Survey Results: Nutraceuticals More Beneficial Than Pharmaceuticals for Autism

Emily Ansell Elfer

omega-3

This research provides important information on the overall and specific benefits and adverse effects of 58 of the most commonly used nutraceuticals in ASD.

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FAB RESEARCH COMMENT:

The data reported here are from a US survey completed by around 1,200 parents of children with Autistic Spectrum Disorders (ASD). Importantly, this means the findings are based purely on subjective reports, not on any formal evaluation of the effects - positive or negative - of the medications or supplements mentioned.

On parent ratings, nutritional supplements were generally perceived as having more benefits than drug treatments, and as having significantly fewer negative side effects.

No drugs or nutritional treatments have been approved specifically for ASD - which is not a unitary condition in any case. However, medications were used for co-occuring conditions, such as epilepsy, sleep problems or anxiety; and 3 in 4 of these parents had tried at least one of a wide range of nutritional supplements to see if these may help manage ASD or related symptoms.

Generic multivitamin supplements were the most commonly used 'nutraceutical' (by 34% of respondents), with omega-3 (including fish oils) a close second. Other individual nutraceuticals were used by around 1 in 10 parents surveyed.

Even for many typically developing children, the poor nutritional quality of typical modern diets means a reasonable case can made for both broad-spectrum multivitamin and mineral supplements, and long-chain omega-3 fatty acids, to avoid essential micronutrient defciencies. In children with ASD, the high prevalence of selective eating and restricted diets make such deficiencies even more likely, as previous studies have documented.

Good clinical trial evidence relating to ASD is still lacking, however, for most of the nutrients mentioned in this report. Meta-analysis of a few small trials suggests possible benefits from long-chain omega-3, and one trial (by this same research group) for a multi-nutrient formulation specifically designed for this population.

Given the huge need for better treatments for ASD, it is to be hoped that surveys like this one may help to generate and inform further research in this area.

For the underlying research please see:

Adams J et al 2021 - Ratings of the Effectiveness of Nutraceuticals for Autism Spectrum Disorders: Results of a National Survey

Why are nutraceuticals used for autism?

People with ASD often have a wide range of comorbidities and biochemical challenges such as oxidative stress and mitochondrial dysfunction. Nutritional supplements are often used to treat both core ASD symptoms and comorbidities, but some have not yet been formally evaluated for autism.

The potential biological mechanisms of nutraceuticals include correction of micronutrient deficiencies due to a poor diet and support for metabolic processes such as redox regulation, mitochondrial dysfunction, and melatonin production.

Survey results

The survey involved 1,286 participants from across the United States. Participants rated the overall perceived benefits and adverse effects of each commonly-used nutraceutical, and also indicated how specific symptoms changed and adverse effects. From these ratings, the top-rated nutraceuticals for each of 24 symptoms were listed.

Compared to psychiatric and seizure medications rated through the same survey, on average nutraceuticals had significantly higher ratings of overall benefit (1.59 vs. 1.39, p = 0.01) and significantly lower ratings of overall adverse effects (0.1 vs. 0.9, p < 0.001). Folinic acid and vitamin B12 were two of the top-rated treatments.

Nutraceuticals

Of the 123 nutraceuticals included in the survey, 58 had 20 or more responses. These nutraceuticals were reported in eight general categories—amino acids, essential fatty acids, glutathione-related nutraceuticals, individual minerals, individual vitamins/vitamin-like nutraceuticals, multivitamins, sleep treatments, and others.

The most commonly used treatments were generic child/adult multivitamin (34%), melatonin (29%), omega 3 fatty acids (15%), vitamin C (14%), krill oil (13%), fish oil (13%), vitamin D (12%), magnesium (12%), Epsom salts (11%), and zinc (10%).

Amino acids

Amino Acids were rated as having a slight to moderate overall perceived benefit with minimal adverse effects. For the amino acid blend, glutamine and taurine, the primary benefit was general benefit (43–57%) with small benefits in other symptoms. For tryptophan, the primary benefits were helping with falling asleep and staying asleep.

Fatty acids

Fatty Acids were rated as having a moderate to good benefit with minimal overall adverse effects. For all fatty acids, the primary benefit was general benefit (32% to 59%), with secondary benefits in attention and cognition.

Glutathione-related nutraceuticals

Glutathione-related nutraceuticals (including NAC) were rated as having a slight to moderate benefit with minimal adverse effects. The most common benefit was general benefit (4% to 56%).

Individual minerals

Individual minerals were rated as having a slight to moderate benefit with minimal adverse effects. The most common benefit was general benefit (15% to 70%). Lithium also helped with anxiety (24%), and magnesium helped with constipation (27%). Iron caused some gastrointestinal adverse effects in 17%.

Individual vitamins/vitamin-like nutraceuticals

These were rated as having slight to moderate overall benefits with minimal adverse effects. The most common benefit was general overall benefit (14% to 62%). High dose folinic acid (above 5 mg/day) improved cognition (33%), attention (29%), and language/communication (24%). Moderate dose folinic acid (below 5 mg/day) also improved language/communication (20%). P5P improved anxiety (20%) and TMG improved language/communication (29%). Injected vitamin B12 improved language/communication (30%), cognition (28%), and attention (20%). Oral vitamin B12 improved cognition (25%) and language/communication (18%). Vitamin C also improved overall health (27%).

Multivitamins

Multivitamins were rated as having a slight to moderate benefit with minimal adverse effects. The most common benefit was general benefit (50–55%). High dose multivitamin also improved general health (26%), and a high dose multivitamin, specifically designed for ASD, improved cognition (21%).

Sleep-related nutraceuticals

Sleep-related nutraceuticals were rated as having slight to moderate benefit, with minimal adverse effects. The primary benefit was falling asleep (36–74%), followed by staying asleep (27–35%). For 5-HTP, there was also a general benefit (27%). It is worth noting that melatonin had the highest overall benefit score and was used by a high number of participants.

Other miscellaneous nutraceuticals

For other miscellaneous nutraceuticals, the general benefit ranged from slight to moderate benefit with minimal adverse effects. All of these nutraceuticals had improvements in general benefit (22% to 67%). Epsom salts improved aggression/agitation (35%) and attention (26%). A fruit/vegetable powder concentrate also improved constipation (24%) and general health (24%). GABA improved anxiety (26%).

Top nutraceuticals by symptom

Information was gathered for the top-rated nutraceuticals for 24 different symptoms. For most symptoms, nutraceuticals were moderately effective (net benefit scores >0.25), including aggression/agitation, anxiety, attention, cognition, constipation, diarrhea, general benefit, health, hyperactivity, irritability, language/communication, falling asleep, staying asleep, and social interaction/understanding. Other symptoms were only slightly affected (net benefit scores between 0.10 and 0.25) such as depression, eczema/skin problems, lethargy, obsessive-compulsive symptoms, reflux/vomiting, sensory sensitivity, stimming and tics/involuntary movements.

It is worth noting that less common problems, such as seizures, might receive lower scores since fewer individuals have these challenges. The ratings should be interpreted cautiously, as they are averages, but they suggest which treatments families felt were most helpful for a given symptom.

Average result and overall effects of nutraceuticals

Averaging all the nutraceuticals reported in the paper, the overall benefit and overall adverse effect was 1.6 (SD = 0.3) and 0.1 (SD = 0.1), respectively, reflecting that participants reported slight to moderate benefits with minimal adverse effects.

As a final part of the survey, participants were asked to rate the overall effect of nutraceuticals. A total of 77% of participants reported that nutraceuticals had a positive effect, ranging from slightly better (24%) to much better (27%), with 23% reporting no effect, and no reports that they generally resulted in worsened symptoms.

“The results of this study found significant benefits for many nutraceuticals with minimal adverse effects and are consistent with the findings of a number of clinical trials studying nutraceuticals in ASD,” the researchers commented.

“Some of the nutraceuticals in this survey have not been previously studied in ASD including an amino acid blend, glutamine, taurine, tryptophan, evening primrose oil, flaxseed oil, krill oil, calcium, chromium, iodine, lithium, potassium, selenium, vitamin E, vitamin K, valerian root, Epsom salts, GABA, and milk thistle. Thus, this survey provides preliminary data on the effects (both beneficial and adverse) of these unstudied treatments which can help guide researchers to choose the most promising treatments to study in the future.”

Summing-up

This research provides important information on the overall and specific benefits and adverse effects of 58 of the most commonly used nutraceuticals in ASD. The overall benefits were rated slightly higher for the nutraceuticals than for the most commonly used pharmaceuticals reported in a previous paper, with significantly lower ratings of adverse effects.

The perception of participants of slight/moderate benefit with minimal adverse effects potentially explains why nutraceuticals were used by 75.2% of individuals with ASD in the survey.

This new research is consistent with the growing number of positive randomized clinical trials of nutraceuticals in ASD, but further research into nutraceutical treatments for biochemical differences and ASD symptoms is needed.

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