Comment on Magner et al. Sulforaphane Treatment in Children with Autism: A Prospective Randomized Double-Blind Study. Nutrients 2023, 15, 718.

I read your recent interesting double-blind study by Magner et al. [...].

Commentary: Suicide risk is high, but often overlooked, in autistic spectrum disorder populations.

Self-Harm Significantly Higher in Populations with ADHD, Anxiety, ASD, Depression, and Eating Disorders. I appreciated your recent paper on the large and well-matched studies on nonfatal self-harm and suicide among adolescents in the UK Clinical Practice Research Datalink (Cybulski et al. 2021). This large study involved 56,008 self-harm cases and 1,399,356 controls aged 10-19 years and reported that many diagnoses were associated with significantly higher rates of self-harm. Compared to controls, the risk of self-harm was significantly higher in attention-deficit/hyperactivity disorder (ADHD) (OR 3.3, 95% CI 3.1-3.4), anxiety disorder (OR 3.8, 95% CI 3.7-3.9), autism spectrum disorder (ASD) (OR 2.4, 95% CI 2.3-2.6), depression (OR 7.9, 95% CI 7.8-8.2), and eating disorders (OR 3.1, 95% CI 3.0-3.2) (Cybulski et al. 2021).

PM2.5, NO2, wildfires, and other environmental exposures are linked to higher Covid 19 incidence, severity, and death rates.

Numerous studies have linked outdoor levels of PM2.5, PM10, NO2, O3, SO2, and other air pollutants to significantly higher rates of Covid 19 morbidity and mortality, although the rate in which specific concentrations of pollutants increase Covid 19 morbidity and mortality varies widely by specific country and study. As little as a 1-µg/m3 increase in outdoor PM2.5 is estimated to increase rates of Covid 19 by as much as 0.22 to 8%. Two California studies have strongly linked heavy wildfire burning periods with significantly higher outdoor levels of PM2.5 and CO as well as significantly higher rates of Covid 19 cases and deaths. Active smoking has also been strongly linked significantly increased risk of Covid 19 severity and death. Other exposures possibly related to greater risk of Covid 19 morbidity and mortality include incense, pesticides, heavy metals, dust/sand, toxic waste sites, and volcanic emissions. The exact mechanisms in which air pollutants increase Covid 19 infections are not fully understood, but are probably related to pollutant-related oxidation and inflammation of the lungs and other tissues and to the pollutant-driven alternation of the angiotensin-converting enzyme 2 in respiratory and other cells.

Mold Exposure and Mitochondrial Antibodies.

CONTEXT: Some studies have reported that airborne levels of mold above 150-1000 spores per cubic meter are sufficient to cause a wide range of human health problems. In trying to understand the mechanism of injury to the mitochondria that trigger an autoimmune response, researchers have learned that pyruvate carboxylase is a major site of antigenicity for antimitochondrial antibodies (AMA). Antibodies to mitochondria are found in over 90% of patients with primary biliary cirrhosis and are occasionally found in patients with other autoimmune diseases. OBJECTIVES: This study intended to examine the prevalence of antimitochondrial antibodies (AMA) in a population of patients exposed to molds, mycotoxins, and other toxins. DESIGN: The research team described 6 case studies. SETTING: The study occurred at an environmental- and occupational-medicine health clinic. PARTICIPANTS: Six patients at the clinic were the participants. These 6 patients represented 6.9% of a cohort of 87 patients who received autoimmune testing during that period. OUTCOME MEASURES: Participants received blood tests for autoimmune, metabolic, hormonal, and nutritional parameters, including AMA. RESULTS: Six patients with a documented history of exposure to indoor mold, mycotoxin, and water damage had elevated levels of AMA. CONCLUSIONS: The fact that high levels of AMA in the 6 patients were all associated with mold and moisture exposure appears to be significant. Exposure to water- and mold-damaged indoor environments might damage mitochondria and trigger autoimmunity. Long term follow-up is needed to determine what may develop in these patients.

Severe Adverse Reactions Following Ketoconazole, Fluconazole, and Environmental Exposures: A Case Report.

In this case report, we describe a 66-year-old man who developed multiple adverse reactions beginning at age 56 after exposure to several azole antifungal drugs including ketoconazole and fluconazole. He also had a history of more than 40 years exposure to chemicals including pesticides, wood preservatives, fertilizers, and welding chemicals. His reactions involved dehydration (requiring several liters of intravenous fluids in less than an hour to alleviate this condition), angioedema, nausea, tinnitus, hypotension, and difficulty breathing. His acute adverse reactions were triggered by a wide range of chemicals including gasoline, diesel fuel, pesticides, chlorine, topical isopropyl alcohol, and paper mill emissions. His acute reactions were also triggered by a wide range of foods such as bananas, apples, milk, white potatoes, and processed sweets. A number of mechanisms could be responsible for his increased sensitivity to chemicals following exposure to fluconazole/ketoconazole, including inhibition of P450 and other detoxification enzymes, acetaldehyde buildup, and neurogenic sensitization.

Neural autoantibodies in patients with neurological symptoms and histories of chemical/mold exposures.

A number of studies have linked exposures to industrial and household chemicals and biological toxins to increased risk of autoimmunity in general and elevated levels of autoantibodies to neural antigens specifically. Elevated neural autoantibodies are biomarkers for many diseases such as multiple sclerosis and Parkinson's disease. Our study reports levels of six types of neural autoantibodies in a group of 24 toxicant-exposed patients. The patients were exposed to a variety of toxicants including contaminated drinking water (four patients), building water/mold damage (eight patients), pesticides (four patients), and other assorted toxic chemicals (eight patients). Levels of all six neural autoantibodies were significantly elevated in most patients and in the patient group at large, with mean antibody levels for the 24 chemically exposed patients (relative to a healthy control population), in descending order: 475% for tau proteins, 391% for microtubule associated proteins-2, 334% for neurofilament proteins (NFP), 302% for myelin basic protein, 299% for glial fibrillary acidic proteins, and 225% for tubulin. Tau protein autoantibodies were significantly elevated in the patient groups with peripheral neuropathy, muscle and joint pain, asthma, and chemical sensitivity. Autoantibodies to tubulin were significantly higher in the chemical sensitivity and asthma patients, autoantibodies to NFP were significantly higher in the patients with sleep apnea, whereas S-100B autoantibodies were significantly increased in patients with muscle/joint pain, asthma, and apnea/insomnia. In patients exposed to environmental toxicants, measurements of autoantibodies may be useful for prevention, diagnosis, and treatment. This study adds to the scientific literature the ability of a broad spectrum of environmental triggers adversely affecting the nervous system through the process of autoimmunity, which may explain the increasing incidence of neurodegenerative diseases.

In Defense of Progesterone: A Review of the Literature.

Context • The medical literature on the use of progesterone in postmenopausal women is often confusing and contradictory. Some physicians implicate natural progesterone in an increase in the risk of breast cancer. The chemical structure of natural progesterone (P4) is quite different from chemically altered, synthetic chemicals called progestins, which results in different actions at the cell level. Objective • The research team intended to review the literature to examine the benefits and safety of natural progesterone and determine whether it can cause an increase or decrease in breast cancer risk. Design • A review of the medical literature to examine the benefits and safety of natural progesterone as compared with synthetic progestins. Intervention • Studies examined compared controls not receiving hormone therapy with women receiving estrogen alone and in combination with natural progesterone and with various synthetic progestins, such as medroxyprogesterone acetate-the most commonly used synthetic progestin. Outcome Measures • Outcome measures included factors such as progression and survival of breast and other cancers and other epidemiological and laboratory data. Results • A meta-analysis of 3 studies involving 86 881 postmenopausal women reported that the use of natural progesterone was associated with a significantly lower risk of breast cancer compared with synthetic progestins. Anovulation and low levels of serum progesterone have been associated with a significantly higher risk of breast cancer in premenopausal women. Use of progesterone has been linked to lower rates of uterine and colon cancers and may also be useful in treating other cancers such as ovarian, melanoma, mesothelioma, and prostate. Progesterone may also be helpful in preventing cardiovascular disease and preventing and treating neurodegenerative conditions such a stroke and traumatic brain injury. Conclusions • Physicians should have no hesitation prescribing natural progesterone. The evidence is clear that progesterone does not cause breast cancer. Indeed, progesterone is protective and preventative of breast cancer.

HSV2 reactivation and myelitis following influenza vaccination.

We report the case of a 57 year-old woman who developed transverse myelitis and acute HSV-2 reactivation following influenza vaccination. Over the next 5 years, she experienced a fluctuating course of improvement and regression for both myelitis and herpes.