Autism Made Easy Therapeutic Nutritional Strategies in the Autistic Spectrum of Disorders

Peta Cohen, MS., RD. Star Academy Johannesburg, Nov 2011

www. PetaCohen .com Therapeutic Nutritional Strategies in ASD

Defining the Problem • Autism is treatable, recovery is possible • Epigenetic Phenomenon (methylation) • Complex – Whole Body, Multi-System, Metabolic Disorder – Many targets for simultaneous treatments • Biological Heterogeneity • Chronic Dynamic Encephalopathy • Disorder that Affects the Brain

www. PetaCohen .com 2 Autism- A Whole Body, Multi-System, Metabolic Disorder

Systems Oxidative Stress Inflammation

Methylation Transulfuration

Mitochondrial Redoxstatus Function Biotransformation Excitation

SNPs – Single Nucleotide Polymorphisms

www. PetaCohen .com 3 Autism- A Whole Body, Multi-System, Metabolic Disorder

Nervous System Gastro-Intestinal System Respiratory System Immune System Endocrine System Eco- System/Microbiome Cardiovascular System

Oxidative Stress Impaired Methylation Inflammation Impaired Trans-Sulfuration Excitation Impaired Detoxification Mitochondrial Dysfunction Nutrient Insufficiencies/Excess pH Balance/Redox Status Cerebral Folate Deficiency

SNP – Single Nucleotide Polymorphisms, Epigenetics Genomics


Proteomics


Metabolomics

www. PetaCohen .com 4 Autism- A Whole Body, Multi-System, Metabolic Disorder

Stressors

Function Feed Forward Dysfunction - Systemic & Metabolic genetics immunity GI biotransformation

www. PetaCohen .com 5 Stress Multiple Routes of Exposure – Environmental – Metabolic • Chemical/Toxic • Nutritional – calories: • Infections Insufficient/excess/imbalance • Sensory d – Psychological • Oxidative stress • Perception/Experience • Chronic inflammation • Thoughts • Hypoxia/Impaired aerobic • Emotions energy metabolism – Physiological – Biological • Structural • Retention toxicity • Trauma • Biofilm • Pain • Excess exercise • Poor sleep

www. PetaCohen .com 6 Dynamic Relationships Systems • GI – Immune – Nervous • GI – Endocrine – Immune • GI – Immune – Cardio • GI – Microbiome – Immune • GI – Immune – Respiratory • GI – Immune - Skin

www. PetaCohen .com 7 Dynamic Relationships Metabolic • Oxidative stress – Inflammation – Excitation • Oxidative stress – methylation – transulfuration – redox status • Oxidative stress – methylation – transulfuration - detoxification • Oxidative stress – Inflammation – Excitation – Mitochondrial Uncoupling

www. PetaCohen .com 8 Biomedical Approach to Healing, Health, and Vitality

“The most fundamental defining characteristic of living organisms compared to machines is that living organisms have the ability to repair themselves.”

Why We Age Steven Austad

www. PetaCohen .com 9 Targeted Nutritional Strategies

“Let Food Be Thy Medicine, And Medicine Be They Food”

Hippocrates, 400 B.C.

www. PetaCohen .com 10 Dietary Interventions – The Need for Change The “Right” Diet

• Clean Diet • Glutamate/Aspartate • GFCF Reduced Diet • GFCFSF Corn Free • Low Copper • SCD • Allergy/Sensitivity • BED Elimination/Rotation Diet • GAPS • Low Phenol • Low Salicylate • Low Oxalate Individualize/Customize

www. PetaCohen .com 11 Cleaning Up The Diet

• Organic • Non-GMO • Free-range, hormone free, antibiotic free • Low-sugar • Avoid high fructose corn syrup • Avoid artificial sweeteners • Avoid hydrogenated/trans fats • Avoid artificial dyes, flavors, preservatives • Avoid sulfites and sulfite dioxide • Avoid nitrates • Avoid aluminum containing baking powder • Minimize the use of food as a reward

www. PetaCohen .com 12 Cleaning Up The Kitchen

• Avoid non-stick cookware • Avoid aluminum cookware • Do not wrap food in foil • Avoid copper cookware • Do not store hot food in plastic containers • Use BPA free plastics • Use stainless steel water bottles • Use cast-iron, enamel, stainless steel, glass cookware • Use only glass in a microwave • Wrap food in recycled parchment paper • Store food in glass containers

www. PetaCohen .com 13 The “Right Diet” When it comes to diets and nutrition, One size does not fit everyone…. Customize & Individualize

www. PetaCohen .com 14 Gluten/Casein/Soy &Corn Free

Pros – Eliminates opioids Cons – Substitute/replacements are often highly processed and refined – Substitute grains are high oxalate – Repeat consumption of the same foods may lead to increased IgG response

www. PetaCohen .com 15 Specific Carbohydrate Diet - SCD

“Breaking The Vicious Cycle” by Elaine Gotchall

• Grain free diet • Avoids all sucrose containing foods • SCD permits the intake of simple sugars (monosaccharides) found in honey, fruits and some vegetables • SCD prohibits the intake of double sugars (disaccharides), such as lactose, sucrose, maltose and isomaltose found in milk, buttermilk, commercial sour cream, commercial yogurt, molasses, corn syrup, maple syrup • SCD prohibits the intake of certain foods containing complex sugars and starches (polysaccharides) such as grains, certain legumes, potatoes, yams, parsnips, seaweed and cottonseed

www. PetaCohen .com 16 Specific Carbohydrate Diet – SCD cont…

Pros – Very healing to the GI – Improves dysbiosis – Improved skills Cons – High allergenic diet – High glutamate diet – High oxalate diet – Can lead to ketosis – Can lead to hyper-ammonemia – Permits dairy that is low lactose

www. PetaCohen .com 17 Body Ecology Diet - BED

“Body Ecology Diet” by Donna Gates • Relies on fermented/cultured foods • Uses the principles of expansion/contraction Pros – Healing to the GI – Improved skills – Improves dysbiosis Cons – Children don’t like the YCK and fermented vegetables – Children don’t like the meals – High oxalate – High glutamate

www. PetaCohen .com 18 Gut And Psychology Syndrome – GAPS cont…

Pros – Very healing to the GI – Improves dysbiosis – Improved skills Cons – High allergenic diet – High glutamate diet – High oxalate diet – Can lead to ketosis – Can lead to hyper-ammonemia – Permits dairy

www. PetaCohen .com 19 Gut and Psychology Syndrome – GAPS Diet

• “Gut And Psychology Syndrome” by Patricia McBride • Gluten and casein free • Corn free • Prohibits all grains • Prohibits phenol and salicylatecontaining food • Prohibits all starchy vegetables and any food produced from them: potato, yams, sweet potato, parsnip, swede, Jerusalem artichoke, cassava, arrowroot and taro • Prohibits sugar and sugar containing foods • Prohibits starchy beans and peas: soybean, mung beans, garbanzo beans, bean sprouts, chick peas and fava beans • Prohibits lactose and lactose containing foods: fluid or dried milk, commercially produced yogurt, buttermilk, and sour cream

www. PetaCohen .com 20 Allergy/Sensitivity Elimination Diet

• Eliminates all IgE mediated reactive foods • Eliminates or rotates IgG mediated sensitive foods Pros – Decreases the TH2 dominant nature of the immune system – Decreases the inflammatory response Cons – May lead to the frequent consumption of other foods

• Ideal to create a 3 – 4 day Rotation Diet

www. PetaCohen .com 21 Low Phenol Diet

• Removes high phenol containing foods – In particular: apple, banana, red grape, tomato, orange, chocolate • Reduces the phenolic stress on the activity of the PST enzyme Pros • Decreased phenolic symptoms • Decreased hyperactivity • May improve function of the PST enzyme Cons • Removes popular fruits and vegetables

www. PetaCohen .com 22 The Feingold Diet

• Promoted to treat ADHD • Prohibits foods containing naturally occurring and synthetic forms of salicylates – Fruit • No berries, stone fruits, citrus fruits (except for lemon), certain apples – Nuts • No almonds – Vegetables • No cucumber, tomato, bell peppers • Prohibits foods containing artificial preservatives • No BHT, BHA • Prohibits foods containing artificial dyes – No yellow, red, blue, etc.

www. PetaCohen .com 23 Low Salicylate Diet…The Feingold Diet cont…

Pros • Improves ADHD symptoms • Eliminates the exposure to foods containing artificial dyes, flavors and preservatives Cons • Significantly reduces the choice of fruits

www. PetaCohen .com 24 Glutamate/Aspartate Reduced Diet (G.A.R.D.)

• Reduces consumption of high glutamate/aspartate foods • Based on veterinary research • Promoted to decrease clinical and subclinical seizure activity Pros • Reduces consumption of high glutamate foods • May help lower ammonia levels Cons • Low protein • Nut and legume free • Limited vegetable intake

www. PetaCohen .com 25 Glutamate/Aspartate Restricted Diet (G.A.R.D.)

Foods rich in glutamate and aspartate

• Grains: Wheat, barley and oats • Dairy: All cheese. Casein is concentrated in cheese and is 20% glutamic acid by composition • Beans: Soy, pinto, lima, black, navy and lentils • Seeds: Sunflower, pumpkin, etc. • Nuts: Peanuts, cashews, pistachios and almonds • Meats: All meats are naturally high, however, rabbit and turkey are the highest, while lamb and eggs are the lowest. There are higher levels of glutamate in grain fed animals • MSG in prepared foods • Diet sodas

www. PetaCohen .com 26 G.A.R.D. cont…

Foods lower in glutamate and aspartate

• Fruits, berries • Vegetables • Potatoes • Lamb and eggs • Tree nuts, such as, pecan, walnuts, macadamias

www. PetaCohen .com 27 Low Oxalate Diet - LOD

High Oxalate Foods to Avoid • Chocolate, cocoa powder, carob • Soy beans, black beans, kidney beans, navy beans, pinto beans • Sesame oil, tahini • Blackberries, currants, dates, figs, kiwi, lemon/lime/orange peel, oranges, persimmons, raspberries, star fruit • Buckwheat, durum wheat, wheat, millet, rye • Oregano, cinnamon, black pepper, turmeric • Almonds, cashews, hazelnuts, macadamia nuts, peanuts, pine nuts, pecans, pistachios, walnuts • Sesame seeds • Milk thistle • Date sugar, stevia • Beets, steamed broccoli/Brussels Sprouts/carrots, celery, dandelion greens, collard greens, Chili peppers, chard, okra, olives, potatoes, sweet potatoes, sorrel, canned tomato paste/sauce/puree, , yellow dock

www. PetaCohen .com 28 Seizures and the Ketogenic Diet • Developed for treatment of pediatric epilepsy in the 1920s • High-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet mimics aspects of starvation by forcing the body to burn fats rather than carbohydrates. If there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures • Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices

www. PetaCohen .com 29 Digestive Tract

“Health Begins in the Mouth ..Dis-ease Begins in the Gut”

www. PetaCohen .com 30 Digestive Tract

Therapeutic Nutritional Strategy 4 “R” Program 1. Remove – Diet 2. Replace – Digestion, motility • Digestive enzymes, Betaine HCL, Aloe Vera juice, magnesium, DGL, Slippery elm 3. Repair – Leaky gut, inflammation • Diet, pantothenic acid, vitamin A, zinc, curcumin, quercetin, boswelia serrata, fish peptides, EFAs, probiotics, prebiotics, 4. Reinnoculate/Rebalance – Microbes • Probiotics, prebiotics, biofilm intervention

www. PetaCohen .com 31 Biofilm

www. PetaCohen .com 32 Digestive Tract

• Biofilm – Chronic Persistent Infection – Hydrated polymeric matrix • Invertase, serratiapeptidase, mucinase – Fibrin • Nattokinase, lumbrakinase – Cations for adhesion and biofilm stability • NaEDTA – Antimicrobials • Neem, olive leaf, caprylic acid, cat’s claw, oregano oil, berberine, grapefruitseed extract, artimesia, plant tannins, uva urse, etc. – Binders • Citrus pectin, chitosan, activated charcoal

www. PetaCohen .com 33 Immune System

Therapeutic Nutritional Strategies • Hypo-function – Chronic and recurrent infection • Biofilm intervention • Hyper-function – Allergens and hypersensitivity • Remove offending agent • Reduce exposure • Quercetin, nettles, vitamin C, curcumin, MSM • Dysregulation – Chronic inflammation • EFAs, curcumin, quercetin, ginger, boswellia serrata

www. PetaCohen .com 34 The Endocrine System

www. PetaCohen .com 35 Endocrine

Therapeutic Nutritional Strategies • Stress and the HPAT Axis – Adrenal Exhaustion • Rhodiola, ashwaganda, Bacopa, Cordyceps, glandulars • Pantothenicacid, liposomal vitamin c, zinc, magnesium, vitamin B6 – Subclinical Hypothyroid/Wilson’s Syndrome • Zinc, selenium, iodine • Dysglycemia • Biotin, chromium piccolinate, CLA, vanandium • Premenstrual Dysphoria Disorder • 5HTP, SAMe, BH4

www. PetaCohen .com 36 The Nervous System

Targeted Nutritional Strategies • Excitatory/Inhibitory Ratio • Diet • 5 HTP, SAMe, Inositol, BH4, magnesium, gaba, L-theanine, DHA, Rhodiola, taurine • Anxiety – SNP • ACE – Kidney/Adrenal support, gaba, L-theanine, taurine, magnesium • Sleep – Gastro-Intestinal tract • Diet – Serotonin/melatonin metabolism • 5HTP, SAMe, BH4, gaba, inositol, L-theanine, melatonin • Perfusion – Porphyrins – Iron deficient anemia • Vinpocetine, ginkgo biloba, huprazine A

www. PetaCohen .com 37 Excitation Glutamate Activation of the NMDA Receptor

www. PetaCohen .com 38 Excitation Support

Targeted Nutritional Strategies • Glutamate/Gaba ratio – Diet • Low glutamate diet – Nutrients • Taurine, magnesium, L-theanine, gaba, inositol, calm EZ, Earth Dragon • Dopamine - NorEpinephrine/Serotonin ratio – Adrenal Support • Rhodiola, Ashwaganda, Bacopa, Cordyceps, Adrenal glandulars • Pantothenic acid, vitamin B6, zinc, magnesium, vitamin C • IgE/Allergies/Histamine – Diet • Remove the allergens, high salicylate foods • Vitamin C, quercetin, nettles

www. PetaCohen .com 39 Excitation

Targeted Nutritional Strategies • Tryptophan - Serotonin – Melatonin Pathway – Diet • Tryptophan rich foods • Tryptophan insulin relationship – Nutrients • BH4, NADH, 5-HTP/tryptophan, SAMe, vitamin B6 • Oxidative Stress – Inflammation – Excitation – Antioxidants, Anti-inflammatories, Inhibitory support • Oxidative Stress – Mitochondrial Dysfunction – Excitation – Antioxidants, mitochondrial support, inhibitory support

www. PetaCohen .com 40 Oxidative Stress

Targeted Nutritional Strategies • SNPs – CBS, GST M1, GST P1 • Redox status – GSH/GSSG ratio • Liposomal GSH, S-acetyl GSH, NAC, milk thistle, alpha-lipoicacid, vitamin E, vitamin C, selenium, NADH • Lipid peroxides – Vitamin E • 8OHDG

www. PetaCohen .com 41 Oxidative Stress

• Mitochondrial function – GSH (NAC, s-acetylGSH, IV GSH, NADH, vitamin E, vitamin C), GPX (selenium), SOD (manganese), CoEnzyme Q10, carnitine, vitamin B2 – Ginkgo biloba, huperazine A, vinpocetine, d-Ribose • Immune dysregulation – Diet – Probiotics, arabinogalactan, Vitamin D, vitamin A, vitmamin C, zinc, curcumin, boswellia serrata, quercetin, garlic, cat’s claw, skull cap, nettles, olive leaf extract • Toxic burden – Diet, water, environment – Silymarin, sulfurophane – S-acetyl-glutathione, liposomal glutathione, NAC, alpha-lipoicacid – Chelation – Far Infra-Red Sauna

www. PetaCohen .com 42 Credit: Dr. Jill James www. PetaCohen .com 43 Credit: Dr. Jill James www. PetaCohen .com 44 Credit: Dr. Jill James www. PetaCohen .com 45 Credit: Dr. Jill James www. PetaCohen .com 46 Inflammation Support

• Targeted Nutritional Strategies – General • Assess the GI, immune, detox systems • Remove or reduce the offending agent/trigger – Diet » GFCF, Allergy elimination, SCD, LOD, BED, GAPs – Environment » Keep windows closed, reduce time outside, use mattress covers, removed carpets, curtains, address indoor mold issues, use a hepa filter, hypoallergenic pets – Toxins » Organic, non-GMO, water filters, air filters, bedding, bedwear, bodycare – Treat • Probiotics, prebiotics, symbiotics, EFAs, plant sterols, ginger, quercetin, boswelia serrate, curcumin, nettles, skull cap, TSOs • Moducare

www. PetaCohen .com 47 Methylation

www. PetaCohen .com 48 Methylation

Targeted Nutritional Strategies • SNPs – MTHFR C677T, MTRR, MTR, COMT, CBS C699T, SHMT, AHCY • SAMe/SAH ratio • Methyl donors – Methyl folate, methylcobalamin, TMG/DMG, DMAE, SAMe

www. PetaCohen .com 49 Transulfuration

www. PetaCohen .com 50 Transulfuration Support

Targeted Nutritional Strategies • SNPs – CBS, GST M1, GST P1, NAT1 • Redox status – GSH/GSSG ratio • S-acetyl GSH, IV GSH, liposomal GSH, NAC, NADH, sulfurophane, ALA, silymarin, vitamin C, vitamin E, methylcobalamin • Xanthine oxidase/sulfide oxide • Molybdenum • PST enzyme • Low phenol diet

www. PetaCohen .com 51 Credit: Dr. Jill James www. PetaCohen .com 52 Credit: Dr. Jill James www. PetaCohen .com 53 Credit: Dr. Jill James www. PetaCohen .com 54 Mitochondria – Aerobic Energy Metabolism

www. PetaCohen .com 55 Mitochondria

Targeted Nutritional Strategies • Diet – Macronutrients • Ketogenic diet – Micronutrients • Nutrient vs Calorie dense • Toxins – Diet/Environment • Pthalates, pesticides, fungicides, herbicides, heavy metals, PVC, Bisphenol A • Porphyrins/heme metabolism – Iron, vitamin C – Vinpocetine, Ginkgo biloba, Organic germanium • Oxidative Stress – Vitamin C, E, zinc, manganese, selenium, glutathione, NADH – NRF2 activation • Resveratrol, green tea, sulfurophane, curcumin, allicin,

www. PetaCohen .com 56 Mitochondria

Targeted Nutritional Strategies • Glutamate - Calcium/Taurine - magnesium status – Magnesium, taurine – Anti-glutamate therapy • Aerobic Energy Metabolism – Pyruvate/lactate ratio • Oxygen, zinc, vinpocetine, organic germanium, ginkgo biloba • TPP, pantothenicacid, Vitamin B2, B3, magnesium – Krebs Cycle • Vitamin B1, B2, NADH, iron, glutathione, magnesium, carnitine – Electron Transport Chain • CoEnzyme Q10, NADH

www. PetaCohen .com 57 Biotransformation-Detoxification Phase I and II Detoxification

www. PetaCohen .com 58 Biotransformation/ Detoxification Support

Targeted Nutritional Strategies • Reduce the Toxic Load – Diet • Organic, non-GMO, farmed fish, predatory fish – Environment • Pesticides, herbicides, fungicides, pthalates, PVC, bisphenol A – Medications • CYP450 system • Phase I – Inducers – Inhibitors • Phase II – Conjugation • Methionine, taurine, glycine, glucuronic acid, cysteine, glutathione, acetylation • Oxidative Stress – Antioxidants

www. PetaCohen .com 59 Nutritional Insufficiencies/Excesses

Targeted Nutritional Strategies • Essential Fatty Acids – EPA, DHA, GLA • Other Fatty Acids – Arachidonicacid • Eggs – MCT • Coconut oil – Omega 9s • Olive oil, safflower oil – SCFA • Butyrate – Eggs, red meat • Cholesterol

www. PetaCohen .com 60 Nutritional Insufficiencies/Excesses

Targeted Nutritional Strategies • Amino Acids – Growth/Bone support • Diet – Protein – GI integrity • glutamine – Thyroid hormones • tyrosine – Neurotransmitters • Tyrosine, tryptophan, glutamate, taurine, gaba

www. PetaCohen .com 61 Nutritional Insufficiencies/Excesses

– Methylation • Methionine, SAMe, TMG, DMG, glycine, serine – Transulfuration • NAC, taurine, glutathione – Biotransformation/Detoxification • Diet – Protein • B Complex, antioxidants, amino acid conjugants

www. PetaCohen .com 62 Nutritional Insufficiencies/Excesses

Targeted Nutritional Strategies • Essential Elements – Adequacy – Copper/zinc ratio • Zinc, molybdenum • Calcium/magnesium ratio – Magnesium, taurine • Oxidative Stress – Zinc, selenium, manganese, copper • Electrolytes – Sodium/potasium ratio • PICA – Iron, calcium, zinc • Digestion – Zinc • Sleep – Calcium, magnesium

www. PetaCohen .com 63 Nutritional Insufficiencies/Excesses

Targeted Nutritional Strategies • Vitamins – Antioxidants • Vitamin A, C, E – Eye Function • Vitamin A, zinc – Mitochondrial Aerobic Energy Metabolism • Vitamin B1, B2, B3, B5 – Biotransformation/Detoxification • B Complex, anti-oxidant vitamins – Neurotransmitter Metabolism • Vitamin B6, B12, folic acid, BH4, NADH – Amino Acid Metabolism • Vitamin B6

www. PetaCohen .com 64 Therapeutic Nutritional Strategies in the Autistic Spectrum of Disorders Thank You

Peta Cohen, MS., RD Total Life Center 11 North Dean Street Englewood, NJ 07631 201-541-7601 [email protected] www.petacohen.com

www. PetaCohen .com 65