The Aging Healthfully Virtual Library - The Works of Majid Ali, M.D.
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CASE STUDIES

Case 1: Destabilized by Fresh Paint

A mother consulted me for her 7-year-old son. She told me her son was in a special class and was experiencing serious difficulties caused by what the boy's psychologist had diagnosed as severe ADHD and learning difficulties. His teacher reported serious and persistent problems with discipline and complete failure to learn in class, and recommended drugs for controlling a situation she considered intolerable. The boy's mother was very committed to helping her child and wanted to avoid Ritalin, if at all possible.

The next week the mother called, very excited, and said, "I know the answer! It was paint in the house." I said, "I thought I asked you about paint." But she explained that it had been in the grandparents' home. Just prior to the initial relapse he had spent the weekend there, and the home had been painted the day before. Since it was wintertime, all the windows had been closed, keeping the fumes inside. I asked, "How did you learn that's what it was?" She explained that her son had again gone to stay with the grandparents just this past weekend (at which time he had been doing very well). But within six hours, the grandparents called and said there was a relapse of symptoms and suggested they take him home. It was then that they started to think about what in the grandparents' home, not just their own home, could have triggered the problem. Within a short time the boy's activity level was stabilized.

This was a good clinical case in which we could identify a clear cause-and-effect relationship. But it also demonstrates that whatever genetic vulnerability he had, clearly the environmental triggers of paint fumes and yeast overgrowth (which go hand in hand with food sensitivities) had been a major cause of the physiological stress.

Case 2: ADHD FORTY YEARS LATER

No effect on speech, but as for receptive language, I swear there is a big difference. He is calmer, can understand things better. better able to follow directions, started doing things on his own, one day urinated in the potty which he had never done before. Cognitive and social benefits have lasted to a substantial degree. After dinner he now sits with anyone else, started putting plate in the sink and arranging knife and fork without anyone asking him. Teacher used to give him 2 happy faces a day, now he has as many as 7 happy faces, now down to 5 happy faces a day." Teachers' words, "playing with other children, able to sit better, able to attend to tasks better, more aware. Now he turns to look at who enters the room." Husband's response, "It has been a positive experience. I'm all for it. Now I wants all 75 units of Secretin." Following is a quote from the boy's grandmother, "There is hope. He is definitely improved."

Three subsequent injections of secretin produced little benefit in mental function. However, during that period, the child was administered large doses of epilpsy drugs by a neurologist who diagnosed epilepsy siezures during sleep with an EEG.
   
Increased Urinary Excretion of Organic Acids, and Effects of Therapy in Case 3

    The table that follows shows data urinary excretion of some organic acids before and after treatment with nutritional and anti-PLF therapies in a four-year-old autistic child. The concentrations of organic acids are expressed in mmol/mol creatinine. The PLF population in the peipheral blood smear was as follows: over 15 PLF organisms per 25 high power fileds at the time of intial evaluation and less than 5 organisms per 25 high power fileds after six weeks of therapy. At the follow-up visit, the mother reported that the child began to "understand language" and "awkwardly utter a few incomplete words."

    The microscopic examination of peripheral blood of some children with autism shows profusion of PLFs, marked changes of oxidative coagulopathy and AA oxidopathy, and increased urinary excretion of certain organic acids not normally fond in urine of healthy children. When such children are managed with comprehensive nutritional and antiPLF therapies, blood PLF population and urinary excretion of those organic acids is reduced. Clinically, reduction of the number of PLFs in blood and organic acid in urine is often associated with unmistakable clinical improvement within days or weeks, such as beginning of awkward verbal communication.

Brain toxicity begins in the bowel. I have recognized that relationship over and over again in my patients with not only the SHALOAT conditions but also with many other disorders such as fibromyalgia, chronic fatigue syndrome, chemical sensitivity syndrome, and severe cases of inflammatory bowel disorders. This should not surprise anyone since the bowel, the primary waste organ of the body, is the main producer and reservoir of toxins. There are an estimated fifty to one hundred trillion microbes in the bowel. Some, like acidophillus and Bifido promote health, while others, such as primordial (yeast-like) microbes, produce several hundred different types of toxins. ater in this section, I show how production of several such toxins is extremely high when there is an overgrowth of primordial microbes in the bowel, and how such production is markedly diminished after proper bowel management.

Dr. Ali, For Me It's Bowel to Brain

    A patient once used the above words to explain to me how he reacts to certian foods. He develops abdominal bloating within several minutes of eating those foods, then get brain-fogged to a degree that he cannot function. When one thing in human biology changes in one way, everything changes in some way. I often use those words to explain to my patient the complete relatedness of everything in the human body with everything there. As for the bowel and the brain, there are many receptors shared by those two organs. An elegant example of that is the presence of receptors for a hormone called secretin.

Questions for Examination
1. Antigen immunotherapy for IgE-mediated allergy is extremely valuable in integrative
    management of Shaloat (spectrum of hyperactivity, ADD, learning disbaility, OCD, autism
    and Tourette's syndrome. T
2.  IgE-mediated responses are the primary mechanisms of food allergy in Shaloat (spectrum
        of hyperactivity, ADD, learning disbaility, OCD, autism and Tourette's syndrome. F
3.    The primary goals in priortizing choices in the kitchen is to avoid rapid hyperglycemic-
        hypoglycemic shifts and adverse food reactions. T
4.    The following may be regarded as liberal doses of redox-restorative substances in
        Shaloat in children: glutathione, 50mg; N-acetylcysteine, 25 mg; and MSM, 10 mg. F
5.    According to the reported data, riboflavin stands out as the member of B-complex of
        greatest value in Shaloat. F
6.    The following may be regarded as liberal doses of minerals in children with Shaloat:
        Zinc, 25 mg; selenium, 400 mcg; chromium, 400 mcg; and molybdenum, 400 mcg each.
7.    Restoration of the bowel ecology with antifungal agents (such as Nystatin), antifungal herbs
        (such as Echinacea), antiparasitic herbs (such as Artemesia) and probiotics (such as
        Lactobacillus species) are necessary for good long-term clinical outcome in children
        with Shaloat. T
8.    Restoration of the liver ecology (glutathioe and other RRS), lecithin, and intermittent use
        of liver-friendly herbs (including milk thistle).
9.    Training in self-regulatory is not an important issue in Shaloat children since stress is not
        an importnat issue in this group. F
10.    Does the clinical picture of ADD ever merge into that of OCD? T
11.    Does the clinical picture of OCD e ver merge into that of ADD? T
12.    Does the clinical picture of OCD ever merge into that of Tourette's syndrome.
13.    Secretin, a secretogogue hormone produced in the bowel, works by inhibiting monoamine
        oxidases in the brain. F
14.    Elevated 24-hour urinary levels of lactic, pyruvic, and glyceric acids indicate the
        existence of dysoxygenosis in Shaloat children. T
15.    Hyperactivity, high intelligence, and increased 24-urinary excretion is an important
        triad to consider in integrative management of Shaloat children. F
16.    The manufacture of Ritalin in the United States during the last ten years has increased by:
    A.    25%
    B.    50%
    C.    100%
    D.    150%
    E.    900%
    Ans: E
17.     According to some recent publications of the American Medical Association, there is
        no evidence that sugar intake affects the cognitive performance of children. T
        (Re: JAMA 1995;274:1617)
18.    Most SHALOAT children during periods of severe symptoms do not exhibit any
        microscopic evidence of oxidative erythrocyte damage. F

OXIDATIVE-GENETIC BRAIN DYSFUNCTION (OGBD):
The Spectrum of Hyperactivity, ADD, Learning Disability, Obsessive-Compulsive Disorder, Autism, and Tourette's Syndrome (SHALOAT)

    In schools across America, as many as 1 million children line up every day for a glass of water and a little yellow pill called Ritalin...But there's no proof that in the long run the drugs help kids get better grades or build better lives.

        U.S.News & World Report November 23, 1998.
   
OUTLINE

1.    Abstract
2.    What Is SHALOAT?
3.    Why SHALOAT?
4.    The Human Faces of Misery
5.    A Spreading Scourge
6.    A Journey of Self Discovery
7.    Genes Legislate Life; Environment Interprets Those Laws
8.    Obsolete Psychological Theories of Brain Dysfunction
9.    The Troubled Bowel, Liver, and Brain Trio
10.   Two Villains: Sugar and Antibiotics
11.   From the Liver to the Brain   
12.   Oxidative-Genetic Brain Dysfunction: A Unifying Theory
13    Diagnosis: Who Needs Empty Labels?
14.   Essentials of Management
15.   Summary

1. ABSTRACT

    A simple model of understanding the spectrum of hyperactivity, Attention Deficit Disorder (ADD), learning disability, obsessive-compulsive disorder, autism, and Tourette's syndrome (SHALOAT) is described. In this model, the focus is on developmental and acquired problems of the bowel, liver and brain ecosystems. Specifically, the important genetic factors include: (1) food and mold allergy and the tendency to develop leaky gut lining in the bowel; (2) impaired detoxification in the liver; and (3) neurochemical uniquenesses that cause SHALOAT brain symptoms. The important acquired factors are as follows: (1) chronic sugar overload, antibiotics abuse, and pesticide and other chemical load in the bowe; (2) increased environmental xenobiotic load in the liver; (3) nutritional and metabolic deficiencies that affect the brain function.

    Human ecologic systems are under increasing oxidative stress. Such stress is caused by an ever-increasing number of oxidants in our internal and external environments. The oxidizing capacity of the planet Earth is increasing due to many factors. Thinning of the ozone layer is oxidizing. The greenhouse effect of carbon dioxide is oxidizing. Industrial environmental pollutants and pesticides are oxidizing. Indoor pollution is reportedly greater than outdoor pollution in many cases. Oxygen transport and utilization in such cases is impaired and directly leads to further oxidizing stress. Sugar overload is prevalent in all countries and excess sugar intake increases oxidant stress. Antibiotic abuse is pervasive in all countries, and antibiotics, as necessary for acute infections as they might be, damage the normal bowel flora, cause proliferation of PLFs (Primordial Life Forms), and so serve as powerful oxidizing agents. Chronically ill patients are generally dehydrated, and lack of optimal hydration is oxidizing since it results in accumulation in the body of organic acids and toxic reactive species. Synthetic hormones are oxidizing, albeit indirectly, by interfering with hepatic detoxification pathways. Lactic acidosis is common in chronic illness such as fibromyalgia and chronic fatigue syndrome, and it is oxidizing. And, finally, the pervasive adrenergic hypervigilence of lifestyle stressors is powerfully oxidizing.

    In a larger sense, the significance of The Pyramid of the Trios of the Human Ecosystems goes far beyond the issues of ADD, hyperactivity, OCD, autism, and related conditions. Its importance also extends to pandemics of fibromyalgia, CFS, Gulf War syndrome, chemical sensitivity syndrome, severe autoimmune disorders such as multiple sclerosis, and disseminated cancer. The growing menace of incremental and unrelenting oxidative stress on our internal and external environments casts long shadows over the future of humankind. The ORPEC hypothesis, in the author's view, is the most compelling argument against the prevailing medical dogma that for every human ailment there must be a drug and that all ecologic issues are utterly irrelevant to the care of the sick. That microecologic-genetic model clearly calls for a primarily restorative (nutritional) rather than an interruptive (drug) approach. The call for ecologic thinking in twenty-first century medicine is this: The health hazards of today cannot be addressed with the one-cause one-disease one-drug thinking of nineteenth century. For the coming century, we will either learn to think ecologically or must prepare for a growing number of pandemics of "mysterious" maladies for which drug medicine will be as helpless as it presently is for ADHD/ADD, fibromyalgia, CFS, Gulf War syndrome and environmental illness.

2 WHAT IS SHALOAT?

    SHALOAT is an acronym for the following six common syndromes of brain dysfunction: hyperactivity and attention deficit disorder (ADHD), learning disabilities, obsessive-compulsive disorder (OCD), autism, and Tourette's syndrome (TS). I use this term to introduce the concept of a spectrum of neurological symptom-complexes which include impulsive acts, disruptive behavior, Dr.Jekyll-Mr. Hyde tantrums, serious discipline and learning difficulties, repetitive thoughts and actions, tics, communication difficulties (autistic isolation), and impaired mental functions. SHALOAT symptom-complexes are caused by some known (and undoubtedly many more as yet unknown) genetic and many recognized acquired factors involving the bowel, liver, and brain ecosystems. In this article, I present evidence for my theory that all such acquired factors are oxidative in nature. Even though the SHALOAT symptom-complexes appear to be related to brain function, I demonstrate in this article how the brain dysfunction is also caused (or worsened) by genetic and acquired mechanisms involving bowel and liver ecologies.

3. WHY SHALOAT?

    There are three important reasons why I propose that the SHALOAT concept of the spectrum of brain dysfunctions is preferable to the prevailing use of individual diagnostic labels.

1.    The individual diagnostic labels are mere descriptions of symptom-complexes. However, there
        is so much overlap between those symptom-complexes as to make the specific diagnostic
        labels useless.
2.    The diagnostic labels do not give us any insights into the energetic-molecular nature of the
        patient's suffering.
3.    The diagnostic labels are used as the basis for prescribing mind-altering drugs without
        addressing the underlying bowel, liver, and brain derangements.

    As for the first reason, I have seen children who were given Ritalin for ADHD and who developed severe OCD as a result of Ritalin therapy. I also have commonly seen children diagnosed to have OCD who suffer from severe attention problems, extreme impulsiveness and destructive tantrums. Recently, I saw a three-year-old "autistic" child who appeared to learn language normally to his mom from 13 to 21 months when hesuddenly developed into a classical picture of autism after a viral infection. The same holds for patients with learning disabilities and Tourette's syndrome. Of course, the degrees of individual symptoms vary widely.

    As for the second reason, the use of diagnostic labels such as ADHD, OCD, and others only create a false sense of knowledge (or worse, claim of phony expertise) when in reality such labels reveal absolutely nothing about the underlying causes of symptom-complexes. Even though our knowledge is far from complete, advances in molecular and microscopy sciences now make it possible to clearly identify many molecular and microscopic abnormalities in SHALOAT patients. Psychologists and psychiatrists fill tomes with their favorite psychological theories of ADHD, OCD, leaning disability, and other disorders, but their books are singularly devoid of specific and objective data about metabolic, nutritional, environmental, and genetic data.

    As for the third reason, many school psychologists promptly use one or the other diagnostic labels when they see SHALOAT children and then refer them to pediatricians who equally promptly write out prescriptions for Ritalin, Cylert, Aderal, or related drugs. No effort is made to search for nutritional, metabolic, and environmental factors that cause the SHALOAT symptom-complexes. That is intellectual bankruptcy, pure and simple. The short-term use of drugs in many cases is clearly necessary. However, a drug for a SHALOAT child (or adult) must be prescribed judiciously and only as a component of a broad, integrative management.

4. THE HUMAN FACES OF MISERY

    I see children who live on metabolic roller coasters. They are afflicted by undiagnosed food sensitivities and mold allergies. They are tormented by unrecognized sugar-insulin-adrenaline rushes. Their teachers, ignorant of the underlying biologic dysregulations, consider them rowdy and punish them for what they brand as disorderly behavior. When that does not work, the children are sent to school psychologists who are ever so quick to label them with their favorite diagnosis, then refer them to pediatricians who only too willingly prescribe Ritalin, Cylert, amphetamines and related psychotropic drugs. Neither psychologists nor pediatricians have any training nor interest in learning the metabolic-ecologic basis of children's anguish. How often does this happen?

    Every parent of a child with hyperactivity/ADD syndrome recognizes a Dr. Jekyll and a Mr. Hyde in the child. At one moment the child is a precious, loving being, and at the next moment he is a monster yelling, scramming, and kicking the parent's shins. The classical symptoms include impulsivity, easy distractibility, irrepressibility, wild temper tantrums, and destructive activities. Rarely does any childhood disorder exasperate parents as much as SHALOAT. Most SHALOAT dads do not see the problem of impulsivity and distractibility as clearly as mothers do since SHALOAT children usually are a bundle of fun to watch on playing fields. Moms see their hyperactive and impulsive children differently as they struggle to get their homework done. As for some other SHALOAT children, they seem clearly fallen out of the worlds of their parents and teachers, their inner anguish little known to those around them.

    Not uncommonly, the SHALOAT children are utterly uncontrollable. As I write this, I am reminded of one such child. At the Institute, the examination tables are so heavy that two staff members are required to move them. The table tops are pressed against the wall for patient safety. One day I examined a very restless three-year-old SHALOAT child who screamed and kicked his mom and two nurses who tried to restrain him for examination. After I finished an unsatisfactory examination, I turned to the counter to write clinical notes. Within several moments, I was startled by a loud screeching noise produced by the examination table moving on the floor. What I saw stunned me just as it obviously had the mom and the two nurses. The little boy had managed to pry open the space between the wall and the table top, wedging his head between the two hard surfaces. All three adults struggled to disengage his head, visibly shaken. Later, when the crisis was over and I found only minor bruises on the boy's scalp, his mom told me that she had not been totally surprised by her son's brute power. She had seen similar displays before.

    Consider the following quote from a biography of one of the most recognized scientists in the history of humankind:

    "Pauline decided it was time to imbue Albert with her passion for music: she bought a fiddle and hired a teacher. Albert resisted, throwing a chair and a tantrum which sent his teacher scurrying for the nearest exit...O the rare occasion when Albert mixed with children his age, he was quiet and withdrawn the onlooker. Relatives thought of him as a dear little fellow...his younger sister knew the other Albert, the little hellion with a wild temper, and she bore the brunt of his ferocity. Maja (the younger sister) escaped serious and frequent injury because she could detect the onset of his rages—his face turned yellow-and would run for cover. His color change was not a foolproof warning signal...ither her luck ran out or she wasn't watching. He closed in for the attack and smashed Maja over the head with a garden hoe. Years later, when her brother was a dedicated pacifist and literally wouldn't swat a fly, Maja quipped, "A sound skull is needed to be the sister of a thinker."

        Einstein: A Life pages 3-4,
        John Willey & Sons, 1996.

    5. THE SPREADING SCOURGE

    No threats to humankind today are as real, immediate and calamitous as the ecologic and nutritional hazards our children face—born as well as unborn. The spectrum of hyperactivity, attention deficit disorder-learning disability, autism, Tourette's syndrome (SHALAOT state) is claiming an increasing number of children. Nearly four decades ago when I began my study of medicine, a medical student could complete his rotation in pediatric clinic without encountering a single child disabled by any of these disorders. Now, hardly a day passes when I do not hear one or more heart-rending descriptions of a mother agonizing over her child's anguish. Consider the following quote from the Journal of the American Medical Association (260: 2256; 1988):

    The results reveal a consistent doubling of the rate of medication treatment for hyperactive/inattentive students every four to seven years such that in 1987, 5.96% of all public elementary school students (in Baltimore County) were receiving such treatment.
   
    A consistent doubling of the rate of medication treatment every four to seven years! Where did this frightening epidemic come from? Is it a new viral affliction? Is it caused by a new bacterium or a mutated yeast? Or perhaps a parasite imported from Baltimore? Is the culprit an obscure pesticide? Some bizarre dragon unleashed by synthetic chemistry? I don't think so.
   
    Regrettably, the researchers in the study quoted above made no attempt to probe the relationship between hyperactivity/ADD and intake of sugar and antibiotics in the children. Had they done so, they would have surely found what all of us at the Institute know: sugar and antibiotics are undoubtedly the two elements that unmask the genetic factors that predispose to the SHALOAT state.

    As reported by Time (The Age of Ritalin), a consensus conference on hyperactivity/ADD/Ritalin conducted in November 1998, by the National Institutes of Health at Bethesda, Maryland, several hundred doctors, experts, and educators came to the following conclusions: (1) The cause of hyperactivity/ADD remains unknown; (2) There is no satisfactory therapy; (3) There is too little communication between doctors, teachers, and parents; (4) Long-term risks of Ritalin (and related drugs) remain unknown; and (5) Nutritional and environmental factors are not important. Not surprisingly, the last conclusion came from drug doctors who had evidently no knowledge or experience with those therapies.

    Consider the following quote from the November 30, 1998, issue of Time magazine:

    Production of Ritalin has increased more than sevenfold in the past eight years, and 90% of it is consumed in the U.S. Such figures invite the charge that school districts, insurance companies, and overstressed families are turning to medication as a quick fix for complicated problems that might be better addressed by smaller classes, psychotherapy or family counselling, or basic changes in the hectic environment that so many American children face everyday.

    Symptom-complexes of SHALOAT are caused by genetic, nutritional, metabolic, and environmental factors, and Time's advice of psychotherapy for SHALOAT children is silly. Anyone who has ever cared for any SHALOAT child knows that only too well.

    The Age of Ritalin is an important and timely report. However, the report has one glaring deficiency: There is only one line concerning the role of nutritional, metabolic, and environmental factors that clearly play significant roles in the causation of symptom-complexes of attention deficit hyperactivity disorder (ADHD). What makes that one line all the more unfortunate is that in it a psychiatrist "argues that critics who claim diet, exercise or other treatments work just as well as Ritalin are kidding themselves." That statement is a gross injustice to all children afflicted by ADHD. I, and other physicians who practice integrative medicine, do succeed in weaning many children off Ritalin and related drugs with nutritional, metabolic, and ecologic approaches. To let such an opinion of a psychiatrist (who it is doubtful ever diligently and for a sufficiently long time tried nondrug therapies for ADHD) go unchallenged is also a gross injustice to all the ADHD parents for it robs them of the possibility of their children avoiding prolonged use of a drug with undetermined long-term chemical consequences.

    The spreading incidence of SHALOAT entities has been documented by many researchers,5-8 including the eminent autism researcher, Bernard Rimland, director of Autism Research Institute, San Diego, and William Shaw, Director of Great Plains Laboratory, Wichita, Kansas.

6. A JOURNEY OF SELF DISCOVERY

    How do my colleagues and I care for the SHALOAT children? The first essential point is: We do not treat diseases.We try to care for children with neurochemical uniquenesses which make them vulnerable to sudden shifts in brain function. Our primary task is to demonstrate to such children and their parents the relationships between their choices in the kitchen and environmental factors and how they affect them at home and school. We seek to lead them through a journey of self discovery.

    This is a journey of self-knowledge and enlightenment. Yes, enlightenment for children! They are the ones who suffer most from problems of the bowel, blood, liver, and brain. And they must be the (little) people who learn to understand somethings about those tissue-organ ecosystems. This is not mere plausibility of an idealogue. It is what the Institute staff and I see happening with our SHALOAT children every week.Indeed, children learn faster than adults, perhaps because they do not carry the load of disbelief adults often do.

    The first four weeks we concentrate on an elimination diet--avoiding certain foods. After that, the family must stick to one principle: Don't focus on what you are sensitive to and can't eat; focus on what you can and should eat. As long as mom is going to the regular supermarket and bringing all the typical stuff home, it's going to be impossible to have good results.

    This whole approach is a journey. No one becomes enlightened in matters of nutrition in a few weeks. We prepare patients that this is going to be a slow process. They will have to learn to use unusual grains or flour—amaranth, quinoa, spelt, artichoke. They have to learn to bring in buckwheat and items that don't cross-react with common foods.

    Of course, this has to be a whole-family project. When you do it for the child, you need to do it for the family, from a practical standpoint. Once a youngster's condition has stabilized, he can probably take a break, within moderation, and eat something he is sensitive to, perhaps once a week or so.

7. GENES LEGISLATE LIFE; ENVIRONMENT INTERPRETS THOSE LAWS
   
    In understanding the true nature of SHALOAT, we must first clearly understand the relationship between genes and environment. In RDA: Rats, Drugs and Assumptions, I wrote that genetic codes are like obscure penal codes—they remain dormant until they are activated by environmental triggers. If this were not so, a hyperactive child would be hyperactive all the time and a child with Tourette's syndrome (TS) would suffer tics all the time. Mothers of hyperactive children and those with TS know that is not so—and so do physicians who care for children afflicted with those disorders. In fact, disorders included in the SHALOAT spectrum often run in families.

    Structural lesions in the brain affect intellectual, sensory, and motor functions of the body. Functional biochemical derangements also create similar difficulties. Recent advances in medical technology allow us to define these lesions in ways that could not have been foreseen only a few decades ago. What is even more remarkable is that such technology also permits us to recognize when and, in many instances, how environmental triggers cause abnormal responses.

    Through PET scans, one can map out areas of the brain associated functionally or metabolically with certain phobias or obsessive-compulsive disorders (OCD). (The term PET stands for positron emission tomography.) Though the technology is limited, progress is being made in this area. In one report from Harvard Medical School, certain parts of the brain (the prefrontal and temporal lobes) were identified as the areas in which abnormal metabolic brain function was located. If one were to treat phobias or OCD through Chinese acupressure, the two areas recommended for pressure, in a rolling motion, are the same—the prefrontal and temporal areas. I find this an interesting correlation. What the Chinese had empirically determined many centuries ago is what we are now demonstrating with the PET scan. As more and more people use PET technology, they are going to see a physiological overlap for autism, TS, OCD, and hyperactivity, just as we are seeing an overlap clinically.

    The technology for determining the genetic makeup or vulnerability is there, but it is very expensive. Perhaps what we should focus on is another concept: while 5 to 10% of the suffering may come from a structural, functional or metabolic derangement, 90 to 95% of the suffering comes from factors that exaggerate the underlying problem.

Some Recognized Structural Abnormalities

    Many abnormalities of the limbic and cerebellar parts of the brain have been found in SHALOAT. The number of one specific type of brain cell called Purkinge's cell is decreased. Neuronal processes of other types of brain cells called dendrites are stunted, while the patterns of branching of other dendrites are abnormal. However, such changes are not limited to autism, and how they might be related to symptom-complexes of autism is far from clear at this time.

Some Recognized Biochemical Abnormalities

    Many defects in the metabolism and enzyme function have been associated with SHALOAT, including histadinemia (elevated blood levels of amino acid histadine), deficiency of heparin-N-sulfaase, and phenylketonuria. It seems safe to predict that future research will uncover many additional metabolic and enzyme defects. It also seems safe to predict that no single enzymatic or metabolic defect will be proven to be responsible for the full and diverse symptom-complexes of autism.

Some Recognized Genetic Factors

    The SHALOAT conditions affect identical twins with much greater frequency than in non-identical twins, strongly suggesting a genetic basis. The incidence of SHALOAT is much higher in boys than in girls. Autism has been associated with other genetic disorders, such as fragile X syndrome and tuberous sclerosis. From a clinical standpoint, the more important genetic aspects of autism are: (1) predisposition to mold and food allergy; (2) impaired detox enzyme function in the liver; and (3) abnormalities of neurochemical responses. Those factors are discussed later in this article.

8. OBSOLETE PSYCHOLOGICAL THEORIES OF BRAIN DYSFUNCTIONS

    Psychologists and psychiatrists have a long history of blaming parents, family members, teachers, and preachers for problems for which they thought there was no physical basis. ADHD, OCD, learning disabilities, and autism, of course, were not exceptions. The less such professionals knew about human nutrition, metabolism, enzymes, neurotransmitters, and human ecosystems, the more dogmatic they were with their psychological theories. Fortunately, such frivolous thinking is dying out, largely because informed and enlightened parents reject silly psychological theories. (Though there are still diehards who think birth canal traumas make children hyperactive, inattentive, and autistic.) The focus now is clearly shifting, as discussed in the later sections of this article to genetic and acquired factors that affect the oxygenative/oxidative aspects of microecologic-cellular and macroecologic tissue-organ ecosystems.

9. THE TROUBLED BOWEL, LIVER, AND BRAIN TRIO

    SHALOAT encompasses a broad spectrum of brain symptom-complexes caused by damage to the bowel, liver, and blood ecosystems. The ecosystem damage is caused by some inherited factors and by excessive oxidative stress. It is critical to recognize that even though those symptom-complexes seem related to the brain, the SHALOAT states are metabolic problems first, and neurologic derangements second. In the preceding article, Understanding Children's Health, I include a schema of The Pyramid of the Trios of Human Ecosystems which demonstrates relationships among the major body organ ecosystems and establishes the base trio of the bowel, blood, and liver ecosystems as the foundation of health.Those who think ADHD, OCD, autism, learning disabilities, and Tourette's syndrome are psychological disorders are either ignorant about all the biologic aspects of such disorders or are simply too lazy to uncover the involved and hidden nutritional, metabolic, sensitivity, and detox problems. I present microscopic and biochemical evidence for my view later in this article. In the bowel, the important genetic factors are food and mold allergy, gut immune deficits, and digestive-absorptive dysfunctions. The mother of one SHALOAT child treated with intravenous injection of secretin reported that her son had normal, formed bowel movements for the first time in his life, a clear evidence of deficiency of digestive pancreatic enzymes. The details of that case are furnished later in this article. The acquired factors involving the bowel ecosystem are overgrowth of primordial microbes, damaged bowel lining (mucosa), and chronic inflammation caused by sugar overload, antibiotic abuse, and pesticide load. For detailed discussion of this subject, please read the chapter, "The Battered Bowel Ecology," in The Canary and Chronic Fatigue.

    As for genetic factors involving the liver, firm evidence of impaired detoxification in the liver has been published by many researchers. The data indicate failure of oxidative enzymes involved in the detox recations. Acquired factors include excess production of toxins (such as tartaric acid) by primordial microbes in the bowel, excess microclot formation in the blood (oxidative coagulopathy), and environmental pollutant burden on the liver. Strong clinical evidence for the role of the liver in the production of SHALOAT symptomatology is provided by clinical benefits observed with detox therapies.

    The genetic and acquired factors involving the brain are discussed later in the section titled "From Bowel to the Brain."

    I end this section with a few comments about what I call the language of biology. Just as one cannot revel in great literature by merely learning to recognize alphabets, one cannot begin to glimpse the great mystery (and marvels) of ecological relationships within the human framework. Disease doctors of drug medicine usually ridicule holistic physicians for their failure to prescribe specific drugs for specific "diseases." They need to understand that ecologic relationships among the major bowel, liver, and brain ecosystems are so diverse, dynamic, and delicate that it seems highly unlikely that the complete mysteries of SHALOAT symptom-complexes will ever by resolved by the drug approach.

10. TWO VILLIANS: SUGAR AND ANTIBIOTICS

    Sugar is also a primary villain. People don't recognize the physiological reactions that sugar can trigger. For example, we have established that people who are prone to panic attacks, have memory and concentration difficulties, or experience mood swings are often riding what we call a metabolic roller coaster. The primary causes are sugar and stress.

    What we recommend is a breakfast of partially digested protein powder with 90% protein, not those with 60% carbohydrates and fats. During the process of isolating protein from natural foods, there's a partial digestive process, which allows the protein to be better assimilated. Even people who are allergic to milk can sometimes tolerate a milk- based protein mixture once a week, if they use other mixtures in between.

    Ideally, the powder should be mixed with organic vegetable juice—fresh, if possible—or bottled juice. Soy milk, rice milk, and other liquids can also be rotated; occasionally, you can use organic apple or cranberry juice. Orange juice is an absolute no-no. No matter how you test for food allergies, orange juice is almost always known to be a problem! Those with orange allergy can often tolerate lime or grapefruit juice.

    It's a process of retraining your palate. We have three different types of protein formulas. One is based on rice—nutritionally the least desirable, but from an allergy point of view, most desirable. The second is based on milk protein—nutritionally most desirable, and from an allergy standpoint, least desirable. The third is soy-based. The person rotates these three mixtures. That is how I myself start my day.

Antibiotics: The Killer Designer Molecules

    Why do we make antibiotics? To kill life. Evidently, antibiotics must be prescribed for life-threatening infections. But that is not what is hurting the SHALOAT children.It is the mindless use of antibiotics for symptoms of undiagnosed allergies and food incompatibilities that the author laments here.

What this protein breakfast does is eliminate the roller coaster insulin effect. If you compared the insulin curve after a child's typical breakfast with the high-protein breakfast we advocate, you would be astounded by the result. After the protein breakfast, the insulin level might start at 5, go up to 15, then gradually climb down to 5; over the four hours you would see a gentle rise and fall. With the typical high-carbohydrate breakfast, it may climb from 5 to 150 or 175—even 200 to 240, then it drops suddenly. The child gets hit as it goes up and as it goes down!

    Insulin is a powerful trigger that affects adrenaline, a primary stress hormone. So what we are doing is setting these children up, before they go off to school, for a major metabolic change. When the insulin shoots up, it drives the sugar down, and that's the beginning of the problem. Actually, we shouldn't focus on the numbers as much as on the rate at which they change.

    Now, do we have to put a child through testing to determine this? Usually not. What we learn from adults we can empirically apply to children. We should have no difficulty recognizing the same type of glucose dysfunction in a six-year-old child as in a thirty-six-year-old man. If parents need objective proof—and sometimes this is helpful to win their cooperation—then we may run a test. There are times when talking in the abstract doesn't work.

11. FROM THE LIVER TO THE BRAIN

    When carefully tested, almost all SHALOAT children show evidence of impaired detoxification in the liver. Such defects in detoxification cannot be uncovered with the commonly performed tests for liver function such as liver enzymes, gamma globulin proteins, and bilirubin. Indeed, this is the main reason most pediatricians and psychiatrists fail to understand the significance of the role of liver-related factors in the production of the SHALOAT symptom- complexes. Abnormally high levels of D-glucaric acid in the urine of most SHALOAT children provides clear evidence of impaired detoxification in that organ. Furthermore, measurements of many xenobiotics in the blood or urine of many SHALOAT children reveal abnormally high levels, again indicating inadequate detox activity.Some light on the role of impaired liver detox in the production of SHALOAT symptoms is shed by considering the case of an alcoholic whose liver develops cirrhosis and so cannot perform its detox functions well. The term hepatic encephalopathy is used to describe the neurologic symptoms which he develops.

    In my view, the problems of impaired liver detoxification are further compounded by the bowel-related factors that lead to accumulatins of large amounts of organic acids in the body. The table below demonstrates how large the bdy burden of toxic organic acid can be and how effectively it can be reduced by therapies directed to restorin the bowel, blood, and liver ecosystems are.

Note that the shifts in lactic and pyruvic acids in the posttreatment values occurred in the opposite direction to those expected with the observed dramatic reduction of urinary excretion of organic acids of yeast and PLF derivation. A possible explanation of such dissociation is that lactacidosis can occur quickly in response to impaired oxygen utilization while urinary excretion of organic acids represent a somewhat delayed response to sustained yeast and PLF overgrowth. Also note that no appreciable change is seen in urinary excretion of two bacterial products (the last two compounds in the above table).

12. OXIDATIVE-GENETIC BRAIN DYSFUNCTION: A UNIFYING THEORY

    Here in simple terms is my theory of OGB dysfunction in SHALOAT states. All genetic and acquired groups of factors which injure the bowel, liver, and brain ecosystems and cause and/or trigger SHALOAT symptom-complexes are oxidative in nature. Oxidation, of course, means loss of electrons and decay. (Electrons are the tiniest packets of energy in atoms). Oxidation turns butter rancid and causes flowers to wilt. In the human body, oxidative injury is the true cause of all diseases. I discuss this important subject in RDA: Rats, Drugs, and Assumptions.1 I refer advanced and professional readers to detailed discussion of this subject in my two recent articles published in The Journal of Integrative Medicine.2,3
   
    The principal strength of the OGB dysfunction theory of SHALOAT is that it shifts the focus from the use of drugs for hollow diagnostic labels to a diligent search for nutritional, allergic, environmental, metabolic, and detox factors that cause and/or trigger symptom-complexes. Specifically, OGB dysfunction requires careful consideration of all energetic-molecular events that take place in the bowel, liver, and brain ecosystems.

Moving Beyond Labels

    I recognize that molecular considerations are tedious for many mothers (and fathers) who are seeking useful information for their SHALOAT children. Many of them may be irked (even turned off) by my bringing scientific terminology concerning oxidative molecular injury in discussion of ADD, hyperactivity, learning disability, OCD, and related disorders, which they have been told for years are brain diseases. However, if one seeks to go beyond empty, meaningless labels, one has to take the step and learn some basic scientific facts. (Doesn't every mom know her child has difficulty learning long before some school psychologist pronounces his "professional diagnosis" of Learning Disability?) I am confident that the readers who persist in reading this article (twice or more often, if necessary) will gain a much deeper and clearer understanding of what the real problems of their SHALOAT children are. Those readers will then have the strength to defy the diagnostic labels of school psychologists and diligently search for the relevant nutritional, metabolic, allergic and environmental factors, which the school psychologists and psychiatrists rarely, if ever, do.

    It is important to recognize in this context that food incompatibility reactions are oxidizing. Sugar overload and sugar-insulin-adrenaline roller coasters (including hypoglycemia) are oxidizing. Mold and pollen allergy reactions are oxidizing. Excess acidity is oxidizing. Insufficient oxygen transport to tissues and inadequate utilization of oxygen is caused by all of the above factors, and lack of oxygen (anoxia) is oxidizing. Pesticides are oxidizing. Anger and hostility generate oxidizing molecules. Advanced and professional readers may read my recent paper published in The Journal of Integrative Medicine4 for a detailed discussion of those issues.

13. DIAGNOSIS: WHO NEEDS EMPTY LABELS?

    What concerns SHALOAT parents most is whether or not the diagnosis of the particular disorder chosen by their doctors is accurate. One principal objective of writing this article is to enable such parents to have the strength to reject empty diagnostic labels used by so-called ADHD experts. The SHALOAT parent must recognize that the diagnosis for their children is made by a process that involves school teachers, administrators, social workers, psychologists, psychiatrists, and pediatricians. Regrettably, rarely are any of those professionals sufficiently knowledgeable to evaluate the critical nutritional, allergic, metabolic, and detox issues that are pivotal to proper management of SCHALOAT children. Consider the following quote:

    "You go to meetings, and everybody thinks your child has a problem," he said. "Doctors and therapists each had a different diagnosis—ADHD, anxiety disorder, obsessive-compulsive disorder, depression and each diagnosis called for a different drug.
        U.S. News & World Report,
        November 23, 1998. page 81.

14. ESSENTIALS OF MANAGEMENT

1.    Diagnose and treatment mold allergy and other ypes of inhalant allergy.
2.    Detect and manage food sensitvities.
3.    Avoid rapid hyperglycemic-hypoglycemic shifts (metabolic roller coasters) and other
        adverse food effects.
4.    Increase alkaline ash foods (vegetables).
5.    Maintain optimal hydration.
6.    Restore bowel ecology. Prescribe probiotics and natural antifungal agents liberally
        (i.e. echinacea and goldenseal drops.).
7.    Use Nystatin when clinically indicated.
        Nutrients of special value (pediatric doses):
        a.    Glutathione 250-1,000 mg
        b.    Taurine 250 to 1,000 mg
        c.    Vitamin B 6 25 to 75 mg
        d.    Zinc 10 to 25 mg
        e.    Dimethylglycine or trimethylglycine (betaine)
        f.    Multimineral
        g.    Multivitamin
        h.    Selenium, chromium, and molybdenum 100 to 250 mcg each
        i.    Injectable vitamin injections in selected cases.

*Included in multivitamin formula

The above protocol was administered in 150 to 250 ml of Ringer's lactate over a period of 75 to 120 minutes. Following items were added to the infusion for improving the rheologic characteristics and to minimize the possibility of phlebitis: heparin, 2.000 units; lidocaine 2%, 1.5 ml; sodium bicarbonate, 0.75 mEq/ml.

1. Ali M, Ali O, Fayemi, AO et al. Efficacy of an integrative program including intravenous and intramuscular nutrient therapies for arrested growth. J Integrative Medicine 1998;2:56-69.

2. Ali M. Darwin, Oxidosis, Dysoxygenosis, and Integration. J Integrative Medicine 1999;1:11-16

3. Ali M. Oxidative regression to primordial cellular ecology:Evidence for the hypothesis and its clinical significance. J Integrative Medicine 1998;2:4-49.

4. Edeleson, SB, Cantor DS. Autism: Xenobiotic influences. Toxicology and Industrial Health 1998;14:553-563.

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