In 2000, the rate of autism was around one in 150; today it is estimated to be one in 31. This incredible steep climb means that autism today is five times more common than it was at the turn of the century.
Autism, now renamed as autistic spectrum disorder (ASD), continues to upend the lives of many families. The accurate diagnosis is complicated because of the wide spectrum of presentations.
These children are almost uniformly loved and appreciated for who they are. Parents of ASD children are my daily teachers and heroes. But many admit it is a parenting path marked by 10,000 joys and 10,000 sorrows.
An earlier diagnosis is one thing, but finding the right treatment is not that easy – in fact, the stress has taken huge tolls on marriages and parental mental wellness.
Dr. Jeff Zadek, an internal medicine specialist, has three children. The first child was diagnosed with ASD, and the next two children were free of this diagnosis. He then took a deep dive into looking at how changing the environment before a pregnancy is planned can significantly reduce the risk of having a child with ASD. Based on his research, Zadek wrote the book, Autism Prevention 5 days a week: New Evidence-based Proposed Guideline for Parents-to-Be.
Other physicians are also studying what might be contributing factors. Dr. Suzzanne Goh and her group at Harvard discovered that in 80 per cent of patients with ASD there is evidence of mitochondrial dysfunction. Other experts claim that inflammation of the brain is the root cause of neurodiverse conditions, both in children and adults.
While researchers are dedicating thousands of hours of their lives to unravel the causes of ASD, many agree that there appears to be a “dance” between genes and the impact of the environment. The latter may be dominant.
The Boston Birth Cohort study suggests that taking methyl folate as part of prenatal vitamins, one month before conception, may reduce the risk of ASD by 70 per cent. This study was an NIH-funded study and extended over 20 years.
Dr. Zadek has expressed surprise that this well-designed study is not that well-known by a majority of doctors. He admits that the type of folic acid and the frequency, timing of exposure, and duration of taking such supplements are indeed very nuanced. A Danish cohort study did not find the same results. However, the antenatal supplement used in the Danish study was folic acid, not in a methylated form. Not all current prenatal vitamins have the methylated form of folic acid.
In fact, ask most doctors what folic acid does and they will say it is used to prevent spina bifida. Few are aware of the difference between folic acid and the methylated form of folate in terms of reducing the risks for ASD.
The world first became aware of vitamins in 1912. The initial excitement was dampened by French researcher Gabriel Bertrand, who cautioned that too much of a good thing is also a possibility. We now know that the amount of folic acid and the duration of treatment is a complex story with numerous nuances.
In fact, the Boston study showed that taking methylated folic acid for five days, rather than seven days, worked the best. It has to be taken well in advance of conception. Its positive impact in reducing the risk of ASD drops significantly after two months into the pregnancy.
In his book, Dr. Zadek also focuses on the role of low iron and underactive thyroid functioning in women who plan to become pregnant. These conditions are often missed if not specifically screened for. Research shows that having proper levels of iron before conception reduces the risk for ASD by 50 per cent.
Other environmental factors which may play a role in the higher incidence of ASD include: low levels of vitamin D, choline and omega-3s; high levels of air pollution, lead and pesticides; micro-plastics and elevated levels of BPA, sourced from canned foods.
Zadek also explains in his book that maternal fevers early in the pregnancy may be factors to consider as possible causes of ASD. He admits, though, that the evidence for this is not overwhelming, and yet it is very plausible.
Not all researchers are impressed by evidence of the above factors. More research is needed, and I predict functional medicine doctors or precision medicine experts will lead the research in the decades ahead.
In an era where more and more families love to do their own research and where trust in allopathic medicine is on a steady downward slope, I would suggest that the passion to advocate for oneself in a so-called broken medical system requires much discernment – particularly in the complex space of ASD causes.
Dr. Nieman is the founder of Centre 70 Pediatrics. For more information, see www.drnieman.com