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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS depressants, neuroleptics, and pain relievers. Our discussion will focus on the evidence for the use of HBO therapy in the treatment of MS. Hyperbaric oxygen therapy, detailed in the introduction, is the use of supplemental oxygen therapy under increased atmospheric pressures. There is divergent opinion on the effectiveness of HBO in the treatment of MS, particularly between the United States and the United Kingdom. HBOT was embraced in the UK and freestanding charity clinics were established throughout Europe, making HBOT a standard treatment in MS for over 20 years. The mechanism of action of HBOT in relationship to MS is thought to include both suppression of the immune response and reduction in partially reduced reactive oxygen species. Partially reduced reactive oxygen species are free radicals which can interact with organic molecules, interfering with enzyme activity and damaging cell membranes.(11) Concern with the use of oxygen and its oxidation promoting potential, as seen in re-perfusion injury, has not been established. For use in MS, Neubauer’s protocol involved the use of oxygen at lower pressures than typical hyperbaric treatment, and it is thought that this may limit the oxidative damage. No recent theory on the mechanism of action of HBOT on MS exists. Case and clinical studies using HBOT to treat MS have been present in the American literature since the 1980’s. Fischer et al. published a randomize, placebo-controlled, double-blinded study in the New England Journal of Medicine evaluating 40 patients. Objective improvement occurred in 12 of 17 HBOT patients and 1 of 20 placebo (P
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS effect persisted for one month, but not 6 months.(24) He did not, however, measure for improvements in the frequency or severity of fecal incontinence. The most compelling recent study, authored by the late D. Perrins in 2005, evaluated 117 patients who received HBOT treatments without interruption for 5 to 15 years in the UK. The authors followed 703 MS patients treated with HBOT 5 or more years previously. Pressure and oxygenation protocols were consistent over the years. Assessments were made between 2 and 3 years, then again between 6 and 8 years, with a final survey being conducted at 11 to 14 years from the first HBO treatment. Among this group, 117 people attended clinic regularly and without interruption for 5 to 17 years. Their findings support that 300+ treatments with low pressure HBOT over 10+ years was required to retard progression of disability. Five-hundred treatments were more effective as these patients had even less disability overall.(25) Despite these positive findings, three separate reviews of HBOT and treatment of MS were performed from 1995 to 2010. All authors concluded that the use of HBOT for the treatment of MS was not recommended based on limited study populations, variable treatment protocols, and a lack of demonstrated benefit.(20, 21, 22) Expert opinion on the use HBOT for MS is controversial. MS is a condition with wide ranging clinical presentations and outcomes. Studies of HBOT in the treatment of MS have used a variety of different treatment protocols, varying in the amount of pressure and oxygen, the number of treatments, how long the clients were followed and the the end-point measured. It appears that the use of HBOT is unlikely to significantly affect patients with longstanding disease, such as chronic progressive MS. Those advocating the use of HBOT in MS suggest that it 143 be used immediately upon diagnosis and chronically thereafter. The use of HBOT in MS has not been compared to the use of interferon, the most recent FDA approved disease modifying agent. Nor have the two been studied together. At this time, the use of HBOT should be considered an adjunct to FDA approved treatments. Possibly the long term use of HBOT in combination with immune modifying drugs would provide patients with the improved outcomes. Continued study is warranted, focusing on the long term use of low pressure HBO therapy in those newly diagnosed or with more mild disease. Autism Clinical Vignette JS is a 3 1/2 year old boy born to a 27 year old white female who had an uncomplicated pregnancy and normal vaginal delivery. JS experienced normal developmental milestones with appropriate feeding, sitting up, crawling, social interaction and expressiveness. At age 2 1/2 he experienced a flu-like illness with high fever and diarrhea and was treated with hospitalization, IV hydration and antibiotics. Over the coming months JS’s parents noted significant regression of his prior verbal development, ultimately experiencing social withdrawal, failure to make eye contact, and difficulty managing sensory stimulation. He was diagnosed with autism spectrum disorder at the age of 3 1/2. Review of the Literature and Discussion Disorders in the development of socialization, communication, and behavior characterize autism spectrum disorders (ASD).(1) This neurodevelopmental disorder may affect up to one out of 150 individuals in the United States and the prevalence of autism may be increasing.(2, 3) The use of a multi-disciplinary team with expertise in the diagnosis and treatment of ASD is preferred. This includes a detailed history and 2012
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