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Nutritional and Dietary Intervention for Autism Spectrum Disorder – a new study

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The research confirms how effective nutritional psychiatry is for anxiety and depression (the SMILEs diet depression trial) so when a 12 month randomized trial reports the benefits of nutrition for autism spectrum disorder (ASD) we celebrate this too. Many of the same mechanisms that contribute to anxiety, can also play a role when it comes to ASD – such as food sensitivities, poor gut health, heavy metals, fatty acid imbalances and so on. Also, many children with ASD experience anxiety – 34 to 47% depending on whether you ask a parent of a teacher. Many adults with autism and Asperger’s syndrome also experience anxiety and overwhelm too. In one study 50% of adults with ASD experienced social anxiety.

This paper was published in March this year: Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder-A Randomized, Controlled 12-Month Trial and was

a randomized, controlled, single-blind 12-month treatment study of a comprehensive nutritional and dietary intervention.

Treatment began with a special vitamin/mineral supplement, and additional treatments were added sequentially, including essential fatty acids, Epsom salt baths, carnitine, digestive enzymes, and a healthy gluten-free, casein-free, soy-free (HGCSF) diet.

Here is the year-long protocol for the study participants:

Day 0: Vitamin/Mineral supplementation begins.
Day 30: Essential Fatty Acid supplementation begins.
Day 60: Epsom salt baths begin.
Day 90: Carnitine Supplementation begins.
Day 180: Digestive Enzyme supplementation begins.
Day 210: Healthy, casein-free, gluten-free diet begins.
Day 365: Final assessment of autism severity and overall functioning status. Final blood draw and urine collection.

And these are the guidelines for the dietary changes for the study participants:

  1. Adequate intake of a variety of vegetables (including leafy greens) and fruit (preferably whole fruit).
  2. Adequate protein quality and intake.
  3. Adequate, but not excessive, caloric intake.
  4. Minimal consumption of “junk” foods and replacement with healthy snacks.
  5. Healthy, gluten-free, casein-free, and soy-free (HGCSF).
  6. Avoidance of artificial flavors, colors, and preservatives.

Parents of participants reported that the vitamin/mineral supplements, essential fatty acids, and HGCSF diet were the most beneficial. And when asked at the end of the study which treatments they planned to continue at the conclusion of the study, over 85% of parents said the vitamin/mineral supplement and the essential fatty acids were the most likely to be continued, 70% planned to continue the Epsom salt baths, 63% planned to continue the healthy HGCSF diet, and 44% planned to continue using the carnitine and digestive enzymes.

I’m really pleased that they mentioned the following limitation because we really do need to address the nutritional needs of each person:

all participants received all treatments, whereas probably only a subset are likely to benefit from any single intervention (for example, only participants with low carnitine are likely to benefit from carnitine supplementation)…. future studies could try to determine which treatments were most beneficial, using the results of this study to guide those future studies.

Despite the above study limitation, the treatment group saw the following improvements:

  • Improved nonverbal intellectual ability
  • Significantly greater improvement in autismsymptoms and developmental age
  • Significantly greater increases in EPA, DHA, carnitine, and vitamins A, B2, B5, B6, B12, folic acid, and coenzyme Q10

Many of the study participants saw improved communication skills as well as improved daily living skills and social skills – all of which can lead to reduced anxiety and social anxiety, and improved overall happiness.

The authors do mention that the combination of all of the above treatments is feasible for most families and that there were minimal adverse effects. They conclude that:

The positive results of this study suggest that a comprehensive nutritional and dietary intervention is effective at improving nutritional status, non-verbal IQ, autism symptoms, and other symptoms in most individuals with ASD [both children and adults].

Julie Matthews, one of the nutritionists supporting the study

My good friend and colleague, Julie Matthews, was one of the nutritionists supporting the study and is one of the co-authors on the paper. I’m so proud of her contribution to this research which further supports prior studies and the work she does clinically.

Julie is the author of Nourishing Hope for Autism: Nutrition and Diet Guide for Healing Our Children and the founder of the Bioindividual Nutrition Institute. She is hosting the Nourishing Hope for Autism Summit running July 30 to August 30 and she interviews lead researcher, James Adams, PhD, Director of the Autism/Asperger’s Research Program at Arizona State University. The interview is titled “The Scientific Evidence Linking Nutrition and Autism Improvement” so be sure to tune in if you’d like more information on this study and other dietary and nutritional interventions for ASD. (You can register here).

 

Shamus diagnosed with moderate to severe autism at age 2

Julie shares Shamus’ success story on her Nourishing Hope blog. He was diagnosed with moderate to severe autism at age 2.

When they began him on nutritional and biomedical protocols, his parents had no expectation of improved speech or ever “mainstreaming” their son. They just wanted him to sleep so they could cope with him being autistic.

Within 3 days of starting a gluten and casein-free (GFCF) diet his projectile vomiting stopped and his meltdowns reduced from 20 per day to just 3. The next step was the GAPS diet (Gut and Psychology Syndrome) which included broths and fermented foods, and did lead to worsening symptoms for a short time. Later on overgrowth of the harmful bacteria Clostridium difficile was addressed and other biomedical/nutritional interventions were included.

Today at age 10, Shamus shows no signs of autism and has been classified as “fully recovered!” He’s in a mainstream classroom at school, his teachers love him and he has a great group of friends. Shamus is great at team sports, and exhibits no problems in the classroom whatsoever.

I’m horrified that the doctor told this mom that she was over-anxious, had post-natal depression and needed to take an antidepressant (but that’s another entire blog post).

 

Both children and adults benefit from dietary changes

I find it very encouraging that the study participants were both children and adults with autism spectrum disorder and their ages ranged from 3 years to 58 years. Julie shares this inspiring and hopeful comment in the press release:

The study also shows that no matter the age of the individual with autism, diet and nutrition intervention can help. It’s never too late to be nourishing hope!

I agree, it’s never too late to make changes. This wonderful success story about an older gentleman with autism is just one example. Carolyn Gammicchia, mom/wife/autism advocate/ disability activist, shared the following on Facebook shortly after the study was published:

I have spoken to many people across the country who implemented this in older individuals, one man was 51 from TX who had been institutionalized and had not spoken. He was in very poor health when a wonderful lady took him in and somehow got my number and called me. She had seen a presentation I had done about five years ago about this and she weaned him off multiple medications, cleaned up his diet (went GFCFSF i.e. gluten-free, casein-free and soy-free) and supplemented with vitamins and minerals, plus exercise. He started speaking, lost 50 lbs, and is able to work now. It works!

Diet reduces anxiety and depression and helps with bipolar and schizoaffective disorder too

I mentioned nutritional psychiatry at the start so here are a few blog posts that highlight how diet reduces anxiety and depression and helps with bipolar and schizoaffective disorder too.

Going back to the study limitation – what this all means is finding the right combination of dietary and nutritional interventions for each person. There is no one-size fits all and bioindividualized nutrition is key – for ASD, anxiety, depression and any other condition.

We’d love to hear what dietary interventions you’ve used with success with a loved one with autism or Asperger’s syndrome.  Have these changes also reduced anxiety and improved other mood symptoms?

If you’re a practitioner, feel free to share a success story about one of your clients/patients with ASD.

Do also share some tips that you have found make this dietary transition easier and some challenges you have faced. Feel free to post your questions too.

The ketogenic diet for mental health, weight loss, inflammation and disease prevention

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I wasn’t aware until recently that “KETO”, “Ketones” “Keto diet”, “Ketogenic lifestyle”, “Ketosis” and “Ketogenic diet” are some of the MOST SEARCHED terms on the internet today.

But there is a good reason for this and host of  The Keto Edge Summit (which runs from May 7-13, 2018), Dr. David Jockers shares this:

The goal of the ketogenic lifestyle is to adapt the body to utilize FAT as its primary fuel source instead of SUGAR.

For our ancestors, eating three meals a day just wasn’t a thing. Instead, they’d hunt and forage for the foods they could find. When there wasn’t food, they wouldn’t eat.

Sometimes they’d go for days without food. To sustain life during times of scarcity, the body is thought to have developed the ability to utilize fat as an alternative fuel source.

Today, there’s an abundance of food available to most of us at all times. We regularly eat three meals per day with intermittent snacking between them.

This kind of frequent eating, along with an overemphasis on carb-rich and sugary foods, causes a REDUCED ability to burn fat. Because we don’t have to hunt or forage for food; we’ve become “sugar burners.”

As these sugar-laden foods damage our bodies, we rely MORE on sugar and lose the ability to produce ketones – as a result, massive blood sugar spikes, inflammation, hormone imbalance and ultimately many of the chronic diseases that plague us today.

In a traditional nutrition course, you’d learn that sugar is the body’s PRIMARY fuel source, while fat is secondary. What we’ve learned now (and so much research is supporting this) fat can be a healthier and more sustainable source of energy.

Ketones help you burn fat for energy, powerfully reduce inflammation and show promise in preventing and eradicating diabetes, cancer, autoimmune and neurodegenerative diseases like Alzheimer’s and Parkinson’s, and they can even play a role in alleviating symptoms in mental health conditions like anxiety, depression and schizoaffective disorder.

One of the amazing speakers on the summit is Dominic D’Agostino, researcher and Associate Professor at the University of South Florida. I attended the Bioceuticals conference in Melbourne this past weekend and had the pleasure of hearing him present on this topic live and all I can say is wow! I don’t want you to miss out and now you don’t have to when you tune in via the Keto Edge Summit.

Here is one of the slides where he shares the many proven and emerging applications of nutritional ketosis:

The applications of nutritional ketosis are extensive – including epilepsy, type 2 diabetes, weight loss, NAFLD, mitochondrial disease and inflammation, with emerging evidence for acne, PCOS, wound healing, cancer, autism, ALS, MS, Alzheimer’s, the brain and anxiety.

(anxiety and depression fall under brain on the right and also under inflammatory disorders on the left)

I shared these case studies a few weeks ago in a blog post – Ketogenic diet: reductions in auditory hallucinations and delusions, better mood and energy, and weight loss. Two schizoaffective patients working with Dr. Chris Palmer, a psychiatrist from Harvard’s McLean Hospital in Belmont, Massachusetts, tried a ketogenic diet for weight loss:

  • After four weeks on the ketogenic diet, the female patient had resolution of her delusions and lost ten pounds.
  • The male patient experienced similar results with “dramatic” reductions in auditory hallucinations and delusions, as well as better mood and energy. He also lost weight, losing 104 pounds over the course of a year.

There is also research reporting the following results:

the patient’s behavior and intellect improved in regard to hyperactivity, attention span, abnormal reactions to visual and auditory stimuli, usage of objects, adaptability to changes, communication skills, fear, anxiety, and emotional reactions

ketone supplementation may represent a promising anxiolytic strategy through a novel means of inducing nutritional ketosis.

As Dr. Jockers states:

The GREATEST health discovery of this century may ALREADY be inside your body!

During this health summit, you’ll discover:

  • What is ketosis (and how does it work)?
  • Myths, and how to separate fact from fiction!
  • How to overcome the challenges of being “keto adapted.”
  • Whether you should start a keto diet (or not!).
  • How to shop, live and eat on a ketogenic lifestyle.

The Keto Edge Summit is online and available at no-cost from May 7-13, 2018! Register here

I will be in learning mode with you for the Keto Edge Summit. I’ve been following Dr. David Jockers for awhile and I’m very excited about the applications of a ketogenic diet for anxiety and depression, given what we’ve learned so far. It’s going to be a great educational opportunity for all of us.

Have you experienced benefits from a ketogenic diet? If yes please do share what benefits?

If you’ve had challenges being on a ketogenic diet please share those challenges too, so we can all learn.

Ketogenic diet: reductions in auditory hallucinations and delusions, better mood and energy, and weight loss

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Two schizoaffective patients of Dr. Chris Palmer, a psychiatrist from Harvard’s McLean Hospital in Belmont, Massachusetts, tried a ketogenic diet for weight loss. As well as losing weight, they experienced reductions in auditory hallucinations and delusions, had a better mood and had more energy.

Here is additional information about these remarkable results, published late last year in this letter to the editor – Ketogenic diet in the treatment of schizoaffective disorder: Two case studies.

The male patient: lost weight, reductions in auditory hallucinations and delusions, better mood and energy

The male patient, diagnosed with schizoaffective disorder, with a prior psychiatric history of attention deficit hyperactivity disorder and major depression, experienced “dramatic” reductions in auditory hallucinations and delusions, as well as better mood and energy on the ketogenic diet. He also lost weight, losing 104 pounds over the course of a year.

He weighed 322 lb and wanted to lose weight by following a ketogenic diet, typically consisting of coffee with medium chain triglyceride (MCT) oil and butter (“bulletproof coffee”), eggs, meat, fish, poultry, spinach, kale, and olive oil. Within 3 weeks, he had lost 15 lb, but also noted a dramatic reduction in his auditory hallucinations and delusions, and improvement in his mood, energy, and ability to concentrate. For the past year, he has largely remained on this ketogenic diet and has lost 104 lb.

His functioning has improved and he has become more independent:

He completed a certification course, successfully participates in an online college program, has friends, began dating, and moved from his father’s home into an independent apartment.

The female patient: lost weight, resolution of her delusions

After four weeks on the ketogenic diet, the female patient, also diagnosed with schizoaffective disorder, and with a prior psychiatric history of major depression and anorexia nervosa, had resolution of her delusions and lost ten pounds:

she wanted to lose weight, and went on a ketogenic diet, consisting mostly of coffee, eggs, poultry, and lettuce. Within 4 weeks, she lost 10 lb and noted that her delusions were no longer present, and that her mood and energy were much better. After 4 months, she lost a total of 30 lb and her PANSS score decreased to 70 [down from 107]

In both instances their symptoms returned when they stopped the diet, but then improved again when back on the ketogenic diet.

In case you’re not familiar with the ketogenic diet here is a quick summary:

The ketogenic diet is a high-fat / low carbohydrate [and low protein] diet that has been used since the 1920’s to treat childhood epilepsy, with some studies suggesting that over 50% of patients experience significant reductions in seizure frequency. The ketogenic diet results in ketone bodies, instead of glucose, being used as the primary energy source in the brain.

There simply is no psychiatric medication available with the power to accomplish these results

I had the pleasure of meeting Dr. Georgia Ede, MD  last year at the ISNPR conference. She is a Harvard-trained psychiatrist and nutrition consultant practicing at Smith College, and writes about these two schizoaffective cases in her article – Low-Carbohydrate Diet Superior to Antipsychotic Medications:

These outcomes are truly remarkable: improvement by dozens of points on the PANSS, significant weight loss, and better quality of life. There simply is no psychiatric medication available with the power to accomplish these results.

I agree with Dr. Ede especially when we look at the medications these patients had trialed. These medication trials for the male patient: methylphenidate, amphetamine salts, dextroamphetamine, bupropion, sertraline, paroxetine, buspirone, lamotrigine, lorazepam, clonazepam, gabapentin, haloperidol, perphenazine, aripiprazole, olanzapine, quetiapine, and clozapine. The female patient had a similarly long list of medication trials and she also received 23 electroconvulsive therapy treatments. For both of them, positive and negative symptoms persisted.

I do still have questions about the ketogenic diet

The research in epilepsy is extensive and the research in mental health is growing. I am really impressed with the results, but I do still have questions about the ketogenic diet. Perhaps you have some similar questions and concerns. Here goes…

  1. If this particular nutritional psychiatry approach works so well for severe mental health disorders such as schizophrenia and psychosis, how will it work for less severe conditions like anxiety and panic attacks? Are these severe cases like the “canaries in the coal-mine” paving the way and teaching us about the benefits of this way of eating?
  2. Should you use a ketogenic dietary approach as the first approach or consider it as a last resort once the other dietary approaches have been implemented and you’re not seeing full symptom resolution? In other words, should you start with a real whole foods diet, then implement a gluten-free diet, then a grain-free diet, then remove dairy (if it’s an issue), then incorporate low FODMAPs if needed and only then implement a ketogenic diet? (low oxalate, low salicylate and low histamine would be incorporated as needed earlier in the process, based on each person’s unique needs).  If we look only at schizoaffective disorder,  there is growing evidence of the role of gluten  in some individuals with this paper “suggesting that an antigliadin IgG positive population of schizophrenia could be a distinct subgroup.” This 2 person pilot study reports the benefits of a gluten-free diet: “this potential mechanism is exciting and may provide improvement for up to one-fourth of patients (antibody-positive) who suffer from this devastating disorder.”
  3. How do we clearly define a ketogenic diet and communicate this definition to practitioners and to those who choose to implement this way of eating on their own? I’ve had feedback from many people who tell me they have been on a ketogenic diet (and it’s worked well for them or maybe it hasn’t worked so well for them), only to discover they are not really eating a true ketogenic diet. How do we simplify this way of eating and make it easy for individuals to understand and then stay in ketosis?
  4. How do we create a ketogenic diet that is nutrient dense and also offers the benefits seen in this research. I have major concerns about long-term nutritional deficiencies with a diet of coffee, eggs, poultry, and lettuce (as eaten by the female patient in this case study). It should ideally include plenty of leafy greens, non-starchy vegetables like broccoli, cauliflower, asparagus etc. and healthy fats like avocado, grass-fed butter and coconut oil, together with fermented vegetables and bone broths. I’m also not convinced that coffee should be part of the ketogenic diet, especially if coffee increases your anxiety and affects your sleep.

  1. How do we help individuals make the switch to this way of low carb eating and help them maintain so they don’t feel deprived and are not relying on willpower alone? As you can see from these 2 cases, the diet can be challenging to sustain and slip ups are common. If you are eating enough health fats (and it’s a lot more than you’re used to eating), this typically helps with cravings. If you still have cravings and feel you are deprived and missing out on treats, the targeted individual amino acids offer powerful results: tryptophan (for afternoon cravings), GABA (for stress eating), DPA (for comfort eating), tyrosine (when there is low motivation) and glutamine (for low blood sugar cravings).
  2. Is the ketogenic diet the next big fad or weight-loss trend as we’re hearing in the media? Based on the above research it truly does have impressive therapeutic benefits beyond only weight-loss. So can we see similar benefits with a modified ketogenic diet, using intermittent fasting and/or cycling in and out of ketosis, and even adding in a ‘feasting day’ of carbs?
  3. Who shouldn’t adopt a ketogenic diet? For example: those with the APOE4 gene, women with adrenal and hormone issues, and individuals with thyroid issues and no gallbladder? The question then becomes this: of those suffering with anxiety and depression or another mental health disorder, who doesn’t have one of these issues? And how do we address the keto rash, constipation, fat malabsorption, fatigue, mineral deficiencies and other issues some people experience on a ketogenic diet?

Right now, this is my thinking: as with any nutritional or functional medicine approach, I would say there is no one-size-fits all for who should implement a ketogenic diet (we need to consider the unique biochemistry of each person) and there is no one set ketogenic diet (it will need to be customized for each person).

I’m hoping to get answers to many of these questions on the upcoming Keto Edge Summit (May 7-13, 2018), hosted by ketogenic diet expert, Dr. David Jockers. If you have similar questions, be sure to tune in too.  I’m going to reach out to Dr. Jockers for an interview too.

I’m also hoping to do my own interview with Dr. Palmer to discuss his interest in the ketogenic diet for mental health, to learn more about these cases and other patients he’s seen success with. Feel free to post your questions for Dr. Palmer (and Dr. Jockers) here and I’ll be sure to get them addressed.  We certainly appreciate Dr. Palmer for sharing these results so we can all learn, and also appreciate his patients for being willing to share their stories.

Please do share if you’ve adopted a ketogenic diet and the benefits you have experienced, and if you experienced any issues. Be sure to share what a typical day’s diet looks like for you.

An “omnivore” like diet or Paleo diet is associated with reduced anxiety and depression

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A new study published last month, Do patterns of nutrient intake predict self-reported anxiety, depression and psychological distress in adults? SEPAHAN study, reports that

An “omnivore” like diet high in amino acids, cobalamin, zinc, phosphorus, saturated fat, cholesterol and pantothenic acid is associated with reduced psychological disorders.

This was a cross-sectional study, meaning it was a type of observational study design where the outcome and the exposures in the study participants are measured at the same time. The aim was to find an association (rather than causal relationship) between patterns of nutrients intake and psychological disorders such as anxiety and depression.

The study authors had 3846 Iranian adults between 18 and 55 of age complete questionnaires in order to assess their diets and nutrient patterns, as well as psychological factors including anxiety, depression, and overall health in general. This group comprised 1712 males and 2134 females.

The study results

After calculating the daily intakes of 57 nutrients (including individual amino acids,

starch, dietary fiber, simple sugars, different fatty acids, vitamins, minerals, and bioactive substances), 3 nutrient patterns were identified:

1) the “omnivore” pattern

high in individual amino acids, cobalamin, zinc, phosphorus, saturated fatty acids, cholesterol and pantothenic acid

in both women and men, with pyridoxine (vitamin B6) high in men only

2) the “grains and dairy” pattern

high in thiamin, folate, selenium, iron, starch, maltose, betaine, calcium, riboflavin, and niacin

and low in the following

mono-unsaturated fats, vitamin E and polyunsaturated fats

3) “fruits and vegetables” pattern

high in copper, vitamin C, glucose, fructose, potassium, dietary fiber, sucrose, vitamin A, magnesium and vitamin K.

These are the associations that were observed after adjusting for confounding factors:

  • Men in the top tertile of the omnivore nutrient pattern had lower anxietyand depression scores than those in the bottom tertile
  • Women in the top tertile of the omnivore nutrient pattern had better overall poor health scores than those in the bottom tertile and had lower odds of psychological distress, such as anxiety and depression.

This type of diet is also referred to as a Paleo or cave-man type of diet. Even though this study was only showing associations and not a cause-and-effect, it’s still very encouraging to see new research in the field of nutritional psychiatry, further supporting the results we see in clinical practice.

What are the mechanisms?

The high amino acids provide the building blocks for the production of our feel-good neurotransmitters such as serotonin, GABA, dopamine and endorphins, with zinc being a key co-factor for making these brain chemicals. The authors share some of the mechanisms for the association in the discussion section of the paper:

Dietary protein intake and also individual amino acid status have been linked to psychological status in previously published studies. For instance, methionine in the form of S-adenosyl-L-methionine, tryptophan and serine were inversely associated to depression. Lysine, arginine, beta-alanine, tryptophan and tyrosine have been shown to have anxiolytic effects. As amino acids are important precursors for neurotransmitters; they might affect psychological condition. Important neurotransmitters like dopamine and serotonin are made from amino acids tyrosine and tryptophan, respectively.

Pantothenic acid is a B vitamin that is key for stress and adrenal health. Low levels of B12 or cobalamin can be associated with both anxiety and depression, as well as fatigue. Both zinc and B12 are common deficiencies, and more so in vegetarian and vegan diets. The authors discuss some possible zinc mechanisms:

  • zinc has antidepressant-like activities such as up-regulation of the expression of brain derived neurotrophic factor (BDNF) gene
  • zinc is an antagonist of the glutamate/N-methyl-D-aspartate (NMDA) receptor

Seeing saturated fat and high cholesterol mentioned in favorable terms in a study – both of which are needed for a healthy brain and for good blood sugar control – is always exciting. The authors discuss these possible mechanisms:

low serum total cholesterol may increase the risk of depression and suicide attempts. It is hypothesized that low cholesterol intake might cause a depressed central serotonergic activity which in turn leads to depression.

Here is my addition to the discussion: in our interview on a prior Anxiety Summit, Dr. Kurt Woeller and I discuss the link between low cholesterol and low oxytocin and the role this plays in anxiety, social bonding and depression.

One area I’m a little confused about is the findings on pyridoxine (vitamin B6). They report it was high only in men in the omnivore group, and not in women. As they report, vitamin B6 is also a key co-factor in the serotonin-tryptophan pathway and we know it’s important for alleviating anxiety- related PMS symptoms in women. It’s mentioned in the concluding paragraph for playing a role in the association for both men and women and yet it is not mentioned in the abstract. I’ll report back as I find out more.

Here are some actual real-life results from someone eating this way

I blogged about anxiety and depression success stories on Paleo and grain free diets around this time last year. I shared Andrea’s feedback about her diet-mood results with a grain-free and high fat diet:

I happened upon a fat loss diet that had me cut out grains, most dairy, and sugar while focusing on mostly meat, fish, fats from nature such as butter, olive, and coconut oils. Nuts, seeds, and legumes were allowed too. These rules made it so I had to avoid processed foods. There was one day a week of eating anything.

Within 6 weeks I was shocked that I got much much more than fat loss. My depression, anxiety, mood swings, sleep issues and all but one pesky health symptom disappeared. I was stronger, faster, and felt energy I never remember having.

Have you found benefits with an omnivore or Paleo diet? Less anxiety and depression? Better overall health? More energy? Better sleep?

If you’re a practitioner have you found this approach works with your clients/patients?