functional medicine and nutritional genomics - American Association ...
functional medicine and nutritional genomics - American Association ...
functional medicine and nutritional genomics - American Association ...
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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS<br />
radical formation can lead to oxidative stress.<br />
Biomarkers related to the body’s ability to<br />
compensate for oxidative stress include carnitine,<br />
urinary 8-isoprostane, vitamin D, glutathione,<br />
ammonia, lactic acid, transferrin <strong>and</strong> ceruloplasmin.<br />
(21) These biomarkers have been identified as<br />
useful in estimating the oxidative burden<br />
<strong>and</strong> guiding the nutrient management of autistic<br />
patients. Other biomarkers considered for use in<br />
establishing a treatment regimen for patients with<br />
ASD include organic acids, intestinal permeability<br />
testing, calprotectin levels, stool cultures,<br />
methylation <strong>and</strong> transsulfuration markers. Autistic<br />
children in particular may be more vulnerable to<br />
oxidative stress in the form of lipid peroxidation<br />
<strong>and</strong> deficient antioxidants.(22,23)<br />
Mitochondrial disease (MD) is likely present in a<br />
subset of autistic individuals. Mitochondrial<br />
dysfunction can lead to multiple metabolic<br />
problems. The incidence of genetic MD in the<br />
general population is greater than 1:2000. (24)<br />
Statistically, if ASD <strong>and</strong> MD were unrelated, they<br />
would uncommonly occur together as 17 million<br />
people would be required to find 76 patients with<br />
both disorders. However, studies indicate<br />
between 4-8% of autistic patients have MD.<br />
(25)<br />
Furthermore, multiple organ dysfunction is common<br />
in patients with MD with the most common<br />
systems affected being the brain, skeletal muscle,<br />
<strong>and</strong> the gastrointestinal tract creating a wide<br />
variety of seemingly divergent symptoms. (26)<br />
Gastrointestinal symptoms are very commonamong<br />
ASD patients. One study compared children with<br />
ASD to normal controls <strong>and</strong> those with<br />
developmental disability. GI complaints were<br />
present in seventy percent of children with ASD<br />
versus 28% <strong>and</strong> 42% in the normal <strong>and</strong> disability<br />
group, respectively. (27) This may only indicate<br />
that GI symptoms are more bothersome to ASD<br />
patients since other studies have not supported an<br />
increased prevalence in ASD.(28) Because every<br />
cell in the human body depends on mitochondria,<br />
these patients often experience multiple system<br />
disorders with the end result involving<br />
neuroinflammation <strong>and</strong> cytokine release.<br />
145<br />
Autism is characterized as a neurodegenerative<br />
disease involving decreased cerebral perfusion,<br />
inflammation, <strong>and</strong> oxidative stress <strong>and</strong> researchers<br />
have explored the use of HBO therapy to address<br />
ASD.(33) HBOT has been successfully used in<br />
the treatment of neuropathy (29), closed head<br />
injury (30), stroke (31) <strong>and</strong> Crohn’s disease<br />
(32) all of which involve similar mechanisms of<br />
injury. Therefore, it seems reasonable that autistic<br />
individuals may benefit from HBO treatment <strong>and</strong><br />
this has recently been explored.<br />
A prospective open-label pilot study performed in<br />
2007 looked at the potential role of HBOT on<br />
oxidative stress in ASD. Eighteen children ages<br />
2-16 underwent multiple HBO treatments following<br />
two protocols. Assessment included parental<br />
symptoms rating <strong>and</strong> evaluation of C-reactive<br />
protein <strong>and</strong> glutathione levels before <strong>and</strong> after the<br />
completion of treatments. HBOT was found to not<br />
worsen oxidative stress <strong>and</strong> to significantly reduce<br />
the CRP values; parental symptoms ratings were<br />
favorable.(34)<br />
These same authors subsequently performed a<br />
multicenter, r<strong>and</strong>omized, double-blind,<br />
controlled trial to assess the efficacy of HBOT in<br />
autistic children. The study r<strong>and</strong>omized sixty-two<br />
children ages 2-7 to 40 one-hour treatments of<br />
either HBO therapy or pressurized room air. The<br />
study concluded that, compared to children<br />
treated with slightly pressurized air, the HBOT<br />
group had significant improvements in ‚overall<br />
functioning, receptive language, social interaction,<br />
eye contact, <strong>and</strong> sensory/cognitive<br />
awareness.‛(35)<br />
In a similar study, 16 patients with ASD<br />
underwent 40 HBOT treatments to evaluate the<br />
effect on behavior. No significant effect was<br />
observed among the observed behaviors<br />
studied.(36) These authors did not look at the<br />
effect of HBOT on inflammatory <strong>and</strong> oxidative<br />
stress markers.<br />
Finally, a small Thai study evaluated social, fine<br />
<strong>and</strong> gross motor, language, <strong>and</strong> self- help<br />
domains before <strong>and</strong> after 10 HBO treatments,<br />
reporting that 75% of participants showed<br />
2012