Autism – Vaccines, Special Diets and Its Relationship With Cancer

In 2007, the United Nations designated April 2 as “World Autism Awareness Day.” Autism is a lifelong neurodevelopmental disorder generally beginning in childhood, characterized by difficulties in social communication and interaction. It is also called autism spectrum disorder (ASD), because symptoms and severity vary between people.

As with cancer, there is tremendous misinformation about autism’s causes and treatments, leading parents without justification to avoid vaccinating children or use special diets uninformedly, creating serious risks for healthy individuals and communities.

We therefore aim to provide the latest information about autism. In part one, we discuss what autism is and mechanisms causing it; in the second and third parts, we address popular but controversial topics, Autism and Vaccines and Autism and Special Diets .

Part one

WHAT IS AUTISM?

Autism involves social interaction and verbal/nonverbal communication problems, repetitive behaviors and restricted interests, and is a neurodevelopmental disorder. Neurodevelopmental means originating in problems of brain and nervous system development during . Autism is actually one of a group called Autism Spectrum Disorders (ASD), sharing symptoms across a broad range but differing in distribution and severity. Others include Asperger Syndrome, Rett Syndrome, Childhood Disintegrative Disorder and pervasive developmental disorders not otherwise specified (this article uses autism to refer to all spectrum disorders).

Although symptoms begin in the first 3 years, diagnosis is generally possible around age 4 , and the disorder persists for life.

There is currently no blood test, imaging method or genetic test for diagnosing autism.

Diagnosis follows assessment by pediatricians and child psychiatrists and developmental tests in suspected cases.

Frequency varies between countries, but approximately of every 100 people, 1 is estimated to have an autism spectrum disorder (in the United States, every 54 people, 1). It is more common in males.

WHAT ARE AUTISM SYMPTOMS?

Autism spectrum disorders involve problems in 3 main areas, observed before age 3 and persisting throughout life.

1. Difficulties in social communication and interaction
2. Delayed or impaired communication skills
3. Repetitive behaviors, interests and activities with restricted content

Let us clarify these symptom groups through examples.

1. Difficulties in social communication and interaction

We communicate verbally and nonverbally. Alongside speech, facial expressions and body language send signals. Saying “There’s no problem, dear!” sarcastically with a frown may mean “I’m very angry; of course there’s a problem.” Autistic people cannot understand and interpret nonverbal elements such as tone, facial expression and body language. They understand “There’s no problem” literally. Similarly, they cannot recognize implied meanings in jokes or hints, making them appear odd in social relationships.

Autistic people also struggle with social relationships and norms. They cannot easily understand needing another person’s emotional presence and prefer spending time alone to forming bonds. They have marked difficulty forming and maintaining friendships. They struggle to identify and express feelings and to read others’ feelings, needs and intentions unless stated explicitly. Unable to understand those needs, they cannot take steps to soothe or support others. They cannot make sense of society’s unwritten rules. Saying “get well soon” when someone is ill, offering condolences after a death or touching a crying person’s shoulder to reassure them is not among their abilities. They may therefore be seen as rude or indifferent.

Signs noticeable in early childhood may include no eye contact or smiling with the mother as an infant, not wanting to be held, no eye contact with others, not playing with other children or sharing toys, disliking touch or hugs, and inability to empathize with a fallen friend’s pain or distress.

2. Delayed or impaired communication skills

People with spectrum disorders may not speak at all, have limited or repetitive speech, or be unable to maintain reciprocal conversation. Speech often begins much later than expected. As noted above, they cannot grasp abstract meanings and therefore cannot respond as expected to idioms, proverbs, jokes or hints.

3. Repetitive behaviors, interests and activities with restricted content

Autistic people are sensitive to changes in order and become markedly uneasy with deviations from routine. They may use the same route to school and eat the same breakfast. They often have a very narrow, intensely focused interest. Computers, programming, trains, sailboats, painting or music may be such interests. They may collect things.

In childhood, signs may include playing with only one toy type, collecting, not sharing and using toys outside their intended purpose (such as grouping or lining up cars instead of driving or racing them).

Beyond these 3 main groups, sensitivity to smells, tastes and textures may occur. Tantrums, aggression, repetitive relatively meaningless bodily movements, skin picking, head banging or hand flapping may sometimes occur.

Of autistic people, %60-70 have varying learning difficulties and intellectual disability. Most others have normal or slightly above-normal intelligence (IQ> 85). Contrary to belief, only a small proportion have high IQ and exceptional abilities in specific areas. Another neurodevelopmental disorder accompanies %83 of spectrum disorders, and one or more mental disorders accompany %10.

WHAT CAUSES AUTISM?

Not all causes are understood. The most widely accepted view is interaction of genetic and environmental factors. Genetic backgrounds in egg and sperm before fertilization, and many factors adversely affecting brain development after fertilization and implantation, have been proposed as causes.

Genetic factors

Among autism causes, genetic factors and complex genetic transmission have a strong place. Twin studies find concordance around % 70 in identical twins (studies range from %36 to %95), versus around %3 in fraternal twins (from % 0 to %31). Higher occurrence among close relatives, lower risk as relatives become more distant, and higher occurrence in new generations of families with multiple autistic members support genetic factors and complex inheritance in etiology. Although “heritability,” meaning the extent the disorder can be explained genetically, is emphasized as high (0,7-0,9)*, current technologies identify genetic causes in only %30-40. Inheritance alone also cannot explain increased frequency over the last 20 years. Environmental factors come into play, and scientists accept autism as arising from genetic and environmental contributions.

* Heritability = 0 means genetic factors have no role in explaining the disorder; heritability =1 means genetic factors are the only explanatory factors.

Environmental risk factors

A review and meta-analysis published in March 2017, without denying inherited causes, suggested %40-50 of cases could be explained environmentally. A few such factors are discussed below. They are proposed to disrupt nerve cell development, normal brain migration and function by altering gene activity, intracellular communication and oxygenation, causing inflammation and hormonal irregularities, and impairing brain neurotransmitter function. Some environmental factors show association without established causation.

• Older parental age
• Maternal autoimmune disease
• Maternal feverish infections during pregnancy; studies implicate infection timing and maternal immune activation rather than infection type. 
• Some birth complications: problems causing oxygen deprivation in the newborn brain, bleeding, trauma, etc.
• Cesarean delivery (association exists but is weak; cause or consequence?)
• Heavy metal exposure in pregnancy or newborns, especially inorganic mercury and lead
• Exposure during pregnancy or in newborns to toxic substances such as pesticides, polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs)
• Certain maternal medications during pregnancy: Valproate, Thalidomide
• Maternal obesity, diabetes and deficiencies of iron, folic acid and vitamins

Remember these factors have been associated with ASD through scientific studies. Causation is strong for some (such as birth complications) but weak for others (such as cesarean delivery). They should not be viewed as causing autism with %100 certainty, but as factors increasing risk!

HOW IS AUTISM TREATED?

For autism, with its wide range of symptoms and incompletely understood causes, no effective treatment yet addresses core symptoms. Drugs and psychotherapies aim to treat symptom clusters, behavioral problems and associated illnesses.

Studies show that families with autistic children tend to try any suggested alternative treatment . Complementary and alternative methods reach %80 use in some countries. Unresolved diagnostic and treatment questions lead some parents not to vaccinate as a supposed protective measure or to turn to special diets.

Part two

AUTISM and VACCINES

We are sensitive about health, even more about our children’s health. Any scientific claim attracts attention and alarms us. Claims linking vaccines and autism are one example. The link first arose in 1998 with a Lancet study of autism-like reactions after MMR vaccination in 8 children. Although symptoms did not match autism exactly, suggestions of a “regressive” type drew scientific attention. Hundreds of studies followed. Influenced by these results, in 2010 Lancet editor Richard Horton said the 1998 study contained entirely false results and claims and distorted data. Andrew Wakefield was struck off by the General Medical Council (GMC) in May 2010 for misconduct and false medical records.

Studies following the 1998 publication generally focused on 2 hypotheses:

1. Whether MMR vaccine is related to autism
2. Whether Thimerosal (a mercury-containing antimicrobial preservative in inactivated vaccines) is related to autism

The MMR Vaccine Relationship

Wakefield attributed “autistic enterocolitis” symptoms to combined MMR and claimed separate vaccines would avoid them. Media and parents began delaying or rejecting vaccination. Scientists urgently conducted numerous studies. The first major meta-analysis in 2003 reviewed 120 studies: compared with placebo, some adverse effects such as joint complaints and thrombocytopenic purpura occurred, but no association with autism, aseptic meningitis, Crohn’s or ulcerative colitis was found.

A meta-analysis published in 2012 involving 14.700.000 children, with 27 follow-up and 17 case-control studies among 58 total, found no MMR association with autism, asthma, leukemia, type1 diabetes or Crohn’s. In 2014, Taylor LE and colleagues obtained results parallel to the first 2 studies, stating there is no genuine autism-vaccine relationship .

Greenberg and colleagues’ study last month showed these scientific facts still do not erase parental doubts. In Canada, attitudes of parents with children under 5, totaling 150.000, were assessed: 92 percent trusted vaccines and 8 percent were skeptical; among the latter, 28 percent feared vaccines cause autism.

Meta-analyses and recent studies show fears of vaccines causing autism are unfounded. Vaccines omitted because of these fears increase vaccine-preventable disease incidence and deaths.

Thimerosal – vaccine relationship

After MMR, the next accused factor is Thimerosal, a mercury-containing preservative preventing contamination in inactivated vaccines. It gained attention after publications opposing the MMR link. Reports around 1998 of mercury side effects resembling autism (irritability, depression and visual problems) led manufacturers in 1999 to reduce Thimerosal or produce vaccines without it, enabling comparison. A study published in 2007 in the respected New English Journal of Medicine found no autism diagnosis difference between children vaccinated with Thimerosal and those unvaccinated or receiving reduced-Thimerosal vaccines!

Scientists questioned whether Thimerosal’s ethylmercury might cause effects like methylmercury poisoning because of their similarity. Ethylmercury leaves the body faster, however, so effects may differ. Careful investigation of these concerns, including studies published this April, found no relationship between thimerosal and autism.

Hundreds of studies and publications show no relationship between vaccines and autism.

Part three

NUTRITION and SPECIAL DIETS IN AUTISM

The nutrition-autism link and special diets as potential treatment became popular especially over the last 10 years. Studies examined Stone Age diets, low-sugar and low-yeast diets and vitamin/mineral supplementation, but most investigated GLUTEN-FREE and CASEIN-FREE DIETS and their efficacy.

Why were special diets thought potentially effective?

Digestive problems are common in autism: abdominal pain, diarrhea 8(diarrhea), constipation and food allergies. These complaints increase behavioral problems. Some mental disorders, especially schizophrenia, showed improvement in some symptoms with special diets in the past, although evidence is weak, supporting the idea. Diets reducing digestive complaints were therefore thought potentially therapeutic.

A second reason, explained below, is strong claims concerning gut flora microbes affecting nervous system development and brain function in early life. This led to claims that regulating digestive flora may help both prevention and treatment of neurodevelopmental disorders.

Why are digestive problems more common in autism?

The first hypothesis explaining these increased problems is Leaky gut; a leaking digestive system , meaning increased intestinal permeability. According to it, genetic causes mean intestinal surface cells in autistic people are more permeable. Normally, digested proteins are broken into amino acids before crossing the gut surface. With a “leaking nervous system,” larger protein fragments (peptides) can cross the wall. Found in barley, wheat, oats and rye, GLUTEN and in milk and dairy products (except goat’s milk, cheese, kefir and yogurt), CASEIN , produce two large fragments during digestion, gluteomorphin and beta-casomorphin. After absorption, these reach the brain through blood and stimulate opiate receptors, producing a morphine -like effect, as shown (Opiate Excess Theory). This was blamed for behavioral problems. New studies, however, show not every autistic person has increased permeability, and suggest these peptides do not bind strongly to opiate receptors and may sometimes have the opposite of morphine’s effect. This hypothesis therefore DOES NOT PROVE gluten- and casein-free diets are valid treatment options for every patient.

A second hypothesis for unexplained digestive complaints is hypersensitivity or food allergy . Autistic patients, like celiac patients, were claimed to have increased immune responses/allergy to gluten and structurally similar casein. Studies did not demonstrate an autism-gluten sensitivity relationship through immune biomarkers . However, blood antibodies that rise after allergen exposure increased following gluten/casein consumption. Hypersensitivity to these and perhaps other foods may therefore explain digestive problems in some autistic patients. Elimination diets removing a confirmed food allergen may help autistic people with that allergy. Gluten- and casein-free diets may calm symptoms in some. However, food allergy/intolerance affects approximately %6-%8 of all children, so recommending these diets therapeutically for every autistic person is wrong and potentially harmful.

The final digestive-system hypothesis is the Microbiome - Gut and Brain Axis (the microbiome-gut-brain axis). Microbiota are microbes such as bacteria, viruses and fungi living in the gut. Increasing research strongly proposes a relationship with brain development. Imbalances in gut flora development or composition in early life may lead to disorders such as autism. Effects on the brain are still studied through animal experiments , and applying or generalizing findings to humans is wrong. Probiotics and prebiotics regulating human gut flora cannot be claimed as primary rather than complementary treatment. Future studies will clarify this area.

What harm could gluten- and casein-free diets do?

Uncontrolled long-term use by families carries health risks, particularly inadequate protein/fiber and deficiencies of B and D vitamins, calcium and iron. These deficiencies predispose to disease and can disrupt development, especially bone development. Risks of amino acid deficiencies also increase. After appropriate food allergy tests, specialists should help decide which foods to remove.

Gluten- and casein-free diet efficacy according to scientific studies

Many studies used small groups and lacked randomization, controls or blinding that strengthen evidence. Evidence is weak and results conflict. Efficacy in autism has not yet been assessed by the strongest statistical studies, META-ANALYSES.

The latest review of all studies, published in February 2017, concluded that despite media/public popularity, high use and positive parental feedback, scientific studies HAVE NOT PROVEN these diets treat autism. Benefit is possible only in some patients with prominent digestive complaints triggering behavioral problems or confirmed gluten/casein allergy.

Autism and cancer relationship

In a genomic database analysis, researchers found autistic people had significantly higher rates of DNA mutations in cancer-development-associated genes.

In a study involving more than 12,000 patients, those diagnosed with autism, especially younger people, showed % 90 less cancer development . This effect was more marked in women.

First, from various databases, a series of oncogenes (tumor-associated genes) and tumor suppressor genes was selected and examined alongside genes for autism, intellectual disability, epilepsy, skeletal dysplasia, dilated cardiomyopathy, retinitis pigmentosa and nonsyndromic hearing loss.

Rare single-nucleotide changes in genes of autistic patients were then compared to examine disease roles through these differences.

Compared with controls, autistic people had a substantial increase in rare nucleotide variants in oncogenes.

However, no significant difference occurred in rare variant numbers for skeletal dysplasia, dilated cardiomyopathy, retinitis pigmentosa or nonsyndromic hearing loss genes.

Researchers then examined cancer rates in 1837 autistic versus 9336 nonautistic people. They observed cancer developed less often in autistic people . Rates were 3.9 percent in controls and 1.3 percent in autistic people. The most interesting difference was among ages 0-14: autistic young patients had 0.3 percent versus 3.3 percent in young controls.

The most interesting feature is lower cancer rates despite more oncogenic DNA mutations in autistic people.

More cancer-driving oncogene mutations but lower cancer risk revealed a different autism-cancer relationship

In fact, similar oncogenes are mutated in cancer and autism. But oncogene mutations alone are insufficient for cancer. Tumor suppressor gene mutation and loss of activity are the most critical point. Another interpretation is that gene abnormalities in autistic people actually work to stop cell multiplication. In addition, epigenetic factors may contribute to differences between autism and cancer. Finding oncogene mutations in autism has also raised the idea of using targeted drugs against oncogene abnormalities in cancer for autism.

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Can everyone be accepted in their own identity and uniqueness?!.. How aware are we of difficulties faced by “different” people and their families?

Autistic people are often misunderstood and unfortunately excluded because of social and communication differences. Since 1986, “True Colors” has offered them and their families strength and hope to accept themselves and discover their strengths.

American singer, songwriter and actress Cyndi Lauper, among the bestselling singers in history, is a popular music icon of the 1980s. “True Colors” was written about co-writer Billy Steinberg’s mother, inspired by her loving, supportive attitude. As the song became popular, it came to represent a universal message.

After Lauper sang it, a connection between “True Colors and autism awareness” arose to promote awareness and acceptance. It became especially a song of protection and acceptance for autistic people and families, conveying that everyone deserves acceptance and love in their “true colors.”

Lauper is a sensitive, active autism advocate. In 2008 she established the “True Colors Fund” to raise awareness and support LGBT and autistic youth.

Autistic people’s intelligence and abilities are independent of social limitations, and despite communication difficulties they may have notable talents and intelligence in other areas.