonarow said. "You can't control your family history, age or sex, but you can keep your blood pressure low, exercise and modify your lifestyle in other ways to reduce risk."

While calling the study "excellent," Dr. Manesh Patel, an assistant professor of medicine at Duke University, added, "The problem is that this is a snapshot, but we're not sure we know all the risk factors and how they interplay."

The researchers did not measure blood levels of other molecules involved in cardiovascular disease, such as the inflammation biomarker C-reactive protein and lipoprotein(a), he said.

But it's quite possible that the cholesterol guidelines will be changed, Patel said. "Ongoing studies have led to getting the LDL level to 100 and then to 70," he said. "As more randomized trials come out, there may be further changes."

Udderly New Insight About Milk and Autism: An Emerging New Hypothesis on A1 and A2 Beta-Casein

by Julie Matthews, Certified Nutrition Consultant

As an autism nutrition consultant, I’ve been supporting clients following the Gluten-Free Casein-Free (GFCF) diet for years.  Some of my clients would report that their child could handle goat's milk or raw milk without allergic reactions. I began to wonder if all milk was created equally.

I conjured various theories: could the protein in goat's milk be different than cow milk, was it the pasteurization process (absent in raw milk) that made the difference, was it something else, or a combination of factors?  Then, one of my clients introduced me to A1 and A2 beta-casein.

There are various types of casein.  Goat’s milk, as well as sheep and buffalo milk, contain A2 beta-casein. Raw milk, while often from cows, is typically produced from small herds of Jersey and Gernsey cows, both of which contain a high percentage of A2 beta-casein compared to most dairies that use mainly Holstein cow’s that produce a majority of A1 beta-casein.  Here's what I have learned through my research about casein and A1 versus A2 beta-casein.

Beta-casein is a protein that contains bioactive peptides and opioids. Bioactive peptides are important for protecting the undeveloped immune system of newborns, and stimulate the growth and development of organs like the gastrointestinal tract and gut. Bioactive peptides have also been shown to kill bacteria that normally cause immune system infections. Opioids have pain-killing effects, sedative properties, induce sleep, and play a role in the control of food intake. Opioids can be produced by the body in the form of endorphins, or be absorbed from digested food, such as milk and wheat, in the form of casomorphins and gluteomorphins (opioid proteins). Several forms of beta-casein exist and make up 25-30% of the proteins in cow’s milk. There are approximately 13 beta-casein variants, with A1 and A2 variants being the most commonly occurring. A1 beta-casein contains the amino acid histidine at position 67 in the protein, while A2 beta-casein instead contains the amino acid proline at the same position. Studies have shown that when digested, A1 beta-casein breaks down to a casomorphin protein called beta-casomorphin-7 (BCM7). This is a direct result of the histidine amino acid that A1 beta-casein contains, as A2 beta-casein does not form BCM7 (1).

Several enzymes in the digestive tract process beta-casein including DPPIV, (dipeptidyl peptidase IV) and cause the break down of bioactive peptides and opioids. Studies suggest that the digestion of cow’s milk (containing A1 beta-casein), leads to the release of opioids, such as BCM7, and can cause harmful effects in children with autism (2) where DPPIV function may be impaired.  As this amino acid structure is more difficult to breakdown, those with compromised or weak digestion may accumulate opioids more readily. Additionally, when the gut is “leaky” (referring to increased gut permeability), these opioids end up in the blood stream in much greater concentrations than in those people with a healthy gut wall that does not leak. BCM7 is not produced when A2 beta-casein is digested, so goat’s, buffalo’s, and sheep’s milk that contain A2 beta-casein but not A1 beta-casein should not cause these harmful effects. There are other opioids that may also be formed; however, BCM7 appears to be the strongest.

As Jon Pangborn, Ph.D. describes, the enzyme DPPIV, which is also called CD26, has several other functions in the body, including involvement in signal transmission via lymphocyte receptors, and assisting the enzyme, ADA, in processing adenosine as an ADA binding protein. DPPIV is impaired by toxic heavy metals like mercury, lead and cadmium, a milk allergy, organophosphate insecticides, and yeast. Children with autism have greater toxic metal burdens, and one theory is that these heavy metals knock out this DPPIV enzyme, and the impaired DDPIV leads to improper processing of dairy and wheat. A supplemented plant analog version of DPPIV cannot substitute for the animal version completely, but it can certainly help.

While it is possible that A2 milk may also release opioids, Japanese and German scientists were unable to release BCM7 from A2 milk (1, 3). It appears that human breast milk may not release BCM7 either. Interestingly, this may explain why breastfeeding does not seem to cause a casein reaction to sensitive babies when dairy is avoided in a mother’s diet. In addition to affecting autism, research suggests that BCM7 may lead to the onset of several diseases, such as heart disease, diabetes, and schizophrenia (4).

Studies have also shown that wheat products, which contain gluten, also cause health problems for children with autism (5)  Gluten has long been established as a problematic protein for many individual, most well studied in celiac patients, causing inflammation in the gut, diarrhea, constipation, abdominal pain, digestive problems, and the improper absorption of nutrients.  Similar responses are seen in many children with autism (that are not diagnosed with celiac).  Gluten, along with an autistic person’s already compromised digestive system, can exacerbate the ability of the body to break down beta-casein.

Scientists believe that opioids like gliadomorphin (a gluten opioid) and BCM7 (a casein opioid) are toxic for children with autism due to the fact that these children have an abnormal, leaky, gastrointestinal tract (6). Instead of completely digesting and excreting these opioid proteins, some of the partially digested gluten and casein proteins leak out of the gut and are transported to other parts of the body before they can be completely digested. These opioid proteins travel through the bloodstream, cross the blood brain barrier (the barrier between the brain and the rest of the body), enter the brain, and stimulate morphine-like effects. Casein proteins (BCM7) negatively affect the brain by causing inattentiveness, unclear thinking, and irregular sleeping and eating patterns (7).

In children with autism, gliadomorphin and BCM7 can also cause the release of histamine, a chemical that regulates immune cell communication. Histamines are normally released in the body in response to an allergic reaction. This mis-regulation of immune cells weakens the immune system’s ability to ward off harmful viruses and bacteria that cause diseases.  This is consistent with the experience that many children with autism get frequent infections and illness.

Antibodies are also released to help target and remove unwanted opioid proteins. IgA is an antibody that can be found in blood, saliva, tears, and mucous membranes of the respiratory system and gastrointestinal tract. IgG antibodies are the most common antibodies in the body, and can be located in all bodily fluids. IgG antibodies are the only form of antibody that can cross the placenta in pregnant woman to protect a fetus (unborn baby). IgG antibodies also play a major role in fighting viral and bacterial infections. When the immune system detects foreign particles such as viruses, bacteria, fungi, or cancer cells it stimulates the production and release of antibodies. These antibodies attach to the foreign particles, labeling them as hazardous so that they can be destroyed and removed from the body (8). So while the peptides from casein or gluten trigger an IgG immune response, the opioids trigger an IgA immune response. So it is not just opioids that trigger an immune response, casein and gluten protein can do so also, just using different types of antibodies.

Studies have shown that in autistic and schizophrenic patients, large amounts of gliadomorphin and BCM7 can be detected outside the gut (8). This further indicates that their bodies are not able to properly break down and utilize these opioid proteins. These studies also showed that in 86% of schizophrenic patients, IgA antibodies that were targeting gluten were released into the body, and 67% had IgA antibodies that were targeting casein. In patients with autism, approximately 30% of the patients had IgA antibodies targeting gluten and casein present in the body. The release of IgG antibodies targeting gluten and casein were also detected in these patients. More than 80% of the autistic and schizophrenic patients had elevated levels of IgG antibodies in their blood.

In recent years, the adverse effects of gluten and casein led researchers and to believe that autistic and schizophrenic patients should be placed on a gluten-free/casein-free diet, and this has become a widespread treatment for both diseases (9). Case studies that involved putting patients with schizophrenia and autism on a gluten-free/casein-free diet normally lead to some improvement of symptoms, but more clinical trials need to be performed to get a better picture of why this is the case. There is not enough data yet to understand all of the complexity behind gluten and casein and the challenges with them, but the experience of thousands of patients support the science we know so far: that a gluten-free/casein-free diet helps. And of course implementing the diet always depends on the patient’s needs, the caregiver’s willingness to try it, and professional supervision (10).

Schizophrenic patients who were put on a gluten-free/casein-free diet or treated with dialysis, a process that cleans the blood in order to rid the body of gliadomorphin and BCM7, were relieved of their symptoms, and low levels of the opioid proteins were detected. Approximately 81% of patients with autism who were put on a gluten-free/casein-free diet for at least 3 months were also relieved of their symptoms. A few parents, who stated that their child with autism had seizures before going on the diet, noticed that the frequency of the seizures either decreased or ceased all together. As previously stated, opioid proteins can cause an allergic response in the body, which leads to the release of histamines. Histamines have a direct effect on immune cell regulation. The disturbed immune response leads to a higher production of antibodies, such as IgA and IgG, as a means of further breaking down and excreting harmful gliadomorphin and BCM7 particles. In other words, the high levels of antibodies that are detected in patients with autism are a direct result of complications that occur when gluten and A1 beta-casein are consumed (8).

A vast majority of children that consume dairy consume cow milk products so removal of dairy on the GFCF diet would be the removal of A1 beta-casein in most instances. This may be the reason the GFCF diet is so successful for children on the autism spectrum.  I’d like to pose a new hypothesis, maybe it is not ALL casein but the A1 beta-casein that is actually the primary problem with milk for children with autism.

With that said, there are most likely are other reactions and problems with dairy for some (if not many) individuals, so I do not think this preliminary information justifies abandoning the GFCF diet.  (In fact, I hesitated writing and talking about this topic for a long time, as I did not want to confuse parents new to diet.)  I have seen many wonderful results from GFCF and know many clients that cannot seem to tolerate goat or raw dairy.  I don’t want children to miss out of the full benefit from diet by not trying a GFCF diet. 

Through my clinical experience, I have found that it is very important to give the GFCF diet a complete trial, free of any infractions.  Once a child has been on this diet for 3-6 months and you see what progress can be made with it, then and only then, do I feel that a parent may experiment with diet and try adding goat’s milk or some other A2 milk back.  It seems that for some children, their casein sensitivity is mild and A2 milk works well.  For others, once the gut is healed, they are able to consume small amounts of A2 milk.  I often hear that as a child’s digestive systems improve, they are able to handle goat’s milk yogurt or raw milk. It is possible that the BCM7 issue is a primary factor for some people, and that A2 milk may provide an option for some individuals.

While milk is not “necessary” in the diet, dairy has health benefits when the individual is not intolerant to it.  (Note that when people are intolerant, it can be very harmful regardless of the “benefits.”)  If there is a way to include some dairy in some children's diets, there can be a positive benefit to having this flexibility and nutrition in the diet.  Dairy makes wonderful probiotic-rich fermented foods such as yogurt and kefir to support a healthy intestinal tract—and often nuts, nut milk and coconut-based fermentations are not tolerated.  Dairy contains essential fatty acids, fat-soluble vitamins A, D, and K, and calcium.  Additionally, as I describe in Nourishing Hope for Autism, butyrate, (also butyric acid), found in dairy, “has been shown to clear ammonia and nitrogen, modulate local electrolyte flux, supports the reduction of diarrhea and improves very large, hard stools. Butyric acid also supports and fuels the intestinal walls to support a healthy gut and is used as an anti-candida substance.”   Raw dairy contains phosphatase (an enzyme important for calcium absorption), probiotics, unadulterated protein, and higher nutritional content (because of what is normally destroyed during pasteurization and because they are pasture-grazed).  This new A1 and A2 information may allow some children with autism to receive the benefits of milk without the problems it can cause.

Please share your experience with A2 milk.

References
 
1. Jinsmaa Y, Yoshikawa M. (1999) Enzymatic release of neocasomorphin and beta-casomorphin from bovine beta-casein. Peptides, 20:957-962.

2. Reichelt KL, Knivsberg AM, Lind G, Nodland M: Probable etiology and possible treatment of childhood autism. Brain Dysfunction 1991; 4: 308-319.

3. Hartwig A, Teschemacher H, Lehmann W, Gauly M, Erhadt G. (1997) Influence of genetic polymorphism in bovine milk on the occurence of bioactive peptides. In: Milk Protein Polymorphism, International Dairy Federation Special Publication, Brussels, Belgium. 9702 :459-460.
 
4. Kamiński S, Cieslińska A, Kostyra E. (2007) Polymorphism of bovine beta-casein and its potential effect on human health. The Journal of Applied Genetics, 48(3):189-198.

5.  Jyonouchi H, Geng L, Ruby A, Reddy C, Zimmerman-Bier B. (2005) Evaluation of an association between gastrointestinal symptoms and cytokine production against common dietary proteins in children with autism spectrum disorders. J Pediatr. May;146(5):582-4.

6. Shattock P, Whiteley P. (2002) Biochemical aspects in autism spectrum disorders: updating the opioid-excess theory and presenting new opportunities for biomedical intervention. Expert Opin Ther Targets. Apr;6(2):175-83

7. Sun Z, Zhang Z, Wang X, Cade R, Elmer Z, Fregly M. (2003) Relation of beta-casomorphin to apnea in sudden infant death syndrome. Peptides, 24:937–943.

8. Cade R, Privette R, Fregly M, Rowland N, Sun Z, Zele V. (2000) Autism and schizophrenia: intestinal disorders. Nutritional Neuroscience, 3: 57–72.
 
9. Knivsberg AM, Reichelt KL, Nodland M. (2001) Reports on dietary intervention in autistic disorders. Nutritional Neuroscience, 4(1):25-37.
 
10. Knivsberg AM, Reichelt KL, Hoien T, Nodland M. (2002) A randomised, controlled study of dietary intervention in autistic syndromes. Nutritional Neuroscience, 5(4):251-61.

UT Houston Researchers Study Diet In Autistic Children: Possible Link Between Gluten, Dairy Products Will be Tested

I just came across this study in my research from the University of Texas website:

HOUSTON—(Aug. 6, 2008)—Researchers at The University of Texas Health Science Center at Houston have embarked on one of the first double-blind, clinical studies to determine whether gluten and dairy products play a role in autistic behavior as parents have anecdotally claimed.

For the double-blind study, funded in its initial phase by supplemental funds granted by the Department of Pediatrics, researchers will enroll 38 autistic children ages 3 to 9. They will look at the influence of gluten and milk proteins in the intestinal function. Gluten is a protein in wheat; casein and whey are proteins in milk. Casomorphin, a peptide in milk; and gliadomorphin, a peptide in gluten, are thought to be related to changes in behavior in these children. Children will be taken off gluten and dairy products before the four-week study and then half will be given gluten/milk powder and half will be given a placebo powder.

Researchers will study intestinal permeability (leaky gut) through urine collection and behavior through psychometric testing.

For more information on the study to be conducted, go to uthouston.edu