il Dr.Mariani assieme al Prof. Paul Shattock in occasione del 7°Congresso Internazionale Teorico-Pratico di Nutrizione Olistica tenutosi a COSTERMANO del GARDA -VR nel maggio 2005

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Sviluppi della ricerca nell’autismo La teoria dell’eccesso di oppiodi

Paul Shattock, Autism Research Unit, School of Health Sciences, University of Sunderland

Many studies are suggesting that there is a real, year on year, increase in the numbers of people with autism spectrum disorders (ASDs). (1) (2). Some of this increase is the consequence of more efficient and effective diagnostic processes and some will be due to changes in diagnostic criteria (3). However, the increase in numbers is dramatic and would suggest involvement of environmental factors in triggering the condition.

The theoretical model is similar to that seen in Coeliac Disease (CD). There is no doubt that there exists a considerable genetic predisposition or fragility towards CD but unless the predisposed individual eats food containing gluten no symptoms will be seen. There could, for example, be vast numbers of people in China with the genetic fragility towards CD but because they do not eat wheat they will never suffer from this potentially lethal disease.

Genetic Fragility

Genetic fragility is not just a black and white, yes or no, situation. In the case of autism there are almost certainly multiple genes involved so the situation will be very much as is seen in a normal distribution curve (Fig 1.)

If a disease (say smallpox) were to strike a particular area, some people (those at the left hand side of the graph) would die, those in the middle portions would get symptoms, recover and be immune from that day on and those on the extreme right hand end would be totally unaffected. The same situation would apply for fragility to most disorders including those included in the autism spectrum.

Fig 1.

Where autism is concerned we must consider a range of genetic possibilities as well as a variety of environmental triggers. There have been many suggestions as what is the environmental "cause" of autism. If there were one universal trigger it is more than likely that it would have identified now. It is much more likely that there is interaction between a number of elements.

1.  Changes in Patterns of Infectious Diseases

   Human beings are much cleaner that they used to be. Consequently, babies are not exposed to disease in the way they used to be. It has been suggested that this lack of exposure in early life has resulted in an immune system that is ill equipped for more serious diseases when they inevitably come along. There is evidence that this excessive hygiene has resulted in increased levels of allergies and atopic disorders in children.

   At the same time as we have the comparatively unprimed immune system the infant body is challenged by a range of potentially hazardous organisms. Some of these "vaccines" are in the form of dead organisms or extracts from them whereas others are mild (attenuated) forms of the living organisms. The wisdom of injecting children with three (measles, mumps and rubella) or four (plus chicken pox) as in the United States has been questioned. Many parents believe that this combination triggered autism in their children. In the UK about 10% of parents believe this to be the case but in the US it is probably over 50% (personal observations).

   A detailed discussion of the scientific evidence for and against this suggestion is beyond the scope of this presentation. It is clear that the definitive studies tp prove safety or otherwise have still to be performed.

   In some countries, (US for example) it has become routine to vaccinate children on the day they are born with a vaccine against Hepatitis B. Until very recently this vaccine contained high levels of thiomersal to the extent that 12.5 microgrammes (mcg) of mercury were injected at this time. It must be born in mind that the US Environmental Protection Agency (EPA) recommends a maximum of 1 mcg per kilogram body weight per day and this by the oral route. This would imply the neonate would be getting approximately 40 times the safe dose on the day that it is born. There is no longer any justification whatsoever for the inclusion of such a dangerous product in vaccines for children or adults. Even if it does not (as many believe) have a role in triggering autism, it should not be used.

    

2. Pesticides

   Every item of food we eat contains pesticide residues unless we have taken positive steps to ensure otherwise. Organic food is comparatively expensive and often looks unattractive. Our own (University of Sunderland) studies are concentrating on this particular aspect. Although some preliminary work has been published (4) this is clearly an area which requires much greater investigation.

   Clearly the quantities (in terms of potencies and quantities) of pesticides in use all has increased all over the world and many products banned in the most highly developed countries are sold to developing countries. (The same applies to vaccines.)

    

3. Drugs

   Drugs such as those used in contraceptive pills and beta-blockers will find their way into water supplies where they will remain to be ingested. Additionally, many infants are given large doses of antibiotics often for allergies or other infections where they are of no relevance. It is perfectly possible that these could have unexpected effects.

    

4. Dietary Changes

   We are now eating foods that are totally different from those we ate, as a species, just a couple of hundred years ago. For example, the milk we drink today bears little relationship to that from our mothers or even from the farm of a few years back. The product is pasteurised and homogenised and much of the cream (fat) has been removed. The cows are nowadays almost universally Friesian/Holstein and there is very much less of the ancient breeds such as Guernsey or Mediterranean breeds. Most cows are fed on grains rather than grass and this results in dramatic changes to mineral content and to the ratios of Omega 3 to omega 6 fatty acids. As a result of this and many other changes, we are consuming way too much of the fatty acids known as omega 6 (inflammatory) and too little of the anti-inflammatory omega 6s.

   It is clear that most of us each less fish than did our ancestors yet much more grass seed (wheat) and cow milk.

    

5. Food Additives and Preservatives

   Preservatives, anti-oxidants, colorants, flavour enhancers (such as mono sodium glutamate) and totally synthetic flavours (such as Aspartame) are almost impossible to avoid in today’s diet. Many of these can have serious effects on some people. It is unlikely that everyone is able to metabolise these products adequately.

    

6. Dysbioses

   Since we are eating different foods we will have different bacteria and fungi in our intestines. These will produce a whole range of waste products which could, under certain situations, cause novel problems. Clearly this area has been under-researched.

    

7. Heavy Metals

As described earlier, there is considerable debate about a possible role for mercury in causing autism. This could be derived from vaccines but in many parts of the world other environmental sources could play a significant role. In areas of great volcanic activity (Indonesia, Sicily, Mexico, Philippines, North West United States) there would be a considerable input from such sources. It is not just the levels of these elements that could have increased but there could well be a concomitant decrease in the levels of elements such as selenium and cobalt which would be required to remove these from the body.

There are many other factors that have changed. These factors do not act independently but could synergise each other. Thus the effects of pesticides and heavy metals could disrupt the immune system so that infections (naural or from vaccinations) could be exacerbated.

We are suggesting that the environmental factors vary throughout the world and that they have changed over time. One consequence of this could be that the "autism" would present differently throughout the world and that autism today is not the same as it was in Kanner’s day or even back in the first days of Autism Europe. We would suggest that this is the case but a discussion of this must be presented elsewhere.

Implications for Therapy and Treatment

Most of the "orthodox" therapies rely solely on treating the symptoms of ASDs. This could involve medication for specific issues but is largely educative in helping children to speak, to improve their sensory and cognitive processing and behaviour and to develop skills. This represents a good approach but as has been pointed out (Sidney Baker &emdash; numerous occasions) if one is sitting on a tack it takes a\ lot of Ritalin to make it feel good. The implication is that it is better to remove the tack (and any other tacks that may be present.

The US based "Defeat Autism Now" (DAN) movement (and others in Europe) has attempted to investigate these biomedical issues and to determine effective treatments. Although the early protocols were somewhat empirical and based largely on experience and some science there have been profound changes over the past few years. I would suggest that the work coming from such groups is having a profound effect upon the treatment of people with ASDs throughout the world.

Many of the interventions have not been tested with necessary scientific rigour but the same applies to most drugs and educative interventions. Partly for these reasons, it has been difficult for the medical establishment to accept or come to terms with these approaches.

We have produced a sequential protocol for implementing many of these interventions. The aim is to maximise benefits whilst minimising possible problems. This is available (free of charge) on our website http://osiris.sunderland.ac.uk/autism Click on "Sunderland Protocol".

References

1. "Autism Spectrum Disorders: Changes in the California Caseload an update: 1999 Through 2002". California Health and Human Services Agency. April 2003
2. Shattock PEG., Whiteley P., Todd L. "Is there an increasing incidence of autism? Evidence and Possible Explanations." Consensus in child Neurology (Supplement to Child Neurology) Nov 2002. 29-34
3. Croen LA., Grether JK., Hoogstrare J., Selvin S. "The changing prevalence of autism in California". J.Aut. Dev Disord. 32(2) 207-215 (2002)
4. Anderson R., Carr K., Cairns D., Jough WJ., Haavik J., Martinez A., Teigen K., Shattock P. "Putting Tryptophan in the Spotlight" Consensus in Child Neurology

1. This protocol is designed particularly for those who are not able to obtain experienced professional help. All of the elements can be introduced without the necessity for prescription medicines but there are additional interventions (glutathione derived products; methyl cobalamine injections for example) that can be of great benefit in particular individuals.
   1. a) Most of these interventions have not been proven to be effective by "gold-standard" methodologies (randomised controlled, double blind crossover trials) and so resistance from the orthodox medical establishment may be evident. However, the same applies to almost all drug based interventions for the problems of autism and the chances of side effects from these interventions appears to be minimal when compared to traditional medication based interventions.
   b) It is our experience that testing can be helpful in assessing the potential usefulness of particular interventions but this is not always the case. On occasions, interventions that would seem to likely to be successful produce no benefits. On other occasions we are fairly certain that a particular intervention will have no positive results yet the person shows great benefits. For this reason we advocate experimental introduction of these interventions in this logical sequence even if metabolic testing does not indicate potential usefulness.
2. Individual practitioners will often have developed their own protocols for intervention based upon their own experience with particular individuals and, to some extent, the presentation of the autism with which they are familiar.
   We greatly welcome any feedback or information concerning these and other interventions. Everything that we have learned has come from parental and professionals and we are reliant upon you for support. Send comments to aru@sunderland.ac.uk please.

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