Sulfate Deficiency As a Risk Factor for Autism
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Journal of Autism and Developmental Disorders (2020) 50:153–161 https://doi.org/10.1007/s10803-019-04240-5 ORIGINAL PAPER Sulfate Defciency as a Risk Factor for Autism Richard J. Williams1 Published online: 27 September 2019 © The Author(s) 2019 Abstract This is a study of water and beverages consumed during pregnancy by mothers of children with autism. Materials included vials for water samples and a survey to describe the water and beverages. Samples were tested for sulfate and surveys evalu- ated for average daily levels. Results were stratifed for selected regions of the United States. Areas with the highest rates of autism showed a trend toward lower levels of sulfate compared to areas with low rates of autism (28% sulfate, n = 45, p = 0.059). Severe autism was associated with low sulfate levels while mild symptoms were associated with higher levels of sulfate (− 0.32 correlation, n = 86, p < 0.01). The results suggest that sulfate may be helpful in reducing both the incidence and severity of autism. Keywords Autism · Sulfate · Pregnancy · Drinking water · Beverages Introduction to become sulfate. An English study reports the urine of those with autism contains 50 times the sulfte and double Autism spectrum disorders (ASD) afect social interaction, the sulfate of neurotypicals (Waring and Klovrza 2000). In communication, behavior and the senses. In the United an Arizona study that investigated blood sulfate levels in a States, the prevalence is 1 in 59 for all children and 1 in 37 cohort with autism, free sulfate was 35% and total sulfate for boys based on data from the Centers for Disease Control was 72% of non-autistic individuals (Adams et al. 2011). In and Prevention (Baio et al. 2014). The cause is not well addition, a French study of nasal stem cells found decreased understood although genetic predisposition coupled with expression of either the molybdenum cofactor sulfurase or environmental infuence is strongly suspected (Lyall et al. aldehyde oxidase genes (MOCOS or AOX) in 91% of a small 2017). It is the purpose of this study to evaluate sulfate levels group (n = 11/12) of autistic participants (Feron et al. 2016). in drinking water and beverages as a risk factor for autism. Both of these genes are part of the molybdenum cofactor It is our goal to better understand the causes of autism and pathway, responsible for sulfte oxidase enzyme, among sev- illuminate possible preventative measures. eral others. Impaired sulfte oxidase production results in an One characteristic of autism is dysfunctional sulfur increase of sulfte as noted above. metabolism. In particular, the oxides of sulfur are implicated: Sulfate is a common nutrient and functions in a variety 2− 2− sulfur dioxide, sulfte and sulfate SO2, SO3 and SO4 . of chemical processes including the development of tissue Sulfate may be ingested directly or it may be produced as an structure for important organs. During human pregnancy, end product of the transsulfuration pathway. In this pathway, maternal circulating sulfate levels double during the fnal the amino acid methionine contributes sulfur dioxide and trimester. This highlights the importance of sulfate in fetal sulfte which is fnally oxidized by sulfte oxidase enzyme development (Dawson et al. 2015). In particular, heparan sulfate is essential for neuron regulation. In studies of mice with compromised heparan sulfate synthesis, symptoms sim- Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s1080 3-019-04240 -5) contains ilar to those found in autism resulted, including impairments supplementary material, which is available to authorized users. in social interaction, expression of repetitive behavior and difculties with vocalization (Irie et al. 2012). In humans, * Richard J. Williams the examination of postmortem brain tissue in young indi- [email protected] viduals showed reduced levels of heparan sulfate for those 1 Rybett Controls, Inc, 21615 Tribune St., Chatsworth, with autism vs neurotypicals (Pearson et al. 2013). Finally, CA 91311, USA Vol.:(0123456789)1 3 154 Journal of Autism and Developmental Disorders (2020) 50:153–161 sulfate supports sulfonation and sulfotransferase enzymes an interest in autism. Water kits were mailed to those with which help to remove xenobiotics and certain pharmaco- children on the autism spectrum willing to provide a ship- logical drugs. Through a sulfonate intermediary, 3′-phospho- ping address. Participants were instructed to sample the adenosine 5′-phosphosulfate (PAPS), sulfate is attached to two most important water sources during their pregnancy. unwanted chemicals increasing water solubility to facilitate Practically speaking, this required that they currently live in removal (Gamage et al. 2005). Without sufcient sulfate, the same place where they gave birth. On the survey, par- developing children may be at heightened risk from xeno- ticipants identifed their sampled water, bottled water and biotics and environmental factors that require metabolism beverages like cofee, tea, milk, wine, beer, juice and soda. via sulfonation. They estimated the daily number of 8 oz glasses for each With the importance of sulfate in mind, the prevalence of liquid. Finally, they provided an estimate of the severity of autism was researched using Department of Education data their child’s condition. as required by IDEA legislation, the Individuals with Dis- abilities Education Act (US DoE 2010). For children aged Participants 6 through 11 in 2010, prevalence was calculated for all 50 states. The states with the highest rates of autism were Min- In addition to the screen described above (adult females nesota, Maine, Oregon and Connecticut. States with very with an interest in autism), three specifc regions within low rates included Iowa, Colorado, Oklahoma, Montana, the United States were targeted. These regions were the 8 Kansas and South Dakota. Water Quality Reports for the states with the highest prevalence of autism, the eight states major cities in each of these states were accessed for data with the lowest prevalence and the southwest region includ- on sulfate levels. Sulfate reporting is not required by the ing Southern California and Central Arizona. As indicated federal government and not all cities include this information earlier, the high prevalence states seemed to have low lev- in their annual water reports. For the ten states mentioned els of sulfate in public water while lower prevalence states above, sufcient data was available and sulfate levels were had much higher. We wanted to confrm this disparity and averaged with population as a weighting factor. The four learn what we could from these two poles of autism. The states with a high incidence of autism averaged 13 mg/L sul- southwest was chosen because it is served by Colorado fate. The six states with low incidence averaged 113 mg/L. River water which is high in minerals and sulfate. If autism This difference prompted our research study (Williams is indeed correlated with low levels of sulfate, then mothers 2017). of children with autism in this region must have avoided the high sulfate water. If not, the premise of the study is proven false. Statistics for participants in these regions plus the full Methods USA are summarized in Table 1. Prevalence weighted by population was calculated from Department of Education The focus of our investigation was drinking water and bever- data as before (US DoE 2010). ages that were consumed during pregnancy by mothers of children with autism. Toward this end, water kits were cre- Statistical Analyses ated containing two sample vials, a survey sheet, a consent form, a background explanation and a postage prepaid return An important consideration is bias in the target popula- box. Participants were recruited via Facebook by boosting tion. Participants were recruited in English via Facebook an invitation post to a targeted audience, adult women with and required to read and complete two sheets of paper: an Table 1 Details of participants by region Participants by region (Mothers of children with autism) Region Description n Boys (%) Mean age (range) High prevalence (1 in 84) Minnesota, Maine, Oregon, Connecticut, Pennsylvania, Massachusetts, New 22 73 6.5 years (2–16 years) Jersey, Indiana Low prevalence (1 in 234) Iowa, Louisiana, Colorado, Oklahoma, New Mexico, Montana, Mississippi, 23 65 6.6 years (2–16 years) Kansas Southwest region Southern California and Central Arizona served by Colorado River water 32 81 5.4 years (2–18 years) Other Other states outside of the target regions 9 100 4.9 years (2–9 years) Total All of the United States combined from above 86 77 5.9 years (2–18 years) 1 3 Journal of Autism and Developmental Disorders (2020) 50:153–161 155 Informed Consent Form and a Survey Form consisting of Supporting Data instructions and 24 spaces for data entry. At frst glance, it might have appeared to be a formidable task, especially After the water samples were tested, the survey form was since the forms concerned behavior many years past. For this evaluated to fgure the average sulfate concentration of reason, it seems likely that the resulting study population the water actually consumed by the participant. A typical was above average in intelligence or education, in addition mother drinks a few glasses of tap or well water, which to being literate in English. It is difcult to judge whether or may be unfltered or fltered. Reverse osmosis flters and not this produced a signifcant bias regarding drinking water multi-stage units like Zero Water remove nearly all sul- or beverage choices. However, since sulfate content is not fate. Simple carbon flters such as Brita pitchers or those well publicized, we suspect any bias was minimal. in refrigerators reduce chlorine but leave sulfate virtually All collected data was stored in an Open Ofce spread- untouched. Tests using the Hanna photometer showed sheet version 4.1.5 by Apache Software.