like compounds to cross the blood-brain barrier. Other dietary interventions such as low phenol diets, the Specific Carbohydrate Diet, low oxalate diets, and allergy avoid- ance diets have been utilized with children on the spectrum. While there is not enough good quality evidence to prove that these diets are helpful, a lack of data does not imply they are not effective, only that more research needs to be done. As advised by the expert panel, however, when children on the spectrum present with gastrointestinal symptoms, appropriate nutritional interven- tion is warranted. Finally, epilepsy presents more commonly in children on the spec- trum, and in these cases, a low-carbohydrate or MADE (Modified Atkins Diet for Epilepsy) diet may be appropriate. Probiotics may help address the under- lying gut imbalances in ASD since they are essential for normal digestive health. They have been used effectively for many gastro- intestinal disorders, and a wide variety of health issues respond to probiotic therapy. They are also known to improve immune function, and alterations in immune balance are additional areas of dysfunction com- monly seen in ASD children. Omega-3 fatty acids are frequently used


in the ASD population, and there is evi- dence that these essential fatty acids (EFAs) can improve symptoms. In one study EFAs showed an advantage over placebo for hy- peractivity and stereotypy. While the method of action is not clear, it is theorized that the EFAs role in modulating the immune system and plasticity of brain cells is responsible for the benefits observed. ASD children are under higher oxi-


dative stress and have reduced levels of antioxidants. Producing the body’s potent antioxidant defenses requires vitamins B6 and B12, folate, and magnesium, among other nutrients. ASD children given folinic acid and B12 supplementation significantly improved their antioxidant status. Lab values of multiple antioxidant nutrients such as zinc, selenium, and Vitamins A and C are lower in ASD children as well. Gut and brain tissue are sensitive to the effects of oxidative stress, so it is essential to support antioxidant production with these critical nutrients.


Up to 80% of children with ASD may


have mitochondrial dysfunction ( an inef- ficiency of the energy producing engines of the cell) which could contribute to a number of symptoms including cognitive impairment, language deficits, chronic gastrointestinal problems, and increased oxidative stress. Children with ASD have been shown to have significantly reduced levels of a compound called carnitine, and


supplementation significantly improved clinical measurements of autism. Folic acid is critical during fetal devel- opment and needed for numerous biochem- ical reactions in the body. It requires both niacin and vitamin B12 for proper process- ing. A larger percentage of children with ASD also have a disorder called Cerebral Folate Deficiency, which reduces the active form of folate in the brain. In one study, children treated with folinic acid supple- mentation showed significant improvements in verbal communication, receptive and expressive language, attention, and stereo- typy. Interestingly, human, cow and goat milk have receptors that may interfere with this process as well. This provides further support for the use of a dairy free diet in a subset of children with autism. Chronic vitamin D deficiency is per-


vasive in the United States, in both adults and children. Evidence of a relationship between vitamin D and autism includes greater prevalence of autism in areas with greater rainfall and cloud cover, in children born in the spring, and in northern latitudes. Low Vitamin D levels in children with ASD, increased risk of autism in those with darker skin, and increased risk of autism in prema- ture infants have also been observed. Another antioxidant that has shown


promise in Autism is called N-acetylcys- teine (NAC). In a pilot trial from Stanford University, a specific formulation of NAC reduced irritability, and repetitive behaviors in children on the spectrum. A formula that comes in individually packaged doses ap- pears to be best, since NAC is very unstable when exposed to light and oxygen. The reason that NAC is effective has not yet been determined, but researchers speculate that it could be a combination of its antioxidant potential as well as NAC’s role in calming overexcited neurotransmitters. In summary, nutrition therapy for ASD can and should be targeted at the underlying nutritional and biochemical alterations that


affect digestion, immune function, oxidative stress, mitochondrial dysfunction and folate metabolism. Foundational interventions to consider include: 1) a “clean” diet, free of the chemicals, pesticides, artificial additives, hormones and antibiotics which may tax poorly functioning detoxification pathways, 2) a diet low in refined and processed foods, low in sugar, and nutrient dense to reduce inflammation and provide antioxidant support, 3) adequate protein for produc- tion of glutathione precursors, 4) removal of inflammatory food allergens that may impair gut function, 5) a trial of a gluten and casein free diet, 6) support with high quality probiotics and essential fatty acids to reduce inflammation and optimize intestinal integ- rity, 7) vitamin D supplementation when clinically indicated, 8) mitochondrial sup- port or folinic acid supplementation when warranted by evidence of mitochondrial dysfunction or CFD, 9) other specialized diets when indicated.


It is important to remember that spe- cialized diets are often deficient in one or more key nutrients, and may also result in reduced intake in a child. It is important to work with a qualified nutrition professional who has experience specifically in the area of autism, to insure that diet and nutritional interventions are implemented safely and effectively.


Vicki Kobliner MS RD, CD-N is a Registered Dietitian and owner of Holcare Nutrition (www.holcarenutrition.com). Vicki works with infants, children and adults with digestive disorders, food allergies, ADHD, autism and other chronic illness, and provides fertility and prenatal nutrition counseling. Vicki has extensive experience in using dietary modification, appropriate supplementation and functional lab testing to achieve optimal wellness. She can be reached at 203.834.9949 or vicki@holcare- nutrition.com. See ad this page.


On...Nutrition & Autism Spectrum Disorders...


The evidence is overwhelming. Children with ASD often have digestive disorders and improving diet and nutrition can improve autistic symptoms. Donʼt ignore this piece of the puzzle.


HolcareNutrition Vicki Kobliner, MS RD | vicki@holcarenutrition.com 3 Hollyhock Rd. • Wilton, CT • 06897 • 203-834-9949 • holcarenutrition.com NaturalNutmeg.com 33


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