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FeaturesAug/Sept 2008 Issue

Food as Medicine for Autistic Children

My son, Sam, was diagnosed with autism in 1992. At the time, autism was considered a rare disorder, affecting about 4 in 10,000 children in the United States. Today it's estimated that 1 out of every 150 children born in the United States will ultimately receive this diagnosis.

What accounts for the dramatic upturn in the number of children diagnosed with an Autistic Spectrum Disorder (ASD)? Along with increased awareness and broader diagnostic criteria, possible explanations, many of them controversial, include the influences of environmental toxins, vaccinations or a combination of genetic predisposition and environmental triggers. 

Whatever the reasons for the autism epidemic, millions of people hope for a cure. Many doctors still offer little in the way of treatment for this pervasive disorder. In 1992, I was told that special education, along with speech and occupational therapy, were the sole treatments for my son’s condition.  Today, parents are finding hope in biomedical options, such as treating intestinal dysbiosis (imbalance in the gut), feeding the brain with vital nutrients, removing heavy metals, administering hyperbaric oxygen therapy (to improve language, awareness and various cognitive deficits), bolstering an impaired immune system and increasing methylation (a biochemical process necessary for a variety of functions, including heavy metal detoxification).

One of the most promising new treatments is dietary intervention. Although many doctors still resist the notion that a special diet can help, for the most part diet is no longer considered an “alternative” therapy. It is supported by several peer-reviewed studies, thousands of documented case studies and a number of new, well-funded research projects. In fact, data from more than 25,000 parents collected by The Autism Research Institute over the last forty years shows that diet is one of the most successful interventions for ASD, achieving positive results in 65 percent of the children who have tried it.

All dietary treatments for autism share one underlying principle based on clinical observations: the gut has suffered damage resulting in permeability and depleted enzyme production. The goal of the diets currently in use is to heal the gut, improve digestion and absorption of nutrients and remove foods that directly or indirectly lead to autistic symptoms. To do this, each of the diets emphasizes one or several aspects of this problem:

• removing allergens and other problem foods.
• treating gut dysbiosis.
• adding supplements to replace missing nutrients.
• using digestive enzymes to improve digestion and the absorption of nutrients.
• identifying and treating any
underlying problems.

Choosing a Diet
There are several diets currently being used for ASD kids. All address similar symptoms—so where do you start?
 
Restricting gluten and casein is nearly always the first step made by parents who choose to try dietary intervention. Relatively speaking, it's the easiest diet to implement and it forms the basis for most of the others. When improvements level off, parents can then choose to try additional changes.

Here are some specifics about the top four dietary interventions currently in use.

The Gluten-Free, Casein-Free (GF/CF) Diet
This intervention has its origin in the observation that some symptoms of autism resemble those shown by individuals addicted to opiate drugs. Research has implicated the incomplete breakdown of gluten and casein during the digestive process, probably due to the absence or inactivation of an enzyme called DPP-IV. When these proteins are not completely digested, they can retain opioid characteristics and, in fact, opioid peptides have been found in the urine of autistic children since the early 1990’s. Because the autistic gut is generally “leaky,” these peptides can pass out of the gut and into the bloodstream, ultimately crossing the blood-brain barrier. These peptides mimic neurotransmitters (the chemicals responsible for communication between nerve cells) and cause all sorts of neurological mischief.
 
The premise of the diet is simple: remove the source of the opioid peptides in order to reduce the neurological effects. In addition, many researchers believe that gluten and casein irritate the intestines of sensitive children, so removing them from the diet promotes intestinal healing.

The diet gained widespread popularity when the emergence of the Internet made it possible for vast numbers of parents to compare notes and share information. There are hundreds of anecdotal reports of improvements, sometimes dramatic, in ASD children who avoid these proteins.  For many children, however, removing these peptides will not be enough to fully heal the gut and further modifications in diet are needed.

The Specific Carbohydrate Diet™ (SCD™)
Some children make only modest improvement on a GF/CF diet, despite strict adherence to it. Those with chronic yeast overgrowth, Clostridia, gas, bloating, diarrhea or constipation are good candidates for the Specific Carbohydrate Diet™ (SCD™). 

SCD™ is a type of gluten-free diet originally developed by Dr. Sidney Valentine to treat Crohn’s disease, ulcerative colitis, celiac disease, cystic fibrosis and other gastrointestinal problems. The late Elaine Gottschall wrote a groundbreaking book on the topic, called Breaking the Vicious Cycle: Intestinal Health through Diet. The last edition included a chapter about using the SCD™ for autism.

The premise of the diet is that damaged intestinal walls and bacterial overgrowth from undigested carbohydrates cause immune dysfunction and poor health. Because the bacteria are believed to feed on these complex sugars and starches, restricting them should restore the proper ecology of intestinal flora and allow the gut to heal.

To accomplish this, the SCD™ limits the diet to simple sugars (monosaccharides), such as honey and fruit (fructose), which require minimal digestion and are easily absorbed. The daily menu primarily consists of meats, fish, eggs, vegetables, fruits, nuts and seeds.  Most sugars, all starches and other potentially problematic foods, such as chocolate and soy, are not allowed.

In the original SCD™ guidelines, some forms of animal milk (a specially prepared goat's milk yogurt, intended to repopulate the gut with good bacteria) are allowed—but this diet was not initially created for the autistic population. SCD™ proponents claim that some children who have a history of reacting to casein can tolerate this yogurt after a sufficient period of gut healing.

A rigorous adherence to the diet is critical. However, some people, unwilling or unable to remove all starches and sugars, have found that cutting out most still yields significant benefits. There are also children who do better when a small amount of a gluten-free grain, an SCD™ no-no, is added to their diet.

Many autistic children have done extremely well on the SCD™ but not everyone is a fan. Dr. Arthur Heller, a New York gastroenterologist who is certified by the American Board of Nutrition, believes there are inconsistencies in the diet and that it’s too restrictive.

“Foods are excluded,” he says, “because of their purported inability to be digested well. But of the foods allowed, legumes are known to contain certain carbohydrates that are not well digested by humans. And while the diet prohibits regular sugar, it allows most fruits and fruit juices, which are high in fructose, or fruit sugar. Not only is fructose dense in carbohydrates, but fructose malabsorption can cause cramps and diarrhea, intensifying the very symptoms the diet is designed to alleviate.” He agrees that the SCD™ improves the health of intestinal flora but says, “there may be less extreme ways of doing the same thing.”

Heller treats patients with Crohn’s disease and colitis, not patients with autism. He insists that many of his patients do well on probiotics, antibiotics and moderate changes in their diet, a treatment regimen that he says is just as effective as the SCD™ and less intrusive to a patient’s lifestyle. Parents of ASD children who have flourished on this diet counter that autistic behaviors are a lot more intrusive to a family’s lifestyle than even the strictest diet.

The Body Ecology Diet (BED)
The Body Ecology Diet was developed by Donna Gates to target fungal infections, viruses and parasites. Gates describes her program in The Body Ecology Diet: Recovering Your Health and Rebuilding Your Immunity, first published in 1996. The premise of the diet is that many cases of chronic illness begin with a fungal infection in the gut, which leads to various secondary illnesses. Incompletely digested nutrients inside the gut wall can trigger allergic reactions and improper absorption. 

The goal of this diet is first to heal the gut by correcting gut dysbiosis and then to nourish and rebuild the body. The BED promotes health and healing using high-quality, easily digested foods rich in healthy fats and minerals. Recommended foods, which are minimally processed, include large amounts of land and sea vegetables, meats, eggs, good fats, Celtic sea salt and certain gluten-free grains. The BED recommends the daily ingestion of cultured drinks and vegetables to reestablish the intestinal flora, just as the SCD™ encourages the use of special goat yogurt. 
 
In 2003, the diet began to receive interest from the autism community since unhealthy flora is linked with food allergies and gastrointestinal problems. It is not yet used as widely as the SCD™.

The Low Oxalate Diet (LOD)
The newcomer to dietary intervention for autism is the low oxalate diet. Oxalates are simple molecules found in many plant foods and in nearly all nuts and seeds; our body also produces them. Oxalates are normally bound with calcium and very few are absorbed by the gut. Under normal conditions, the gut flora either metabolizes oxalates or they simply pass into the stool. Under some conditions, however, oxalates crystallize into a spiky form that can irritate surrounding tissues. When the gut is leaky, too many dietary oxalates can be absorbed. This is known to cause problems for people with kidney stones and for those who have experienced a loss of gut integrity, such as people with celiac disease and inflammatory bowel conditions.

A low oxalate diet was originally developed for people with urinary problems and vulvar pain, but in 2005 autism researcher Susan Owens suggested the diet for autism spectrum children. She  reasoned that the high incidence of leaky and inflamed guts in children with autism might make them vulnerable to problems with oxalates. The premise of the diet is that by reducing inflammation throughout the body, the gut can heal properly.

Foods high in oxalates cause no problems for most healthy people. However, without enough minerals or the right type of bacteria in the gut, unbound oxalates can slip through gaps in the gut lining and cause inflammation throughout the body. Oxalates from food or those secreted by the body may also keep the gut from healing properly. The goal of the LOD is to speed up the process of healing the damaged gut by sharply reducing dietary oxalates.

It is possible that many ASD children will be helped by the LOD but it’s too soon to tell. To date, there are no formal studies that point to the efficacy of this diet for autism, nor is it clear which children are most likely to benefit. However, many physicians have been impressed by the improvements of their patients on the LOD and have been recommending a trial period on the diet for individuals with inflammation and/or gastrointestinal symptoms.

Children who have done poorly on diets that rely heavily on nuts or grains are good candidates for a trial on the LOD, since these foods are particularly high in oxalates. Parents may also want to try the LOD if their child has urinary issues, low energy, poor growth, fatty stools or unresolved skin problems. If a child repeatedly touches the genital area, it may indicate discomfort and the LOD may help. Gluten-containing foods are high in oxalates, which may explain why some people suffering from these symptoms find that they improve on a gluten-free diet. Owens encourages those on the LOD to stay or become gluten free, as gluten can increase gut permeability.

Owens recommends a gradual implementation of the LOD, first removing oxalate-containing foods, particularly those very high in oxalates, such as nuts, chocolate, potatoes and citrus fruits. Over time, lower-oxalate foods are slowly added back to the diet until the daily oxalate count remains below 40 mgs per 2000 calories.

As with many autism treatments, an initial worsening of symptoms may be seen as a positive sign. As built-up oxalates are released from the body, there are physical and sometimes behavioral symptoms. LODers refer to this detox process as “the dump.”

If this diet is helpful, there should be improvements (between “dumps”) in the areas of physical comfort, complex thinking, sociability, speech, gross and fine motor skills, energy, loss of stiffness and amelioration of skin problems, such as eczema. Children may be willing to eat foods previously avoided and their craving for high-oxalate foods may disappear. After detoxing is complete, a process that can take several months to a couple of years, higher-oxalate foods can be gradually returned to the diet.

Although it may be necessary to continue to restrict foods that are very high in oxalates, this diet is not meant to be a lifetime program for autism. After some time on the LOD, when healing has taken place and gut health has improved, higher oxalate foods will probably be tolerated. If there is no change for the better or worse after two weeks on a very low oxalate diet, assuming that the guidelines for supplements are being followed, then this diet will probably not be helpful.

Discovering the Right Diet
Finding the diet that most helps your child can be a challenge. But the potential benefits are so great that it’s well worth the time and effort. Every child is unique and it takes an involved and dedicated adult to tease out and determine the best dietary treatment for a youngster.

For a few autistic spectrum children, no diet will resolve their symptoms. If that’s the case, parents who attempt special dietary intervention will at least become familiar with the principles of good nutrition. Happily, however, most autistic children will see some benefits from diet changes. And for a lucky few, dietary intervention may be their first step on the road to recovery.  LW

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