Thursday, March 1, 2012

Dietary Intervention Step One for Children With a Suspected Neurodevelopmental Disorder

Since we have already discussed general nutrition tips that apply to all children (see 'Good Nutrition is the Cornerstone of Treatment'). Lets move to specific nutritional interventions that may be helpful for children with a neurodevelopmental disorder.

Feingold Diet:

One that may be useful is the Feingold diet. This was originally developed for children with ADHD but really applies to any disorder in which hyperactive behavior is a symptom. This can be tried without any lab testing and should be used as an elimination diet. One part of the diet involves removing all artificial sweeteners, flavorings, colorings, high fructose corn syrup, msg, and some specific preservatives from the diet. If you recall we talked about avoiding this in the general nutrition section as applicable to all children. The second part of the diet includes a list of about thirty foods, which include different fruits, vegetables and condiments, which should be eliminated. The foods listed are actually healthy so it is not the original product that is the problem. The trouble arises as these foods and the artificial products are being processed in the body in preparation for excretion. If these steps are deficient in any manner the middle products of the process can build up in the system. They are then available to travel to the brain and cross the blood/brain barrier. These middle products fit nicely into receptors in the brain that are stimulatory and can cause hyperactive behavior. This process is not deficient in every child but since the intervention requires no testing and no out of pocket expense it should be tried in every child for at least four weeks. If after four weeks of vigilant avoidance you notice no difference in behavior then your child does not have that problem and you can return to normal consumption of those food products, minus all the artificial products.

Gluten Free/Casein Free Diet:

We are going to continue discussing nutritional interventions and look at one of the more commonly used diets for children on the spectrum. If you have a child with autism you have most likely have heard or read something about the Gluten Free/Casein Free diet. The descriptions have probably been anywhere from " amazing difference " to " did not notice a difference at all". This diet requires removing gluten, the protein in wheat and other grains, and casein, a protein in milk from the diet COMPLETELY for at least six months. This diet, just like any other intervention in medicine, will work for some and not others and it important not to proceed with unrealistic expectations.

There is confusion, even among parents with autistic children, as to why this diet may be helpful. There are two main reasons for restricting these food sources. The first is based on an inflamed and dysbiotic gastrointestinal tract. This dysbiosis will often include a yeast overgrowth. When there is dysbiosis and inflammation the connections between the cells lining the gastrointestinal tract start to allow food particles to enter before they have been completely broken down. This is known as leaky gut. These food particles, in the case of proteins, are called peptides and they are brought into the blood stream in a larger segment than is usual. These peptide fragments then travel through the body and eventually make their way to the brain. Once there they happen to fit very nicely into the same receptors that opioids, like oxycontin, use when they are affecting the brain. This is not the only example of this as we mentioned during our last discussion. Phenols from foods wreck havoc the same way by fitting nicely onto the same receptors for adrenaline. As you would imagine providing substances that target opioid and adrenaline receptors is not desirable and will produce some unwanted behaviors. This will include hyperactivity, emotional instability, and cravings for the foods that cause those effects. Just like an addict who needs a fix a child with this problem will seek out the offending foods for the pleasurable feeling they get from eating it. For many children on the spectrum this mechanism is the reason why avoiding these foods should be attempted while at the same time taking care of the inflammation and dysbiosis. It is important to remember that the gluten and casein peptide fragments look similar and they can fit interchangeably into the receptor so it is necessary to remove both of these foods to truly see if it helps.

The second reason these foods can cause problems is that the immune system is actually mounting a response to the protein portion of the food. This is evidenced by elevated antibodies to gluten, gliadin and casein that are seen on blood tests. This means the immune system is inappropriately using its resources against an ingested food. These allergies are IGG not IGE so they do not cause immediate life-threatening symptoms but with constant exposure and inappropriate upregulation of the immune system secondary effects are felt. The body may start to mistakenly attack other parts of the body, which is called an autoimmune disorder, or it may lose its potentcy in taking care of true threats to the body. Upregulation of the immune system may also have a negative impact on gut inflammation and contribute to the leaky gut. Not all children have an immune system that is fighting food so it is important to check as that will affect long term treatment.

In beginning treatment almost all children are going to need to avoid gluten and casein due to inflammation and leaky gut. If children have no evidence of elevated antibodies to these proteins then it may not need to be a long term intervention. If the dysbiosis is corrected and the inflammation resolved then they will be able to eat those foods without any problems. The child who shows evidence of an immune response to one or both of the food proteins really should avoid them life long even if the gut issues are resolved. If the exposure remains the inflammation will persist, the immune system will not function at its best, and there is the risk of a secondary autoimmune disorder.

Traditionally we have looked at two different reasons for avoiding gluten and casein in the diet. The first is because of the gut dysbiosis and inflammation that affects so many children on the spectrum. This inflammation allows these protein pieces to be absorbed in sizes that are larger than normal. These pieces, also known as peptides, then circulate and hit receptors in the brain that are also used for opioids. The treatment for this is to resolve the dysbiosis and inflammation which will prevent the leakage of these peptides into the gut.

The second reason is due to an immunological response to these peptides as the body inappropriately recognizes them as foreign and produces antibodies to them. These antibodies are of the IGG variety and can remain elevated even after consumption of these foods has ceased. An individual with elevated antibodies to gluten and casein should maintain a diet free of these substances. The twist on this scenario is that individuals may still be having an immune response to these proteins even if the antibody levels are low. This can happen if the attack is being led by the portion of the immune system that attacks directly and without the help of antibodies.

This means that all chidren on the spectrum, which includes children with ADD and ADHD, should do a trial of eating gluten free and casein free even if antibody levels are not elevated. This diet should be followed strictly for at least 6 months before deciding if it is producing results. Recognizing that this is difficult to do it is helpful to use digestive enzymes. These will help if there are any dietary infractions and will break down the proteins into smaller pieces so they do not fit nicely into the opioid receptors. When using enzymes you should pick one that helps digest proteins, carbohydrates as well as phenols. This is because many children have trouble with carbohydrate digestion as well as being sensitive to foods with phenols in them. Restricting foods with phenols is the premise behind the Feingold diet.

The take home message is that almost all children should do a trial of eating gluten free/ casein free and using digestive enzymes for six months. Everyone should also do a trial of the Feingold diet.

Dr. Lisa Rankin is a Family Medicine physician who lives and practices in Port Saint Lucie, FL. She has a solo practice [] which serves patients of all ages from newborn to geriatrics. Dr. Rankin also has a special interest in children with a Functional Disconnection Syndrome because her son is on the Autistic Spectrum. She is a co-founder of the Brain Training center of the Treasure - a practice dedicated to improving the lives of children and adults with Autism, ADD, ADHD, Dyslexia, Aspergers, and other neurodevelopmental disorders.

Dr. Rankin holds a Bachelor's Degree in Nutrition, graduated from University of Miami Medical School, and did her residency at the University of Florida. She and her husband, Sean Rankin DDS, have three children altogether.

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