Evidence Supporting a Nutritional Approach for ASD and Comorbid Conditions

Vicki Kobliner, MS RDN, CD-N, dives into evidence-based approaches for nutrition in autism, PANS/PANDAS, and POTS. She describes nutritional biochemistry and which nutrients are vital to proper gut and overall body function. The speaker discusses a 2018 study that employed holistic nutrition-based treatment strategies over 12 months. Kobliner underscores the gut-brain communication pathway and outlines what a nutrient-rich, healing diet looks like. She touches on PANS/PANDAS and POTS, noting that nutritional treatments and strategies greatly resemble those she discussed for autism. The presenter highlights inflammation as a driver for many behaviors and presentations of autism, PANS/PANDAS, and POTS. Kobliner underscores the importance of balance in a healthy diet before the Q & A session.

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In this webinar: 

1:56 – Nutritional biochemistry and neurological health
5:14 – Standard American Diet (SAD)
8:06 – Goals of nutritional intervention
9:35 – Systems and pathways affected by poor nutrition
10:09 – Study – Nutritional and dietary interventions for autism
12:08 – Study protocol
13:35 – Intervention reasonings – Multivitamins
14:30 – Essential fatty acids
15:08 – Epsom salt baths – sulfate
15:55 – Carnitine – mitochondria
16:40 – Common GI issues in autism
19:20 – Gut-brain axis and the microbiome
19:40 – Gluten/casein and soy
21:50 – Methylation/transsulfuration/Folate BH4
23:07 – Supplement contents and quantities
26:20 – Intervention diet contents
27:14 – Study results
29:55 – PANS/PANDAS introduction
31:45 – PANS treatment protocol and guide
33:45 – Dietary interventions for PANS/PANDAS
34:54 – Inflammation and diet
38:30 – Herbs and spices for treating OCD
41:25 – Summary
42:25 – POTS/Dysautonomia
44:08 – Foods to avoid while treating POTS
46:02 – Balancing nutrient density and over-restriction
47:12 – Chair analogy
48:15 – Q &A

Background

Kobliner explains how amino acids, vitamins, and minerals are integral factors in all biochemical processes, including neurotransmitter production and balanced gut microbiomes (1:56). She highlights the bidirectional gut/brain communication pathway, noting that more communication travels from the gut to the brain than vice versa (3:00). Therefore, she continues, diet and nutritional support serve as effective treatment options for many neurological and psychiatric conditions. GI difficulties commonly co-occur with neurological and psychiatric conditions and can be caused by things like stomach acid or food sensitivities (16:40). Koblnor explains that autistic children often have deficiencies in multiple vitamins (13:35), fatty acids (14:30), sulfate (15:08), carnitine (15:55), and B vitamins (21:50), and that many have antibodies to gluten and casein in their gut (19:40). 

The speaker outlines the Standard American Diet (SAD) as high in sugar and processed/refined foods and low in fiber and nutrition density (6:20). Such diets do not support a healthy gut microbiome. Kobliner underscores that imbalances in the gut microbiome affect digestion, inflammation, detoxification, mitochondrial function, immune system responses, and methylation/transsulfuration (9:35). She reiterates the importance of the gut/brain communication pathway (19:20) and highlights the significance of combining interventions to create holistic treatment plans (11:15). 

Evidence-based treatment of autism symptoms

Evidence-based nutritional interventions have proven effective for many neurological conditions, including autism. Intervention goals generally include (8:06): 

• Remove stressors like chemicals or infectious agents
• Replace digestive secretions by eating nutrient-dense, healing foods
• Reinoculate beneficial gut bacteria by taking probiotic foods or supplements
• Repair cellular integrity by supplying essential nutrients like zinc, magnesium, and B vitamins
• Rebalance lifestyle choices to accommodate a healthy cycle (e.g., sleep, exercise, and stress)

The presenter details a 2018 randomized placebo-controlled study on nutritional and dietary interventions in autistic children across 12 months. The writers hypothesize that a “combination of nutritional and dietary interventions would be effective in reducing autism symptoms and GI problems, and increasing overall function level” (10:09). Kobliner outlines study protocols, tools, and methodology (12:09). Interventions monitored in the study include various vitamin, essential fatty acid, and carnitine supplementation, Epsom salt baths, and diet changes (24:23). 

Study diets contained adequate intake of quality vegetables, fruits, and proteins, sufficient caloric intake (but not too much), minimal consumption of junk foods, healthy GFCF and soy-free diets (HGCSF), and avoidance of artificial flavors, colors, and preservatives (26:20). Study results show significant behavioral improvements in the treatment group compared to the non-treatment group (27:14). Kobliner notes that this study is open source and offers it as a great starting point for information and additional sources. 

PANS/PANDAS and POTS

PANDAS is characterized by clinically significant compulsions and/or disordered eating, which onset abruptly in association with other neuropsychiatric symptoms (e.g., ADHD, anxiety, developmental regression). PANDAS is also associated with streptococcal infections and is only diagnosed if symptoms are not explained by another known disorder (29:55). PANS is similar but not necessarily associated with streptococcal. Kobliner outlines treatment guidelines for PANS/PANDAS (32:50), noting that dietary intervention suggestions are similar to those for autism. Dietary interventions for PANS/PANDAS include:

• Nutrient-dense, whole, and clean plant food with clean proteins and fats.
• No processed foods or inflammatory compounds.
• Large amounts of anti-inflammatories.

For those with eating disorders, guidelines suggest frequent meals with higher fat content (33:45). 

The speaker emphasizes the role that inflammation plays in overall body health and function and outlines how to treat systemic inflammation via diet (34:23). She notes that some probiotics contain strep thermophilus and suggests avoiding these (35:45). Other interventions can include vitamin D supplementation, ibuprofen, lacto-fermented foods, probiotics (without strep thermophilus), alkalinization (e.g., vegetables), and prebiotics. Kobliner lists herbs and spices with anti-inflammatory, antimicrobial, and appetite-stimulating properties (38:30) and details compounds and herbs that can help treat OCD (39:30). While clinical evidence cannot define clear PANS/PANDAS protocol, Kobliner provides some overall suggestions: 

• Nutrient-dense, unprocessed whole foods in a diet free of food allergens and sensitivities
• Gut healing treatments, including probiotics, antimicrobial herbs, and an anti-inflammatory diet
• Addressing strep and other pathogens and stressors
• Immune-modulating foods and herbs
• Replenishment of depleted vitamins and minerals

POTS or Dysautonomia is a dysregulation of the autonomic nervous system expressed as abnormal control of heart rate, blood pressure, digestive processes, and other smooth muscles. This leads to orthostatic intolerance (dizziness, fatigue, nausea), abdominal pain, decreased cognitive function, headaches, and disrupted sleep (42:25). While treating POTS, the speaker suggests avoiding processed foods, artificial colors, or flavorings, canned/packaged foods, hydrogenated fats, oils, and caffeine (44:08). She also suggests increasing water/fluid and salt intake, using compression wear to support blood volume, getting adequate sleep and exercise and maintaining a diet similar to the ones discussed. B12, iron, and magnesium are especially supportive in treating POTS (44:45). Kobliner underscores balancing nutrient density and food elimination and warns against over-restriction (46:02). Everything that is removed must be replaced with something beneficial. She uses a chair analogy to reiterate holistic treatment strategies (47:12) before the Q & A (48:15). 

Published: 05/23/2018

Ms. Kobliner is a Registered Dietitian and owner of Holcare Nutrition (www.holcarenutrition.com). She practices a functional nutrition approach to help the body heal itself, and has extensive experience using various diet modalities to help children with autism and related disorders. Vicki works with infants, children, and adults with chronic illnesses, digestive disorders, food allergies, ADHD, and autism, and provides fertility and prenatal nutrition counseling. She is a contributing author to A Compromised Generation: The Epidemic of Chronic Illness in America’s Children.