Gillian Goodfriend, NCHPAD Registered Dietician

The Centers for Disease Control and Prevention estimate that approximately 1 in every 110 children is diagnosed with autism. Autism is the most common of five Pervasive Developmental Disorders (PDD), which is a category of neurological disorders with severe and pervasive impairments affecting development of social interactions and communication skills. The other four PDDs are Rett's Disorder, Child Disintegrative Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.

Autism is a spectrum condition of neurobiological origin, currently with no known cause. Development in 3 main areas is impaired: verbal and non-verbal communication skills, social skills, and restricted range of play/interests. Impairments range from mild to severe, and each area of development may be affected to a different degree in the same child.

Statistics show that at least 40% of children with autism have been placed on a specialized diet at some point in their lives in an effort to improve the symptoms of autism. There is ongoing research about which diets are most effective. Some of this research is based more on science, while some is more anecdotal or hope-based. There are challenges to research in this area, including that the disorder is so variable (a spectrum condition) and that the causes of autism are poorly understood.

The most common specialized diets are summarized below:

Gluten-Free/Casein-Free Diet
Some research has proposed that people with autism have GI abnormalities that are exacerbated by gluten and casein. Several research studies have focused on the elimination of all foods containing gluten and casein. Gluten is a mixture of proteins found in wheat, rye, and barley. Casein is the main protein in dairy products.

Studies by Knivsberg et al (2010) and Elder et al (2006) examined behaviors of autistic children on a gluten-free/casein-free diet versus a regular diet. For the diet group in the Knivsberg et al (2010) study, results indicated that social contact increased and ritualistic behaviors decreased at 8 and 12 months. This study, however, lacked a double-blind or placebo element. Therefore, potential effects derived from influences outside of dietary changes could not be disqualified. The Elder et al study (2006) did not show any significant group differences between those children on the specialized diet and those who were not.

Although the research is inconclusive, several parents have reported anecdotal evidence of improvements and choose to continue the gluten free/casein free diet. Currently, this diet is one of the most commonly prescribed for children with autism. Despite the lack of solid evidence, many caregivers and parents report having seen behavioral improvements in children following this diet.

Ketogenic Diet
Ketogenic diets have been used effectively to prevent seizures in children with epilepsy. More recently, some researchers are examining whether ketogenic diets can play a role in autism. Some believe this diet can be used to manage intractable seizures in people with autism. Others hypothesize that the diet can be used to improve the core symptoms of autism.

A ketogenic diet is high in fat, adequate in protein, and low in carbohydrates. This diet forces the body to burn fat for energy instead of glucose. It is a very strict and difficult-to-follow diet.

There is very limited research in ketogenic diets for children with autism. A pilot study by Evangeliou et al (2002) examined children's behavioral responses after 6 months of following the John Radcliffe ketogenic diet, which uses MCT (medium chain triglyceride) oil as the main source of energy. Eighteen of the 30 children completed the study, while the remaining children could not tolerate the diet. Based on the Childhood Autism Rating Scale ( http://en.wikipedia.org/wiki/Childhood_Autism_Rating_Scale), results indicated that significant improvement was seen in two of the children, eight children showed average improvement, and another eight children showed minor improvement. These results are very preliminary and more research needs to be done in this area.

Organic Diet/Limiting Processed Foods
A new area of research is looking at the effects of a diet that minimizes exposure to artificial dyes, flavorings, and preservatives and focuses mainly on organic, plant-based foods. Artificial ingredients are believed to be highly inflammatory in the body, and can, therefore, potentially exacerbate the symptoms of autism. Some research has suggested that there may be a link between attention deficit hyperactivity disorder and pesticides, which provides a strong basis for looking at these same effects for children with autism.

The Center for Discovery, located in Harris, NY, offers individuals with a range of disabilities - and their families - innovative educational, clinical, residential, social and creative arts experiences designed to enrich their lives through personal accomplishments. Children and adults with autism comprise a large part of the Center's population.

The basic nutritional philosophy at the Center for Discovery is to serve a seasonal, whole foods, plant-based menu to the residents.

Jennifer Franck-Wyant, Director of Nutrition and Food Services at the Center, states "We strive to use food directly from our farm which is certified organic and biodynamic. With this diet, we really minimize our residents' exposure to highly processed foods, especially those with artificial colors, flavors, and ingredients. We are increasing our animal-based food production, including, eventually, a dairy. All animals are pasture-raised, which increases key nutritional components in meat and milk, including omega-3 fatty acids. In addition, our menu has very little "white" food (i.e., refined sugars, flours, etc.), is high-fiber, and is high in heart-healthy fats, all of which help us control chronic diseases, such as obesity, diabetes, and heart disease."

Researchers at the Center for Discovery are currently working to quantify the benefits of their nutrition and food program to provide evidence that this organic, preservative-free, plant-based approach is effective in reducing autistic behaviors.

References:

The Center for Discovery
(http://www.thecenterfordiscovery.org/)

Elder, et al. (2006). The gluten-free, casein-free diet in autism: Results of a preliminary double blind clinical trial. Journal or Autism and Developmental Disorders, 36(3), 413-420.

Evangeliou, et al. (2002). Application of a ketogenic diet in children with autistic behavior: pilot study. Journal of Child Neurology, 18(2), 113-118.

Knivsberg et al. (2007). The ScanBrit randomized, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutritional Neuroscience, 13(2), 87-100.

Please send any questions or comments to Gillian Goodfriend at ggoodfri@uic.edu.