Autism/PDD
Deciding Which Tests to Do
It’s a balancing act weighing the expense of tests with their usefulness
in improving symptoms. In general, the more abnormal the results, the
greater the chance for improvements after implementing therapies. Keep
in mind that one approach never fits all cases, and we’re available
for consultation. The following recommendations are not meant to take
the place of sound medical advice from a doctor. (A doctor’s signature
is necessary to do the following tests though not necessary to order and
have the sample transport containers sent to you.)
Initial Testing Recommendations
Organic Acids Test - Virtually all specimens
from children with autism or PDD have one or
more abnormal Organic Acid compounds, due to abnormal levels of yeast
and other gastrointestinal bacteria. These compounds can affect, among
other things, neurological functioning, vitamin utilization, energy level,
intestinal wall integrity, hormone utilization, and muscle function. In
addition to identification of excessive levels of GI yeast or bacteria,
the test also reveals nutritional or antioxidant deficiencies, inborn
errors of metabolism, amino or fatty acid problems, exposure to solvent
toxins, indications of possible diabetic conditions, deficiencies of B
or C vitamins, and unusual levels of neurotransmitters.
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Yeast Culture and Sensitivity - This
test should be done in combination with the organic
acid test to get the most accurate reading for yeast and bacteria
overgrowth. By doing both of these tests you will have all the evidence
your doctor needs to help you treat this problem. The urine
organic acid test is the most accurate measure of yeast, which can
sometimes be overlooked in the stool test. Yeast can sometimes attach
to the intestinal lining and will not be eliminated in the stool. In some
cases, the sections of stool where the yeast is present are not the sections
that are collected and sent in to be analyzed. Generally, however, the
stool test is an accurate test. The greatest benefit of the stool test
is the sensitivity portion of the test, which will tell you which antifungal
agents your intestinal yeast will respond best to.
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Food Allergy - The impact of food allergies
on behavior can be astounding, and cravings are very often, for the same
foods that cause allergic reactions. And, those foods may play a role
in abnormal levels of GI organisms. We have two panels available; one
that tests for 92 foods, and another that tests for 10 of the most common
foods people are allergic to. We recommend doing one of these two panels.
It is best to have the full panel done. However, the 10 food panel is
good for those who have limited resources, or for those who do not want
to wait until the yeast problem is under control to see what food allergies
they have.
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Immune Deficiency Panel - Numerous papers
document inadequate immune functioning in this many populations, increasing
the vulnerability to bacterial/viral/fungal infections. In particular,
yeast is well-documented as suppressing the immune
system. So, if there is an excessive yeast population, it increases
the likelihood of an inadequate immune response, in turn, increasing the
probability of more infections and more yeast. Our panel is designed specifically
for this patient population; for instance, levels of zinc, and specific
immune proteins like IgA and subclasses of IgG, are often inadequate.
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Peptide Testing for Milk and Wheat
- In most cases people that have food allergies
to milk and wheat, also have problems with peptides from milk and wheat
interacting with their brain and causing an opiate-like affect. However,
there are some people that may not show a food allergy to milk or wheat,
but have the peptide problem and vice
versa so it is a good idea to have both the peptide and food allergy testing
done. If you prefer to have only one of the tests run, we recommend the
food allergy testing since it can be assumed
that the majority of people who have food allergies to casein and gluten
also have the peptide problem. The peptide test is also a urine test and
thus may be more convenient.
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Inhalants (Comprehensive or Basic) IgE
- Particularly useful when allergies to inhalants, such as dust, molds,
and pollens are suspected; blood tests have improved considerably over
the years, and are especially helpful with individuals who would have
difficulty complying with skin testing or have skin rashes; to save time;
or for very young children. May also be considerably cheaper than skin
testing.
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Follow-up Testing Recommendations
Organic Acids Test - It is helpful to
re-test about 4-6 months after the start of treatment, mainly to refine
the treatment. If the original test demonstrated undesirable levels of
GI microbial metabolites exclusively, then the less comprehensive microbial
panel will suffice. The microbial panel measures only 20 of the 62 compounds
in the full organic acid profile.
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Yeast Culture and Sensitivity - When
redoing the organic acid test or microbial panel
it is a good idea to redo this test as well to see if any of the sensitivities
have changed after treating the yeast. In some cases yeast can develop
resistance to antifungals after being exposed to them. Retest 3-6 months
or as needed for treatment directed by your doctor.
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Comprehensive Food Allergy Panel - If
you did the basic food allergy test originally, or waited until the yeast
problem was addressed or alleviated, it is a good time to do this test.
If you did the comprehensive food panel first, when the yeast was present,
you should follow up with this test again to see what food
allergies are still present. A lot of times food allergies may disappear
when the yeast problem is taken care of.
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Amino Acids - Helpful in assessing causes
and treatments for lethargy, muscle weakness, vitamin deficiency, protein
intolerance, vomiting, kidney stones, inborn errors of metabolism, and
seizures. Since many of these symptoms are caused, or worsened, by elevated
levels of GI yeast/bacteria, we recommend that Amino Acid testing follow
Organic Acid testing and treatment (if indicated) for GI organisms. The
Organic Acid test includes some indicators of inborn errors of metabolism.
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Essential Fatty Acids - Deficiencies of essential
fatty acids are associated with hair loss, dry or peeling skin, diarrhea,
eczema, fatigue, aggression, dry brittle hair, eating disorders, excessive
thirst, gallstones, growth impairment, immune deficiency, hyperactivity,
and impaired wound healing. Essential fatty acids can be deficient due
to inadequate dietary intake, diarrhea, loose stools, inadequate production
of pancreatic enzymes, or inadequate production or secretion of bile or
bile salts. The pattern usually observed in children with autism is deficiency
of omega-3 fatty acids, especially alpha-linolenic acid with elevations
of arachidonic acid and trans fatty acids.
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Arachidonic acid is extremely important since it is converted to the
regulatory substances called prostaglandins. Grains and meats from grain-fed
animals may be very high in arachidonic acid. Trans fatty acids are unnatural
fatty acids produced by hydrogenating unsaturated fatty acids. Trans fatty
acids may be especially harmful when alpha-linolenic acid is deficient.
Trans fatty acids may affect neuronal fluidity by virtue of different
dimensions compared to cis fatty acids. Trans fatty acids are high in
foods like French fries, potato chips, margarine, cookies, and cake.
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Metals (blood, hair or urine) - Hair is useful
for the detection of toxic metals such as lead, aluminum, mercury, and
cadmium. Lead may be found in dirt near roads and is commonly present
in paint from older houses. Children with pica or who eat paint chips
may develop toxic lead levels. Cadmium is used in batteries, steel-belted
tires, and plastics. The clear plastics used to cover foods may be a source
of cadmium and it is also found in cigarette smoke. Mercury is used in
batteries, dental amalgam, vacuum pumps, valves, and seals. High amounts
of mercury from the dental fillings of the cremated deceased have caused
contamination of the surrounding neighborhoods. Arsenic is high in seafood
and may also be found in animals fed arsenic in their feed. Arsenic is
also present in wood preservatives, fungicides, herbicides, corrosion
inhibitors, and in lead and copper alloys. Children with autism may respond
favorably to removal of toxic metals. Children with autism as a group
also have low values of essential elements like calcium, potassium, zinc,
and magnesium. Treatment of heavy metal exposure usually involves the
removal of the heavy metal source and/or treatment with chelating agents.
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Frequently Asked Questions about
Autism/PDD Testing
Please remember that general questions about all our tests are answered
in our testing FAQ, information
about payment is available on our insurance and
payment page, and questions about specific tests are usually answered
on the page about that test. (See the test listing in the lefthand menu
bar.)
Yeast Questions
If my child has no external signs of yeast
such as thrush or anal or genital rashes, could he still have a yeast
problem?
Yes. In many cases,
a behavioral abnormality is the only clue to an underlying yeast overgrowth.
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Could an intermittent low-grade fever be
a symptom of yeast infection?
Fever often accompanies yeast infection of
the blood stream, which is termed "systemic yeast infection."
To test for yeast in the blood, you need to have a yeast culture and/or
yeast antibody tests on the blood. The patient may also have an intestinal
yeast overgrowth.
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My child has a white coating of the mouth.
Could this be a yeast problem?
Yes. One of the most common yeast in the
intestine is Candida albicans. "Albicans" is a Latin word for
white, and a white coating of the tongue may very well be Candida.
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My child has a yeast infection in the genital
or anal area. Does this indicate a yeast overgrowth of the intestinal
tract?
Yes, it could very likely indicate such an
overgrowth, but it is impossible to know for sure without testing to confirm
it.
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My child has urinary tract infections or
a vaginal yeast infections. Could the microorganisms in the urinary tract
affect the test results?
Microorganisms might contaminate the sample
and lead to erroneous results if the urine stands too long at room temperature.
Consider stool testing as an alternative in
this case.
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Can I test my infant, who is having frequent
ear infections, to see if s/he is developing abnormal yeast products?
Yes. We provide tape-on bags to collect urine
samples from infants or children who are not potty-trained. Simply check
the box next to "Include a tape-on sample collection bag..."
on your test order form.
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My child has a large number of food allergies.
Could this be related to the yeast problem? When should I get food allergies
tested?
Yes, food allergies
can be related to a yeast problem. Yeast can exist in two forms: a floating
single cell form or a colony form. When yeast form colonies, they secrete
enzymes such as phospholipase and proteases that break down the lining
of the intestinal tract in order to attach the yeast colony to the intestinal
wall. The holes made by the yeast produce a condition called "leaky
guy syndrome" in which large undigested food molecules are absorbed
into the bloodstream and elicit food allergies.
Once the underlying yeast problem is controlled,
the holes in the intestinal wall will heal. Then less undigested food
gets into the blood and the number of food allergies will drop.
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Will the use of Nystatin interact adversely
with other medications a patient is taking?
Nystatin is not absorbed from the intestinal
tract in an appreciable quantity unless extremely larger doses are used.
Therefore, there are no adverse reactions with drugs such as anti-seziure
medications, antidepressants (such as Prozac or Elavil) or other medications.
If you use antifungals that are absorbed
from the intestinal tracts (such as Lamisil, Sporonox, Diflucan and Nizoral),
then drug interactions must always be considered. It's important to be
aware that other drugs used simultaneously may be more potent or make
the antifungal drug more potent when these latter drugs are used.
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What about starting out all of these therapies
at the same time?
We recommend that the antifungal therapy
precede the allergy and gluten/casein
testing, since the yeast may be making the situation worse.
As far as supplements such as SuperNuthera
and DMG, we recommend that they be tried 2 months before or after the
antifungal therapy so that you can know which therapies have been the
most beneficial. If you do everything simultaneously, you won't be able
to say which therapy is most helpful.
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Could there be adverse reactions to the
food colors and flavors in Nystatin?
Yes, that is a possibility. If that is the
case, then you may have to use the pure Nystatin powder and disguise it
in food. One way to disguise it might be to combine it with Stevia, a
sweetener that cannot be utilized by the yeast. Stevia is available in
most large health food stores.
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What kind of changes might I expect with
the antifungal drug therapy?
Results are highly variable but the most
usual improvement noted is increased focus and concentration. Other improvements
may include increased and clearer vocalization, less spinning, decrease
in aggressive or self-abusive behavior like head-banging, better sleep
pattern, increased socialization and better eye contact.
Antifungal therapy does not appear to help
individuals with normal or marginally elevated yeast metabolites. Ultimately,
antifungal therapy is not a cure for autism by itself, but can significantly
improve the life of the individual with autism and their family.
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Miscellaneous Questions
My child only eats bread, cereal or pasta.
How can I change his diet without starving my child?
Many parents have reported that their children
may refuse the altered diet for three or four days, then give in and eat
the new foods. However, it would be wise to consult your physician before
starting the diet. A short time without eating is not harmful to most
children, but might be significant if your child has a special medical
problem like diabetes.
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What foods have Lactobacillus acidophilus
in them?
Yogurt is high in Lactobacillus acidophilus.
The unflavored or plain kind is more highly recommended than flavored,
because yeast may grow in the kind with fruit on the bottom. Some milk
now also has acidophilus added. Just read the labels.
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What about the use of "Sara's diet"
and the reported sensitivity to vitamin A and carotenes? What can you
tell me about your organic acid test and this diet?
At this time, the organic
acid test is not useful in predicting whether or not a person will
respond favorably to Sara's diet. Currently there is no known biochemical
basis for this diet.
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Where can I get dimethylglycine?
Wholesale Nutrition
Box 3345
Saratoga, CA 95070
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Where can I get various antifungal supplements
such as caprylic acid, MCT oil, grapefruit seed extract or garlic extract?
All of these supplements can be obtained
in health food stores or from mail order companies. The does for children
are usually not specified with these products, and the yeast die-off reaction
is usually just as severe as with prescription drugs.
The main benefits of prescription drugs are
the additional quality control measures required for these products and
the availability of pediatric guidelines.
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What side effects may be associated with
the use of Flagyl or oral Vancomycin to control the overgrowth of Clostridia
in the intestinal tract?
The main side effects of Flagyl or Vanocmycin
are probably due to the release of bacterial toxins as the Clostridia
and other bacteria die. Side effects may be very severe and usually
last from 2-10 days. A child should be under close medical supervision
while on this drug. Side effects may include severe diarrhea, heart
palpitations, extreme lethargy and fever with drenching sweats.
A child should not start both the Flagyl/Vancomycin
and antifungal therapy simultaneously because the combined die-off reaction
may be too severe.
Both Flagyl and Vancomycin will kill the
friendly bacteria and it is very important to start Lactobacillus acidophilus
as soon as the Flagyl/Vancomycin therapy stops or there will be a recurrence
of the Clostridia or a yeast overgrowth. It is OK to continue Nystatin
during Flagyl/Vancomycin therapy. Just don't start the antifungal and
antibacterial therapies simultaneously.
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