Autism Supplement Guide: How to Choose the Best Vitamins for Your Child 

Making Smart Decisions About Nutritional Supplements for Your Child 

What are nutritional supplements?

Nutritional supplements (also known as dietary supplements or dietary ingredients) are defined by the U.S. Food and Drug Administration as a vitamin, mineral, enzyme, herb (botanical), or amino acid for use by humans to supplement the diet. Supplements can come in many forms, including: 

• Pills (e.g. capsules, tablets, softgels) 

• Chewables 

• Powders 

• Liquids 

• Topical Treatments 

Some nutritional supplements have a special designation as "medical food" which is defined by the FDA as a nutritional product used under the supervision of a physician which is intended for the specific dietary management of a disease or condition. Unlike medications, nutritional supplements are not intended to treat, prevent, or cure diseases. 

Autism and Nutritional Supplements

So, why are nutritional supplements often used in the care of children with developmental delays? Children with conditions that affect brain development often have limited intake of nutrient-dense foods. They may have sensitivity to certain tastes or textures that lead them to avoid specific foods. Over time, a child’s diet may become restricted to select foods that do not provide the full range of nutrients that are needed for the optimal growth and development of the brain and body - this includes both micronutrients (vitamins and minerals) and macronutrients (protein, fat, and carbohydrates). Expanding the diet of any child requires consistently providing opportunities for new foods, as well as a willingness on the child’s part to try them. When behavioral challenges are present, this is often difficult to achieve.

There is a growing body of research to suggest that children with neurodevelopmental delays may also have differences in metabolism – in the way that their bodies take in, convert, and eliminate what is consumed from food, drink, and air. These differences in the biochemical processes in the body may increase the need for certain nutrients. For many children, these needs exceed what the child is able to consume through food.

How do I choose the right supplements for my child?

Before you introduce any supplement into your child’s diet, it’s important to speak to your pediatrician or dietary specialist about which supplements are suitable for your child based on their needs. An expert can help you determine the quantities as well as when to take them. Some commonly recommended supplements for autism include: 

• Digestive Enzymes and Probiotics: Protein digestion may be impaired in some children with ASD due to imbalances in the gut microbiome. This can contribute to gastrointestinal difficulties like diarrhea or constipation. Digestive enzymes and probiotics are “good” bacteria that help balance the gut microbiome and may help in relieving food allergies and treating inflammatory bowel disease. 

• Fish Oil: Otherwise known as omega-3’s, essential fatty acids found in supplements like fish oil are important to support the digestive system. The human body cannot produce omega-3’s on its own, but the nutrient can readily be found in foods such as fish, nuts and seeds, and plant oils. Research suggests that specific omega-3 fatty acids can help to reduce inflammation in the gastrointestinal tract, as well as improve hyperactivity and improve brain function through the support of healthy blood levels.  

• Melatonin: A supplement commonly used to treat sleep difficulties associated with autism spectrum disorder. To produce natural melatonin, the body needs enough of an amino acid called tryptophan, which is often found in too low or too high quantities in autistic children. There is an abundance of clinical evidence suggesting that introducing melatonin to your child’s diet can improve their quality of sleep, and consequently help improve overall behavior. 

• B6 & Magnesium: An effective combination that has received wide scientific support as an effective biological intervention for autism. Magnesium is an essential nutrient responsible for over 300 biochemical reactions in the body. Magnesium helps improve gastrointestinal issues, mood regulation, energy production, and physical performance. Vitamin B6, which requires extra magnesium to be effective, is a supplement important for brain development and the promotion of a healthy nervous system. Pairing magnesium and B6 can help to decrease negative behavioral problems, improve brain activity, and reduce seizure activity in autistic children.  

How do I make safe choices about nutritional supplements?

• Understand the differences in quality of manufacturing

• Examine both the active and inactive ingredients

• Understand how best to store and use the supplement

• Know the appropriate dose (or dose range) and if there are any risks of toxicity at high doses

• Know how to start and stop

Nutritional Supplements and Safety

Nutritional supplements are not subject to the same strict regulatory and scientific standards applied to drugs. As a result, the majority of nutritional supplements available in stores and online are of poor quality – meaning that the ingredients in the supplement do not match the ingredients and doses listed on the label and contaminants may be present. Nutritional supplements may still be used safely, but the selection of specific products must be made with care. Only use supplements that meet the following criteria:

• Manufactured according to FDA Good Manufacturing Practices – these are referred to as GMP standards, and manufacturers that comply with these standards will make this known on the product packaging or on their website.

• Certified by the U.S. Pharmacopeial Convention (USP) or by NSF International – organizations that set higher standards for determining product and ingredient identity, strength, quality, and purity and offer third-party, independent verification services for nutritional supplements. A manufacturer that meets these standards will indicate USP-certified or NSF-certified on the product packaging or website.

A small percentage of over-the-counter supplements are “pharmaceutical-grade” – meaning that they are manufactured according to the same high standards set for medications. These supplements are difficult to find and sometimes contain artificial additives that are commonly found in pharmaceutical products. The higher standard of manufacturing practices must be weighed against the potential risks that such additives may pose to a particular individual.

What does it mean when a supplement has "inactive" ingredients?

In addition to the active ingredients, all supplements contain inactive ingredients. These may include flavorings, stabilizers, or other ingredients that aid in the manufacture, appearance, taste, or stability of the product. Because some individuals may be sensitive to these ingredients, they are just as important to consider as the active ingredients. In general, supplements in the form of powders and capsules have fewer inactive ingredients, whereas gummies and liquids have more. Also important is the specific form of the active ingredient. For example, vitamin B9 (also known as folate) comes in many forms, and individuals with certain genetic makeup may have difficulty metabolizing the most common form (folic acid) and benefit more from other forms (such as L-methylfolate or 5-methyltetrahydrofolate).

Do supplements expire?

Like food products, supplements degrade over time. The dose of a particular ingredient within a capsule at the time of purchase, for example, is not likely to be the same as the dose at the expiration date. For the most part, the variation in dose is small and does not impact the essential efficacy of the ingredient. However, for certain products, such as probiotics, that are very sensitive to degradation, the dose at the time of consumption may be far lower than what is indicated on the label. Some probiotics are labeled according to what the expected dose will be at the time of the expiration date, ensuring that the dose will be at or above what is indicated on the label for the full life of the product. When this is the case, the manufacturer will state this clearly on the product packaging or website.

Research studies that have looked at the effects of nutritional supplements for neurological and other symptoms employ a range of different dosages. L-carnitine, for example, is a nutritional supplement that has been studied in children with autism and the dose used in these studies has ranged from 50mg per kilogram of body weight per day up to double that dose. A particular child may not benefit from the lower dose, but may benefit from the higher dose. Another child may have side effects at the higher dose, but do well at the lower dose. Some supplements have toxicity at high doses (for example, fat-soluble vitamins like the commonly used vitamin D). For these reasons, and many others, it’s important for nutritional supplements to be used under the supervision of a qualified practitioner.

Some nutritional supplements need to be started at a low dose and increased gradually. Potential side effects may be as serious as seizures. More common side effects include gastrointestinal upset, drowsiness, or headaches. Often, side effects can be averted by starting a supplement gradually. Withdrawal side effects are also possible with certain supplements, and these may need to be gradually tapered.

If my child takes nutritional supplements, are dietary modifications still needed?

Our recommendation is always to first improve the nutrient density of a child's diet.There are very likely to be benefits to consuming nutrients in their original form (in food). The combinations of nutrients in whole foods interact in complex (and likely beneficial) ways within the human body. These steps should be taken whether or not a child is also on nutritional supplementation.