Autism Diets: It’s Not Rocket Science…

There’s a lot of evidence—both scientific evidence and anecdotal—indicating that children with autism can improve and even re- cover from the disorder, and that making strategic changes to the foods that our children eat may be fundamental to that recovery, and to engaging their potential. I’ve personally consulted with hundreds of parents who have witnessed the power of diet, and attribute much of their child’s improvement to food and nutrition choices. Many feel that diet was the factor that helped their child most, and some cited it as the main factor in their child’s recovery (losing their autism diagnosis).

By understanding the underlying biochemistry and systems affected by autism, parents can influence the behavior, cognitive function, and health of their children. Food and nutrition play a key role, and attention to these factors can help balance biochemistry, effect systemic healing, and provide relief of autism symptoms. Certain food substances (most notably, gluten and casein, the principal proteins in wheat and cows’ milk, respectively) are known to be problematic for many children with autism[1], while other foods that are rich in healing nutrients are known to be beneficial.

A WHOLE BODY DISORDER

Historically, autism was considered a “mysterious” brain disorder, implying that it began and ended in the brain. In recent years, a more appropriate “whole body disorder” perspective of autism has emerged, based on the theory that the brain is affected by the biochemistry of the body. Martha Herbert, MD, PhD, an assistant professor of neurology at Harvard Medical School, was one of the first experts in the field to describe autism in this way, and she refers to the brain as “downstream” from the body.

Common physical symptoms in children with autism include diarrhea, constipation, bloating and gastrointestinal (GI) pain, frequent infections, sleeping challenges, and inflammation/pain. [2] The fact that there are physical as well as behavioral symptoms illustrates that autism isn’t solely a brain disorder. When we appropriately identify autism as a whole body disorder, we can comprehend how what happens inside the body and cells affects the brain—and how the food we feed a child affects the body and its biochemistry.

For many children with autism, factors such as nutrient deficiencies, imbalanced biochemistry, and digestive problems can play a significant role in causing or exacerbating symptoms. Altering food choices can affect physiological functioning and help improve physical and behavioral symptoms.

HOW FOOD MATTERS

A healthy diet and good digestion are essential for good health. For many children, the physiological and behavioral symptoms of autism may stem from or be aggravated by impaired digestion and gastrointestinal (GI) health. Research has identified that “unrecognized gastrointestinal disorders… may contribute to the behavioral problems of the non- verbal autistic patients.”[3]

Poor digestion can lead to a condition known as leaky gut (increased intestinal permeability), which can result in malabsorption of nutrients, inflammatory responses to foods that aren’t broken down, and overload of the detoxification system. Adequate nutritional status, essential to proper biochemical and brain functions, requires both the consumption of nutrient-dense foods and proper digestion to break down and absorb those foods.

Impaired digestion can stem from negative environmental factors (as well as genetic susceptibility), lack of beneficial bacteria, inflammation, and immune system response to certain foods; and studies have shown leaky gut [4] low levels of beneficial flora,[5] inflammation, oxidative stress[6], nutrient deficiencies, and immune response to food[7] [8] in children with autism. Additionally, the response to certain foods, such as gluten and casein, can create an opiate or inflammatory reaction that can affect the brain.

Thus, it is essential to understand and address gut issues in autism. The largest part of the immune system is located in the gut, and the immune system is often imbalanced in autism, resulting in an inability to fight viruses, yeast, and other pathogens proper- ly, while contributing to an overactive inflammatory and allergic response. Toxins originating in the gut, often from “bad” (pathogenic) bacteria and yeast, can affect the brain. Foods that aren’t digested properly can create inflammatory y and immune system responses that also affect the brain. Ninety percent of the brain chemical serotonin stems from the gut, and it has a profound effect on the gut/brain connection and regulating gut motility and pain sensitivity.

According to Hippocrates, “All dis- ease begins in the gut,” and this certainly proves true with autism. In fact, the gut was coined “the second brain” by Columbia University’s Michael Gershon, MD, who spent many years studying the gut-brain connection. Derrick MacFabe, MD, director and assistant professor at the University of Western Ontario’s departments of psychology and psychiatry, identified this gut-brain connection in autism. In his recent study on propionic acid, a fatty acid that originates in the gut, he found that in rats, propionic acid caused behavioral and biochemical symptoms similar to those found in autism.[9]

CHOOSING A DIET

I hope that parents and practitioners can see the possibilities for positive influence and realize that diet can help autism. Diet is a powerful personal tool; it has few downsides and is accessible to everyone. With diet, parents have great control over choices that can have immediate positive impact in the health of their children.

The most successful parents (and children) in my private practice are those who take steps to carefully and conscientiously make diet changes. They have seen from the experience of others that recover y is possible and that it can, through calculated food choices, make a difference for t heir child. While modern medical channels present few opt ion s, parents are following Hippocrates’ traditional advice by letting food be their medicine.

There are many autism diets to choose from, and deciding how to begin can seem overwhelming, but it needn’t be. While eliminating gluten and casein has been the primary onus of autism diets —via the gluten-free casein-free (GF/CF) diet— additional advances in biomedical nutrition research and mom-centric anecdotal data have resulted in broader dietary strategies for autism. Because every child is different, a diet t h at helps one child may not be the best for another. Each child has unique biochemistr y, immune functioning, genes, environmental assaults, and eating preferences.

Some of the most effective and popular diets apart from  GF/CF include the specific carbohydrate diet (SCD), the gut and psychology syndrome (GAPS) diet, the paleo/primal diet, the body ecology diet, the low oxalate diet, the Feingold diet and the Failsafe diet. I describe these diets in my book, Nourishing Hope for Autism, along with the biochemistry that is affected and how to choose the best diet for an individual. For the simplicity of this discussion, I’ll focus on the GF/CF diet since it’s the most common place to start and has some of the best results for people new to special healing diets.

THE GF/CF DIET

When parents decide to “do diet,” they t y pic ally begin with the GF/ CF diet, which entails the removal of all gluten-and casein-containing foods from a child’s diet. Gluten is a protein found in wheat, rye, barley, spelt, kamut, and commercial oats; and casein is a protein found in dairy.

When ingested by children with a compromised digestive tract (common with autism), these proteins can cause gut inflammation, pain, and digestive problems. If the protein isn’t properly broken down during digestion, it can form opioids (opiate or morphine-like compounds).[20]  Scientists believe that opioids in gluten and casein are toxic for children with autism when they have an abnormal, leaky gastrointestinal tract.[21] The properties of gluten and casein can lead to digestive problems such as diarrhea, constipation, gas, and bloating, as well as foggy thinking and in attentiveness form any children with autism.

Studies and many thousands of parental reports indicate physic al symptoms and autistic behaviors can decrease on the GF/CF diet. According to parents surveyed by the Autism Research Institute, the GF/CF diet is helpful for 70 percent of children with autism spectrum disorder, even though a food sensitivity panel may not show a reaction to these foods. [22] Therefore, I typically recommend a GF/CF trial period, often beginning the diet by removing first one and then the other, so that both are removed.

Most of the food s containing these offending proteins are easy to identify. You’ll need to avoid any breads, crackers, pasta, or baker y item s made w it h wheat and other gluten grains, and all dairy foods, such as milk, cheese, butter, yogurt, and cream. Some sources, however, can be sneaky, as some foods contain offending ingredients that are not apparent,  such  a s soy sauce (except gluten-free soy sauce), potato  chips and  fries (often dusted with gluten during processing, al- though it may not be listed on the label— ensure they are gluten-free by checking with the company), and malt (derived from barley).

When beginning the GF/CF diet, be careful not to introduce a bunch of GF/CF junk foods, such as cookies, candy, and chips. Even though they don’t include gluten or casein, the sugar can feed yeast, imbalance blood sugar, and dysregulate energy. Remember, diet is more than just the removal of offending foods—attention must be placed on ensuring healthy and nutritious food intake. While following any autism diet, it is important to monitor and moderate the intake of certain additional food-based substances as needed. Common problematic food substances are:

` Phenols and salicylates (removed in the Feingold Diet and Failsafe diet).

` Amines and glutamates (also removed in Failsafe, along with phenols and salicylates).

` Oxalates (reduced in the low- oxalate diet).

In addition to removing problematic foods, such as wheat, dairy and others, it’s also important to add nutrient-dense foods. These include grass-fed meat, pastured eggs, live lacto-fermented foods (such as non- dairy yogurt and raw cultured vegetables), organic and locally grow n produce, homemade bone broths such as chicken stock, and freshly pressed vegetable juices.

YOU CAN DO IT

You may be thinking, “My child is picky and very inflexible with eating new foods. I’m never going to be able to get him to eat anything other than wheat and dairy—never mind any- thing healthy.” I appreciate these concerns! I’ve had some very picky eaters in my nutrition practice—many children ate only bread and dairy; others subsisted on just pancakes and fries. However, there are solid reasons why these children were so one-sided in their food choices.  When the body creates opiates from foods, one can be- come addicted to them and thus crave nothing but those foods; or, when yeast overgrowth is present, a preference for only carbs and sugars can result. Children eventually narrow their food choices to include only those that make them “feel better” (in the short term).

It’s worth trying diet because once the child gets past the cravings (in a few days to a few weeks), they often expand their food choices dramatically. I’ve polled many parent groups and find this true a majority of the time. Now, there are some children who are very self-limiting, and it takes time to change their diet s — but keep at it. Sometimes, as occupational therapy or sensory integration begins to address food textures, a child begins to expand more. Also, seek out the support of a feeding therapist if you have a picky eater—they can be incredibly helpful.

You can help the situation by get- ting creative. Make foods crunchy or smooth based on your child’s preferences. Begin to add new food options, such as gluten-free pasta, before re- moving existing foods. Be aware that brand preference may be based on the presence of MSG or other additives that can be addicting and make that food “exciting.” Add enough salt to make your versions of favorite foods more flavorful — don’t go overboard, but don’t feel you need to limit salt.

Today, growing numbers of parent s are wisely and correctly applying autism diets with great success. These diets and nutritional approaches are helping children recover from autism. Any child’s diet can change, and recovery is possible. It may take time and re- quire great patience, but you can make improvements. It’s crucial that parents believe it’s possible for their children to change and improve. By envisioning the changes, you project a positive image that is important for your child and the success of your overall efforts. I’ve never known a child who didn’t benefit from dietary intervention, and I’ve never seen a child’s diet that didn’t (with proper attention) eventually expand and improve.

5 Strategic Food Choices to Help Improve Symptoms

NIX THE YEAST, by removing sugars and yeast-containing foods from the diet, reducing or removing refined starches (such as white bread and baked goods, and white rice), and adding probiotic-rich foods (such as non-dairy yogurt and kefir) that naturally combat yeast growth. Yeast overgrowth is often triggered by heavy antibiotic use (common in children with autism, who tend to have poor bacteria- fighting ability) and can cause gut inflammation and decrease gut function.

BOOST BIOCHEMICAL PATHWAYS via vitamins b12, b6, and folate. Methylation, transsulfuration, and sulfation are just one set of biochemical pathways that don’t function optimally for many children with autism [11]. These pathways lead to the production of glutathione and other substances used for detoxification, immune function, gut integrity, and antioxidant status—therefore, children with autism commonly have impaired detoxification and digestion, and oxidative stress. in addition, methylation is required for properly activating neurotransmitters—if these aren’t working properly, the likelihood of anxiety, depression, ADHD, and sleeping issues is increased.[12]

SOOTH GUT INFLAMMATION improving digestion, reducing inflammation, and healing the gut are important steps in overall health and healing. Commonly reported benefits include reduced diarrhea and constipation, improved behavior, greater language skills, and fewer skin rashes. remove foods that inflame the gut, such as gluten, casein, and soy; and add foods that heal the gut and are anti-inflammatory, such as antioxidant-rich fruits and vegetables. Also add foods that supply beneficial probiotics, and foods that support beneficial bacteria growth (prebiotics), such as raw dandelion greens, garlic and onions.

IMPROVE DETOXIFICATION When children’s detoxification systems aren’t working optimally, as is common with autism,[13] toxins from food and the environment—such as salicylates, artificial food ingredients, monosodium glutamate (MSg), mercury, and aluminum—can cross the blood-brain barrier and affect the brain, causing hyperactivity, aggression, irritability, and self-injurious behavior.[14] Avoid food additives and toxins in the food supply by serving organic foods, and add foods that support the liver, such as sulfur-rich cruciferous vegetables (such as broccoli, brussels sprouts), and eggs, beets, grass-fed liver, and probiotic-containing lacto-fermentations.

SUPPORT DIGESTION When digestion is poor and the gut is too permeable, nutrients aren’t absorbed properly. This leads to nutrient deficiencies, which can negatively affect all cellular function, including brain function. Nutrient deficiencies are common among children with autism [15, 16,17], and poor quality and limited diets exacerbate the problem. In addition to providing a wide variety of nutrients through foods, supporting digestion is important, and supplementation including b6, magnesium and vitamin C has shown to be supportive. [18, 19]. Measures to address nutrient deficiencies can include increasing the quality and digestibility of food, sneaking in vegetables for children who are picky eaters, juicing vegetables, preparing homemade bone broths, and adding appropriate supplementation.

1.   Knivsberg AM, reichelt KL, nodland M. (2001) reports on dietary intervention in autistic disorders. nutritional neuroscience, 4(1):25-37.

2.  Molloy CA, Manning-Courtney P. Prevalence of chronic gastrointestinal symptoms in children with autism and autistic spectrum disorders. Autism. 2003 Jun;7(2):165-71.

3.  Horvath K, Papadimitriou JC, rabsztyn A, Drachenberg C, Tildon JT. gastrointestinal abnormalities in children with autistic disorder. J Pediatr. 1999 nov;135(5):559-63.

4.  D’Eufemia P, Celli M, Finocchiaro r, et al. Abnormal intestinal permeability in children with autism. Acta Paediatr. 1996 Sep;85(9):1076-9.

5.  Finegold SM et al. gastrointestinal microflora studies in late-onset autism. Clin infect Dis 2002 35(Suppl 1):S6-S16.

6.  Adams Jb, Audhya T, McDonough-Means S, rubin rA, Quig D, geis E, gehn E, Loresto M, Mitchell J, Atwood S, barnhouse S, Lee W. nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity. nutrition & Metabolism 2011 Jun 8;8(1):34.

7.   Jyonouchi H, et al. Proinflammatory and regulatory cytokine production associated with innate and adaptive immune responses in children with autism spectrum disorders and developmental regression. J neuroimmunol. 2001 nov 1;120(1-2):170-9.

8.  Jyonouchi H, Sun S, itokazu n. innate immunity associated with inflammatory responses and cytokine production against common dietary proteins in patients with autism spectrum disorder. neuropsychobiology. 2002;46(2):76-84.

9.  MacFabe DF, et al. neurobiological effects of intraventricular propionic acid in rats: possible role of short chain fatty acids on the pathogenesis and characteristics of autism spectrum disorders. behav brain res 2007:176(1): 149-69.

10. Logan BK, Jones, AW. Endogenous ethanol ‘auto-brewery syndrome’ as a drunk-driving defence challenge. Med Sci Law. 2000 Jul;40(3):206-15.

11. James SJ, Cutler P, Melnyk S, Jernigan S, Janak L, Gaylor DW and Neubrander JA. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. American Journal of Clinical nutrition. 2004 Dec;80(6):1611-7.

12. Miller AL. The methylation, neurotransmitter, and antioxidant connections between folate and depression. Altern Med rev. 2008 Sep;13(3):216-26.

13. Waring rH, ngong JM, Klovrza L, green S, Sharp H. biochemical Parameters in Autistic Children. Dev brain Dysfunct 1997;10:40-43.

14. Wang HT, Luo b, Huang Yn, Zhou KQ, Chen L. Sodium salicylate suppresses serotonin-induced enhancement of gAbAergic spontaneous inhibitory postsynaptic currents in rat inferior colliculus in vitro. Hear res. 2008 Feb;236(1-2):42-51. Epub 2007 Dec 15.

15. Vancassel S, et al. Plasma fatty acid levels in autistic children. Prostaglandins Leukot Essent Fatty Acids. 2001 Jul;65(1):1-7.

16. Arnold gL et al. Plasma amino acids profiles in children with autism: potential risk of nutritional deficiencies. J Autism Dev Disord 2003 33(4):449-54.

17. Adams Jb, george F, Audhya T. Abnormally  high plasma levels of vitamin b6 in children with autism not taking supplements compared to controls not taking supplements. J Altern Complement Med. 2006 Jan- Feb;12(1):59-63.

18. Dolske MC, Spollen J, McKay S, Lancashire E, Tolbert L. A preliminary trial of ascorbic acid as supplemental therapy for autism. Prog neuropsychopharmacol biol Psychiatry. 1993 Sep;17(5):765-74.

19. Martineau J, barthelemy C, garreau b, Lelord g. Vitamin b6, magnesium, and combined b6-Mg: therapeutic effects in childhood autism. biol Psychiatry. 1985 May;20(5):467-78.

20. Reichelt KL, Knivsberg AM, Lind g, nodland M: Probable etiology and possible treatment of childhood autism. brain Dysfunction 1991; 4: 308-319.

21. Shattock P, Whiteley P. (2002) biochemical  aspects in autism spectrum disorders: updating the opioid-excess theory and presenting new opportunities for biomedical intervention. Expert Opin Ther Targets. Apr;6(2):175-83.

22. Rimland, b., & Edelson, S.M. (2005). Parent ratings of behavior effects of biomedical interventions (Pub. 34, rev.

March 2005). San Diego: Autism research institute.

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