That is, what do we do while we wait for all the hundreds of studies that need to be done to see if the vitamin D theory is correct? The studies will take years. If we do nothing but just wait, we are continuing an unplanned naturalistic experiment on pregnant women, the brains of their unborn children, and upon autistic individuals. A risk/benefit analysis tells us the risk of doing nothing is potentially great while the risk of treating vitamin D deficiency is minimal, simply good medicine, and the better choice.

So until we know for sure, pregnant women, infants, children, everyone—especially autistic children—should receive sensible sun exposure daily: around noon or 1:00 p.m., expose as much skin as possible, 10–30 minutes duration, depending on how easily one sunburns. In the winter, use a suntan parlor once a week, with the same precautions—or better yet, purchase an ultraviolet vitamin D lamp for home use.

I Prefer to avoid sunlight, what should I do?

You and your child should have a vitamin D blood test, called a 25-hydroxyvitamin D . Then take enough vitamin D to achieve adequate (natural summertime) levels. Given what we do know, adequate 25(OH)D levels are now thought to be somewhere above 40 ng/mL (100 nmol/L) and probably closer 50 ng/mL (125 nmol/L). Ideal levels are unknown but they are probably close to levels that were present when the human genome evolved. Natural levels (levels found in humans who live or work in the sun) are around 50–80 ng/mL (125–175 nmol/L). These levels are obtained by only a small fraction of modern humans.

How much vitamin D should I take?

The Food and Nutrition Board set the current Upper Limit for medically-unsupervised intake by infants and babies (up to the age of 1 years-old) at 1,000 units/day. This means the government says it is safe to give infants and babies up to 1,000 units a day without getting a blood test. Of course, with correct sun exposure in the summer this is not necessary, but it will be in winter. Children over 1 years of age, according to the Food and Nutrition Board, may safely take 2,000 units/day—again, without requiring a blood test.

For adolescents, pregnant women, and other adults, the government’s Upper Limits are a problem. While a 2,000-unit Upper Limit is entirely appropriate for younger children, such limits in heavier adolescents, adults, and pregnant women limit effective treatment of vitamin D deficiency. However, these limits no more impair a physician’s ability to treat vitamin D deficiency with higher doses than comparable Upper Limits for calcium or magnesium impair their ability to treat calcium or magnesium deficiencies with higher doses, should those deficiencies be diagnosed.

In the absence of sun exposure and in winter, heavier children, adults, and pregnant women may require doses above 2,000 units daily (depending on pre-existing blood levels, body weight, degree of skin pigmentation, age, and latitude of residence) in order to obtain and maintain levels of 50–80 ng/mL. For example, Professor Heaney at Creighton University has estimated that about 3,000 units/day is required simply to assure that 97% of adult Americans obtain levels greater than 35 ng/mL. Healthy adult men utilize up to 5,000 units of vitamin D per day, if present in the body. Professors Bruce Hollis and Carol Wagner, in South Carolina, have been giving pregnant women 4,000 units/day for years. Professor Vieth, at the University of Toronto, found that actual vitamin D toxicity, with systemic symptoms, is exceedingly rare and requires much higher doses than those discussed above. When exceeding the Upper Limit, periodic serum 25(OH)D and calcium levels will reassure both physician and patient that such amounts are safe as well as convince all concerned that the government should revise their 10-year-old (yet most current) recommendations—the sooner the better.

Is Autism Iatrogenic

If the vitamin D theory of autism is correct, then to the extent it is correct, the current plague of autism is an iatrogenic disease, caused by modern sun-avoidance and the organizations that promulgated it. Long before we worshipped our current gods, primitive humans venerated an older god, the sun. Much as we have shunned our modern gods, 20 years ago we shunned the sun, hiding from it under buildings, cars, shade, and sunblock. We told the sun she was damaging us, and banished her from our lives—and from the lives of our pregnant women and our children. Tragically, we relied on medical knowledge instead of human traditions, government recommendations instead of common sense, the latest science instead of basic instincts. The ancient Greeks, who loved the sun, knew the gods seldom reward such hubris.

Since autism was first added to the psychiatric literature fifty years ago, there have been numerous studies and theories about its cause. Researchers still have not reached agreement regarding its specific causes. First, it must be recognized that autism is a set of a wide variety of symptoms and may have many causes. This concept is not unusual in medicine. For instance, the set of symptoms that we perceive of as a “cold” can be caused by literally hundreds of different viruses, bacteria, and even our own immune system. Autism is, undoubtedly, a biologically-based disorder. In the past, some researchers had suggested that autism was the result of poor attachment skills on the part of the mother. This belief has caused a great deal of unnecessary pain and guilt on the part of the parents of autistic children, when in fact, the inability of the individual with autism to interact appropriately is one of the key symptoms of this developmental disorder.

In support of a biological theory of autism, several known neurological disorders are associated with autistic features. Autism is one of the symptoms of these disorders. These conditions include tuberous sclerosis (an inherited disorder), the fragile X syndrome, cerebral dysgenesis (abnormal development of the brain), Rett syndrome, and some of the inborn errors of metabolism (biochemical defects). Autism, in short, seems to be the end result or “final common pathway” of numerous disorders that affect brain development. In general, however, when clinicians make the diagnosis of autism, they are excluding the known causes of autistic behaviors. However, as the knowledge of conditions that cause autism advances, fewer and fewer cases will be thought of as being “pure” autism and more individuals will be identified as having autism due to specific causes.

There is a strong association between autism and seizures. This association works in two ways: First, many patients (20% to 30%) with autism develop seizures. Second, patients with seizures, which are probably due to other causes, may develop autistic-like behaviors. One special and often misunderstood association between autism and seizures is the Landau-Kleffner Syndrome. This syndrome is also known as acquired epileptic aphasia. Some children with epilepsy develop a sudden loss of language skills–especially receptive language (the ability to understand). Many often also develop the symptoms of autism.

These children often, but not always, have a characteristic pattern of electrical brain activity seen on EEG (electroencephalogram) during deep sleep called electrographic status epilepticus during sleep (ESES). The usual age of onset of language loss or regression is around four years of age, which makes the Landau-Kleffner syndrome distinguishable from autism on these grounds, in that autism usually is first exhibited in younger children. However, in recent years, some children (very, very few) who did not exhibit overt (observable) seizures were found to have Landau-Kleffner syndrome.

The importance of these findings is that, although rare, the Landau-Kleffner syndrome can resolve spontaneously and in some cases can be treatable with prednisone, a steroid medication related to cortisone. This association between the Landau-Kleffner syndrome and autism has led many clinicians and families to search for the typical EEG pattern (ESES) in autistic individuals. This unusual EEG pattern is seen only in deep sleep, which usually requires prolonged recordings of up to 12 hours. Many, many autistic children and adults will display some abnormalities on their sleep EEG, but probably very few have true Landau-Kleffner syndrome that will respond to treatment.

It must also be noted that prednisone, in the very high doses used to treat Landau-Kleffner syndrome, almost invariably produces side effects, which may include weight gain, high blood pressure, diabetes, growth failure, stomach ulcers, irritability, destruction of the hip joint, and susceptibility to infectious disease (suppressed immune system). While most of these side effects are reversible, some of the complications of high dose prednisone therapy can be irreversible and even fatal.

Other treatments ranging from common anticonvulsant therapy to surgery have been proposed and are being tried for Landau-Kleffner syndrome. It is difficult to evaluate the true effects of any treatment for Landau-Kleffner syndrome due to the high rate of spontaneous resolution of symptoms (remission).