Üsküdar University, Faculty of Health Sciences, Department of Nutrition and Dietetics. Faculty Member Pınar Hamurcu shared important information about the nutrition of children with Autism Spectrum Disorder.

It is assumed that there are 550 thousand individuals diagnosed with autism and around 0 thousand children in the 14-150 age group in Turkey. Experts state that the incidence of autism is 3-4 times higher in boys than in girls, and that children with autism tend to eat more than healthy children. Experts share the dietary options that can be applied by emphasizing that individuals with autism experience many vitamin and mineral deficiencies as a result of their gut being extremely permeable and being very selective in nutrition.

Dr. Lecturer Pınar Hamurcu said that Autism Spectrum Disorder (ASD) is defined by the American Psychological Association as "a neurodevelopmental condition that occurs in early childhood, characterized by limited and repetitive behaviors in verbal and nonverbal communication (behavioral) and interest areas". .

54 in every 1 children has Autism Spectrum Disorder

Stating that the Centers for Disease Control and Prevention (CDC) data report that 54 out of every 1 school-aged children worldwide today, Autism Spectrum Disorder is seen. Faculty Member Pınar Hamurcu said:

“The incidence of autism is 3-4 times higher in boys than in girls. Within the scope of Turkey 2015 Autism Screening Project, 44 out of 45 children were found to be in the risk group. The Autism Platform assumes that today there are 4 thousand individuals diagnosed with autism and around 605 thousand children in the 550-0 age group. When parents, siblings and close relatives of individuals with autism are taken into account, more than 14 million individuals affected by autism are mentioned in Turkey. Although it is not certain, the opinion that genetic factors are effective in autism is dominant. In addition, it is stated that environmental factors such as viruses, radiation exposure and drug use are also effective. In addition, the sensitivity of the brain to toxic substances and prenatal exposures are also thought to be associated with autism in later life.

Special foods should be prepared for children with autism

Stating that children with autism have a tendency to eat more than healthy children, Hamurcu said, “This situation has recently become a prominent issue in the literature on nutritional behavior problems. The literature shows that children with autism reject many foods, need special eating tools, require special food preparation, have a very narrow food preference and unique nutritional behaviors. It is reported that the most common nutritional problems in these children are food refusal and limited food repertoire, and this situation is associated with sensory problems. While similar nutritional problems disappear with age in children with normal development, the problem continues to increase in children with autism.” said.

They are deficient in vitamins and minerals

Expressing that individuals with autism are deficient in many vitamins and minerals as a result of their intestinal permeability and their being very selective in nutrition, Dr. Lecturer Pınar Hamurcu talked about various treatment approaches in nutritional support as follows:

Gluten-free-casein-free diet

Grains and products, which have an important place in nutrition, are excluded from the diet in some diseases due to gluten content. A gluten-free diet devoid of wheat, rye, barley and sometimes oats, which is the only treatment option for celiac disease, is also used in individuals diagnosed with autism. In addition, due to the casein in milk, it is thought that removing all milk and dairy products such as cheese, yogurt and buttermilk from the diet of individuals with autism will be effective.

In a study conducted in 2012, 293 children with autism and their families were included in the study and 223 children participated in the study were given a completely casein-free/gluten-free diet, while 70 children were given a partial diet. It was determined that the children whose gluten and casein were completely restricted after the diet had a decrease in their gastrointestinal symptoms, food allergies, sensitivity to food, and improvements in their psychological and social behaviors compared to the partially restricted group.

Ketogenic Diet

Although the relationship between autism and epilepsy is seen as complex, studies reveal that individuals with ASD are 3 – 22 times more prone to epilepsy compared to normal individuals. The ketogenic diet, which is defined as a therapeutic method to reduce the number and severity of epileptic seizures, is reported to have a positive effect on mental state-related behaviors and hyperactivity. While fat provides most of the energy in the ketogenic diet, protein is the minimum part of the daily requirement and carbohydrates are severely limited.

In the first study on this subject, 4 children with ASD between the ages of 10 and 30 were applied the John Radcliffe diet, which is a modified version of the ketogenic diet, at 6-week intervals, and a normal control diet for 4 weeks, for 2 months. Of the 18 children who had adhered to the diet by the end of the study, 10 showed moderate or significant behavioral improvement according to the 'Childhood Autism Rating Scale' scoring.

Special Carbohydrate Diet

While complex carbohydrates are restricted in the diet, simple carbohydrates are completely excluded. The opinion is that the Special Carbohydrate Diet has a positive effect on various diseases such as irritable bowel syndrome (IBS), celiac disease and autism.

The purpose of this diet is to control the damaged intestinal wall and bacterial growth, to restrict the types of carbohydrates that intestinal pathogens feed on, and thus to restore the intestinal flora. The diet encourages the use of fermented foods, especially homemade yogurts and probiotics. While starches are banned, it mainly consists of meat, chicken, fish, eggs, vegetables, fresh fruit, nuts and oilseeds. The diet begins with limited nutrient intake and is gradually increased as the intestinal tract heals.

Feingold Diet

Phenol is an organic compound found naturally in salicylates and can be produced artificially. Phenols are used as coloring and preservative food additives. It is reported that these food additives can cause hyperactivity in children.

It is thought that removing these foods containing coloring and preservatives or foods containing natural salicylates such as tomatoes from the diet of autistic children due to the defect in the phenol sulfide transferase (PST) enzyme has a positive effect. For this reason, foods containing coloring, flavoring, preservatives and sweeteners should be removed from the diet and foods containing common reactive salicylates such as almonds, apples, apricots, strawberries, cucumbers, curry and similar spices and grapes, raisins, oranges, honey, peaches, peppers and tomatoes should be excluded. Restriction of foods is also recommended.

Candida Body Ecology Diet

“Candida Albicans” is a yeast-like fungus that can cause infections, especially in immunocompromised individuals. Overgrowth of Candida has been associated with problems such as concentration impairment, aggression and hyperactive behavior seen in children with autism, and can also occur with headaches, stomach problems, gas pain, fatigue or depression. Candida Body Ecology Diet, in order to prevent the spread of Candida, to support the health of the intestine and to maintain the acid / base balance; It contains easily digestible, fermented foods with or without low acidity, low sugar and starch, and other solid nutritional recommendations. Raw sauerkraut and other cultured vegetables contain many fermented foods, such as kefir and yogurt made with non-animal milk. In addition to being gluten-free, it is rice-free, corn-free, and soy-free. Only a few foods such as quinoa, millet, whole wheat and amaranth are allowed in the diet.

Eliminate Allergy Diets

Food sensitivities are frequently encountered in individuals with autism due to abnormalities in the digestive and immune systems. Undigested carbohydrates or amino acids cause beneficial bacteria in the intestine to react to these elements. For this reason, it is recommended to determine the problem by performing the necessary tests for food allergy or intolerance, or it is recommended to remove the suspected food from the diet for 2 weeks and to observe the allergic symptoms when the same food is added to the diet again. Foods to be excluded from the diet include milk, wheat, soy, eggs, peanuts, nuts, fish and shellfish.

low oxalate diet

It is thought that hyperoxalemia and hyperoxaluria may play a role in the pathogenesis of autism. In a study conducted to examine the oxalate metabolism in children with ASD, oxalate levels were measured 2.5 times higher in the urine and 3 times higher in the plasma than in the control group in children with ASD. Foods rich in oxalate (spinach, cocoa, black tea, figs, lemon peel, green apples, black grapes, kiwi, tangerines, strawberries, oats, wheat, millet, peanuts, cashews, hazelnuts, almonds, blueberries) are low in the diet. There is an opinion that it may be beneficial to give it in large quantities.

How should children with autism be fed?