Janet Lintala DC Autism Health Pllc 2401 S

Therapeutically: • The DSM 5 criteria are what we see, what we know, what

Medically: Symptoms and Behaviors are matched to Rx’s Constipation Sleep Disruption Irritability and Aggression

Medically: Symptoms and Behaviors are matched to Rx’s Constipation Miralax Sleep Disruption Clonidine Irritability

Let’s use medical research to peek inside: Copyright 2016 Janet Lintala, DC All rights

Autism Spectrum Disorder must be recognized as a spectrum of diseases, each of which

Gastrointestinal Dysfunction Immune Dysfunction Chronic Inflammation Oxidative Stress Mitochondrial Dysfunction Abnormal Methylation Chemistry Detoxification

Sensory Processing Disorder Developmental Optometry Tics and OCD ADD/ADHD Anxiety and Psychiatric disorders Sedation

This is what you see… Copyright 2016 Janet Lintala, DC All rights reserved. 9

Copyright 2016 Janet Lintala, DC All rights reserved. This is what you get! 10

I. Gastrointestinal Dysfunction Copyright 2016 Janet Lintala, DC All rights reserved. 12

Healthy Esophageal Tissue Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical

Barrett’s Esophagus with salmon-colored patches Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment

Nodular Esophagitis Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas

When the breath smells “just like poop”… Reflux of bile and stool in the

Multiple duodenal aphthous ulcerations Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A.

Aphthous ulcers in the colon Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment

Marked lymphoid hyperplasia of the duodenum Photo credit: Gastrointestinal Pathology in Autism: Description and

Dysbiosis Children and adults with Autism Spectrum Disorder are prone to chronic candidiasis and

Research is revealing: • 50 percent don’t make enough digestive enzymes • Many don’t

How do these children and adults present? • • Pale and pasty Dark under-eye

• • • Foul breath Bloated bellies Acid reflux Constipation/diarrhea THE Frequent night

Diagnostic Criteria for ASD A. Persistent deficits in social communication and social interaction 1.

Aren’t there medications approved for autism? Why not just give those? Copyright 2016 Janet

American Academy of Pediatrics: “Medications have not been proven to correct the core deficits

3 YO Autistic Female - Stool Test Her pediatrician wanted to put her on

Stool Test Copyright 2016 Janet Lintala, DC All rights reserved. 28

Copyright 2016 Janet Lintala, DC All rights reserved. 29

Copyright 2016 Janet Lintala, DC All rights reserved. 30

Aggression, irritability and difficult behaviors - what is causing them? Copyright 2016 Janet Lintala,

Statement 6 Individuals with ASDs and gastrointestinal symptoms are at risk for problem behaviors.

Statement 7 For a person with an ASD who presents for treatment of a

Care providers should be aware that problem behavior in patients with ASDs may be

Statement 7, cont’d When abdominal pain or discomfort is a setting event, psychotropic medications

effects of Side effects of commonly prescribed medications for ASD • • • CONSTIPATION

Side effects Commonof symptoms/problems commonly in ASD patients prescribed medications for ASD • •

Constipation Poor Sleep Aggression Copyright 2016 Janet Lintala, DC All rights reserved. 38

Constipation Poor Sleep Clonidine Copyright 2016 Janet Lintala, DC All rights reserved. Mira. LAX

Constipation Mira. LAX GI Pain and inflammation Poor Sleep Clonidine Copyright 2016 Janet Lintala,

Rules of Tack Sitting by Sid Baker, MD Rule #1: If you are sitting

Rules of Tack Sitting by Sid Baker, MD The proper treatment for tack-sitting is…

Rules of Tack Sitting by Sid Baker, MD …tack removal. Copyright 2016 Janet Lintala,

Rules of Tack Sitting by Sid Baker, MD Rule #2: If you are sitting

Rules of Tack Sitting by Sid Baker, MD Chronic illness is, or becomes, multifactorial.

Same child after treatment of GI tract in B a P as w t

Statement 11 Anecdotal reports have suggested that there may be a subgroup of individuals

Why does the Gluten-free, Casein-free Diet benefit the children with these gastrointestinal problems? Copyright

Opiates are very constipating Copyright 2016 Janet Lintala, DC All rights reserved. 55

Neuropeptides are very addicting Addicted to mac-n-cheese, nuggets, pizza, milk Copyright 2016 Janet Lintala,

Effects of Opioid Neuropeptides: • • Constipation Affect language areas of brain Affect behavior

Nonprescription approach • Heal the Gut -GFCF Diet/Digestive Enzymes with DPP -IV -Probiotics -Antimicrobials

Copyright 2016 Janet Lintala, DC All rights reserved. 59

When the gut is dysfunctional, the immune system is affected as well 70% OF

• These children are often sick and miss a lot of school •

Th 1 to Th 2 shift in Autism Spectrum Disorders(ASD’s) Copyright 2016 Janet Lintala,

Autoimmunity to Central Nervous System tissues Several studies have demonstrated the presence of autoantibodies

Nonprescription approach • Heal the gut • Support and balance the immune system -

Physiological Abnormalities in Autism III. Chronic Inflammation High levels of Oxidative Stress Copyright 2016

“…preliminary evidence suggests that some immunohistochemical features (of the GI tract) may be unique

Increased levels of pro-inflammatory cytokines … and decreased levels of anti-inflammatory cytokines… have been

Nonprescription approach • Anti-inflammatory supplements (support a healthy response to inflammation) • Antioxidant support

Physiologic Abnormalities in Autism IV. Mitochondrial Dysfunction Copyright 2016 Janet Lintala, DC All rights

Mitochondrial Dysfunction in Autism • Inflammation generates free radicals and oxidative stress and can

In Class • Easily fatigued • Poor fine motor skills • Low muscle tone

Nonprescription approach • Anti-inflammatory and antioxidant support (Hyperbaric Oxygen therapy, cod liver oil, curcumin)

Physiological Abnormalities in Autism V. Abnormal Methylation Chemistry Detoxification Impairments Copyright 2016 Janet Lintala,

Overview of the Methionine Transsulfuration Pathway Copyright 2016 Janet Lintala, DC All rights reserved.

Implications of Reduced Glutathione Status in Autism Reduced ability to detoxify environmental toxicants and

Nonprescription approach • Lab Testing • Nutritional support of the methylation cycle/MTHFR • No

Physiological Abnormalities in Autism VI. Nutritional Deficiencies Copyright 2016 Janet Lintala, DC All rights

Organic Acid Test Summary Copyright 2016 Janet Lintala, DC All rights reserved. 79

Organic Acid Test Summary, continued Copyright 2016 Janet Lintala, DC All rights reserved. 80

Nonprescription approach • • • Lab testing Gastrointestinal healing Nutritional support Green the diet

Attention and Focus The role of food sensitivities • • Sensitivity – Ig. G

The Role of the 4 -Day Rotation Diet • Reduce and eliminate food sensitivities

The Role of the Feingold Diet • • • Learning Mood Hyperactivity Behavior Handwriting

Feingold Diet Copyright 2016 Janet Lintala, DC All rights reserved. 85

Nutritional Genomics MTHFR Methylation pathways Genetic testing Nutritional support = “Nutrigenomics” Copyright 2016 Janet

VII. Sensory Issues on the Autism Spectrum Copyright 2016 Janet Lintala, DC All rights

“Sensory processing (SP) difficulties have been reported in as many as 95% of children

Appropriate Referral • Refer for Occupational Therapy • Sensory Diet • Refer to Feeding

VIII. Developmental Optometry Have you ever heard things like: • He knows how to

VIII. Developmental Optometry • The brain doesn’t always coordinate sensory input well. • Vision

Copyright 2016 Janet Lintala, DC All rights reserved. 92

Copyright 2016 Janet Lintala, DC All rights reserved. 93

Regular Optometry checks out the puppets… Copyright 2016 Janet Lintala, DC All rights reserved.

Developmental Optometry checks out the puppet master AND the puppets… Copyright 2016 Janet Lintala,

Recommended Book on Developmental Optometry About 25% of my patients have unsuspected visual abnormalities,

Appropriate referral • Developmental Optometrist Copyright 2016 Janet Lintala, DC All rights reserved. 97

Relationship to PANDAS/strep Copyright 2016 Janet Lintala, DC All rights reserved. 98

Nonprescription approach • Anti-strep strategies - Xylitol products for oral/nasal cavities Copyright 2016 Janet

X. Anxiety About ty e i x n a ave h % 5 9

Nonprescription approach • GABA • Magnesium • CES – Cranial Electrical Stimulation device •

XI. Sedation Dentistry Copyright 2016 Janet Lintala, DC All rights reserved. 102

Dental support strategies: Xylitol oral care products Xylitol gum and candy Probiotic toothpastes and

The brain is under silent attack in Autism Spectrum Disorder • • • Opiate

On the “radar screen” • • Nutrigenomics Epigenomics MTHFR/Methylation pathways TMS – Transcranial Magnetic

Slides: 105

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Janet Lintala, DC Autism Health! Pllc 2401 S. Kanawha St Ste 106 Beckley, WV 25801

Therapeutically: • The DSM 5 criteria are what we see, what we know, what we expect. • Many behavioral, therapeutic, and educational approaches and interventions are based upon these descriptive criteria Copyright 2016 Janet Lintala, DC All rights reserved. 2

Medically: Symptoms and Behaviors are matched to Rx’s Constipation Miralax Sleep Disruption Clonidine Irritability and Aggression Risperidone, Lexapro Attention and Focus Focalin, Ritalin, Vyvanse, Strattera, etc. Copyright 2016 Janet Lintala, DC All rights reserved. 4

Autism Spectrum Disorder must be recognized as a spectrum of diseases, each of which may have a distinct cause and disease process. Paula Goines, B. S. , Paul Ashwood, Ph. D. , and Judy Van de Water, Ph. D. Copyright 2016 Janet Lintala, DC All rights reserved. 6

Gastrointestinal Dysfunction Immune Dysfunction Chronic Inflammation Oxidative Stress Mitochondrial Dysfunction Abnormal Methylation Chemistry Detoxification Impairments Impaired Nutrition Copyright 2016 Janet Lintala, DC All rights reserved. 7

Healthy Esophageal Tissue Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 13

Barrett’s Esophagus with salmon-colored patches Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 14

Nodular Esophagitis Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 15

When the breath smells “just like poop”… Reflux of bile and stool in the stomach Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 16

Multiple duodenal aphthous ulcerations Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 17

Aphthous ulcers in the colon Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 18

Marked lymphoid hyperplasia of the duodenum Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 19

Research is revealing: • 50 percent don’t make enough digestive enzymes • Many don’t have enough beneficial bacteria • They are more prone to infection and dysbiosis in the GI tract Copyright 2016 Janet Lintala, DC All rights reserved. 21

How do these children and adults present? • • Pale and pasty Dark under-eye circles Under eye puffiness Pale mucosa, allergic salute Often have a “bleary, tired” look Foggy, spacy Eczema Pain behavior Copyright 2016 Janet Lintala, DC All rights reserved. 22

• • • Foul breath Bloated bellies Acid reflux Constipation/diarrhea THE Frequent night awakenings “UNHOLY 3” Irritability or aggression Hyperactive Burp a lot, pass gas “that will peel paint off the walls” Addictive eating habits High or low pain tolerance Pica-type behavior Copyright 2016 Janet Lintala, DC All rights reserved. 23

Diagnostic Criteria for ASD A. Persistent deficits in social communication and social interaction 1. Deficits in social-emotional reciprocity s ? k l ? a ? ? w ? t 2. Deficits in nonverbal communicative ha w h t i w behaviors used for social interaction teria fit cri e s e r? h o t o d y m w h g u o 3. Deficits. H inodeveloping, maintaining, r th and understanding relationships Copyright 2016 Janet Lintala, DC All rights reserved. 24

3 YO Autistic Female - Stool Test Her pediatrician wanted to put her on Risperdal for her irritability, constant crying and disrupted sleep patterns. Copyright 2016 Janet Lintala, DC All rights reserved. 27

Statement 6 Individuals with ASDs and gastrointestinal symptoms are at risk for problem behaviors. Sleep disturbances and the other problem behaviors mentioned above may indicate abdominal discomfort. Copyright 2016 Janet Lintala, DC All rights (emphasis mine) reserved. 32

Statement 7 For a person with an ASD who presents for treatment of a problem behavior, the care provider should consider the possibility that a gastrointestinal symptom, particularly pain, is a setting event, that is, a factor that increases the likelihood that serious problem behavior (e. g. self-injury, aggression) may be exhibited. (emphasis mine) Copyright 2016 Janet Lintala, DC All rights reserved. 33

Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. Copyright 2016 Janet Lintala, DC All rights reserved. 34

Statement 7, cont’d When abdominal pain or discomfort is a setting event, psychotropic medications are likely to be ineffective and may even aggravate the problem if they have adverse gastrointestinal effects. (emphasis mine) Copyright 2016 Janet Lintala, DC All rights reserved. 35

effects of Side effects of commonly prescribed medications for ASD • • • CONSTIPATION Nausea, stomach pain Anxiety Sleep disruption Systemic inflammation and oxidative stress Copyright 2016 Janet Lintala, DC All rights reserved. 36

Side effects Commonof symptoms/problems commonly in ASD patients prescribed medications for ASD • • • CONSTIPATION Nausea, stomach pain Anxiety Sleep disruption Systemic inflammation and oxidative stress Copyright 2016 Janet Lintala, DC All rights reserved. 37

c sti i t u r. A o r vio r? a h Be havio n i a P Be Child draping belly over arm of couch

c sti i t u r. A o r vio r? a h Be havio n i a P Be Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 49

Same child after treatment of GI tract in B a P as w t I vio a h e r! Photo credit: Gastrointestinal Pathology in Autism: Description and Treatment A. Krigsman/Medical Veritas 4(2007) 1522 -1530 50

Effects of Opioid Neuropeptides: • • Constipation Affect language areas of brain Affect behavior Dull cognition Slow processing time Decrease ability to feel pain Addictive eating habits Copyright 2016 Janet Lintala, DC All rights reserved. 57

Nonprescription approach • Heal the Gut -GFCF Diet/Digestive Enzymes with DPP -IV -Probiotics -Antimicrobials -Healing, supportive supplements • This eliminates opiates, eliminates reflux and pain, improves sleep and bowel habits Copyright 2016 Janet Lintala, DC All rights reserved. 58

• These children are often sick and miss a lot of school • “Frequent Flyers” at the pediatrician and pharmacy • Asthma, allergies and eczema are common – hard to pay attention when all stuffed up • Prone to candida and bacterial overgrowth of the Copyright 2016 Janet Lintala, DC All gastrointestinal tract rights reserved. 61

Autoimmunity to Central Nervous System tissues Several studies have demonstrated the presence of autoantibodies specific to CNS tissues in subjects with autism… Copyright 2016 Janet Lintala, DC All rights reserved. 63

Nonprescription approach • Heal the gut • Support and balance the immune system - Short term goals: Fewer colds and sick days - Long term goals : Diminished allergies and congestion Copyright 2016 Janet Lintala, DC All rights reserved. 64

“…preliminary evidence suggests that some immunohistochemical features (of the GI tract) may be unique to ion t a m m a inflammation. GIassociated with ASDs. ” Infl Copyright 2016 Janet Lintala, DC All rights reserved. 66

Increased levels of pro-inflammatory cytokines … and decreased levels of anti-inflammatory cytokines… have been observed in children with ASD. Imbalanced levels of these cytokines can augment inflammation and cause excess damage to tissues. (oxidative stress) Copyright 2016 Janet Lintala, DC All rights reserved. 68

Nonprescription approach • Anti-inflammatory supplements (support a healthy response to inflammation) • Antioxidant support (support a healthy response to oxidative stress) Copyright 2016 Janet Lintala, DC All rights reserved. 69

Mitochondrial Dysfunction in Autism • Inflammation generates free radicals and oxidative stress and can result in damage to mitochondria • Mitochondrial dysfunction is common in children with autism. May be as high as 60%. Copyright 2016 Janet Lintala, DC All rights reserved. 71

Nonprescription approach • Anti-inflammatory and antioxidant support (Hyperbaric Oxygen therapy, cod liver oil, curcumin) • Mitochondrial support supplements • Referral for occupational therapy Copyright 2016 Janet Lintala, DC All rights reserved. 73

Nonprescription approach • Lab Testing • Nutritional support of the methylation cycle/MTHFR • No acetaminophen (reduces GSH by about 20%) • Detox support only if necessary Copyright 2016 Janet Lintala, DC All rights reserved. 77

The Role of the 4 -Day Rotation Diet • Reduce and eliminate food sensitivities • Improves health and how you feel • Improves behavior and attention Copyright 2016 Janet Lintala, DC All rights reserved. 83

VIII. Developmental Optometry Have you ever heard things like: • He knows how to do it, he just doesn’t want to • He’ll only do it if he feels like it • Oh, he’s smart but he’s lazy Copyright 2016 Janet Lintala, DC All rights reserved. 90

VIII. Developmental Optometry • The brain doesn’t always coordinate sensory input well. • Vision is one of the five senses • Two eyes = duplicate sensory input to an overloaded brain • ASD patients often have double vision and other issues that are unsuspected Copyright 2016 Janet Lintala, DC All rights reserved. 91

Recommended Book on Developmental Optometry About 25% of my patients have unsuspected visual abnormalities, such as seeing double, that are undetected by a regular eye exam. They need an evaluation by a Developmental Optometrist and corrective prism lenses.

Dental support strategies: Xylitol oral care products Xylitol gum and candy Probiotic toothpastes and mouth rinses Reducing/eliminating use of juices, sugary drinks and sports drinks • Dental sealants • • Copyright 2016 Janet Lintala, DC All rights reserved. 103

The brain is under silent attack in Autism Spectrum Disorder • • • Opiate neuro-peptides Toxins from dysbiosis in the gut Neuroinflammation Neuro-toxicity Autoimmunity to various brain tissues Oxidative stress Nutritional deficiencies Tics Seizures Double Vision from poor sensory integration Copyright 2016 Janet Lintala, DC All rights reserved. 104

On the “radar screen” • • Nutrigenomics Epigenomics MTHFR/Methylation pathways TMS – Transcranial Magnetic Stimulation Cannabis Hemp oil Fecal Transplants Copyright 2016 Janet Lintala, DC All rights reserved. 105