New Harvard Paper on Autism

My problem with the paper is the same problem I have with any of the air and water pollution autism theories, why now? Certainly, if a toxin was causing autism, evidence exists that exposure to that toxin has increased part and parcel with the epidemic of autism.

For awhile, that was one of the strongest arguments for the mercury in vaccines theory; administration of more and more mercury-containing vaccines paralleled the increase in autism. The problem with the vaccine theory is that when they took the mercury out of vaccines, the incidence of autism went up, not down.

What about air and water pollution? Any self-respecting environmentalist will tell you pollution in the USA is at record levels today; that is, American air and water has never been dirtier. However, I am older than sixty, so that nonsense won’t work on me. I remember acid lakes, burning eyes and blazing rivers.

As a child, I remember thinking God wanted me to see the air I breathed. That is, I remember the USA before the clean air and clean water acts of the 1960s. If air and water pollution caused the autism epidemic, then that epidemic began in the late 1940s, climbed dramatically in the 1950s, peaked in the 1960s and then decreased in the late 1970s. Just did not happen.

One could accurately say that cleaner American air and water is associated with increasing rates of autism, but with a significant lag time. Perhaps air pollution from Eastern Europe, India and China, which has been increasing in the last 20 years, has engendered the current crop of autism, the “foreigners did it” theory of autism. However, why would foreign coal-burning air pollution of today do what good old American coal-burning air pollution of the 50s and 60s could not?

Take mercury in seafood, terrible right? As mercury is one of the autism-causing toxins he listed, I assume Dr. Kinney predicts mercury-containing seafood consumption during pregnancy would increase risk of autism. However, I predict the opposite, that is, consumption of mercury-containing seafood during pregnancy would improve the offspring’s mentation, the benefits of Vitamin D in fish overwhelming any detriments of mercury.

Consistent with that prediction, the three largest studies found higher maternal consumption of mercury-containing fish was associated with better, not worse, infant cognition with the greatest benefit for infants whose mothers consumed the most mercury-containing fish. Do not misunderstand me; the three studies below show mercury is bad, Vitamin D-rich fish and mercury is better, and Vitamin D-rich fish without mercury is the best.

Oken E, et al. Maternal fish consumption, hair mercury, and infant cognition in a U.S. Cohort. Environ Health Perspect. 2005 Oct;113(10):1376-80.

If you think the beneficial effect was from omega-3 fats, you’d be wrong. In another Harvard study, the benefits for the child of mother’s fish consumption again overwhelmed the harm from mercury. Omega-3 fats consumption could not explain the beneficial effects of mercury-containing seafood, that is, neither total maternal intake of omega-3, nor omega-3 content of mother’s red blood cells, was associated with the child’s cognition.

Oken E, et al. Maternal fish intake during pregnancy, blood mercury levels, and child cognition at age 3 years in a US cohort. Am J Epidemiol. 2008 May 15;167(10):1171-81.

In yet a third study, NIH researchers found benefits for mothers who ate mercury-containing seafood during pregnancy. Benefits of fish consumption again overwhelmed the harm of toxins in fish. More importantly, low maternal seafood consumption (and thus low seafood mercury consumption) resulted in children with lower verbal IQs and suboptimal outcomes for pro-social behaviors, fine motor, communication, and social development, that is, autistic symptoms.

Hibbeln JR, Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet. 2007 Feb 17;369(9561):578-85.

So I heartily recommend seafood to expectant mothers and give my highest endorsement to vitamin D-rich, mercury-poor fish like small salmon. (By the way, the omega-3 literature is hopelessly confounded by Vitamin D.) However, the essence of Dr. Kinney and colleagues’ addition to the Vitamin D theory is that at least some of the autism generating toxic genetic damage is done to the father’s sperm, not the mother’s egg.

That is, toxins ingested by Vitamin D deficient men causes oxidative damage leading to genetic mutations in sperm. The authors’ suggestion is to give Vitamin D to men, before they go around impregnating women, to prevent genetic damage by toxins and thus prevent autism. While I certainly agree men should take Vitamin D before they impregnate anyone (and I suspect they will be more successful in their mission if they do), I doubt healthy men will take Vitamin D any time soon.

Even if the new Food and Nutrition Board recommends 5,000 IU/day for healthy adults – and they won’t – healthy men will ignore any new FNB recommendation because most men will not take supplements, unless they think it prevents hair loss, increases sexual abilities or improves athletic performance (Vitamin D has no effect on the first two but certainly improves the third).

However, unlike men, pregnant women will take a supplement, and almost always do so, a prenatal vitamin. Currently, that prenatal contains a meaningless 10 micrograms of Vitamin D (400 IU). Say it contained a physiological amount, say 125 micrograms (5,000 IU). If it did, I predict the incidence of congenital autism (obvious in the first few months of life) would dramatically reduce almost immediately and the overall incidence would begin decreasing in several years. However, it would not affect the autism caused by the severe childhood Vitamin D deficiency that occurs when toddlers are weaned from Vitamin D rich formula to my favorite toxin, natural organic fruit juice.

All in all, I liked Dr. Kinney and colleagues’ paper; I hope Dr. Kinney can wake someone up at Autism Speaks, which funds Dr. Kinney. (If Autism Speaks doesn’t hurry and help fund the Vitamin D Council, they won’t be able to get any credit at all for helping discover the cause of autism.) The authors also listed evidence that strengthens the Vitamin D theory of autism, evidence I discussed in the original paper.

That evidence is: 1) autism is more common in cloudy and rainy areas; 2) dark-skinned immigrants have much higher rates of autism; 3) there are more cases in the northern US than in the South, and 4) autism is more common in urban than rural areas, just like rickets. The authors forgot to add a fifth fact, the NIH found widespread bony abnormalities in autistic kids, abnormalities that look like the effects of chronic low-grade rickets to me.

Also, if Dr. Kinney and colleagues are correct in their revision of my theory, then Vitamin D should not have a treatment effect in children with autism, unless Vitamin D can repair genetic defects. I predict the opposite: Vitamin D will be found to have a treatment effect in autism, as Vitamin D acts quickly to prevent further oxidative brain damage and increases brain glutathione, which promptly dispatches the usual suspects.

John Cannell, MD

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