A new study now guesstimates that 1 in 53 cases of ASD may be linked to obesity during pregnancy.
First thought on this -- isn't it entirely possible that obesity during pregnancy is indicative of an unhealthy lifestyle? Isn't it also likely that an unhealthy lifestyle, in and of itself, could cause issues for a developing fetus?
Second thought -- doesn't obesity during pregnancy mean that mom is probably not eating right? On this note, research indicates that prenatal nutrition and nutrition during the first few months of pregnancy has a direct impact on the occurrence of ASDs. See Rebecca Schmidt, Robin Hansen, et al., “Prenatal Vitamins, One-carbon Metabolism Gene Variants, and Risk for Autism,” Epidemiology Vol.22:4 (July 2011)). Moreover, this research showed that women who took prenatal vitamins three months prior to conceiving and during the first month of pregnancy had a statistically significant lower chance of having a child with ASD.
Third thought -- if obesity does contribute to the issue, then seeing a good nutritionist isn't just a luxury.
Nutrition DOES matter! Tina can help . . .
Showing posts with label nutrition. Show all posts
Showing posts with label nutrition. Show all posts
Thursday, June 14, 2012
Friday, January 7, 2011
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Monday, October 4, 2010
The Warnings Keep Coming, But Is Anybody Listening?
Got a few things to talk about this week. The theme? We keep getting warned about potential issues with medications, the political underpinnings of health care, and dangers regarding products we use and consume, but the warnings are side-notes, buried in the back of the paper, confined to the pages on health books generally dismissed by the mainstream medical community, and on the web – if you know where to look. But, if you’re reading this, then you might want to know a couple of things. In no particular order:
When a new client joins our Center, we always ask if they ever (a) suffered from any form of chronic infection, such as ear infections, sinus infections, etc.; and (b) took antibiotics for extended periods of time. You’d be surprised to learn that the majority of our students answer these questions with a resounding “Yes!”
We ask for two main reasons. First, chronic infections often are a sign of a food allergy (or, if you prefer, a food “aversion”). Simply put, the student is eating something that is triggering an immune response and making them sick. But, food allergies are not the point of this blog -- that’s a whole ‘nother story.
It is the second reason that I’d like to address here. For years, we have known that antibiotics can wreak havoc on the digestive system. This can negatively impact the student’s immune system, since the vast majority (70% to 80%, depending on your reference source) resides in the digestive system. Your immune system, of course, has a direct impact on your overall health, but it also has a major impact on your mood and behavior.
Surprise, surprise. While everyone knows that antibiotic use can upset your stomach, a new study reveals that “repeatedly taking [antibiotics] can trigger long-lasting changes in all those good germs that live in your gut, raising questions about lingering ill effects.” Newsday, 9/14/10 at A33. The article noted that three healthy adults who had not used antibiotics in at least the past year where given low, five-day courses of the antibiotic Cipro, six months apart. The researchers found that the “bacterial diversity” of those three individuals “plummeted as a third to half of the volunteers’ original germ species were nearly wiped out, though other species moved in.”
How could this not affect your immune system?
Did you hear? The Food Pyramid may be “so politically influenced that it is ineffective.” (check out Newsday, 10/4/10 at A23). “This year, the meat lobby has opposed strict warnings on sodium that could cast a negative light on lunch meats. The milk lobby has contested warnings to cut back on added sugars, lest chocolate- and strawberry-flavored milk fall from favor.” Really? You don’t say. And, here I thought the Food Pyramid was a totally objective, science-based guide to eating healthy . . .
So who says Frankenfood is bad for you? Well, a lot of people, actually. According to “This Supermarket ‘Health Food’ Killed These Baby Rats in Three Weeks,” written By Jeffrey Smith and Posted By Dr. Mercola on October 4, 2010, Biologist Arpad Pusztai; Irina Ermakova, a senior scientist at the Russian National Academy of Sciences; Embryologist Andrés Carrasco; Epidemiologist Judy Carman; prominent virologist Terje Traavik; and Ohio State University plant ecologist Allison Snow. In one way or another, these researchers and scientists proved that genetically modified foods can be quite harmful. But, each and every one of these individuals was put through a trial by fire. Some were fired from their positions, others had research funding withdrawn, some had their research blocked, and some were even subject to baseless rumors attacking their credibility. See http://articles.mercola.com/sites/articles/archive/2010/10/04/watch-out-there-are-more-problems-with-genetically-modified-foods-than-youre-allowed-to-know.aspx.
Really, if we can’t trust the companies that are genetically mutilating our food, who can we trust?
When a new client joins our Center, we always ask if they ever (a) suffered from any form of chronic infection, such as ear infections, sinus infections, etc.; and (b) took antibiotics for extended periods of time. You’d be surprised to learn that the majority of our students answer these questions with a resounding “Yes!”
We ask for two main reasons. First, chronic infections often are a sign of a food allergy (or, if you prefer, a food “aversion”). Simply put, the student is eating something that is triggering an immune response and making them sick. But, food allergies are not the point of this blog -- that’s a whole ‘nother story.
It is the second reason that I’d like to address here. For years, we have known that antibiotics can wreak havoc on the digestive system. This can negatively impact the student’s immune system, since the vast majority (70% to 80%, depending on your reference source) resides in the digestive system. Your immune system, of course, has a direct impact on your overall health, but it also has a major impact on your mood and behavior.
Surprise, surprise. While everyone knows that antibiotic use can upset your stomach, a new study reveals that “repeatedly taking [antibiotics] can trigger long-lasting changes in all those good germs that live in your gut, raising questions about lingering ill effects.” Newsday, 9/14/10 at A33. The article noted that three healthy adults who had not used antibiotics in at least the past year where given low, five-day courses of the antibiotic Cipro, six months apart. The researchers found that the “bacterial diversity” of those three individuals “plummeted as a third to half of the volunteers’ original germ species were nearly wiped out, though other species moved in.”
How could this not affect your immune system?
Did you hear? The Food Pyramid may be “so politically influenced that it is ineffective.” (check out Newsday, 10/4/10 at A23). “This year, the meat lobby has opposed strict warnings on sodium that could cast a negative light on lunch meats. The milk lobby has contested warnings to cut back on added sugars, lest chocolate- and strawberry-flavored milk fall from favor.” Really? You don’t say. And, here I thought the Food Pyramid was a totally objective, science-based guide to eating healthy . . .
So who says Frankenfood is bad for you? Well, a lot of people, actually. According to “This Supermarket ‘Health Food’ Killed These Baby Rats in Three Weeks,” written By Jeffrey Smith and Posted By Dr. Mercola on October 4, 2010, Biologist Arpad Pusztai; Irina Ermakova, a senior scientist at the Russian National Academy of Sciences; Embryologist Andrés Carrasco; Epidemiologist Judy Carman; prominent virologist Terje Traavik; and Ohio State University plant ecologist Allison Snow. In one way or another, these researchers and scientists proved that genetically modified foods can be quite harmful. But, each and every one of these individuals was put through a trial by fire. Some were fired from their positions, others had research funding withdrawn, some had their research blocked, and some were even subject to baseless rumors attacking their credibility. See http://articles.mercola.com/sites/articles/archive/2010/10/04/watch-out-there-are-more-problems-with-genetically-modified-foods-than-youre-allowed-to-know.aspx.
Really, if we can’t trust the companies that are genetically mutilating our food, who can we trust?
Wednesday, September 15, 2010
ADHD: Nutrition versus Meds
Came across an interesting little snippet on an ADHD forum to which I belong. In an attempt to avoid medicating her child, suspected by doctors of having ADHD, a Mom tried to help her son through a nutrition intervention. It is unclear whether she had consulted with anyone about her approach, but what was clear is that the child had an immediate reaction to the intervention – apparently a very bad one which prompted this Mom’s call for help on the forum. Specifically, she indicated that it was as if the child was going through “withdrawal” and after two weeks, she only saw his behavior getting worse.
Tina responded privately to her offering advice and insight into the situation. Among other things, she noted that, as we always tell the parents here at the center, while the “withdrawal” like symptoms may be upsetting, the fact that her child had a definitive response to a new intervention is usually a very positive sign. At a minimum, it shows a clear sensitivity related toward that intervention (in this case, what the child was eating), and that usually means you’re looking in the right direction. The trick now is to figure out the proper approach.
Moreover, as we always tell parents, whenever trying a new intervention, many times things tend to get worse before they get better – especially behaviors. The child literally feels very different, the body is physically affected, and the child’s mind and body must adapt. This can be rough, and lead, at least in the beginning, to worse behaviors.
Finally, like anything else, it takes time to adjust to new interventions. Unlike medication, nutrition intervention takes time. This is especially so if the gut is affected or you are addressing a deficiency. Simply put, it takes time for the body to heal.
Another gentleman on the forum (we’ll call him “Biff”) had a different response. Posted on the forum: give up the diet and give him meds.
Guess who had the right approach?
It turns out that not long after Biff’s post, Mom gave us an update. It took a couple of weeks, but she stuck with the dietary intervention and was now seeing very positive results. In particular, she noted that her son was “calmer,” “focus[ing] longer,” and experiencing “less sensory break downs.”
Tina 1: Biff O
Tina responded privately to her offering advice and insight into the situation. Among other things, she noted that, as we always tell the parents here at the center, while the “withdrawal” like symptoms may be upsetting, the fact that her child had a definitive response to a new intervention is usually a very positive sign. At a minimum, it shows a clear sensitivity related toward that intervention (in this case, what the child was eating), and that usually means you’re looking in the right direction. The trick now is to figure out the proper approach.
Moreover, as we always tell parents, whenever trying a new intervention, many times things tend to get worse before they get better – especially behaviors. The child literally feels very different, the body is physically affected, and the child’s mind and body must adapt. This can be rough, and lead, at least in the beginning, to worse behaviors.
Finally, like anything else, it takes time to adjust to new interventions. Unlike medication, nutrition intervention takes time. This is especially so if the gut is affected or you are addressing a deficiency. Simply put, it takes time for the body to heal.
Another gentleman on the forum (we’ll call him “Biff”) had a different response. Posted on the forum: give up the diet and give him meds.
Guess who had the right approach?
It turns out that not long after Biff’s post, Mom gave us an update. It took a couple of weeks, but she stuck with the dietary intervention and was now seeing very positive results. In particular, she noted that her son was “calmer,” “focus[ing] longer,” and experiencing “less sensory break downs.”
Tina 1: Biff O
Monday, May 3, 2010
And they worry about vitamins . . .
There has been a movement afoot by the medical and pharmaceutical industries calling for the strict regulation of the manufacture and sale of vitamins and supplements. The justification offered by the med/pharm industries is that consumers should be assured that what is on the label of such vitamins and supplements is exactly what is in such vitamins and supplements -- nothing more and nothing less. In addition, the med\pharm industry wants to make sure that any health claims on the vitamin and supplement labels are true. And, finally, there is always med\pharm talk about the safety of such vitamins and supplements.
Now, I agree. Vitamins and supplements, like every other product on the market, should be safe, contain what they purport to contain, and do what they purport to do. That's just decency, honesty, and common sense. Likewise, I am sure that in the vitamin and supplement industry, some manufacturers are good, honest companies selling good, honest products, while some companies may not be quite so good or quite so honest -- just like every other industry on this planet. For the most part, whenever we make a purchase, the best we can do is do our research, check reputations, lay our money down and hope that we get that for which we have paid.
But, I have to ask, what is really prompting the push for such regulations, and exactly how effective would such regulation be anyway?
Regarding the first question, let's, for the moment, assume that the altruistic justifications given by the med/pharm industries are true. Is it possible that something else is motivating such a push? Sure. Money.
If vitamins and supplements became subject to regulation, the testing, studies and manufacture of such vitamins and supplements would become prohibitively expensive. Many companies would be forced out of business -- less competition for the drugs made by the pharmaceutical companies and pushed by the medical industry.
Of the companies that remain, the costs of such vitamins and supplements would skyrocket, thereby becoming less attractive than the alternative med/pharm drugs.
Finally, it may actually become cost effective and/or profitable for the med/pharm industry to get in on the vitamin and supplement market big time. With an infrastructure already steeped in regulation, big advertising dollars, and a worldwide distribution network, it may not cost as much for the pharmaceuticals to produce vitamins and supplements, and with the combination of the government's imprimatur supporting such vitamin and supplement content and effectiveness and the inflated costs of such vitamins and supplements, don't you think that "pharmaceutical grade" vitamins and supplements would be a big hit?
Regarding the second question, exactly how effective would such regulation be? Well, with respect to labeling, I'd like everyone to read "Food Politics" by Marion Nestle. You'll discover how the various lobbies in the food industry work the government, its regulator, and its regulations to the point where you can't really tell what's in the box or its healthiness, despite the label!
And, if you follow this blog, I don't need to point out how many "FDA Approved" medicines hurt and even kill people.
But, even on a more basic level, does regulation keep bad stuff out of medicines? Did anyone catch the Johnson & Johnson major recall of children's and infants' Tylenol, Motrin, Zyrtec and Benadryl? See "Medicines for kids recalled," Newsday at A17 (Sunday, May 2, 2010). Seems that the products were recalled
"in consultation with the FDA after discovering manufacturing deficiencies that could affect the quality, purity or potency of the medicines. The FDA said some of the products many not meet required quality standards.... Some of the products affected by the recall may contain a higher concentration of active ingredient than specified; others contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles, the FDA said."
What those "tiny particles" are was not disclosed in the article.
Now, I point this out not only to show that even with regulations, bad stuff can get in, but also note, it apparently was the MANUFACTURER that issued the recall -- NOT the government agency that's supposed to regulate the industry.
Now, I agree. Vitamins and supplements, like every other product on the market, should be safe, contain what they purport to contain, and do what they purport to do. That's just decency, honesty, and common sense. Likewise, I am sure that in the vitamin and supplement industry, some manufacturers are good, honest companies selling good, honest products, while some companies may not be quite so good or quite so honest -- just like every other industry on this planet. For the most part, whenever we make a purchase, the best we can do is do our research, check reputations, lay our money down and hope that we get that for which we have paid.
But, I have to ask, what is really prompting the push for such regulations, and exactly how effective would such regulation be anyway?
Regarding the first question, let's, for the moment, assume that the altruistic justifications given by the med/pharm industries are true. Is it possible that something else is motivating such a push? Sure. Money.
If vitamins and supplements became subject to regulation, the testing, studies and manufacture of such vitamins and supplements would become prohibitively expensive. Many companies would be forced out of business -- less competition for the drugs made by the pharmaceutical companies and pushed by the medical industry.
Of the companies that remain, the costs of such vitamins and supplements would skyrocket, thereby becoming less attractive than the alternative med/pharm drugs.
Finally, it may actually become cost effective and/or profitable for the med/pharm industry to get in on the vitamin and supplement market big time. With an infrastructure already steeped in regulation, big advertising dollars, and a worldwide distribution network, it may not cost as much for the pharmaceuticals to produce vitamins and supplements, and with the combination of the government's imprimatur supporting such vitamin and supplement content and effectiveness and the inflated costs of such vitamins and supplements, don't you think that "pharmaceutical grade" vitamins and supplements would be a big hit?
Regarding the second question, exactly how effective would such regulation be? Well, with respect to labeling, I'd like everyone to read "Food Politics" by Marion Nestle. You'll discover how the various lobbies in the food industry work the government, its regulator, and its regulations to the point where you can't really tell what's in the box or its healthiness, despite the label!
And, if you follow this blog, I don't need to point out how many "FDA Approved" medicines hurt and even kill people.
But, even on a more basic level, does regulation keep bad stuff out of medicines? Did anyone catch the Johnson & Johnson major recall of children's and infants' Tylenol, Motrin, Zyrtec and Benadryl? See "Medicines for kids recalled," Newsday at A17 (Sunday, May 2, 2010). Seems that the products were recalled
"in consultation with the FDA after discovering manufacturing deficiencies that could affect the quality, purity or potency of the medicines. The FDA said some of the products many not meet required quality standards.... Some of the products affected by the recall may contain a higher concentration of active ingredient than specified; others contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles, the FDA said."
What those "tiny particles" are was not disclosed in the article.
Now, I point this out not only to show that even with regulations, bad stuff can get in, but also note, it apparently was the MANUFACTURER that issued the recall -- NOT the government agency that's supposed to regulate the industry.
Wednesday, January 6, 2010
Autism and Diet -- Expert Panel Calls for Further Research
Don't be misled. I came across an article of some importance to those with children with ASD. However, the title of this article, as well as the opening paragraph, are extremely misleading and discouraging. It should be just the opposite.
I am referring to "Evidence lacking for special diets in autism," by Carlak Johnson of The Associated Press.
Mr Johnson reports that, "[a]n expert panel says there's no rigorous evidence that digestive problems are more common in children with autism compared to other children, or that special diets work, contrary to claims by celebrities and vaccine naysayers."
While this is technically a true reading of the panel's report published in the January issue of Pediatrics, the title of the article and the manner in which it is written, paint a very distorted view of the diets that many parents and professionals have found to help children with ASD, the connection between digestive issues and autism, and of course, those who employ such diets and believe there is a connection.
In truth, the article should have been entitled, "Experts call for more research concerning diet and autism."
The first paragraph should have read, "An expert panel has found that more research is needed to determine whether digestive problems are more common in children with autism. The panel also called for more research concerning the effectiveness of special diets now employed by the many concerned parents and professionals who work with children with ASD."
I mean, really, what message is Mr. Johnson trying to send when he compares "an expert panel" that "says there's no rigorous evidence" to the "claims by celebrities and vaccine naysayers"?
And, isn't it odd the way the second part of that sentence reads? It sounds like it says that the panel determined that "special diets" don't work. But, what it really says is that "celebrities and vaccine naysayers" belief that there is "rigorous evidence" supporting the use of special diets is incorrect.
Note the difference: the expert panel never, ever said that special diets don't work. It only said that there is a lack of "rigorous evidence" concerning the effectiveness of such diets, and the panel called for more research on this issue!
Words really do matter.
In fact, a careful reading of the actual report paints a very different picture. In a nutshell, the panel recognizes that (i) ASD children do suffer from gastrointestinal issues - some studies noting the prevalence of such issues to be as high as "70% or higher" in that population; (ii) there is evidence that these children have a more prevalent occurrence of food sensitivities and food allergies; and (iii) it is very important that these issues be treated since they may be the cause of many of the behavioral problems these children exhibit. The reason the study was undertaken in the first place was to determine whether there was an "evidence-based" diagnostic and treatment regime for gastrointestinal problems presented by ASD children!
And, while not finding well-structured studies that demonstrate that special diets help these children, the panel acknowledged the anecdotal evidence supporting such diets and called for more research in this area.
Specifically, the report found the following pertinent points:
1. The panel acknowledged that more research is needed on the prevalence of gastrointestinal issues and ASD: "The prevalence of gastrointestinal abnormalities in individuals with ASDs is incompletely understood" with "the reported prevalence of gastrointestinal symptoms in children with ASDs has ranged from 9% to 70% or higher." Furthermore, while "[m]ost of these studies had 1 or more methodologic limitations . . . the preponderance of data were consistent with the likelihood of a high prevalence of gastrointestinal symptoms and disorders associated with ASDs."
2. A specific gastrointestinal issue, i.e., "autistic enterocolitis" has not been indisputably established. The report does not state that "autistic enterocolitis" does not exist. Instead, it merely states that the study that "suggested" its existence is flawed, and therefore, in the panel's opinion, the existence of "autistic enterocolitis" has not been established.
3. At least one study found that 43% of children with ASDs have a problem with "altered intestinal permeability." However, the panel believes the "[e]vidence for abnormal gastrointestinal permeability in individuals with ASDs is limited," and that "[p]rospective studies should be performed to determine the role of abnormal permeability in neuropsychiatric manifestations of ASDs."
4. Nutritional deficiencies are presented by ASD children. "Nutritional deficiencies have been reported in patients with ASDs, which is not surprising because of the narrow food preferences of many affected individuals and/or purported therapeutic diets that might be nutritionally inadequate. In a study of 36 children with ASDs, regardless of unrestricted or restricted diet, essential amino acid deficiencies consistent with poor protein nutrition occurred more frequently than in age- and gender-matched controls."
5. There is evidence that at least some ASD children do respond to dietary interventions. However, the panel believes that more data is needed before dietary modifications can be routinely recommended. "Anecdotal reports have suggested that there may be a subgroup of individuals with ASDs who respond to dietary intervention. Additional data are needed before pediatricians and other professionals can recommend specific dietary modifications. Dietary modifications such as removal of milk for symptoms of lactose intolerance may be approached empirically, as with any other pediatric patient with consistent symptoms. The data on the value of specific diets being effective in the treatment of individuals with ASDs are difficult to assess. Many dietary modifications are believed to have a beneficial outcome, although placebo effects are likely to be high in this setting. The few studies in the literature are difficult to interpret without adequate control groups.
"Many parents and care providers have observed and reported improvements in problem behaviors with nutritional or medical interventions. Some of these therapies are based on purely observational reports; many are based on studies that may have reached erroneous conclusions because of recruitment bias, lack of validated or standardized outcomes, or inadequate controls. . . . Anecdotal reports that restricted diets may ameliorate symptoms of ASDs in some children have not been supported or refuted in the scientific literature, but these data do not address the possibility that there exists a subgroup of individuals who may respond to such diets."
6. While not endorsing a "gluten-free" or "casein-free" ("GFCF") diet, the panel does recognize that in at least one study, parents of ASD children who undertook these special diets "reported positive subjective clinical changes while their child was on the GFCF diet." Moreover, the panel does not explicitly discourage the use of such diets.
"Few studies have examined the effects of a casein-free diet, a gluten-free diet, or combined GFCF diet on the behavior of individuals with ASDs. To our knowledge, only 1 double-blind placebo controlled study has been published to date. In this double-blind crossover trial of GFCF or typical diet in 15 children with ASDs, there were no differences in measures of severity of ASD symptoms, communication, social responsiveness, and urinary peptide levels after 12 weeks. Nevertheless, after being informed of the results, 9 parents wanted to continue the diet and reported positive subjective clinical changes while their child was on the GFCF diet. . . . Parents need information to help plan a balanced diet within the restrictions imposed by the chosen diet. Given the real hardships associated with implementation of a strict GFCF diet, additional studies are needed to assess risk factors and possible markers that identify individuals who might benefit from these diets."
7. The panel recognized that immune problems have been reported in ASD children, and that research exists that suggest such problems may impact neurodevelopment. However, the panel notes that a direct relationship between immune dysfunction and ASD needs to be proven.
"There has been research to suggest that immune responses can influence neurodevelopment and that significant immunologic alterations may play a key pathogenic role in some individuals with ASDs. We are now able to accurately define immune status in individuals with ASDs. Well-defined studies are needed using larger sample sets and age- and geographically matched controls, with extensive immune analysis, to determine the precise relationship of immune dysfunction to clinical symptoms."
8. Moreover, there are preliminary findings that suggest a relationship between gastrointestinal inflammation and gastrointestinal symptoms associated with ASDs. Additional investigation into such a relationship is needed. "A few studies have suggested a relationship between gastrointestinal inflammation and gastrointestinal symptoms associated with ASDs. The gastrointestinal tract is the largest immune organ in the body, containing up to 80% of Ig-producing cells in the body. . . . These studies suggest an underlying chronic inflammatory process in some individuals with ASDs and co-occurring gastrointestinal disturbances. . . . These findings should be considered preliminary and will require confirmation."
9. Gut flora, health and disease are significantly related. Additional research concerning the relationship between gut flora and ASDs must be performed. "The microbiological ecosystem of the gut is complex and poorly understood but likely plays a significant role in both health and disease. Few researchers, however, have attempted to critically examine the relationship of gut microflora to ASDs. Future studies will require molecular approaches aimed at identification and quantification of microbial species. If an association is identified, it may lead to novel treatment trials."
In summary, the panel noted, [a]ccrual of new knowledge will advance our approach to the management of ASDs and co-occurring medical conditions. Recognition that problem behaviors might indicate an underlying medical condition will facilitate diagnosis and treatment and ultimately improve the quality of life for many persons with ASDs. This expert panel has addressed considerations in the diagnostic evaluation of gastrointestinal symptoms in individuals with ASDs that may lead to effective treatment options, with the hope that patients will have better access to enlightened care."
"Enlightened care." I like the sound of that.
I am referring to "Evidence lacking for special diets in autism," by Carlak Johnson of The Associated Press.
Mr Johnson reports that, "[a]n expert panel says there's no rigorous evidence that digestive problems are more common in children with autism compared to other children, or that special diets work, contrary to claims by celebrities and vaccine naysayers."
While this is technically a true reading of the panel's report published in the January issue of Pediatrics, the title of the article and the manner in which it is written, paint a very distorted view of the diets that many parents and professionals have found to help children with ASD, the connection between digestive issues and autism, and of course, those who employ such diets and believe there is a connection.
In truth, the article should have been entitled, "Experts call for more research concerning diet and autism."
The first paragraph should have read, "An expert panel has found that more research is needed to determine whether digestive problems are more common in children with autism. The panel also called for more research concerning the effectiveness of special diets now employed by the many concerned parents and professionals who work with children with ASD."
I mean, really, what message is Mr. Johnson trying to send when he compares "an expert panel" that "says there's no rigorous evidence" to the "claims by celebrities and vaccine naysayers"?
And, isn't it odd the way the second part of that sentence reads? It sounds like it says that the panel determined that "special diets" don't work. But, what it really says is that "celebrities and vaccine naysayers" belief that there is "rigorous evidence" supporting the use of special diets is incorrect.
Note the difference: the expert panel never, ever said that special diets don't work. It only said that there is a lack of "rigorous evidence" concerning the effectiveness of such diets, and the panel called for more research on this issue!
Words really do matter.
In fact, a careful reading of the actual report paints a very different picture. In a nutshell, the panel recognizes that (i) ASD children do suffer from gastrointestinal issues - some studies noting the prevalence of such issues to be as high as "70% or higher" in that population; (ii) there is evidence that these children have a more prevalent occurrence of food sensitivities and food allergies; and (iii) it is very important that these issues be treated since they may be the cause of many of the behavioral problems these children exhibit. The reason the study was undertaken in the first place was to determine whether there was an "evidence-based" diagnostic and treatment regime for gastrointestinal problems presented by ASD children!
And, while not finding well-structured studies that demonstrate that special diets help these children, the panel acknowledged the anecdotal evidence supporting such diets and called for more research in this area.
Specifically, the report found the following pertinent points:
1. The panel acknowledged that more research is needed on the prevalence of gastrointestinal issues and ASD: "The prevalence of gastrointestinal abnormalities in individuals with ASDs is incompletely understood" with "the reported prevalence of gastrointestinal symptoms in children with ASDs has ranged from 9% to 70% or higher." Furthermore, while "[m]ost of these studies had 1 or more methodologic limitations . . . the preponderance of data were consistent with the likelihood of a high prevalence of gastrointestinal symptoms and disorders associated with ASDs."
2. A specific gastrointestinal issue, i.e., "autistic enterocolitis" has not been indisputably established. The report does not state that "autistic enterocolitis" does not exist. Instead, it merely states that the study that "suggested" its existence is flawed, and therefore, in the panel's opinion, the existence of "autistic enterocolitis" has not been established.
3. At least one study found that 43% of children with ASDs have a problem with "altered intestinal permeability." However, the panel believes the "[e]vidence for abnormal gastrointestinal permeability in individuals with ASDs is limited," and that "[p]rospective studies should be performed to determine the role of abnormal permeability in neuropsychiatric manifestations of ASDs."
4. Nutritional deficiencies are presented by ASD children. "Nutritional deficiencies have been reported in patients with ASDs, which is not surprising because of the narrow food preferences of many affected individuals and/or purported therapeutic diets that might be nutritionally inadequate. In a study of 36 children with ASDs, regardless of unrestricted or restricted diet, essential amino acid deficiencies consistent with poor protein nutrition occurred more frequently than in age- and gender-matched controls."
5. There is evidence that at least some ASD children do respond to dietary interventions. However, the panel believes that more data is needed before dietary modifications can be routinely recommended. "Anecdotal reports have suggested that there may be a subgroup of individuals with ASDs who respond to dietary intervention. Additional data are needed before pediatricians and other professionals can recommend specific dietary modifications. Dietary modifications such as removal of milk for symptoms of lactose intolerance may be approached empirically, as with any other pediatric patient with consistent symptoms. The data on the value of specific diets being effective in the treatment of individuals with ASDs are difficult to assess. Many dietary modifications are believed to have a beneficial outcome, although placebo effects are likely to be high in this setting. The few studies in the literature are difficult to interpret without adequate control groups.
"Many parents and care providers have observed and reported improvements in problem behaviors with nutritional or medical interventions. Some of these therapies are based on purely observational reports; many are based on studies that may have reached erroneous conclusions because of recruitment bias, lack of validated or standardized outcomes, or inadequate controls. . . . Anecdotal reports that restricted diets may ameliorate symptoms of ASDs in some children have not been supported or refuted in the scientific literature, but these data do not address the possibility that there exists a subgroup of individuals who may respond to such diets."
6. While not endorsing a "gluten-free" or "casein-free" ("GFCF") diet, the panel does recognize that in at least one study, parents of ASD children who undertook these special diets "reported positive subjective clinical changes while their child was on the GFCF diet." Moreover, the panel does not explicitly discourage the use of such diets.
"Few studies have examined the effects of a casein-free diet, a gluten-free diet, or combined GFCF diet on the behavior of individuals with ASDs. To our knowledge, only 1 double-blind placebo controlled study has been published to date. In this double-blind crossover trial of GFCF or typical diet in 15 children with ASDs, there were no differences in measures of severity of ASD symptoms, communication, social responsiveness, and urinary peptide levels after 12 weeks. Nevertheless, after being informed of the results, 9 parents wanted to continue the diet and reported positive subjective clinical changes while their child was on the GFCF diet. . . . Parents need information to help plan a balanced diet within the restrictions imposed by the chosen diet. Given the real hardships associated with implementation of a strict GFCF diet, additional studies are needed to assess risk factors and possible markers that identify individuals who might benefit from these diets."
7. The panel recognized that immune problems have been reported in ASD children, and that research exists that suggest such problems may impact neurodevelopment. However, the panel notes that a direct relationship between immune dysfunction and ASD needs to be proven.
"There has been research to suggest that immune responses can influence neurodevelopment and that significant immunologic alterations may play a key pathogenic role in some individuals with ASDs. We are now able to accurately define immune status in individuals with ASDs. Well-defined studies are needed using larger sample sets and age- and geographically matched controls, with extensive immune analysis, to determine the precise relationship of immune dysfunction to clinical symptoms."
8. Moreover, there are preliminary findings that suggest a relationship between gastrointestinal inflammation and gastrointestinal symptoms associated with ASDs. Additional investigation into such a relationship is needed. "A few studies have suggested a relationship between gastrointestinal inflammation and gastrointestinal symptoms associated with ASDs. The gastrointestinal tract is the largest immune organ in the body, containing up to 80% of Ig-producing cells in the body. . . . These studies suggest an underlying chronic inflammatory process in some individuals with ASDs and co-occurring gastrointestinal disturbances. . . . These findings should be considered preliminary and will require confirmation."
9. Gut flora, health and disease are significantly related. Additional research concerning the relationship between gut flora and ASDs must be performed. "The microbiological ecosystem of the gut is complex and poorly understood but likely plays a significant role in both health and disease. Few researchers, however, have attempted to critically examine the relationship of gut microflora to ASDs. Future studies will require molecular approaches aimed at identification and quantification of microbial species. If an association is identified, it may lead to novel treatment trials."
In summary, the panel noted, [a]ccrual of new knowledge will advance our approach to the management of ASDs and co-occurring medical conditions. Recognition that problem behaviors might indicate an underlying medical condition will facilitate diagnosis and treatment and ultimately improve the quality of life for many persons with ASDs. This expert panel has addressed considerations in the diagnostic evaluation of gastrointestinal symptoms in individuals with ASDs that may lead to effective treatment options, with the hope that patients will have better access to enlightened care."
"Enlightened care." I like the sound of that.
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