Syndrome of allergy, apraxia, and malabsorption: characterization of a neurodevelopmental phenotype that responds to omega 3 and vitamin E supplementation
Morris C R, Agin M C (2019) Altern Ther Health Med 2009 Jul-Aug;15(4):34-43
Web URL: Read this research on PubMed
Abstract:
Objective:
Verbal apraxia is a neurologically based motor planning speech disorder of unknown etiology common in autism spectrum disorders. Vitamin E deficiency causes symptoms that overlap those of verbal apraxia.
Polyunsaturated fatty acids in the cell membrane are vulnerable to lipid peroxidation and early destruction if vitamin E is not readily available, potentially leading to neurological sequelae. Inflammation of the gastrointestinal (GI) tract and malabsorption of nutrients such as vitamin E and carnitine may contribute to neurological abnormalities.
The goal of this investigation was to characterize symptoms and metabolic anomalies of a subset of children with verbal apraxia who may respond to nutritional interventions.
Design and patients:
A total of 187 children with verbal apraxia received vitamin E + polyunsaturated fatty acid supplementation. A celiac panel, fat-soluble vitamin test, and carnitine level were obtained in patients having blood analyzed.
Results:
A common clinical phenotype of male predominance, autism, sensory issues, low muscle tone, coordination difficulties, food allergy, and GI symptoms emerged.
In all, 181 families (97%) reported dramatic improvements in a number of areas including speech, imitation, coordination, eye contact, behavior, sensory issues, and development of pain sensation.
Plasma vitamin E levels varied in children tested; however, pretreatment levels did not reflect clinical response. Low carnitine (20/26), high antigliadin antibodies (15/21), gluten-sensitivity HLA alleles (10/10), and zinc (2/2) and vitamin D deficiencies (4/7) were common abnormalities. Fat malabsorption was identified in 8 of 11 boys screened.
Conclusion:
We characterize a novel apraxia phenotype that responds to polyunsaturated fatty acids and vitamin E. The association of carnitine deficiency, gluten sensitivity/food allergy, and fat malabsorption with the apraxia phenotype suggests that a comprehensive metabolic workup is warranted.
Appropriate screening may identify a subgroup of children with a previously unrecognized syndrome of allergy, apraxia, and malabsorption who are responsive to nutritional interventions in addition to traditional speech and occupational therapy. Controlled trials in apraxia and autism spectrum disorders are warranted.
FAB RESEARCH COMMENT:
This study found striking benefits from supplementation with a combination of Vitamin E and omega-3 fatty acids in a large case series of children with 'developmental verbal apraxia' - a neurodevelopmental syndrome involving speech and language delay and diffculties with motor planning and coordination.Both motor and speech and language difficulties are often seen in children who are diagnosed with other neurodevelopmental syndromes, particularly autism but also dyspraxia (developmental co-ordination disorder or DCD), specific language impairment (SLI), dyslexia and ADHD.
Standard clinical assessment and management of such children does not usually include consideration of nutrition - even though food allergies and intolerances are commonly reported in all these populations.
Some randomised controlled clinical trials (RCT) have already reported that supplementation with the long-chain omega-3 fatty acids found in fish oils (EPA and DHA) can reduce ADHD-type symptoms, and one study also found significant improvements in reading and spelling in children with dyspraxia / DCD - but no group differences were seen for the core dyspraxic difficulties with motor coordination (for which there was a large placebo effect). See:
In children with autism, case reports and one very small RCT also indicate possible benefits from omega-3 supplementation:
While the supplements used in most studies to date have included a little Vitamin E (primarily to protect the omega-3 in the supplement from oxidation) this was only at very low dosage.
As this new study explains, modern western-type diets increase the risk of deficiencies in both Vitamin E and omega-3, as well as other nutrients that work in synergy with these to counteract and resolve inflammation and oxidative stress - which can easily be triggered by allergies to foods, chemical or other environmental exposures.
Mounting evidence indicates that these nutritional deficiencies may contribute to neurodevelopmental problems in children with a genetic predisposition to conditions.
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