Healing the New Childhood Epidemics: Autism, ADHD, Asthma and Allergies

by Kenneth A. Bock, MD
108 Montgomery Street
Rhinebeck, NY 12572
845.876.7082
kbock@rhinebeckhealth.com

In the world’s industrialized, developed nations, epidemics of malnutrition, as well as the common childhood infectious illnesses, are almost a thing of the past, due primarily to the technological advances of our industrial era.  However, we are in the midst of a group of new childhood epidemics, which are directly related to this same industrialism and to its associated pollution, environmental degradation, and toxicity.  One set of epidemics has, unfortunately, been replaced by another.
             I have termed the new childhood epidemics “The 4-A Disorders”.  They include autism, ADHD, asthma and allergies. Over the past two decades, autism has increased 1500%, ADHD 400%, asthma 300% (with asthma deaths increasing by 56%) and allergies 400%.  These are staggering statistics, and these meteoric increases demand explanations.
            This concomitant rise is not coincidence.  All of these disorders appear to be tied together by a similar mechanism: an underlying genetic vulnerability, triggered by environmental insults.  The primary underlying genetic vulnerability appears to be, in many children, an impaired ability to detoxify, which has left them unable to cope with the increasing toxicity to which they are exposed.  These toxins include numerous chemicals and heavy metals.  Many of these chemicals and heavy metals are neurotoxic, as well as toxic to the immune system.
              Furthermore, recent information indicates that there is a phenomenon of synergistic toxicity among heavy metals and toxic chemicals.  This destructive synergy can cause serious problems, even when the threshold levels of individual toxins have not been exceeded.
             Heavy metals implicated in the 4-A disorders include mercury and lead.  The effects of low-dose mercury toxicity on various organ systems include: deficits in language, memory, and attention; disruption of fine motor function; atopic eczema; and immune dysregulation, including immune deficiency, and autoimmunity.  This constellation of damage often results in a diagnosis of autism, ADHD, asthma, or allergy.
               Recent research has also shown that low levels of lead, even below the current designated level of concern of 10mcg/dL, can be harmful to the developing brains and nervous systems of fetuses and young children.  These small amounts of lead may contribute to behavioral problems, learning disabilities, and/or lower intelligence scores in children.
               
             In addition, biological insults from both lead and mercury, as well as some chemicals, can lead to a Th2 (T helper type 2)-skewed immune system, with an increase in humoral or antibody immunity, as compared to cellular immunity.  This can result in excessive allergies and autoimmunity.
                  All of the 4-A disorders are typically characterized by allergies, and by a general predominance of Th2 immunity.  In autism, however, some studies have shown an increase in Th1 predominance, while others have shown a predominance of Th2 immunity.  A recent study by Molloy, et al, in The Journal of Neuroimmunology, concluded that children with ASD have increased activation of both the Th2 and the Th1 arms of the adaptive immune response, with a Th2 predominance, and without the compensatory increase in the regulatory cytokine IL-10.  Therefore, it appears as if there is a lack of balance between Th1 and Th2 arms of the immune system, as well as a lack of regulatory control.  Allergies and sensitivities are not only common in autism, but are common in ADHD and asthma as well.  Asthma, in fact, is the most obvious Th2-related chronic inflammatory disorder.
           Thus, chronic inflammation is another primary causative factor that appears to underlie these new childhood epidemics.  This inflammation occurs via a cascade of biological processes.  First, impaired detoxification leads to an overload of toxins in the body, and these excess toxins can then lead to oxidative stress, and to chronic inflammatory conditions.  In autism and asthma, there is ample evidence of increased oxidative stress and chronic inflammation, and there is also chronic inflammation present in chronic allergic states.  In addition, ADHD has been associated with chronic allergies.   
            We often see this inflammation in multiple organ systems, including the gastrointestinal systems of many children with autism, who often suffer particularly from esophagitis and colitis.  Many children, in addition to their asthma and neurodevelopmental disorders, also have atopic eczema.  There is also evidence of immune inflammation, with elevations of proinflammatory cytokines.  Most disturbingly, there is also evidence of neuroinflammation, as described recently by Vargas and others.
              The key to resolving inflammation, in an integrative approach, is to always look for what’s driving the inflammation.  The driving force may be underlying infections, or it may be allergies or sensitivities to foods and inhalants, or it may be exposure to toxic heavy metals and chemicals.  These factors, often in combinations, may underlie and contribute to chronic inflammation.  Therefore, they must be eliminated, or at least decreased.
            Furthermore, gastrointestinal issues of dysbiosis and hyperpermeability must also be resolved, because they can cause not only local inflammation in the gastrointestinal tract, but may also cause inflammation and allergies in distant sites.
            In addition, many of the 4-A children, when viewed from a biomedical perspective, have multiple nutritional defiencies and imbalances, as well as metabolic imbalances, and all of these conditions must be addressed, in order to resolve the underlying chronic inflammation.  We must also remediate immunological imbalances, including Th2 skewing and lack of adequate immunoregulation.
             To effectively overcome the inflammation, oxidative stress, nutritional defiencies, immune dysfunction, and the other disparate factors that often result in a diagnosis of one of the 4-A disorders, a comprehensive treatment program must be initiated.  This program consists of five primary elements: decreasing environmental exposures, dietary modification, nutritional supplementation, detoxification, and administration of medication.
            Decreasing environmental exposures is crucial to stopping this chronic inflammatory process.  Exposure to a variety of toxins, including arsenic in chicken; mercury in large fish; lead in soil, water or dust; pesticides in various foods; and numerous types of polybrominated compounds must be reduced and eliminated if possible in order to allow the process of healing to begin.  Additionally, avoiding allergens and treating underlying infections, which can frequently be covert, are keys to helping the body recover from chronic ongoing inflammation and oxidative stress.
            Dietary modification is almost always pivotally important.  Most 4-A children suffer from significant nutritional deficiencies, which not only contribute to neurological dysfunction, but also to other metabolic processes that disrupt the proper functions of the body and brain.  Also, most 4-A children have food allergies and sensitivities that harm the way that they think and feel.  Many other 4-A children suffer from other neurologically disruptive conditions that are related to diet, such as hypoglycemia, carbohydrate intolerance, and intestinal hyperpermeability.  These children often respond positively to a gluten-free/casein free diet, avoiding food allergens, and at times, an anti-yeast diet and/or anti-hypoglycemia diet.  Some children may require further dietary modifications, including the specific carbohydrate diet (SCD), or occasionally, the low oxalate diet (LOD).
            Nutritional supplementation is virtually always needed to support healing.  Because there is a significant overlap in the causative factors of the 4-A disorders, there is also often a significant overlap in the nutritional supplement programs that benefit the children suffering from these new childhood epidemics.  For example, many of these children, regardless of their discrete diagnoses, benefit from the minerals magnesium, zinc, selenium, chromium and iron, the latter of which can enhance attention, cognition and energy.  4-A children also typically respond to antioxidant vitamins, including, A, C and E, as well as the B vitamins B-6 and methylcobalamin.
             Other widely effective nutrients include targeted amino acids, and anti-inflammatory essential fatty acids, such as EPA and DHA, which are found in fish oils, and gamma linolenic acid (GLA). 
            Probiotics are also markedly helpful for restoring proper microbial balance in the gastrointestinal system, and for helping to balance Th2-skewing of the immune system, as well to enhance immunoregulation. More and more research is emerging that supports the therapeutic role of probiotics in allergies, as well as the related conditions of asthma, autism and ADHD.
            Detoxification, the essential process of eliminating toxins from the body, can be significantly improved in many children, particularly those who suffer from impaired detoxification abilities.  One method for improving detoxification is to administer nutritional and herbal substances, such as glutathione, methylcobalamin, N-acetyl cysteine, garlic, and thiamine tetrahydrofurfuryldisulfide (TTFD).  Detoxification can also be assisted by the careful use of pharmaceutical chelators, such as DMSA, and CaEDTA.
            The natural detoxification processes of methylation and sulfation are key to proper detoxification, and, unfortunately, they are frequently impaired in many of the 4-A children.  Restoring these processes can lead to symptomatic improvements in autistic and ADHD related behaviors, including both expressive and receptive language, presence and awareness, and attention and focus.
            Also, we know that polymorphisms in the D4 dopamine receptors can contribute to ADHD, and that mercury can affect the process of methylation at the D4 receptor.  Therefore, restoring methylation can often ameliorate symptoms of ADHD.
           
            Medication, the fourth and final element of the program, is an integral part of treatment for most of the children who suffer from these disorders. Medications can be useful when they are applied early in treatment, to help control behaviors, as the comprehensive program gradually begins to take hold.  Medications are also helpful in the mid to latter stages of treatment.  They can, for example, help to control inflammation.  Medications that may be effective for this include the PPARγ agonist, Actos, and an older generic medication, Spironolactone.  Preliminary research also suggests that the neuropeptide hormone oxytocin promotes prosocial behavior, as well as facilitating social information processing in patients with autism.  Because no other medications aside from Risperdal are FDA-approved for autistic disorders, it is helpful to be open to the off-label use of FDA-approved medications for these children. 
            Obviously, medications are important in controlling asthma.  The mainstay of asthma treatment has been anti-inflammatory medications, including inhaled steroids.  However, it is essential in asthma to look for underlying causations and triggering events.  When this is done, and the root causes have been remediated, the need for medication is reduced, and sometimes even eliminated.  In many situations, the use of rescue medication, such as an inhaler, may be needed on only an occasional basis.
            In all of the 4-A disorders, a wide variety of medications may be of value, depending upon the individual needs of the child.  These medications include anti-infective medications, such as antivirals, antibacterials, antiparasitics and especially antifungals.  In addition, some children may benefit from immunomodulatory medications, such as low-dose Naltrexone and intravenous gamma globulin.
            This comprehensive program, when applied cautiously, patiently and systematically, drawing from scientific research and coupled with clinical experience, has been shown to trigger recoveries in children with each of the 4-A disorders.  It appears as if this approach may represent one of the most promising avenues of treatment for autism, ADHD, asthma, and allergies.
              Nonetheless, the inescapable bad news is that we are now without doubt in the midst of a tragic onslaught of the new childhood epidemics.  Our children are growing up in a toxic world, and those who have an impaired ability to detoxify appear to be the proverbial “yellow canaries,” who are most affected by these disorders.
             The good news, however, is that these 4-A disorders can be remediated and reversed.  Children and their families can be healed.
             Healing the environment, and decreasing toxic exposures, may ultimately be even more effective than medical treatment at stopping the proliferation of these new childhood epidemics.  That task, though, will take time, and will require the cooperation of both government and corporate officials in addition to the efforts of clinicians, researchers, and parents.
            For now, our focus must be on healing our children, one at a time.  Our grave responsibility, as physicians and as parents, is to allow our children – born of love, and nurtured by those who love them most – to have the healthy, happy lives that all children deserve to have.