Optimizing the Efficacy of Nutraceutical Complementary Therapies for Autism

Complementary therapies are experiencing broader mainstream acceptance within the clinical context of autism therapy. However, complementary therapies for autism are not without controversy. While parents of patients and clinicians report that complementary therapies, particularly nutraceutical therapies, are helpful, the scientific literature on the topic suggests that this isn’t uniformly the case. Now, some believe the variable bioavailability of nutraceuticals may explain inconsistencies in research findings. Additionally, increasing the bioavailability of nutraceutical supplements by catering their delivery mechanisms to the unique gut microenvironment in autism spectrum disorders is essential to providing better therapeutic benefits.

Parents Report Benefits of Complementary Therapies for Autism

Complementary therapies are defined as therapies that are used in conjunction with conventional medical treatments. Unlike alternative medicine, which seeks to replace conventional medicine, complementary therapies work alongside conventional treatments to promote more complete relief of symptoms while optimizing quality of life for the patient. Today, complementary therapies are increasingly being recognized as invaluable components of an integrative model of care.

For the treatment of autism, nutraceutical complementary therapies are particularly popular. Nutraceutical therapy refers to the use of food or food products, such as supplements, to provide medical benefits. Parents of children with autism often turn to these therapies because they may potentially alleviate autism spectrum disorder (ASD} symptoms that have not been successfully resolved using conventional medicine alone while also avoiding the risk of undesirable side-effects. Unfortunately, empirical studies are limited in their scope for assessing the efficacy of complementary therapies in general and nutraceuticals in particular for treating symptoms of autism. Instead, most studies focus on parent perception of the therapy’s efficacy in their child’s treatment.

According to a 2015 study, 74.5% of parents of children with autism reported that they had tried using a nutraceutical complementary therapy recently or in the past. Research indicates that a large majority of parents find these therapies to be valuable, with one study revealing that parents felt that 75% of the nutraceutical therapies they tried were at least somewhat effective in producing remission of general symptoms of autism or the specific symptoms for which the therapy was indicated. In a similar study, a majority of parents using nutraceutical complementary therapies for autism agreed that the therapies were often helpful in producing symptom remission and were at worst ineffective; no negative effects were reported.

These studies show that many nutraceuticals are experienced as an important part of many children’s autism treatment despite a lack of rigorous studies suggesting a single effective nutraceutical treatment regimen. If the science doesn’t demonstrate the success of nutraceuticals for treating the symptoms of autism, why do parents tend to think they work? What are parents seeing that researchers are not?

Explaining the Inconsistencies in Studies on Complementary Therapies

Parents are not the only ones who believe in the positive effects of nutraceuticals; clinicians too are increasingly integrating such therapies in treatment plans. Already, many clinicians are prescribing supplements like Omega-3 fatty acids, digestive enzymes, probiotics, and Vitamin D to address specific symptoms and observing their benefits.

However, the efficacy of these therapies remains controversial within the scientific community owing to conflicting research findings; some researchers conclude that nutraceutical complementary therapies may be efficacious whereas other researchers conclude the opposite. These inconsistencies may be caused by a number of factors. Such factors include methodology flaws that prevent the identification of positive results, inadequate supplement testing conditions, and the unique GI tract of ASD patients that interferes with nutraceutical bioavailability.

Many studies of complementary treatments for autism suffer from the same issues:

• Relying on parent reports of symptoms rather than firsthand reports of symptoms
• Lumping disparate types of therapies into one group
• Lumping disparate symptoms into one group
• Failing to connect specific therapies with response to specific symptoms
• Failing to control for or compare to conventional medicine

Any or all of these issues make differentiation between the most and least effective therapies impossible. They also preclude meaningful insight into whether specific complementary therapy regimens are helpful in reducing patient symptomatology. Thus, many complementary therapies for autism may be held back by study designs that fail to capture the benefits experienced by the patients or observed by parents and clinicians.

Nutraceutical complementary therapies, in particular, present an additional methodological challenge. Many nutraceuticals have their pharmacokinetics established in studies of healthy individuals. Popular supplements like fish oil are the perfect example of this phenomenon. The expected bioavailability of fish oil assumes the gastrointestinal tract of a neurotypical person. As a result, studies of the efficacy of fish oil in different pathological contexts use these assumptions to establish a dose-response relationship. ASD is typically accompanied by a substantially altered GI tract. Therefore, it is inadequate to use the same pharmacokinetic standards for fish oil for ASD individuals as for those without. This inappropriate expectation is part of a larger issue that could account for the discrepancies with the literature: autism-related GI issues can interfere with nutraceutical bioavailability and this nutraceutical bioavailability is essential for effective symptom remission. The ability to benefit from nutraceuticals may then vary from person to person based on their specific GI challenges, which could explain why some parents and clinicians report symptom improvement that research studies don’t reflect on a larger scale.

Bioavailability May Be the Key to Nutraceutical Complementary Therapies

Given the link between autism spectrum disorders and GI-tract pathologies, the primary challenge for GI-tract targeted nutraceuticals for autism is bioavailability. Unfortunately, current scientific literature on nutraceutical use in the treatment of autism-related symptoms does not account for bioavailability variation between individuals. Researchers also overwhelmingly do not test nutraceuticals in the context of highly bioavailable formats made specifically for treating individuals with autism but test in the context of common supplements. Common supplements are compounded (or prepared) without special release systems. As a result, many common supplements may have low bioavailability in autistic individuals. For example, one study found significant differences in the bioavailability of orally administered linoleic acid between neurotypical individuals and autistic individuals when using a traditional delivery system.

The bioavailability of nutraceutical complementary therapies for people with autism is a complex issue, as GI tracts and drug metabolism are markedly different in individuals with autism than in neurotypical individuals. People with autism may absorb nutraceuticals less efficiently (preventing the therapeutic concentration from accumulating) or with excess efficiency (causing a spike in nutraceutical plasma concentration which is then eliminated too quickly for sustained symptom remission). As such, treating individuals with autism requires a nutraceutical delivery system that can account for these abnormalities to optimize therapeutic efficacy.

In response to the growing body of evidence documenting the nature of autism-related GI pathologies, new nutraceutical delivery systems are already being developed to offer higher bioavailability of nutraceuticals. Cutting-edge delivery systems, such as those recently introduced by Tesseract Medical Research, are designed to allow complementary therapies for autism to produce better, more predictable results. As our understanding of the bioavailability challenges experienced by people with autism expands, such systems may one day become the standard for nutraceutical therapies targeting symptoms of autism, helping patients enhance quality of life.