Despite tremendous progress toward therapies targeted at improving the lives of people with autism spectrum disorder (ASD), patients and caregivers continue to struggle with the effects of the condition. Too often, symptoms ranging from behavioral difficulties like aggression or hyperactivity to physiological issues like gastrointestinal distress are treatment-resistant or seemingly intractable. Due to the incomplete relief provided by conventional treatment and the wide scope of the unaddressed difficulties associated with autism, patients and caregivers often turn to therapies that are separate from those prescribed by doctors. For many, these therapies take the form of dietary supplements, an appealing route that may potentially address symptoms left untreated by conventional therapies, frequently without incurring side effects.
Today, dietary supplement use is increasingly prevalent among ASD patients; one study found that 56% of caregivers administer at least one supplement on a regular basis. These supplements typically include vitamins and minerals like vitamin B, vitamin K, magnesium, calcium, and zinc. Unfortunately, research suggests that many supplements are ineffective at reducing symptoms and some, such as caffeine or ashwagandha root extract, may even be actively harmful. Caregivers seeking a dietary supplement will, therefore, need to consider their options carefully to find an effective and safe solution. For caregivers who do find the right dietary supplement for autism, the benefits may be massive for their loved ones—especially if those loved ones are unwittingly suffering from a nutrient deficiency.
Why Are Supplements Necessary?
The benefits of some dietary supplements for ASD patients stem from solving unaddressed deficiencies in their diets. Even with the mainstream administration of dietary supplements, ASD patients often aren’t getting enough of several core vitamins; studies have found that nearly a third of patients are deficient in vitamin D, and over half are deficient in calcium. While these dietary needs remained unaddressed patients may experience aggravated behavioral symptoms like social withdrawal or agitation. In addition to deficiencies, some nutrients may be present in excess. Folate, vitamin C, manganese, and copper, for example, are widely found in higher concentrations than necessary to maintain health. The consequences of these excesses vary from diarrhea, which can be caused by too much magnesium, to desiccation, caused by a surplus of vitamin A.
As a result of a growing body of literature, researchers are confident that these differences in physiological molecules and nutrient concentrations contribute to the severity of ASD symptoms. The relationship between nutrient levels and symptom severity is complex but is likely caused by malfunctioning enzymes. Many vitamins and minerals are necessary for enzymes to facilitate chemical reactions in the body. When these nutrients are absent or too sparse, these vital reactions can’t occur, and the resulting shortage of the reaction’s product causes diverse and unpredictable symptoms. As such, the right balance of nutrients is necessary for patients with autism to experience relief from their symptoms. However, finding this balance is more difficult with ASD patients than it would be with healthy people due to the fact that patients with autism have markedly different metabolic profiles.
Physiological molecules like NADH, ATP, tryptophan, and biotin are significantly more sparse in patients with autism, and the consequence of their scarcity is that the body has a reduced ability to compensate for experiencing stress or recovering from activity. Compensating for stress is critical because molecules that inflict stress are a natural byproduct of metabolism. When the stressors generated by normal and healthy metabolic activity are allowed to accumulate rather than processed by the body, cellular damage can occur, generating inflammation. Inflammation caused by stress damage has a wide variety of detrimental effects depending on the tissue where it occurs. In general terms, inflammation reduces the efficiency of whichever tissue it occurs in. In the brain, inflammation has been linked to difficulty concentrating, brain fog, and even depression. Inflammation is also linked to cognitive difficulties like shorter working memory and reduced processing speed; ASD patients might experience these symptoms either chronically or during acute incidents of inflammation.
Elsewhere, like in the GI tract, inflammation is correlated with reduced motility and increased difficulty with bowel movements. These inflammation-based difficulties are prevalent in the ASD population. Likewise, in patients with ASD, molecules like uridine and other biomarkers of stress are significantly more common. The implication is that the bodies of ASD patients are routinely heavily stressed far more than normal and are also less capable of dealing with that stress. This means that the effect of stress is multiplicatively worse than it might be for a normal person.
Reducing the impact of stress is thus an important treatment goal for individuals with ASD. By reducing cellular stress, patients can experience a reduction in their symptoms. This requires providing the nutrition which ASD patients’ bodies need in a format which their bodies can use. In some cases, the best approach may be to simply circumvent the metabolism of ASD patients by providing them with the compound which is a product of their metabolism rather than providing them with the nutritional precursors to that product. With this in mind, there is a small subset of nutritional supplements which can effectively reduce the severity of certain symptoms associated with autism. These supplements don’t necessarily address the same symptoms, however. Thus, it may be necessary for patients to use more than one of these supplements to achieve broader improvements.
Multivitamins are appealing supplements for treating ASD because they can cover a swath of essential nutrients within one pill. This can be particularly beneficial for patients with autism because supplement adherence is often challenging for this population. Supplements often smell or taste unappetizing, which, when paired with the sensory integration difficulties experienced by patients with ASD, can make maintaining a regimen difficult; what might be an unpleasant odor or mediocre taste to a normal person could potentially feel immensely magnified to a person with ASD. If the patient only needs to cope with the difficult sensations once, there’s a much higher chance of regimen adherence, which is necessary to derive benefits from any medication or supplement. Significantly, certain formulations of multivitamins are proven to have a beneficial impact on ASD symptoms.
One placebo-controlled clinical trial performed over the course of three months found that a multivitamin supplement formulated for the purposes of the study reduced hyperactivity, increased receptive language, and reduced the incidence of tantrums as measured by clinical rubrics. On a scale ranging from -3 (indicating much worse symptoms after treatment) to 3 (indicating vast improvement of symptoms), the use of receptive language was .4 greater in the supplement group than in the placebo group. Likewise, hyperactivity was .37 less severe in the supplement group and tantrums were .51 less severe. The multivitamin tested in the study wasn’t a panacea, however. General sociability and sleep quality were unaffected by the supplements when compared to placebo.
Overall, the researchers said:
Since the supplement resulted in many significant improvements in nutritional and metabolic status after three months, we hypothesize that the child’s overall health and learning ability is improved at that point but that more time may be needed for the increase in learning ability to fully translate into greater skills in language, social understanding, and behavior.
Additionally, the supplement itself contained over 20 different common vitamins and minerals, making direct attribution of its beneficial effects difficult. However, the supplement wasn’t associated with any adverse effects. Caregivers seeking information on the formulation of the supplement can consult the methods section of the study which is open to the public. Notably absent from the pill’s contents is the popular supplement, fish oil.
Fish oil is a widely used supplement for patients with autism owing to its minimal side effect profile and its potential impact on behavioral symptoms. A recent study by researchers at the University of Hawaii School of Medicine has suggested that fish oil can reduce the frequency and intensity of self-injurious behavior (SIB) in patients with ASD. In the study, patients receiving fish oil experienced a 52% reduction in the intensity of their self-harm episodes when compared with patients who were receiving pharmaceutical treatment. Intensity of self-harm was not the only variable impacted, however. While the frequency of self-harm episodes remained the same for episodes which were classified as mild in intensity, the episodes which would have been classified as severe intensity were entirely suppressed in the patients receiving fish oil over the course of the study. Thus, fish oil appeared to be more effective at reducing the frequency of severe intensity incidents than reducing the frequency of mild intensity incidents. Importantly, patients who received antipsychotic pharmaceutical medications like risperidone in the study instead of fish oil experienced similar results to the group which received fish oil in terms of the incidence and intensity of self-injurious behavior episodes, indicating that fish oil could be as effective as the medications for those patients in some cases. This suggests that fish oil might be a good add-on therapy if medications are failing to lower the incidence of severe-intensity self-harm episodes.
Other studies claim that 66% of the patients in their treatment group experienced minor improvements in their behavioral symptoms like hyperactivity after consuming fish oil for several months. For patients who struggle with self-injurious behavior or agitation, fish oil might just be the missing piece of their treatment strategy. For patients who struggle with gastrointestinal issues more than SIB, however, butyrate might be a better solution.
A growing body of research has found that using butyrate as a dietary supplement for autism may potentially treat a variety of ASD symptoms, including gastrointestinal distress. Butyrate is a chemical which the body produces to regulate white blood cells in the gastrointestinal tract. By controlling their behavior with butyrate, the white blood cells maintain the health of the gut microbiome, which uses butyrate as an energy source and provides protection from undesirable bacteria in the gut in return. ASD patients as a group experience drastically low levels of butyrate, causing their microbiomes to be populated by different proportions of bacterial populations than in healthy people. Because the bacterial populations responsible for warding off detrimental microbiota in the intestinal space are weakened, harmful bacteria can take root. Once established, these harmful bacteria cause inflammation in the gastrointestinal tract, generating many of the GI symptoms of autism like constipation or difficulty with digestion.
Importantly, inflammation in the gut has consequences for the rest of the body, too; thanks to the nerves connecting the gut to the brain, a sickly gut microbiome could cause behavioral symptoms like anxiety or anger in ASD patients. With the help of a butyrate supplement, it might be possible to restore a healthy microbiome and ward off these behavioral symptoms. While clinical research on butyrate supplementation in patients with ASD is sparse, there is ample in vivo evidence which supports the idea of regular butyrate consumption.
A recent study investigating butyrate supplementation using mouse models of autism found that mice who received butyrate exhibited less social inhibition and repetitive behavior than the mice which did not. These changes were likely caused by differences in the regulation of certain genes which are linked to excitation and inhibition of the brain. The researchers found that in the mice that received butyrate, genes associated with excitation were suppressed and genes associated with inhibition were promoted. While butyrate hasn’t been tested in this same context in patients with ASD, the butyrate supplements which are currently on the market could potentially be powerful tools for patients who struggle with agitation, social withdrawal, and compulsive repetitive behaviors. Other benefits might include reductions in hyperactivity and gastrointestinal issues, though they weren’t measured by the researchers who performed the mouse study.
Though the research consensus is still forming, there is reason to believe that the molecule known as glutathione (GSH) may be an effective treatment for autism. Glutathione is a molecule produced by the body which is used to protect cells from being damaged by stress. Under normal conditions, when molecules associated with causing stress damage are produced by metabolic processes, glutathione removes them from the locations where they could cause harm. When there are too many stressor molecules, however, there may not be enough glutathione molecules to prevent 100% of the damage. The damage subsequently causes inflammation.
But how does this relate to autism? Patients with ASD have far lower GSH levels than healthy people and far higher levels of molecules associated with stress damage. While the reason behind this disparity is still unknown, the basis for a glutathione supplement is simple: increasing the GSH levels in ASD patients via a supplement will reduce the inflammation caused by stress damage. There are currently no clinical trials that have investigated glutathione supplements in ASD, but the potential benefits for patients are substantial. Given that ASD patients struggle with both neurological and gastrointestinal symptoms, the currently available glutathione supplements may be a very effective therapy.
Supplementation for a Higher Quality Of Life
Exciting new research will soon shed more light on the promising early results of dietary supplementation for ASD. In the meantime, caregivers may want to take advantage of sophisticated supplements that bring nutrients like butyrate and glutathione to patients in more effective formats than ever before. Importantly, these supplements are compatible with each other, and there is no evidence which suggests that they induce worse side effects when taken simultaneously. Combining these supplements may well be the best way to reduce a broad range of autism symptoms to enhance the lives of patients and caregivers.
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