Updated on February 8, 2023
Scientists and practitioners alike are increasingly cognizant of the fact that the characteristics and symptoms of autistic individuals must be considered as points on a spectrum rather than criteria that fall neatly within single categories. As a result, when the American Psychological Association (APA) revised the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013, one of the most significant changes between the previous version (DSM-IV) and the updated version (DSM-5) was the elimination of separate subcategories on the autism spectrum, such as Asperger’s syndrome, autistic disorder, childhood disintegrative disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). This broader understanding of autism should be taken into account when choosing between alternative therapies for autism, which are growing in popularity because conventional management strategies often fail to bring complete relief of symptoms. With so many options available—and so little scientific consensus on the effectiveness of the various alternatives—it is critical to consider a patient’s unique characteristics when choosing between therapies. This includes nutritional support for the gastrointestinal symptoms that so often accompany ASD.
To be diagnosed with autism, an individual must demonstrate symptoms within two domains of impairment—social communication and repetitive patterns of behavior—each of which includes a variety of specific criteria. The specific symptoms that fall within these criteria can vary significantly in both their nature and their intensity, from discomfort when meeting the eyes of a stranger to a complete lack of verbal communication. It is also important to recognize that autism-related symptoms go beyond the behavioral observations that practitioners make during the initial diagnostic process. This is especially true for gastrointestinal symptoms; according to one preliminary study from 2017, the prevalence of constipation might be as high as 45.5 percent in patients with autism, while the prevalence of diarrhea might exceed 75 percent. Combining data for all GI symptoms, the research suggests that up to 96.8 percent of autism patients experience one or more gastrointestinal symptoms. Thus, even though GI symptoms do not fall within the criteria for diagnosis, they are thus an important target for therapy.
One of the reasons every patient displays a unique set of symptoms is that the biological underpinnings of autism vary significantly between individuals. This becomes evident when considering what researchers today know about the genetic aspects of autism. In April 2017, a group of more than 40 researchers from all over the world (led by scientists at the Centre for Applied Genomics at The Hospital for Sick Children in Toronto, Canada) collaborated on a study that involved the whole-genome sequencing of 5,205 samples from families of patients with ASD. Their work revealed several different types of mutations in patients’ DNA, including 73.8 de novo single nucleotide variants and 12.6 de novo insertions, deletions, or copy number variants in autism patients. Based on this research, they ultimately identified 18 new candidate autism-risk genes, a finding that built on previously knowledge about possible gene variants associated with autism. Ultimately, this research indicates that ideal therapeutic targets can differ significantly between autism patients.
To further complicate therapy development strategies, it is important to note that autism is not merely a genetic disorder. Rather, environmental factors and gene-environment interactions are also known to have a role in the etiology of each individual patient’s condition. Even similar gastrointestinal symptoms in autism patients might have different causes. For example, in some patients, their GI symptoms like diarrhea or constipation might be the result of an inflammatory bowel disorder like Crohn’s disease, ulcerative colitis, or autism-associated ileocolitis. In other patients, their GI symptoms might arise from non-inflammation-related conditions, like disruptions in the health of the microbiome.
Given the diametric opposition of certain symptoms (like diarrhea and constipation) and the different biological and environmental factors underpinning individual symptoms, it is not a surprise that scientists have been unable to distinguish a single go-to therapy among the alternative therapies for autism. In fact, the effectiveness of the conventional therapies can be just as varied amongst patients; certain strategies work well for some autism patients, while having little effect on symptoms in others. In so many cases, it simply depends on the patient.
Although dietary changes and nutritional supplements are among the most commonly used alternative therapies for patients with autism, the clinical data suggests no single approach will work for every patient. According to a 2017 systematic review of the nutritional approaches to autism management, there is evidence that elimination diets (such as gluten free/casein free and ketogenic diets) can help, as can the introduction of camel milk, curcumin, probiotics, and fermentable foods. At the same time, the reviewers identified high-sugar diets, synthetic food additives, pesticides, genetically modified foods, highly-processed foods, and certain starches as possible aggravators of GI and/or behavioral symptoms. Nevertheless, because the evidence for individual options was limited, the researchers’ final conclusion was that more research is necessary.
However, even without a rigorous scientific consensus, practitioners and their patients can build on the preliminary research to narrow down the options for a particular patient, depending on what is feasible based on their symptoms and lifestyle. For example, if it is determined that a patient has an inflammatory bowel disease, an elimination diet that is designed to address inflammation—such as the Autoimmune Protocol Diet—might be an appropriate intervention. Alternatively, if inflammation is not a factor, then it could be better to add fermented foods to the patient’s diet to support a healthy microbiome.
Still, these dietary changes are simply not feasible for some patients and their families. Following a highly restrictive elimination diet can significantly disrupt everyday life to the point where some patients do not consider it worth the resulting symptom relief. On the other hand, some autism patients have the opposite problem—that is, a problem with adding foods that might ameliorate their symptoms. Studies show that some autism patients have heightened sensory experiences related to eating, which can render the addition of new fermentable foods practically impossible, even though it might support their neurological or gastrointestinal health.
In these cases, patients and families might want to consider nutritional supplements because these therapies can be easier for a patient to follow. Instead of fermentable foods, a probiotic or prebiotic supplement might be a good choice, because these kinds of supplements address deficiencies in the gut microbiome, which are associated with the neurological and gastrointestinal symptoms of autism. Similarly, a butyric acid supplement might help relieve symptoms for patients with microbiome-related symptoms; butyric acid and other short-chain fatty acids are involved in a variety of body processes associated with autism symptoms and might not be adequately produced by the gut bacteria in autism patients. For patients with inflammation-related GI symptoms, a curcumin supplement is another feasible alternative therapy. In fact, a supplement might actually be more effective than a dietary intervention because the latest formulations are designed to enhance bioavailability, making such supplements more effective for dampening the immune response and combating inflammation-inducing free radical damage in the gut.
Given the genetic and symptomatic diversity among autism patients, it is important for practitioners and their patients and families to recognize the therapeutic potential of a wide range of alternative therapies for autism. Although complementary therapies are certainly worth considering, it ultimately comes down to the specific needs of the patient, in terms of both the direct effectiveness of the therapy and the impact it has on the patient’s quality of life. A targeted, highly bioavailable supplement can be an easy way for practitioners to address the diverse symptoms of their autism patients without severe lifestyle disruptions like food restrictions and food introductions.
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