Wednesday, February 5, 2014

New Directions in Autism

Last Sunday I put out yet another new post on Psychology Today, but failed to link it here. It is a discussion of a very interesting long term cohort study in Crete, where the researchers used a sifting haystack approach to find some metabolic problems that might be causing the symptoms, then, in certain cases, presumptively treating the problem, leading to two successful remissions of severe autistic symptoms. While the methods are too cumbersome and there isn't enough data to use the approach on everyone, I can't help but think we are looking at the next iteration of the future of medicine. Better knowledge of what different organic acids mean when found in the urine, and how different metabolites present in the blood after a fast or a glucose bolus tell us something about the overall functioning of the metabolism…then a tailored approach. Those who had trouble with fat metabolism were on high carb diets and reported decreased symptoms. Those who had trouble with glucose metabolism went on ketogenic diets…etc. etc. It's a smart and forward-thinking approach that makes sense in research and in these devastating conditions for which there is no treatment or cure. (Yet more data would be nice!)

Song: Big Data, Dangerous

But when does the needle in a haystack approach go to far? It's common for someone to go to a naturopath and get full blood, urine organic acids, and stool samples for fatigue, poor skin, lack of ability to lose weight, or constipation (or insert other chronic difficult to treat condition here.) In the case of the naturopath, the patient is paying out of pocket for this sort of treatment and that's free market health care. In the case of large population medicine and insurance/medicare/medicaid, there are not the resources for such an approach. Also, the most bang for the buck in the general population has to come from cheaper, more generic approaches, such as education and motivational interviewing about exercise, proper eating, and sleep…then if everything is more or less ship shape (or if the problem is disastrous), more investigation is warranted. My bias tends to be toward *less* testing and more listening, common sense, and empirical treatment (with the caveat that you don't want to miss the life-threatening condition, for example, my first break psychosis patients will get directed toward that MRI, low yield though it may be, so as not to miss the occasional brain tumor).

With no further ado:

Targeted Diet Interventions in Autistic Spectrum Disorders

And via Paul Whiteley: Autism, Treating the Whole Person


4 comments:

  1. I think it would be hard to get most people generally healthy without at a blood test. On this side of the 49th parallel, most people have a blood test by the time they reach middle-age, typically for a lipid profile and glucose. If the doctors check a few extra boxes on the blood lab request, it wouldn't add much to the cost and could pick up some important health concerns.

    I'm diagnosed with ADHD and Asperger's (I still say Asperger's even though the DSM-5 calls it ASD). After asking my doctor for a full blood test, I found my B12 was barely above 200 pmol/L. Getting my B12 levels up with a boost of cyanocobalmin shots followed by sublingual methylcobalmin tablets improved my frustration tolerance more than 60mg/day of atomoxetine.

    Another reason I think the blood tests are needed is to confront people with the reality of their poor health. You can tell people that they can improve their health by limiting refined carbs, but they are unlikely to change until they their blood test reveals they are diabetic. Even then, many are unlikely to change, but at least their doctor may be able to lessen the ongoing damage with a metformin prescription...

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    1. I would agree with you…I pretty much check everyone's B12, TSH, and a basic CBC, vitamin D, and other labs if indicated. But everyone who comes to my door is not going to get complete metabolic panels and stool tests and fasting beta hydroxybutyrate…not until we know whether or not the tests are useful, and if they help us do something different, or if the results (as you point out) are motivating, such as a dropping HbA1C for someone who goes from poorly controlled diabetes to better control.

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  2. And what about daydreaming.Since I was a child I was very quiet and didnt really talk to anyone except parents and family,didnt like going to kindergarten either.I always had few friends because i cannot open up until i get to really know that person,then i am funny,talkative but never really completely myself.When I am alone at house i just put earphones and I go to this world of imagination and fantasy.I imagine myself as this cool person who can do everything whenever,wherever ,who is open,completely opposite to what I am.I can spend hours,even days doing just nothing but daydreaming and walking around the house and talking to myself when I am in some dangerous situation in my imaginary world-I feel like my brain is alwasys active in this daydreaming state and cannot be turned off.Its better for me in this unreal world then in my life.I dont know what to do,I cant continue like this because I think that I am not living to my full potential.Like I could be studying or doing something constructive.Also when i was signing up in the elementary school we did some kind of a test and on the half I was bored solving it and I just didnt want to do it anymore.Our school psyhologist literally told my mother i was stupid.Somehow that didnt turned out to be true and I became straight A student throught my whole elementary,highschool and now I am in the dental school.I was always told that I am a huge nerd,and that I study whole day,but it isnt true,I am literally studying hour,or two and the rest of the day I am daydreaming,especially on my classes , dont pay any attentionto them because i am in my imaginary world.i find it hard time to focus so I managed to study for 20 minutes than daydream for 2 hours,then study again and somehow i managed to get great grades by this model.I also have very low self esteem and dont find myself intelligent,I always joke that I am stupid because of this daydreaming and because everyone tolds me that i am nothing more then a big nerd and also that I am just studying whole days,while in fact I am not,I am in my imaginary world the whole day. -PART1

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  3. PART 2
    This is taking my life away,also i tried to talk about this whit my parents but they say that I am just lazy.I really try not to daydream but when I stop it i feel angry,anxious and i just want to do it again.I also tried going out to the beach,ride bycicle but it is very boringg to me,my brain is constantly active in this imaginary world and I cant stop it.Even when I am with a few friends that I have I am bored,especially if we just go in disco and dance.I dont know how can a person go out and just have a great night,Its always boring to me.I think I dont know how to just lay back and enjoy,my brain is always daydreaming about adventurous stuff,it is alwys in a very active state.The only times when I can shut my brain is when something active is happening,for example when there is literally life and death situation like skiing in very high speed or something like that.Also when I am problem solving I am extremly concetrated and I dont daydream,or when I am reapiring electrical devices such as xbox or when I am put under the pressure.If something non adventurous is happening like 99 percent of my time i just completely shutt myslef down.I dont know what should i do,i really dont,because I feel traped inside this world of fantasy.Or maybe I am just lazy,but I dont think I am,I wish I was because then I could watch tv,or relax,but I cant,i cant even watch the movie without daydreaming.The best thing for me is just to turn music,walk around the house and daydream.In my imaginary world I am always active and doing something adventurous. I am also extermly ambitious and want to achive something in my life but because of this I am not living to my full potential.I want to be a maxillofacial surgeon or maybe do both dental and bussiness school and become and IB banker(if I could shut this daydreaming and be focused i would have a lot of time) because when i do something that is very stressful,that is the only time my brain is actually doing something and not daydreaming and than i feel exteremly focused even hyperfocused.Just like when I am doing maths.I think this is the only subject i enjoyed because of its complexity.I wish i could always be in high pressured situations but i cant.I l also find it very hard to talk in social situations,I feel like everyone is judging me and my whole life we joked that I was mute,hehhehe.I think thats why i am very ambitious because I want to show them that i can do something great.Its very hard for me to write this,I am not quite good at writing as you can see,I think that I am a complete emotional mess and that I will live in this imaginary world forever and I just want to be out in real world doing great things which I am capable of and I just dont know how to do it.Or maybe I am just lazy like my parents say :/

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