Dietary Intervention & Autism Spectrum Disorders

1. Dietary Intervention & Autism Spectrum Disorders Hannah Kaye Nutritional Therapist www.hannahkaye.co.za

2. Outline for today – Part 1 Research Diet Why special diets may help your child Diet options Gluten & Casein Free Food elimination Feingold / Low Phenol

3. Outline for today – Part 2 SCD GAPS Good nutrition and overcoming common problems

4. Autism Spectrum Disordersare caused by genetic predispositions combined with environmental factors that create disordered biochemistry and damaged organs & systems. Nutrition affects this chemistry and the body

5. Brain is Downstream Yeast toxins Undermethylated neurotransmitters Brain inflammation Increased toxicity Nutrient deficiencies Opiates Complex & Inter-related Whole Body Disorder

6. Research

7. Pediatrics, 2008 ADHD & Food Additives Revisited, 19;17 “ there was a trend for more hyperactive behaviors associated with the food additive drink in virtually every 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.”

8. 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.”

9. 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

10. Diet The Basics Macronutrients: Carbohydrates, Proteins & Fats

11. A Healthy Diet Quality is Key! • 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

12. 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 Sugar cravings - Yeast overgrowth, stress/anxiety (sensory sensitivity), and blood sugar imbalances

13. Signs of protein deficiency: Stunted growth, lack of appetite, suppressed immune system, muscle wasting, anxiety, sparse hair, dry skin Protein • Protein (essential amino acids) building blocks for: • Muscle and tissue growth and repair, neurotransmitters, immune responses, enzymes, detoxification • Bio individuality - amounts vary.

14. Fats • Brain development & brain function • Hormone balance & mood • Formation/fluidity of cell membrane • Reduce inflammation

15. 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 • 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

16. 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

17. 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

18. Why Special Diets May Help Your Child Leaky gut Protein Digestion Malnutrition & Malabsorption Yeast Detoxification

19. 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

20. 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

21. 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

22. 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

23. 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

24. Diet Options

25. Diet Options to Choose From

26. Symptoms Diet May Improve Feeling Better >>> Learning Better • Ability to focus • Eye contact • Aggression • Gastrointestinal problems • Language • Sleep difficulties • Toilet training • Rash or eczema may improve • Behaviour

27. Gluten & Casein Free “It’s not the food you avoid that makes you sick. It’s the food you crave and eat every day!”

28. 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

29. Gluten-free substitutesavailable in South Africa

30. Casein-free substitutesavailable in South Africa

31. 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

32. Is GFCF safe? Gluten and casein are not essential food groups Calories, protein and nutrients must be maintained Replace missing nutrients like calcium

33. Replacing calcium…when milk is eliminated

34. 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

35. 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

36. Food Elimination Allergies Sensitivities Intolerances

37. 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.

38. 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.

39. 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

40. 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

41. 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

42. 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.

43. Feingold Diet / Low Phenol

44. 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

45. Affects of Faulty Sulfation ©Julie Matthews, CNC 2007

46. 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

47. Feingold – foods eliminated in phase 1

48. Feingold – acceptable foods

49. IN CONCLUSION – PART 1

50. Diet strategy Begin GFCF or SCD Consider & Adjust Food sensitivities Glutamates Low Oxalate GAPS Phenols BED Histamines SCD Yeast /dysbiosis /inflammation? Food intolerances? Nourishing Diet for Each Child