CAM or SHAM? Where is the evidence for natural therapies and autism?
It’s often difficult to determine what is evidence-based Complementary and Alternative Medicine (CAM) and what is simply a money and time-wasting SHAM. A good rule of thumb is if it sounds too good to be true, it probably is.
Complementary and Alternative Medicine (CAM), includes modalities of nutrition, herbal medicine, naturopathy, homeopathy, manipulative therapies (chiropractic and osteopathy), and acupuncture. The use of natural therapies dates back to Hippocrates some 2000+ years ago and is foundation from which modern medicine was established. Many CAM practitioners use a newer term, “integrative medicine” which focuses on the individual’s microbiota, biochemical pathways, genomics and environment. These systems of treatment can often be helpful in providing support for a variety of medical conditions as well as promoting general health and well-being. The problem is that Integrative medicine and CAM therapies are often umbrellaed with modalities that are unsafe and non-evidence based. Some of these therapies include stem cell, chelation, Lupron therapy, secretin injections, bleach therapy, holding therapy, transcranial magnetic stimulation, and nicotine patch therapy. This is also the case in the ‘treatment’ of ASD.
Autism Spectrum Disorder (ASD) is complex disorder that has many possible etiologies, most of which are unclear. Various factors have been associated with the development of or an increased susceptibility to autism including; genetics, environmental factors, nutritional deficiencies and overloads, exposure to viruses, gut microbiome abnormalities, dysfunction of the immune system and allergies.2 Some integrative and CAM therapies may be beneficial when implemented using an evidence-based and individualised model, while continuing with other allied health support (e.g. Speech therapy, occupational therapy). It is important to remember that none of these integrative therapies should be looked to as a complete treatment for autism, but rather as helpful support in improving many of the conditions often associated with ASD. As you can appreciate, autism is a spectrum so there is no one size fits all. Integrative and CAM therapies should primarily do no harm, focus on optimising overall health, and support the growth and development of your child. Looked at in this light many of the un-safe and un-proven therapies do none of this, but rather focus on the false hope of an all-encompassing ‘cure’.
The majority of families dealing with autism seek out alternate treatments. The use of CAM and integrative therapies in the autism community is reported to be between 52-95%, which is higher than in any other populations.3 CAM and integrative therapies can offer relationship-based care that focuses on the whole child, not simply the diagnosis, while providing the family with the opportunity and tools to take control of their health and wellbeing. 3 Many consider this its primary appeal over modern medicine. CAM and integrative therapies can help a variety of issues including correcting nutritional deficiencies, alleviating gastrointestinal symptoms4, managing food allergies and addressing restrictive eating patterns, all common conditions in children with ASD.
So Where is the evidence?
Most ASD parents and carers rely on the internet for information3, which can be problematic as there are a lot of non-evidence based sources freely available. Reliable sources of information include peer reviewed journal articles, scientific literature and well controlled and designed clinical trials, though a lot of this literature is often difficult to find and interpret. There is some evidence for the effectiveness and safety of some CAM and integrative therapies, though not all. Research on CAM and integrative therapies is growing but more randomized, placebo-controlled blinded trials are needed to validate the claims and effectiveness.
Nutrition and Autism Spectrum
There is no such thing as an autism diet. Nutritional approaches should be individualised, comply with The Australian Dietary Guidelines, focus on optimising thegrowth and development of the child while correcting any nutritional imbalances. Long term restricted diets, can lead to nutritional deficiencies, if not balanced correctly and monitored regularly. 2
Restrictive eating and sensory issues are a common occurrence in ASD individuals, and dietary interventions that further restrict foods can be counterproductive and can add further stress around meals and feeding for all involved. There is evidence that nutritional and behavioral interventions to address restrictive eating can reduce the risk of malnutrition, as well as developmental and medical problems arising from chronic feeding probelms.5
The gluten and casein free diet (GF/CF) tends to be popular in autism circles. The evidence is weak for the “opioid excess theory”, on which the diet is based on and GF/CF is not widely accepted as a dietary intervention for autism. It is a common occurrence, as observed in multiple studies, that ASD individuals have increased intestinal permeability or “leaky gut”, decreased digestive enzyme activity, and impaired protein digestion. These conditions may be somewhat be symptomatically resolved by a GF/CF diet, but it does not address the underlying gastrointestinal issues. 2 Long term, a poorly implemented GF/CF diet can have adverse health effects included decreased bone density, constipation, nutritional imbalances and malnutrition.
Nutritional and biochemical imbalances are more common in children with autism than in the general population.6 There is little evidence for the use of vitamin and minerals in the absence of true deficiency or imbalance. It is important to note, just because it is “natural”, doesn’t mean it is safe. Vitamins and minerals can be toxic in high doses.
The Gut-Brain Link
The link between the gut and brain is emerging in mainstream in medicine, which in the past has been a more integrative and CAM approach. Recent studies have estimated that 40% of ASD individuals suffer from GI symptoms. GI symptoms, particularly alterations in bowel habits and chronic abdominal pain, strongly correlate with the severity of ASD symptoms. Gastrointestinal microbial alterations are common finding in ASD patients, with imbalances in commensal and pathogenic bacteria. The colonization of the pathogenic bacteria, Clostridium difficile has been associated with ASD.7 Clostridium difficile is hypothesized to have direct neurological and mitochondrial effects, though further research is needed. Research is now focusing on microbial alteration in autism patients, with the use of highly specific strains of probiotics (including Bifidobacterium and Lactobacillus, Streptococcus spp.) and faecal microbiota transplants in extreme cases, to alleviate GI, neurological and central nervous system associated symptoms seen in autism.2
Often CAM or integrative therapies come at an additional cost that are not covered by government funding or Medicare. Families need to weigh up the potential pros and cons time required to implement and associated costs. The choice to use integrative or CAM therapies is an individual one. For families who are in a financial position to access CAM therapies, these services can offer relationship-based care and have potentially positive effects when implemented and monitored with a registered or accredited health professional. Parents report feeling empowered because they are able to help their child, but caution needs to be taken when getting information from non-reputable internet sites, implementing restrictive diets and high dose supplementation.
The Integrative Model and Accredited Practitioners
It is essential to inform your primary care physician or pediatrician of your decision to implement CAM or integrative therapies. It is essential to work with an accredited or registered health care practitioner who is trained in the area of pediatrics as well as with additional needs, in conjunction to conventional care. You will find a list of reputable CAM and Integrative Associations below. These associations can help you navigate to a practitioner in your area with the experience with working with ASD individuals. Be careful of practitioners offering a “cure” and when in doubt always seek a second opinion. Close monitoring of the patient should be taken at regular intervals to ensure the CAM therapies are achieving the desired outcome, as with any other type of therapy or intervention.
Accredited Nutritionist and Herbalist
BHSc Nut Med, Adv Dip WHM, Cert. Ped Nutrition (Monash), NSA
Resources and References
CAM and Integrative Associations & Directories
Other Useful Resources
- Beware of Non-Evidence-Based Treatments, https://autismsciencefoundation.org/what-is-autism/beware-of-non-evidence-based-treatments/.
- A. Fattorusso, L. Di Genova, G. Dell’Isola, E. Mencaroni and S. Esposito, Nutrients, 2019, 11, 521.
- R. S. Akins, K. Angkustsiri and R. L. Hansen, Neurotherapeutics, 2010, 7, 307–319.
- K. Horvath and J. A. Perman, Curr. Gastroenterol. Rep., 2002, 4, 251–258.
- W. G. Sharp, R. C. Berry, C. McCracken, N. N. Nuhu, E. Marvel, C. A. Saulnier, A. Klin, W. Jones and D. L. Jaquess, J. Autism Dev. Disord., 2013, 43, 2159–2173.
- M. Arora, A. Reichenberg, C. Willfors, C. Austin, C. Gennings, S. Berggren, P. Lichtenstein, H. Anckarsäter, K. Tammimies and S. Bölte, Nat. Commun., 2017, 8, 15493.
- I. Argou-Cardozo and F. Zeidán-Chuliá, Med. Sci., 2018, 6, 29.