Updated on January 3, 2023
Autism spectrum disorder (ASD) is a multifaceted neurological condition with a multitude of emotional, cognitive, behavioral, and physical symptoms that vary in presentation among individuals. These symptoms are influenced by a variety of internal and external factors, ranging from genetic characteristics to comorbid conditions to home and school environments. Due to ASD’s complexity, clinicians, parents, and patients often struggle to find alternatives that effectively address the full spectrum of symptoms.
Because conventional therapies, such as pharmacological and behavioral interventions, often fail to produce satisfactory symptom remission, professionals in the research and clinical communities are increasingly considering the potential benefits of diet-based therapies. Owing to a growing body of research, there is now evidence that well-informed, patient-specific dietary decisions and high-quality supplements can address some of the underlying issues that cause or exacerbate autism symptoms. When it comes to autism and diet, here’s what you need to know:
“Gut-brain axis” is a major buzzword in the research and medical communities, especially in the context of autism. This term describes the ongoing bidirectional communication between the Central Nervous System and the components of the enteric nervous system in the gastrointestinal tract. Some of the emotional and cognitive centers in the brain are closely connected to the function of the gastrointestinal system. Communication between the brain and the GI tract is largely facilitated by microbial communities in the gut. Therefore, maintaining a healthy gut microbiome is essential to supporting the normal functioning of the gut-brain axis. In recent years, growing knowledge of how to modulate the microbiome through dietary interventions has opened the door to new approaches that address a range of autism symptoms.
Although supporting the gut microbiome is important for individuals with a wide range of health conditions, microbiome-friendly diets are particularly critical for autism patients due to the fact that the gut microbial communities in autism patients are significantly different from those of their healthy counterparts, thus compromising gut microbiome health. For instance, multiple studies reveal lower levels of bacterial diversity (both within and between phyla) in the GI tracts of autism patients. Other studies show lower levels of “good” bacteria, like species of Bifidobacterium species, as well as higher levels of “bad” bacteria in the Caloramator, Sarcina, and Clostridium genera.
To address these discrepancies, autism patients with autism should be encouraged to choose probiotic-rich foods. Some clinicians are even considering the development of patient-specific probiotic and prebiotic supplementation regimens, which can be tailored to a patient’s needs based on the microbial composition of their GI tract. So far, the evidence on the efficacy of probiotics for improving the gastrointestinal and behavioral symptoms associated with autism is mixed. There is also early biochemical evidence suggesting that vitamin B12 supplements might be able to modulate the gut microbiome in autism patients to support healthy functioning.
One of the reasons it is important for autism patients to support the health of their gut microbiome is that gut bacteria are responsible for generating the bulk of butyric acid in the colon. Patients can get some of this beneficial short-chain fatty acid by eating foods that contain animal fats and plant oils, but in general, patients rely on the bacteria in the gut microbiome to produce the butyric acid they need. Butyric acid plays an important role in the production and function of cells throughout the body, but it is especially important in the colon. By regulating gene expression, mediating signaling protein activity, and serving as an energy substrate, butyric acid supports a healthy GI tract and protects against cellular abnormalities that can trigger debilitating symptoms.
There is also a growing body of research suggesting that butyric acid supplementation can address neurological symptoms in autism patients. According to a 2017 review paper, symptoms of autism are directly associated with problems with gastrointestinal permeability—commonly called Leaky Gut syndrome. This might be associated with defects in intestinal structures like tight junctions. When these protein complexes are not assembled properly by the body, it is easier for metabolites to “leak” out of the GI tract and into the bloodstream, where they have the potential to disrupt chemical balances in the brain and possibly exacerbate autism symptoms. Because butyric acid regulates the genes that code for the proteins in tight junctions, autism patients who have an insufficient butyric acid level can be more vulnerable to Leaky Gut syndrome, which often manifests with gastrointestinal symptoms like diarrhea, in addition to adverse neurological effects.
In addition to supplementation, there are several elimination diets that are increasingly popular for autism patients, the most well-known of which is the gluten-free, casein-free diet. Although there are a variety of hypotheses why this diet works, one of the most popular is that eliminating these two proteins from the diet down-regulates systemic inflammation. Scientists acknowledge this diet is widely acclaimed by parents who say it can “cure” autism, but empirical evidence has yet to offer definitive evidence to support the diet’s efficacy. Although some individual trials have highlighted positive results—such as better scores for the social interaction and communication subdomains on autism symptom measurement scales—the bulk of the evidence remains mixed. Similarly, specific carbohydrate diets—in which certain types of carbohydrates are eliminated—have been proposed as alternatives, although larger research trials are required to assess their effectiveness. So far, there have been only small studies with mixed results on the GI functioning of autism patients.
The mixed outcomes of elimination diets for autism patients might be caused by the complexity of the neurological disorder itself. Autism manifests differently in different patients, and the underlying contributors vary as well. In some patients, the microbial content of the gut might not be sufficient to support the processing of gluten and/or casein, so an elimination diet can make a big difference for both the behavioral and the GI-related symptoms; in other patients, however, an elimination diet might be less effective.
As our understanding of the relationship between autism, the gut microbiome, and diet grows, it is likely that diet-based approaches will be further refined, opening up new possibilities for durable symptom remission. However, even today there are promising options for meaningful intervention, including specialized therapies targeting gut microbiome health.
If you are interested in the connection between autism and diet, then what you need to know is that there is no one-size-fits-all approach. That’s why it is critical for clinicians to work closely with patients and their families to find well-tolerated alternatives that address each individual’s symptomatology.
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