Pediatrics
I perform well-child exams for ages 6 weeks through 18 years, and sports physicals for any age.
I have experience helping parents and kids with allergies, skin rashes, stomach pain, ear infections and other types of acute and chronic infections, attention deficit disorder, autism spectrum disorders, and more. Allergy testing, both immediate- and delayed-hypersensitivity, is available and helpful for many conditions.
Article: Diet Therapy for Autism Spectrum Disorders
Proper nutrition has been found to be one of the most successful interventions in the treatment of autism and ASD. The following diets have been the most useful clinically, in terms of parental reports, and in research:
1. Gluten-Free, Casein-Free, (Soy-Free) Diet
The theory of this dietary intervention is the presence of a genetic peptidase deficiency (specifically for diaminopeptidase IV) that causes improper digestion of wheat and dairy products. The result is improper digestion of gluten and casein proteins and formation of opioid-like peptides casomorphin and gliadorphin. The compounds cross the intestinal barrier due to “leaky gut” and attach to opiate receptors in the brain. Symptoms such as insensitivity to pain, decreased awareness of the environment, and fogginess can result. The peptides act as a drug, interfering with motivation, perceptions, and brain development; they also cause strong cravings for wheat and dairy products (like a drug addiction).
Three to six months of strict avoidance of gluten and casein is necessary as the proteins can take several months to clear from the body. As withdrawal symptoms occur, behavior can be temporarily worsened- very much like an addict going through drug treatment. Beneficial responses often take the form of engagement in the environment, language improvement, decreases in self-stimulation, improved eye contact, and increased cognitive ability. In the research literature, positive responses are seen in approximately 65% of children (range 50-80%).
I often include soy as an avoidance item along with this diet because so many children are reactive to soy protein.
2. Food Allergy Avoidance
Another dietary strategy for ASD includes avoiding foods that may be causing inflammation. IgG and IgE food allergy tests are the ones most commonly used in my office to evaluate inflammatory food reactions- both delayed hypersensitivity (IgG) and immediate hypersensitivity (IgE). I typically use a food panel that includes 96 different foods, although other panels are also available.
Eliminating moderate to highly reactive foods can improve autistic symptoms especially related to digestive and behavioral problems. Studies have consistently found significantly elevated antibodies to food antigens in autistic children. IgG food reactions are also associated with ileal lymphoid hyperplasia, found in children with autism.
Symptom improvements with food allergy elimination diets include head banging, self-stimulatory behaviors, sleep disturbances, self-injury, aggression, constipation, diarrhea, and rashes. A trial elimination of 6 weeks followed by a food challenge can be used to test beneficial effects.
The most common allergens in children with ASD are dairy, gluten, soy, wheat, eggs, corn, and peanuts.
3. Anti-Yeast Diet
The anti-yeast or Candida diet is often necessary in children with ASD due to intestinal yeast overgrowth (as evaluated via stool testing, blood antibody testing, or via clinical history and symptoms). Restriction of sugar, yeast, fermented foods, and mold products while supplementing probiotics (beneficial gut bacteria) and beneficial yeast as well as anti-fungals are necessary to treat this chronic issue.
Children with ASD often exhibit certain behaviors when they have yeast overgrowth: excessive stimming, sugar cravings, giddiness, inappropriate laughter, spaciness, and “drunk” behavior including loss of balance. Physical symptoms may include gas, bloating, constipation, diarrhea, oral thrush, and candidal rash.
4. Low-Oxalate Diet
A significant number of children on the autism spectrum have excessive urine oxalate levels. It is theorized that these oxalate crystals can accumulate in and damage body organs, including the gut, brain, skin, heart, tendons, kidneys, bones, and eyes. Oxalates are also known to bind with heavy metals, forming complexes that may be deposited in body tissues.
Symptoms of oxalate damage include digestive pain, toe walking, eye poking, skin lesions, urinary pain or frequency, bedwetting, and sandy stools. Restriction of high-oxalate foods such as spinach, soy, peanuts, chocolate and berries has been beneficial in these cases; less than 50 mg per day of dietary oxalate is recommended.
High urinary oxalic acid levels are often found in conjunction with yeast overgrowth, as candida can encourage oxalate formation; an anti-yeast protocol is suggested when oxalate levels are high. Supplementing with taurine and calcium citrate also helps to reduce dietary oxalate absorption.
5. Phenol-Restricted Diet
Some children have difficulty processing certain substances like phenols, which requires a process known as sulfation to take place in the liver. Many of these children have a deficiency of the phenol sulfotransferase (PST) enzyme and so show sensitivity to phenolic amines, compounds which they cannot properly metabolize and excrete.
Typical behaviors in the phenol-sensitive ASD child include hyperactivity and red face and ears after consuming phenol.
Treatment includes restriction of high-phenol foods such as bananas, chocolate, cheese, apples, grapes, and tomatoes. An enzyme supplement containing xylanase is often used to aid phenol digestion as well.
6. Specific-Carbohydrate Diet
The SCD was originally used for the therapy of inflammatory bowel disease. The theory is that some foods lead to intestinal dysbiosis (an overgrowth of “bad” gut bacteria). The goal of the diet is therefore to restrict those foods that lead to dysbiosis and thereby starve pathogenic bacteria. As a result, gut inflammation is decreased, preventing the incomplete digestion of food particles which results from chronically inflamed intestines.
The SCD limits complex carbohydrates, particularly disaccharides, relying on protein, fats, and simple carbohydrates to heal the gut. Partially digested food particles, particularly starches, lead to further dysbiosis and inflammation, as well as excessive mucous production and “leaky gut” syndrome.
Many children who do not respond well to the previous diet protocols often benefit from the SCD, especially those with chronic digestive problems. According to a parent-report survey, 69% of children on average improved on the SCD more than with any other autism dietary protocol.
Resources:
J. McCandless Children with Starving Brains: A Medical Treatment Guide for Autism Spectrum Disorder, 2nd ed. 2003.
S. Baker and J. Pangborn Autism: Effective Biomedical Treatments, 2nd ed. 2005.
Medline- Search numerous research articles relating to dietary interventions for ASD.