NOURISH
By Vicki Kobliner MS, RD, CD-N
Autism Spectrum Disorders: Current Research on the Role of Diet and Nutrition T
he incidence of Autism Spectrum Disorders (ASDs) in the United States continues to skyrocket, and is currently estimat- ed to be 1 in 88 American children (and 1 in 54 boys). While the cause has still not been identified, current evidence points to a combination of genetic predisposition combined with environmen- tal triggers. Emerging data has identified the existence of medi- cal conditions such as alterations in the gastrointestinal, immune, detoxification, and energy generating systems in children on the spectrum. In the recent issue of the supplement to the journal Pedi- atrics, called “Improving Health Care for Children and Youth With Autism and Other Neurodevelopmental Disorders”, the American Academy of Pediatrics has acknowledged “Many individuals with ASDs have symptoms of associated medical conditions, including seizures, sleep problems, metabolic conditions, and gastrointestinal disorders, which have significant health, developmental, social, and educational impacts.” Whether these abnormalities are the cause or a consequence of autism remains to be determined, but in each case nutrition plays a critical role. Autism has been called a gut disorder by some, and parents commonly report that their ASD children experience gastrointes- tinal (GI) problems at a greater rate than unaffected siblings. The most common presentations include chronic abdominal pain, constipation, and/or diarrhea and symptoms of gastro-esophageal reflux. These symptoms are often apparent from infancy, before the diagnosis of autism has ever been made, reinforcing the theory that underlying medical issues contribute to the development of autism. Digestive disorders may well be underreported since nonverbal
children are not easily able to communicate pain. Self- injurious be- haviors such as head banging and the application of pressure on the abdomen are nonverbal cues that discomfort is present. Sleep dis- turbance has also been reported at a higher rate in autistic children with GI distress. Many pediatricians have considered the digestive component as simply a “part of autism” and have not treated the un- derlying gastrointestinal abnormalities. In 2010 the journal Pediat- rics published a supplemental article entitled “Recommendations for
Evaluation and Treatment of Common Gastrointestinal Problems in Children with ASDs.” The position of the panel of gastroenterologists who authored the article was that children with ASDs should be evaluated for GI disorders as thoroughly as non-ASD children who present with the same symptoms. In addition, the panel stated that “Pediatricians and other primary care providers [should] be alert to potential nutritional problems in patients with ASDs. Evaluation by a nutritionist who is familiar with nutrition support for individuals with ASDs is recom- mended if caregivers raise concern about the patient’s diet or if the patient exhibits selectivity of intake or is on a restricted diet.” Parents and caregivers who believe their child is suffering from GI problems should also be firm in demanding a thorough evaluation for their child.
Nutritional deficiencies have been identified in patients with
ASD, and are likely a result of a combination of self-limited food choices, malabsorption, and restricted diets. The panel also recom- mended steps be taken to identify potential associations between food allergens and gastrointestinal problems and called for further research into the existence of intestinal permeability and the effec- tiveness of gluten and casein free diets. Parents report that a gluten and casein free diet (GFCF) positively affects children with ASD and recent research from Penn State University reinforces their observa- tions. There are multiple theories as to why a GFCF diet improves autistic symptoms and it is possible that more than one is correct. Children with ASD who present with gastrointestinal disorders may suffer from intestinal permeability (also called leaky gut) and imbal- ances in the balance of bacteria that are a normal part of the human intestinal tract. This can result in malabsorption of key nutrients, worsen food sensitivities and inflammation, and increase absorption of toxins through the intestinal wall. All of this increases the stress on children’s developing bodies and brains. Gluten and casein are common allergens which may influence or aggravate these condi- tions. In addition, the gluten and casein proteins have a molecular structure similar to morphine and are suspected of allowing opiate-
32 Natural Nutmeg April 2013
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