I remember thinking Rich Von Konynenburg had gone off his rocker when he proposed, years ago, that autism and chronic fatigue syndrome (ME/CFS) were somehow related. Looking at autism’s severe cognitive, communication and emotional issues, the male gender bias, the vastly younger age of the patients and the two just didn’t fit at all for me.
It’s not clear that they are but appearances can be deceiving. The Klimas/Broderick/Fletcher team is making it clear, for instance, that two people with Gulf War Illness and chronic fatigue syndrome can look exactly the same clinically but differ enormously under the hood.
It’s also possible that people who look very differently clinically, say people with autism and people with ME/CFS, might look much more related physiologically. Dr. Kogelnik, Dr Nathan and Dr. Hornig have all remarked on possible similarities and when Neuro-Immune institutes show up, both autism and ME/CFS are often in the mix. It was the pathophysiological similarities between the two that enticed Rick Von Konynenburg. They include
- Poor natural killer cell functioning (low cytotoxicity)
- Low glutathione levels (brain -ME/CFS)
- High rates of oxidative stress
- Th2 immune shift
- High sensitivity to toxins
- Many gastrointestinal problems including dysbiosis, leaky gut, gluten intolerance
- Sleep disorders
- HPA axis dysfunction (decreased morning salivary cortisol)
- Possible glutamate excitotoxicity
Advances in autism were summed up in a recent article in the New York Times. Substitute ME/CFS for autism in many places in this blog and see what kind of a fit you get. Sometimes you have cheat a little; autism is far better studied than ME/CFS but if you connect the dots what you get is an infection triggered disorder causing inflammation and immune activation in the brain….that show up looking like autism in some cases perhaps like chronic fatigue syndrome in others.
Dr. Klimas, Dr. Maes and others believe ME/CFS is, among other things, an inflammatory disorder and it’s pretty clear that inflammation is a key driver in about one-third of autistic patients. (There’s another similarity – subsets :)).
Infection triggered Illnesses
Just as in ME/CFS infection, a very early infection – in the case of autism – can be a trigger. Population studies indicate an infection during pregnancy increases the mother’s odds of having an autistic child. A bacterial infection in the mother during the second trimester increases her odds by 40%. Getting a serious enough infection to land the expectant mother in the hospital triples her child’s odds of getting the disease.
Now replace autism with ME/CFS and shoot forward several decades in a baby’s lifespan and watch some bug, maybe any bug, from Epstein-Barr virus to giardia to enteroviruses knock adolescents and adults for a loop – often permanently. The boomers are getting exposed to fewer infections but when they do encounter them, they appear to be getting hit harder by them.
It turns out that the pathogen, though, is probably little more than an innocent bystander.
The Inflammatory Disorder Epidemic and ME/CFS
Infection per se does not appear to be the culprit. Autism rates are up at same time mothers and others are getting fewer and fewer infections. Paradoxically, a dropping incidence of serious infections over the past 30 years has coincided with a boom – what some people call an ‘epidemic’ – of inflammatory and autoimmune disorders. Asthma is now believed to strike 1/10 children in the US – double the rate since 1980 and autoimmune disorders effect about 1/20 people in the US. Both can be triggered by infections.
Does ME/CFS belong in this group? Did ME/CFS explode in the 1980’s or were a large number of very sick people simply just finally uncovered? Nobody knows but its possible chronic fatigue syndrome is just another example of something going wrong on a very large scale in recent years. That something is the female immune system.
In autism the problem appears not to be the infection, but the mothers’ immune system. Dr. Hornig noted in her NSU talk on chronic fatigue syndrome that she believes the immune response to the pathogen was probably more important that the pathogen itself.
- Check out - Infection, Autoimmunity and PANDAS: Dr. Hornig on Chronic Fatigue Syndrome at Dr. Klimas’ NSU Conference
Researchers now know that, infection or not, the amniotic fluid of fetuses who later develop autism is inflamed – not a lot, apparently, but possibly just enough in this early stage of growth to contribute to a devastating process. They know that a mother diagnosed with asthma or allergies during pregnancy – two signs of her immune system going off the rails a bit – increases her child’s risk of coming down with autism.
The same general trend runs true with metabolic syndrome, a disorder associated with insulin resistance which is also characterized with, yes, low-grade inflammation. A mother with rheumatoid arthritis increases her child’s risk by 80%, and if she happens to have celiac disease her child’s odds go up by a whopping 350% and that takes us to the gut.
The big question, then, may be what has gone wrong with our immune systems? One answer could lie in our environment. Researchers, taking note of the reduced prevalence of autoimmune and inflammatory disorders in developing countries, are asking what’s different between the two and one difference is very clear; the number of bugs present….
People in developing countries are exposed to more bacteria and other bugs and that exposure could be key. Studies find that wild rats exposed to lots of different pathogens can quickly put a lid on their inflammatory response, but laboratory rats can not. Why? Nobody’s sure but some believe the parasites the wild rats carry – and they’re loaded with them – are responsible. (Some pathogens have figured out a way to blunt the inflammatory immune response.) It may be that to be human, has, until the 50 years or so, meant being loaded with ‘parasites’ and that includes things like (ugh) worms and s here we are at gut; i.e., the ‘second brain’ and the biggest single immune repository in the body.
In her NSU talk, Dr. Hornig linked low gut enzymes and massively changed gut flora in Autism to low antioxidant levels in the blood which lead to inflammation which lead to brain issues. Bacterial imbalances in the gut have been associated with arthritis, diabetes, autism and other disorders.
How to fix the problem? If the theory of bacterial/parasite imbalance is correct the fix is simple; replenish our natural ecosystem by returning the bugs to our guts by using such therapies as probiotics, worms (yes, worms) and fecal (yes) transplants and the inflammation that is knocking so many people about will go away…..
The Gut Series on Health Rising
All this is really an introduction a new series on the gut on Health Rising that will appear over the next couple of months. We’re going to look at gut composition, how to diagnose and treat small intestine bacterial overgrowth (SIBO), how the gut can affect the brain and the mind, how probiotics, fiber and diet fit into all this, and we’re going to explore some new, different and some would say disgusting, therapies that just might help such a fecal transplants and worms.