Nutritional treatments for autism - Nutritional Influences on Illness

Townsend Letter for Doctors and Patients,  Oct, 2003  by Melvyn R. Werbach

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About 1 out of 2000 children has infantile autism, a severe brain disorder whose victims are unable to socialize normally and often exhibit bizarre behaviors. Despite the severity of the disorder, nutritional medicine may be of some assistance in its treatment.

Particularly exciting are the results of studies in which autistic patients were supplemented with vitamin B6. For example, in one study, autistic children who appeared to benefit from supplementation either continued to receive the supplement or were switched to placebo under double-blind conditions. Only those children who were withdrawn from the supplement showed significant behavioral deterioration. (1)

Moreover, vitamin B6 supplementation changes the abnormal electrophysiological and biochemical measures of autistic children to more normal ones. (2) Homovanillic acid is the principal derivative of the neurotransmitter dopamine. While the supplement normally increases urinary homovanillic acid excretion, it has been shown to decrease its excretion in autistic children. (3)

Magnesium is usually added to vitamin B6 to prevent the vitamin from causing magnesium depletion while also preventing the irritability, sound hypersensitivity and enuresis that sometimes follows B6 supplementation. (4) While dosages vary, 500 mg of vitamin B6 is often given along with 250 mg magnesium. (Be aware that this large a dose of the vitamin can, over time, cause a peripheral neuropathy.) One crossed-sequential double-blind study found that a behavioral improvement was only noted when the two nutrients were given together; then urinary homovanillic acid excretion decreased and the EEG cortical evoked potential normalized. (5)

The combination of vitamin B6 and magnesium does not cure autism, but improvements are sometimes dramatic. Moreover, all of the more than a dozen research studies, some of them double-blind, have reported positive outcomes. When roughly 4000 parents of autistic children were asked to rate the various treatments, the nutrient combination received the highest rating of any biomedical treatment, with 8.5 parents reporting behavioral improvement for every parent who reported worsening on the regimen. By contrast, thioridazine, the most commonly used drug on the list, had an improvement to worsening ratio of only 1.4 to 1. (6)

Supplementation with another B complex vitamin has also proven to be beneficial in autism, although only for a specific sub-group of autistic patients. Folic acid plays an important role in DNA synthesis, repair and methylation. (7) Tissue folate deficiency may provoke chromosomal breakage at a fragile site, while folate supplementation may interfere with the detection of constitutive fragile sites. (8)

Behaviors from the autistic spectrum are often seen in males with the fragile X syndrome, the most common known familial form of mental retardation and developmental disability. Can folate supplementation aid patients with this syndrome by reducing breakage at the fragile site on the chromosome? The results of studies have been mixed, possibly because the earlier in life folate supplementation is started, the more likely it is to be effective. In one study, for example, boys with fragile X syndrome showed improvement in their behavior as well as in their motor ability after receiving folate supplements while adult males showed no change. Concurrently, the fragile X positive cells of the autistic boys became rarer or disappeared. (9) Ten milligrams of folate daily for at least a few months appears to be necessary to achieve changes.

Finally, some autistic patients are food-sensitive. (10,11) Try removing common foods from their diets for at least a week and see if their behavior improves. If so, try to identify the inciting food(s) by returning individual foods every two or three days and observing for signs of regression.

Doctor Werbach cautions that the nutritional treatment of illness should be supervised by physicians or practitioners whose training prepares them to recognize serious illness and to integrate nutritional interventions safely into the treatment plan.

References

(1.) Rimland B et al. The effect of high doses of vitamin B6 on autistic children: A double-blind crossover study. Am J Psychiatry 135:472-5, 1978

(2.) Lelord Get al. Electrophysiological and biochemical studies in autistic children treated with vitamin BS, in D Lehmann, E Callaway, Eds. Human Evoked Potentials: Applications and Problems. New York, Plenum Press, 1979

(3.) Lelord G et al. [Modifications in urinary homovanillic acid after ingestion of vitamin B6: Functional study in autistic children.] Rev Neural (Paris) 134(12):797-801, 1978

(4.) Rimland B. An orthomolecular study of psychotic children. J Orthomol Psychiatry. 3:371-7, 1974

(5.) Martineau J et al. Vitamin B6, magnesium, and combined B6-Mg: Therapeutic effects in childhood autism. Biol Psychiatry 20:467-78, 1985

(6.) Rimland B. Controversies in the treatment of autistic children: vitamin and drug therapy. J Child Neurol 3 Suppl:S68-72, 1988