Naturopathic perspective on the assessment and treatment of Lyme-associated autism

Townsend Letter for Doctors and Patients, April, 2007 by Nicola McFadzean

Autistic-spectrum disorders (ASD) affect one in 160 children in the United States and up to one in 80 in certain states. (1) Both complex and multi-factorial, the myth of ASD as a genetic disorder with no effective treatment or cure is being debunked by the biomedical community, which is using special diets, nutritional supplementation, and detoxification therapies to treat the underlying biochemical imbalances that perpetuate the behaviors of ASD children.

Part of the investigation involves an examination of the role of infectious agents in ASD. Certainly viruses such as human herpes virus 6, Epstein-Barr virus, and rubella have been discussed. (2-4) More recently, Borrelia burgdorferi, the spirochete bacteria responsible for Lyme disease, has come under more careful examination as a contributing factor in autism. Borrelia burgdorferi (Bb) is primarily a tick-borne agent, although there is evidence of transmission via mosquitoes, fleas, and lice. (5,6) Originating in the town of Old Lyme, Connecticut, Lyme disease is no longer the domain of New England, with increasing numbers of cases reported across the US. (7)

Epidemiological studies investigating the link between Lyme disease and autism are underway. (8,9) There is strong anecdotal evidence that some connection exists, based on interviews with several doctors who practice biomedical approaches to autism. Such doctors--doctors who belong to Defeat Autism Now (DAN!), a domain of the Autism Research Institute--who have tested for Lyme disease nationwide, report 50-90% of children test positive. Clearly, further studies are needed to gain more objective and substantiated data; however, at face value, rates look frighteningly high.

The challenges facing assessment and treatment of Lyme disease and autism are significant. Laboratory testing for Lyme disease produces many false-negatives, mostly due to the ability of the Borrelia spirochete to disable the immune system, dampening the antibody reactions that are measured on testing. A newer IFA assay run by IGeneX is proving a high level of sensitivity, with specificity of 80%. Coupled with IgG and IgM Western Blots and a PCR, IGeneX provides a comprehensive panel that assists with the diagnosis of Lyme.

The bigger question is how to treat a child who has tested positive for Lyme disease. At the time of writing, there is contention between two groups of physicians who work with Lyme disease in general. The Infectious Disease Society of America (IDSA) recently published guidelines stating that short courses of antibiotic therapy (three to four weeks) are sufficient even for chronic Lyme disease; while the International Lyme and Associated Disease Society (ILADS) claims that, in some individuals, longer-term use of antibiotics is warranted. Lyme disease treatment has become a highly politicized arena.

Debates over these protocols relate to the Lyme population in general, not specifically to pediatrics and certainly not to autistic children. The biomedical community involved in autism treatment recognizes that frequent courses of antibiotics in early childhood are a potential contributing factor to autism, giving rise to the preponderance of yeast overgrowth seen in the intestinal tracts of many ASD kids. Within this context, it is almost impossible to conceive of treating autistic children infected with Borrelia burgdorferi with antibiotics in any capacity. The need arises to find effective treatments that do not further tax the already fragile systems of autistic children, but instead build them up and strengthen their immune capabilities.

To date, there are several pioneers is the area of natural treatments for Lyme disease, and it is inevitable that their protocols will be drawn upon for guiding the treatment of Lyme disease in autistic children. Among them are the Chinese medicine protocols of Dr. Qingcai Zhang (10) and the more Western herbal approach of Harold Buhner. (11) The Lyme-Induced Autism Foundation (12) held their first think tank in February 2007 in San Diego, California, bringing together experts in the fields of Lyme disease and ASD to collaborate and further develop safe and effective treatments for individuals with both diagnoses.

The approach to Lyme/autism treatment must be three-tiered: first, to support the immune system of the individual or "host" to strengthen their capacity to fight foreign invaders; second, to allow antimicrobials to reduce the infectious load on the system; and third, to address comorbid factors such as toxicity, nutrient imbalance, digestive dysfunction, and enzymatic defects such as poor methylation.

The DAN! approach to autism treatment already takes many of these factors into account. Immune support takes the form of both dietary intervention, such as reducing food allergens and refined sugar consumption, and specific supplementations such as monolaurin, olive leaf, and transfer factor, to name just a few. Antimicrobials in autism treatment must be expanded to incorporate the Borrelia species. Current treatments center largely around yeast control, using medications such as Diflucan and Nystatin as well as many effective natural treatments, among them, oregano oil, caprylic acid, pau d'arco, and garlic. Many children on the autistic spectrum have bacterial imbalance in their gut also, requiring treatment targeting Klebsiella, Pseudomonas, Citrobacter, or Clostridia. Again, berberine, olive leaf, pau d'arco, caprylic acid, garlic, and oregano can be used quite effectively. Probiotics are a large part of treatment, to recolonize the gut with healthy flora and prevent the predominance of unhealthy microbes.