One of the Most Comprehensive Studies on Nutrition for Autism By Julie Matthews, Certified Nutrition Consultant As a nutritionist working with children with autism for ten years, I was particularly excited to read the most recent research findings. For those who continue to say, “There is no science behind diet and nutrition for autism” or “there is nothing you can do about autism,” you’re about to finally be convinced. A study entitled, “Nutritional and Metabolic Status of Children with Autism vs Neurotypical Children and the Association with Autism Severity,” conducted by Jim Adams, was recently published in the journal of Nutrition and Metabolism in June 2011. It provides an excellent framework for consideration of dietary intervention and supplementation for children with autism. This study validates what many clinicians have observed in their practices for years—that children with autism have biomedical imbalances that are strong factors in their autistic symptoms, and that diet and supplementation play a role in helping children to heal, even lose their autism diagnosis. In my clinical experience, I’ve witnessed hundreds of children improve through specialized attention to diet and nutrition. A fairly large number of children (99) were included in the research that measured a wide range of nutritional and metabolic markers—i.e. scientific, quantitative indicators of children with autism’s unique biochemical status. In the “Background and Significance” and “Discussion” sections of the published paper, Adams, et al. provides a straightforward interpretation of the results that were measured, and explains functional testing, interpretations, and makes comparisons to previous study results (both consistent and contrary). I believe it’s an excellent analysis of the current biomedical understanding of autism and supports clinical findings reported worldwide. And, it presents fresh new data to guide the use of supplementation and diet. The study compared 55 children with autism diagnoses with 44 controls (neurotypical children of similar ages ranging from 5-16 years old). Neither group had taken nutritional supplementation for two months prior to the testing conducted in the study. The research indicated that for the children with autism, their levels of vitamins, minerals, and most amino acids were within published reference ranges; however many of their biomarkers were significant different from the control group. Biomarkers are a way of discovering the functional insufficiency of a nutrient by measuring markers in biochemical pathways that indicate a deficiency, and comparing that to the actual amount of the nutrient in the body (as measured in blood, etc). This is an interesting finding—nutrient levels appear “normal” but functional testing shows that they are not normal in children with autism. Functional testing (that identifies these biomarkers) are not used in most traditional medical settings. If the medical community is looking for nutrient deficiencies through standard testing of nutrient levels (as an underlying factor and course of treatment), they most likely will not find it – even though biochemical/nutritional insufficiencies are common and supplementation is necessary. In this study, biomarkers for increased oxidative stress, decreased sulfation and detoxification, vitamin and glutathione insufficiency, and reduced energy transport were also found. And, several of the biomarker groups were significantly associated with the severity of autism. Again, this parallels what autism clinicians routinely report —that children with autism have decreased detoxification, energy disregulation, and increased oxidative stress. The authors conclude, “These nutritional and metabolic differences are generally in agreement with other published results and are likely amenable to nutritional supplementation.” I absolutely concur. Here are some of the specific areas measured and details of the study’s findings, and my discussion of the results. Vitamins Biotin was the only vitamin with a significant difference in the children – it was 20% lower in the children with autism. B5, vitamin E and total carotenoids levels showed “possibly significant” lower levels in children with autism. The functional need for certain vitamins (folate and niacin) was assessed using FIGLU and n-methyl-nicotinamide, and were somewhat higher and possibly significant in autism. This suggests and an increased need for folate and niacin in children with autism. Minerals While most mineral levels tested within neurotypical reference ranges, the study found a statistical significance with lower levels of WB (whole blood) lithium, but higher levels of iron in the autism group. Twenty-five percent of the autism group was below the reference range for iodine and calcium. Sulfation Free and total sulfate in plasma (necessary for adequate sulfation) were very significantly lower in children with autism – 28% and 65%. Sulfate is necessary for proper sulfation. Sulfation comprises varied processes that use sulfate (sulfur) in the body, such as in forming sulfated glycosaminoglycans (GAGS) in the gut for intestinal integrity, or detoxifying compounds in phase II liver detoxification. Sulfate is used in many biological processes, and adequate sulfur is required both from consumption of sulfur rich foods and recycling sulfate in the kidneys. The results of this study are consistent with the findings of Dr. Rosemary Waring who found children with autism (and adults with autoimmune conditions) to have low sulfate levels. Methylation SAM (S-adenosylmethionine) was also significantly lower in children with autism – very much so. Uridine in plasma was very significantly higher in children with autism +93%. Uridine is believed to be a marker of methylation status, with high levels indicating poor methylation. For SAM, SAH and SAM/SAH ratio 25-39% of the autism group had low levels. SAM is the primary methyl donor in methylation reactions (more than forty in the body). Methylation is important for the methylation of neurotransmitters, proteins, and DNA methylation (gene expression). Methylation affects fatty acid metabolism, allergic responses, myelination, cellular energy, and more. Proper methylation is also necessary for the body to produce adequate levels of glutathione. ATP ATP is the primary energy source for the brain and the body. SAM is converted from methionine with methionine adenyosyl transferase, which requires ATP. Methionine was at normal levels but ATP was very significantly lower in the autism group. The authors suggest, “low levels of ATP are at least part of the reason for decreased levels of SAM.”ATP is required by the kidney to resorb sulfate and “recycle” it. The authors believe that decreased ATP is a significant contributor to decreased sulfate levels in children with autism. I believe that oxalates could be a factor. When sulfate is insufficient, oxalate (instead of sulfate) can be shuttled into the cell on the sulfate transporter and “gum up” the works of the mitochondria, affecting ATP and energy metabolism. Could there be a “vicious cycle” at work, where adequate sulfate is needed to produce ATP and ATP is needed for recycling sulfate? Given the benefits I’ve observed with the low oxalate diet, I’d welcome more research and discussion of this possibility. Oxidative Stress Reduced plasma glutathione (GSH) was very significantly lower in children with autism. All three markers for oxidative stress were very significantly higher in children with autism; oxidized glutathione (GSSG), GSSG/GSH ratio, and plasma nitrotyrosine. NADPH, a precursor to ATP, is needed to recycle GSSG to GSH. NADPH was found to be substantially lower in the autism group. These results were also consistent with the work of Dr. Jill James, who found low levels of glutathione in children with autism (as well as positive benefit of certain forms of folate). Glutathione is imperative for preventing oxidative stress. In addition to being an antioxidant, it supports proper detoxification, inflammation, pathogen fighting, and more. Amino Acids in Plasma Two amino acids used in building neurotransmitters were significantly different from controls. Tryptophan, a precursor to serotonin was significantly lower in the autism group, and glutamate, an excitatory neurotransmitter, was significantly higher. Low tryptophan can play a role in depression and poor sleep, and glutamate is a factor in hyperactivity. Other differences were possibly significant such as slightly decreased tyrosine and phenylalanine and slightly higher serine. Dietary Intervention and Supplementation This study supports the use dietary intervention for autism (individualized to the child). There is much valuable data we can gather from this study on how to apply and adjust diet and supplementation for autism. Adequate protein intake is crucial for children with autism. Decreased levels of amino acids such as tryptophan, phenylalanine, and taurine most likely indicate a need for increased protein intake or proper digestion of protein (possibly through the use of digestive enzymes). Supplementation with individual amino acids, particularly those consistent with signs of deficiency, may be warranted. For example, tryptophan or 5-HTP supplementation may be helpful with a low tryptophan level and depression. This study highlights the need for foods rich in antioxidants and antioxidant supplementation for children with autism. Foods rich in antioxidants like vitamins A, C and E, as well as zinc and selenium are important. Berries, beans, spices like turmeric and rosemary, nuts, grass-fed beef and pastured poultry are good sources of antioxidants. Foods rich in glutathione and glutathione precursors to include in your child’s diet consist of: broccoli and other cruciferous vegetables, garlic, kale, cumin and cinnamon, eggs, and avocado. Supplementation with biotin, folate, vitamin B12, liposomal glutathione, SAM, lithium, sulfate, and many other nutrients are important (on an individual basis) for children with autism. The Feingold and Failsafe diets remove salicylates, amines, and glutamates, substances that require proper sulfation (and methylation) for proper breakdown. For the children with these biochemical insufficiencies, these diets can be very helpful. I was glad to see further research that supports what I am finding clinically. The low oxalate diet has been very helpful for many of my clients with autism. More discussion is needed about the role of oxalate in the oxidative stress and low ATP found in this study in children with autism. For these children, the low oxalate diet may prove particularly helpful. Benefit to Autism I greatly appreciate scientists and researchers like Dr. Jim Adams, whose dedication has helped thousands of parents and clinicians to gain useful information about addressing autism. I’ve spent more than 5 years compiling research and presenting the case for diet and supplement intervention in my book “Nourishing Hope for Autism,” which has nearly 200 scientific references regarding the biochemistry of autism and the use of food, nutrition, and supplementation to ameliorate symptoms. Dr. Adams’ earlier research was instrumental in guiding my query. The current study by Adams, et al greatly advances our understanding of these factors and further solidifies the case for “Autism is treatable.” It solidifies a foundational understanding of how diet and nutrition intervention benefits autism and helps nutritionists like me address the diet naysayers who deny Hippocrates dictum “let food be they medicine” by asking “is there a double-blind study to support diet changes?” Yes, there is! Adams JB, Audhya T, McDonough-Means S, Rubin RA, Quig D, Geis E, Gehn E, Loresto M, Mitchell J, Atwood S, Barnhouse S, Lee W. Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity. Nutrition & Metabolism 2011 Jun 8;8(1):34.