As research in both the lab and the clinic has progressed, scientists and practitioners alike have grown increasingly cognizant of the fact that the characteristics and symptoms of patients with autism spectrum disorder (ASD) must be considered as points on a spectrum, rather than criteria that fall neatly within single categories. As a result, when the American Psychological Association (APA) revised the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013, one of the most significant changes between the previous version (the DSM-IV) and the updated version (the DSM-5) was the elimination of the separate subcategories on the autism spectrum, such as Asperger’s syndrome, autistic disorder, childhood disintegrative disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). This broader understanding of autism must be taken into account when choosing between alternative treatments for autism, which are growing in popularity as conventional management strategies fail to bring complete relief of symptoms. With so many options available—and so little scientific consensus on the effectiveness of the various alternatives—it is critical to consider a patient’s unique characteristics when choosing between treatments. This includes recognizing the need to treat the gastrointestinal symptoms that so often accompany ASD and finding appropriate interventions based on each patient’s symptoms.
Recognizing and Understanding the Wide-Ranging Symptoms of Autism
In order to be diagnosed with autism, a patient must demonstrate symptoms within two domains of impairment—social communication and repetitive patterns of behavior—each of which includes a variety of more specific criteria. The specific symptoms that fall within these criteria can vary significantly in both their nature and their intensity, from discomfort meeting the eyes of strangers to a complete lack of verbal communication. It is also important to recognize that autism-related symptoms go beyond the behavioral observations that practitioners make during the initial diagnostic process. This is especially true for gastrointestinal symptoms; according to one preliminary study from 2017, the prevalence of constipation may be as high as 45.5 percent in patients with autism, while the prevalence of diarrhea may exceed 75 percent. Combining data for all GI symptoms, the research suggests that up to 96.8 percent of patients with autism experience one or more gastrointestinal symptoms. Thus, even though GI symptoms may not fall within the criteria for diagnosis, they are thus an important target for therapy.
One of the reasons every patient displays a unique set of symptoms is that the biological underpinnings of autism vary significantly between individuals. This reality becomes evident when considering what researchers today know about the genetic aspects of autism. In April 2017, a group of over 40 researchers from all over the world (led by scientists in a lab at the Centre for Applied Genomics at The Hospital for Sick Children in Toronto, Canada) collaborated on a study that involved the whole-genome sequencing of 5,205 samples from families of patients with ASD. Their work revealed several different types of mutations in patients’ DNA, including 73.8 de novo single nucleotide variants and 12.6 de novo insertions, deletions, or copy number variants in patients with autism. Based on this research, they ultimately identified 18 new candidate autism-risk genes, a finding that built on what was previously known about possible gene variants associated with autism. Ultimately, this research indicates that the ideal therapeutic targets can differ significantly between patients with autism.
To complicate treatment development strategies even more, it is important to remember that autism is not a genetic disorder alone. Rather, environmental factors and gene-environment interactions are also known to play a role in the etiology of each individual patient’s condition. Even similar gastrointestinal symptoms in autism patients may have different causes. For example, in some patients, GI symptoms like diarrhea or constipation may be the result of an inflammatory bowel disorder like Crohn’s disease, ulcerative colitis, or autism-associated ileocolitis. In other patients, GI symptoms may arise from non-inflammation-related conditions, like disruptions in the health of the microbiome.
Considering the Feasibility of Different Alternative Treatment Options for Individual Patients
Given the diametric opposition of certain symptoms (like diarrhea and constipation) and the different biological and environmental factors underpinning individual symptoms, it comes as no surprise that scientists have been unable to distinguish a single go-to therapy among all the alternative treatment options for autism. In fact, the effectiveness of the conventional therapies can be extremely just as varied amongst patients; certain strategies work well for patients with autism, while others seem to have little effect on symptoms. In so many cases, it simply depends on the patient.
Dietary changes and nutritional supplements are among the most commonly used alternative therapies for patients with autism, but the clinical data suggests that no single treatment will work for every patient. According to a 2017 systematic review of the nutritional approaches to autism management, there is evidence that elimination diets (such as gluten free/casein free and ketogenic diets) can help, as can introduced camel milk, curcumin, probiotics, and fermentable foods. At the same time, the reviewers identified high-sugar diets, synthetic food additives, pesticides, genetically modified foods, highly-processed foods, and certain starches as possible aggravators of GI and/or behavioral symptoms. Nevertheless, since the evidence for each individual option was limited, the researchers’ final conclusion was that more research was necessary.
However, even without a rigorous scientific consensus, patients and practitioners can build on the preliminary research to narrow down the options for particular patients, depending on what is feasible based on their symptoms and lifestyle. For example, if it is determined that a patient has an inflammatory bowel disease, an elimination diet that is designed to reduce inflammation—such as the Autoimmune Protocol Diet—be an appropriate intervention. Alternatively, if inflammation is not a factor, it may be better to add fermented foods to the patient’s diet in order to support a healthy microbiome.
Still, these dietary changes are simply unfeasible for some patients and families. Following a highly restrictive elimination diet can significantly disrupt everyday life to the point where some patients may not even consider it worth the resulting symptom relief. On the other hand, some patients with autism have the opposite problem—that is, a problem with adding foods that might help ameliorate their symptoms. Studies show that some patients with autism have heightened sensory experiences related to eating, which can render the addition of strange new fermentable foods practically impossible, even if it might help support neurological or gastrointestinal health.
In these cases, patients may want to look to nutritional supplements, since these treatment strategies can be easier for patients to follow. Instead of fermentable foods, a probiotic or prebiotic supplement may be a good choice, since these kinds of supplements can help address deficiencies in the gut microbiome, which are associated with the neurological and gastrointestinal symptoms of autism. Similarly, a butyric acid supplement may help relieve symptoms for patients with microbiome-related symptoms; butyric acid and other short-chain fatty acids are involved in a variety of body processes associated with autism symptoms and may not be adequately produced by the gut bacteria in patients with autism. For patients with inflammation-related GI symptoms, a curcumin supplement is another feasible alternative treatment option. In fact, a supplement may actually be more effective than a dietary intervention, since the latest formulations are designed to improve bioavailability, making them more effective for dampening the immune response and combating inflammation-inducing free radical damage in the gut.
Given the genetic and symptomatic diversity among patients with autism, it is important for patients and practitioners to recognize the therapeutic potential of a wide range of alternative treatments for autism. While complementary therapies are worth considering, the treatment strategy ultimately comes down to the specific needs of the patient, in terms of both the direct effectiveness of the treatment and the impact it has on the patient’s life. A targeted, highly bioavailable supplement can be an easy way for patients to target some the diverse causes of autism without severe lifestyle disruptions like food restrictions and introductions.
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