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Diet & nutrition

Parents, keen to address concerns about the health of their children, often ask me about the various tests available. The issue of testing children with autism may have so befuddled them that they have delayed or even dismissed the idea of treatment that could have profound benefits. Perhaps you wonder why children with autism should be tested at all. It’s worthwhile because there is mounting evidence to suggest that there are significant metabolic, gastrointestinal and nutritional differences between autistic and neurotypical (nonautistic) children and that these differences can have a significant effect on autistic behaviours. As a practitioner, I assess each child individually using a comprehensive questionnaire, but certain biomedical tests can offer additional, useful information. Biomedical testing involves taking samples of urine, stool, blood or hair and analysing them for levels of particular substances associated with autism. If the levels found of these substances are significantly higher or lower than ‘normal’ ranges, then appropriate dietary interventions are recommended.

Key considerations

Beginner’s guide to biomedical testing An increasing number of parents are embracing biomedical intervention to treat their loved one’s nutritional issues. Those new to the approach can find the wealth of tests available overwhelming, says biomedical dietician Emma Mills, who provides an easy-to-follow guide for getting you started

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Although every child with autism can potentially benefit from biomedical testing, there are some key considerations that need to be addressed before starting. First, most of the tests will not be routinely available on the National Health Service (although it’s always worth asking your GP or consultant), so private laboratories are used. The costs of the tests vary considerably, depending on what is being analysed, and range from around £25 up to £1,000. Second, some tests require taking a blood sample, which can be problematic for some children. With biomedical testing, you should seek the advice of a suitably qualified practitioner to interpret the results and give appropriate recommendations for a modified diet, nutritional supplements, probiotics, prebiotics and enzymes. Biomedical tests are best done

when your family is in a position to do something with the results and with the recommendations of your practitioner. For example, you may wish to carry out tests following diagnosis or when there are significant problems such as constipation, abdominal bloating, diarrhoea, restrictive eating habits or significant communication, sleep, mood or behavioural problems. Although it might be tempting to get all the tests done at once, it is better to have a more personalised, targeted approach based on the clinical condition of each child. I’ve outlined typical conditions below and the tests appropriate to them.

For gut problems ● Protein Intolerance Test Some children with autism who exhibit symptoms of gut malfunction (such as constipation, diarrhoea, abdominal bloating and pain) may be suffering from a ‘leaky gut’, which is when partially digested proteins (peptides) pass through the gut wall and circulate around the brain and body. These peptides have the potential to adversely affect behaviour, worsening any negative autistic traits you child may have. Eventually, these peptides will be excreted from the body via the kidneys and appear in the urine. Peptides from the proteins gluten (found in cereals) and casein (found in milk and dairy foods) are thought to be the most problematic in autism. The test looks for levels of IAG, a substance produced from the amino acid tryptophan. Individuals with ASD who have high levels of IAG in their urine are more likely to respond positively when following a gluten and casein-free diet. The test looks for the presence of gluten and casein-based peptides and IAG in the urine to indicate a ‘leaky gut’ and associated intolerance to gluten and casein. A positive result confirms that the gut is not functioning properly and that foods containing gluten and casein are not being tolerated. An IAG and Dietary-Derived Peptides Test is available from Analutos (see Contacts on page 21). The test costs £60.

● Gut Microflora Test Another important aspect of a healthy, functioning gut relates to the type of microflora (bacteria and yeasts) that colonise our digestive tract. Certain species are known to be beneficial to maintaining a healthy gut, such as Lactobacillus and Bifidobacteria, while others such as Clostridia and Candida are highly detrimental. When levels of beneficial microflora decline, more harmful strains take over, leading to a situation called ‘dysbiosis’. This microbial imbalance can cause significant inflammation of the gut wall and affect the digestion and absorption of nutrients. Elevated levels of harmful microflora and their metabolites indicate dysbiosis and a malfunctioning bowel. Testing for

Individuals with ASD who have high levels of IAG in their urine are more likely to respond positively when following a gluten and casein-free diet” dysbiosis can be carried out using a stool or urine test. The stool test will identify and measure the different types of microflora found in the gut: A GI Effects Microbial Ecology Profile is available from Nutrition Geeks (see Contacts) at £172. The urine test measures substances (metabolites) that are specifically produced by different types of microflora: An Organix Dysbiosis Profile is available from Nutrition Geeks and costs £178. An Intestinal Dysbiosis Markers Test is available from Analutos at £95.

For a restricted diet Many children with autism eat a very limited range of foods, either because they are on a therapeutic, modified diet or they self-restrict their intake because of rigid likes and dislikes. Whatever the reason, Au t i s m | e y e I s s u e 9 2 0 1 3 19


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Diet & nutrition Building a future for people with autism Specialist day and residential provision for young people from 5-25 with autism and learning difficulties. Additional complex needs and challenging behaviour supported. Prior’s Court School

Developing independence and life skills. Day, 38, 44 & 52 week specialist autism education 5-19 years.

Prior’s Court Young Adult Provision

Emma Mills runs the website Brain & Body Nutrition: www. brainandbody.co.uk

A transitional step towards a more inclusive life. 52 week supportive living & learning19-25 years.

Prior’s Court Training & Development

a limited diet can lead to low levels of key nutrients, a particularly harmful situation in active, growing children. Cases of severe nutritional deficiencies have been recorded in children with ASD (references 1, 2, 3, 4 & 5). The severity of autism is also associated with low levels of calcium, iron, zinc, and vitamins B6, B3 and C (reference 6). Normalising dietary intake and blood levels of these key nutrients is crucial. Tests are available that measure the levels of different

Children with autism tend to have lower levels of sulphate and glutathione… This can compromise their capacity to detoxify”

Autism training for practitioners and parents. Includes 5 day TEACCH and 3 day Structured Teaching. For further details, visits and training dates please visit www.priorscourt.org.uk or email: mail@priorscourt.org.uk Prior’s Court School, Hermitage, Thatcham, Berkshire, RG18 9NU Registered charity no 1070227

nutrients, but to be accurate they require a blood sample. A Plasma Mineral Profile to measure calcium, iron, zinc, chromium, copper, magnesium, manganese and selenium is available from Biolab at £60. A Micro Nutrient Test to measure calcium, zinc, copper, magnesium, manganese and antioxidants, plus vitamins A, B1, B2, B3, B6, B12, biotin, folate, C, D and K is available from Regenerus Laboratories at £437.

For the physically well If your child has issues with attention, communication or behaviour despite being physically well and eating a varied and balanced diet, then an accumulation of toxic, heavy

metals could be a significant factor. Research has shown an association between the severity of autism and the relative body burden of toxic metals such as mercury, cadmium and lead7. The body can normally get rid of toxins by combining them with sulphate and glutathione to produce non-toxic substances that can be excreted. Unfortunately, children with autism tend to have lower levels of sulphate and glutathione compared with neurotypical (non-ASD) children6. This can compromise their capacity to detoxify. A Hair Mineral & Toxic Elements test, using a hair sample, measures levels of aluminium, arsenic, cadmium, mercury and lead. Available from Biolab at £44. A Hair Mineral/Elements and Toxic Elements test, using a hair sample, measures levels of aluminium, arsenic, cadmium, mercury, lead and antimony. Available from Regenerus Laboratories at £59. A Toxic Elements Screen, using a blood or urine sample, measures levels of aluminium, arsenic, cadmium, mercury, lead and 13 other elements. The test is available from Biolab at £122, or individual elements can be measured for £23 each. If high levels of any toxic elements are discovered they could be worsening your child’s autism and chelation therapy should be considered. Chelation is

GLOSSARY Probiotics: beneficial bacteria that have been clinically proven to reach the bowel and exert a positive effect. Prebiotics: non-digestible carbohydrates specifically used as fuel by probiotic bacteria, helping them proliferate. IAG: stands for trans-indolyl3-acryloylglycine, a metabolite of the amino acid tryptophan. DMSA: stands for dimercaptosuccinic acid, a chelating agent.

the process by which toxic substances, such as mercury, cadmium and lead, are safely removed from the body by the oral administration of a special agent such as DMSA. This process should be undertaken only by a suitably qualified practitioner and should never be administered intravenously, as this can be dangerous. Chelation therapy should never be undertaken if there are any underlying physical health problems, especially if the gut, liver or kidneys are affected. The book Fight Autism and Win is written by parents who have successfully used chelation therapy with their children and is a useful read8.

CONTACTS Tests are available from these commercial laboratories: ● Analutos: www.analutos.com; Email: info@analutos.com; Tel: 0191 516 6366 ● Biolab: www.biolab.co.uk; Email: reception@biolab.co.uk; Tel: 020 7636 5959/5905 ● Nutrition Geeks: www.nutritiongeeks.co.uk; Email: Tel: 01865 338 045 ● Regenerus Laboratories: www.regeneruslabs.com; Email: info@regeneruslabs.com; Tel: 0333 9000 979

REFERENCES 1 McAbee et al, 2009: ‘Permanent visual loss due to dietary vitamin A deficiency in an autistic adolescent’, Journal of Child Neurology 24 (10) p1288-89 2 Stewart & Latif, 2008: ‘Symptomatic nutritional rickets in a teenager with autistic spectrum disorder’, Child: Care, Health and Development 34 (2) p276-8 3 Hediger et al, 2008: ‘Reduced bone cortical thickness in boys with autism or ASD’, Journal of Autism and Developmental Disorders 38 (5) p848-56 4 Monks et al, 2002: ‘A case of scurvy in an autistic boy’, Journal of Drugs in Dermatology (1) p67-9 5 Tang et al, 2011: ‘Severe feeding disorder and malnutrition in two children with autism’, Journal of Developmental and Behavioral Pediatrics 32 (3) p264-7 6 Adams et al, 2011: ‘Nutritional and metabolic status of children with autism vs neurotypical children and the association with autism severity’, Nutrition and Metabolism (8) 34 7 Adams et al, 2009: ‘The severity of autism is associated with toxic metal body burden and red blood cell glutathione levels’, Journal of Toxicology article ID 532640 8 Fight Autism and Win: Biomedical Therapies That Actually Work! by Jan Martin and Tressie Taylor with Rebecca Claire, JRT Publishing, ISBN 061-558-2095

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7 from our spring 2013 issue