Oh no, not another diet for autism!

food

“Why consider a low glycemic diet for my child with autism? Simply getting him to eat daily is a struggle, and his food choices are so limited I’m afraid to remove any of the few foods he’ll eat.” Many of you parents have struggled mightily to remove gluten and casein from child’s diet, and this may feel like all you can do. You somehow managed to make these changes, because you believed it could improve your little one’s health; and he did survive. Now, I want to suggest that you may find many more benefits by going to a formal SCD or GAPS diet, or, more generally, to a low glycemic diet.

For some children, going to a GFCF diet produces remarkable improvements in appetite and food selections, with increased variety and elimination of “addictive” eating patterns. For these children, the low glycemic diet may be pretty easy to accomplish. However, many other children with autism remain restrictive, or even may further reduce food choices, in response to gluten and casein elimination. In these children, a healthy appetite is lacking, and it often seems as if their eating is obsessive. The effect of their self-restricted diet is nutrient deficiencies, and often sensitization to some of the foods they’re choosing to eat. My purpose in presenting these suggestions, is to facilitate the transition to a healthier diet, aiming to make it easier for you to succeed with this difficult process.

The low or reduced glycemic diet has been presented in many versions over the past 150 years, each version touting its value in some particular human ailment. So it has been successfully prescribed, in many different versions with small differences, for obesity, diabetes/metabolic syndrome, inflammatory bowel problems, food allergies, mitochondrial disturbances, neurodegenerative disorders, vascular disease, seizures, certain brain tumors, psychological disorders, and recently, for general health (“paleo diet”). People using this dietary approach for all of these conditions have seen impressive improvements in their health. As children with autism share many findings with people with inflammatory bowel disease, neurodegenerative disorders, seizures, food allergies, mitochondrial disturbances, hypoglycemia/metabolic syndrome, and psychological disorders, it makes sense to offer them this rigorous approach to dietary treatment. The low glycemic diet contains the essential elements of all of these different diets, though requiring further modification in some cases, for example, SCD or GAPS require more stringent restrictions, as does the ketogenic or Atkins diet. Also, I recommend all children with autism continue to avoid gluten and casein when they move further into a low glycemic program.

The most common challenges to implementing a low glycemic diet with an autistic child, is getting him to eat more vegetables, and, in general, more variety of foods. Some children are particularly resistant to eating protein, which is a critical nutrient, as are essential fatty acids, which are found in nuts and seeds, fish, wild meats, avocadoes, and some beans. Carbohydrates are not required for health, although many important nutrients are co-passengers with carbs in fruits and vegetables.

Breakfast is thought to be the most important meal of the day, and is often the most hectic and difficult. In working with this diet, it’s very desirable to get a protein and good amount of fat in each meal, particularly breakfast. First, be aware that it’s perfectly ok to eat lunch or dinner foods for breakfast; many Polish kids have soup for breakfast. Or a hamburger patty or sausage or eggs with some fruit would be a good start for the day. A more novel breakfast could be a bowl of fresh fruit covered with nuts and coconut cream or other nut cream. (see photo below).

You can make a “cereal” with a few dates or other dried fruit (keep quantity low, to taste), 1/2 cup nuts, 2 cups water, dash salt, and tapioca or arrowroot starch thickener. Put the nuts and dates and boiling water into the blender, and spin until creamy. Then blend in a few tbsp. of the thickener, pour into a sauce pan and stir for a few minutes, simmering to thicken (or bake in the oven 20-30 minutes till thickened). You may have to whisk in additional starch when simmering, until you get the recipe right for your child, in which case you can do it all in the blender, and let it thicken as it cools. It’s delicious, and could be modified to use figs or apricots or peaches or other fruits, with nuts and thickening to give the protein, fat, and texture. This is a fairly high glycemic food, partially counterbalanced by the nuts, and you can reduce the glycemic index by replacing a few of the dates with stevia. If you can’t add an egg or some meat to the meal, using bone broth as half or even all of the liquid would make it a pretty well-balanced breakfast.

My breakfast for years has been a smoothie, with some fruit, herb tea, lots of nuts, berries, a carrot, some spinach, protein powder (or a soft boiled egg), and sometimes a half banana. The banana makes it pretty high glycemic, but the nuts and the protein help to balance it. I like to add chocolate powder or cinnamon, as these are both tasty and healthful seasonings.

Another breakfast treat our kids like is sweet potato pancakes, made with baked yams or sweet potatoes, scooped out after cooked. Add to the pulp tapioca starch and a little salt, and keep working more starch in, until you have a bread dough like consistency. Fry in oil (they’re kind of sticky, so put a blob into the frying pan, cook a couple of minutes, then flip and smash with spatula to get it pretty thin. If you try to smash them before doing this, they’ll just stick to the spatula and make a mess–it’s a bit of a trick). They don’t reheat well, but the dough refrigerates well. You can do the same with winter squash-the main reason for doing this is to “dilute” the squash or yam, as their flavor is often pretty strong for kids, and the added starch totally changes the texture and lightens the flavor. These are pretty high glycemic, and can be made less glycemic by adding lots of oil (to dough and the frying pan), and blending an egg into the dough. They should be cooked at very low temperature. Other pancake recipes are available at dailyburn.com/life/recipes/paleo-recipes-pancakes/‎. Some of these recipes are not low carbohydrate, so be sure to review the ingredients carefully, and be willing to make substitutions if needed.

In general, it is important to cook foods at low temperatures, and to avoid browning as much as possible. For example, caramelizing onions or carrots produces (by the Maillard reaction) toxic substances called “advanced glycation end products” (AGE’s). Also, grilling and browning meat will greatly increase AGE production. These substances cause inflammation and oxidative stress, and contribute torisk of diabetes, vascular damage, neurodegenerative disease, and cancer. Cooking food at low heat with added water will greatly reduce formation of AGE’s, and when possible, adding a little lemon juice or vinegar to the cooking water, will help further.We have found that burgers or chops can be simmered on the stove top with added water in a covered pan, with good results. Baking in a covered pan, with a little water and lemon added, makes excellent poultry or roasts.

One appropriate concern about a low glycemic diet, is the tendency to eat lots of animal products. While these meats are well utilized by humans, and are not subject to fermentation, as are carbohydrates, they are higher up the food chain than plants. As a result, animals are liable to accumulate fat soluble toxins, which are passed on to the consumer. This problem can be reduced by eating only organically grown meats and eggs. Also, we can lessen exposure by choosing low fat meats, by trimming the fat, and by cooking with added water and draining off the fat. If more oil is needed with low fat meats, coconut or olive oil may be added to the pan.

Try to stay away from concentrated carbs like fruit juice or dried fruit, and instead use whole fresh fruit. We make a delicious “ice cream” with frozen unsweetened fruit (mango is great) and coconut cream, only two ingredients. You pulverize the icy fruit by itself in the blender, then add a small amount of high fat canned coconut milk (about 1 cup of fruit with 2-3 ounces coco milk), gradually, while blending/creaming the mix. The blender won’t do it without stopping and stirring repeatedly until it’s creamy. I sometimes add some nuts or seeds at the first stage of pulverizing, to add more good fat and flavor. It needs to be eaten quickly, as it tends to melt and lose its ice cream quality. You can blend in a little stevia if it’s not sweet enough (or a small amount of honey or xylitol or erythritol). Also, you can make this “ice cream” with any frozen fruit–peaches, blueberries, strawberries, etc.

Another challenge with the low glycemic diet (and autistic children in general) is snacks. You can make “jerky,” a salted homemade meat with a little spice like garlic, honey, pepper, from any fresh meat. Slice thinly, and season the meat with a simple seasoning mix (only spices, nothing fancy), then dry in the oven at low temperature on a stainless cookie sheet or glass pan (our old cookie sheets turn the meat kind of black from rust or something, so use glass or stainless steel). Another easy snack is chicharrones (fried pork rinds), which you’ll find in the Mexican food section. They’re actually high protein, and pretty low fat (and the fat is healthier than the oils used to make chips-these oils oxidize readily with heat). Some kids like to eat dips, and guacamole, hummus, refried beans or salsa are excellent dips for chicharrones, vegetables, or “crackers” made from nuts and/or coconut flour. Also, sliced fruit with nut butter makes a good portable and balanced combination. “Sandwiches” with lettuce as a wrap for bread, filled with sliced home-made meat, pickle, tomato, mayo, mustard, or home made ketchup may work for some kids. There are multiple GAPS and SCD websites which offer good recipes for low carb bread.

It’s a very good idea to soak nuts and seeds and beans overnight before using, to improve digestibility. You can dry them after soaking, in a dehydrator, or on a glass pan in the oven at lowest heat. It takes 4-5 hours at 170 degrees for nuts to get tasty and a little crisp (use the oven’s time bake feature to improve your chances of having an edible product).

Some children like spaghetti sauce, which presents an opportunity to enrich the marinara with avocado or zucchini or spinach, etc. blended in thoroughly. Even if they’re not eating pasta, they may eat the sauce (think of it as soup, and make it thick), or conceivable accept it served on spaghetti squash or julienned carrots, broccoli stalks, asparagus, or green beans. Likewise, if your child will eat meat loaf, you can puree a vegetable mix to blend into the meat and eggs, along with nut or seed meal or psyllium powder to improve the texture

If he’ll eat soup, you can easily cover lunch with a thermos of homemade stew, chili, lentil, etc.Interestingly, in our evaluation of over 100 families in Hungary and Poland, we found that almost every child with autism does consume soup. Conversely, in the US, almost every child with autism doesn’t consume soup. Is this epigenetic or simply a reflection of family eating habits? I think the latter, and hope that your child will get more interested in soup when he experiences healthy hunger, and sees the rest of the family eating it. I encourage generous use of spices, but keep them simple, and read all labels (on everything except fresh produce).

While there is good evidence that all children may benefit from reducing the glycemic index of their diet, clearly some children have other problems with foods. These include food allergies, though most common food allergens are eliminated by removing grains, soy, dairy and sugar. Sometimes eggs or citrus or yeast or nuts or fish turn out to be allergens, so one must be observant when a diet change is made, watching for new or aggravated symptoms.

A diet high in nuts and eggs may unmask an unrecognized problem with oxalates, and, particularly if gut symptoms seem to worsen on the new diet, or if genitourinary complaints increase, investigating oxalate intolerance is recommended. Alternatively, if bloating or abnormal stools is ongoing, or worsened with the low glycemic diet, I recommend investigating the FODMAPS approach as another powerful approach to healing the gut. Finally, phenol/salicylate sensitivity is not well addressed by the above described low glycemic diet. These sensitivities may be causing volatile behavior, unexplained rashes/flushing, giggling/drunken behavior, hyperactivity, nighttime waking, and sometimes unexplained achiness. In this case, I recommend doing a trial with a low phenol diet for a few weeks to test the possibility that some of the healthy but high phenol foods on the low glycemic diet could be contributing to the problems.

In essence, we are following our traditional history as hunter gatherer people, also as primates, in choosing a diet of simple whole foods, which also happen to be low glycemic. This is a safe and reasonable way to begin building a sustainable life-long approach to eating. You will likely be rewarded with improvements in your child’s symptoms, in addition to reducing his risk of developing degenerative diseases later in life. It’s all food for thought!
John A Green III MD