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Biomedical Troubleshooting 101: Is There An Autism Diet?

Biomedical interventions for autism can get a little overwhelming

Recently I held a “Biomedical Troubleshooting” session at the Imagine! Colorado offices, sponsored by Autism Society of Boulder County.  Both veteran and newbie parents showed up – parents who had done everything from heavy metals chelation and special diets, to nothing but behavioral interventions – but across the board, the same questions were asked:  Which diet does my kid need for an autism diagnosis?  What lab tests? Special food, weird meal routines, hours in the kitchen making bone broths and nut milks – is it worth it?

Well, there is no “diet for autism”. Every child with autism in my practice is unique. There are several nutrition and GI problems that come up often with an autism diagnosis, and these are treatable. I map those for families, using clinical standards for nutrition assessment as well as functional nutrition lab tests that look deeper for problems. Find the trouble, make a plan to fix it, and children feel, function, learn, grow and behave better. Nutrition perfectly supports and complements all your child’s other interventions. All are important. But none unravel underlying physiological barriers to progress the way a targeted nutrition program can.

It comes down to being a nutrition detective, and finding that nutrition understory that is meaningful in your child’s case. Whether you have placed your child on Gut and Psychology Syndrome diet (GAPS), Specific Carbohydrate diet (SCD), gluten – casein free (GFCF), low oxalate (LOD), Body Ecology diet, yeast free diet, Paleo, Feingold, or no diet at all – you first need to know if it’s the right measure for your child. I meet families week after week who implement special diets without expert help.  Sometimes it works wonders… and sometimes it just drives a family nuts.

This didn’t emerge anew in the last few years, just for kids with autism. I’ve been a registered dietitian since 1989. In both my graduate and undergraduate training, much emphasis was placed on infant and child health, and how nutrition impacts these.  Since about the mid 1990s, “biomedical treatment for autism” tools have tapped tenets in pediatric nutrition, and expanded on that evidence base with an integrative medical approach. This works for kids with any chronic condition – from autism, to ADHD, epilepsy, growth or feeding problems, Down’s syndrome, or severe behavior and mood problems. And, good news, pieces of this may be accessible within insurance networks you already have.

For instance, before you leap into provoked urine toxic metals tests, spaghetti squash fries, and methylcobalamin injections (all of which their place when indicated), knock off the simple stuff first with your mainstream physician.  These are things that can also profoundly impact a child’s behavior, sleep, growth, learning, appetite, immune function, or development – and may prevent progress with more novel therapies if left unaddressed:

1 – Is your child underweight, below 5th percentile for age for body mass index (check here), eating enough  most the time?  A shortage of just one or two hundred calories a day over the long term is enough to derail a child. In fact, low body mass index is linked to more frequent, more severe infections in kids, as well as more difficulty with sleep, behavior, focus, and attention.

2 – Does your child hold it together through the school day, then blow up or show rage and reactivity once home?  Does this shift abruptly with a hefty snack? Check usual calorie needs for kids here, to see if your child is coming up short.  Check usual protein needs here.  You can also work with your provider to screen for bowel infections, and rule out inflammation from foods with food allergy and food sensitivity testing – both of these can drive mood swings, anxiety, and appetite in kids. If your in network provider isn’t familiar with thorough testing, this is my niche – schedule a free ten minute chat to talk to me!

3 – Got iron? Iron is key for learning, focus, attention, mood, behavior, sleep, and immune function.  Some children with autism don’t absorb or metabolize this typically; anemia and poor iron status are common problems for children with or without autism, across the US.  Balancing iron metabolism is crucial for kids. Ask your pediatrician to check ferritin, serum iron, and transferrin to get a sense of whether diet or supplements can help. Ferritin levels below 30 – though considered “in reference range” – usually correlate with lesser ability for focus, attention, and behavior – plus more frequent infections – in my experience. Since iron can become toxic if used incorrectly, don’t use iron supplements for a child without your provider’s input.

4 – Got pica? If your child puts non-food items in his mouth often, eats non food items, has oral tactile sensitivity for certain food textures, or has difficulty swallowing or tolerating food textures in his mouth, then a review of mineral intakes from foods or supplements is in order. These symptoms can signal problems like poor status for iron or zinc, or heavy metals exposures. Eating non-food is called pica, and is a classic flag for mineral imbalances. Learn more about pica here. Correcting mineral balance can dramatically improve behavior, mood, self regulation, anxiety, rageful reactions, and more.

5 – Gut biome – the bacteria populating your intestines – is crucial for digestion, absorption, and even immune function. Is your child dependent on Miralax or reflux medication? Needed antibiotics? These can disrupt that biome, and change how foods and nutrients are digested and absorbed. If your child isn’t able to pass comfortable stool daily without prescription medications, then screen for bowel infections or inflammation from foods. Many functional nutrition lab tests can define the biome in enough detail to direct treatments, so chronic constipation or diarrhea can be resolved. Normal passage of stools means optimal uptake of nutrients, and this means the brain gets what it needs to function every day.

6 – If you feel you’ve done it all and just want to throw in the towel, two thoughts: One, call me and let’s see if you really un-turned all the possible stones. Two, call me, and let’s discuss how to explore immune dysregulation (autoimmune reactions, immune deficiency) as an underlying piece of an autism presentation. Promising treatments are becoming more and more available and I am happy to pass these resources on to my patient families.

There are many other nutrition-detective steps I take in practice to bring children through assessment. We create a sequence that fits your family. In fact, nutrition intervention may be one of the least expensive and most beneficial tools you engage. I offer new patient families a six month, six visit Nutrition Transition package for at $1200 that maps the journey, from lab tests to supplements, foods, recipes, and meal plans. We move at a good clip and get results. I find discounted supplements and lab test fees where possible for my patient families, and throw in free copies of my books too.

Jumping out of sequence can backfire, which is why many families have mixed results when using nutrition care, biomedical tools, and special diets for autism. But working a methodical, professionally monitored nutrition plan may afford your child a few nice leaps, before you order up a $3500 battery of tests with an out-of-network doctor and pay thousands for six hours of his face time. For more info on sequencing, troubleshooting, and using nutrition-focused tools for autism, see Special Needs Kids Eat Right and Special Needs Kids Go Pharm-Free. And, call me!

Baby Can’t Sleep? Kids Have Insomnia? Tips On Using Melatonin

baby-asleep

How to help your baby get some sleep?

News this week from Hasbro Children’s Hospital in Rhode Island: A lot of kids don’t sleep. They needed a study to figure that out?

The study also found that youngsters with insomnia are medicated for it, perhaps too much. Ironically, a day or two before this story came out, CNN announced a study decreeing it “abusive” for parents to give a cold or allergy medicine (like Benadryl), to help a child sleep instead of scream through a long flight. What’s a parent to do?

This is one of the many dilemmas that prompted me to write Special Needs Kids Go Pharm-Free. Kids are medicated for more problems than ever before, but less healthy than a generation ago. And sleep is so crucial to overall health.

Sleeplessness in a baby, child, or teen is one problem you might be able to tackle easier than you think, with nutrition tools instead of medications.There are several options to choose from if you’re wondering about supplements. Melatonin is just one of them. Others include theanine, chamomile, rooibos, ashwaghanda, holy basil, taurine, tryptophan, 5-hydroxytryptophan, magnesium glycinate, calcium lactate, and more. They can be helpful, and are best used with some professional guidance.

Food intolerances and digestive issues can disrupt sleep too. I often work with parents to rule these out, before adding a supplement to improve sleep. I believe it’s best to work at the root cause when possible.

Melatonin is a safe and easy place to start, as long as you’ve ruled out any serious health problems with your pediatrician first. It can trigger intense dreams in children who don’t need it, and may make your child more wakeful. This may imply a need for different supports along the serotonin pathway, which is shared with melatonin. Or it may suggest other supports are needed altogether – for adrenal glands, certain minerals, for reducing inflammation, or for digestive issues. If melatonin is helpful, use only as long as needed and in the lowest effective dose. More is not better. And, know that it’s worth looking more broadly at your child’s functional nutrition picture. Using melatonin long term may reduce testosterone levels or may mask other imbalances needing support. Here’s an excerpt about melatonin from the chapter on sleep in my book Special Needs Kids Go Pharm-Free: Nutrition Focused Tools To Minimize Meds and Maximize Health and Well Being (© contact me for permissions) :

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“... As mentioned earlier, melatonin is not a medication, but a hormone we make ourselves to signal the brain into sleep. I have not used melatonin in children younger than eighteen months. Is it safe for infants? Probably, but this is a question to review with your pediatrician. Infants make a lot of melatonin naturally; if they aren’t sleeping, it may be quite depleted, a state that is possibly detrimental for them. Some research suggests that melatonin may be lifesaving when it comes to SIDS: Infants who die from SIDS have very low levels of melatonin in their brains. Because melatonin is a powerful antioxidant, there is speculation that it may play a role in preventing the severe, life-threatening oxidative stress that occurs with SIDS. Discuss giving your baby melatonin with your health care professional.SNKGPF-cover-design-199x300

If your infant is persisting in a stressful, screaming pattern at night instead of sleeping, melatonin may be useful, but ask your pediatrician about dosing first. Prolonged screaming is not healthy for infants. It is extremely costly for them, in terms of energy balance. Young infants need more than twice the calories per pound that a school-age child requires in order to maintain a normal growth pattern. When an infant is awake more than normal, or expending precious energy screaming night after night instead of sleeping, growth and immune function can suffer. This can, of course, also harm an infant’s delicate emotional well-being and threaten normal attachment to his or her parent.

Young children should not need more than 1–2 milligrams of melatonin per night. Start with a very low dose, and as always, inform your provider team before you start. Use the least amount to encourage sleep, and no more. Many preparations for melatonin are available that are suited to children, as drops, melting wafers, chewables, or sublingual sprays. These are given under the tongue and work fairly quickly; they don’t need to pass through the stomach and small intestine to take effect. Some parents give melatonin 30–60 minutes before bedtime, to shorten the time it takes a child to actually drop off. Rules for using melatonin:

  • Start with a quarter-milligram dose for young toddlers.
  • Start with a half-milligram if your child is two years or older.
  • Stop at the lowest effective dose. More is not necessarily better.
  • Children with autism may need more. Still start at a low dose, and work up slowly.
  • Older children (70 pounds or more) can start with a 1-milligram dose.
  • Periodically try weaning your child off melatonin. He may no longer need it.
  • An effective dose lets your child fall asleep in about 30 minutes or less, and stay asleep, most nights per week.
  • Don’t use melatonin preparations with other supplements in them. If there is a problem, you won’t know which component is causing the trouble.
  • Avoid melatonin preparations that include pyridoxine (vitamin B6). This vitamin can trigger wakefulness. Your child may do fine with extra B6 early in the day, but may struggle to sleep if it is given at night.

Children with autism, anxiety, depression, or other mood disorders may benefit from a higher dose of melatonin. If your doctor isn’t sure on dosing, ask for a referral to someone who is sure. This may be a psychiatrist, a naturopathic doctor, or even a neurologist. A clinical trial that used melatonin in children with autism showed no side effects, other than good ones: There was a reduction in compulsive and ritualistic behaviors while the kids with autism used melatonin. Some of the children needed up to 6 milligrams of melatonin to reap benefits. All children are different, so start with the smallest appropriate dose and use only what is needed to elicit the benefit of sleep.

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For more on how to use other supplements for sleep, as well as how to troubleshoot foods that may be keeping a child awake, pick up a copy of Special Needs Kids Go Pharm-Free. Wondering what else is in the book? Click here for table of contents.

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