Treating Autism with Special Diets

dietBy Amy Eisenbeisz, RD, LN, and Marcie Kemnitz, MS, RD, LN

Does following a certain diet or eliminating certain foods from a child’s diet help treat autism symptoms? This is a common question that parents of children with Autism Spectrum Disorders (ASD) ask. Unfortunately, there is no easy answer to this question.  Several studies show some improvement with these various diets, while other studies show minimal effect.  We put together information on the three most common diets used for treating ASD symptoms to help you better understand them.

Elimination Diet
This diet is used to determine if a child has a potential allergy to certain foods by starting with a very basic diet low in potential allergenic foods and then gradually adding back in these foods to see what type of reaction occurs.  We might expect to see an allergic reaction such as hives or runny nose or we might see gastrointestinal symptoms such as diarrhea or constipation.

These foods tend to be responsible for 90% of all allergic reactions:  milk*, wheat*, egg*, soy*, peanuts*, tree nuts*, fish and shellfish (*more commonly seen in children).  There are multiple tests for food allergies including blood and skin prick tests.  However, there may be false negatives or positives with these tests.  The ELISA test is sometimes recommended, but it is not a validated food allergy test and many not indicate accurate results.

We know that, according to Elizabeth Strickland, children with food allergies are at a higher risk for nutrition related problems and decreased growth.  Also, children with autism are more likely to be more negatively affected by problems with food allergies because of their issues with sensory dysfunction.

Gluten Free/Casein Free (GF/CF Diet)

With this diet, the child must avoid all sources of gluten (the protein found in wheat-based foods) and casein (the protein found in milk and dairy foods).  There are two theories as to why this diet might work:
1. The protein found in gluten and casein may cause disruption in normal brain activity resulting in the symptoms seen in autism.
2. These same proteins may cause an inflammatory response resulting in the symptoms seen in autism. While this diet is considered to be experimental, many families have found a positive response to the diet. This response is more commonly seen in younger children.  Reichelt recommends trying this diet for a minimum of three months to see the full benefit.  However, to see the benefit of this diet, strict adherence is required.  Adherence is often difficult because of the complexity of the diet, and even minute amounts of gluten or casein will affect the outcome and you may not see any benefit.  The diet has to be followed
at home, school, and wherever the child eats.  Even eating a small graham cracker (which contains gluten) could throw off the outcome of this diet.

Specific Carbohydrate Diet (SCD)

This diet is considered the last resort and is not commonly used.  It is based on a belief that certain carbohydrates can cause gastrointestinal (GI) inflammation, which causes pain and discomfort.  By removing these carbohydrates (mainly lactose, sucrose and maltose), these symptoms are lessened and the bowel can heal.

Should this diet be recommended?  Current studies show that many children with autism have a lot of GI problems and a child presenting with these problems should be referred to a gastroenterologist for an appropriate diagnosis before starting this restrictive diet.

Problems with the above diets
• These diets are quite restrictive in terms of the types and categories of foods that need to be avoided; therefore, if not done correctly, a child can become deficient in many nutrients such as protein, B- complex vitamins, iron, and calcium.  We recommend visiting with a registered dietitian before beginning any of these to receive guidance as to how to follow these properly.

• Foods required by the diets can be quite expensive.  For example, a normal brownie mix costs around $2.00, but a GF/CF brownie mix is going to cost about $4.00-$5.00.  Generally, most GF/CF foods will cost 50%-100% more than their regular counterpart.

• Strict adherence to these particular diets is required.  Often it is difficult for families to adhere to the diet for the three months required to see any benefit.  Many parents think that they don’t have to follow the diet every day or all day and eventually give in and allow their child to eat foods not allowed on the diet.  This is especially noted in families where other siblings are eating regular food items.

Recommendations
While many of these diets might seem to be the answer to helping deal with the aspects of autism, they are rather difficult to follow and can be expensive.  Several studies have shown that these diets may improve ASD symptoms, but the overall results are inconclusive.  We recommend visiting with a registered dietitian and getting a full nutritional assessment of the child before starting any diet changes or modification.

If you have questions about the above information, please feel free to contact us at 800-658-3080 and we
would be glad to answer your questions.

References:
Strickland, Elizabeth; Nutrition Therapy for Children with Autism Spectrum Disorder, Autism, Asperger’s, PDD, and Other Related Disorders, 2005.

Reichelt K. et al.  Gluten, milk proteins and autism: Dietary intervention effects on behavior and peptide secretion.  J Appl Nutr, 1990; 42:1-11.

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