Autism
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Autism

Autism is defined as permissive developmental disorder characterized by impairments in social interaction, communication, and repetitive activities and behaviors. Autism has increased dramatically over the last several decades.  According to the Centers for Disease Control (CDC), the prevalence is approximately 1 in 150 among 8 year-old children. It remains unknown why Autism has seen such a dramatic rise.  The increase in autism might be due to an increased reporting/awareness of the condition that has led to increased diagnoses or that changes in the definition of autism have broadened, leading to more children being diagnosed  with the condition.

Autism is believed to be a multifactorial genetic condition. Twin studies have shown a 90% concordance rate among identical twins versus a 30% concordance among fraternal twins.  Genetic association studies have implicated several distinct loci believed to contribute to the condition. However, it remains unknown what (if any) environmental triggers/factors may also contribute to the development of Autism. Many environmental agents have been suggested to have a role in the development of Autism including: mercury, allergies, GI flora changes, nutritional deficiencies, and vaccines.

Complementary and Alternative Medicine (CAM) therapies are popular treatments used by parent's of children with autism. In 2006, it was reported that 74% of families with children with Autism used some type of CAM therapy. Supplements and special diets were utilized by 54% of the families. Nutritional modifications are simple to begin and are proactive methods which may explain their popularity and high frequency of use among families of children with Autism.  Many in the Autism community whom have explored CAM therapies have developed generalized theories about what causes Autism and what therapies are helpful. The following is a brief overview of some of these suspected causes of autism and the nutritional CAM therapies believed to treat them:

GI Pathology

Many children with Autism have gastrointestinal symptoms including constipation, diarrhea, reflux, and abdominal pain. It is believed that 30-40% of children with Autism have GI symptoms. It remains unknown why some children with Autism develop these GI symptoms. Common ideas that have been put forth to explain these GI phenomenon include:

  • Dysbiosis - overgrowth of gastrointestinal flora. A few studies have shown an increase in various bowel flora and improvement of GI symptoms with antibiotics. One of the more popular beliefs held by some CAM believers is that children with Autism have overgrowth of intestinal yeast, although the evidence is weak.

  • "Leaky Gut"- increased permeability of the GI tract. The significance of this remains unclear.

  •  Food Sensitivities- are immune mediated process that lead to GI symptoms. This is a popular and widely held belief among many attempting to treat Autism through CAM therapies. Many believe that Gluten and Casein play some primary role in causing the GI symptoms seen in children with Autism. The data to support these claims is limited and remains unclear.

CAM Nutritional Treatments

Many who use CAM therapies for children with Autism believe that either individually or in some combination that bacteria, yeast, and exposure to gluten may cause the GI symptoms and possibly the neurological changes exhibited in Autism. Therefore, many of the CAM nutritional therapies are geared toward replacing suspected nutritional deficiencies or at eliminating the microbes/proteins believed to be responsible.

  • Gluten-free & Casein free diets (GFCF)- it is widely felt that gluten and casein play some role in Autism either through GI disturbances/depletion of nutrients or through some pathway that impairs neurological function. A Cochrane Review in 2009 determined that there is poor evidence for the GCSF diets. They found only one small study of less than 20 patients that showed a decrease in autistic traits among participants. They concluded that much larger studies needed to be conducted.

  •  Nutritional Supplements- that are commonly used in CAM therapies include: Vitamin B6, Vitamin B12, Folate, Omega-3-Fatty Acids, Probiotics, Colostrum, Cod Liver Oil, minerals.

  • Antimicrobial Agents- that have been purposed for treatment include acyclovir,

  • Avoid toxic chemicals - found in household cleaners, fluoride, artificial colors/sweeteners

  • Avoid Allergens

  • Avoid Vaccines- Recently, vaccines (particularly the MMR vaccine) have been targeted by some parents, media, and celebrities (eg Jenny McCarthy). In response manufacturers have discontinued any use of the mercury-based preservative thimerosal in the production of pediatric vaccines. Despite, the discontinued use of thimerosal in pediatric vaccines, the incidence of autism has continued to increase. The Johns Hopkins Bloomberg School of Public Health Institute on Vaccine Safety has a nice summary of the thimerosal debate within the popular media and scientific literature. The scientific literature continues to show no evidence to date that vaccines contribute to the development of Autism. Despite the scientific evidence, many parents remain uncertain of the safety of vaccines and are not vaccinating their children. Recently, public health officials and doctors have attempted to better understand and address parent's concerns about vaccination. Physicians fear that the increase in the number of parents not vaccinating their children will lead the reemergence of vaccine preventable diseases.

Summary

Supporters of CAM therapies for children with Autism have a general theory that toxic substances (including exposure to heavy metals, mercury in vaccines, viruses, microbes, gluten/casein) all in some way contribute to the development of Autism. Therefore the CAM therapies that are used attempt to reduce exposure to these toxic agents and replace suspected nutritional deficits. These diets/nutritional supplements are sometimes referred to as "Biomedical Treatment". Some of the popular diets include the: DAN! (Defeat Autism Now) Protocol and the Cutler Protocol. 

Unfortunately, medical science has yet to fully understand the etiology of Autism. It appears that CAM nutritional supplements exist solely because conventional medicine has yet to provide parents/families with adequate understanding and treatments for Autism. The evidence for these CAM nutritional treatments is lacking and it remains unclear how these treatments may work.