Thursday 28 April 2011

Iron deficiency in autism

Iron. The metal that had its own age. A metal we consistently find in extra-terrestrial material. A metal that carries several important roles in numerous bodily functions. A metal that even has its own superhero. It is in relation to the body and health that I will look at iron connected to autism and a few other things (although I am tempted to talk more about Iron Man given my childhood love of the Marvel comics).

I have, in a previous post, hinted at a possible issue with iron in some cases of autism. The limited research done on the topic of iron deficiency in autism suggests that it might be more widespread than you think.When taking into account ferritin levels as possible indicators of iron deficiency, the research does get a little bit serious in terms of the numbers potentially deficient. This last piece of research also suggests that things get potentially worse as chronological age increases.

So why is iron so important to autism and why might we be seeing the scientific results that we are?

Well like everything it is complicated. I will do my best but can't guarantee making things any clearer by the end of this post. We get our iron from a few sources: endogenous recycling following hemoglobin breakdown, dietary intake and the various supplements that we seem to be taking ever more of. Iron is important for lots of different bodily processes and where not enough is present, anaemia is diagnosed. For children, anaemia can affect growth measurements among other things.

One could assume that given the potential for dietary issues in some cases of autism, there might be some problem in consuming adequate levels of dietary iron. Indeed, quite a few studies have suggested that the recommended nutritional intake of iron (and lots of other things) might be less in autism than what they should be. I would however temper that statement by saying that controls were also tending to be low in iron intake also. Levels of ascorbic acid (vitamin C) which is also pretty important for the absorption of non-heme dietary iron has also been suggested to be 'different' in some cases of autism.

There is some suggestion that supplementing iron in autism might have some interesting knock-on effects with regards to ferritin levels and also sleeping patterns. The ferritin levels bit suggests that the metabolism of iron might not be particularly problematic in autism; rather low intake or some mechanism that depletes iron being more important. This is where I am going to be a bit speculative so please get that pinch of salt ready.

Regular readers might know that I talk quite a bit about coeliac disease as being potentially quite an important co-morbidity to some cases of autism. Coeliac disease has also been associated with iron deficiency whether through poor absorption of dietary iron or more controversially as a result of blood loss.

Question: could the low levels of iron present in some cases of autism be due to similar mechanisms?

I am not suggesting that every case of low iron in autism is due to coeliac disease; indeed nothing close. What I do however wonder is whether the proposed 3% of the autistic population with co-morbid coeliac disease might be populous in our low iron group? What about those with gut hyperpermeability also potentially affecting the amount of iron absorbed from diet?

If you want more information on testing for levels of iron, please have a look here on what testing involves and speak to your medical physician.

Because I can't resist it, here is a Marvel link that many of you may remember from days gone by.

[Update: 23 September 2014: Here is my take on the paper by Schmidt and colleagues looking at maternal iron supplementation during pregnancy and offspring autism risk]


  1. I don't want to offend or judge but I just finished reading a book called "Autism's False Prophets" by Paul A. Offit, MD. He clearly debunks many of the "theories" that you have listed above. The revival of some external "thing" has caused autism is very frustrating to read about and hear. I have a child on the spectrum, a brother, an uncle and two cousins - all from one side of the family. Generationally there is a gap between the oldest and the youngest by about 40 years. Treating children with autism with some of the treatments that are out there is not only horrifying but offers parents false hope of a "cure". I just don't know what it will take for people to understand that vaccines, iron, mercury, belly troubles are not autism. Autism is just autism and it has been around for a very long time. People are putting the health and well being of their children in jeapordy because of these theories. It is now the leading cause of preventable diseases - outbreaks of whooping cough, measles and reubella have occurred as a result of these myths. Children will grow up as they are meant to and it is up to us as their parents and advocates to keep them safe and healthy. Read the book - it is absolutely shocking but it is good and as close to "right" as I have ever seen.

  2. Thanks for the comment Connie, it is appreciated. You raise some very important points which have been echoed by many other parents and people with autism. This blog is a place to discuss autism research and I go to great lengths to ensure that discussions stay just as that - discussions. With regards to iron deficiency related to autism, it is not me saying this might be present in a percentage of people with autism but rather the research which I always reference in my posts. Same thing with coeliac disease. What these and some of the other 'co-morbidities' which have been associated with autism tell us is that autism does not confer any protection against other conditions, diseases, etc which the rest of the population are also susceptible to in varying degrees. Where a condition such as iron deficiency or coeliac disease or lactose intolerance is present alongside autism, it requires the same treatment as it would if it were not related to autism. This is a basic human right - not least because coeliac disease for example can have some pretty dire consequences if left untreated. As for the 'cure' word, aside from this reply and reference to epsom salts being used as a traditional 'cure-all' in Roman-times, I have never used the word and will continue not to. Respectful that there are varying presentations of autism and differing views of autism, my aim is to provide accurate and balanced information on research into interventions, co-morbidities, etc potentially related to autism. Nothing more and nothing less.

  3. Connie,

    All of the "debunking" in the world can't change reality. All three of my daughters were iron deficient at a young age and all three required iron supplements to bring their levels back to normal. This is in spite of the fact that all three should have had more than enough sources of iron in their diet.

    This deficiency wasn't found and treated by some quack or radical doctor but rather by their mainstream pediatrician.

    I don't know whether this specific deficiency had anything to do with my daughters' autism (I think there might be a relation) but treating a deficiency like this is not "horrifying".

    If you know that a specific group of children are at higher risk for a deficiency like this, I think it is completely justified in testing the child's iron level and treating any deficiency if it is present.

    Please keep in mind that autism is a vast spectrum and just because your family isn't effected in a specific way doesn't mean that others aren't - Paul Offit's ideas notwithstanding. My children have many documented nutritional and dietary problems in addition to their autism and I think we would be bad parents if we didn't try and treat them.

    If that helps improve the symptoms of their autism, that's great. If it doesn't then at least they are getting the nutrients that they need to grow up healthy.

  4. Severe anemia is a profound problem in other parts of the world. We are so ethnocentric, and have little idea of how the rest of the world suffers. You might find this interesting about the importance of iron in diet. A friend of ours is a medical missionary in central Africa.

    We haven't a clue.

  5. Thanks for the comment and link. Absolutely agree that we don't generally see how the 'other half' live and perhaps don't realise how lucky we are.

  6. Speaking as a mother of an autistic child here who has done a great deal of research: No, autism has not been around for "a long time". On the contrary, the John Hopkins study by Dr. Kanner in the 1930s and 1940s was the first clinical observation of autism. Although fellow doctors initially claimed that he was merely describing existing cases of psychiatric disorders, they relented when they realized that he was describing a very NOVEL, OBSERVABLE set of symptoms and traits. A review of historical case descriptions by psychiatrists and doctors rarely indicates a case that would presently be diagnosed as autism. It is a relatively modern disorder.


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