Posted by on Nov 21, 2012 in Featured | Comments Off

Dietary and Nutritional Interventions

Dietary and Nutritional Interventions for Individuals with Autism and other Neurological Challenges

Individuals with neurological disorders such as autism, PDD-NOS, Asperger’s syndrome, attention deficit disorders, Tourette’s, and Down syndrome have an unusually high rate of food allergies and sensitivities.  Many have found that the identification of food sensitivities through laboratory testing and/or elimination diets has alleviated not only the obvious symptoms of food allergies such as chronic nasal congestion, asthma, or diarrhea, but the core symptoms of their neurological condition.  Many experience greater mental clarity and improvements in cognitive function when their ideal diet is identified and implemented.

Multiple food sensitivities are most likely to occur in individuals with increased intestinal permeability (“leaky gut”), which is often associated with symptoms such as diarrhea, constipation, gas, bloating, or foul-smelling stools.  The absence of gastrointestinal symptoms does not rule out the possibility of food allergies or sensitivities, however, and should not preclude a medically-supervised dietary trial or formal diagnostic testing.

The most common food allergens are wheat and other sources of gluten, dairy products, corn, soy, eggs, peanuts, tree nuts, tomatoes, citrus fruits, fish, and shellfish.  It is the protein content of these foods and protein fragments called peptides that are most problematic.  Casein, for example, is a peptide found in all dairy products.  Gluten is the primary peptide in grains such as wheat, rye, barley, spelt, and kamut.  Under ordinary circumstances, these peptides would be digested into their amino acid building blocks, which would then be absorbed into the bloodstream and utilized in various parts of the body for the construction of new proteins.  If dietary proteins are not completely digested, they may trigger an immune response and may also be biologically active.  Gluten and casein contain multiple repeats of amino acid sequences that are nearly identical to morphine.  These compounds are referred to as gliadomorphins and casomorphins and have been proven to cause a morphine-like response when injected into laboratory animals.  Just as a person given morphine or other opioid drugs would likely experience impairments in concentration, cognitive reasoning, and motor skills, individuals unable to properly digest or metabolize gluten or casein may suffer these drug-like effects after eating seemingly healthy foods.  Many, in fact, appear to be addicted to these foods and exclude other forms of nourishment from their diet.  This observation has become known as the opioid excess theory, and a growing body of evidence supports this theory.

While other foods may also be problematic, the strict elimination of all gluten and dairy products leads to significant improvements in many individuals with autism, Down syndrome, attention deficit disorders, Tourette’s, and other conditions.  A six month dietary trial is required to achieve the full benefit of this intervention, as inflammatory changes in the bowel and nervous system will take months to improve.  Even small dietary infractions can reverse the healing process.  The elimination of all corn, soy, food dyes, artificial sweeteners, artificial flavorings, and monosodium glutamate (MSG) is also highly recommended, as these are often problematic as well.

An additional concern is the finding that antibodies directed against gluten, milk, corn, and eggs have the ability to cross react with brain tissue.  In other words, if a person is unfortunate enough to be allergic to these foods, yet chooses to consume them, each exposure may stimulate his or her immune system to produce anti-brain antibodies.  In the case of autism, several anti-brain antibodies have been identified in both children with autism and in some of their mothers.  It is believed that this is one mechanism that is halted or diminished with the removal of these foods from the diet, leading to significant improvement in symptoms.

When faced with the prospect of removing all gluten, dairy, corn, soy, and junk food from their child’s diet, most parents state that their child eats nothing else and will undoubtedly starve.  Many of these children eat almost no fresh fruits or vegetables and quite a few have elected to become what I refer to as vegetarians without the vegetables!  These children almost all have some form of gastrointestinal inflammation.  By eating bland foods, a child initially neutralizes the acid in the stomach and may feel better for a short period of time.  If acid reflux is occurring, these foods will temporarily relieve their esophageal pain.  This perpetuates a cycle of inflammation, however, as partially digested peptide fragments enter the bloodstream and their immune system becomes further stimulated to mount an autoimmune response.  A hypoallergenic, rotational, organic diet and certain key supplements are usually required to break this cycle and begin the healing process.

High quality probiotics and vitamin and mineral supplementation can be very beneficial as well.  Aperture is a hypoallergenic multivitamin and mineral supplement created for individuals who benefit most from the more biologically active forms of folic acid and vitamin B12 known as 5-methyltetrahydrofolate and methylcobalamin.  These nutrients support our ability to make and repair cells, a mechanism that is almost universally impaired in children with autism due to metabolic weaknesses, inadequate nutrition, and/or intestinal inflammation.  Because the cells that line our intestinal tract have an average lifespan of only three days, any compromise in a person’s ability to keep up with this cell turnover will inevitably lead to gastrointestinal symptoms.  The nutrients in Aperture also support glutathione production.  Glutathione is the body’s primary antioxidant and is essential for the clearance of many toxins.  Multiple research studies have documented low glutathione levels in children with autism and in their mothers.  These levels can improve significantly with high level nutritional support.

Adopting this diet as a family is optimal, both out of respect for the family member whose health is compromised, and out of concern for the nutritional status and health of the entire family.  Most family members who make these dietary changes find that they have more energy, better concentration, and fewer health problems such as asthma, arthritis, eczema, and headaches.  By not eating processed, boxed, canned, or fast foods, we dramatically increase the nutritional content of our meals and decrease our exposure to genetically modified foods, pesticides, food additives, and other chemicals that ultimately put a burden on our liver and kidneys.  Whenever possible, organic meats and produce should be consumed rather than conventionally grown foods to reduce exposure to pesticides, antibiotics, hormones, chemical flavorings and other ingredients that can be detrimental to our health.

Initiating a Casein-Free Diet

Eliminate Dairy Products

  • Butter

  • Casein and caseinate

  • Cheese

  • Cottage cheese

  • Cream

  • Curds

  • Ice cream

  • Lactose and lactalbumin

  • Milk and milk solids

  • Sour cream

  • Whey

  • Yogurt

Avoid Hidden Sources of Casein

  • Medication fillers

  • Most soy cheeses

  • Hot dogs and lunchmeat

  • Flavorings

  • Caramel coloring

  • Milk chocolate

  • Goat’s milk

Consider Milk Substitutes

  • Almond milk

  • Cashew milk

  • Coconut milk

  • Rice milk

  • Potato milk

  • Hazelnut milk

Caveats

  • Some rice milk may be high in arsenic

  • Some brands are high in sugar

  • Vanilla flavoring sometimes contains gluten

  • Soy and nut allergies are common

A Note about Calcium

Children are said to need approximately 800 mg of calcium daily, but there is debate on this subject.  A combination of calcium, magnesium, zinc, and other minerals is actually ideal.  Individuals with mitochondrial dysfunction, self-stimulatory behaviors, seizures, tics, or hyperactivity may need to limit their calcium intake, as it can worsen these conditions in some cases.  While some professionals automatically recommend calcium supplementation when dairy products are eliminated, there is a large body of scientific evidence to dispute this recommendation.  Please discuss all supplements with a qualified physician and consider nutritional testing to guide your decisions.

Initiating a Gluten-Free Diet

Sources of Gluten

  • Wheat

  • Oats (due to cross-contamination)

  • Rye

  • Barley

  • Spelt

  • Kamut

Hidden Sources of Gluten

  • Semolina, duram, graham, and other forms of wheat referred to by their less familiar names

  • Vanilla and other flavorings extracted with alchohol

  • Hydrolyzed vegetable protein

  • Hydrolyzed plant protein

  • Malt flavoring (extracted from barley)

  • Cake meal

  • Vitamin and medication fillers

  • Waxed fruits

  • Some spices and baking powder

  • Some rice syrups

  • Raisins and other dried fruits are sometimes dusted with flour to prevent sticking

  • Cereal fillers in hot dogs and lunchmeat

  • Soy sauce

  • Caramel coloring

  • Grain vinegars (apple cider and rice vinegars are usually gluten-free)

  • Modified food starch

  • Millet and buckwheat may be cross-contaminated with gluten

  • Starch

Wheat Flour Alternatives

  • 3/4 cup ground nuts + 1/4 cup sorghum or other flour

  • Comercial flour mixtures

  • The following blend can be used in place of wheat flour in most recipes:

         2 cups rice flour  +  2/3 cup tapioca flour  +  1/3 cup sorghum flour or almond meal

Gluten-Free Flours

  • Amaranth:  Nutty flavor.  High in protein, calcium, and iron.

  • Arrowroot:  Good substitute for corn starch as a thickening agent in gravy and pie fillings.

  • Bean flours (chickpea, garfava, soy, etc.):  High protein flours with a heavy texture and strong flavor.  These cause gastrointestinal distress in many and are common food allergies.

  • Buckwheat:  Cross contamination with gluten is common.  Strong flavor.

  • Coconut flour

  • Corn meal:  Not recommended due to frequent GMO contamination and sensitivities

  • Millet:  Cross contamination with gluten is common

  • Nut flours:  Monitor for allergic reactions.  Grind just before use to prevent flour from becoming rancid and refrigerate or freeze ground flour.

  • Potato flour:  Combine with lighter flours for a better texture.

  • Quinoa:  High protein flour with a nutty taste.

  • Rice and sweet rice flours:  Recent reports exposed concerns about the arsenic content of rice and rice products.  Rice flour is a simple carbohydrate tolerated by most, but not all sensitive individuals.  While very versatile and useful in gluten-free cooking, also explore other options.

  • Sorghum:  Mixes well with rice and other lighter flours for general baking needs

  • Tapioca flour:  May use for 25-50% of flour mix.  Light texture similar to corn starch.

  • Teff:  Strong flavor best used for brownies and pancakes.  Does not rise well.  Rich in iron and calcium

Getting Started

  • Remove all dairy products and casein

  • Remove all wheat

  • Learn to read labels

  • Remove oats, rye, barley, and malt flavoring

  • Avoid all food dyes, artificial flavorings, and artificial sweeteners

  • Buy organic and cook from scratch whenever possible

  • Meat, fresh fruits and vegetables, rice, and potatoes will be staples of the diet

  • Shop the perimeter of the store

  • Rotate foods whenever possible

  • Avoid cross-contamination of nut butter, margarines, jelly jars, toasters, and colanders

When the GFCF Diet “Fails”

Patients often tell me that they tried eliminating gluten and casein from their child’s diet, but their child’s health did not improve.  While this may truly be the case, more often than not, other problems have not been addressed.  Common reasons for an inadequate response to a gluten and casein-free diet include the following:

  • Dietary infractions: school, nanny, grandparents, cross contamination, unidentified gluten or casein exposure

  • Undetected food allergies:  Corn, soy, peanuts,eggs, and citrus fruits are common allergies and sensitivities that may also need to be addressed

  • Yeast or bacterial dysbiosis

  • Parasites

  • Constipation/colitis/gastritis/GERD/Eosinophilic esophagitis:  There are many aspects to bowel health that may need to be evaluated

  • Methylation defects:  An unmet need for additional B12 or the methylated form of folate (5MTHF) can cause continued gastrointestinal and neurological symptoms

  • Amino acid deficiencies:  Many children refuse to eat meat or other high protein foods and become severely malnourished.  An inadequate protein intake can have a devastating effect on brain, heart, immune, and gastrointestinal health.

  • Carbohydrate junkies:  Switching from junk food made from gluten to gluten-free donuts, cookies, cakes, and cereals will lead to disappointing results.  It is important to limit your child’s intake of sugar and other simple carbohydrates.

  • Excessive juice or fruit intake:  Processed juices are a sugar load and even a high intake of naturally sweet fruits such as apples and bananas can be more sugar than a child should consume, particularly if they are prone to intestinal yeast overgrowth.

  • Food dyes, artificial sweetener, and artificial flavorings:  Again, not all GFCF food is healthy.  As you learn to read labels, your entire family will be consuming safer and more nutritious foods.

  • Sensitivity to phenols, oxalates, salicylates, histamine, or other contents of food:  Some individuals have unusual sensitivities to these or other components of food.  Identifying these sensitivities may require trial periods of avoidance and laboratory testing.

  • More advanced dietary interventions may be necessary:  GAPS, Specific Carbohydrate Diet, Paleo diet, and others are sometimes required.

There are both positive and negative studies of the effect on gluten and dairy restriction in children with autism in the medical literature.  A critical assessment of each study will reveal any weaknesses, which are common.  Many dietary trials involved a very small number of individuals, ignored dietary infractions as if they were insignificant, allowed the intake of very unhealthy and often problematic foods such as those high in corn, soy, sugar, or food dyes, and were too short in duration to allow a true assessment of response.

At the end of the day, only your child’s response is what matters and you will obtain the best results with the help of a qualified medical professional.

Please consult a knowledgeable physician or nutritionist before implementing any dietary intervention. Every patient requires individualized recommendations for optimal results.  Baseline and follow up nutritional testing will guide your decisions and clarify dietary needs.