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Diet as a Treatment of Autism and ASD – a guide
Diet is a common therapy for autism, Asperger’s syndrome and PDDNOS – collectively known as autism spectrum disorder (ASD) (read more about what this is here).
Many web sites and support organisations support the use of diets and supplements (biomedical interventions) for the treatment of autism and other ASDs, but dietary treatment has not yet been welcomed by the majority of mainstream health professionals.
There are many different approaches to the dietary treatment of autism, and the advice from different organisations is often contradictory.
As a registered dietitian, I am sceptical as to the benefit of many of these interventions for the majority of individuals with ASD, however, like any other children, a small proportion of children with autism are likely to have allergies or intolerances to different, and we know that allergies and intolerances can cause gut problems, and behavioural problems – common problems in children with ASD. When the ‘offending’ foods are cut out of their diets, it is then common sense that their symptoms improve. Therefore I do readily support families who want to attempt dietary treatments for autism and ASD.
This guide is designed to give an impartial overview of these interventions to help you make an informed, and safe choice.
- Diets for the treatment of autism
- Tests available
- Nutritional supplements or biomedical interventions for the treatment of autism
- Multivitamins
- Fish or omega 3 oils
- Getting started with diet for the treatment of autism or ASD
- Autism and diet downloads, links
Which diets are there for the treatment of autism?
There are lots of different diets suggested by different organisations.
The most common is to avoid gluten and casein (proteins commonly found in wheat, rye, oats and barley, and milk).
Other suggestions include avoiding chocolate, yeast, sugar, citrus fruits, salicylates (a natural compound found in many fruits and vegetables), fruit juice, bananas, aspartame (an artificial sweetener), MSG (a flavour enhancer), nitrates and nitrites (preservatives) or food colourings; the elimination of a number of different artificial additives and foods containing salicylates (the Feingold Diet); rotation of different foods in the diet on different days; eating a diet of natural foods plus other foods thought to have special properties (such as The Body Ecology Diet), or eating a diet low in a specific food group (such as The Specific Carbohydrate Diet™)
Unfortunately none of these are proven to help – independent reviews of the evidence by both the multi-agency group producing the National Autistic Plan (can be viewed on www.nas.org.uk), and by a specialist group of dietitians working in autism (available on www.bda.uk.com) found that neither dietary changes nor supplements could be recommended as a treatment for autism or ASD.
There are theories that children with autism have some sort of metabolic reaction to these foods, distinct to common allergies or intolerances, but in the absence of good evidence to support these theories, I remain unconvinced.
Is there harm in trying diet as a treatment for autism or ASD?
Yes, possibly…
Restricting a child’s diet without the expert advice and supervision of a dietitian can lead to nutritional deficiencies and compromise a child’s growth. For example, cutting out gluten can cause your child’s diet to be low in fibre, and cause constipation. If your child is not willing to eat gluten-free substitutes, then their diet could be too low in calories, and they could fail to grow well. Cutting out casein can lead to a low calcium intake, which in severe cases can cause bone disease (rickets).
The more foods that are cut out of a child’s diet, the higher the risk is of an inadequate nutritional intake.
If your child is a very selective or picky eater, restricting their diet further can also put them at further risk of nutritional deficiencies. Some organisations suggest that following a special diet for ASD can result in a child eating a more varied diet, but this is often not the case.
Diets restricting major food groups such as all carbohydrates are not recommended for children unless under close medical or dietetic supervision. Following such a diet long-term would only recommended if the benefits of following the diet are clearly seen and outweigh the risks of such a restrictive diet.
Following a restrictive diet can also be really time-consuming and it can be difficult to cut favourite foods out of your child’s diet. It can also be expensive – special gluten-free and milk-free products cost more than regular products. Some families prefer for the whole family to follow the same diet, so their child does not feel singled out, which adds to the overall cost.
What tests are there to see if my child would benefit from a special diet?
Unfortunately none…
There are no reliable tests available either privately or on the NHS that can determine if your child would benefit from any of these diets.
There are a couple of tests carried out on the NHS to help to diagnose severe food allergies (skin prick tests and blood RAST tests) – however these are only really useful to point to foods that can cause immediate reactions such as a life-threatening anaphylaxic reaction to nuts.
None of the blood, hair, electromagnetic or alternative tests available privately have been shown to have any reproducibility or efficacy.
Urine tests commonly available for children with ASD have not been proved to have any connection with food intolerance.
The only recommended test is for a Coeliac disease – a lifelong gut disease which is treated by strict gluten avoidance. Symptoms include general unwell, diarrhoea, constipation, weight loss and anaemia, or it can have no symptoms. Blood and gut biopsy tests for Coeliac disease are available on the NHS, but they are only useful if your child is currently eating gluten – so it is often best to request these tests before starting a gluten-free diet. One advantage of a diagnosis of Coeliac is that some gluten-free products can be obtained on prescription on the NHS.
Which different nutritional supplements (“biomedical interventions”) are suggested for the treatment of autism and ASD?
Some organisations suggest that taking high doses of different vitamins and minerals
can help with ASD, these include Vitamin A, Vitamin B3, Vitamin B6, Vitamin C, Folic
Acid, Calcium, Magnesium and Zinc. Some also suggest fish oils, evening primrose
oils or cod liver oil.
There is no strong evidence that any of these are needed, or help with the symptoms of autism or ASD.
Is there any harm in trying these supplements?
Again, yes, possibly…
It is not recommended for adults, let alone children, to take high doses of any individual vitamins or minerals unless they have a specific need, and there is no good quality evidence at present to show that children with ASD have any specific needs for these supplements.
Care should be taken not to exceed the safe upper limit set by government agencies for any nutrients, as long term effects of taking large doses is unknown, particularly in young children. You can find current recommended doses of different vitamins and minerals from the foods standards agency www.foodstandards.org.
For example the safe upper limit of vitamin B6 for adults is 10mg/d. Taking high doses (more than 200mg/day) of vitamin B6 has been linked to neuropathy (e.g. muscle pain and weakness), and more than 2000mg/day to irreversible nerve damage (in adults). Some organisations suggest that doses of up to 1000mg per day are beneficial for children with ASD. It is not advised to exceed 200mg/day, especially not for children who may be unable to communicate any feelings of neuropathy.
What about a multi-vitamin and mineral supplement?
If you don’t feel your child eats a varied diet, your local pharmacist can recommend
an appropriate multivitamin and mineral supplement for your child’s age. Alternatively
a registered dietitian is skilled in identifying any specific nutrients deficient
in a child’s diet.
What about fish oils or omega 3 fatty acids for the treatment of autism or ASD?
Omega 3 fatty acids (omega 3) are proven to improve brain development in under-5s
and protect against heart disease in adulthood. There is research being done to
see if they help with learning and behaviour.
The government recommends that we all should get omega 3 from eating 2 portions of fish a week including one serving of oily fish.
Examples of omega-3-rich oily fish are: Mackerel, Kippers, Pilchards, Trout, Salmon, Sardines, Herring, Eel, Whitebait, Anchovies, Bloater, Cacha, Carp, Hilsa, Jack fish, Katla, Orange roughy, Pangas, Sprats, fresh or frozen Tuna (omega 3 oils are extracted in tinning in the UK)
There are limits on the amount of fish recommended for children, due to the toxins usually present in their oil - boys can have up to four portions of oily fish a week, but girls should have no more than two portions of oily fish a week. Don’t give your child any shark, swordfish or marlin.
If your child does not eat fish there are other foods containing omega 3s:
· dark green leafy vegetables
· wholegrain cereal products, e.g. granary bread
· linseeds/flax, walnuts, pecans, peanuts and almonds (remember to avoid whole nuts in children under 5 years or if your child is at risk of allergies)
· omega 3 enriched foods, e.g. Columbus eggs, some margarines, some milks
· olive oil, rapeseed/canola oil, linseed/flax oil and walnut oil
If your child does not like oily fish or any of the foods listed above, then they may benefit from a fish oil or plant based omega 3 oil supplement.
Consult your doctor before taking a supplement if your child is on medication or has a medical condition such as epilepsy or haemophilia.
There have been some studies to investigate whether high doses of omega 3 oils as a supplement can help children with their concentration at school and even improve the symptoms of children with attention deficit hyperactivity disorder (ADHD) or ASD. These studies are as yet inconclusive, and it is not clear what precise dose of omega 3 is needed, and what balance of essential fats (known as EPA and DHA) are best. Researchers feel that these high doses take 3 months of daily supplements before their full effects are seen. High dose supplements can be quite expensive.
There are many different omega 3 and fish oil supplements on the market. When choosing a supplement watch out that:
· It is suitable for the age of your child
· It is not too high in vitamin A as this can become toxic in large amounts, especially in children
· It has Vitamin E (tocopherols) to help the body to use the omega 3 and improve the supplement’s shelf life.
· It is a reputable UK brand, as all fish oils supplements in the UK have to have been purified to reduce pollutants.
If I haven’t managed to put you off trying these dietary treatments for a child with
autism or ASD, I recommend the following steps:
1. First discuss with your doctor
2. Second seek a dietitian’s support – they should be able to provide you with written
information supporting you in following some avoidance diets e.g. gluten and/or casein
free diets. They can also monitor your child’s growth, assess their diet to ensure
an adequate nutritional intake is maintained, and advise on the safe maximum levels
of different nutritional supplements taken.
3. Plan well - take a systematic approach to any changes. Only attempt one dietary change at a time, and try not to make dietary changes when your child is starting other treatments– e.g. an intensive behaviour programme or change in medication.
4. Try to implement dietary change in stages:
First record your baseline - monitor
your child’s behaviour and bowel habit carefully for a couple of weeks on their normal
diet and record this in a diary
Then implement one dietary change strictly for a
set time, e.g. a month. Continue to keep a diary of your child’s behaviour and bowels
Then,
importantly, stop the dietary change (even if you are sure it has helped – you don’t
know it’s just coincidence till you have stopped it) and monitor any changes in behaviour
and bowels.
If there is a clear deterioration in your child’s symptoms, consider
the significance of any changes seen on the diet. Weigh this up carefully with any
difficulties you have found in following the diet, and consider reinstating the diet.
If you decide to continue with a dietary restriction long-term, a dietitian can help to ensure that your child’s diet is adequate – you probably need to continue seeing a dietitian regularly - yearly at least.
Acknowledgements
Adapted from a leaflet produced by Zoe Connor with help from other
members of the BDA dietitians autism group, some information adapted from leaflets
by dietitians at West Middlesex University Hospital.
Related pages:
What is autism / ASD? Helping an extreme faddy eater Useful links and books
> Buy our e-book Help with a gluten-free and milk-free diet for autism and other disorders
Please contact us if there is something you think we could add to or change on these pages, or if you would like a private consultation.
* A guide to considering diet or biomedical interventions as a treatment for
autism or ASD (PDF file, 218KB)
* A guide to considering a gluten-free and casein-free diet for the treatment of autism (PDF file, 123KB)
* ASD symptom monitoring chart (Word file)
* ASD symptom monitoring chart (PDF file, 46KB)
* Diet in the treatment of autism - a summary of the evidence, Nov 2006 (PDF file, 138KB)
* Autism and Diet food fact sheet (British Dietetic Association website)
Page first published: September 17th 2006, last updated: June 25th 2009.