- Study Reports Remarkable Response to Broccoli Extract
- Autism Advocacy Group Offers Cautious Optimism
- Father/Son Cozy Combo for Commercialization Pathway
I’m quite sure that most of you, like me, are very familiar with various ways to improve or preserve your well-being by doing such things as adopting a Mediterranean diet, eating less red meat and more chicken, fish and beans, drinking a glass of red wine, and so on. And like me, you might be somewhat skeptical of the actual benefits but, nevertheless, try to follow some of these recommendations—especially if you enjoy a nice merlot.
Having said that, I was tempted to ignore a very recent ABC News story with a headline that read “Broccoli Sprout Extract May Help Curb Autism Symptoms” were it not for two things: firstly, autism is a very common and challenging disorder, and secondly the story referred to a publication in the Proceedings of the National Academy of Sciences (PNAS), which is a very highly regarded scientific journal. So, let’s consider some facts about autism, and then delve into the publication.
Here are selected facts about autism taken from NIH.gov—my “go to” source of reliable information about all things health related.
What is Autism?
Autism is more accurately referred to as “autism spectrum disorder” (ASD) because it covers a wide range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. Classical ASD is the most severe form of ASD, while other conditions along the spectrum include a milder form known as Asperger syndrome, as well as childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD-NOS). Although ASD varies significantly in character and severity, it occurs in all ethnic and socioeconomic groups and affects every age group. Experts estimate that 1 out of 68 persons have an ASD. Interestingly, males are four times more likely to have an ASD than females.
What are Some Common Signs of Autism?
The hallmark feature of ASD is impaired social interaction. As early as infancy, a baby with ASD may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with ASD may appear to develop normally and then withdraw and become indifferent to social engagement.
Many children with an ASD engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. Children with an ASD don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.
Children with characteristics of an ASD may have co-occurring conditions, including Fragile X syndrome (which causes mental retardation), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. About 20 to 30 percent of children with an ASD develop epilepsy by the time they reach adulthood.
What Causes Autism?
Given the prevalence of autism, you may find it surprising that scientists aren’t certain about what causes ASD, although there’s agreement on the likelihood that both genetics and environment play a role—nature vs. nurture. Researchers have identified a number of genes associated with the disorder. Studies of people with ASD have found irregularities in several regions of the brain. Other studies suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that ASD could result from the disruption of normal brain development early in fetal development. Where the disruption is caused by defects in genes that control brain growth and regulate how brain cells communicate with each other, possibly due to the influence of environmental factors on gene function.
Do Symptoms of Autism Change Over Time?
Thankfully for many children, symptoms improve with treatment and with age; however, children whose language skills regress early in life—before the age of 3—appear to have a higher than normal risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with an ASD may become depressed or experience behavioral problems, and their treatment may need some modification as they transition to adulthood. It’s also encouraging to know that many people with an ASD are able to work successfully and live independently or within a supportive environment.
What Research is Being Done?
NIH is currently funding and coordinating 11 Autism Centers of Excellence (ACE). The ACEs are investigating early brain development and function, social interactions in infants, rare genetic variants and mutations, associations between autism-related genes and physical traits, possible environmental risk factors, potential new medications and biomarkers.
I’m “big on biomarkers” for all diseases, and was pleased to find a promising press release about Stemina Biomarker Discovery receiving a $2.3 million investment from the Nancy Lurie Marks Family Foundation to support its clinical study of biomarkers in the blood of children with ASD. Using blood samples, Stemina was able to distinguish patients with autism from typically developing children with 81% accuracy, which I think is amazingly good given the complexity of ASD. Moreover, Stemina CEO Elizabeth Donley was quoted as saying “What is exciting about the data we are generating … is that we are beginning to identify metabolic subtypes in comparing one child with ASD to another. This has the potential to revolutionize the way children are diagnosed and treated based on the individual’s metabolism.”
PNAS Publication on Autism and Broccoli
Now that we’ve covered the basics of autism, let’s see how broccoli may help ease ASD symptoms. Full details of this collaborative study are freely available here in a PNAS publication from this past September entitled “Sulforaphane treatment of autism spectrum disorder (ASD).” The investigators outline four premises that led them to test treatment of ADS with sulforaphane, which is an isothiocyanate derived from broccoli—as well as other cruciferous vegetables such as Brussels sprouts or cabbages—and has the remarkably simple molecular structure shown below.
Here’s a short synopsis provided by Dr. Cindy Haines on MedlinePlus, which is a part of NIH that has the stated objective of providing “trusted health information for you.”
Researchers included 44 young men with moderate to severe ASD in a small study involving the chemical sulforaphane. The participants, ages 13 to 17, were randomly assigned to take either a daily dose of sulforaphane extracted from broccoli sprouts or placebo. Investigators and caregivers were not told who was receiving the active substance. Behavior and social interaction were evaluated at the start of the study and then at 4, 10 and 18 weeks. Half of the teenagers underwent a final assessment about a month after treatment ended.
- At 18 weeks, 46% of the sulforaphane recipients showed significant improvement in social interaction,
- 54% in atypical behavior
- and 42% in verbal communication.
The researchers say improvements were so noticeable that by the end of the treatment period, both staff and family members correctly guessed treatment assignments. Still, they point out the chemical did not work for everyone.
About one third of those taking sulforaphane showed no improvement. They say a larger study including adults and children is needed to confirm any therapeutic benefits.
Comments on this Study by Autism Speaks®
To get independent, informed opinions about this study, I consulted Autism Speaks® and found the following blog comments posted by developmental pediatrician Paul Wang, Autism Speaks® senior vice president for medical research. BTW, I’ve underlined three of his comments that I thought were particularly important:
Today, a lot of parents are talking about adding broccoli sprouts to their kid’s salads and sandwiches. Can this help? Hurt?
The amount of sulforaphane that was administered in the study is many times higher than you can reasonably get through food. Even sulforaphane-rich foods like brussels sprouts, broccoli and broccoli sprouts don’t have enough of the chemical to get you close. So eating these vegetables can’t be expected to improve autism symptoms. Within reason though, eating sulforaphane-rich vegetables is safe and healthy.
What about taking sulforaphane supplements or giving them to a child with autism? Are they safe?
I would caution against starting sulforaphane supplements at this time. First and foremost, this was a very small trial – much too small to assure safety. There was actually a potentially worrisome side effect in the study: Two of the 29 boys and men taking sulforaphane had seizures during the study. Both had a history of seizures in the past, so this could have been a coincidence. However, none of those taking the placebo, or dummy treatment, had seizures during the study.
The study also showed a small increase in liver enzymes in study participants who received sulforaphane. None of these individuals showed any symptoms related to this side effect. However, it poses the possibility that sulforaphane may produce liver inflammation.
It’s important to remember that anything powerful enough to exert biological effects – even beneficial effects – also has the potential to produce unwanted side effects. Just because sulforaphane is found in vegetables doesn’t mean it’s safe. There are many chemicals found in nature that can be toxic. This is particularly true when these chemicals are concentrated into a supplement. Much more study is needed to understand sulforaphane’s actions in the body – for good or bad.
Also, though sulforaphane supplements have been on the market for some time, nutritional supplements don’t go through the kind of rigorous safety testing required for pharmaceutical medicines. So we don’t have good safety data on these products.
No doubt, some people will decide to take sulforaphane supplements based on this study’s findings, regardless of potential safety concerns. How can they select a reputable brand? What would be a safe and reasonable dose?
The brand of supplement used in the study was a patented, pharmaceutical-grade product not available for purchase over the counter. So there’s no way of using the study’s results to gauge the effectiveness or safe doses of the many related health-food products with lesser quality-control during manufacturing.
In the study, the researchers used doses ranging from 50 to 150 µmol daily, depending on the participant’s weight. Their weights ranged from around 120 to 220 pounds.
So if an individual or parent decides to try these supplements – despite safety concerns – I would urge them to work closely with a physician to monitor possible reactions. This monitoring needs to include, but not be limited to, seizures. For example, blood work should probably be done to monitor liver enzyme levels.
Cozy Combo for Commercialization Pathway
I noticed that the conflict of interest statement in this PNAS paper reveals that U.S. patent applications have been filed by three Johns Hopkins University inventors, who include Paul Talalay, one of the corresponding authors, who is also a member of the prestigious National Academy of Sciences. The statement adds that he has divested himself from all potential financial benefits. Furthermore, the sulforaphane is not a commercial product, and has been licensed by Johns Hopkins to Brassica Protection Products LLC, whose CEO, Anthony Talalay, is the son of Paul Talalay.
While inventor Paul Talalay’s apparent largess is laudatory, Hopkins University’s licensing to a company run by his son, Anthony, seems a bit too cozy—in my opinion. On the other hand, publically stating these facts seems to imply that all parties involved are comfortable with legalities.
Anyway, I became interested in learning more about this company, and dug around, so to speak on the internet. The following is some of the backstory on Brassica Protection Products that I gleaned from researching Paul Talalay’s publications and reading a 2013 interview of Anthony Talalay by Adam Stone with bizjournal.com.
The company was founded in 1996 based on Paul Talalay’s long-held belief that certain chemicals in plants might prove to be useful in preventing cancer by inducing enzymes that safely metabolize cancer-causing molecules. Originally the focus was on commercializing broccoli sprouts, which had 20-times more of sulforaphane than mature broccoli, but there were farm-to-market distribution problems, and—perhaps more problematically, I think—people didn’t want to change their eating habits.
After years of disagreement, the company’s board of directors finally convinced Anthony Talalay to abandon this approach and instead commercialize an extract of broccoli sprouts, which is prepared by methods you can read here. That was done three years ago, and business has doubled for each of the past three years.
The company was said to be trying to raise money from family and friends in order to expand operations and sales, which I think ought to be relatively easy now based on the very promising clinical data published in PNAS.
My parting comment is that April 2015 is National Autism Awareness Month, but don’t wait—become engaged now! The Autism Society website offers loads of information and ways to get involved plus advice for living with autism.
As usual, your comments are welcomed.