More on Fecal Smearing

By Dr. Sidney Baker
Posted July 20, 2015

When last writing about fecal smearing, I promised to ask my colleagues for any stories about fecal smearing that might offer insight into this difficult problem. Here are the answers I have received so far. Below, you will find comments and feedback from other clinicians about interventions for fecal smearing.

Response

Pam Compart MD, Maryland:

Unfortunately I do not have any biomedical success stories.  I find fecal smearing usually requires behavioral intervention.

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Miriam Jang MD, California:

Of the fecal smearing cases that I've had, I've found that Sensory Integration, especially for smell and touch, really helped.  But then, all the kids were on all kinds of biochemical interventions at the same time, so the observations of improvement were never pure!

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Carol Wester RN and Pam Ferro MD, Massachusetts:

Pam and I have often found that fecal smearing, ingestion, rectal digging, saving stool in drawers, and other stool- focused behaviors seem to correlate with having digestive difficulties with corn/corn syrup. There have been a few folks for whom we have removed all forms of corn, and all of the stool-related problems ceased. Don't know why.

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William Shaw PhD (Founder and Director of Great Plains Laboratory):

Parents of a 21 year old son with autism reported that their son smeared feces over the whole bathroom after each bowel movement. The behavior had been going on for years. They had tried numerous behavioral treatment and multiple neuroleptics with no success. After positive Candida results on the organic acid test, they tried antifungals. The behavior stopped a short time later with no further recurrence of the behavior.

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Stephen G. Kahler, MD, Professor of Pediatrics, University of Arkansas Medical School: 

Shortly after your question arrived I had a visit from a patient (7-year-old girl) with a good story for your survey.  Here’s the relevant bit from my clinic note…

“She has autism spectrum disorder.  She had severe symptoms due to milk, including fecal smearing, screaming episodes, and general misery.  When milk was stopped, the fecal smearing stopped within a couple of weeks, and has only returned when she has had straight milk.  When she has milk-derived foods, such as cheese, this does not occur.  She can tolerate small amounts of cheese or other dairy products without significant change in symptoms.  She also was seriously constipated, which resolved with eliminating milk from her diet.”

Your question has me thinking about goat, camel, and Jersey or Guernsey milk.” 

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Dr. Stephen Kahler’s contribution was followed by an exchange among him, Dr. Derrick Lonsdale (Ohio), and Dr. Richard Deth () taking the discussion though a path beginning with Dr. Lonsdale’s comment,

“Steve, this interests me. I had an ADHD patient who became normal within five days of discontinuing milk.” And went on to  There may be a connection here since it has been recently found that thiamine pyrophosphate is cofactor to the enzyme 2-hydroxyacyl- Co A lyase in the peroxisome (HACL1).  Thus thiamin pyrophosphate becomes a crucial factor in alpha oxidation.  Although the HACL1 gene has been mapped to chromosome 3p25, no diseases have been linked to this gene locus so the phenotype is unknown.  With dietary restriction of thiamin, alpha oxidation would be impaired, leading to accumulation of phytanic acid and 2- hydroxy straight chain fatty acids.  Milk and meat are the major sources of phytol, the precursor of phytanic acid, accumulation of which has been associated with risk for some malignancies.  What I am obviously suggesting here is that fecal smearing in relation to milk maybe a sign of thiamin deficiency.  Finding phytanic acid in urine of a milk-drinking ASD child might be a clue." - Derrick Lonsdale

"Derek/Steve-

I would think that the benefit of stopping milk is likely due the absence of casein-derived opiate peptides, as postulated by Tiny Reichelt many years ago. In the past year published the attached two papers showing that the casein-derived peptide BCM7 (as well as morphine) inhibits uptake of cysteine, which is needed for glutathione synthesis and whose levels are low in autistic kids. When GSH levels are low it impairs methylation, include D4 dopamine receptor-mediated phospholipid methylation, which is involved in attention.

Notably, BCM7 is not released from casein if it is the A2 genetic type, which has a SNP that restricts  casein proteolysis. Guernsey and Jersey cows carry the A2 SNP more than other breeds, but still typically have a mixture of A1 and A2.  [There’s a nice explanation at this dairy site: http://www.snowvillecreamery.com/a1-and-a2-beta-casein-in-cow-milk.html  ]   There is an A2 Milk Company that creates A2-only herds and markets A2 Milk. Other dairy farmers (like Snowville Creamery) are converting their herds as well. A2 Milk was recently introduced as a brand in California and will gradually be available across the US in the next year or two. I expect that ADHD and autism kids (and adults) will do better on A2 Milk." -  Dick

"1)       Derrick--What levels of phytanic acid are we talking about?  Patients with Refsum disease (phytanoyl-CoA hydroxylase deficiency--I’ve never seen it) are loaded with phytanic acid.  Ataxia, peripheral neuropathy, retinitis pigmentosa—I’ve not seen mention of thiamine for these patients, nor anything about abnormal behavior, just slow decline over many years.  I’ll have a look on PubMed, and maybe write Dr. Bill Rizzo in Omaha about this one.

2)      Anyone--Does using naltrexone or LDN ever cause a sudden improvement in autism symptoms, the way it does with opiate toxicity?" - Steve