This Article reprinted with permission from Living Without Magazine.
Kenneth A. Bock, MD, a leading expert on the biomedical approach to treating autism and author of Healing the New Childhood Epidemics: Autism, ADHD, Asthma and Allergies, talks with editor Alicia Woodward about the critical role of diet for children with autism spectrum disorder.
Why does diet matter?
There’s a strong connection between the gut and the brain, and with autism, substances in the gut profoundly impact the brain. The gut is like a huge, amazing factory with trillions of players that are incredibly metabolically active. If things aren’t in balance, metabolic byproducts produced by the overgrowth of bad microorganisms—bacteria, yeast, fungi—can cause dramatic neurobehavioral effects. Our children with autism and ADHD are like canaries in the coal mine. They’re vulnerable to toxins in the environment, as well as microbial and metabolic toxins from within. There are certain things in the diet, specifically gluten and casein, which are incompletely digested in a significant number of kids who have autism, as well as those who have ADHD. With insufficient digestion, gluten and casein produce endogenous opioids, brain-active compounds similar to morphine. In this way, diet can have a very, very profound effect on the brain. In essence, it’s like these kids are stoned.
Often when children first come into my office, they have glazed eyes, dilated pupils, staring, unresponsive and inappropriate behaviors and they’re craving foods with gluten and dairy, like chicken nuggets and mac and cheese, as if they’re addicted. When you remove gluten and dairy from the diet, they can actually go into withdrawal. Not every child and not all the time but a number of children do. They become really hyper, agitated, irritable or they become lethargic and really spacey. I let the parents know that this might happen. If parents can bear with it, in one to three days, sometimes up to a week—and trust me, this is a very difficult period—the child comes out of it. The dazed look, the staring is gone. They make eye contact for the first time, hug mom for the first time or sometimes say something they’ve never said before. Mothers call me, crying and saying, “It’s unbelievable. I have my child back.”
Do you recommend the gluten-free, casein-free (GFCF) diet as the first step of treatment?
Yes, that’s generally the first step. We suggest a GFCF dietary trial for most kids but the trial has to be sufficient. In other words, parents should keep their child off gluten at least three months and off casein at least three weeks. I tell parents they have to be very, very strict with the diet, which isn’t easy but it is necessary. You might not see a change in three days to a week. Sometimes it takes a lot longer. And you won’t always see a dramatic change, like when a child who never sleeps suddenly starts sleeping through the night. Sometimes it’s much more subtle.
Do parents normally remove both gluten and casein at the same time?
Generally we remove both but it depends on the situation. One size doesn’t fit all. So in select circumstances with certain families, if a child has really intense craving and the parents are having a lot of trouble, we may go with one. But if parents can do both, they do both.
Does this work better with younger children?
The earlier we start intervention, the better the child tends to do.
Do parents balk at making these dietary changes?
I see families from all over the country and the world and I have to say they’re very determined, especially the moms. Imagine having a healthy child who’s developing normally and then, when that child is 12 or 18 months old, he or she regresses. In essence, you’ve lost your child and you’ll do anything to try to get your child back. So parents are willing to make this sacrifice regarding dietary modifications. Many doctors don’t recommend the GFCF diet. They say the research is lacking. There are published studies that support the diet, as does the clinical experience of hundreds of doctors. In addition, thousands upon thousands of parents have had success with this diet. My practice sees over 2,000 kids on the autism spectrum and we see positive results approximately 60 percent of the time, anywhere from mild to moderate to marked. The Autism Research Institute surveyed tens of thousands of parents about a number of treatments, including dietary intervention, supplements, chelation, medications, and over 60 percent of respondents reported improvement on the diet. Not every child responds—but a significant number do. Remember, we’re not treating kids with psychotropic medicines to get this rate of success. We’re just removing things from the diet.
Do you make other dietary changes besides gluten and casein?
The GFCF diet is where we start but there are other foods that kids can be sensitive to or allergic to and these can contribute to things like hyperactivity and inability to concentrate. We test each child and target the particular foods that affect that child. In addition, we address the microbes in the gut, the bad bacteria, anaerobes like Clostridia, and pathogenic yeast that can create metabolic problems. Depending on the child, these are treated with anti-microbials—antibacterials, antibiotics, antifungals—which makes a significant difference. If you clear up the abnormal fungus or yeast in the gut, the child’s bloating, gas, constipation and/or diarrhea gets better and the neurobehavioral improvement can really be profound. The intense self-stimulatory behaviors, like flapping, spinning, weird hand-eye movements, can be improved or resolved, as can the agitation, irritability, aggressiveness, brain fog, staring. Again, it attests to the gut-brain connection.
Do you use probiotics to help repopulate good bacteria in the gut?
Depending on the child, we may administer probiotics early on in the course of treatment. Probiotics are also important because they help modulate immunity and bring it back into balance. A small percentage of kids don’t tolerant probiotics but most who need them do very well on them. Children with really prominent gut-brain connection, those with gastrointestinal symptoms, really respond to treatment for the gut and probiotics are very important for them. Increasingly, effective treatment of autism is based on the understanding of how children fall into medical subtypes—gut-brain, immunity, infectious, metabolic. There’s a lot of overlap between subtypes and often kids have more than one condition.
Are you saying that success is based on categorizing symptoms?
Not just symptoms but biomarkers. We’re getting more and more sophisticated at testing for important biomarkers that indicate, for example, whether a child is low in glutathione or has dysbiosis, autoimmunity, recurrent infections with immune deficiency. We’re testing for biomarkers now but we’re going to become much more skilled in the coming years. This will also improve research in terms of selecting the subtype of children who are likely to respond to a particular treatment. For example, some kids appear to respond to secretin, a neuro-hormone. They wake up, make eye contact and possibly even speak for the first time, that sort of thing. But double-blind, placebo-controlled studies of children with autism haven’t duplicated these results, possibly because secretin may only help one specific subtype of children, not all.
Is this the future of autism treatment?
The future is definitely about subtyping, about getting better and better at determining and assessing biomarkers. And that’s the challenge of treating children as if they’re all the same. You can look at two or three kids with similarities and overlapping symptoms but they may be very different in what treatment works for them. Individualizing treatment is very hard work but it’s also very gratifying when the treatment hits the mark. As we get better at figuring out what each child needs, more and more children are recovering, which is really exciting. Overall, I’d say the vast majority of kids can be helped to some degree.
Kenneth A. Bock, MD, FAAFP, FACN, CNS, is co-founder and co-director of the Rhinebeck Health Center (rhinebeckhealth.com) in New York state and the author of Healing the New Childhood Epidemics: Autism, ADHD, Asthma and Allergies.
This Article reprinted with permission from Living Without Magazine. © 2011 Belvoir Media Group, LLC. All rights reserved.
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