Autism Spectrum Disorder, ASD, is defined as a collection of neuro-developmental conditions characterized by challenges in social communication and interaction, as well as repetitive and specific behaviors and interests. These atypical patterns of development typically occur in early childhood with a higher rate of diagnosis in males than females.
The diagnosis of ASD has been steadily increasing, widely attributed to the increased awareness and recognition, as well as the increase in early diagnosis, and the frequent changes in the diagnostic characteristics. Routine pediatric screenings are now highly recommended as early intervention and have been shown to be impactful in promoting positive outcomes for the child but also for the caregivers, who play a tremendous role in ASD treatment. While genetics play a role in the overall risk factor, ASD has become increasingly researched and understood to be a combination of genetic and environmental risk factors.
The majority of individuals with ASD have coinciding medical, psychiatric, or developmental condition. There is a growing body of research demonstrating that ASD may be due, in part, to issues in neural connectivity as opposed to solely being to atypical or little activity in specified areas of the brain.
While research continues to build, deeper understanding and education around and for those with ASD advance in strength. Integrative, multidisciplinary, and individualized treatment, involving biological and behavioral interventions, stand as a strong framework to support kids with ASD.
One area of ongoing research with clinical promise is improving upon gut health. The gut is lined with over 70% of the immune cells in the body as well as over 80% of neurons originate in the gut. Research out of both Harvard and MIT indicate that gut inflammation is not only a trigger for autism potentially set off in utero, but a mediator, as well. Meaning that by working to down-regulate immune activity and inflammation in the gut, those with ASD can experience overall improvements.
The Gut-Brain Axis
A common concurrent problem for those with ASD is GI upset, with children with ASD showing a higher prevalence of dysbiosis, or pathogenic bacteria, in the gut compared to children without ASD. Studies have demonstrated a decreased amount of short chain fatty acids (SCFA) in children with ASD as well. SCFAs play a vital role in decreasing inflammatory cytokines and increasing anti-inflammatory cytokines, therefore, SCFAs act as an important modulator in gut-brain communication. As pathogenic bacteria increase and beneficial bacteria, such as Bifidobacterium Lactobacillus decreases, the integrity of the mucosal lining continues to be challenged, upregulating inflammation and a cycle of cognitive and behavioral challenges. Individuals with ASD were found to have a higher serum level of the endotoxin, lipopolysaccharide, compared to the levels of neuro-typical kids. LPS are found in circulation through the mechanism of leaky gut that moves them to the blood. LPS are also inversely related to social interaction scores. All of this information confirms that individuals with ASD show an interconnection with gut health: including bacterial overgrowth, leaky gut, and increased systemic inflammation.
While the information on the gut-brain axis continues to gain in strength, clarity, and number, so does our understanding on the foundational role the overall health and integrity of the gut plays for individuals with ASD. This line of communication between the gut and the brain suggests that strengthening the health of the gut may not only improve potential GI symptoms but may also improve neuropsychiatric symptoms.
Prebiotics and gluten and casein-free diet
There is a lack of evidence showing the efficacy of probiotics on GI symptoms and behavior in those with ASD, however there is more to be demonstrated through prebiotics. The combination of prebiotics, specifically beta-galacto-oligosaccharide and bovine colostrum, with the exclusion of gluten and casein, demonstrated an increase/improvement in anti-sociability scores, as well as irritability scores. Beta-galacto-oligosaccharides are a form of complex carbohydrates that are resistant to digestion in the upper gastrointestinal tract. They can be found in beans and root veggies. Oligosaccharides can be found in onions, garlic, kale, cabbage, artichokes, blueberries, raspberries, bananas, and more.
Gluten-free and casein-free diets have shown a significant reduction in GI symptoms such as abdominal pain and bowel movements. Multiple studies have demonstrated the reduction in behavior concerns such as aggressiveness, hyperactivity, and tantrums, as well as the improvement in language, communication, and attention. Promising studies have also shown an improvement in desires to learn at school. These encouraging results again point back to the role of the gut, and we can assume that these exclusion diets are successful because of the role they play in healing the gut lining.
Omega-3s and Vitamin D
While implementing a GFCF diet may be impactful to one with ASD, those same studies that praised its power in improving language and behavior, also highlighted the noticeable deficit of vitamin D levels in children on these restricted diets. In a 12-month, randomized, double-blind, placebo-controlled study, results showed that children that took vitamin D (2000 IU/day) had greater reduction in hypersensitivity than those in the placebo. Interestingly, we know of the role omega-3s play in modulating behavioral challenges in children with ASD. This same study found that those that took vitamin D (2000 IU/day) and omega-3 (DHA, 722 mg/day) combined had a higher reduction in irritability than those who only took vitamin D and the placebo group. Vitamin D levels also increased more in those who were taking a combination of the two as opposed to those only taking vitamin D. While on their own, vitamin D and omega-3s stand as powerful supplemental tools, but together, they seem to have a magnified beneficial effect.
Although navigating the treatment and nutritional needs for those with ASD can seem overwhelming, there is encouragement and hope found in addressing the foundations of nutrition, finding and implementing exclusion diets that work for the individual, while implementing basic evidence-based supplementation.
Work with us
Ashley Koch, MS, is a skilled provider with advanced training in pediatric gut health and neuro-developmental factors. With a deep understanding around the unique dietary challenges that parents often face when creating a healthy meal plan for their children, Ashley is able to build approachable and sustainable customized nutrition protocols for kids that heal the gut improve brain health.