Is autism an autoimmune disease? Both scientists and physicians have been suggesting that it may be for years. Coming to a black and white conclusion as to whether it is or it isn’t has been complicated by the fact that we make the diagnosis of autism based on clinical observations or things that we see, and not based on objective measures such as blood tests or diagnostic imaging like we do in diabetes or with a broken toe. The problem here is that there is likely to be a variety of different causes to the group of conditions we refer to as autism spectrum disorders or ASD. Within the category of ASD, there may be various sub-categories, and without separating the people who have an ASD out by category when we study the conditions, our research will likely be inconclusive or just plain old wrong. Well, despite the fact that for years we weren’t using objective measures to tease out the cause of ASD, the latest research is showing that there is likely at least a subsection of autism that is due to immune dysfunction, much like in autoimmune disease. Allow me to explain and then I’ll share some professional experience relating to using an integrative functional medicine approach to address this concern. Stay with me here.
ASD and Infection
First of all, scientists are finding that, while there are definitely other important aspects of an autism diagnosis, both infection and inflammation play major roles, roles which begin while the child is still in the womb. Research shows that, keeping other variables constant, moms who were hospitalized for viral infection such as the flu in the first trimester of pregnancy or bacterial infection during the second trimester were far more likely to give birth to children who would later be diagnosed with an autism spectrum disorder. In the case of the flu, the correlation was found to be more strongly associated with episodes of prolonged fever than with the actual influenza virus itself. In fact, if mom has a fever during the second trimester of pregnancy, her child’s risk of an ASD diagnosis increases by 40%. If she has 3 or more fevers after the first trimester, her child’s risk of an ASD diagnosis increases by 300%. In another study, respiratory infections and gastrointestinal infections during pregnancy did not increase the developing child’s risk of an ASD diagnosis as much as mom having an infection of the reproductive or urinary tract such as a UTI or a skin infection did.
ASD and Inflammation
Maternal infection isn’t the only factor that increases a child’s risk of ASD. Scientists are finding that higher levels of inflammation in mom are also linked to an increased risk of ASD in the child. Have a look at these statistics:
According to one study,
- Simply having a family member who has been diagnosed with any autoimmune disease increases a child’s risk of being diagnosed with an ASD by as much as 28%.
- Having a parent with type 1 diabetes increased a child’s risk of being diagnosed with an ASD by as much as 64%.
- Having a family member with rheumatoid arthritis increases a child’s risk of being diagnosed with an ASD by as much as 51%.
- Having parents with psoriasis increased a child’s risk of being diagnosed with an ASD by as much as 59%.
- Having a mother with hypothyroidism increases a child’s risk of being diagnosed with an ASD by as much as 64%.
We don’t believe that this significantly increased risk of ASD in children of mothers with infections and autoimmune diseases during pregnancy is due to the virus or bacteria or the autoimmune condition itself. Instead, it appears as though the increased risk is due to the effect of mom’s inflammatory response on baby’s developing brain. It sort of sets the immune activation in motion and paves the way for an ongoing, hyper-responsive inflammatory-like state in the brain and body throughout the child’s life. This inflammatory state was found in the bodies of both children and adults with autism.
Studies show that injecting interleukin-6 (a pro-inflammatory chemical in the body) into pregnant rats leads to future abnormal behaviors and changes in the expression of certain genes in the brains of the offspring. At the same time, blocking interleukin-6 or increasing interleukin-10 (an anti-inflammatory chemical in the body) in pregnant rats whose immune systems have been previously activated prevents the offspring from developing these abnormal behaviors in the future and experiencing changes in brain gene expression.
Normal human pregnancy does involve a certain level of inflammation, though, so increasing mom’s intake of anti-inflammatory compounds or the amount of anti-inflammatory chemical messengers in her body during pregnancy isn’t necessarily the solution to eradicating autism. In fact, one animal study found that increasing the anti-inflammatory cytokine interleukin-10 during pregnancy when the mother’s immune response was not activated (e.g. she wasn’t sick) led to behavioral abnormalities in the adult offspring.
You may be wondering, then, what’s next? Can anything be done? As one study puts it, “…despite the fact that [maternal immune activation] has induced many changes in the brain during fetal development, postnatal behaviors can be subsequently altered.” In other words, even if mom has an infection or high levels of inflammation during pregnancy, there are things that can be done to limit inflammation in the child and to alter the resulting behaviors after his or her birth.
I believe this information is important to both those who support finding a cure for autism such as DAN! proponents and those who believe autistic people shouldn’t be made to be more neurotypical such as Neurodiversity advocates.
Here’s my reasoning: if you have a child with autism and you believe that, like any other disease, we need to find a cure for autism, then you will likely support the research along these lines and utilize the information to test inflammatory biomarkers and help decrease your child’s inflammation and consequently, the behaviors that are associated with it. On the other hand, you may have a child with autism and believe that your child’s brain functioning and associated behaviors are simply a variation of normal that does not need fixing. You may still find, however, that your child does have gastrointestinal concerns that could be improved. Here’s the thing: in children with autism, the likelihood of having looser tight junctions in the GI tract (commonly referred to as “leaky gut”) is much higher compared to neurotypical children, and this is also largely due to the higher levels of inflammation that we’ve been discussing. Also, studies show that young adults with autism are at significant risk for developing heart disease if nothing is done about it, and, as you probably know, inflammation plays a major role in all stages of the development of the atherosclerosis which leads to heart disease. You’ll find that addressing high levels of inflammation in children with autism when indicated does not only affect their brains, but their whole body. In other words, addressing inflammation isn’t so much a way to “fix” an autistic person, but rather a way to help the body function in its best state. This includes gut repair, heart health, and more.
My Experience with Immune Dysregulation and ASD: Let’s Consider Greg
In a talk that my husband did recently about our practice, he mentioned that we work with people who have been diagnosed with ASD. Let me share the case of a child with whom I’ve had the privilege of working. This boy, let’s call him Greg, had between 5 and 10 words before the age of 2, but subsequently lost them. He was evaluated as being at high risk for autism. As I discussed in a previous article, it can be difficult to definitively diagnose children with autism before the age of 3, so it often isn’t done. He had been diagnosed as having a developmental disorder of speech and language delay and he also had symptoms of difficulty focusing, communicating, and following commands. Additionally, he had some additional behaviors that were of concern to his parents, such as banging his head against the floor, biting, spinning, and inappropriate laughter.
What We Did for Greg
We recommended a gluten-free, casein-free diet for Greg and put him on a good probiotic since some children with ASD have been shown to have non-Celiac intestinal damage attributable to gluten and casein. We then tested him for biomarkers of inflammation, heavy metal toxicity, and other possible contributors to his parents’ concerns. We found that his inflammatory biomarkers were, in fact, elevated, so we started him on an individualized protocol to help decrease his inflammation. Around the same time, he started speech therapy.
After 9 weeks on our protocol and doing speech therapy, Greg’s mother reported at his follow-up appointment that he was much more self-aware, more calm, and interacted far better with other children. His focus and attention were improving and he had been talking more. His ability to understand and obey commands had improved and he was able to better communicate. His eye contact had improved and his tantrums were much more controlled. He was no longer banging his head against the floor, laughing inappropriately, or spinning. He was still somewhat of a picky eater, but his appetite was improving. He had some straining with bowel movements, but it wasn’t prolonged. He had no new behaviors that mom felt were problematic and she stated that, overall, he was continuing to improve on our protocol.
So there you have it. In short, although there are always other factors involved, research is showing that there is likely a subset of ASD that is related to immune dysregulation in the brains and bodies of children and adults who carry the diagnosis. I’ve had the privilege of seeing this to be true in my own experience. The hyper-inflammatory condition that is commonly seen with ASD affects the brain, the heart, the gastrointestinal tract, and other parts of the body. Adopting a gluten-free, casein-free diet and taking a good, evidence-based, professional-grade probiotic may help decrease some of the gastrointestinal inflammation. Having your doctor check for certain biomarkers of inflammation that are frequently elevated in children and adults with ASD may provide you with further direction as far as constructing an individualized protocol to help decrease inflammation as well as help improve many of the effects of this inflammation.
As always, your input is welcome. What do you think? Do you think there’s a relationship between a dysregulated immune system and ASD? Feel free to comment below.
Also, to learn more about Dr. Janelle Louis, ND, the author of this blog post, click here.