Autism Spectrum Disorder (ASD), also known simply as Autism, is a complex biological disorder characterized by difficulties with speech; abnormalities of posture or gesture; problems with understanding the feelings of others; sensory and visual misconceptions, fears and anxieties; and behavioral abnormalities such as compulsive/obsessive behavior and ritualistic movements. The National Autistic Society estimates that more than half a million people have autism with four times more boys than girls affected.
No single cause has been established, although genetic and environmental factors are implicated. Possible suspected causes of autism include advanced parental age, low birth weight, and multiple births. A viral infection, such as the flu, in the first trimester has been shown to triple the odds of a child developing ASD, and a bacterial infection, such as a urinary tract infection, in the second trimester has been found to increase the risk of ASD by 40%. Recently, researchers examined inflammatory disease as a possible cause of autism and found that it could possibly contribute to the etiology of the disorder.
There is growing evidence that nutritional therapy can really make a big difference to children with autism. Many have severely disrupted digestion, so restoring balance in the gut is a key focus for nutritional therapy. Also important is balancing blood sugar, checking for brain-polluting heavy metals, excluding food additives, identifying food allergies and possible nutrient deficiencies, and ensuring an optimal intake of essential fats.
Nutritional Therapy for Autism
For a variety of reasons, children with autism spectrum disorder (ASD) may not get the nutrition they need for healthy growth and development. Some children with autism will only eat certain foods because of how the foods feel in their mouths. Other times, they might avoid eating foods because they associate them with stomach pain or discomfort. Some children are put on limited diets in hopes of reducing autism symptoms.
It is important that parents and caregivers work with a nutrition specialist such as a registered dietitian or health care provider to design a meal plan for a person with autism, especially if they want to try a limited diet. Such providers can help to make sure the child is still getting all the nutrients he or she needs to grow into a healthy adult, even while on the special diet.
Digestive Problems in ASD
Some people with autism have digestive problems, such as constipation, abdominal (belly) pain, or vomiting. Some research suggests that digestive problems occur more often in people with autism than in people without autism, but more research is still being done on this topic. Working with a dietitian can help ensure that a diet does not make digestive problems worse.
For example, many children with ASD are on gluten-free or casein-free diets. Gluten and casein are types of proteins found in wheat and milk products, respectively. Available research data do not support the use of a casein-free diet, a gluten-free diet, or a combined gluten-free, casein-free diet as a primary treatment for individuals with ASD.
Supplementation
One aspect of ASD treatment involves supplementation with multivitamins, omega-3 fatty acids, vitamins D and B6, magnesium, and other nutrients. Beginning multiple supplements at one time may impede the ability to determine what’s working or not working in ASD patients. Therefore, the best strategy may be to start one supplement at a time for several weeks to determine whether there’s an improvement in symptoms.
If the patient takes one supplement for several weeks and experiences no improvements in symptoms, it means the supplement may not be helpful for that particular patient. If improvements are seen, stopping the supplement for a week or so to determine whether symptoms return can be a good strategy to gauge effectiveness. This process allows ASD patients to follow the least restrictive regimen possible while identifying improvements in symptoms.
Multivitamins
Most practitioners who work with ASD patients agree that a good-quality multivitamin without artificial colors or flavors can help offset limited dietary preferences and poor nutritional intake. Finding the right multivitamin will depend on a patient’s tolerance. Some will swallow a pill, while others will prefer a liquid, gummy, or chewable form. Registered Dietitians (RD) are in a perfect position to determine what’s acceptable and meets each patient’s needs.
Omega – 3 Fatty acids
Research has shown that adding omega-3 fatty acid supplements to ASD patients’ diets may provide many benefits. Omega-3s are critical for brain development and proper neural function. Multiple studies have shown imbalances in the ratio of omega-3 to omega-6 fatty acids in the bloodstreams of ASD patients. Obtaining adequate amounts from food alone may be difficult because of the limited number of foods they may eat. For example, some children with ASD won’t eat cold-water fish (salmon, tuna, etc), and some parents won’t add fish to their children’s diet because they believe it contains mercury that may exacerbate ASD symptoms. Still, many parents do give their children omega-3 supplements.
Elimination Diet Therapy
The elimination diet is another option that has shown promise in treating ASD and involves removing certain foods from the diet for a period of time to determine whether they’re causing symptoms of food allergies and intolerances. Research has shown that eliminating gluten and casein from the diet of ASD patients can alleviate symptoms such as behavior problems and poor cognitive and social functioning.
There are several theories as to why the elimination diet may be beneficial. One hypothesis is that ASD patients can’t digest gluten and casein, causing the formation of the peptides gluteomorphin and caseomorphin and their absorption into the bloodstream because of increased gut permeability, or leaky gut syndrome. These two peptides, which appear to have a chemical structure similar to opiates, can cross the blood-brain barrier and cause symptoms such as delayed social and language skills, and withdrawn behavior.
There are concerns about the use of a gluten-free/casein-free diet because its planning requires a skilled professional who understands the complexities of elimination diets and the restrictions of appropriate foods. The exclusion of wheat and milk puts an ASD patient at risk of nutrient deficiencies in calcium, protein, vitamin D, folic acid, and B vitamins. And studies have found that diets lacking gluten and casein raise the risk of decreased bone density and stunted growth, making children with autism have thinner bones than children without autism. Restricting access to bone-building foods, such as dairy products, can make it even harder for their bones to grow strong.
However, RDs can introduce other foods into the diet as well as provide advice on nutritional supplements to compensate for low nutrient intakes and also, help ensure that children who are on special diets still get the bone-building nutrients as well as other nutrients they need.
A more complex elimination diet that some specially trained dietitians use is called the LEAP (Lifestyle, Eating, and Performance) protocol. This involves eliminating any known foods or chemicals suspected of triggering symptoms. These foods and chemicals are identified by a blood test called the Mediator Release Test, which shows reactions to multiple foods and chemicals. Such reactions involve the immune systems of patients who ingest foods and chemicals to which they’re sensitive. Their immune system identifies these foods and chemicals as foreign invaders, causing the immune system to release mediators to fight off the “invaders.” Some of the mediators released include histamine, prostaglandins, leukotriene, cytokines, and peroxides. These mediators have been shown to cause reactions such as inflammation, diarrhea, pain, intestinal cramping, constipation, headache, and pain receptor changes.
Reactions to certain foods and chemicals also can cause the release of the brain neurotransmitters dopamine and serotonin. Dopamine appeals to the sense of reward and enjoyment, and plays a role in addictive behavior. Serotonin contributes to feelings of well-being and happiness.
When dopamine and serotonin are released as a result of ASD patients ingesting foods and chemicals to which they’re sensitive, they may experience less pain, brain fog, or inability to focus and concentrate. According to certified LEAP therapists, ASD patients also may feel euphoric after ingesting a reactive substance or stop throwing a tantrum after eating a reactive food. It’s in these instances where the Mediator Release Test may help with identifying reactive substances that can be eliminated to improve behavior, communication skills, and other immune-related health issues and allow for more variety in the diet for better nutrition.
The Way Forward
So, what does the future hold for individuals with ASD? While there’s no concrete answer to this question, we know RDs can play a huge role in the management and treatment of ASD symptoms.
RDs’ ability to analyze diets for nutritional deficiencies can help concerned parents. Contacts with other healthcare disciplines that monitor patient behaviors make RDs invaluable as they provide holistic approaches to treatment for optimal cognitive and social functioning. They are the best source for providing accurate and up-to-date information on supplementation, elimination diet therapy, and current research on new nutritional approaches.
More and more patients will depend on dietitians as the source of information that will enable patients to live productive lives. Dietitians with the passion to work with this challenging segment of the population will be a much-needed resource in the dietetics community in the years to come as they can work with health agencies and organizations to learn more about how children with autism grow and if they have specific nutritional needs.
Further reading: http://www.todaysdietitian.com/newarchives/010713p46.shtml
https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml