Understanding Autism Diet, Nutrition and Supplementation
At Nourishing Hope, we believe that autism diet, nutrition and supplementation are fundamental to the health and healing of children with autism. Diets and other autism-specific nutrition essentials are applied as a complement to physician recommended medical treatments, behavioral and cognitive therapies. The most successful recovery stories as told by parents always include diet intervention and imrovements in nutrition intake. Generation Rescue, a biomedical web site designed to support parents, has many true parent accounts of the benefits of diet as does Autism Research Institute. There are five main diets to consider when researching this area of science: Gluten-free Casein-free (GFCF), Specific Carbohydrate Diet (SCD), Feingold Diet, Body Ecology Diet, Low Oxalate Diet/Phenols and Weston A. Price.
For the parent helping their child, autism diet and nutrition are a powerful avenue of healing!
While there are a number of effective "autism diet" options to choose from, beginning nutritional intervention need not be overwhelming. Ten years ago, the diet choice was simple – do diet! And, "do diet" meant do the Gluten-Free Casein-Free Diet (GFCF). Eliminating gluten (the protein in wheat) and casein (the protein in dairy) was the primary focus of diet for autism for many years and this diet has proven to be very beneficial for many children on the spectrum.
Today, additional advances in nutrition research and parent-centric anecdotal data have resulted in broader dietary strategies: Specific Carbohydrate Diet (SCD), Body Ecology Diet, Feingold Diet, Low Oxalate Diet, and others. Significant scientific data and overwhelming anecdotal analysis indicate a link between autism symptoms and diet. As reported by Autism Research Institute (ARI) in a survey of thousands of parents; The Gluten- (wheat) and Casein- (dairy) free diet has a 69% improvement rating, and the Specific Carbohydrate Diet has a 71% improvement rating. That is, most parents who diligently apply diet and nutrition intervention report some positive affect on behavior, cognition, general health, or well being. This can be confirmed by networking with other parents on our Facebook group: Nourishing Hope for Autism Diet Community.
The common symptoms reported by parents to improve with diet are: stimming, language, attention, hyperactivity, learning, fatigue, aggression, self-injurious behavior, rashes, digestion, diarrhea, constipation, gas, and more. Several dietary options exist for children and adults on the autistic spectrum. The best for a particular individual depends on many factors such as digestive capacity, bio-individuality, family history, symptoms and more. Currently, the two most common diets are the GFCF Diet and SCD.
Gluten-free Casein-free Diet (GFCF)
The GFCF Diet is the typical place to begin when initiating nutritional intervention for autism. This diet entails the removal of all gluten and casein containing foods from the foods you feed your child. Gluten is the protein found in wheat, rye, barley, spelt, kamut, and commercial oats. Gluten can be found in bread, crackers, pasta, cereal, packaged foods, baked goods, and many other foods. Casein is the protein found in milk which is used in dairy products such whole and reduced fat milk, cheese, cream, butter, ice cream, yogurt, cottage cheese, sour cream, powdered milk additives in food, and more.
When ingested by children with a compromised digestive tract, like many children that have autism, gluten and casein proteins can cause gut inflammation, pain, and digestive problems. If the protein is not properly broken down during digestion, it can form opioids (opiate or morphine-like compounds). Scientists believe that opioids in gluten and casein are problematic for children with autism because these children often have an abnormal gastrointestinal tract. These medical issues can be diagnosed by physicians who treat children with autism.
The properties of gluten and casein can lead to digestive problems such as diarrhea, constipation, gas, bloating, as well as foggy thinking and inattentiveness for many children with autism. Studies along with many thousands of parental reports from around the globe indicate physical symptoms and behaviors associated with autism decrease on the GFCF Diet. A gluten-free and casein-free trial period is often recommended for children with autism upon diagnosis by autism physicians practiced in biomedical (whole body) approaches. A parent begins the GFCF Diet by removing casein first and then gluten from the foods prepared for snacks and meals.
Most of the foods containing these offending gluten and casein proteins are easy to identify. Some gluten and casein sources can be sneaky, as some foods contain offending ingredients that are not apparent when reading a label – such as soy sauce and malt (barley). Some products, like potato chips and fries, are often dusted with wheat flour (gluten) during processing. This information is not listed on the product label but can be verified with the product manufacturer. It's important to follow an autism diet strictly – infractions can inhibit or mask progress.
When beginning a GFCF Diet, be careful not to introduce too many GFCF junk foods such as cookies, candy, and chips. Even though they don't include gluten or casein, the sugars can feed yeast, imbalance blood sugar, and dis-regulate energy. Remember, diet is more than just the removal of offending foods – attention must be placed on ensuring healthy and nutritious food intake and additions.
As the GFCF Diet is implemented, improvements in autism symptoms are often noted as the diet evolves and progresses. Some children experience rashes and eczema clearing up – others note improvements in behavior, concentration, cognitive ability, eye contact, gastrointestinal issues, speech and more. There are many good books to assist parents in effectively implementing the GFCF Diet, and the food marketplace is increasingly GFCF friendly.
Understanding Autism Diet Options
Specific Carbohydrate Diet (SCD)
The SCD is the second most applied diet for autism. While most begin with GFCF, some begin with SCD (for reasons particular to their child's circumstance). Others, who began with GFCF will evolve to SCD to see what further gains can be made, often when digestive problems persist and greater attention is required.
According to ARI, 71% of parents say SCD is beneficial for their child. In addition to helping alleviate many of the traditional symptoms of autism, this diet is very helpful for those who have inflammatory bowel conditions and chronic diarrhea. It can also help to alleviate constipation in some children.
This diet involves the removal of all complex sugars and starches, with the exception of honey and fruit sugar. When putting this diet strategy into place, parents remove maple syrup, cane sugar, agave nectar, brown rice syrup and other sources of sugars from snacks and meals. Foods containing these ingredients often include baked goods, candy, jelly fruit snacks, granola bars, juices, fruit punch style drinks, ice cream, ketchup, soda, chocolate milk, salad dressings and sauces, cereal and other pre-packaged and freezer foods that contain sugar in their ingredient list. SCD also removes all starches and all grains, including potatoes and sweet potatoes.
The goal of the Specific Carbohydrate Diet is to reduce gut inflammation and aid healing by "starving out" bad gut bugs and avoiding foods that require carbohydrate digesting enzymes. Children with autism frequently lack these enzymes and have digestive systems that are attacked by pathogenic bacteria such as clostridia; they often need specific nutrition and diet support. By eliminating problematic foods, the bugs cannot continue to feed, and they die out. As these bacteria are eliminated from the body and their enzyme function improve, children with autism experience healing. They feel better and some autism symptoms are alleviated.
As parents implement the SCD, they cook meals for their children and family that are centered around meat, fish, eggs, nuts and seeds, certain beans, all non-starchy vegetables, and fruit. They introduce honey and fruit sugar to their recipes and meal preparation. This diet is not a low carbohydrate diet but a specific carbohydrate diet that focuses on non-starchy vegetables, fruit, honey, and certain beans for carbohydrates and avoids other sugars and starches. An autism nutritionist might also suggest that a parent implement SCD without casein in case the child is sensitive to it.
Because SCD is more restrictive than the GFCF Diet, parents don't usually begin their dietary intervention journey with SCD. However, if there is a significant inflammatory gut condition diagnosed by an autism pediatrician, some parents will go straight to SCD. There is no reason not to begin with SCD; it's an excellent diet for autism. Many parents begin with the GFCF Diet with its fewer restrictions and then advance to SCD if needed. A variation of SCD is the GAPS Diet (Gut and Psychology Syndrome), created by Natasha Campbell-McBride, M.D. It includes the essentials of SCD, plus the addition of wonderful healing principles such as fermented foods and homemade broths.
Feingold Diet / Phenols
The Feingold Diet removes phenols and salicylates. Artificial ingredients such as artificial coloring, artificial flavoring, aspartame (Nutrasweet), and artificial preservatives such as BHA, BHT, TBHQ are made from a petroleum base and are strong phenols. Salicylates are naturally occurring phenols in plants – particularly in many fruits such as apples and grapes.
For some children, their bodies have difficulty processing phenols. Build up of phenols in the system can affect behavior and the body's physical condition. This was first discovered by Dr. Ben Feingold, when he noticed that these phenols created hyperactivity in some children. Phenols can have negative effect on the brain when our chemistry can't processes these phenols and they build up in the body. Although phenols and salicylates do occur naturally in healthy foods, children who are sensitive to these chemicals can have significant reactions.
Many children with autism, ADHD and other neurological and immune system disorders commonly have faulty sulfation systems and cannot process phenols and salicylates well. (See Nourishing Hope for Autism for an extensive explanation of this chemistry). Common physical signs of phenol sensitivity in children include dark circles under eyes, red cheeks/ears, ear infections, asthma, sinus problems, diarrhea, hyperactivity, impulsivity, aggression, headache, head banging/self-injury, impatience, short attention span, difficulty falling asleep, night walking for several hours, inappropriate laughter, hives, stomach aches, bed wetting and day wetting, dyslexia, sensitivity to noise/lights/touch, speech difficulties, tics and some forms of seizures.
When implementing the Feingold Diet, people avoid phenols and salicylates that are not tolerated – typically determined through food trial/testing. These substances and foods may include: FD & C colors, artificial flavors, preservatives, vanillin, aspirin, almonds, peanuts, oranges, apples, apricots, all berries, cherries, chili powder, cider and cider vinegar, cocoa, cloves, coffee, cucumbers, pickles, currants, red grapes, raisins, plums, prunes tangerines, tea, tomatoes, wine and wine vinegar and oil of wintergreen.
Feingold Association of the United States reports that 70 out of 100 people using this diet can expect good results, although their studies used only approximations of the diet. Member of their surveys have indicated that the diet success rate is just above 90%. A qualified autism nutritionist can help a parent implement this diet and suggest supplements and substances that add sulfate to aid sulfation and enzymes to help break down remaining phenols. Other low phenol diets that might be discussed could include the Failsafe Diet and Sarah's Diet. Some children may need to keep phenols very low, while others may only need to reduce phenols by avoiding the high phenol foods such as apples and grapes.
Low Oxalate Diet
The low oxalate diet consists of consuming a diet low in oxalates. It is a newer diet for autism that came about from the work of Susan Owens and the observation from parents that foods high in oxalates were problematic for their children.
While this is a newer diet, there is a lot of science that helps explain what might be going on for some children with autism. Oxalates are sharp crystals and are the same ones responsible for certain forms of kidney stones. Oxalate crystals can be inflammatory and damaging to a child's delicate biochemistry and the low oxalate diet reduces these compounds. In cells, oxalates can lead to oxidative damage, depletion of glutathione, pain associated with urination, and inflammation related to the immune system. Glutathione is important for immune function, inflammatory regulation, detoxification, and antioxidant status. Levels of glutathione are often low in children with autism; therefore oxalates could exacerbate challenges for some of these children.
Normally, a healthy digestive system will not absorb too many oxalates that are found in various foods in a child's diet. Oxalates pass through the digestive tract and they are metabolized by the good bacteria in the gut or bind to calcium and are excreted in the stool. When the digestive system of a child with autism is diagnosed as leaky, oxalates are absorbed and high levels end up in the blood, urine, and tissues – specifically damaging tissue. Once the oxalates are in the tissue, they create inflammation and pain in your child's body. It is also theorized that oxalates contribute to further inflammation in the intestines and more profound leaky gut, and may be the reason that some children have trouble healing leaky gut and yeast overgrowth; although, more study on oxalates and the low oxalate diet needs to be done.
Parents whose children respond positively to the low oxalate diet, report that high oxalates in their children affected: recurring body pain, urinary tract infections, skin sensitivity, irritable bowel/diarrhea and yeast/fungal over growth.
A parent cooking for a low oxalate diet will typically limit and/or omit the following from a child's snacks and meals: spinach, broccoli, brussels sprouts, sweet potato, spinach, beans kiwi, strawberries, oranges, kidney beans, cinnamon, chocolate, red raspberries, blackberries, blueberries, tomato, almonds, cashews, pecans, peanuts, beets, carrots, carob, cocoa powder, flour, potato, stevia, soy beans, pasta, blue cheese, red cabbage, butternut squash, purple grape juice, grapefruit, garlic, havarti cheese, oatmeal, graham crackers and more.
A comprehensive list of oxalate levels in foods can be found in the parent autism diet guide, Nourishing Hope for Autism: Nutrition Intervention for our Children.
Body Ecology Diet
If a child's pediatrician has performed yeast tests and they have come back positive, many parents consider implementing the Body Ecology Diet along with physician recommended yeast removal treatments. When there is a systemic yeast diagnosis, it's important for parents to know that they are not alone. Many children with autism have problems with yeast growth in their systems and help for this condition is well within reach. Yeast is known as a "bad gut bug". In order to combat these bad gut bugs that cause children to experience lethargy, spaciness, inappropriate laughter, insomnia, constipation, diarrhea, joint/muscle pain, and poor memory some parents implement the Body Ecology Diet. It provides the child with autism with a system of healing that establishes and nourishes the growth of beneficial bacteria and balances the digestive tract.
Regarding this bacteria, Donna Gates, the creator of the Body Ecology Diet, says "this microscopic militia serves as a child's key line of defense against disease-causing unfriendly microbes (bad gut bugs)" such as yeast. This diet is designed to help your child "cultivate, nourish, cleanse and repair their impaired inner ecosystem." It is very important for parents of children autism understand that their digestive system is intimately linked to the immune, endocrine, circulatory, and central nervous system.
The Body Ecology Diet incorporates excellent principles of proper food combining, acid/alkaline balance with low acid-forming foods, low sugars and starches, easily digestible foods, fermented foods, and other solid nutrition recommendations to clear up candida overgrowth in the body. The diet allows a few grains such as quinoa, millet buckwheat, and amaranth when properly soaked. The Body Ecology Diet incorporates the addition of cultured foods, a change to the quality of fats and oils consumed and a drastic reduction in the intake of carbohydrates and sugars.
Acid/alkaline is the principle of eating mostly alkaline forming foods. This will assist the body in maintaining a slightly alkaline blood pH. When the body is too acidic it leaches alkalizing minerals from the bones to balance the pH. Alkalizing the system supports the health of the gut as well. The standard American diet is awfully acid forming: sugar, meat, processed foods, and refined grains and carbohydrates. As meat is acid-forming, this diet uses much less animal protein than the SCD and others. The most alkalizing foods are most mineral rich so vegetables top the list. The particular grains that are allowed are on the alkalizing side, while rice, wheat, oats, and most others are acid-forming. Note that acid-forming foods are not necessarily acidic foods. To fully understand and implement the Body Ecology Diet, a parent should visit www.NourishingHope.com and www.BodyEcology.com for educational information.
Nourishing Traditions / Weston A. Price Diet (NT/WAP)
Weston A. Price was a dentist in the 1930s and 40s who was very interested nutrition and health. He studied indigenous cultures around the world before globalization to see whether there was a connection between nutrition and health. He tried to discover what the culture had in common to keep the people healthy. While there were cultures that ranged from mostly plant foods to exclusively animal foods, he did not find an exclusively plant eating (vegan) group. All cultures had learned that the more balanced diets, of some animal and some plant food, were the healthiest. Visit the Price-Pottenger Nutrition Foundation to learn about the work and discoveries of Dr. Price.
Sally Fallon popularized Weston A. Price's work with her wonderful book, Nourishing Traditions - she founded the Weston A. Price Foundation. This diet (NT/WAP) uses Price's findings as a foundation for healthy eating. As Price lived in the time where food additives and processed foods were just coming into the food supply and before most indigenous cultures were influenced by "modern commerce," he was able see the effects of modern diet versus the traditional cultures' diets. It was an important observation that is not available today. We are very fortunate he observed and recorded this information. This was also a time when farming and animal husbandry animals used natural, sustainable techniques – not used in today's commercial farming. The Weston A. Price foundation and many small family farms are promoting a return to this way of farming and living that supports the health of the animals, the people who eat them, the land, and our future. In addition to producing food of the highest nutritional quality, the Nourishing Traditions/Weston A. Price diet includes a focus on:
Animal foods and fats such as eggs, butter and dairy, beef and other animal protein, that are all pasture-raised or grass-fed, and additional saturated fats such as coconut oil. A belief that saturated fat and cholesterol are good for health.
Raw, unprocessed dairy products
Soaking and sprouting grains, beans and seeds for increased digestibility and nutrient availability
Stocks, broths, and nutrient-dense foods
Lacto-fermented foods (not a finding of Price but a cultural consistency)
Avoiding "foods of modern commerce" such as processed foods with additives, soy foods (unless traditionally fermented), and refined sugar
This diet is high in omega-3, saturated fat (animal fat and coconut oil), and cholesterol – substances that are important to a healthy brain. Often children (and adults) do well with a diet of 40% or more fat. Recommendations like this are unheard of in mainstream nutrition but very helpful for many. Fallon's other book, Eat Fat Lose Fat, has great information on coconut oil. Mary Enig's book, Know Your Fats, is another great book on fats.
The health benefits of many of these foods can be found in the Holistic Nutrition, Part 3, Step #7, Evolving the Diet: Nutrition Boosters.
When to use this diet: This is a nourishing diet that can be applied to any other diet someone is on. The Nourishing Traditions/WAP diet is great diet for brain, neurotransmitter and cellular function through the introduction of omega-3 and saturated fats. Implement any principles that will work – there is no "strict adherence" to this diet. The WAP diet is a wonderful diet for a pregnant mother.
Pitfalls: This diet is high in fat and can be problematic for those with gall bladder and fat digestion problems.
Clinical Experience: Many parents tell me they feel "nourished" while on this diet. They also report that their children often attend better in school and that the fermented foods aid digestion and reduce sugar cravings. Kids often love some of the fermented drinks such as kombucha and the fermented "sodas." However, a colleague once had a gallbladder attack while on this this diet, it may have been too high in fat for her particular condition. The guidance of a qualified nutrition professional is always recommended.