1. Autism: Solving the Puzzle !!!
Mostafa Waly, MPH, PhD
Assistant Professor
Food Science and Nutrition Department
College of Agriculture & Marine Sciences
Sultan Qaboos University, Oman

2. Autism Spectrum Disorder:
Who?
What risk factors?
Where?
Clinical Picture & Social Impact?
Biochemical & Dietary profile?
Genetics?

3. Brain defects in autism

4. Autistic spectrum disorder (ASD)*
Childhood
Disintegrative
Disorder
Pervasive Developmental Disorder Not Otherwise Specified
Rett’s Disorder
Asperger’s Disorder
Autism
* Diagnostic criteria (DSM IV & ICD 10)
No diagnostic laboratory tests are available

5. 1. Who? Male: female ratio is 3:1 Breastfeeding is a protective factor
No clear relation to socio-economic status
Onset prior to age 3 years

6. 2. What risk factors? Insults Nutrition & Biochemical abnormalities
Infection &
Vaccination
Environmental
Insults
Nutrition
&
Biochemical
abnormalities
Genetic
Predisposition
Timing Autism

7. 3. Where?
Autism is an epidemic disorder !

8. Prevalence at the United States

9. 4. Clinical picture & Social Impact
Gut Problems
Absorptive Difficulties
Enzyme Disorders
Deficiency Syndromes
Poor Detoxification Abilities
Immune Reactivity
Allergies
Poor Blood Flow To The Brain
Hippocampus Malfunction
Social Impact:
Communication Problems
Cognitive Difficulties
Emotional Disorders
Problems With Awareness
Poor Eye Contact
Behavior Problems
Problems with Play
Poor Understanding Of Cause and Effect
Delayed Development
Sleep Problems
The DAN approach to treating autism is a biological approach that works hand-in-hand with all the other types of therapies.
For those of us who have been involved with DAN, many catchwords keep appearing and reappearing.

11. 5. Biochemical & Dietary profile?
Autism Research in Oman:
Folate and Vitamin B12.
Oxidative Stress and Neuronal Cells Damage.
Glutathione (GSH), Intracellular Antioxidant.
Reduced Methylation Capacity in Autistic Children.
Neurodevelopmental Toxicity and GSH Depletion.

12. SOURCES OF OXYGEN FREE RADICALS AND CELL INJURY
= Oxidative Stress

13. MECHANISMS OF FREE RADICAL-MEDIATED CELLULAR INJURY
Lipid peroxidation – implications for increased permeability in gut and BBB

14. Antioxidant Defense Counterbalances Oxidative Stress
Oxidative Stress Antioxidant Defense
Heavy Metals
Hydroxyl Radical
Hydrogen Peroxide
Superoxide
Peroxides
NO-
Superoxide Dismutase
GSH Peroxidase
GSH Reductase
Vitamin E
Vitamin C
Lipoic Acid
GSTs
GSH

15. Cell Death Damage Oxidative Stress Antioxidant Defense
Superoxide Dismutase
GSH Peroxidase
GSH Reductase
Vitamin E
Vitamin C
Lipoic Acid
GSTs
GSH
Heavy Metals
Hydroxyl Radical
Hydrogen Peroxide
Superoxide
GSSG
Cell Death
Damage

16. Folate and Vitamin B12-dependent HCY- Methionine Cycle

17. Folate and Vitamin B12 Status
Control Children Autistic Children
(n=30) (n=30)
Serum Folate (µg/l) *
Serum B12 (pg/ml) *
Dietary Folate (µg/Day) *
Diteary B12 (µg/Day) *
Results are Mean ± SD,
* Significantly lower than control children, P<0.05

18. Oxidative Stress Markers
Control Children Autistic Children
(n=30) (n=30)
Homocysteine , HCY(µmol/l) #
Glutathione, GSH (µmol/l) *
Total Antioxidant Capacity *
TAC, (mmol/l)
Results are Mean ± SD,
# Significantly higher than control children, P<0.05
* Significantly lower than control children, P<0.05

19. 6. Genetics? twin studies --- 90%; multiple genes in
chromosomes 2 q , 7 q, 16 p, 19 p.
Chromosomal anomalies 15 and fragile X syndrome.
Recurrence risk studies- siblings of autistic people are more likely to be autistic.
Our journey through METHYLCAL SCHOOL begins here with the DAN brochure.

20. Acknowledgment Dr. Marwan Al-Sharabati, Behavioral Medicine Dept.
Dr. Mohammed Al-Shafaee, Family Medicine& Public Health Dept.
Dr. Yahya Al-Farsi, Family Medicine& public health Dept.
Dr. Amanat Ali, Food Science and Nutrition Dept.
Dr. Majeed Al-Ani, Food Science and Nutrition Dept.

21. They Disserve Our Effort!!
شكراً /
I am currently treating between 150 to 200 children with methyl-B12 injections and I receive letters just like these every day!