Posts tagged: Picky Eating

There is no cure for Autism Spectrum Disorder (ASD); the ideal treatment includes educational and behavioral interventions that meet the specific needs of the child. Because autism is incurable, many parents seek alternative therapies, including specialized diets. Although research is limited and results vary, several diet strategies have been suggested as possible treatments for ASD.

One of the most popular diets eliminates gluten (a protein found in most grains, including wheat) as well as casein (a milk protein). Other dietary interventions include restricting food additives; including probiotics in the diet; following a yeast-free diet; and supplementing the diet with vitamins and minerals.

The amount of information available via internet, books, parent network and other organizations to parents of children with ASD, can be overwhelming and often contradictory.

SPECIAL DIETS

There are many diets parents say work for their children to improve health, behaviour, attention, sleep and reduce ASD symptoms. Although some of these diets are a popular treatment for ASD but there is a lack of consistent and good quality scientific evidence to support their recommendation as a treatment for ASD symptoms.

All diets have something in common – unprocessed foods. Feeding your special needs child a healthy and balanced diet help with therapy results and behaviour. Let’s take a look at these diets.

GLUTEN FREE CASEIN FREE (GFCF) DIET

The most commonly tried and the most studied diet is the Gluten Free Casein Free (GFCF) Diet. Gluten is a type of protein found in wheat, rye and barley. Casein is a protein found in milk.

It has been suggested that people with ASD have a “leaky gut”. The poorly digested casein and gluten leak into the bloodstream where these “opoid-like” proteins interfere with the normal functioning of the nervous system, affecting mental function and behaviour. Therefore, it is proposed that by eliminating foods containing gluten and casein from the diet, autistic behaviours may be reduced.

How To

Prior to starting a gluten free diet, it is important to test for Celiac Disease especially if the child exhibits any potential signs or has first degree relatives with Celiac or other auto-immune disorders. The reason this is suggested is that gluten needs to be consumed for the test for Celiac to be accurate and in case the family chooses to stay on the diet, it is important to test first.

Also, prior to starting the diet, the family requires education regarding foods to avoid, foods to eat and hidden sources of gluten and casein.

It is really important to not just focus on what not to eat, but to explore what the child can eat. 

There are many expensive gluten free products available but there are also many foods that are NATURALLY gluten free and less costly then the specialty products.

It is helpful to eliminate gluten or casein one at a time so that you can assess the effects of each protein. Normally, casein is easier to remove from the diet first. 

Evidence

GFCF diets can increase the challenge of ensuring adequate nutrition. Some studies indicate that these diets may be effective for certain children, controlled scientific studies have not proven this to be true so more research is needed.

FEINGOLD DIET (PROGRAM) 

This diet is food elimination program developed by Ben F. Feingold M.D. This diet is created for individual who has behaviour disorders, such as hyperactivity, learning problems, and attention deficit disorder (ADD). It removes all synthetic colourings and flavourings, certain preservatives (BHT, BHA and TBHQ) and salicylates from the diet (Check out the list).

SYNTHETIC (ARTIFICIAL) COLORS & FOOD DYES

Nearly all food dyes (Blue 1 and 2, Green 3, Red 3, Red 40, and Yellow 5 and 6, Citrus Red 2) found in modern food, medicine, toothpaste, beverages, vitamins, cosmetics are synthetic. They are made from petroleum.

A dye which is listed as “FD&C” is permitted by the Food & Drug Administration (FDA) to be added to foods, drugs, and cosmetics. 

A randomized, double-blinded, placebo-controlled trial was conducted at Southampton University in England. They found a link to food dyes and hyperactive behavior in children. The research does not prove that food colorings actually cause ADHD behaviors but there does seem to be a link.

SYNTHETIC (ARTIFICIAL) FLAVOURING

ARTIFICIAL PRESERVATIVES

Preservatives are used primarily to prevent fats and shortening from becoming rancid.  They allow foods to have a longer shelf-life.  Most preservatives are not believed to be a health hazard, but the three petroleum-based preservatives that are eliminated by the Feingold Diet have been found to trigger behavior and health problems:

• BHA (Butylated Hydroxyanisole, E320)
• BHT (Butylated Hydroxytoluene, E131)
• TBHQ (Tertiary Butylhydroquinone, E319). 

While the avoidance of particular additives is very common, there has been little good quality research on the affect of food additives on people with ASD.

ARTIFICIAL SWEETENERS

Aspartame, acesulfame-K, neotame, and saccharin have been known to cause headaches, mood changes, nausea, vomiting, and diarrhea in the general population (here).

SALICYLATES 

Salicylates are a family of plant substances found naturally in a variety of fruits, vegetables, nuts, herbs, jams and juices. Also, these chemical compounds are similar to aspirin. Salicylates may be elevated in produce that is picked early and shipped long distances and in concentrated foods such as tomato sauce, ketchup or fruit juices.

Foods high in salicylates include almonds, apples, apricots, avocados, berries, broccoli, cherries, citrus fruits, cloves, coffee, cucumbers, dried fruits, grapes, kiwis, nectarines, olive oil, peaches, peppers, pickles, pineapple, plums, prunes, raisins, rose hips, strawberries, tea and tomatoes.

How To

Current recommendations of the Feingold diet would recommend a two-stage plan. Stage One lasts 4 weeks, and eliminates the above-listed ingredients, plus natural salicylates (including aspirin products). After a person has been successfully on this Stage One diet for 4-6 weeks, the food containing natural salicylates are added back in carefully to to test for tolerance. The effects of natural salicylates are dose-dependent. Some people find they need to remind on Stage One, while others are able to tolerate some salicylate-containing items occasionally, and still others can eat them freely. The artificial colors, flavours, preservatives, and sweeteners listed above are not re-introduced.

Evidence

YEAST FREE DIET 

It is believed that a “leaky gut” in people with ASD, may be caused by an overgrowth of yeasts (Candida) in the gut, resulting in symptoms such as fatigue, headache, mood swings, sinus, congestion, depression, poor memory and concentration and cravings for sweets. Excess yeast in the gut is thought to penetrate the intestine wall, causing yeast and other unwanted particles to be absorbed into the body. The absorbed yeast particles are thought to active the immune system, resulting in an allergic hypersensitivity to Candida.

How To

Yeast live and feed on sugar. Therefore, the diet requires to avoid all foods that contain any type of yeast, and foods that break down into simple sugars.

Evidence

Yeast overgrowth in the gut is usually treated by prescribed medications and there is no evidence that eating less dietary sources of yeasts helps.

SPECIFIC CARBOHYDRATES DIET (SCD) 

The Specific Carbohydrate Diet (SCD) helps children with autism who may be experiencing difficulty with digestion or malabsorption in the intestine resulting in GI issues. SCD starts to help and restore balance in the intestines by eliminating complex carbohydrates the the body has difficulty breaking down, which causes an overgrowth bacteria. The bacteria in the intestines feed off the complex carbohydrates creating more bacteria, which SCG refers to as the vicious cycle.

How To

This is not a “low carb diet” or “Paleo Diet”. The diet eliminates foods that contain complex carbohydrates (rice and potatoes), and replaces with simple carbohydrates (banana, and squashes). The diet will continue to keep the body well feed but starve the microbial flora. The SCD also encourages the use of fermented foods, especially homemade yogurt, and probiotics. The consumption of fermented foods and probiotics replaces the starving microflora with beneficial bacteria. Given enough time, the diet changes the nature of the microbial flora and gives the body the nutrients and environment needed to heal.

Evidence

The SCD is a very strict, complex and restrictive diet which requires an individual to prepare foods on his own. More scientific studies are needed for people with ASD.

Resources 

• www.breakingtheviciouscycle.info
• www.pecanbread.com

SUPPLEMENTATION 

People with autism may have abnormal or impaired metabolic or biochemical processes and high doses of vitamins or minerals may be needed to correct for this (here) . Also, children with autism are selective eaters and supplement use may just by improving overall nutrient intake.

The treatment may provide “benefit” but may not be “treating” the autism.

There are numerous dietary supplements which have been suggested as possible treatments for people with ASD including Vitamin B6, Folic Acid, Vitamin B12, Vitamin C, Vitamin D, Magnesium, Omega-3 fatty acids, Probiotics and Digestive Enzyme. 

BOTTOM LINE 

More research is needed to support a link between autism symptoms and nutrition. If you are considering a supplement or a special diet, speak with your child’s doctor or a Registered Dietitian first. They can help you make the right choice and lower the risk of possible side effects or nutrient deficiencies.

Keep in mind that restrictive diets require careful planning to make sure your child’s nutrition needs are being met.

If you enjoyed this post, you may also also be interested in learning about Nutrition Concerns for ASD, check out my last blog post.  

Disclaimer:

The above information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional. 

Autism Spectrum Disorder (ASD) is a complex developmental and neurological condition that typically appears during the first three years of life. ASD includes:

• Autism 自闭症
• Asperger Syndrome 阿斯伯格综合症
• Pervasive Developmental Disorders (PDD) 广泛性发育障碍
• Rett’s disorder 雷特氏症
• Childhood Disintegrative Disorder (CDD) 儿童期崩解症 or Heller syndrome 海勒症候群

People with ASD have trouble with social interaction and communication. They may also have unusual interests, activities, and behaviours. (CDC).

It is about four times more common in boys than in girls.

PREVALENCE

According to the Centres for Disease Control Prevention, one in every 59 children in United States is diagnosed with autism. In Malaysia, there is no official registry for the number of individuals diagnosed with autism. The only statistics which shed some light into the occurrence of autism in Malaysia is a local survey conducted in 2008 which revealed that autism affects one in 625 children.

SIGNS & SYMPTOMS

• Trouble communicating with people include delayed talking
• Trouble interacting with people including not wanting to be held or cuddled and poor eye contact
• Behaviour that is different than other people
• Lack of interest in playing with other children
• Lack of interest in food or uncommon food preferences
• Trouble with motor skills including picking up small objects, catching a ball and riding a bike

Autism affects each person differently and can range from mild to severe.

DIAGNOSIS

There is no medical test, like a blood test, to diagnose the disorders. A medical diagnosis of ASD is most frequently made by a Family Physician, Developmental Pediatricians, Child Neurologists, Child Psychologists or Psychiatrists. (CDC).

ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable (here).  However, many children do not receive a final diagnosis until much older. This delay means that children with ASD might not get the early help they need.

CAUSES & RISK FACTORS

There is no known cause for ASD, but both genetics (here) and environment are believed to play a role, such as advanced parental age (here), medications during pregnancy (here, here), parental obesity (here) and environmental pollutants (here).

TREATMENT

There is no known cure for autism. Treatment is based on individual, such as early intervention, physiotherapy, speech therapy, occupational therpy, behavioural therapy, to help individuals cope with their symptoms.

Behaviour modification needs to be tailored to each individual child and family situation.

NUTRITION CONCERNS

Child with ASD often repeat behaviors and have narrow, obsessive interests. These types of behavior can affect eating habits and food choices, which can lead to the following health concerns.

• Social impairment. It may limit a child’s ability to learn eat through modeling. The child may not be motivated by eating with peers or family members.
• Restrictive, repetitive and rigid behaviours. The child may have difficulty accepting new foods due to sensitive to the taste, smell, color, texture, temperature and packaging of foods. They may limit or totally avoid some foods and even whole food groups. Rigidity may also lead to an insistence on sameness in food, including the presentation of food, utensil use, brand and location where to eat. Common dislikes include fruits, vegetables and slippery, soft foods; prefer crispy and crunchy foods (potato chips, French fries, crackers).
• Not eating enough food. The child may have difficulty focusing on one task for an extended period of time. It may be hard for a child to sit down and eat a meal from start to finish. Allergies or intolerances appear to be more common in children with autism and can decrease overall food intake.
• Constipation. This problem usually is caused by a child’s diet low in fibre and high in processed foods, abnormal function of GI tract and sensory response (withholding due to discomfort with the sensation of defecation).
• Medication interactions. Some stimulant medications used with autism, such as Ritalin, lower appetite. This can reduce the amount of food a child eats, which can affect growth. Other medications may increase appetite or affect the absorption of certain vitamins and minerals. If your child takes medication, ask your healthcare provider about possible side effects.

STRATEGIES FOR DEALING WITH SELECTIVE EATING

Because children with ASD often have restricted diets as well as difficulty sitting through meal times, they may not be getting all the nutrients they need, particularly iron, calcium and protein. Here are some nutrition strategies that you can use to help make feeding a little easier. These strategies may help in the slow and steady process of improving feeding issues.

1. Be Prepared for Pickiness

Many parents find their child’s sensitivity to tastes, colors, smells and textures the biggest barriers to a balanced diet. Getting your child to try new foods — especially those that are soft and slippery — may seem nearly impossible. You may find that your child avoids certain foods or even entire food groups.

• Get your child involved. Have your child visit the supermarket with you to choose a new food. When you get home, research it together on the internet to learn about where it grows. Then, decide together how to prepare it. When you are done, don’t worry if your child doesn’t want to eat it. Simply becoming familiar with new foods in a low-pressure, positive way eventually can help your child become a more flexible eater.
• Avoid snaking all day. This decreases appetite, willingness to try new foods, and the number of total calories taken for the day.
• Limit mealtime. Limit mealtimes and snacks to 15-30 minutes.
• Use the rule of 3. Work to broaden the variety of a child’s diet expanding on already accepted food groups. A good rule of thumb is to only offer three foods at a time. Include one to two foods your child already likes and one food your child does not yet like. If your child will not tolerate the new food on his or her plate, place the new food near him or her on a separate plate to help get your child used to the new food.
• Food presentation. Present new foods in small bites and in fun, creative or familiar ways to make it more likely that your child will eat it. 
• Reward positive behaviours. Offer praise when your child approaches or tries new foods. Immediate rewards, such as a sticker, can be helpful to encourage new feeding behaviors. Remember that rewarding good mealtime behaviors will increase the likelihood that they will happen again.
• Ignore Negative Behaviors. When possible, ignore your child when he or she is doing things such as spitting, throwing or refusing food. Remember, you don’t want to encourage these behaviors by paying attention to them. 

2. Make Mealtimes Routine

A child with ASD will have to work harder at mealtimes because a busy kitchen, bright lights and even the way the furniture/utensil is arranged all are potential stressors.

• Set a feeding schedule and routine. Serving meals at the same time and same place every day is one of the simplest ways to reduce stress. You can use visual timetables and visual schedules. Written timetables or picture symbol schedules detailing when and where they will eat, what will be eaten and the type of behaviour expected at meal times makes mealtimes more predictable and a less anxious occasion for the child.
• Provide comfortable and supportive seating. Place your child in a high chair or booster seat that he or she is ale to sit upright without leaning or dangling his or her feet. This physical stability promotes good feeding behaviours and reduces distracting behaviours by allowing them to feel “grounded” and safe.
• Remove all distractions. Distractions such as the TV or iPad which can take the focus off the food and the task at hand. Feed your child only when he or she is alert and attentive. If your child is sensitive to lights, try dining by candlelight.

3. Regular Bowel Movement

Traditionally, a high-fiber and fluid diet, as well as regular physical activity are recommended to treat constipation but this is not always an effective recommendations. Making a dietary change is a long process but is necessary. First is to make it safe and comfortable for the child to have bowel movement.

• Stool softeners or lubricants may be used to reduce the potential of pain with defecation.
• Regular bathroom routine are needed to reduce anxiety and facilitate normal bowel movement.

BOTTOM LINE

Caring for a child with ASD can be challenging on many levels, and healthy eating is no exception. For children with ASD, a nutritious, balanced diet can make a world of difference in their ability to learn, how they manage their emotions and how they process information.

Changes in dietary intake will be a slow process and not all strategies will work for each child. 

A Dietitian can identify any nutritional risks based on how your child eats, answer your questions about diet therapies and help guide your child on how to eat well and live healthfully.

AUTISM RESOURCES IN MALAYSIA 

The National Autism Society of Malaysia (Nasom).

Autism Behavioral Center

Early Autism Project Malaysia 

If you enjoyed this post, you may also be interested in learning about Special Diet for Autism.  

Disclaimer:

The above information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional.