A Functional Medicine Approach to Autism
Rates of autism spectrum disorders are rising in the U.S., with 1 in 59 children diagnosed in 2014 according to the latest CDC estimate — a 15% increase from 2012.(1) We know that both genetics and environment play roles in the development of autism, but since human genes are not changing at rapid rates, an increasingly toxic environment is to blame.
Autism spectrum disorder (ASD) is a neurological and developmental disorder that begins early in childhood. It affects how a person interacts and communicates with others, and it is considered a “spectrum” because the symptoms can range from mild (poor eye contact, difficulty vocalizing feelings and emotions) to more severe (nonverbal and unable to follow instructions). Individuals with ASD may also have restricted interests and exhibit repetitive behaviors.
The development of ASD involves multiple organ system imbalances, including the brain, gut, and immune systems, and often problems in detoxification pathways. This is why a functional medicine approach is beneficial as we look at the entire picture of what’s happening and treat all imbalances.
Cleaning Up the Diet and Supporting Nutrition
The first step I recommend is following a primarily plant-based whole-foods diet that is free of gluten, dairy, and sugar, with an emphasis on consuming organic foods when possible. Removing packaged foods eliminates a lot of the toxic dyes and preservatives. Emphasizing vegetables such as leafy greens supports detoxification pathways and the gut microbiome. I also recommend adequate fat intake, especially good quality omega 3 fatty acids found in olive oils, low-mercury containing fish, walnuts, and nori seaweed.
Most patients on the spectrum are deficient in vitamins, minerals, and fatty acids, and addressing these deficiencies allows the body to function optimally. Patients receive thorough nutrient, vitamin, and fatty acid testing. I add a daily multivitamin and replace any deficient nutrients like iron, B vitamins, and Vitamin D.
All autism patients I have worked with have had some digestive issues, which signify altered gut microbiomes (bacteria and their metabolites). Some patients have such severe symptoms that they experience incontinence or chronic loose stools. Most have food sensitivities or allergies to multiple foods.
I recommend my patients have a comprehensive stool analysis where we look at the gut microbiome in depth to see the level of bacterial imbalance and if there are overt infections like parasites or yeast. For food sensitivity investigation, I place them on an elimination diet while we are waiting for blood testing to confirm which foods are causing them problems.
Patients with ASD have ramped-up immune responses in their brains, specifically the microglial cells, which police the brain for pathogens and other threats. Genes for inflammatory responses are turned on at higher levels in these patients, but we are not clear on what is triggering the response. Chronic infections like HSV, yeast, and mold, as well as heavy metal exposure, could be potential triggers. There is a definite connection between the gut and the brain, so controlling gut inflammation is also key to treatment of brain inflammation.
Along with evaluating for chronic infections, I also follow blood inflammatory markers like C-reactive protein and omega 3 and 6 fatty acids to assess full body inflammation. Cleaning up the diet and removing food sensitivities are the best tools for decreasing inflammation throughout the body. I also add supplements like high quality fish oils, curcumin, Vitamin A, Vitamin E, alpha lipoic acid, glutathione and glutathione precursors like N-acetylcysteine (NAC), and supplements targeted to microglial activation, like Glialia.
Our world today is loaded with toxins that have weakened our intestinal, immune, endocrine, and neurological systems, overwhelmed our detoxification systems, and can be passed from mother to child. More than 80,000 chemicals are registered for use in the United States, and each year an estimated 2,000 new ones are introduced.(2) These range from pesticides and herbicides on our foods to heavy metals in our personal care products, household cleaners, medical products, and water. Most registered chemicals are unregulated and have never been tested by the EPA. Some, including glyphosate, the main ingredient in Roundup herbicides that are now sprayed on almost all conventional food, have been identified as Class 2 Carcinogens.
There is mounting evidence that toxins play a major role in ASD, and most patients have genetic alterations that cause their detoxification pathways to be less effective, allowing toxins to build up in their tissues and brain, leading to inflammation and poor functioning. Toxins also feed chronic viral and yeast infections.
In treating ASD, I test for toxic burden in the blood and urine and then determine detoxification protocols based on what is found. I prefer slow, gradual detoxification protocols once we have strengthened the gut and have replaced nutrients.
Patients with ASD often also have ADHD and tend to have anger outbursts as well as hyperactivity. They suffer from sensory processing problems, which leave them in constant states of stress and elevated cortisol, manifested by “stimming,” or self-stimulating behavior of repetitive physical movements or sounds. By checking neurotransmitters like serotonin, dopamine, GABA, and glutamate, norepinephrine and epinephrine, and hormones like cortisol, we can identify which ones will benefit from a low glutamate diet, as well as supplements that support neurotransmitters like L-theanine, GABA, 5 HTP, and tyrosine. CBD oil is also helpful for anxiety, sleep, and outbursts.
ASD is one of the most complex disorders I treat, and it takes a team approach. I recommend my patients also see occupational therapists, physical therapists, acupuncturists, speech therapists, and massage therapists. It’s also important that the family is supported and participates in the care of the person being treated. Life’s journey can be more challenging along the autism spectrum, but thoughtful effort is rewarded with improved health and happiness.