The Myth of Autism

by Dr. Michael J. Goldberg, Elyse Goldberg, Dr. Ismael Mena

  Contrary to general medical teaching, I have seen many positive ANAs turn negative, once an immune system is given a chance to return to normal—by removing ongoing stressors with The Goldberg Approach. This does not involve using steroids or other strong, potentially harmful, immune suppressant agents.

  Before approaching therapy in a patient, one must understand the patient and their illness, their whole body and how it is creating dysfunction, and what those dysfunctions really are. As a physician, as a clinician, I was given a unique insight into this “mysterious” disorder by first working as noted with my wife and then some other mothers in the practice presenting with this new, “mysterious” illness in adults being called CFS/CFIDS. The insight into the clinical dysfunction of these children was sadly all too easy to connect after working with adults and teenagers who could remember when they functioned normally and who could remember and relate to what was working and not working for them presently and before the illness. What can this be like for a child who has no “well” perspective to relate to? If not previously damaged, or miswired “mysteriously,” how much are these children being left to suffer?

  Think about the comparison in adults and children and the real overlap of symptoms and problems occurring in both. For adults (often previously high-functioning, type A, college-educated people) with CFS/ CFIDS it is common to have severe sleep problems, classically what we call a “nonrestorative” sleep cycle. In the mid-1980s I was exposed to research documenting that these supposedly “psychosomatic” adults had an altered stage IV, REM sleep cycle. This explained how an adult (and now these children) can sleep for hours yet wake up mentally and physically still tired. Likewise, adults with CFS/CFIDS often would report “sensitivity to bright lights.” Many of these children have the same obvious symptom. In an excellent medical school, with excellent professors, I was taught “sensitivity to bright lights” meant inflammation or “a virus on the brain” till proven otherwise. Shouldn’t those patients, both children and adults, receive that same scrutiny, that same concern, today? These children may not only have sensitivity to bright lights but also may exhibit intolerance to heat (just like lupus patients or others with “autoimmune”-mediated disorders).

  Consider that when this disease, which we are calling NIDS, affects a previously intelligent, usually high-functioning adult, they will now have distressing memory and concentration loss, word blocking, fogginess, forgetfulness. They are overwhelmed by loud and conflicting noises, have impaired judgment, and are unable to link up auditory and visual input. They may develop dyslexic-like symptoms, have difficulty maintaining attention set, and often will have difficulties/impairment in inputting, encoding, and retrieving information (comprehending and remembering what has been read).

  If these dysfunctions can occur with a mature adult brain, it is not hard to understand (especially thanks to NeuroSPECT) how a supposedly “autistic” child will present with abnormal responses to sensations—often a combination of sight, hearing, touch, pain, balance, smell, and taste. The way a child holds his body will be affected; there will be disturbances in the rate of appearance of physical, social, and language skills (to the extent speech and language are frequently absent or delayed); and there will be altered thinking, abnormal ways of relating to people, objects, and events. This is essentially the same process that we witness in adults, but an immature brain in a child.

  Author Note: These related changes have been documented repeatedly with adults, with the medical literature over thirty years ago demonstrating outright development of “autistic” symptoms, in a previously normal individual from a herpes virus. How much longer are we going to ignore the obvious? We’re ignoring the fact that these children are suffering from a real disease, not an impossible, “mysterious” presumed neurodevelopmental disorder.

  Role of Diet Elimination and Reduction of Allergy-Related Stresses

  To constructively begin to approach therapy and ultimately prevention in these children, one must start with a background that is versed in an understanding of the physiology and the biology of children. As noted, I remain thankful for my medical and residency training, which resulted in an early exposure to collagen vascular disorders (the principles behind many autoimmune disorders today), along with a heavy emphasis on infectious disease, immunology, and allergies. A professor (many years ahead of his time) taught me to consider the role of food in creating stress and the subsequent reactions within the immune system.

  With the first step of therapy being the removal of triggers that create ongoing stress to a child, the next step for me as a pediatrician becomes how I can apply my medical school training, my postgraduate training, and new tools and information that have evolved since to help a child further reduce stresses and the dysfunction within the body in order to help the immune system and brain become healthy. This would not be possible with developmental autism/PDD, ADHD, etc., but it is expected and very possible when these disorders are recognized as variations of a disease process.

  The idea of removing dairy was not always an accepted practice. It has been a sad point for medicine that if we cannot conclusively document or prove with markers what is happening to the body, the medical profession is all too quick to dismiss it. I had professors who taught me to think, question, understand, and be skeptical. Sadly we have entered an era of medicine in which you do A, B, C, and D, but if you do not respond to ABCD, you are often out of luck or considered to be psychosomatic. We are in a world in which the general pediatrician has to be very cautious, very afraid of doing anything not dictated as correct by the AAP or his or her local medical society.

  It may seem like common sense, but I was taught if a child was chronically congested or having upset stomachs, rashes, eczema, or allergy symptoms, take away potential triggers. Don’t just keep treating the symptoms, the recurrent ear infections, the bronchitis, and so forth. The teaching in this country was that colic was merely evidence of a child’s immature brain or immature system and was therefore unavoidable.

  However Europeans generally believe colic does originate from the GI tract, and they believe strongly in the connection with the stomach. Because I recommended preventive diets, taking children off dairy, and avoiding exposure to allergenic foods and substances, very few children in my regular practice suffered from colic, chronic rashes, eczema, etc. We must understand that a baby’s superreactive GI sensitivity is a strong background and great training and experience for the GI sensitivity affecting so many children and adults today. The best way to help a stomach do better and relieve stress was not to gauge how many things I could throw into it, but, rather, to focus on removing the negatives.

  All of these children (and adults with these disorders) have superreactive GI tracts. When a mother asks, “What is the best thing to give my child to help his immune system?” my response is always, “Take away the negatives.”

  Much of my background comes from my training as a pediatrician, looking at babies as having very sensitive GI tracts. If there was ever an understanding, an on-the-job “induction” preparing me for these children now, it was certainly and thankfully my training. Thinking about what impact foods have on the stomach of a baby, and being trained always to introduce foods very slowly, and not to introduce solids too soon to a child, I have great skepticism. I tend to be concerned what may be firing off the child’s stomach, their immune system. Early along I learned that if I gave whole-grain, “natural” and “healthy” food to young babies, it often sent them up the wall. The principle is clear: Nothing can be healthy for an adult or child if it fires off the GI tract and the immune system.

  I began telling mothers they should avoid dairy and whole grains (and other allergenic foods) during pregnancy. While breast feeding is good, I advised pregnant women and new mothers to stay off dairy, whole grains, and other allergic foods if she was going to be breast feeding. While we believe nursing is in theory better for a child, we seem to forget that anything a mother eats can go through her
breast milk. Whether a mother was nursing or making sure formula choices were not causing GI irritability, congestion, and rashes, this led to a generally very healthy pediatric practice and is the starting point for preventing stress in children being born today. Since, over the years I always practiced preventative pediactric medicine, I found myself first focusing on feeding and nursing advice to prevent allergies and congestion in infants and children. Also, consistent now with recommendations from the Academy of Pediatrics I practice allergy prevention and stress management with pregnant mothers—preventative care in the womb. While my first focus was mothers within my practice getting ready to have their next child this also involved preventative advice for any parent with a history of allergies or immune disorders in their families, or who had a previous child who showed symptoms of NIDS.

  Working with babies was yet another learning lesson. A child might tolerate a heat-treated, sterilized formula but react when given milk or dairy. By heat treating and processing, you change the protein structure, the allergy potential of a food. With the push to everything “natural,” we are ignoring the fact that “natural” often causes allergic reactions in these children. A simple test that can be done on any child is what we call a CBC with a full differential that shows what are called eosinophils. If a baby has elevated eosinophils, it is a sure thing that something that child is receiving is allergenic to that child and creating immune stress. (Note: The opposite is not always true, since some children will show elevated eosinophils, but others may not—part of how imperfect lab testing for allergies can be.)

  An additional learning lesson is that to avoid slip-ups, rigidity of restrictions is far more important now than it was in my early days of practice given the known role of the accumulation of stress on a fetus or infant. With the recognition a number of years ago that “bovine protein” could act as a superantigen (and trigger multiple immune reactions in an immune-sensitive individual), the Academy of Pediatrics made the recommendation that in a family with a history of atopy (that’s a polite word for allergies), the mother should avoid dairy and whole-wheat foods during her pregnancy. As noted above, they missed a critical point when they did not carry that through to a mother nursing. Finally, the academy now does recommend that when there is a history of allergies in the family, a mother should avoid milk and dairy and whole-wheat whole grains when nursing. I would certainly expand that to include avoidance of red things such as strawberries, cherries, and, in this physician’s experience, tropical fruits (think of what is native to where you grew up; what is not native is likely to be more difficult to handle) and with preventive caution for any food that falls into a category of potentially reactive substances. Removal of potential triggers is a key to being preventive during pregnancy, after delivery, and with the eventual slow introduction of different foods for a baby.

  Sugar, dairy, and dueling dietary theories

  Unfortunately, over the years, the role of diet and the need to avoid “negatives” has increased, rather than diminished. The issue of “cheating” by feeding a patient something allergenic, or cheating by giving sugars or carbohydrates, now has begun to overlap. It was always easy to say that a “cheat” with dairy or a food that was an allergen was far more disruptive than a cheat just with “sugar,” but parents have often not understood that.

  While sugar, or carbs (simples carbs become “sugar” in one metabolic step in the body) give an immediate “rush,” can create a sugar “high” or contribute to a rebound hypoglycemia (episode of low blood sugar), an “allergic” cheat will throw off the immune system for up to seven to ten days. Worth avoiding, when thinking of long-term recovery, and the need for the body to have a chance to build itself back up, to recover. Uniquely, dairy, what we call “bovine” protein, acting as what we call a “superantigen,” can set up the immune system in a dysfunctional manner, resulting (like the aftereffect of some viruses, particularly flu viruses) in the immune system attacking and wiping out the beta cells (the cell that produces insulin) in the pancreas, leaving a “predisposed” individual now diabetic, requiring shots of insulin for the rest of his or her life.

  Taking the time to explain this connection helps parents understand why diet is important, and over the years is very helpful with a child who is doing better and thinking well enough to get into “trouble.” A strong reason is often better than just a vague “it can hurt you!”

  The issue with carbohydrates—besides the issue of simple ones becoming sugars very easily—is that any product made from a grain, as noted elsewhere, is potentially allergenic. I will usually see ongoing “allergenic shiners” (circles under the eyes) frequently, or an elevation in what are called “basophils,” as indicators for suspicion of “too many carbs,” or evidence that the wrong food choices are still being made.

  The role of diet is major in thinking of removal of potential triggers, in looking at how you cool down an overall reactive, inappropriately reactive immune system. Since this did not begin metabolically, and was never caused by any specific food or vitamin deficiency, one cannot expect to cure this or fix it by diet alone; but understanding the relationship between the brain, the immune system, and the gut is a key part in learning to take stresses off a child, both in treatment and prevention.

  In medical school we are taught that we all have what is called a triad, a strong connection between the brain, the immune system, and the gut. Short of the immune system, the GI tract has more lymphocytes than any other organ in the body. We do not routinely think about this, but physiologically the inside of the GI tract from the mouth to the rectum is essentially outside the body. Nature designed us logically. The GI tract is lined with all these lymph cells to protect us, to prevent infection and disease. Foods and other exposures can cause tremendous reactivity that may seem to originate in the GI tract, but it is a large mistake to think this is the origin or control point of the ongoing dysfunction. It is very foolish to think that the gut would be the control point. The key, the overall control is in the brain and what we have learned is a very complex “neuroimmune” system.

  As expressed earlier in the book, the neuroimmune system, not the gut, is the key to understanding this dysfunction. The neuroimmune system is in control. For example, a cold is a virus that does not go to the brain. In trying to protect us (how the system was designed), the neuroimmune system shuts down blood flow to key parts of our brain. We will feel “zoney,” “spacey,” tired, or achy, but in a healthy person, once well, the system returns to normal, the brain opens up again, and we feel fine and think well. If we start thinking about the shutdown going on in the children’s brain, rather than many supplements and foods helping them to get better, if any food, any supplement, any product irritates the GI tract, it stimulates the immune system, leading to greater attack and shutdown of the brain. This leads back to the discussion above; the best principle to help the brain and the GI tract is removal of triggers, removal of negative exposures. The practice of removing exposures has served me extremely well over the years, both in therapy as well as in prevention.

  As I found out early along, work done in the 1930s and 1940s showed that nonprescription grade products did not make it past the liver. While making most of them a waste of money, that fact may also protect some of these children from the potentially negative manipulative megadose effects. I cannot stress enough that years of exposure and experience have taught me that the safest thing about most products that you buy in a health food store that are not pure is the body does not absorb them. It seemed at least a fairly sophisticated approach from a nutritional direction to work with a company and using prescription grade products, based on a very logical principle of doing a blood profile of amino acids, then prescribing a supplement pattern meant to help.

  I soon found out that while I could often help a patient, I was not going to end this process. Believing in a strong supportive role for nutrition choices (particularly avoidance of negatives), I could help, but not solve this problem by nutriti
on (since it did not begin metabolically). I also learned rapidly, while trying to do things with a somewhat controlled environment, that while within the amino acids, lysine and arginine were the markers for the immune system, and most of these patients were low in one or both; it became apparent by watching and controlling individual factors that I might give a patient lysine and it might help them, but even though the body was low in arginine, if I gave arginine (which is in many of the “customized” formulas given to these children), the patient often did much worse. This was a rapid learning lesson (which ultimately made sense) that these herpes-related viruses thrived on arginine. Part of the lesson learned was that we as physicians and therapists have to be careful to not just assume the body being low in some factor is bad. The immune system may allow the reduction of arginine levels as a protective step.

  A general pediatric note is needed here. Between multiple sensitivities and dietary or other manipulations, many of these children will go through periods of constipation. Always speak with your pediatrician, but over the years, I remain thankful that my pediatric GI professor was one of the top three pediatric GI specialists in the country. Over the years, physiology and basic principles again hold true. One does not want to use stimulants or laxatives (sometimes necessary under very limited circumstances, never over the long-term), but rather you must try to create a natural softening effect, then let the bowel (and the child) retrain themselves. For this purpose old-fashioned mineral oil is still an excellent choice, while if a child is old enough (too young is dangerous—can choke), I prefer something like a sugar-free Citrucel, a very safe, very natural stool softner, no laxative or stimulant effect. Since a product like “sugar-free Citrucel” is not absorbed, it is then safe over the long-term, and arguably can help regulate both constipation and diarrhea with IBS. Both types of softeners are more effective when given twice a day, amount per dosing based on child’s weight and sensitivity to effect. With mineral oil, one “titrates” that the stool is soft, but ideally not oily or leaking oil. It is wise to give vitamins and most medicines at least an hour before or after administering mineral oil.