Navigating different Diets in Children with Autism

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Navigating different Diets in Children with Autism

• Bariah Dardari, M.D, FAAP
• American Hospital Dubai

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What the diet have to do with it???

• Increased prevalence in Autismgtgtenvironmental
  factorsgtgtDiet
• Parents survey on ARI list diet as the most
  successful intervention
• Global displacement of traditional foods
  accompanied by malnutrition and chronic disease
• When traditional people adopt modern diets there
  are increased rates of CVD, diabetes, cancer,
  hyperlipidemia,hypertension, and obesity.
• we face the Dilemma where traditional high-fat
  foods also contain high amounts of PCBs, mercury,
  pesticides, and other contaminants.

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What the diet have to do with it???

• Ketogenic diet and seizures
• Feingold diet and ADHD Pesller et al. 2010
  pilot study in Netherland
• Celiac disease

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What the diet have to do with it???

• previous reports indicate that the prevalence of
  GI symptoms ranges widely in individuals with
  ASD, from 9 to 91 in different study populations
• Macroscopic and histological observations in ASD
  include findings of ileo-colonic lymphoid nodular
  hyperplasia, enterocolitis, gastritis, and
  esophagitis
• Associated changes in intestinal inflammatory
  parameters include higher densities of lymphocyte
  populations, aberrant cytokine profiles, and
  deposition of immunoglobulin (IgG) and complement
  C1q on the basolateral enterocyte membrane
• Reported functional disturbances include
  increased intestinal permeability, deficient
  enzymatic activity of disaccharidases, increased
  secretin-induced pancreatico-biliary secretion ,
  and abnormal fecal Clostridia taxa
• Some children placed on exclusion diets or
  treated with the antibiotic vancomycin are
  reported to improve in cognitive and social
  function. Furthermore, a recent study found a
  strong correlation between GI symptoms and autism
  severity

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Recent Data about the role of Diet

• Impaired Carbohydrate Digestion and Transport and
  Mucosal Dysbiosis in the Intestines of Children
  with Autism and Gastrointestinal Disturbances.
  PLoS ONE 2011
• Major findings in this study that may shed light
  on GI morbidity in ASD include the observations
  that (1) levels of transcripts for
  disaccharidases and hexose transporters are
  reduced in AUT-GI children
• (2) AUT-GI children have microbial dysbiosis in
  the mucoepithelium
• (3) dysbiosis is associated with deficiencies in
  host disacharidase and hexose transporter mRNA
  expression.
• propose a model whereby deficiencies in
  disaccharidases and hexose transporters alter the
  milieu of carbohydrates in the distal small
  intestine (ileum) and proximal large intestine
  (cecum), resulting in the supply of additional
  growth substrates for bacteria. These changes
  manifest in significant and specific
  compositional changes in the microbiota of AUT-GI
  children .

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Nutritional Genomics

• The human genome today is virtually unchanged
  from what it was 50,000 years ago. Yet todays
  food supply bears little resemblance to that on
  which our ancestors evolved.
• expectations for this field is to match foods to
  the individuals genetically determined ability
  to digest, absorb, and use the nutrients within.
  Avoiding foods that are not an appropriate match
  and focusing on those with a positive impact on
  health

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Nutritional Genomics

• ex MTHFR gene encodes enzyme 5,10-methylenetetra
  hydrofolate reductase that activates folate,
  which in turn serves as a critical methyl donor
  as well as being essential to maintaining
  desirable levels of homocysteine.
• Individuals with the 677CgtT variation in the
  MTHFR gene are at risk for impaired MTHFR
• enzymatic activity when folate intake is low.
• The Role of Nutritional Genomics in Developing an
  Optimal Diet for Humans Ruth DeBusk, PhD,
  Nutrition in Clinical Practice December 2010

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The Gut Brain connection

• The first hypothesisKetogenic diet and Seizures
  glucidic catabolism could cause excess of ketonic
  products that will initiate comitial seizures.
  Few studies with ketogenic diet have been
  conducted but, as it has been described with
  epileptic subjects, those diets would diminish
  autistic symptoms.
• The second hypothesis phenylketonuria has been
  described as being associated with autism. In
  this case, adapted diet prevents mental
  retardation and autistic symptoms
• The third hypothesis is the amino acid domain.
  Some autistic children lack some amino acids such
  as glutamic or aspartic acids and this deficiency
  would create autistic symptoms. However, these
  deficits are attributed to nutritional deficits
  caused by the food selectivity of children

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The Gut Brain connection

• A fourth hypothesis concerning metabolic
  implication in autism is the suspicion that a
  food allergy phenomenon could interfere with
  development, and it has been observed that Ig
  levels are higher in autistic children than in
  control children. Autistic children with a
  positive reaction to food Ig would have a more
  favorable outcome with diet excluding some kinds
  of food
• The fifth hypothesis is linked with vitamin
  deficiencies that are a notably important area of
  research in the treatment of autism. Vitamin B12
  or B6 deficiencies have been studied in several
  articles, and many of them were controlled
  studies. French teams also emphasize an interest
  in supplementation with B12 or B6. The two last
  hypotheses concern auto-immune patterns and the
  toxic effects of heavy metals like mercury
• as evoked by Rimland, 11 controlled placebo-blind
  studies have been conducted and 50 of autistic
  children with this supplementation had improved
  autistic signs.

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The Gut Brain connection

• The opioid-excess hypothesis of autism suggests
  that autism is the consequence of the incomplete
  breakdown and excessive absorption of peptides
  with opioid activity (derived from foods which
  contain gluten and casein), causing disruption to
  biochemical and neuroregulatory processes.
• Biochemical evidence has indicated the presence
  of increased levels of peptides in the urine of
  people with autism
• previous behavioral studies have demonstrated a
  connection between the long term exclusion of
  gluten and casein from the diet and improvements
  in the behavior of some children with autism

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The CF/GF Diet

• A Gluten-Free Diet as an Intervention for Autism
  and Associated Spectrum Disorders Paul Whiteley
  Autism Research Unit, University of Sunderland
• The introduction of a gluten-free diet to
  children with autism (n 5 22) was monitored over
  a 5 month period using a battery of parental and
  teacher interview/questionnaire sessions,
  observation reports, psychometric tests and
  urinary profiling.
• Results suggested that participants on a
  gluten-free diet showed an improvement on a
  number of behavioral measures
• no significant decrease in specific urinary
  compounds excreted when compared with controls
  and a gluten challenge group.

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The CF/GF Diet

• Freidman 1999 certain ASD subjects deficent in
  enzyme Dipeptidyl peptidase DPP-IV responsible
  for breakdown of peptides

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The specific Carbohydrate Diet

• The purpose is to deprive the microbial worlds of
  the intestine of the food it needs to
  overpopulate, the sugars from the carbohydrates.
• contains predominantly "predigested"
  carbohydrates allows maximal nourishement without
  overstimulation of the intestinal microbial
  population.
• As the microbial population decreases due to lack
  of food (while being balanced by lactobacilli),
  its harmful by-products also decrease, freeing
  the intestinal surface of injurious substances.
  No longer needing protection, the mucus producing
  cells stop producing excessive mucus, and
  carbohydrate digestion improved.
• many people with IBS and IBD are unable to split
  disaccharide sugars (lactose, sucrose, maltose,
  and isomaltose) into single molecule sugars.
• The Specific Carbohydrate Diet also eliminates
  grains, which generally cause inflammation of the
  intestines in people with IBD. Leo Galland, MD,
  has found that the Specific Carbohydrate Diet
  works well for people with IBD."

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The specific Carbohydrate Diet

• many research articles to show that the toxins
  found in microorganisms play an important role in
  the suspected causes of ASD, in particular,
  lipopolysaccharide ( LPS) the bacterial toxins
  from gram negative bacteria that inhabit the guts
  of autistic children.
• LPS toxicity works synergistically with mercury
  and other heavy metal poisonings to expand
  damage. These heavy metals increase harm from
  LPS.1 In addition, LPS decreases glutathione
  levels making it even more difficult for the body
  to detoxify heavy metals.

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The GAPS Diet

• An altered Abnormal intestinal permeability in
  children with autism P D'Eufemia JAN 2008 Acta
  Paediatrica
• intestinal permeability was found 43) autistic
  patients, but in none of the 40 controls. We
  speculate that an altered intestinal permeability
  could represent a possible mechanism for the
  increased passage through the gut mucosa of
  peptides derived from foods with subsequent
  behavioural abnormalities.

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Elimination Diet

• Disruptive behavior A dietary approach Dan
  O'Banion, Betty Armstrong The effect of
  particular foods on levels of hyperactivity,
  uncontrolled laughter, and disruptive behaviors
  was studied in an 8-year-old autistic boy.
• Data gathered during four phases. During an
  initial 4-day period the child was fed a normal
  American diet. A 6-day fasting period followed,
  during which time only spring water was allowed.
  The third phase lasted 18 days and involved the
  presentation of individual foods. During the
  final phase of the study the child was given only
  foods that had not provoked a reaction in the
  third phase. Results showed that foods such as
  wheat, corn, tomatoes, sugar, mushrooms, and
  dairy products were instrumental in producing
  behavioral disorders with this child.

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Low Oxalate Diet
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Low phenol Diet

• Effects of Phenol-Depleted and Phenol-Rich Diets
  on Blood Markers of Oxidative Stress Hwa-Young
  Kim, MSc J AM college of nutrition June 2003
• Evidence of difference in phenol metabolism in
  patients with ASDgtgtcausing oxidative stress in
  CNS ( Evans 2008, Waring 2000)
• Some individuals show reaction to phenol
  containing foods( spinach, berries, soya, cocoa)
  and Salycalate due to Phenolsulfotransferse
  enzyme which seems to function abnormally in some
  ASD patients.Waring 1993 UK

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Low Glutamate/ Aspartame diet

• Glutamic acid excitatory Neurotransmitter in
  Brain
• Glutamine is found in the following foods Beans,
  brewer's yeast, brown rice bran, caseinate, dairy
  products, eggs, fish, lactalbumin, legumes, meat,
  nuts, seafood, seeds, soy, whey, whole grains.
  Hydrolysis of gluten, beet root or other proteins
• In 2005 Tebartz et al of Germany reported
  "increased prefrontal and hippocampal glutamate
  concentration in schizophrenia".
• Reynolds (1991) In 1991 Reynolds of the UK
  reported glutamate concentrations to be high

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Serotonin Diet

• Dietary increase in Serotonin ( e. g Banana,
  avocados, pineapple, papaya, walnuts) decreased
  self injury behavior in Developmentally delayed
  and Downs patients
• Gedye, A. Biological Psychiatry. 1991 Placebo
  controlled study Buspirone was more effective in
  reducing aggressive/ self injury behavior when
  combined with serotonin diet.

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The Body Ecology Diet

• Started by Donna Gates 2006. no published data
  about its efficacy
• Draws on different dietary approaches (
  Macrobiotic diet, DAdamos Eat for your blood
  type diet, the Raw food diet..)
• Low carbohydrate, low sugar, low dairy, emphasis
  on raw/ minimally processed foods, fermented
  foods
• Provide high probiotic support, may be beneficial
  for patients with Dysbiosis.

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Supplemental Diet

• Low urine Calcium level in autistic patients with
  eye poking behavioral
• Clinical pilots Studies showed that ASD and
  related neurological disorders in adults stems
  from lack of circulating nutritional neural
  lipids.
• Lipidomics the function of Vital lipids in
  embryogenesis preventing ASD. T.Tallberg, J
  Lipids 2011
• Recommendation of high vital lipids diet for pre
  and post pregnancy and during BF to secure normal
  development and enhance IQ in offspring.

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Supplemental Diet

• MIND institute A proteomic study of serum from
  children with autism showing differential
  expression of apolipoproteins and complement
  proteins
• Children with autism 46 years of age (n 69)
  were compared to typically developing children A
  total of 6348 peptide components were
• quantified. Of these, five peptide components
  corresponding to four known proteins had an
  effect size gt 0.99 with a P lt 0.05 and a Mascot
  identification score of 30 or greater for autism
• compared to controls. The four proteins were
  Apolipoprotein (apo) B-100, Complement Factor H
  Related Protein (FHR1), Complement C1q and
  Fibronectin 1 (FN1). In addition, apo B-100 and
  apo A-IV were higher in children with high
  compared to low functioning autism.
• Apos are involved in the transport of lipids,
  cholesterol and vitamin E. The complement system
  is involved in the lysis and removal of
  infectious organisms in blood, and may be
  involved in cellular apoptosis in brain.

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How do I know if my child will benefit?

• Hyperactivity, sleep problems
• Bloating, constipation, diarrhea
• Recurrent OM, Eczema, shiner, AR
• Craving food, Pica,
• Fatigue, excessive sweating
• Family history of Allergies, Celiac Dx, GI
  diseases.

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Laboratory Assessment

• Casomorphine, Gliadomorphine
• Food RAST ( IGG, IGE)
• Iron, Ca, Vit D, Oxalate, Zinc, Mg.
• Lipid profile
• Comprehensive Stool analysis
• OAT, AA profile
• Celiac disease panel

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How to assess results

• Do it with guidance of physician/dietitian
• Do it right
• But be flexible
• Assess every 3 month
• Not every diet work for every patient
• Keep a food dietary
• Remember that its only part of the biomedical/
  behavioral therapy

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Avoid pitfalls

• CF/GF diet osteoporosis, lethargy, retinal
  degeneration, kidney stones.
• Low phenol diet low cholesterol, low antioxidant
• Low phenylalanine diet low Omega 3-6-9
• SCD osteoporosis, lethargy, retinal
  degeneration, kidney stones, high copper

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Books to read

• Dietary interventions in ASD. By Kenneth Aitken
• Food and the Gut Reaction by Elaine Gottschall,
  B.A., M.Sc.

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• Thank you