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Cited by 267Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesTrace Elements in Health

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Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder—A Randomized, Controlled 12-Month Trial

Open access
Adams, James, Audhya, Tapan, Geis, Elizabeth, Gehn, Eva, Fimbres, Valeria, Pollard, Elena, Mitchell, Jessica, Ingram, Julie, Hellmers, Robert, Laake, Dana, Matthews, Julie, Li, Kefeng, Naviaux, Jane, Naviaux, Robert, Adams, Rebecca, Coleman, Devon, Quig, David·2018·Nutrients
DOI 10.3390/nu10030369PMC PMC5872787
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Abstract

This study involved a randomized, controlled, single-blind 12-month treatment study of a comprehensive nutritional and dietary intervention. Participants were 67 children and adults with autism spectrum disorder (ASD) ages 3–58 years from Arizona and 50 non-sibling neurotypical controls of similar age and gender. Treatment began with a special vitamin/mineral supplement, and additional treatments were added sequentially, including essential fatty acids, Epsom salt baths, carnitine, digestive enzymes, and a healthy gluten-free, casein-free, soy-free (HGCSF) diet. There was a significant improvement in nonverbal intellectual ability in the treatment group compared to the non-treatment group (+6.7 ± 11 IQ points vs. −0.6 ± 11 IQ points, p = 0.009) based on a blinded clinical assessment. Based on semi-blinded assessment, the treatment group, compared to the non-treatment group, had significantly greater improvement in autism symptoms and developmental age. The treatment group had significantly greater increases in EPA, DHA, carnitine, and vitamins A, B2, B5, B6, B12, folic acid, and Coenzyme Q10. The positive results of this study suggest that a comprehensive nutritional and dietary intervention is effective at improving nutritional status, non-verbal IQ, autism symptoms, and other symptoms in most individuals with ASD. Parents reported that the vitamin/mineral supplements, essential fatty acids, and HGCSF diet were the most beneficial.

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Crossref · 10.3390/nu10030369

Cites

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Figures

Figure 1 Study Flowchart.
Figure 1 Study Flowchart.CC BY · PubMed Central
Figure 2 Summary of significant changes in major evaluations, for both the treatment and non-treatment groups. For some scales an increase is an improvement, and for some the opposite is true; so, here we plot them with improvement being in the same direction on the y-axis. Note that the % change for the PDD-BI composite is based on the average change in each of the composite subscales. Error bars represent standard deviations.
Figure 2 Summary of significant changes in major evaluations, for both the treatment and non-treatment groups. For some scales an increase is an improvement, and for some the opposite is true; so, here we plot them with improvement being in the same direction on the y-axis. Note that the % change for the PDD-BI composite is based on the average change in each of the composite subscales. Error bars represent standard deviations.CC BY · PubMed Central
Figure 3 Reynolds Intellectual Assessment Scales (RIAS) nonverbal IQ score at the beginning and end of the study, for the treatment and non-treatment groups. RIAS scores are normalized so that 100 is an “average” IQ; thus, the average of the ASD groups is substantially lower than the average for the general population. Error bars represent standard deviations.
Figure 3 Reynolds Intellectual Assessment Scales (RIAS) nonverbal IQ score at the beginning and end of the study, for the treatment and non-treatment groups. RIAS scores are normalized so that 100 is an “average” IQ; thus, the average of the ASD groups is substantially lower than the average for the general population. Error bars represent standard deviations.CC BY · PubMed Central
Figure 4 CARS-2 scores at beginning and end of the study. The scale goes from 15 to 60, with scores of approximately 27 and above being the cut-off for ASD. Error bars represent standard deviations.
Figure 4 CARS-2 scores at beginning and end of the study. The scale goes from 15 to 60, with scores of approximately 27 and above being the cut-off for ASD. Error bars represent standard deviations.CC BY · PubMed Central
Figure 5 SAS scores (as rated by the professional evaluator) at beginning and end of the study. The scale goes from zero (no symptoms) to 10 (severe autism). Error bars represent standard deviations.
Figure 5 SAS scores (as rated by the professional evaluator) at beginning and end of the study. The scale goes from zero (no symptoms) to 10 (severe autism). Error bars represent standard deviations.CC BY · PubMed Central
Figure 6 Change in the developmental age for the Vineland domains, and the average of the three domains. “T” refers to the treatment group and “N” refers to the non-treatment group. Note that the physical age of the participants at the start of the study was 10.8 and 12.3 years for the treatment and non-treatment groups, respectively. So, their developmental age was far below their physical age, even after a significant increase for the treatment group. Error bars represent standard deviations.
Figure 6 Change in the developmental age for the Vineland domains, and the average of the three domains. “T” refers to the treatment group and “N” refers to the non-treatment group. Note that the physical age of the participants at the start of the study was 10.8 and 12.3 years for the treatment and non-treatment groups, respectively. So, their developmental age was far below their physical age, even after a significant increase for the treatment group. Error bars represent standard deviations.CC BY · PubMed Central
Figure 7 Vineland Subscale Changes.
Figure 7 Vineland Subscale Changes.CC BY · PubMed Central
Figure 8 Change in PDD-BI subscale scores. Note that the first seven subscales are for maladaptive behaviors, so a decrease is beneficial. The last three subscales are for adaptive behaviors, so an increase is beneficial. Error bars represent standard deviations.
Figure 8 Change in PDD-BI subscale scores. Note that the first seven subscales are for maladaptive behaviors, so a decrease is beneficial. The last three subscales are for adaptive behaviors, so an increase is beneficial. Error bars represent standard deviations.CC BY · PubMed Central
Figure 9 The scores for the four ATEC subscales at the beginning and end of the study. “T” refers to the treatment group and “N” refers to the non-treatment group. Higher scores represent greater severity. Error bars represent standard deviations.
Figure 9 The scores for the four ATEC subscales at the beginning and end of the study. “T” refers to the treatment group and “N” refers to the non-treatment group. Higher scores represent greater severity. Error bars represent standard deviations.CC BY · PubMed Central
Figure 10 ABC subscales at beginning and end of the study. “T” refers to the treatment group and “N” refers to the non-treatment group. Higher scores represent greater severity. Error bars represent standard deviations.
Figure 10 ABC subscales at beginning and end of the study. “T” refers to the treatment group and “N” refers to the non-treatment group. Higher scores represent greater severity. Error bars represent standard deviations.CC BY · PubMed Central
Figure 11 Total SRS scores at the beginning and end of the study. Higher scores indicate greater severity, and 54 is the cut-off for an ASD diagnosis. Error bars represent standard deviations.
Figure 11 Total SRS scores at the beginning and end of the study. Higher scores indicate greater severity, and 54 is the cut-off for an ASD diagnosis. Error bars represent standard deviations.CC BY · PubMed Central
Figure 12 SSP scores at the beginning and end of the study. Note that higher scores represent fewer sensory problems. Error bars represent standard deviations.
Figure 12 SSP scores at the beginning and end of the study. Note that higher scores represent fewer sensory problems. Error bars represent standard deviations.CC BY · PubMed Central
Figure 13 PGI-R2 scores during the study. The scale goes from −3 (much worse) to 0 (no change) to 1 (slightly better), 2 (better), 3 (much better). Error bars represent standard deviations.
Figure 13 PGI-R2 scores during the study. The scale goes from −3 (much worse) to 0 (no change) to 1 (slightly better), 2 (better), 3 (much better). Error bars represent standard deviations.CC BY · PubMed Central
Figure 14 Effectiveness of each treatment as rated by parents. This is rated on a scale of −3 (much worse) to 0 (no effect) to 1 (slightly better) to 2 (better) to 3 (much better). Error bars represent standard deviations.
Figure 14 Effectiveness of each treatment as rated by parents. This is rated on a scale of −3 (much worse) to 0 (no effect) to 1 (slightly better) to 2 (better) to 3 (much better). Error bars represent standard deviations.CC BY · PubMed Central
Figure 15 Percentage of participants who plan to continue each treatment.
Figure 15 Percentage of participants who plan to continue each treatment.CC BY · PubMed Central

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Citations

Cites

1 retracted

Show all 74 references

Research works printed but not linked: 4

  1. Chang, R. (2007). Chemistry, McGraw-Hill. [9th ed.].
  2. Waring, 1997, Sharp, H. Biochemical Parameters in Autistic Children, Dev. Brain Dysfunct., 10, 40
  3. Warning, 1993, Enzyme and Sulphur Oxidation Deficiencies in Autistic Children with Known Food/Chemical Sensitivities, J. Orthomol. Med., 8, 198
  4. Adams, 2013, Nutritional, Dietary, and Medical Treatments for Autism—Based on over 150 published research studies, Autism Res. Inst. Publ., 41, 1

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Metadata

Authors
Adams, J., Audhya, T., Geis, E., Gehn, E., Fimbres, V., Pollard, E., Mitchell, J., Ingram, J., Hellmers, R., Laake, D., Matthews, J., Li, K., Naviaux, J., Naviaux, R., Adams, R., Coleman, D., & Quig, D.
Affiliations
  • Arizona State University (US)
  • Span Diagnostics (India) (IN)
  • Southwest College of Naturopathic Medicine & Health Sciences (US)
  • Arizona Allergy Associates, Phoenix, AZ 85004, USA
  • Dana Laake Nutrition, Kensington, MD 20895, USA
  • Nourishing Hope, San Francisco, CA 94117, USA
  • University of California San Diego (US)
  • Doctor’s Data, St. Charles, IL 60174, USA
Corresponding author
Adams, James
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2018-03-17
Volume
10
Issue
3
Pages
369
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu10030369
PMC
PMC5872787
OpenAlex
W2792168441
Cited by
267
References
74
Citations by year
2026: 16 · 2025: 27 · 2024: 36 · 2023: 56 · 2022: 27 · 2021: 39 · 2020: 35 · 2019: 20 · 2018: 11
FWCI
15.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
  • Autism Research Institute
  • National Institute of General Medical Sciences (R25GM099650)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
Keywords
autism spectrum disorder, dietary intervention, vitamin and mineral supplementation, essential fatty acids, EPA and DHA, L-carnitine, digestive enzymes, nonverbal intelligence, autism symptoms, developmental age, nutritional status, children and adults with autism
MeSH terms
Autism Spectrum Disorder, Diet, Healthy, Adolescent, Adolescent Behavior, Adult, Arizona, Caseins, Child, Child Behavior, Child Development, Child, Preschool, Female, Humans, Intelligence, Male, Middle Aged, Nutritional Status, Time Factors, Single-Blind Method, Treatment Outcome, Diet, Protein-Restricted, Dietary Supplements, Soybean Proteins, Adolescent Development, Diet, Gluten-Free, Young Adult

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