Autism, Vitamin D and COVID – 19 Infections
Although Autism and COVID-19 would appear, at first sight, to have very little in common, there are elements of the two conditions which do have unexpected similarities and provide further clues about the underlying problem.
At this point, it’s customary to run through the defining symptoms and the problems which may present themselves. We must assume that anyone reading this is already aware of these problems.
Our Autism Research Unit initiated our studies in the (now) University of Sunderland in England in about 1982. We were seeking metabolic abnormalities by analysing the urine of people diagnosed with autism compared to control populations. We did not collect detailed clinical histories or any other personal details apart from the contact details, birth date, and name of the diagnostician. When we had completed these initial studies, we stopped taking samples because that particular project was complete. However, by this time our work had become better known and many parents and professionals were contacting us to have samples analysed. We agreed, provided they covered the costs involved. As well as asking for names, we requested information of racial/ethnic backgrounds. This was not possible to determine from the name alone. We observed that we had rather more samples from children from ethnic minority backgrounds than we had expected. In particular, we also had more samples from Muslim families.
We did not mention this in publications as our observations were not derived from a properly designed population study; The data may have been entirely random but could result from consequence of groups of similar groups encouraging each other to contact us. We had no data with which to confirm these observations, but we also noted a greater incidence in mixed race children and had no real explanation for this – again we reported nothing.
Over the intervening years, we learned, principally through the work of Dr John Cannell (1) and his colleagues, that Vitamin D metabolism abnormalities may be more common in people diagnosed with autism. This was just one more factor which we accepted for consideration but were unable to include in our own studies.
In 2008, a series of reports came from some of the Northern States in the USA (Minnesota and Nebraska) that there was an outbreak of autism in the region and, in particular, amongst the immigrant populations who originated in Somalia in East Africa. We immediately interpreted this as a possible consequence of reduced Vitamin D levels as a result of the lower levels of sunlight in that (Northern) part of the USA. The comparatively dark skin of the Somali children and especially the fact that Somali mothers, being Muslim, would have minimal areas of exposed skin (thus accessing minimal levels of sunlight throughout pregnancy) would enhance this effect.
As a fairly frequent visitor to the Middle East, I became aware of the possibility of the lack of direct sunlight being a potential problem even there. Most adults wear traditional Arabic clothing which involves being covered to avoid the hot sun and keep cool. The women are usually covered and may or may not have facial protection. The consequence is that the direct sunlight is diminished and there could be a reduction in Vitamin D especially during pregnancy. I suggested that a change of diet to include more seafood or supplementary Vitamin tablets might be useful.
A couple of years later, I observed that many pregnant women (in Saudi Arabia) were now taking appropriate nutritional supplements – including Vitamin D to avoid conditions such as rickets.
It is interesting to note that farmers have, for as long as can be remembered, supplemented the diet of ewes before, during and after pregnancy. Human beings do this for their sheep but not necessarily for their own children.
There is evidence that supplementing the diets of autistic children with Vitamin D can be beneficial. (2) No-one is talking about curing a person with autism, but it does seem to have beneficial effects on some of the faulty metabolic processes.
Like everyone else, we learned about this viral disease during the early months of 2020 and, like many other cynics, we assumed it was just the next in a long line of diseases which would permit pharmaceutical companies to market their vaccines across the world. Gradually, we learned that it was a very unusual disease which was, as Gregg (3) stated when describing influenza, “seemingly unmindful of traditional infectious disease behavioural patterns.”
It was different from influenza type diseases in many ways – not least in its capacity to spread rapidly and to kill victims rapidly. It was described as a Coronavirus which is related to two other Corona viruses which had, in recent years, been held responsible for epidemics of SARS and MERS in humans but on a comparatively local scale.
This new disease was spreading very rapidly and there was talk of it becoming a Pandemic.
It was noted that a weird selection of unusual interventions were being employed with, allegedly, some success in the regions of China where it had first been reported (– the District of Wuhan). Then, in other countries of the Far East, Vitamin C and Vitamin D were being given by injection in heroic doses. The antibiotic Azithromycin was used (presumably to prevent secondary bacterial infections?), as well as Hydroxychloroquine (a somewhat unfashionable drug normally employed to treat or prevent malaria)..
The use of each of these for treating a viral infection (the vitamins apart) would not be an obvious choice. However, it was the Vitamin D element that caught the attention of people involved with autism.
It has been reported that many people suffering from COVID-19 also suffer from Vitamin D deficiency
Is the deficiency of Vitamin D conducive to the colonisation by the virus or is the deficiency a consequence of the infection?
Either way, it would seem that we should be concerned about the effects of low Vitamin D in people with autism at a time when such a disease is rampant.
Service Providers for Autism!
Those of us who are involved with the education, care or employment of autistic people were terrified about the situation.
Vitamin D has a very important role to play in modulating the immune system. It is required to stimulate the immune system when appropriate and, through a different system, dampen it down. We remain concerned and vigilant because any interference with the natural systems in our body by chemical or other means are not predictable or under our control. Abnormalities in the immune system are already common in people diagnosed with autism. My family and I all take 1g of Vitamin C (as a drink prepared from an effervescent tablet). It also includes 15mg of Zinc. We also take a capsule of 50 micrograms of Vitamin D3 (the most active form of the vitamin) (but intend dropping the amount (to 12.5 micrograms) shortly). We may be wasting our money (but it is only 7 pence per day per person) and at those levels and in the British climate this is unlikely to result in side effects.
It is theoretically possible to overdose with Vitamin D especially if your levels are not low in the first place. (If in doubt contact an experienced professional).
Back to COVID – 19
Most of the people who die with the virus are elderly (over 60 years) and/or have underlying health problems. Many of them have been recorded as deaths from these other causes but the disease seems to trigger other, even more serious conditions, which could result in death.
It is worth exploring these conditions and considering their relationship to Vitamin D3
Having read numerous published reports there is little consensus around the precise numerical data which seems to vary with the severity of the infection, the geographical location; the “phase” of the epidemic in that location and the differences in classification used by different authors. Hopefully, the situation will become clearer with time but I will restrict this report to general trends rather than guessing which set of data to use,
- It is reported that up to 26% of the deaths with COVID -19 occur with people diagnosed with Diabetes,
Vitamin D is believed to help improve the body’s sensitivity to insulin – the hormone responsible for regulating blood sugar levels – and thus reduce the risk of insulin resistance, which is often a precursor to type 2 diabetes (5)
- Reduction and Functional Exhaustion of T Cells in Patients with Coronavirus Disease 2019 (6)
Scientists have found that vitamin D is crucial to activating our immune defenses and that without sufficient intake of the vitamin – the killer cells of the immune system — T cells — will not be able to react to and fight off serious infections in the body.
There are many ways in which our immune system operates to keep us healthy but there must be a balance between the various systems. T Cells are the main ‘killing and destroying’ cells involved in the system. However, recent evidence suggests that they are present in insufficient numbers to control the COVID infections. Without Vitamin D, they will not overcome the virus. Was the insufficiency a precondition to catching the disease or was the reduction caused by a reduction in Vitamin D activity as a result of the infection?
- Vitamin D Supplementation Improves Cytokine Profiles
The invading organism is attacked by host’s immune system and part of the immune system general stimulation is by inflammatory cytokines. Sometimes this process can get out of hand and a “cytokine storm” results during which time the immune system attacks the host’s own cells (auto-immunity). This is probably when the real, possibly permanent, damage occurs and death can result. (7)
In the early stages of hospitalisation,, relief can be given by ventilation methods so that sufficient oxygen is absorbed. And the victim recovers. As well as inflammatory cytokines there are anti-inflammatory cytokines which act to keep the inflammatory activity optimal. Vitamin D acts to control the balance of these cytokines. Reduced levels of Vitamin D will disrupt this, otherwise balanced, inflammatory process.
The drug dexamethasone is a well-known steroidal anti-inflammatory which is being studied by a number of research teams in a coordinated way. Of course, it would not be helpful in the treatment of the early symptoms (in the ventilation stage) but could be very useful in the later stages where inflammatory consequences are more important. This damage is long lasting and difficult to control. The correct level of Vitamin D is necessary to control both of these complementary systems.
It would seem to indicate that supplementation of Vitamin D would be a more natural and less risky approach and should be used much earlier in the programme
- Effects on Blood Clotting – Increase in Blood Clots (Thrombosis) with low levels of Vitamin D
Italian physicians reported some months ago that during post-mortem examinations of those who have died of COVID – 19 infections, lung tissues were filled with black residues of clotted blood. They suggested that this was the cause of death rather than the pneumonic damage shown higher up in the lungs. British physicians, more recently, reported similar observations but felt that this indicated bacterial infection rather than the response described above.
Clinical reports correlating vitamin D deficiency with an increase in thrombotic episodes implicate the role of vitamin D and its associated molecule in the regulation of thrombosis-related pathways. Thrombosis is the formation and propagation of a blood clot, known as thrombus. (8)
There have also been a number of reports of long-lasting problems with swelling and itching; rashes and swellings of the lower limbs and especially the big toes following COVID infections. This was interpreted by the physicians as being indicative of microthrombic events in those areas. In other words, mini-thromboses around the feet and extending into the lower regions of the calves.
- Loss of sense of Smell now a diagnostic marker for COVID – 19
Possible Correlation Between Vitamin D Deficiency and Loss of Smell: 2 Case Reports (8)
Although by no means identified in all patients diagnosed with the infection. Loss or reduction of the sense of smell is now regarded as supportive of a diagnosis o COVID – 19 in the United Kingdom
Reduced levels of Vitamin D and COVID-19 causation
Is it a coincidence that the principal mechanisms underlying the disease are the same as those seen when levels of Vitamin D are lower than they should be? It could be that the virus causes the considerable reductions in Vitamin D and this results in the production of the symptoms. However, the affected subjects do not become autistic and we have yet to determine if people with autism are more susceptible to the disease virus but, at this observational phase of our studies, we see no evidence of that.
Perhaps the virus interferes with the transfer of the Vitamin (as D3) by removing the Vitamin D Binding Protein from the system for example. Such possibilities are still to be investigated and could result in another way to prevent the disease
(There is one, potentially simple explanation. I am hoping that there are enough clues here to indicate where this presentation is heading.)
Sunlight, Vitamin D and Black Asian and Minority Ethnic (BAME) individuals.
Perhaps one of the most contentious elements of the debate is: ‘Why is the relative proportion of the population with dark skins so much more likely to catch and die from the disease?’.
Sunlight stimulates the production of Vitamin D in the skin. Dark skinned people need approximately six times as much sunlight to perform this task as pale skinned people.
As far as Vitamin D is concerned, BAME persons experience significant reductions in the vitamin when living in a place where sunlight is scarce. It will be interesting to see, when all the data is collected, if the prevalence of the disease (in terms of numbers per 100,000) is higher in those parts of the United Kingdom which are further North and West and which tend to have less sunlight.
Indeed, many nutritionists suggest that even native British populations living n the Northern areas of the UK, can experience reduced levels of vitamin D throughout the Winter months when sunlight is very limited. Supplementary vitamin D is proposed. This requirement should certainly be considered by
In our local Hospital Service (South Tyneside and Sunderland NHS Foundation Heatth Trust,) BAIM staff in the front line, as well as others who are at risk and who are more likely to be affected have been invited to work elsewhere within the service. I am also informed that some hospital trusts are providing Vitamin D supplements for all of their medical staff.
The lack of sunlight has been reported as a triggering factor for COVID – 19 already but ignored. Whilst there are probably multiple causative elements which interplay in controlling the prevalence of disease, the simple evidence provided here should encourage serious consideration and evaluation. The WAO would encourage the medical establishment to investigate these plausible explanations which suggest simple and cheap steps which could help to control the disease.
The WAO is NOT claiming that dietary supplementation is a cure or a preventer of COVID-19 infections, but should be considered in helping to reduce symptoms as part of a complete programme for individuals. We encourage further studies in these areas. These mechanisms must be regarded, at this time, as hypothetical and the evidence as partially circumstantial. We are aware of a number of potentially relevant studies that are being considered or actually in progress, and will report any relevant, updating material as it becomes available.
Late News It has just been announced (18th June 2020) (11) that the two UK based official bodies “Public Health England” and “NICE” (“National Institute for Clinical Excellence”) are to examine the feasibility of using Vitamin D as a remedy for COVID-19 infections. There are a number of explanations as to why it has taken so long for the potential benefits of such an intervention have not attracted attention from the “experts” but these are beyond the scope of this presentation.
Some selected references
- Cannell J. On the Aetiology of Autism, Acta Paediatrica 2010 99 (8) 1128-1130
- Adams J.A., Audhya T et al. Effect of a vitamin/mineral Supplement on Children and Adults with Autism. M.C. pediatric Dec. 2011
- Gregg MB On the Epidemiology of Influenza in Humans.Y Academy of Science Proceedings 1980 353 45-53
- McCartney D.M., Byrne D.G. Optimisation of Vitamin B Status for Immuno-protection against COVID-19 Irish Med Journal; 113; (4); 58 – 61 2020
- Seshadri G., Tamilselvan B., Rajendran A. Role of Vitamin D in Diabetes. Journal of Endocrinology and Metabolism, 1, (2), 47-56’ 2011
- von Essen et al. Vitamin D controls T cell antigen receptor signaling and activation of human T cells. Nature Immunology, 2010; DOI: 1038/ni.1851
- Brackley P. Lower vitamin D levels associated with higher Covid-19 mortality rates (in Press)
- Syed M., Mishra A., Ashraf M Z. Emerging Role of Vitamin D and its Associated Molecules in Pathways Related to Pathogenesis of Thrombosis Biomolecules 9 (11), 649; (2019)
- Bigman G, Age-related Smell and Taste Impairments and Vitamin D Associations in the U.S. Adults National Health and Nutrition Examination Survey Nutrients 12 (4) 2020 984-1001
- Letter to the Editor, Guardian Newspaper, April 15th 2020
- Guardian Newspaper June 18th 2020