Camel milk and autism: two humps or three?

In a previous post with the cringe-worthy title: 'Camel milk for autism: one hump or two?' (you can see why I could never be a comedian) I talked about some rather intriguing research [1] asking whether, under double-blind, placebo-controlled conditions, camel milk could affect various clinical measures of severity when it comes to the label of autism, some autism. The answer was very possibly, yes; with the strong requirement for quite a bit more follow-up research in this area.

Lo and behold, yet more data has emerged from the research pen of one Laila Al-Ayadhi and colleagues [2] (open-access available here) on the topic of camel milk and autism and specifically the idea that: "camel milk could be [a] very promising therapeutic intervention in ASD [autism spectrum disorder]." Again, under double-blind, placebo-controlled conditions, Al-Ayadhi et al describe how 2 weeks of camel milk (raw or boiled) seemed to show some 'significant differences' on schedules such as the CARS (Childhood Autism Rating Scale), SRS (Social Responsiveness Scale) and the ATEC (Autism Treatment Evaluation Checklist). The placebo (cow milk) group by contrast, didn't show anything at all in terms of significant changes between baseline and post-intervention testing occasions.  The ATEC in particular, is something I'm quite keen to see more autism investigations using (see here).

I have some time for Dr/Prof. Al-Ayadhi and colleagues given some previous musings on their wide and varied research with autism in mind (see here). This recent work continues one of their important themes based on the idea that not all mammalian milk forms are alike (see here) and hence, following a tradition potentially implicating milk and dairy products in some autism (see here), a switch to other varieties of milk outside of those normally populating our diet might be beneficial for at least some. Other more 'N=1' reports [3] have offered similar discussions on this topic.

As per my previous musings on this topic, I can't readily offer a substantial and/or universal reason for what it is about camel milk that may be important to some people on the autism spectrum. Lactose content, milk protein structure or nutritional content are perhaps some of the most pertinent variables to consider given that all have some research 'history' when it comes to at least some autism (see here for some discussion on the seemingly forgotten work by Tim Buie et al on lactose issues and autism for example). In other peer-reviewed publications, Dr/Prof. Al-Ayadhi has talked about the antioxidant properties of camel milk as being key [4]. I'm hoping that in future times I might be able to discuss further this area of investigation as and when some research ideas in my own day job reach fruition.

And just in case you think I'm advocating camel milk for all autism, no I'm not. As we've seen from other research outside of autism recently, personalised nutrition is the way forward [5] not sweeping generalisations...

Music to close and a song that's growing on me (I think I need some earworm therapy).
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[1] Al-Ayadhi LY. et al. Behavioral Benefits of Camel Milk in Subjects with Autism Spectrum Disorder. J Coll Physicians Surg Pak. 2015 Nov;25(11):819-823.

[2] Bashir S. & Al-Ayadhi LY. Effect of camel milk on thymus and activation-regulated chemokine in autistic children: double-blind study. Pediatr Res. 2014 Apr;75(4):559-63.

[3] Adams CM. Patient report: autism spectrum disorder treated with camel milk. Glob Adv Health Med. 2013 Nov;2(6):78-80.

[4] Al-Ayadhi LY. & Elamin NE. Camel Milk as a Potential Therapy as an Antioxidant in Autism Spectrum Disorder (ASD). Evid Based Complement Alternat Med. 2013;2013:602834.

[5] Zeevi D. et al. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015 Nov 19;163(5):1079-1094.

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Al-Ayadhi LY, Halepoto DM, Al-Dress AM, Mitwali Y, & Zainah R (2015). Behavioral Benefits of Camel Milk in Subjects with Autism Spectrum Disorder. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 25 (11), 819-823 PMID: 26577969

Camel milk for autism: one hump or two?

I am so sorry dear readers for the dreadful pun used in the title of this post. It comes from years of reading books about 'knock-knock' jokes and the ever versatile 'the boy stood on the burning deck' ditties. More so in recent times with the advent of one of my brood starting to use the old 'Dr Who' version of the knock-knock joke. Having said all that I'm sure some people might think I am joking when it comes to talking about camel milk as a potential intervention for autism (some autism).

Send in the camel corp @ Wikipedia 

But I assure you readers that I am quite serious...

The primary fodder for this post comes in the shape of the trial results reported by Bashir and Al-Ayadhi [1] and their assertion that "camel milk administered for 2 weeks significantly improved clinical measurements of autism severity". The results are based on a small sample of children diagnosed with an autism spectrum condition and who were randomly assigned to one of three conditions: (a) boiled camel milk (CM), (b) raw camel milk and (c) normal cows milk (acting as a placebo). Alongside plotting responses to group assignment based on the CARS, the authors also reported on serum levels of Thymus and Activation-Regulated Chemokine (TARC) otherwise known as CCL17.

The results: well bearing in mind this was a small study looking at intervention over the course of only 2 weeks "significant improvements were observed in CARS score (p=0.04) in raw CM group only". That and levels of TARC also being reported to have dropped significantly in both the CM groups but not the placebo group.

I would echo the sentiments of the authors in their desire to see further more methodologically strong trials on whether CM might indeed have some potentially important effects for at least some people on the autism spectrum. One might argue that use of cows milk as a placebo may be problematic or indeed that the study may have benefited from a milk exclusion or non-mammalian milk source group as part of the trial. But it didn't.

This is also not the first time that the words 'camel milk and autism' have appeared together in a research sense as per the study by Al-Ayadhi & Elamin [2] (open-access here) looking at what happened to antioxidant biomarkers as a function of adopting camel milk including that very important compound, glutathione (see here). That and some research write-up of a case study of camel milk use in one child with autism [3] (open-access here). Don't underestimate the value of the N=1 when it comes to autism... 'if you've met one person with autism' and all that.

As for the hows and whys of camel milk potentially affecting the presentation of autism, well, outside of the possible immunological effects as per other research from some of the same authors [4] I'm inclined to suggest a few areas which might be important:

• Lactose, the sugar in milk, has previously appeared on the autism research radar as per the Kushak findings a few years back (see here). Although I'm no expert on the chemical composition of camel milk, there is some evidence to suggest that some of those with a lactose intolerance might be able to better 'tolerate' camel milk [5]. One might envisage similar things where lactose intolerance / lactase deficiency is present in cases of autism too.
• Milk protein structure is another area of possible inquiry. Harking back to some elements of the opioid-excess hypothesis of autism [6] the suggestion is that not all milk protein derived from various mammals is the same. Indeed, even within the same species, milk protein composition might not necessarily be the same [7]. So, would the subtle changes in milk protein (and subsequent peptide formation) be different in camel milk vs. cows milk?
• Interestingly, camel milk is nutritionally different from other forms of milk [8]. When we're talking about higher levels of things like iron or zinc being present in comparison to more typical bovine milk samples, there's always the possibility that this might also have an effect. Having said that iron and calcium for example, aren't necessarily good bed-fellows...
• The very interesting paper by Yang and colleagues [9] describing the proteomic analysis of various types of milk, placed camel milk in its very own category when it came to the expression of proteins distinct from every other animal milk investigated (cow, goat, buffalo, yak). I might be making mountains out of molehills here but this could be potentially important. I could spend all night listing the correlations being made from GABA to phospholipids. Take yer pick... Oh, and on the topic of GABA, I'll also direct you some other recent preliminary research from some of the authors of the camel milk trial (see here).

Science is science, and whether or not you believe that camel milk or any other alternative to regular cow milk might be able to exert an effect on at least some cases of autism, this is nevertheless a potentially interesting area of autism research. Complimentary perhaps to some of the other dietary intervention research that has been done (see here) but with the added bonus that, if found to be effective in larger scientific trials, exclusion of milk may not be as daunting a prospect as it is currently for many people with autism.

So the question remains, one hump or two?

And since we're on the topic of camels and the very soft connection with Egypt, I leave you with a song about walking [like an .....] by the Bangles.

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[1] Bashir S. & Al-Ayadhi L. Effect of camel milk on Thymus and Activation-Regulated Chemokine (TARC) in autistic children: double blind study. Pediatr Res. 2013 Dec 27. doi: 10.1038/pr.2013.248.

[2] Al-Ayadhi LY & Elamin NE. Camel Milk as a Potential Therapy as an Antioxidant in Autism Spectrum Disorder (ASD). Evid Based Complement Alternat Med. 2013;2013:602834.

[3] Adams CM. Patient report: autism spectrum disorder treated with camel milk. Glob Adv Health Med. 2013 Nov;2(6):78-80.

[4] Al-Ayadhi LY. & Mostafa GA. Elevated serum levels of macrophage-derived chemokine and thymus and activation-regulated chemokine in autistic children. J Neuroinflammation. 2013; 10: 72.

[5] Cardoso RR. et al. Consumption of camel's milk by patients intolerant to lactose. A preliminary study. Rev Alerg Mex. 2010 Jan-Feb;57(1):26-32.

[6] Shattock P. & Whiteley P. Biochemical aspects in autism spectrum disorders: updating the opioid-excess theory and presenting new opportunities for biomedical intervention. Expert Opin Ther Targets. 2002 Apr;6(2):175-83.

[7] Kamiński S. et al. Polymorphism of bovine beta-casein and its potential effect on human health. J Appl Genet. 2007;48(3):189-98.

[8] Sawaya WN. et al. Chemical Composition and Nutritional Quality of Camel Milk. J Food Sci. 1984; 49: 744-747.

[9] Yang Y. et al. Proteomic Analysis of Cow, Yak, Buffalo, Goat and Camel Milk Whey Proteins: Quantitative Differential Expression Patterns. J Proteome Res. 2013 Mar 25.

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Bashir S, & Al-Ayadhi L (2013). Effect of camel milk on Thymus and Activation-Regulated Chemokine (TARC) in autistic children: double blind study. Pediatric research PMID: 24375082