Dr. Mark Hyman Misses the Mark on Autism

Skepti-Forum moderator PennyLane Hadley and Skepti-Forum blog contributor Robert Sacerich join forces to show how wrong Dr. Hyman is on Autism.  This article was originally published at Rationality Unleashed!

PennyLane also runs several other evidence based on-line forums: Healthy Skepticism,  Parents who Science, and the closed group Sex and Gender Lab.

Robert Sacerich is a science communicator and advocate. You can follow him on his Facebook page and his website Rationality Unleashed!

Are you interested in writing about a science related topic? Then check out our information on becoming a guest writer.

There’s a hospital that is nearly a village unto itself situated in the middle of a large city. Upon entering the monolithic entrance hall of the hospital, a great tree is projected upon the wall. Ahead, there is a line of shops, the first of which is called 360 Wellness, which is essentially a modern apothecary that sells all manner of magical remedies and ideologies. Within this hospital exists covens of nursing staff who practice energy healing and other such magicks. There are doctors who believe water has memory and drink the magic energy potions from the small snack shop to keep functioning. Within this hospital is a center based around mystical and spiritual ideologies called Functional Medicine, where the leader believes he can cure genetic dispositions with herbs and food.

Summer of Giles

No, this is not Sunnydale, CA, though it sure sounds like it. This is the Cleveland Clinic, and Mark Hyman – Autism Slayer is making claims most erroneous from the mystical domain of the Center for Functional Medicine.

In this piece, PennyLane Handley and I address Dr. Mark Hyman’s claims regarding autism and delve into the mind of someone who has a real problem with evidence-based medicine.

“Can Autism be cured?” Dr. Mark Hyman asks right in the title of one of his 2012 blog posts. Well, can it? That is quite the question. The fact that it cannot seems so obvious that you probably didn’t even allow yourself to consider the affirmative. But you should, because the majority of Dr. Mark Hyman’s readership no doubt has – amongst them parents of autistic children who are desperately looking for another option besides their child’s current tedious, often painful therapies with slow, minimal gains; from a man who is meant to be trustworthy, credible, even venerable. His credentials are stellar, his title impressive. Director, Center for Functional Medicine at the prestigious Cleveland Clinic. The inclusion of “Functional” might hold a touch of foreshadowing for those who are aware of the the current state of pseudoscience in which we find ourselves, but to most who visit his site it is just a word, nothing more.

So what does this impressive and credentialled man tell us about the possibility of curing autism? Wait for it. He tells us that he has cured a child a of autism – that’s right. With nothing more than diet, vitamins and “detoxification”, he was able to return the child to being “normal” (I will let you sit with his choice of words for a minute). The boy in question, Sam, was two and a half when he was presented to the Clinic. Hyman makes sure to let us know that he was healthy until his MMR vaccine. He claims the boy had multiple food allergies (hidden food allergies are a major unrecognized epidemic in the twenty-first century, according to Dr Hyman), he was deficient in many vitamins, unable to detoxify the high levels of heavy metals in his system, with a leaky, inflamed gut. He was, to hear Hyman tell it, a very sick and toxic little boy.

The treatment protocol that the doctor used in his “normalization” of the boy is as follows:

Step 1: Fix His Gut and Cool the Inflammation There

• Taking away gluten and other food allergens
• Getting rid of his yeast with antifungals
• Killing off the toxic bacteria in his small intestine with special antibiotics
• Replenishing healthy bacteria with probiotics
• Helping him digest his food with enzymes

Step 2: Replace the Missing Nutrients to Help His Genes Work Better

• Added back zinc, magnesium, folate, and vitamins A, B6, B12, and D
• Supported his brain with omega-3 fats

Step 3: Detoxify and Reduce Oxidative Stress

• Once his biochemistry and nutrition was tuned up, we helped him detoxify and reduce oxidative stress.

Hyman closes by reminding us of his steps – improve nutrition, reduce inflammation, heal the gut, detoxify. They are a streamlined version of his Seven Keys to Ultrawellness, a program that he hawks in his books as well. The plan sounds reasonable enough at first glance, but is it evidence-based?

The first step of the child’s protocol was to “fix his gut” and “cool his inflammation” through diet and a drug regimen. The diet in this case would primarily be one that is quite practiced in alternate treatment autism circles – the gluten-free and casein-free diet. Research has found weak, limited and poor evidence for this diet as a legitimate treatment to reduce symptoms of autism or ASD. It is currently recommended that it only be used as a last resort. The addition of anti-fungals to the regimen is ill advised as there is “no evidence to support any antifungal agent as an autism cure.” not to mention they are “potentially harmful”, with possible side effects that include itching, diarrhea, stomach pain, skin rashes and liver damage. When it comes to antibiotics as a treatment for autism, this is the entirety of the research along this vein: One study with 10 subjects, and one case study. Some promising early results, but a clear case of more research needed. Next we have probiotics. So far the evidence of their efficacy seems to be limited to mice models. Perhaps this will prove fruitful in the years to come but currently mice are not men. Lastly, enzymes were ineffective in clinical trials for improving behaviour, food variety, gastrointestinal symptoms, sleep quality, engagement with therapist, or the Language Development Survey Vocabulary or Sentence Complexity Scores. In short, enzymes, along with the rest of the assortment of supplements in Hyman’s “Step 1”, are not evidence-based treatments for autism as it stands today.

Vegan Magazine

Dr. Hyman’s second step is to “replace the missing nutrients” to help Sam’s “genes work better”. He proposes doing this through a series of, you guessed it, supplements. The first listed is zinc, which has actually been linked to autism – a deficit of it in infancy correlates with an increased likelihood of an autism diagnosis in toddler years. There is also the suggestion that supplementing this trace element in infancy might provide some symptom relief; although this has yet to be conclusively established and direction of causality has yet to be determined. As for magnesium and B6, two supplements that are usually administered together because one (B6) can result in a deficit of the other (magnesium); there is “weak” and “poor quality” research evidence to suggest some benefit for some people on the autism spectrum, however these studies are largely “inconclusive”. Both also have moderate to severe side effects – magnesium can result in diarrhea and cramping, while B6 can lead to “nerve damage to the arms and legs”. On folate, low levels of this vitamin during fetal development correlated to increased autism diagnoses. Meanwhile. lower folate levels in patients with ASD have been reported, but, as of yet, the benefits of folate-enhancing interventions have yet to be confirmed. Vitamin B12 has been shown to be ineffective in all but potentially a small subset of the autistic population, and, interestingly, a deficiency in this vitamin can actually mimic autism symptoms leading to incorrect autism diagnoses. Vitamin A has no research to support its effectiveness in treating autism whatsoever, and Omega 3 is likewise unsupported in terms of this goal. Vitamin D is somewhat evidence-based, in that higher serum concentrations of vitamin D  may reduce the established symptoms while a deficiency during fetal development may contribute to risk of autism.  There is speculation that Vitamin D might also reduce the risk or severity of ASD through several complex mechanisms. Of all the supplements listed this one seems to hold the most potential, although clearly more evidence is needed before this becomes a mainstream treatment option. Overall, the remaining supplements listed are weakly supported, if at all.

As to Hyman’s statements that the aforementioned combination of magic beans will somehow make the boy’s genes “work better”; he is (attempting to) speak to the field of nutrigenomics, which he defines as the study of how we are able to control how certain genes express themselves through changes in diet. He speaks about this as though it is already viable science, but a recent review of the field was far less enthusiastic. Science Based Medicine summed up its findings nicely: ”the relationship between nutrition and personal health is complex and we do not yet have the scientific knowledge to apply to practice. The article concludes that, while promising, the field is not yet ready for the marketplace.” Currently this field is more pseudoscience than science and therefore should not be used to treat any disease or disorder.

From Refutations to Anti-Vaccine Memes

The final aspect of Hyman’s “cure” is the detoxification portion. This is left incredibly vague within this article and the other, in which he regurgitates the tale verbatim; but he goes into detoxification within a Huffpo piece from 2011 on mercury that we will look into more in a moment. He makes the statement that “liver detoxification” is facilitated by “Epsom salt baths”,  “magnesium sulfate creams” and “glutathione”;  while mercury and other heavy metals are detoxified by a “DMSA provocation challenge” – otherwise known as chelation therapy. Chelation has been around alternative autism treatment circles for ages, but it has also gained traction in the mainstream. This is chilling when one considers that there is no support for the idea that chelation provides any benefit to those with on the autism spectrum and has risks which include vomiting, hypertension, cardiac arrhythmias, and hypocalcemia (low calcium), which can lead to fatal cardiac arrest. This scenario played out with a five year old American boy in 2005 and resulted in his senseless death. This tragedy has not kept other parents from lining up for this “therapy” – far from it, one must only look to the distressingly high percentage of autism spectrum persons who have tried it to confirm this fact, as research estimates that 7%- 8% of individuals with ASD have undergone the procedure. A panel tasked to determine its safety and efficacy strongly stated: “Forbes did a great article on this disturbing trend and their words are as apt as any:
“ The current estimated prevalence of autism is about 1% among children in the United States, which has about 76 million children in 2012. If 8% of them are being chelated, that means that there are about 61,000 children who have undergone a “treatment” for autism that is “unfounded and illogical,” in addition to being hazardous and potentially fatal. And one of them has died.”

It is important to note that while chelation is complete and utter woo for autism, ADHD, cancer and the like; for actual heavy metal poisoning it is a legitimate treatment that saves lives. This is the true meaning of the term “detox” insofar as medicine is concerned – chelation done in a hospital is legit. Chelation done by a naturopath is not science-based, it is pseudoscience pure and simple, including Hyman’s “liver detox” of  magnesium and epsoms salts mentioned previously. Scott Gavura writes for Science Based Medicine:

“There is no scientific evidence to show that detox treatments have any useful medical effects. The reality is that our bodies are constantly being exposed to a huge variety of natural and synthetic chemicals. The presence of any chemical in the body, (natural or synthetic) does not mean that it is doing harm…Importantly, the dose makes the poison – even water can be toxic (dilutional hyponatremia) when consumed in excessive amounts.”

Detox is magical thinking, we want to believe in the concept of purity and rebirth but the reality is that there is very little if we can do to “cleanse” ourselves, nor is this an actual legitimate need in most instances.

So let’s unpack this shall we? We have a diet which has been clinically shown to do nothing at all. We have a fistful of supplements, out of which maybe one (and a half?) are approaching evidence-based in regards to treating the symptoms of ASD. We have a “detoxification” aspect which is either smoke and mirrors, this would be the liver cleanse, or an unsupported, risky and potentially life threatening course of chelation. I can take the point that the sum can be more than the whole of its parts, but no matter how I try I cannot make this make this puzzle look like a “cure” to autism. Even if every part of the equation, when working in tangent, someone synergises into a cure for autism, this combination has never been put through the rigors of experimental challenge. It should not be part of an evidence-based protocol for any disorder until such a time that there is clear data to support both its safety and efficacy. As mentioned though, the lackluster performance of each individual part of this treatment in past research leads this writer to suspect that when tested, this method will not even approach either mark. Is there another explanation then, you ask, that would explain Dr. Hyman’s results without having to believe in magic? Why, yes dear reader, there are two. The obvious answer is that the child never had autism at all. False diagnoses exist – take the B12 deficiency mentioned earlier on. Easy enough to misdiagnose and would have been resolved under this regimen, so long as B12 was on the cocktail list of vitamins and minerals. This answer fulfills my need for catharsis, to be clear, but there is another possibility. Research shows that some children “lose” their autism diagnoses. One account has this phenomenon pegged at around 10% – if accurate, this figure is pretty startling. Either one of these scenarios explains “Sam” and his miraculous remission from autism in a much more credible, evidence-based way than Dr. Hyman has to date.

So what is Dr. Hyman’s point of view and why does it seem so dreadfully familiar? He is espousing the biomedical theory of autism; Jenny McCarthy and her infamous Generation Rescue are true believers as well. While autism is traditionally viewed within the medical community as a brain-based spectrum of neurodevelopmental cognitive disorders and delays with deficits in socialization and communication; those who adhere to the biomedical view of this disorder claim that it is a systemic body disorder that affects the brain and that a “toxic environment” comprised of infectious agents, vaccines, foods, pesticides, pollutants/heavy metals triggers certain genes in susceptible individuals. This is a threshold model; once the threshold is reached, the result is autism. Treatments target the various areas of the body, such as the microbiome and gut, that are, according to biomed proponents, involved in this process. Dr Hyman states, “Heal your body and you heal your brain.”

This disorder model and treatment regimen is certainly novel, but is it science-based? The answer is: maybe – slightly. The recent discovery of a connection between the immune system and brain via a previously unknown vessel allows for a mechanism by which immunological issues could directly impact cognitive functioning. Actual proof of the existence of said impact is years and countless studies away, however. Meanwhile, the question of the amount of influence the gut microbiome exerts on brain disorders, if any, is being asked by those who are tasked with studying the complex interactions. A conference was recently held to address the topic of involvement of the enteric gut in autism processes from which a framework for future clinical trials was developed. It proposed several different experiments that would modulate or manipulate the gut microbiome and spoke to the complexity of the subject matter and the difficulty this creates methodologically. The studies that were designed at this conference are laborious, time consuming and painstakingly detailed in an attempt to control as many confounding variables as possible – factors such as appropriateness of participants, behavioral and cognitive assessments, biomarkers, safety concerns, and ethical considerations all have to be taken into account. The required complexity of the experimental design coupled with the myriad of possible avenues for research under the vast umbrella encompassed by “microbiome” mean that any potential answers that this field might have for the question that is autism won’t be seen for years, if not decades, to come. At this point the role of the immunological system and gut microbiome offer tantalizing areas for future research, not the basis for the creation of treatment protocols for this or any other disorder.

Sadly, Dr. Hyman believes in more magic than just his ability to cure people of ASD. Further light is shed on some of the nuances of his bizarre belief system in an article he opined for the Huffington Post in 2011. Full of supposition and light on facts, research or evidence, it is an eye-opening peek into this man’s views on the the subjects of both autism and vaccines. And it is frightening when read with the knowledge of his position, and the sphere of influence that he has as a result. First off Hyman does not believe that the rising ASD diagnosis rate can be explained by the broadening of the criteria for inclusion, coupled with the fine tuning of measures that has allowed clinicians to more easily identify those who are in need of the diagnosis. Instead, he claims that it is due in large part to mercury poisoning and that thimerosal played a critical part in distributing this heavy metal to the masses. This is in spite of the fact that research has been able to assign close to two thirds of the increase on the implementation of the new autism criteria alone and thimerosal has been shown to have no link to autism here, and here and here and here and here, and in fact autism has been shown to have no link whatsoever to the MMR vaccine here, and here, and here. And here and here. And here and here. There are actually over 100 of these studies, so I could literally do this all day.

The overabundance of evidence clearing MMR from any causative culpability in regards to ASD falls on deaf ears in the biomedical community, however. They, and Mark Hyman, hold the position that Wakefield was right. That his work was not medical fraud, not horribly manipulated and agenda driven and that it never should have been retracted and he never should have had his license revoked. I am not sure how you bring these beliefs up in polite circles, any attempt I make to envision it immediately evokes Godwin’s Law. I honestly think that I would rather find out that my doctor had a record for stealing cars or selling drugs than to have him casually remark how horribly maligned “poor Andrew” has been while performing a pap smear. It would immediately make me flash to any time he had ever given me test results with sick dread. Not, ever, ok.
I think that most but the fringes of the anti-vaccination crowd at this point understand that vaccines do not cause autism. Because they don’t. While Dr. Hyman hasn’t done the necessary self talk to get to this place on his own, he does not cast the blame solely at the feet of vaccines either. He explains that there are a multitude of “toxins” that can result in a “broken brain” including dairy, gluten, GMOs, aspartame, and pesticide exposure (click the link for an explanation of why Hyman is wrong on each point). His quest to cast a villain for his tragedy is understandable- after all he has already firmly established that the hero of his tale is the good doctor himself; but in relegating ASD as the monster in the closet of millions of children, one that lurks intent on “breaking” their brains and making them no longer  “normal”, he does what so many before him have which is to throw every autistic under the bus to champion his cause. He does not own the patent on albeism but by painting a clear dichotomy between desirable “normals” and undesirable autistic persons he reaffirms society’s inherent bias against those who are disabled. Having a child with autism is not the worst thing that can happen to a family. Autism isn’t a death, and it isn’t a tragedy.

As someone who holds both authority and influence, Dr. Hyman should use his position to champion for autism awareness, instead of feeding fear about the disorder by spreading misinformation, pseudoscience and magical thinking. By questioning consensus on the science of autism he makes it seem more reasonable to disregard safe, effective treatment protocols in favour of untested, unproven and often dangerous alternative treatments- and children have already died as a result. As David Gorski of Science Based Medicine states, “Autistic children deserve no less than the best scientific medicine that can be brought to bear on helping them to develop and alleviating their symptoms. They most certainly don’t deserve the unethical and uncontrolled experimentation to which far too many of them are being subjected.” It is every doctor’s duty to support their patients in receiving the safest, most effective evidence-based therapies availables, not to use them to test theories while stepping past them to prestige, riches and book deals . The worst thing about Mark Hyman is the palpable juxtaposition between the good he could do for the ASD community and the harm he chooses to cause instead.

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References

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