Nutrition & Autism

This is an assignment that I had and I found it to be interesting. Nutrition & Autism is a huge topic right now in the world of dietetics. I would love to have one answer for everyone that asked me what to do but I don't. Each child requires an individualized plan. Enjoy my assignment about it:

Autism Spectrum Disorder (ASD) is a broad disorder. Multiple websites, books, and magazine articles are written with generalized information that is available to the public with information on ASD. Subjective information can cause confusion in parents or anyone else looking for information due to the fact that anyone can write a book or write something online. The problem with this information is that every autistic person is different and autistic adults and children are all different and range from having mild autism to severe autism so there is no one solution. Some people with ASD may avoid multiple foods due to the texture and some tend to fixate on only one food item. (Mahan & Escott-Stump, 2008)  Some parents search for answers because their child with ASD may avoid contact or interaction with people providing or preparing the food and they want that to change. Once again the problem with current information is that each person with ASD is different and needs specialized attention and there is not one quick fix to make a change.

There is research on the elimination diet and on the gluten-free-casein-free diet (GFCF) and the results vary. Some researchers believe that those with ASD have difficulty breaking down some compounds of food so they are suggesting alternative therapies such as enzyme therapy. “Enzyme therapy can be helpful, since some researchers have suggested that children on the spectrum may have an inborn error of metabolism: they may lack certain enzymes that break down compounds in foods (eg, peptides in gluten and casein). If these undigested peptides cross the blood brain barrier, they may potentially interfere with cell signal transmissions” (Peregrin, 2007). In one study, thirty-one parents of children with ASD gave three-day food records to the researchers on their child’s regular diet or on their child’s gluten-free, casein-free diet. Children who followed the gluten-free, casein-free diet consumed less foods from the dairy group and from the fruit group, therefore there were multiple micronutrient inadequacies. Some nutrients not consumed such as calcium are important micronutrients that are essential while a child is growing. Although, this diet may produce small results and changes in a child, there are consequences and not enough evidence to state that it is a diet backed with evidence of solid results. (Burzminski, Caine-Bish, Ha, & Mantos, 2011) If young enough, instead of an elimination diet, parents could partake in an introduction diet where they introduce foods one at a time of different textures such as applesauce, yogurt, toast, cheese, crackers, and so on. If a parent keeps a diary of the foods liked and disliked by the person with ASD, this can help prevent food aversions that would arise otherwise. This can be brought to meetings with a dietitian in order to make sure that the patient is receiving all of the macro and micronutrients that the patient needs. If the needs are not met, the dietitian would need to make diet recommendations for the patient in which their needs would be met. The gluten-free-casein-free diet definitely would not meet all of the patients’ needs and deficiencies should be addressed immediately.

Registered Dietitians’ need to be knowledgeable about what parents of children with ASD may be reading on the internet. “For example, there is research on gluten-free/casein-free (GF/CF) causing rickets, and there is research paper on GF/CF helping with autism, but they aren’t multidisciplinary. Each is looking for their own conclusion without taking the concerns of the other into account.” “Much of the research is anecdotal; but that doesn’t mean any of these treatments won’t yield improvements” (Peregrin, 2007). There are over 40 studies that have been completed trying to place a link between nutrition and ASD in reports that were recorded over a course of fifty-three years. According to researchers, most of the research lacked a control and a measurable outcome. Although some ASD patients and children may benefit from some nutrition modifications, it is a fact that more research is needed. (Brown, et al., 2009)

Before approaching a patient with ASD, a dietitian would need to know the underlying facts of the specific ASD patient’s disability and diagnosis. This information may be obtained from the patient’s psychological examination and physician’s evaluation. This may show if the patient is malnourished or not.  Interviewing the parents is essential in determining the patient’s daily intake at home if the patient is under their parent’s care. After obtaining this information, a dietitian should introduce him or herself to the patient and the patient’s main caregiver to create an appropriate plan to meet the patient’s nutritional needs.  Establishing a relationship with the patient’s caregiver is key to maintaining communication in order to properly meet the patient’s nutritional needs.

Interventions that I would include when seeing an ASD patient would be: monitoring a food diary kept by the patient’s caregiver, monitoring the patient’s labs and the medications taken by the patient, and correct issues such as deficiencies, diarrhea, and constipation if they are found to be nutrition related. Also, if a diet is started, follow up visits should be regular to monitor the tolerance of the diet and to evaluate the intake to see if needs are being met. Interventions also include giving a list of foods that the patient should avoid if the caregiver states that the patient has allergies, intolerances, texture issues, food jags, or cannot chew or swallow well. If that patient is a child, I would not recommend trying a gluten-free/casein-free diet because they would be at a high risk of developing rickets. For children with ASD, I would suggest introducing one food at a time and each food should have a different texture. Introduce milk to see if the child likes the creamy texture and then try orange juice with pulp added to see if the child likes the texture of it and so on. Then the caregiver should try meat products or dairy like yogurt and cheese and then items like bread and crackers. I would make sure that the caregiver is keeping a diary or a list of likes and dislikes. For adults with ASD, a gluten-free/casein-free diet may be a good idea if the caregiver is willing to aide in providing the foods that are allowed on the diet. I would remind the caregivers that the gluten-free/casein-free diet is not a diet that has any definite proven outcomes but that it does work for some ASD patients while for others it does not. It does however severely limit the items a patient can have and may promote deficiencies. If the gluten-free/casein-free diet is not tolerated or the caregiver does not want to try it, I would recommend trying to incorporate different textures one at a time. There is not one intervention that I would recommend to all ASD patients. Each one will be highly individualized based on the patient.