Henren- Complementary and Integrative Medicine, Building whole body resilience throughout the lifecycle Flashcards
What are the “three hits” described in the Model for Neurodevelopmental Disorder Etiology?
- First hit – Genetic neurodevelopmental vulnerability
- Second hit – Environmental “stressor” and interaction between the two
- Third hit – Restricted development
What represent the full picture of the expression of an individual’s genes given the environment?
phenotype
What is the study of how the environment can influence gene expression and even pass it along through generations without altering the gene structure?
Epigenetics
Epigentetics is the process through which an environmental stimulus during development alters epigenetic marks (e.g. DNA methylation, histone modifications, etc) and thus gene expression altering developmental trajectory and expression.
phenotypic
Below are some gene-environment interactions that can affect endophenotype
- abnormalities/inflammation
- stress
- Disturbed
- Mitochondrial
- Free fatty acid metabolism
- Excitatory/inhibitory imbalance
- Hormonal effects
- Microglia
Immune
Oxidative
methylation
dysfunction
There are 4 layer based interventions to improve or interfere with possible epigenetic changes. What are those layers?
Layer 4 – interventions, family support, structure
Layer 3-4 – Speech and language, OT, therapy, CBT
Layer 2-3 –
Layer 2 – Biomedical/epigenetic
Layer 1 – modification
Behavioral
Pharmacotherapy
Gene
What role do stimulants play in treating ASD?
can treat ADHD symptoms as upto 40% of those with ASD meet the criteria for ADHD
What medication may work for anxiety, does not work for OCD and ASD in children, and has positive results in adults with autism?
antidepressants
Which 2 drugs have been approved for irritability with those with ASD?
Risperidone and aripiprazole (irritability) are the only FDA-approved medications or biomedical agents for treating autism
What is the grade scale regarding net benefit and recommendation for practice by the US Preventive Services Task Force (USPSTF)?
A (high certainty of benefit),
B (moderate certainty of benefit),
C (net benefit small),
D (no benefit or harms outweigh benefit),
I (evidence lacking or conflicting).
What are the levels of certainty regarding net benefit and recommendation for practice by the US Preventive Services Task Force (USPSTF)?
Low
Moderate
High
Regarding the perinatal risk factors of autism:
Our review, in agreement with other reviews, supports the possibility that interventions to normalize or mitigate these processes, particularly in the or perinatal period, could lead to resilience and health in the developing and child.
preconception
newborn
What maternal infection and associated inflammation during pregnancy that is associated with increased risk of autism?
congenital rubella
methylmercury, PCBs, Toluene, Arsenic are all examples of what? And can increase the risk of autism if pregnant woman exposed?
environmental toxins
Which mood stabilizer is contraindicated during pregnancy?
valproic acid
What medication once used to treat morining sickness during pregnancy, can increase the risk of autism for offspring?
thalidomide
What OTC medication can increase pregnancy autism risk?
acetaminophen
SSRIs may/may not increase pregnancy autism risk?
may
- Air Pollution
- Pesticides
- Bisphenols and Phthalates
and heavy metals have all been associated with increased pregnancy risk.
autism
Acid and multivitamin Supplements before and during pregnancy associated with reduced risk of ASD (45,300 children; P
Folic (associational evidence only)
What are the 4 OTC supplements that may have enough evidence to make a positive difference with ASD?
Omega 3
N-acetylcysteine (NAC)
Micronutrients
Digestive enzymes
Which 4 BioMedical/CIM treatments might be seriously recommended in treatment of ASD?
- Melatonin
- Omega-3
- Vitamin D3
- NAC
Which 2 BioMedical/CIM Treatments have interesting yet not convincing evidence for treatment of ASD?
- Methyl B12
- Vitamin/Mineral Supplements
What kind of evidence was provided for the following BioMedical/CIM Treatments:
• Diet • Microbiome • Pancreatic Digestive Enzymes • CBD/THC • Probiotics
Not enough evidence to be recommended
What 2 BioMedical/CIM Treatments have been found to have positive benefit and are recommended for immune/inflammation?
Melatonin (Grade B; Mod; Rec/Offer)
Vitamin D (Grade C; Mod; Rec/Offer for selected patients),
CoQ10, L-carnosine, and Carnitine did/did not provide net benefit had a low/high level of certainty affecting mitochondrial function?
did not
low
What endogenous neurohormone causes drowsiness, establishes circadian rhythms and synchronization of peripheral oscillators, and is produced from serotonin?
and
May also benefit social communication impairments and stereotyped behaviors or interests
Melatonin (Grade B, Moderate, recommended)
What vitamin is lower in patients of sever autism vs. mild/moderate autism and significantly improved CARS and ABC outcomes?
Vitamin D3 (Grade B, Mod, rec for those interested)
Among the 73 completers, both vitamin D and recipients had reduced irritability symptoms, while vitamin D group also had reduced symptoms relative to placebo.
omega-3
hyperactivity
Dysfunctional and alterations in reactive oxygen species homeostasis are potentially involved in the pathogenesis of Down syndrome, Rett syndrome, autism, and Fragile-X.
mitochondria
group reported statistically significant improvements in sleep (65.38%) and gastrointestinal problems (61.53%) for those with ASD in an RCT.
CoQ10
Which 2 BioMedical/CIM Treatments could be considered for treatment/prevention of oxidative stress?
Methyl B12 (Grade C; Low; insuff/consider )
(Net benefit; Level of certainty; Recommendation for practice)
NAC (Grade B; Mod; rec/offer)
Primary outcome measure CGI-I and the mean at 8 weeks was significantly better (lower) in the
group (2.4) compared to the placebo group (3.1) (95% CI 1.2 to 0.2, P = .005 • Clinical improvement in CGI-I was significantly correlated with methionine (P = .05), decreases in SAH (P = .007), and improvements in SAM/SAH (P = .007)
methyl B12
(Grade C Low; insuff/consider)
What is a glutamatergic modulator and an antioxidant?
N-acetylcysteine (NAC)
(Grade B Mod; consider)
What supplement was used in a study considering the following urinary metabolites?
§ Oxidative stress
§ Amino acid/gut microbiome
§ Neurotransmitters
§ Hormones
§ Sphingomyelin metabolism
sulforaphane
Review the following BioMedical/CIM Treatments that could be useful or of some benefit?
Omega 3 Grade B; Mod; rec/offer
Folic/Folinic acid Grade C; Mod; recommend if low levels
Vitamin D Grade C; Mod; Rec/Offer for selected patients
Oxytocin Grade C; Mod; possible accept
Micronutrients Grade B; Mod; possible rec
Iron Grade C; Mod; rec if low levels
Omega 3 Grade B; Mod; rec/offer
Folic/Folinic acid Grade C; Mod; recommend if low levels
Vitamin D Grade C; Mod; Rec/Offer for selected patients
Oxytocin Grade C; Mod; possible accept
Micronutrients Grade B; Mod; possible rec
Iron Grade C; Mod; rec if low levels
• Normative brain development and function relies heavily on fatty acids (PUFA), and for children and adolescents with neurodevelopmental disabilities
polyunsaturated
Multiple RCTs reported on social awareness, social motivation, social communicative functioning, and hyperactivity levels, revealing slight to significant improvements for children with autism who supplemented their diet with (Bent et al. 2014; Ooi et al. 2015; Mazahery et al. 2018).
omega-3
• An RCT in N=31 preterm-born toddlers with ASD aged 18-38 months tested omega-3-6-9 supplementation (338 mg eicosapentaenoic acid, 225 mg DHA, and 83 mg GLA) versus placebo. Those assigned to the daily supplement treatment group exhibited a greater reduction in ASD symptoms (reflected by improved sensory processing in Boone et al. 2017; improved ASD symptoms per the Brief Infant Toddler Social Emotional Assessment ASD scale.
omega-3
Which BioMedical/CIM Treatment improves verbal communication in children with autism and language impairment?
Folinic acid
Which 2 Microbiome treatments exhibited Grade I; Low; insufficient/ possible accept if family interested?
probiotics
parncreatic digestive enzymes
What can Modulate Behavioral and Physiological Abnormalities Associated With Neurodevelopmental Disorders?
Microbiota
Open-label trial of Transfer Therapy (MTT) of 18 ASD-diagnosed children. 80% reduction of GI symptoms at the end of treatment that persisted 8 weeks after treatment.
ASD symptoms improved significantly which persisted 8 weeks.
Microbiota
Enzyme deficiencies in children with autism result in an inability to digest • The inability to digest affects the production of amino acids essential for brain function
protein
protein
What system is thought to be involved in social interaction and emotional responses and is being investigated as a component of the underlying pathophysiology of ASD?
endocannabinoid system
What products are thought to have neuroprotective and anti-inflammatory effects as well as the ability to modulate the endocannabinoid system?
Cannabidiol (CBD)
The biomedical CIM treatments that have the most published evidence with enough certainty and safety to recommend include melatonin, , vitamin D, and. Those with some evidence and significant promise for treating ASD or associated symptoms in children include methyl B-12, , and folic acid for families interested in trying them.
omega-3
NAC
sulforaphane
Review the Integrated Whole Body Approach to NDD Treatment
- Medical – genetic, neurology, GI, other medical symptoms
- Ancillary – speech, OT, OMT
- Behavioral
- Treat associated symptoms – pharmacology
- Biomedical assessment and treatments – melatonin, omega-3, vitamin D3, probiotics, digestive enzymes
- Building personal relationships and resilience are all encompassing
- Medical – genetic, neurology, GI, other medical symptoms
- Ancillary – speech, OT, OMT
- Behavioral
- Treat associated symptoms – pharmacology
- Biomedical assessment and treatments – melatonin, omega-3, vitamin D3, probiotics, digestive enzymes
- Building personal relationships and resilience are all encompassing
