Autism rates continue to skyrocket at an alarming rate. In 2024, the CDC estimates that 1 in 36 children are diagnosed with Autism Spectrum Disorder (ASD). The argument that the increase in rates is due to changes in diagnostic criteria and the belief that ASD is strictly a genetic disorder is naive and inaccurate, in my opinion. We must question what is causing this. In my view, this is multifactorial, but one contributor to autism that is rarely investigated is underlying infections, including tick-borne diseases. Tick-borne diseases, such as Lyme Disease (Borrelia burgdorferi), Bartonella, Babesia, Ehrlichia, and Anaplasmosis, could be contributing to autism.
Lyme Disease rates also continue to increase. In 2024, the CDC estimated 476,000 annual cases of Lyme Disease. This is likely a gross underestimation since Lyme Disease is not often tested for. Additionally, this estimate does not include chronic or post-treatment Lyme Disease cases.
When I first started my career, I believed Autism and Lyme Disease were completely separate. However, after working in this field for nearly a decade, I have realized the staggering overlap between Autism and tick-borne diseases. In my ideal world, all children with neurodevelopmental disorders, including Autism, would be tested for tick-borne diseases.
My Approach to Autism:
When I see a child with Autism in practice, I conduct a thorough history and comprehensive physical exam, including a nutritional assessment. My clinical approach involves identifying which categories require further exploration based on the child's case:
- Gut
- Immune
- Metabolic
- Mitochondrial
What's intriguing is that children with Lyme Disease and other tick-borne illnesses can also show symptoms in these same four areas and require additional support.
Gut Support:
Between 5-23% of individuals with early Lyme borreliosis experience a range of gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, loss of appetite, hepatitis, and enlargement of the spleen and liver (Zaidi and Singer, 2002). It's conceivable that additional symptoms may arise with chronic Lyme disease, and the spirochetes could potentially penetrate deeper into the gastrointestinal tract.
Treatment for Lyme Disease and other tick-borne diseases typically involves antibiotics, which can often result in gut dysbiosis, including conditions like candida overgrowth or C. difficile infection. A study conducted in 2020 discovered that the gut microbiome of patients post-treatment for Lyme disease exhibited distinct differences from that of healthy individuals (Morrissette et al., 2020). Similarly, research conducted on children with Autism has revealed differences in microbial communities compared to their neurotypical peers (Rose et al., 2018).
Immune Support:
Children with Autism may not exhibit typical acute illness symptoms but instead may experience an exacerbation of their Autism symptoms when they fall ill. A notable example of this was highlighted in a study that demonstrated a correlation between pollen counts and autism symptoms. As pollen counts rose, so did the severity of autism symptoms, and conversely, when pollen counts decreased, symptom severity also decreased (Boris and Goldblatt, 2004).
Parents often tell me that aside from having Autism, their child is healthy because they rarely get sick. However, it's important to recognize that experiencing occasional illness is essential for children to develop resilient immune systems.
I encounter similar scenarios with children diagnosed with PANS/PANDAS, who experienced flare-ups following COVID-19 infections. Parents would report that their child had weathered COVID-19 well, either showing no symptoms or only mild ones. However, weeks later, their child might experience a flare-up. This pattern was particularly notable in children with underlying tick-borne infections (Zajac et al., 2022).
Metabolic Support:
Children with Autism often require metabolic support in various ways, with one of the most significant needs being assistance in their detoxification pathways. Genetic mutations and issues in their methylation cycle are common. One of the most prevalent genetic mutations, both in the general population and among individuals with autism, is MTHFR. Research has shown a significant association between the C677T MTHFR mutation and autism, which ultimately affects glutathione production (Rai, 2016).
Glutathione stands out as one of the body's most potent antioxidants. It plays a crucial role in shielding cells against oxidative stress caused by dietary and environmental free radicals, as well as those resulting from normal metabolic processes. Glutathione not only safeguards vulnerable DNA from damage but also plays a vital role in proper detoxification processes.
Lyme Disease disrupts glutathione metabolism in both children and adults, leading to a compromised ability to eradicate the infection (Kerstholt et al, 2018). Glutathione plays a crucial role in the immune system's ability to produce essential factors needed to fight the infection and reduce inflammation. Therefore, individuals with tick-borne diseases, particularly those with MTHFR mutations, need to support their detoxification pathways.
Mitochondrial Support:
The mitochondria serve as the powerhouse of the cell, generating energy in the form of ATP essential for proper cellular and bodily function. During times of illness, the mitochondria play a crucial role alongside the immune system's defense mechanisms. However, in cases of chronic illness and infections, the mitochondria can become fatigued, leading to symptoms such as fatigue, lethargy, attention and focus issues, memory impairments, and more. These symptoms arise from various factors including mitochondrial depletion, deficiencies in the electron transport chain, oxidative stress, and so forth.
Between 60-80% of children with Autism exhibit mitochondrial dysfunction. This dysfunction can manifest in various ways, including low muscle tone, delays in gross and fine motor skills, constipation, speech and communication challenges, seizures, and more. When a child with Autism also presents with mitochondrial dysfunction, it's essential to investigate underlying infections, including tick-borne diseases, as potential contributing factors that may be placing stress on their mitochondria.