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