Brain Inflammation

It is always gratifying when science catches up with natural medicine, as in the case of the gut-brain connection and toxic influences on autism spectrum disorders (ASD).  The involvement of environmental toxins, including pesticides, herbicides, heavy metals, vaccines and others, has now been recognised as has the importance of diet.  Welcome to the world of natural health!

Interpretation of findings is always relevant – particularly in the role of prevention.  We often read about the effects of toxic substances on our health, in this case the health of our children, but rarely are we given advice on how to prevent damage.  For anyone considering having children, please recognise the importance of first detoxifying your body before conceiving.

In situations when toxins have already affected the brain, natural remedies are highly effective in gently removing these and supporting healthy brain and neurological functions.

The high amount of trans fats in our diets are now increasingly implicated in both depression but also ADHD. The importance of a nutritious diet, high in wholesome fresh foods cannot be stressed enough – for everyone – but particularly for those suffering any kind of brain inflammation.

The following is a clinical update regarding ASD and the most recent findings of researchers, including the role of vaccines :

Autism spectrum disorders (ASD) are less an intractable and damning life sentence for the brain, rather than a dynamic whole-body disease processes that respond to nutritional and environmental therapies, a leading paediatric neurologist told practitioners in Sydney in October.

Dr Martha Herbert, assistant professor in neurology at the Harvard Medical School, presented recent findings from her TRANSCEND (Treatment Research and Neuroscience Evaluation of Neuro-developmental Disorders) Research Program, based at Massachusetts General Hospital, at the Mindd Foundation’s seminar, A Whole-Body Approach to Autism & Related Neuro-Developmental Disorders, at the University of NSW.

The blossoming of systems biology, which studies the interconnectivity between neurological, immune and cognitive responses and explores changes to bodily systems over time, has set the stage for changes in scientific thinking about autism, said Dr Herbert.

To date, the conventional approach to ASD had them classified as behavioural disorders as a result of the brain being ‘broken’ due to genetic disorders. But Dr Herbert said that from a systems point of view, ASD could be seen as a consequence of environmental challenges to cellular function of the body, including the brain, which is particularly vulnerable in children.

According to Dr. Herbert, the challenge of making sense of the development of larger-than-average head and brain size in young autistic children is best met by a systems biology approach. Brain measures including an atypically fast increase in head circumferences of autistic children during the first 1 ½-2 years of life, as well as microscopic and MRI studies at TRANSCEND and elsewhere, have revealed size increases in the outer white matter, where myelin and glial cells – now reappraised in neurobiology as a link for ‘crosstalk’ between the nervous and immune systems – are particularly rich.

The cause of this increase is not fully known. However, a lot of evidence suggests that most of this additional volume may consist of water, which Dr Herbert said may be a reflection of altered tissue properties or swelling and inflammation of glial cells from oxidative stress.

Although the body had its own anti-oxidant defences, such as glutathione and superoxide dismutase, these were found to be low in ASD, making these individuals vulnerable so that toxic insults such as pesticides, heavy metals and even air pollution at a young age easily overwhelmed them.

This set up a cascade of glial inflammation and reduced perfusion in the brain. “Also, the blood–brain barrier is virtually non-existent at birth and takes up to a year to develop, making infant brains particularly vulnerable,” added Dr Herbert. There is much known about how these kinds of changes can increase the neural excitation–inhibition ratio. “More research needs to be done on how this altered chemistry affects sensory pathways, which are so often altered in autism.”

“These brain changes can be a consequence not only of early brain development changes but of environmental exposures that happen in everyday life,” said Dr. Herbert. “Microwaves, radiation, infection, inflammation, ishaemia, injury, deficient vitamin C or flavonoids –– all environmental factors –– can open the blood–brain barrier at any point in life,” said Dr Herbert.

Clinical episodes of fever or where antibiotic, anti-epileptic, anti-allergenic or anaesthetic treatment temporarily improved ASD symptoms demonstrated the dynamic properties of the brain that appear to be impacted in autism. “If core features of autism can improve over hours to days, then perhaps they are not hardwired so much as rooted in stubborn chronic tissue problems. Perhaps they are “states” rather than ‘”traits,” she said. “The brain isn’t fixed for life but changes a lot after birth. Active medical problems like neuroinflammation may be capable of impacting brain states, and these problems continues in an ongoing fashion across the lifespan though they may be more intense in the younger brain,” explained Dr Herbert.

TRANSCEND and other neuroscientists were also now seriously investigating the gut and immune disorders so commonly comorbid with ASD. Recently the American Academy of Pediatrics had published Autism GI Consensus reports. “They’re very conservative but they have put the gut on the map,” said Dr Herbert.

Dr Herbert acknowledged that integrative practitioners had recognized the brain–gut–immune triad for some time, and praised functional medicine for its systems-based approach.

Case reports from clinical practice were needed to develop a consensus around the new dynamic model of autism, added Dr Herbert. “The integrative community needs a structure where we can pool data and describe for the world what we observe. We need to show what individualized medicine is like, how we take account of all its complexity and messiness. We have a lot to contribute to figuring out and dignifying the truth to help people learn that you don’t need to apply an off-the-shelf rigid algorithm to everybody but can adapt your treatment approaches to each individual’s situation.”

For further information on this workshop and other MINDD activities, please go to www.mindd.org

Retreat and eat to treat

The role of environmental toxins in the epidemic of ASD in developed countries, as much as the increased vulnerability to them of autistic children, attracted repeated scrutiny from Professor Herbert at the Mindd seminar.

The epidemiology of autism incidence –– which had risen in California by 600% in the decade until 2001, and 1200% from 1987-2007, appeared to be at least two-thirds due to environmental factors, according to a study by Dr. Irva Hertz-Picciotto at the University of California, Davis MIND Institute.

In Australia there is also an increase in ASD. A paper still under review which reports the work from The Early Language in Victoria Study (ELVS)[1] cohort study has shown the prevalence rates are now at 1 in 100 (1%)[2], as opposed to the 1 in 160 as previously thought.

“Increases like this demand assessment from an environmental point of view,” said Dr. Herbert. Studies in Texas had shown that with each 1000 lbs of mercury released, there was a 61% increase in the rate of autism. “We don’t know anywhere near what we need to know about the impact of environmental chemicals on human development or health.”

Nearly 3000 such chemicals were manufactured in quantities above 450 tonnes each year, yet only about 20–30 (0.4%) were tested for neurodevelopmental toxicity according to Environment and Protection Authority (EPA) guidelines, said Dr Herbert.

“About 21% have some data on developmental toxicity but the remaining 78% have no such evaluation at all because it is not required,” she pointed out.

“It is amazing that the first investigation of toxic body burden in infant cord blood was done by a non-profit organization and not by the government,” said Dr. Herbert. According to an investigation by the Environmental Working Group (www.bodyburden.org), of the 287 chemicals they detected in umbilical cord blood, 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, 208 cause birth defects or abnormal development in animal tests and nearly 200 had been banned from the market for years.

Dr. Herbert reviewed a sampling of evidence on the range of harm to human health and development from environmental exposures. Maternal exposure to high levels of pesticides such as DDT led to daughters having earlier puberty – an increased risk for breast cancer – while the odds for a Californian child developing autism increased with the amount of organochlorine applied and decreased with the distance from sprayed sites.

Other than pesticides and heavy metals, solvents, PCBs, vaccines, flame retardants, antiseptics in hand washes, vitamin D deficiency, antibiotic overexposure, essential fatty acid deficiency, IVF, rubella, valproic acid and dietary deficiencies of folic acid, vitamin B12 and magnesium were all being investigated as possible environmental contributors to autism, Dr Herbert added.

While research continues Dr. Herbert said there were many practical things that could be done prudently to avoid harm and build resiliency. This included eliminating neural excitotoxins from the diet, such as MSG, aspartame and processed foods generally, as “they make everything that goes wrong worse.”

Resistance to environmental insults could also be decreased by increasing glutathione levels in ASD patients with antioxidant therapy. Including fermented foods and probiotics can help to heal the gut and restore the contribution of healthy bacteria to immune and metabolic function. Avoiding foods that exacerbated GI problems, such as simple sugars and high-fructose corn syrup–– which has mercury used in its production–can help markedly.

Elimination diets, such as of gluten or casein, had shown some efficacy in ASD children. Although the evidence was conflicting due to the complexity of trials and idiosyncratic responses in subjects, a recent strong study by Whitely showed strong effect. Many children seem to need to eliminate other foods as well, such as starchy foods and soy. Dr Herbert said the clinical picture could improve “if you’re persistent and comprehensive”.

Practitioners could contribute by documenting ASD treatment case studies and TRANSCEND wanted to work with Mindd so individual clinical success stories could help other practitioners and families, added Dr Herbert.

The current complimentary Blackmores Professional Food Chemical Sensitivities webcast presented by Dr Mark Donohoe and practitioner Elizabeth d’Avigdor also discusses the wider implications of food sensitivities. Clinical strategies, coupled with case studies, are presented.

[1] J. Child Lang. The Early Language in Victoria Study: predicting vocabulary at age one and two years from gesture and object use*. f2008 Cambridge University Press 35 (2008), 687-701 http://www.olsel.catholic.edu.au/_uploads/_cknw/files/ELVS-%20Predicting%20Vocabulary.pdf Accessed online 10 NOV 10

[2] Private email correspondence with Professor Margot Prior 12 November 2010

[3] Barbaro J and Dissanayake C. Prospective Identification of Autism Spectrum Disorders in Infancy and Toddlerhood Using Developmental Surveillance: The Social Attention and Communication Study. Journal of Developmental and Behavioural Paediatrics. 31 (5): 376-385, June 2010