Nutrition In Autism Spectrum Disorders: A Scientific Guide For Parents

Children with ASD often reject bitter or sour tastes. This preference can cause obesity, diabetes, and dental caries.

Autism spectrum disorders (ASD) are a group of neurodevelopmental disorders whose features generally become evident within the first three years of life. ASD is defined by core symptoms, including deficits in social interaction/communication and restricted/repetitive patterns of behaviour. In addition, behavioural disturbances and co-morbidities like aggression, anxiety, impulsivity, hyperactivity, tantrums, and self-injuries are also frequently observed. The most common Gastro-intestinal symptoms seen in ASD children include chronic diarrhoea, abdominal distention, discomfort and bloating, gastroesophageal reflux disease (GERD), excessive gas, constipation, faecal impaction, food regurgitation, and a leaky gut syndrome. Early treatment and rehabilitation have been the key to successfully managing children with ASD, including dietary management, in the past decade. Dr Mohd Amir, Senior Consultant- Neonatologist and Paediatrician at Cloudnine Group of Hospitals, Gurgaon, Sector 14, explains the two common approaches for dietary management in ASD.

Additive Approach

Children with ASD often reject bitter or sour tastes. This preference can cause obesity, diabetes, and dental caries. Additionally, they usually have inadequate vitamin D, vitamin B12, vitamin C, calcium, zinc, and other micronutrients. Supplements generally in use include vitamin B6, vitamin C, vitamin D, vitamin B12, dietary fatty acids (omega-3 fatty acid and cod liver oil), melatonin, folic acid, probiotics, L-carnitine, iron, magnesium, zinc and copper. In addition, it is imperative to include fresh fruits and vegetables and avoid sweet foods in the diet of a child with ASD. Instead, focus on a natural and varied diet, avoiding pesticides, preservatives, artificial ingredients, and fast or processed foods.

Restrictive/Subtraction Approach

It focuses on eliminating certain foods or food items from the diet. These foods are believed to trigger allergies and food intolerance (for example, casein and gluten); and contribute to the symptoms of ASD.

1. The GFCF diet: The Gluten Free Casein Free diet is used for children with ASD. This diet aims to eliminate the usage of casein (dairy products) and gluten (wheat, barley, rye oats) in the diet. Some children with ASD suffer from a "leaky gut", signifying abnormalities in intestinal permeability that allow more significant components of proteins or peptides to be absorbed directly; these peptides bind to opioid receptors in the brain and worsen symptoms of ASD. Thus eliminating gluten and casein from the diet helps improve symptoms of diseases in ASD.
2. The Ketogenic diet: It is believed that autistic behaviours may result from abnormalities in carbohydrate metabolism at the cellular level. Thus a diet high in fat, low in carbohydrates and having regulated protein (GFCF) is found to cause symptoms of ASD. A ketogenic diet often leads to poor growth, poor weight gain, and increased cholesterol levels, so it is imperative to use this approach under the supervision of a registered dietitian and paediatrician.
3. Monosaccharides as dietary carbohydrates: As proposed earlier, abnormalities in carbohydrate metabolism might add to symptoms of ASD. A diet based on monosaccharides, the simplest form of carbohydrates, is sometimes helpful. However, the efficacy of using such a diet may be beneficial only in exceptional circumstances where enzyme deficiency might be the reason for the symptoms of ASD.

In Summary

Although much research has been done which helped bring a lot of insight into the aetiology and pathogenesis of ASD, it remains a mystery and challenge in various aspects, and nutrition is one of the grey areas in such children. A diet with the probable trial of omitting casein and gluten might benefit in multiple cases. Therefore, it is imperative to supplement any micronutrient or trace element in the diet of such children for a wholesome effect of nutritional management.

In Conclusion

Further research is thus needed to explore more domains as far as nutrition is concerned. In all families with a child with ASD, close monitoring of correct eating habits by family paediatricians is thus warranted.