Nutrition and Autism (ASD)
“Let food be thy medicine and medicine be thy food” 431 B.C.
Regrettably, Hippocrates’ philosophy has been largely overlooked in the management of
children diagnosed with Autism Spectrum Disorder (ASD).
Children on the Autism Spectrum have very complex eating issues. They are notoriously
difficult to feed. They can be very selective regarding their food choices often influenced by
sensory processing difficulties. Their diets can become very restrictive, leading to nutrient
deficits, which will impact their physical health, mental wellbeing and brain development.
It is recognised that a subset of children with ASD experience gastrointestinal complaints
with constipation, diarrhoea, abdominal pain and bloating being the most common
symptoms. Inflammation of the stomach lining can further complicate the digestion of food
resulting in poor absorption of nutrients. An overgrowth of “unfriendly” bacteria and yeast,
can lead to reduce nutrient synthesis and increased abdominal distress.
Children with ASD are also known to experience a greater prevalence of immune system
dysregulation resulting in more frequent ear infections, eczema and food
allergies/intolerances. Detoxification pathways are also less effective in children with ASD.
They tend to accumulate toxins and heavy metals in the body more readily than neurotypical
children. Poor sleeping patterns, anxiety and poor concentration are also features all too
common to these children.
Nutrition plays a key role in supporting the improvement of all the above-mentioned
conditions. Making changes to the diet may result in improvements in sociability, language
development, behaviour and gut symptoms.
There is no scientific evidence to suggest that substances within the diet cause these problems
but rather they aggravate the underlying condition in sensitive children.
Which foods should you consider?
Many possible food substances may have negative effects in children with ASD. Worth
considering:
Added chemical
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Artificial colours and annatto 160b a natural yellow colour in custard/yoghurt
Preservatives – propionates 280-283 in bread especially
Flavours & flavour enhancers- especially monosodium glutamate-MSG E621
Aspartame- artificial sweetener (NutraSweet, Equal E951) has been linked to
health problems including headaches and migraines.
Natural chemicals
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Salicylates in many fruits (oranges, peaches, berries, grapes, sultanas),
vegetables (tomato, capsicum, broccoli), olives, honey, vegemite, juices &
cordials, peppermint products and aspirin
Amines in foods such as bananas, grapes, avocado, chocolate, mushrooms,
broccoli, citrus fruits, vegemite, mature cheeses and less than fresh meats
Glutamates in foods such as tomatoes, grapes, parmesan cheese, mushrooms,
vegemite and soy sauce
Whole foods
Some research has indicated that gluten, found in wheat (including spelt), rye,
triticale, barley and oats and casein, found in all animal milks and dairy products have
a negative role in the behaviours & symptoms seen in children with ASD.
Gluten and casein are proteins which have a similar chemical structure. When they are
not adequately broken down by the body they form substances called peptides. It is
hypothesised that these peptides enter the bloodstream through a "leaky gut" and cross
over to the brain where they can negatively affect brain function and exert opioid- like
effects.
Keep in mind that not all children with autism will improve on a gluten and caseinfree diet. There is also a lack of good scientific evidence to support the link between
symptom improvement and removal of gluten and casein. This is an important area to
study and more research is needed. However, some parents do report improvements.
If you wish to make changes to your child’s diet consult a dietitian to ensure the
diet remains balanced. Gluten takes 3-6 months to fully remove from the body
while casein takes 3- 4 weeks.
SIGNS OF PROBLEMS WITH DAIRY OR GLUTEN
* pale face and/or dark circles under eyes
* a history of lactose intolerance as a baby
* frequent ear infections as a baby or toddler, history of glue ear or grommets
* red ears or one red ear
* constant runny nose
* craves dairy foods, unwilling to give them up
* craves bread, cereals, noodles (wheat rich foods) would live on them
* low-key stomach aches and ill-health
* diarrhoea and or constipation and or bloated stomach
* excessive wind
* excessive thirst and sweatiness
* aches, cramps and tiredness
* unexplained low iron levels
* a range of neurological dysfunctions including behaviour and depression
* seems unable to feel pain and laughs uncontrollably
In summary, food sensitive children vary in their reactions to different foods and food
chemicals, so there is no simple diet that suits every child. According to the RPA
Allergy clinic, reactions to natural and artificial food chemicals are common in
children with ASD. Children with ASD that respond favourably to the GF/CF diet
may further benefit from the removal of foods containing high levels of artificial and
natural chemicals.
www.sswahs.nsw.gov.au/rpa/allergy/resources/foodintol/ffintro.cfm
A milk-free diet is thought to give the most significant improvements but don’t
forget to keep the bones strong with adequate calcium. Seek a dietitian’s advice.
Information can be found at www.gfcfdiet.com and www.autismhelp.org/intervention-casein-gluten-free.htm
Other ideas to help children with ASD:
What about A2 milk?A2 is the name of a milk protein that was in all dairy
herds until a natural mutation occurred in the European herd thousands of years ago.
Milk from Jersey cows, Guernsey cows, camels, sheep, buffalo, yaks, donkeys, goats,
and Asian cows naturally contain mostly these A2 beta casein proteins. Milk from
cows such as Holsteins usually contains mostly the protein called A1 beta casein. In
the 1970’s Australian dairy herds switched from using Jersey cows to Holsteins cows.
A2 is also the brand name of milk containing predominantly A2 beta casein protein
(see www.a2australia.com.au). Jalna now also sells A2 yoghurt.
What are the health benefits of A2 milk?
Milks containing mostly A2 proteins are often said to be better for ‘allergies’ (such as
gut, skin rashes, hay-fever, cough).
Changing to A2 milk is easy to do as they taste is the same. A2 milk seems to work
best for those with physical symptoms – such as gut, rashes, ear infections – than
behaviour, although some children with behavioural conditions do improve on A2
milk. However, they may do better on a protein enriched, calcium fortified rice milk.
What about probiotics?
Probiotics are living microflora or friendly bacteria that protect us from sickness by
preventing the growth of bad bacteria in our intestines. Friendly bacteria play a crucial
role in maintaining good health for your children by supporting normal digestive,
absorption of nutrients and bowel function as well as a healthy immune system. A
healthy digestive system is vital for a strong immune system. Probiotics will be of
help if your child is bloated, has bowel issues ( constipated or diarrhoea ) has bad
breath or excessive flatulence / burping.
The gut is considered the small brain. Therefore a healthy gut = a healthy brain
Aim for at least 25 billion good bacteria/day. You can by probiotic drinks such as
yakult and kefir as well as yoghurt. Vaalia and Jalna are brands with high levels of
good bacteria. “Inner Health plus” sells a dairy-free acidophilus powder from the
fridge section of the chemist. Remember, the amount of good bacteria decreases with
the shelf life of the product coming to an end.
If your child has to take antibiotics, make sure you have a probiotic during the course
of antibiotics and for 3-4 weeks afterwards to replenish the good bacteria killed by the
antibiotics. Probiotics help to prevent antibiotic induced diarrhoea.
What about multivitamin and mineral supplements that are free
from chemicals? Fussy eater may benefit from an additive free supplement.
Orthoplex:
http://www.b2bworld.com.au/hp/category77_1.htm is a children’s
multivitamin and mineral supplement available online.
Amcal One-A-Day multivitamin and mineral formula. Take ½ a tablet for kids under
12 years.
What about fish oils?
Omega 3 fats are an essential nutrient that forms the building block of the brain and
eye. Omega 3 fats protect the brain and maintain communication between brain cells.
Omega 3 fats tend to be in low amounts in the typical Western children’s diet.
Published studies using supplementation with a unique omega3/6 formulation called
“Eye q” have been shown to significantly support in learning, concentration, reading,
writing, problem solving and behaviour. Scientific studies have also shown significant
gains in language development. The children in these studies were given 6 capsules or
3 teaspoons per day of the eye q formula. Parents reported children were also calmer.
Further information can be found at www.novasel.com.au or call 1800 222 655
Children with a strong sensitivity to amines may not tolerate fish oils. Small amounts
of salicylates are present in the strawberry flavouring of the Eye q chews.
What about artificial additives?
A child’s reaction to additives depends on how much is eaten. Some children can be
very sensitive while others may be able to tolerate additives with no problem. Sue
Dengate from the Food Intolerance Network has many useful resources on this
subject. www.fedup.com.au
Adverse reactions to additives:
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skin rashes: eczema, hives, swelling, itching
irritable bowel symptoms: reflux, constipation and/or diarrhoea, stomach aches,
bloating, nausea, bedwetting
behavioural changes: irritability, restlessness, inattention, hyperactivity,
oppositional defiance, mood swings, difficulty falling asleep, frequent night
waking, night terrors, restless legs
headaches & migraines
asthma
How a child reacts to chemicals is very individual. A two week trail of a low artificial
chemical diet may be beneficial (trail it as a family)
The Eating for Success Booklet for avoiding additives can be found at
http://www.fedupwithfoodadditives.info/extras/Eatingforsuccess.pdf
The Scientific Evidence
Research from Southampton University in the UK looked at 153 children aged 3 and
144 children aged 8/9 from the general population. The study reported increased
hyperactivity when children were given these
E102- tartrazine yellow
food colourings. The amounts consumed were
E104-quinoline yellow
at the maximum level of safety set by the EU.
E110- sunset yellow
The 3 year olds were given two 56gram bags of
E122- carmoisine/azorubine
lollies/day. The 8/9 y.o were given two to four
E124- ponceau/brilliant scarlet 56g bags of lollies/day.
E129- allura red
The Food Intolerance Network in Australia has
detected 1154 products listing at least one of six controversial bright red or yellow
added colours on labels. The highest concentrations of artificial colours were found in
savoury snack foods, ice-cream/ ice blocks, confectionery, cakes, muffins and pies.
Despite these findings, Australia's food watchdog insists there is no need for a ban
because the colours are not consumed in high levels in Australia. Bans and/or
warnings are in place in the UK and Europe.
Nasties to Avoid
from www.fedup.com.au
Colours 102,104,107,110,122,123,124,127,128,
129,132,133,142,151,155
natural colour 160b (annatto)
Preservatives
Sorbates
200, 201, 202, 203
Benzoates
210, 211, 212, 213
Sulphites
220, 221, 222, 223,
224, 225, 226, 227, 228
Nitrates, nitrites
249, 250, 251, 252
Propionates
280, 281, 282, 283
Antioxidants
Gallates
TBHQ, BHA, BHT
310, 311, 312
319, 320, 321
Flavour enhancers
Glutamates including
MSG 620, 621, 622, 623,
624, 625
Ribonucleotides
627, 631, 635
Hydrolysed Vegetable Protein (HVP)
What to do if your child is difficult to feed?
.
Children with ASD have complex eating issues
They often experience
gastrointestinal symptoms (tummy pains/bloating/constipation/loose bowel motions).
They may also show clinical signs of nutrient deficiencies (zinc, iodine, magnesium,
iron, omega 3 fats)
As so many parents will state a child with ASD is notoriously difficult to feed. They
may have issues with taste, issues with texture. Children with ASD may prefer white
or brown foods and prefer plain flavours. They may also have food fixations.
If you have concerns regarding your child’s eating discuss this with your Doctor and
ensure weight and height is monitored regularly.
Monash University has an excellent fact-sheet re Feeding Selective Eaters. It is a must
read for any parent that is concern regarding their child’s eating.
http://www.med.monash.edu.au/spppm/research/devpsych/actnow/factsheet17.html
Professor Bruce Tonge, from Monash Uni suggests:
To bring about change you need to:
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Be persistent and patient
Be consistent (set time for meals)
Have a routine (always sit at the table to eat)
Always offer a non preferred food at each meal alongside what your chid
prefers to eat
Make gradual changes to taste, texture, flavour, smell and quantity of food
Social stories about food and mealtimes may be helpful eg a favourite hero
eating peas.
There are some things that don’t work if you want to change your
child’s eating and behaviour:
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Ignoring the behaviour will not make it go away
Coaxing and pleading for your child to eat will fall on “deaf ears”
Threats and punishment usually make things worse
Force feeding may stop the child eating
Always making a separate meal or multiple meals for your child with autism
(the child quickly learns that he/she will be getting the preferred food and hold
out for it)
FOOD INTOLERANCE NETWORK FACTSHEET has useful
information - http://www.fedupwithfoodadditives.info/factsheets/Factautism.htm
Paula Tazzyman 0418162202