Common Medical Issues Seen In Autism

That You Need To Know About

Copyright© 2016, Kurt N. Woeller, D.O. and Educational Resource

Association. This material may not be reprinted, distributed or used
without permission.
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 Content Disclaimer
The material contained within this document/presentation is not
intended to replace the services and/or medical advice of a
licensed health care practitioner, nor is it meant to encourage
diagnosis and treatment of disease. It is for educational purposes
only. Kurt N. Woeller, D.O. (or associates) does not accept legal
responsibility for any problems arising from experimentation with
the information described herein. Any application of suggestions
set forth in the following portions of this document/presentation
is at the reader's discretion and sole risk. Implementation or
experimentation with any supplements, herbs, dietary changes,
medications, and/or lifestyle changes, etc., is done so at your sole
risk and responsibility and should be discussed with your (or your
child’s) personal physician first.

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 Lecture Overview

• Overview of the 4 pillars of biomedical

intervention.
• Common medical (aka. biomedical or
biological) problems you need to know
about.

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 Support Documents for Module #1

• Getting Your Child To Take Supplements (pdf)

• Suggestions for Implementing a Gluten and
Casein-Free Diet (pdf).
• Lecture slides (pdf)
• Lecture slides: note-taking (pdf)

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 The Roadmap
Biomedical Intervention For Autism
Autism
Assessment

Signs &
Symptoms

Lab Testing

Dietary Foundational Digestive Methylation

Intervention Supplements System Other
Treatment Interventions

GFCF Diet, Food IgG Starter Packets – Candida, Clostridia

Elimination, SCD, multivitamin/mineral,
EFAs, Cal/Mag, etc. Treatment, etc.
GAPS, Failsafe, etc.

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 What Is Autism?
American Psychiatric Association Diagnostic and Statistical Manual (DSM) –
Diagnostic Criteria for Autistic Disorder (ICD.9: 299.0)

6 or more identifiers from 3 major categories:

• Social interaction impairments
• Failure to use eye contact, body posture, facial expression
• Failure to develop peer relationships
• Lack of social interaction, sharing, or enjoyment with others
• Lack of social or emotional reciprocity
• Communication impairments
• Delay or total lack in speech development
• Inability to initiate or maintain conversational speech
• Stereotyped or repetitive use of language
• Repetitive and stereotyped behaviors, interests, and activities
• Abnormal intensity or focus on stereotyped or restricted patterns of interest
• Inflexible adherence to rituals and routines
• Repetitive movements (hand-flapping, finger flicking or twisting, or complex body movements)
• Preoccupation with parts of objects
www.cdc.gov/ncbdd/autism
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 Failure to Evaluate & Treat By Some In The
Medical Community – Prejudiced by
the Diagnosis?
Child w/o Autism (example) Child with Autism (example)
• Physical milestones delayed • Physical milestones delayed
• Chronic diarrhea – 5+ BM’s per day • Chronic diarrhea – 5+ BM’s per day
• Recurrent sinus, ear & upper • Recurrent sinus, ear & upper
respiratory Infections respiratory infections
• Eczema • Eczema
• Bloating, gas and distended • Bloating, gas and distended
abdomen abdomen
• Anxiety, attention issues • Anxiety, attention issues
• Irritable, poor sleep • Irritable, poor sleep

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 List of Co-Morbid Conditions
Centers for Disease Control: “several medical conditions are significantly over-represented in
people with ASD compared to the general population and other developmental conditions.”
Individuals with ASD have much higher than expected rates of various medical conditions studied,
including:
• Ear and respiratory infections
• Asthma, allergic rhinitis and atopic dermatitis
• Sleep disorders
• Headaches, migraines
• Seizures
Just a Partial List
• Gastrointestinal disorders
• Early mortality – death rates ranging from 3 to 10 times higher than general population

“Comorbidity is to be expected in autism spectrum disorders ― directly or indirectly.

Comorbid conditions may be markers for underlying pathophysiology and request a
more varied treatment approach.” Isaksen, J., Bryn, V., Diseth, T.H., et al. (2012) Children
with autism spectrum disorders–The importance of medical investigations. Eur J Paediatr
Neurol. 17:(1):68-76.

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 Autism & The Biomedical Approach
Autism-Spectrum Disorders:
• The majority of individuals on the autism-spectrum
are dealing with underlying biological and medical
concerns
• More than just a psychological or neuro-
developmental condition.
• Brain Disorder versus Multi-System Disorder that
effects the Brain (the latter is true)
Biomedicine = Autism for many individuals is a
Medical Issue with true underlying medical
conditions at the root of their problems.
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 Medical Complexities of
Spectrum Disorders
• Genetics:
• Methylation (MTHFR)
• Nutritional Imbalances:
• Cholesterol deficiency, zinc and mineral deficiencies, copper
excess, and more.
• Food Sensitivities:
• Gluten and casein peptides, multiple food allergies, phenol
sensitivity, etc.
• Biochemical Imbalances – too many to list
• Digestive Problems:
• Constipation, diarrhea, Inflammatory Bowel Disease
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 Medical Complexities of
Spectrum Disorders
• Chronic Infections:
• Bacteria, i.e. clostridia, yeast, chronic virus infections
• Heavy Metal Toxicity:
• Mercury, lead, arsenic, etc.
• Neuroinflammation:
• Microglia hyper-reactivity
• Glutamate sensitivity
• Dysregulated Neurochemistry:
• Serotonin, dopamine, oxytocin, MAO-A, acetylcholine
imbalances, Cerebral Folate Deficiency

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 Brain Region Dysfunction and Autism

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 1 st Pillar
Dietary Intervention

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 Diet
• MUST start with diet
• Dietary modification plays a key role in autism
intervention.
• Without a healthy diet and the removal of toxic
and reactive foods, the ability to significantly help
your will be compromised.

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 Differences Between
IgE and IgG Food Allergies
IgE IgG
• Releases histamine • Does not usually release
• Tested by skin pricks histamine.
• Anaphylactic shock • No immediate skin prick
reaction.
• Symptoms immediate • No anaphylactic shock
• Most common allergy • Symptoms may be delayed
test.
• Clinical usefulness • Uncommon allergy test
mainly with allergic • High clinical usefulness for
reactions, chronic illnesses, psychiatric
hives, sneezing, etc. diseases.

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 When peptide is acted upon by digestive enzymes there is a release
of a morphine-like chemical (aka. casomorphin) that can have opiate
activity as well as interfere with serotonin metabolism.

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 Urinary Peptide –
Great Plains Laboratory

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 Childhood Autism Rating Scale (CARS)

Measuring the amount of casomorphin in urine

and severity of autism.
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 Gluten and Casein-Free (GFCF)
• Clinical Improvements Observed:
• Better bowel function, i.e. less constipation and/or
diarrhea.
• Improved skin tone, reduced rashes, i.e. eczema
• Improved sleep, mood, and emotional volatility
• Improved pain tolerance, decreased self-injurious behavior.
• Improved language, eye contact, focusing/attention
• Increased appetite for other foods.
• Trial Diet: 100% - no infractions and done minimally for at
least 3 months. Start with casein 1st for 3 weeks, then start to
eliminate gluten.

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 Combining Food IgG and
Urinary Peptide Tests

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 Dairy

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 www.specialdietsforspecialkids.net
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 Dietary Proteins &
Brain Immune Reactivity
Immune response to dietary proteins,
gliadin and cerebellar peptides in
children with autism. Vojdani A., O’Bryan T., Green
J.A., McCandless J., Woeller K.N., Vojdani E., Nourian A.A.,
Cooper E.L. Nutritional Neuroscience 7(3):151-161, June 2004.

Findings: increased immune activity in

central nervous system from dietary
protein cross-reactivity.
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 Microglial Activation &
Brain Inflammation

Direct and Indirect activation

of microglia leads to cell
damage.
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 Gut and Brain Connection
More to be discussed shortly

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 2 nd Pillar
Nutritional Supplements

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 Supplement Support Is Essential

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 Starter Supplements
• Recommend a ‘Starter Packet’ that minimally
includes the following:
• Multivitamin/mineral blend
• Calcium and magnesium
• Cod liver oil
• Why? – there is ample evidence, both researched
based and via clinical experience, to support the
concept that many children on the autism-
spectrum are deficient in certain nutrients.

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 My Personal Preference
• Spectrum-mate ‘powder’ – 1
scoop or teaspoon (adults or kids >
4 years of age). Less than 4 years
of age – ¼ to ½ scoop or teaspoon
daily.
• Cod liver oil – one teaspoon daily
to start.
• Calcium chewable w/magnesium
– 1 to 4 tablets daily (children > 8
years to adults – 4 tablets, children
greater than 1 year of age to 7
years – 3 tablets daily).

Package contains approximately

www.nbnus.com 2 to 3 month supply

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 My Personal Preference
• Spectrum-mate ‘capsules’ – 6
capsules daily (adults or kids > 4
years of age). Less than 4 years
old use 1 to 3 capsules daily.
• Cod liver oil – one teaspoon daily
to start.
• Calcium chewable
w/magnesium – 1 to 4 tablets
daily (children > 8 years to adults
– 4 tablets, children greater than
1 year of age to 7 years – 3
tablets daily).

Package contains approximately

www.nbnus.com 2 to 3 month supply

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 3 rd Pillar
Digestive System Function Assessment
& Intervention - Understanding the Role
of Toxin Producing Pathogens

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 Alcohol-related behavior has been observed
(clinical observation)

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 Clostridia Bacteria

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 Toxins From Clostridia Bacteria

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 Gut and Brain Connection
Revisited

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 Small Bowel Inflammation
• The Ileum is the last part of the small
intestine.
• High immunologically reactive area –
large amount of lymphoid tissue.
• An area that is commonly affected in
ASD.
Signs and Symptoms:
• Diarrhea or constipation
• Self-injurious behavior (SIB)
• Food avoidance
Severe inflammation of • Poor sleep
the Ileum
• Poor absorption and growth
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 Large Bowel Inflammation

Inflammatory Polyp Ulcerations in Large Bowel

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 Bile Reflux Esophagitis

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 Digestive Issues Are a Major
Medical Problem
• Gastritis (stomach inflammation)
• GERD (gastrointestinal reflux disease)
• Colitis (inflammation of the colon)
• Irritable Bowel Syndrome
• Constipation
• Motility-based disorders
• Food allergy and sensitivity
• Overgrowth syndromes (probable Small Intestine
Bacterial Overgrowth).

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 How Prevalent Are GI Issues in Autism?
J Dev Behav Pediatr. 2006 Apr;27 (Valicenti-McDermott
M. et. al.) - evaluated children with ASD and two
control groups matched for age, sex and ethnicity (one
with non-autism-related developmental disorders, and
the other developmentally normal). There were 50
children in each group.
Findings:
70% of the children with ASD had GI Issues
compared to 42% of the children with
developmental disorder other than ASD.
• 28% of children with typical development
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 Does Your Child’s Stools Look Like This?

Occasional loose stools are normal part of our existence. However, as

Dr. Krigsman explains in his article, “if most or all of the stools are
unformed – it is pathologic.”
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 Does Your Child Do This?

Posturing across the edge of a table, the arm of a chair or

couch, or pressing abdomen into the floor is not normal. It
may be a sign of intestinal pain.
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 Self-Injurious Behavior

Is self-injurious behavior a normal part of autism? In many

children it is triggered because of pain. This behavior warrants
investigation and any sign of intestinal issues need to be assessed
for underlying pathology. 48
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 List of Co-Morbid Conditions
Centers for Disease Control: “several medical conditions are significantly over-represented in
people with ASD compared to the general population and other developmental conditions.”
Individuals with ASD have much higher than expected rates of various medical conditions studied,
including:
• Ear and respiratory infections
• Asthma, allergic rhinitis and atopic dermatitis
• Sleep disorders
• Headaches, migraines
• Seizures
Just a Partial List
• Gastrointestinal disorders
• Early mortality – death rates ranging from 3 to 10 times higher than general population

“Comorbidity is to be expected in autism spectrum disorders ― directly or indirectly.

Comorbid conditions may be markers for underlying pathophysiology and request a
more varied treatment approach.” Isaksen, J., Bryn, V., Diseth, T.H., et al. (2012) Children
with autism spectrum disorders–The importance of medical investigations. Eur J Paediatr
Neurol. 17:(1):68-76.

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 Sadness and Despair

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 Severe Head-Banging

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 Exhausted From Self-Abusive Behavior

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 Padded Room

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 Family Trapped and On The
Edge Emotionally

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 Behavior Often Preceded By
Leveraging Against Furniture

Is Child In Pain?
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Presence of Inflammatory Bowel Disease

• He was referred to Dr.

Krigsman for evaluation.
• Scope examination
reveals abundant
inflammatory lesions
throughout bowel.
• Treatment approach
similar to Chron’s
disease, i.e. Entecort,
Pentasa.

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 Intestinal-Liver Circulation

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 “Gut Microbiome and Brain-Gut Axis in
Autism — Aberrant Development of
Gut-Brain Communication and Reward
Circuitry” Intech, 2013
Elizabeth M. Sajdel-Sulkowska1 and Romuald Zabielski2
[1] Dept. Psychiatry Harvard Medical School and BWH, USA
[2] DDept. Physiological Sciences, Warsaw University of Life

Sciences, Poland

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 4 th Pillar
Methylation Support

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 Why is Methylation Intervention So
Important in Autism?
The chemistry of methylation and its impairment
explains a lot with regards to autism-spectrum
disorders:
• Lack of awareness
• Language issues
• Lack of eye contact
• Diminished environmental awareness
• Immune problems
• Neurochemical imbalances
• Detoxification problems

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 Methylation Cycle

Methionine
The cycle constantly
spins from
homocysteine to
DMG
methionine. Methyl-B12
SAMe
Methyl-B12 has its influence
(Methionine through the enzyme
Synthase) TMG complex called
Methionine Synthase.

Homocysteine

P5P

Glutathione
(Potent Antioxidant)

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 Methyl-B12 Book – Autism-Spectrum
Disorders

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 Methyl-B12 Injections

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 DNA Methylation Pathway Panel – Great Plains laboratory

MTHFR

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 Learning To Troubleshoot
Problems
Certain behaviors may not always
be related to a medical issue

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 Steven
14 years old
Dx: age 2-1/2 (severe autism)
Main Issues:
• Non-verbal
• Poor socialization skills
• Anxiety, high sensory seeking behavior, and aggression.
Main reason for consult: Aggressive behavior
and destructive tantrums.
Main physical challenge: constipation – would not have
bowel movement for 5 to 6 days.
Constipation remedies: Ducolax suppositories, Miralax
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 Intervention for Constipation
• Fleet’s enema – 2 hours prior to Miralax dosing
• Miralax – ½ capful in 6 ounces of water every ½ hour
for 6 dosages, followed by a Ducolax suppository one
hour later (did for 2 days in a row).
• Miralax - ½ capful twice daily for 3 weeks.
• Ground flax seeds, slippery elm herb (6 capsules daily)
and magnesium citrate 400mg daily for long-term
maintenance.

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 Aggression and Tantrums
Greatly Diminished
• Mother reports that within 4 days of bowel
evacuation his aggressive tantrums diminished by
75%.
• Mom reported great progress overall, i.e. happier,
more calm, less agitated, sleeping better, but still
remained aggressive at times – particularly when he
was being reprimanded for negative behavior.
• Not all of his aggressive behavior seemed
related to physical discomfort.

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Not Everything Is A “Biomedical” Issue
• He would only hit mom, sister,
aunt, and in the past grandma.
• Didn’t hit his brother, father or
grandfather - didn’t hit any males.
• Grandma got tired of being hit,
and one day she slapped him in
the face and stated “don’t ever hit
me again.”
• He never hit his grandmother
again.

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 Module #2

Topic
• Nutritional Supplement Intervention, Supplement
Rules/Helpful Hints:
• Why are supplements important?
• Which ones should be started first?
• What supplements are most helpful for specific
conditions?
• Helpful hints on supplement success

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 Gain access to comprehensive testing including Organic Acids,
Comprehensive Digestive Stool Analysis, Adrenal Hormone, Hair,
Amino Acids, etc.
• All tests kits sent to your home or office
• No doctor visit needed for ordering
• Each lab reviewed personally by integrative medicine doctor
• Written lab review provided with recommended action steps based on lab test markers
• Access to professional line supplements
• Great Plains Laboratory, BioHealth Laboratory, Doctors Data, ZRT, etc.

www.labtestsplus.com for a
complete list of lab tests available
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 Thank You
Kurt N. Woeller, D.O.
www.AutismRecovery101.com
AutismRecovery101@gmail.com

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