The role of dietary interventions for autism
Natural whole foods, weighted in favour of plant-based nutrition, can’t be bad or a fad
The current incidence of autism is thought to be one in 59 children. Over the years, autism — also known as ASD (autism spectrum disorder) — has become significantly more prevalent. The exact mechanism and explanation for why this trend is observed remain unclear.
What is also unclear is whether dietary interventions such as restrictive diets or supplements work, or not.
Families of 25 per cent of patients with ASD choose to use dietary interventions as part of treating ASD. The most common restrictive modality is gluten-and casein-free diets.
Vitamins — such as B6, B12, vitamin C, folic acid, folinic acid and vitamin D — along with minerals, amino acids, herbal compounds and omega-3 supplements are also used in many instances.
A recent article published in Pediatrics (November 2019) describes what many researchers love to do when they are confused or curious: embarking on a meta-analysis. Researchers out of Madrid and San Francisco decided to look deeper into 27 double-blind, randomized clinical trials including 1,028 patients with ASD. The average age of children in the trials was 7.1 years. The duration of dietary interventions on average was 10 weeks.
The conclusion was that omega-3 and vitamin supplements were more efficacious than placebo in improving clinical outcomes, but they also had a caveat — the role remains very small and statistics were not that convincing.
Whenever I read journals and the word “statistics” appear, it reminds me of an expression I heard about four decades ago: statistics are like bikinis ... they reveal much, but hide what is essential.
What is essential is a proper longitudinal and well-designed study to go in-depth about the role of nutrition on the neurodevelopment of an ASD patient’s brain.
We know that complementary and alternative approaches are viewed with a great degree of skepticism by traditional clinicians. And sometimes with good reason. When secretin was offered as a new hope to treat ASD, the media and a number of researchers got very excited, but this flame did not last long. In the end, it appeared to be based on false hope.
Chelation was also suggested as a solution, but according to an editorial with great references, also published in Pediatrics 2019, there is clear evidence of potential harm.
In the same editorial, the authors lament the fact that even when ASD is diagnosed early, interventions are costly and limited. Parents are often asked to navigate long wait times in order to obtain proper treatment. It thus makes sense to look into modalities such as nutrition which may offer help in a primary care setting and communities at large.
In over close to four decades of caring for patients with ASD, I am concluding that 40 years ago the role of dietary interventions was frowned upon by most traditional doctors. The tide has shifted from skepticism to having an open mind. But even when research shows there may be a small role, with the caveat of statistically only small changes, one can always predict the last sentence of yet another research paper: “In this study, we also highlight the need for better-designed clinical trials assessing dietary interventions in this population.”
Where does this leave parents and physicians in primary care who are interested in common sense and practical approaches to treating children with ASD? I use an approach I refer to as the ABC method: Accept, Believe and Continue.
Accept that because of complexity and clinical heterogeneity of ASD there will never be a one-size-fits-all treatment. Accept the fact that better designed clinical trials assessing dietary interventions will remain elusive for now because they are very hard to do and, by nature, doctors will remain either ignorant, uneducated or skeptical when it comes to the role of dietary interventions.
Accept the fact that better designed clinical trials assessing dietary interventions will remain elusive for now.
Believe in common sense, which means that natural, non-processed whole foods, heavily weighted in favour of plant-based nutrition, rich in fibre and vitamins/minerals cannot be dangerous or a fad. We are only recently learning more about the positive role of these foods on the gut microbiome and the role of the latter on the function of the developing brain.
Finally, consistency in eating the foods mentioned above matters the most. To my knowledge, there are no papers yet published to divide patients into two groups and then longitudinally follow them over decades. One group being children who grow up in a plant-based eating family and another group those who eat SAD foods (Standard American Diet). Such a study is probably too hard to do and may be met with skepticism by most traditional clinicians.
For more information on the study in Pediatrics, see https:// pediatrics.aappublications.org/ content/144/5/e20183218
Dr. Nieman is a community pediatrician and the author of Moving Forward: The Power of Consistent Choices in Everyday Life.