The Foods that Works Best for Children with Autism
Autism spectrum disorder (ASD) is defined as a complex neuro- developmental syndrome, and food may be one of the biggest contributing factors for causing and improving autism symptoms through its direct impact on a person’s microbiome, brain and gastrointestinal tract. Scientific research is clearly demonstrating that how food today is grown, processed, stored, cooked, and ultimately consumed is dictating a wide range of positive and negative effects when it comes to autism.
An increasing number of scientists are now recognizing the enormous beneficial effects of “food as medicine” as a stand-alone remedy. This year alone I have already addressed this topic in previous blog posts you can find here:
What we are more frequently seeing in clinical practice is not overt disease, but complex, chronic syndromes. Autism is just that— a syndrome. Children with autism are not “diseased”; they just share a collection of similar “disorders” which determine the severity of where they land on the autism spectrum. Because pharmaceuticals are not the best solution for effectively addressing this growing epidemic, different dietary interventions have been well studied to address how to make the most meaningful impact. Some of these diets include the ketogenic diet and the gluten- and casein-free diet:
Ketogenic Diet: Long-chain triglycerides constitute most of the fat in the ketogenic diet. It’s characterized by high-fat content with sufficient protein for growth but not enough to raise the levels of carbohydrates for metabolic needs. As a result, the ketogenic diet keeps glucose concentrations low and forces the body to use fat as a primary fuel source. This dietary approach is typically studied as a ratio of 4:1, lipid to non-lipid (protein + carbohydrate) ratio with around 75-80% fat, 10-15% protein, and 5% carbohydrate. This intervention also involves intermittent fasting (i.e., 14-16 hours at night) has been shown to work wonders in children with epilepsy and other neurological disorders (Neal et al., 2008) in studies done at Johns Hopkins Medical School. Note:
Gluten-free and casein-free diet (GFCF): By removing two commonly consumed proteins: casein, found in all animal milk and its byproducts, and gluten, found in wheat, barley, rye, and some types of oats through cross-contamination, the GFCF diet decreases damage to the gastrointestinal tract and overfeeding of pathogenic bacteria. It has led to dramatic improvements in behavior and other symptoms in autistic children (Hyman et al. 2016) along with enhancing their long-term developmental outcomes (Whiteley et al. 2013).
In order to tease out which dietary intervention, if any, is more effective in children diagnosed with ASD, El-Rashidy and colleagues (2017) compared the effects of these two different approaches versus a standard American control diet in 45 autistic children. The children were randomly assigned to three groups:
Group 1: Ketogenic diet — Children were placed on the less restrictive Modified Atkins Diet (MAD) —, with 60% fat, 30% proteins, and 10% carbohydrates by teaching parents how to cook meals, calculate dietary carbs and measure urinary ketones. (Note: While urinary ketones aren’t the best measurement to guarantee one is in ketosis, they are helpful in guiding the parent to understand if they are achieving a desired nutritional ketosis).
Group 2: GFCF Elimination diet — Parents and children in this group were instructed to avoid all milk and milk-derived products along with gluten (found in wheat, barley, rye, and some types of oats). While not as restrictive as the ketogenic diet, parents still needed to be trained on how to make meals without these common food additives and learn how to read food labels carefully to ensure none of their meals had hidden sources of dairy or gluten.
Group 3: Control diet on “Standard American diet”. These children and parents were not given any instructions on changing their diet and were allowed to eat whatever they preferred.
The results of this simple 6 month study were profound. Both group 1 and 2 showed significant improvements in:
Speech, Language, and Communication
Sociability
Sensory and Cognitive Awareness
Health, Physical, and Behavior.
Specifically, the ketogenic diet group had statistically significant improvements in speech, sociability, and cognitive awareness with some decrease in behavioral problems. The dairy-free and gluten-free diet group had statistically significant improvements in speech and behavior only with some improvements in sensory/cognitive awareness.
No significant improvements in autism symptoms were seen in the control group — the children consuming the standard American diet. This meant they were unlikely to experience any benefit in their overall development and autism symptoms if they chose to not change their diet.
The above mentioned study was a very simple intervention. Imagine the additional benefits of the child undergoing a full workup not limited to more extensive food sensitivity testing, heavy metal and industrial toxin detection, mold and microbiome analysis to gain insight on how the whole body and mind are functioning and leading to diseases like autism. The immense value of these additional diagnostic tests can give a great deal of insight on what exactly is going wrong inside our body and how best to personalize a patient’s treatment plan.
Even if one does not have access to additional workup, using “food as medicine” can be the simplest, cheapest, and most effective way to help lessen autism symptoms. As the results clearly demonstrated in this study, removing excess sugar, wheat, dairy and dramatically lessening saturated fat from animal protein along with incorporating nightly fasting of 14 to 16 hours can make a world of difference.
Fortunately, as science continues to prove the importance of “food as medicine”, more healthcare providers are starting to understand that diet plays an enormous role in human health and disease. The hope is that we will all begin to recognize the benefit of “food as medicine” and care for patients and ourselves more holistically.
References
Bjørklund, G., Saad, K., Chirumbolo, S., Kern, J. K., Geier, D. A., Geier, M. R., & Urbina, M. A. (2016). Immune dysfunction and neuroinflammation in autism spectrum disorder. Acta neurobiologiae experimentalis.
El-Rashidy, O., El-Baz, F., El-Gendy, Y., Khalaf, R., Reda, D., & Saad, K. (2017). Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metabolic brain disease, 32(6), 1935-1941.
Hyman, S. L., Stewart, P. A., Foley, J., Peck, R., Morris, D. D., Wang, H., & Smith, T. (2016). The gluten-free/casein-free diet: a double-blind challenge trial in children with autism. Journal of autism and developmental disorders, 46(1), 205-220.
Neal, E. G., Chaffe, H., Schwartz, R. H., Lawson, M. S., Edwards, N., Fitzsimmons, G., ... & Cross, J. H. (2008). The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. The Lancet Neurology, 7(6), 500-506.
San Mauro Martin, I., & JA, B. O. (2019). Impulsiveness in children with attention-deficit/hyperactivity disorder after an 8-week intervention with the Mediterranean diet and/or omega-3 fatty acids: A randomised clinical trial. Neurologia (Barcelona, Spain).
Whiteley, P., Shattock, P., Knivsberg, A. M., Seim, A., Reichelt, K. L., Todd, L., ... & Hooper, M. (2013). Gluten-and casein-free dietary intervention for autism spectrum conditions. Frontiers in human neuroscience, 6, 344.
AUTHOR
Dr. Payal Bhandari M.D. is one of U.S.'s top leading integrative functional medical physicians and the founder of SF Advanced Health. She combines the best in Eastern and Western Medicine to understand the root causes of diseases and provide patients with personalized treatment plans that quickly deliver effective results. Dr. Bhandari specializes in cell function to understand how the whole body works. Dr. Bhandari received her Bachelor of Arts degree in biology in 1997 and Doctor of Medicine degree in 2001 from West Virginia University. She the completed her Family Medicine residency in 2004 from the University of Massachusetts and joined a family medicine practice in 2005 which was eventually nationally recognized as San Francisco’s 1st patient-centered medical home. To learn more, go to www.sfadvancedhealth.com.