A very cool vitamin you can get from the sun!

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What If Vitamin D Deficiency Is a Cause of Autism?

A few researchers are turning their attention to the sunshine vitamin as a

culprit, prompted by the experience of immigrants that have moved from their

equatorial country to two northern latitude locations

By le Glaser

As evidence of widespread vitamin D deficiency grows, some scientists are

wondering whether the sunshine vitamin—once only considered important in bone

health—may actually play a role in one of neurology's most vexing conditions:

autism.

The idea, although not yet tested or widely held, comes out of preliminary

studies in Sweden and Minnesota. Last summer, Swedish researchers published a

study in Developmental Medicine and Child Neurology that found the prevalence of

autism and related disorders was three to four times higher among Somali

immigrants than non-Somalis in Stockholm. The study reviewed the records of

2,437 children, born between 1988 and 1998 in Stockholm, in response to parents

and teachers who had raised concerns about whether children with a Somali

background were overrepresented in the total group of children with autism.

In Sweden, the 15,000-strong Somali community calls autism " the Swedish

disease, " says beth Fernell, a researcher at the Karolinska Institute in

Stockholm and a co-author of the study.

In Minnesota, where there are an estimated 60,000 Somali immigrants, the

situation was quite similar: There, health officials noted reports of autism

among Somali refugees, who began arriving in 1993, comparable to those found in

Sweden. Within several years of arrival, dozens of the Somali families whose

children were born in the U.S. found themselves grappling with autism, says Huda

Farah, a Somali-born molecular biologist who works on refugee resettlement

issues with Minnesota health officials. The number of Somali children in the

city's autism programs jumped from zero in 1999 to 43 in 2007, says Ann Fox,

director of special education programs for Minneapolis schools. The number of

Somali-speaking children in the Minneapolis school district increased from 1,773

to 2,029 during the same period.

Few, if any, Somalis had ever seen anything like it. " It has shocked the

community, " Farah says. " We never saw such a disease in Somalia. We do not even

have a word for it. "

What seemed to link the two regions was the fact that Somalis were getting less

sun than in their native country—and therefore less vitamin D. The vitamin is

made by the skin during sun exposure, or ingested in a small number of foods. At

northern latitudes in the summertime, light-skinned people produce about 1,000

international units (IUs) of vitamin D per minute, but those with darker skin

synthesize it more slowly, says Adit Ginde, an assistant professor at the

University of Colorado Denver School of Medicine. Ginde recommends between 1,000

to 2,000 IUs per day, calling current recommendations of 200 IUs per day

outmoded.

It's hard to definitively assess the extent to which Somali immigrant families

in Sweden and Minnesota are experiencing increased rates of autism. Somalia

doesn't have great records of the condition, says Berkowitz, who works

for a United Nations–affiliated NGO called Global Education Motivators.

" Children in Somalia may not even be getting diagnosed with autism due to the

overall lack of awareness of the disorder, " Berkowitz says, in a nod to the fact

that there is no Somalian word for it. And Swedish scientists have reported

autism rates overall have risen since they began studying the epidemiology of

the disorder in the mid-1980s—just as U.S. Centers for Disease Control officials

have noted an increase.

Still, proponents of the vitamin D–autism link say there is biological

plausibility to their theory. They cite a 2007 review by Allan Kalueff, a

researcher now at Tulane University, in Current Opinion in Clinical Nutrition

and Metabolic Care. That review—based on more than 20 studies of animals and

humans—concluded that vitamin D during gestation and early infancy was essential

for " normal brain functioning. "

At the same time, the theory needs a lot of data to back it before others will

give it much credence, given how many other potential reasons there are for a

climb in autism rates. Even Kalueff says he isn't sure how vitamin D could be

related to autism, even if it is an important player in the brain: " Discussions

around autism specifically may be a right step or a wrong step, but they should

not distract us from a much bigger picture. "

Lord, the director of the University of Michigan at Ann Arbor's Autism

and Communication Disorders Center, says she finds the Swedish study intriguing.

" But it is going to be really important to replicate these findings, " says Lord,

who has studied the disorder for 40 years and has been instrumental in

developing autism diagnostic instruments used in practice and research

worldwide. " We are talking about a small group of children with a lot of social

factors, including that these kids are very conspicuously different from your

average Swedish child, and being assessed by people who are from very different

culture. " There is also the issue of consanguinity, she says, as many Somalis

marry cousins. " This doesn't mean the study is wrong, " she says. " But we need

methodical testing. "

So Fernell and her colleagues are now measuring vitamin D blood levels in

mothers and children with autism of both Somali and Swedish origin and comparing

them with a control group of mothers and healthy children. She will not say how

many subjects the study includes, describe any preliminary results nor say when

it will be complete. Farah says Minneapolis researchers are now preparing to

study the vitamin D levels of pregnant Somalis, other ethnic groups and

Minnesotans of European stock. (That data is particularly hard to come by

because Vitamin D levels are not typically screened in pregnancy in the U.S.,

says , a spokeswoman for the American College of Obstetricians and

Gynecologists.)

The other potential reasons for a climb in autism rates: There is increased

attention to the condition in the U.S., and Somalis are more likely to see a

doctor after moving here. Also, genes, studies have found, may play a role; a

number of papers, including a 1989 study of five Nordic countries and a 1995

British study, found that the concordance rate among identical twins was as high

as 90 percent. (Then there is the much-ballyhooed but ultimately disproved link

to vaccines.)

Somali refugees, in particular, faced multiple stressors as they adjusted to

their new lives in Sweden and Minnesota: They had fled civil war, lost a

supportive tribal culture, and replaced a diet of fruit, fresh meat and grains

with processed food. Perhaps, most importantly, they had traded family compounds

and regular exposure to the equatorial sun for cloistered high-rise apartments.

But some of those potential cultural reasons could also point to vitamin D.

Surrounded by strangers, the predominantly Muslim women covered themselves

almost continuously when outdoors, says A. Plotnikoff, medical director

of the Penny Institute for Health and Healing in Minneapolis. Plotnikoff,

an internist, speaks Somali and has many Somali patients. That meant less

exposure to the sun for pregnant women, who would have worn less modest dress in

private areas of their own family compounds.

And there is other evidence for a vitamin D link: Last November, Cornell

University researchers published a study in Archives of Pediatrics & Adolescent

Medicine showing that children in rainy (and therefore more overcast) counties

of Oregon, Washington and California were two times more likely to be diagnosed

with autism than their counterparts in drier parts of the state. " Our research

is sufficiently suggestive of an environmental trigger for autism associated

with precipitation, of which vitamin D deficiency is one possibility, " says

study co-author Waldman, a professor of management and economics at

Cornell's Graduate School of Management. " Further research focused on

vitamin D deficiency is clearly warranted. " His research on environmental links

to autism are ongoing; he plans to publish in the coming months but will not

disclose any of his studies until they are accepted by a journal.

Gene Stubbs, an associate professor emeritus of psychiatry and pediatrics at

Oregon Health & Science University, says the preliminary research is already

intriguing. " We don't have proof, but I am certainly leaning in the direction

that this hypothesis could be correct for a proportion of kids, " says Stubbs,

who has been studying autism for 30 years. He is launching a pilot study of 150

pregnant women who have at least one child diagnosed with the disorder. The

women will receive 5,000 IUs of vitamin D3 during gestation and 7,000 IUs during

lactation. " If we find that we are able to reduce the recurrence rate of autism

within families substantially enough, others will want to study this in larger

groups with larger controls. "

http://www.scientificamerican.com/article.cfm?id=vitamin-d-and-autism & print=true

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