functional medicine and nutritional genomics - American Association ...

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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS EGID vary widely, depending on the area affected, and can mimic the symptoms of other disorders like food allergies, IBD, IBS, and GERD. Eosinophilic esophagitis in particular is commonly misdiagnosed as GERD. Common symptoms of EGID include: � nausea or vomiting � diarrhea � failure to thrive � abdominal or chest pain � reflux that does not respond to usual therapy � dysphagia � food impactions � gastroparesis � poor appetite � bloating � anemia � blood in the stool � malnutrition � difficulty sleeping If the child has EGID, it can cause significant pain, which can result in severe feeding problems and refusal to eat foods. EGID can only be diagnosed through an upper endoscopy, colonoscopy, and biopsy. Once the presence of EE, EG, and/or EC is confirmed, food allergy testing is typically ordered by the gastroenterologist. Since reactions to foods can not always be identified with food allergy testing, an elimination/challenge diet is recommended to help identify problematic foods. The foods that are most likely causing EGID are milk, wheat, soy, eggs, and/or peanuts. 4) CONSIDER ELIMINATION DIETS Elimination diets are very popular in the autism community. The most common elimination diets initiated by parents include the Gluten Free Casein Free Diet, Specific Carbohydrate Diet (SCD), Gut and Psychology Syndrome Diet (GAPS), Rotation, Antifungal, Feingold, and the Low Oxalate diets. Parents have long claimed that many of these diets are effective in relieving their child’s autistic symptoms. However, there is very little evidencebased scientific research that supports or refutes 128 these claims. There are a few studies published with mixed results (68, 69). Currently, there is ongoing research on the Gluten Free Casein Free Diet; the study ‚Diet and Behavior in Young Children with Autism‛ is sponsored by the National Institute of Mental Health. You may find additional information on this research study at www.clinicaltrials.gov. The Gluten Free Casein Free Diet (GFCF Diet) The GFCF diet is the single most common elimination diet recommended for children with autism. Clinical observation over thirty years has shown this to be the most effective elimination diet for children with autism. According to anecdotal reports, the GFCF diet may relieve the child’s GI symptoms, increase focus, improve sleep, decrease hyperactivity, and reduce behavioral problems. It is not considered a ‚cure‛ for autism, but rather a means to relieve autistic, behavioral, and gastrointestinal symptoms. Currently, there is no clear explanation of why the GFCF diet is effective for many children with autism. In the early 1980’s, the ‚opiate excess‛ theory arose suggesting that incompletely digested peptides, gliadomorphine and casomorphine, with opioid activity could precipitate autism (70, 71). The opiate excess theory is still very popular today; however, it remains very controversial. Another theory, ‚non-IgE mediated food allergy‛ theory arose in 2002. Research conducted by Dr. Harami Jyonouchi suggest that children with autism may be predisposed to allergic reactions to the dietary proteins, gluten, casein, and soy, which leads to gastrointestinal inflammation and behavioral symptoms. Jyonouchi’s research indicates that while only a small percentage of children with autism tested positive for IgEmediated food allergies via IgE RAST and skin prick tests for gluten, casein, and soy, a significant percentage of these same children experienced symptom improvement on a gluten, casein, and soy elimination diet. Jyonouchi found that children with autism had an increased proinflammatory cytokine response to gluten, casein, and soy, which indicates that these children have a non-IgE mediated immune reaction 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS to dietary proteins. The studies concluded that non-IgE mediated immune reactions to gluten, casein, and soy play a role in gastrointestinal symptoms in children with autism (72, 73, 74, 75). Gluten is the protein found in wheat, barley, and rye. It gives flour its elasticity, which allows for leavening and provides texture to baked products. Gluten is commonly found in breads, pasta, cereals, and baked goods. It is not found in oats, but oat is usually eliminated from the GFCF diet because of the high possibility of cross contamination by wheat, barely, or rye during its processing and distribution. Avenin, the protein found in oats, has a peptide sequence that closely resembles wheat gluten, so oat is eliminated. Casein is the protein found in cow’s milk and milk products. Soy, soybean, also known as soya bean, is a type of legume. Until recently, soy was used as a substitution for dairy products in the GFCF Diet. However, because of the research conducted by Dr. Jyonouchi and the fact that soy is one of the top five common food allergens, it is best to also eliminate soy while on the GFCF diet. If a parent is interested in trying the GFCF diet for their child with autism, a three month elimination/challenge diet is suggested. A referral to a knowledgeable Registered Dietitian to ensure the diet is implemented properly, effectiveness of the diet is assessed, and parents are instructed on how to replace loss nutrients from eliminated foods so the child’s nutritional health is not compromised. 5) IDENTIFY AND TREAT FOOD REACTIONS If a child with autism suffers from a food allergy, sensitivity, or intolerance, it may cause him to have intestinal, respiratory, skin, neurological, behavior, and feeding problems. Gut symptoms, such as reflux, nausea, vomiting, abdominal pain, abdominal distension, gaseousness, loose stools, diarrhea, and chronic constipation, are painful for the child. The child will quickly learn that eating food makes him feel bad. The child may often refuse food, gradually limit the number of foods he is willing to eat, and have tantrums and behavioral 129 problems at mealtime. Identifying food allergies, sensitivities, and intolerances; and eliminating the problematic foods from the child’s diet is a critical component of his comprehensive treatment plan. Food Reactions – Autism - Behavior Connection Food reactions do not cause children to have autism, but they do affect children with autism more than typically-developing children. Children with autism tend to have some degree of Sensory Processing Disorder. Children with Sensory Processing Disorder have difficulty responding appropriately to sensory information from their environment. They are more sensitive, become easily overwhelmed, and may over react or under react to auditory, visual, and tactile stimulation. If the child has sensory issues, food reaction symptoms will stress his sensory system further, making it even more difficult for him to function normally. The combination of food reactions and sensory issues can hinder the child’s ability to sit still, concentrate, maintain focus, process information, learn, and control his impulses and behavior. Relieving the child of food reaction symptoms will lessen the sensory burden he has to deal with, which will improve his behavior. Children with autism are unique because they are often unable to verbally express the physical discomfort and pain they feel from food reaction symptoms. If the child is non-verbal or has an expressive language delay, he can not tell you if he feels nausea, abdominal pain, chest pain from reflux, or headaches. Instead, the child has to communicate physical pain through his behavior, such as head banging, tantrums, irritability, and food refusal. These behaviors are mistaken for typical autistic behavioral problems instead of behaviors caused by undiagnosed food reactions. What is a Food Allergy? Food allergy is an adverse immune response to a food protein. The immune system mistakenly identifies a specific protein found in food as a harmful substance and defends against it. Food allergies are classified as either IgE mediated or non-IgE mediated. Food allergies are becoming a serious concern for children in the U.S. In 2007, approximately 4 2012
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