Studying Low Cholesterol in Autism

A new clinical trial was announced was announced earlier this month that is looking at the relationship between low cholesterol levels and autism.  According to the press release -

Researchers at The Ohio State University Medical Center are studying whether simple nutritional intervention – adding cholesterol to the diets of children with autism spectrum disorders after a test to see if they need it – can improve core autism symptoms.

In excess, cholesterol can be harmful, but a certain amount is crucial for the proper development and maintenance of the brain. So it stands to reason that lower levels of cholesterol, particularly during crucial periods of growth, can lead to mental dysfunction, said principal investigator Dr. L. Eugene Arnold, a child psychiatrist at Ohio State’s Nisonger Center who specializes in researching and treating autism.

(read the rest at the link above)

Full details on the trial are available from the U.S. National Institute of Health's clinic trial website, but the general idea is as follows.

1. Find out how many children with autism have extremely low total cholesterol.  Low cholesterol in this context will probably mean less than 120.
2. See if there are unique characteristics of these individuals that set them apart from with other children with autism who have normal cholesterol.
3. Test whether giving dietary cholesterol supplements will improve "behavioral and other characteristics" in these individuals.

The main part of the study is going to be a 12 week randomized and placebo controlled trial of 60 children immediately followed by a 12 week open-label trial in the same children.

This seems to be a well designed study but I do have one concern - what will be considered an "improvement"?  Is successfully raising the child's cholesterol level back into a normal range going to be considered an improvement or do there have to be clinical significant behavioral improvements to go along with it?  The details provided on the NIH's site don't make that clear.

This may seem like a small point but it really isn't - dietary supplements aren't the same things as drugs.  They don't tend to have large, immediate effects nor do they work as quickly as drugs do.  The supplement may succeed in raising the cholesterol level in these children but will that translate into noticeable changes in behavior in such a short time period?

Remember, almost all of the tests that look at autism look solely at behaviors.  Behaviors are - even in autism - things that are learned. So even if you take out the underlying cause of the behaviors it will take time and effort to unlearn the behaviors.

But more than that, if cholesterol is important for normal development, it might be that the absence of cholesterol during certain periods that impairs normal development.  Simply giving cholesterol isn't going to repair or fix the things that didn't develop properly.  But maintaining a healthy level of cholesterol might prevent other things from going wrong in the future.

Regardless, it is good to see these sorts of trials being done.  I believe that there are many children with autism who will benefit from taking a more biological approach to treating autism.