Recent government decisions to change the autism funding formula in this country have left many parents scrambling to scrape money together for costly behaviour therapies. There is anger, outrage and fear amongst parents that is more than justifiable given our current discourse about how to approach autism.
But I think the time has come to think outside the box and shift our approach so we can better help our kids. Let me explain what I mean...
Last year (2018) a team of researchers published the results of their year-long study on dietary interventions for autism spectrum disorders in the journal Nutrients (the link to the full text is at the bottom of this post and you can follow links within that text to some of the other research referred to in this post). I want to break down for you what they found out and what it means for parents who have kids with autism or any other type of mood, behavioural or neuro-developmental challenge.
This study I want to focus on was relatively small; 67 families with an autism diagnosis were enrolled. Based on prior autism research the team made educated choices about the nutritional interventions most likely to make an impact and decided on six. They introduced those sequentially to 37 people over the course of seven months and continued them for a year. 28 of those folks actually made it to the end of the study period.
I'll break down the specifics of the study for you in a minute, but first...
The most compelling result to me was this: the group that stuck to the nutritional interventions gained an average of 18 months of development over the 12 month study period with substantial progress in communication, social, and daily living skills.
The developmental progress of the control group over the same 12 month period? 4 months.
So over the course of a year, the treatment group developed 4.5 times better than the control group. The treatment group also performed significantly better on all of the ASD/behavioural assessments and constipation and diarrhea improved as well as stool smell.
Were they still autistic? Yes.
So is there more to the story on how to help people with autism? Yes.
But they functioned better and had a better quality of life because of these nutritional shifts. And that's huge for these families.
The conclusion of the researchers is that, “a comprehensive nutritional and dietary intervention is effective at improving non-verbal IQ, autism symptoms, developmental age, and other symptoms in most individuals with ASD.”
This is one of a number of studies that our government in this country does not seem to notice as they create (or undo) policy and services to help parents support their autistic kids. Do you have a child with autism? And were you given any nutritional advice when you got your diagnosis? Probably not, unless you searched it out. But imagine if we were to incorporate this information into our autism treatment plans at the ground level? Imagine if we were to improve the baseline of health first and then start the behavioural therapy? I think it reasonable to expect that a child with higher IQ, fewer autism symptoms, and who feels better and is advanced in developmental age wold progress faster. Don't you?
Let's break this study down.
First of all it examined layers of nutritional intervention rather than trying to isolate The One Thing that would make the difference to health and function.
I was delighted to see that the researchers took into account the synergy between nutritional deficiency and food irritation. They recognized that if we just look at removing foods we are unlikely to see the changes we hope to see; if we just look at adding one particular supplement we are unlikely to see the changes we hope to see. But if we address both deficiency and irritation at the same time, we are likely to get better results. So that's what they did.
This is the same approach that I take my clients through when we raise resilience... We start with nourishment and then explore irritation while continuing to make sure the body is well nourished. It is the two-pronged approach I outline here and walk parents through here.
A second reason this study was unique is that they continued observing the participants for 12 months; longer than any prior study looking at nutritional interventions for autism. It takes time for nutritional status to change and it takes time for body systems to rev up once the building blocks are in place. So a 12 month study period makes good sense.
Third, the study looked at adults as well as children. The fantastic (and somewhat unexpected) conclusion was that in contrast to prevailing opinion, improvements in mood, behaviour and cognitive function can be experienced regardless of age. Great news for our older autistic loved ones! It makes sense and is what I saw first hand when I collaborated with the Centre For Conscious Care on their pilot project serving adults with intellectual disabilities in a community care setting: as we get the body healthier mood, behaviour and function improve regardless of diagnosis or age or anything else.
Healthier Body = Better Function.
1. They started with a multivitamin/mineral supplement dosed in accordance to the child's weight.
Why This? Because vitamins and minerals are at the foundation of our health. They (along with enzymes and bacteria) drive every biochemical process in our bodies. Without sufficient vitamins and minerals systems ranging from metabolism to detoxification to hormone function to brain function slow down, and this impacts development, mood and behaviour. Prior research revealed some vitamin and mineral deficiencies common to autism including B vitamins and antioxidants, along with other deficiencies like glutathione, tryptophan and GABA.
2. An essential fatty acid supplement containing 425mg EPA, 110mg DHA, 198mg omega-6 (including 128mg GLA), and 15mg omega-9 was added. Dosage was adjusted depending on weight.
Why This? Fatty acids are critical to many processes in the body including brain development and function, the regulation of inflammation, immune function and digestive function. Autistic children have been found to often have fatty acid deficiency arising from a variety of factors including genetics, poor intake and poor digestion. Studies have also shown fatty acid supplementation to be helpful in other mood and behaviour-related conditions like schizophrenia, ADHD, depression, bipolar disorder, and dementia. This research on brain health along with its known effectiveness in Crohn's disease management (ASD and digestive disorders often go hand-in-hand) make fatty acid supplementation a reasonable idea for this autism study.
3. A warm bath containing two cups of Epsom salts and half a cup of baking soda twice a week for 20 minutes each was added two months in.
Why This? Epsom salt is a combination of Sulphate and Magnesium, two essential minerals that many autistic children tend to lack. Sulphate is particularly important to autism because of its role in detoxification, the synthesis of brain tissue and hormone function. Since folks on the spectrum often have digestive issues, providing these minerals through the skin by soaking in a bath can be a better way to improve levels. Baking soda is known for its ability to improve detoxification and alkalization, which can be helpful for people with autism.
4. 50mg of acetyl-L-carnitine/kg bodyweight was started three months in. This dosage was gradually increased to a maximum of 2 grams/day split into two doses.
Why This? Carnitine is a nutrient that contributes to fatty acid metabolism and energy production in the mitochondria. Whereas mitochondrial disease continues to be quite rare, mitochondrial dysfunction continues to surface as a factor underlying many cases of autism. The researchers hypothesized that carnitine supplementation would rev up mitochondrial processes which would then provide the body with better energy to function.
5. A digestive enzyme with each meal was started four months in.
Why This? Enzymes break food apart into elements the body can use. Several studies have found digestive insufficiency to be extremely common in autism. In fact, this same research group had previously found that severity of gastrointestinal pain and inflammation correlated closely with the severity of autistic symptoms. Looking at autism through the lens of nutritional deficiency it would make sense to enhance each participant's ability to extract the most nutrition from their food as possible using digestive enzyme supplements.
6. And finally diet was changed seven months in. The participants started a special diet that was free of gluten, casein, soy, refined sugar, additives (MSG, artificial flavours, colours) and industrial seed oils. It was also full of organic produce, quality protein, healthy fats and sufficient calories. The diet portion was overseen by two nutritionists - Julie Matthews (author and CEO of Nourishing Hope) and Dana Laake (author of The Kid Friendly ADHD & Autism Cookbook).
Why This? Along with their predisposition to micronutrient deficiency and digestive distress, children and adults with autism have been found in several studies to have a higher than average likelihood to struggle with carbohydrate metabolism, blood sugar instability and food sensitivities. They often have a reduced ability to digest certain foods like gluten and dairy and a heightened immune response to foods. They need premium fuel and lots of it! There is a lovely overview of these studies explained in section 1.5 of the Introduction of this particular study here. You can also browse my blog for more details on the impact of diet on the body and brain (or watch this or this).
The special diet along with all of the supplements were continued for the remaining 5 months of the study.
Autism is not caused by poor food choices.
Autism is not caused by gluten or casein.
There is no one thing that will cure a child's autism.
What this and other studies show us is that with autism comes some distinct nutritional needs and that parents can help their kids feel better and function better if they take those needs into account. I'll say it again... autistic kids and kids with other mental health and neuro-developmental issues need premium fuel and lots of it!
Given the recent autism funding formula changes this type of strategy is something we need to pay attention to now more than ever.
This study is one of many that shows us that we can improve the health and function of the body and rev up developmental processes by attending to underlying nutritional deficiency and irritation.
So what if we were to do that first and then try the behavioural approaches?
If the body were healthier and the child feeling better couldn't we expect the expensive and long term behaviour therapies that are no longer affordable to work better? Faster? More efficiently? Shouldn't we look into that?
Parents might raise an eyebrow at me and say nutritional interventions for autism are not "evidence based". Well, I beg to differ and will stand my ground firmly on this as I have seen amazing improvements before my very eyes when deficiencies are addressed and irritation is reduced (if you have too, please tell us about them in the comments!). This study, though small, gives us even more evidence that good nutritional support matters for autism.
Here's the common sense of it all... nutrients drive every function in our bodies. They are the workers in the business of human development and if they can't do their work, progress slows down. So when a child is diagnosed with a condition characterized by delayed function and development doesn't it make logical sense that the very first thing we look at is whether the building blocks for function are in place? And shouldn't the second thing we look at be clearing away irritation and inflammation that's getting in the way of proper function?
That's what we do when we take a nutritional or biomedical approach to autism.
Should we not be giving parents advice on this as soon as their child gets an autism diagnosis? It seems ridiculous to me that we don't do that.
Autism is not the result of a parent's poor feeding of their child and behavioural and other therapies still have their place. But autistic kids (and adults) have some specific nutritional needs. Exploring them can help them feel better and function their best. From there we can layer on additional tools to help them learn and progress in their development; those tools are likely to work better and faster when the foundation of health is stronger.
You can read the full text of the 2018 autism study here and follow the links in it to the rest of the studies referred to in this post.
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Jess is a Registered Holistic Nutritionist™ and Family Health Expert, specializing in brain health & resilience for kids. She is the author of Raising Resilience: Take the stress out of feeding your family & love your life, a mother and an advocate for children’s health. Her book and online resources have helped families all over the world improve the lives of their children with learning differences, anxiety, ADHD, autism and mood disorders by fitting the food and feeding piece into their health puzzles. She is the 2019 recipient of the CSNNAA award for Clinical Excellence for her work helping families get healthier, and she continues to work at bringing an understanding of the power of good nutrition to the mainstream conversation about children’s mental health, learning, and overall resilience through her blog, courses and as a contributor to print and online magazines. You can reach Jess at www.jesssherman.com
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