Essential nutrients for autism spectrum disorder
Rosalba Maistoru M.A., BCBA
The incidence of early-onset-type autism has not changed since it was first described by Dr. Leo Kanner in 1943. At that time, the disorder was generally being diagnosed before the age of 2. Rather, it is the later-onset-type that has suddenly appeared and dramatically increased around the globe and across the country. Today’s autism spectrum disorder (ASD) children are being diagnosed at more advanced ages. Today, about 1 in 150 children are born with some kind of neurological developmental disorder. Clearly, the explosion of ASD is real, and the frightening rate of increase does not seem to be dropping off, leaving us with the responsibility to at least address what may be causing these alarming trends and what we can do about them.
While ASD presents as a complex clinical problem for many in the professional fields, parents of newly diagnosed children are baffled, because so many children on the spectrum present with coexisting medical conditions that are not explained by an ASD diagnosis. Physical illness symptomatology include ailments such as gastrointestinal problems, immune dysfunction, and/or recurrent infections. For several years now there has been a strong consensus among many scientists and practitioners that, while hereditary plays a vital role in the susceptibility for ASD, environmental factors (e.g., toxin exposures, infectious agents or other stressors) appear to contribute to the cause or triggering of ASD.
In the past, ASD has primarily been treated through educational, behavioral and psychosocial modalities. Advocates of “the new paradigm of ASD” propose that autism is not strictly an inherited disease, but that environmental factors contribute to its incidence and that dietary interventions, detoxification strategies and other medical treatments may contribute to the amelioration of ASD symptoms. One could reasonably argue that perhaps the most important reason to pursue the medical paradigm of environmental effects is the possibility of identifying underlying factors causing ASD and ultimately achieving successful treatments for those diagnosed with ASD.
Practitioners who treat children with ASD using biomedical approaches have been sharing data and several themes with abnormalities in related and overlapping areas have emerged, such as ASD and the role of oxidative stress (e.g. free radicals), immunological dysregulation and increased toxic burden (e.g., heavy metals). In addition, they have also noted that the extent of the nutritional problems in these observations include the following dietary abnormalities, such as zinc deficiency, copper excess, calcium and magnesium deficiencies, omega-3 fatty acid deficiency, fiber deficiency and antioxidant deficiency.
Toxic chemicals, at any level of chronic exposure, affect human biochemistry. Fortunately, the body has mechanisms for transforming, eliminating or sorting out many toxic chemicals encountered over a lifetime. Nonetheless, these ‘safety’ mechanisms may be inadequate or even inappropriate in our modern industrialized society, especially for “at risk” individuals, such as the elderly, those with poor nutritional habits, or children who are born with a genetic susceptibility to having trouble detoxifying.
One class of ‘textbook’ toxic chemicals capable of subtle yet insidious health effects that may mimic other disorders, especially in children, is that of the heavy metals. Lead, mercury, arsenic, aluminum and cadmium are well-documented examples. Chronic exposure to these metals often results in organ-specific accumulation, which compromises the physiology of that organ. Similarly, chronic exposure to organic chemicals such as herbicides, pesticides, industrial and manufacturing byproducts can have deleterious impact on the body’s biochemistry, resulting in decline of cellular function.
New research indicates that oxidative stress and free radicals (highly reactive molecules) may play a role in the development of ASD. Free radicals are submicroscopic damaging particles that occur naturally in the body during normal metabolic functions and may also come from other sources, including environmental toxins (e.g., ultaviolet light, radiation, cigarette smoking and air pollution). These destructive molecules are inherently unstable since they contain more energy than they need. To reduce their extra energy, free radicals react with certain cells in the body. This interferes with those cells’ ability to function properly, may alter cell membranes, tamper with DNA and even cause cell death.
Chronic illness is characterized by the presence of large numbers of free radicals throughout the body. Free radicals not only damage cells but also cause viruses living in a person’s body to mutate. Poor nutrition greatly magnifies this process, generating significant more free radicals and increasing the likelihood that the live virus will mutate to a more virulent strain (which can increase the person’s exposure to a very high risk of viral persistence). A number of new studies confirm previous studies showing a strong correlation between eating fresh fruits and high density vegetables (squash, onions, garlic, greens, broccoli and Brussels sprouts) and a lower risk of developing chronic illness, with incredible protection against many diseases associated with free radical formation.
Ensuring proper biochemical functioning requires a consistent balance among various essential nutrients. Nutrients are substances that are involved in the creation of every molecule in the body. The body needs more than 45 nutrients, and the ways that nutrients are used are as varied as the molecules, cells and tissues they help to create. Carbohydrates, proteins and fats (called macronutrients) are broken down (metabolized) to give the body energy. Vitamins and minerals (called micronutrients) are not themselves metabolized for energy, but they are crucial in helping the macronutrients convert to energy. Six macrominerals are required by humans in varying amounts. Four of them (sodium, potassium, calcium, and magnesium) are cations, and two (phosphate and chloride) are accompanying anions. Nine trace minerals (microminerals) are required by humans in small amounts including iron, iodine, fluorine, zinc, chromium, selenium, manganese, molybdenum and copper.
Researchers and scientists continue to uncover the therapeutic role of nutritional supplements in the prevention and treatment of disease. The term “nutritional supplement” refers to vitamins, minerals, and other food components that are used to support good health and treat illness. While all vitamins and minerals play an essential role in the body’s normal metabolism, growth, and development, some are pivotal and they do this by helping the body to perform various tasks. For example, vitamins B-6 (pyridoxine), B-9 (folate) and B-12 (methylcobalamin), regulate a special series of metabolic steps in brain cells necessary for forming neurotransmitter chemicals and repairing DNA. When these nutrients are deficient, a special chemical homocysteine accumulates. Homoysteine is in a class of special brain cell toxins called excitotoxins. These toxins literally excite certain brain cells to death. Excitotoxins are considered a central mechanism in all of the neurodegenrative diseases and generate large numbers of free radicals in brain cells and brain cell connections (synapses).
Numerous studies have found that many children with ASD have elevated homocysteine levels, which is usually a sign of impaired metabolism. Many of the recent studies have also shown that the greatest risk is among those with impaired immunity. Protection against free radicals and excitotoxins can be achieved from dietary, supplemental and endogenous antioxidants. Antioxidants are intimately involved in the prevention of cellular damage - the common pathway for a variety of diseases. These molecules safely interact with free radicals and terminate the chain reaction before vital molecules are damaged. They neutralize free radicals by donating one of their own electrons. The antioxidant nutrients themselves don’t become free radicals by donating an electron because they are stable in either form. Instead, they act as scavengers, helping to prevent cell and tissue damage that could lead to cellular damage and disease.
Although there are several enzyme systems within the body that scavenge free radicals, the principle antioxidants are vitamins C, E, alpha-lipoic acid (ALA), N-acetyl L-cysteine (NAC) and curcumin, which increase brain cell glutathione levels. Vitamins C and E are thought to protect the body against the destructive effects of free radicals. Glutathione, one of the more powerful brain antioxidant systems, can neutralize free radicals and may reduce or even help prevent some of the damage they cause. Selenium is also included in this category, a trace metal that is required for proper function of one of the body’s antioxidant enzyme systems. Additionally, the carotenoids and special antioxidants from plants called flavonoids all act together to protect the brain from free radicals and, hence, excitotoxicity.
One of the more common reasons for immune dysfunction is nutritional deficiency. It is known that even individual nutritional deficiencies can have devastating effects on the immune system, an example of this is exemplified with a deficiency in selenium which can impair cellular immunity. It is also known that vitamin E (natural E), selenium, zinc, vitamin C and flavonoids (from fruits and vegetables) are critical for normal immune function. These nutrients have been sited as common deficiencies seen in children with ASD. Severe chronic infections have been known to deplete nutrients and this worsens immune function. Immune-stimulant supplements and nutrients, such as mixed carotenoids (beta-carotene, alpha-carotene, canthoxanthin, lutein), most B vitamins, vitamins C, E, D-3, and the minerals zinc, selenium (as selenomethionine) and magnesium, taken together all support immunity.
Of the many biochemical similarities seen in ASD, one of the most defining is their limited ability to detoxify effectively. While hereditary plays a vital role in our ability to detoxify, it is now known that the most important factor is nutrition. Many flavonoids found in fruits and vegetables greatly enhance our detoxification ability. These include curcumin (from the spice turmeric), quercetin, hesperidin and luteolon. Special plant substances, such as indole-3 carbinol (broccoli), glutathione and taurine stimulate detoxification. In addition, the omega-3 fats, such as fish oil docosahexaenoic acid (DHA), also improve detoxification.
Another deficiency which appears to be particularly common in children with ASD includes DHA. This nutrient plays a particularly important role in cellular membrane function, especially mitochondrial membranes, in synaptic membranes and reduces excitotoxicity. DHA is essential for the proper functioning of our brains as adults, and for the development of our nervous system and visual abilities during the first six months of life. Lack of sufficient DHA may be associated with impaired mental and visual functioning as well as attention-deficit hyperactivity disorder (ADHD) in children. Low levels have also been associated with depression and Alzheimer’s disease in adults. Our bodies naturally produce some DHA, but in amounts too small and irregular to ensure proper biochemical functioning.
It is important to maintain an appropriate balance of omega-3 and omega-6 (another essential fatty acid) in the diet as these two substances work together to promote health. They make up the cells in the body and play a critical role in endocrine function, brain maintenance, cell function, immune regulation and controlling inflammation. While omega-3 fatty acids help reduce inflammation, most omega-6 fatty acids tend to promote inflammation. Of particular concern are the omega-6 oils, which are metabolized in the body to produce a powerful immune-suppressing substance (PGE2) and thus interfere with immune function. Corn, safflower, sunflower, peanut and soybean oils are all omega-6 oils. The typical American diet tends to contain 11 to 30 times more omega-6 fatty acids than omega-3 fatty acids and many researchers believe this imbalance is a significant factor in the rising rate of inflammatory disorders in the United States.
There have been numerous studies showing the health-promoting effects when combining fruits and vegetables, and increased intakes of omega-3 oils. Good nutrition can dramatically improve our detoxification ability and therefore prevent many diseases from occurring. Improving detoxification is especially important for those with chronic diseases, in such cases, regular measurements of detoxification should be conducted until normal levels are attained. Some authorities also suggest that before considering supplementation, one should have comprehensive testing for nutrition deficiencies, which should include all of the major nutrients listed for nutritional guidelines and exercise.
The idea that different disease diagnoses that occur at different points in the lifespan may share some common underlying mechanisms, is gaining more support. This means that more work needs to be done not just on the behavioral overlaps between ASD and other neurological (e.g., language impairment), but also on the physiological overlaps (metabolic, biochemistry, immune system, exposure history) between ASD and other disorders. This is relevant to developing treatments.
While skeptics and objectors will continue to insist that what we are witnessing is simply a shift in diagnostic criteria, the full complexity of all environmental and heritable factors drives our understanding of the clinical, research and treatment issues. In the meantime, mounting evidence shows that most children diagnosed with ASD can be helped. Many families are discovering that with the proper biomedical and educational interventions, coupled with hard work and dedication, children are leading happier, healthier and more independent lives.
Please note: All information is for educational purposes only and is not intended or implied to be a substitute for professional medical advice. Any references to treatment options, programs, or services are not endorsements and the author and any parties associated with the materials printed do not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. Nothing herein is intended to prescribe for, or to treat disease, but is intended to inform, and to recommend certain courses of action that may be viable to investigate further. In every instance, it is advised that these actions be undertaken with the advice and consent of your medical professional. The reader is advised to Always seek the advice of your physician or other qualified medical provider for all medical problems prior to changing or starting any new treatment and to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein. We hope you will find the materials mentioned helpful as a means to begin learning more about ASD, Essential Nutrition & Biomedical Approaches. Some helpful resources can be found at the following web links: http://www.autismwebsite.com/ari/index.htm and http://www.autism.org/contents.html,