Tests are pending. A 12-year-old autistic boy, equivalent to 4-year-old in all aspects. Struggled with sleep, has a lifetime of poor sleep quality, never slept well in his life. Moderate digestive problems, mostly related to motility. Developmental delays are severe. As a young infant, he suffered from infantile seizures and was prescribed ACTH. Seizures resolved. Autism was then diagnosed in early toddler years based on rare genetic disorder. Don’t know full details on the disorder beyond the current recorded case. I surmise that ACTH administration in a young infant may permanently disrupt the HPA axis if not addressed with a rebuild post prescription. I’m not sure that’s even possible with an infant. Obviously that didn’t happen with this boy 12 years ago. Now how to support this possible permanent alteration 12 years later? Does his body produce ACTH efficiently on its own if that production was bypassed for a formative length of time in early infancy? Or are all these thoughts a stretch? Here’s the good news: Parents were in tears of hope after talking about functional medicine with me. Twelve years searching, and our conversation was the first of its kind. What we are doing for people is legit and reshaping healthcare. I plan on ordering gut testing, hacked [indiscernible] if he will comply, and DUTCH.

Chris Kresser:  Yeah, that’s a very interesting case and interesting hypothesis, and we do know, as I mentioned in the DUTCH unit, that early life events can permanently influence HPA axis programming, which is very sad. It can even be prenatal events, so when we’re in the womb. Some severe stress that happens with mom can affect the programming of the developing baby’s HPA axis and permanently impact things like their cortisol levels. That could have happened here, but I’ve never heard of that causing autism spectrum disorder. It tends to cause lower cortisol levels or other issues, specifically with the HPA axis. Because I haven’t heard of it happening doesn’t mean it’s not possible, but I would suspect that there’s something else at play as well. Having said that, I think your ideas for testing are good. I would probably add an ACTH stim test if possible, or at least test ACTH. If you’re going to do some blood work on this patient, that might be a useful thing to add in. It looks like you did. Ashley, I just saw your comment come in. Nutrient testing as well, like the stuff we’re going to be talking about in the blood chem unit, ways of assessing. The status of various nutrients is really important in any kid on the autism spectrum because they typically have gut issues, as you noted he did, and they often are not able to absorb nutrients effectively.