Friday, May 18, 2018

Nutritional Supplements for Children with Autism: How to Choose

Nutrition & Autism

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. Some nutritional supplements have special designation as a “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.

Why are nutritional supplements often used in the care of children with neurodevelopmental 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 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 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 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.

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 make-up may have difficulty metabolizing the most common form (folic acid) and benefit more from other forms (such as L-methylfolate or 5-methyltetrahydrofolate).

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.

What are good sources for high-quality nutritional supplements?

There are many NSF-certified and USP-certified manufacturers that offer products in stores and online. At Pediatric Neurology Therapeutics, we stock a small selection of nutritional supplements that are made by NSF-certified manufacturers. We started stocking supplements at the request of the families we work with who were seeking quicker and easier access to high-quality products. Some of the supplements stocked in our office are manufactured for our clinic (according to our specifications for ingredients, dosages, and formulation). These include

We also stock MitoSpectra, a mitochondrial supplement based on the formulation by Dr. Richard Kelley, former Director of the Division of Metabolism and Johns Hopkins University’s Kennedy Krieger Institute, and one of the leading researchers in the field of mitochondrial medicine. By stocking this supplement (and certain others), we are able to acquire the product at wholesale retailer pricing and to provide the product to our patients at a discount off the retail price. If there are products that you would like us to obtain wholesale so that we can provide them to you at a discount, please don’t hesitate to let us know.

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

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. Our recommendation is always first to improve the nutrient-density of a child’s diet. These steps should be taken whether or not a child is also on nutritional supplementation.