Spotlight on Autism
Editorial by Deborah Colson, Nutritional Therapist, Brain Bio Centre
April is World Autism Awareness Month and this is a great opportunity to reflect on this complex condition and the supporting role of nutrition in its treatment.
Autism is defined as a complex, lifelong, neurodevelopmental condition of largely unknown cause. It is a condition, usually diagnosed in early childhood (at around 2-3 years of age), which is characterised by difficulties with socialisation, verbal and non-verbal communication, restricted and stereotyped interests and behaviours. The presentation of autism (signs and symptoms) varies widely amongst individuals. Research has identified a wide range of brain abnormalities. Genetics are involved too - a number of genes are associated with autism; however no single gene of overwhelming significance has been identified. Autistic children commonly have bowel irregularities  and there have been concerns over the links with vaccines although recent research has found no solid evidence to support this.
The conventional approach to autism involves a range of behavioural and learning strategies and there is no drug treatment available. The lack of pharmaceutical options for autism means that the pharmaceutical industry (the primary financier of medical research worldwide) has little interest in researching the condition. Research on nutritional approaches to autism is sparse – consider the practical and ethical challenges of conducting a randomised controlled trial on autistic children, and combine that with the lack of funding, and you begin to understand why.
Nutritional therapy for autism is complex and should be individualised and is best undertaken with professional guidance. The key factors which parents should bear in mind are:
1. All children benefit physically and mentally from a healthy diet. A typical autistic trait is to develop an extremely self-restricted diet, so a key challenge for all parents is to broaden the diet. This has to be done with patience and gentle persistence and often a great deal of imagination. Focus on foods which provide concentrated nutrition such as vegetables, fruits, oily fish, seeds and nuts. Unfortunately these are also the foods which most children tend to restrict.
2. Dump the sugar! We find at the Brain Bio Centre that almost all children eat more sugar than is good for them, and this impairs mental and emotional function and behaviour. Sometimes this is in the form of obvious sugar such as sweets and biscuits or less obvious forms such as cartons of juice or store-bought smoothies (these items have been heat-treated so the sugars are altered and therefore faster releasing) or white carbohydrates (white bread, pasta, rice etc) which also release their sugar very quickly resulting in sugar ‘highs’. Ensuring all carbohydrate foods are combined with protein helps reduce this ‘sugar effect’.
3. Many children on the autistic spectrum appear to benefit from the reduction or removal of gluten and casein  – these are the proteins in wheat, rye, barley and milk products. This is a controversial approach and should be supervised by an appropriately qualified health professional to ensure the child’s diet remains healthy and balanced.
4. Because digestive symptoms are common in autism, many children may benefit from the use of a probiotic supplement to improve levels of beneficial gut flora – the best are good quality powders and capsules available from good health food stores, rather than the more widely available probiotic drinks.
Five year old Veronica had been diagnosed with mild autism and had also been suffering her entire life with chronic constipation and regular tummy aches. When her parents brought her to us at the Brain Bio Centre, we arranged an IgG food intolerance test that revealed an intolerance to gluten. When this was removed from her diet, her parents were pleased to report a significant improvement in her sociability and much improved digestion with regular bowel movements and no tummy aches.
For more details on the Brain Bio Centre approach to autism, please take a look at our website. Additional reading around more general biomedical and therapeutic interventions for autism can be found at www.treatingautism.co.uk.
 Williams BL, Hornig M, Buie T, Bauman ML, Cho Paik M, Wick I, Bennett A, Jabado O, Hirschberg DL, Lipkin WI.(2011) Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal
 Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003498.
Dear Prime Minister
Open letter from the Food for the Brain Board of Trustees
It is certainly good news that you have doubled the budget for research into dementia prevention. However, we have great concerns that yet more money will be spent on ineffective drug research, when there already exists very clear evidence of a potentially much more cost-effective way to prevent dementia and to identify a significant proportion of those at risk.
Thanks to decades of thorough research by Emeritus Professor David Smith FMedSci from Oxford University, it is now clearly established that:
1. Having a raised blood homocysteine level (above 10mcmol/l), which any GP can test, identifies those at risk of dementia. Approximately 3 in 4 people aged over 70 do have a homocysteine level above 10, putting them at risk.
2. In those with mild cognitive impairment (MCI) and a homocysteine level above 10mcmol/l the accelerated brain shrinkage and memory loss, which are the diagnostic criteria for Alzheimer’s disease (AD), greatly slows when patients are given high dose B vitamins (B6, B12, folic acid) versus placebo. Furthermore, the brain scans show that the area of the brain that stops shrinking is exactly that part associated with the diagnosis of AD.
All that is needed to confirm that this inexpensive (10p a day) B vitamin treatment does stop those with MCI developing AD, is a further trial of 1,000 people with MCI to see if B vitamins prevent the conversion to dementia over a two-year period.
At Food for the Brain Foundation, an educational charity, we have developed an on-line Cognitive Function Test which has been validated against accepted paper and pencil tests, to enable members of the public to screen themselves. It has proven very popular with over 100,000 people completing the test in the last year. Approximately 18 per cent of those completing have scores consistent with memory decline. They then receive a letter to take to their GP for further investigation, including the recommendation of a homocysteine test. If raised, the current evidence recommends B vitamin prescription plus other diet and lifestyle modifications. We think that this approach of self-screening has tremendous merit in the quest to prevent AD.
The Cognitive Function Test needs further improvements and validation against MCI and AD populations, however all of this requires funds which we do not have. The objective is to have a simple screening tool to identify those at risk and encourage them to take positive prevention steps. A small amount of funding could reap big rewards.
The trouble is, to put it bluntly, that there appears to be a built-in bias against research funding for non-patentable, non-drug approaches, that might be seen to compete with lucrative drug approaches, despite the fact that the science stacks up extremely well and no dementia prevention drugs have yet been proven to work. Please fund this vital research which would prove, once and for all, that Alzheimer’s disease is preventable in those with raised homocysteine levels, and also give people an easy way to take positive prevention steps. To date, it is the most promising finding.
Here are two links:
The first, a summary of the research to date, with further links to the key papers: www.foodforthebrain.co.uk.
The second, a plea from Professor David Smith in the Daily Mail last month: www.dailymail.co.uk/health/article-2116392/Dementia-Vitamin-B-supplement-tackles-disease-drug-industry-spending-billions.html.
We hope that your interest in preventing dementia, which has massive consequences for current and future health care costs, will encourage you to pursue this very promising direction, the proof of which would save the NHS a fortune, since both screening and treatment are remarkably inexpensive.
Patrick Holford, CEO
On behalf of the Board of Trustees:
Dr Rona Tutt OBE
Professor David Russell
A flawed analysis?
Meta-analysis shows no cognitive benefit of homocysteine-lowering
A systematic review and meta-analysis of 19 studies that used B vitamin supplementation to lower homocysteine in the elderly has shown no benefit to cognitive function.
Our comment: A meta-analysis is the grouping together of multiple studies and performing complex statistical analyses to draw conclusions. A meta-analysis essentially treats the group of studies as if they were one large study. However, the short-comings of meta-analyses are that they mix together studies that are varied in design so at times it can be a little like mixing together blueberries and bananas and making conclusions about fruit. Some of the studies were on healthy elderly and some were on those with cognitive impairment so this is a combination of studies which (presumably) were looking for enhanced cognitive function and reduced cognitive impairment respectively, which is not the same thing at all. The lengths of the trials ranged from only 2 weeks to 5 years, with only 6 of the studies having a duration of 12 months or more. These very short-duration trials are unlikely to show benefit, even for those subjects with cognitive impairment.
Ford AH, Almeida OP. (2012) Effect of homocysteine lowering treatment on cognitive function: a systematic review and meta-analysis of randomized controlled trials. J Alzheimers Dis. 29(1):133-49
Click here for the abstract.
Mild dehydration results in lower mood in normal healthy women
A study in the Journal of Nutrition found that women with just 1.36% dehydration showed markedly lower mood scores as well as other symptoms including headaches and impaired concentration. The study looked at twenty-five females investigating the impact of exercise-induced dehydration both with and without the use of diuretics.
Our comment: While the cause of low mood is likely to be multi-factorial, poor hydration is something that can be simply and easily remedied. Drink 1 ? litres of water daily, more if you’re exercising or in hot weather to take account of water lost through sweat.
Armstrong, LE, Ganio, MS, Casa, DJ, Lee, EC, McDermott, BP, Klau, JK, Le Bellego, LL, Chevillotte, E, Lieberman, HR (2012). Mild Dehydration Affects Mood in Healthy Young Women. J Nutr 142(2):382-388.
Click here for the abstract.
Healthy body, healthy brain?
A high saturated fat diet increases markers of Alzheimer’s (in mice)
It is known that mid-life obesity increases the risk for Alzheimer’s disease (AD), and that both adipose (body fat) tissue and AD brains have increased levels of inflammation. One of the hallmarks of AD is increased levels of dysfunctional amyloid protein in the brain. A precursor protein called amyloid precursor protein (APP) is found at increased levels in the AD brain, but also in the adipose tissue of the obese suggesting that APP is involved in both obesity and AD. In this study, mice were made obese through being fed a high fat diet for 22 weeks. Increased levels of inflammatory markers and APP were found in both fat and brain tissue, compared to the control group of mice fed a normal diet.
Our comment: This study illustrates a direct link between a high fat diet and obesity and their contribution to the development of Alzheimer’s disease.
Puig KL, Floden AM, Adhikari R, Golovko MY, Combs CK. (2012) Amyloid precursor protein and proinflammatory changes are regulated in brain and adipose tissue in a murine model of high fat diet-induced obesity. PLoS One. 2012;7(1):e30378
Click here for the abstract.
Cognitive Function Test
Annual retest reminders
It has been a year since the launch of the Cognitive Function Test and over 106,000 people have now completed the first version of the test (CFT1). If you completed the Cognitive Function Test and requested an annual reminder you will receive an invitation to complete the next version of the test (CFT2) on the anniversary. It is important to note that the Cognitive Function Test is a screening tool, it is not therefore meaningful to compare this year’s numeric score with last year’s score, the key factor is that it is a green result. Any green result is a good result!