CENTER ON BEHAVIORAL MEDICINE

ADDITIONAL MATERIAL

RELATED PAPERS
Related Papers Menu

Autism and the Endocrine Response
   
Permission graciously given by the author to reproduce this paper: 

www.naturopathydigest.com/archives/2006/oct/skowron.php

Children and Autism

Jared M. Skowron, ND
2006


About the Author: Jared M. Skowron, ND, is in private practice in Hamden, Conn., where he specializes in pediatrics and successfully treating children on the spectrum. A graduate of NCNM, he is the senior naturopathic physician with Metabolic Maintenance and has formulated a vitamin/mineral/amino supplement therapy for autism, currently undergoing clinical trials. Dr. Skowron also is an adjunct professor at the University of Bridgeport, teaching pediatrics, CPD and EENT. 

Autism has long been deemed a medical mystery. Conventional medicine has sought to treat the symptoms of the disorder; can naturopathic medicine treat the cause?  Autism currently is a worldwide epidemic, with approximately one in 100 children affected. The most successful treatments are naturopathic, focused on treating the cause and acknowledging every part of the body. In this three-part series on autism, I will discuss the pathophysiology, connections and treatments for the endocrine, nervous and gastrointestinal systems. 

Starting at the root of this disease, we can see how the branches and leaves of autism stem into all parts of the body. Beginning with toxic deposition of heavy metals or other chemicals, the body reacts to remove the offenders. The deeper the toxins are in the tissue, the stronger the reaction of the young body. Inflammation, altered immune response from vaccinations, altered endocrine response, increased action potentials of the nervous system, increased sympathetic tone and gut inflammation are all homeodynamic responses to removing the toxins buried deep within the tissue. 

The role of the naturopathic doctor is to detoxify the body, removing the cause of disease and balancing the homeostatic response to improve the quality of life for the entire family. 

Thyroid 

As the body's stress response to toxins increases, endocrine production adjusts. In children with autism, melatonin production is decreased and its circadian rhythm altered.1 Serotonin, melatonin's precursor, also is low, contributing to this dysregulation. While melatonin is abnormal, the entire cascade of hormones which follow are equally out of sync. 

Hypothalamic-pituitary dysfunction is the next to follow. The pituitary TSH (thyroid-stimulating hormone) levels are very unresponsive to hypothalamic stimulus of TRH (thyrotropin-releasing hormone).2 Combined with mineral deficiencies - 45 percent lower iodine levels in autistic children, 38 percent lower chromium levels in autistic spectrum disorder (ASD) children with pica and more than 66 percent lower potassium levels in ASD children with low muscle tone - one easily can see how thyroid response is inconsistent.3 These abnormal and inconsistent blood levels of thyroid hormone will affect neurological growth, as well as speech, language and other social trainings. 

Conversely, hypothyroid does not cause autism. Children with ASD who were given thyroid hormone for six months developed hyperthyroidism and had no beneficial change in symptoms.4 Areas of the country with large amounts of perchlorate, a known thyrotropic agent, have increased amounts of hypothyroidism; the perchlorate interferes with normal thyroid hormone production. There are no significant increases in the percentage of children with autism in these areas with increased perchlorate in the water system.5,6 

The process of thyroid imbalance is unidirectional. Children with ASD have imbalanced melatonin, H-P axis and, therefore, thyroid hormones. Thyroid testing should be used as a monitor for treatment, and a portion of the therapy needs to be supplementing the extreme deficiency in certain minerals, giving the bodies the tools needed to heal itself. In any mineral screen, always include lithium levels, for both child and mother (30 percent, 56 percent lower, respectively). Clinically, I find the more aggressive children have a stronger lithium deficiency. Iodine, selenium, zinc, copper, potassium and magnesium levels also are essential and should be supplemented if deficient. 

Adrenal 

Paralleling the thyroid imbalance is an extreme adrenal dysregulation. ACTH (adrenocorticotropin hormone) production is significantly higher in children with autism.7 Cortisol production, while lower in amounts, is extremely pulsatile, with hypersecretions throughout the day during environmental stressors.8  Cortisol rhythm is extremely out of sync in children with ASD, due to imbalanced melatonin and ACTH production. The more severe the autism, the more abnormal the diurnal rhythms.9 The need for cortisol is so great however, that cortisol suppression is resistant to dexamethasone-suppression testing.10 While there is a huge cortisol dysregulation, DHEA-S and testosterone seem to be similar in children with autism and those without.11 

Clinically, hypersensitivities and insomnia, two common symptoms of ASD, have a large connection to the adrenal and nervous systems. Diurnal cortisol testing can aid treatments, and also be used in monitoring adrenal restoration. Melatonin use for insomnia can be very effective, especially when concurrent with a serotonin and zinc deficiency. Creating a consistent exogenous melatonin stimulus for the H-P axis also is beneficial for rebalancing circadian cortisol rhythms. Holy Basil (Ocinum sanctae) is an herb I use with great success to balance cortisol spikes. 

Individualization 

Each child with autism is unique. In the future, we will see more detailed diagnoses with ASD, depending on the individual's physiological response to toxins. As naturopaths, our testing and individualized treatments set us far and above conventional treatments for autism. Your testing must include: 

• Heavy metal testing 
• Mineral screen 
• Vitamin screen 
• Food allergy IgG 
• Endocrine testing 
• Gut microbiology/candida
 
These results will guide your treatments. However, the following five areas must be addressed: 

• Detoxification 
• Endocrine balancing 
• Gut rejuvenation 
• Nervous system calming 
• Vitamin/Mineral replenishing 

Autism is completely treatable, and you will be amazed at how children can awaken and mainstream. When you help a child, it has innumerable effects on their family, as well as providing a future for them - a future they would never have had the opportunity to explore without this help. Part two of this discussion on autism will explore the adaptations of the young nervous system in autism. 

References 

1. J Autism Dev Disord. 1995 Dec;25(6):641-654. 
2. Dev Med Child Neurol. 1991 Apr;33(4):313-319. 
3. Biol Trace Elem Res. 2006 Jun;110(3):193-209. 
4. J Autism Child Schizophr. 1978 Dec;8(4):383-387. 
5. J Toxicol Environ Health A. 2004 Apr 23-May 28;67(8-10):835-844. 
6. Birth Defects Res A Clin Mol Teratol. 2003 Oct;67(10):886-892. 
7. J Autism Dev Disord. 2003 Aug;33(4):443-448. 
8. J Autism Dev Disord. 1992 Sep;22(3):433-447. 
9. Jpn J Psychiatry Neurol. 1987 Jun;41(2):227-235. 
10. J Autism Dev Disord. 1992 Sep;22(3):433-447. 
11. J Autism Dev Disord. 1995 Jun;25(3):295-304.

As explained in part one of this series (www.naturopathydigest.com/archives/2006/oct/skowron.php), autism currently is a world epidemic, with approximately one in 100 children affected. The most successful treatments are naturopathic, focused on treating the cause and acknowledging every part of the body. In this second of three articles on autism, we will continue looking at the pathophysiology, connections and treatments for the nervous and the gastrointestinal systems. 

Theory of Increased Action Potentials 

The hypothalamus, the regulator of neurotransmitters, will produce certain chemicals under certain homeostatic circumstances. Constant stress on the brain from toxic heavy metals,6 chemicals, viruses or immune aggravators will establish a chronic state of neurotransmitter imbalance. This shift of neurotransmitters will shift electrostatic balance on neurons, increasing their action potentials. 

A neuron action potential is electrically just that: a "potential for action." The higher the charge on the neuron, the more easily a signal will be sent. The lower the charge on the neuron, the more stimulus it will take to fire a neuron. Children with autism have an extremely high action potential; it takes very little stimulus to fire a nerve. Therefore, within a certain period of time, their nerves fire much more often than a person off the spectrum. 

We see this symptomatically with almost all symptoms of autism, most of all with hypersensitivities. Tantrums from light touch - from tags on the back of the shirt, socks or a hair brush - can be very overstimulating. Noises, normal to you or me, can be overbearing. Strange tastes or textures on the lips, the part of the body most innervated by nerves, sends too many signals to the brain, overloading it, and leading children to eat only certain foods comfortable to them. This also pertains to eye contact. Looking at someone's eyes sends much more information to the brain than looking at their arm or torso, body parts with less information. A stimulus or sense sending one signal to our brain might send hundreds or thousands of signals to the brain of a child with autism. 

This rapidly firing brain also leads to other common symptoms of autism. A brain that fires often will get caught in certain neural patterns, repeating the same "Dora" or "Spongebob" phrase, for example. Children get fixated on a certain object, phrase or television show for a week because the neural pattern is stuck in that area of the brain. A brain that cannot calm down will have insomnia or restless sleep. A brain stuck in one area will not want to stop and branch to other parts of the brain, including learning, which takes repetition. Children who have an extraordinary talent or knowledge are repeating that area of the brain day and night. Repetition is the mother of learning, and if the brain does not spend time in certain areas, including speech, toilet training and sociability, those behaviors will not be learned. 

An action potential is determined by the electrical charge created by neurotransmitters. Certain chemicals, excitatory neurotransmitters or EPSPs, will increase the action potential, encouraging the nerve to fire with less stimulus. Other chemicals, inhibitory neurotransmitters or IPSPs, will decrease the action potential, discouraging the nerve to fire. Neurochemistry still is a novice field and while we have identified certain neurotransmitters, there is a wealth of knowledge still to be discovered, including neurons releasing their own neurotransmitters away from synapses, neuron coupling and brain wave function.1 

We can utilize the neurotransmitter knowledge we currently possess. Excitatory neurotransmitters such as dopamine, PEA and glutamate are increased in the nervous systems of those with autism.5 Inhibitory neurotransmitters such as serotonin, GABA and taurine are decreased or ineffective. New research is beginning concerning the neurotransmitter activity of sex hormones. There is the obvious link of a predominantly male condition with altered levels of testosterone,3 that not only inhibit the detoxification of mercury and other heavy metals, but also might have a potential effect of altering brain chemistry. 

This imbalance creates a chronic neuron charge where nerves fire easily and often. Improving a child's and family's quality of life involves altering this chemistry to improve symptoms and also detoxifying the metals, chemicals or viruses causing the disturbance. This imbalance can temporarily be improved by giving the body the nutritional components that create inhibitory neurotransmitters and decrease action potentials. As I tell parents, "If you have peanut butter and bread, you can only make peanut butter sandwiches." 

Important supplementation includes tryptophan or 5-hydroxy-tryptophan and zinc7, which will form serotonin. The serotonin and zinc will later form melatonin. Theanine will form GABA.4 Along with magnesium,2 (I prefer glycinate) and taurine, these synergistically will decrease action potentials on the neurons. Mineral screens should always be run. Watching for an increased copper:zinc ratio will indicate a need for both zinc supplementation and molybdenum supplementation, which chelates copper out of the body. Lithium levels always should be checked, especially in children with a tendency toward hyperactivity and violence. 

The majority of studies performed in this area have been drug trials; however, information can be gleaned through their physiology. Risperidone, a dopamine blocker and serotonin agonist, has improved irritability, aggression, hyperactivity and stereotypy.8 Discontinuing risperidone results in a relapse in children with autism spectrum disorders.9 SSRIs have been shown to effect significant improvement in global functioning and in symptoms associated with anxiety and repetitive behaviors,10 as well as a reduction in hypersexual behaviors11 (along with a healthy dose of hyoscyamus). Reduction of central nervous system serotonin, induced by acute tryptophan depletion, causes a worsening of stereotyped behavior.12 On the opposite side of the neuron, metabolic turnover of dopamine in the central nervous system improves symptoms.13 However, despite these studies, there continues to be questions about the tolerability and appropriate dosing of SSRIs in children with autism.14 

Decreasing action potentials almost always improves symptoms. A clinical study is being run out of my office with a combined powder of these supplements. One child with insomnia who would wake every hour was having nine hours of consistent sleep after one week. Another child with hypersensitivities could never go to the beach; the sand was too overstimulating for him. He would wear socks on the sand for about five minutes before breaking into a tantrum that sent the family home. This family, living three blocks from the beach, could not enjoy its favorite summer activity. After three weeks into the clinical trial, the family went to the beach and the child ripped off his socks, and then spent the entire day running in the sand and playing in the ocean for the first time in his life. 

Brain Restructuring 

New research shows this neuro-transmitter imbalance and constant hyperfocus on certain activities or items restructures the brain, causing a reduction in the connectivity between specialized local neural networks in the brain and possible overconnectivity within the isolated individual neural assemblies.16 The amygdala and lateral nucleus undergo abnormal postnatal development, which includes a reduced number of neurons.15 Larger right amygdalar volume at 3 and 4 years of age, but not left amygdalar, hippocampal or total cerebral volume, is associated with a more severe clinical course and worse outcome at 6 years of age.17 The corpus callosum, or connectivity of the two halves of the brain, also is disproportionately small with significant reductions in the splenium and genu.18,19 

Individualization 

Each child with autism is unique. In the future, we will see more research into brain remodeling, neurotransmitters and glia communication. As naturopaths, our testing and individualized treatments set us far and above conventional treatments for autism. (Specific testing protocols were outlined in part one of this article.) 

Balancing the nervous system includes decreasing action potentials by giving the nutrients the hypothalamus uses to create inhibitory neurotransmitters. I also find homeopathic organotherapy effective with Corpus callosum 4C and Hypothalamus 9C. 

Autism is completely treatable, and you will be amazed at how children can awaken and mainstream. The final article in this series will explore the adaptations of the young gastrointestinal system in autism. 

References 

1. Fields RD. "Beyond the Neuron Doctrine." Scientific American Mind, 2006 Jun/Jul. 
2. Magnes Res. 2006 Mar;19(1):52-62. 
3. Horm Res. 2006 Jul 5;66(4):182-188. 
4. Neurogenetics. 2006 Jul;7(3):167-74. Epub 2006 Jun 13. 
5. Med Hypotheses. 2006 Jan 6. 
6. Health Place. 2006 Jun;12(2):203-9. 
7. Med Hypotheses. 2001 May;56(5):641-5. 
8. Ann Pharmacother. 2006 May;40(5): 909-16. Epub 2006 Mar 8. 
9. Evid Based Ment Health. 2006 May;9(2):56. 
10. J Clin Psychiatry. 2006 Mar;67(3):407-14. 
11. Pediatr Neurol. 2006 May;34(5):417-8. 
12. Curr Opin Pediatr. 1996 Aug;8(4): 348-54. 
13. Brain Dev. 2005 Sep 14. 
14. J Child Adolesc Psychopharmacol. 2006 Feb-Apr;16(1-2):181-6. 
15. J Neurosci. 2006 Jul 19;26(29):7674-9. 
16. Int J Psychophysiol. 2006 Jul 1. 
17. Arch Gen Psychiatry. 2006 Jun;63(6): 686-93. 
18. J Autism Dev Disord. 2006 Apr 20. 
19. Biol Psychiatry. 2006 Aug 1;60(3): 218-25. Epub 2006 Feb 7.