The Essential Diet for
Children with Autism
By Natasha Campbell-McBride MD. Copyright Reserved
After the publication of my article in The Autism File (issue 5, Autumn 2000) on nutritional management of our son Nicholas, I get a lot of phone calls from parents asking, what diet would be most appropriate for their autistic child. There is a lot of confusing information on this subject and it can be difficult to make sense out of it. After years of research and experimenting, we developed a diet, that I firmly believe, is most appropriate for our children. This is the diet that made an enormous difference to our son Nicholas.
A gluten and casein free diet is well known and has got a solid scientific basis behind it. However, there is much more to your child's nutritional management, than just cutting out gluten and casein.
Let us start from the very beginning.
I believe in Nature. Nature made us and at the same time it provided us with every food we need to stay healthy, active and full of energy. However, we have to eat these foods in the form Nature made them. It is when we start tampering with the natural foods, we start getting into trouble. Any processing, that we subject the food to, changes its chemical and biological structure. Our bodies were not designed to have these changed foods! The more food is processed, the more nutrient depleted and chemically altered it becomes. Apart from loosing its nutritional value, processed food looses most of its other properties: taste, flavour, colour. So, to compensate for that, various chemicals are added: flavour enhancers, colours, all those E - additives and preservatives, - all those chemicals, that have conclusively been shown to contribute to learning disabilities, psychiatric disorders and other health problems. If we look at the supermarket shelves, we will see that the bulk of processed foods are carbohydrates. All those morning cereals, crisps, biscuits, breads, pastas, chocolates, sweets, jams, sugar, preserved fruit and vegetables, frozen pre-cooked meals with starches and batter are highly processed carbohydrates. We will examine them one at a time. But first, let's look at them as a group.
All carbohydrates in foods get digested and absorbed as glucose. Nature provided us with plenty of carbohydrates in the form of fruit, vegetables and cereals. When we eat them in the natural untampered form, the carbohydrate part of them gets absorbed slowly, producing a gradual increase in blood glucose, which our bodies were designed to handle. Processed carbohydrates get absorbed very quickly, producing a very rapid increase in blood glucose. Now, blood glucose is one of those factors which our bodies go to great lengths to keep within certain limits, because both
high and low values are harmful. A rapid increase in blood glucose, called hyperglycaemia, puts the pancreas into a shock state to pump out lots of insulin very quickly to deal with the excessive glucose. As a result, about an hour later the person has got a very low level of blood glucose, called hypoglycaemia. Did any of you notice that after eating a morning cereal for breakfast you feel hungry again in an hour. That is hypoglycaemia. What do people usually have at that time in the morning to satisfy their hunger? A biscuit, a chocolate bar, a coffee or something like that, and the whole cycle of hyper - hypoglycaemia begins again. This up and down blood glucose roller-coaster is extremely harmful for anybody, let alone our autistic children. It has been proven that a lot of hyperactivity, aggression and other behavioural abnormalities in school children are a direct result of this glucose roller-coaster. The hyperglycaemic phase produces a feeling of a "high" with hyperactive tendencies and self-stimulation in our children, whilst the hypoglycaemic phase makes them feel unwell, often with a headache, bad mood, tantrums and general fatigue, with excessive sweating.
Most foods have been assigned what is called a "glycemic index" - an indicator of how quickly they increase the blood glucose after being ingested. Processed carbohydrates, including sugar, have got some of the highest glycemic indexes, as well as white rice, cooked potatoes and cooked carrots and peas. It is best to give an autistic child carbohydrates with low glycemic indexes - raw fruit and vegetables, and some whole cereals that you cook yourself. Fructose has got a low glycemic index. A natural form of fructose is unprocessed honey (a lot of honeys sold in the shops have been heat treated, which destroys valuable enzymes and other nutrients, and gives honey a higher glycemic index). We use it as the only sweetener allowed in our house. But, even honey is given to our son rarely and in moderation.
Another important point about processed carbohydrates is their detrimental effect on the gut flora. I tried to describe the crucial role of the normal gut flora in the health of an autistic child in The Autism File (issue 5, autumn 2000). Processed carbohydrates feed pathogenic bacteria and fungi in the gut, promoting their growth and proliferation. Apart from that they make a wonderful glue-like environment in the gut for various worms and parasites to take hold and develop. All these micro-creatures produce toxic substances going into the blood stream and literally "poison" the child. The more processed carbohydrates you give your autistic child, the more "toxic" he will become and the more autistic symptoms you will see.
Recent scientific evidence suggests, that autism may be an autoimmune disorder. An imbalance between two major arms of the immune system: the Th1 and Th2 immunity has been found in autistic children to have overactive Th2 and suppressed Th1. The same picture is seen in many chronic diseases - viral, bacterial, parasitic, cancer, allergies, asthma and other autoimmune conditions. Processed foods, particularly processed carbohydrates and sugar, directly weaken the functioning of macrophages, natural killer cells and other white blood cells and undermine systemic resistance to all infections. For example, an immune compromised person, (like an autistic child) who has soft drinks and french fries or crisps daily, will worsen their condition by these food choices. An appropriate nutritional management is an essential part of dealing with an immune imbalance. As I tried to describe in the 5th issue of The Autism File, the gut flora plays a major part in the normal functioning of the immune system. A powerful probiotic, like Primal Defense, will not only restore the normal gut flora but rebalance the Th1 and Th2 parts of immunity.
Let us have a look at various forms of those processed carbohydrates.
We will start with morning cereals. They are supposed to be healthy, aren't they? Unfortunately, the truth is just the opposite. Morning cereals are highly processed carbohydrates, full of sugar, salt and other substances. They have a high glycemic index and are detrimental to the gut flora balance. The fibre in them is full of phytates - substances which bind essential minerals and take them out of the system, contributing to the mineral deficiencies. There is nothing healthy in them for an autistic child.
Crisps and chips (and pop-corn), a backbone of children's diet nowadays, are highly processed carbohydrates with high glycemic indexes. But that is not all about them. They are saturated with vegetable oil, which has been heated to a very high temperature. Any oil, that has been heated, has got substances, called trans-fatty acids. These are unsaturated fatty acids with altered chemical structure. What they do in the body is to replace the vital omega-3 and omega-6 fatty acids in cellular structure, making cells in a way disabled. Consuming trans-fatty acids will increase the activity of Th2 and weaken Th1 immunity. As you remember, the Th1 immunity is already suppressed in autistic children and Th2 - overactive. Cancer, heart disease, eczema, asthma, neurological conditions and even the famous cellulite have been linked to trans-fatty acids in the diet.
Wheat. The gluten free diet is widely recommended and a lot of families with autistic children found it very helpful. But, let us have a look at wheat as a whole with gluten or without it. Virtually nobody buys wheat as a grain and cooks it at home. We buy foods made of wheat flour. The flour arrives to bakeries in pre-packaged mixes for different kinds of breads, biscuits and pastries. These mixtures are already processed with the best nutrients lost. Then they are "enriched" with preservatives, pesticides to keep the insects away, chemical substances to prevent it absorbing moisture, colour and flavour improvers, softeners, just to mention a few. Then the bakery makes breads, pastries, cakes, biscuits, etc. out of these chemical cocktails for us to eat. The producer is quite happy to take the gluten out of these mixtures and make gluten free products. So, you will get all the processed carbohydrate with all the chemical additives in it , but this time without gluten. Once swallowed, a piece of white bread turns into a glue-like mass, which feeds parasites and pathogenic bacteria and fungi in the gut, contributing to the general toxic overload, your child already has got. I strongly believe, that autistic children should not have wheat in any shape or form. Being a staple in the western world, wheat is also a number one cause of food allergies and intolerances.
Sugar and anything made with it. Sugar was once called a "white death". It deserves 100% of this title. The consumption of sugar in the world has grown to enormous proportions in the last century. It is estimated that an average western person consumes about 160 - 200 pounds of this unnatural substance per year. Sugar is everywhere and it is hard to find any processed food without it. Apart from causing the blood glucose roller-coaster and having a detrimental effect on the gut flora, it has been shown to have a direct damaging effect on the immune system (which is already compromised in our children). On top of that, to deal with the sugar onslaught, the body has to use available minerals, vitamins and enzymes at an alarming rate, finishing up being depleted of these vital substances. An autistic child should not have sugar in any form. Cakes, sweets, and other confectioneries are made with sugar and wheat, as the main ingredients, plus lots of chemicals like colours, preservatives, flavourings, etc.. It goes without saying that they should be out of your child's diet (with or without gluten). For birthdays and other rare occasions home made cakes with honey instead of sugar and ground almonds (or other ground nuts) can be made. I would highly recommend a book by Elaine Gottschall "Breaking The Vicious Cycle", ISBN 0-9692768-1-8. It has got some wonderful recipes as well as a good insight into nutrition.
Soft drinks are a major source of sugar in children's diets, not to mention all the chemical additives. Fruit juices are full of processed fruit sugars and moulds. Unless freshly pressed, they should not be in your child's diet either. Aspartame, a sugar replacement in many drinks, was found to be carcinogenic and should be avoided. It turns into methanol and its derivatives in the body. Methanol is a well known poison. Bottled mineral or filtered water with a slice of fresh lemon is the best drink for our children. Drinking chlorinated tap water will further damage your child's gut flora, since the chlorine is there to kill bacteria in the first place.
To summarise, an autistic child should have no processed foods at all in his/her diet. All foods should be as close to the way Nature made them as possible. Fresh fish, crayfish, fresh meats (not preserved), eggs, fresh vegetables and fruit, nuts and seeds, garlic and cold pressed virgin olive oil, buckwheat, millet, quinoa should be prepared at home from fresh supplies. I have deliberately repeated the word fresh four times.
Fruit and vegetables should be eaten raw as much as possible in the form of salads, "sticks", slices, etc.. Fresh fruit and vegetables are not just a good source of various vitamins, minerals, antioxidants and other nutrients, but they are an excellent source of vital enzymes, which autistic children are lacking. Those enzymes are essential in the detoxification of the body. Eating raw vegetables with meals will assist in the digestion of meats and cereals. Cooked vegetables and fruit loose a lot of their nutritional value: enzymes and vitamins get destroyed, carbohydrates change their structure. Carrots, cucumber, peppers, cauliflower, broccoli, celery are delicious in a form of sticks or rosettes with a dip (mayonnaise; avocado, mashed with plenty of cold pressed virgin olive oil and a dash of lemon juice, with a choice of fish and onions or garlic and tomato). Avocado is a wonderfully nutritious fruit and should be a regular part of your child's diet. Half an avocado with prawns and mayonnaise or any meat or fish makes a quick and delicious meal.
Talking about fruit, there is a lot of confusion in this area. I always take a very cautious view of any scientific laboratory findings, done on chemically isolated nutrients, when the researches say something like this: "This nutrient is found in apples and oranges, so do not eat apples and oranges". Apples and oranges are not made from a laboratory purified substance in question! On the contrary, they are natural products with a very complex biological structure. Within that structure the chemical in question might behave completely differently to the way it behaved in the laboratory. You cannot transfer scientific laboratory findings, done on an isolated nutrient to a piece of food, made by Nature. In a piece of food, for example a piece of fruit, that nutrient is in a complex chemical structure of another big molecule, incorporated into a cell structure of the whole fruit. There are plenty of examples to illustrate this point. For instance, we all know that cyanide is a poison. However, it is an important part of the vitamin B12 molecule and we all know, that we cannot live without vitamin B12. Another good example is breast milk. Breast milk has got a very high content of casein. However, it is one of the best foods for autistic children. All parents recall how normally their child was developing, while exclusively breast fed. In fact, in the 5th issue of The Autism File there is an article "Breast Feeding Miracle", where a mother brought a lot of improvement in her autistic boy by giving him breast milk (luckily, she was breast-feeding her next baby at the time). I do not believe in limiting fruit in children's diet. An important thing to remember, however, is to provide as big a variety of fruit as possible and not to fall into a trap of eating bananas every day. Some fruits are particularly beneficial for our children. Fresh and frozen berries are number one and should be eaten as often as possible (Remember, no sugar! A bit of cream will do no harm.). Amongst many other beneficial substances berries contain nitrilosides, essential in detoxification in the body. Paw-paw and pineapple will provide proteolitic enzymes, which our children are lacking. Fruits should be eaten on their own, not with meals, as they have a very different digestion pattern and can make the work harder for the stomach. Serve fruit as a snack between meals with their skins and seeds (skins and seeds have a lot of very valuable nutrients). Never cook fruit!
Meats, fish, poultry, organ meats and eggs should be a large part of your child's diet. They need to be bought fresh, not preserved, and cooked at home. Meats, fish and eggs are the best source of most nutrients for us, human beings. Contrary to popular beliefs, most vitamins, minerals, amino-acids and essential fats come from meats, fish and eggs. The plant foods, like cereals and green leafy vegetables are full of vitamins and minerals, but their bio-availability to us, humans, is much lower, than from animal sources. We are not ruminants, who have got special bacteria in their stomachs to digest plants. Our digestive tracts have been designed to live largely on meats. Some northern people, like the Eskimos, live almost entirely on fish, meat and fat. They were found to be one of the healthiest people on Earth.
Fresh eggs deserve a special mention. According to its ability to be digested and absorbed by the human gut, eggs are the only food that is placed close to breast milk. Raw egg yolks are one of the best sources of all essential amino-acids, vitamins, minerals and fatty acids in the most assimilable form. It is best to buy free range eggs from a source you trust. The egg white should always be cooked as in the raw form it may impair the syntheses of biotin in the gut. But the yolk is best uncooked!
The question of salmonella in eggs needs to be addressed. The likelihood of salmonella poisoning is very low in the UK, particularly if you buy your eggs from a reliable source. However, if you feel uncomfortable with eating uncooked yolks, then cook them to your liking. It is better to eat cooked eggs than no eggs at all. Two eggs for breakfast will provide your child with daily amounts of many vitamins, including some vit.B, vit.A, vit.E and vit.D, as well as all those amino-acids, our children are deficient in. .When my children want a snack, I often give them 2 -3 raw egg yolks - delicious and extremely nourishing. They love it! Instead of morning cereals for breakfast give your child two eggs (soft boiled, fried with runny yolks or cooked any other way) with pure meat sausages (or any other meat), stir-fried onion and raw vegetables in any form. Pour a liberal amount of cold pressed virgin olive oil on the served meal.
It is important to use plenty of onion and garlic in your cooking. Onion has got wonderful immune-stimulating properties, cooked or raw. Garlic is known to have anti-fungal, anti-parasitic and anti-viral properties as well as Th1 stimulating ability. However, it gets destroyed by cooking very easily. That's why it is important to add it into your dishes at the end of cooking (3-4 min before turning the heat off). Add raw garlic in minute quantities into salads or ready meals. To start with, you can just rub some garlic onto your child's plate before putting the food on it. As your child will get used to the taste of raw garlic, slowly increase the amount. Eating garlic cooked and raw on a regular basis will do a lot of good to him/her.
Olive oil has got lots of properties similar to garlic as well as being an excellent source of oleic acid - an essential monounsaturated fatty acid, which will strengthen the Th1 arm of your child's immune system. Make sure it is cold pressed and virgin and use it liberally on served dishes. It is not a good idea to cook with it, as it has got lots of unsaturated fatty acids which will be turned into harmful trans-fatty acids by heating. It is best to cook with fully saturated fats, like ghee, coconut oil, pork dripping and lard, because they do not alter their structure, when heated. They even can be reused. Saturated fats have been out of favour in the last decades due to some ill founded research and misconceptions. We need about as much of saturated fats in our diets as unsaturated. The important point here is that we should consume natural fats. For example, butter is much healthier than any so called "healthy" synthetic substitutes. All cooking and vegetable oils have been heated to extreme temperatures in the production process and are full of trans-fatty acids. Eat fats, that Nature provided us with, and you will not go wrong. I would like to emphasise, that autistic children need plenty of natural fats. Let them eat the fat on the meats, the skin of the chicken, pour plenty of olive oil on their served meals, give them good cod liver oil or other source of omega-3 fatty acids (DHA/EPA) on a daily basis. Omega -3 fatty acids, found in cold water fish, reduce IL-6 (Th2 cytokin) and strengthen Th1 immunity. Contrary to popular believes, fat is a preferred source of energy in the human body. The brain and the rest of the nervous system are largely made of fats.
What about cereals? Cereals generally are hard work for the digestive system, particularly for an unhealthy one. Autistic children do not have a healthy digestive tract, so wheat, oats, rye, rice ,corn, particularly processed, are better out of their diet. However, there are some cereals, which, eaten once or twice a week, can be beneficial. These are buckwheat, millet and quinoa. They have a relatively high percent of protein in them and are not processed to the same degree as other cereals. Buckwheat and millet, in particular, have got substances in them, called nitrilosides, which are essential in the detoxification processes in the body. There are some 1500 foods that contain nitrilosides. The main ones are: apricot kernels, peach kernels, grape seeds, apple seeds, blackberries, blueberries, strawberries, bean sprouts, lima beans, macadamia nuts. To cook a cup of buckwheat, millet or quinoa, bring to boil two cups of water with some sea salt, rinse the cereal under cold water and put it into the boiling water. Cover and simmer on a very low heat until all the water disappears and the cereal is soft. Serve with a handful of pumpkin seeds (or sunflower seeds) and olive oil poured on it liberally. Do not forget that cereals are largely made of starch, which will feed the Candida colony in your child's gut and possibly other pathogens. That's why even buckwheat and millet should be limited until your child's gut flora improves.
Nuts and seeds are a wonderful source of very good nutrients. They are the best source of magnesium, zinc, selenium and other vital minerals in their most bio-available form, which our children all lacking. Avoid peanuts, unless you buy them in their shells, known as ground nuts. All nuts are at their best if you buy them in their shells and crack them just before eating. This way they are an excellent source of essential fatty acids and are free of moulds. Ground almonds you can use for making your own bread, pancakes and even cakes at home (for the recipes look in the book by Elaine Gottschall "Breaking The Vicious Cycle") . Nuts and seeds should be a regular part of your child's diet.
All autistic children have got faulty digestion. To make your child's meals easier to digest try not to serve protein and starch at the same time as they interfere in each other's digestion. It means that, if he/she is having meat, fish, eggs or other protein foods, serve them with vegetables only (salad or cooked) without potatoes, cereals or any other starchy foods. If you cooked potatoes, grains or any other starchy foods, serve them without meats, fish, eggs, cheese or any other protein foods. Instead serve them with salads or other vegetables. The proportion of protein/vegetables on the plate should be 1:3 (1 part of fish for example, 3 parts of vegetables). The same is for starchy meals: 1 part of starchy food, 3 parts of vegetables.
If you are spending your day out take a packed lunch with you (a choice of meats, vegetables, avocado, fruit, nuts, water to drink). Eating out should not be a problem. Choose from the menu foods that are allowed. Most restaurants will serve meats/fish with fresh salad instead of chips.
What about lunch boxes? This is a common question. We order pure meat sausages at our local butcher. My children have two or three of these sausages, tomato, cucumber, carrot sticks, celery sticks, pepper sticks and a fruit in their lunch boxes, as well as a bottle of mineral water to drink. Sometimes I would put nuts, pancakes made with ground nuts and egg, any meat left from the night before, salad, prawns with mayonnaise and chopped onion. Of course, my children get some unfavourable comments from other children at school, who eat chocolate bars, crisps and cakes. We have to reassure them and explain why they have lunches, different to other children. Educating our son Nicholas about foods is an essential part of his upbringing. He has to have a lifetime of a diet ,very different to the one , people are commonly having. As he sees his friends, eating sweets and crisps all day long, of course he wants to do the same. This education process doesn't always go smoothly. Once, after explaining to Nicholas why he can't have sweets and cakes, we walked into our local corner shop. After a few minutes Nicholas loudly announced: "Mummy, is there anything in this shop without bad chemicals?".
It is not always easy to persuade our children to have healthy foods. I found that the easiest way to introduce new foods into my son's diet is to quietly put them in front of him, when he is watching television. Anything gets munched up when he is absorbed by a TV programme. Behaviour modification (ABA or Lovaas) also has got good ways to introduce new foods.
Everything I said here may look completely overwhelming. I would agree with you 100%! It took us years to establish the right diet for our son. It is not easy! But, what is easy with our children?! So, please, don't get disappointed by early failures, persevere. After all you are making a change for life. So, take it at your own stride as slowly as you and your child need to. Throwing yourself into the deep end is the best way to fail the whole thing. Introduce foods one at a time, developing your own way of cooking and serving them. Remember the rule number one: cook everything as little as possible, do not cook anything that can be eaten raw. An efficient probiotic, like Bio-Kult, will help your child to digest and absorb the good meals, you cooked for him/her. I believe that this diet will provide the nourishment, your child both needs and deserves.
Natasha Campbell-McBride MD.