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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS Children with autism tend to eat an excess amount of white refined carbohydrates with their diets lacking in whole grains, protein, healthy fats, vitamins, minerals, and water. As long as the child continues to eat a limited diet consisting primarily of white refined carbohydrates, we can expect the child to have GI problems. So, the first step is to expand the child’s diet to include a variety of whole healthy foods. Adequate water and fiber from fruits, vegetables, and whole grains will help promote normal daily bowel movements. The Registered Dietitian will provide specific nutrition recommendations for the individual child to promote normal bowel movements. Step 2: Supplements, Herbs, and Nutraceuticals Probiotics, anti-fungals, and digestive enzymes play a major role in healing the child’s GI tract. The right combination of these supplements will support and maintain a healthy balance of naturally-occurring microorganisms in the child’s gastrointestinal tract. Probiotics - The GI tract contains microflora which must be maintained at an ideal balance in order to support the immune system and the production of certain vitamins and digestive enzymes. Research shows that children with autism have significant imbalances in their upper and lower gut microflora. A study published in the Journal of Medical Microbiology in 2005 indicated that severe gastrointestinal problems in children with autism may be due to an imbalance of the gut microflora, and that rebalancing the microflora may help to alleviate gastrointestinal disorders common in children with autism (66). Probiotics, which are live microorganisms that are similar to the beneficial ‚good bacteria‛ found in the gut, can help improve the microflora balance in the child’s gastrointestinal tract. Most often, the bacteria used for probiotics come from two groups, Lactobacillus or Bifidobacterium. Within each group, there are different species (for example, Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium infantis, and Bifidobacterium lactis), and within each species, different strains (or varieties). Bifidobacterium, especially Bifidobacterium lactis, is the most prevalent bacteria found in breastfed babies, 126 making it the better supplement choice for infants and young children. Saccharomyces boulardii are yeasts that have probiotic properties and are often used in conjunction along with other probiotic supplements. Anti-fungal - Herbs and natural food sources that have anti-fungal properties are often used in conjunction with probiotics. They help support a healthy balance of intestinal bacteria and yeast by keeping Candida albican yeast growth under control. Unlike probiotics, the child should not take an anti-fungal product on a daily basis indefinitely. Anti-fungal products are typically taken for a short period of time, 3 – 6 months to assist in healing the gut and then they may be discontinued. Antifungal products contain herbs such as pau d’ arco and other natural food sources that have antifungal properties such as garlic extract, grapefruit seed extract, and caprylic acid. Although most herbs are free of known side-effects, there may be potential contraindications, precautions, and adverse reactions to consider, especially for children. Digestive Enzymes - Digestive enzymes are secreted in the mouth, stomach, and small intestines to break down food so the body can absorb and utilize the nutrients. Studies have indicated that some children with autism have low levels of intestinal carbohydrate digestive enzymes. A digestive enzyme supplement with meals may help these children better digest their food and improve GI symptoms, such as bloating, gas, diarrhea, and constipation. The body produces different digestive enzymes to break down different types of food, so select a multi-spectrum digestive enzyme product that contains a blend of several different digestive enzymes. This will ensure the child will be able to handle a wide range of foods. Some examples of important digestive enzymes include protease, lipase, amylase, lactase, and sucrase. Step 3: Consider Advanced Supplements Omega-3 fatty acids - A significant number of children with autism have inflammation throughout their GI tract. Omega-3 fatty acids have natural 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS anti-inflammatory properties, and research suggests that omega-3 fatty acid supplements may reduce the pain and inflammation associated with inflammatory bowel diseases. If the child has severe gastrointestinal symptoms or if the gastroenterologist has identified any gastrointestinal inflammation, a therapeutic level of omega-3 fatty acids for a short period of time may be a good option for the child. Glutamine - An amino acid necessary for gastrointestinal function. One of its most important roles is to help protect the lining of the gastrointestinal tract known as the mucosa. Recent research studies have linked glutamine to several other GI health benefits, such as aiding in the maintenance of the gut barrier, promoting intestinal cell growth, promoting healing of the mucosa, inhibiting the growth of ‚bad bacteria‛ in the gut, improving diarrhea, and reducing the symptoms of inflammatory bowel diseases (67). Glutamine is manufactured by the body, but it’s also found in many dietary sources, such as beef, pork, chicken, fish, eggs, milk, dairy products, cabbage, spinach, and parsley. If the child has a very poor diet or suffers from certain medical conditions, infections, or prolonged stress, his glutamine level may be depleted and he may benefit from a glutamine supplement. Glutamine supplements are generally labeled as Lglutamine and are sold as an individual supplement or as part of a protein supplement. There is no RDA for glutamine, so the child’s Registered Dietitian will suggest a proper dosage. Step 4: Identify and Eliminate Problematic Foods Common gastrointestinal symptoms, such as reflux, vomiting, abdominal pain, abdominal distension, gaseousness, loose stools, diarrhea, and chronic constipation, are indications that the child may have an allergy, sensitivity, or intolerance to one or more foods. The most common food allergies among children are cow’s milk, wheat, egg, soy, peanuts, and tree nuts. Problematic foods can have a huge impact on a child’s overall health, gut function, brain function, feeding, and behavior, so it’s crucial to identify and eliminate them from 127 his diet. The good news is that if the child’s GI symptoms are indeed being caused by one or more problematic foods, you’ll quickly see a significant improvement in his symptoms once the foods are eliminated. Medical Treatment - If the child still has GI symptoms after trying the basic nutritional interventions, his physician may refer him to a pediatric gastroenterologist. A pediatric gastroenterologist will examine the child for more serious GI disorders, such as gastroesophageal reflux disease (GERD), eosinophilic gastrointestinal disorders (EGID), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), intestinal inflammation, gastritis, celiac disease, abnormal intestinal anatomy, lactose intolerance, sucrose or fructose malabsorption, fat malabsortion, enteric infection, or parasites. The gastroenterologist may have to perform certain procedures to make his diagnosis, such as a diagnostic trial of proton-pump inhibitor, trial of lactose restriction, pH Probe, abdominal radiograph, lactose breath test, measure lactase-specific activity, stool analysis, esophagogastroduodenoscopy, and colonoscopy. The results of the testing will help the gastroenterologist recommend the appropriate medical treatment, which may include medication and additional dietary interventions. For more detailed information related to identification and treatment of gastrointestinal disorders in children with autism refer to Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorder in Individuals with ASDs published in the Journal of the American Academy of Pediatrics, January 2010 (64). Eosinophilic Gastrointestinal Disorders (EGID) is a chronic and complex group of disorders characterized by having excessive amounts of eosinophils, a type of white blood cell, in one or more specific places in the digestive system. For instance, if the child has Eosinophilic Esophagitis (EE), he has high amounts of eosinophils in his esophagus. If he has Eosinophilic Gastroenteritis (EG), his stomach and small intestines are affected, and if he has Eosinophilic Colitis (EC), the problem is in his colon. The symptoms of 2012
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