Biological Treatments for
Autism and PDD
Third Edition
Dr. William Shaw
Smashwords Edition
Copyright 2011 William Shaw
With
contributions by Bernard Rimland Ph.D., Bruce Semon M.D. Ph.D., Lisa
Lewis Ph.D.,
Karyn Seroussi, and Pamela Scott
This ebook is licensed for your personal use only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
ISBN 978-0966123852
DISCLAIMER
This book is a summary of current research and medical therapies in use for the treatment of autism and PDD. The authors have written this book to serve as a guide to therapies and as a reference source for both professionals and nonprofessionals. All of this information is meant to be used under the care of the patient’s health care professional and the authors do not intend that the information in this book be considered as a prescription for medical therapy for anyone. Many of the therapies discussed in this book are relatively new and may be associated with risks that may not be known for decades. Every medical therapy has inherent risks. The reader and the medical professional who treats himself or his children are responsible for weighing the risks involved in any of the therapies reviewed in this book before instituting such therapies. Although the authors have exhaustively researched all sources to ensure the accuracy of the information in this book, we assume no responsibility for errors, inaccuracies, or omissions.
Acknowledgements
I would like to thank the following individuals who have assisted me in many different ways in this work: Steve and Sandy Passer, Sidney Baker M.D., Bernard Rimland Ph.D. at the Autism Research Institute, Ellen Bolte and Portia Iversen at the Cure Autism Now Foundation, William Crook M.D. of the International Health Foundation, Kelly Dorfman and Patricia Lemer at the Developmental Delay Registry, my teachers, especially Samuel Rogers Ph.D., D.V.M. for his outstanding instruction in basic biochemistry, and Ellen Kassen for her outstanding work in the laboratory. I would also like to thank the hundreds of other parents and professionals who supported and encouraged my work and offered me additional information that led to me to explore new therapies and theories.
William Shaw Ph.D.
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each recipient. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.
TABLE OF CONTENTS
Chapter 1: Infections, antibiotics, and their relationship to autism and ADD: Alternative treatments.
Is there an autism epidemic? The antibiotic revolution: Ear infections; Nonhuman use of antibiotics and the rise of antibiotic-resistant bacteria; Bacteria that causes ear infection; Vaccines; Ear infections and other recurrent infections and how to break the cycle or at least reduce the damage
Chapter 2: The microorganisms in the gastrointestinal tract
Bacteria in the intestinal tract; Yeast overgrowth of the intestinal tract; Evidence for abnormal bacterial byproducts in autism; HPHPA as a possible indicator of abnormal neurotransmitter formation; Control of clostridia overgrowth; Relationship between the immune system; early use of antibiotics and the microorganisms in the gastrointestinal tract
Chapter 3: Organic acid testing, byproducts of yeast and their relationship to autism
Metabolic disease testing: the history of organic acid testing; Evaluation of two brothers with autism, Evaluation of a third child with autism; Properties of tartaric acid; Arabinose and Candida; Other sources of arabinose; Arabinose, pentosidine, and protein crosslinks; Arabinose and impaired vitamin function; Pentosidines, tangled nerves, Alzheimer’s disease, and autism; Prevention of pentosidine formation with high doses of vitamin B-6 and other vitamins
Chapter 4: Yeasts and fungi: How to control them
Diagnosis of yeast disorders;Stool testing; Organic acid test for yeast and bacterial byproducts; Blood tests for candida; Interactions of yeast and other bacteria; Antifungal therapies; Probiotics; Nonprescription Antifungal products; Diet to control yeast overgrowth; The yeast die-off or Herxheimer reaction. Garlic; Oregano; Caprylic acid and MCT oil; Colloidal silver; Lactoferrin; Combination products; Biotin; Biotinidase deficiency; Prescription antifungal products;Amphotericin B; How to administer nystatin
Chapter 5: Immune deficiency, food allergies, and yeast suppression of the immune system in autism
Overview of the immune system; Antibodies or immunoglobulins; Cellular immunity; Types of immune deficiency that occur in autism; Myeloperoxidase deficiency; Severe combined immunodeficiency disease (SCID); Selective IgA deficiency; IgG subclass deficiency; Complement C4b deficiency; Gliotoxins and other immunotoxins produced by yeast and fungi; Other toxic byproducts of Candida; Autoimmunity, molecular mimicry, and Candida; The wheat and yeast connection; Therapies; Gamma globulin therapy. Insurance coverage for immune therapies; Cimetidine; Transfer factor therapy; Bovine colostrums; Pentoxifylline; IL-2; Allergic phenomena, food sensitivity, and altered behavior; Tests of allergies; Immunotherapy with enzyme-potentiated desensitization (EPD);Homeopathy; Treatment for allergic symptoms of wheat and dairy products; NAET
Chapter 6: Abnormalities of the digestive system
Gluten and casein sensitivity; Historical perspective; Antibodies to transglutaminase cause celiac disease; Differences between wheat sensitivity in autism and celiac disease; Testing for wheat and dairy sensitivity; Restriction of gluten and casein from the diet; Prevention of calcium deficiency on the casein free diet; Soy Sensitivity, Use of other therapies to control gluten and casein sensitivity; Other new peptides that may be important in autism; High-Protease/Peptidase Enzyme Products Enhance Protein Digestion; Alpha-1-antitrypsin deficiency; Pancreatic atrophy, hypoglycemia, and antibiotics; Secretin; Routes of administration and forms of secretin; Adverse reactions to secretin; CCK; Abnormal bile secretion; Tests of pancreatic function; Other digestive enzyme supplements; Behavior, food dyes and inactivation of digestive enzymes
Chapter 7: Immunizations and autism
Congressional investigation of vaccine safety; A brief history of vaccines; A parent speaks out on vaccines; MMR vaccination and autism; Credibility gap of health care officials on vaccine reactions; Positive aspects of childhood diseases; Hepatitis B vaccine and autism; DPT vaccine and autism; The acellular pertussis vaccine; Reporting vaccine damage; Class action lawsuits in the United Kingdom; Vaccine damage fund in the United States; When to think about refusing vaccination; What factors to consider in delaying or omitting vaccination
Chapter 8: Heavy Metals Toxicity
Heavy metals, especially mercury, implicated in autism and learning disabilities; What is mercury? Health effects of mercury and recurrent Candida; Other heavy metals; Treatments of mercury toxicity; How to decide which test is most appropriate for metals testing; Side effects of DMSA; Treatment for heavy metal toxicity; DMSA treatment; Lipoic acid; PCA; Tests available from the Great Plains Laboratory
Chapter 9: Inborn Errors of Metabolism as Causes of Autism
Abnormal purine and pyrimidine metabolism in autism: new tests and treatments for people with unique subtypes of autism and PDD; Dihydropyrimidine dehydrogenase deficiency; Low urine uric acid and elevated nucleotidase in autism: A subtype of autism that responds to dietary pyrimidine supplementation; High uric acid and autism: A subtype of autism that responds to dietary restriction of purines and/or allopurinol; Abnormal succinylpurines and autism; Testing
Chapter 10: Frequently Asked Questions
Chapter 11: The Use of Vitamin B6, Magnesium, and DMG in the Treatment of Children and Adults with Autism, by Bernard Rimland Ph.D.
Vitamin B6 (and magnesium) in the treatment of autism; Vitamin B6 in autism: the safety issue; Dimethylglycine (DMG), a nontoxic metabolite, and autism.
Chapter 12: Treating yeast in children with autism: typical results of anti-yeast therapy, by Bruce Semon, M.D. Ph.D.
Introduction; Case histories; Diet and antifungal treatment; Origin of the treatment; The medical regimen: diet plus nystatin; Is this treatment worth the family's aggravation for the sake of my child? Using nystatin; Other anti-fungal medications; How long does treatment last? How does the anti-yeast treatment compare with standard psychiatric medication for children with autism? Are there any other natural substances to treat autism? Conclusion
Chapter 13: Dietary Intervention for the Treatment of Autism: Why Implement a Gluten and Casein Free Diet? by Lisa Lewis Ph.D.
Introduction; What is gluten? Why eliminate it from the diet? Further research; Sam's story; Jake's story; Testing for urinary peptides; Testing for celiac disease; Phenol-sulfur transferase (PST) deficiency; Where to go for help with a gluten and casein free diet; Where do we go from here? Sam’s story-today
Chapter 14: Managed recovery from autism and ADD: One family’s journey, by Pamela Scott
Introduction; Diagnosis of Autism, “Intervention”; Anti-Candida Diet; Taylor’s Supplements; Alan’s Supplements, Implementing the Anti-Yeast Diet and Dealing with the Yeast die-Off Reaction; The Tide Begins to Turn; Home-Based Program; Therapy Schedule; Behavioral Effects of Food Allergies and EPD Therapy; Recovery from Autism; The Rest of Our Story
Chapter 15: Following a different path. A child’s documented recovery from autism, by Karyn Seroussi
Frequently asked questions about dietary intervention
Chapter 16: Summing up, by William Shaw, Ph.D.
Implications for Gene-Searching; Where Do We Go From Here?
PREFACE
Many new developments have occurred in the field of autism since the first edition of Biological Treatments for Autism and PDD in 1998. The most significant developments have been the discovery of significant abnormalities in the structure and function of the gastrointestinal tract in children with autism by Andrew Wakefield at the Royal Free Hospital in London and by Karoly Horvath at the University of Maryland School of Medicine. Wakefield’s hypothesis is that these gastrointestinal abnormalities are due to the infection of the gastrointestinal tract by the vaccine strain of the measles virus. The presence of this virus in the intestinal biopsy samples of children with Autism while not being present in the controls is powerful evidence supporting his hypothesis. In addition, high concentrations of numerous heavy metals found in many children with Autism and the reduction of autistic symptoms after their removal points to multifactorial causes for autism. The marked increase in the incidence of autism has been confirmed in almost every state in the United States as well as in numerous other nations as well. The work of Ted Page, Mary Coleman, and others that research the genetic diseases which cause disordered purine metabolism, is very exciting because a simple dietary supplement of uridine can reverse almost all autistic symptoms in this subgroup of people. Confirmation of the effectiveness of many other therapies introduced in the first edition such as gluten and casein restriction, antimicrobial therapy, gamma globulin treatment, and use of secretin have now been confirmed by both additional scientific studies and the experience of tens of thousands of parents and physicians who have utilized them.
As in the first edition, the purpose of writing this book is to integrate information from the fields of biochemistry, immunology, genetics, nutrition, and microbiology about autism, ADD, and PDD into a form that could be assimilated by both parents, professionals such as nutritionists, dietitians, and physicians who deal with children with these disorders. Long conversations with hundreds of parents of children with autism and PDD, including many who are themselves physicians, have provided me with many clues to these disorders.
The information in this book may be useful not only for people with autism, but also for those with other disorders that share in some of the symptoms of autism including pervasive developmental disorder (PDD), Rett’s syndrome, Williams disease, neurofibromatosis, tuberous sclerosis, Fragile X, Down’s syndrome, Tourette’s syndrome, Prader-Willi syndrome, and attention deficit disorder (ADD). Many of the same abnormalities in autism are also present in these disorders and the therapies suggested in this book for autism may also help children and adults with these other disorders as well. My objectives are to describe the abnormalities in autism and related disorders and to discuss some of the therapies that have frequently been beneficial for many children and adults. Although a few children have completely recovered from autism using the therapies outlined in this book (and the parents of two of them include their accounts in this book), I am not suggesting that all children will benefit but hope that many will benefit to some degree. Biological Treatments for Autism and PDD has now been translated into Spanish, German, and Dutch and many other languages. The feedback I have received is that the therapies covered in this book have been effective worldwide.
The accounts of the two mothers whose children completely recovered are very significant because of the similarities of the therapies they used. Both mothers obtained information and instituted therapy independently. Both children were diagnosed early about the age of two years. Both mothers independently began using antifungal therapy, an antiyeast diet low in sugar and free of yeast, treatment of food allergies, and a gluten and casein-free diet as key cornerstones of their therapy, both also used intensive behavioral interventions as well. You will note that there are significant differences in the nutritional and antifungal approaches presented by different authors in this book. I realize that this may be confusing, but this information honestly reflects the fact that there are still many unknowns. You may wish to experiment with several of the different nutritional and antifungal approaches to determine which ones are most beneficial for your patient or child.
Some of this material may be difficult but every attempt has been made to simplify it without distorting the meaning. Knowledge is power. Much of this information may not be familiar to parents or to medical practitioners. The parent who reads this book should assume that their family doctor or even their neurologist or other specialist may not know nearly as much as they do about autism after reading this book. Until recently, most of this information has been available only in the form of research papers accessible only to medical research specialists, and was essentially unknown by persons outside each narrow specialty. There has been a tremendous increase in the application of knowledge about autism and PDD that was stimulated by a group of physicians and scientists who met in Dallas in January 1995 as a part of Dr. Bernard Rimland’s Defeat Autism Now! (DAN!) Conference.
My goal is that this book will enable your child to become healthier and function better so, as a result, both you and your child will have a better life. I am sure to be criticized for recommending therapies based on “incomplete” or “anecdotal” data. While acknowledging the great benefits of antibiotics and vaccines in treating disease, I think the overuse of antibiotics and vaccines have harmed substantial minorities of treated individuals. However, I think the dangers to our children are too great to wait until all the data is perfect, which could take a very long time. The Red Cross refused to act on behalf of the Jews in German concentration camps in World War II despite numerous reports of genocide because the evidence was “anecdotal" rather than “definitive.” It has taken nearly 50 years from the time of the first research linking lung cancer and smoking to get restrictions on cigarette use for minors. It took 25 years from the initial discovery that folic acid supplementation prevented a birth defect called spina bifida until extra folic acid supplements were recommended for pregnant women. The stakes for the safety of our children are too high to wait forever.
William Shaw Ph.D.
ABOUT THE AUTHORS
William Shaw received a Ph.D. in biochemistry from the Medical University of South Carolina. He has board certifications in both the fields of Clinical Chemistry and Toxicology. He worked for six years in nutritional biochemistry, endocrinology, and immunology at the Centers for Disease Control; for twelve years in a large medical testing laboratory called Smith Kline Beecham Clinical Laboratories, involved with specialized medical testing for toxicology (poisons and drugs), chemistry, immunology, and endocrinology. The next five years, he was an associate professor at the University of Missouri at Kansas City (UMKC) School of Medicine and Director of Clinical Chemistry, Toxicology, and Endocrinology and the organic acid testing for metabolic diseases at Children’s Mercy Hospital, the teaching hospital for the University of Missouri at Kansas City School of Medicine. Dr. Shaw has lectured throughout the world on autism and has been a keynote speaker at the Autism Society of America National Meeting, the National Meeting of the American Association for Environmental Medicine, and the National Meeting of the American College for Advancement of Medicine. He is actively involved with both the “Defeat Autism Now” (DAN) group and the “Cure Autism Now” (CAN) foundation. Dr. Shaw is the author of many scientific papers and the co-author of two book chapters dealing with laboratory medicine and nutritional biochemistry. Dr. Shaw can be reached by phone at (913)341-8949 or by e-mail at williamsha@aol.com. The website for The Great Plains Laboratory is www.greatplainslaboratory.com and the mailing address is The Great Plains Laboratory, 11813 W. 77th St, Lenexa, KS 66214.
Bernard Rimland Ph.D. passed away in 2006. He was a research psychologist and was the director of the Autism Research Institute since it was founded in 1967. He was the editor of the Autism Research Review International and was the founder of the Autism Society of America. His prize-winning book Infantile Autism: the Syndrome and its Implications for a Neural Theory of Behavior is credited with changing the field of psychiatry from its “blame the mother” orientation to its current recognition that autism is a biological disorder, not an emotional illness. He lectured on autism and related problems throughout the world, was the author of numerous publications and received many awards for his work on autism. Dr. Rimland served as primary technical advisor on autism for the film Rain Man. Dr. Rimland, who earned his Ph.D. in experimental psychology and research design at Penn State University, had also conducted research on the relationship between nutrition and behavior. He was a past officer of several societies devoted to research in this area, and had lectured and published extensively on this topic, as well as in the field of autism.
Bruce Semon M.D. Ph.D. is both a child psychiatrist and nutritionist practicing in Milwaukee, Wisconsin. He has practiced nutritional medicine since 1991. He received his M.D. from University of Wisconsin-Madison in 1984 and his Ph.D. in Nutrition from University of California-Davis in 1989. He was a Fellow at the National Institute of Health, National Cancer Institute (Laboratory of Nutritional and Molecular Regulation) from 1989-1991. He completed an adult residency in psychiatry at the Medical College of Wisconsin in 1995 and a fellowship in child and adolescent psychiatry in 1997. Dr. Semon has published several academic papers relating to nutrition. Dr. Semon has treated many patients suffering from autism and other disorders in conventional ways, seeing very few positive changes. He has treated many patients for yeast-related illnesses, including eczema, psoriasis, depression and autism, with remarkable results. He is using the nutritional approach in his private practice in Milwaukee, as well as in a Milwaukee based mental health clinic with which he is affiliated. Dr. Semon and his wife, Lori Kornblum, have publishing a cookbook Feast Without Yeast with recipes for a diet free of yeast and fermented foods, casein, gluten, eggs, corn, and soy. Dr. Semon can be reached at: 250 W. Coventry Court, Suite 101, Glendale, Wisconsin 53217, (414) 352-6500.
Lisa S. Lewis Ph.D. is the mother of two children, one of whom was diagnosed with autism at the age of three. Her formal academic training is in biological anthropology and while earning a doctorate in that field, she studied genetic variation and performed studies of blood proteins in several species of non-human primates. This background in science laid the foundation for understanding the theories underlying dietary interventions. In additions, she has a great interest in baking and runs a small catering business which specializes in children’s birthday cakes. For the last ten years, Dr. Lewis has been in the computing field. After her son’s autism diagnosis, she found that doctors had little to offer in the way of information or treatment. As a result of doing her own research, dietary intervention, which began as a trial, has now become a way of life for her son. Having spent so much time and energy trying to understand the why’s and the how’s of this diet, she was able to put together an eighteen page information brochure that was widely distributed. She is the author of the recent book Special Diets for Special Kids: Understanding and Implementing Special Diets to Aid in the Treatment of Autism and Related Developmental Disorders.
Karyn A. Seroussi is the co-founder with Lisa Lewis of the Autism Network for Dietary Intervention, and a co-founder of the Rochester, NY chapter of Parents of Allergic Children. She lives with her husband and two children, all of whom have different dietary requirements. She has completed a very popular book, Unraveling the Mystery of Autism and Pervasive Developmental Disorder, A Mother’s Story of Research and Recovery, which tells of her family’s experience and her son’s recovery from autism.
Pamela Scott is a parent first and an advocate for life. She is currently working as a Parent Training Consultant for The Parent Connection. The Parent Connection is devoted to making broad systems change in the way families access services through Missouri's Division of Mental Retardation and Developmental Disabilities. The Parent Connection offers educational workshops, training, and presentations. These services are available to families, parent groups, and the professionals who work with them.
FORWARD
Dr. Shaw has performed a great and much needed service for the parents of children with Autism--and the physicians who work with children with Autism--by publishing this book.
There are a great many parent guidebooks, which offer psychological and educational advice. There are also many books, which discuss esoteric medical and scientific issues. There are, however, very few books like this one which address the practical, here and now biomedical treatments that can bring about dramatic improvement in many autistic individuals.
The term autism (and the newer, quite confusing term “PDD”) are umbrella words which cover a broad array of disorders sharing a number of overlapping symptoms, but having a large variety of different causes. No one knows how many causes of autism there are. But there are some causes we do know about, and about which we have a rudimentary understanding.
Children or adults with autism caused by some of the factors covered in this book can be treated with some success and often with quite dramatic success. And it is to some of these known causes, and their treatments, that this important new book is addressed.
The reader will quickly discover that this book is “user friendly”. Its purpose is to clarify, to explain, to guide, and to encourage so that at long last the parents themselves can begin to do what they have always wanted to do—have a real hand in the healing of their child with Autism.
Thank you Dr. Shaw.
---------Bernard Rimland Ph.D., November 1997.
Chapter 1-Infections, Antibiotics, Vaccines, and their Relationship to Autism and ADD:Alternative Treatments
Dr. William Shaw
Is There an Autism Epidemic?
The late Bernard Rimland Ph.D., at the Autism Research Institute (1), asked the question “Is there an autism epidemic?” His data in Table 1 shows that, between 1965 and 1969, only 1% of parents who contacted him were inquiring on behalf of a child with autism less than 3 years old. However, between 1994 and 1995, 17 % of the parents who called him were inquiring on behalf of a child under the age of 3. Presumably, the higher percentage of inquiries on behalf of children under three could be attributed to two factors: (1) a greater knowledge about autism on the part of physicians and parents, leading to an earlier diagnosis and/or (2) a higher incidence of autism in the younger age group. Furthermore, a large number of professionals, including pediatricians and physicians with large practices in the field of autism, have noticed an increase in the incidence of autism. William Crook M.D., a pediatrician who started his practice in the 1950’s, although being aware of the symptoms of autism, says that he did not see a case of autism until 1973, 24 years later. From that point on, it seemed to him that the incidence of autism accelerated. Acknowledging this increase is critical for determining whether autism is mostly caused by genetic or environmental factors. If autism is mainly due to genetic factors, the incidence of autism would be constant. Furthermore, the percentage of individuals with autism in a particular age group would be the same. Thus, if the incidence of autism in three year olds is one in a thousand, the incidence of autism in fifty year olds should also be one in a thousand.
Table 1
Fortunately, similar data has been reported in Iceland (2). Iceland is an ideal country for this evaluation since a single institution confirmed all cases of autism in the entire country and since the investigators personally reviewed all the diagnosed cases, data variability was minimized. These investigators found that the incidence of autism had doubled over the last 20 years. Furthermore, the male to female ratio had increased significantly over the same time period. This study is extremely important since it shows that factors other than genetics may be causing autism. What could some of these nongenetic factors be?
Kontstantareas and Homatidis (3) at the University of Guelph in Ontario, Canada found a high correlation between the prevalence of ear infections and the incidence of autism. They found that the earlier a child with autism had an ear infection, the more likely that child had a more severe form of autism. They also found that the increased incidence of ear infections was also associated with the more severe rather than mild form of autism. Many similar studies have been conducted in the field of attention deficit hyperactivity (ADHD). These studies also indicate that increased ear infection early on in life results in much greater incidents of hyperactivity (4-8). Roberts and his colleagues (4) reported that recurrent otitis media during infancy was correlated with increased distractibility of the students later in life. Other studies (5-8) correlated recurrent otitis media in infancy with later low IQ scores, poor performance on reading, spelling, and math tests, increased retention in grade levels, increased attention deficits, and increased behavior problems in school.
Both the autism and ADHD research groups have assumed that this abnormal development is caused by hearing impairment brought on by the ear infection. My own interpretation of this data is that the abnormal development is instead caused by abnormal byproducts of yeast and drug-resistant bacteria being absorbed into the body from the intestines following the excessive use of antibiotics. Later chapters will deal with the mechanism of this problem in great detail.
The Antibiotic Revolution
Antibiotics were first produced on a commercial scale around the end of World War II. In 1949, the amount of antibiotic production was very low, about 80 tons per year (9). In addition to this low production, the kind of antibiotic used was mostly of the injectable type. But by the 1950’s, the use of oral antibiotics became more predominant. As a child in grammar school in the 1950’s, I got most of my antibiotics injected into the buttocks. By 1954, 250 tons of antibiotics per year were being produced. By 1990, 20,000 tons (40 million pounds) of antibiotics per year were being produced (9). I believe that this explosive growth in the use of antibiotics is a major factor for the increased incidence of autism, developmental disorders such as ADD, as well as a number of adult disorders such as fibromyalgia. In the United States, one of the main reasons for antibiotic use in children is to treat the condition called otitis media or ear infection.
Ear Infections
According to a publication (10) by The Panel for Otitis Media, a group of prominent pediatricians and scientists from throughout the United States concluded that:
Ear infections account for one-third of all visits to the pediatrician and 75% of all follow-up visits.
Between 1975 and 1990, office visits for otitis media increased by 150% to 24.5 million visits per year.
Children under age two had the highest rate per year of office visits to the doctor for evaluation of otitis media and also the greatest increase in visits per year between 1975 and 1990: 224%!
A two year study of children between the ages of 2 and 6 years in day-care showed that 53% had at least one episode of otitis media during their first year and 61% during their second year. Thirty percent of the children had recurrent bouts of otitis media.
A cost analysis in 1991 estimated that the cost per episode, including direct and indirect costs, prescription drugs, and parents’ time lost from work at $406 for a total yearly cost in 1991 of about ten billion dollars.
Otitis media has proven to be a cash cow to both primary care physicians and the drug industry. Now consider another 30 billion dollars a year spent on specialized speech and developmental therapy (11) and billions of dollars more spent to treat ADD, PDD, autism, and other disorders. If, in fact, the overuse of antibiotics is related to the increase in these disorders, then the financial impact of otitis media is very large indeed.
Nonhuman Use of Antibiotics and the Rise of Antibiotic-Resistant Bacteria
In addition to the marked increase in antibiotic use in humans, the use of antibiotics in food animals has also sky-rocketed, not because the animals are sicker than usual, but because they gain weight much faster when antibiotics are given with their feed. According to regulations, the animals are supposed to be withdrawn from antibiotic use prior to slaughter so that most of the antibiotics they are exposed to will have been eliminated by the time of their death. However, the abnormal microbial ecology in the intestines of these animals caused by the use of antibiotics persists. It seems likely that chemical byproducts (such as gliotoxins) produced in the intestines of these animals by yeast, fungi, and antibiotic-resistant bacteria may be absorbed into their bloodstream and are likely to be present in their meat as well. It is difficult to know how much of a problem this is for humans who eat this meat. Pamela Scott, who has written a later chapter in this book, was so concerned about this problem that she only fed her son meat from range animals not exposed to antibiotics in feedlots.
According to Stuart Levy M.D. a professor at Tuft’s University School of Medicine in his book The Antibiotic Paradox: How Miracle Drugs Are Destroying the Miracle (9), the use of antibiotics for fattening animals and other agricultural uses also selects for more drug-resistant bacteria. These bacteria then enter the ecosystem through the meat and feces of these animals and, in turn, may infect humans. Dr. Levy found that six months after the use of antibiotics in feed for chickens, stool samples from humans in the surrounding community contained the same drug-resistant bacteria that had developed in the chickens. The use of human antibiotics in animal feed has been banned in Great Britain but is still allowed and is widely used in the United States. Antibiotics have even been added to the water in which salmon and catfish are raised, and as a result, antibiotic-resistant bacteria have been found in the flesh of these fish. In addition, antibiotics such as Streptomycin and oxytetracycline have been sprayed from airplanes to control diseases in fruit trees and potatoes, allowing the development of drug-resistant bacteria in soils over a wide geographic area. Some pathogenic bacteria may now be resistant to as many as 10 different antibiotics.
Bacteria That Causes Ear Infections
The three most common bacteria causing ear infection are Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis. These organisms account for 70-90% of all ear infections (12). These organisms commonly inhabit the nose and throat of children and can easily move into the ear via the Eustachian tube. Streptococcus pneumoniae accounts for 30-40% of all cases. As many as 28% of strains of this organism have been found to be penicillin resistant. Haemophilus influenza is responsible for about 21% of otitis media cases; 15-30% of strains of this bacteria are resistant to several types of penicillin. Moraxella catarrhalis accounts for 12 % of all cases. As many as 96% of strains of this organism may be resistant to penicillin such as amoxicillin (12). Moraxella catarrhalis is present at some time in the nose or mouth of 75% of infants before the age of two years.
The Panel for Otitis Media (10) stated:
“It is characteristic of health care providers in the United States to intervene for otitis media with effusion, but the panel was impressed by data suggesting that otitis media usually follows a benign course without treatment. Thus, although such a study might be difficult to implement because it runs counter to prevailing attitudes, research to document the natural course of otitis media with effusion is essential.”
Translated into simple English, this means that doctors and parents are used to using antibiotics for ear infections. The proof that they work over the long run is shaky. However, it is going to be extremely hard to change the way things are done because habits are difficult to change.
A large Dutch study was done using 1,439 children, divided into two groups with one of the groups receiving no treatment and the other receiving antibiotics and antihistamines. In the untreated children, 60% of the children recovered without medical intervention within three months. This kind of treatment would almost never be done in the United States. To understand the cultural differences between the two countries for treating ear infections, only about 30% of physicians in Holland prescribe antibiotics compared to the United States, where close to 99% of physicians prescribe antibiotics on a regular basis. Parents and employers must also share in the blame for this antibiotic overuse because with so many two-income families, mothers are under pressure to be at work rather than stay home with a sick child. The parents put pressure on the physicians to use antibiotics even when inappropriate. The physician knows he may lose the patient unless he complies.
In another study of 518 children with ear infection, Cantekin (13) found that six weeks after stopping the antibiotic amoxicillin, the recurrence was 2-6 times higher in the antibiotic-treated children than those in the placebo group. Van Buchem (14) treated one group of otitis media patients with antibiotics, one with tubes in the ears, and a third with neither. The outcome in the three groups was essentially the same.
After examining the medical histories of many children with autism, I became very interested in otitis media due to the fact that a very high percentage of these children had a history of frequent ear infections or other infections treated by antibiotics. In hundreds of medical charts I examined at a hospital, children with seizures, autism, and even psychosis had a history of antibiotic use prior to the development of these conditions. The urine organic acid testing of these children frequently revealed high concentrations of compounds derived from yeast and/or bacteria that are commonly resistant to broad-spectrum antibiotics. The pattern was so prevalent and so striking that there is little doubt in my mind that there is a relationship between the high concentrations of yeast and bacteria byproducts and the resulting disorders.
Exposure to cigarette smoke is also a significant risk factor for otitis media. In a study of seven year old British children, the authors found cotinine, a metabolite of nicotine was present in the saliva of children exposed to secondhand smoke and that the level of cotinine increased with the number of smokers in the household. The authors (15) found that one-third of the cases of otitis media could be attributed to exposure to secondhand smoke.
In addition, allergies can frequently be the major underlying cause of ear infection because an allergic reaction can cause swelling of the tissues in the ears which interferes with proper drainage enabling bacteria to grow more readily. McMahan (16) and Nsouli (17) both found that treatment of underlying allergies greatly diminished the recurrence of otitis media. Because ear infections are such a difficult medical problem for both parents and children, I have compiled a list of different approaches for treating these ear infections, which is given at the end of the chapter.
Vaccines
Numerous parents have reported the regression of their normally developing child within hours or days of vaccination with the MMR, DPT, or hepatitis B vaccines. The most serious research linking the vaccination to autism and PDD can be seen in the work of Andrew Wakefield, a British gastroenterologist. Dr. Wakefield perceived a significant increase in the incidence of Crohn’s disease, an inflammatory bowel disease that he believes is related to the MMR (measles, mumps, rubella, vaccine). After parents of children with autism begged him to examine the gastrointestinal tracts of their children, Wakefield found that lymphoid hyperplasia was prevalent in children with autism who had been vaccinated with the MMR vaccine. Some of the children had severe fecal impaction with stool masses as large as a grapefruit. Many of the parents mistakenly thought that their children had diarrhea because much of the time, a limited amount of liquid stool would ooze around the fecal impaction. In some cases, the lymphoid hyperplasia was so severe that the intestinal lumen was nearly closed off. Wakefield describes the lymphoid hyperplasia as being similar in appearance to pus-filled tonsils. Data gathered in California indicates an increased incidence of autism that correlates with the introduction of the combined MMR vaccine (Figure 1). A significant increase in the incidence of autism appears to occur about three years after the MMR introduction. The vaccine issue is covered in greater detail in a separate chapter on vaccinations.
Figure 1
Distribution of Birth Dates of Regional Center Eligible Persons with Autism
Ear Infections and Other Recurrent Infections: How to Break the Cycle or At Least Reduce the Damage
The following are different techniques that will help break the cycle and minimize the damage. Remember that there are exceptions to every rule and antibiotics may sometimes be needed.
Tough it out or employ watchful waiting. Use ear drops containing benzocaine and a decongestant to stop the pain. A large study conducted in Holland showed no difference in outcome when children receiving antibiotics were compared to a placebo group. Antibiotics are not used nearly as much in Europe as in the United States. Only 31% of general practitioners in Holland use antibiotics to treat ear infections. By not treating the infection immediately, your child’s immune system is allowed to react and build up a defense against future infections. If infections are treated immediately, the immune system will not have a chance to strengthen itself.
Eliminate milk, wheat, and other allergy causing foods from the diet. Milk is one of the most common food allergies, often causing sinus infections, leading to blockages of the Eustachian tubes, and resulting in ear infections. If milk and dairy elimination does not clear up the infections, get a comprehensive IgG food allergy test to determine if other foods are a problem.
Stop any cigarette or other smoking inside the house.
Never use antibiotics for colds or flu since antibiotics kill only bacteria, not cold or flu viruses.
If you have to use antibiotics for your child, have your doctor prescribe the antifungal drug nystatin along with the antibiotic. There are no adverse reactions between nystatin and antibiotics because nystatin is only minimally absorbed into the bloodstream from the intestine. If your doctor won’t prescribe nystatin, give one of the natural antifungal products such as garlic, caprylic acid, or grapefruit seed extract along with the antibiotic. Giving the beneficial bacteria Lactobacillus acidophilus while taking antibiotics may not help since the antibiotics may kill the acidophilus bacteria as well. Penicillin, chloramphenicol, erythromycin, tetracycline, oxacillin, vancomycin, and ceftriaxone all will kill the acidophilus bacteria. After antibiotics are completed, give supplements of Lactobacillus acidophilus for at least 30 days. Actually, giving acidophilus supplements regularly, on a daily basis, will help maintain a healthy intestine.
Get a throat culture done if your child has frequent infections. The most common organisms causing ear infection commonly inhabit the nose and throat. There is a vaccine available for Streptococcus pneumoniae, which is the most common cause of ear infections. If your child has a positive throat culture for Streptococcus pneumoniae, ask your pediatrician about getting vaccinated against this organism. The vaccine is termed the 23-type pneumococcal polysaccharide vaccine.
Consider having one parent stay home with your child until he is at least two years old and avoid preschool and day care centers. Day care is a breeding ground for germs.
Breast-feed your child for as long as possible since breast-milk contains antibodies against the bacteria that cause ear infections and other infections as well. Children who are breast-fed are much less likely to get frequent infections during the first six months of life (18,19).
Echinacea, the coneflower, was used extensively by the Plains Indians of the United States to treat infections and this knowledge was transferred to the settlers. Echinacea is a stimulant of the immune system and is available in pediatric doses in many health food stores such as Wild Oats. It can also be ordered over the phone (800-494-WILD) if a store is not nearby. This therapy is even more effective if drops of garlic and mull (also called mullein) oil are placed in the ears while giving the Echinacea. (My son used this method and resolved his earache overnight.) Three days of this therapy will clear up most ear infections. If this doesn’t work, there is still always the option of using antibiotics. Echinacea will help to decrease the incidence and severity of colds and flu because of its stimulating effect on the immune system. This product has been used extensively in Germany for many kinds of illnesses. Although much of the literature documenting its use is written in German, some of the articles in English are listed in the references (20-23). Echinacea works best if it is given for 10 days and then discontinued for two weeks before starting again.
Ask your doctor to give your child a “shot” of rocephin in the buttocks instead of oral penicillin. As a child in the 1950’s, I regularly received shots of penicillin as did millions of other people. The main benefit of the injection over oral antibiotics is that it will not kill the beneficial bacteria in the intestinal tract. Killing the beneficial bacteria often leads to an overgrowth of the intestinal tract with yeast and harmful bacteria like Clostridia. Therefore, the antibiotic “shot” will reach the human cells in the intestine, but will not reach the bacteria inside the intestinal cavity.
If your child has four or more infections in one year, consider an evaluation of their immune system. Many children with autism have an inborn weakness of the immune system called an immunodeficiency. It is best to consult with a clinical immunologist, a physician (M.D. or D.O.) who specializes in these diseases. Usually these physicians are also part-time researchers and are associated with a medical school. If your child has a significant immunodeficiency, ask your physician about the possibility of using antibody infusions (called IVIG or intravenous immunoglobulin) to help your child’s immune system fight off new infections. Sudhir Gupta M.D. at the University of California at Irvine has obtained complete remissions of some cases of autism (24) using IVIG therapy. See the chapter on the immune system for more detailed information.
Consult a health practitioner trained in homeopathy. The technique called homeopathy was shown to be more effective (25) than conventional antibiotic treatment in a German study of 103 children between 1 and 11 years. Homeopathy drops are also available at most health food stores. After one year, 70.7% of the children treated with homeopathy had no relapses compared to 56.5% of children treated with antibiotics. The average number of relapses was also much higher in the children treated with antibiotics than in those treated with homeopathy.
Consider tubes in the ear (tympanotomy tubes) if all else fails.
References
Rimland B. Is there an autism epidemic? Autism Research Review International 9: 3, 1995.
Magnusson P and Saemundsen E. A study of prevalence of autism in Iceland. Proceedings of the 5th European Congress of Autism. Barcelona, Spain, 1996.
Kontstantareas M and Homatidis S. Ear infections in autistic and normal children. J Autism and Dev Dis 17:585, 1987.
Roberts J, Burchinal M, and Campbell F. Otitis media in early childhood and patterns of intellectual development and later academic performance. J Ped Psychol 19:347-367, 1994.
Hagerman R and Falkenstein A. An association between recurrent otitis media in infancy and later hyperactivity. Clin Pediat 26:253-257, 1987.
Teele D, Klein J, Rosner B, and The Greater Boston Study Group. Otitis media with effusion during the first years of life and development of speech and language. Pediatrics 74: 282-287, 1984.
Silva P, Chalmers D, and Stewart I. Some audiological, psychological, educational, and behavioral characteristics of children with bilateral otitis media with effusion: a longitudinal study. J Learning Disabilities 19: 165-169, 1986.
Sak R and Ruben R. Effects of recurrent middle ear effusion in preschool years on language and learning. Developmental and Behavioral Pediatrics 3: 7-11, 1982.
Levy S. The Antibiotic Paradox. How Miracle Drugs Are Destroying the Miracle. Plenum Press, New York, 1992.
Stool SE et al. Otitis media with effusion in young children. Clinical practice guideline. Number 12. AHCPR Publication No.94-0622.Rockville, M.D.: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services. July 1994.
Nsouli T. Serous otitis media and food allergy. Clinical Pearls News 5: 1, 1995.
Barnett E and Klein JO. The problem of resistant bacteria for the management of acute otitis media. Pediatric Clinics of North America 42: 509-517, 1995.
Cantekin E et al. Antimicrobial therapy for otitis media with effusion. JAMA 266: 3309-3317, 1991.
Van Buchem F and Dunk J. Therapy of acute otitis media: myringotomy, antibiotics, or neither? Lancet 2: 883-887, 1981.
Strachah D et al. Passive smoking salivary cotinine concentrations and middle ear effusion in seven-year-old children. Brit Med J 298:1549-1552, 1989.
Mc Mahan J et al. Chronic otitis media with effusion: modified RAST analysis of 119 cases. Otolaryngol Head Neck Surgery 89: 427-431, 1981.
Nsouli T et al. Serous otitis media and food allergy. Ann Allergy 73:215-219, 1994.
Teele, D et al. Epidemiology of otitis media during the first seven years of life in greater Boston: a prospective cohort study. J Infect Dis 160: 83-94, 1989.
Williams E. Breast feeding attitudes and knowledge of pediatricians-in-training. Amer J of Prev Med 11:26-33, 1995.
Luettig B et al. Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpurea. Infection Immunity 46: 845-849,1984.
Roesler J et al. Application of purified polysaccharides from cell cultures of the plant Echinacea purpurea to mice mediates protection against systemic infections with Listeria monocytogenes and Candida albicans. Int J Immunopharmacol 13: 27-37, 1991.
Wacker A and Hilbig W. Virus inhibition by Echinacea purpurea. Planta Medica 33:89-102, 1978.
Vogel V. American Indian Medicine. University of Oklahoma Press, Norman, OK, 1970 pp 356-357.
Gupta S, Aggarwal, and Heads C. (1995). Dysregulated immune system in children with autism. Beneficial effects of intravenous immune globulin on autistic characteristics. J. Autism Develop Dis 26:439-52, 1996.
Friese KH et al. Otitis media in children: A comparison of conventional and homeopathic drugs. Head and Neck Otorhinolaryngology 44:462-466, 1996
Chapter 2-The Microorganisms in the Gastrointestinal Tract
Dr. William Shaw
Bacteria in the Intestinal Tract
In order to understand the devastating effects that may be caused by the widespread use of antibiotics, it is necessary to understand the role of microorganisms in the intestinal tract.
There are two main kinds of bacteria in the intestinal tract: aerobic and anaerobic. The aerobic bacteria need oxygen while the anaerobic bacteria don’t need oxygen to live and even may be killed if oxygen is present. Some bacteria grow faster with oxygen but can adapt to a low oxygen environment. Another major group of organisms in the intestine are the yeast and fungi. In the intestinal tracts of some individuals, there may be single-celled animals called protozoa as well. These organisms, in a normal intestinal tract, are usually found in a natural balance that is healthy. It is estimated that there are 500 or more different species of bacteria in the average human intestinal tract (1). Because there is limited oxygen in the intestinal tract, the anaerobic bacteria that don't require oxygen predominate. Of the 500 species, there are perhaps 30 or 40 species that constitute the majority of the bacteria present. It's estimated that there are about 10-100 trillion cells of bacteria in the intestinal tract at any one time (1). To give you an idea of the size of that number, there are about a 100 trillion human cells in the entire human body. Thus, in a normal individual who is not on antibiotics, 10-50 % of their total cell volume is composed of bacteria.
There are very few bacteria in the stomach because the stomach acid kills them. In comparison, the colon harbors a million times more bacteria than the stomach. In the normal individual, this acid is neutralized with bicarbonate from the pancreas as food passes into the small intestine, allowing greater microbial overgrowth. Bacteria constitute about 50% of the content of feces. These residents of the intestinal tract are always in a state of flux with new bacteria continuously being produced and old bacteria continuously being flushed out in the moving intestinal contents and later in feces.
A study that was reported in the Journal of Infection and Immunology (2) found that when oral penicillin was administered to experimental animals, the total population of anaerobic bacteria, including the beneficial bacteria, was reduced by a factor of 1,000. These bacteria, which are called Lactobacilli, are also present in yogurt. As the good bacteria are killed off, the potentially harmful bacteria increase rapidly. This study reported translocation of the harmful bacteria out of the intestinal tract and into the lymph nodes surrounding the intestinal tract. From these lymph nodes, these bacteria were then strategically placed to cause new infections throughout the body.
Yeast Overgrowth in the Intestinal Tract
Another harmful effect of antibiotics is that killing off all the normal bacteria results in the proliferation of yeast. There are hundreds of articles in the scientific and medical literature indicating that yeast over-growth is associated with antibiotic use. Some of the most important are included in the references at the end of this chapter (3-13). There are two reasons for this. First, when the normal bacteria in the intestine are killed off, the yeast have no competition so they are able to get the lion's share of all the food that passes through the intestinal tract after a meal. Second, the yeast may actually be stimulated by many of the antibiotics (12, 13).
Scientific work on animals is relevant to yeast infection in humans. Infant mice were much more susceptible to Candida infection than older mice and, once exposed to Candida at an early age, developed persistent candidiasis (3). If these mice were given antibiotics at an early age, the Candida in the intestinal tract increased an average 130-fold. Exposure of infant mice to the hormone cortisone increased Candida in the intestine 8-fold. Similar results with antibiotics and cortisone are found in humans (5-11). Largely because of the overuse of antibiotics, the incidence of disseminated candidiasis has changed from a rare occurrence prior to 1960, to the fifth most common organism encountered in infections acquired at a hospital in Southern California (14). It is important to know that bacteria and yeast produce chemical byproducts in the body that are normally only present in very low concentrations. When yeast and bacteria, normally only present in small quantities in the intestinal tract, reach extremely high numbers, they produce these byproducts in much higher concentrations which are then absorbed from the intestinal tract into the blood. From there, they circulate throughout the body to all the tissues and are eventually filtered out of the body into the urine.
In addition to the production of these byproducts, the yeast cells may convert to their more invasive colony form. The yeast in this hypha form imbed themselves into the lining of the intestinal tract like ivy climbing a brick wall. This attachment is facilitated by the secretion of yeast digestive enzymes at the point of attachment. The intestinal lining is thus digested by a variety of yeast enzymes including phospholipase A2, catalase, acid and alkaline phosphatases, coagulase, keratinase, and secretory aspartate protease (15-17). The secretory aspartate protease is of special importance because it may destroy the lining of the intestinal tract and may also digest the IgA and IgM antibodies produced by the body to attack the yeast (15). The destruction of this gastrointestinal lining may be the reason for the abnormal secretin response discussed in the chapter on the digestive system.
As a result of multiple yeast attaching to the intestinal lining, some of the intestinal cells may die and the lining may appear like Swiss cheese on a microscopic level. Ordinarily, undigested food molecules would not be able to pass through this intestinal lining. However, because of the holes in the intestinal lining, undigested food molecules can pass through. This phenomenon is called the leaky gut syndrome. A major consequence of the leaky gut syndrome is a much greater susceptibility to food allergies. The undigested food is recognized as an invader by the immune system and as a consequence, antibodies of both the IgE and IgG types may start to be produced. After a while, both behavioral and allergic reactions may occur after eating these foods. Many times, patients with multiple allergies will be retested after anti-yeast therapy and find that their allergies have disappeared. When the yeast overgrowth has been eliminated, the intestinal lining heals, the intestine is no longer leaky, and the immune system may diminish its attacks against the offending foods.
Evidence for Abnormal Bacterial Byproducts in Autism
As discussed in the first edition of my book, one of the chemical compounds in urine that I initially suspected was due to intestinal yeast overgrowth was called dihydroxyphenylpropionic, acid-like compound (DHPPA). Several years ago, I began a collaborative study with Dr. Walter Gattaz, a research psychiatrist at the Central Mental Health Institute of Germany in Mannheim to evaluate urine samples of patients with schizophrenia. These samples were very valuable since they were obtained from patients who were drug-free. Thus, any biochemical abnormalities would be due to their disease and not a drug effect. Five of the twelve samples contained a very high concentration of a compound identified by gas chromatograph-mass spectrometer (GC/MS) as a derivative of the amino acid tyrosine, which is very similar to, but not identical to 3,4-dihydroxyphenylpropionic acid. I have since then identified this compound as 3-(3-hydroxyphenyl)-3-hydroxypropionic acid or HPHPA.
Newborn infants tested at approximately one month of age had extremely low values of this compound in urine since newborns are not colonized with intestinal germs (Figure 2). In older children, the values are much higher. In children with autism, values may be extremely high. There is some degree of overlap in the normal and autism population but the median and the mean values are significantly higher in the children with autism. (The median is the middle value of a group of numbers while the mean is the average value of the group.) The mean value for all infants is 3.7 mmol/mol creatinine with a standard deviation of 3.6 mmol/mol creatinine and a range from 0.3 - 12.7 mmol/mol creatinine. In normal male control children, the mean value is 91.5-mmol/mol creatinine with a standard deviation of 90.4; the median value in this group is 51.1 mmol/mol creatinine. In autistic male children, the mean value is double that of the controls: 192.4 mmol/mol creatinine with a standard deviation of 90.4; the median value in this group is 143.5 mmol/mol creatinine, nearly triple the value of the control group. In normal female control children, the mean value is 85.5-mmol/mol creatinine with a standard deviation of 55.9; the median value in this group is 74.5-mmol/mol creatinine. In autistic female children, the mean value is double that of the controls: 182.4 mmol/mol creatinine with a standard deviation of 200.6; the median value in this group is 111 mmol/mol creatinine, a value 49% greater than the control females. In all groups the median values are smaller than the corresponding mean values indicating that the values are not normally distributed and that the populations are skewed by some samples with very high concentrations of HPHPA.
What was surprising to me was that there was not a significant decrease in HPHPA after antifungal drug therapy. The mean value for the HPHPA actually increased a little. This increase indicated to me that this compound could not be due to the yeast, but was probably due to a different microorganism. Several children and adults with Clostridium difficile infection of the intestinal tract had high values of HPHPA in their urine and also a similar compound, called monohydroxyphenylpropionic (18, 19), which I suspected was being produced by one or more species of the bacteria genus Clostridium.
There are many different species of Clostridium. Some of the common species are Clostridium tetani which causes tetanus; Clostridium botulinum which causes food poisoning (botulism); Clostridium perfringens and Clostridium difficile which cause diarrhea; Clostridium perfringens, Clostridium novyi, Clostridium bifermentans, Clostridium histolyticum, Clostridium septicum, and Clostridium fallax which may all cause gangrene (20). Many other species of Clostridium are normal inhabitants of the intestinal tract but may not even be scientifically described or named as a species. The major reason for a lack of knowledge about these organisms is that they are strict anaerobes that cannot tolerate oxygen. Since they must be processed in an oxygen free environment, many hospital laboratories do not have the capability to identify these organisms.
Figure 2
Distribution
of Values for Clostridia Metabolite in Urine Samples of Male Infants,
Control Boys, and Boys with Autism.
The Creatinine Ratio Corrects
for Differences in Fluid Intake.
3-(3-Hydroxphenyl)-3-Hydroxpropionic Acid mmol/mol Creatinine
The exception is Clostridium difficile, which is identified by the toxin it produces in the stool rather than by the isolation of the organism itself. Clostridium difficile overgrowth of the intestinal tract causes a severe and potentially fatal disorder called pseudomembranous colitis (21). This overgrowth is frequently associated with the use of oral antibiotics, indicating that this organism is resistant to many of the common antibiotics such as penicillin, ampicillin, tetracyclines, cephalosporins, chloramphenicol, and others (22). This organism is usually treated with either metronidazole (Flagyl) or vancomycin followed by a replenishment of the intestine with Lactobacillus acidophilus (23). Since many bacteria can genetically transfer drug resistance to other similar species and even unrelated species, it is likely that multiple species of Clostridia may now be resistant to the most common drugs.