Thursday, November 12, 2009
No link between vaccines and autism

By Dr. Anthony Policastro

Two weeks ago Daniel Richardson wrote an editorial on autism. The editorial discussed the fact that immunizations and autism were not linked. Last week Mr. Eger responded in a letter to the editor. His letter stated that we needed to work hard to find the cause of autism because of its high frequency. Both writers were right on target. There has been an increase in autism over the years. It has gone from about 1 in 1,500 births to 1 in 150 births. The most recent study put it at about 1 in 91 births. There are several reasons for this. One is related to the fact that the medical and educational professions are getting better at diagnosing the condition. In the past, we only identified severe cases of autism. Now we know that there are many milder cases that were missed in the past. In addition, there is less reluctance to label a child with the diagnosis of autism. In the past, physicians wanted to be sure before they gave that diagnosis. Now we need to make sure that affected children receive proper services. For that reason, we must identify those children so physicians are more willing to call a child autistic than they were in the past. Unfortunately, the increased ability to make the diagnosis accounts for a relatively small increase in the frequency. What we do know is that there is no scientific evidence to support immunizations as the cause of autism. That whole line of reasoning was created by Dr. Wakefield in England. The story goes something like this. Dr. Wakefield did research on the cause of autism. The research was funded by a lawyer who represented the families of autistic children. Dr. Wakefield applied for a patent for a new form of MMR (measles-mumps-rubella) vaccine. Once that was done, he published a paper showing that MMR vaccine caused autism. The plan was for Dr. Wakefield to have everyone switch to his vaccine. Then the lawyer who funded the study could sue the MMR vaccine manufacturer. Fortunately, Dr. Wakefield was found out. His research was deemed bogus and he lost his license in England. Then he came to the U.S. to promote his immunization theory. There is still no evidence to support that theory and there is a lot of evidence to the contrary. One of the known causes of autism is chromosomal disorders. At one time our genetic tests were not very specific. Chromosomal disorders accounted for only 1% of cases of autism. The tests improved and the percentage went up to 3%. Now we have an even more improved test. It is called aCGH (array comparative genomic hybridization). With that test, we now know that 10-20% of cases of autism are due to chromosomal disorders. It is likely that number will go up as our tests become more sophisticated. However, that is not the only cause. There appears to be a sub group of autistic children who have gastrointestinal problems related to their symptoms. What is not clear is whether the same thing that causes the intestinal problems also causes the autism or whether the intestinal problems themselves cause the autism. There will be more to come on that front. In addition, there is likely some environmental hazard that creates a biochemical cause of autism. Pesticides are one possibility that have been discussed. However, we are not yet sure. Mr. Eger is correct in making the point that we need to address the causes aggressively. That is indeed happening. I recently attended the annual meeting of the American Academy of Pediatrics. The research into autism is going hot and heavy. Autism is indeed increasing in frequency. As a developmental pediatrician, I see many autistic children in my practice. We continue to aggressively seek the causes which will likely prove to be multiple rather than just a single one.

Follow these tips to get enough 'sunshine' vitamin in your diet
By Mary Trotter, MS, RD

Recent studies have brought to our attention that millions of adults and children in the United States have extremely low levels of vitamin D. Why is this a concern? Known as the "sunshine" vitamin, vitamin D is produced when ultraviolet light reacts with the skin. Vitamin D maintains the body's normal blood levels of calcium and phosphorus and helps deposit these minerals in bones and teeth. It helps regulate cell growth and plays a role in immunity. Adults who are deficient in vitamin D may experience bone loss (osteoporosis) or a softening of the bones (osteomalacia). Children who are deficient in vitamin D may develop rickets or defective bone growth, which was an epidemic among children during the 18th century. This led to the fortifying of milk, formula, cereals, and other foods with vitamin D in the 1920s and helped to virtually eliminate rickets in the U.S. However, cases of rickets now appear to be on the rise across the country. Other risks associated with inadequate levels of vitamin D include heart disease, hypertension, autoimmune diseases like multiple sclerosis, type 1 and 2 diabetes, and osteoporosis. Vitamin D may also protect against seasonal affective disorder and other mood disorders. While the sun, our primary source of energy for producing vitamin D, continues to shine every day, how is it that some children have become so dangerously low in vitamin D? Researchers believe there is a combination of factors at work. Kids are spending more time indoors watching TV and playing video games. When they do go outside, they are covered head to toe in sunscreen which blocks the UV-B rays that stimulate the body's production of vitamin D. In addition, kids are drinking more soda so much more that it is replacing milk and other foods fortified with vitamin D. Bottom line once again, too much TV and soda and too little time outdoors is putting our kids at risk for a myriad of health issues. New pediatric guidelines recommend infants and children get a daily dose of 400 international units (IU) of vitamin D. A mere 10 minutes a day, without sunscreen, is the best way for everyone over the age of 6 months to get our daily intake of this "sunshine" vitamin. So, bring the kids along when you take the dog for a walk around the neighborhood, have them ride their bikes before dinner's ready, or sit outside while you read them a short book. But during the winter months in the Northeast, when the angling of the sun inhibits UV-B rays from penetrating the atmosphere and you are bundled up in warm, bulky clothing other options are available. Fish & fish oils - Grandma was right. Good old cod liver oil is an excellent source of vitamin D! Fatty fish, such as salmon and mackerel, naturally supply vitamin D. Another reason to enjoy two servings a week! Egg yolks - One whole egg a day is recommended for both adults and children. Fortified foods - As a public health strategy, most milk is fortified with vitamin D.

Also look for vitamin D fortified yogurt, cheese, soy drinks, cereals, breads and even juices. But don't assume all dairy is fortified with vitamin D, be sure and read the nutrition label. Supplements - A supplement with vitamin D is required for exclusively breastfed babies because breast milk itself is not a good source of the vitamin, not to mention Mom could very likely be deficient as well. In addition, the Dietary Guidelines for Americans advised that older adults, people with dark skin, and anyone who is exposed to insufficient sunlight consume extra vitamin D from fortified foods and/or supplements. But before taking a supplement, consult with your doctor or your child's pediatrician. Overall, our best, natural source for vitamin D is the sun, followed by a healthy diet that includes vitamin D fortified foods. So, rake those leaves, ride those bikes, and take those walks - then come inside for a cold glass of milk!

About the author Mary Trotter is a Program and Policy Analyst for Nemours Health & Prevention Services. A registered dietician with a Masters Degree in Human Nutrition, Mary provides technical assistance, training, and staff support to community agencies, organizations, and coalitions implementing new health promotion strategies.

Monthly support group Compassionate Care Hospice, The Wellness Community-DE and Nanticoke Memorial Hospital will collaborate to present a monthly bereavement group, The Next Step. The group focuses on issues of loss that continue beyond the early stages of grief. Mary Van House, bereavement coordinator, will facilitate the group at 10 a.m. on the third Tuesday of each month, at the Nanticoke Cancer Care Center, second floor conference room. To register, call Lisa at 629-6611, ext. 2378.

HIV/AIDS fundraiser The Delaware HIV Consortium and Ministry of Caring present their sixth annual 'Easy As Pie' fundraiser. For each $20 donation, you will receive a Thanksgiving pie of your choice from local bakers. All proceeds help the Delaware HIV Consortium and House of Joseph II, a program of the Ministry of Caring, provide housing and supportive services to Delawareans living with HIV/AIDS. Pies can be ordered by calling the Delaware HIV Consortium at 302-654-5471 or visiting Orders must be received by Friday, Nov. 20 at noon. Printed order forms are also available to be mailed or faxed to the Delaware HIV Consortium. Linvilla Orchards, located in Media, Pa., will provide this year's selection of Dutch Apple Crumb, Pumpkin, Pecan, No Sugar Added Apple pies, as well as a two pound, eight inch New York Style Cheesecake. Just Desserts by Jekeitta in Wilmington, will bake its famous sweet potato pie. In Sussex County, pies will be available for pick up on Tuesday, Nov. 24, at Kent/Sussex Counseling Services, 20728 DuPont Blvd., Georgetown and CAMP Rehoboth, 37 Baltimore Ave., Rehoboth Beach. Visit for specific pie pick-up hours.

Woman dies from H1N1 Delaware's Division of Public Health (DPH) has learned of another H1N1-related death, this time an 80-year-old Sussex County woman. She passed away Saturday, Oct. 24, in a Delaware hospital. Because she doesn't fit the typical age profile, additional H1N1 investigation was conducted to confirm her status. While people 65 years and older are much less likely to become ill with novel H1N1 flu, when people in this age group get the infection, especially those who are immunocompromised, their risk of poorer outcomes is increased. This is not surprising given that people 65 and older are generally considered at higher risk of serious flu-related complications, including those requiring hospitalization, from seasonal flu illness. Certain groups of people are at higher risk of complications from the H1N1 flu, including people with chronic underlying health conditions such as asthma, diabetes, heart disease, obesity, and those who are immunosuppressed. For most healthy people this has been a mild infection. Grief holiday workshop Delaware Hospice invites everyone who is grieving the loss of a loved one to "The Ups and Downs of the Holiday" workshop on Thursday, Nov. 19, from 4 to 5:30 p.m., at Nanticoke Memorial Hospital, Seaford. Paul Ganster, LCSW, grief counselor, will lead the workshop and discuss topics such as: why the holidays are stressful and difficult for those grieving; problem solving to reduce stress; suggestions on coping with the holidays; and rituals to honor your loved one. Each participant will receive a 64-page booklet, "How Will I Get through the Holidays?" by James E. Miller. Light refreshments will be provided. The workshop is free and open to the public, but registration is required as space is limited. To register, call Paul Ganster, 357-7147, or email

Fitness activities at Delaware Tech Have fun and stay active this fall by participating in fitness activities at Delaware Technical & Community College, Owens Campus. Horseback riding is offered for beginners at Singletree Stables in Seaford; participants will learn the basics of safety, stable management and equestrian skills beginning Saturday, Nov. 14, for ages 8 to 14 and Wednesday, Nov. 18, for ages 15 and up. For more information, contact Delaware Tech's Corporate & Community Programs at 854-6966.

Hospice offers Grief Support group Delaware Hospice is offering an eight-week group meeting for adults who have experienced the death of a loved one. The group will meet Wednesday afternoons from 5 to 6:30 p.m., until Dec. 2, at Nanticoke Memorial Hospital, 801 Middleford Road, Seaford. Find out what normal grief "looks" like; learn about the "tasks of mourning;" identify your coping style and develop coping skills that feel right for you; share as much or as little as you would like. This activity is provided free to the public by Delaware Hospice; however, registration is required. To register, call Paul Ganster at 302-357-7147.

Depression Support Group There is a free bimonthly Depression Support Group meeting in Laurel on the second and fourth Wednesday evenings from 7 to 8:30 p.m. Any person who has signs and symptoms of depression and is under the care of a professional counselor/MD is welcome to attend. To register, call Life Matters Counseling and Consulting at 302-465-6612.