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Your Child’s Autism Diet - Set Up for an Eating Disorder?

 

The incidence of autism is rising. As of 2010, 1 in 68 children had autism according to CDC data. We still don’t know the cause of autism but it likely stems from a combination of genetic and environmental factors. Since we can’t control genes, parents often look for ways to control the environment – eliminating toxic chemicals and dyes, for example. Special diets are common. However, could these diets be setting the stage for an eating disorder?

The two most widely used diets for autism are the Gluten-Free Casein-Free (GFCF) and the Specific Carbohydrate (SCD). Both diets involve eliminating large groups of foods.

THE GLUTEN-FREE CASEIN-FREE DIET 

The GFCF diet removes gluten (wheat protein) and casein (one of the dairy proteins) from the diet.  This means no wheat bread, crackers, many cereals, cow's milk, cheese or yogurt among other things such as condiments (ketchup, for instance). The use of the GFCF diet in the autism population stems from the theory that some may digest gluten and casein differently.  Peptides called gluteomorphins and casomorphins were found to be present in large quantities in the urine of autistic children. These peptides result from the incomplete breakdown of wheat and dairy protein.  As the name suggests, have a similar structure to morphine. The theory is that these peptides may enter the brain, affecting it in similar ways.  While alternatives to wheat and dairy are widely available, this diet is extremely challenging to implement, especially for children. Still, many parents see improvements in symptoms with this diet. Reported improvements are seen in the areas of gastrointestinal health, focus, eye contact, emotion regulation and stereotyped, repetitive behaviors often seen with autism.

THE SPECIFIC CARBOHYDRATE DIET
The Specific Carbohydrate Diet (SCD) developed by Dr. Sydney Valentine Haas  is a strict grain-free, lactose-free, and sucrose-free dietary regimen intended for those suffering from Crohn's Disease, Ulcerative Colitis, Celiac Disease, IBD, and IBS. 80% of individuals with autism spectrum disorders have gastrointestinal issues and some have seen improvements with this diet. A strong link has been made between gut health and brain health (more here).

 In her popular book, The Gut and Psychology Syndrome, Dr. Natasha Campbell-McBride, a neurologist with a postgraduate degree in human nutrition, demonstrates how she adjusts the SCD protocol for her patients suffering from intestinal and neurological conditions. She states that certain neurological conditions are the result of an imbalanced bacterial ecosystem within the GI tract. Campbell-McBride coined the term “GAPS” (Gut and Psychology Syndrome) in 2004 after years working with individuals with autistim spectrum disorders, attention deficit hyperactivity disorder (ADHD/ADD), schizophrenia, dyslexia, dyspraxia, depression, obsessive –compulsive disorder, bi-polar disorder and other neuro-psychological and psychiatric problems. The GAPS diet includes various stages and alterations based on individual needs but basically, involves eliminating all processed foods, dairy, wheat, starchy vegetables and most beans. Dr. Campbell-McBride talks in more detail about the link between gut and brain health in this video here.

CONSIDERATIONS
As a nutritionist specializing in eating disorders, I worry about unnecessary or excessive restrictions on a child’s diet. The question is, are diets for autism unnecessary? If you’d asked me this question 6 years ago, I would have answered unequivocally, “yes”. There wasn’t enough evidence to support them and it seemed obvious that one wouldn’t want to restrict the dietary choices of children who are already extremely finicky with food.

However, my strong conviction about diet therapies for autism has shifted. Over the past five years, I’ve learned so much through working with children on the spectrum and their parents. Also, more research has surfaced supporting the GFCF diet along with a great deal of anecdotal evidence.

Unless you have a child with autism, you can’t fully understand what it looks like and how disruptive it can be -- to the child and the whole family. Many of my clients report improvement in symptoms after only a week on a GFCF diet. Improvements reported include increased eye contact, decreased non-purposeful vocalizations, decreased sensory-seeking behaviors, reduction in unusual hand & body movements and less meltdowns (think tantrum on steroids). An occupational therapist I work closely with reported the improved participation in her work in one client. The changes these patients saw made their lives (and their families’ lives) easier. Exploring these alternative diets with patients and their parents has opened my mind to the concept of diet therapy for autism. If a patient can avoid medication through dietary change and, I’m entirely open to that.

While my stance has shifted, I still worry that these diets could set the stage for other eating problems, such as eating disorders. One risk factor for developing an eating disorder is excessive focus on diet at a young age. Additionally, childhood eating conflicts and struggles around meals have been linked to anorexia nervosa (AN). Following a GFCF or SCD is challenging and stressful. It’s easy to see how conflicts and struggles could arise at the dinner table. Any anxiety a parent experiences around food translates to the child. Think about parties, restaurants and other occasions where parents would have to say “no” to appetizing foods, leaving the child feeling angry and/or deprived.

 Children with medical conditions requiring focus on diet are at increased risk for eating disorders. For example, Type I diabetics have twice the risk of developing an eating disorder as those without diabetes (read more here). While we don’t have similar research on those following an Autism diet, it’s worthwhile to consider a similar outcome is possible.

Special diets have social implications too. Children with autism tend to have low self-esteem and are at risk for depression. Low self-esteem and depression are two risk factors for eating disorders. Exclusion from social activities that involve food or requiring “different” food could further alienate a child who is already struggling socially. Beyond nutrition, food connects us socially and culturally. Alternately, exacerbated autistic symptoms due to certain foods could alienate a child. Parents need to weigh the pros and cons, considering their values and the best interest of the child. If a child has a meltdown at a birthday party, it could have a much greater impact on her socially than opting out of a slice of pizza or piece of cake. Plus, there are many suitable alternatives, albeit requiring a little extra effort and creativity on the parents’ part.

The primary goal of feeding in childhood, aside from growth, is to help children develop a healthy, loving relationship with food that sets them up to self-regulate and feed themselves down the road. Can you follow a therapeutic diet AND facilitate a good relationship with food?  I think the answer is yes. When implemented with proper guidance and while maintaining a consistent and positive feeding style, a child on a special diet can become a competent eater.

Feeding style is an extension of parenting style. Certain feeding styles (authoritarian, permissive, neglectful) correlate with disruption in weight trends and can lead to fixation on food. Childhood nutrition expert, Jill Castle explains that there are 4 different feeding styles. Authoritative feeders set boundaries around food but the child is given some ownership of the process. Parents decide what and when food will be served and the child decides whether or not to eat it and how much. Castle explains that this promotes independence and self-regulation around food. Read more about the 4 different feeding syles and their impact on childhood eating behavior here .

Coupled with the authoritative feeding style, a therapeutic diet for autism could help your autistic children improve functioning while also maintaining a positive, empowered relationship with food. It’s the feeding style and parental attitudes about food and body that have the largest impact on a child’s relationship with food.

 

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