Sunday, September 12, 2010

Autism 4 - Inflammation Speculation

Charles Ives (insurance specialist and modern composer) wrote The Alcotts (right click to open in new tab) somewhere around 1911.  It's his most accessible work, as he was one of the first experimenters with polytonal music - you'll hear some, but not too many, of the clashing polytones in this piece.  He composed many melodies from the early 1900s right up until 1927, when one day he came downstairs and said he could compose no more.  "Nothing sounds right."

And so we come round again to autism.  The heartbreaking disorder where, in 30% of cases (1), children seem to be developing normally, only to regress and lose speech and language development somewhere between 18 and 36 months.  It seems that in most children, the disorder is detectable very early with differences in gaze and response to social stimuli (2).  The reason no one has been able to find a specific pathological cause or cure is because it is multifactorial - it seems that a combination of genetic, environmental, neurological, and inflammatory factors contribute to the development of autism.  Today I would like to focus specifically on the inflammation.

The best evidence of the actual inflammatory damage comes from the work of some neurologists and pathologists at Johns Hopkins.  They were able to examine the brains (post-mortem) of several children and adults with autistic disorders, and also the CSF obtained via spinal tap from autistic children and normal controls (3).  They found that the most striking differences between autistic and normal brains were loss of the purkinje cell layer in the cerebellum, and marked activation of the microglia, which are cells in the central nervous system which mediate the inflammatory response.  In the CSF, the researchers found elevations of many pro-inflammatory cytokines and chemoattractants for macrophages - cells that are called into action to eat and destroy invaders.  Other studies have shown that autism is possibly an autoimmune disease of some kind (4).   Only this one seems to work on susceptible developing brains, leading to the devastating consequences we are all too familiar with.

In the evolutionary medicine paradigm, autoimmune disorders are diseases of civilization, caused by our highly inflammatory diets and stressful lifestyles.  And, indeed, this theory brings together the possible "bad guys" we've discussed already, gluten, casein (which may be a bad guy only in the context of gluten exposure also), and insufficient vitamin D. (Hat tip again to Jamie, who pointed out this study he saw first in a comment on Whole Health Source, where a high fiber diet seemed to reduce the plasma half-life of vitamin D.  The fiber used in the study was wheat fiber.)

Epidemiological studies suggest that autoimmune disorders are much more common than normal in families of kids with autism.  In addition, mothers with asthma, psoriasis, and type I diabetes were more likely to have autistic kids.  In fact, mothers diagnosed with asthma or allergies during the second trimester seem to have especially high risk, suggesting that a flare-up of autoimmune disease at a particular stage in fetal development might be causative (4).  Epidemiologists at the Harvard School of Public Health did a meta-analysis of studies of prenatal risk factors and autism (5), and they found higher risk for mothers and fathers of "advanced" age, a two-fold increased risk among mothers with gestational diabetes, and also increased risk among mothers who had bleeding during pregnancy and psychiatric medication use (there are specific studies demonstrating an increased risk with depakote use during pregnancy and autism).

Inflammation, inflammation, inflammation.  Psoriasis is associated with obesity (inflammation), gestational diabetes with insulin resistance and inflammation.  All these diseases of civilization are floating around autism.  All these diseases of civilization with multifactorial causes, genetic susceptibilities, and chronic management in lieu of cure.

What if mothers and young children had sufficient rest, play, vitamin D, and an anti-inflammatory, nutrient-rich diet? (My go-to choice here being a primal or paleo style diet, of course.)  No processed food, no extreme fructose, minimal and balanced omega 3 and 6 fatty acids, and no gluten.

There are too many variables.  The study will probably never be done.  But, as always, our health is in our hands.


  1. Thank you for interesting posts on autism.
    Do you now of any data that has differentiated between the effects of gluten free and casein free diets? Is it likely that one of the proteins is potentially more to blame than the other?

  2. Hi Pal - I'm looking for some actual studies, but my general take is that casein has a tough time breaching the intestinal border without wheat doing the deed. There's a nice discussion of the association between milk (particularly beta casein A1) and type I diabetes and the likely co-conspiracy with wheat in Food and Western Disease, pages 213 and 214. However , I vaguely remember some studies (it was probably in rats or guinea pigs though) demonstrating that casein can sneak through on its own, but I'm not finding any references for that on a brief look.

  3. Appreciate the link to Charles Ives Wikipedia entry. Sounds like he was a Rennaisance man. How fitting that his wife was name "Harmony."

  4. i am so glad you started a blog and even gladder i found it!! your posts are so interesting to read and always get my wheels spinnin!!

  5. In case you find something interesting here:


  6. Steve - Ives was an interesting fellow! Apparently invented estate planning.

    Malpaz - I'm glad your wheels are spinning :)

    Kevin - thanks for the link - yet another study came out today (or was at least reported on in my daily APA news email) that found no link between thimerosol vaccines and autism. In my opinion it was worth looking into (though the original Lancet study suggesting the link was withdrawn as a fraudulent study, and the lead author had his license taken away in Britain for scientific misconduct), but there are many other causes worth looking into, and let's spend our money on those, so we can help these kids and families.

  7. Just saw a video on five families with recovering autistic children:

    Mercury poisoning and gluten/casein allergy seemed to be the case here.

  8. Emily-
    Wondering what you think of this paper. Would love to hear your feedback.


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