Nutritional Considerations for Autism
PediaSmart® May Help Balance Feeding IssuesWhat is Autism Spectrum Disorder?
Autism Spectrum Disorders, also called ASDs, are a group of life-long neurological (nervous system) developmental conditions associated with how a child socially interacts with others and the environment; various verbal and nonverbal problems in communication; and restricted and repetitive behaviors and interests.1 The most familiar ASDs include autistic disorder, often referred to simply as autism, and Asperger Syndrome. ASD is rarely diagnosed before 3 years of age but researchers are seeking methods to diagnosis the condition as early as possible to aid the child and family in understanding and managing the disorder.2 Because the prevalence of ASDs has increased dramatically in the last 20 years with 1 in 88 children currently affected in the United States3, research into the causes of this disorder has advanced considerably, especially in the area of environmental factors such as toxic chemical exposure during pregnancy.
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Although genetics appear to play a role in ASD, environmental factors that affect the biochemical pathways in the body are being investigated as well. These include age of parents at time of conception, maternal-fetal immune status, in vitro fertilization, maternal ingestion of drugs, and toxic chemicals in the environment during pregnancy. These environmental factors can interact with genes. Modifying exposure to them could possibly reduce the risk of ASD.4 There are presently no published scientific reports on use of an organic diet during pregnancy, lactation and infancy as a way of reducing the risk of ASD. Yet, avoidance of harmful pesticides and other harsh chemicals by "going organic" seems a logical approach to reducing the risk of ASD. A helpful book covering many aspects of ASD including toxins in the environment and in foods along with other useful information for parents is reviewed on the authors webpage at The Autism Revolution: Whole body strategies for making life all it can be. This book explains how certain dietary factors like vitamin deficiencies, pesticides and heavy metals in our food supply, and high fructose corn syrup consumption could impact complex metabolic functions which affect the body’s ability to eliminate toxic chemicals, indirectly contributing to autism and other disorders.
What may be viewed as peculiar food and eating habits of a child with ASD may sometimes be related to gastrointestinal distress or discomfort after eating certain foods or types of foods. Other eating behaviors may be related to the repetitive or restricted aspects of the disorder such as resistance to trying new foods or a strong preference for foods of a certain color or texture or type of packaging. Smell, color, texture, and temperature of a food can all be factors in a child's decision to eat or not eat a specific food or food group. Unusual behaviors such as foods not touching other foods on a plate or rituals such as use of only certain eating utensils may also be observed in a child with ASD. There may be a strong avoidance to milk, for example, because of a lactase deficiency. Lactase is the enzyme that the body uses to break down the sugar in milk known as lactose. Lactose free nutritional supplements such as organic PediaSmart® Complete Nutrition Beverage can be used in place of milk and will help to relieve the distress in a child with a lactase deficiency.
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Meal times can become stressful and can negatively impact the family's quality of life. Picky eating, also known as food selectivity, and varying meal time behaviors do not need to be a cause for poor nutritional intake and stressful family meal times. Working with a multidisciplinary team of healthcare providers who specialize in ASD can help parents to determine the cause of the eating behaviors and steps that can be taken to improve them while also providing a healthy and nutritional diet for a child with ASD. The team can consist of a pediatric gastroenterologist, registered dietitian, occupational therapist, and behavioral psychologist.5 Nutritional supplements and in some situations tube feeding may be recommended by the team to ensure a child is receiving appropriate daily nutrition. PediaSmart® Complete Nutrition Beverage is an organic option in these situations. Learn how PediaSmart® Complete Nutrition Beverage can be an organic option in these situations.
Common symptoms of the gastrointestinal tract affecting an ASD child's nutritional status can include chronic constipation, encopresis (leakage of liquid stool around the constipation causing underwear stains), stomach pain with or without diarrhea, stomach bloating, gastroesophageal reflux disorder (known as GERD), and a lack of or deficiency in certain enzymes, such as lactase, that breakdown various sugars like milk sugar which is called lactose.1 Because ASD affects verbal and non verbal communication skills, a child affected by ASD may have difficulty in explaining or expressing pain or discomfort after eating. For example, acid reflux may trigger the child's posture and various movements as the child tries to stop the acid from refluxing and causing great discomfort. Any of the gastrointestinal problems can result in loss of appetite, avoidance of certain foods, becoming a "picky eater," and an inadequate nutrient intake to support good growth and development.
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The ASD healthcare team can help to determine the causes of the various gastrointestinal problems a child is having. Testing for various food sensitivities will determine if the child's daily diet needs to be modified to avoid certain foods and food ingredients. For example, if the child has an allergy or intolerance to dairy proteins but not to soy proteins, a soy-based beverage such as PediaSmart® Soy Complete Nutrition Beverage can be substituted for milk in the diet. If milk sugar (lactose) is the problem, then a lactose-free product such as PediaSmart® Dairy or Soy Complete Nutrition Beverage could be used in place of milk. Other recommendations the healthcare team may provide include ways to help prevent or treat constipation. These may include:
- Drinking plenty of water and fluids
- Adding high fiber foods to the diet such as use of whole grain breads, cereals and crackers
- Adding natural laxatives to the diet such as prune juice, apple juice, figs, pears, plums, peaches and apricots
- Making sure the child gets adequate exercise each day
- Using a soy beverage such as PediaSmart® Soy Complete Nutrition Beverage in place of milk since soy-based beverages are less constipating than cow's milk.
There are numerous suggestions in the media, especially on the Internet, for use of special diets to treat a child with ASD. There are even theories related to food opioid peptides (small protein units that act like morphine) passing through a damaged intestinal wall, called "leaky gut," playing a role in ASD.1 At present, a "magic bullet" diet for ASD does not exist. Although 23-50% of children with ASD are reportedly on special diets, these diets have not been tested in a systematic, scientifically controlled way.6
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In fact, a thorough review of the scientific literature on the most popular of these diets, the GFCF diet, was conducted and the authors concluded "current evidence for efficacy of these diets is poor."7 This is not to say that all of the research has had poor results. Some research is beginning to show that there may be a subset of children with ASD who do respond well to certain dietary interventions. So some children will benefit from a special diet and others will show no improvement in symptoms.8
Before embarking on a special diet that may or may not work and which could also place the child at nutritional risk, consultation with the child's healthcare team, especially the registered dietitian, is warranted. The pros and cons of introducing a special diet can be reviewed. If a special diet is to be tried, there can be collaboration between the family and the healthcare team with a focus on nutrients of greatest concern such as Vitamin D, calcium and iron; ways to increase the variety of foods in the daily diet to ensure nutritional needs are being met; and the appropriate use of supplemental nutrition if needed, such as PediaSmart® Complete Nutrition Beverage.
The various diets in the media being written about and promoted for ASD are all types of elimination diets where food items are withdrawn from the diet to determine if their removal results in a decrease or disappearance of various symptoms. The easiest to use and perhaps a good starting point for trying a special diet is the Feingold Diet. The Gluten Free/Casein Free Diet can then be added on under the guidance of the ASD healthcare team before going to the very difficult and restrictive diets being suggested in the media. Some of the diets being tried in ASD include:
- The Feingold Diet
The Feingold Program, often referred to simply as the Feingold Diet, was originally introduced to assist with the treatment of ADHD (Attention Deficit Hyperactivity Disorder). It is now also being investigated for the treatment of children with ASD. The program eliminates all artificial colorings and flavorings, aspartame (an artificial sweetener), artificial preservatives like BHA, BHT and TBHQ, aspirin, foods containing salicylate (a group of chemicals related to aspirin), and fragrances and non-food items containing any of these ingredients. The theory is that the body has a difficult time removing these harmful substances and they cause behavioral problems. Organic foods and organic certified food products, such as PediaSmart® Complete Nutrition Beverage (dairy & soy), are often recommended on this diet because they do not contain these harmful chemicals. The Feingold diet is perhaps the least difficult and least expensive diet to use before moving on to more complex diets. When other dietary restrictions are needed, the Feingold diet is often used in combination with the GFCF diet. Additional information on the use of this diet in children with ASD can be found at: Feingold.org
- Gluten Free/Casein Free (GFCF) Diet
The GFCF diet is perhaps the most popular and also most studied of the special diets being used to treat ASD. Gluten is a protein found in wheat and other grains such as barley and rye. It can also be found in other food items such as soy sauce, malt vinegar, artificial colors and hydrolyzed vegetable proteins. Casein is also a protein found in milk and milk products such as cheese and yogurt. Caseinate is a form of casein that can be used as an ingredient in some non-dairy foods such as hot dogs. The theory behind the GFCF diet is that gluten and casein are not digested properly resulting in small peptides (small protein units) that act like opiates. These opioid peptides affect the way the brain responds to the environment and causes the child to have altered behaviors and speech. Studies are inconclusive regarding the effectiveness of the GFCF diet but there does appear to be a subset of autistic children who respond well to the diet. Some parents report less constipation or diarrhea and others claim improvements in a child's behaviors and speech. Because the GFCF diet requires a lot of work for parents when planning meals, shopping for gluten-free and casein-free foods, and ensuring a healthy and nutritious diet, checking with the child's ASD healthcare team is best. Tests can be done to determine if certain proteins are causing food intolerances or sensitivities and help can be obtained in meal planning and finding nutritious gluten-free and casein-free foods and beverages. PediaSmart® Soy is both casein and gluten free. For additional information about the GFCF diet, the following website can be helpful: Webmd.com
- Soy-Free Diet
The theory behind avoidance of soy and soy products in ASD is similar to the theory behind the GFCF diet and that is the proteins in soy may have an opiate effect. Soy is known as one of the major allergens and testing can be done to determine if a child has a soy sensitivity. A soy-free diet is often used in conjunction with the GFCF diet. As with the restriction of any specific group of foods and food products, consultation with the child's registered dietitian can help to ensure that a soy-free or GFCF and soy-free diet is healthy, nutritious, and meets the growth and developmental needs of the child with ASD. PediaSmart® Dairy is free of soy protein; however, this product does contain organic soybean oil and organic soy lecithin.
- Specific Carbohydrate Diet™
Also known as SCD, the Specific Carbohydrate Diet™ was originally designed to help with bowel disorders such as Crohn's Disease or ulcerative colitis and has more recently been suggested to be of benefit to treat ASD. The diet is grain-free, lactose-free and sucrose-free and is much more restrictive than the Gluten-Free/Casein-Free diet. A few of the many food restrictions in this diet include avoidance of sugars, canned vegetables, all grains and grain products such as breads and pastas, all starchy vegetables such as potatoes and yams, all milks, creams, yogurts and high lactose cheeses such as ricotta, cottage cheese and cream cheese, and some oils. The theory behind this diet is that undigested carbohydrates are the energy source for bacteria in the intestines. These undigested carbohydrates cause the formation of acids and toxins that harm the small intestine and destroy the enzymes that allow for carbohydrate digestion and absorption. Other than personal testimonials, the SCD diet is unproven with little scientifically published information to support its use. It is difficult to follow and can be potentially risky. The use of this diet with an ASD child should be thoroughly discussed with the child's healthcare team and, if the decision is to try the diet, then consultation with a registered dietitian is warranted to ensure that the child does consume adequate nutrients from the limited list of allowed foods. Vitamin and mineral supplementation may also be needed. Additional information on this diet and autism can be found at: Researchautism.net
- Gut and Psychology Syndrome (GAPS) Diet
The GAPS diet is a variation of the Specific Carbohydrate Diet™. The primary difference is that all dairy containing products except for clarified butter and ghee are eliminated rather than just high lactose containing dairy products. In addition, the GAPS diet also includes probiotic, essential fatty acid, digestive enzyme, and vitamin and mineral supplements. As with the SCD diet, the theory is that there is a relationship between intestinal health and behavior – a connection between the gut and the brain – and use of the diet will help behavioral disorders such as ADHD and autism. There are presently no scientific studies to support the use of this diet in ASD and, as suggested with the SCD diet, consultation with the child's healthcare team should be done prior to starting the GAPS diet protocol. Additional information about the GAPS diet can be found at: Livestrong.com
1 Buie T, Campbell DB, Fuchs GJ, et al. "Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report," Pediatrics. 2010; 125:S1-S18.
2 Landa R, Garrett-Mayer E. "Development in infants with autism spectrum disorder: a prospective study," Journal of Child Psychology and Psychiatry. 2006; 47:629-638.
3 Centers for Disease Control. "CDC estimates 1 in 88 children in United States has been identified as having an autism spectrum disorder", March, 2012, www.cdc.gov/media/releases/2012/p0329_autism_disorder.html.
4 Szatmari, P. "Is autism, at least in part, a disorder of fetal programming?" Archives of General Psychiatry. 2011; 68:1091-1092.
5 Cermak SA, Curtin C, Bandini LG. "Food selectivity and sensory sensitivity in children with autism spectrum disorders," Journal of the American Dietetic Association. 2010; 110:238-246.
6 Stewart P. "Diet and autism: What is current evidence-based practice?" Presented at the American Dietetic Association Food & Nutrition Conference & Expo, September 26, 2011.
7 Millward C, Ferriter M, Calver SJ, Connell-Jones GG. "Gluten- and casein-free diets for autistic spectrum disorder," Cochrane Database of Systematic Reviews. 2008; Issue 2. Art. No.: CD003498. DOI: 10.1002/14651858.CD003498.pub3.
8 Buie T. "Diet and autism: What is current evidence-based practice?" Presented at the American Dietetic Association Food & Nutrition Conference & Expo, September 26, 2011.