Such a mysterious disease-condition-behavior! Most physicians have not seen a case of autism and if they have, they and everyone else seem to be totally baffled by the condition. Almost fifty years ago (1951) the medical definition was "The condition of being dominated by subjective, self-centered trends of thought and behavior." Dorland’s Medical Dictionary 23 edition. The 28th edition of the same medical dictionary (1994) changed it to, "autistic thinking; preoccupation with inner thoughts, daydreams, fantasies, delusions, and hallucinations; egocentric, subjective thinking lacking objectivity and connection with reality. The self often predominates to the total exclusion of that which is not self. Seen in schizophrenia, some forms of depression, and a variety of other mental disorders."

The term autism was first introduced in 1943 by Kanner to indicate the condition wherein children, despite excellent motor skills (normal motor milestones and facile use of hands) and retentive memory, fail to mature socially, i.e., to form any emotional bonds with parents and other individuals, and often to learn speak. There are thought to be two general types of autism. In one group, the child is seemingly well until 18 to 24 months at which time an alarming regression in their development occurs and they may stop speaking and begin to lose interest in their surroundings and interactions. Often these developmental regressions begin to occur shortly after some type of stress such as a DPT shot or other immunization, injury, fever, toxin, infection (such as Kawasaki’s), etc.

With the other type of autism, the child appears to be abnormal from the first months of life. The level of activity is reduced, the child cries little and is indifferent to his or her surroundings. According to many authorities the outcome of childhood autism is discouraging. One third of the patients never speak, another third acquire a rudimentary language devoid of communicative value, and in the remainder, an affected, stilted, colorless speech develops. As many as a third of these patients as they grow older will manifest signs and symptoms of a variety of cerebral diseases.

So much for the books! In my experience, most of these children have a variety of problems which all come together to cause the behavioral and speech difficulties. In my opinion and experience, once the various problems are sorted through and corrected, these children do have a chance to become much more normal than heretofore thought possible.

The recent discovery that secretin helps a number of these children is a good example that shows that we have a tremendous amount of knowledge yet to be learned about this condition. Of considerable interest in this regard is that in general at this point the information I have been receiving is that secretin may be most beneficial for those children with abnormal bowel functions. Hypocretin (a part of the secretin molecule) is a newly discovered neurotransmitter and acts by stimulating the hypothalamus and other brain centers. My idea that secretin injected into the body breaks down to hypocretin and this then is what is causing the beneficial results may not be correct or it may be part of the answer. On the other hand secretin acts on the pancreatic ducts to cause copious secretion of a very alkaline pancreatic juice that is rich in bicarbonate. Secretin is secreted by the S cells that are located deep in the glands of the mucosa of the upper portion of the small intestine. The chemical structure is similar to that of glucagon, GLI, VIP, and GIP. Its half life is 5 minutes and augments the action of CCK in producing pancreatic secretion of digestive enzymes. It decreases gastric acid and may cause contraction of the pyloric sphincter. The secretion of secretin is increased by the products of protein digestion and by acid bathing the mucosa of the upper small intestine. Normally the acid passing from the stomach to the upper small intestine will act to stimulate the secretion of secretin which then releases the alkaline pancreatic juice which neutralizes the acid entering the upper small intestine. As the pH is changed from acid to alkaline, the secretion of secretin is shut off and pancreatic juices also stop flowing. In autistic children this feedback mechanism and the secretion of secretin may be impaired. This would explain the persistently acid pH’s of the stool contents of these children and would explain the benefit of the secretin when given by injection. If secretin is not normally being produced by the S cells or is not being regulated by the stomach acid content then the pancreas will not secrete the alkaline pancreatic juice in response to protein digestion products. The stool contents will become persistently acid and this acid will wreak havoc on the intestine’s inner walls. Persistently lower stool pH’s (more acid) will cause damage to the delicate inner intestinal mucosa which will increase the permeability "openness" of the mucosa. Bacteria, yeast, food and all of their various metabolic breakdown products will be able to pass much more easily into the blood and lymphatics of the intestine. All of these become "toxins" and are carried to the brain or enter into the intestine’s wall and undergo a chemical war with the body’s defense system. This war that develops in the intestinal walls between the entering toxins and the white blood cells of the body may well release a variety of "biogenic amines" "cytokines" and indoles, skatoles, polyamines, etc. all of which can pass into the blood and also the CSF (via the intestinal lymphatics and Bateson’s paravertebral shunt). From there these toxic substances become readily available to interact with a "predisposed brain."

Autistics are also predisposed to allergies and this predisposition may partially explain why so many siblings have autism. Many parents observe that autistic episodes are often worsened when their child eats certain foods such as wheat, milk, sugar, eggs, corn, etc. High levels of certain food derived polypeptides are found in the urine and their immune complexation with IgG antibodies as well. High levels of immune complexes, anti-nuclear antibodies and other markers of chronic infection and vasculitis are often found if looked for (blood tests). These children often suffer from recurrent middle ear infections and fluid in the middle ear. Frequently they have been given multiple antibiotics and have developed chronic intestinal yeast infections which neither they, their parents or their doctors have noticed or tried to diagnose. Often these children suffer from colic during the first year of life (long thought to be caused by food allergies), or from diarrhea, constipation, and mal-odors. These various bowel problems need to be investigated and treated. I generally recommend the Great Smokies Lab for this test (comprehensive stool exam and parasitology test). Follow up tests should be done every three months to be sure that these infections have been corrected.

Hyperactivity is often a problem which gets worse with the ingestion of certain foods or exposures to the smell of chemicals, or perfumes. These people often have seizures (epilepsy) which can be brought on by certain foods, or sugars and often suffer from the development of a red and hot face and/or ears due to food allergies. Sometimes they have food cravings or are very "picky" or may refuse to eat anything but a few of their favorite foods. They often are of small statue and look somewhat younger than they are- possibly due to malnutrition. Of interest is that the speech centers of the brain require iron and zinc or they don’t develop during their critical times of development. Both of these can be severely depleted by an acute infectious process such as autistic children often have had as a precipitating event.

A predisposed brain is what these children have in that they have subtle brain injuries that have occurred in utero, at birth or secondary to some other subsequent trauma. A good bibliography for this is found on the web at http://nodulus.extern.ucsd.edu/. which is the web site for the Laboratory for Research on the Neuroscience of Autism. Unfortunately, up to recently, these subtle brain injuries were not recognizable by the diagnostic tests that were available. Since the tests doctors used on these children didn’t show up the problems, it was thought that they didn’t have any injuries. (Another tribute in the hall of shame to the ego of doctors.) Finally, diagnostic tests such as 3-D, 3 headed SPECT scans, PET scans, MRI spectroscopy and functional MRI are beginning to show that many if not all of these children do have subtle brain injuries.

Some of these injuries occur by genetic errors. Cell proliferation, migration, growth and differentiation are all regulated by genetic codes which if there are errors present will result in abnormal development or lack of development of critical parts of the brain such as the cerebellum.

Other factors include various toxins such as xenobiotics which are foreign chemicals which when breathed in or swallowed or absorbed will damage the brain. For example, alcohol ingestion by a pregnant woman can result in the loss or damage of a type of cerebellar cell called the Purkinje cell. Loss of Purkinje cells occurs when a pregnant woman takes various drugs such as the anticonvulsant valproic acid. This and ingestion of thalidomide have been associated with the development of autism.

Viruses can infect the rapidly divided brain cells especially of the cerebellum which results in a smaller structure which has been associated with autism. Viral infections can do a tremendous degree and a great variety of types of brain maldevelopment and disturbed neural connections all of which could result in autism.

Trauma is a very serious problem for babies and children and can be due to a number of different events. Birth trauma is associated with lack of oxygen (hypoxia), pressure changes on the brain, hemorrhage into the brain, shear stress, ischemia-reperfusion injury, free radical production, etc. Changes in the inner blood vessel wall involving the endothelium secondary to these traumatic events can create permanently spastic microvessels which in turn causes chronic hypoxia. The trauma can also trigger the production of a variety of genetic changes including the induction of early-response genes, heat shock genes, metallothionin genes, etc. in the endothelium and in the neurons and glia cells of the injured areas. These damaged tissues in turn can react with white blood cells to induce the production of autoantibodies. These antibodies can then continue to be produced forever and always be in the system causing inflammation and vascular spasm. These autoantibodies may also be directed at the various decarboxylases present at the terminal nerve synapses. Glutamate decarboxylase and histidine decarboxylase are found close together in these synapses. Autoantibodies can penetrate through the neurons to reach these sites and inactivate these enzymes. If this happens the glutamate decarboxylase would no longer be able to convert the glutamate that is being released by the neurons to glutamine. Glutamate would remain in the extracellular spaces and contribute or totally cause the hyperactivity, seizures and loss of attention of these children. The inactivation of histidine decarboxylase could result in more histamine being present which would help explain the allergic and chemical sensitivities these children have. Both of these decarboxylase enzymes are vitamin B-6 and magnesium dependent enzymes and when these children are given supplemental vitamin B-6 and magnesium, often you see improvements in their conditions. Vitamin C is also helpful and this may be due to a variety of reasons including more rapid detoxification of xenobiotics, decrease in histamine levels, a decrease in adrenalin levels, a decrease in stress hormones, improvement in capillary permeability (less), improvement in connective tissue construction, etc.

The endothelium is the inner lining of the blood vessels and in this condition, may well be the key factor involved with causing the symptoms. Correction of the damage these brain endothelial cells have suffered from trauma, hemorrhage, viruses, xenobiotics, intestinal bacterial and yeast metabolites, etc is vitally important since these damages will remain fixed in these cells forever unless actively corrected. To do this a variety of tests need to be done. These include the Great Smokies quantitative plasma amino acids, quantitative urine amino acids, serum and urine minerals, urine organic acids (Great Plains Laboratory, Wichita, Kansas), fatty acid profile, Great Smokies comprehensive stool and parasite test, TORCH viral panel, Epstein-Barr comprehensive panel, Herpes VI, food allergy panels IgE and IgG4, ANA, interleukin 6 and11, interferon alpha, interferon gamma, ESR, C-R-P, haptoglobin, Adrenal stress panel, chemistry panel, thyroid panel. These may look overwelming and there is no way that I would order all of these to be done at one time. Start with the comprehensive stool test and allergy tests since these are things you can change around with the food choices you are making.

After you get the diet changed around and the bowels cleaned up, and you have tried the secretin a few times, start to look at the other tests and begin to correct the abnormalities you find with these. About this time you should begin to think about the use of hyperbaric oxygen and magnetic therapy. Both of these seem to be quite helpful at changing the health of the endothelial cells and thus the brain’s blood vessels. Results can be seen within a few days with these therapies. A magnetic bed can be used every night and is helpful. Static magnetic field treatments using 3000 gauss given for a total of 150 to 200 hours will generally produce a long term very positive effect and daily hyperbaric oxygen treatments for a total of between 60 and 180 treatments also have been shown to be quite helpful in my experience.