Mel Seabright, PharmD, MBA
Mel Seabright, PharmD, MBA
Mel Seabright, PharmD, MBA, is a clinical pharmacist specializing in pharmacy benefits management and managed care. He has extensive experience in utilization management, medical writing and drug information.

An Unofficial Guide to Autism Supplements

FEBRUARY 05, 2016
It’s highly likely that someone you know has autism. 
 
According to the US Centers for Disease Control and Prevention, autism affects 1 in 68 children and is reported to occur in all racial, ethnic, and socioeconomic groups.1
 
Autism treatment consists of behavior and communication approaches, dietary approaches, medication, and complementary and alternative medicine. Risperidone is currently the only FDA-approved drug for the treatment of specific autism symptoms, which involve irritability in children aged between 5 and 16 years.

A casein-free, gluten-free, soy-free diet may be tried, and immunoglobulin G levels can be measured to determine whether limiting these foods may have a beneficial effect on the child.2 Currently, there is insufficient evidence to recommend this diet. If caregivers wish to try it, pharmacists should encourage them to do so in a safe and reliable manner.
 
Keeping a food and behavior journal is a helpful way to quantify the effect of dietary changes and supplements. On a personal note, I can tell you that a lot of these food substitutes are not very palatable and are also very expensive.
 
As a pharmacist, patients may ask you about supplements.  This puts you in a difficult position because there is very little data to support the majority of autism supplements.
 
In addition, a product that works in 1 child may have either no effect or a detrimental effect in another child. Encourage caregivers to consult with a physician about the need for laboratory monitoring before initiating therapy with any supplement or special diet.  
 
Potential autism supplements may include the following:

Vitamins
In a study by the Autism Treatment Network, investigators found that supplements and special diets for children with autism often result in excessive amounts of some nutrients, but deficiencies in others.3
 
Zinc 
Zinc deficiency has been found in infants with autistic spectrum disorders. Some patients with autism may have immune dysfunction, and zinc is given to enhance immunity. However, the Autism Treatment Network’s supplements study found that many children may be receiving too much zinc.4
 
Fish Oil 
Fish oil supplementation may be tried to decrease autism symptoms and encourage language development. While itis generally safe, a small Autism Treatment Network study found no benefits of omega-3 fatty acid supplement versus placebo.5
 
Probiotics 
Probiotics have been found to ease autism-like behaviors in a mouse model.6
 
N-Acetylcysteine (NAC)
In small study, NAC has been shown to lessen irritability in children with autism, as well as reduce children’s repetitive behaviors.7

Remember that it’s perfectly appropriate to tell patients that you can’t make specific recommendations for autism supplements. While you may not feel confident in making specific recommendations, remember to show empathy towards patients with autism and their caregivers.
 
References
  1. Centers for Disease Control and Prevention. Autism spectrum disorder (ASD): facts about ASD.  http://www.cdc.gov/ncbddd/autism/data.html. Accessed February 4, 2016.
  2. Autism Speaks. How helpful is the casein-gluten-free diet? https://www.autismspeaks.org/node/112986. Accessed February 4, 2016.
  3. Autism Speaks. For kids with autism, supplements often result in nutrient imbalances.  https://www.autismspeaks.org/science/science-news/kids-autism-supplements-often-result-nutrient-imbalances. Accessed February 4, 2016.
  4. Yasuda H, Yoshida K, Yasuda Y, Tsutsui T. Infantile zinc deficiency: association with autism spectrum disorders. Scientific Reports. 2011;1:129. doi:10.1038/srep00129.
  5. Autism Speaks. Autism study fails to show benefit of omega-3 fatty acids. https://www.autismspeaks.org/science/science-news/autism-study-fails-show-benefit-omega-3-fatty-acids. Accessed February 4, 2016.
  6. Autism Speaks. “Good” bacteria ease autism-like behaviors in mouse model. https://www.autismspeaks.org/science/science-news/good-bacteria-ease-autism-behaviors-mouse-model. Accessed February 4, 2016.
  7. Stanford Medicine. Antioxidant shows promise as treatment for certain features of autism, study finds. https://med.stanford.edu/news/all-news/2012/05/antioxidant-shows-promise-as-treatment-for-certain-features-of-autism-study-finds.html. Accessed February 4, 2016.


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