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What is Comorbidity?

“Comorbidity” is a word you will often see if you spend any time researching autism – especially the medical and scientific literature. Comorbidity means you have one or more additional conditions occurring at the same time as a primary condition. For example, sore throat and a runny nose are often comorbid. They tend to rear their heads at the same time – you start with one then get the other -although they may be caused by completely different things. Autism, however, isn’t as nearly as simple. Like the autistic mind itself, several comorbid factors can co-occur via connections that may come and go unpredictably, or remain for life.

Why Do Autistic People Typically Have Comorbid Conditions?

Based upon my own research and reflection, I’d say that comorbid factors associated with autism are typically linked to our well-known environmental sensitivities.  So, any part of our bodies that is exposed to the environment around us is susceptible. Eyes, skin and lungs are three obvious contenders. But let us not forget that the digestive system is basically an open tube travelling from the mouth to the anus. In a manner of speaking, the environment around us also travels straight through our core – pausing at four sphincters, of course.  Thus, it is also highly susceptible to things from our environment – those things that we put into us, whether we know it or not.

Here are some examples of common comorbid factors in autistic people:

Epilepsy

Asthma

Allergies

IBS

Psoriasis

Psoriatic Arthritis

Nerve Inflammation (joint, back and hip pain)

Anxiety

Depression

Sleep Disorders

Attention Deficit Hyperactivity Disorder

 

In addition to having asthma, I have also had pneumonia and bronchitis when I was young. I was also allergic to feathers (still am!), cat hair, horses, hay, dust and chrysanthemums, amongst a plethora of other things. In fact, at the age of nine I was assessed by an allergy specialist. This involved over forty painful injections into my back. I remained so quiet during the procedure, and the specialist was so impressed, that –instead of giving me a single piece of gum, which he gave all the children afterward – he gave me “the whole damn pack!” (I was so proud of that story!).  This hints at my high pain threshold, which I will discuss in a future post.

This susceptibility to our environments makes sense because, in general, autistic people are fussy eaters who are often sensitive to lights, sounds and smells. Autoimmune conditions are commonplace, as our bodies battle our environments – be it pollen, gluten or additives. Unfortunately, they can become more pronounced as we age, as I can attest. I’m reminded of a line from a Montgomery Clift biography, describing his acting, personality and odd behavior. Someone was quoted saying he was an: “open nerve.” That’s a great description of my autism. For better or worse, I am very sensitive to everything in my environment. Sometimes, this sensitivity results in conditions that I must manage. The trick is to determine what that condition is, to the best of my ability, so I can seek treatment.

Advice on Seeking Treatment

Dealing with all these conditions doesn’t help anxiety levels, but we have no choice – we carry on. I do have some advice that has brought me piece of mind.

I recommend typing your symptoms into Google and see what comes up. That’s what I did. I feel much more comfortable and confident with a few facts under my belt. I feel ready to converse with the GP. Also, in advance of going to a GP, I type and print all of my symptoms, so I don’t forget anything or get side tracked. It’s proven to be really worthwhile in the UK, where patients are allowed 10 min per issue, one issue per appointment – not exactly ideal, if you have comorbid issues! I find that GPs talk fast. They seem is a rush and who can blame them – they are probably stressed out, with too many appointments and forms to complete each day. To make things easier, and ensure I get the best care possible, I need a tick list. I hand it to the GP at the beginning of my 10 min appointment. I may forget to say something, but he will see it on my list. It helps if I have trouble verbalizing my symptoms or get sidetracked, which often happens when I’m in a doctor’s office.

It may seem like a lot, but these comorbid conditions are all manageable. It is a lot of work, being autistic! People don’t realize that at all. They don’t go through what we do – every second, minute, hour, day and year. Managing the social interactions and communications is tiring enough, but we also have to manage comorbid conditions. We can and we must. I manage mine through a holistic combination of prescription medication (which I’m trying to cut down on), professional advice, my own research, exercise, herbal supplements and studying family history. Family history is key. You are all linked by genetics, so if something works for one family member, it may well work for you. If you choose to take herbal supplements, research their drug interactions carefully; you may want to speak to your GP. I generally list all supplements I’m taking, so he can recognize any conflicts.

 

Combating IBS

My counselor told me how common stomach complaints were amongst autistic people. To combat my IBS, I analyze my diet, conduct ample research and consider my family history. My mother, father, sister and brother all have digestive issues. In particular, my mother and I share the embarrassing trait of bloating – a markedly distended stomach – following even the smallest meal. Through trial and error, I learnt what I should not be eating.

For example, I used to LOVE a certain spicy aubergine Thai dish, but I suffered upset stomach the next day. I realized that grilled aubergines had the same affect. As much as I love aubergines, I knew I had to give them up. I researched them and discovered they were members of the nightshade family. I realized that several other family members also caused me tummy trouble; thus, I gradually came to the conclusion that I was allergic to the nightshade family. This makes it VERY difficult to enjoy a trip to a Mediterranean country, but I can’t help it – I enjoy the food knowing I will pay for it later. The things we do for love!

Another odd symptom I have is sneezing. It took me a long time to realize it, and it got worst as I got older, but I would sneeze – loudly and repeatedly – after I ate certain foods. I started to notice that it was cheap bake goods that were the usual suspects (e.g. those clear plastic box biscuits, squares and donuts that people unleash on the staff room table, figuring they’re doing everyone a favor). But what was it in those bake goods that was making me sneeze as soon as I ate them? I did some research and discovered I was not alone; other people had the exact same response – instantly sneezing, as soon as they took a bite. The question remained – what was the causative agent? Gluten, perhaps? It’s hard to tell.

Gluten was a different story. I did not realize I was allergic to it by eating it then observing an adverse reaction; instead, I removed it from my diet as an experiment to see if it improved my digestion. Two weeks after I went gluten free, my IBS subsided and, much to my amazement, symptoms of early onset arthritis disappeared from my fingers and hands, allowing me to grasp objects with more power.

 

To be honest, I feel that everyone could benefit from finding out which foods they are allergic to. In addition, it would be helpful to find out what your gut bacteria ecosystem is like. Specialists can determine if it is healthy and balanced, or missing key bacteria due to something in the diet limiting their growth and success. For example, there is ample evidence to suggest that consuming artificial sugar substitutes negatively affects the gut biome; some bacteria need real sugar in order to respire.  Just like a forest ecosystem that can only support a certain number of deer and wolves, your gut ecosystem should have a balance of different types of bacteria.

Conclusion

I have discussed some comorbid conditions that are surprisingly common among autistic people. Perhaps the reason we suffer these conditions is two fold:

  1. Our unique neural connectivity, and neurological sensitivities, perhaps makes us more susceptible to these conditions, compared to neurotypicals.
  2. Perhaps our gut biomes, and related neurons, have developed in such a manner that they also increase our sensitivities to various environmental stimuli, leading to increased susceptibility.

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