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From PreConCePTion environmenTal and nuTriTional sTraTegies For lowering The By DAviD BERGER, MD, FAAP prevalence not only of ASDs but also of allergies, asthma, and autoimmune and Autism spectrum disorders (ASDs) represent a cluster of neurobehavioral- hyperinflammatory conditions in children for whom there is a family history of developmental conditions characterized by varied levels of impairment in such conditions. Families with such histories may be particularly interested in communication, behaviors, social interactions, and sensory integration. To date, strategies to prevent these conditions in their future children. no single medical hypothesis has adequately explained the increasing prevalence The purpose of this review article is to explore how environmental exposures of ASDs as well as the wide range and intensity of symptoms. There is a growing and nutritional factors may play a role in the development of ASDs in children. belief in the medical world that ASDs have both genetic and environmental This implies that there are also certain precautions and steps that may be taken triggers, and there is growing interest in how the environment (both internal to minimize the risk of having a child who develops an ASD (and other chronic/ and external to the body) interacts with the genetic code as well as the various disabling medical conditions). These measures include avoidance of environmental body organs to produce symptoms of ASDs. exposures and implementation of nutritional testing and optimized nutrition. At a glance, it is obvious that ASDs cannot have a purely genetic cause. There are Since i began using these strategies 10 years ago with families, to the best of multiple documented cases of identical twins where one child is severely affected my knowledge, not a single child born into my medical practice has gone on to by autism, while the other twin is neurotypical and indistinguishable from his or develop an ASD. Furthermore, of the more than 500 patients who joined my her peers. i have seen identical twins where one child received multiple courses practice at birth, none have developed diabetes, just one has developed asthma, of antibiotics while the other did not, and the antibiotic-exposed child (but not and only one family (of 3 children) has developed recurring ear infections. the unexposed twin) is now on the autism spectrum. i have also seen identical Some of the recommendations listed below are not specific to and may have twins where one child received vaccines in accordance with the recommended never been studied in relation to ASD. However, strategies intended to decrease schedule and subsequently developed signs of being on the autism spectrum, antibiotic exposure, Candida development, and the incidence of allergies, while the other twin did not receive early infant vaccines at 2 or 4 months of age asthma, and autoimmune diseases likely are relevant to lowering the incidence due to il ness at time of check-up and remained unaffected by autism. On the of autism as are strategies to increase cognitive development and optimize other hand, genetics play some role. it is well known that there is an increased There is a growing belief in the medical world that ASDs have both genetic and environmental triggers, and there is growing interest in how the environment (both internal and external to the body) interacts with the genetic code as well as the various body organs to produce symptoms of ASDs. www.autismone.org REPRINTED WITH PERMISSION • AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE • ISSUE 04 DaviD Berger, MD, faaP, is a board certified pediatrician who specializes in holistic pediatric primary care; nutritional and detoxification therapies for autism, ADhD, and related disorders; and immune dysregulation, such as allergies, asthma, and autoimmune disorders. he also sees adults with these medical conditions. Dr. Berger graduated from the medical College of Pennsylvania in 1994 and completed his pediatric residency at the University of South Florida. he has served as the team doctor for tampa Catholic high School, the medical director for a summer camp run by the tampa AIDS Network, and the medical liaison for the Palm Beach County Breast Feeding task Force. Dr. Berger has been in private practice since 1997, and in 2005 he opened wholistic Pediatrics in tampa, Florida. he has been an advanced practitioner of the philosophy formerly known as Defeat Autism Now! (under the auspices of the Autism research Institute) since 1999. In 2010, Dr. Berger was appointed to the position of assistant professor at the University of South Florida College of Nursing. most recently, Dr. Berger became the vice president of the medical Academy of Pediatric Special Needs. Please see www.medmaps.org and www.wholisticpeds.com.
preconcepTion and pregnancy
example, the abnormal gene sequence found between the cadherin 9 and 10 protein Many families of ASD children have asked me throughout the years if there are on chromosome 5, which was widely reported in 2009, was only present in 15% of things that they could do even prior to conception to decrease the likelihood children with ASD.3 Fragile X is present in about 2% of children with autism.4,5
of having another child develop an ASD. Few formal studies have looked into
While this incidence of fragile X in ASD children is significantly higher than the this issue, and with so many different variables in play, it would be very difficult to 1 in 4000 males who carry the full fragile X mutation and the 1 in 1000-2000 who perform good research on this. Nonetheless, the approach i have taken over the carry the premutations,6 it still represents a very small percentage of children with
past 10 years seems to be successful. i have not had any subsequent siblings develop an ASD, although the incidence in siblings has otherwise been documented to Genes involved with methylation and transsulfuration (see Figure 1), the be high (close to 1 in 5)1 when compared with 1 in 91 for the general population.2
pathway that breaks down homocysteine and produces glutathione, may contribute Most of the concepts that i take into account when evaluating and treating a to autism. Genes code for various enzymes, and these genes and enzymes often have woman prior to conception are similar for women who are pregnant. Factors that the same name. Cystathionine β-synthase (CBS) is the enzyme that metabolizes i consider both preconceptional y and prenatal y are summarized in Table 1 and homocysteine to cystathione, and methionine synthase (MS) is the enzyme that described in greater detail in the rest of the article.
converts homocysteine back to methionine. CBS and MS genes may play a role in the abnormal biochemistry that can be observed in ASD, although most labs do not run these tests. MTHFR (methylenetetrahydrofolate reductase), the enzyme that converts 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate (a substrate Preconceptional and prenatal in the homocysteine-to-methionine methylation reaction), is commercial y considerations in autism prevention available at most labs. As abnormal nucleotide sequences have been associated
with fetal miscarriage7,8 and cardiovascular disease,9,10 MTHFR has become a
particularly useful test.
The biochemical abnormalities that can occur due to these atypical genes Genetic mutations may be at least partial y overcome with the use of methylcobalamin (M-B12) and activated folate (folinic acid or L-methylfolate).11 Supporting the methylation/
Maternal single nucleotide transsulfuration pathway with proper B vitamin supplementation may be polymorphisms (SNPs) particularly important for a mother of a child with ASD as parents of children with autism have often been found to have similar abnormal biochemical markers Cel ular environment Maternal nutrition to those of the children.12 interestingly, one study found that mothers of children
Toxic exposures (i.e., bisphenol A) with autism were less likely than those of typical y developing children to report having taken prenatal vitamins during the 3 months before pregnancy or the first Nutrition-related month of pregnancy.13 Significant interaction effects were observed for maternal
Gluten and casein opioid peptides MTHFR 677 TT, CBS rs234715 GT + TT, and child COMT 472 AA genotypes. Maternal allergies Children were 4.5 times more likely to be diagnosed with autism if their mothers had the homozygous MTHFR C677T single nucleotide polymorphism (SNP) Intestinal flora (SNPs are DNA sequence variations) and 7 times more likely with the COMT SNP.13 Because of the greater risk for autism when mothers did not report taking
prenatal vitamins, the authors suggest that the B vitamin component of prenatal
Mercury (thimerosal, amalgams, and vitamins may protect against fetal brain development deficits.
Although vitamins for pregnancy are referred to as "prenatal," for an optimal pregnancy i propose the use of "preconceptional" vitamins, a product still under development. While waiting for a preconceptional product to become available, i suggest that women start taking prenatal vitamins prior to getting pregnant Thyroid autoantibodies to ensure that adequate nutrition is provided from the moment of conception. A recently identified concern about multivitamins, in general, however, is the possibility that chromium, an essential mineral, could be present in its carcinogenic chromium vi (hexavalent chromium) form.15 Unfortunately, most manufacturers
do not test for the different forms of chromium to make sure that the hexavalent form is not present. i would, therefore, ask the manufacturer if they are testing for Omega-3 fat y acids and rejecting hexavalent chromium and only use companies that do this.
ePigeneticS anD the ceLLuLar envirOnMent An emerging hypothesis for potential causes of ASDs is related to epigenetics. Although there are genetic abnormalities that have been associated with ASD, no An epigenetic trait is a stably heritable phenotype resulting from changes in a genes have been identified that are present in even close to a majority of children chromosome without alterations in the DNA sequence.16 The environment
with ASD (and most of these gene tests are not commercial y available). For within the cell can affect the way that genes are expressed. An example of this Although there are genetic abnormalities that have been associated with ASD, no genes have been identified that are present in even close to a majority of children with ASD.
www.autismone.org REPRINTED WITH PERMISSION • AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE • ISSUE 04 Figure 1.
Protein synthesis methylation of DNA, rNA, proteins, membrane phospholipids, creatine, thf: tetrahydrofolate (image by S. Jill James,14 used with permission)
Ultimately, epigenetics may be the map that explains how the body and its environment interact in a manner that prevents or causes disease. is found in Prader-Wil i and Angelman syndromes, where there is abnormal the presence of opioid peptides derived from gluten and casein. Just as we would
imprinting of the ubiquitin protein ligase E3A (UBE3A) gene.17 in fragile X
not want to have morphine or other pharmacological opiates present during fetal syndrome, the epigenetic effects result in a CGG-repeat expansion that triggers development, i presume that opioids derived from foods containing these two hypermethylation and silencing of the FMR1 gene.18 i expect that in coming
proteins could also have a negative effect on the developing fetus. years, research will reveal specific alterations in the cellular environment that Circulating maternal y derived antibodies may have a negative impact on lead to these epigenetic changes. Ultimately, epigenetics may be the map that the future health of children. The intake of foods that a woman is allergic to explains how the body and its environment interact in a manner that prevents during pregnancy may increase the risk of allergy in the offspring.22 Taking this
or causes disease. While this is being figured out, we already know enough to into account, performing maternal igE and igG antibody testing for various minimize toxic exposures and enhance maternal nutrition to give cel s an foods and avoiding those foods during pregnancy may bring an immunological optimal environment in which to develop and reproduce. advantage to the child later in life.
nutritiOnaL iSSueS Certain laboratory tests that can be run on a woman preconceptional y or during As many families who have explored biomedical treatments for ASD have pregnancy may be helpful in providing the information needed to support an discovered, control ing Candida (yeast) can significantly reduce many of optimal fetal environment. i often run a celiac panel because untreated celiac the symptoms of autism. Unfortunately, most of the research performed by disease can cause nutritional deficiency.19 And, although not well studied in gastroenterologists has yet to support these clinical findings. Nonetheless,
humans, mammalian studies have suggested that celiac disease could increase
especial y for women who have a significant history of frequent antibiotic intestinal permeability (leaky gut), which could, in turn, permit gluten-based exposure or recurring yeast infections, i test for the presence of Candida species opioid peptides and other toxins to gain access to the maternal bloodstream20,21
using stool microscopic evaluations and cultures as well as the urine Organic and, thus, the fetus. in addition to testing for celiac disease, i often also test for Acids Test. if the woman is not pregnant, i often treat with systemic antifungal AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE • ISSUE 04 • REPRINTED WITH PERMISSION medications (fluconazole, ketoconazole, itraconazole, or terbinafine), probiotics, and dietary control (low-carbohydrate diet or Specific Carbohydrate Diet™). Heavy metals such as mercury and lead are well established to be toxic to fetuses i do not use most systemic antifungal therapies during the first two trimesters and young children, and all efforts should be made to minimize exposure in these of a pregnancy. However, the oral form of the antifungal medications nystatin populations.28,29 Although there is no consensus on what defines increased heavy
and amphotericin B are not absorbed into the bloodstream, meaning that both metal exposure or toxicity, i recommend that a woman consider performing a can be considered safe to use oral y at any point during pregnancy. Systemic single dose chelation challenge with baseline urine metal testing prior to get ing amphotericin B is the antifungal medication that has been most studied during pregnant to determine if heavy metals are present. if there is a significant increase pregnancy. it is in the FDA's pregnancy risk category B (the second safest in heavy metals following this single dose, i would recommend that she consider category but only recommended for use during pregnancy when the benefit chelation therapy with the agent that brought about the increased metal excretion. outweighs the risk), and there have been no reports of fetal abnormalities from Chelation therapy should not be used during pregnancy, however.
its use, even when administered intravenously.23 Fluconazole is the most studied
vaccines that contain thimerosal (a mercury compound), such as certain flu azole antifungal medication during pregnancy; abnormal fetal development shots, should not be given to pregnant women. Consumption of fish that have has been seen at high doses (> 400 mg/day) but not at lower doses (150 mg).24
significant mercury levels should also be avoided. (A list of the mercury levels in Because herbs that are used to treat Candida have not been studied, in general, i commercial fish and shel fish is available at the US Food and Drug Administration avoid these during pregnancy.
website.30) Women found to have high levels of mercury and who have amalgam
(50% mercury) fil ings should consider having the fil ings replaced (except during
pregnancy), but this should only be done by a dentist who is knowledgeable and Multiple species of clostridia bacteria have been implicated in contributing experienced in safe removal procedures. improper amalgam removal can lead to to symptoms of ASD. Elevated levels of a measurable clostridia metabolite, increased mercury exposure. Living in close proximity to coal-fired power plants HPHPA, have been found in some individuals with autism and schizophrenia; also can increase exposure to mercury. An increased incidence of autism has use of a treatment appropriate for eliminating clostridia (vancomycin) reduced been associated with communities that have high levels of mercury-releasing coal HPHPA levels and simultaneously improved symptoms.25 Treatments for plants31,32 (see Figure 2).
clostridia that are safe to use during pregnancy include Saccharomyces boulardi and certain strains of lactobacillus. vancomycin oral capsules are a FDA risk category B pregnancy medication. Testing for hypothyroidism is one of several other tests that i perform before and during pregnancy, with correction of the abnormality if present. Hypothyroidism is a known cause of developmental delay in children,33 and thyroid hormone
Bisphenol A (BPA) is used in many different products to harden plastics. it also is also a growth factor for fetuses and young children.34 The prevalence of
can be found in or on tin can linings, dental sealants, and cash register receipts. it is hypothyroidism in pregnant women has been estimated at 5%, and thyroid believed that BPA is an estrogen hormone disruptor, and there is mounting evidence autoantibodies can be seen in 12% of pregnant women.35 My personal observation
that exposure during pregnancy may lead to negative outcomes. Prenatal BPA is that the actual percentages are higher. Women with true hypothyroidism and exposure has been linked to aggression in 2 year olds26 as well as anxiety, depression,
those with positive antibodies (especial y those with consistently low basal body and poor emotional control in girls.27 Avoidance of BPA-containing products is the
temperatures under 97°F) should receive consideration for thyroid hormone best strategy to minimize the impact of BPA on a fetus or young child.
supplementation and be closely monitored during both pregnancy and lactation.
Figure 2. environmental mercury release and autism
Observed rate of autism 1998 - 2000 by county of Texas Levels of total toxicity by Texas county for 2001 with top two deciles of Bayesian autism rates (1998-2001) Aggregated from school districts with Texas Education Agency (TEA) districts On average, for each 1000 lb of environmental y released mercury, there was a 43% increase in the rate of special education services and a 61% increase in the
rate of autism.31,32
www.autismone.org REPRINTED WITH PERMISSION • AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE • ISSUE 04 receptor 1 antibodies may be indicated if there is a significant family history of any vitamin D has long been established to be essential for bone health, and emerging of the above conditions. if CFD is identified, folic acid should be stopped and high evidence is showing its importance for proper immune development. Children doses of activated folate (i.e., folinic acid or L-methylfolate) taken, working up to born to women who are low in vitamin D have an increased incidence of allergies 25 mg twice a day.47
and severity of asthma36 and a greater incidence of type i diabetes.37 The vitamin
D Council has hypothesized that vitamin D deficiency may be contributing to
addiTional consideraTions during pregnancy
the increased incidence of autism.38 Most recently, in Pediatrics, Whitehouse et al.
Beyond folate, iron, and vitamin D, there are two additional nutrients (calcium and demonstrated a link between maternal vitamin D insufficiency during pregnancy omega-3 fatty acids) that i focus on with pregnant women to ensure that there are and offspring language impairment at 5 and 10 years of age. in the study, women no deficiencies. with 25-hydroxyvitamin D levels under 18 ng/ml were twice as likely to have a child with language impairment when compared with those above 33 ng/ml. caLciuMThe vitamin D Council recommends that pregnant women get their level of Adequate calcium intake is essential for bone growth and long-term health. 25-hydroxyvitamin D (the storage form of vitamin D, also called calcidiol) above A pregnant woman should take between 1000-1200 mg daily. if a woman is 50 ng/ml and suggests a dose of 5000 iU of vitamin D3 a day for pregnant women avoiding dairy, this may be difficult to accomplish through the diet, and calcium who cannot get their level checked.39
supplementation may be needed. As lead has recently been found to be present in some calcium supplements, it is essential to use supplements from manufacturers who are testing for lead and rejecting calcium raw materials that have increased iron is an essential mineral not only for the production of hemoglobin, but it also amounts of lead. (This means verifying that the manufacturer is screening for lead may affect a person's cognitive function. While a low hemoglobin level (anemia) is in the raw material or in each batch produced.) When taking calcium supplements, one indicator that a patient may be iron-deficient, a low blood ferritin level (<30 ng/ i suggest that women also take magnesium in a 2:1 ratio of calcium to magnesium.
ml) is a better early indicator of low iron stores.40 iron deficiency without anemia
has been associated with autism,41 attention-deficit/hyperactivity disorder OMega-3 fatty aciDS
(ADHD),42 and lower math scores in children.43 Correcting non-anemic iron
Omega-3 fatty acids are essential for brain and cardiovascular development and deficiency has been shown to correct verbal learning and memory44 as well as growth. The DHA form of omega-3 fatty acid (available in certain sea algae and
symptoms of ADHD.45
other marine sources but not plant-based sources of omega-3 fatty acids) is the During pregnancy, a hemoglobin level under 10.5-11.0 g/dl (depending on one that is best utilized by the developing brain. it is recommended that pregnant trimester) is considered anemia. When i document that a woman has a low ferritin and lactating women take at least 300 mg per day of DHA,48 and some studies
level, i try to correct the level to above 50 ng/ml.40 During pregnancy, 40 mg have suggested that significantly higher doses may be even more beneficial.
of elemental iron per day is usual y sufficient to prevent iron deficiency,46 and Children of mothers who took 3.3 grams of combined EPA and DHA during
doses of between 60-120 mg are recommended if there is already iron deficiency
pregnancy demonstrated greater hand-eye coordination,49 and children of
present.40 Some forms of iron can cause intestinal discomfort and constipation,
mothers who took about 2 grams of combined EPA/DHA (as 2 teaspoons of especial y during pregnancy. i find that iron in the ferrous bisglycinate chelate form cod liver oil) had increased mental processing.50 Fish oil supplementation during
is best tolerated by the Gi tract and has very good absorption. iron absorption can pregnancy has also been associated with lower potential for allergies and possibly be enhanced if taken at the same time as vitamin C but should be taken away from other immune-mediated diseases.51,52
thyroid hormone supplementation. i have also found that using a cast iron skillet for pan frying and sautéing can increase food's iron content.
birTh and posTnaTal consideraTions
An increased prevalence of autism has been identified in children born by both
emergency and elective cesarean section (C-section).53 it is logical to suspect
Folate is known to be essential for fetal brain development. Folate deficiency has that when an emergency C-section is performed due to fetal distress, this stress been associated with spina bifida and other neural tube defects. All pregnant could be related to a lack of blood flow to the fetal brain that could lead to brain women should get a minimum of 400 mcg of folic acid daily. However, because injury with resulting autism symptoms. Because the prevalence of autism is also women who have the abnormal MTHFR gene sequence may not be able to higher with elective C-sections, however, all efforts should be made to avoid efficiently complete the conversion of folic acid to methylfolate, they may have C-sections whenever possible. Although many women are told that they need issues if taking only folic acid. in such cases, i recommend that women not take to have a C-section if they had a previous C-section, the American Congress folic acid but rather L-methylfolate or folinic acid or possibly a combination of of Obstetricians and Gynecologists (ACOG) recently declared, "Attempting both. These two forms bypass the faulty MTHFR enzyme and provide the fetus a vaginal birth after cesarean (vBAC) is a safe and appropriate choice for most with activated folate. women who have had a prior cesarean delivery, including for some women who Another potential complication of faulty folic acid metabolism is cerebral have had two previous cesareans."54
folate deficiency (CFD) and the presence of cerebral folate receptor antibodies. i instruct parents that a baby is not considered past due until after 42 weeks. CFD has been associated with low-functioning autism, mitochondrial There is no reason to artificial y rush the delivery of a baby before the baby and
disease or dysfunction, Rett syndrome, epilepsy or seizures, and an abnormal placenta indicate that it is time for delivery. if there is any concern, an ultrasound
electroencephalogram.47 While this disorder is not something that i routinely can be performed to ensure that the baby is healthy and not under stress.
check for in all preconception or pregnant women, testing for the presence of folate
induction of pregnancy itself may have a negative role on a child's development. i instruct parents that a baby is not considered past due until after 42 weeks. There is no reason to artificial y rush the delivery of a baby before the baby and placenta indicate that it is time for delivery. AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE • ISSUE 04 • REPRINTED WITH PERMISSION in one study, there was almost a 2-fold increase in ADHD diagnosis in children the amino acid composition of human milk is different from that of cow's milk.68
born to mothers who were induced.55
For these and other reasons, i encourage adherence to the AAP breastfeeding Some families express concern about exposing their newborn to the antibiotic ointment that is placed in newborns' eyes soon after delivery. This is used Babies who are breastfed are provided antibodies through the milk to fight off specifical y to prevent neonatal infection from sexual y transmitted diseases infection within hours of a mother being exposed to a virus or bacteria. This can (STDs) such as chlamydia and gonorrhea that can be contracted during passage protect the baby against a host of different pathogens that could otherwise lead through the birth canal. Therefore, this has to do with the STD status of the to the baby being exposed to antibiotics. Another advantage of breastfeeding is mother. (it should be remembered that these STDs can be asymptomatic or that a mother who continues to optimize her nutrition (as already discussed with missed on vaginal screening.) While i am not overly concerned about a topical regard to pregnancy) provides the nutrients to her baby through the breast milk. one-time exposure to an antibiotic (using a route that would not have an effect on the baby's intestinal flora), it is the case that the ointment may cause chemical intrODuctiOn Of SOLiD fOODS irritation or interfere with the initial eye contact and bonding that happens when infants who are fed solid foods too early are prone to developing food allergies. the mother is first holding the baby. Parents should evaluate the pros and cons in general, the American College of Allergy, Asthma, and immunology and decide what they think is best for their baby.
recommends that solid foods not be introduced until 6 months of age, with dairy vitamin K is routinely administered by intramuscular injection soon after products introduced at 12 months, eggs at 24 months, and peanuts, tree nuts, birth. This is done to prevent a rare newborn condition called hemolytic disease fish, and seafood not introduced until at least 36 months of age.69 For younger
(a condition where the baby's blood cannot clot and the baby has a hemorrhage). siblings of children on the autism spectrum, i also recommend waiting at least The injected form does not contain thimerosal. Deficiency in vitamin K can until 1 year of age before introducing gluten. When foods are final y introduced, cause the hemorrhagic condition in about 1 in 10,000 births, and the bleeding only small amounts should be offered for the first few days, and one new food can occur up to 12 weeks after birth. For families who have concerns about the should be introduced every 4 days to watch for negative reactions.
injected form of vitamin K, there are protocols available for its oral use from the
Canadian Pediatric Society,56 the Pediatric Society of New Zealand,57 and the
Australian government.58
Much controversy surrounds the potential connection between vaccines and Babies are routinely given the first dose of hepatitis B vaccine on the first ASD. i find it interesting that pediatricians routinely tell parents that to prevent or second day of life. i discuss vaccines at greater length below. Many parents an undesirable immune reaction (allergies) they should wait six months to question why they should give a newborn a hepatitis vaccine at birth if the introduce a foreign substance (food) to their baby and advise parents to give mother tests negative for the virus during pregnancy and babies do not engage foods one at a time to watch for reactions, yet recommend that vaccines be in activities that would spread hepatitis B. While the administration of the given starting at birth (hepatitis B) and continuing with another 21 antigens vaccine along with hepatitis B immunoglobulin may be effective in preventing given simultaneously at 2 months of age: diphtheria, tetanus, pertussis, 3 strains the acquisition of hepatitis B in babies born to infected mothers, all pregnant of polio, 13 strains of pneumococcus, Haemophilus influenzae type b (HiB), and women should have been tested for hepatitis B, meaning that their infection rotavirus. This displays a significant disconnect between pediatricians' feeding status should be known at the time of delivery. if the mother is not infected with and vaccine advice. hepatitis B, i see little benefit to vaccinating a baby for this at birth.
in my pediatric practice, i follow the true meaning of informed consent, After birth, i advocate for discharging mother and baby from the hospital explaining vaccine benefits, risks, and alternatives to families so that they are as soon as possible. Hospitals are known to harbor higher levels of certain ful y and meaningful y informed when making their decision. Ultimately, infections (such as Candida, methicil in-resistant Staphylococcus aureus [MRSA], parents have both the right and responsibility to make medical decisions and and clostridia) than most of the outside world, including most people's homes. decide what is best for their child. They can choose to give vaccines according to the recommended Centers for Disease Control and Prevention (CDC) schedule, or they can split vaccines, delay them, or not give any at al . The AAP recommends that pediatricians listen careful y and respectful y to parents' The importance of breastfeeding is now universal y accepted. The American concerns about vaccines, convey respect for continued refusals that follow
Academy of Pediatrics (AAP) recommends that babies be breastfed for at adequate discussion,70 and not discharge families who refuse vaccination from
least the first year of life, and longer if desired by the mother and baby.59 Babies
their pediatric practice. Notwithstanding these recommendations, almost who are breastfed have been suggested to have higher iQs and cognitive 40% of pediatricians said they would not provide care to a family that refused
development60,61 and a lower incidence of type 1 diabetes,62 allergies (when all vaccines, and 28% said they would not provide care to a family that refused
compared with cow's milk and soy formulas),63 asthma,64 and ear infections.65
Babies who receive cow's milk-based formula may have increased intestinal Although thimerosal is a known neurotoxin with no natural biological role, permeability (leaky gut) when compared with babies who receive breast milk,66
concerns about vaccines go beyond the mercury in vaccines. With the exception especial y if they were born prematurely.67 Although some families express of flu shots and tetanus vaccine (DT has trace thimerosal and tetanus toxoid
concern about feeding any form of milk to their babies due to the casein content,
may have the full 25 mcg of mercury), thimerosal was removed from most in my pediatric practice, i follow the true meaning of informed consent, explaining vaccine benefits, risks, and alternatives to families so that they are fully and meaningfully informed when making their decision. Ultimately, parents have both the right and responsibility to make medical decisions and decide what is best for their child.
www.autismone.org REPRINTED WITH PERMISSION • AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE • ISSUE 04 vaccines in the early 2000s, yet the prevalence of autism has continued to climb.  vaccines are documented to have the potential to induce autoimmune One possible explanation is that exposure to injected antigens from vaccines diseases,78,79 and although rare, MMR vaccine has recently been
can cause undesirable immunological effects with or without the presence of associated with immune thrombocytopenic purpura.80 As a subset
mercury. The diseases that children are vaccinated against (with the exception of children with ASD has documented autoimmunity against the of tetanus and hepatitis B) are not contracted in the natural world through brain,81-83 it is plausible that vaccines could induce autoimmunity
injection but through the respiratory tract or the gastrointestinal (Gi) tract, against the brain with resulting symptoms consistent with autism. and, therefore, the immune system's first line of defense, which sets in motion the rest of the natural immune response, is bypassed. Both of these systems  Large epidemiologic studies have been published that found statistical y (respiratory and Gi) have specific white blood cel s and antibodies residing on significant evidence to suggest that boys in the United States who were their surface that serve as a first line of defense against invading organisms. The vaccinated with the triple series hepatitis B vaccine during the time injection of vaccines prompts an artificial immune response. Abnormal shifts period in which vaccines were manufactured with thimerosal were more in white blood cel s following vaccination were suggested to be the reason why susceptible to developmental disability than were unvaccinated boys.84 in
children who were given the DTwP vaccine (note that this had a different form addition, a study based on vaccine records suggests that US male neonates of pertussis antigen than the current vaccine and did contain thimerosal) at 2 vaccinated with the hepatitis B vaccine prior to 1999 had a threefold months of age were significantly more likely to develop asthma than children higher risk for parental report of autism diagnosis when compared with who did not start receiving this vaccine until 4 or 6 months of age.72 The authors
boys not vaccinated as neonates during that same time period.85
of this study hypothesized that the vaccinations can be viewed as promoters of
asthma development, perhaps by stimulating a Th2-type immune response conclusion
and shifting the cytokine balance.73 They also note that at birth the newborn
There is considerable interest in developing strategies to try and prevent autism, immune system has a limited ability to produce Th1 cytokines, but levels especial y for families who are at higher risk by having one child on the spectrum increase over the next 6 months.74
already. in this article, i reviewed a variety of possible strategies that can be More research is warranted to examine possible subtypes of autism relative considered beginning at the time of preconception and beyond. These include to vaccine exposure and vaccinated versus unvaccinated children. Nonetheless, supporting the methylation/transsulfuration pathway with proper B vitamin existing medical literature makes it clear that a role between autism and vaccines supplementation; avoiding or minimizing toxic exposures (including BPA and is biological y plausible. To cite a few examples: heavy metals); enhancing maternal nutrition (including supplementation, as appropriate, with vitamin D, iron, folate, calcium, and omega-3 fatty acids); assessing  Some children with ASD have been found to have mitochondrial maternal food allergies and intolerances; screening for maternal hypothyroidism; dysfunction.75 in the case of Hannah Poling, the United States
control ing maternal fungal and bacterial infections; breastfeeding newborns and Court of Federal Claims decided that there was enough evidence to introducing solid foods with care; and careful y weighing the pros and cons of show that vaccines may have aggravated her mitochondrial disorder postnatal interventions including vaccines. Further study is warranted to examine and triggered problems consistent with autistic-like behavior.76 Some
the issues raised in this review article so that we can determine if the prevalence people even argue that vaccines can be the trigger for secondary of autism can be reduced by correcting imbalances and insults that can occur preconceptional y, during pregnancy, and during early childhood.
1. Ozonoff S, Young GS, Carter A, Messinger D,
7. Li XM, Zhang YZ, Xu YX, Jiang S. [Study on the
14. James SJ, Slikker W 3rd, Melnyk S, New E, Pogribna
Yirmiya N, Zwaigenbaum L, et al. Recurrence risk relationship of MTHFR polymorphisms with unexplained M, Jernigan S. Thimerosal neurotoxicity is associated for autism spectrum disorders: a Baby Siblings recurrent spontaneous abortion]. [Article in Chinese]. with glutathione depletion: protection with glutathione Research Consortium study. Pediatrics. 2011 Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2004 precursors. Neurotoxicology. 2005 Jan;26(1):1-8.
15. Martone N, Mizanur Rahman GM, Pamuku M.
2. Insel T. NIMH's response to new HRSA autism
8. Rodríguez-Guil én M del R, Torres-Sánchez L, Chen
Determination of chromium species and mass balance prevalence estimate. Director's blog, National Institute J, Galván-Portil o M, Blanco-Muñoz J, Anaya MA, in food supplements using speciated isotope dilution of Mental Health, October 15, 2009. Available online et al. Maternal MTHFR polymorphisms and risk of mass spectrometry. Pittsburgh, PA: Department of spontaneous abortion. Salud Publica Mex. 2009 Jan- Environmental Science and Management, Duquesne University, unpublished study.
9. Klerk M, Verhoef, P, Clarke R, Blom HJ, Kok FJ, Schouten
16. Berger SL, Kouzarides T, Shiekhattar R, Shilatifard A.
3. Wang K, Zhang H, Ma D, Bucan M, Glessner JT,
EG, et al. MTHFR 677C→T polymorphism and risk of An operational definition of epigenetics. Genes Dev. Abrahams BS, et al. Common genetic variants on coronary heart disease: a meta-analysis. JAMA. 2002 5p14.1 associate with autism spectrum disorders. Nature. 2009 May;459:528-33. 17. Lalande M, Calciano MA. Molecular epigenetics
10. Cortese C, Motti C. MTHFR gene polymorphism,
of Angelman syndrome. Cell Mol Life Sci. 2007 4. Bailey A, Bolton P, Butler L, Le Couteur A, Murphy
homocysteine and cardiovascular disease. Public M, Scott S, et al. Prevalence of the fragile X anomaly Health Nutr. 2001 Apr;4(2B):493-7.
amongst autistic twins and singletons. J Child Psychol 18. Coffee B, Keith K, Albizua I, Malone T,Mowrey J,
Sherman SL, et al. Incidence of fragile X syndrome by 1993 Jul;34(5):673-88.
11. James SJ, Melnyk S, Fuchs G, Reid T, Jernigan S, Pavliv
O, et al. Efficacy of methylcobalamin and folinic acid newborn screening for methylated FMR1 DNA. Am J 5. Reddy KS. Cytogenetic abnormalities and fragile-x
treatment on glutathione redox status in children with Hum Genet. 2009 Oct;85(4):503-14.
syndrome in Autism Spectrum Disorder. BMC Med autism. Am J Clin Nutr. 2009 Jan;89(1):425-30.
19. Nelsen DA Jr. Gluten-sensitive enteropathy (celiac
2005 Jan;6:3.
12. James SJ, Melnyk S, Jernigan S, Hubanks A, Rose S,
disease): more common than you think. Am Fam 6. Crawford D, Sherman SL. Fragile X syndrome:
Gaylor DW. Abnormal transmethylation/transsulfuration Physician. 2002 Dec;66(12):2259-66.
application of gene identification to clinical diagnosis metabolism and DNA hypomethylation among parents and population screening. In MJ Khoury, J Little, W of children with autism. J Autism Dev Disord. 2008 20. Sandhu JS, Fraser DR. Effect of dietary cereals on
Burke (Eds.), Human Genome Epidemiology: A Nov;38(10):1966-75. intestinal permeability in experimental enteropathy in Scientific Foundation for Using Genetic Information rats. Gut. 1983 Sep;24(9):825-30.
13. Schmidt RJ, Hansen RL, Hartiala J, Al ayee H, Schmidt
to Improve Health and Prevent Disease (Chapter LC, Tancredi DJ, et al. Prenatal vitamins, one-carbon 21. Hall EJ, Batt RM. Abnormal intestinal permeability
23). Atlanta, GA: Centers for Disease Control and metabolism gene variants, and risk for autism. could play a role in the development of gluten- Prevention, Office of Surveillance, Epidemiology, and Epidemiology. 2011 Jul;22(4):476-85.
sensitive enteropathy in Irish Setter dogs. J Nutr. Laboratory Services, Public Health Genomics, revised AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE • ISSUE 04 • REPRINTED WITH PERMISSION 22. Sausenthaler S, Koletzko S, Schaaf B, Lehmann I, Borte
45. Sever Y, Ashkenazi A, Tyano S, Weizman A. Iron treatment
63. Gruskay FL. Comparison of breast, cow, and soy feedings
M, Herbarth O, et al. Maternal diet during pregnancy in in children with attention deficit hyperactivity disorder. A in the prevention of onset of allergic disease: a 15-year relation to eczema and allergic sensitization in the offspring preliminary report. Neuropsychobiology. 1997;35(4):178- prospective study. Clin Pediatr (Phila). 1982 Aug;21(8):486- at 2 y of age. Am J Clin Nutr. 2007 Feb;85(2):530-7.
23. Physician's Desk Reference, 65th edition. PDR Network,
46. Milman N, Bergholt T, Eriksen L, Byg KE, Graudal N,
64. Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanley
2011, p. 3113.
Pedersen P, et al. Iron prophylaxis during pregnancy -- how FJ, et al. Association between breast feeding and asthma in 24. King CT, Rogers PD, Cleary JD, Chapman SW. Antifungal
much iron is needed? A randomized dose-response study of 6 year old children: findings of a prospective birth cohort therapy during pregnancy. Clin Infect Dis. 1998 Nov; 20-80 mg ferrous iron daily in pregnant women. Acta Obstet study. BMJ. 1999 Sep;319(7213):815-9.
Gynecol Scand. 2005 Mar;84(3):238-47.
65. Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig
25. Shaw W. Increased urinary excretion of a
47. Frye RE, Rossignol DA. Cerebral folate deficiency in autism
LM. Exclusive breast-feeding for at least 4 months protects 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), spectrum disorders. Autism Science Digest. 2011;Issue 2:9-15.
against otitis media. Pediatrics. 1993 May;91(5):867-72.
an abnormal phenylalanine metabolite of Clostridia spp. 48. Simopoulos AP, Leaf A, Salem N. Workshop on the
66. Weaver LT, Laker MF, Nelson R, Lucas A. Milk feeding
in the gastrointestinal tract, in urine samples from patients essentiality of and recommended dietary intakes for and changes in intestinal permeability and morphology with autism and schizophrenia. Nutr Neurosci. 2010 omega-6 and omega-3 fatty acids. J Am Coll Nutr. 1999 in the newborn. J Pediatr Gastroenterol Nutr. 1987 May- 26. Braun JM, Yolton K, Dietrich KN, Hornung R, Ye X,
49. Dunstan JA, Simmer K, Dixon G, Prescott SL. Cognitive
67. Taylor SN, Basile LA, Ebeling M, Wagner CL. Intestinal
Calafat AM, et al. Prenatal bisphenol A exposure and assessment of children at age 2(1/2) years after maternal permeability in preterm infants by feeding type: mother's milk early childhood behavior. Environ Health Perspect. 2009 fish oil supplementation in pregnancy: a randomised versus formula. Breastfeed Med. 2009 Mar;4(1):11-5.
controlled trial. Arch Dis Child Fetal Neonatal Ed. 2008 68. Lawrence R, Lawrence R. Breastfeeding: A Guide for the
27. Braun JM, Kalkbrenner AE, Calafat AM, Yolton K, Ye X,
Medical Profession, 5th Edition. St. Louis, Missouri: Mosby Dietrich KN, et al. Impact of early-life bisphenol A exposure 50. Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA.
Inc., 1999, pp. 117-9.
on behavior and executive function in children. Pediatrics. Maternal supplementation with very-long-chain n-3 fatty 2011 Nov;128(5):873-82. acids during pregnancy and lactation augments children's 69. Fiocchi A, Assa'ad A, Bahna S. Food allergy and the
introduction of solid foods to infants: a consensus document. 28. Goldman LR, Shannon MW. Technical report: mercury in the
IQ at 4 years of age. Pediatrics. 2003 Jan;111(1):e39-e44.
Adverse Reactions to Foods Committee, American College environment: implications for pediatricians. Pediatrics. 2001 51. Dunstan JA, Prescott SL. Does fish oil supplementation in
of Allergy, Asthma and Immunology. Ann Allergy Asthma pregnancy reduce the risk of allergic disease in infants? Curr Immunol. 2006 Jul;97(1):10-20.
29. American Academy of Pediatrics Committee on
Opin Allergy Clin Immunol. 2005 Jun;5(3):215-21.
70. Pickering LK, Baker CJ, Kimberlin DW, Long SS (Eds.). Red
Environmental Health. Lead exposure in children: prevention, 52. Dunstan JA, Mori TA, Barden A, Beilin LJ, Taylor AL,
detection, and management (AAP Policy Statement). Book: 2009 Report of the Committee on Infectious Diseases, Holt PG, et al. Fish oil supplementation in pregnancy 28th ed. Elk Grove Village, IL: American Academy of Pediatrics. 2005 Oct;116(4):1036-46.
modifies neonatal allergen-specific immune responses Pediatrics, 2009, p. 8.
30. US Food and Drug Administration (FDA). Mercury levels in
and clinical outcomes in infants at high risk of atopy: a 71. Flanagan-Klygis EA, Sharp L, Frader JE. Dismissing the family
commercial fish and shellfish (1990-2010). Available online randomized, controlled trial. J Allergy Clin Immunol. 2003 who refuses vaccines: a study of pediatrician attitudes. Arch Pediatr Adolesc Med. 2005 Oct;159(10):929-34.
31. Palmer RF, Blanchard S, Wood R. Proximity to point sources
53. Glasson EJ, Bower C, Petterson B, de Klerk N, Chaney
of environmental mercury release as a predictor of autism G, Hallmayer JF. Perinatal factors and the development 72. McDonald KL, Huq SI, Lix LM, Becker AB, Kozyrskyj
prevalence. Health Place. 2009 Mar;15(1):18-24.
of autism: a population study. Arch Gen Psychiatry. 2004 AL. Delay in diphtheria, pertussis, tetanus vaccination is associated with a reduced risk of childhood asthma. J 32. Palmer RF, Blanchard S, Stein Z, Mandell D, Miller C.
Allergy Clin Immunol. 2008 Mar;121(3):626-31.
Environmental mercury release, special education rates, and 54. American College of Obstetricians and Gynecologists.
autism disorder: an ecological study of Texas. Health Place. ACOG practice bulletin #115: vaginal birth after previous 73. Johnston SL, Holgate ST. Asthma: Critical Debates. London:
Cesarean delivery. Obstet Gynecol. 2010 Aug;116(2 Pt Blackwell Science Ltd, 2002.
33. Sutandar M, Garcia-Bournissen F, Koren G. Hypothyroidism
74. Marodi L. Down-regulation of Th1 responses in human
in pregnancy. J Obstet Gynaecol Can. 2007;29(4):354-6. 55. Kurth L, Haussmann R. Perinatal pitocin as an early ADHD
neonates. Clin Exp Immunol. 2002 Apr;128(1):1-2.
34. Fisher DA, Hoath S, Lakshmanan J. The thyroid hormone
biomarker: neurodevelopmental risk? J Atten Disord. 2011 75. Rossignol DA, Bradstreet JJ. Evidence of mitochondrial
effects on growth and development may be mediated by dysfunction in autism and implications for treatment. Am J growth factors. Endocrinol Exp. 1982 Nov;16(3-4):259-71.
56. Canadian Paediatric Society. Routine administration of
Biochem Biotechnol. 2008;4(2):208-17.
vitamin K to newborns. A joint position statement of the Fetus 35. Nambiar V, Jagtap VS, Sarathi V, Lila AR, Kamalanathan
76. Child Doe/77 v. Secretary of Health and Human Services.
and Newborn Committee, Canadian Paediatric Society S, Bandgar TR, et al. Prevalence and impact of thyroid 2010 WL 3395654 (Fed. Cl. July 21, 2010). Available (CPS), and the Committee on Child and Adolescent Health, disorders on maternal outcome in Asian-Indian pregnant College of Family Physicians of Canada. Paediatr Child women. J Thyroid Res. 2011 Jul;2011:article ID 429097.
Health. 1997;2(6):429-31. Reaffirmed February 2011.
36. Brehm JM, Celedón JC, Soto-Quiros ME, Avila L,
77. Rossignol DA, Frye RE. Mitochondrial dysfunction and
Hunninghake GM, Forno E, et al. Serum vitamin D levels Fetus and Newborn Committee of the Paediatric Society autism spectrum disorders: a simplified approach. Autism and markers of severity of childhood asthma in Costa Rica. of New Zealand. Vitamin K prophylaxis in the newborn. Science Digest. 2011;Issue 2:20-7.
Fetus and Newborn Committee of the Paediatric Society Am J Respir Crit Care Med. 2009 May;179(9):765-71.
of New Zealand, The New Zealand College of Midwives 78. Cohen AD, Shoenfeld Y. Vaccine-induced autoimmunity. J
37. Sorensen IM, Joner G, Jenum PA, Eskild A, Torjesen PA,
(Inc.), The New Zealand Nurses Organisation, The Royal Autoimmun. 1996 Dec;9(6):699-703.
Stene LC. Maternal serum levels of 25-hydroxy-vitamin New Zealand College of General Practitioners, The Royal 79. Koppang EO, Bjerkås I, Haugarvoll E, Chan EK, Szabo NJ,
D during pregnancy and risk of type 1 diabetes in the Australian and New Zealand College of Obstetricians and Ono N, et al. Vaccination-induced systemic autoimmunity offspring. Diabetes. 2012 Jan;61(1):175-8.
Gynaecologists. Prescriber Update No. 21:36-40. Available in farmed Atlantic salmon. J Immunol. 2008 Oct ; 38. Vitamin D Council. Autism: introduction. Revised 2011 May
17. Available online at: http://www.vitamindcouncil.
80. O'Leary ST, Glanz JM, McClure DL, Akhtar A, Daley MF,
58. National Health and Medical Research Council. Joint
statement and recommendations on vitamin K administration Nakasata C, et al. The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. 39. Vitamin D Council. Vitamin D Council statement on FNB
to newborn infants to prevent vitamin K deficiency bleeding Pediatrics. 2012 Jan 9. [Epub ahead of print] Vitamin D Report. 2010 Nov 30. Available online at: http:// in infancy. National Health and Medical Research Council, Paediatric Division of the Royal Australasian College of 81. Singh VK, Lin SX, Newell E, Nelson C. Abnormal measles-
Physicians, Royal Australian and New Zealand College of mumps-rubella antibodies and CNS autoimmunity Obstetrics and Gynaecology, Royal Australian College of in children with autism. J Biomed Sci. 2002 Jul- 40. Centers for Disease Control and Prevention.
General Practitioners, Australian College of Midwives. 2010 Recommendations to prevent and control iron deficiency in Oct: 1. Available online at: http://www.nhmrc.gov.au/ the United States. MMWR. 1998 Apr;47(RR-3):1-36.
82. Connolly AM, Chez MG, Pestronk A, Arnold ST, Mehta S,
Deuel RK. Serum autoantibodies to brain in Landau-Kleffner 41. Latif A, Heinz P, Cook R. Iron deficiency in autism and
59. American Academy of Pediatrics. Breastfeeding and the use
variant, autism, and other neurologic disorders. J Pediatr. Asperger syndrome. Autism. 2002 Mar;6(1):103-14.
of human milk. Pediatrics. 2005 Feb;115(2):496-506.
42. Konofal E, Lecendreux M, Arnulf I, Mouren MC.
60. Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt
83. Singer HS, Morris CM, Williams PN, Yoon DY, Hong
Iron deficiency in children with attention-deficit/ RW, Matush L, et al. Breastfeeding and child cognitive JJ, Zimmerman AW. Antibrain antibodies in children with hyperactivity disorder. Arch Pediatr Adolesc Med. 2004 development: new evidence from a large randomized trial. autism and their unaffected siblings. J Neuroimmunol. 2006 Arch Gen Psychiatry. 2008 May; 65(5):578-84.
Sep;178(1-2):149-55. 43. Halterma JS, Kaczorowski JM, Aligne CA, Auinger P,
61. Isaacs EB, Fischl BR, Quinn BT, Chong WK, Gadian DG,
84. Gallagher C, Goodman M. Hepatitis B triple series
Szilagyi PG. Iron deficiency and cognitive achievement Lucas A. Impact of breast milk on intelligence quotient, brain vaccine and developmental disability in US children aged among school-aged children and adolescents in the United size, and white matter development. Pediatr Res. 2010 1-9 years. Toxicol Environ Chem. 2008 Sep;90(5):997- States. Pediatrics. 2001 Jun;107(6):1381-6.
44. Bruner AB, Joffe A, Duggan AK, Casella JF, Brandt
62. Majeed AA, Mea, Hassan K. Risk factors for type 1
85. Gallagher CM, Goodman MS. Hepatitis B vaccination of
J. Randomised study of cognitive effects of iron diabetes mellitus among children and adolescents in Basrah. male neonates and autism diagnosis, NHIS 1997-2002. J supplementation in non-anaemic iron-deficient adolescent Oman Med J. 2011 May;26(3):189-95.
Toxicol Environ Health A. 2010;73(24):1665-77.
girls. Lancet. 1996 Oct;348(9033):992-6.
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