Panel 2 - segment from Autism Live Tv Show

Leo Trasande MD, Jerry Kartzinel MD and Jane Tavyev Asher MD discuss the latest research, environmental factors that could be contributing to the rise of Autism diagnosis as well as treatment, vitamins and vital nutrients needed to supplement very limited diets children with Autism will often have.
Panel 2 - segment from Autism Live Tv Show | Kids in the House
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Panel 2 - segment from Autism Live Tv Show

- Leana: And now we're gonna go back to Leo Trasande, and Jerry Kartzinel. Great to have you on again. - LEO: Thank you for having me. - Leana: So the increase in austism in the last 20 years has been so incredible. I hear a number like 1500% in 20 years, I don't know if that's right, if those numbers are right. That's what Healthy Child Healthy World says, but ... What do you think are the causes? - Leo: Clearly we know that there are some changes in the criteria that may have contributed in part to the large increase, but it's hard to explain that entirely away on those factors alone. And we know that concomitant with the increase in autism spectrum disorder, we've seen an increase in use and exposure to many synthetic chemicals that are part of the better living through chemistry movement, but they come with the adverse consequences for the developing brains of children. We've known for a long time that chemicals such as lead and methyl mercury can damage the developing brain, and now we know that a broader array of synthetic chemicals, especially those called endocrine disrupting chemicals, chemicals that disrupt the hormones in our body, can also contribute. And the brain develops at such a rapid rate and requires a symphony of signals across the body to ensure it's proper development. You can't revisit or redo that part of a symphony when there is an error or a disruption of brain development. And ultimately that can have consequences for the child's lifespan on an ability to maintain attention, avoid impulsivity or other actions, let alone the cognitive potential of those exposures. - And is any of the factor genetics? - Clearly there's some part of autism that's genetic, there is a wide array of studies that have examined the genetic contribution to autism, they've given varied estimates, but it's not 100%, that is a fair statement. And what little we know suggest a substantial contribution of environmental factors to developmental disabilities. I still quote an over decade old study, from the National Academy of Sciences, that documents at least 28% of developmental disability is due to environmental factors. With the vast majority being the byproduct of genetics together with environment. Now that doesn't mean the genetics is acting alone, it's the environment as a factor that opens the lock, if you will, with the key being the environmental exposure that triggers, in the context of genetic susceptibility, conditions such as autism. - What can a parent do then? Like if I'm pregnant, what kind of toxins should I watch out for? What are the steps that I should take? - I think it's a great question actually, Leana, because I think pregnancy is the most important time, because as Dr. Trasande said, pregnancy is the time when the environmental factors are influencing the genes through epigenetic changes. So I would say, um, I would say first of all not to stress out about it, because we know that stress also is a toxin to the body. So I know that's easier said than done when you're pregnant and you're thinking about this. - And if you have kids already that's even harder. - Exactly, so I would say start with baby steps. I've posted this on Healthy Child Healthy World as well, but in my opinion the most important step that you can make in your home is having a good water filter. Because you use water to cook, you use water to drink, and then carry your water around in a bottle that's not made out of plastic. So with that you've eliminated the endocrine disrupting potential of the plastic water bottle, and you've eliminated lead, the intake of lead through your filtered water, and numerous other contaminants that could be in your water. So I would say that's the number one step, but I'll let you guys jump in with other ideas as well. - Jerry what do you say? - Well you know, I think minimizing the amount of exposures that the pregnant mom is exposed to is tantamount. And you know, this is a very precious time, were not smoking during this time, we're not drinking alcohol, we're limiting out coffee exposure if any at all, we have to be very careful what we allow to go into our body either orally or what we're doing as far as cleaning agents go. So I think getting the house cleaned is gonna maybe go into more natural products that we can use as opposed to say using bleach, being exposed to things. So I think that's all helpful and good. - And what about GMOs guys? Is GMOs a factor? - There's been no study that has linked GMOs to autism per-se, but the study than I'm, that just came out recently, showed that increased blood sugar circulating in the mother can possibly be connected to autism. So I think if you're making a diet change then thinking about what we call a low glycemic index diet may be the healthiest diet change that you can make. And I think that ultimately many of the GMO containing foods are processed foods, and the main GMO crops are corn and soy and so if you are avoiding processed foods which tend to have a very high glycemic index, you end up avoiding the GMO crops anyways but I wouldn't place the blame on GMO necessarily and then go to non-GMO processed foods that will still raise your blood glucose and have no nutritional value. The other disadvantage, there is a slight disadvantage to some GMO foods, which is that they can tolerate higher amounts of herbicide without killing the crop. So in that sense it's not actually the GMO process that is toxic to you as a consumer, but it's the fact that the GMO crop can tolerate herbicide, the herbicide may be killing out beneficial gut flora, and that may have an impact as we'll talk about a little bit later in this segment as well. - Right now we're actually going to take a question from an audience member. From a parent if you can give this person some help. - Hi, I have a nephew who I believe might be autistic and I just wanted to know what are some of the early signs of that diagnosis, and how would I mention to my sister that I think he might be autistic. - Jerry what do you say about that? - Okay, that's a tough one. Usually the person who brings the idea that a child is autistic is not a favored person in that family whether it be the mother in law, or the sibling, or the hairdresser, or the daycare lady, so that's a very difficult area and it has to be approached with a lot of sensitivity. As far as the signs are, I mean, I look at how the child is relating to stimuli, whether the child is not making eye contact, or not turning to his or her name, if the child is starting to line up toys instead of playing with toys, or has this, what we call stimming behavior, where they have non-purposeful movements of their hands or their legs. A child who's having tantrums or getting obsessed with certain things, lights on, lights off, doors open, doors closed. These are all symptoms that the child is not relating to stimuli in a normal fashion for that age group. So whether we have a one year old or a two year old, losing language is a big one, where the kids are developing language and then all of a sudden they're not using words anymore. No longer sleeping well at night, changes in bowel habits if they're having liquid stools or constipation. Changing the way they react to food for example, well they used to eat a lot of many different varied foods, now they have limited their foods to maybe three or four things and those to me are warning signs that the child may fall on the spectrum. As far as presenting it, I think there are ways we can gently discuss development, like have you noticed your child is a little bit different than the other kids that he or she is playing with at a party? Do you notice your child is not as talkative as some other kids their age? And kind of help them, kind of like you're dealing with a husband who's in denial, help them actually come to the conclusion themselves as opposed to pointing it out to them, is a pretty safe way and can foster a continued relationship with that family member. - Can you talk a little bit about the diagnosis on the more lighter? - I would say if we're looking for, I loved that list of symptoms that we can see, I think if we're just looking for two main symptoms that can just really make it easy for a parent to either have concerns, or lay their concerns to some rest, the two main things I would say would be language delay, you must have language delay as part of the diagnostic criteria for autism, not for Asperger's, which, though that diagnosis doesn't exist anymore, but for classic autism you do. And then a lack of what we call joint attention. So I think joint attention is pretty key. Joint attention would be described as having a shared enjoyment of a situation. So an example of a child having joint attention with you would be that they would see an airplane in the sky and to a young child this would be a new thing that they haven't seen before, they would look at it in amazement, they would point to the airplane, then look back at the parent with this idea that they're communicating non-verbally through their eye contact which is basically saying wow, what is that thing in the sky? Did you see that? I think that's amazing. Do you think that's as amazing as I do? So it's a desire to connect together through an emotional experience or shared enjoyment of something that's outside of the two of them. So that's why pointing, or lack of pointing, is so key to the autism diagnosis. Another example of joint attention would be that a child shows the parent, brings things to the parent just to show them, not just to have them open it or fix it, there's a difference between using the parent as a tool so they bring you a jar that they can't open, or some toy where only you can push the button because their fingers aren't quite strong enough, something like that, that is not joint attention. Joint attention is just showing them something that they drew, something that they made, something of interest where you are not required to act on it, just to show enjoyment and share in their enjoyment. So if the child is not having some words, at least one or two words, or signs or gestures of non-verbal communication by one year of age, and is also not showing any joint attention or pretend play in that same age range then we want to seek medical attention to see if some of the other symptoms are there. I think those may require going through with a doctor to evaluate in greater detail. But I would say those are the two red flags. - Leo, we know that low income families have higher risk of chemical exposure, do we see a higher rate of autism in these communities? - Well, we have unfortunately limited data about the frequency of autism, at least based on data from the Centers for Disease Control the best data come from four states across the country. But what we do know is that chemical exposures do unfortunately get passed in a disproportionate way to some populations such that chemicals such as pesticides which are arguably more likely to be linked to autism and developmental disabilities, let alone effects on the developing brain, than lets say the GMO herbicides that we talked about. Certain pesticides are known to be in the foods and in the routes of exposure through use in homes in low income and minority families and so in so far as their higher exposures, there are higher impacts on the developing brains of those children, and ultimately they suffer a greater burden of disease and disability due to those environmental exposures so it's quite possible that there is a disproportionate burden being passed on on the basis of factors such as income and race and ethnicity. - Autistic kids tend to have more OCD and more anxiety, Jerry, what are some great advice for parents on how to deal with that? - That is a big topic. Anxiety is huge. Currently, you know, I'm always looking for the underlying cause of some of these behaviors. Sometimes it is overgrowth of unfavorable bacteria, and antibiotics can actually mitigate obsessive compulsive behaviors. Yeast can grow in these children as well, and you put them on anti-fungals and they improve. My practice is clinical, meaning that when I do something I expect to see some results, such as doing dietary changes removing gluten, removing dairy it's not done just to do it. It's done to say hey, does this child improve when you remove gluten, remove dairy, are they able to sleep through the night? Do they regain eye contact? Does language come to them a little bit easier? From an anxiety point of view, I'm wondering if some of these children have an abnormal control over adrenaline response. And we have two kinds of adrenaline, one of them is for flight and another one is for attack and kill. And sometimes if you work on the adrenaline, in other words adrenaline might affect a certain receptor site and you block that receptor site will the anxiety go down? They don't need Prozac, 'cause Prozac doesn't affect receptor sites like that. It actually can block the adrenaline's response and their heart rate goes down their blood pressure goes down, their pupil dilatation goes down, and they're more flexible. The other adrenaline, we call noradrenaline, that effects alpha receptor sites. And that makes these kids very destructive and mean and break things. And we can block that too, we have alpha receptor site blockers and all of a sudden they improve dramatically. The obsessive compulsive component is mitigated because usually when they're obsessive compulsive thing that they want so desperately to happen doesn't, then the anxiety screeches forward and then they have these meltdowns and we can kind of help with both of those. But we always want to look for the source of their problem but it is a treatable issue and it's just so gratifying when they improve dramatically. - If you like this show here today please support us by joining Kids in the House premium subscription. - [Female Voiceover] Parenting is not easy and you could always use the extra help. Kids in the House has over 500 best selling authors, doctors, and experts, all at the touch of your fingertips. Providing the answers and insight when you need it. - [Male Voiceover] With over 9000 videos if you've got a question, Kids in the House has got the answer. - [Female Voiceover] Get instant access today to the premium content parents need. ♫ Oh yeah ♫ We shine ♫ Like stars - [Male Voiceover] Be a parenting superstar today by subscribing to our premium content. - [Female Voiceover] Inspire. - [Male Voiceover] Educate. - [Female Voiceover] Entertain. ♫ Like stars - [Male Voiceover] Kids in the House. - Well we're back in the studio talking about autism and we're getting some questions here on Facebook. What are some ways that parents can help with language development? Jane what do you say about that? - I would say the main way to help with language development is turning off the TV. So we know that there is some confusion about TV as a way of learning language, but the studies all show that TV is not a good way to learn language and in fact it inhibits the learning of joint attention, which is what I mentioned just a moment ago. So what you really want to teach is language with the back and forth sharing of that interaction. And so that can only be done with another person. That cannot be done in a one sided way through the TV. So once the parent has turned off the TV they should just try to talk to their child as much as possible. Sing songs that show, that have language used in many different ways, many different pitches and things like that. And then also encourage the development of language by trying to get the child to do some sort of gesture or sound when they want something. So you may know that they want the milk, maybe they are standing next to the milk and you know that its the time for them to have their milk but what you might try to have them do is either show you a sign for more milk or say the sound "ma ma" and then you would give them the milk. You want to do it in baby steps. If they have no language you can't expect them to suddenly say milk. But you could, through positive feedback, teach them to get an approximation for the word milk or do some other gesture like pointing to communicate that to you. - Jerry do you have anything to add? - Oh yes I do, I do a little bit more to augment that. You know, again I'm looking for a history. Many of these children come to me on a very self selected diet and they're eating chocolate chip cookies, french fries, bacon, sugary cereal and a gallon of milk every day and they've been doing this for a year 'cause that's all they'll eat, so they do have vitamin and mineral deficiencies. You know, medicine started with learning about vitamin C deficiency and scurvy for example, so I want to actually put them on some vitamins and minerals to help augment what they are not getting in their diet. Then we can look a little bit deeper and we can look at carnitine levels. Children with low carnitine levels are not going to speak and I can document that in my laboratory and put them on carnitine. Some of these children have folate receptor antibodies and we can actually put them on extra folate to overcome that cerebral folate deficiency syndrome. We can't do a spinal tap on all of these kids to get that, but we can actually look at folate levels. B12 I use injectable B12, it's been absolutely amazing getting language is almost overnight. Omega oils, I learned about this a long time ago when I was doing residency I had a little granny come up and tell me "If a child is ever slow to speak, give him some cod liver oil." And I remembered that and I started that with my son and I got language like within 3 days starting him on the, back then it was this stinky old probably rancid, cod liver oil. So there are a lot of things nutritionally we can do to augment our therapists and our parents involvement of removing TV and working with words and sign language to help those synapses really connect and develop language. They do want to speak, they do want to tell us about their world, they just have a problem connecting. - So we have another parent standing by wanting help um, here were go. - Hey guys, I have a nine year old son that's affected with autism, and I'm wondering, you know, I'm lookin' at how he has a lotta good days and a lotta bad days. How can I get more good days? Is it me, am I triggering something? Is it um, his diet, or you know, maybe there's something I'm not doing right. Is this how it normally is? 'Cause we wanna have more good days. The good days are awesome. And that's what I'm lookin' for, more good days. - Thank you very much that is a very good question actually. How can he get more good days guys? - I would say, one make sure that, see if you can find a relationship between the amount of sleep that he's had the night before and the diet. See if you feel that that plays a role in his good days. And then assuming that he has an autism diagnosis he should qualify for behavioral therapy in most states. So I would work with the behavioral therapist to see if that therapist can identify what we call and antecedent to the behavior. So can they help this father to identify that a certain event always triggers a challenging behavior? And the behaviorist can help you do that. But otherwise, if he's just looking at patterns in their life look for sleep and diet changes. - Well we're kind of running out of time, but I would just like to ask Leo really quickly here also what do you think about the food and how it impacts ... - So I'll take that question and expand on it. So there are safe and simple steps to limit exposures that are concerns for their impacts on the developing brain. And that's whether mom is pregnant, or a child with autism or without is trying to live his or her daily life. So we've talked already about lead exposure, making sure the home is free of lead based paint hazards which are equally important, I know a lot of attention was already given to water contamination, but paint still remains the major source of exposure. Eating fish that are high in omega-3 fatty acids and low in mercury which is a contaminant that can also affect the developing brain. We talked a little bit earlier about pesticides eating organic is a great way to reduce levels of pesticides and if families are a little bit tight on resources there are the so called dirty dozen a group of leafy green typically vegetables that tend to have higher residues of pesitcides that ultimately get into our bodies. So there are some easy, safe, and simple steps that families can take to reduce their exposure to the contaminants that are know to affect the developing brain, the brains of babies growing in utero, and then out of the womb, and even in children who are affected with developmental disabilities that can have great benefits. - Well Jerry Kartzinel, and Leo Trasande you both have great videos on Kids in the House, but can you briefly also say where can parents get a hold of you. Jerry, what's the name of your books? - Well you can always get a hold of me at I'm always available for for um, new patients, we're still taking new patients. I have an office in both California and in Orlando. And you can also find what we're writing about on Generation Rescue. I've also got a Facebook page, Dr. Jerry Kartzinel, and I'm always blogging about something on there as well. - Dr. Leo Trasande, I know you do a lot of great work with Healthy Child Healthy World which is a great organization, but where can people get a hold of you or follow you? - We have a division of Environmental Pediatrics here at NYU School of Medicine, its, uh, these days it's easy enough to Google. I'm also strongly working in collaboration with The American Academy of Pediatrics that has a strong track record on environmental health issues and advocacy and guidance for families. - Well thank you, both of you, for all the great work you do out there and for taking the time to be with us.

Leo Trasande MD, Jerry Kartzinel MD and Jane Tavyev Asher MD discuss the latest research, environmental factors that could be contributing to the rise of Autism diagnosis as well as treatment, vitamins and vital nutrients needed to supplement very limited diets children with Autism will often have.


Expert Bio

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Leonardo Trasande, MD, MPP

Associate Professor, NYU School of Medicine

Dr. Leo Trasande's research focuses on identifying the role of environmental exposures in childhood obesity and cardiovascular risks, and documenting the economic costs for policy makers of failing to prevent diseases of environmental origin in children proactively. Dr. Trasande is perhaps best known for a 2012 Journal of the American Medical Association study associating Bisphenol A exposure in children and adolescents with obesity, and a 2011 study in Health Affairs which found that children's exposures to chemicals in the environment cost $76.6 billion in 2008. His analysis of the economic costs of mercury pollution played a critical role in preventing the Clear Skies Act (which would have relaxed regulations on emissions from coal-fired power plants) from becoming law. He has also published a series of studies which document increases in hospitalizations associated with childhood obesity and increases in medical expenditures associated with being obese or overweight in childhood.

These studies have been cited in the Presidential Task Force Report in Childhood Obesity, and another landmark study identified that a $2 billion annual investment in prevention would be cost-effective even if it produced small reductions in the number of children who were obese and overweight. He serves on the Executive Committee of the Council for Environmental Health of the American Academy of Pediatrics, and on the Scientific and Technical Advisory Committee for the World Trade Center Health Program. He recently served on a United Nations Environment Programme Steering Committee which published a Global Outlook on Chemicals in 2013, and on the Board of Scientific Counselors for the National Center for Environmental Health at the Centers for Disease Control and Prevention.

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