The prescription of nutritional supplements is one of the most common treatments for autism but little research exists about the effectiveness of supplements in autistic children and adults.  According to the authors of this study, 49% of physicians recommend vitamin / mineral supplements for children with autism.  In light of this fact, the authors designed a trial to determine if the recommendation is useful.  The randomized, double-blind, placebo-controlled three month vitamin / mineral intervention study was published in December 2011.  The study involved 141 children and adults with autism.   The researchers insured that none of the participants had taken a vitamin / mineral supplement for at least 2 months prior to the commencement of the study.  The outcomes that were assessed during the trial included nutritional status, metabolic status and scores on the Parental Global Impressions – Revised (PGI-R) Scale.  The PGI-R is an assessment tool that asks caregivers to rate the changes in certain symptoms over time on a scale from 1 to 7 with 1 being ‘much worse’ and 7 being ‘much better.’  The symptoms specified by the PGI-R are Expressive Language, Receptive Language, Hyperactivity, Tantrumming, Play, Cognition, Gastrointestinal Symptoms, Sleep, Sociability, Eye Contact, and Overall.

     When compared with healthy children, children with autism had statistically significant differences in their average levels of many important molecules such as biotin, glutathione, S-adenosylmethionine (SAM), plasma ATP and plasma tryptophan.  The autistic children also had higher levels of oxidative stress biomarkers.  During the study, the participants had a compliance rate of over 95% and both the vitamin / mineral supplement and the placebo were well tolerated.  The participants in the supplement group improved the levels of all of the biomarkers and in some cases, completely normalized the levels to match those of healthy children.  I should probably mention that lab tests were only performed with the local children who participated in the study.  Therefore, most of the reported results are in reference to the small group of local pediatric participants (there were 53 children ages 5-16 in this group).  All 141 participants were assessed using the PGI-R Scale at the conclusion of the study.

     Overall, the participants in the supplement group had significantly greater improvement than the placebo group on the Average Change of the PGI-R scores.  The supplement group actually reported approximately twice the improvement when compared with the placebo group.  The Average Change of the PGI-R scores refers to the overall combined average of all the PGI-R scores.  The most interesting part of this study is the association of certain nutrient levels with the Average Change of the PGI-R scores.  Through statistical analysis, the researchers determined that the levels of biotin, Vitamin K and lipoic acid were strongly associated with the Average Change of the PGI-R scores in the small sub-group of local children.  As pointed out by the authors of the study, both biotin and Vitamin K are produced in the intestines by the beneficial bacteria known as probiotics.  It is estimated that half of the biotin and Vitamin K in humans is produced by our intestinal flora.  It is also known that children with autism not only have a higher incidence of GI problems than healthy children but also, on average, have a much higher use of oral antibiotics in their past medical history than healthy children.  After reading these results I performed a quick literature search to find out if anyone had supplemented autistic patients with probiotics and then measured the outcome.  Shockingly, no trials have ever been performed looking at the potential benefits of probiotic supplementation in autistic patients (according to PubMed).  Currently there is not even a trial in progress (I checked the NIH Registry) that is looking at probiotics as a potential treatment for the symptoms of autism.  I did find several published reviews that suggest controlled intervention trials should be designed and performed but to date, none are being performed.  It will be a long time before we know if probiotic supplementation in autistic patients is helpful but, for now, thanks to this study, we do know that prescribing a multi vitamin / mineral to autistic patients is a well-tolerated, reasonable and beneficial treatment.

Adams, James, Tapan Audhya, et al. "Effect of a Vitamin/mineral Supplement on Children and Adults with Autism." Biomed Central Pediatrics. 11.111 (2011). Web. 18 Jan. 2012. 

     While this treatment has yet to be universally accepted by conventional medicine, a relevant study that involved collaboration between The University of Pittsburgh, the Portland VA Medical Center and the VA Pittsburgh Healthcare System was published in September of 2010.  The study concluded that there is in fact a schizophrenia-associated niacin response abnormality and attempted to determine a potential cause for the reduced niacin skin flush.  Hopefully over time, more studies that investigate the connection between niacin and schizophrenia will provide concrete answers and a treatment regimen that is accepted by conventional medicine.  Until then, Dr. Abram Hoffer recommends that schizophrenic adults begin with one gram of niacin three times a day and slowly increase to 4,500-18,000 mg per day to achieve the best possible outcome.  Dr. Hoffer also recommends other nutrients in addition to niacin such as Vitamin C.  Please consult the references below, especially the Alternative Medicine Review, and your naturopathic physician before attempting to implement this nutrient protocol.