Thin Bones Seen In Boys With Autism And Autism Spectrum Disorder

January 29, 2008

---------- Forwarded message ----------

From: NIH OLIB (NIH/OD) <olib@...>

Date: Jan 29, 2008 8:16 AM

Subject: THIN BONES SEEN IN BOYS WITH AUTISM AND AUTISM SPECTRUM DISORDER

NIHPRESS@...

U.S. Department of Health and Human Services

NATIONAL INSTITUTES OF HEALTH NIH News

National Institute of Child Health and Human Development (NICHD) <

http://www.nichd.nih.gov/>

For Immediate Release: Tuesday, January 29, 2008

CONTACT: Bock or nne Glass , 301-496-5134, <e-mail:

bockr@...>

THIN BONES SEEN IN BOYS WITH AUTISM AND AUTISM SPECTRUM DISORDER

Results of an early study suggest that dairy-free diets and unconventional

food preferences could put boys with autism and autism spectrum disorder

(ASD) at higher than normal risk for thinner, less dense bones when compared

to a group of boys the same age who do not have autism.

The study, by researchers from the National Institutes of Health and

Cincinnati Children's Hospital Medical Center, was published online in the

" Journal of Autism and Developmental Disorders " .

The researchers believe that boys with autism and ASD are at risk for poor

bone development for a number of reasons. These factors are lack of

exercise, a reluctance to eat a varied diet, lack of vitamin D, digestive

problems, and diets that exclude casein, a protein found in milk and milk

products. Dairy products provide a significant source of calcium and vitamin

D. Casein-free diets are a controversial treatment thought by some to lessen

the symptoms of autism.

Funding for the study was provided by the NIH's National Institute of Child

Health and Human Development and National Center for Research Resources. The

research team that conducted the study was led by L. Hediger, Ph.D., a

biological anthropologist in NICHD's Division of Epidemiology, Statistics

and Prevention Research.

" Our results suggest that children with autism and autism spectrum disorder

may be at risk for calcium and vitamin D deficiencies, " Dr. Hediger said.

" Parents of these children may wish to include a dietitian in their

children's health care team, to ensure that they receive a balanced diet. "

Dr. Hediger stressed that the current study results need to be confirmed by

larger studies. Until definitive information is available, however, it would

be prudent for parents of children with autism and ASD to include a

dietitian in their care, particularly if the children's diets do not include

dairy products or they are not otherwise eating a balanced diet, she said.

Because girls are much less likely to have autism or ASD than are boys, the

researchers were unable to enroll a sufficient number of girls within the

short time frame of the study to allow them to draw firm conclusions. Dr.

Hediger added that if a girl with autism or ASD is not eating diary products

or eating a balanced diet, it would be prudent for a dietitian to be

included in her health care team.

Autism is a complex brain disorder involving communication and social

difficulties as well as repetitive behavior or narrow interests. Autism is

often grouped with similar disorders, which are often referred to

collectively as autism spectrum disorders. The underlying causes of autism

and ASD are unclear. There is no cure for the disorders and treatments are

limited.

When the boys were enrolled in the study, the researchers asked the boys'

parents if the boys were taking over-the-counter or prescription

medications, were taking any vitamin or mineral supplements, or were on a

restricted diet.

During the study, researchers X-rayed the hands of 75 boys between the ages

of 4 and 8 years old who had been diagnosed with autism or ASD. The

researchers then measured the thickness of the bone located between the

knuckle of the index finger and the wrist and compared its development to a

standardized reference based on a group of boys without autism.

Dr. Hediger said that the research team measured cortical bone thickness.

She added that this procedure was done as a substitute for a conventional

bone scan, which measures bone density. Bone density is an indication of

bones' mineral content. Less dense bones may indicate a risk of bone

fracture.

The researchers used the measure of bone thickness because many of the boys

were unable to remain still long enough for the conventional scan, which

requires individuals to lie immobile for an extended period of time. To

successfully complete the bone scan, many of the boys would have required

sedation -- a step the researchers were reluctant to take for an early

study.

The hand X-ray, Dr. Hediger explained, offers an approximate indication of

bone density. She added, however, that because the researchers were unable

to use a conventional bone scan, the results of the current study should be

confirmed by additional studies using conventional bone scans.

The investigators found that the bones of the boys with autism were growing

longer but were not thickening at a normal rate. During normal bone

development, material from inside the bone is transferred to the outside of

the bone, increasing thickness, while at the same time, the bones are also

growing longer.

At 5 or 6 years of age, the bones of the autistic boys were significantly

thinner than the bones of boys without autism and the difference in bone

thickness became even greater at ages 7 and 8.

The bone thinning was particularly notable because the boys with autism and

ASD were heavier than average and would therefore be expected to have

thicker bones.

The researchers do not know for certain why the boys had thinner than normal

bones. A possible explanation is lack of calcium and vitamin D in their

diets. Dr. Hediger explained that a deficiency of these important nutrients

in the boys' diets could result from a variety of causes. Many children with

autism, she said, have aversions to certain foods. Some will insist on

eating the same foods nearly every day, to the exclusion of other foods. So

while they may consume enough calories to meet their needs -- or even more

calories than they need -- they may lack certain nutrients, like calcium and

vitamin D.

Other children with autism may have digestive problems which interfere with

the absorption of nutrients. Moreover, many children with autism remain

indoors because they require supervision during outdoor activity. Lack of

exercise hinders proper bone development, she said. Similarly, if children

remain indoors and are not exposed to sunlight, they may not make enough

vitamin D, which is needed to process calcium into bones.

The boys in the study who were on a casein-free diet had the thinnest bones.

In fact, the 9 boys who were on a casein-free diet had bones that were 20

percent thinner than normal for children their age. Boys who were not on a

casein-free diet showed a 10 percent decrease in bone thickness when

compared to boys with normal bone development.

The study authors wrote that bone development of children on casein-free

diets should be monitored very carefully. They noted that studies of

casein-free diets had not proven the diets to be effective in treating the

symptoms of autism or ASD.

Only 9 boys on casein-free diets were available to participate in the study,

Dr. Hediger said. When conducting a scientific study, it's easier to obtain

statistically valid results by studying a larger number of individuals than

with a smaller number of individuals. However, the dramatic difference in

the boys' bone thickness when they were either on a casein-free diet or an

unrestricted diet and when compared to normally developing bones strongly

suggest that the bone thinning the researchers observed was statistically

valid.

The researchers recommended that larger studies be conducted to confirm

their results.

Until those studies can be conducted, Dr. Hediger offered the following

advice: " Our study shows that it couldn't hurt -- and would probably help --

if parents of children with autism or autism spectrum disorder consulted

with a dietitian during their children's routine medical care to make sure

that their diets are balanced. "

General information about autism and ASD is available from the NICHD's Web

site, at <

http://www.nichd.nih.gov/publications/pubs/autism/overview/index.cfm>.

The NICHD sponsors research on development, before and after birth;

maternal, child, and family health; reproductive biology and population

issues; and medical rehabilitation. For more information, visit the

Institute's Web site at <http://www.nichd.nih.gov/>.

The National Institutes of Health (NIH) -- The Nation's Medical Research

Agency -- is comprised of 27 Institutes and Centers and is a component of

the U. S. Department of Health and Human Services. It is the primary Federal

agency for conducting and supporting basic, clinical, and translational

medical research, and investigates the causes, treatments, and cures for

both common and rare diseases. For more information about NIH and its

programs, visit <www.nih.gov>.

##

This NIH News Release is available online at:

<http://www.nih.gov/news/health/jan2008/nichd-29.htm>.

To subscribe (or unsubscribe) from this list, go to

<http://list.nih.gov/cgi-bin/wa?SUBED1=nihpress & A=1>.

January 29, 2008

Louis, Interesting thanks for posting. My middle daughter has always

been thinner than her siblings(long before eating disorder) and had

allergies and up to weekly migraines that interfered with appetite.

Plus eating very slowly. She is the one, of my 3 OCD kids, who seemed

more in autistic spectrum. Though that aspie quality seems to become

less pronounced as she matures.

Since we could not determine what would be normal weight for her

after her eating disorder began to improve, because it struck right

before puberty, she had a bone scan, that did find her bones to be

lacking normal density. Depending on category it could be severe or

moderate. As she had not completed puberty at that time (though 15-no

menses) it was hard to know what statistical category to put her in-

child, teen, or adult. Most of the bone density data comes from 20 yr

old women-they in fact have very little bone data on pubertal girls,

unless in girls with cancer or something. So that arena is still

inconclusive for her and will need further evaluation.(She was also

referred to an orthopedist and has slight scoliosis). Meanwhile she

takes calcium supplement. I do worry about frailty of her bones.

This month she is also seeing an endocrinologist. Again there are

concerns re effects of her eating disorder, but I also think there

were hormonal/metabolic disturbances before the eating disorder

(maybe predisposing to the eating disorder?). So I do wonder if they

can pinpoint something in regard to autistic/aspergers spectrum

children in this area of bone endocrine metabolic concerns.

The study seems to suggest that the casein free diet contributes to

bone abnomalities. In my dd's case her allergies and sensitivity

dicted some food avoidances, it was not something I instituted, and

she did prefer soy milk. She also never liked meat or could not eat

it, but I gave it to her anyways. The question is does a normal diet,

in some way harm kids with allergies/sensitivities? And does a special

(restricted) diet confer actual benefits- I've always wondered

how " evidence-based " that may be b/c most of what you hear are

parental aneccdotes(?). Or does special diet result in nutritional

deficiencies- so do you have a catch 22? Because of these type

questions I end up trying to take approach of as much nutritional

variety as possible.That way if there is something harmful-maybe it

will be offset by something beneficial( yeah-very scientific).

Having dealt with the eating disorder I guess I am naturally cautious

with regard to rstricting diet. And with OCD, I also wonder if

emphasis on " bad " foods " could allow the OCD to focus in that arena.

Plus I think aspie and OCD together in a girl predisposes possibly

more to likelihood of severe eating disorer, than one or the other

alone.

nancy grace

In , " Louis Harkins "

<louisharkins@...> wrote:

>

> ---------- Forwarded message ----------

> From: NIH OLIB (NIH/OD) <olib@...>

> Date: Jan 29, 2008 8:16 AM

> Subject: THIN BONES SEEN IN BOYS WITH AUTISM AND AUTISM SPECTRUM

DISORDER

> NIHPRESS@...

>

> U.S. Department of Health and Human Services

> NATIONAL INSTITUTES OF HEALTH NIH News

> National Institute of Child Health and Human Development (NICHD) <

> http://www.nichd.nih.gov/>

> For Immediate Release: Tuesday, January 29, 2008

>

> CONTACT: Bock or nne Glass , 301-496-5134, <e-

mail:

> bockr@...>

>

> THIN BONES SEEN IN BOYS WITH AUTISM AND AUTISM SPECTRUM DISORDER

>

> Results of an early study suggest that dairy-free diets and

unconventional

> food preferences could put boys with autism and autism spectrum

disorder

> (ASD) at higher than normal risk for thinner, less dense bones when

compared

> to a group of boys the same age who do not have autism.

>

> The study, by researchers from the National Institutes of Health and

> Cincinnati Children's Hospital Medical Center, was published online

in the

> " Journal of Autism and Developmental Disorders " .

>

> The researchers believe that boys with autism and ASD are at risk

for poor

> bone development for a number of reasons. These factors are lack of

> exercise, a reluctance to eat a varied diet, lack of vitamin D,

digestive

> problems, and diets that exclude casein, a protein found in milk

and milk

> products. Dairy products provide a significant source of calcium

and vitamin

> D. Casein-free diets are a controversial treatment thought by some

to lessen

> the symptoms of autism.

>

> Funding for the study was provided by the NIH's National Institute

of Child

> Health and Human Development and National Center for Research

Resources. The

> research team that conducted the study was led by L. Hediger,

Ph.D., a

> biological anthropologist in NICHD's Division of Epidemiology,

Statistics

> and Prevention Research.

>

> " Our results suggest that children with autism and autism spectrum

disorder

> may be at risk for calcium and vitamin D deficiencies, " Dr. Hediger

said.

> " Parents of these children may wish to include a dietitian in their

> children's health care team, to ensure that they receive a balanced

diet. "

>

> Dr. Hediger stressed that the current study results need to be

confirmed by

> larger studies. Until definitive information is available, however,

it would

> be prudent for parents of children with autism and ASD to include a

> dietitian in their care, particularly if the children's diets do

not include

> dairy products or they are not otherwise eating a balanced diet,

she said.

>

> Because girls are much less likely to have autism or ASD than are

boys, the

> researchers were unable to enroll a sufficient number of girls

within the

> short time frame of the study to allow them to draw firm

conclusions. Dr.

> Hediger added that if a girl with autism or ASD is not eating diary

products

> or eating a balanced diet, it would be prudent for a dietitian to be

> included in her health care team.

>

> Autism is a complex brain disorder involving communication and

social

> difficulties as well as repetitive behavior or narrow interests.

Autism is

> often grouped with similar disorders, which are often referred to

> collectively as autism spectrum disorders. The underlying causes of

autism

> and ASD are unclear. There is no cure for the disorders and

treatments are

> limited.

>

> When the boys were enrolled in the study, the researchers asked the

boys'

> parents if the boys were taking over-the-counter or prescription

> medications, were taking any vitamin or mineral supplements, or

were on a

> restricted diet.

>

> During the study, researchers X-rayed the hands of 75 boys between

the ages

> of 4 and 8 years old who had been diagnosed with autism or ASD. The

> researchers then measured the thickness of the bone located between

the

> knuckle of the index finger and the wrist and compared its

development to a

> standardized reference based on a group of boys without autism.

>

> Dr. Hediger said that the research team measured cortical bone

thickness.

> She added that this procedure was done as a substitute for a

conventional

> bone scan, which measures bone density. Bone density is an

indication of

> bones' mineral content. Less dense bones may indicate a risk of bone

> fracture.

>

> The researchers used the measure of bone thickness because many of

the boys

> were unable to remain still long enough for the conventional scan,

which

> requires individuals to lie immobile for an extended period of

time. To

> successfully complete the bone scan, many of the boys would have

required

> sedation -- a step the researchers were reluctant to take for an

early

> study.

>

> The hand X-ray, Dr. Hediger explained, offers an approximate

indication of

> bone density. She added, however, that because the researchers were

unable

> to use a conventional bone scan, the results of the current study

should be

> confirmed by additional studies using conventional bone scans.

>

> The investigators found that the bones of the boys with autism were

growing

> longer but were not thickening at a normal rate. During normal bone

> development, material from inside the bone is transferred to the

outside of

> the bone, increasing thickness, while at the same time, the bones

are also

> growing longer.

>

> At 5 or 6 years of age, the bones of the autistic boys were

significantly

> thinner than the bones of boys without autism and the difference in

bone

> thickness became even greater at ages 7 and 8.

>

> The bone thinning was particularly notable because the boys with

autism and

> ASD were heavier than average and would therefore be expected to

have

> thicker bones.

>

> The researchers do not know for certain why the boys had thinner

than normal

> bones. A possible explanation is lack of calcium and vitamin D in

their

> diets. Dr. Hediger explained that a deficiency of these important

nutrients

> in the boys' diets could result from a variety of causes. Many

children with

> autism, she said, have aversions to certain foods. Some will insist

on

> eating the same foods nearly every day, to the exclusion of other

foods. So

> while they may consume enough calories to meet their needs -- or

even more

> calories than they need -- they may lack certain nutrients, like

calcium and

> vitamin D.

>

> Other children with autism may have digestive problems which

interfere with

> the absorption of nutrients. Moreover, many children with autism

remain

> indoors because they require supervision during outdoor activity.

Lack of

> exercise hinders proper bone development, she said. Similarly, if

children

> remain indoors and are not exposed to sunlight, they may not make

enough

> vitamin D, which is needed to process calcium into bones.

>

> The boys in the study who were on a casein-free diet had the

thinnest bones.

> In fact, the 9 boys who were on a casein-free diet had bones that

were 20

> percent thinner than normal for children their age. Boys who were

not on a

> casein-free diet showed a 10 percent decrease in bone thickness when

> compared to boys with normal bone development.

>

> The study authors wrote that bone development of children on casein-

free

> diets should be monitored very carefully. They noted that studies of

> casein-free diets had not proven the diets to be effective in

treating the

> symptoms of autism or ASD.

>

> Only 9 boys on casein-free diets were available to participate in

the study,

> Dr. Hediger said. When conducting a scientific study, it's easier

to obtain

> statistically valid results by studying a larger number of

individuals than

> with a smaller number of individuals. However, the dramatic

difference in

> the boys' bone thickness when they were either on a casein-free

diet or an

> unrestricted diet and when compared to normally developing bones

strongly

> suggest that the bone thinning the researchers observed was

statistically

> valid.

>

> The researchers recommended that larger studies be conducted to

confirm

> their results.

>

> Until those studies can be conducted, Dr. Hediger offered the

following

> advice: " Our study shows that it couldn't hurt -- and would

probably help --

> if parents of children with autism or autism spectrum disorder

consulted

> with a dietitian during their children's routine medical care to

make sure

> that their diets are balanced. "

>

> General information about autism and ASD is available from the

NICHD's Web

> site, at <

>

http://www.nichd.nih.gov/publications/pubs/autism/overview/index.cfm>.

>

> The NICHD sponsors research on development, before and after birth;

> maternal, child, and family health; reproductive biology and

population

> issues; and medical rehabilitation. For more information, visit the

> Institute's Web site at <http://www.nichd.nih.gov/>.

>

> The National Institutes of Health (NIH) -- The Nation's Medical

Research

> Agency -- is comprised of 27 Institutes and Centers and is a

component of

> the U. S. Department of Health and Human Services. It is the

primary Federal

> agency for conducting and supporting basic, clinical, and

translational

> medical research, and investigates the causes, treatments, and

cures for

> both common and rare diseases. For more information about NIH and

its

> programs, visit <www.nih.gov>.

>

> ##

>

> This NIH News Release is available online at:

> <http://www.nih.gov/news/health/jan2008/nichd-29.htm>.

>

> To subscribe (or unsubscribe) from this list, go to

> <http://list.nih.gov/cgi-bin/wa?SUBED1=nihpress & A=1>.

>

January 29, 2008

I have to question whether a casein free diet really does contribute to the bone

abnormalities or if something else is at play. Humans really aren't designed to

be drinking

cow's milk anyway, and it is a the top of the allergen list, as well as simply

being difficult

for many people to digest. Some studies also indicate that drinking milk can

actually

contribute to loss of calcium from the body. Eating other calcium rich foods

should

replace milk consumption, and taking a supplement can help.

I would suspect that any intolerance that affects the intestinal system can

wreak havoc on

any part of the body, including the brain. If casein and gluten are truly a

problem for those

with autism spectrum, then it would make sense that the damage being done to the

gut

would affect the absorption of nutrients from food, including calcium. This is

seen in

those with Celiac Disease. Untreated, celiacs can develop any number of

disorders due to

malabsorption (such as osteoporosis or osteopenia), some of which become

irreversible if

left untreated for too long.

> The study seems to suggest that the casein free diet contributes to

> bone abnomalities. In my dd's case her allergies and sensitivity

> dicted some food avoidances, it was not something I instituted, and

> she did prefer soy milk. She also never liked meat or could not eat

> it, but I gave it to her anyways. The question is does a normal diet,

> in some way harm kids with allergies/sensitivities? And does a special

> (restricted) diet confer actual benefits- I've always wondered

> how " evidence-based " that may be b/c most of what you hear are

> parental aneccdotes(?). Or does special diet result in nutritional

> deficiencies- so do you have a catch 22? Because of these type

> questions I end up trying to take approach of as much nutritional

> variety as possible.That way if there is something harmful-maybe it

> will be offset by something beneficial( yeah-very scientific).

> Having dealt with the eating disorder I guess I am naturally cautious

> with regard to rstricting diet. And with OCD, I also wonder if

> emphasis on " bad " foods " could allow the OCD to focus in that arena.

> Plus I think aspie and OCD together in a girl predisposes possibly

> more to likelihood of severe eating disorer, than one or the other

> alone.

> nancy grace

>

January 29, 2008

I agree, , it could be something else. In talking about

autism and what may cause behavioral and physiologic abnormalities

(like bone density problem) I think reserchers end up more with

speculation than scientific fact (somewhat similar in any neuropsych

field like with ocd and tourettes for example) because so many

variables and possibilities come into play. In other words they can

pinpoint an 'effect' to do something about it, but not necessarily

a 'cause' (to prevent the effect).

If I think of the list of what may cause or influence autistic

spectrum behaviors, including dietary intolerances or allergens, it

goes on and on, with research and findings in many different

categories (pre-natal, birth trauma, head injury, head size,

chromosomal, endocrine/hormonal, respiratory allergies, viral,

infectious, environmental toxins, vaccinations, additives and dyes,

leaky gut, yeast, autoimmune dusfunction...). Maybe the casein/gluten

is just the first speculation since the symptom has been uncovered.

In my daughter's case I can only end up saying low bone density is

something we may want to alleviate (or restore if possible). The

causes of various problems always ends up being a wild-card with all

her neuro-psych symptoms.

nancy grace

>

> > The study seems to suggest that the casein free diet contributes

to

> > bone abnomalities. In my dd's case her allergies and sensitivity

> > dicted some food avoidances, it was not something I instituted,

and

> > she did prefer soy milk. She also never liked meat or could not

eat

> > it, but I gave it to her anyways. The question is does a normal

diet,

> > in some way harm kids with allergies/sensitivities? And does a

special

> > (restricted) diet confer actual benefits- I've always wondered

> > how " evidence-based " that may be b/c most of what you hear are

> > parental aneccdotes(?). Or does special diet result in

nutritional

> > deficiencies- so do you have a catch 22? Because of these type

> > questions I end up trying to take approach of as much nutritional

> > variety as possible.That way if there is something harmful-maybe

it

> > will be offset by something beneficial( yeah-very scientific).

> > Having dealt with the eating disorder I guess I am naturally

cautious

> > with regard to rstricting diet. And with OCD, I also wonder if

> > emphasis on " bad " foods " could allow the OCD to focus in that

arena.

> > Plus I think aspie and OCD together in a girl predisposes

possibly

> > more to likelihood of severe eating disorer, than one or the

other

> > alone.

> > nancy grace

> >

>

February 10, 2008

Interesting - I thought dairy products weren't regarded as a good source of

calcium?

http://www.sciencedaily.com/releases/2008/02/080206204948.htm

Thin Bones Seen In Boys With Autism And Autism Spectrum Disorder

ScienceDaily (Feb. 9, 2008) — Results of an early study suggest that

dairy-free diets and unconventional food preferences could put boys with

autism and autism spectrum disorder (ASD) at higher than normal risk for

thinner, less dense bones when compared to a group of boys the same age who

do not have autism.

The researchers believe that boys with autism and ASD are at risk for poor

bone development for a number of reasons. These factors are lack of exercise

a reluctance to eat a varied diet, lack of vitamin D, digestive problems,

and diets that exclude casein, a protein found in milk and milk products.

Dairy products provide a significant source of calcium and vitamin D.

Casein-free diets are a controversial treatment thought by some to lessen

the symptoms of autism.

Funding for the study was provided by the NIH’s National Institute of Child

Health and Human Development and National Center for Research Resources. The

research team that conducted the study was led by L. Hediger, Ph.D., a

biological anthropologist in NICHD’s Division of Epidemiology, Statistics

and Prevention Research.

“Our results suggest that children with autism and autism spectrum disorder

may be at risk for calcium and vitamin D deficiencies,” Dr. Hediger said.

“Parents of these children may wish to include a dietitian in their

children’s health care team, to ensure that they receive a balanced diet.”