Dietary Intervention & Autism Spectrum Disorders
Hannah KayeNutritional Therapist
www.hannahkaye.co.za
Outline for today – Part 1
1. Research
2. Diet
3. Why special diets may help your child
4. Diet options
5. Gluten & Casein Free
6. Food elimination
7. Feingold / Low Phenol
Outline for today – Part 2
8. SCD
9. GAPS
10. Good nutrition and overcoming common problems
Autism Spectrum Disorders
are caused by
genetic predispositions
combined with environmental
factors
that create
disordered biochemistry and
damaged organs & systems.
Complex & Inter-related Whole
Body DisorderBrain is Downstream
Yeast toxins
Undermethylated neurotransmitters
Brain inflammation
Increased toxicity
Nutrient deficiencies
Opiates
©Julie Matthews, CNC 2007
Research
Pediatrics, 2008
ADHD & Food Additives Revisited, 19;17
“ there was a trend for more hyperactive behaviors
associated with the food additive drink in virtuallyevery assessment. Thus, the overall findings of the
study are clear and require that even we skeptics,who have long doubted parental claims of the effects
of various foods on the behavior of their children,admit we might have been wrong.”
Clinical Paediatrics, 2011
Dietary Sensitivities & ADHD Symptoms: 35 years of Research, 50;4
“ Of children with suspected sensitivities, 65%-89% reacted when challenged with at least 100 mg of AFC. Oligoantigenic diet studies suggested that some children in addition to being sensitive to AFCs are also sensitive to common non salicylate foods (milk, chocolate, soy, eggs, wheat, corn, legumes) as well as salicylate-containing grapes, tomatoes, and orange. Recently, 2 large studies demonstrated behavioural sensitivity to AFCs and benzoate in children both with and without ADHD.”
The Lancet, 2011
Effects of a restricted elimination diet on the behaviour of children with ADHD : RCT, 377
• Findings:– Restricted elimination diet had a beneficial effect
on ADHD symptoms in 64% of children– Reintroducing foods led to a significant
behavioural relapse– The mechanisms and effects of food need to be
investigated—e.g., at a functional and structural brain level and in relation to genetic factors that increase the susceptibility to ADHD
Diet
The Basics
Macronutrients: Carbohydrates, Proteins & Fats
A Healthy Diet
• Provide a nutrient dense diet that nourishes the body.
• Healthy foods include:– Fresh, plant-ripened, local, organic & in-
season produce
– Grass-fed animal foods including organs and bones
– Unprocessed
– Good fats
Carbohydrates
• Add complex carbohydrates: whole grains, vegetables, fruit, starchy vegetables
• Reduce refined carbohydrates: flour products (bread, crackers, chips), cookies, pasta
• Avoid Sugars: Refined sugar, honey, juices
©Julie Matthews, CNC 2007
Sugar cravings - Yeast overgrowth, stress/anxiety (sensory sensitivity), and blood sugar imbalances
Protein
• Protein (essential amino acids) building blocks for:
– Muscle and tissue growth and repair,
neurotransmitters, immune responses,
enzymes, detoxification
• Bio individuality - amounts vary.
Signs of protein deficiency: Stunted growth, lack of
appetite, suppressed immune system, muscle wasting, anxiety, sparse hair, dry skin
Fats• Brain development & brain function
• Hormone balance & mood
• Formation/fluidity of cell membrane
• Reduce inflammation
©Julie Matthews, CNC 2007
Vital Roles of Saturated Fat
• Brain—Saturated fats are important for development of the brain
• Bones – Saturated fats help the body put calcium in the bones
• Liver – Saturated fats protect the liver from poisons
• Lungs – Can’t function without saturated fats—protects against asthma
• Immune System – Enhanced by saturated fats—fights infection
• Essential Fatty Acids – Work together with saturated fats
©Julie Matthews, CNC 2007
Coconut Oil:
• Contains many antifungal and
antiviral components
• Anti-inflammatory effects
• More easily digested and
absorbed
• Used immediately to create
energy
• Enhances absorption of
minerals
Benefits of Cholesterol
• Brain development & function• Boosts mental performance• Aids digestion• Builds strong bones• Builds muscle• Building block for hormones• Regulates your blood sugar• Repairs damaged tissue• Protects against infectious diseases
©Julie Matthews, CNC 2007
Key Nutrients for Brain
Development• Vitamin A - Cod liver oil; liver, butter
& egg yolks from grass-fed animals
• Vitamin D - Cod liver oil; butter & egg yolks from grass-fed animals
• Choline - Cod liver oil, egg yolks• DHA - Cod liver oil; liver, butter, egg yolks from
grass-fed animals• Zinc - Red meat of grass-fed animals, shellfish• Tryptophan - Meat of grass-fed animals• Cholesterol - Dairy foods, eggs, seafood,
meat of grass-fed animals
Why Special Diets May Help Your Child
Leaky gut
Protein Digestion
Malnutrition & Malabsorption
Yeast
Detoxification
Leaky Gut Syndrome
• Most children with ASDs have digestive issues
• Critical part of a healthy digestive system is the lining of the intestine
• When lining is damaged, harmful large food molecules enter the bloodstream
Trouble with protein digestion
• Protein that is not completely broken down is called a peptide.
• Body views peptide as an ‘intruder’ – IgE antibodies to expel it out.
• Histamine reaction
• Inflammation of gut lining
• Opioid-like substances
• Dairy, wheat, soy, corn, egg, sugar, peanuts, beans & nuts
Malnutrition & Malabsorption(Nutrient Deficiencies)
• First signs of malnutrition are mental and emotional
• Malnutrition contributes to pickiness, pickiness contributes to malnutrition
• 85% of children on the spectrum have malabsorption
• Increase the quality of food
• Improve digestibility of food
Yeast Overgrowth
• Exacerbates symptoms and places stress on biochemical pathways
• Sugar: feeds yeast, depresses immunity, contributes to inflammation
• Remove sugars
• Reduce refined carbs
• Add probiotic-rich foods
Poor Detoxification
• Nutrition is vital to biochemistry of detoxification
• Avoid additives, preservatives, artificial colours, MSG
• Improve detoxification pathways
• Avoid toxins in food supply & meal preparation
Diet Options
Diet Options to Choose FromASD Diet Option ARI Survey Results
Parents reporting noticeable symptomatic improvement
GFCF (Gluten-free and Casein-free)No gluten (wheat, rye, barley, spelt, kamut, oats) or casein (dairy)
GFCF - 66% improvedNo Dairy - 50% improvedNo Wheat - 49% improved
Food Sensitivity EliminationEliminating all other food sensitivities: Soy, corn, eggs, citrus, peanuts, chocolate, cane sugar
No Eggs – 41% improvedNo Chocolate – 49% improvedNo Sugar – 50% improvedRotation Diet – 51% improved
Feingold Diet/Low PhenolsRestricts high phenolic foods, including all artificial ingredients and high salicylate fruits
56% - improved
SCD (Specific Carbohydrate Diet)Restricts carbohydrates to only fruits, non-starchy vegetables, and honey.
SCD – 69% improved
Body Ecology DietAnti-yeast diet, acid/alkaline, fermented foods
Candida diet – 54% improved
Nourishing Traditions/ Weston A. PriceGood quality fats, soaking and fermenting for digestion
Low Oxalate DietRestricts high oxalate foods (nuts, beans, greens)
Symptoms Diet May Improve
• Ability to focus• Eye contact• Aggression• Gastrointestinal problems• Language• Sleep difficulties• Toilet training• Rash or eczema may improve• Behaviour
Gluten & Casein Free
“It’s not the food you avoid that makes you sick. It’s the food you
crave and eat every day!”
Gluten-free, Casein-free (GFCF)
• What is it?– No gluten (wheat, rye, oats, barley, spelt, kamut)– Wheat-free is not gluten free– No casein (dairy)
• When to use it?– Cravings – Constipation, diarrhoea – Poor focus & eye contact– OCD, self injury– High pain tolerance– Sensory, stims
Gluten-free substitutesavailable in South Africa
Grains Flours Thickeners
Rice Nut flours Arrowroot
Millet Coconut flour Cornstarch
Quinoa Gluten-free grain flours Gelatin
Amaranth Guar gum
Buckwheat Tapioca
Wild rice Xantham gum
Corn
Tapioca
Casein-free substitutesavailable in South Africa
Milk & Yoghurt Oil / Butter
Rice milk Extra virgin coconut oil
Coconut milk Ghee
Nut milks Lard
What about Soy?
• Not a good alternative
• 50% of children cross-react between casein and soy
• 90% genetically modified
• Endocrine disruption
• Blocks thyroid function
• Blocks absorption
Is GFCF safe?
• Gluten and casein are not essential food groups
• Calories, protein and nutrients must be maintained
• Replace missing nutrients like calcium
Replacing calcium…when milk is
eliminatedCalcium RDA (mg) Substitutes for 300mg Calcium
in 1 cup of milk
0-6 months 400 85g sardines, with bones
6- 12 months 600 100g pilchards (in tomato sauce)
1-10 years 800 ½ cup tofu
11-24 years 1200 150g can salmon
Adults (premenopausal) 800 1 cup rhubarb
Pregnant & Lactating 1200-1500 200g prawns
1 cup spinach
2 tbsp molasses
100g almonds
Fortified rice milk
GFCFSF Menu Plan
• Breakfast:– Bacon, eggs– Millet porridge, chicken/turkey sausage
• Lunch / Dinner:– GF pasta with meatballs, pureed veg in sauce– Meat patties, butternut squash fries– Gluten-free fish fingers, tomato sauce, potato
• Snacks:– Apple/pear with nut butter– Hummus with vegetables
Healthy lunch box
• Chicken or other protein with:– Fruit– Raw veggie sticks with dipping sauce (hummus, nut
butter)– Healthy snacks
• Slice lunch meat roll ups with shredded veg• Sandwich on GF bread with sunflower seed butter• Use a thermos for hot food
– Dinner leftovers– Soup, stew– GF pasta– GF chicken nuggets, burgers
Food Elimination
Allergies
Sensitivities
Intolerances
Food Allergies
• The antibodies that result in traditional allergies are called immunoglobulin E (IgE) antibodies.
• Obvious and fast• Cause and effect easy to figure out. e.g.
peanut allergy• These do not have a direct negative effect on
the brain• Milk, soy, eggs, peanuts, tree nuts, fish,
shellfish, wheat.
Food Sensitivities
• May result in a range of symptoms including behavioural or developmental.
• Occur over a longer period of time (1-3 days).
• For those with compromised systems, number of IgG sensitivities may be high.
Food Intolerances
• Not IgG or IgE
• Include problems with the digestion of foods due to lack of enzymes (e.g. lactose intolerance)
• May also include an inability to metabolise a component of food such as fructose, phenylalanine, phenols & salicylates
Symptoms of food sensitivities &
intolerances• General: fatigue, food cravings• Skin: eczema, allergic shiners, red face• Digestion: stomach aches, loose stools,
constipation• Respiratory: mucus production, congestion• Neurologic: headaches, tinnitus, dizziness,
tics• Psychological: depression, anxiety,
aggression, sleep disorders• Behaviour: ADHD symptoms, mood swings
Elimination Diet
• The gold standard for food reactions is an elimination diet & challenge
• Give up all possible food sensitivities for 10 days– Gluten, dairy, eggs, soy, sugar, chocolate,
corn, citrus, peanuts
• Add back one at a time
• Wait for 3 days and record symptoms
• Proceed to next item
Sensitivity test
• At bedtime, take a drop of the food in question (if solid, mash and mix with a little water) and place on inside wrist.
• Let it dry and let patient go to sleep
• In the morning check the spot, if there is an angry red reaction, avoid food for a few weeks and try again.
Feingold Diet / Low Phenol
What is Feingold/Low Phenol Diet
• Restricts food additives along with natural food chemicals called salicylates
• Impaired sulfation (natural detox process)• Phenol Sulfotransferase Deficiency (PST)• Symptoms:
– Disrupted sleep– Regressive behaviour after eating food– High consumption of apple juice– Hyperactivity– Unexplained red cheeks /flushing
©Julie Matthews, CNC 2007
Affects of Faulty Sulfation
©Julie Matthews, CNC 2007
Stages
• Stage 1:
– Eliminate artificial colours, flavours,
preservatives, aspartame, salicylate foods
• Stage 2:
– Salicylates reintroduced and tested for
tolerance
– Artificial colours, flavours, preservatives never
reintroduced
Feingold – foods eliminated in
phase 1Salicylates Phenols & other additivesAlmonds BHA, BHT – synthetic antioxidantApples PreservativesApricots Anticaking agentsAspirin Artificial coloursBerries, raspberries, cherries Artificial flavoursChili powder Artificial preservativesCider and cider vinegar BenzoatesCloves Corn syrupCoffee EmulsifiersCold drinks Hydrolyzed vegetable proteinCucumbers and pickles Mineral saltsCurry powder MSGEndive NitratesGrapes, raisins, currants NitritesHoney PerfumesNectarines and peaches SorbatesOranges SulfitesPaprikaPeppers (Bell and chili)PineapplePlums and prunesRadishesTeaTomatoesWine and wine vinegar
Feingold – acceptable foodsFruits VegetablesPears ArtichokesLemon/lime AsparagusGrapefruit AlfalfaMango BeansPapaya BeetrootPomegranate BroccoliKiwi CabbageDates CarrotsFigs CauliflowerMelon CeleryHoneydew melon CornWatermelon EggplantCantaloupe Green beansAvocado Leafy greensGuava LettuceCoconut Lentils
MushroomsOlivesParsleyParsnipsPeasPotatoesRadishesRhubarbSpinachSquashSweet potatoesWatercress
IN CONCLUSION – PART 1
Food sensitivities
Diet strategy
GFCF SCD
GAPS Low Oxalate
BEDSCD
Glutamates
Phenols Histamines
Yeast /dysbiosis /inflammation? Food intolerances?
Nourishing Diet for Each Child
or
Thank you!
Hannah Kaye, BSc (hons)
Nutritional Therapist
www.hannahkaye.co.za