Friday, November 2, 2012

Autism and Maternal Metabolic Health

I've been sitting on this study for a while. It was published in Pediatrics in May, 2012:

Maternal Metabolic Conditions and Risk for Autism and Other Neurodevelopmental Disorders

In California, many children aged 2-5 between 2003 and 2010 were involved in population based cohorts with the CHARGE study. I've covered a previous paper from this study before

Captial Cities: Safe and Sound

Diagnoses of children in the cohort were confrimed using standard assessments Information on mothers was ascertained by medical records or a structured interview. The results are not terribly surprising… all metabolic conditions were more common among autism cases than among controls. Odds ratios were about 1.66, which isn't earth-shattering, but is more than 1, and in a large study, at least worth noting.

Currently: 1:110 kids have an autistic spectrum disorder. 1:83 have some other developmental delays. It is known that mothers with gestational diabetes (GD) have babies with more cognitive impairments than children born to mothers without GD. In the CHARGE study, children born to mothers with obesity, gestational diabetes, and hypertension were all followed (as "any metabolic condition").

All told, 28.6% of the autistic children and 34.9% of the children with any developmental delay had a mother with a metabolic condtion compared to 19.4% of controls. Within the autistic spectrum disorder group, children of mothers with diabetes performed worse on an expressive language scale than did children of mothers without diabetes. Given the fact that obesity and diabetes are increasing, we are looking at a worrying trend. The paper did not speculate much as to causation, but generalized inflammation and insulin resistance are the pathogens of interest. It would have been nice if inflammatory markers were measured, but with such a large study, that may be asking too much.

Poorly regulated maternal glucose can result in adverse fetal consequences. Maternal diabetes is due to a number of factors, but I'm sure a modern processed food diet can be counted among them. I know how hard it is to control appetite during pregnancy, even while eating supposedly "real" foods.  Keep to the outside of the grocery store and skip the bakery. Not terribly controversial advice, I would hope!

16 comments:

  1. Emily - this is totally anecdotal, but my son is autistic. And the only foods my wife could keep down for the first 4 1/2 months of her 2004 pregnancy with him were macaroni and cheese and mashed potatoes. I've often wondered whether that had something to do with his condition. I've never said anything to her about it, because what's the point now (she was fine during our neurotypical daughter's pregnancy, no issues with food, and we're not having any more kids). But it's just something I've always wondered about - especially after going Paleo in 2008.

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  2. For the first part of my pregnancies, I lived on vitamin water and instant mashed potatoes. I couldn't even go into a grocery store or restaurant without throwing up. My poor husband would try to make me meals that wouldn't trigger the nausea, and sometimes he succeeded and sometimes he didn't. Nutrient status prior to pregnancy has to be important, and I wouldn't judge anyone for what they could choke down during those first months!

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    1. i wonder if it isnt partially reversed! the baby's status affecting the mothers diet and hormones....

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  3. Interesting study!

    I couldn't keep ANY solid food down in the first four months and drank energy drinks to keep going.
    4 mths in I was told I had gestational diabetes. It was controlled via diet only.

    I have an autistic son who showed signs of autism from a very early age.

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  4. Interesting... The age of the father is known to be correlated with ASD, so I checked to see if they had corrected for that. They hadn't, but cases and controls were matched for the mother's education level, which is a pretty good proxy for age of the parents, including the father. 95% CI for all the ORs barely clear 1, but they do, so it looks like the correlation is solid. Possibly quite small, but solid.

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  5. I would still have some concerns about paternal age particularly in the case of comparison between two polygenic conditions and wide range in models of paternal base substitution estimated from population studies. See models in following reference:

    Hurles M. Older males beget more mutations. Nat Genet. 2012 Oct 29;44(11):1174-6. doi: 10.1038/ng.2448. PubMed PMID: 23104062.

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    1. @George and @Sarra, there's a reason the study sat around for so long. It's not that specacular a finding for the weakness of the dat collection. But it is somewhat interesting.

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  6. Great post Emily... Glad you put it up.

    Have you seen Hyman's IFM material and stories of autism recovery? He idenitifies toxins and metals which can lead to neurodegeneration as well as significant clinical metabolic disorders (diabetes, IGT, GD, obesity MetSyn, etc). Often moms of autistic children have them too as the study you reviewed demonstrates.

    He and Amy Yasko try to identify also genetic polymorphisms that predispose a subpopulation that are inherently less likely to eliminate and process these neurogenerating toxins and metals such as MTHFR which you've discussed thoroughly here. Metals have several mechanisms for toxicity that includes raising intestinal permeability and yeast/pathogen small intestinal overgrowth. I had this and it's plain f_ckin awful. Better now because I had them all removed this past summer (subsequently instantly lost 5 lbs +edema)

    Other SNPs worth evaluating and 'bypassing' to correct deranged metabolism and reverse neurodegeneration (slide 61):

    Impaired Methylation
    ���� MTHFR (Methylenetetrahydrofolate reductase)
    ���� MS (methionine synthase)
    ���� COMT (catechol‐O‐methyltransferase)
    ���� Methyl‐transferrases

    Impaired Sulfation SNP’s
    ���� GSTM1, GSTP1 (glutathione transferases)
    ���� Apo E 4 (apolipoprotein E 4)

    Impaired Metallothionein (MT1, MT2, etc) Function

    http://www.ultramind.com/at/atlantic.pdf

    http://www.dramyyasko.com/wp-content/files_flutter/1327512160_9_1_1_8_pdf_02_file.pdf

    Thank you for your awesome post,
    G

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    1. Dr Amy Yasko is a great resource, thanks!!

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    2. Hi Dr. BG, thanks for all the info. I've seen literture on autistic kids with trouble metabolizing metals, trouble with energy metabolism, leaky guts, and inflammation out the wazoo, so it all makes sense. Clinically, I work with adults, and I've seen two folks who have come to me after seeing naturopaths and were taking chelators. Both became acutely worse psychiatrically, with increase anxiety, depression, fatigue, and worsening cognitive abilities, after the chelation. It makes me think in these folks it would have been best to let the body keep the metals sequestered as well as possible and work on other ways to decrease overall inflammation (neither of these folks were autistic, but both had histories of workplace exposure to toxic metals, and one had lab results pointing to high amounts of certain metals).

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    3. Emily

      Yes I'd agree if they had high exposures, then it is more crucial to not muck the metals around without adequately healthy gut and elimination pathways. Some protocols I do not agree with as well. I think that NDs learn at Bastyr and other schools only the IV route of chelation which is too bad as I believe it is too rapid and also presents a risk of plastics/plthlates.

      The half lives of the chelators are not considered as well. Alpha lipoic acid and DMSA have half lives of 3-4 hours and thus should be dosed accordingly and unfortunately some protocols do not (unfortunately like Hyman's listed). It can unleash metals into other reservoirs. Only q3-4 PO is considered safe.

      The benefits of safe chelation that is done with optimized p450 metabolism and liver/bile/gallbladder elimination is that issues such as mental degeneration, ADHD, severe gluten intolerances, hypothyroidism, etc are often resolved as well. My niece has had 90-95% autism recovery with Paleo and safe slow chelation. I've had the fortune to meet many who have safely chelated and improvements in all aspects of health (I'm half way here too).

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    4. According to Stephen Barrett, many naturopaths use provoked testing and compare the levels to unprovoked norms.
      http://quackwatch.org/01QuackeryRelatedTopics/Tests/urine_toxic.html

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  7. Sorry for more... I wouldn't do a provocation test especially in really toxic people; this moves too many metals around (particularly the CNS). The Metametrix/Genova urine porphyrin toxin test is completely noninvasive yet super diagnostic (if the sample is handled correctly, FYI). It can help reveal which metal is disrupting which pathway:
    http://www.metametrix.com/files/test-menu/interpretive-guides/porphyrins-ig.pdf

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  8. Dr. Emily; out of this topic. I came across your blog on searching for ketogenic diet for bipolar. Do you have any diet protocol for patients...or have you conducted any trial?

    Thank u.

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    1. Hello Dr. H, I have not tried a ketogenic diet for bipolar disorder clinically. There are no clinical trials, even pilot trials, in the literature, only two successful case studies and two unsuccessful ones. However, there are RDs online (Amy at Whole9life is one) who can design a ketogenic diet for you. The Perfect Health Diet book also has a relatively high-ish carbohydrate whole foods ketogenic profile that looks workable and flexbile. Main side effects I would worry about in adults would be kidney stones, though good hydration and (perhaps) potassium supplementation is supposed to be helpful. I know they have been trying to conduct a proper trial at Stanford for years, but I don't think they ever got it off the ground.

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    2. Thank you for the feedback; may be I'll start encouraging grain free diet for my bipolar, esp. so those with acne..but asking others to diet is diff. unless the person is doing it out of his/her own motivation.

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