It is vital to consider anecdotal evidence as well as the results of clinical trials, to accurately assess chronic illness. It is essential to recognize that the results of clinical trials, when taken on their own, have their limitations.
Dr Elizabeth Mumper gave presentations at the 2019 Mindd Forum. Dr Mumper is president and CEO of The RIMLAND Center, a practice devoted to the care of children with neurodevelopmental problems and a wide variety of chronic childhood illnesses. As the Medical Director of the Autism Research Institute for five years, an international lecturer, mentor, receiver of many awards, author of textbook chapters and, having published five peer-reviewed articles in the medical literature, Dr Elizabeth Mumper’s Presentations at The Mindd International Forum 2019 can be reviewed online
Dr Mumper’s extensive clinical experience as an integrative doctor has provided her with a sound understanding of the specific causation and pathology of various chronic illnesses, including childhood illnesses.
In her practice, Dr Elizabeth Mumper provides individualized biomedical evaluations, therapies, and pediatric care in a nurturing atmosphere while recognizing and addressing the uniqueness of every patient and their presenting symptoms. Dr Mumper listens to every single symptom and takes into consideration all anecdotal evidence, no matter how seemingly insignificant.
Gastrointestinal Upset and Neurological Disorders frequently occur in Chronic Illness
Dr Mumper’s years of practice have enabled her to identify trends in patient health such as children with neurological disorders experiencing gastrointestinal upsets.
She believes that although many doctors have been told by parents that their children with chronic neurological illnesses also experience gastrointestinal upsets, the symptoms are often put down to just being a part of the condition and may not be adequately investigated as a potential for chronic illness.
This is also evident in adult conditions such as chronic fatigue syndrome, where gut-related symptoms are often part of the cause. By denying the role of digestive symptoms, leaky gut or any kind of dysbiosis and their link to causation, the appropriate treatment may be missed.
Important Statistics
A 2014 meta-analysis pooled studies that included a total of 2,215 children with autism spectrum disorder (ASD). The analysis concluded that children with ASD are 4.42 times more likely to have gastrointestinal symptoms. Specifically, they are:
- 63 times more likely to have diarrhea
- 86 times more likely to have constipation
- 45 times more likely to have abdominal pain
What the Research Says
In the summary of the 2014 meta-analysis, these were the highlighted facts:
- Children with ASD have a fivefold risk of developing feeding problems compared to their peers
- Children with ASD are at higher risk for suboptimal breastfeeding which may result in atypical colonization of the gut microbiome
- Atypical feeding patterns in ASD place the children at risk for long-term nutritional problems or medical complications that cannot be identified by the standard height and weight measurements
- In a treatment network of 14 academic medical centers in the U.S., feeding and GI problems were reported in 50% of patients who participated in the treatment protocols
Anecdotal Evidence in Chronic Illness
Although the meta-analysis concluded that there is insufficient research to determine whether gastroesophageal reflux, gastroenteritis, food allergies or inflammatory bowel disease are more common among children with ASD, Dr Mumper states that in her anecdotal experience, those conditions are present in hundreds of children with chronic childhood illness including ASD and other neurological conditions.
Dr Mumper was discouraged by the findings of the meta-analysis but is grateful for the addition of literature on this topic. She says that change is still slowly coming and that this research is a portrayal of how the medical industry is poorly structured to care for people with chronic illness.
“As we wait for the well designed, carefully controlled, standard scientific studies to study one variable and draw conclusions, we are missing critical windows of opportunity for clinicians to address the symptoms of the individual patients who come to us for help.”
It is also estimated that digestive disorders and intestinal permeability are frequently present in autoimmune conditions in adults, highlighting the importance of assessing all symptoms holistically at a young age to prevent disease development later on in life.
Addressing Nutritional Deficiencies and Supplementation
The meta-analysis also stated that dietary interventions such as the gluten-free or casein-free diet, supplementation and antimicrobials need further investigation before they can be substantiated.
Dr Mumper acknowledges that supplementing with a good probiotic to replenish gut flora, as well as a good quality essential fatty acid for cellular membrane function, has been extremely useful in her practice when treating neurological disorders.
She also highlights the need for addressing common deficiencies found in children with neurological disorders such as zinc, especially in those children with low appetite. Some children with chronic illnesses will also need B vitamins and will be found to be low in selenium and other trace minerals.
Is Research Always Translated into Practice?
In 2010, a stand-out research paper highlighted that the importance of gastrointestinal pain associated with ASD should not be taken lightly, and all patients deserve all symptoms to be fully diagnosed, managed, and treated.
Although this was addressed in the literature, Dr Mumper feels this is not translated into practice, and a large part of her work now is ensuring that these patients are given the appropriate time and treatment that thoroughly considers all factors.
The Limitations of Clinically Trialled Evidence
Dr Mumper believes clinical trials are not well equipped at assessing chronic childhood illness such as:
- Genetic predispositions in multiple single nucleotide polymorphisms
- Individual variations in function of various enzymes
- The infinite variety in our microbiome composition
- Changes in nutrients eaten and absorbed
- Differences in detoxification capabilities
Dr Elizabeth Mumper concludes that it is essential for a clinician to consider individual variations in nutritional status, take a thorough case history, review socioeconomic status, stress, pathology, and family circumstances. She also believes it is important to support organizations that are challenging existing paradigms to raise more awareness.
Learning Objectives addressed from Mindd 2019 classes given by Dr Mumper:
- Understand Atypical ways that conditions may present in infants and children
- Identify potential triggers in childhood conditions that may not have been considered before
- Practical strategies to support childhood neurological disorders and other common childhood conditions such as atopic conditions and migraines
- Develop strategies for decision making about preventative treatment
- Healing underlying immune dysregulation
- The multifaceted connections between autoimmunity, overall health, and chronic childhood illness
