***What should autistic kids eat? For some of them weight gain is a problem and the short term answer is anything they are willing to swallow. With time and patience more variety may be accepted but the children may be avoiding some foods because they make them feel worse. forcing a “balanced diet” from all food groups may not be in their best interests. Food sensitivity testing can identify more types of sensitivities that traditional allergy tests miss.The following article provides physiologic guidance towards why some foods may be preferred or despised. Allergens can have an addictive effect due to an opioid like reaction. We can crave what is good for us but we can also crave what is bad for us – it can be exciting physiologically speaking. Some of the chemicals that build up can have neurotransmitter activity in the brain – literally over stimulating the brain cells. Can bananas and tomatoes kill brain cells? Not in everybody but maybe in autistic bodies overloaded with toxins.
Excerpts from: Autism, an extreme challenge to integrative medicine. Part II: medical management.
by Parris M. Kidd
Magnesium sulfate (Epsom salts) can benefit the autistic child through a novel route of delivery. A parent reported her child’s oppositional behavior disappeared overnight after a bath in Epsom salts. (67) Other parents who used the treatment soon reported improvements in speech, mood, cooperation, and motor development.
*** Over soaking in an Epsom salt/magnesium sulfate salt bath can lead to too much absorption of magnesium and produce temporary side effects of a fluttery/weak heart and possibly diarrhea. A soak for 20 minutes to 40 minutes at the very most seems an effective time for me. I use about 1-2 cups of the Epsom salt to a full bath.
I have also been adding a little vitamin C powder or spoon of cooking vinegar to balance the pH. The Epsom salt gives about an 8 pH and a 7 is more skin and hair friendly. I use pH strips to check the acidity after adding a little vitamin C powder or cooking vinegar (apple cider vinegar leaves me smelling like apple pickles). Kids and all of us love a hot bath, however warmish is better for the body than too hot. Pruney, wrinkly finger tips can be a easy sign for children to see for themselves – the body absorbed as much extra fluid as it can hold and now the skin is all ripply – cool and cold, water and cool, wrinkly fingers means its past time to get out of the tub. [17,18: links about Epsom salt baths]
Vitamin B6 and Magnesium (excerpt con’t, by Parris M. Kidd)
Vitamin B6, in its active form of pyridoxal-5-phosphate (P5P), is an essential cofactor for a majority of metabolic pathways of neurotransmitters, including serotonin, gamma-amino-butyric acid (GABA), dopamine, epinephrine, and norepinephrine. Magnesium is an essential macronfineral required for a wide range of enzyme-catalyzed metabolic pathways. Rimland recently reviewed 18 autism studies conducted with vitamin B6, especially in combination with magnesium, (22) and concluded that all provided positive results with no significant adverse effects. While no cures of autism by vitamin B6 are known, many cases of remarkable improvement have been documented.
A 1988 paper by Rimland provided an in-depth review of the history of vitamin B6 for autism. (29) In 1966, Heeley and Roberts reported vitamin B6 corrected abnormal tryptophan metabolism in 11 of 19 autistic children. (30) In 1968, Bonisch (cited in Rimland, 1988 (29)) reported vitamin B6 (100-600 mg per day) improved behavior in 12 of 16 autistic children. According to Rimland, three of Bonisch’s subjects spoke for the first time while participating in this open trial.
After conducting an exploratory, non-controlled study in the early 1970s, (31) in 1978 Rimland published the findings from a small double-blind trial that involved 15 children with autistic symptoms. (32) In this trial only half the children involved qualified as ASD by current criteria. (32) In this crossover trial, each child received vitamin B6 at a dose of 2.5-25.1 mg/kg body weight/day (75-800 mg per day) or a placebo. Following a complex, five-phase protocol, each child continued taking whatever vitamins, minerals, or drugs they had been receiving prior to the study and the duration of B6 dosing was individualized. Rimland stated they also received “several hundred” mg per day of magnesium and a B-complex vitamin to guard against overdosing with B6. (22) Statistically significant benefits emerged from this trial, including better eye contact, less self-stimulatory behavior, more interest in surroundings, fewer tantrums, and better speech. (32) Rimland began to suspect for many children autistic symptomatology might be a type of vitamin B6 dependency syndrome. (29)
Taken together, the studies seem to establish that vitamin B6 can benefit as much as half of children and adults with autism, and that its efficacy and safety are improved when combined with magnesium. None of these studies reported any significant adverse effects, even though the vitamin B6 doses ranged as high as 1,000 mg per day. Rimland emphasized that thousands of autistic people have been taking large daily doses of vitamin B6 (as much as 1,000 mg) for decades without experiencing problems. One publication reported on seven cases of peripheral neuropathy from daily intakes of more than 2,000 mg vitamin B6. (37) These patients were not taking magnesium or other B vitamins, as usually recommended when taking large vitamin B6 doses; nor were they taking the active form–P5P–that has not been associated with toxicity. In a later study, doses of 30 mg/day of B6 as pyridoxine hydrochloride (equivalent to as much as 2,100 mg for a 70 kg adult) were administered with 10 mg/kg/day of magnesium lactate to 11 autistic children for eight weeks; behavior significantly improved and no adverse effects were evident. (38) The latest ARI parent ratings in 2002 (24) reported a B:W ratio for vitamin B6 used alone of 4.1:1, for magnesium alone 5.2:1, and for the combination of vitamin B6 plus magnesium, 11:1.
Cases of hereditary impairment of pyridoxine metabolism have been described, sometimes manifesting as seizure disorder and autism symptomatology. (39) Conversion of vitamin B6 to its active form P5P by the liver can be compromised in some autistic children. For these cases P5P supplementation may work more effectively, although hyperactivity is a possible adverse effect. (40) An intake threshold for achieving benefit may be approximately 200 mg vitamin B6 (as pyridoxine) and 100 mg magnesium per day for the 70 kg individual. (41) In any case, the cumulative results from the double-blind trials and numerous other studies and case history reports are consistent with impressive efficacy of the combination of vitamin B6 and magnesium for autism, superior to either nutrient alone. (38,42-44)
Vitamin C has a reputation for its involvement in a plethora of metabolic, antioxidant, and bio-synthetic pathways, and as a cofactor for certain enzymes necessary for neurotransmitter synthesis. In a double-blind trial for 30 weeks, vitamin C (8 g/70 kg body weight/day) improved total symptom severity and sensory motor scores. (50) Its current parent B:W ratio is an excellent 16:1, from 1,306 questionnaires.
(***That is an awful lot of vitamin C but it is water soluble and is not stored. We need it daily. The B vitamins are also water soluble and non-toxic. “Expensive pee” is the joke but if it is helping the body on the way through than it isn’t that expensive compared to ill health.)
Among its many functions, zinc is needed for the development and maintenance of the brain, adrenal glands, GI tract, and immune system. Serotonin synthesis relies on zinc-activated enzymes; and zinc is also essential for antioxidant enzyme activity and other proteins important for growth and homeostasis. Breeding experiments with rodents indicate a zinc deficiency in the mother can be passed on to the offspring and negatively influence immunity and brain development. (51) Zinc currently has a very favorable B:W ratio, 17:1 from 835 questionnaires.
Zinc operates in a relationship with copper, i.e., when zinc levels go down, copper levels often go up. Bradstreet and Kartzinel assert zinc is deficient in 90 percent of ASD cases and copper in excess in 90 percent of cases. (14) Walsh analyzed copper and zinc in the blood of 318 ASD subjects and reported finding abnormally elevated copper:zinc ratios in 85 percent. (52) A smaller sampling of 22 subjects had 100-percent incidence of abnormally high, unbuffered copper (unbound to ceruloplasmin proteins)–about four times normal. Walsh’s findings corroborate recommendations by Adams (25) and others that autistics should exclude copper from their multiple vitamins.
(***Minerals can be dangerous at chronically high doses and the balance can be crucial. Wilson’s Disease is a copper overloading disease caused by a genetic defect. Pumpkin seeds, the green shelled part, are an excellant source of zinc and can be crisped by lightly toasting them in a skillet. Pepitos are another name for the Mexican snack version. Pre-toasted and salted pepitos can be quite salty unless you find raw pumpkin seeds at a health food store.)
Essential Fatty Acids Studies on EFA deficiency in autism are few, but with consistent results. Bradstreet and Kartzinel found omega-3 fatty acids are deficient in nearly 100 percent of ASD cases. (14) Vancassel and collaborators reported DHA 23-percent reduced, total omega-3s 20-percent reduced, and omega-6s unchanged in plasma phospholipids. (57) Hardy and Hardy studied 50 children with the more inclusive diagnosis Pervasive Developmental Disorder (PDD), and reported almost 90 percent omega-3 deficient via red cell analysis. (58)
Amino Acid Abnormalities
At least two-thirds of autistics have abnormal amino acid levels, as measured in 24-hour urine or lasting blood plasma. High phenylalanine is rarely seen (one per several thousand autistics) but can occur without overt phenylketonuria (PKU), which may be observed in children from countries that do not test for PKU at birth. High histidine (histidinuria and usually concurrent histidinemia) is seen in one per 250-500 autistics, and also can mimic autism. High urine levels of several amino acids (generalized hyperaminoaciduria) almost always indicate toxic chemical exposure and consequent liver damage. Such is also attributable to heavy metal contamination and Wilson’s disease, Fanconi syndrome, cystinosis, fructose intolerance, galactosemia, and several other hereditary disorders. (6)
Low urine threonine suggests malabsorption. In maldigestion, anserine and carnosine are high, while the essential amino acids are low. Anserine and carnosine may also be high due to zinc insufficiency. When citrulline, methionine, ethanolamine, and phosphoethanolamine are elevated, functional magnesium deficiency is likely. Elevated sarcosine indicates toxic exposures and/or folate deficiency. And, when detoxification capacity is limited, the cysteine/cystine ratio, and methionine, taurine, and glycine levels tend to be abnormal.
Amino Acid Abnormalities
Autistic subjects who poorly metabolize tryptophan can carry its potentially toxic metabolite indoylacrylic acid (IAA) in their blood. IAA would normally be detoxified by combining it with glycine to make indoylacryloylglycine (IAG). Organophosphate pesticide contamination may shunt tryptophan down the IAG pathway. (6) Tryptamine, found in tomatoes and all types of bananas, may also raise IAG levels. Certain citrus fruits also may contain tryptamine-like substances. Assays for IAG are not routinely available and are easily contaminated.
(***Tryptamine may act as a neurotransmitter and is part of tryptophan, melatonin, serotonin and the psychoactive chemical in Psilocybin mushrooms and LSD. Tomatoes and bananas may not be good for some autistic people due to an enzyme defect and removing dairy protein and wheat protein improved symptoms for up to 80% of ASD subjects.)
Removing Casein and Gluten Foods from the Diet
There is a great deal of evidence that foods containing casein or gluten contribute significantly to ASD and should be eliminated from the diet. In well-conducted studies, as many as 80 percent of ASD subjects improved following strict dietary exclusion of these proteins. (13,14) Implementation of a strict casein- and gluten-free (CFGF) diet almost always leads to symptomatic improvement, and lays the foundation for a diet that can markedly benefit the condition.
It has been suggested that the adverse brain effects associated with dietary casein and gluten are likely due to opioid-acting peptides (small amino acid polymers, also called exorphins) metabolically generated from these proteins. (15) In their Sunderland Protocol for autism, Shattock and Whiteley note that clinical improvement often occurs on the CFGF diet even when laboratory tests fail to detect such peptides in the urine. (14) They suggest autistic subjects could be biochemically processing casein and/or gluten into other bioactive derivatives not being detected; or, while urinary levels measure normal, the quantities reaching the CNS could be high, perhaps due to abnormal permeability of the blood-brain barrier. Yet another possibility they suggest is children subjected to oxygen deprivation or other perinatal brain insults may have heightened vulnerability to even “normal” levels of the offending peptides.
Reichelt et al studied 15 ASD subjects (5 girls and 10 boys, age 3-17 years) for one year after implementing casein and gluten restriction. (16) They reported that 13 of 15 showed some degree of behavioral improvement and none got worse, as judged from parent-teacher consensus. Seizure activity was decreased in 3 of 4 subjects; gross motor behavior improved in 13 of 15; social contact increased in 10 of 15; eye contact improved in 9 of 15; ritualistic behavior decreased in 8 of 11; language improved in 10 of 13; and sleep patterns normalized in 9 of 11. These investigators concluded that incomplete digestion of casein or gluten-gliadin by digestive peptidase enzymes could be a biochemical cause of autistic syndromes.
Since abrupt simultaneous removal of casein and gluten from the diet can cause withdrawal symptoms, a two-step phased withdrawal is appropriate. The first phase is removal of casein via removal of milk and other dairy products. From a 1995 trial, Lucarelli et al reported 66 percent of subjects showed benefits from this intervention. (17) Benefits can manifest quickly–usually within 2-3 days in young children or 10-14 days in adults. However, a much longer period is required for casein to be fully cleared from the body.
Shattock and Whiteley documented the known metabolic dangers to children from consuming cow’s milk. (14) Milk consumption is linked to increased autism incidence among the immigrant population in Sweden as compared to the indigenous population. (18) Some children are clearly addicted to cow’s milk and will drink large quantities. Symptoms linked to casein intake include projectile vomiting; eczema, particularly behind the knees and in the crook of the elbow; white bumps under the skin; ear discharges and infections; constipation, cramps, and/or diarrhea; and respiratory disorders resembling asthma. Shattock and Whiteley report that casein withdrawal symptoms can be severe, especially in young children. (14)
Some higher-functioning ASD children voluntarily cease casein intake, apparently sensing it is not good for them. Gluten products, on the other hand, stir strong cravings and children are less likely to refuse them. (19) Gluten exclusion requires the removal of several common cereals from the diet, wheat, barley, rye, and oats, in particular; but many other foods contain hidden gluten. (19-21) The elimination process usually takes a minimum of 3-4 weeks, and a trial period of three months is appropriate. The urinary gluten profile persists for much longer than does the casein profile, and correspondingly the withdrawal effects are usually milder in severity than casein’s, but typically more prolonged.
Full clearance of dietary casein-gluten symptoms is a long-term process. Withdrawal can be evident for three months or longer. (16) Whiteley’s group (19) found a mere 26-percent reduction in urinary levels of gluten after a five-month exclusion diet. In some cases dramatic improvement emerged a full 7-9 months after initiating the diet, but maximal improvement can require up to two years of rigid dietary exclusion. Shattock and Whiteley advise against adding these foods back into the diet, since severe opioid symptoms could result. (14)
Sensitivities to Other Foods
Whereas children with neurodevelopmental disorders frequently have sensitivities to common foods, ASD children seemingly have extreme sensitivity to a wide range of foods. These sensitivities may contribute to the perceptual and processing difficulties that typify autism, yet are difficult to objectify. The classic allergy symptoms such as stuffiness, eczema, wheezing, and itching may be absent, yet cognition and behavior remain affected. (2)
Once the main sources of food intolerance–casein, gluten, and gliadin–are removed from the diet, other foods may emerge as sources of symptoms. Parents, particularly those who keep food diaries, can often associate the child’s consumption of a particular food with deterioration in behavior, sleep patterns, or performance. Beef, pork, rice, and potatoes are only occasionally implicated; whereas, foods that consistently cause problems are eggs. tomatoes, eggplant, avocados, red peppers, soy, and corn. Seroussi (21) described how corn was revealed as a problem food only after strict removal of gluten and casein from the diet. If a particular food is suspected, it should be removed from the diet for a trial period of at least three weeks and any improvements noted. On being reintroduced into the diet, it will likely trigger an exacerbation of symptoms.
1. Kidd, Parris M.. “Autism, an extreme challenge to integrative medicine. Part II: medical management. (Autism).(Brief Article).” Alternative Medicine Review. Thorne Research Inc. 2002. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.
*** Chocolate is the main food eaten by one little girl with autism spectrum disorder in a later link. As a dietitian in a public health program I have worked with several autistic children and “crisp” was a popular food group. I personally love Lundberg rice cakes because they are more dense and crispy than regular store brand rice cakes. A varied diet has benefits but excluding allergens and enzymatically indigestible foods has benefit as well. The chocolate itself is a healthy start but continuing to offer variety and to enjoy variety as a role model of healthy eating generally will help a child find more foods that help more than hurt.
The tomato and banana news surprised me – I don’t eat either after my migraine history. Both were early “avoids” and since becoming less sensitive I just haven’t enjoyed them much. Dairy is a big congesting no-no for me and I still avoid gluten in general. Rice feels better, and seems to help me think and move better.
Chocolate is an excellent source of minerals and B vitamins. A hundred grams of pure dark chocolate (no sugar or cream) contains 556 calories, 136 mg magnesium, 56 mg calcium, 559 mg potassium, 8 mg iron, 2 mg zinc, 1 mg copper, 1.4 mg manganese and 3 mcg selenium. It is also a good source of B vitamins and is one of the few known sources of cannabinoids. See the page Bbliography on iodine and autism for a little more info.
6. “It’s hard to cry for Kieran …we know it’s not what he would have wanted; Tribute to 10-year-old meningitis tragedy boy.(News).” Evening Gazette (Middlesbrough, England). Media Wales Ltd. 2011. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>. **This is a different boy, autistic, loved chocolate, unfortunately died of meningitis.)
7. Javier Fernández-Ruiz, Rosario de Miguel, Mariluz, Hernández, Maribel Cebeira, and José A. Ramos, Endocannabinoids : The Brain and Body’s Marijuana and Beyond, Chapter 11, Endocannabinoids and Dopamine-Related Functions in the CNS, (2006 by Taylor & Francis Group, LLC) ,
“Previously, the existence of anandamide analogs in chocolate had been demonstrated (di Tomaso et al., 1996). It is thought that chocolate and cocoa contain N-acylethanolamines, which are chemically and pharmacologically related to anandamide. These lipids could mimic cannabinoid ligands either directly by activating CBRs or indirectly by increasing anandamide levels (Bruinsma and Taren, 1999).”
8. http://www.nal.usda.gov/fnic/foodcomp/cgi-bin/list_nut_edit.pl Nutrient Data Base # 19902: Chocolate, dark, 45- 59% cacao solids
10. “Great Culinary News for Individuals with Autism.” PRWeb Newswire. Vocus PRW Holdings LLC. 2010. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.
11. “Easy Steps to Convert Favorite Recipes to be Gluten (and Dairy) Free.” PRWeb Newswire. Vocus PRW Holdings LLC. 2010. HighBeam Research. 14 Mar. 2011 <http://www.highbeam.com>.