The Biomedical Approach
to Autism:
The Gut-Brain Connection
Dr. Irfan Qureshi, ND
Pacific Highway Natural Medicine
15245 International Blvd., Suite 210
Seattle, Washington 98188
Phone: (206) 923-7600
Email: phnatural@gmail.com
2007 Dr. Irfan Qureshi, ND
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Naturopathic Medicine
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Philosophy and Scope of Practice
A discipline of medicine requiring a doctorate level education
similar to degree programs in allopathic medicine
A holistic system of medicine encompassing diet therapy,
lifestyle changes and therapeutic nutrition.
In a number of states in the US, Naturopathic Physicians are
licensed to practice as Primary Care Physicians
Naturopathic Physicians stress treatments that are “natural” to
help with chronic conditions, such as diet and lifestyle
changes, herbal medicine and nutritional supplementation;
however, they also can prescribe drugs, when necessary.
Aim is to address the cause of the illness and not just treat the
symptoms.
2007 Dr. Irfan Qureshi, ND
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Dr. Irfan Qureshi, ND
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Pre-med. BSc Microbiology (University of Washington)
Doctor of Naturopathic Medicine (Bastyr University)
Licensed Primary Healthcare Physician, State of Washington, USA
In practice since 2003 in Singapore and Washington State
Special areas of interest include natural alternatives for Autism,
Attention Deficit Disorder, Diabetes and other chronic diseases
Specifically:
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Gastrointestinal health in Autism and other developmental
disorders
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Autoimmune disorders
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Clinical nutrition
2007 Dr. Irfan Qureshi, ND
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Objectives of the Talk
To develop an understanding of the
Biomedical approach to Autism (especially
as it relates to gut health)
 How to measure progress
 To understand how to get started
 Individualized therapy
 How to decide if you should try it
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2007 Dr. Irfan Qureshi, ND
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Autism on the rise
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There has been a disturbing trend over the last 2
decades
Incidence in the past was always cited as nearly 1 in
2000 individuals
Evidence is that the incidence has increased to 1 in
200, with the incidence in some areas even higher!
No one definitive cause for this condition that has
been identified.
An autism epidemic? No decrease in cases in sight.
2007 Dr. Irfan Qureshi, ND
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Overt Signs and Symptoms of
impaired digestion
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Gas and bloating
Belching
Heartburn
Acid Reflux
Nausea/vomiting
Constipation
Diarrhea
2007 Dr. Irfan Qureshi, ND
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Hidden Signs and Symptoms of
Gut disturbance
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Behavioral changes
“Dazed” sensation
Food reactions
Toe Walking (a sign of constipation)
Asthma
Skin rashes
Headaches
Attention deficits
History of chronic infections
Impaired immune function
2007 Dr. Irfan Qureshi, ND
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Evidence of poor intestinal health
in Autism
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Food Allergies
Dysbiosis (Imbalance) of bacterial flora in intestines
Candida and Clostridium overgrowth in the gut
Increased intestinal permeability  “Leaky Gut
Syndrome”
Opioid-receptor effects of milk and wheat proteins
(casein and gluten)
Oxidative damage of intestinal tissues
Abnormal immune function
Increased levels of heavy metals
Impaired detoxification…and increased toxic load
2007 Dr. Irfan Qureshi, ND
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Autism: The Biomedical Approach
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Aims to correct the underlying abnormalities seen
in Autistic patients.
Treatment consists of:
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Dietary modification
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Removal of food allergens and sensitivities from the diet
Decrease sugars and processed foods
Targeted nutritional supplementation
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Determined by results of functional physiological testing of
stool, blood, and urine
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To improve gut health
Reduce toxic burden
2007 Dr. Irfan Qureshi, ND
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Autism: The Biomedical Approach
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Treatment targets the following areas:
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Food Allergies
Reducing Free Radical damage
Improving Digestive Function
Rebuilding intestinal mucosa and correcting “Leaky
Gut”
Correcting bacterial imbalances
Eliminating intestinal pathogens (Candida and
Clostridia)
Removing toxins and improving detoxification
systems
Stimulating immune function
2007 Dr. Irfan Qureshi, ND
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Food Allergies
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A number of autistic kids have been shown to have one or more
significant food allergies.
Dramatic improvement can be seen in many cases upon elimination
of allergic foods from the diet. Lucarelli S, et al. Food allergy and infantile autism.
Panminerva Med. 1995 Sep;37(3):137-41.
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The majority of problematic food allergies are the delayed-onset
type (IgG), taking hours to days to occur.
Immediate reactions are easier to identify and eliminate because
they have a fast onset (IgE antibody). (Skin prick testing identifies
only these type, and is better for environmental sensitivities)
The blood testing screens multiple foods for reactions based on both
immediate and delayed onset (IgG and IgE antibody reactions).
Major allergens may be dairy, wheat, soy, eggs. Other foods can
also be reactive.
2007 Dr. Irfan Qureshi, ND
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Gluten and Casein defined
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Gluten is a protein component of grains. The following grains
contain gluten:
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Wheat (durum, semolina)
Rye
Barley
Spelt
Triticale
Kamut
Farina
Oats (controversial)
Casein is a protein derived from dairy products:
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Includes milk, butter, cheese, yogurt, ice cream, etc.
Goat’s milk has casein, but it may or may not be reactive
(controversial). Elliott RB, Harris DP, Hill JP, Bibby NJ, Wasmuth HE. Type I (insulin-dependent)
diabetes mellitus and cow milk: casein variant consumption. Diabetologia 1999 Mar;42(3):292-6
2007 Dr. Irfan Qureshi, ND
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The Role of Gluten and Casein in
autism
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Opioid-like effects
Food Allergies
Free-radical damage to gut cells
“Leaky Gut” syndrome
2007 Dr. Irfan Qureshi, ND
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Opioid effects of gluten and casein
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These are not food “allergies” and are not
necessarily immune-mediated reactions.
Many food proteins are known to exert
opioid-like effects on the brain. Teschemacher H.
Opioid receptor ligands derived from food proteins. Curr
Pharm Des. 2003;9(16):1331-44.
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These proteins attach to receptors in the brain.
They are nearly identical in structure to
natural opioid-binding peptides. (Can have
morphine-like effects)
The proteins enter the blood circulation in
incompletely digested forms (due to digestive
enzyme deficiencies and “leaky gut”) and
potentially cause changes in mood and brain
function.
2007 Dr. Irfan Qureshi, ND
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Opioid effects of gluten and casein
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These effects may be responsible for autistic children
seemingly being “dazed”.
Components of gluten and casein have been found in
abnormally high levels in the urine of autistic patients.
Reichelt, et al. Gluten, milk proteins and autism: dietary intervention effects
on behavior and peptide secretion. J Appl Nutrition 1990; 42(1):1-11.; Shaw,
William, Ph.D. Biological Treatments for Autism and PDD. Overland Park,
KS: 2002.
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Studies show that elimination of gluten and casein
from the diet has improved behavior in autistic
children. Knivsberg AM, Reichelt KL, Hoien T, Nodland M. A
randomised, controlled study of dietary intervention in autistic syndromes.
Nutr Neurosci. 2002 Sep;5(4):251-61.
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Important to remember that autistic children can have
both allergies AND sensitivities to wheat and dairy.
2007 Dr. Irfan Qureshi, ND
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Leaky Gut Syndrome
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The normal intestinal barrier 
Tight junctions between cells do not
normally allow the entry of large
molecules into the bloodstream.
Leaky gut develops when these tight
barriers between cells are compromised
and loosen up due to cell injury
This shriveling allows the passage of
large molecules (especially food
particles such as casein and gluten)
into the bloodstream.
These large molecules are incompletely
digested food proteins (possibly due to
digestive enzyme deficiencies or
dysfunctions)
2007 Dr. Irfan Qureshi, ND
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Leaky Gut Syndrome
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Causes of increased intestinal
permeability include:
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Allergenic foods causing
inflammation of cells
Incompletely digested food
proteins (gluten/casein, etc.)
Medications such as antibiotics,
steroids, aspirin (irritate lining,
causing imbalance in bacterial
flora)
Other potential causes include
heavy metals, yeast and bacterial
overgrowth, and components of
vaccines
2007 Dr. Irfan Qureshi, ND
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Leaky Gut Syndrome
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Evidence of intestinal problems in Autism
and ADHD
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Chronic nonspecific diarrhea is associated with
attention deficit disorder in childhood
There is a relationship between the presence of
ADHD and greater severity of irritable bowel
syndrome. A significant number of ADHD
individuals also had IBS. Wender PH, Kalm M.
Prevalence of attention deficit disorder, residual type, and other
psychiatric disorders in patients with irritable colon syndrome. Am
J Psychiatry. 1983 Dec;140(12):1579-82.
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There is mounting evidence of impaired
intestinal permeability in autistic children
showing intestinal signs such as gas, bloating,
diarrhea, reflux and constipation. White JF. Intestinal
pathophysiology in autism. Exp Biol Med (Maywood). 2003
Jun;228(6):639-49.
2007 Dr. Irfan Qureshi, ND
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Leaky
Gut
Syndrome
Evidence of Intestinal problems (cont’d)
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Abnormal intestinal permeability (or “leaky
gut”) was even found in 43% of autistic
children showing no intestinal signs or
symptoms. D'Eufemia P, et al. Abnormal intestinal
permeability in children with autism. Acta Paediatr. 1996
Sep;85(9):1076-9.
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57% of patients with neurological dysfunction
(including Autism and ADD patients) were
shown to have antibodies to gluten (a
component of wheat and other grains.) Lahat E, et
al. Prevalence of celiac antibodies in children with neurologic
disorders. Pediatr Neurol. 2000 May;22(5):393-6.
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A unique type of enterocolitis (infection of the
colon) was found in 93% of individuals with
developmental disorders. Wakefield AJ, et al.
Enterocolitis in children with developmental disorders. Am J
Gastroenterol. 2000 Sep;95(9):2285-95.
2007 Dr. Irfan Qureshi, ND
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Casein:
A role in Pain suppression and
Self-injurious behavior
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Many autistic individuals commonly display
self-immolating behavior
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Self-injurious
Head banging
Scratching to the point of bleeding
2007 Dr. Irfan Qureshi, ND
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Casein:
A role in Pain suppression and SIB
Casein has analgesic effects
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Casein is a “food hormone” that elicits opioid effects on opioid
receptors in the brain. Teschemacher H, Koch G, Brantl V. Milk protein-derived opioid receptor
ligands. Biopolymers 1997;43(2):99-117
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In animals, casein was shown to greatly increase the pain threshold
compared to controls.
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These researchers concluded that one derivative of casein showed painrelieving activity 1000x more potent than morphine. Ruthrich HL, Grecksch G, Schmidt R,
and Neubert K. Linear and cyclic beta-casomorphin analogues with high analgesic activity. Peptides 1992 May-Jun;13(3):483-5
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Beta casomorphin, the casein derivative found in high quantities in
cow’s milk, causes a decreased response to pain. This protein causes
behavioral changes. Blass EM, Blom J. Beta-Casomorphin causes hypoalgesia in 10-day-old rats:
evidence for central mediation. Pediatr Res 1996 Feb;39(2):199-203
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Researchers studied 8 children for the presence of casein derivatives in
the brain. Casein derivatives were found in 19 different functionallyrelevant areas of the brain. These proteins can play a role in the
regulation of many physiological processes. Pasi A, et al. Beta-Casomorphinimmunoreactivity in the brain stem of the human infant. Res Commun Chem Pathol Pharmacol 1993 Jun;80(3):30522.
2007 Dr. Irfan Qureshi, ND
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Casein:
A role in Pain suppression and SIB
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The link to self-injurious behavior
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A study was conducted on 80 autistic children. Researchers
concluded that there is a significant relationship between certain
self-injurious behaviors and the apparent reduced pain reactivity in
autistic children. Tordjman S, Antoine C, Cohen DJ, Gauvain-Piquard A, Carlier M, Roubertoux P,
Ferrari P. [Study of the relationships between self-injurious behavior and pain reactivity in infantile autism].
Encephale. 1999 Mar-Apr;25(2):122-34.
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A study was performed on autistic children with and without SIB.
The results supported the idea that severe self-injurious behaviour
is related to functional disturbances in the endogenous opioid
system. Willemsen-Swinkels SH, Buitelaar JK, Weijnen FG, Thijssen JH, Van Engeland H. Plasma
beta-endorphin concentrations in people with learning disability and self-injurious and/or autistic behaviour.
Br J Psychiatry. 1996 Jan;168(1):105-9.
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Avoidance of casein may be particularly useful in autistic
children who show signs of self-injurious behavior.
2007 Dr. Irfan Qureshi, ND
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Gluten:
Direct harm to the intestines
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Components of gluten can harm the intestines through a
variety of mechanisms.
Studies have shown that components of gluten can cause
death (apoptosis) of intestinal cells in gluten-sensitive
patients. Giovannini C, Matarrese P, Scazzocchio B, Vari R, D'Archivio M, Straface E,
Masella R, Malorni W, De Vincenzi M. Wheat gliadin induces apoptosis of intestinal cells via an
autocrine mechanism involving Fas-Fas ligand pathway. FEBS Lett. 2003 Apr 10;540(1-3):117-24.
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Gluten activates enzymes in the intestines that cause the
breakage of tight junctions between intestinal cells. 
“Leaky Gut”. Clemente MG, De Virgiliis S, Kang JS, Macatagney R, Musu MP, Di Pierro
MR, Drago S, Congia M, Fasano A. Early effects of gliadin on enterocyte intracellular signalling
involved in intestinal barrier function. Gut. 2003 Feb;52(2):218-23.
2007 Dr. Irfan Qureshi, ND
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Gluten:
Direct harm to the intestines
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Gluten causes an abnormal immune response with the activation of high levels of
inflammatory substances and white blood cells. Leads to active inflammation in the
guts. Westerholm-Ormio M, Garioch J, Ketola I, Savilahti E. Inflammatory cytokines in small intestinal mucosa of patients
with potential coeliac disease. Clin Exp Immunol. 2002 Apr;128(1):94-101.
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Some gluten-sensitive patients have been shown to have low levels of enteropeptidase
enzymes (responsible for digesting gluten protein) in their intestines.
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Giving digestive enzymes resulted in near normalized growth. Moroz SP, Hadorn B,
Rossi TM, Haworth JC. Celiac disease in a patient with a congenital deficiency of intestinal enteropeptidase. Am J
Gastroenterol. 2001 Jul;96(7):2251-4.
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Gluten causes flattening of the villi in the intestines of gluten-sensitive
patients.
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Villi are the projections on intestinal cells that allow absorption of nutrients
from foods.
This results in decreased absorption and documented nutritional deficiencies.
The villi return to their normal shapes after gluten removal, and the nutritional
deficiencies are corrected.
2007 Dr. Irfan Qureshi, ND
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The Gut-Brain Connection:
The link between digestion and behavior
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The Gut is our “second brain,” also known as the
enteric nervous system. Both the brain and the gut
develop from the same tissue in the fetus.
There is a network of nerves and neurotransmitters in
the tissue lining the gut that are directly linked to the
brain.
The digestive organs can operate independently from
the CNS. In people who are brain-dead, the stomach
functions properly.
Evidence suggests that emotions and feelings are
intimately associated with bowel function. Example
is Irritable Bowel Syndrome, where stress and
emotions can cause digestive symptoms.
2007 Dr. Irfan Qureshi, ND
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The Gut-Brain Connection:
The link between digestion and behavior
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Many autistic children develop intestinal symptoms at the
same time they are losing acquired skills such as language.
This shows that gut health can have a major impact on
development of sensory skills. Mcmillin DL, et al. The Abdominal Brain and
Enteric Nervous System. J Alt and Compl Med. 1999; 6:575-586.
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One study looked at 12 autistic children with a history of
normal development followed by a loss of acquired skills. All
of them had developed diarrhea and abdominal pain. Wakefield AJ,
et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental
disorder in children. Lancet 1998; 351:637-641.
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The gut, like the brain, has opiate receptors. Drugs like
morphine act on the brain, but also on the gut, to cause
constipation by binding to the opiate receptors.
(http://immune.altmedangel.com/gutbrain.htm)
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Casein and gluten proteins can similarly bind to the gut opiate
receptors, causing digestive complaints.
2007 Dr. Irfan Qureshi, ND
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The Gut-Brain Connection:
The link between digestion and behavior
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Neurological dysfunction in ADD and Autism may be explained
by allergies to foods and additives (as in the case of gluten). Lahat E, et
al. Prevalence of celiac antibodies in children with neurologic disorders. Pediatr Neurol. 2000
May;22(5):393-6.
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Wheat gluten component was shown to have high opioid activity.
Bound receptors as well as a dose of morphine. Huebner FR, Lieberman KW,
Rubino RP, Wall JS. Demonstration of high opioid-like activity in isolated peptides from wheat gluten hydrolysates.
Peptides. 1984 Nov-Dec;5(6):1139-47.
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A group of adults with dementia were later found to be sensitive to
gluten. GF diet improved cognitive activity in some patients. Collin P,
Pirttila T, Nurmikko T, Somer H, Erila T, Keyrilainen O. Celiac disease, brain atrophy, and dementia.
Neurology. 1991 Mar;41(3):372-5.
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A significant number of adults with migraines may have gluten
sensitivity. Gluten-free diet improved symptoms in majority of
cases. Gabrielli M, Cremonini F, et al. Association between migraine and Celiac disease: results from a
preliminary case-control and therapeutic study. Am J Gastroenterol. 2003 Mar;98(3):625-9.
2007 Dr. Irfan Qureshi, ND
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The Gut-Brain Connection:
The link between digestion and behavior
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Study showed that gluten sensitivity can cause
ataxia (problem with coordination and walking) .
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Gluten caused inflammation and damage to the
cerebellum, the spinal cord, and to peripheral nerves in a
group of gluten-sensitive patients. Hadjivassiliou M, Grunewald RA, et al.
Clinical, radiological, neurophysiological, and neuropathological characteristics of gluten ataxia. Lancet. 1998
Nov 14;352(9140):1582-5.
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Clinical evidence of an association between gluten
and schizophrenia. Schizophrenics showed
improvement on a GF diet. Ross-Smith P, Jenner FA. Diet (gluten)
and schizophrenia. J Hum Nutr. 1980 Apr;34(2):107-12.
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Interestingly, there is a subgroup of autistic children who
develop schizophrenia. Petty LK, Ornitz EM, Michelman JD, Zimmerman
EG. Autistic children who become schizophrenic. Arch Gen Psychiatry. 1984
Feb;41(2):129-35.
2007 Dr. Irfan Qureshi, ND
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Determining the need for CFGF diet
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Signs and symptoms- Digestive symptoms indicate the presence of one or
more food sensitivities.
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Researchers have observed that children who exhibit autistic signs near the
time of birth are more sensitive to casein.
 Children exhibiting signs only after the age of 2 are usually more
sensitive to gluten.
Self-injurious behavior and clear digestive signs and symptoms may
be enough to warrant a trial on the diet.
Urine Testing
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Detects the levels of casein and gluten in the urine.
Elevated levels suggest the need to go on the diet. Eliminating gluten and
casein lowers the amount of these proteins in the urine.
Research has shown lowered levels correlate to behavioral improvement.
Advantage of testing:
 May be able to determine whether gluten or casein or both are
problematic.
Testing is only valid prior to beginning CFGF diet!!
2007 Dr. Irfan Qureshi, ND
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Urinary Test for Casein and Gluten
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Available from Great Plains Laboratory (USA)
Relatively simple specimen collection – 5 ml. or more of first
morning urine (ideally).
Sample reports
Patient 1: Results indicate elevated casein and gluten in urine.
Patient 2: Results show elevated gluten, but normal levels of casein.
2007 Dr. Irfan Qureshi, ND
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Outcomes
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Many researchers recommend removing one food at a time.
Start by eliminating casein (dairy products)
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If individual is casein sensitive, results should be seen in 7 to 10
days.
Continue for 3 weeks to be sure of its benefits. If beneficial,
continue further.
Casein is a major culprit in constipation.
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Second, eliminate gluten (wheat and other grains)
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50% of autistic children have constipation.
Gluten elimination takes longer to produce results
Trial should be done for 3 months to determine effectiveness. If
effective, continue the diet.
***There are some reports of benefit seen only after 6
months or longer on the diet.***
2007 Dr. Irfan Qureshi, ND
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Cumulative effects of opioids
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The effects of gluten and casein are mediated by
the concept of “Total Load”
This means that in order for gluten and casein to
have an effect on the brain, a majority of
“opiate” receptors need to be bound
simultaneously.
Reducing the total body burden by eliminating
these foods eliminates the opioid effects.
Eliminating these foods for 4-6 months as much
as possible is a good idea.
Thereafter, the person may be able to have some
casein and gluten-containing food (on a rotation
basis, once every 4-5 days) without problems.
Supplemental enzymes can help
2007 Dr. Irfan Qureshi, ND
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The Bottom Line
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Be as strict as possible on the diet!!
But you will see benefit even if not 100%
compliant!
A trial on the diet is certainly worth
undertaking.
80% of the cases have shown benefit on
the diet in research trials and in practical
experience.
2007 Dr. Irfan Qureshi, ND
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Cautions and Considerations
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Gluten and casein-containing foods are “feel good” foods
because of their opioid effects.
Withdrawal symptoms may be seen (but not in all cases), such
as strong cravings for these foods.
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Yeast and bad bacteria (often seen as an issue in autism) thrive on
these foods, and this is one reason autistic people crave these foods.
Increased irritability is a common symptom.
Withdrawal will last a maximum of 1 to 2 weeks and will diminish
after that.
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Withdrawal is less severe with casein (observation)
Withdrawal symptoms may be avoided by removing only one food
group at a time.
Beneficial side effects include improved presence of mind,
concentration, behavior, diminished self-immolation, drastically
improved digestive function and more!
2007 Dr. Irfan Qureshi, ND
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Nutritional Deficiency with CFGF
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In many autistic children, wheat and dairy form a significant
part of the diet.
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Autistic patients tend to be finicky eaters, with a limited diet.
One reason may be the “feel good” effects of wheat and dairy
products. People “feel good” when eating these foods.
Removal of these foods can pose a problem with nutrition
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Dairy is the major source of Calcium in many of these children
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It is important to seek help from knowledgeable professionals when
considering the CFGF diet
Adequate supplementation may be needed to prevent vitamin and
mineral deficiencies
Professionals can help to properly guide the implementation of the diet.
Interestingly, experience shows that when patients go on a
CFGF diet, their dietary choices tend to significantly broaden.
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Other good sources of Calcium in the diet include green leafy
vegetables, fish, seafood (beware of high levels of mercury and other
heavy metals), beans, nuts and seeds.
2007 Dr. Irfan Qureshi, ND
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CFGF is not the Complete Story
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Other Dietary factors
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Eliminating sugars and simple carbohydrates to
control yeast and bacteria overgrowth
 Eating a healthy well-rounded diet high in
nutrition
Increasing fiber intake and water consumption
to remove toxins
Testing for and removing other food allergens
2007 Dr. Irfan Qureshi, ND
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CFGF is not the Complete Story
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Correcting Leaky Gut and Digestion
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An integral part of the biomedical approach
Intolerances to Casein and Gluten are a result of Leaky
Gut and poor digestive health
Research in patients on a GF diet showed that there was
still an imbalance in the bacteria of the intestines. Patients
still had digestive symptoms.
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The overgrowth of harmful bacteria and yeast persisted even
months into the GF diet. Tursi A, Brandimarte G, Giorgetti G. High prevalence of
small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal
symptoms after gluten withdrawal. Am J Gastroenterol. 2003 Apr;98(4):839-43.
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Treating Leaky Gut and related issues can improve the
effectiveness of the diet
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Reduces reactions to food allergens
Dietary measures can be relaxed when the guts are healed.
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2007 Dr. Irfan Qureshi, ND
Intestinal bacterial imbalance
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Decreased amounts of beneficial bacteria seen in autistic
patients.
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Allows for overgrowth of harmful bacteria and yeast
Can be due to chronic use of antibiotics and other medications,
as well as dietary factors (high intake of refined foods, sugars)
Antibiotics are frequently given for ear infections in
childhood. Overuse and unnecessary use of antibiotics leads
to a number of problems
Autistic children tend to have a number of ear infections
during childhood  Physicians treat with (and parents
request!) antibiotics.
 Earlier incidence of ear infections was correlated to the
development of autism spectrum disorders. In autistic
children, frequency of ear infections also correlated with
severity of autism. (Konstantareas M and Homatidis S. Ear infections in
autistic and normal children. J Autism and Dev Dis 17:585, 1987.)
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Stool tests of autistic patients frequently show no or low
levels of growth of L. acidophilus and Bifidobacterium
species.
2007 Dr. Irfan Qureshi, ND
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Candida and Clostridium

Candida overgrowth of the intestinal tract is
common in autistic individuals, as shown by
increased yeast byproducts in the urine. Shaw, William,
Ph.D. Biological Treatments for Autism and PDD. Overland Park, KS: 2002


Antifungal treatment has also been shown to
decrease the amount of these yeast byproducts
and improve autistic symptoms.
Chronic or frequent antibiotic usage allows
Candida overgrowth of the intestines by killing off
normal beneficial bacteria. Samonis G, et al. Prospective
evaluation of the impact of broad-spectrum antibiotics on the yeast flora of the
human gut. Eur J Clin Microbiology & Inf Dis 13:665-7, 1994.

Some antibiotics have actually been shown to
promote yeast growth. Kasckin P. Some aspects of the candidosis
problem. Mycopathologia et Mycologia applicata. 53:173-181, 1974.
2007 Dr. Irfan Qureshi, ND
39
Candida and Clostridium

Intestinal overgrowth of Clostridium bacteria has also been
identified in some children with autism. Many have high
levels of a metabolite of Clostridium in their urine. Shaw,
William, Ph.D. Biological Treatments for Autism and PDD. Overland Park, KS: 2002


Various Clostridium species cause diseases such as tetanus,
gangrene, diarrhea and botulism.
The DPT vaccine may cause a low level tetanus infection in
autistic children. Shaw, William, Ph.D. Biological Treatments for Autism and
PDD. Overland Park, KS: 2002.; Crone N and Reder A. Severe tetanus in immunized
patients with high anti-tetanus titers. Neurology 42: 761-764, 1992.

Decreased levels of beneficial intestinal bacteria can lead to
an overgrowth of Clostridium following the use of
antibiotics. Clostridium species are resistant to a number of
antibiotics. Finegold S. Anaerobic infections and Clostridium difficile colitis
emerging during antibacterial therapy. Scand J Inf Dis Suppl 49: 160-164, 1986.

Clostridium species produce a potent neurotoxin that can lead
to sensory hypersensitivity, which may help explain some
traits of autistic children.
2007 Dr. Irfan Qureshi, ND
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Intestinal oxidative damage

Oxidative Stress is cellular injury resulting from free-radical
generation that exceeds available antioxidants.



The interplay of genes, nutrients and toxins
determines the level of oxidative stress.
Free-radicals are highly-reactive molecules which damage
cells by oxidizing fats, proteins and DNA.
Some free-radicals are a product of energy metabolism

Environmental toxins (heavy metals such as
mercury, pesticides) are either free-radicals
themselves, or lead to the generation of freeradicals in the body (as do infections and food
allergies).
2007 Dr. Irfan Qureshi, ND
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What Increases Free-Radicals?
Smoking, pollution, ozone
Heavy metals
Inflammatory cytokines
Infections, allergies
Oxidized foods, food additives
Dirty foods (insecticide, herbicide)
Depleted anti-oxidant defense
2007 Dr. Irfan Qureshi, ND
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Antioxidants as free radical scavengers
2007 Dr. Irfan Qureshi, ND
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Free Radical damage
Healthy cells
Delinearization of FFA’s affects
cellular communication and transport
2007 Dr. Irfan Qureshi, ND
44
Immune System abnormalities

Candida interfering with immune function

The immune system of Candida-infected individuals produces
antibodies against Candida proteins that are involved in reproduction.
Vojdani A, et al. Immunological cross-reactivity between Candida albicans and human tissue. J Clin
Lab Immunol 48: 1-15, 1996.

Alpha-gliadin (a part of gluten) from wheat is similar in structure to a
Candida reproductive protein. Antibodies produced against yeast may
be tricked into reacting against wheat. Theoretically, this may be one
reason autistic individuals react to wheat. Shaw, William, Ph.D. Biological
Treatments for Autism and PDD. Overland Park, KS: 2002

Increased WBC’s in the colon

Intestinal analysis performed in 21 autistic children showed increased
numbers of white blood cells, indicating an inflammation or infection
of the intestines. These white cells seem specifically targeted against
the cells of the intestinal walls. This points to gut wall dysfunction in
autistic individuals. Furlano RI, et al. Colonic CD8 and gamma delta T-cell infiltration with
epithelial damage in children with autism. J Pediatr. 2001 Mar;138(3):366-72.
2007 Dr. Irfan Qureshi, ND
45
Immune System abnormalities


Immune proteins (Ig) have been found to be deficient in
autism.
In one study, 20 % of autistic children had IgA antibody
deficiency; 8% lacked it completely; none of the controls
had IgA deficiency. 20% also showed deficiency of IgG.
Gupta S, et al. Dysregulated immune system in children with autism. Beneficial effects of intravenous immune
globulin on autistic characteristics. Autism Develop Dis 26: 439-452, 1996.


Deficiencies of proteins lead to low immune function 
inability to fight off infections.
IgA is the major class of immune globulin associated with
intestinal tissue. A deficiency of IgA means low gut immunity,
predisposing to local inflammation, infection and allergies.
2007 Dr. Irfan Qureshi, ND
46
Putting it all together: A vicious cycle?
•Impaired Digestion/ •Binding of opioid foods, toxins to brain
•Enzyme deficiencies
•Behavioral changes
•Improper breakdown of foods
•Hypersensitivity
•Food Allergies and sensitivities
•Sugars feed Candida/Clostridium
•Food allergens inflame intestines
•Vaccines – DPT and MMR
•Mercury damages gut cells
•Organisms produce chronic infections
•Development of Leaky Gut
•Ear infections/Lung Infections
•Release of toxins
•Antibiotics kill beneficial bacteria
•Entry of toxins
•Allow overgrowth of yeast
•Entry of opioid food proteins
•Promote Clostridium growth
•Impaired detoxification
2007 Dr. Irfan Qureshi, ND
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Relevant Laboratory Assessment

CBC +Chem panel


Serum Homocysteine


a way of determining general health status and
gathering information about vitamin and mineral
deficiencies, liver function, etc.
indicator of methylation status for DNA repair and
detoxification  indirectly assesses need for
methylation cofactors such as B6, folic acid, B12 and
DMG/TMG.
Methylmalonic acid (MMA)

Measure of vitamin B12 deficiency
2007 Dr. Irfan Qureshi, ND
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Relevant laboratory assessment

Food Allergy Assessment

Multiple Options
IgG + IgE Antibody Assessment (blood test).
 Identifies immediate and delayed food reactions.
 Intradermal Testing
 Food Elimination and Challenge.
Intestinal Permeability Studies.
 Testing for “leaky gut”
 Lactulose/Mannitol urine concentrations are measured.
 Patient drinks a solution of two sugars and collects urine for next 6 hours
 Mannitol is a small molecule and is normally absorbed; Lactulose is a large
molecule and is not normally absorbed.
 Elevated concentration of Lactulose in the urine means “Leaky Gut” is
present.


2007 Dr. Irfan Qureshi, ND
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Relevant laboratory assessment

Comprehensive Digestive Stool Analysis.
 Assesses Microbiology, Digestion, Yeast Infection, Absorption /
Malabsorption
 Assess gut bacterial balance.
 Measures levels of Lactobacillus and Bifidobacterium in the
intestines.
 Gives us information on the presence of Candida and pathogenic
bacteria and how they affect gut health.

Urinary Peptide Test
 Checks for excretion of gluten and casein peptides in the urine
 Elevated levels of these proteins correlates with them having opioidlike effects in children.
2007 Dr. Irfan Qureshi, ND
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Relevant laboratory assessment

Organic Acid Testing (OAT panel)






This tests for byproducts of yeast and bacteria.
Urine collection.
Good for picking up systemic infection with Candida
Also useful for testing for the presence of Clostridium
in the intestines
Helpful for distinguishing Candida from Clostridia
overgrowth, or presence of both simultaneously.
Also tests for certain nutrient and vitamin deficiencies.
2007 Dr. Irfan Qureshi, ND
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Relevant laboratory assessment
Not all tests will be positive in all cases of
autism.
 Tests serve as a guide towards
implementation of the protocol
 They help to identify areas of focus for
therapeutic intervention.

2007 Dr. Irfan Qureshi, ND
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Therapeutic Nutritional protocol
•
The goal is to correct underlying digestive
imbalances to:
Improve absorption and assimilation of nutrition
 Reduce food sensitivities
 Impact the physiology of mental function and behavior

2007 Dr. Irfan Qureshi, ND
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Treatment targets and principles
•
•
•
•
•
•
•
•
Dietary Modification
Reducing oxidative damage
Improving Digestive Function
Rebuilding intestinal mucosa and correcting “Leaky
Gut”
Correcting bacterial dysbiosis
Eliminating intestinal pathogens (Candida and
Clostridia)
Removing toxins
Stimulating immune function
2007 Dr. Irfan Qureshi, ND
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Dietary Modification



This is assessed by Food Allergy testing
and Urinary Peptide testing.
Based on the above results, avoidance of
potentially allergenic foods for the duration
of protocol.
If urinary peptide test is positive, avoidance
of gluten and casein is important for the
duration of protocol.
2007 Dr. Irfan Qureshi, ND
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Reducing Oxidative Damage




Increase dietary intake of foods rich in
antioxidants
Good quality, high-potency multiple
vitamin and mineral formula
Additional antioxidant supplements on a
rotation basis
A, C, E, Zinc and Selenium
2007 Dr. Irfan Qureshi, ND
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Improving Digestive function




Dietary avoidance of any potential food
allergens as determined by testing.
Acid-stable fungal-sourced digestive
enzymes
Hydrochloric acid (determined by CDSA)
These improve the breakdown of foods and
increase the absorption of nutrients.
2007 Dr. Irfan Qureshi, ND
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Correcting Leaky Gut / Rebuilding
intestinal tissue
Nutrition for intestinal cell repair and
rebuilding:
 L-Glutamine and other Amino Acids
 Gamma-oryzanol (rice bran)
 Phosphatidylcholine
 Essential fatty acids (combination product
containing both omega 3 and omega 6 oils)
2007 Dr. Irfan Qureshi, ND
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Correcting Intestinal Bacterial
Balance
Aim is to restore beneficial bacteria that normally
colonize the intestines. These bacteria aid in the
digestion of our foods and increase the absorption of
our nutrients.
 Probiotics (containing Lactobacillus and
Bifidobacterium species)
 Fructooligosaccharides (FOS) – food for the
beneficial bacteria. Promotes growth of
Bifidobacterium while inhibiting growth of yeast
such as Candida
2007 Dr. Irfan Qureshi, ND
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Eliminating Candida and Clostridia
overgrowth




Assessed by the CDSA test and organic acids. Can
vary from individual to individual.
Diet should be low in sugars, simple carbohydrates,
alcohol and processed foods. These foods can feed
the yeast.
Various treatments based on type of pathogens
Herbs/ Drugs to control Candida



Products containing Caprylic acid and Oregano oil.
Nystatin and other antifungals
The most effective treatment for Clostridium has
been the use of Probiotics. Shaw, William, Ph.D. Biological Treatments
for Autism and PDD. Overland Park, KS: 2002
2007 Dr. Irfan Qureshi, ND
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Removing intestinal toxins



Increase all sources of dietary fiber.
Candida and other pathogens release toxins
in die-off reactions. These toxins can
further injure the intestinal mucosa.
Fiber binds the toxins in the GI tract and
aids in their removal through the stools.
2007 Dr. Irfan Qureshi, ND
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Improving Detoxification through
Enhanced Methylation






Depending on results of lab tests for
homocysteine and MMA:
Methyl-B12
Vitamin B6
Folic/ folinic acid
Dimethylglycine / Trimethylglycine
Magnesium
2007 Dr. Irfan Qureshi, ND
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Monitoring of Therapy


Two methods to monitor improvement
Clinical/observational (Physician, parents)






Monitoring of behavioral improvements throughout the treatment period
and thereafter.
Customized assessment questionnaires for individual children.
Monitoring improvement over time of gastrointestinal signs and
symptoms (reductions in gas, bloating, constipation, reflux, diarrhea,
etc.)
Questionnaires and food diaries
ATEC (Autism Treatment Evaluation Checklist) scores (ARI website)
 To establish a baseline and to monitor progress
Objective – To monitor improvements in physiology


Initial assessment followed by reassessment of laboratory measures can
be done (Food allergy, Intestinal permeability, CDSA) to determine
physiological changes.
Signs of improvement are reduction of intestinal permeability, improved
digestive function, idealization of intestinal bacterial balance and
reduced number of food allergies.
2007 Dr. Irfan Qureshi, ND
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Practical issues of implementation
specific to Autism
 Collection
of test samples for laboratory
assessment: blood, urine and stool.
 Sensitivity to taste of supplements, ability to
swallow capsules.
 Determining correct dosages of supplements
based on age and body weight.
2007 Dr. Irfan Qureshi, ND
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Remarks



Proper treatment of Autism using the biomedical
approach entails finding the cause of the problem.
Correcting digestion provides a foundation for
optimizing health.
Avoid using the “shotgun approach” to nutrition,
as it may do more harm than good.



Many doctors treat with this approach, rather than
performing the necessary testing (out of ignorance??)
The laboratory testing helps to customize therapy.
“The road to Health is paved with good Intestines” -Unknown
2007 Dr. Irfan Qureshi, ND
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How to Get Started
Co-operation from families and friends
 Where are the sources of casein and gluten
 Learning how to read labels
 Substitutes
 Eating Out

2007 Dr. Irfan Qureshi, ND
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Results of GFCF Survey 2002
Respondents
Average age at
diet start
Average time spent
on diet
Average change in
ATEC score
Dramatic
11.5% (16)
3.0 years
18 months
-85 (82 %)
Excellent
29.5% (42)
3.3 years
13 months
-54 (62 %)
Good
27% (37)
4.7 years
8 months
-28 (38 %)
Moderate
22.6% (31)
4.4 years
7 months
-12 (16 %)
No result
5% (7)
5.7 years
1 month
0
Regression
4.4% (6)
5.5 years
7 months
+5 (16 %)
2007 Dr. Irfan Qureshi, ND
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