Autism:A Nutraceutical ApproachDecember 2007
By Julius G. Goepp, MD
Many people with autism also demonstrate poor absorption of nutrients due to inflammation in the gut.26 Poor nutrient absorption can lead to a host of health problems in growing children, including impaired growth and well-being. Individuals affected by autism also commonly suffer problems with elimination, such as diarrhea or constipation.5 Diarrhea can contribute to dehydration and depletion of vitamins and minerals, while constipation impairs the body’s elimination of toxic wastes.
Additionally, it is not unusual to find that those with autism have fewer beneficial bacteria in the gut to manufacture critical vitamins such as B12, K, and biotin.5,27 Autism has also been linked with a common deficiency in a host of micronutrients such as vitamins A, B1, B3, B5, and biotin, selenium, zinc, magnesium, certain essential amino acids, and essential fatty acids.5,28 In addition, some studies suggest that vitamins B6, B12, and folate, which are critical for healthy mood and cognitive function, are also lacking in autism.5
Research has revealed the use of multivitamin supplementation to be beneficial for children with autism.29,30 A 2004 double-blind, placebo-controlled trial showed that by increasing the levels of vitamins B6 and C, children with autism showed improvements in sleep and bowel patterns.29 Sleep provides crucial healing and mood stabilization for most children, and disturbed sleep can lead to a host of childhood complications. It should be noted that multivitamin-mineral supplements for autistic children should not include copper, because people with autism often have elevated copper:zinc ratios.5
Vitamin B6 and Magnesium
Children with autism may have low levels of the enzyme needed to convert dietary vitamin B6 into its active form, which is required to produce important nerve-signaling chemicals (neurotransmitters) that ensure healthy brain function. 29 For these reasons, having low levels of B6 may reduce levels of neurotransmitters that are critical for the development of language and attention and for optimizing sleep, activity, and alertness. Supplementation with vitamin B6 can increase levels of the vitamin’s active form, and has been found to improve sleep, attention, and language.29,31 Rigorous, placebo-controlled trials with B6 have also demonstrated statistically significant improvements in eye contact, speech, and interactions with the environment in children with autism.32
The combination of B6 with magnesium has been described as a “breakthrough autism intervention,”5 with improvement in about half of the cases studied.33,34 Magnesium is an essential mineral that many enzymes require in order to function properly, particularly the enzyme systems that manufacture brain neurotransmitters.5 Multiple studies of vitamin B6 (75 to 800 mg per day) and magnesium (100 to 700 mg per day) have now shown that this particular nutrient combination is dramatically more effective than either nutrient alone.5,35
One of the most impressive and recent studies of this combination comes from France, where researchers treated 33 children aged 1-10 years with autism, using a daily supplement containing B6 (0.6 mg/kg) and magnesium (6 mg/kg) for six months.36 Supplementation safely improved symptoms in 23 of the 33 children, with the most powerful effects seen in social interactions and communication.
Vitamins A and C
Further improvements in the symptoms of autism have been observed with vitamins A and C. Vitamin A is essential for rapidly growing tissue such as gut, brain, and nerves—systems that malfunction in autism. Deficiencies in vitamin A have been noted in some individuals with autism.5,37 In one study, supplementation with vitamin A for three months or longer produced improvements in eye contact, social skills, and sleep in children with autism.38 Vitamin A is stored in body fat, and high levels can be toxic, so it is best to determine a safe dose in consultation with your physician or nutritionist.
Vitamin C, on the other hand, has dual biochemical and antioxidant roles, as well as being an important co-factor in the production of nerve-signaling chemicals.5,39 A 1993 study of high-dose supplementation with vitamin C (8 grams per 154 pounds of body weight) in 18 autistic children revealed improvements in their measures of social relationship to people, observed emotional responses, and sensory responses. These improvements disappeared when the supplements were replaced by placebo.40
Nutrients to Support Detoxification
Boosting the body’s detoxification system has yielded impressive benefits in combating autism. Children with autism often demonstrate impaired ability to detoxify harmful compounds from food, water, air, and byproducts of the body’s own metabolism. Due to these faulty elimination systems, toxic compounds that would normally be quickly neutralized can linger, damaging the delicate nervous system.
The most important detoxification systems in the body require sulfur in a variety of forms to function effectively.3,24 Sulfur compounds such as glutathione, and sulfur-containing amino acids methionine, cystathionine, and cysteine, are often depleted in autistic children, yet are crucial in the enzymatic destruction of toxins, such as phenolic compounds and tyramine, known to be harmful in autism.41,42
In 2002, Lonsdale reported improvements in behavior, speech, and communication in 8 out of 10 autistic children with the sulfur-containing vitamin B1 derivative, thiamine tetrahydrofurfuryl disulfide (TTFD), at a dose of 50 mg twice daily, which also promoted the excretion of some toxic metals in the urine.43 While not yet widely available, TTFD is beginning to reach the dietary supplement market in specialty products targeted at boosting detoxification.
Another promising approach to enhancing the detoxification capabilities of individuals with autism is supplementation with substances that promote healthy levels of glutathione. This substance occurs abundantly in the livers of healthy people where it facilitates the removal of toxins from the body. Natural glutathione taken orally reduces inflammation in the gut, but is not well absorbed from the gut into the bloodstream.44 As people with autism have lower levels of glutathione, 42 supplementation with nutrients that are converted to glutathione, such as glutamine, N-acetylcysteine, lipoic acid, and glycine, can ensure a ready supply of glutathione for the liver.5
An alternate approach to ensuring healthy glutathione levels is to supplement with folinic acid (an active form of folic acid naturally found in food), betaine, and methyl-cobalamin (vitamin B12), all of which are necessary in converting sulfur-containing compounds to glutathione, making it available for its crucial role in neutralizing toxins that may contribute to the symptoms of autism.42
Other Vitamins and Nutrients that May Benefit Autism
Significant improvements in social interaction, communication, and sleep disturbances in autistic individuals have been seen with folic acid, tetrahydrobiopterin (BH4, a chemical derived from folate), iron, and L-carnosine.
Folic acid is a B vitamin that is critical for nervous system development in children, which has been reported via parent questionnaire responses to improve behavior in autistic children.5 In addition, two small studies have shown that folic acid supplements improve motor skills45 and behavior in children with autism.46
Children with autism often display behavioral problems such as repetitive movements and restlessness, and can occasionally experience psychomotor regression (loss of previously attained motor skills). Supplementing with folic acid may help avert these troubling symptoms.
Furthermore, research suggests that tetrahydrobiopterin (BH4), a folate derivative and an essential co-factor in the synthesis of the neurotransmitters dopamine, epinephrine, and serotonin, may play a role in autism. In 2005, Swedish scientists treated 12 boys aged 4-7 years, who had autistic disorder and low concentrations of tetrahydrobiopterin, with daily doses of BH4 (3 mg/kg body weight) or placebo for six months.47 Using an autism rating scale to assess the boys’ behavior, the researchers noted significant improvement in social interaction, one of the core symptoms of autism, among the treated group compared with controls. While BH4 is not yet widely available as a dietary supplement, folate and S-adenosylmethionine (SAMe) influence its synthesis in the body.48,49
Iron deficiency has also been implicated in autism. A recent study revealed that 77% of a group of children with autism spectrum disorder were deficient in iron. Remarkably, iron supplementation significantly improved sleep disturbances in these children. This finding suggests that all children with autistic disorder should be screened for iron deficiency as part of their regular medical care, and that they should treated with iron as indicated.50
Notable benefits for children with autism have been discovered using L-carnosine, a dipeptide that is a potent antioxidant.39 The nutrient is perhaps best known for protecting against damaging glycation (non-enzymatic binding of a sugar with a protein) reactions, which have been implicated in aging and in the complications of diabetes.51 L-carnosine appears to be highly beneficial in autistic subjects, successfully improving socialization, communication, and vocabulary.52
Essential Fatty Acids
Essential fatty acids, particularly the omega-3 fatty acids known as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are cell membrane components that are crucial in normal nerve and blood cell development and function.5 A number of studies have revealed these omega-3 fatty acids to be deficient in the majority of children with autism.53-55 Supplementation with essential fatty acid-rich fish oils has been shown to correct these deficiencies.56 Many physicians believe that their autistic patients benefit from omega-3 supplementation in terms of behavior control and learning.5 Essential fatty acids are also important in fighting the increased inflammatory response seen in many autistic children.57-59
Most recently, Austrian researchers published a double-blind placebo-controlled pilot study comparing omega-3 fatty acid supplementation with placebo in 13 autistic children aged 5-17 years who had severe tantrums, aggression, or self-injurious behaviors.60 After six weeks of treatment with either placebo or 1.5 g/day of omega-3 fatty acids containing 800 mg of EPA and 700 mg of DHA, the treated group showed noticeable improvement on a behavior-rating scale for hyperactivity and stereotypical behavior. No adverse effects were noted, and the researchers concluded that this study provided “preliminary evidence that omega-3 fatty acids may be an effective treatment for children with autism.”
Autism has appropriately been called “an extreme challenge to integrative medicine.”5 At the same time, integrative medicine and nutritional approaches offer tremendous promise for the future of this heartbreaking group of disorders. Autistic children’s quality of life can be greatly improved even with what we now know. We can have high hopes that the growing interest of the scientific community will result in urgently needed research to defeat autism within our lifetimes.
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