Asthma-Autism Hypothesis and Immunomodulatory Therapy for Autism

You may be aware that about a third of people with autism also have asthma; this is not a coincidence, just as the finding that autistic people have elevated cholesterol was not a coincidence. 

Since Monty, aged 10,  has both autism and asthma, I have had to become informed on both conditions.  Having now read the research on both autism and asthma, it is somewhat shocking that there are so  many parallels.  I would now go so far as to make my own hypothesis:-

The causes of Autism and Asthma are overlapping; so much so, that some drug treatments for the core symptoms of one may be effective in the other.

This may sound a strange, even bizarre proposition, but I will show that it is at worst plausible and at best proven.  Note that it was the observation that bumetanide was an effective treatment in neonatal non-convulsive seizures ,that led to the idea of trialling that drug on autistic children.  Many children with autism subsequently develop epilepsy or other forms of seizure.  So investigating the so-called comorbidities is not such a novel idea.
 

Drugs effective in both Asthma & Autism

·         NAC (N-acetyl cysteine) – reduces oxidative stress

·         Prednisone – powerful steroid for short term use to supress immune system

·         Statins – reduce neuroinflammation

·         Ketotifen – mast cell stabilizer and anti-histamine

In case you are not familiar with asthma, there are some remarkable similarities between asthma and autism, just take a look:-

·         Both affects boys much more than girls

·         Both involve neuroinflammation

·         Both are linked to defects in the auto-immune system

·         Exact cause of both is not known, but is seen as a combination of genetic and environmental factors

·         Both were thought of as a psychological disorders and were unsuccessfully treated as such

·         Both are usually lifelong conditions, though functional recovery is much more common with asthma than autism, often occurring after puberty with asthma

·         In recent decades there has been an “epidemic” increase in prevalence of both. 

Asthma is much more prevalent among those with autism the general population and is frequently cited as a comorbidity, along with epilepsy and GI disorders.

Left untreated, asthma can easily be fatal, so it has been well studied and numerous drugs have been specially developed.  I thought that perhaps there are insights for autism to be gained by looking at how asthma is treated;   indeed there are.

Asthma Prevalence

There is a lot of research into the prevalence of asthma.  After increasing for several decades, there are some reports of it plateauing or even declining.

Is the prevalence of asthma declining? Systematic review of epidemiological studies

 

It is generally accepted that asthma is a disease of the developed world and the apparently the English-speaking world in particular.

Asthma Statistics

The American Academy of Allergy Asthma & Immunology (AAAAI) has an eye-opening summary of asthma statistics showing:-

·         The prevalence of asthma in different countries varies widely, but the disparity is narrowing due to rising prevalence in low and middle income countries and plateauing in high income countries.

·         An estimated 300 million people worldwide suffer from asthma, with 250,000 annual deaths attributed to the disease.

·         It is estimated that the number of people with asthma will grow by more than 100 million by 2025.

·         Workplace conditions, such as exposure to fumes, gases or dust, are responsible for 11% of asthma cases worldwide.

·          About 70% of asthmatics also have allergies.

·         Approximately 250,000 people die prematurely each year from asthma. Almost all of these deaths are avoidable.

·         Occupational asthma contributes significantly to the global burden of asthma, since the condition accounts for approximately 15% of asthma amongst adults.
 

Asthma Treatment

To learn more about asthma and how it is treated the University of Maryland have a helpful summary, just click the link.

There are generally three lines of treatment.  The well-known first line of treatment is the “rescue” inhaler that children are seen with at school, this is to treat acute attacks.  These are bronchodilators, like Ventolin, that open the airways in moderate to severe attacks.

If acute attacks become frequent, then typically an anti-inflammatory steroid inhaler is prescribed.  Long-term control medications are essential to minimize long-term damage of the inflammatory response, to reduce the risk of serious exacerbations.  This is used daily in the hope of preventing future attacks.

In case of an acute attack that does not respond to the rescue inhaler, an oral corticosteroid can be given .  These are powerful drugs that because they are administered orally will affect the whole body;  the steroid inhaler substantially avoids this drawback.  The corticosteroid  works by deactivating the immune system.
 

There are many other therapies used by allergists, in particular the use mast cell stabilizers and anti-histamine drugs.

Ketotifen

Ketotifen is mast cell stabilizer, which means it blocks mast cells from releasing histamine it is also an H1 antagonist, which means it blocks H1 histamine receptors.  It is primarily used as a long term treatment of asthma.  It will not stop an acute asthma attack, but it should reduce their frequency.  If given to high risk children, its use can avoid the initial onset of asthma.

Prevention of asthma by Ketotifenin infants with atopic dermatitis.

It is used in irritable bowel syndrome and it is by DAN doctors to treat GI problems in autism.  If have read about mast cells and Dr Theoharides, then you can see how mast cells may play a key role in autistic behaviour and as such Ketotifen could be a prime therapy.

Autism and the auto immune system

There is a substantial body of opinion that autism is itself a disease linked to the auto immune system, like asthma and indeed type 1 diabetes.  The over active immune system is destroying certain important body functions.

The logical conclusion would be to find a way to down rate the immune system so that the unwanted affects were minimized, without leaving the body open to attack.  This strategy is indeed followed in asthma therapy where the emergency treatment is oral corticosteroid Prednisone

If all this sounds familiar, it should do.  The hygiene hypothesis has also been used to  link asthma, autism and the overactive immune response. 

In the case of autism at least one therapy is also based on this approach.

There is the case of Stewart Johnson in America, who trawled through the research looking for ways to help his autistic son.  He became convinced that the immune system was the key and looked into ways to down rate it.  He came upon the idea of using the TSO parasitic worms.  These parasites live in pigs(?) and in order to preserve themselves they evolved a method of reducing the immune system of their host so that they would not be expelled.  Treatment with such worms has been tried with other conditions, such as Crohn’s disease.  Mr Johnson ordered some TSO from Germany and fed them to his son.  He found that initially there was no impact on his son’s autism, but when he increased the dose there was a marked reduction in autistic behaviours.

Every couple of weeks or so, he gave his son another dose of TSO.

A clinical trial is being carried out at the Albert Einstein medical school to test the effectiveness of the treatment.  Mr Johnson created a website to document his experiences.  

It appears that not all people with autism respond to TSO; perhaps this is not surprising, not all people with autism have asthma either.

Perhaps Mr Johnson should see if a mild dose of Prednisone has the same effect as the worms?

Prednisone & Autism

It turns out that some doctors have indeed been prescribing prednisone for autism.  Most are DAN doctors, but not all.

You will even see on autism forums that when kids were given prednisone for their asthma, they suddenly had a big improvement in their autism.

http://www.autismweb.com/forum/viewtopic.php?p=109879

http://www.autismweb.com/forum/viewtopic.php?f=4&t=30238

While extended use of steroids causes side effects, it seems some doctors used them to try to proactively reverse regressive autism and to get non-verbal kids to speak.  This would seem entirely logical.

Immunomodulatory Therapy in Autism

An truly excellent review paper of Immunotherapy in Autism has been written by Dr Michael Chez, a respected mainstream specialist from Sacramento.  He also seems to be endorsing the use of the prednisone steroid in autism therapy

Immune Therapy in Autism: Historical Experience and Future Directions with immunomodulatory Therapy

 Here are two important paragraphs:-

Experience with EEG abnormalities and autistic regression cases that respond to steroids have been described in various case reports. Treatment was usually prescribed with daily prednisone doses of 2 mg/kg/day for 3 to 6 months. Limitations to therapy were usually Cushingoid side effects. As in other chronic conditions requiring steroids, pulse dosing was tried with steroids in the form of prednisone or prednisolone at 5 to 10 mg/kg twice per week. Long-term success with no dependence or minimal Cushingoid effects has been noted in several hundred patients treated in this manner.

 

In summary, among the current studies of immune targeted therapies, the most collective data on steroid effects on autism is probably the largest. Clear clinical improvements are consistent between different groups that had peer-reviewed assessments. In addition, all reported similar outcomes and side effects were made with the use of steroids. As in IVIG treatment, there has been no report of cure or elimination of all autism features. In the majority of cases, steroid effects did not permanently alter an autism diagnosis in these patients. Clinical concerns about steroid dependency and side effects, such as Cushingoid or long-term, well-known steroid effects have limited more randomized or controlled studies of steroid medications in autism. This is unfortunate, as there may be a potential for significant improvement from steroid treatment on cytokine and chronic immune dysregulation in autism.

Oxidative Stress, Nitrative Stress and Inflammation in Asthma

Much has been written about oxidative stress and inflammation in autism, well it turns out these are key issues in asthma.  In asthma, fortunately, they have been looked into very seriously and all is well documented.

Another superb paper, this time by Professor Peter Barnes, from Imperial College in London is:- 

Histone acetylation and deacetylation: importance in inflammatory lung diseases

 This paper should be read from cover to cover, it is full of interesting information.  For example cigarette smoking in asthma causes oxidative stress.  That stress continues even after the patient has given up smoking, so it is chronic.  To treat this oxidative stress, guess what? He uses NAC just like I using for oxidative stress in my son’s autism.

Also, oxidative Stress causes steroid resistance, so steroids that work in asthma do not work well in COPD.

Cytokines in asthma

Because asthma affects so many people and can be fatal, there is a considerable research effort and drug pipeline.

Cytokines play a key role in all inflammation.  The keys ones have been identified in both autism and asthma; the difference is that in asthma they are being studied in great detail.

Also several cytokine modulators are in various stages of development, but tested on asthma sufferers.
 

For the scientists among you, this subject is covered in depth by Professor Barnes, from Imperial College.

The cytokine network in asthma and chronic obstructive pulmonary disease

How Corticosteroids control inflammation

If you are tempted to make a trial of Prednisone, then you should be interested a read how such steroids control inflammation.  Here is an excellent paper that explains how corticosteroids control inflammation:-

How corticosteroids control inflammation: Quintiles Prize Lecture 2005

 

Asthma and statins 

I have established that the anti-inflammatory properties of statins, already applied neuroscientists in other fields, are very helpful in treating autism.

Researchers are also looking to see whether these properties of statins can be helpful in treating asthma.  Here is a recent paper:-

Do statins improve outcomes in patients with asthma on inhaled corticosteroid therapy? A retrospective cohort analysis

The paper concludes -

The findings suggest beneficial effects of statins in asthma management.

 Yet again the same drug has a positive effect in both conditions.

Conclusion

If you have made it this far in my post, congratulations!

So far from asthma, the autism world has taken Prednisone, Ketotifen and NAC.  I suspect that as new anti-inflammatory drugs are developed for asthma, other little gems will become available.  Also new stronger anti-oxidants are likley to be developed for asthma, since they find NAC not powerful enough. 

Prednisone clearly has drawbacks, but in the case of a sudden regression in autism, it might well be a very smart short term intervention.  Perhaps also in kick-starting development where it has stalled/plateaued.

Quite remarkably, statins not only reduce autistic behaviours but also help control asthma.

I think I have proved my hypothesis

The causes of Autism and Asthma are overlapping, so much so, that some drug treatments for the core symptoms of one may be effective in the other.

Also, we learned from Professor Barnes that corticosteroids do not work well in the presence of oxidative stress.  In asthma he reduces this stress using NAC; I do the same in autism with NAC.  This means that if you are going to trial prednisone, it would be very wise to start with NAC first.  It also means that if your child has both autism and asthma, their inhaled steroid will work better if you  are also using both NAC and statins.   

In case you were wondering, prednisone, Ketotifen and statins are all off-patent and very cheap.  NAC is an OTC supplement and inexpensive if you buy it online.


 

Potassium may play an important role in Autistic Behaviours

This is not the kind of post that I expected to be writing.  How can the effect of something so simple as a mineral, not have been noticed by others and researched in depth?

Potassium (K⁺),  is one of several electrolytes that occur in humans, the others being sodium(Na⁺), calcium (Ca²⁺), magnesium (Mg²⁺), chloride (Cl⁻), hydrogen phosphate (HPO₄²⁻), and hydrogen carbonate (HCO₃)

Electrolyte balance or homeostasis is regulated by specific hormones.  These electrolytes are used to control many aspects of your body.  The concentration of each electrolyte varies across the boundary of each cell.  Electrolytes pass through the cell wall/membrane through so called ion channels.  These are like special valves that open and close based on particular pre-programmed circumstances.  When these ion channels malfunction, often due to a genetic fault, disease occurs.  Ion channel diseases have a special name - channelopathies.  This is still an emerging area of science.

In autism the brain has developed in an unusual way and although it is thankfully not a degenerative disease, the biological equilibrium it has evolved to is not the one originally intended.  There are both channelopathies and hormonal irregularities; indeed the two are interrelated.

Many hormones are interrelated and have multiple functions and therefore a change in one may have a cascading effect on others.  The same applies to the electrolytes, for example a deficiency in magnesium will trigger a deficiency in potassium.

Choride (Cl-)

I started my blog when I read about a successful clinical trial that set out to prove whether an imbalance in chloride between the extra/intra cellular fluid could cause one of the brain’s main neurotransmitters (GABA) to malfunction.  A clever Frenchman called Ben-Ari, had been researching neonatal seizures and proposed to trial the drug Bumetanide.    Bumetanide is known to block the NKCC1 cation-chloride co-transporter, and thus decreases internal chloride concentration in neurons. In turn, this concentration change makes the action of GABA more hyperpolarizing.  Do not be put off if this does not make sense to you.

The trial showed the positive effect on autistic behaviours of this long established and inexpensive drug.

 

A randomised controlled trial of bumetanide in the treatment of autism inchildren

Potassium (K⁺)

Not long after making a trial of bumetanide on Monty, then aged 9 years, I started this blog and my own research.  I soon came across a condition called Hypokalemic Sensory Overstimulation.  In this condition, the subject becomes overwhelmed by his senses of sound, light, smell etc.  After taking oral potassium, the symptoms disappear within 20 minutes.  It is claimed that this is also a characteristic of ADHD (attention deficit hyperactivity disorder).  Well sensory overload is pretty common in autism, and, as I have learnt, ADHD is really just a light case of autism.

There is almost no research into this condition, which is odd since it is linked to the very common ADHD condition.  The paper below  was only ever cited 3 times in other research, and only once in English.

• Hypokalemic sensory overstimulation

I then did my own experiment using a small dose of K+  supplement (equivalent to one banana) to see if by any chance I could see a reduction in sensory overload.  I tested both my sons, and only in the ASD son did the potassium have any impact; and it was a marked impact.  I wrote this up in a blog post.

I kept potassium and channelopathy on my list of things to research and left it at that.

 

Ion Channels & Ion Channel Diseases (Channelopathies)

Ion channels are an emerging area of science all about how signals are sent throughout your body to control it.  It gets very complicated and is still far from fully understood.  So you may want to skip this part.

So far 300 types of ion channel have been identified.  The main types are:-

·         Chloride (Cl-) channels

·         Potassium channels

·         Sodium channels

·         Calcium channels

·         Proton channels

·         Non-selective cation channels

 Then there are differing ways in which the channels open and close such as:-

·         Voltage gated

·         Ligand gated

And odd ones like

 

·         Light gated

·         Temperature gated

·         Calcium activated potassium channels

When the ion channel and/or its gating does not work properly then a disease called a channelopathy may result.  Examples of well know disease are cystic fibrosis, various types of epilepsy and ataxia.

 

Puberty and Epilepsy  

As a result of the changes in hormones triggered by puberty it is therefore not surprising that around this time other changes occur in the body.  In some children with asthma, their symptoms become more mild or even appear to disappear.  In autism the hormonal changes often trigger an improvement, but may be the trigger of the onset of epilepsy.  When you consider the importance of all these electrolyte levels, and the variation of each across one each cell boundary in the body and how this is intertwined with how the neurotransmitters function, it is not surprising that a shift in Homeostatis occurs.

That shift in Homeostatis could be reflected in a mellowing of autistic characteristics.  But if you can now make some small adjustments in these levels via diet and mild drugs, why not investigate it?  You will not be able to achieve perfection, but you might be able to shift from one stable equilibrium to another one, with milder autism and no troubling side effects.

This would also imply that those children developing epilepsy during puberty might be able to treat it using the diuretic bumetanide.  By blocking the NKCC1 transporter, the level of Cl- is blocked and GABA becomes more inhibitory and thus the risk of an epileptic attack might be reduced, or perhaps eliminated.  This is surely worth some research?

 

K+ ion channel disease – Epilepsy & Autism

There is existing research linking potassium ion channels to both epilepsy and autism

 K+ CHANNELEPSY: progress in the neurobiology of potassium channels and epilepsy

The emerging role of the inwardly rectifying K+ channels in autism spectrum disorders and epilepsy

Dysfunction of the Heteromeric KV7.3/KV7.5 Potassium Channel is Associated with Autism Spectrum Disorders

ADHD & Ritalin

I read some research about a stimulant drug used to calm children with ADHD.  It seemed odd to use a stimulant to produce calm.  Here again potassium (K+) and sodium (Na+) levels are at the centre of argument.

 

Then I noted a very recent article (July 2013) reporting a study of Ritalin on children with ASD and/or ADHD.

In the world of alternative medicine there is talk of Ritalin helping in ADHD due to it altering the level of potassium:-

The Ritalin paradox

This inverted ratio of Na/K may be helpful in explaining why a stimulant drug like Ritalin would have a calming effect on hyperactive children and adolescents. Ritalin does, indeed, have a stimulating effect on these children, but its stimulating mechanism is neuroendocrine and biochemical, not behavioural. More specifically, its stimulating effect is on the adrenal glands and the retention of sodium in the tissues relative to potassium. It is critical for normal cellular functioning that sodium and potassium (Na and K) be in balance for the optimal operation of the Na/K pump at the cellular level. It is also critical for efficient neurotransmissions that there be a proper balance between sodium and potassium (Na and K) for neuronal conductance.

 

Measuring electrolyte (Ka, Na, Mg, Cl etc.) levels

I would have expected that it was easy to check the level of electrolytes and indeed to check the levels in blood is very easy.  I have done this and all was normal.  When you read further in the literature, you will realize that the level of electrolytes at the extra/intra cellular level is not so easy to measure.  A whole business has been created by people analyzing hair samples for clues as to the balance or imbalance of various minerals in the body.

Hair analysis is used in forensic toxicology and  drug testing to detect the presence of various chemicals in the body.  The method has been adopted by the complementary and alternative medicine (CAM) community to try to predict food intolerance and dietary deficiency.  It is viewed by the scientific community that much of the CAM use of the technology is not valid and potentially fraudulent,

So there is no certain way of checking the cellular level of electrolytes.  You can only measure what you eat and you can measure what is in your blood.

Other suspected electrolyte imbalances in Autism

There have been several studies regarding Magnesium and autism, but the peer reviews of these studies are highly critical of the methodologies used and conclude that nothing has been proven.

Vitamin B6-magnesium treatment for autism: the current status of the research

Calcium has also been put forward as an intervention.  One mother spent a great deal of time collecting supporting information in her paper below.

Central Role of Voltage Gated Calcium Channels and Intercellular Calcium Homeostasis in Autism

 

DAN doctors and Spironolactone

Having come across a “bible” of therapies proposed by DAN (Defeat Autism Now) doctors I noted the use of a potassium-sparing diuretic called Spironolactone.  For a change, there is actually a published paper setting out their case for this drug.  The case made has nothing to do with potassium, even though the intended purpose of the drug is to raise potassium levels.

Bradstreet et al wrote a paper on this in 2006.  It has been cited only 7 times up until 2013 and two of these times by the authors themselves.  This tells you that other researchers were either skeptical or just disinterested.

 

Spironolactone might be adesirable immunologic and hormonal intervention in autism spectrum disorders

Potassium Supplements

 

There are many hundreds of types of mineral and vitamin supplements; these days many contain far more than recommended daily amount (RDA).  This is not the case with potassium.  Even though the RDA for adults is 3,500 – 4,700 mg, in the US supplements by law may not contain more than 100 mg of potassium.  In Europe potassium supplements with 500mg are common.

A typical banana contains over 400mg of potassium, which would seem to make a 100mg supplement pretty pointless.

In the US it seems that there is a perceived fear of potassium poisoning.  It is indeed the home of the lethal injection.  Potassium chloride in a very high dose will stop your heart.

You will even find people debating whether you can poison yourself with bananas .  It would seem that while you can reduce your high blood pressure with bananas, it does not kill you.  One person was even eating 30 bananas a day!!

The fear of potassium though remains and it is all over the American internet.

 

But, in the UK, the National Health Service advises:-

You should be able to get all the potassium you need by eating a varied and balanced diet. If you take potassium supplements, do not take too much because this could be harmful.

Taking 3,700mg or less of potassium supplements a day is unlikely to cause any harm.

That amount of potassium would require 37 American supplement tablets each and every day!

In reality, a concentrated dose of potassium may indeed upset your stomach and this is why it is better to get it from a healthy mix of fruit and vegetables.  The average American apparently consumes about 1,000mg of potassium per day.

Internet Chatter

If, like me, you use Google to see what other people are up to, you will come across talk of potassium and autism.  The discussions in forums never get far, because someone starts talking about lethal injections, and then fear prevails.

Sodium Potassium Pump  (Na+/K+-ATPase)

The sodium-potassium pump was discovered in the 1957 by a Danish Scientist, who later went on to win a Nobel prize for his discovery in 1997.  Its main application has been in the understanding and treatment of heart disease, but it is now thought to be directly involved in a critical part of the brain already known to be damaged in autism. 

Here is an animation showing how the pump works.

As I have already mentioned in my blog, the comorbidities of autism (asthma, high cholesterol etc.) mean that much of the work has already been done by others.

Those many people with hypertension (high blood pressure) are suffering due the way the sodium potassium pump works.  They eat too much sodium and far too little potassium and the end result is high blood pressure.

An author and researcher, Dr Richard Moore, has a simple explanation on his website and a link to his book showing how diet can indeed control your blood pressure.  If you check the book on Amazon you will see many very favourable comments from people who have indeed lowered their blood pressure with bananas.

His book is called: The High Blood Pressure Solution: A Scientifically Proven Program for Preventing Strokes and Heart Disease.

 

Sodium Potassium Pump and Autism

I was looking for evidence (other than my own) that potassium levels affect the autistic brain.  Potassium plays a key role in how most ion channels function, but I was looking for something really tangible.  I think I have found it.

In my earlier posts I introduced readers to a part of the cerebellum called the Purkinje Cell Layer (PCL).  This is a critical part of the brain and unfortunately in autism, half of the cells are dead and this then manifests itself in altered brain functioning and hence behaviour.  

As recently as 2012, scientists in England showed that the neurons in the PCL are controlled by the Sodium Potassium Pump.

The Sodium-Potassium Pump Controlsthe Intrinsic Firing of the Cerebellar Purkinje Neuron

The paper’s summary concludes “We propose that Na⁺/K⁺ pump activity controls the intrinsic firing mode of cerebellar Purkinje cells”

 
Our new friend Dr Richard Moore puts it very simply:-

For the Na-K-pump to operate normally, the diet must have a ratio of potassium to sodium ratio (the K/Na ratio, or "K Factor") that is above a threshold that is somewhere between 2 and 4. Our ancestors ate a diet with a K/Na ratio ranging between 12 and 16. However, the average American white eats a diet with a K/Na ratio of less than 1 - about 0.6 - and the average American black eats a diet with an average K/Na ratio of about only 0.38! Obviously, the American diet generally has a very deficient K/Na ratio.

A low dietary K/Na ratio causes a low K/Na ratio in each and every cell in your body. This has been known since the end of World War II when whole body radio-active counters were used to determine the amount of potassium (a small part of which is naturally radioactive) in the human body. Almost universally, to their surprise, it was found that people with hypertension have a deficient amount of potassium in their body.

By 1983, several scientists including myself had worked out the vital role of the Na-K-pump in cell function to the point where our understanding predicted that other dysfunctions, or disease states, of the body's cells would occur. Not until the mid 1990's did anyone bother to look for these other conditions. Since then, it has become well established that in the U.S., our typical diet with its low K/Na ratio is the cause of:

About 95% of the cases of high blood pressure.
At least 90% of strokes whether or not high blood pressure is involved.
Much of the osteoporosis and kidney stones.
An increased likelihood of h-pylori infection with resulting stomach ulcer and stomach cancer.
An increase in the severity of asthma.
An increased likelihood of mental decline with aging.

In addition, there is some evidence that this low K/Na ratio in the American diet contributes to insulin resistance, to obesity, and to adult diabetes

  

So since in autism a critical part of the brain is already damaged and has been shown to be subject to oxidative attack and neuroinflammation, it is not surprising that it is particularly susceptible to further interference.  As a result whereas, in a typical childlike Ted, aged 13 with an aversion to fruit and vegetables, can function perfectly well and additional potassium made no measurable difference to his sensory behaviour, the same was not true of Monty, aged 10 with ASD, and with a diet full of fruits and vegetables.  The additional potassium actually changed his sensory behavoiur.  Now I have a plausible explanation

Electrolytes etc.

 If you really want to go into the biology and understand intercellular/extra cellular fluid, role of hormones vasopressin and aldosterone and all about sodium and potassium balance, then take 10 minutes to carefully read the following link:-

 

Fluid/Electrolyte Balance

 

Autism and Heart Disease, Diabetes and Cancer

On this blog I have already shown that several strategies for cardiac health also help autism.  Since in autism there is proven high cholesterol and high neuroinflammation and most likely also hypertension, it would make great sense reduce these risks regardless of the fact that those steps may likely also reduce autistic behaviours and improve functioning.

I made a study into omega 3 and conclude “eat fish”, it is cheaper than omega 3 oil, and it definitely will help cardiac health, but probably will do little to nothing for the autism.

Eat Fish – all about omega 3

A high potassium diet, particularly if it is based on food rather than supplements, will protect your child from heart disease later in life.  He/she is already in an at risk group.

 So there are two very good reasons increase potassium and reduce sodium in his/her diet.  If you are not aware of the health issues surrounding autism, take a look at this:-

Chronic Disease Risks in Young Adults With Autism Spectrum Disorder: Forewarned Is Forearmed

Without intervention, adults with autism spectrum disorder appear to be at significant risk for developing diabetes, coronary heart disease, and cancer by midlife.

For a general discussion on these and other health issues, there is a well-researched paper called:

 

Medical Comorbidities in Autism Spectrum Disorders

  

Conclusion

In the case of Monty, aged 10 with ASD, incremental potassium in diet and via an over the counter potassium supplement (that also contains magnesium and B vitamins) has a positive effect on autistic behaviours.  The total daily potassium ingested (1g as supplement, plus banana, orange juice, potato etc.) is still probably below the adult RDA of 3.5g, but much higher than most 10 year olds with ASD.

There is a scientific logic to show why potassium might produce beneficial effects due to better functioning of the sodium-potassium pump, particularly in the Purkinje cell layer of the brain, which is a known to be damaged in ASD.

It may also be that the magnesium, that is also present in the potassium supplement, is having a beneficial effect.  This could easily be investigated by some further research, should anyone be so inclined.

In any case, a relatively high potassium diet is well established to be very healthy and, along with strategies to lower cholesterol, will promote a healthy heart.  The literature shows that autistic people have elevated cardiac risk and so already have a good reason to be following this kind of diet;  I have just added another good reason.

 

Autism - A Neurodevelopmental Journey from Genes to Behaviour

I am getting a little behind in writing up the findings of my research; I have several posts in preparation.  Here today is a link for those scientists among you:-

Autism - A Neurodevelopmental Journey from Genes to Behaviour


This is a free e-book with 24 scientific papers.  You can download the entire book or just individual chapters.  The book is from 2011, so it is quite up to date.

In the meantime I am looking at ion channels and transporters; and a new term to me "sensory gating".  This is all connected to an earlier observation I have noted about the effect of potassium (K+) on behaviour and a paper I found about the use of spironolactone (a potassium-sparing diuretic) as a therapy in autism.  The paper claims the benefits are do to a secondary anti-inflammatory effect of the drug; I am not so sure they got their science right.  This all goes back to the role of the neurotransmitter GABA, its role in how the brain develops as it grows and then how it functions thereafter; this is all affected by transporters NKCC1 and KCC2.


Asthma - Autism Hypothesis
 

Autism flare ups and comorbidities

Anyone familiar with autism will know that it seems to go in waves of good and not so good.  Generally this gets accepted as just the way it has to be.

I chanced upon an unusual paper recently, it was all about comorbidities in autism.  As you may know, comorbidities are other diseases that seem to frequently occur alongside autism.  The main point of the paper and the charity behind it, is that comorbidities should be diagnosed and treated, rather than ignored, just because the person has ASD.

The paper was produced by Treating Autism, a UK charity that follows a biomedical approach similar to the American DAN organisation.  They have a link to a very comprehensive summary of what DAN actually recommends. The DAN paper is by a Dr Jepson.

The idea of treating the comorbidities as they crop up, seems entirely logical to me; but it seems to miss the bigger issue of what the comorbidity might help tell us about the autism itself.

Their list of comorbidities to keep a look at for:-

·         Allergic disorders in ASD: effects of allergies on behaviour, cognition and anxiety. Food and inhalant allergies, allergic rhinitis.

·         Autoimmunity in ASD. 

·         Autonomic nervous system dysfunction (dysautonomia) in ASD

·         Seizure disorders in ASD

Allergic rhinitis was of course the one that caught my eye.  This is the medical name for the itchy red eyes and runny nose caused by summertime pollen and pollution.  This reinforced by own observation that histamine can have a major negative impact on behaviour in ASD.  This was presented in my recent posts on histamine and antihistamine drugs.

Also of note to me was the observation that atopic dermatitis (itchy skin) and asthma are comorbidities.  Asthma was one of the comorbidities I choose to investigate myself.  An interesting observation I came across was that atopic dermatitis is actually a good predictor of developing asthma and, in fact, that by effectively treating it with a particular drug (ketotifen), you can actually halt the progression to asthma.  There is a study investigating exactly this issue; one half of the trial were itchy toddlers with a placebo and the other itchy toddlers had ketotifen.  A year later the group with ketotifen had a far lower percentage that had developed asthma than the placebo group.  I call that interesting but how many family doctors, let alone parents, are aware of that?

 Prevention of asthma by ketotifen in infants with atopic dermatitis

Also, another interesting paper all about childhood allergies is called The Allergic March.

Conclusion

Autism flare ups seem to be common and a little investigation may well lead to a better understanding of your child’s type of autism.  By recording data on bad behaviours, as in an ABA programme, or my preference, by just be keeping a watchful eye, you may well identify the cause and then find a remedy.  It might be a wobbly tooth, or it might be something more subtle like histamine.

I also believe that a detailed understanding of the comorbidities will ultimately lead to some effective therapies for autism itself.  Since it is clear that different people have different types of autism, knowing what triggers your child's flare ups may well help define what type of autism he/she has and therefore what therapies may or may not prove effective.