Novel Personalized Dietary Treatment for Autism Based on the Gut-Immune-Endocrine-Brain Axis

Abstract

Autism spectrum disorder (ASD) is a neurodevelopmental condition manifesting with impaired social interaction and communication, and restricted and repetitive behaviors and interests. In this perspective article, a more comprehensive approach than the gut-brain axis, hereby termed the “gut-immune-endocrine-brain” axis, is taken, based on which a personalized treatment plan for ASD is presented. ASD has no known etiology or cure, making desperate parents willing to try any treatment that worked for an individual with ASD, without much regard for its effectiveness, safety or side effects. This has been the case for restrictive dietary interventions as gluten-free/casein-free and ketogenic diets and recently, probiotics have emerged as the new such fad. One of the concerns about these dietary and probiotic treatments is their non-specificity: they may not be effective for all individuals with ASD, not all probiotic strains may have the beneficial qualities advertised indiscriminately for probiotics, and strains conferring benefits in one condition may not be probiotic in another. Not all children with ASD show immune reactivity to dietary proteins in wheat and milk, and wheat and milk may not be the only dietary elements to which reactivity is exhibited, where dietary aquaporins that resemble human aquaporins may elicit antibody reactivity in genetically susceptible individuals, which may include individuals with ASD. These observations are utilized to formulate a three-step plan to create effective, targeted, personalized treatments with as few side effects as possible, enabled by a systems approach connecting the various findings for dietary, immune, and neuroautoimmune reactivity in individuals with ASD.

Dietary Intake, Nutritional Status and Sensory Profile in Children with Autism Spectrum Disorder and Typical Development

“…It is important to have a good knowledge of the different diets that children and adolescents with ASD are following to continue to study them and if it covers the recommended nutritional intakes so that health workers can provide scientific information in this regard. This finding attests once more to the need for personalized dietary recommendations for ASD [ 27 , 28 ].…”

“…The ASD group also showed higher tactile sensitivity, under responsive/seeks sensation, auditory filtering, and total sensory profile scores. A study using the same questionnaire for 281 children with ASD compared to age-matched peers with typical development reported similar results, showing ASD children´s greater sensitivity in the same aspects [ 28 ].…”

“…The use of this fat for treating epilepsy with ketogenic diets might be a reason for parents of children on an ASD-diet to consider it as beneficial for this common comorbidity [ 26 , 27 ]. However, the same randomized controlled trials show that coconut oil intake increases low-density lipoprotein cholesterol and total cholesterol when compared with other vegetable oils, and the current recommendation is to include it only within 10% of total caloric intake [ 28 ]. Interestingly, children with normal nutritional status in the TD group consumed significantly less coconut oil than the excess weight group, which is consistent with a broad range of studies proving a link between consumption of saturated fatty acids and an increase in fat cell (adipocyte) size and number [ 29 ].…”

Effects of l-Carnitine in Patients with Autism Spectrum Disorders: Review of Clinical Studies

“…The nutritional status of ASD patients has recently been considered a potential etiological factor for attention/communication disorders [6,46]. According to it, nutritional interventions, such as a ketogenic diet in ASD patients [47,48], need to evaluate carnitine intake through diet or supplemented carnitine because the high fat intake in this diet means more fatty acids need to be transported into the mitochondria for oxidation, requiring more carnitine and, therefore, increasing the risk of depletion of body carnitine stores in those ASD patients with low carnitine levels. Moreover, specific considerations, such as the features and behavior of ASD, might increase or even fall in the higher risk range, due to the sub-optimal nutritional status [44].…”

The Use of Probiotic Therapy in Metabolic and Neurological Diseases

“…Probiotics potentially impact gut microbiota communities to alter the levels of harmful metabolites in ASD children, reducing GI inflammation and intestinal permeability ( 1 , 99 ). However, the results of probiotic supplementation in individuals with ASD remain inconclusive and controversial.…”