Children with Spectrum Disorders Benefit from Special Diets

Has your child been diagnosed with ADD, ADHD, or Autism Spectrum Disorder? If such conditions have not touched your family, it’s likely that you know someone for whom it has.

The incidence of autism has risen from 1 in 150 American children in 2007 to 1 in 88 in 2012 according to the Center for Disease Control. The dramatic and continued increase in incidence is thought to be primarily environmental since genetics do not alter that rapidly. I personally feel that, like autoimmune diseases which show a similar trajectory of increase, it is our environment of increasing chemicals, toxins, and poor diet that is primarily to blame.

There is much positive research to share on the efficacy of a gluten-free, casein-free diet, while much negative research exists on the life-threatening dangers of the drug therapies frequently used to treat these conditions.

Research shows the actual condition creating ADHD or autism-like symptoms is factually the presence of celiac diseaseor gluten sensitivity. In other words, gluten intolerance can so mimic ADHD and autism that a misdiagnosis can occur.

A 2012 study out of Neuroscience 1 evaluated the effectiveness of autistic children on a gluten-free, casein-free diet. The authors noted that prior studies suggested a benefit from undertaking such dietary changes and they wanted to evaluate it for themselves. The results were that the diet was efficacious among children whose parents reported that they suffered from GI symptoms, food allergy diagnoses, and/or suspected food sensitivities. For these children, the parents noted improvements in autism spectrum disorder (ASD) behaviors, physiological symptoms, and social behaviors.

Another study out of Complementary Therapies in Medicine2, also in 2012, evaluated a gluten-free, casein-free diet (GFCF). The results were that parents of all the children on GFCF diets reported improved GI symptoms and behavior patterns. While it may seem obvious that a food reaction can cause GI problems, what about brain function? It has been well established that gluten affects the nervous system, perhaps more than any other system in the human body, but you may be surprised to learn that we have known the effect gluten has on the brain, specifically in autistic children, for well over a decade.

Back in 2000, the journal Brain3 presented research that assessed the relationship between blood flow deficiencies to certain regions of the brain and symptom profiles associated with autism. In other words, they wanted to know if the specific symptoms that certain autistic children demonstrated could be associated with poor circulation to the part of the brain that controlled that type of behavior. The answer was yes. Each specific pattern of poor brain circulation was correlated with a specific syndrome profile suffered by the child.

By marrying this data with data from a later study performed in 2004 from The American Journal of Medicine4, we can see how this relates to gluten. The researchers stated that neurological and psychiatric disorders occur in approximately 10% of patients with celiac disease. And while some of these alterations respond to a gluten-free diet, the cause of these abnormalities remains uncertain.

The study examined 15 untreated celiac patients and evaluated them for poor blood flow to the brain (hypoperfusion). They found that 11 patients or 73% had at least one hypoperfused brain region, compared with only one patient (7%) of the 15 who followed a gluten-free diet. It is gratifying to see that those following a gluten-free diet had none of the circulatory problems seen in the untreated celiacs–revealing that the poor circulation could be remedied with a gluten-free diet.

Putting the findings of these two studies together, we see that autism creates poor brain circulation and for some, the cause of such circulatory problems is celiac disease. Does that not warrant a trial of a gluten-free diet for those with autism? I’m suggesting a trial even if celiac tests come back negative. Remember that tests aren’t perfect. Run the test but also perform a 30 day elimination diet.

What would you do with this compelling information if you had a child with autism?
The Journal of Pediatric Gastroenterology and Nutrition5 presented a fascinating study supporting a well known fact that the gut is hardwired to the brain. These researchers measured the incidence of leaky gut (increased intestinal permeability) in children with autism as well as their first degree relatives and compared them to a normal, unaffected population. The researchers found a high percentage of leaky gut, 36.7%, among patients with autism. Their first-degree relatives also showed an increased percentage, numbering 21.2%, while the normal subjects only showed a 4.8% incidence. A high percentage of the autistic children presented with GI symptoms (46.7%) such as constipation (45.5%), diarrhea (34.1%), or alternation of both (15.9%).

The conclusion was as follows: “The results obtained support the leaky gut hypothesis and indicates that measuring IPT (intestinal permeability) could help to identify a subgroup of patients with autism who could benefit from a gluten-free diet. The IPT alterations found in first-degree relatives suggest the presence of an intestinal hereditary factor in the families of subjects with autism.”

As we know, gluten intolerance has a genetic component. We also know that several members of a family can have gluten intolerance but that doesn’t mean their symptoms will be identical. One person with migraines may have a brother with a skin condition or depression. The symptoms vary widely but the root cause is the same: gluten.

A 2010 study out of Nutritional Neuroscience6 also looked at the benefits of a GFCF diet. During a two-stage, 24-month, randomized, controlled trial on 72 Danish children, the researchers concluded that “such a dietary intervention may positively affect developmental outcome for some children diagnosed with ASD.”

Gluten intolerance is often called the “great masquerader” because it can take on the faces of many diseases. Both seizures and schizophrenia can be completely caused by gluten intolerance. Fatigue, IBS, constipation, skin problems, liver disease–gluten intolerance, the great masquerader, has many faces. Does it also have the face of autism? Read on.

The Chang Gung Medical Journal7 out of Taiwan reported in 2009 a case study of a young boy with autism. At three and a half years old, the child was put on a GFCF diet. After two and a half months, interpersonal relations such as eye contact and verbal communication improved. At five and a half months, he was capable of playing and sharing toys and his behavior more approximated an unaffected child than one with autism.

This child became completely normal with a dietary change. Yes, it’s a single case study, but as you can see there is plenty of evidence to support at least trying such a safe intervention. Consider another case study presented in the Journal of Child Neurology8. The title of the paper says it all: “Celiac disease presenting as autism.” This study discussed a five year old boy who was diagnosed with severe autism. Upon implementation of a gluten-free diet, the boy’s digestive symptoms resolved quickly and the signs and symptoms of autism also abated. The authors felt this was a case of celiac disease being misdiagnosed for autism. They suggested that “all children with neurodevelopmental problems be assessed for nutritional deficiency and malabsorption syndromes” such as celiac disease.

Alternative Therapies in Health and Medicine9 published a study in 2009 whereby they addressed gluten intolerance plus nutritional deficiencies in autism. Over 180 families (97%) reported dramatic improvements in a number of areas with their autistic child, including speech, imitation, coordination, eye contact, and behavior. Gluten intolerance was positive in 71% of those tested. One hundred percent of those tested positive for the celiac gene. Also common were zinc deficiencies, vitamin D deficiencies, and fat malabsorption, present in 73% of those screened.

The researchers concluded that a subset of autism patients with nutritional deficiencies, fat malabsorption, and gluten sensitivity predisposed them to apraxia, a condition wherein someone is unable to perform a task, despite understanding the command. They recommended such patients be worked up for gluten sensitivity and certain nutritional deficiencies. Nutritional Neuroscience10 in 2001 summarized research on GFCF diets for the prior 12 years, stating, “Beneficial results are reported in all but one study – reduction of autistic behavior, increased social and communicative skilled, and reappearance of autistic traits after the diet has been broken.” If there are so many studies to support the efficacy of dietary change, why then is it not the first line of treatment? Why are drugs the most common “solution” offered? .

Unfortunately, we live in a highly drug oriented society. Too many are taught to believe that if something is malfunctioning in the body, a pill is the answer. Sadly, the drugs often prescribed to our defenseless children have the worst of all possible side effects: death.

Value Health11 published an article in 2012 where pediatric patients with major depressive disorders were evaluated. SSRI (selective serotonin reuptake inhibitors) drugs, also commonly utilized for children with autism, were associated with the highest number of suicide-related deaths while cognitive behavioral therapy (CBT) was associated with the lowest risk. Cognitive behavioral therapy utilizes no drugs. The authors warned that, “considering the risk-benefit profile over a 5-year period, CBT offers a safer profile than combination treatment or SSRIs alone with respect to suicide deaths and attempts.”

A study in Pediatrics12 from 2011 noted that there was no consensus on the best treatment for autism. Evidence to support any benefit of drugs such as risperidone and aripiprazole must be weighed against the significant adverse effects of these drugs, the authors warned. Their conclusion said it all: “Although many children with ASDs are currently treated with medical interventions, strikingly little evidence exists to support benefit for most treatments.”

Can antidepressants predispose an unborn chid to autism? Horrifying as it sounds, a 2011 study in Archives of General Psychiatry13 supports such a premise. The study discovered a two-fold increased risk of autism associated with utilization of SSRI drugs taken by the mother within a year before delivery. The strongest effect was found in those mothers taking the SSRI within the first trimester of pregnancy. Biological Psychiatry14 reported on a trial of a natural substance, N-acetylcysteine (a form of cysteine, an amino acid, not found in food sources), to address behavioral disturbances in children with autism. This 2012 study concluded that N-aceylcysteine is useful in treating autistic children with irritability, showing that clinical nutrition has an impact even without dietary changes.

Another study evaluating natural versus drug remedies looked at the use of melatonin, a natural hormone, in autism. Developmental Medicine & Child Neurology15 in 2011 cited that reported side effects of melatonin were minimal to none, obviously a great improvement over the life threatening medications discussed earlier. Further, they found that administering melatonin was associated with improved sleep as well as better daytime behavior.

ADHD also has a gluten component according to research. A 2011 paper out of The Primary Care Companion for CNS Disorders16 evaluated 67 patients with ADHD. Ten of them were positive for celiac disease. Upon initiation of a gluten-free diet, their parents reported significant improvement in their behavior and functioning. The authors concluded that “celiac disease is markedly overrepresented among patients presenting with ADHD. The results further suggest that celiac disease should be included in the ADHD symptom checklist.”

I heartily agree with this last point and hopefully all the research presented here confirms the need for this. Imagine what might happen when positive natural therapies are utilized together. That is the type of program we have created at my clinic. I can tell you from our experience it is rare to find an autistic child who does not have a food sensitivity, with gluten and dairy heading the list.

Hopefully I’ve “made my case” for initiating a gluten-free, dairy-free diet in any child exhibiting such symptoms. Even if your child is “antsy” or “unfocused” with no formal diagnosis,it certainly couldn’t hurt to see if a dietary change would help.

References:

1. Nutritional Neuroscience. 2012 Mar;15(2):85-91. Effectiveness of the glutenfree, casein-free diet for children diagnosed with autism spectrum disorder: based on parental report. Pennesi CM, Klein LC.

2. Complemenary Therapies in Medicine. 2012 Dec;20(6):437-40. doi: 10.1016/j. ctim.2012.08.004. Epub 2012 Sep 19. A pilot study to evaluate nutritional influences on gastrointestinal symptoms and behavior patterns in children with Autism Spectrum Disorder. Harris C, Card B.

3. Brain. 2000, 123, 1838-1844 . Abnormal regional cerebral blood flow in childhood autism. Takashi Ohnishi, et al.

4. The American Journal of Medicine. Volume 116, Issue 5 , Pages 312-317, 1 March 2004. Regional cerebral hypoperfusion in patients with celiac disease.

5. Journal of Pediatric Gastroenterology and Nutrition. 2010 Oct;51(4):418- 24. Alterations of the intestinal barrier in patients with autism spectrum disorders and in their first-degree relatives. de Magistris L, Familiari V, Pascotto A, Sapone A, Frolli A, Iardino P, Carteni M, De Rosa M, Francavilla R, Riegler G, Militerni R, Bravaccio C.

6. Nutritional Neuroscience. 2010 Apr;13(2):87-100. The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Whiteley P, Haracopos D, Knivsberg AM, Reichelt KL, Parlar S, Jacobsen J, Seim A, Pedersen L, Schondel M, Shattock P.

7. Chang Gung Medical Journal. 2009 Jul-Aug;32(4):459-65. The effects of a gluten and casein-free diet in children with autism: a case report. Hsu CL, Lin CY, Chen CL, Wang CM, Wong MK.

8. Journal of Child Neurology. 2010 Jan;25(1):114-9. Epub 2009 Jun 29. Celiac disease presenting as autism. Genuis SJ, Bouchard TP.

9. Alternative Therapies in Health and Medicine. 2009 Jul-Aug;15(4):34-43. Syndrome of allergy, apraxia, and malabsorption: characterization of a neurodevelopmental phenotype that responds to omega 3 and vitamin E supplementation. Morris CR, Agin MC.

10. Nutritional Neuroscience. 2001;4(1):25-37. Reports on dietary intervention in autistic disorders. Knivsber AM, Reichelt KL, Nødland M.

11. Value Health. 2012 Jul-Aug;15(5):724-9. doi: 10.1016/j.jval.2012.03.1390. Epub 2012 Jun 8. Modeling the risks and benefits of depression treatment for children and young adults. Soeteman DI, Miller M, Kim JJ.

12. Pediatrics. 2011 May;127(5):e1312-21. Epub 2011 Apr 4. A systematic review of medical treatments for children with autism spectrum disorders. McPheeters ML, Warren Z, Sathe N, Bruzek JL, Krishnaswami S, Jerome RN, Veenstra-Vanderweele J.

13. Archives of General Psychiatry. 2011 Nov;68(11):1104-12. doi: 10.1001/ archgenpsychiatry.2011.73. Epub 2011 Jul 4. Antidepressant use during

pregnancy and childhood autism spectrum disorders. Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V.

14. Biological Psychiatry. 2012 Jun 1;71(11):956-61. Epub 2012 Feb 18. A randomized controlled pilot trial of oral N-acetylcysteine in children with autism. Hardan AY, Fung LK, Libove RA, Obukhanych TV, Nair S, Herzenberg LA, Frazier TW, Tirouvanziam R.

15. Developmental Medicine & Child Neurology. 2011 Sep;53(9):783-92. doi: 10.1111/ j.1469-8749.2011.03980.x. Epub 2011 Apr 19. Melatonin in autism spectrum disorders: a systematic review and meta-analysis. Rossignol DA, Frye RE.

16. The Primary Care Companion to CNS Disorders. 2011;13(3). pii: PCC.10br01104 Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Niederhofer H.

Written by, Dr. Vikki Petersen author of The Gluten Effect