Today's guest post is by Madiha Ahmad, who is a few weeks away from receiving her Master of Science degree in Nutrition. You can read more about Madiha at http://blog.themaddiet.com/
Autism spectrum disorder is a behavioral disorder that has become prevalent in one out of every 166 children in the U.S. (1). It has been ranked 3rd among the most common developmental disabilities seen in children today.(1) This disorder can delay a child’s verbal communication, affect their social skills, and cause lack of interest in activities. Usually children are diagnosed by the time they are 2 ½ years old. Medical intervention of autism is helpful, but there is now emerging research and studies being done on the dietary aspect of treating this disorder.
Nutrition plays a huge role in the growth of development of children. Autistic children are presented with many challenges in life due to their behavioral symptoms. It is imperative to provide these children will optimal nutrition to avoid any malnutrition, decreased weight, vitamin deficiencies or Gastrointestinal (GI) issues. Many autistic children experience GI issues or malnutrition due to their current dietary habits. Lack of appetite or lack of interest in eating can lead to malnutrition. Issues of irritable bowel syndrome, constipation, gluten sensitivity, Crohn’s disease, and celiac disease can be seen in autistic children. This is where dietary intervention comes into play. If we try to resolve these GI or malnutrition issues sometimes we see an improvement in the autistic child’s behavioral patterns.
Several autism organizations support using nutrition as a method of treatment for autistic children. National Autism Association, Autism Network for dietary intervention, Autism Society, Talk About Curing Autism (TACA), and Defeat Autism Now (DAN) are just some examples of organizations and support groups that advocate nutritional intervention for this disorder. What is the dietary intervention for this disorder? There are many different diets that are being researched such as; gluten free/casein free diet, ketogenic diets, specific carbohydrate diet, and organic diet/limiting process foods. Research and studies are being done to study the effectiveness of these different diets and their impact on autism. The most common diet where research and studies have been done is the gluten free/casein free diet. Another diet mentioned by the National Autism Association group, but where not much research is been done is the Specific Carbohydrate Diet (SCD). These two diets seem to show some improvement in behavioral symptoms of autism. (2) The goal through dietary intervention is to try to decrease the symptoms of autism and give these children a chance for some relief.
The gluten free/casein free diet is the most commonly used diet for autistic children. The gluten free portion of it involves removing the protein “gluten” from the diet. Gluten is found mainly in whole grain products. Anything made with wheat, barley, and rye is to be avoided on this diet. The casein free portion involves removing the protein “casein” from the diet. Casein is found in milk products. An important thing to remember when starting this diet is to eliminate one of the proteins first and then move on to the next one. This way we can determine if there is an allergy to either protein by observing if symptoms improve or not with the removal of the proteins. Usually it is recommended to remove the milk products first, since casein can be eliminated from the body at a more rapid pace than gluten. Once milk has been removed from the diet for about 1 month then gluten products can be eliminated from the diet. It takes about 6 months to rid the body of gluten. Parents who put their children on this diet must remember to continue it for a span of about 6-8 months to see how effective it is. (3)
The reasoning behind removing gluten and casein from the diet is that autistic children might have problems digesting these two proteins. The digestion of casein and gluten produce certain by-products and it is these by-products that are believed to cause or worsen the symptoms of autism. (3) The breakdown of gluten produces a byproduct called gluteomorphine. Gluteomorphine is believed to have “drug” like symptoms and might be contributing the symptoms of autism once in the bloodstream. There is some speculation that autistic children might have a “leaky gut” which allows gluteomorphine to enter the bloodstream. (3) This would provide good reasoning behind removing gluten from the diet and maybe explain why it actually has benefited some autistic patients.
Parents in support groups for autism have reported that the gluten free/casein free diet actually has benefited their children. Support groups, like Healing Thresholds and National Autism Association advocate this diet. Also, there have been parental testimonials that this diet has in fact alleviated some of the symptoms associated with autism. There is a concern about risk of nutritional deficiencies when on this diet. Since there is no milk intake, calcium deficiency can be a concern. It is important that children on this diet be followed up by a registered dietitian for proper advice in other foods that are rich in calcium or possibly adding a calcium supplement.
There are several studies that have been done on the effects of the gluten free/casein diet on autistic children. Several articles suggested that the elimination of these two proteins in the diet actually improved behavioral patterns in autistic children and when the proteins were re-introduced in the diet behavioral patterns shifted.(4,5,6) One randomized control study that was done recently on a Danish population of 72 autistic children in which26 were put on gluten free/casein diet and the other 29 were a control group. (No diet)(7) The study concluded that “dietary intervention” had a positive impact on children with autism spectrum disorder. There were definite improvements in behavior among the 26 children that were on the diet.(7) Research on the effect of the gluten free/casein free diet on autism need to continue to provide us with additional concrete evidence.
The National Autism Association advocates another diet called the Specific Carbohydrate Diet (SCD). The SCD involves removing starches and certain sugars from the diet. (8) Because autistic children tend to have GI issues, removing starches which are harder to digest may improve the GI issues and improve digestion. It is the improvement of digestion and food sensitivities from the elimination of starch and sugar that might improve the behavioral symptoms associated with autism. (8) There has not been much research on this diet’s effect on autistic behavior and some experts have brought up inconsistencies in the diet. However, autism support group websites have enthusiastic recommendations from parents who say it has drastically improved behavioral symptoms in their children. More research for this diet as an actual treatment for alleviation of autistic symptoms is warranted.
Most of the research on diet and autism concentrates on the elimination of gluten and casein; this dietary intervention is also the most commonly used. The belief is that these two proteins cause most of the digestive issues leading to the behavioral problems that are seen in autism. Parents of autistic children have tried this diet and many support groups advocate it. If the parent thinks that the child is ready and they are ready to follow this strict diet, it may be beneficial. The parent must remember that is essential to consult with a registered dietitian while their child is on this diet to prevent any occurrence of malnutrition or vitamin deficiencies.
- Brown, Judith E. Nutrition Through the Life cycle,4th edition. Wadsworth Cengage Learning. Belmont, CA. 2011.
- National Autism Association http://www.nationalautismassociation.org/diet.php
- 3. Autism Web http://www.autismweb.com/diet.htm
- Healing Thresholds http://autism.healingthresholds.com/therapy/gluten-free-diet
- Knivsberg AM, Reichelt KL, Nodland M: Reports on dietary intervention in autistic disorders. Nutr Neurosci 2001;4(1):25-37.
- Knivbserg A.M., Reichelt K.L., Nodland M., Hoien T.: Autistic syndromes and diet. A four year follow-up study. Scand J Educat. Res. 1995, 39: 223-236.
- Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-freediets for autistic spectrum disorder. Cochrane Database Syst Rev.2004;(2):CD003498. Review. Update in: Cochrane Database Syst Rev.2008;(2):CD003498.
- Whiteley P, Haracopos D, Knivsberg AM, Reichelt KL, Parlar S, Jacobsen J, Seim A, Pedersen L, Schondel M, Shattock P. The ScanBrit randomised, controlled,single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutr Neurosci. 2010 Apr;13(2):87-100.
- “SCD diet” http://pecanbread.com/p/intro/introhome.html