Autism and nutrition

''My autism isn't what makes me stand out, it's what makes me unique - Rachel Barcellona (actress).

When we hear autism, many of us picture Dr Sheldon Cooper in the iconic scene where he states: ‘My mother had me tested, and there is nothing wrong with me’.

Characterised by deficits in the ability to socialise, communicate and use imagination with repetitive movements and special interests, autism is considered a neurodivergence, meaning there is change from traditional brain pathways.

Approximately 1% of the world has been diagnosed with a form of autism (ASD) (which includes: Aspergers, autistic disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified and Rett’s). The etiology of autism is a topic currently being investigated but factors include maternal stress and diet, age of parents, environment and other factors and familial history. Several hypotheses are being causative to autism including involvement of abnormal gastrointestinal microbiota composition.

Whether the cause is determined or not, many individuals with autism struggle with many associated problems. Problems which do not miraculously disappear as the indivual ages.

An autism diagnosis has also been linked to:

1.      ‘Picky eating’- food avoidance based on texture, smell, flavour

2.      Insomnia

3.      Hyperactivity

4.      Drastic mood swings

5.      Selective eating with preference to high salt, calorie-dense foods such as take-out and snacks on the unhealthier side of life

6.      Intestinal inflammation

7.      Abdominal pain- cramping, gas, diarrhoea and constipation

With so many food-linked as nutrition-linked problems, there are many associated nutrition linked problems such hypertension, diabetes mellitus and obesity. Certain studies have also noted that individuals who have autism are less likely to enjoy fruits, legumes, whole-grains, protein and vegetables, and physical activity. These circumstances create a breeding ground for nutrient deficiencies such as iron-deficiency, phosphate, calcium, vitamin D, folic acid and the list goes on.

There have been different diet therapies proposed from the 70’s to alleviate the above-mentioned problems:

Mediterranean diet:

A diet consisting predominantly of fish, legumes, fruit, vegetables, olive oil, and wine. This diet has a lower intake of saturated fats and red meat. The combination between the lower saturated fats increased fibre and omega 3 from the fish reduces the inflammation in the intestines and the rest of the body which in turn reduces abdominal pains; some studies have even noted increased social relations and reduced adverse behaviours.

Pre and probiotics

The microbiome and dysbiosis theory have been widely accepted over the last few years. Where the types and concentrations of these said bacteria in the gut has a monumental impact in our day-to-day living.  When there is a wrong balance, people can suffer from nutrient deficiencies, be prone to illness and of course, have gastro-linked issues such as bloating, constipation, uncontrollable farting etc.

One specific bacterium which has been positively associated with ASD is Clostridium and decreased concentrations of Bifidobacteria and Lactobacilli. Bifidobacteria and Lactobacilli are commonly found in fermented foods such as kimchi, sauerkraut, and kimchi as well as some dairy products such as yogurt.

Then we have the GFCF diet

This stands for Gluten-free and Casein-free diet. In short and simple terms, no typical starches and no dairy to reduce the associated symptoms with ASD (irritability, gastro issues, hyperactivity and anxiety etc.). It comes with increased risk of bone problems due to the lack of calcium and phosphorus in this diet. This diet derives from the opioid excess theory which states that children with ASD are symptomatic due to excess unwanted specific peptides, derived within their bodies, as well as from incomplete food breakdowns which have a detrimental neurological impact. An additional excess of these peptides is specifically from wheat, cereals and dairy products. By eliminating gluten and dairy from the diet, one can reduce the excess peptides circulating within the body.

However, like most restrictive diets, in the long run- they are often impractical to adhere to. And as a child with ASD grows into a teenager and adult with ASD they will begin to have more and more autonomy in their choice of foods. Nutrition education along with slow introduction to new foods becomes paramount in ensuring that these individuals consume adequate and healthy amounts of fruits, vegetables, whole-grains and protein.

I have a more in-depth podcast episode available on Google Podcasts, Spotify and iTunes on: Steps with Nutrition.

References:

• Burcu Rodop, B., Başkaya, E., Altuntaş, İ., & Erbaş, O. (2021). E N TA L AND B A S IC Nutrition Effect on Autism Spectrum Disorders. Journal of Experimental and Basic Medical Sciences, 2(1), 7–17. https://doi.org/10.5606/jebms.2021.75633

• Doreswamy, S., Bashir, A., Guarecuco, J. E., Lahori, S., Baig, A., Narra, L. R., Patel, P., & Heindl, S. E. (2020). Effects of Diet, Nutrition, and Exercise in Children With Autism and Autism Spectrum Disorder: A Literature Review. Cureus. https://doi.org/10.7759/cureus.12222

• Monteiro, M. A., dos Santos, A. A. A., Gomes, L. M. M., & Rito, R. V. V. F. (2020). Autism spectrum disorder: A systematic review about nutritional interventions. In Revista Paulista de Pediatria (Vol. 38). Sao Paulo Pediatric Society. https://doi.org/10.1590/1984-0462/2020/38/2018262

• Peretti, S., Mariano, M., Mazzocchetti, C., Mazza, M., Pino, M. C., Verrotti Di Pianella, A., & Valenti, M. (2019). Diet: the keystone of autism spectrum disorder? In Nutritional Neuroscience (Vol. 22, Issue 12, pp. 825–839). Taylor and Francis Ltd. https://doi.org/10.1080/1028415X.2018.1464819

• Şengüzel, S., Cebeci, A. N., Ekici, B., Gönen, İ., & Tatlı, B. (2021). Impact of eating habits and nutritional status on children with autism spectrum disorder. Journal of Taibah University Medical Sciences, 16(3), 413–421. https://doi.org/10.1016/j.jtumed.2020.11.010

• Van De Sande, M. M. H., Van Buul, V. J., & Brouns, F. J. P. H. (2014). Autism and nutrition: The role of the gut-brain axis. In Nutrition Research Reviews (Vol. 27, Issue 2, pp. 199–214). Cambridge University Press. https://doi.org/10.1017/S0954422414000110