Picture: jar of chai with raspberries. Text: Understand the Role of Special Diets
 

Undertand the role of speical diets

You've probably heard of the gluten-casein free diet. Before we knew a lot about autism, there was a theory that gluten (found in wheat) and casein (found in milk) might be causing autism and that avoiding foods with gluten and casein could cure autism. Like a lot of early autism theories (think refrigerator moms) that idea was based on faulty logic and science. Now, although we don't know the exact causes of autism, all the evidence is pointing toward complex genetic pathways.

So what about special diets?  Special diets can be very stressful for families.  Does that mean you shouldn't try a special diet? Not necessarily, but it does mean you should take on the stress of a special diet just on a whim. Many families are interested in using special diets because they think it will help with behavioral problems. Children with autism can have food allergies and intolerances which, in turn, can cause behavioral problems that can be addressed through diet. Kids with food allergies and intolerances need a special diet - but if the underlying cause of a behavior isn't food, then addressing it with food won't help.

Here's some information on food allergies in the U.S.:

Infographic: Child food allergies in the United States. Each year 200,000 people need emergency medical care for allergic reactions. Food allergies affect 1 in 13 or 8% of children - that's 5.9 million children. A food allergy is when the immune sys…
 

Question: What about other problems like constipation or stomach cramps?

In addition to food allergies, gastrointestinal issues can be a problem for kids on the spectrum. It is likely that kids on the spectrum have more gastrointestinal issues than kids with typical development - things like diarrhea, constipation, and abdominal pain. It's hard to understand the exact role of diet in these problems. It could be that there are genes associated with autism that are also associated with gastrointestinal issues. It could be that there are differences in the microbiome of individuals with autism (which could be caused by a variety of different factors). It could be that children's diets are so funky that it causes gastrointestinal issues. What's even trickier is that kids on the spectrum may have similar gastrointestinal issues, but caused by different factors. 

In short, kiddos could experience gastrointestinal issues in the absence of a food allergy or intolerance - which means cutting out a food (like gluten) won't help these kids. For kids who have gastrointestinal issues that aren't related to allergies, it can be really complicated to address, but if the gastrointestinal problems are happening because the kiddos diet is off balance - it's about adding food (not eliminating food) - specifically fruits and vegetables as well as getting plenty to drink.  

Question: my kiddo has gastrointestinal issues. How do I know if it's an allergy, intolerance, or caused by something else?

That question is really difficult to answer and one of the reasons why so many kids with autism are on special diets. Sometimes allergies are easy to get a definitive answer on because there can be clear symptoms (if your child eats almonds and then gets welts - they have an allergy). Some kiddos get allergy testing - the gold standard is called an oral food challenge which has to be conducted by a specially trained doctor. Unfortunately, this kind of test can be difficult for children, but especially kids on the spectrum. Having said that, not all allergies are that obvious. Regardless of whether it is an allergy, intolerance, or other issues - the symptoms can be similar and the response can be delayed which can make it really difficult to find the underlying cause. The best way to tease it out is to do a food diary. It can be time-consuming but will provide you with the kind of information your doctor will need to guide you through the process.    

Question: How do I know if my child has Celiac?

Celiac Disease is a serious autoimmune disorder in which the body attacks the small intestine when there is the presence of gluten in the body. The reason why Celiac disease often comes up in conversations about autism is from those now-debunked theories that thought autism was caused by gluten (which is understandable given the Celiac is caused by gluten), but it doesn't look like there is actually a link. Kids with autism aren't immune from Celiac disease. Families with a history of Celiac disease and children with other autoimmune disorders are at the greatest risk for having Celiac.   

There is another food triggered autoimmune disorder called eosinophilic esophagitis (EoE) which a recent study found in higher rates among children with ASD. From the study, it is impossible to tell if EoE actually occurs in kids with ASD more or if kids with ASD are getting diagnosed more. 

Question: My child needs a special diet. Now what?

The good news is that being on a special diet is now a lot easier than it used to be. The bad news is that it can be stressful and take a lot of careful planning. Here are some resources to get you started:

 

 
 

References

All content is original to Mealtimes on the Spectrum, but is based on the following scientific literature:

  • Chaidez, V., Hansen, R. L., & Hertz-Picciotto, I. (2014). Gastrointestinal problems in children with autism, developmental delays or typical development. Journal of autism and developmental disorders, 44(5), 1117-1127. doi: 10.1542/peds.2013-3995

  • Ho, M. H. K., Wong, W. H. S., & Chang, C. (2014). Clinical spectrum of food allergies: a comprehensive review. Clinical reviews in allergy & immunology, 46(3), 225-240. doi: org/10.1007/s12016-012-8339-6

  • Lyall, K., Van de Water, J., Ashwood, P., & Hertz‐Picciotto, I. (2015). Asthma and allergies in children with autism spectrum disorders: results from the CHARGE study. Autism Research, 8(5), 567-574. doi: 10.1002/aur.1471