New Proposed DSM 5 Autism Guidelines

used by permission

New Proposed DSM 5 Autism Guidelines

At first when I looked at the proposed new autism guidelines I was struck by how similar they look to the current guidelines.  

Then I looked a little further at the proposed DSM 5 guidelines for the diagnosis of autism spectrum disorder.  That's when I realized that the new functionality clause has implications as does the previous three-year old clause.  

With this discovery I decided to look into the reasons for coming up with the new, slightly changed guidelines.  It is clear to me that there are going to be some individuals who are currently classified within the autism spectrum who might be excluded from this diagnosis by these new guidelines. There may well be a group of individuals who fit the current ASD diagnosis guidelines and who are currently able to function within our society because of the assistance provided by social assistance agencies and currently by law covered by insurance. These individuals may not quite fit the proposed new guidelines for Autism and might lose that assistance which enabled them to function. For them the proposed autism diagnosis guidelines would be a tragedy.  

I asked myself the question: could the American Psychiatric Association be intending to try to lower the numeric incidence (and prevalence) of autism spectrum disorder by adding the functional status clause and before age 3 clause and thereby artificially cover-up or hide the mushrooming epidemic we have been facing? Could the reason behind the proposed changes to the old guidelines be because there is incentive to lower the burden on support associations and insurance corporations?  This could have the appearance of impropriety or collusion. I just don’t want to think that, especially from such a respected organization as the APA. Asperger’s is frequently diagnosed after age four when social settings become more demanding. The proposed new criteria would certainly not fit all Asperger’s individuals and may leave off some who will need assistance to be independently functional in society. 

I am clear on the idea that the old criteria are not as much of a spectrum as the real world cases manifest, and this leads to some confusion over exactly which of the DSM-IV neurodevelopmental disorders a particular individual fits if they exhibit behaviors on the “border” between more than one of the current categories. Since the revision process has been in place for a long time, I feel we should work hard to be inclusive of care and not exclude any of the least among us even if they are affected the least within their diagnosis spectrum.

Jonathan Murphy, MD

Winter tune-up – how to get healthy and stay healthy

One way to get and stay healthy is to make sure that your intestinal tract has the right organisms in it.[i] Most of us have been given antibiotics at one time or another – often in our infancy, because we kept getting those pesky ear infections. As it turns out, our intestinal bacterial population is pretty well determined by the age of 2, and that population is what we live with for the rest of our lives. If the population has already been decimated by antibiotics, allowing only the more resistant (and less helpful) bacteria to survive, then we are out of luck.

But wait! What of those probiotics that we keep hearing about?

Interestingly, if we take probiotics (helpful bacteria) and prebiotics (substances that help the intestinal bacteria to flourish), we can actually prevent infections and stay healthier.[ii]^,[iii] We can even help bring allergies under control.[iv]

How to choose among the hundreds of offerings in health food stores and at your practitioner’s offices? Choose the ones that have GMP certification (Good Manufacturing Practices – certifying that the product is tested by an outside party, and does indeed contain what it says it contains on the label, with no added heavy metals or drugs that are not written on the label). If in doubt, check with your practitioner.

So Moms, take note: give your kids probiotics, and take some yourselves, while you are at it. Your family will be healthier this winter and all year round.

And if in spite of everything somebody gets sick anyway, consider this: Did your mother ever tell you, “feed a cold, starve a fever”? Sometimes mother knew best – as we are finding out from contemporary research.

It turns out that food intake results in stimulation of that part of the immune system which deals with viral infection, while fasting stimulates the production of those substances that deal with bacterial infection.[v]

So either way, have a healthy winter, full of love and gratitude, and good health.

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[i] Pregliasco F, Anselmi G et al. A new chance of preventing winter diseases by the administration of synbiotic formulations. J Clin Gastroenterol. 2008 Sep;42 Suppl 3 Pt 2:S224-33.

[ii] Cazzola M, Pham-Thi N et al. Efficacy of a synbiotic supplementation in the prevention of common winter diseases in children: a randomized, double-blind, placebo-controlled pilot study. Ther Adv Respir Dis. 2010 Oct;4(5):271-8. Epub 2010 Aug 20.

[iii] Merenstein D, Murphy M et al. Use of a fermented dairy probiotic drink containing Lactobacillus casei (DN-114 001) to decrease the rate of illness in kids: the DRINK study. A patient-oriented, double-blind, cluster-randomized, placebo-controlled, clinical trial. Eur J Clin Nutr. 2010 Jul;64(7):669-77. Epub 2010 May 19.

[iv] Kukkonen K, Savilahti E et al. Probiotics and prebiotic galacto-oligosaccharides in the prevention of allergic diseases: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol. 2007 Jan;119(1):192-8. Epub 2006 Oct 23.

[v] Van den Brink GR, van den Boogaardt DE et al. Feed a Cold, Starve a Fever? Clin Vaccine Immunol January 2002 vol. 9 no. 1 182-183.

BPA in canned soups – what are we feeding our children?

So we think that canned food is safe to eat? The government says it’s OK, right? So it must be safe. Well… maybe think again.

That chicken noodle soup that we give our kids when they are sick? Look at the ingredients – Chicken stock, enriched egg noodles (wheat flour, egg solids, niacin, ferrous sulfate, thiamine, mononitrate, riboflavin, folic acid), cooked chicken meat, water, contains less than 2% of the following ingredients: salt, chicken fat, cooked mechanically separated chicken, monosodium glutamate, cornstarch, onion powder, modified food starch, yeast extract, spice extract, soy protein isolate, sodium phosphates, beta carotene for color, chicken flavor (contains chicken stock, chicken powder, chicken fat), flavoring, dehydrated garlic.[i] I put into italics the ingredients which would never appear in homemade soups.

Of course, the list of ingredients does not mention the BPA which is also present in the soup. BPA linked to heart disease, cancer and diabetes[ii] – three of the most common chronic illnesses seen so far in the 21^st century.

A study recently published in JAMA reports BPA concentrations in urine of people who ingested 5 different varieties (Progresso brand) of vegetarian canned soups for 5 days, and then fresh soups (no canned ingredients) for 5 days – same soups, same ingredients, no other dietary restrictions.

BPA was present in the urine of 77% of those who ate fresh soups and 100% of those who ate canned soups. And those who ate canned soups had over 20 times the amount of BPA as those who ate fresh soups. The increase in urinary BPA from the fresh soup week to the canned soup week was over 1200 percent.

The BPA is produced as a byproduct from the epoxy resin linings of the cans, used to prevent corrosion.

So… what does this mean for us?

We can choose alternative packaging. A 2009 Consumer Reports article[iii] found that plastic containers and/or bags of the same foods tended to have less BPA than epoxy-resin coated cans. Even foods advertised as BPA free contained detectable levels of BPA.

We can insist that our government eliminate BPA from our foods. In Japan, BPA was eliminated in 1997, and urinary levels had dropped by 50% within 5 years.

Even better, we can choose fresh foods over canned foods. We can make that chicken noodle soup ourselves – using gluten-free noodles and free range chicken[iv]. We can be VERY careful what we feed our infants – fresh is better, organic is better. We can avoid all canned goods, until the linings are changed to something that does not produce BPA as a byproduct. We can let manufacturers know what we are doing. We can vote with our pocketbooks.

We have a choice.      

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[i] Ingredients list downloaded on November 27, 2011 from Campbell's Soup website

[ii] Lang IA, Galloway TS, Scarlett A, et al. Association of urinary bisphenol A concentration with medical disorders and laboratory abnormalities in adults. JAMA. 2008;300(11):1303-1310.

[iii] Consumer Reports article downloaded November 27, 2011

[iv] Downloaded November 27, 2011 from the Food Network webpage

ILADS 2011 - Lyme Disease - A Global Pandemic

ILADS 2011 Toronto attendees

The overwhelming impression of the most recent ILADS Scientific Meeting in Toronto, Canada this fall was the sheer numbers of people involved in diagnosing, treating and experiencing Lyme Disease – and the different disciplines of the researchers who are attempting to find effective treatment. It’s not just a medical illness. It’s also a veterinary illness, and an ecological illness – it does not occur without the participation of many more creatures than is typically understood. It’s an illness that affects a wide spectrum of patients, with a wide spectrum of symptoms. It’s not just in the United States – it is found all over the world, on every continent, in increasing numbers of patients.

And the illness is remarkably difficult to diagnose, with our current methods, resulting in patients going from doctor to doctor in search of a name for what is wrong with them.

No other illness in the 21^st century has been so polarizing. In the last century, we had HIV/AIDS, which caused pandemonium among the people. Everyone was so afraid that they could catch AIDS from a drinking glass – and besides, it only affected homosexuals, so if we just got rid of the homosexuals, we figured we could get AIDS under control. 20 years later, we have more knowledge and compassion, and AIDS is on the way to becoming a chronic illness susceptible to treatments authorized by the “disease management” school of medicine.

Not so with Borrelia burgdorferi – and its host of co-infections – at least not yet. The medical profession largely denies that Lyme disease can cause chronic infection or chronic symptoms. We relegate neuroborreliosis to the category of “it’s in your head” and treat it with psychotropic medication as though manipulation of neurotransmitters were sufficient to eradicate the effects of neurologic infection. We diagnose rheumatoid arthritis, and treat with anti-inflammatory and anti-metabolic drugs, as though reducing inflammation would be sufficient to eradicate joint infection with B burgdorferi.

It is important for us to realize that we are not alone in being affected by tick-borne disease. We are infected, yes. But we are part of a huge circle of vectors, including ticks, deer, dogs, rodents, and migrating songbirds. Without the participation of every single one of us, the disease does not happen, because the organism requires all its vectors to complete its life cycle.  

So… what are our choices? Kill all the ticks? Forbid the songbirds from migrating and carrying those pesky ticks with them? Get rid of the deer? Keep our dogs inside 24/7? Kill the ticks with insecticides? Always exercise indoors? Never walk outside where we could pick up ticks?

None of those seems like very good options, do they? So what’s left?

The most logical thing would be to make the terrain (ourselves) really uncomfortable for the organism that actually causes the disease. And how do we do that?

A surprising number of chronically ill and undiagnosed patients test positive for this disease – and not only for Borrelia, but also for a host of other chronic infections, viral, bacterial, cell wall deficient, and spirochetal. Not that this is proof that Lyme disease causes chronic illness – but it certainly provokes thought, doesn’t it?

Is it possible that we are meant to live in harmony with these organisms? I cannot at the moment think about what they provide for us – except proof that our internal milieu is deficient – but perhaps that is the whole point. If we haven’t figured it out before, surely we can figure it out now, if the body just screams loudly enough.

 

Is it not then possible to clean up the terrain, so that the body can actually deal with the Borrelia organism – or their friends, the co-infections – in the way that our immune systems were intended to function?

Medical treatments discussed at the ILADS meeting included various antibiotics, prescribed by various routes – oral, intramuscular, intravenous – for various lengths of time. The main point was that most antibiotics appear to work on some organisms, and that it is important to be persistent with the therapy. We are talking months of therapy here, not weeks.

Naturopathic and herbal treatments were also discussed, at break-out sessions. Herbs are mainly given orally, in liquid extract or capsule form. Again, we are talking months of therapy, not just a few weeks.

It was also quite clear that Lyme is a relapsing disease. It may appear to be under control – and stopping therapy is appropriate at that point. However, it may well relapse, whether because the therapy was simply insufficient, or because some other stressor occurred and the immune system was insufficient to the task.

When relapse occurs, it is important to re-treat, and to look for emerging co-infections, to switch antibiotics, to treat all known forms of the disease – spirochetal and cystic – and most importantly never to give up.

Equal importance was given to treating the terrain – our own bodies. Cleaning up the diet was mentioned as primary, so that we are not putting chemicals, preservatives, colorings, processed sugars and starches into our systems. The closer to nature, the better. This has always been the foundation of all our treatments at the Arizona Center for Advanced Medicine.

Mention was made of detoxification – other infectious organisms, chemicals, heavy metals – all of which put the immune system under significant stress, so that it less able to deal with the immediate threat of Lyme and the coinfections. Environmental illness and mold exposure was one topic discussed. Food sensitivity was another.

The dreaded Herxheimer reaction was discussed – therapies mentioned included intravenous Vitamin C as a way of dealing with the vascular instability and excessive oxidative stress caused by dying organisms releasing toxic compounds into the cells.[i] 

Fungal hypersensitivity may manifest in symptoms as diverse as chronic itching, chronic yeast infections, GI distress, bloating, coated tongue, chronic skin infections, fatigue, carbohydrate intolerance, brain fog. How many of our Lyme patients complain of many of those symptoms?

A new test for Lyme and coinfections was described by Elizabeth Valentin-Thon. This Lymphocyte Transformation Test – LTT-MELISA – is called LymphoLyme™, and will be available soon in the United States. It has been used in a slightly modified format in Europe for the last decade.

One of the most comprehensive talks, by Steven Bock, MD, discussed the treatment of Lyme disease from the perspective of functional medicine. With this approach, we look at all the body’s systems, biochemical, electrical, and energetic, and find the best treatments to bring balance to the system on all levels. Many levels which are appropriately addressed in order to restore the system to a fully functional state include the following:

•         Toxins

•         Organisms

•         B burgdorferi (mainly arthritis symptoms, prevalent in the USA and Europe)

•         B afzelii (mainly dermatologic symptoms, prevalent in Asia and Europe)

•         B garneri (mainly neurologic symptoms, prevalent in Asia and Europe)

•         Coinfections

•         babesia

•         HME

•         HGE

•         bartonella

•         Heavy metals

•         Autoimmune diseases

•         Fungal infections and hypersensitivity

•         Viral infections

•         Food sensitivities

•         Fatigue

•         NT function

•         Sleep disturbance

•         Stress

•         Nutritional deficiency

•         Immune deficiency

•         Endocrine function

•         GI function

•         Liver dysfunction

•         Inflammation

•         Fibromyalgia

As you can see, the treatment of Lyme disease is complex, and cannot be limited to the use of antibiotics. No wonder allopathic medicine has such a hard time dealing with this disease. There are so many components, and they spread across so many different specialties – there is no way that any one specialty could adequately treat the whole gamut of the illness. When specialties treat illness, they like to see one well-defined problem in one organ system – about which they know almost everything there is to know – resulting in control of disease in that one organ system. How can we possibly think of treating a systemic illness which involves multiple organ systems with a single therapy? Even long-term antibiotics would be only a relatively small part of the treatment picture – albeit an important part.

The take-home message from the conference was, on the whole, positive. There are ways to diagnose the disease. There are ways to treat the disease. These ways involve treating the whole person – body, mind and spirit – and it may be necessary to use many of the modalities for the rest of the person’s life. What is more important that health, growth and development? What more important lessons do we have to learn in this life?

The choice is ours – to be a victim, to learn a limited amount, to learn as much as we can absorb… to take charge of our lives, our nutrition, our environment and our medical therapies.

I am honored to be a part of that journey for those who choose to undertake it with us at the Arizona Center for AdvancedMedicine. 

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[i] Wilson JX. Mechanism of action of vitamin C in sepsis: ascorbate modulates redox signaling in endothelium. Biofactors. 2009 Jan-Feb;35(1):5-13.

Save the lowly potato!

“Senate Saves the Potato on School Lunch Menus” trumpets the headline in the October 18, 2011 edition of the New York Times. Senators from the potato-growing states affirmed that decreasing the number of servings of starchy vegetables has no basis in nutritional science. Voices from non potato growing states were conspicuously absent, Apparently the concept of “low glycemic” has not yet hit our congressional representatives.

How can we promote diet and exercise to reduce the incidence of diabetes in our school children, and then shoot down a regulation aimed at reducing the incidence of diabetes in our school children. How can we let our desire to be re-elected triumph over our desire to provide healthy nutrition for our children. What is wrong with this picture?

I love potatoes as well as the next guy. But I am also well aware that when I eat a potato, my body’s requirement for insulin skyrockets – almost as much as if I eat a piece of cake. I don’t eat cake every day. Why would I allow my children to eat potatoes every day? I guess our senators forgot to consider that piece of the picture.