Nutrition and Autism: Evidence vs. Speculation
By: Lara C. Pullen, PhD
CEO and Co-Founder of Healing Thresholds
The Autism Therapy Web site
For some reason that I don’t fully understand, the subject of nutrition and autism can quickly become controversial, with many individuals holding very strong ideas about the role of a particular diet and/or supplement in the treatment of autism. I find the controversy strange because it largely misses some fundamental aspects of children and nutrition that most people can agree upon.
The Basics of Children and Nutrition
First of all, most, if not all, children require a diet rich in protein and fat and vitamins and minerals in order to grow a healthy mind and body. Since many children are finicky eaters and/or don’t eat a lot of food, this often means placing in front of the child a diet that is varied and rich in protein, fat, vitamins, and minerals. We all agree, right?
Most children eat a diet that includes many processed foods. My definition of processed foods is a food bought in a store with an ingredient label that contains more than three ingredients. Many of these processed foods are far removed from their original plant or animal source and the processing has stripped vitamins and minerals from the original whole food. Moreover, many of these processed foods do not contain high quality proteins with all of the essential amino acids or high quality fat (especially omega-3 fatty acids). Instead, many snacks and meals are based on processed empty carbohydrates such as white flour. Therefore many children are deficient in quality protein, quality fat, vitamins and minerals. Do you still agree?
The Role of Special Diets
Now, here is where the special diets come in. Even if you do not believe in the gluten free diet or the casein free diet or the processed food free diet, you likely can understand how removing processed foods from a child’s diet and focusing on a child’s nutrition will likely improve the health of that child, especially if the child has an underlying medical condition, as so often happens with a child with autism.
The evidence behind the use of special diets is mixed. In many cases, the studies are confounded by the endpoints measured in the studies as well as by whether or not that particular child responds to the specific diet. In general, most parents will tell you that their child does better on a special diet. In my opinion, these parents are not delusional. Their child is doing better, at a minimum because their child is eating more nutritious food that is more consciously chosen.
The Evidence Supporting Special Diets
Studies have shown the following:
Gluten-free diet and casein-free diet http://autism.healingthresholds.com/ther…-free-diet and http://autism.healingthresholds.com/ther…-free-diet: Although the casein-free diet combined with a gluten-free diet is popular, there is little evidence to support or refute this intervention and reviewers have determined that meaningful conclusions cannot be drawn from the existing literature.
Specific carbohydrate diet: This nutritionally rich diet avoids most grains and processed sugar. While two studies have suggested that this diet may help with treatment of bowel problems, there are no published data on the use of this diet to help symptoms of autism.
Modified Atkins diet: This nutritionally rich diet also minimizes/eliminates grains and sugars. While there are no studies testing its effect on symptoms of autism, it has been shown, however, to minimize/eliminate seizures in children with epilepsy. Epilepsy is common in the autistic population.
The Evidence Supporting Supplements
The logic that applies to diets can also be applied to nutritional supplements. Many children have diets that are deficient in critical vitamins and minerals. Therefore overcoming these deficiencies with supplements may be very beneficial. Specifically:
Omega-3 fatty acids http://autism.healingthresholds.com/ther…-acids-efa: In a double-blind, placebo-controlled study, 117 children with dyspraxia, a motor disorder frequently associated with cognitive, behavioral and social challenges, received fish and evening primrose oil (a source of omega-3 fatty acids) during treatment. Significant improvements in reading, spelling, and behavior were reported during the treatment period, and these improvements continued as long as the treatment was underway. These positive effects have been documented in other studies as well.
Vitamin C http://autism.healingthresholds.com/ther…orbic-acid: So far, only one controlled study has shown that vitamin C can help treat behavioral problems associated with autism. This double-blind experiment showed that high doses of vitamin C in children with autism had significant positive effects on behavior, compared against their own behavior scores when they were taking a placebo. However, this study was very small (only 18 children), and has not been replicated.
Vitamin B6 and magnesium http://autism.healingthresholds.com/ther…-magnesium: These two supplements are believed to work together to improve symptoms of autism. There is some controversy surrounding the evidence for the effectiveness of vitamin B6 and magnesium in autism. Two small but well-controlled studies showed no effects, positive or negative, of combined vitamin B6 and magnesium therapy. One larger, but less well-controlled study showed positive and significant behavioral effects of combined vitamin B6 and magnesium, but not vitamin B6 or magnesium alone.
Vitamin A http://autism.healingthresholds.com/ther…inoic-acid: There have been very few studies published on the effects of vitamin A therapy on people with autism. One case report of two children has shown that vitamin A therapy can help people with autism. These two children were believed to have a G-alpha protein defect. When treated with vitamin A therapy, they showed improvements in speech, eye contact, and vision. Note that some researchers have expressed concerns that vitamin A supplements will compete with vitamin D supplements and contribute to vitamin D deficiency.
Vitamin D: While many studies have indicated that many children (especially those with darker skin and those who live in norther climates) have a vitamin D deficiency, to date there has been no published study indicating that supplementation with vitamin D will improve symptoms of autism. Vitamin D deficiency is an acknowledged medical problem, however, and therefore it may be worth testing for such a deficiency in children with autism who have the above risk factors.
Very few quality studies have been done to examine the efficacy of diets and supplements as treatments for autism. Common sense as well as many small studies would suggest that many children would benefit from a nutritionally dense diet as well as from supplements. Common sense also dictates that care be taken if a child is placed on a restrictive diet. Some nutritionists have expressed concerned that a gluten-free casein free diet may limit the variety of foods and nutrients consumed by the charge. This could obviously be detrimental to a child.
Any diet that is restricts macronutrients and/or micronutrients should be done with the guidance of a nutritionist. Caution should also be taken when supplementing with megadoses of fat soluble vitamins such as vitamin A and vitamin D. These vitamin supplements could theoretically be toxic at high levels and children should be monitored to make sure that they are not being given toxic doses.
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Many Thanks to Lara Pullen, PHD, CEO for allowing for providing this article for this months newsletter.
Lara is a former research scientist in the field of immunology. She has been a medical writer since 1999 and has written on a wide range of topics from Alzheimer’s disease to diabetes. She is the mother of three children, the youngest of whom has Prader-Willi Syndrome.
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