Compounded Dietary Supplements for Autism: Deficits, Excesses, and Helping Parents Make Choices
After the FDA cracked down on providers touting quack treatments to cure autism, a concerned hospital manager asked me whether parents cared about evidence-based services. The short answer—yes, of course they do—is lost in the bigger truth that evidence-based options are limited. In 2014, the Agency for Healthcare Research and Quality reported that the existing evidence was weak and substantial scientific advances are needed to determine best practices in autism treatment.1
Where does this leave parents desperate to help their kids? They’re not going waste precious time waiting for reliable studies, so they turn to treatments that may be largely unproven but seem safe. Dietary supplements for autism are one such treatment chosen by half of all parents. Compounding pharmacists are in the perfect position to counsel these parents about choosing appropriate vitamins, potential toxicities, and the benefits of custom compounded dietary supplements.
Why Parents Treat with Vitamin Supplements
Feeding problems are common in children with autism spectrum disorder (ASD), so it’s natural for parents to worry about nutritional status and figure that supplements can fill the gap. The core deficits of autism—restricted communication, difficulty with social interaction and repetitive rituals—certainly make mealtimes a challenge, but other co-occurring issues contribute to restrictive feeding patterns.
Imagine trying to get your child to eat a balanced diet if they had impaired brain connections that affected their sensory system, making them unable to tolerate crunchy or mushy foods, or causing an involuntary gag response at the slightest whiff of certain odors. At least 90 percent of children on the autism spectrum have this exact problem, called sensory processing disorder.2
Gastrointestinal problems also factor into food avoidance, which limits nutritional intake and may interfere with nutrient absorption. Compared to their typical peers, children with ASD are more likely to have food allergies and intolerances. Their risk of general gastrointestinal problems, such as diarrhea and constipation, is threefold higher and they’re at double the risk for suffering from abdominal pain.3
Nutritional Needs Versus Potential Toxicities
After studying the daily diet of 288 children diagnosed with ASD, estimating their micronutrient intake from food and supplements, and comparing that data with Dietary Reference Intakes, researchers produced some surprising information. Even though half of the children took multivitamins, nearly one-third of them remained deficient for vitamin D and about half stayed low in calcium.4
On the flip side, taking supplements led to excessive intake of folate, vitamin A, and zinc in all of the children. The 2 to 8-year-olds consumed more copper than they needed, while those in the the 4 to 8-year-old group also had high levels of manganese. When the tolerable upper intake is exceeded, these nutrients become toxic. This is a big concern because early signs of toxicity are hard to distinguish from autism-based issues. GI problems are the first symptoms of excessive copper and vitamin A, while cognitive or behavioral deficits arise from toxic manganese.
Tips for Counseling Parents
Autism is truly a spectrum disorder that defies a one-size-fits-all approach. What works for some, won’t even begin to help others. Any treatment, including dietary supplements, must be customized to each individual, which makes compounding pharmacists a great resource.
When you have the opportunity to counsel parents seeking supplements for their children with ASD, keep these tips in mind:
- Tell them it’s important to know their child’s total nutrient intake from dietary sources before adding supplements because the cumulative effect can lead to excessive intake and toxicity.
- Parents can keep track of everything their child consumes for a week, then tally nutrient intake using the food nutrition label or online resources, but this is an overwhelming job if they want to track all the essential nutrients.
- Advise them to consult their pediatrician or a registered dietitian. This is an opportunity for compounding pharmacists to reach out to health care and autism service providers and create working partnerships.
- Some evidence suggests that multivitamins boost metabolic markers such as antioxidants and methylation, but targeted supplements for nutrients such as vitamin D and calcium may be all that’s needed.5
Benefits of Compounded Dietary Supplements
Many parents of children with autism are wary of unwanted ingredients in supplements and medications. They may also be familiar with biomedical treatments, from probiotics and enzymes to special diets. But they may not be fully aware of the benefits they stand to gain from compounded pharmaceuticals.
When encountering parents, don’t hesitate to speak with them about these advantages, which are highly desired for autistic children and available only from compounded products:
- Doses and individual nutrients that can be compounded to provide precise individual needs and avoid consuming excessive nutrients.
- Bulk APIs from FDA-approved facilities that ensure purity and safety.
- Ability to control excipients and formulate supplements that are free of gluten, casein, dyes, yeast and other additives.
- Alternative forms such as flavored liquids and lollipops that make supplements easier to swallow.
Counseling to Meet Individual Needs
Parents shopping for OTC supplements are a diverse lot. Some are already convinced their child needs multivitamins/minerals; others aren’t so sure. Their sole motivation may be the knowledge that their child doesn’t eat well. Or they may feel pressure from other parents who saw amazing progress after using supplements. A few will have been to doctors who did blood tests and are implementing biomedical protocols, but most are on their own because insurance doesn’t cover alternative treatments. As a group, they depend on compounding pharmacists for information and guidance about nutritional supplements. As compounding pharmacists, we should be poised to address parent questions and concerns in their quest to raise healthy children.
ASD patients in need of specially compounded supplements and medications represent a growing market for your pharmacy. Count on Pharmaceutic North America for compounding kits, bulk APIs and quality delivery systems that support your practice. Please contact Pharmaceutica North America to talk about how we can help you.
- “Therapies for Children With Autism Spectrum Disorder: Behavioral Interventions Update,” August 2014, http://www.ncbi.nlm.nih.gov/pubmed/25210724 ↩
- “Autism and Sensory Processing Disorders: Shared White Matter Disruption in Sensory Pathways but Divergent Connectivity in Social-Emotional Pathways,” July 2013, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0103038 ↩
- “Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-Analysis,” May 2014, http://pediatrics.aappublications.org/content/133/5/872.long ↩
- “Dietary Supplementation in Children With autism Spectrum Disorders: Common, Insufficient, and Excessive,” August 2015, tttp://www.ncbi.nlm.nih.gov/pubmed/26052041 ↩
- “Effect of a Vitamin/Mineral Supplement on Children and Adults With Autism,” December 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266205/ ↩