How Can a Dietitian Help with Autism?
If you are a parent with a child with autism, you have most likely tried (or been told to try) many different approaches to help your child succeed. These approaches are (but not limited to) Speech Therapy, Occupational Therapy, Physical Therapy, Social Groups, Applied Behavioral Analysis (ABA), Behavioral Therapy, and nutrition. With most therapies, treatment can be rather straight forward. When diagnosed, you were most likely referred to a local clinic or center that offers Speech Language Pathology, Occupational Therapy, Behavioral Therapy, etc. where your child can begin getting the help they need. You may have even googled “Occupational Therapy near me” and found a nearby clinic. The issue with nutrition therapy is that there are very few dietitians that specialize in autism, and the odds are very low that there is one in your area. The scariest thing (for me as a dietitian) is when I have clients who take advice from blogs, uncredentialed “nutritionists”, or other parents sharing their experiences that are “personal trials” and not backed in research.
As a Registered Dietitian Nutritionist (RDN), I know that nutrition for autism is not something that is typically taught in school. For me, autism is an area that is very dear to me since my younger brother was diagnosed on the spectrum nearly 20 years ago (read my story here if you are interested). Through my studies and experience in interdisciplinary clinics for individuals with autism, I decided to develop my own private practice, Autism Dietitian, to further specialize my passion for nutrition and autism spectrum disorders.
Many parents wonder how nutrition can help their child with autism, and I’m here to tell you how. Let’s start with this graphic:
Now I know what you’re thinking… this is a lot! And it is. The good news is that I am here to guide you through it! This is everything I cover in an initial consult (if applicable). Now, let’s talk some logistics and further explain this busy graphic.
Managing Food Selectivity
Did you know that 70-90% of parents with a child with ASD report problems with food selectivity and intake of foods?  Children with ASD are also more likely to avoid foods and exhibit neophobia (the fear of trying new foods) than their typically developing siblings and peers . On average, children with ASD consumed fewer foods than children who are typically developing (33.5 vs 54.5 foods, respectively). 
Because a large majority of individuals with ASD also have Sensory Processing Disorder (SPD), this can heavily affect the foods they will or will not eat. Eating is a very sensory-rich experience - you smell the aroma of the food, feel the texture with each chew, hear the crunch, sense the temperature, and see the colors and appearance. If you have SPD, this can be a very off-setting and anxiety-provoking experience. I work with parents to help their child increase their food repertoire by using feeding therapy and connecting them to other practitioners (like Speech and Occupational Therapists) in their area who do the same. I meet the child where they are at, and gradually work to increase their foods while staying within their comfort zone and gaining their trust.
Solving Gastrointestinal Issues
Compared to children who are typically developing, children with ASD and developmental disabilities are at least three times more likely to experience a higher frequency of most GI symptoms  like constipation, bloating, and diarrhea. There can be many different reasons for GI issues including, but not limited to, (1) food sensitivities (2) imbalance of gut bacteria (3) low fiber diet (4) low water intake (5) low physical activity. It’s important that we find the root cause of GI issues, and not just treat the symptoms. I have clients who have been on Miralax for years (note: Miralax is not meant to be used for more than 7 days!!! Read the label here), which is only treating symptoms. Let me help you find and treat the root cause of your child’s GI issues.
Uncovering Food Sensitivities
It’s important here that you understand the difference between food sensitivities and food allergies. A food allergy is defined as ”an immune system reaction that occurs soon after eating a certain food. Even a tiny amount of the allergy-causing food can trigger signs and symptoms such as digestive problems, hives or swollen airways.” Food sensitivities tend to be more delayed, often making it difficult to identify the trigger foods. Food sensitivities can cause chronic inflammation in the gut and body, which can lead to symptoms such as:
Irritable Bowel Syndrome
Restless Leg Syndrome
Atopic Dermatitis & Eczema
It’s critical that we identify which foods are causing an inflammatory reaction. I help identify food sensitivities using the MRT test (find a description of the test here) with my clients and transitioning them out of the diet.
Both overweight/obesity and underweight/malnourishment are common in ASD, with food selectivity often being the main cause. Children with ASD & SPD tend to gravitate toward foods that are higher in carbohydrates, calories, and fat. These foods are commonly lacking in vitamins, minerals, and other nutrients. Nutrient deficiency can cause us to crave more food, since the food we are getting is not giving us the nutrients our body needs. This cycle can lead to overweight and obesity, and poor nutrient status can also lead to abnormal hormone levels, furthering this issue. Although a child may be overweight or obese, they can still technically be malnourished from the lack of nutrients.
Food selectivity can also cause children to be underweight and malnourished since they are only eating a few select foods. By eating only a few foods, the child may not be getting sufficient calories and nutrients, causing them to have difficulty gaining weight and show other signs of nutrient deficiency. It’s important in both scenarios that we assess the diet, check for nutrient deficiencies, and work on feeding therapy.
Developing a Supplement Regimen
Since many children with ASD are selective in the foods they are eating, they often do not consume the appropriate amount of vitamins and minerals. If a child is selective, I will start with getting them on a generic supplement regimen to cover our bases. From there, I will check nutrient levels so that we can determine which nutrients we should increase or decrease. During this time, it is also helpful for us to have a genetic panel so that we can determine which form of certain supplements we should use (for example, in the case of the MTHFR gene mutation, we would be sure to use L-5-MTHF vs folic acid to replete folate levels).
While supplement regimens are second best to diet, often times diet is not able to be modified immediately if we have a selective eater. Supplements are a great way to get in nutrients when the diet is poor. ALWAYS consult a dietitian or physician before you begin supplements. I build individualized supplement regimens for my clients daily. If you are interested in supplement recommendations, you can schedule an appointment or contact me.
Solve Underlying Sleep Issues
Sleep issues are commonly associated with GI issues. I have many clients who tell me that when we solved their child’s gastrointestinal issues, we also solved their sleep issues. Sleep can also be affected by nutrient deficiency, as many nutrients play into the production of hormones and neurotransmitters, like serotonin. Children with SPD can also have a tough time winding down for bed since their senses are all firing at once and their brain just can’t seem to slow down or shut off.
Helping with ADD/ADHD
Many nutrient deficiencies can cause inattention & other neurological symptoms. Micronutrient testing is one way for us to identify which nutrients are playing a role in decreasing concentration and focus. Food sensitivities have also been known to cause brain fog, which can further increase (or cause) ADD/ADHD symptoms. Food sensitivity testing, micronutrient testing, and an individualized supplement regimen can drastically help with symptoms.
Discovering Genetic Mutations
Humans have around 24,000 genes in our genome. That being said, genetic mutations are impossible to avoid. Some genetic mutations can be “silent”, meaning they do not cause an issue. Other genetic mutations play a major role in certain syndromes and disorders like Down Syndrome, Cystic Fibrosis, and Celiac Disease. While we don’t know of a specific mutation causing autism, we can still use genetics to decrease symptoms. We have many genes that are involved in the way we metabolize (break down) certain nutrients from nutrition supplements and from our food. It’s important that we analyze these genes so that we can be sure to use the correct forms of supplements and follow the appropriate diet for your child’s body.
All of this to say….
We need to change our mindset from a “blanket approach” to an individualized approach. Children with autism are like fingerprints, no two are the same. It’s important that we customize our approach so that we can set each child up for optimum health and the highest quality of life. If you’d like guidance in doing this, feel free to schedule an appointment and let’s talk! If you’re not quite sure yet, you can schedule a FREE 15-minute phone call to discuss options and ask questions about services.
Autism is a puzzle, and nutrition is one of the pieces. Together, let’s find which piece fits!
 Mulle JG, Sharp WG, Cubells JF. The gut microbiome: a new frontier in autism research. Curr Psychiatry Rep. 2013;15(2):337.
 Schreck KA, Williams K, Smith AF. A comparison of eating behaviors between children with and without autism. J Autism Dev Disord. 2004;34(4):433-8.
 Zimmer MH, Hart LC, Manning-courtney P, Murray DS, Bing NM, Summer S. Food variety as a predictor of nutritional status among children with autism. J Autism Dev Disord. 2012;42(4):549-56.
 Chaidez V, Hansen RL, Hertz-picciotto I. Gastrointestinal problems in children with autism, developmental delays or typical development. J Autism Dev Disord. 2014;44(5):1117-27.
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