In the past, oxalate research was relegated to kidney-related disorders. Now much more is known.

Whether your interest is autism, cancer, chronic pain, autoimmunity, or generalized inflammation, understanding the role dietary oxalates can play is critical for your clients.

Inflammasome activation is a new discovery related to the immune system and oxalate – which can have some significant implications, especially with age-related disorders and chronic conditions.

What is the inflammasome? It is an innate part of the immune system involved with creating inflammation. It is now known that oxalate can tigger it. The inflammasome has been implicated with several age-related disorders including gout, type 2 diabetes, obesity, cancer, and neurodegenerative and cardiovascular disorders, [1] as well as autoimmune conditions.

So as we begin to understand a broader picture of the various ways high oxalates can be detrimental to optimal health, we can see how/why a low oxalate diet can be helpful for our clients.

Here is some of the latest research. The first study is on the inflammasome. The second is on oxalate and breast cancer, and we just mentioned the inflammasome connection to cancer. The final two research papers are on autism including a study on autism and oxalate, and a paper on diet for autism including the recommendation of a low oxalate diet.

Oxalate Triggers the Inflammasome

A review of the current literature surrounding oxalates and inflammasome activation is compelling.

In this scientific paper, researchers explain how when the body is burdened with oxalates (either through diet or endogenous production) the kidneys can be damaged by the build up. When this happens, blood levels of oxalate rise even more which can activate the inflammasome.

Researchers pointed out how reducing dietary oxalate is important in reducing inflammation that stems from inflammasome activation. In fact, the authors conclude: “Accordingly, inhibiting oxalate-induced inflammasome activation, or lowering plasma oxalate, may prevent or mitigate progressive renal damage in CKD, and also reduce morbidity and mortality due to systemic inflammation.”

Given that the inflammasome is associated with gout, type 2 diabetes, obesity, cancer, autoimmune conditions, and neurodegenerative and cardiovascular disorders it is critical for practitioners to understand the effects oxalate can have on the body, the inflammatory process, and disease, and the important role a low oxalate diet plays. With this new research, oxalates become even more important to consider when working with patients or clients facing age-related conditions involving the inflammasome. 

Reference: Ermer, T., Eckardt, K. U., Aronson, P. S., & Knauf, F. (2016). Oxalate, inflammasome, and progression of kidney disease. Current opinion in nephrology and hypertension, 25(4), 363. 

Breast cancer and oxalates – is there a link?

Research has tied excess oxalate build-up to breast cancer.

Two types of mice were involved in this study, namely BALB/c or BALB/c nude female mice. BALB/c mice had a wild type immune system.

The researchers found that injecting oxalates in the mammary fat pad region of BALB/c nude mice favored the growth of breast tumors. More specifically, the scientists reported that oxalates promoted the growth of MCF-7 and MDA-MB231 breast cancer cell lines as well as the normal breast cell line, MCF10A.

Moreover, the higher the oxalate concentration, the faster the breast tumors developed.

Interestingly, injecting oxalates in the animals’ back did not induce cancer suggesting that oxalates may cause only breast cells to proliferate abnormally.

BALB/c mice were also injected with oxalates but did not develop tumors although some of the animals did experience some swelling in the mammary fat pad area. Since this swelling disappeared within 24 to 48 hours, this could indicate that the oxalate may have triggered tumor formation, but the immune system of BALB/c mice was strong enough to destroy the cancer cells.

Given this new research, the potential role of oxalate in cancer should be researched much more extensively. And the use of a low oxalate diet and nutritional approach should be studied as well.

Reference: Castellaro, A. M., Tonda, A., Cejas, H. H., Ferreyra, H., Caputto, B. L., Pucci, O. A., & Gil, G. A. (2015). Oxalate induces breast cancer. BMC cancer, 15(1), 761.

How ascorbic acid may cause oxalate nephropathy

In this case study, a 69-year-old patient with benign prostate hyperplasia and small bowel resection presented with reduced urinary output, fatigue, and trouble speaking. The patient had been taking 2g of ascorbic acid daily for the past 2 years.

Since his creatinine and blood urea nitrogen remained elevated, he had to undergo 4 sessions of hemodialysis on the fifth day of admission.

A renal biopsy was performed to identify the cause of this patient’s acute kidney failure. The sample revealed presence of edema, tissue thickening and scarring, and inflammation. Calcium oxalate crystals were also present.

The study authors explain that:

  • Ascorbic acid in doses above 2g/day can cause oxalate crystals to deposit in the kidney. This can cause oxalate nephropathy which refers to oxalate-induced damage to delicate structures within the kidney. Nephropathy can eventually result in kidney failure.
  • The benign prostate hyperplasia caused chronic urinary retention which probably increased crystal deposition in the kidney.
  • Small bowel resection can also increase oxalate absorption by impairing fat absorption in the gut. Reduced dietary fat absorption can cause calcium to bind to fatty acids that aren’t absorbed. This reduces excretion of calcium oxalate in the feces.

Reference: Lin, W. V., Turin, C. G., McCormick, D. W., Haas, C., & Constantine, G. (2019). Ascorbic acid-induced oxalate nephropathy: a case report and discussion of pathologic mechanisms. CEN case reports, 8(1), 67-70.

Oxalates and Autism

Researchers studied oxalates in autism, and they measured a 2.5-fold greater level of oxalates in the urine, and a three-fold greater level of oxalate in the plasma, in children with autism.

Their finding was specifically, hyperoxaluria; a condition of high oxalate.

It’s significant to note that the study on autism and oxalate excluded the following groups from their selection criteria: those on a special diet, those with a history of seizures or antibiotic use, those with gastrointestinal disease (in addition to those with kidney stones). This is important to note, because all of these can be conditions of or cause hyperoxaluria.

The study’s selection criteria (omissions) may affect an underrepresentation of the range of oxalate (plasma and urinary) that would occur in a full range of autistic patients. Even with the exclusions, significant oxalate issues were identified. This warrants further study, without excluded variables, to investigate how results may differ. If these groups had been included, rates and levels of oxalate would most likely be even higher.

The study concluded that: “hyperoxalemia or hyperoxaluria may be involved in the pathology of autism spectrum disorders in children.” 1 It then continues to explain that based on the high oxalate finding, certain treatment options, such as a low oxalate diet, probiotic therapy, possibly with Oxalobacter formigenes, and a variety of supplementation may be helpful in these children.

Oxalates are significant in autism because clinically we see a great deal of oxidative stress, considerable inflammation, mitochondrial damage or dysfunction, as well as faulty sulfation and seizures—areas where oxalates can wreak havoc. The discovery and clear indication that high oxalate may be involved in the pathology of autism is both significant and hopeful. This research and the biochemical connections we are highlighting provide further hope and direction for helping children with autism.

 

Reference: Konstantynowicz, J., Porowski, T., Zoch-Zwierz, W., Wasilewska, J., Kadziela-Olech, H., Kulak, W., Owens S.C., Piotrowska-Jastrzebska J., and Kaczmarski, M. (2012). A potential pathogenic role of oxalate in autism. European Journal of Paediatric Neurology, 16(5), 485-491.

Dietary and therapeutic strategies for inflammation in autism spectrum disorders.

Brain development and function can be influenced by the environment, gut health, and diet in utero and after the child is born.

This is particularly important in autism. In this article entitled, “Interplay Between Peripheral and Central Inflammation in Autism Spectrum Disorders: Possible Nutritional and Therapeutic Strategies” the authors reviewed diet, nutrition, and other interventions such as probiotics and fecal transplants for helping individuals with autism. I am excited to see two diets that I have found very helpful in my nutrition practice for children with autism on this list: the low oxalate diet and the Specific Carbohydrate Diet (SCD).

In the paper, they explain how lab studies indicate that offspring of mothers who were obese during pregnancy were more likely to develop social communication impairment and repetitive behavior. Scientists explain that the low-grade inflammation caused by obesity could impair the brain’s neuronal circuit which controls behavior in the offspring.

Moreover, anything that adversely influences the development of the gut microbiome (such as the mode of delivery, stress, antibiotics, and diet) will also affect the gut-brain axis. Since gut microbes produce neurochemicals that play a role in social cognition, emotion, and behavior, improving gut health during pregnancy could decrease risks of ASD in the offspring.

As such, they discuss the following promising adjuvant therapies for ASD including:

  • A gluten-free and casein free diet – this free step-by-step guide can help you get started
  • The Specific Carbohydrate Diet
  • A diet low in oxalates
  • Adequate intake of micronutrients such as carnitine, zinc, selenium, vitamins A, D, E, and B-complex and omega-3s and omega-6s from real foods and/or high-quality supplements
  • Prebiotics and probiotics from the Lactobacillus and Bifidobacterium genus
  • Fecal transplants which involve transferring fecal microbiota from healthy donors to an unhealthy individual

While grain-free diets like SCD have gained attention in recent years, the low oxalate diet has been slow to become mainstream nutrition knowledge. So I’m thrilled to see it gaining traction in the nutrition world. I hope researchers continue to study this important diet for gut health, neurodevelopmental disorders, and many other conditions.

Reference: Cristiano, C., Lama, A., Lembo, F., Mollica, M. P., Calignano, A., & Mattace Raso, G. (2018). Interplay between peripheral and central inflammation in autism spectrum disorders: possible nutritional and therapeutic strategies. Frontiers in physiology, 9, 184.

Conclusion

Tailoring the right nutritional guidance for your clients or patients is important. As we can see through these studies. elevated oxalate can have a big impact on inflammation, oxidative stress, kidney function, mitochondrial function, and even cancer. Having a clear understanding of how (and when) to safely guide clients and patients through transitioning to a low oxalate diet can make all the difference in their lives.

To learn more on personalized nutrition and therapeutic diets, like the low oxalate diet, and how to use them in your practice as part of a BioIndividual Nutrition® plan, explore my BioIndividual Nutrition Training.

The right bioindividual nutrition plan for your client can bring about profound improvement and benefit.

In this article, I want to focus on some diets that have received a lot of attention in the news and nutrition community: the ketogenic diet and intermittent fasting.

But is this diet right for your client or patient and how do you know?

This is something that I cover extensively in the BioIndividual Nutrition Training program. I teach practitioners in my professional program to consider symptoms, diet history, conditions, lab results, genetics, microbiome, and more.

Today I want to present 5 studies that are using these diets for three important neurological and metabolic conditions: autism, Alzheimer’s, and diabetes.

The ketogenic or “keto” diet has been long-studied in regards to the benefit for individuals with intractable seizures and other neurological conditions. You may also have heard a friend or relative talking about the weight loss effects from a ketogenic diet. It can be very helpful for those looking to switch from carb burning to fat burning. The ketogenic diet can also improve blood sugar regulation in type 2 diabetes. Intermittent fasting, while not a ketogenic diet, does encourage lower carbohydrate consumption, and has also been shown to improve blood sugar control and risk markers of disease.

But, is it safe for your clients?

The science says… it can be. And I’ll share some research showing the ketogenic diet can provide adequate nutrition.

Just like any other diet out there, there are pros and cons and a specific profile of people who may find the greatest benefit. And getting support from a qualified nutrition practitioner and health care provider are important, especially for diets that restrict macronutrients as these do.

And similarly, there are ways to do a healthy ketogenic diet and intermittent fasting as well, as ways that are less than healthy in my opinion. All fats are not created equal so slathering on cheese or loading up on poor quality, high fat meats is technically keto (as long as protein is not too high) but not very healthy by my standards. Whereas a diet high in fats like avocado, nuts, seeds, coconut oil/MCT (depending on individual allergies/intolerances) can provide those nutrients in a healthy way.

So what does the research say? Below, I break down 5 different research studies looking at the ketogenic diet (and intermittent fasting) and how they may benefit your clients and patients.

The Ketogenic Diet and MCT Oil for Children with Autism
GFCF vs. Keto Diet in Autism
The Ketogenic Diet Provides Adequate Nutrition (in Alzheimer’s Disease)
A Ketogenic Diet Improved Blood Sugar Regulation in Type 2 Diabetes
People with Type 2 Diabetes May Reverse or Reduce Their Insulin Use with Intermittent Fasting

The Ketogenic Diet and MCT Oil for Children with Autism

Low in carbohydrates, moderate in protein, and high in fat, the ketogenic diet has shown promise in the treatment of ASD.

In this study, 15 children aged 2 to 17 were prescribed a modified ketogenic diet with supplemental medium-chain triglycerides (MCT) oil for 3 months.

Individuals with ASA suffer from mitochondrial dysfunction –mitochondria act like the cell’s “engine” and helps produce energy. The scientists wanted to see if adding MCT to the modified ketogenic diet could improve ketone and fatty acid production which would optimize mitochondrial efficiency.

The children’s caregivers received 2 hours of training on the modified ketogenic, gluten free diet and MCT protocol. This diet consisted of:

  • 20 – 25g of carbohydrates per day
  • Protein, twice the RDA requirements, based on the child’s weight and height
  • Various types of fats including 20% of pure MCT oil or coconut oil

At the end of the study, 50% of the children showed moderate to considerable improvement in ADOS-2 scores for the social affect component. No significant difference was observed in restricted and repetitive behavior scores.

Furthermore, 50% showed improvement on CARS-2 scores in the areas of imitation, body use, and fear or nervousness.

Findings from this study suggest that this modified diet could improve inflammation levels, gut health, and cellular health in ASD patients.

 

Study Reference: Lee, R. W., Corley, M. J., Pang, A., Arakaki, G., Abbott, L., Nishimoto, M., … & Lum-Jones, A. (2018). A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder. Physiology & behavior, 188, 205-211.Physiology & behavior, 188, 205-211.

 

GFCF vs. Keto Diet in Autism

In this 6-month study, Egyptian researchers compared the effects of two different dietary interventions versus a normal (control) diet on core symptoms of autism.

The study population consisted of 45 children – 33 boys and 12 girls – aged between 3 and 8. The children were randomly assigned to three groups:

  •     Group 1: received the modified ketogenic diet (keto)
  •     Group 2: received a gluten-free, casein-free diet (GFCF)
  •     Group 3: the control group, received balanced nutrition

The results were exciting. Both the GFCF and Keto group have significant improvements compared to the control group (that did not do a special diet). There were some differences, but overall the results show that a special diet is very helpful to improving autism symptoms.

Autism severity decreased among children in groups 1 and 2 indicating that the Keto and GFCF diet were effective in improving autism symptoms.

The ketogenic diet yielded better results than the GFCF diet. The ketogenic diet can be a great diet for autism… for the right person. The keto diet can address some underlying mitochondrial issues and neuroinflammation that can be wonderful!! By improving the underlying biochemistry, the symptoms of autism can be significantly reduced (as we saw in the study).

However, 1/3 of the children dropped out of the Keto group. The fact that the keto diet is more restrictive is one of its challenges. No one dropped out of the GFCF group and great benefits were seen by that group too.

This research is further proof that a special diet helps people with autism.

And it shows: both a GFCF diet and a keto diet were effective. See more on my write up of this paper, here, at my autism nutrition website: NourishingHope.com.

Study reference: El-Rashidy, O., El-Baz, F., El-Gendy, Y., Khalaf, R., Reda, D., & Saad, K. (2017). Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metabolic brain disease, 32(6), 1935-1941.

 

The Ketogenic Diet Provides Adequate Nutrition (in Alzheimer’s Disease)

Researchers wanted to study whether the ketogenic diet is nutritionally dense and can provide adequate nutrition. 15 older adults with very mild, mild, or moderate Alzheimer’s disease were involved in this study.

The study partners of each participant were counseled by a registered dietitian and participants were instructed to consume a 1:1 ketogenic diet consisting of about 70% fat, 20% protein, and at most 10% of carbohydrates.

The participants’ study partners completed self-reported 3-day food records (i) at baseline, (ii) after one month, and (iii) after two months. To assesses ketosis, evening urinary ketones was monitored daily by participants and serum beta-hydroxybutyrate was measured after a 12-hour fast within 48 hours of each 3-day food record.

Although only 10 of the 15 participants adhered to the diet, results indicated that it is possible to consume a nutrient-dense ketogenic diet with MCT oil and:

  • Plenty of non-starchy vegetables
  • Avocados
  • Nuts and seeds

Study reference: Taylor, M. K., Swerdlow, R. H., Burns, J. M., & Sullivan, D. K. (2019). An Experimental Ketogenic Diet for Alzheimer Disease Was Nutritionally Dense and Rich in Vegetables and Avocado. Current Developments in Nutrition, 3(4), nzz003.

A Ketogenic Diet Improved Blood Sugar Regulation in Type 2 Diabetes

This study looked at 28 overweight participants with type 2 diabetes for a 16-week diet trial. It is interesting that the research team noted that prior to the use of exogenous insulin for the treatment of diabetes in the 1920’s, the traditional therapy was dietary modification. Diet recommendations during that time were very different than the current recommendations of a low-fat, high-carbohydrate diet and consisted of “meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea.”

This study focuses on a keto diet’s effects on blood sugar and diabetes medication use in patients who prepared (or bought) their own high fat, low carb meals.

The majority of the participants were males and the mean age was 56. The study provided Low Carb Ketogenic Diet (LCKD) counseling, with an initial goal of consuming less than 20 g carbohydrate/day, and diabetes medication dosages were reduced at the start of the diet. Measurements, counseling, and medication were adjusted as needed every other week. Food records were completed and evaluated several times throughout the study.

The results were impressive!

Results included a 6.6% decrease in body weight, 42% decrease in triglycerides, 16% reduction in hemoglobin A1c, 17% decrease in mean fasting glucose, and 10% in reduction in uric acid levels. “The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most [17 out of the 21] participants.”

Yancy WS, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutrition & metabolism. 2005 Dec;2(1):1-7.

People with Type 2 Diabetes May Reverse or Reduce Their Insulin Use with Intermittent Fasting

Note: this study is on intermittent fasting rather than the ketogenic diet.

In a new study, Suleiman Furmli, MD, and his team reported that, under medical supervision, therapeutic 24-hour fasting regimens can help reverse type 2 diabetes. The fasting interventions could also reduce the use of medications in patients with type 2 diabetes and minimize surgical interventions in this population.

This small study involved 3 male patients aged between 40 and 67. The 3 participants also had high blood pressure and high cholesterol levels in addition to type 2 diabetes and were taking at least 70 units of insulin daily at the beginning of the study.

Two of the patients fasted three times weekly for 7 months. After the intervention, one patient discontinued insulin and metformin use while the other stopped his fixed-dose insulin mix.

The other patient fasted on alternating days for 11 months and was able to eliminate metformin and pre-mixed insulin.

HbA1c levels improved for all 3 participants who also lost weight and inches off their waists.

“On eating days, patients are encouraged to eat a diet low in sugar and refined carbohydrates, which decreases blood glucose and insulin secretion.”

Study reference: Furmli, S., Elmasry, R., Ramos, M., & Fung, J. (2018). Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. Case Reports, 2018, bcr-2017.

As you can see there is science to validate the ketogenic diet and intermittent fasting for some individuals.

What is clear through these studies is how impactful the right diet can be for improvement in health and wellness and even reduction in symptoms and improvement in metabolic markers. A healthy ketogenic diet, when guided by an experienced and knowledgeable practitioner for the right individual can make the world of difference to individuals seeking relief from neurological issues, obesity, diabetes, and increased metabolic health. The ketogenic diet is one of over a dozen diets we study at the BioIndividual Nutrition Institute. If you are a practitioner seeking advanced level training on specialized diets like the ketogenic diet, I encourage you to explore my BioIndividual Nutrition Training.

 

In my years of helping children with autism, I have heard many times (erroneously) that there is no science behind diet for autism, or the gluten-free casein-free diet (GFCF diet) for autism. 

This is simply not true. There is a great deal of research illustrating why gluten and dairy can cause and contribute to symptoms and the condition of an autism spectrum disorder, and how a GFCF diet can help. 

On one of my live Q&A calls recently, a wonderful medical doctor earnestly asked about what research existed on a gluten-free, casein-free diet for autism. While I’ve been writing and speaking on it for years, this request sparked my desire to put together the LATEST science to help fellow practitioners looking for science-based support for using the GFCF diet in your practice. 

In this article, I will share seven underlying biochemical mechanisms for which gluten and casein cause problems in autism, and studies showing how a GFCF diet helps, including one I was part of.

Recommending and helping your clients implement a gluten-free and casein-free diet for their child with autism (or themselves) can be beneficial in many ways, even life changing.  I’ve seen children:

  • Improve language skills and communication
  • Reduce hyperactivity and increase focus and attention
  • Improve eye contact
  • Reduce anxiety and increase calm
  • Improve socialization
  • Reduce irritability and aggression
  • Decrease digestive symptoms
  • Improve sleep

You may have your own “success stories” from families in your practice and may know firsthand how beneficial the diet can be (I’d love to hear them in the comments below).

While this research is on autism, you’ll notice that the underlying factors apply to many other conditions including ADHD, anxiety, neurological conditions, digestive disorders, autoimmune conditions, and more. 

Gluten and Casein 

Gluten is a protein found in wheat, barley, rye, and triticale, and products made from them. The actual problematic component of gluten is called gliadin. But most often you’ll hear it referred to as simply gluten.

 “Glu-ten” acts as a “glue” and helps flour-based foods maintain their shape. You can find gluten in many types of foods, such as pasta, soups, cereals, baked goods, even in  dressings, sauces, and processed meats. 

Casein is a protein in milk. While there are different types of casein in different animal milks (a conversation for another day), a casein-free diet avoids all milk and dairy products from all animals. 

Some practitioners personalize their client’s diet plan with special milk products like camel milk or ghee once they see how their client does 100% casein-free. However, to really know how a casein-free diet works for a client, I always recommend to the practitioners in my BioIndividual Nutrition® Pediatric Program to remove all animal milk of any kind.  

We will discuss the challenges related to gluten and casein and how they impact autism symptoms in depth later in this article.

Soy

Soy is also important to remove on a GFCF diet. 

Soy has many of the same characteristics and effects as gluten and casein. Soy is one of the most common food sensitivities and is inflammatory. Soy can also form opioid compounds like gluten and casein. 

So, when I’m working with clients or educating practitioners, I recommend removing soy as well. 

To me, a GFCF diet is really a GFCFSF diet. 

Personalized Autism Diet Plan

A personalized, BioIndividual Nutrition approach is one that is focused on the unique needs of the individual, and while a gluten-free casein-free diet is not the only “autism diet” out there, it is one of the most widely used and effective diets.  

As a nutrition practitioner or health professional, you are likely aware that the body and brain are intricately connected. Autism is a whole body disorder. So for your clients, following a therapeutic diet plan based on their unique needs can reduce, or in some cases even alleviate, both their autism symptoms, as well as the physical symptoms and comorbid conditions like diarrhea, constipation, sleeping challenges, and skin rashes. While these are not part of an autism diagnosis, these physical symptoms are common in autism because of the underlying biochemistry that affects both body and brain.. As you improve the body, you improve the brain.

The result is healing that brings improved health, learning, mood, and behavior. 

I use many diets in my nutrition practice for children with autism; however, the most common is gluten-free casein-free because I find it extremely helpful and fairly easy to implement. Given the prevalence of negative reactions associated with both gluten and dairy (in the autism and general population as well), it’s often the first therapeutic diet I suggest to people when getting started.

If your client needs more help you may want to consider a grain-free diet such as the Specific Carbohydrate Diet, GAPS diet, or Paleo. And I always recommend understanding how a low salicylate diet or low amine diet can improve behavior and mood. And other diets that I teach to practitioners in my BioIndividual Nutrition Pediatric Program include the low oxalate diet, low FODMAPs diet, low glutamate diet, ketogenic diet, and more. 

A Safe and Effective Intervention

 A question I get from both clients and practitioners is “Is a gluten-free and casein-free diet safe to implement?” 

I have found that improving the nutritional density of foods, removing harmful additives and things devoid of nutritional value, and tailoring a diet to the unique needs of the individual has virtually no downside. 

Additionally, eating foods that cause inflammation, like gluten and dairy, cause nutrients to not be able to be absorbed and cause deficiencies. So when someone says, “children ‘need’ dairy for the nutritional value,” I would argue that they do not, and that it can actually harm nutrient status. 

On the other hand, it is important that we help clients eat a nutritious diet and meet their nutritional needs through foods and added supplementation when required.

I want to share a video from my friend and colleague Dr. James Adams, PhD on nutritional intervention and our published study.

Meal Planning On An Autism Diet?

A healthy gluten-free and casein-free diet includes foods such as: red meat, chicken, eggs, vegetables, fruits, nuts, seeds, potatoes, rice, and beans. There is a wide variety when it comes to naturally gluten-free and casein-free foods available. But, your clients may need coaching, meal ideas, and food lists to understand just how varied a diet they can have until they get the hang of it. 

Another important piece of education your clients will need is to understand food labels and hidden sources of gluten and casein. Identifying hidden sources of these inflammatory and problematic foods goes a long way in getting your clients the results they are seeking. 

Providing your client handouts to guide them with dietary implementation is important. My BioIndividual Nutrition Pediatric Program includes many handouts and guides that can be given to your clients related to this and other nutritional education. Whether you make your own or have access to already done-for-you handouts like mine, equipping your clients with tools is important to their success… and yours.

The Science and Research on How Gluten and Casein Negatively Affect Autism

As we move into the science behind the gluten-free and casein-free diet for autism, please pay particular attention to the issue of inflammation. This applies to both the gut and the brain. Localized inflammation in the gut can impact digestion and nutrient absorption, and gastrointestinal inflammation can become systemic causing inflammation in the brain. Neurological inflammation has been linked to many chronic conditions and diseases such as autism, ADHD, depression, anxiety, and more. 

Reducing inflammation is critical for our clients to heal. Therapeutic diet intervention targeted to their personalized nutrition needs is a key to reducing inflammation, and the GFCF diet is a great place to start.  

Opiates from Gluten and Casein Impact the Brain in Autism

Certain long-chain peptides have a very similar structure to natural opioid-binding peptides. Gluten and casein are two of these proteins. Gliadorphin (also known as gluteomorphin) is the name of the opiate peptide formed during the incomplete or partial digestion of gluten, and casomorphin is the opiate peptide derived from dairy. 

There can be a few reasons as to why these peptides enter the bloodstream. Firstly, the body requires adequate enzymes to break down these proteins effectively. Specifically the DPP-IV enzyme is required. It has been shown that children with autism have lower DPP-IV activity. [1]

Leaky gut, a condition you may be very familiar with already, is another way these peptides can get into the bloodstream. Leaky gut, a condition where the intestinal lining becomes permeable, is common in autism. [2] When these peptides get into the bloodstream, they can bind to opiate receptors in the brain, causing issues like high pain tolerance or a feeling of being disconnected or “foggy”. Many clients report that their child self-selects foods with gluten and/or dairy, often at the exclusion of other foods because of this opiate connection. Removing gluten and/or dairy can then result in withdrawal symptoms in the beginning. However, after removal of these foods from the body, some families report an improvement in restrictive eating!  

Additional research on how opioids in foods impact individuals with autism: 

  • This study postulated that the opioids from gluten and casein excreted in the urine are possible etiological factors, and the diet a treatment option, in autism. And researchers stated, “A gut-to-brain axis is both possible and probable” [3]
  • Studies have linked A1 beta-casein (BCM-7) from certain forms of dairy with autism and schizophrenia [4]
  • Gluteomorphins and casomorphins are found in the urine of people with autism [5]
  • Studies show gluteomorphin/gliadorphin and casomorphin can impact neurotransmitters in the central nervous system  resulting in the social impairment seen in autism [6]

Another consideration related to opioids is the inflammation they cause in both the gut and brain. Their direct impact on the brain can cause issues such as irritability, pain, anxiety, foggy thinking, as well as addiction to foods with gluten and dairy.

The Role of Zonulin in Leaky Gut and Autism Spectrum Disorders

Gluten is known to trigger a protein called zonulin so that is an additional advantage of a gluten-free diet. What is so problematic with zonulin is that it modulates the permeability of the GI tract in humans. It has been shown to “unzip” the tight junctions causing leaky gut. Scientific research has shown zonulin’s link to gut permeability in autism [7, 8] and other chronic inflammatory disorders including cancer, neuroinflammation, autoimmune disorders, and metabolic issues. [9]

Gut permeability can cause higher reactions to other food components for children with autism. As a result, your clients may see an increase in trouble concentrating, inflammation, diarrhea, constipation, and of course food allergies/intolerances. The brain cannot function optimally if the gut is unhealthy because of the gut-brain connection. 

Individuals with ASD have a higher prevalence of gastrointestinal distress (read my article on NourishingHope.com). Additionally, the severity of GI symptoms has been linked to autism symptom severity in a study by Dr. James Adams. [10]

The study referenced above on zonulin from 2021 showed that children with severe autism had significantly higher serum zonulin than controls. This could be the missing link from Dr. Adams’ study in regards to the correlation between autism severity and GI severity! It may be related to increased  permeability of the gut. 

Children who follow a gluten-free diet have lower incidence of leaky gut than those children who do consume it.

Gluten and Casein Food Sensitivities and Inflammation in Autism 

Inflammation can be created in the body and GI tract in response to IgG antibodies to foods. This issue is even more critical in the autism community. Researchers found high IgG antibodies levels to gliadin (i.e. gluten) in 87% of people with autism, as well as 86% of those with schizophrenia. They also found high IgG antibodies to casein in 90% of individuals with ASD and 93% in schizophrenia. [11]

Another study found elevated cytokines (inflammatory markers) to gluten in people with autism who had GI symptoms. [12]

This cycle of inflammation, issues in the gut, and symptoms such as constipation, diarrhea, gas, and pain can create systemic inflammation that also impacts the brain. In addition, the individual suffers because of incomplete breakdown of foods and poor nutrient absorption as well. 

Histamine Released by Gluten and Casein and Mast Cell Activation in Autism

High histamine levels and mast cell activation are common in autism. And research even suggests that this activation leads to inflammation both in the brain and in the gut causing or exacerbating the symptoms of autism, and when exposed perinatally may even be a possible cause of the development of autism. [13]  

Histamine release can be caused by general food allergies, as well as gluten and casein. [14] Gastrointestinal disorders can also be triggered by high histamine [15] along with resulting in high acid in the stomach and/or GERD. And in a converse manner, histamine can exacerbate food allergies.

Digestive disorders, high histamine, and mast cell activation in autism can lead to increased symptoms and severity of autism.

Higher risk of Celiac in Autism 

Celiac disease is defined as an autoimmune response to gluten. This results in the body attacking the lining of the digestive tract, and causes severe digestive symptoms, along with other health conditions. While the majority of the time we see non-celiac gluten intolerance in autism, there is an increased risk of celiac disease as well. 

In fact, there is research that shows people with autism are more likely to carry the HLA gene with the HLA-DRB1 *11-DQB1*07 structure, which raises the risks of celiac disease. [16]

The Connection Between Gluten, Casein, and Glutamate in Autism

Studies show that individuals with autism have a higher risk of elevated glutamate. [17

Some children and adults with autism are more sensitive to glutamate, an excitatory neurotransmitter. And they have less ability to convert glutamate to the calming neurotransmitter GABA. As a result, their brains are more responsive to the effects of glutamate and you can see increased hyperactivity, irritability, restlessness, anxiety, migraines, seizures, and many more symptoms in these individuals. 

A diet rich in gluten and casein can increase glutamate levels because gluten is 25% glutamate by weight, and casein is 20%. For those sensitive individuals or those with high levels of glutamate such as those with autism, foods with gluten and dairy can worsen neurological symptoms, including stress, anxiety, irritability, and hyperactivity. Glutamate has also been shown to cause inflammation in the brain and gastrointestinal system. [18]

Reducing gluten and dairy in the diet can help reduce the symptoms of autism in some individuals, in part because of this glutamate connection.

Cerebral Folate Deficiency and Dairy

Cerebral folate deficiency involves folate not being able to be adequately transported into the brain because of autoantibodies to the folate receptor. This means the brain does not have adequate folate. Some children with autism have this condition. Cerebral folate deficiency can cause slow head growth, low muscle tone, irritability and sleep problems, loss of bodily movement, speech complications, and seizures. 

There is scientific data showing that 75.3% of children with autism had autoantibodies to folate receptors. [19

So for children with autism who have cerebral folate deficiency, studies show that soluble folate-binding proteins in milk cross react with folate receptors, this increases autoantibodies to folate receptors making the problem even worse by decreasing folate to the brain even further. But, the good news is that studies show removing dairy from the diet can reduce folate receptor autoimmunity in cerebral folate deficiency syndrome. [20] 

Removing dairy from the diet reduces folate receptor autoantibodies and autoimmunity.

Scientific Research: Gluten-Free Casein-Free (GFCF) Diet Improves Autism Symptoms

Now that I have given you the underlying factors that can cause gluten and dairy to be problematic for individuals with autism, I want to also share the growing scientific data on the efficacy and benefits of removing gluten and casein from the diet.

Study Shows 91% of Children with Autism Had Improved Behavior, Speech, and/or GI Symptoms with GFCFSF

We’ve learned through the research that autism may be accompanied by inflammatory immune responses. This mechanism may also be what predisposes them to sensitivity to the proteins in wheat, dairy, and soy. Inflammation of the digestive system is the result of this increased sensitivity to these dietary proteins and this often exacerbates negative behaviors.

One very interesting study showed clinical improvement in 91% of the children as observed by therapists, teachers, and parents following the implementation of a gluten-free, casein-free and soy-free (GFCFSF) diet. Improvements were seen in speech, focus, sleep, GI symptoms, and less hyperactivity. [21]

6.7 points in Non-Verbal IQ and 4.5x Developmental Age Improvement  from GFCFSF Diet and Nutrition Intervention in Autism

I am particularly proud of this next study because I was part of it! It showed a 6.7 pts increase in non-verbal IQ and a 4.5 fold developmental age improvement. 

The study included individuals aged 3-58 years old who implemented a healthy gluten-free, casein-free, and soy-free diet, a multivitamin/mineral formula, an essential fatty acid supplement, carnitine supplementation, digestive enzymes, and epsom salt baths. Read my complete write up here.

Major improvements outside of development and IQ included: a reduction in autism symptoms, decrease gastrointestinal symptoms, improved language, increased focus, reduced anxiety, and more. [22]

Increased Social and Communication Skills Along with Reduced Autism Behaviors with GFCF Diet

A review of the existing scientific literature found consistently positive results with a gluten-free and casein-free diet for autism. The literature included both individual case studies and papers where groups of children were studied. 

What researchers found was an overall decrease in autism behaviors as well as increased social skills and communicative skills. 

It is important to note that they found the autism traits reappeared after the diet was broken. [23]

Better Development for Individuals with Autism on a GFCF Diet

This study evaluated the effects of a gluten-free and casein-free diet for children with autism in regards to urinary opioid peptides associated with gluten, gliadin, and casein. 

The study concluded that children following a gluten-free and casein-free diet had better development than the control group. [24]

Significant Improvement in Autism and ADHD Symptoms in Children with ASD on the GFCF Diet

In this two-stage, 24-month, randomized, controlled trial,  72 Danish children (ranging from 4 years old to 10 years 11 months) were assigned to diet (A) or non-diet (B) groups. To assess core autism behaviors they used the Autism Diagnostic Observation Schedule and the Gilliam Autism Rating Scale. Vineland Adaptive Behaviour Scales was used to determine developmental level, and the Attention-Deficit Hyperactivity Disorder – IV scale was used to determine inattention and hyperactivity. 

There were significant improvement scores in the diet group on all of the scales by 12 months. Group B was also assigned to the diet midway through the trial because of the improvement seen in group A! The results indicated that dietary intervention using a gluten-free and casein-free diet may positively affect developmental outcomes for children with ASD. [25]

GFCF and Keto Diets Improve Autism Symptoms

One interesting study looked at the differences between the GFCF diet and the ketogenic diet for autism. Both diets resulted in significant improvement in autism symptoms. There were some differences between the diet results, one diet had better results in behavior, while the other diet group showed better scores for cognitive awareness and sociability. For a more detailed review of this study, you can check out my article on NourishingHope.com. The end result was that both diets appear to improve symptoms of autism, depending on the individual needs of the person. This study highlights yet another example of how the gluten-free casein-free diet can be beneficial to those with autism. [26]

Closing Thoughts

The science is clear, following a gluten-free and casein-free diet can help improve autism. 

Creating a personalized autism diet plan for your clients can help them implement a GFCF diet smoothly and successfully. 

The great news is that our BioIndividual Nutrition Institute community continues to set the standard for dietary intervention for autism. 

Do you share my interest in clinical nutrition and therapeutic diets to improve conditions like ADHD and autism?  Have you considered specializing in this niche and serving this clientele in need? 

A special group is forming right now; I’m cultivating an exclusive group of 25 nutrition professionals to be on the cutting edge of helping children. 

My BioIndividual Nutrition Training: Pediatric Program, is the most advanced training program in personalized nutrition for children. I launched it seven years ago to fill a gap in the application of special diets targeted to an individual’s specific needs. 

Now we’ve got hundreds of professionals from 46 countries; nutritionists, dietitians, integrative medical practitioners, health coaches, and more! 

These are people just like you – who have a passion for helping kids with ADHD, autism, and other pediatric special needs.

For those ready to connect with colleagues who are as equally passionate as you …. some of the smartest in the nutrition community, and want to have the confidence to work with any client who walks through your door…

Join our Exclusive Pediatric Nutrition Professionals Group – Open right now!

  • 25 nutrition practicing professionals talking their career to the next level
  • Virtual meet-and-greet with like-minded colleagues
  • Roundtable symposium on autism, ADHD and other pediatric topics
  • Discounted enrollment (& payment plan)
  • Combo-Diet Meal Planning Package (saves you hours customizing meal plans and food list for complex, combination diet needs) 

The need for this expertise is at an all time high…so, if now feels like the right time for you, click here to email me and I’ll get you the details you need to join.

References for this article

  1. Bashir, S. and Laila, A.A., 2014. Alterations in plasma dipeptidyl peptidase IV in autism: A pilot study. Neurology, Psychiatry and Brain Research, 20(2), pp.41-44.
  2. Fowlie, G., Cohen, N. and Ming, X., 2018. The perturbance of microbiome and gut-brain axis in autism spectrum disorders. International journal of molecular sciences, 19(8), p.2251.
  3. Reichelt, K.L., Knivsberg, A.M., Lind, G. and Nødland, M., 1991. Probable etiology and possible treatment of childhood autism. Brain Dysfunction.
  4. Kamiński, S., Cieślińska, A. and Kostyra, E., 2007. Polymorphism of bovine beta-casein and its potential effect on human health. Journal of applied genetics, 48(3), pp.189-198.
  5. Tveiten, D., Finvold, A., Andersson, M. and Reichelt, K.L., 2014. Peptides and exorphins in the autism spectrum. Open Journal of Psychiatry, 2014
  6. Horvath, K. and Perman, J.A., 2002. Autism and gastrointestinal symptoms. Current gastroenterology reports, 4(3), pp.251-258.
  7. Esnafoglu, E., Cırrık, S., Ayyıldız, S.N., Erdil, A., Ertürk, E.Y., Daglı, A. and Noyan, T., 2017. Increased serum zonulin levels as an intestinal permeability marker in autistic subjects. The Journal of pediatrics, 188, pp.240-244
  8. Karagözlü, S., Dalgıç, B. and İşeri, E., 2021. The Relationship of Severity of Autism with Gastrointestinal Symptoms and Serum Zonulin Levels in Autistic Children. Journal of Autism and Developmental Disorders, pp.1-7.
  9. Fasano, A., 2020. All disease begins in the (leaky) gut: Role of zonulin-mediated gut permeability in the pathogenesis of some chronic inflammatory diseases. F1000Research, 9.
  10. Adams, J.B., Johansen, L.J., Powell, L.D., Quig, D. and Rubin, R.A., 2011. Gastrointestinal flora and gastrointestinal status in children with autism–comparisons to typical children and correlation with autism severity. BMC gastroenterology, 11(1), pp.1-13.
  11. Cade, R., Privette, M., Fregly, M., Rowland, N., Sun, Z., Zele, V., Wagemaker, H. and Edelstein, C., 2000. Autism and schizophrenia: intestinal disorders. Nutritional Neuroscience, 3(1), pp.57-72.
  12. Jyonouchi, H., Geng, L., Ruby, A., Reddy, C. and Zimmerman-Bier, B., 2005. Evaluation of an association between gastrointestinal symptoms and cytokine production against common dietary proteins in children with autism spectrum disorders. The Journal of pediatrics, 146(5), pp.605-610.
  13. Theoharides, T.C., Angelidou, A., Alysandratos, K.D., Zhang, B., Asadi, S., Francis, K., Toniato, E. and Kalogeromitros, D., 2012. Mast cell activation and autism. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease, 1822(1), pp.34-41.
  14. Miller, M.J.S., Zhang, X.J., Gu, X., Tenore, E. and Clark, D.A., 1991. Exaggerated intestinal histamine release by casein and casein hydrolysate but not whey hydrolysate. Scandinavian journal of gastroenterology, 26(4), pp.379-384.
  15. Schnedl, W.J. and Enko, D., 2020. Considering histamine in functional gastrointestinal disorders. Critical Reviews in Food Science and Nutrition, pp.1-8.
  16. Rahmoune, H. and Boutrid, N., 2018. Autism & Gluten: The Proof By Regression!. Pediatric neurology briefs, 32, p.9.
  17. Shinohe, A., Hashimoto, K., Nakamura, K., Tsujii, M., Iwata, Y., Tsuchiya, K.J., Sekine, Y., Suda, S., Suzuki, K., Sugihara, G.I. and Matsuzaki, H., 2006. Increased serum levels of glutamate in adult patients with autism. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 30(8), pp.1472-1477.
  18. Xu, L., Sun, J., Lu, R., Ji, Q. and Xu, J.G., 2005. Effect of glutamate on inflammatory responses of intestine and brain after focal cerebral ischemia. World journal of gastroenterology: WJG, 11(5), p.733.
  19. Frye, R.E., Sequeira, J.M., Quadros, E.V., James, S.J. and Rossignol, D.A., 2013. Cerebral folate receptor autoantibodies in autism spectrum disorder. Molecular psychiatry, 18(3), pp.369-381.
  20. Ramaekers, V.T., Sequeira, J.M., Blau, N. and Quadros, E.V., 2008. A milk‐free diet downregulates folate receptor autoimmunity in cerebral folate deficiency syndrome. Developmental Medicine & Child Neurology, 50(5), pp.346-352.
  21. Jyonouchi, H., Sun, S. and Itokazu, N., 2002. Innate immunity associated with inflammatory responses and cytokine production against common dietary proteins in patients with autism spectrum disorder. Neuropsychobiology, 46(2), pp.76-84.
  22. Adams, J.B., Audhya, T., Geis, E., Gehn, E., Fimbres, V., Pollard, E.L., Mitchell, J., Ingram, J., Hellmers, R., Laake, D. and Matthews, J.S., 2018. Comprehensive nutritional and dietary intervention for autism spectrum disorder—a randomized, controlled 12-month trial. Nutrients, 10(3), p.369.
  23. Knivsberg, A.M., Reichelt, K.L. and Nødland, M., 2001. Reports on dietary intervention in autistic disorders. Nutritional Neuroscience, 4(1), pp.25-37.
  24. Knivsberg, A.M., Reichelt, K.L., Høien, T. and Nødland, M., 2002. A randomised, controlled study of dietary intervention in autistic syndromes. Nutritional neuroscience, 5(4), pp.251-261.
  25. Whiteley, P., Haracopos, D., Knivsberg, A.M., Reichelt, K.L., Parlar, S., Jacobsen, J., Seim, A., Pedersen, L., Schondel, M. and Shattock, P., 2010. The ScanBrit randomised, controlled, single-blind study of a gluten-and casein-free dietary intervention for children with autism spectrum disorders. Nutritional neuroscience, 13(2), pp.87-100.
  26. El-Rashidy, O., El-Baz, F., El-Gendy, Y., Khalaf, R., Reda, D. and Saad, K., 2017. Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metabolic brain disease, 32(6), pp.1935-1941.

And How to Select the Right Therapeutic Diet for Your Client’s Personalized Nutrition Needs

If you’re a nutrition or healthcare professional, you’ve definitely run into clients with at least one of the following conditions:

  • Gastrointestinal disorders
  • Neurologic symptoms such as anxiety, depression, brain fog
  • Autism
  • Infertility
  • Lyme Disease
  • Chronic Fatigue Syndrome
  • Autoimmune disorders like thyroid disease, diabetes, fibromyalgia

 And you’re certainly aware that, to truly help your clients, you need to address the root cause of these issues. So, what’s the underlying ‘culprit’ here?

The root cause is often a damaged gut and imbalanced microbiome. These underlying gastrointestinal conditions result in a struggle with inflammatory and digestive disorders.

As such, it’s important to balance the microbiome, remove inflammatory foods, and repair the gut lining in order to restore food tolerance and alleviate symptoms, with the best therapeutic diet tailored to the personalized nutrition (BioIndividual Nutrition) needs of the individual. 

To do so, it is crucial for you to know (i) how foods can repair or harm the microbiome and (ii) how the microbiome’s health can influence tolerance so that you can effectively tailor diet and nutrition advice based on your client’s unique biochemical needs. 

But first, let’s do a quick overview of factors that can harm the microbiome.

How the Microbiome Gets Damaged

At birth and during infancy

The development of the gut microbiome during the first three years of life is influenced by the gut-brain axis as well as [1]:

Maternal exposures like maternal obesity, stress, and infection

Neonatal exposures including mode of delivery (vaginal vs.c-section), antibiotic exposure during labor, and feeding patterns

Adverse childhood experiences or trauma 

Stress and emotions can change the composition of the gut microbiome by affecting bacterial growth and compromising the integrity of the gut lining. This may allow bacteria and toxins to enter the bloodstream. 

Research shows that adverse childhood experiences and trauma were associated with increased gastrointestinal symptoms, and that GI symptoms were associated with anxiety. [2] Furthermore, this particular study showed that in a subset of children, adverse childhood experiences were associated with changes in diversity of the microbiome and in bacteria levels.

Poor dietary choices

A diet high in processed meats, sugars, inflammatory oils, and low in fiber can increase inflammation in the gut.

Pesticides, herbicides, and exposure to pathogens

These can damage intestinal tight junctions, promoting gut inflammation which can adversely modulate the microbiome. 

Antibiotics 

An increasing number of studies indicate that antibiotics can result in microbial dysbiosis and the disruption of the microbiota, leading to various diseases. [3]

Proton pump inhibitors 

PPI use is linked with reduced bacterial diversity and profound changes in the gut microbiome, accompanied by an increase in oral bacteria and potential pathogenic bacteria in the gut microbiota of PPI users. [4]

Foods That Cause Inflammation and Damage the Microbiome

How long do you think it takes for diet to alter the microbiome?

According to research [5], the relative abundance of various bacteria species can shift within a day after the food reaches the gut – the microbiota will revert back to its original structure two days after the diet is stopped. The scientists also reported that sticking to a diet for around three days can, not only change the makeup of the microbiota, but alter the behavior of the gut microbes as well.

One proposed mechanism is that foods can also directly disrupt the microbiome since our microbes get to eat what we eat. In one study, researchers found that a Western diet can cause both structural and behavioral changes in the resident microbiome. [6] For instance, a highly processed diet can lead to (i) a permanent loss of bacteria critical for the proper functioning of the microbiome and (ii) an increased levels of endotoxin-producing bacteria in the gut as well as their virulence factors.

Inflammation can directly cause dysbiosis by favoring the growth of Enterobacterial species as well as other pathogenic microbes. Studies suggest that an inflamed gut creates a favorable environment for bacteria that can produce antimicrobials. For instance, Enterobacteriacae can produce colicins which are peptidic toxins that prevent the growth of similar or closely related bacterial strains. [7] 

Specific foods and food components can also damage the mucosal layer, triggering an inflammatory response as described below. The following are foods that can cause inflammation as well as damage the microbiome. 

Gluten

What is gluten? Gluten is a type of prolamin, a toxic lectin known to interact strongly with the brush borders of the intestinal lining. This can damage the gut barrier and cause inflammation. [8] Gluten is the most common food intolerance.

Moreover, numerous studies on gluten, or more specifically, gliadin, the protein component of gluten indicate that it may not be completely broken down during the normal digestive process due to (i) the protein’s structure being incompatible with our digestive enzymes and (ii) the presence of protease inhibitors which neutralize the digestive enzymes in charge of degrading the proteins (and toxins) in food.

Therefore, these protein fragments and toxins can cross the gut barrier largely intact, thereby further damaging the barrier and causing a leaky gut. 

Salicylates

Found in plants, salicylates are a type of phenol which protects the plant against diseases, insects, fungi, and bacterial infection. The body breaks phenols down via a biochemical process known as sulfation which also helps with intestinal integrity.

However, insufficient sulfate supply, having a condition that impairs sulfate use, depletion of sulfates by pathogens, renal sulfate wasting or poor renal reabsorption can cause tissues to be starved for sulfate. [9] This can lead to inadequate sulfation, resulting in leaky gut, gastrointestinal symptoms, and salicylate intolerance. Additionally, pathogens can release phenolic compounds as a defense mechanism and can deplete sulfate and sulfation, either causing or exacerbating salicylate intolerance and digestive distress.

Oxalates

Oxalate is a type of organic acid salt which is naturally present in many plant foods, and can also be produced endogenously. For individuals with a SLC26A1 mutation – that’s the gene involved in oxalate breakdown – oxalates can be toxic and irritate the mucosal lining throughout the body, thereby triggering inflammation. [10] 

Excessive oxalate consumption may also kill beneficial bacteria. [11] For more information about oxalates and their role in chronic illness, click here.

Histamine

Histamine is a biogenic amine which is endogenously produced by mast cells and basophils in response to an inflammatory immune reaction.

In susceptible individuals, histamine may contribute to epithelial dysfunction thereby affecting DAO secretion by the gut enterocytes. [12] This can result in an imbalance between accumulated histamine and the body’s ability to break it down.

Glutamate

Glutamate is an excitatory neurotransmitter which can increase intestinal permeability by triggering inflammation in the gut. This can allow microbial overgrowth in the gut, thus affecting the microbiome.

FODMAPs

These short chain carbohydrates, rich in fructose molecules, are inefficiently absorbed in the small intestine, even in healthy people. Research suggests that, in individuals with a FODMAP-intolerance, a significantly larger amount of these molecules can enter the colon unabsorbed where they act as fuel for pathogens, leading to dysbiosis. Scientists explain that a FODMAP-intolerance can be triggered by a lack of digestive enzymes or a deficiency of GLUT5 which can be further blocked by polyols. [13] 

Grains

 For instance, high-carbohydrate diets consisting mostly of wheat, refined sugar, grains, and processed foods have the ability to damage the gut lining, promoting a leaky gut. As such, elimination of these foods can allow the gut and the microbiome to heal.

Low carbohydrates

The ketogenic diet is very high in fat and very low in carbohydrates, it can either improve the microbiome or be difficult on it. The ketogenic diet is usually low in fiber – gut bacteria ar break down plant fiber to create SCFAs which are anti-inflammatory and protect the gut lining, and thus the microbiome. However, in other cases, the ketogenic diet has been found to improve the diversity of the microbiome.

The Microbiome Can Also Affect Food Intolerance

Scientists who study the gut microbiome have discovered unique microbial differences in patients with food allergies compared to healthy patients. They suggest that the dysbiosis of the microbiome precedes the development of food intolerance.

 For instance:

  • SIBO can thwart the body’s ability to digest FODMAPs.
  • Gut dysbiosis can lead to  sulfate depletion – this could result in an overgrowth of intestinal bacteria which produce phenol and p-cresol and would therefore, reduce tolerance to salicylates and phenols.
  • Antibiotics can wipe out healthy bacteria including oxalobacter formigenes which are involved in oxalate degradation in the gut. This could result in high oxalate levels.
  • H.pylori infections, which can promote GERD and cause peptic ulcers, can also trigger a complex immune response which activates mast cells and histamine release. As such, these infections may decrease tolerance to histamines.

One way to improve your microbiome is via therapeutic diets. Think of it as your client’s personalized microbiome diet.

How Therapeutic Diets Can Help

For nutrition and dietary interventions to be effective, these need to be tailored to individual patients’ specific requirements based on their unique biochemistry, health history, nutrient deficiencies, microbiome state, and genetics.

By addressing these underlying factors, diets can be customized to control the intake of certain foods or food components which could damage enterocytes and the junctions between them, promote bacterial overgrowth, and trigger a cytokine storm.

As such, elimination of these food components can help alleviate symptoms while taking the burden off the system. Moreover, therapeutic diets also promote the consumption of various foods which help our gut bacteria produce various bioactive compounds. These regulate the proteins that form the tight junction complexes and can help heal the gut barrier.

The latest nutrition research indicates that people with an imbalanced or unhealthy microbiome are more likely to react to food compounds such as phenols, salicylates, histamine, oxalates, glutamate, and FODMAPs. 

How to Select the Right Therapeutic / Microbiome Diet

Here’s a brief overview of the various types of therapeutic diets and when they can be useful to personalize the right microbiome diet for your client. Remember to tailor the selected diet to your clients’ needs. You might also want to recommend intake of ceylon cinnamon and turmeric if your client isn’t salicylate intolerant. 

To recap: when your client has a microbiome imbalance or has inflammation from certain foods, a personalized dietary strategy can be very helpful. I always teach the practitioners in my BioIndividual Nutrition Training that dietary intervention is key to healing, and explain how the right diet:

  1. Provides the client relief
  2. Takes the burden off the system
  3. Then allows time to work on underlying factors: microbiome and biochemical pathways/nutrients depleted 

Here’s more on some of my favorite approaches I use when bioindividualizing a dietary strategy.

Diets that Reduce Inflammation and Support the Microbiome

Gluten-free, casein-free, and soy-free diet

The gluten-free, dairy-free, and soy-free diet is definitely the most common and popular low inflammation diet, and a great starting point for most clients.

In one study, investigating the effects of a gluten-free diet on the gut microbiota, scientists found that levels of Veillonellaceae dropped. This bacterium is thought to trigger gut inflammation and is linked to Crohn’s and other digestive diseases. [14]

I advise my clients to eliminate these major gut-disrupting foods for at least 3-6 months to see the full effects of this diet. However, if symptoms are acute, after 2 to 3 weeks on a GFCFSF diet you may consider eliminating further food compounds (in addition to gluten, casein, and soy) in the diets described below.

Low salicylate diet

As we discussed earlier, salicylates can cause leaky gut, gastrointestinal symptoms, and inflammation. And people with dysbiosis may be more intolerant to salicylates. As such, a low salicylate diet can help some people with GI distress. 

If your client presents with gastrointestinal symptoms and has asthma-related or behavior symptoms consistent with salicylate intolerance (such as hyperactivity, aggression, or trouble falling issues, among others), you might want to consider a low salicylate diet such as the Feingold diet or the FAILSAFE diet.

Low histamine (and low amine) diet

A low salicylate/low amine diet may be useful for individuals with low sulfate levels caused by dysbiosis and poor sulfation capacity from genetic or other biochemical reasons.

A low histamine diet is recommended for individuals who often experience facial flushing, itchiness, or nausea after meals, or for those with an H.pylori infection.

Low oxalate diet

As oxalate can irritate the intestinal tract, cause gut inflammation, and kill beneficial bacteria, a low oxalate diet can help with gut and microbiome issues.

Consider a low oxalate diet if your client has kidney stones, or oxalate-related muscle and joint pain. The diet might also be useful for clients with a history of antibiotic use, when the good bacteria that breaks down oxalate may have been wiped out.

Low FODMAP diet

For individuals where FODMAPs fuel pathogens and dysbiosis, as well as cause inflammation and pain, the Low FODMAPs diet can be very helpful.  Clients with SIBO and who have a hard time managing symptoms, especially diarrhea, might want to try this diet especially if more serious culprits have been ruled out.

Low glutamate diet

Individuals with allergies, obesity, diabetes, digestive issues, asthma and other autoimmune diseases may benefit from reducing their glutamate consumption. While this may not reverse their disease, it can help alleviate inflammation, thus allowing easier management of their condition and support healing of the gut.

Ketogenic diet

The ketogenic diet may help individuals with metabolic syndrome, neurological conditions, as well as seizures. However, as they work with their physician, they might want to include resistant starch for SCFA production and to modify the macronutrient composition of the diet for those with a thyroid dysfunction.

Grain-free diet 

The Specific Carbohydrate diet, GAPS diet, and Paleo diet are all wonderful diets to help support the gut by reducing grains and starches which can feed bacteria and pathogens and cause inflammation in the gut. The autoimmune paleo diet protocol is more comprehensive than the paleo diet since it focuses on the elimination of all food components and lifestyle habits that have the potential to damage the gut lining and trigger inflammation including eggs, nuts, nightshades, and more.

Additional healthy diet principles and Foods that reduce inflammation

Fermented foods contain probiotics that can help reduce inflammation and heal the gut lining, which in turn helps improve the microbiome. You want to be cautious with fermented foods though, especially when working with clients who are histamine intolerant.

Prebiotic foods such as chicory root, dandelion greens, Jerusalem artichokes, garlic, onions, leeks, and asparagus can help stimulate the growth of beneficial bacteria in the gut and help reduce inflammation. However, like most substances, always consider BioIndividual Nutrition factors, as they may cause issues in individuals with a FODMAP intolerance.

Conclusion

The microbiome is essential for optimal health and longevity. There is a two-way relationship between diet and the microbiome since (i) what we eat can either support the microbiome or damage it and (ii) the state of the microbiome will ultimately determine what the person can safely tolerate.  

As such, healthcare professionals, especially those who are new to BioIndividual Nutrition, may find it difficult to help clients heal their gut especially if they present with complex medical diagnoses.

My professional Bioindividual Nutrition Training provides a methodology and framework for determining the best interventions for personalized nutrition for clients with specific health concerns and demonstrates how to tailor those plans to meet clients where they are in their health journey, along with all the tools, food lists, and meal plans you need. Check it out here.

 

 

1.  Yang, I., Corwin, E. J., Brennan, P. A., Jordan, S., Murphy, J. R., & Dunlop, A. (2016). The infant microbiome: implications for infant health and neurocognitive development. Nursing research, 65(1), 76.

2.  Callaghan, B. L., Fields, A., Gee, D. G., Gabard-Durnam, L., Caldera, C., Humphreys, K. L., … & Tottenham, N. (2020). Mind and gut: associations between mood and gastrointestinal distress in children exposed to adversity. Development and Psychopathology, 32(1), 309-328.

3.  Zhang, S., & Chen, D. C. (2019). Facing a new challenge: the adverse effects of antibiotics on gut microbiota and host immunity. Chinese medical journal, 132(10), 1135.

4.  Imhann, F., Bonder, M. J., Vila, A. V., Fu, J., Mujagic, Z., Vork, L., … & Dijkstra, G. (2016). Proton pump inhibitors affect the gut microbiome. Gut, 65(5), 740-748.

5.  David, L. A., Maurice, C. F., Carmody, R. N., Gootenberg, D. B., Button, J. E., Wolfe, B. E., … & Biddinger, S. B. (2014). Diet rapidly and reproducibly alters the human gut microbiome. Nature, 505(7484), 559-563..

6.  Zinöcker, M. K., & Lindseth, I. A. (2018). The Western diet–microbiome-host interaction and its role in metabolic disease. Nutrients, 10(3), 365.

7.  Nedialkova, L.P. et al. Inflammation fuels colicin Ib-dependent competition of Salmonella serovar Typhimurium and E. coli in enterobacterial blooms. PLoS Pathog 10, e1003844 (2014)

8.  Alaedini, A., & Latov, N. (2006). Transglutaminase-independent binding of gliadin to intestinal brush border membrane and GM1 ganglioside. Journal of neuroimmunology, 177(1-2), 167-172.

9.  Sonestedt, E., Wirfält, E., Wallström, P., Gullberg, B., Orho-Melander, M., & Hedblad, B. (2011). Dairy products and its association with incidence of cardiovascular disease: the Malmö diet and cancer cohort. European journal of epidemiology, 26(8), 609-618.

10.  Williams, R. J. (2020). Sulfate deficiency as a risk factor for autism. Journal of Autism and Developmental Disorders, 50(1), 153-161.

11.  Peck, A. B., Canales, B. K., & Nguyen, C. Q. (2016). Oxalate-degrading microorganisms or oxalate-degrading enzymes: which is the future therapy for enzymatic dissolution of calcium-oxalate uroliths in recurrent stone disease?. Urolithiasis, 44(1), 45-50.

12.  Suryavanshi, M. V., Bhute, S. S., Jadhav, S. D., Bhatia, M. S., Gune, R. P., & Shouche, Y. S. (2016). Hyperoxaluria leads to dysbiosis and drives selective enrichment of oxalate metabolizing bacterial species in recurrent kidney stone endures. Scientific reports, 6, 34712.

13.  Albert-Bayo, M., Paracuellos, I., González-Castro, A. M., Rodríguez-Urrutia, A., Rodríguez-Lagunas, M. J., Alonso-Cotoner, C., … & Vicario, M. (2019). Intestinal mucosal mast cells: key modulators of barrier function and homeostasis. Cells, 8(2), 135.

14.  Gibson, P. R., & Shepherd, S. J. (2010). Evidence‐based dietary management of functional gastrointestinal symptoms: the FODMAP approach. Journal of gastroenterology and hepatology, 25(2), 252-258.

15.  Bonder, M. J., Tigchelaar, E. F., Cai, X., Trynka, G., Cenit, M. C., Hrdlickova, B., … & Wang, Y. (2016). The influence of a short-term gluten-free diet on the human gut microbiome. Genome medicine, 8(1), 45.

Aggression is a difficult and sometimes devastating symptom that occurs in children for varied reasons—some known and some unknown.

The correlation between food and behavior intrigued me 20 years ago, and sparked my career as a nutrition researcher and clinician.

And aggression is one of the areas parents are most concerned with, when their child has it. I feel for all of them – the children when they can express it later on often feel terrible about it and trapped by this uncontrollable response. And parents worry so much about what this might mean for their child’s future.

It’s a difficult area to study for many reasons, especially for children and adults with autism that cannot speak. Causes and triggers of aggression are difficult for any child to understand and describe (autism or not).

So when can aggression be caused by food and/or improved by dietary choices?

Pain (often gastrointestinal) can cause people to injure themselves or others. We know this because parents and doctors report that when serious GI disorders are addressed, aggression has been known to disappear. Supporting the gut with a special diet can be very beneficial.

Additionally, an imbalance of neurotransmitters or hormones can cause aggression, this can be caused by many things including puberty or microbial pathogens but can also be caused by food reactions, or nutrient deficiencies.

Potential causes of aggression we’ll cover in depth include:

  • Gluten, dairy, soy and food allergies
  • Sugar
  • Phenols and salicylates
  • Amines and glutamate
  • Nutrient deficiencies

Certainly, aggression can happen from the frustration or anger associated with a child being denied food. For the purpose of this article though, we will focus on foods that can trigger/cause aggression from consumption.

Gluten, Dairy and Food Allergens

There is much support for the notion that gluten and dairy can lead to aggression – including published articles and case studies, and a myriad of online anecdotes.

Gluten and dairy can cause aggression in several ways. While not all of the mechanisms have been identified as yet, I do have some theories. If you are eating these foods and your body is creating opiates, opiates themselves can cause mood changes. Additionally, opiates peak and drop, these “withdrawals” from these opiate-compounds can cause irritability and aggression. Also, pain from these foods could cause aggression. Regardless of the underlying mechanism in each case, aggression can improve with a gluten-free, dairy-free, soy-free diet.

Other food allergens can also cause aggression. Doris Rapp, M.D., explains in her book, Is this Your Child, how aggression can be a symptom of food allergy and describes a variety of child case studies where a food allergen (specific to that individual) caused aggressive behavior (1). It could be wheat, dairy, corn, soy, oranges, or other foods. In these cases, they are associated with allergy or intolerance in the individual.

A gluten-free,casein-free (dairy-free), soy-free, and allergen-free diet (specific to the individual’s BioIndividual Nutrition needs) is often a great place to start with dietary changes.

Sugar

Have you been to a toddler’s birthday party and watch (almost in unison) as the kids come down from the “sugar high” and the crying ensues? When they consume excess sugar, one result is poor behavior, mood changes, and yes, even aggression!

Maybe you or a client has experienced this, indulging in a sugary treat only to become short tempered or irritable after. Our children (especially those who are nonverbal and cannot explain what they are feeling) can react even more drastically.

Sugar itself can cause aggression. Research shows that high sugar intake and high fructose corn syrup increases the risk of aggression, as well as ADHD (2).

Also, the after effects of sugar can cause low blood sugar levels which have also been shown to cause aggression. (3)

So sugar can cause aggression by two mechanisms, the sugar itself and the aftermath of the low blood sugar levels it can cause.

Reducing refined sugars can be a simple way to support stable blood sugar and mood. I have many resources on my NourishingHope.com site related to lower-sugar treat options and even recipes with lower sugar or using alternative sweeteners like dates, stevia, or honey.

Phenols and Salicylates

In my one-on-one nutrition practice, I’ve found that phenols, salicylates, and amines are the foods that are (by far) the greatest instigators of aggressive behavior.

Artificial food additives such as artificial colors, flavors, and preservatives are phenol compounds that can trigger irritability, sleeping problems, ADHD, hyperactivity and aggression. Food additives are a well-known cause of aggression—Dr. Ben Feingold and others have been studying this and publishing papers for decades. Dr. Feingold stated in his paper, “Dietary Management of Juvenile Delinquency” that he had 60-70% success with an additive-free diet “for control of behavior.”

In addition to “artificial phenols” there are “natural phenols” in the form called salicylates. Salicylates have a phenolic structure, or aromatic chemical ring, that occur naturally in fruits, vegetables, nuts, herbs and spices, and other plant foods. These foods are rich in wonderful nutrients, but if your body has trouble “detoxifying” the salicylates, they can be a big problem for a child causing significant aggression, hyperactivity, and many other symptoms.

High Salicylate Foods

  • Grapes
  • Apples
  • Strawberries
  • Blueberries
  • Raspberries
  • Melons
  • Tomato sauce and ketchup
  • Oranges
  • Honey
  • Almonds
  • Herbs and Spices: Cinnamon, cumin, turmeric, rosemary and more

One of my client’s children, a boy 10 years old, had daily aggression toward his family and therapists.  It would happen dozens of times per day, seemingly out of the blue.  People were getting hurt and it was a scary situation for everyone involved.  I suspected salicylates as the culprit, and after a dietary trial removing them, his aggression virtually disappeared—it went from 50 times per day to one time a month (and likely that was an accidental exposure)!

Amines and Glutamates

Amines are a different natural food chemical that is processed by the same detoxification pathway, and therefore, often create similar reactions, and people with salicylate sensitivity are more likely to have amine or glutamate intolerance.  Amines and glutamates are found in fermented foods including sauerkraut and yogurt, salami, smoked meats and fish, bacon, canned fish, and broths.  Sometimes I find it is amines, not salicylates, that is the main culprit.

Glutamate, also comes in the additive-form of MSG (monosodium glutamate).  One client I worked with was a teenager—he was very aggressive and only wanted to eat certain things.  When I looked to see what they all had in common, it was MSG as an ingredient. For him, removing both MSG and a food sensitivity made a huge improvement and his aggression diminished dramatically.

For children with aggression, I always explore the possible role of salicylates, amines, and glutamates for causing or contributing to the reaction, as I have seen many times in my practice that removing these foods reduces aggression for those that don’t tolerate them.

Nutrient Deficiencies

Before we wrap up this conversation about food and aggression, let’s discuss how not only food reactions can cause aggression, but nutrient deficiencies as well.

Nutrients are important for building neurotransmitters, as well as hundreds, if not, thousands of functions in the body and brain. And certain deficiencies have been associated with aggression.

Serotonin is the feel good brain chemical that when in low supply not only can cause depression but aggression as well. The amino acid tryptophan converts to serotonin, and low levels of tryptophan are associated with aggression in rat-mouse studies (4). 

Also, vitamin B6, zinc, magnesium, and iron are all important for the production of serotonin – and all of these vitamins and minerals have been showing in studies to cause aggression when low.

Lithium is another important mineral. A well known study showed how areas with little to no lithium in their drinking water had significantly higher rates of violent crime than those with more adequate levels. (5) contains lithium (in low doses) is beneficial. And I’ve heard Dr. James Greenblatt speak on the benefits of low dose lithium at the Integrative Medicine for Mental Health conference and the benefits are quite amazing. (6)

There are more nutrients as well that can be helpful with aggression such as vitamins B1, B3, B5, niacin, and vitamin C. 

A healthy nutrient dense diet and a multivitamin/mineral formula can help supply the nutrients we need for many everyday functions, including more stable mood. 

World of Difference

Aggression can have so many various causes, and food is not the cause for everyone. However, what is clear is that if foods are triggering aggression for a child, removal of those foods can make a world of difference in decreasing aggression, and huge improvements in the quality of everyone’s life.

Further Resources

For a more in depth discussion on BioIndividual Nutrition, a list of common reactions and symptoms, food lists and meal plans for foods containing salicylates, amines, and glutamates, how to implement the diet with your clients, as well as supplement support,  check out my BioIndividual Nutrition Training program for practitioners.

Most thriving nutrition practitioners have a few “secret tools” and strategies that get them results, even for some of the most “difficult cases.”

Throughout my 18+ years as a nutrition professional working with complex neurological and physiological conditions, this one nutritional strategy has repeatedly triggered breakthrough results…  Assessing oxalate levels.

This approach is something that most practitioners are unaware of today; but as YOU learn this one key principle and approach and put it to work for your clients, your practice will thrive too.

I have written extensively on this topic so you may already have some background on oxalates. They are a natural food compound which are found in very high amounts in foods considered “healthy” such as almonds and almond flour, beans, soy, quinoa, dark chocolate, green tea, turmeric, and a list of fruits and vegetables including spinach, swiss chard, beets, celery, carrots, sweet potatoes, raspberries, kiwi, and pomegranate.

A fair number of your clients may have issues breaking down oxalates in their food. Oxalates can cause a host of problems when a person is not able to properly eliminate them, and they build up in tissues, organs, and joints. Some issues are very serious because they cause oxidative stress and mitochondrial damage. And this can cause problems in any system of the body, be it: digestive, neurological, immune, pain-related disorders, and many chronic diseases.

Oxalates can be the cause of the disease or a contributing factor.

If your patient’s oxalic acid marker is high as measured by the urinary OAT lab test (the image featured below is from The Great Plains Laboratory version), you can infer they likely have high levels of oxalate in their body, and may have built up to harmful levels that cause damage and a host of primary symptoms.

I teach practitioners that you can have a normal (not high) organic acid marker (like my colleague Trudy Scott had), and actually still have a problem with high oxalate levels in the body. And subsequently a low oxalate diet may be needed.

You may be a nutrition practitioner who cannot or does not wish to use lab testing…

So how can you determine if the low oxalate diet would benefit your client?

Well, you need to look at multiple factors to truly determine dietary direction.

Within step 5 of my 6 Pillars of BioIndividual Nutrition, one of the things I use to Customize BioIndividual Nutrition Strategy are the steps needed to determine diet direction.

You need to consider all of these options before create a plan, and that requires consideration of multiple factors, laboratory testing being one of them.

The factors I teach in my BioIndividual Nutrition Training program include:

  • Food cravings
  • Diet record, food frequency
  • Reactions to foods
  • Common symptoms
  • Laboratory testing
  • Genetics
  • Client considerations

BioIndividual Nutrition practitioners consider the whole picture when making dietary recommendations. When I look at it from every angle/factor I can paint a more accurate picture of what’s going on. And the best way for me to do that, is to see if several of the above factors are consistent.

Laboratory testing is one piece of the puzzle. When I suspect a client has problems with oxalates, yet their organic acid testing showed “normal,” I would consider all of the factors above to determine if the low oxalate diet was a reasonable strategy.

  • I’d look at their diet record to understand the frequency/quantity of their consumption of high oxalate foods such as nuts, almond flour, beans, potatoes, sweet potatoes, chocolate, beets, spinach, and other leafy greens.
  • I’d investigate any existing reactions to oxalate foods. Have they already noticed some reaction to them?
  • I’d ask and see if my client’s symptoms were consistent with high oxalates such as: fatigue, pain, burning feet, urinary urgency or frequency, anxiety, vulvodynia, kidney stones, pain in the eyes, and others.
  • I’d be curious – do they have any genetic polymorphisms or poorly functioning biochemical pathways that might shed further light on whether oxalates could be an issue? For example, could they have pyroluria (like many mental health patients) and be low in Vitamin B6? We know endogenous oxalate (oxalate internally manufactured) can be caused by low B6. So to best serve my client, I consider these important factors.

So when you are making a determination on your next dietary direction, be sure to keep oxalates in mind, as well as all of the contributing factors in order to save you extra time by avoiding trial and error.

If you’d like to learn all of the ins and outs of the low oxalate diet without years of trial and error, join us for the BioIndividual Nutrition Training, discounted winter enrollment is underway now.

Knowing and applying ONE key principle can significantly improve your practice.

Professionals are joining the program from around the world, I hope you will join us.

Julie

Explore the BioIndividual Nutrition Training Program

CLICK THROUGH…

How would you like it if your clients described you as a “life-changing genius?”

I believe that most of us become nutrition professionals to help change lives. So today, I’d like to share how BioIndividual Nutrition is helping practitioners like you do just that.

The following case study comes from Holly Morello, she’s a Nutritional Therapy Practitioner (NTP) and BioIndividual Nutrition Practitioner – her practice is called Nourishing Excellence.

Holly attended the Nutritional Therapy Association for her nutrition certification, and then graduated from our BioIndividual Nutrition Training and Pediatric Program. She has a passion for nutrition and healing and works with many families to help their children reach their full potential

I believe that case studies are one of the most valuable tools to help us learn, grow, and make a difference for others. Before the days of social media, I used to meet in person at a doctor’s office to share case studies and recommendations. It was incredibly helpful!

Holly’s case will help you in the future when you think through your own client situations – and how to help them, even when they have severe autism. 

Her client, let’s call him, Cody, is a 3 yr. old extremely unhappy boy with severe autism. His parents had him on the GAPS Diet for many months. The results were fantastic, but they had not been able to get past the first stage without experiencing regressed behavior and explosive diarrhea.

So Holly asked me for suggestions on where to go next with Cody’s diet and nutrition plan. We talked for an hour as Holly honed her advice for Cody’s mom.

The story’s not over, they still have things to work on and improve, but soon after Holly provided her new suggestions, the mom wrote to Holly in gratitude, about her being…

“A life changing genius.”

Who doesn’t want a compliment like that?!

Here’s what Holly did, and how BioIndividual Nutrition helped.

Client History

  • Antibiotics since he was born
  • GFCF started originally / saw Improvements
  • Then did GAPS / amazing results on behavior, mood, some good BM’s showed (however, only 5 times total in 5 months) – but were encouraged
  • At the time of the client session he was on GAPS Diet Stage 1, except with lots eggs and bacon, as he was begging for food
  • And he was regressing again
  • Distended belly / begging for food / refusing GAPS soups / weight issue
  • Salicylates issues showing from BioIndividual Nutrition assessment questionnaire, one of the tools in the BioIndividual Nutrition Training (score was 21, with 14 being considered high)

Here are some “alarm bells” that went off for me as I listened to the story, along with some refined BioIndividual Nutrition advice for Holly and her client.

Salicylate/Amine

This client PRESENTS with many symptoms of salicylate/amine reactions, which can include: hyperactivity, inattentiveness, irritability, aggression, defiant behavior, poor sociability, emotional sensitivity, difficulty falling asleep, diarrhea, gas and bloating, and more. Cody had quite a number of these symptoms.

Salicylates were high in his multivitamin and diet from the bacon and other foods. And amines were high in his diet.

How to APPROACH >> Reduce salicylates and do a low salicylate diet trial. If client reacts to ferments then look at amines too. If he has issues with amines then probiotics may cause a reaction. Watch for the type of probiotics used and be careful as some may work better than others. Maybe try a low histamine probiotic.

Current GAPS Diet

The client PRESENTS that they cannot get off Stage 1 of GAPS and still has poor BM’s (but saw 5 good poops in 5 months while on GAPS).

How to APPROACH >> GAPS is very high in amines, so if you suspect amine issues either: 1) do FULL GAPS Diet (not intro) for the most variety and remove broths and high salicylate foods or try the low phenol/salicylate diet (and not a GAPS diet.)

My Suggestions for this Client

Since improvements on GAPS had plateaued (and because it did not seem to be addressing his gastrointestinal issues at this point, he was hungry and not happy on the diet, and because restricting it further with an additional diet approach was even more limiting), I thought loosening up GAPS and moving to a low salicylate and lower amine diet might be very helpful. Based on Holly’s knowledge of her client she agreed and suggested they try this.

RECAP in order of importance for this client

  •  Stop the multivitamin (salicylate concern), add new one after diet changes
  •  Evolve diet from GAPS to low salicylate/amine diet
  •  Use digestive enzymes to improve digestion

I followed up with Holly after these changes were made, and she said,

“My client has made significant gains behaviorally and developmentally. Behavior, mood, eye contact, calmness, language has improved. He was not a happy child and now he is – despite the poop issue.”

And the client’s mother even shared gratitude for Holly being a “life-changing genius!”

Remember; while the GAPS Diet is wonderful, it is a GENERAL “out of the box” approach so to speak. Your clients with complex problems like Cody need SPECIFIC and customized diet and nutrition advice—a BioIndividual Nutrition approach—if they’re going to get the best results.

Holly’s client still has more to go. Healing is like peeling the layers of an onion. You start with one thing, see what improvement is gained and what symptoms remain and then go from there with deeper insight and discernment. Now that Cody’s behavior has improved immensely, they are working on his GI symptoms.

Here are some of the additional suggestions that arose from our bioindividualizing discussion (Holly and I) that might be helpful as next steps for this client:

  • Gut support
  • Microbiome support
  • New multivitamin
  • Minerals
  • Essential fatty acids

And one more important lesson from this client is about gluten infractions. In this case, the boy got an accidental ingestion from some French fries because of a restaurant error. One infraction can cause a significant set back in GI symptoms. Sometimes parents/clients don’t realize the importance of staying strictly gluten and dairy free.

Always let your clients know how important it is to communicate clearly with teachers, loved ones, and restaurants to ensure their diet stays clean.

Here’s more from Holly’s client…

“Holly is incredible; she has helped our boy and our family so much. Over that last 3 months, following Holly’s diet and supplement protocol, our boy has gone from strength to strength and has been the happiest he’s ever been – it’s been the most amazing thing to see. Holly is utterly wonderful and we are so grateful to have found her. Thank you Holly, so much!”

Would you like to have clients raving about you like this?

If you work with autism or related pediatric conditions, consider joining my BioIndividual Nutrition Pediatric Program. Practitioners with other interests (non-pediatric) join my BioIndividual Nutrition Training.

More from Holly

Here’s what Holly said after our call and about our BioIndividual Nutrition Program…

“I feel so much better and confident after my call with you and feel hopeful about working with more autism kids so I think the more of us feeling that way, the more of us helping to reach more kids!”

She has a practice of about 2/3 children. Here are some of the wonderful results she has achieved (the first one is Cody)

  1. An extremely unhappy toddler with severe autism and little verbal skills, eye contact, and inability to stay still is now happy, talking, smiling, maintaining eye contact and is calm. His parents think I am a miracle worker but really, it’s their hard work that has made it happen.
  2. A toddler with extreme digestive issues was about to face surgery and a friend mentioned my work to them so they decided to try nutritional therapy first and during our work together, his surgery was no longer needed and his digestion normalized.
  3. A girl with serious stomach issues, extreme anxiety and ADHD. Her doc had no answers except meds, which were a consideration but they decided why not try nutritional therapy first since it was the summer. Within a couple months, all the symptoms went away and the following school year was a success. This is a very typical client.
  4. A boy with nearly the same issues as above (again, it’s a VERY common theme I see), even had GI scoping done with no findings (also common), after 1 month, nearly all symptoms are gone, and he is now extremely focused and getting his homework done in a timely manner rather than spending endless hours at it. 
  5. Teen girl with similar issues as above plus exponential weight gain and concerning thyroid symptoms – within 3 weeks all these symptoms resolved and troubling weight gain resolved soon afterwards. 

I feel so proud of Holly and our BioIndividual Nutrition Institute members and all they have achieved through their hard work and dedication.

If you’re as passionate about diet and nutrition as we are, I hope you’ll join us!

Learn more about the BioIndividual Nutrition Pediatric Program (if your interest is autism, ADHD, pediatrics), and for professionals addressing a wide-range of chronic disorders, consider enrolling in the BioIndividual Nutrition Training. 

I hope you will join my team!

Julie

Ruminating thoughts, worry, fears, OCD or obsessive tendencies or thoughts, PMS, sleep issues, anger, rage…

Do you or a loved one experience these symptoms?

How about, butterflies in your stomach, physical tension in your muscles, pain… or self-medicating with wine in order to relax?

Honestly, I can relate to many of these symptoms. 

My good friend and nutrition colleague, Trudy Scott, specializes in anxiety. Through my years of nutrition study and practice – and her help – I’ve been able to address many of these symptoms and significantly reduce, or eliminate, them! And you can too!

See, these symptoms are often from low neurotransmitter levels, often due to biochemical insufficiencies, as well as environmental exposures.

And the good news is there is something natural you can do about it! 

Trudy Scott is putting together her 6th Anxiety Summit: This one is on Toxins, Medications, and Infections.

She has given me permission to share some of this amazing information with you from her upcoming summit interview, GABA and Tryptophan: Anxiety-Toxin Connections.

Serotonin and GABA


In it she explains that GABA and tryptophan are amino acids which are used as supplements to boost your neurotransmitter levels (GABA and serotonin, respectively), and improve symptoms of anxiety, depression, and many of the symptoms mentioned above.
 

She sees clients get very quick results with amino acids (under five minutes!)… if they are needed because of low serotonin or low GABA. 

In the interview she explains details of these neurotransmitters, their corresponding symptoms when levels are low, toxins that can interfere with these neurotransmitters and cause anxiety and mood issues, and how to boost them!

I’m so excited to share more with you because I have many clients and Nourishing Hope families that suffer from these symptoms.

In the interview, she explains low serotonin in the following way,

“And then when it comes to low serotonin, these are the symptoms that you could expect; mental worry, this ruminating thoughts, worry, fears, OCD or obsessive tendencies or thoughts, PMS, sleep issues, anger, rage. I often have feedback from mom saying they’ve got kids with huge rage issues. And then with the low serotonin you’ll have the afternoon and the evening cravings. You also may have pain, depression, the winter blues, and you may even have increased anxiety in the winter as well. Similar to the winter blues, we can get more anxious in the winter time as well. And tryptophan is the amino acid that we use in order to support serotonin levels.” 

With low GABA, she states,

“It’s more physical tension. You have the butterflies in your stomach, you may feel physically tense in your muscles, you may feel this really tight in your shoulders. You may have pain as well; sleep can be an issue. And often, we self-medicate with wine in order to relax. And then the amino acid for this low level of neurotransmitter is GABA, it happens to be the same name.”

Now that you understand more about two of the neurotransmitters she mentions in the interview, let’s talk about how the toxins in your home can contribute to low levels of these neurotransmitters. 

Let’s dive into the scientific research – one of the things I love about Trudy’s work – on toxins and neurotransmitters.

Phthalates

The first toxin she discusses is phthalates. These toxins are found in plastics to make them soft, and are contained in many plastics found in the kitchen, vinyl toys, shower curtains, paint, nail polish, and anything with a fragrance (from candles, to air fresheners, and body care products). 

One study looked at 990 university students who were widely exposed to these phthalates which are associated with anxiety, depression, and stress[1]. In another study on prenatal exposure, researchers found that their children who were exposed in utero experienced anxiety, depression, and ADHD[2].

Research shows that phthalate exposure causes anxiety. And in one study on rats, Trudy explains that, “they found that the effects caused by the phthalates could be alleviated by GABA.[3].

Trudy also explains how these plastics can negatively affect male sex hormones, and anxiety like behavior, and that “GABA could participate in the modulation of these reproductive and behavioral effects of phthalates.”

This illustrates how chemicals can cause anxiety and mood changes and how the amino acids taken orally can help.

Pesticides 


Also, pesticides, including ones we use on our pets and in ant bait, can inhibit GABA. 

She discusses one I used to use on my pets, and maybe you do too, called Frontline, known as Fipronil. 

She explains that “it works to kill insects by inhibition of glutamate and GABA activated chloride channels. And the main mechanism of action is blocking these GABAA receptors. And what the research is finding is increased anxiety, aggressive behavior, memory problems, and even Alzheimer’s disease have been connected to this particular insecticide.” 

After listening to Trudy’s interview, I did some research of my own and even found a study on Fipronil and autism, and the use of vitamin C to help[4]. It states,

“Fipronil and pyriproxyfen used in the studied concentrations had significant toxic effects on juvenile zebrafish brain and behavior. They triggered a high increase in the intensity of the antisocial behavior that is similar to a zebrafish ASD research model. Furthermore, oxidative stress was also affected by these insecticides. However, vit. C supplements significantly reduced the neurotoxicity of insecticide mixture and oxidative stress.”

There is so much fascinating and important information in Trudy’s Anxiety Summit interview!

Lead

I want to share one more valuable nugget of 

information on lead, tryptophan, and vitamin C. Lead is a well known neurotoxin. The most common sources of exposure come from lead-based paint in old homes, from paint chips and dust.

In the study, Trudy explains,

“The rats were given oral doses of lead, they were given ascorbic acid, which is vitamin C, and they were given tryptophan for four weeks. Of course, they saw an increase in the blood lead levels, but they found that there was also anxiety and aggression in these rats. They also saw decreased brain serotonin, increased oxidative stress, and decreased levels of reduced glutathione. But what they found is that in the rats that were given the ascorbic acid and the tryptophan, they found a reversal of all of these. 

They found brain serotonin levels went up, the oxidative stress went down, and they found that glutathione levels normalized. And their conclusion is that ascorbic acid and tryptophan can be used to complement chelating therapy in lead neurotoxicity. And clearly, we need robust human studies. But it’s exciting to think that an amino acid like tryptophan could have some of these additional benefits against toxins like lead. And then as I’ve mentioned earlier, fluoride, pesticides, herbicides and phthalates.” 

I hope you enjoyed some of this recap of her interview. It was so robust, I was only able to share a small amount of it, so don’t miss it on the Anxiety Summit

She shares more about: additional neurotransmitters and amino acids, how to use them, what amounts to start with, as well as additional toxins, genes, and nutrients to learn more about to help you or your loved one with anxiety and other mental health needs.

Register today to watch this interview and so many more!

1. Honglv Xu, Xiaoyan Wu, Chunmei Liang, Jie Shen, Shuman Tao, Xing Wen, Wenwen Liu, Liwei Zou, Yajuan Yang, Yang Xie, Zhongxiu Jin, Tingting Li, Fangbiao Tao. (2020). Association of urinary phthalates metabolites concentration with emotional symptoms in Chinese university students.

2. C, Hyland; A, Mora; K, Kogut; A, Calafat; K, Harley; J, Deardorff; N, Holland; B, Eskenazi; S, Sagiv. (2019). Prenatal phthalate exposure and behavior in the CHAMACOS cohort.

3. Huan Liu, Youting Guo, Tongwang Yang, Zhicheng Fan, Minhao Huang, Shuqin Liang, Chunhong Liu. (2018). Intervention effect of gamma aminobutyric acid on anxiety behavior induced by phthalate (2-ethylhexyl ester) in rats.

4. Madalina Andreea Robea, Roxana Jijie, Mircea Nicoara, Gabriel Plavan, Alin Stelian Ciobica, Carmen Solcan, Gilbert Audira, Chung-Der Hsiao, and Stefan-Adrian Strungaru. (2020). Vitamin C Attenuates Oxidative Stress and Behavioral Abnormalities Triggered by Fipronil and Pyriproxyfen Insecticide Chronic Exposure on Zebrafish Juvenile.

Do you have clients who are experiencing regressions right now? Inflammatory response going haywire, despite their usual dietary patterns? Maybe you work with autism families and they are reporting that their children seem to be going through a yeast flare despite anti-candida diets or maybe even anti-fungal therapy? What about clients reporting skin condition flare ups?

Something to consider at this time of year is histamines! Many practitioners are faced with clients or patients reporting worsening of symptoms related to both environmental and/or dietary sources of histamine.

Common physical manifestations of excess histamine:

  • Itchy eyes
  • Runny nose
  • Sneezing
  • Itchy throat
  • Headaches – especially migraines
  • Rashes

Yet don’t be surprised if your client has none of these either! The histamine can be more locally focused, like in the stomach for example, and cause acid reflux. And for clients with auto-immune conditions, their immune response may be atypical

I had a client with a child with autism for example and her son had no outward symptoms of histamine issues yet saw a flare in yeast every spring/fall. Once my client was made aware of this, they were able to reduce high histamine foods, focus on bringing in natural antihistamines, and they were able to bypass this seasonal yeast flare as a result! It was an answer to a long-standing question of why each year they saw this pattern. Getting an answer, and something to do about it, was a complete win for this family!

The body is usually well-equipped to prevent the build-up of histamine

In the body, histamine is enzymatically degraded one of two ways [5]:

  • Oxidative deamination by diamine oxidase (DAO) into imidazole acetaldehyde
  • Methylation by histamine N-methyltransferase (HNMT) into N4-methylhistamine

However, in some cases, the body may be unable to deal with the histamine produced or consumed either because consumption is too high, or enzymatic activity is too low.

Histamine excess can also place a burden on the immune system so any symptom or condition that is connected with immune function can be impacted by histamine. If you client or patient is expressing that they are experiencing a flare in an inflammatory condition, it is good to ask the following questions.

  • Is there a big “bloom” happening in their region now
  • Do they live in an area surrounded by greenery/trees
  • Have they seen a shift in seasons
  • Has it started getting wet and rainy
  • Are they eating a diet high in amines, histamines, salicylates, or oxalates

You may have plenty of “gray area” clients who don’t have full-blown Mast Cell Activation Syndrome (MCAS) but who suffer from histamine-related issues each year or as the seasons change. If you do have clients who have mast cell activation syndrome, check out the blog I did on When Histamine Goes Haywire which goes much deeper into the biochemistry of histamine as it relates to MCAS. 

So What is a Practitioner to do?

A good clinical assessment is important. Understanding their biggest symptoms or flares can give you the information needed to pinpoint the right nutritional intervention. Then you can look at environmental and dietary patterns that may be contributing to the problem.

Suggesting that your client focuses on lower amine, histamine, and oxalate foods can help calm down the histamine response. 

Foods High in Histamine

Histidine is converted to histamine in the body.

 

There are several foods high in either histidine, which the body then naturally converts into histamine, or histamine itself. A diet high in histidine rich foods will naturally exacerbate the symptoms and is usually combined with other causes of intolerance, as do histamine rich foods. Fermented foods produced using anaerobic bacteria contain high levels of biogenic amines, like histamine, produced when bacteria break down amino acids.  These foods include:

  • Fermented dairy products such as matures cheese (cheddar and gouda are very high)
  • Other processed dairy products such as yogurt and buttermilk
  • Fermented soy products
  • Wine and beer and other alcohols
  • Processed and cured meats (salami, pepperoni, cured meats, deli meats, sausage)
  • The ‘nightshade’ vegetables (tomato, eggplant) and also spinach
  • Fermented and pickled foods (sauerkraut, kombucha, pickles)
  • Berries contain benzoates which trigger histamine release
  • Citrus foods liberate histamine

What is a Low Histamine Diet Trial and Why is it Important

A low histamine diet trial is a trial of low histamine foods and supplements designed to provide the body relief from histamine overload. You can gauge response with this approach and help guide your client through the foods and supplements that may be contributing to high histamine levels. Having them keep track of their foods and note symptoms – reduction or exacerbation – can give you great data in moving forward towards lower histamine levels.

A low histamine diet trial involves the elimination of:

  • Foods rich in histamine
  • Foods that release histamine
  • DAO enzyme inhibitors 

Foods Rich in Histamine 

  • Fermented foods: Sauerkraut, kombucha, fermented dairy including yogurt, kefir, sour cream, soy sauce, fish sauce
  • Vinegar and vinegar-containing foods: Pickles, olives, mustard
  • Cured meats: Bacon, salami, hot dogs, sausage
  • Aged, dried, jerky, smoked and less fresh meat and fish, as well as anchovies and mackerel
  • Aged cheese
  • Nuts: Peanuts, walnuts, and cashews
  • Vegetables: Avocados, mushrooms, eggplant, spinach, and dried tomatoes and tomato sauce
  • Dried fruit and citrus fruits
  • Long/slow simmered and roasted foods: Bone broths and pot roast
  • Fermented alcohol: Wine, beer, brandy, port, sherry, rum, champagne
  • Probiotic supplements

Foods That Release Histamine 

  • Bananas
  • Chocolate
  • Alcohol
  • Milk
  • Nuts and peanuts
  • Fruit: Papaya, Pineapple, Strawberries
  • Tomatoes
  • Shellfish
  • Artificial preservatives and dyes

DAO Enzyme Inhibitors

  • Alcohol
  • Tea (black, green, mate)
  • Various energy drinks

Low Histamine Foods 

  • Fresh meats
  • Fresh fish
  • Vegetables (except spinach, pickles, olives, eggplant, mushrooms)
  • Fruits (except bananas, papaya, pineapple, strawberries, citrus, dried fruit, tomato sauce) 
  • Beans
  • Gluten-free grains
  • Butter and ghee 

But, it may take an even more aggressive approach, which may even include a review of probiotics your client may be taking. Probiotics, while wonderfully supportive for many of our clients, can be high in histamine depending on the strains. Ones to be on the lookout for include:

Probiotic Strains That Contribute to High Histamine 

  • Lactobacillus casei 
  • Lactobacillus Bulgaricus 
  • Streptococcus thermophilus 
  • Lactobacillus delbrueckii 
  • Lactobacillus helveticus

Beneficial Probiotic Strains That Help 

  • Bifidobacterium infantis 
  • Lactobacillus gasseri 
  • Bifidobacterium breve 
  • Bifidobacterium bifidum 
  • Lactobacillus salivarius 
  • Lactobacillus rhamnosus (especially GG) 
  • Bifidobacterium lactis
  • Lactobacillus plantarum

For complex cases, reducing even foods higher in salicylate, amines, glutamates, and even oxalates to soothe the inflammatory response.

For the practitioners in my BioIndividual Nutrition Institute, you have access to my comprehensive diets guides for low salicylate, amine, glutamate, and oxalate. These can be wonderful resources for clients looking to reduce their dietary sources. Helping them identify and manage inflammatory responses through nutritional intervention is huge and makes you the most effective clinician you can be!

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129797/

https://pubmed.ncbi.nlm.nih.gov/16461989/

https://pubmed.ncbi.nlm.nih.gov/23545338/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773229/ 

For our clients and patients, changing diet requires time, energy, and money.

When they’re not well, there’s no time to waste on approaches that are not helpful.

So if your recommendations are “wrong,” they may lose confidence in you  as a professional.

I believe that if you’re entrusted to give someone advice about what food and nutrition choices to be making – someone who’s in great pain, or their child has been suffering – you really want to be as “on target” as you can be. 

Personalized nutrition, or BioIndividual Nutrition (my practice/methodology), is about customizing nutrition to the specific needs of each individual. Personalized nutrition is crucial to get the results you and your client want and need. 

It’s becoming increasingly understood as the way to most effectively support the health and nutrition needs of people.

If you are a nutrition professional, you may have seen the positive results you get when you help a client find the right diet. 

And if you’ve been practicing nutrition for years, you’ve likely seen this pattern emerge time and time again. 

This has been my experience, which is why I developed this approach of personalized/bioindividual nutrition.

Each person is unique. An individual has different genetics, prenatal nutrition, birth experience, childhood experiences, health history, pathogen exposure, diet, nutrient intake, and lifestyle. This means our genetics, biochemistry, metabolism, and microbiome are different.

That’s why our food and nutrition needs will be different, and our diet and nutrients needs to be individualized.

Functional medicine doctors, nutritionists and researchers are realizing that a personalized, bioindividual nutrition approach leads to the best results for clients and will be the way nutrition is practiced, now and into the future.

Personalized Nutrition and BioIndividual Nutrition

I was excited to read a recent position paper by The American Nutrition Association entitled “Toward the Definition of Personalized Nutrition: A Proposal by The American Nutrition Association”[1]  because it explained the importance of utilizing Personalized Nutrition (PN) to support clients and patients optimally. It states:

“PN [Personalized nutrition] is a field with great potential to address chronic disease and optimize human health and performance.”

I couldn’t agree more! My work over the last 2 decades has validated the intricate interplay between our environment, individualized biochemistry, genetics, food, and nutritional factors in health conditions… and the need for bioindividual nutrition.

As a Certified Nutrition Consultant and published researcher specializing in autism and related childhood neurological disorders, I learned long ago that the approach most effective with my clients was a personalized, or BioIndividual Nutrition, approach. I found when I addressed the specific dietary and nutritional needs of the individual they improved significantly.

By specializing in one area, autism, I was able to dive deep and see hundreds of children with this condition and determine what approach was the best for the neurological, immune, and digestive difficulties/differences they had. This then allowed me to see how to apply food and nutrition strategies individually to each client.

I listened and observed how different diet strategies helped different people. I studied their symptoms, underlying biochemistry, observed their labs, nutrient deficiencies, genetics, family history. I studied the various diets and why they were purported to work.

After hundreds of client interactions, I observed patterns… patterns in their symptoms and certain food compounds, patterns in underlying biochemistry, laboratory test markers, and dietary needs, and patterns in what diets worked best and additional nutritional needs that required support.

For example:

  • I’d discover one client did very well on a gluten-free and dairy-free diet; however, while another found small or moderate benefit from the diet. 
  • Yet, that second client had tremendous gains after adding a low salicylate diet.
  • Someone else would tell me that the Specific Carbohydrate Diet or GAPS Diet did wonders for their child, while the next seemed to get worse on the same diet.  

Because I had clients with the same condition coming to me using different diet approaches… and getting different results. I was able to see what was working for whom and why, and why certain approaches didn’t for an individual. 

And after seeing how these same diets helped their parents, siblings, and relatives (with different conditions but with the same underlying factors)…  it even further solidified that these principles can address the underlying factors causing most chronic disease. 

Over many years I gained a body of knowledge that was helping people get better, so my fellow practitioners began to ask me to teach them what I know. This was how my BioIndividual Nutrition Institute was born.

BioIndividual Nutrition stems from the concept that no one size fits all – and therefore there is no one size fits all diet or nutrition plan. That is the foundation for my training program. 

I created the BioIndividual Nutrition Institute and the 6 Pillars of the BioIndividual Nutrition® Framework, a methodology to train practitioners in what I call “BioIndividual Nutrition®.” Practitioners learn how to apply dozens of different diet and nutrition strategies to the unique individual needs of the person.

Because this is a subject I am deeply passionate about, I wanted to share with you my thoughts on research and published papers into personalized nutrition.

Personalized Nutrition Research

In a recent paper in the Journal of the American College of Nutrition article by Bush, et al, the authors state:

“Personalized Nutrition Holds Tremendous Potential To Improve Human Health”

They describe how personalized nutrition has “come about relatively recently, is based in scientific evidence, relies on analytical technologies as well as the coaching of trained practitioners, and is multidisciplinary, drawing on knowledge from other fields such as genomics, epigenetics, systems biology, medicine, and behavioral sciences in addition to traditional nutrition science and clinical practice; and PN enables further tailoring of interventions to meet the needs of individuals or specific groups of people.” 

The clinicians and researchers writing the paper explain that science and data of Personalized Nutrition fosters an “understanding about the impact of genetic, phenotypic, biochemical and nutritional inputs on an individual’s health.”

They also mention that “biochemistry, metabolism, genetics, and microbiota contribute to the dramatic interindividual differences observed in response to nutrition, nutrient status, dietary patterns, timing of eating, and environmental exposures.”

This is true. 

Chronic disease is typically caused by a combination of genetic predispositions and environmental assaults, and “Understanding Chronic Disease” from this perspective is the first pillar of BioIndividual Nutrition

And, nutrition is the link between our genes and our environment.

Nutrition can bridge that gap and help overcome challenges with genes and biochemical pathways that are not functioning optimally and can help address and overcome environmental exposures.

BioIndividual Nutrition is the STRATEGIC use of NUTRITION personalized to the individual’s biochemical (and other) needs.

The interaction between our environment and genes is the main cause of chronic disease.  Let’s dive into these…

Environment

Environmental exposures such as chemicals, mold, infections, and toxins can create vulnerability, depletion of nutrients, and damage to a person.

Nutrition is key with environmental exposures. Nutritional deficiencies can cause us to be more damaged by toxins.

An interesting study on heavy metals and nutrition status highlights this well. Researchers found that, “Malnourished individuals, especially women of reproductive age and young children, may be more vulnerable to adverse health effects of chemical exposures.” [2]

In addition to causing depletion of nutrients, poor nutrition can cause us to be injured by toxins we might otherwise be able to handle. So environmental exposures can not only cause depletion, the depletion causes more damage from the toxins. 

The interplay is important to understand, and well trained practitioners can use strategic nutrition as a way to help support the link between our genes and environment.

While we might not be able to change our genetics and our past environmental exposures. We can do something about our nutrition that can both overcome deficits and nourish the body so we can handle exposures and our biochemical situation better.

Genes

Genetics plays an important role in personalized nutrition. Your genes inform what you can eat and what you eat informs how your genes express themselves.

Nutrigenetics is the branch of science about how your specific genome should inform what and how to eat to maximize health

And nutrigenomics is the scientific study about how the foods you eat change how your genes are expressed.

Both of these areas are important for us to understand and consider as nutrition and health professionals when bioindividualizing diet and nutrition recommendations.

Personalized dietary intervention through the use of therapeutic diets tailored to the individuals genetics is crucial and can make a profound difference in healing. 

In a paper by International Society of Nutrigenetics/Nutrigenomics (ISNN), they authors state  “Individuals respond differently to lifestyle interventions, especially those modulating diet, because of genetic variants that influence how dietary components are absorbed, metabolized and utilized. Therefore, dietary advice that is specific to individuals with a particular genotype should be more effective at preventing chronic diseases than general recommendations about diet.” [3]

In another published paper, the authors explain why nutrigenomics is so important, “Nutrigenomics seems to be a promising approach to identify new biomarkers in nutrition, through an integrative application of transcriptomics, proteomics, metabolomics, epigenomics, and nutrigenetics in human nutritional research. [4]

The more we can identify the biomarkers and underlying factors affecting an individual’s nutrition and overall health, the more we can apply personalized nutrition.

Tailoring food and nutrition to the unique needs of the individual is a powerful link between our genes and environment. 

We can take this even further by understanding the specific phenotype of the individual and other underlying factors that influence their condition.

BioIndividual Nutrition®

The BioIndividual Nutrition model includes personalizing nutrition based on:

  • Inflammation
  • Immune Dysfunction
  • Poor Digestion
  • Microbiome
  • Dysbiosis
  • Poor Methylation
  • Poor Transsulfuration
  • Poor Sulfation
  • Poor Detoxification
  • Mitochondrial Dysfunction
  • Cellular Metabolism
  • Gene Expression.

The BioIndividual Nutrition Institute bases its teachings on the latest scientific research and evidence, both published and clinical. We coach our trained practitioners and use analytical technologies such as our online Dietary Assessment Questionnaires, symptom charts, genetics, functional lab markers, as well as provide clinical guidance. 

All of these aspects are essential in the BioIndividual Nutrition methodology and taught at the BioIndividual Nutrition Institute Training program. 

Bioindividual Nutrition also takes into consideration the clients diet, nutrition, nutrient status, dietary patterns, toxin and infections, symptoms, and further considerations such as travel for a busy executive or picky eating in a child with autism.

Learn more about the BioIndividual Nutrition Institute and our training programs. 

The BioIndividual Nutrition Training combines cutting edge nutritional science with tools and guides to improve your clinical success and save you time during consultations. You will dive deep into how to correct underlying imbalances seen in clients who have complex neurological and physiological needs such as gastrointestinal ailments, autoimmune disorders, autism, and anxiety.

You’ll be prepared with handouts, guides, questionnaires, and templates so that you know when and how to implement each advanced diet without guesswork.

The BioIndividual Nutrition Training program details dozens of therapeutic diets; explaining how to adapt for individual food allergies and sensitivities such as: gluten, dairy, salicylates, amines, histamines, glutamates, oxalates, and FODMAPS for clients with a wide variety of health conditions. 

Our training includes a deep understanding of dozens of special therapeutic diets along with food lists and meal plans and implementation instructions and handouts to bioindividualize diet strategies.

Therapeutic Diets

This means you’ll get much greater patient compliance and outstanding results

Our Foundational Training is for practitioners that work with a wide range of disorders from autoimmune conditions to digestive disorders and who want to master the use of therapeutic diets to get breakthrough results with even the most complex clients. 

Our Pediatric Program consists of BOTH training courses (the Foundation training on all of the special diets for all chronic disease AND our Pediatric Intensive for those specializing in children and autism).

Personalized, BioIndividual Nutrition is the future of health care.

Join our over 700 practitioners from 46 countries that are just like you.

Fall 2021 Enrollment Opens Soon!

Tuition savings – Limited Enrollment

…CLICK THROUGH to EXPLORE

1. Bush, C. L., Blumberg, J. B., El-Sohemy, A., Minich, D. M., Ordovás, J. M., Reed, D. G., & Behm, V. A. Y. (2019). Toward the Definition of Personalized Nutrition: A Proposal by The American Nutrition Association. Journal of the American College of Nutrition, 1-11.

2. Kordas K, Lonnerdal B, Stoltzfus RJ. Interactions between nutrition and environmental exposures: effects on health outcomes in women and children. The Journal of nutrition. 2007 Dec 1;137(12):2794-7.

3. Ferguson LR, De Caterina R, Görman U, Allayee H, Kohlmeier M, Prasad C, Choi MS, Curi R, De Luis DA, Gil Á, Kang JX. Guide and position of the international society of nutrigenetics/nutrigenomics on personalised nutrition: part 1-fields of precision nutrition. Lifestyle Genomics. 2016;9(1):12-27.

4. Rubio-Aliaga I, Kochhar S, Silva-Zolezzi I. Biomarkers of nutrient bioactivity and efficacy: a route toward personalized nutrition. Journal of clinical gastroenterology. 2012 Aug 1;46(7):545-54.

Oxalates are finally getting their due!

When I started working with the low oxalate diet 15 years ago, no one was talking about oxalates at all (outside of kidney stones). But I’m noticing a big awareness of oxalate in recent months which I am very excited about.

If you’re a practitioner and you want to be up on the latest important oxalate information, join me for this interview I did with Donna Gates. Register here.

I explain oxalates, salicylates, and the sulfate/sulfation connection, as well as share information on lectins and other food intolerances and how we can positively influence our health by understanding these nutrition concepts and the genetics involved.

We do a deep dive into oxalates and the biochemistry involved including the nutrient co-factors that are important. I explain the role of poor sulfation and how that can affect not only oxalate issues, but also salicylate sensitivity.  

And since this is a genes summit, I explain many genes that can be a factor in these biochemical imbalances and food intolerances. 

Some of the genes, their functions and co-factors include:

AGXT enzyme – converts oxalate and glycine back and forth (B6 co-factor)

DAO enzyme – converts glycine to oxalate (B2 co-factor)

HAO1 enzyme – converts glyoxylate to oxalate (B2 co-factor)

HOGA1 – hyperoxaluria type 3 – overproduction of oxalate – conversion of hydroxyproline to glyoxylate

LDH enzyme – converts glyoxylate to oxalate

GRHPR enzyme – converts  glyoxylate to glycolate

Oxalate can be generated endogenously (i.e. inside the body). This can be from glycine and hydroxyproline supplementation or foods such as gelatin and collagen, as well as ascorbic acid. Glyphosate can also be a source of the oxalate problem. See, glyoxylate is converted to oxalate, unless we have vitamins B6 and B1 since the enzymes involved with this conversion are dependent on these nutrients.

The low oxalate diet is something I have been helping clients with for over 12 years, and I love sharing my clinical experience and biochemistry knowledge with practitioners and individuals looking for answers in their own health.

I also discuss: SUOX, SULT, SAT1 genes and their relationship to sulfate levels and sulfation.

Challenges with these genes can cause intolerance or an inability to consume certain food and food compounds; such as, salicylates, amines, oxalate, and others.

Join me for the Genius of Your Genes Summit and discover more on genes, biochemistry, food reactions, therapeutic diets, and BioIndividual Nutrition.


What makes one nutrition professional more clinically successful than another?

Specifically, why do some practitioner’s clients get radically better (despite years of struggle) when others cannot figure out how to resolve their troublesome symptoms?

I have learned some of the reasons why, and in this article I share 5 common errors that inhibit results.

…then I give you insight to avoid them and help improve your overall success.

I’ve helped hundreds of clients with disorders resulting from complex neurological and physiological needs, and I discovered some interesting and important information that can help you…

I tend to see the “tough cases,” the “non-responders,” in my nutrition practice.

By the time they’ve come to me, clients have already seen 3 or more practitioners that have provided nutrition advice, yet they still have not gotten better.

I’ve always investigated why their prior practitioners were unsuccessful. And as I explored each of their case history files, I uncovered what they had overlooked.

Here are 5 Errors to Avoid…

#1 Being Too Dogmatic

There will always be a latest trend in diet. A diet becomes popular because it works well for a subset of people, or for a finite period of time. Some practitioners jump on board and start recommending that ONE popular diet for MOST their clients. They become blinded by their love and loyalty to that diet and cannot see that a different approach might be necessary.

Practitioners who are dogmatic about one dietary approach, are not able to see that it’s the wrong diet for their client because they don’t know how to cater to the biodindividual nutrition needs of the unique person.

Nutritional needs change over time and combining several different diet principles can allow consistently better clinical success. For example, while following a grain-free diet such as SCD or GAPS, a low FODMAPs or low oxalate diet may ALSO be necessary. Dogmatic thinking prevents that small dietary tweak from happening, even though it could make the difference between success and failure! Knowing how to be flexible, yet targeted, is key.

There is no dogmatic thinking in the BioIndividual Nutrition training, we teach you how to think not what to think.

#2 Being Too Rigid

When a practitioner insists that a certain diet must be done a certain way, and becomes inflexible – even if its not working. For example, a client on a special diet that emphasizes certain foods like bone broth or sauerkraut multiple times per day, but the individual has a food reaction to the amines or glutamates in those foods.

The client does not feel well, but the practitioner insists that it cannot be the “sacred foods” on the special diet, and instead assumes the client must be making a mistake or needs to be more strict. But then the client gets worse, not better.

Even within a special diet, food choices and rules may need to be modified, i.e. removing allowed foods (or adding non-compliant foods) in order to see success on that diet. In the BioIndividual Nutrition training, you’ll learn the specific strategies you need to make these kinds of complex customized recommendations.

#3 Being Too Simplistic

Some practitioners focus solely on “health food” diet. The challenge is that one man’s medicine is another man’s poison. Even certain “health foods” can be a problem for some people to the point of causing serious reactions including pain, inflammation, or digestive challenges.

A common example is practitioners who recommend almond flour as a grain-free alternative, without realizing that many people who need special diets have sensitivities to salicylates or oxalates, the compounds found in high levels in this health food. As a result, the individual’s health may be negatively impacted and the practitioner will see negligible improvements in their client’s symptoms.

Understanding the complexity of naturally occurring food chemicals and compounds can be the difference between being a world-renowned nutrition expert, or not.

#4 Being Too Overwhelming

You can make the best diet recommendations, but if your patient is confused on how to implement the diet, feels overwhelmed, doesn’t have the resources to make the diet work, isn’t certain of what to eat, or doesn’t know how to fit it into their lifestyle, then they will not make the necessary changes.

Without strategies, resources, lists, charts, and guides for helping your clients implement the complexities of a new diet, implementation will be unlikely, and their health does not improve…that’s why my BioIndividual Nutrition training provides practitioners with client handouts and resources to improve the process of transitioning/sustaining a new diet and addresses their leading questions.

#5 Being Too Limited/Restrictive

Some practitioners understand the value of all the different therapeutic diets, but they are not able to determine which diet to implement, prioritize, stagger, alter, or combine. Therefore the practitioner recommends implementing three or four diets simultaneously, causing the client to have too few foods to choose from. The variety in the diet suffers, and the client may develop nutrient deficiencies or food sensitivities to the few foods they are able to eat.

To prevent this problem, practitioners need to learn about common symptoms, underlying biochemical imbalances, and how to prioritize the right diets at the proper time. Doing so will ensure success with even the most complex and sensitive patients.

This is an advanced strategy of combining special diets and preventing over-restriction, something I cover in detail in my practitioner course.

There IS more you can do to help your clients truly feel better!

To start integrating these advanced strategies in your practice and become the MOST successful practitioner in your field, enroll in the BioIndividual Nutrition training.

Summer enrollment is open.

Explore the BioIndividual Nutrition Training program now.

The right personalized nutrition plan for your client can bring about profound improvement and benefit.

In this article, I want to focus on a diet that can be helpful for your clients, especially those with gastrointestinal issues: The low FODMAPs diet.

For those not familiar with FODMAPs, it is an acronym for fermentable oligo-, di-, monosaccharides and polyols – which are short chain carbohydrates and alcohol sugars fermented by bacteria. And the Low FODMAPs diet is an elimination diet that removes/reduces these foods when they cause difficulty for an individual.

Low FODMAPs diet restricts foods such as: certain fruits with high fructose like apples, pears and mango; high fructose corn syrup; lactose-containing dairy products; fructans such as onions, garlic, inulin, and wheat; galacto-oligosaccharide rich foods including beans and legumes, as well as foods with polyols like avocados and prunes.

The sugars reduced or eliminated on a low FODMAPs diet need to be digested and absorbed in the gastrointestinal tract, and some people have a decreased ability to digest these disaccharides and/or absorb the monosaccharides. Oligosaccharides and polyols need to be fermented by bacteria, and some people have either too much or too little of the wrong bacteria in the wrong place, causing pain and digestive upset with these carbohydrates and sugar alcohols.

When you consume FODMAPs, they travel through the gut and are a food source for your gut microbiome. Unfortunately, when imbalanced gut bacteria eat FODMAPs they can produce hydrogen or methane gas – causing gastrointestinal discomfort in sensitive people. FODMAPs can also trigger diarrhea by bringing water into the gut. For people with a food intolerance to FODMAPs, symptoms may include gas, bloating, distension, diarrhea, or constipation. In fact, FODMAPs have been linked with IBS.

A severe GI disorder like IBS causes significant pain and discomfort, and supporting our clients quickly and effectively is important. Nutritional intervention can be powerful in reducing or eliminating GI distress. That is where the low FODMAPs diet can be effective for some clients, but not all. So who needs to be on a low FODMAPs diet?

This is something that I cover extensively in the BioIndividual Nutrition Training program. I teach practitioners in my professional program to consider symptoms, diet history, conditions, lab results, genetics, microbiome, and more.

Below, I break down 8 different research studies looking at the low FODMAPs diet and how it may benefit your clients and patients with IBD, IBS, and fibromyalgia.

Efficacy of Diet Therapy in IBD: A Review

Although dietary choices play a crucial role in the progress of inflammatory bowel disease (IBD), diet is rarely addressed by clinicians, probably due to lack of nutrition knowledge and time constraints. This study includes many diet therapies including low FODMAPs.

A 2019 review of clinical studies conducted over the last 3 to 4 years concludes that:

  • Exclusive enteral nutrition (EEN) (aka tube feeding) is effective in cases of complicated Crohn’s disease (CD) with either inflammatory strictures or enterocutaneous fistulas but isn’t useful in ulcerative colitis (UC). EEN helps decrease antigen exposure in the intestines and thus reduces the likelihood of an anti-inflammatory response in the body.  However, EEN is unpalatable and may not be an effective long-term solution.
  • Crohn’s disease exclusive diet combined with partial enteral nutrition is a promising approach for patients with severe CD. This diet eliminates all foods that could promote gut dysbiosis.
  • Specific carbohydrate diet (SCD), which eliminates complex carbohydrates and processed foods, is recommended for both CD and UC. However, the review’s authors do not prescribe this diet in their practice due to excessive weight loss and adherence issues. The authors also recommend monitoring vitamin D levels in patients who choose to be on the SCD.
  • Autoimmune paleo diet (AIP) involves eliminating pro-inflammatory foods as well as those that can damage the gut’s lining. While results are promising, more studies are needed.
  • Low FODMAP diet is recommended for patients with active GI symptoms or with structuring or fibrostenosing disease. 

The efficacy of the following supplements was also reviewed:

  • Curcumin – 3g/day recommended for patients with moderate UC
  • Omega-3 – Not currently recommended due to lack of observed benefits
  • Vitamin D – 50,000IU weekly if lab results indicate a deficiency

The authors concluded that, while it is important to address the benefits of diet therapy in IBD, it is also crucial to come up with strategies that will ensure long-term adherence to the diet.

Study Reference: Damas, O. M., Garces, L., & Abreu, M. T. (2019). Diet as Adjunctive Treatment for Inflammatory Bowel Disease: Review and Update of the Latest Literature. Current treatment options in gastroenterology, 17(2), 313-325.

The low-FODMAP Diet and IBS: Efficacy, Adherence, and Weight Management

The low FODMAP diet eliminates highly fermentable carbohydrates and has shown promising results for patients with digestive issues like IBS. However, since it is quite restrictive, the low-FODMAP diet can cause excessive weight loss and is considered by many to be difficult to adhere to.

In a recent 8-week study which aimed at assessing the tolerability of the low FODMAP diet, scientists recruited 63 patients with IBS. The participants’ complaints were recorded on a validated questionnaire before and after implementing standardized dietary advice about the low FODMAP diet. The Bristol stool form scale was used to document characteristics of bowel movements.

The results confirmed the effectiveness of the low FODMAP diet for patients with IBS.

While 30 patients (47% of the study sample) dropped out of the study and 36% of the remaining patients reported considerable weight loss during the study…

79% of the patients who completed the study reported significant improvement in their overall symptoms:

  • Abdominal pain – 85%
  • Meteorism (rapid accumulation of intestinal gas) – 79%
  • Flatulence – 69%
  • Borbogymi (rumbling or gurgling noise in the intestine) – 69%
  • Fatigue – 69%
  • Nausea – 46%

Moreover, the severity of symptoms decreased, and stool characteristics improved in 14 patients.

Study Reference: Frieling, T., Heise, J., Krummen, B., Hundorf, C., & Kalde, S. (2019). Tolerability of FODMAP–reduced diet in irritable bowel syndrome–efficacy, adherence, and body weight course. Zeitschrift für Gastroenterologie, 57(06), 740-744. 

The low-FODMAP Diet and IBS: Efficacy, Adherence, and Weight Management

According to a study published this year, the IGUBAC Diet® plus a turmeric-based supplement could help alleviate some of the symptoms of fibromyalgia in the short term.

13 women aged 30 to 60 were selected from the Research Centers in Nutrition and Health, and Asociación de Fibromialgia de Madrid, in 2016. None of these women were pregnant, breastfeeding, under corticoids medication and none had renal disease, turmeric allergies, or a severe psychiatric disorder. They were randomly allocated to the study group or the control group.

For 1 month, women in the intervention group received:

  • 500mg of a turmeric-based supplement, since turmeric is a natural anti-inflammatory painkiller. 
  • The IGUBAC Diet® (Inflammatory Gut-Brain Axis Control Diet) which is (i) gluten-free, (ii) low-FODMAP, (iii) low in histamine and other amines, (iv) preservative free, and (v) consists of natural foods. In a nutshell, this diet focuses on the interconnection between food, inflammation, and the gut-brain axis.

After one month of treatment, the scientists reported:

  • Considerable improvements in pain disturbances in work activities.
  • Moderate (but not statistically significant) decreases in the Fatigue Symptom Score which helps assess the presence and severity of fatigue in fibromyalgia patients.
  • No significant improvement in CPGS (which measures pain intensity and pain-related disability), PCS (the pain catastrophizing scale), FIS (the fatigue severity scale), and PSQI (the Pittsburgh Sleep Quality Index).

While participants in this study may not have seen much improvement, it is worth noting that (i) the sample size of this study was very small and (ii) the IGUBAC Diet® showed promising results in other studies when it was followed for at least 2 months.

In another paper, this same team from the CINUSA Clinic in Spain have been using the IGUBAC Diet for the:

–treatment of rheumatic diseases, such as fibromyalgia(FM) or irritable bowel syndrome (IBS), in adults

–neurodevelopmental disorders, such as autism or attention-deficit/hyperactivity disorder (ADHD), in children.

They found “modulation and correction of the usual symptoms are achieved in 100% of patients after following the diet at least for 2 months.”

Fibromyalgia is considered as a chronic pain disorder with no cure. These studies highlight adjuvant therapies which include dietary changes and high-quality supplements which could provide hope and needed help to improve the quality of life in those with fibromyalgia.

Study Reference: Martin, I. S. M., Oliva, S. L., Yurrita, L. C., Rojo, S. S., & Vilar, E. G. (2019). Anti-inflammatory and antioxidant feeding and supplementation may serve as adjuvants in women with fibromyalgia. Journal of Nutrition & Intermediary Metabolism, 15, 3-9.

San Mauro-Martín, I., Garicano Vilar, E., & Lopez Oliva, S. (2018). New therapeutic approaches for chronic diseases on the rise: the IGUBAC Diet®. International Journal of Recent Scientific Research, 9, 23083-23088.

Additional FODMAP Studies

The research on FODMAPS is extensive. It’s one of the most researched diets currently. When I put “FODMAPs” into the Google Scholar search bar over 3,500 references come up in the last 10 years alone. Here are a few more study highlights on the effectiveness of FODMAPs…

A diet low in FODMAPs reduces symptoms of irritable bowel syndrome

Study conclusion, “In a controlled, cross-over study of patients with IBS, a diet low in FODMAPs effectively reduced functional gastrointestinal symptoms. This high-quality evidence supports its use as a first-line therapy.”

Study Reference: Halmos, E. P., Power, V. A., Shepherd, S. J., Gibson, P. R., & Muir, J. G. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(1), 67-75.

FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial

Results found, “Histamine, a measure of immune activation, was reduced eightfold in the low FODMAP group (p<0.05). Low FODMAP diet increased Actinobacteria richness and diversity, and high FODMAP diet decreased the relative abundance of bacteria involved in gas consumption.”

And researchers concluded, “IBS symptoms are linked to FODMAP content and associated with alterations in the metabolome. In subsets of patients, FODMAPs modulate histamine levels and the microbiota, both of which could alter symptoms.”

Study Reference: McIntosh, K., Reed, D. E., Schneider, T., Dang, F., Keshteli, A. H., De Palma, G., … & Vanner, S. (2017). FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut, 66(7), 1241-1251.

Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study

In this study, researches found 50% of individuals with inflammatory bowel disease had improvement in symptoms. Abdominal symptoms, abdominal pain, bloating, wind and diarrhoea improved in patients with Crohn’s disease and ulcerative colitis; although constipation did not. Researchers concluded, “These data suggest that reduction of FODMAP intake offers an efficacious strategy for patients with IBD who have concurrent functional gut symptoms. A controlled dietary intervention trial is indicated.”

Study Reference: Gearry, R. B., Irving, P. M., Barrett, J. S., Nathan, D. M., Shepherd, S. J., & Gibson, P. R. (2009). Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study. Journal of Crohn’s and Colitis, 3(1), 8-14.

Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis

In a meta-analysis of 22 studies, 6 randomized controlled trials and 16 non-randomized studies were evaluated. Researchers found a significant decrease in IBS symptom severity scores for individual on a low FODMAPs diet. A low FODMAPs diet was found to significantly reduce the severity of abdominal pain, bloating and overall symptoms. The authors concluded, “The present meta-analysis supports the efficacy of a low FODMAP diet in the treatment of functional gastrointestinal symptoms.”

Study Reference: Marsh, A., Eslick, E. M., & Eslick, G. D. (2016). Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. European journal of nutrition, 55(3), 897-906.

What is clear through these studies is how impactful the right diet can be for improvement in health and wellness, as well as reduction in symptoms and improvement in metabolic markers. Removing problematic high FODMAPs foods, when guided by an experienced and knowledgeable practitioner, can make the world of difference to individuals seeking relief from severe or persisting GI issues (and even other pain related conditions).

To learn more on personalized nutrition and therapeutic diets, like the low FODMAPs diet, and how to use them in your practice as part of a BioIndividual Nutrition plan, explore my BioIndividual Nutrition Training.

When it comes to emerging treatments to address symptoms of autism, few things have garnered the attention (or Google searches) as the fecal transplant. This treatment gained the spotlight in early 2019 after researchers in Tempe and Flagstaff, AZ completed the first clinical trial with very positive results.

Fecal transplants stand on the cutting edge of autism innovation. Recent research highlights these transplants as a treatment for autism spectrum disorder — one that has huge potential. If you’re familiar with autism or my work, you may be aware that gut health can affect autism symptoms, from repetitive behaviors to social interaction.

In the past few years, science has begun to catch up to the idea that the microbiome matters for nearly every facet of health. The microbiome is the unique combination of organisms that live in your body. These microscopic building blocks are specifically concentrated in the intestines.

An excellent microbiome can “prevent disease and optimize health.” For people with autism, the issue is of vital importance, since autism is associated with distinct, severe gut problems and microbiome deficiencies. So, how can we improve the microbiome and expand the good bacteria in the body?

New research is showing that an answer may be found in a total reset of gut bacteria by using the extensive microbiome of a healthy gut, this can be accomplished by a new medical procedure called a fecal transplant. Fecal transplants have, so far, been used with differing levels of success to treat recurrent C. difficile infection, inflammatory bowel disease (IBD), and even Alzheimer’s.

While there’s not enough research yet to make this a widely practiced treatment, it’s worth our attention. Read on for the practice, potential, and pitfalls of this emerging treatment of fecal transplant for autism.

What is a fecal transplant?

Typically, we hear the word “transplant” associated with organs and tissue, but a transplant can refer to moving any specimen from one location to another. This is exactly what happens in a typical fecal transplant — extremely healthy, screened feces is transplanted into the colon of the recipient. This process is also referred to as microbiota transfer therapy (MTT).

This idea was first brought into the arena by Dr. Thomas Borody, an Australian gastroenterologist looking for ways to improve the gut health of his patients. As a doctor specializing in GI problems, he noticed that repopulating the bacteria in the digestive tract could benefit his patients long-term. In fact, he noticed that roughly 90% of patients being treated for recurring digestive diseases saw improvement after the procedure. Now, the ripple effect of this transplant is being studied for other conditions, like ASD.

While a traditional fecal transplant involves implanting a stool sample through a colonoscopy, other ways are emerging to achieve the same benefits. Fecal microbiota transplantation doesn’t have to be a rectal insertion. Truly, any maneuver that allows healthy microbiota to get into the digestive tract can be effective. One study I discuss later in the article involves the purification of waste matter down to just the bacteria, and then provided this concoction of gut microbes, orally. 

This procedure is more effective than an over-the-counter probiotic due to its high diversity and potency, as well as its method of delivery. However, the bowel cleanse required before the procedure is also very helpful, as it provides something akin to a clean slate. In their new home, these beneficial bacteria can begin to improve both the gut-brain axis and autism-related symptoms of the individual. A fecal transplant for autism holds incredible potential.

Autism and Gut Microbiome Problems

Autism is generally known for its neurological symptoms: impairments in behavior, communication, and social skills. As such, most treatments until now have focused on behavior modification, speech therapy, or medication. 

However, at Nourishing Hope, we know good nutrition puts hope into action. In extensive  research, including the paper I participated in, we’ve effectively proven how much diet can affect autism symptoms (improvements in gastrointestinal function and behavior), and this fecal transplant fits right into our gut-centered theory and nutritional strategies.

Why would this highly unusual procedure be necessary? Clinical trials and research alike increasingly show that gut microbiota have a strong connection to both brain development and behavioral symptoms. The greater microbial diversity, the better the odds of a healthy gut. Adding in the gut microbes of a healthier person diversifies the good bacteria, improving social, behavioral, and communication symptoms of ASD.

Unfortunately, children with autism are generally plagued by gastrointestinal symptoms. This is partially due to their unusual microbiomes, with higher ratios of “bad” bacteria than other patients, and lower percentages of “good” bacteria like Bifidobacterium. This lack of microbial diversity, along with disproportionate rates of harmful microbiota, affects everything from the immune system to neurological health. 

In fact, just one bacteria, Prevotella, is commonly lacking in autistic patients. As it turns out, lack of Prevotella is linked to autism-like symptoms. The researchers in this study found that a lack of diversity in the gut influenced symptoms of autism (interestingly, separate from their individual diet, although they did point out the presence of “unusual diet patterns” in the subjects).

This Prevotella study shows that microbiome diversity is a major key to addressing autism symptoms. The connection between the gut and autism is undeniable. The question has been: how can we correct these gut issues to resolve symptoms?

New research in this field may offer one of the first solid answers to this question.

Current Research on Fecal Transplant for Autism

Aware of the major breakthroughs being made in Australia with these transplants, an American team decided to apply them to an issue close to home. Dr. James Adams (my mentor), Dr. Rosa Krajmalnik-Brown, and a team of Arizona State University and Northern Arizona University researchers pursued a more palatable way to perform a fecal transplant for autism. 

The results were far beyond what they were looking for as an outcome of their groundbreaking new open-label trial.

The team at the Biodesign Institute was aware of the rising epidemic of an autism diagnosis. The CDC has estimated that more than one in every 59 children now has ASD. Knowing this link between the potential therapeutic role that a healed gut microbiome can play and the severity of ASD symptoms, they innovated a new angle on a fecal transplant for autism. 

Researchers from the Swette Center for Environmental Biotechnology took the feces of a screened, extremely healthy donor pool. From these samples, they purified out the waste matter. This left the “super probiotics,” or the gut bacteria found in these healthy specimen’s microbiome. Their theory was that this diverse, healthy microbiome sampling would improve not only the childrens’ GI symptoms, but their ASD symptoms as well.

First, the children were prescribed vancomycin, an antibiotic to cleanse the gut microbiome. This was meant to knock out Clostridium difficile  (C. diff) and any other “bad bacteria” existing in the intestinal tract. This assists in the goal to raise the level of beneficial bacteria, since it removes the microbiota that might attack any beneficial bacteria. Next came a bowel cleanse and a half-day fast, then the transplant could begin safely. 

They began taking this probiotic orally in high doses for two days, and lower doses for eight more weeks. A stomach acid suppressant was also used, boosting the new bacteria’s chance of surviving. Each clinical trial participant had their microbiomes tested over these eight weeks, and the results were astounding.

By week five, the scientists saw an 80% reduction in gastrointestinal problems. By week eight, there was a 25% reduction in overall symptoms of ASD. And the benefits continued over two years, and counting.

These kind of results are extremely rare in autism intervention and study! The benefits seemed to last throughout the trial, and preliminary results pointed to a fecal transplant for autism as a real solution.

Recently, the team at ASU conducted a two year follow-up study, published in early 2019. Surprisingly, this demonstrated that the benefits of the transplant are still in effect. More than just continuing far past the expected impact, the children’s microbiomes are even more diverse than at the end of the trial. This potential treatment is a rare breed: one that seems to show even more significant improvements as time passes, and continues benefits after intervention has ended. 

Other proposed therapies in the past have included antibiotics, but benefits end shortly post-treatment. On the other hand, this could have lasting, positive effects on recipients’ overall symptoms and health. A professional evaluator at the two year follow-up found that subjects showed a 45% decrease in core ASD symptoms.

In a startlingly good outcome, 44% of children originally diagnosed with ASD were now below the cutoff to even be diagnosed with autism. This sounds like “autism recovery” to me. This is tremendous news! The improvement in GI symptoms, behavioral and social symptoms, and gut microbiota is a holistic solution to many of the gastrointestinal woes children with autism face.

Areas of Future Study

While the initial findings of this team are promising, further clinical trials are needed to plug certain holes in the current research. The sample size of 18 children is small, and by no means conclusive or applicable to everyone. We would need a much greater number of successful efforts to vet and successfully reproduce the results of this trial. 

Excitingly, the researchers are embarking on a larger, placebo-controlled trial of this fecal transplant for autism in adults. We also aren’t yet sure how these procedures affect adults, since only children participated in the first trial. 

Furthermore, for more well-rounded scientific reports, it would be excellent to include double-blind studies. Removing researchers’ bias will help provide a more unbiased report. There is always a potential for the placebo effect unless double-blinded studies are used. This term refers to the bias in participants that something is changing simply because they’re participating in the trial. 

It may be several years before sufficient research has been published to gain FDA approval for fecal transplant for autism. However, in May 2019, the FDA did give this treatment “fast track status,” meaning it will receive priority in approvals. At the moment, this procedure isn’t performed outside of research settings for this particular condition.

It also remains to be seen exactly how fecal transplant for autism will differ from the development of probiotics. To date, research on fecal transplant therapy displays a much higher efficacy for this therapy as opposed to generalized probiotics. Theories for this are limited, but I think it’s because there are many more strains of bacteria in stool, not to mention other microbes (beneficial viruses, etc.) that likely affect the diversity of the microbiome.

The isolated microbiome of a healthy host in fecal transplant for autism is also different than, say, fecal transplant for C. diff infection. The individualized biome markers used to treat one condition don’t extend to the next condition — an additional reason why a probiotic with generalized bacterial strains is less effective (though may still be beneficial).

Dangers of Fecal Transplants

The FDA published a strong warning about fecal matter for transplantation (FMT) on June 13, 2019. The warning elaborates on a lack of testing that occurred with a stool donation. Unfortunately, that stool was later tested and found to contain E. coli traces. And the effects were deadly for one immunocompromised recipient. 

Of the two known subjects that received a transplant from the infected donor, one died and the other became extremely ill. This poses an extra level of concern since most patients receiving FMT are not in top immune condition, even if they aren’t immunocompromised. Clearly, standardized and thorough testing should be a top priority before administering a fecal transplant for autism or other purposes.

It’s worth noting, however, that no major medical procedure exists without some reasonable risks that may occur in a very small number of cases. 

In light of this development, there are FDA concerns that must be met before it becomes an FDA-approved treatment. Firstly, there is a call for stool donations and donors to be tested for MDROs (drug-resistant bacteria)– such as MRSA, VRE, and resistant Acinetobacter. These typically resist antibiotics and other attempts to medicate, and can be deadly to patients with an already-weak microbiome.

The FDA also urges doctors to openly discuss the risks of this procedure and the investigational nature of fecal transplants. Properly informing and receiving consent from patients is key. Finally, guidelines were recently published about how and how often to screen donations for MDROs. 

Clearly, until these potentially fatal flaws can be worked out of a fecal transplant for autism, it won’t be widely administered. However, as research and standards move forward, its chances improve. Until then, it’s not widely available outside clinical trials. 

Summary

  • Fecal transplants (microbiota transfer therapy or FMT) hold great promise for the future of autism treatment.
  • Unlike most treatments, the positive effects of FMT are long-lasting, increase over time, and have exceptional success in treating ASD core behaviors.
  • A fecal matter transplant gets at the microbiome issues that ASD patients can suffer from, helping with digestive discomfort as it diversifies the microbiome. 
  • While the research is highly promising, larger-scale studies, double-blind participation, and adult patients are needed for a rounded approach.
  • Unfortunately, fecal matter transplants aren’t yet widely available in the U.S., but progress is being made toward FDA approval.

In Conclusion

This helps us to see how powerful and important the microbiome is in autism, and how improving the microbiome can improve symptoms, in cases leading autism recovery. Though it may not compare or replace FMT, while we await further study on fecal transplant, it seems prudent to use the food strategies we know that may be able to positively improve the microbiome. Strategies such as: fermented foods and probiotics, and foods that support the growth of good bacteria like prebiotic foods have been used by nutritionists and functional medicine practitioners for decades. 

Parents should be enthused by the research and scientific vigor of today. Hope continues.

Sources

  1. Mayer, E. A., Padua, D., & Tillisch, K. (2014). Altered brain‐gut axis in autism: Comorbidity or causative mechanisms?. Bioessays, 36(10), 933-939. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/25145752
  2. Hollister, E. B., Gao, C., & Versalovic, J. (2014). Compositional and functional features of the gastrointestinal microbiome and their effects on human health. Gastroenterology, 146(6), 1449-1458. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181834/
  3. Bakken, J. S., Borody, T., Brandt, L. J., Brill, J. V., Demarco, D. C., Franzos, M. A., … & Moore, T. A. (2011). Treating Clostridium difficile infection with fecal microbiota transplantation. Clinical Gastroenterology and Hepatology, 9(12), 1044-1049. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223289/
  4. Cryan, J. F., & O’mahony, S. M. (2011). The microbiome‐gut‐brain axis: from bowel to behavior. Neurogastroenterology & Motility, 23(3), 187-192. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/21303428
  5. Vuong, H. E., & Hsiao, E. Y. (2017). Emerging roles for the gut microbiome in autism spectrum disorder. Biological psychiatry, 81(5), 411-423. Abstarct: https://www.ncbi.nlm.nih.gov/pubmed/27773355 
  6. Horvath, K., & Perman, J. A. (2002). Autism and gastrointestinal symptoms. Current gastroenterology reports, 4(3), 251-258. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/12010627
  7. MacFabe, D. (2013). Autism: metabolism, mitochondria, and the microbiome. Global advances in health and medicine, 2(6), 52-66. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865378/
  8. Williams, B. L., Hornig, M., Parekh, T., & Lipkin, W. I. (2012). Application of novel PCR-based methods for detection, quantitation, and phylogenetic characterization of Sutterella species in intestinal biopsy samples from children with autism and gastrointestinal disturbances. MBio, 3(1), e00261-11. Abstract: https://pubag.nal.usda.gov/catalog/130227
  9. De Angelis, M., Piccolo, M., Vannini, L., Siragusa, S., De Giacomo, A., Serrazzanetti, D. I., … & Francavilla, R. (2013). Fecal microbiota and metabolome of children with autism and pervasive developmental disorder not otherwise specified. PloS one, 8(10), e76993. Full text: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0076993
  10. Kang, D. W., Park, J. G., Ilhan, Z. E., Wallstrom, G., LaBaer, J., Adams, J. B., & Krajmalnik-Brown, R. (2013). Reduced incidence of Prevotella and other fermenters in intestinal microflora of autistic children. PloS one, 8(7), e68322. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700858/ 
  11. Kang, D. W., Adams, J. B., Gregory, A. C., Borody, T., Chittick, L., Fasano, A., … & Pollard, E. L. (2017). Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study. Microbiome, 5(1), 10. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5264285/
  12. Li, Q., & Zhou, J. M. (2016). The microbiota–gut–brain axis and its potential therapeutic role in autism spectrum disorder. Neuroscience, 324, 131-139. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/26964681
  13. Kang, D. W., Adams, J. B., Coleman, D. M., Pollard, E. L., Maldonado, J., McDonough-Means, S., … & Krajmalnik-Brown, R. (2019). Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota. Scientific reports, 9(1), 5821. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456593/
  14. Rosenfeld, C. S. (2015). Microbiome disturbances and autism spectrum disorders. Drug Metabolism and Disposition, 43(10), 1557-1571. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/25852213
  15. Khoruts, A. (2018). Targeting the microbiome: from probiotics to fecal microbiota transplantation. Genome medicine, 10(1), 80. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208019/

Nutritional and dietary intervention is effective at improving non-verbal IQ, autism symptoms, developmental age in children and adults with ASD.

I’m very excited to share the results of a new scientific study on autism: this is my first published paper!

You read that right! I am one of the co-authors of this study, which was led by James Adams, PhD, entitled “Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder—A Randomized, Controlled 12-Month Trial.”[1]

Dr. Adams is the director of the Autism/Asperger’s Research Program at Arizona State University, where he has been studying this condition for the past 15 years. He’s also the father of a daughter with autism.

Five years ago, Dr. Adams approached me and my colleague Dana Laake to help with a study on autism; specifically researching how nutrition and diet can improve the symptoms of autism. He asked that we contribute to the research by educating and guiding participants how to implement a healthy GFCF diet, which was a core intervention of the study.

The Highlights

As a nutritionist specializing in Autism Spectrum Disorder, I’ve been investigating the unique physiology, etiologies, and “bioindividual” biochemistry in people with ASD since 2002; specifically, how food and nutrition choices affect the body and behavior (symptoms) in autism, and how to devise individualized therapeutic diet strategies that help alleviate these symptoms. I’ve witnessed significant improvements in the health and happiness of children with ASD using special diets and nutritional supplementation; from modest digestive improvement to complete recovery. Regardless of the degree to which the person with autism recovers, we see improvement, across the board, with a healthy, gluten free, casein free, soy free diet.

This study supports what many practitioners and parents have been seeing in practice all along. Finally, we have conclusive evidence that nutritional and dietary intervention is effective at improving non-verbal IQ, autism symptoms, and developmental age in children and adults with ASD! There were improvements in anxiety, mood, aggression, hyperactivity, focus, and more!

Thus, I’m thrilled to share the results of this 1-year comprehensive study with all of you. The outcomes were life changing for many of the children that participated, and their families and communities, too.

And there were some stunning recoveries. One study participant recovered so quickly through treatment that she no longer has to use her wheelchair! Simply from dietary and nutritional approaches, another boy no longer has to be catheterized! Other stunning results from this study include: eliminating pica (eating non-food items which can be life threatening) in two children, improving symptoms of autism, helping them connect more with loved ones, and having a better quality of life… all of which were found from this research.

Furthermore, the hope that it brings to the rest of us: that this simplifed approach is safe, accessible. and doable for any autism family!

This study should greatly influence the medical and educational community regarding treating those with autism: for awareness and progress is so necessary, as most doctors are poorly informed. Even the Academy of Nutrition and Dietetics (formally the ADA) erroneously indicates that there “not enough science to support dietary intervention for autism.”

In this article, I’ll discuss the details in this recently published study, and clarify how we used specific supplements with an allergen-free diet, to address the most common etiologies and co-morbidities within the ASD subpopulation.

Who was included in the research?

A total of 117 individuals, aged 3 to 58, enrolled in the study. None of them had taken nutritional supplements (vitamins, minerals, essential fatty acids, carnitine) or consumed “special” diets in the previous two months.

67 of the participants had been previously diagnosed with ASD (autism, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), or Asperger’s). Arizona State University staff verified the participant’s ASD diagnosis using the Autism Diagnostic Observation Schedule (ADOS) and/or the 2nd edition of the Childhood Autism Rating Scale (CARS-2).

The remaining 50 participants were neurotypical, meaning that none of them had been diagnosed with a mental disorder including ASD, ADHD, depression, or anxiety. Moreover, none of these participants had a first-degree relative with ASD.

How was the study conducted?

The study was designed as follows:

Assessment of ASD symptoms

After enrollment, autism severity and overall functioning level were assessed among participants with ASD. ADOS, CARS-2, Reynolds Intellectual Assessment Scales (RIAS), or Severity of Autism Scale (SAS-Pro) were utilized during the evaluation.

Moreover, parents or high-functioning adult participants filled in a medical history form at the beginning of the study. They also completed various questionnaires at the beginning and end of the intervention to assess autism and related symptoms.

Random Assignment

The participants with ASD were then randomly assigned to either the ASD treatment group or to the ASD Non-treatment group as outlined below:

  • The treatment group consisted of 37 participants (30 males and 7 females). This group was composed of 28 children (ages 3 to 12), 6 teenagers (ages 13 to 20), and 6 adults (over 20 years old).
  • The non-treatment group included 30 participants (25 males and 5 females). This group consisted of 20 children, 7 adolescents, and 3 adults.

The neurotypical group consisted of 41 males and 9 females (34 children, 11 teenagers, and 5 adults).

Health and Biomarker Assessments

The study physician physically examined all the participants to ensure that they were sufficiently healthy to participate in the research.

First-morning urine and blood samples were collected once at the start of the study in the neurotypical group and at the beginning and end of the study in the treatment and non-treatment groups and.

These samples were sent for analysis to commercial laboratories approved by the Clinical Laboratory Improvement Amendments (CLIA) program.

The blood biomarkers measured included:

  • Ammonia
  • Lactic acid
  • Creatine Kinase
  • C-Reactive protein
  • Thyroid panel (TSH, T3, T4)
  • Complete Blood Count (CBC)
  • Red blood cells (RBC) minerals and fatty acids
  • Homocysteine-related metabolites (homocysteine, cysteine, methionine)

Treatment protocol

Only participants in the ASD treatment group received the combined treatment protocol.

Participants in the non-treatment group were promised that they would obtain all the supplements and diet advice once the study was completed. The only condition was that they made no significant change to their nutritional therapy, medical treatment, or education treatment for 12 months. This step helped reduce drop-outs.

The treatment group started treatment with a multivitamin/mineral supplementation. The dose was adjusted based on the child’s weight and split into 3 doses (breakfast, lunch, and dinner).

On day 30 of the study, the participants received an essential fatty acid supplement containing 609mg omega-3’s (425mg EPA, 110mg DHA, 74mg other omega 3’s), 198mg omega-6 (including 128mg GLA), and 15mg omega-9. The participants started with 1 capsule daily and then increased to a maximum of 4 capsules daily depending on their weight.

On day 60, participants were asked to take one warm Epsom salt bath for 20 minutes, twice a week. Two cups of Epsom salts and half a cup of baking soda were added to the bath.

On day 90, participants started taking 50mg of acetyl-L-carnitine/kg bodyweight-day. This dosage was gradually increased to a maximum of 2 grams/day over 4 weeks and split into two doses (breakfast and dinner).

On day 180, the participants were advised to take a plant-based digestive enzyme supplement. The dose was as follows:

  • 1 capsule for a snack or small adult meal
  • 2 capsules for a typical adult meal
  • 3 capsules for a large adult meal

On day 210, the participants started a healthy, gluten-free, casein-free, soy-free (HGCSF) diet outlined below.

All the supplements and dietary changes were continued until the end of the study.

Why this protocol?

  • Vitamins/minerals: As mentioned earlier, individuals with ASD have profound nutritional deficiencies which can have deleterious effects on overall health and ASD symptoms. Supplementation can help increase several biomarkers and vitamin status.
  • Essential fatty acids (EFAs): These fatty acids help maintain cell membrane health. It is, therefore, no surprise that an EFA deficiency could adversely affect brain health and lead to depression and psychological disorders.But did you know that our intestines need EFAs to function correctly? In fact, an EFA deficiency could explain why supplementation can help improve GI symptoms that are common in ASD.
  • Epsom salt baths: Epsom salts are magnesium sulfate salts and have been found to be highly effective in increasing plasma sulfate levels. Healthy sulfate levels are required for optimal detoxification, synthesis of healthy brain tissue, intestinal and brain barrier function, neurotransmitter and gastrointestinal functions.
  • Acetyl-L-carnitine: Carnitine is involved in energy metabolism and mitochondrial protection. This compound helps remove potentially harmful substances from the mitochondria and cell so that they can be excreted from the body. In previous research, Dr. Adams found that individuals with ASD who supplemented with carnitine scored better on scales that assessed severity of autism symptoms and global functioning [4].
  • Digestive enzymes: Gastrointestinal symptoms can predict autism severity. Digestive enzymes enhance digestive function and alleviate gastric upset, thus relieving pain and associated autistic behaviors, as well as improving nutrient absorption and nutrition levels.
  • HGCSF diet: If not properly digested, gluten, casein, and soy can favor the production of opiates, which can fit opiate receptors in the brain. This can cause brain fog, trouble concentrating, constipation, and inflammation. Moreover, gluten, casein, and soy can increase intestinal permeability – this can severely affect the gut-brain axis.

Besides removing potential food triggers, the HGCSF diet also aims to heal cells throughout the body (including the gut) by reducing inflammatory proteins, support detoxification pathways, and strengthen the immune system.

My role in this study

Dana Laake and I were the two nutritionists on the team of 15 other medical professionals and academic researchers. I really enjoyed working with Dana – she’s very collaborative, passionate and knowledgeable. I’ve known this lovely person for years, and I’m very impressed with her super smart nutrition brain. Dana is also the author of two successful books.

So, for this study, Dana and I designed a 1-hour power point presentation with audio for the families of the participants in the treatment group. The presentation aimed to help these families better grasp:

  • What the HGCSF diet is all about
  • The science, or what we called the [numerous] “whys” behind the diet
  • How to implement the HGCSF diet easily
  • How to assess the effectiveness of this diet

Dietary changes recommended in this study

In a nutshell, the intervention group was advised to:

  • Consume a nutrient dense diet with adequate organic produce, quality protein, and sufficient calories from healthy fats like coconut oil, olive oil, ghee (certified casein-free if no dairy IgE allergy), and grass-fed tallow.
  • Remove food toxins that place extra burden on detoxification pathways (like MSG, artificial flavors, colors, and preservatives) by avoiding processed foods.
  • Remove foods that promote gut inflammation (such as gluten, casein, soy, sugar, and industrial seed oils).

Now, that you know everything there is to know about this study, let’s discuss the study’s findings.

Findings of this study

Improvements in cognitive, GI function, and medical biomarkers

Compared to the control group, the treatment group experienced significant changes in:

  • Cognitive function as indicated by considerable improvements in non-verbal IQ tests with gains of 6.7 IQ points.
  • The treatment group ‘gained an average of 18 months of development’ with substantial progress in communication, social, and daily living skills. This was 5 times the development over the control group. They also performed significantly better on all of the ASD/behavioral assessments.
  • Gastrointestinal symptoms: Constipation and diarrhea improved as well as stool smell.
  • Carnitine levels increased in the treatment group.
  • Fatty acids levels: DHA and EPA levels increased in the treatment group. Levels of arachidonic acid decreased and could result in a reduced production of pro-inflammatory molecules.
  • Red blood cell minerals: Selenium and chromium levels increased in the treatment group.
  • Homocysteine pathway: The combined treatment helped reduce homocysteine levels to normal.
  • Vitamins: Levels of vitamin B2, B5, folic acid, CoQ10H2, one vitamin B6 biomarker, and cyanocobalamin (a form of vitamin B12) improved in the treatment group.

Improvements in mood, behavior, and focus 

There were significant improvements in the diet and nutrition treatment group based on Parent Global Impressions. These included statistically significant improvement in:

  • Mood/happiness
  • Anxiety
  • Sociability
  • Attention focus
  • Hyperactivity
  • Tantrums
  • Aggression

There were three exceptional cases

Three participants in the treatment group also showed remarkable improvements:

  • A 7-year-old boy with pica was healed entirely within one week of starting the HGCSF diet. Pica is the eating of non-food items like rocks, twigs, or batteries, and it can be very dangerous.
  • A 27-year-old male with severe ASD and a history of severe urinary retention requiring daily catheterization was able to urinate on his own after only 4 days eliminating dairy products. By the end of the study, the young man no longer needed catheterization and had zero episodes of kidney stones, urinary tract or bladder infections.
  • One 9-year-old girl with severe ASD had poor strength, endurance, and energy levels at the beginning of the study. Four months after the treatment, she no longer needed her wheelchair. We found out that her pre-treatment diet was deficient in carnitine due to total avoidance of beef and pork products, so supplementation showed to be critical for her strength and stamina.

Some adverse effects were observed

The following treatments caused a few reactions:

  • Vitamins/Minerals: Two brothers experienced a moderate worsening of behavior and stopped all supplements after 4 months. They did, however, benefit from the HGCSF diet which cured severe pica for one child.
  • Carnitine: This supplement made one child “feel sick” and was discontinued by the parent.
  • Digestive enzymes: The enzymes caused intestinal symptoms in one child who discontinued use after one month. Extended use of this supplement triggered facial rash in another participant who eventually decided to stop taking it despite noticing improvements in behavior and constipation.
  • HGCSF diet: Removing one child’s favorite foods led to frustration and caused behavioral problems as well as an inability to solve problems.

There is No Magic Window

Some people believe in a “window” for treatment, that the older an individual gets the less likely treatment will help. This study proves that wrong! And thank goodness!

It’s always bothered me that people would think that, because I have found it not to be true – and that people of all ages can improve. After all, our message behind “Nourishing Hope” doesn’t exclude anyone, no matter their age or diagnosis. I certainly believe no one should dash the hope of older children and adults unnecessarily and erroneously.

The study found under Age Effects, “An evaluation of changes on all the outcome measures suggests that there was no significant correlation of benefits with age, so children and adults of all ages are likely to benefit from this combination treatment.”

Implementing nutritional and dietary intervention at any age is worthwhile. It’s never too late to be nourishing hope.

Additional insights

  • L-carnitine may be better absorbed than acetyl-l-carnitine.
  • Some vitamins that did not increase significantly during the study, such as vitamin D, may be needed in larger doses and/or more bioavailable forms to have a therapeutic value.

What does this research confirm?

1.    Autism is a whole-body disorder and the brain is downstream

Autism has long been considered as a cluster of psychiatric/psychological behaviors caused by defective genes that induced structural changes in the brain before birth. However, current research clearly shows that autistic individuals have suboptimal biochemical pathways that affect neurological function.

For example, a majority of children with autism have issues with:

  • Methylation which is responsible for controlling DNA synthesis, building neurotransmitters (brain chemicals), and enzyme production. This pathway also ensures that neurons fire in sync. It also helps the body create ATP (or cellular energy).
  • Transsulfuration, which is the primary part of the body’s innate detoxification system, depends on a healthy methylation pathway.
  • Sulfation which helps the body eliminate toxins by binding them to sulfates. This renders the toxins more water-soluble and, hence, safer to excrete. Sulfation relies on methylation and transsulfuration.

So, as you can imagine, if any of these pathways are ‘broken,’ a cascade of symptoms will occur. For example, individuals with autism often suffer from:

  • Digestive issues
  • An inflamed gut
  • Decreased detoxification
  • Increased intestinal permeability
  • An imbalanced gut flora (with too many pathogens and few beneficial bacteria)

All of these symptoms can significantly impact the brain since they impair nutrient absorption, cause oxidative stress, and increase inflammation. The good news is that various studies show that supporting these pathways can considerably improve ASD symptoms.

2.    Individuals with ASD are severely deficient in various nutrients

As I have mentioned in a previous article, multiple studies indicate that children with ASD often have deficiencies in:

  • Vitamins
  • Essential fatty acids
  • Sulfate
  • Digestive enzymes
  • Antioxidants like glutathione

These studies also indicate that supplements can correct these deficiencies and alleviate ASD symptoms.

3.    Food sensitivities are common in autism

Studies have shown that children with ASD often have abnormal immune responses to:

  • Gluten (in wheat, rye, oats, barley)
  • Casein (from dairy products)
  • Soy (not always)

In one study, 81% of children who eliminated gluten and casein for 1 year improved considerably [2]. These improvements continued over the next 12 months!

What kind of study was this?

This research used a single-blinded approach where the clinical evaluators, but not the participants, were blinded. What this means is that only the participants knew whether they were receiving the combined intervention or no treatment at all.

Since clinical evaluators are blinded, this approach eliminates the possibility of bias or manipulation of results during assessments and laboratory measurements. A single-blind study is also more realistic and practical and better mimics real-world implementation. It also reduces the possibility that participants will drop out of the study.

I proudly assert that this study followed the strictest scientific rigor for research of its kind, and that it’s findings are credible. Some diet naysayers may dismiss the current study, arguing that it’s not the “gold standard” of a randomized, double blind, placebo controlled study, or that it studies too many variable at once.

Firstly, when dealing with whole foods, it is very difficult, or nearly impossible, to conduct a double-blind study (one in which both the evaluators and the participants are blinded). The participants are eating real food and need to know what they are eating; anybody would agree, it’s hard to get around that. Secondly, with multiple interventions being used, it more closely depicts how most families conduct a dietary intervention and nutrition program. Families are not going to try one intervention, wait a year and then try the second, and the third, etc. And there is synergy among diet and nutrient treatments: vitamins and minerals are co-factors for each other enhancing their individual effects, and diet and nutrients also have improved results when used together.

What sets this study apart?

Why did we conduct this study when previous studies already indicate that dietary changes and specific nutritional supplements can improve ASD symptoms?

Well, these earlier studies looked at either the effects of diet or nutrition therapy individually and over a short period of time. None of them investigated whether combining these two treatments over the long-term could be more efficient.

So what sets this study apart?

Comprehensive approach

Since autism is a whole-body disorder, combining a comprehensive nutritional intervention with specific dietary modifications could be more effective in improving many ASD symptoms.

Duration of the study

Individuals with ASD often use supplements over an extended period. And the effects of nutritional interventions are often slower than those of pharmaceutical interventions.

Therefore, we conducted this research over 12 months to assess the long-term effects of this combined approach on ASD symptoms among adults and children. The long duration of the study also allowed for a more extensive evaluation of possible adverse effects.

Quality of supplements used

Dr. Adams has improved the vitamin/mineral supplements used in this study based on findings from his previous research [3]. The new and improved version of the supplement contains:

  • A higher dose of vitamin D, niacin, pantothenic acid, biotin, selenium, mixed tocopherols.
  • Added vitamin K, potassium, carnitine, vanadium, and boron.
  • A lower dose of manganese, molybdenum, lithium.

Note: Dr. Adams makes no money from the sale of the supplements used in the study.

Quality of study design

This study utilized a very robust study design, as described below, to ensure that the findings are reliable and not due to chance or bias.

Takeaway Message and Conclusion

  • Combining nutritional supplements and dietary changes is safe and efficient at improving ASD symptoms.
  • Even adults with autism can improve with nutritional and dietary intervention.

In my opinion, future studies may yield ever greater results with a more refined bioindividual approach. For example, certain approaches like carnitine did not offer noticeable improvements for a majority of the participants, but for those that it did, like the girl in the wheelchair, it was life changing. While this study wasn’t looking at this specifically, customizing a nutritional approach to the biochemical and individual needs of the person, can likely yield even more beneficial results.

The study’s conclusion says it all, “The positive results of this study suggest that a comprehensive nutritional and dietary intervention is effective at improving non-verbal IQ, autism symptoms, developmental age, and other symptoms in most individuals with ASD, with the vitamin/mineral supplement, essential fatty acids, and healthy HGCSF diet reported by parents to be the most beneficial.”

It was an honor to be part of this study. The finding supports the clinical results I have been seeing in my clinical nutrition practice for the past 16 years. And this study helps support clinicians and parents all over the world that want to use a diet and nutrition approach to help children and adults with ASD

Now, I’d love to hear from you: have you tried any of the supplements or dietary changes described in this study? If so, it would be wonderful if you could share your experience in the comment section below. I’m sure your feedback could help others take the lead.

By Julie Matthews

References

1. Adams, J.B.; Audhya, T.; Geis, E.; Gehn, E.; Fimbres, V.; Pollard, E.L.; Mitchell, J.; Ingram, J.; Hellmers, R.; Laake, D.; Matthews, J.S.; Li, K.; Naviaux, J.C.; Naviaux, R.K.; Adams, R.L.; Coleman, D.M.; Quig, D.W. Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder—A Randomized, Controlled 12-Month Trial. Nutrients 2018, 10, 369.

2. Cade R, Privette M et al. “Autism and Schizophrenia: Intestinal Disorders” Neurosci 3 (2000) 57-72. Published by Overseas Publishers Association, (OPA) N.V.

3. Adams JB, Audhya T, Mcdonough-Means S, Rubin RA, Quig D, Geis E, Gehn E, Loresto M, Mitchell J, Atwood S, Barnhouse S, Lee W Effect of a Vitamin/Mineral Supplement on Children with Autism, BMC Pediatrics 2011, 11:111

4. Geier DA, Kern JK, Davis G, King PG, Adams JB, Young JL, Geier MR. A prospective double-blind, randomized clinical trial of levocarnitine to treat autism spectrum disorders. Med Sci Monit 2011 Jun;17(6):PI15-23.

What do berries, apples, and grapes have in common?

Salicylates.

A vast majority of children with autism and ADHD in my nutrition practice have salicylate reactions. The most common symptoms are red cheeks. red ears, hyperactivity, and irritability..

SALICYLATES are a #1 food related cause of BEHAVIOR issues.

There is a reasonable explanation for the prevalence I see in my practice. It’s not just because I am aware of reactions and so I recognize more than the average nutritionist, although that is true too.

It is because there are underlying factors and biochemistry that can cause an inability to process these food compounds and has such, reactions are common.

The good news is that there are things you can do.

What are Salicylates?

Salicylates are naturally-occurring food chemicals in fruits, vegetables, and other plant foods like herbs, spices, nuts, etc.).  In the 1950’s and 60’s, Dr. Ben Feingold observed that artificial additives and high salicylate foods caused hyperactivity and other symptoms in some children.  Biochemically, salicylates are a type of “phenolic acid” or “phenol.” Phenols need to be broken down in the body, i.e. “detoxified,” which occurs through a process called sulfation.

Salicylates to Avoid

Fruits (most fruit is high)

  • Grapes
  • Strawberries
  • Blueberries
  • Raspberries
  • Most melons including watermelon
  • Peaches
  • Nectarines
  • Plums
  • Apples

Vegetables

  • Red bell peppers
  • Cucumbers and pickles
  • Tomato sauce and ketchup (technically a fruit)
  • Spinach
  • Zucchini (with the peel on)

Herbs and spices

  • Cinnamon
  • Cloves
  • Rosemary
  • Thyme
  • Turmeric
  • Ginger

Additional high salicylate foods

  • Almonds
  • Honey

These fruits are delicious and plentiful, children eat quite a bit more during summer than any other time.  The resulting increase in salicylate consumption can cause a child’s body to become overloaded, and cause physical, emotional, and behavioral symptoms.  

Symptoms of Salicylates

Symptoms vary by individual, but some of the most common salicylate sensitivity symptoms are:

  • Red cheeks and ears (not from the heat)
  • Hyperactivity
  • Irritability
  • Defiant behavior
  • Aggression toward self or others
  • Overly emotional/crying
  • Bedwetting and day-wetting accidents
  • Sleeping challenges

Artificial Additives

Junk food with artificial additives are more plentiful during summer.  Artificial additives such as artificial colors, flavors and preservatives are strong phenols–and require the same biochemical processes.

If you don’t consume these, good for you. You shouldn’t.

In the average American family, however, blue-colored sports drinks on hot days, cotton candy from the beach boardwalk or fair, shaved ice or blended slushies from the amusement park are all to common occurrences (sadly).   Alone they are known to cause hyperactivity, combined with these other stressors and they can be particularly problematic.

Underlying Contributors and Biochemistry

Inadequate sulfation is the underlying biochemical issue in salicylate intolerance. This can be due to depletion of sulfate from sources such as food or a pathogen. It can be due to inadequate supply. Or the kidneys can dump sulfate, wasting it.

Without proper sulfate we cannot have proper sulfation. Sulfation handles many processes such as sealing up the gut so it’s not leaky. And detoxifying chemicals and processing salicylates and phenolic compounds.

Poor sulfation, and salicylate reactions, are common in autism and ADHD.

Salicylates can mask your GFCF Success

A very common scenario is that a family will go gluten-free and dairy-free, typically a great choice. And then start eating more healthy foods. But instead of feeling better the child has just as many, if not more, reactions and behavior issues than before.

Sadly, parents often think this means the diet is not working or wrong for them. However, that’s an incorrect assumption most of the time.

What’s usually going on is that the salicylate reactions mask the GFCF diet success. When they reduce salicylates the symptoms go away and they see the benefit they had been hoping for from dietary intervention.

Experience from a Mom…

“I was at a conference listening to nutritionist Julie Matthews. She was showing a slide of various behaviors, pretty accurately describing my son. At that time, my son had started showing some aggressive behaviors, mostly directed towards me (biting, causing bruises), and I was getting phone calls from school about him lashing out. The follow up slide was which foods to eliminate in order to stop the behaviors. It was all of my son’s favorites. I immediately texted my husband and told him, when I got home, we were doing a diet overhaul. We took out all of the problem foods, and his behaviors stopped! The change was so dramatic that his doctor, who had wanted to start medication, decided it was unnecessary. Do not discount diet!”

-Jennifer S.

What can you do?

Avoid Junk Food

Firstly, if your child eats artificial additives, cut them all out. It’s the first step of my Nourishing Hope for Healing Kids nutrition program. And it can be a simple, yet tremendously helpful step.

Look for Reactions

If you want to determine a food intolerance to salicylates, you might start by simply observing your child within the hour after they eat, and before bedtime—making correlations with high salicylate consumption.  The best way to determine salicylate intolerance is to avoid high salicylate foods for a period of time and observe any improvements, and then add them back and see if you notice a reaction.

What to Eat

There are two diets that I like that address this: The Feingold Diet and The Failsafe Diet.  The Feingold Diet is a smaller list of salicylates to avoid—it includes many of the big offenders (but misses some) and is easier to do.  The Failsafe diet is much more comprehensive, but more complex and restricts more foods. And at Nourishing Hope, we have our own list that I created from 17 years of working with this diet with my clients.

Below are some of my favorite low salicylate replacements to eat.

Fruit:

  • Pears

Vegetables:

  • Brussels Sprouts
  • Butternut Squash
  • Celery
  • Green Beans
  • Lettuce (head)
  • Rutabagas

Nuts:

  • Cashews

Herbs, Spices. and Seasoning:

  • Chives
  • Green onions
  • Vanilla
  • Salt

Most meats, grains, and beans/legumes are low salicylate.

Do a Dietary Trial

Try taking these foods out of your child’s diet for a few weeks and see what happens. Do you notice improvement? Which symptoms have gone away? Record what your child is eating and what you are noticing. You can do a dietary provocation, adding foods back to see if the reaction returns.

Add Back Allowed Foods

And remember you don’t want to overly restrict a diet, so add back any foods that are not causing a reaction. There are testing phases to the diet to help you determine: 1) if salicylates are causing a problem, 2) what your child’s threshold is.

And get support so your child has a healthy diet while on this diet. Make sure you find a practitioner that can address the underlying factors so you can go back to eating a more variety diet in time.

Epsom salt baths

You can also try Epsom salt (magnesium sulfate) baths or magnesium sulfate cream—the sulfate absorbs and helps supply sulfate for sulfation/detoxification.  This can help a child process the salicylates better, and reduce reactions from salicylates.

Support

To learn more on whether a low salicylate diet is right for your child and for tools on how to implement it easily and effectively, check out my Nourishing Hope for Healing Kids nutrition program for parents.

With the popularity of the ketogenic (keto) diet these days and the amazing results people are reporting, my clients have been asking whether the ketogenic diet is right for their child with autism.

I have been looking for good science that can guide us as to whether the ketogenic diet improves the symptoms of autism. And how it compares to other diets, and which diet is best.

And I have found the science!

In this 6-month study, Egyptian researchers compared the effects of two different dietary interventions versus a normal (control) diet on core symptoms of autism. Although more research is needed, findings from this study are promising.

How the study was conducted

The study population consisted of 45 children – 33 boys and 12 girls – aged between 3 and 8. Two senior psychologists specializing in the diagnosis and management of children with ASD confirmed the participants’ diagnosis of autism using the DSM-5 criteria.

The researchers assessed the following:

  • Anthropometric measurements such as weight, height, and head circumference
  • ASD symptom severity using the “Childhood Autism Rating Scale” (CARS) once at the beginning of the study, before implementing any dietary changes and again after 6 months. The higher the score the more severe the autism symptoms.
  • Treatment efficacy using the “Autism Treatment Evaluation Test” (ATEC) questionnaire before starting the diet and 6 months later. As with the CARS test, the higher the ATEC score the more severe the autism.
  • Fasting lipid profile, liver function tests, complete blood count, and fasting blood sugar levels
  • Urinary ketones and random blood sugar levels were checked weekly

The children were randomly assigned to three groups:

  • Group 1 received the ketogenic diet as the Modified Atkins Diet (MAD). The MAD was used in this study to make the ketogenic diet less restricting for the children and account for their growth requirements.

The original ketogenic diet consists of 80% dietary fat (mostly from long-chain triglycerides), 15% protein, and 5% carbohydrates.

The MAD used in this study consisted of 60% fat, 30% proteins, and 10% carbohydrates. Carbohydrates were restricted to 8 to 10g per day based on the patients’ age and weight.

A team of expert dietitians explained the principles of MAD to the 15 children’s parents. The parents were also taught how to:

(i) Prepare meals at home by following meal plans designed by the dietitians
(ii) Count dietary carbohydrates
(iii) Measure urine ketones at home using the ketostix
(iv) Detect signs and symptoms of ketosis and hypoglycemia

  • Group 2 received a gluten-free, casein-free diet. The 15 children in this group were asked to avoid the proteins casein (found in all milk and derived products) and gluten (found in wheat, barley, rye, and some types of oats).

The dietitians taught the parents how to:

(i) Create and maintain the GFCF diet by following meal plans
(ii) Read food labels

(iii) Complete 24-hour food recalls

  • Group 3, the control group, received balanced nutrition. The remaining 15 children weren’t on any type of diet therapy and allowed to eat at their own preferences. Their parents were explained how to provide balanced diets to their children during one session with the dietitians.

What the researchers found

Keto Group

Five of the fifteen children (33%) in the Keto/MAD group dropped out of the study due to poor compliance to the diet (vs. 0 % dropped out in the GFCF group).

The remaining 10 children in the Keto group showed significant improvements in their:

  • Childhood Autism Rating Scale (CARS) scores  
  • Total ATEC scores, as well as ATEC scores for speech, sociability and cognitive awareness.

Behavioral problems in this group decreased but no statistically significant changes were observed.

GFCF Group

All children in the GFCF group compiled with the diet. In the GFCF group, children showed significant improvements in:

  • Childhood Autism Rating Scale (CARS) scores
  • Total ATEC scores, and ATEC scores for speech and behavior improved.  

Participants showed improvements sensory/cognitive awareness but they were not statistically significant.

The Keto group showed more improvements in terms of CARS and ATEC scores, compared to the GFCF diet group.

No significant changes were seen in the control group.

Charting the Results

After I plugged the data into a spreadsheet, the results became more clear to me. The following charts compare the results of Keto, GFCF and the control group. Notice how both the GFCF and Keto group have significant improvements compared to the control group (that did not do a special diet). There were some differences, but overall the results show that a special diet is very helpful to improving autism symptoms.

What the findings mean

So what do we do with this data. This is MY interpretation of the findings. (This is not the study author’s opinion.)

  1. Autism severity decreased among children in groups 1 and 2 indicating that the Keto and GFCF diet were effective in improving autism symptoms.
  2. The ketogenic diet yielded better results than the GFCF diet. The ketogenic diet can be a great diet for autism… for the right person. The keto diet can address some underlying mitochondrial issues and neuroinflammation that can be wonderful!! By improving the underlying biochemistry, the symptoms of autism can be significantly reduced (as we saw in the study).
  3. However, 1/3 of the children dropped out of the Keto group. The fact that the keto diet is more restrictive is one of its challenges. If a child goes on keto, but the family stops because it’s too difficult to maintain (no judgement), then the child doesn’t receive any of the results that were seen in the study. (Unless they transition to a different diet.) No one dropped out of the GFCF group and great benefits were seen by that group too. In this case, the “best” diet is the one the family can do, that yields positive results. For some it’s keto, for some it’s GFCF.
  4. Since results were better on the ketogenic diet, this might lead people to think the ketogenic diet is the best place to start or the best diet for everyone. It might be, especially if you have reasons to think that approach would address underlying biochemical problems and be a better diet. As I mentioned, the keto diet can address metabolic issues and neuroinflammation and be very helpful.  However, the ketogenic diet has some challenges and deficiencies that can result. I have seen children with autism do really well on the ketogenic diet, and other children do poorly on the ketogenic diet. Although, for the right people, most are negatives are outweighed by the benefit of keto or can be overcome with diet hacks. More study will help us determine the reasons the ketogenic diet was helpful and if the benefits continue for long term. The choice is a bioindividual one.
  5. Why did keto help people? The study did not isolate why the ketogenic diet worked better. The keto diet removes: gluten, grains, starches, and other compounds in foods that can be irritating to the system. So, if keto is showing improvement, we don’t know what caused the improvement. It might be the 1) removal of gluten, 2) the removal of grains and starches, 3) “lower” carbs (but not ketosis), 4) a decrease in total sugar (or some other compound like FODMAPs, oxalates or salicylates) that was reduced that was the key to the diet’s success. Graduating the food removal from simple to more restrictive is a good way to see WHAT about the diet was helping. This leads me to #6…
  6. In my clinical experience, if someone is transitioning from the Standard American Diet, it might be easier and better to start with a GFCF diet. It’s an easier diet and lifestyle choice (if it’s effective), and can eliminate some of the most common reactions: gluten and casein. Going step by step can help determine which diet is ideal.  It’s helpful to start with gluten and casein, then eliminate all grains and starches to see if the issue are foods that irritate the gut (i.e. grains and starches), then proceed to the ketogenic diet. While it is true that some people can jump right into the ketogenic diet, gradually decreasing the amount of carbohydrates consumed with a grain-free diet first can help the body adapt to a lower carbohydrate diet before starting the ketogenic diet. And since we don’t know exactly what it is that’s contributing to the improvements on a ketogenic diet, taking it step by step, helps someone figure out how far they need to restrict their diet, and help them understand the reason they are benefiting from the diet change.
  7. Diet support. This study shows us that having access to foods that meet the specifications of the dietary regimen can improve compliance. In this study, participants in groups 1 and 2 had access to a specialized kitchen that provided group 1 children with low carbohydrate biscuits, cakes, and bread and group 2 children with alternatives to gluten and casein. Having support with ready-made meals, or even building into your schedule to prepare the meals, can help increase your success. For instance, Seek out help when doing a special diet if you need the extra support. Even though some people dropped out of the study, from my experience they had very good compliance. And I believe part of the success was this diet support.
  8. Individuals with autism have impaired gut function and various nutrient deficiencies which can slow down gut healing and how quickly you see results. As such, someone with ASD may require several months of dietary intervention before seeing significant symptom improvement. Remember, this study was 6 months. You often need to give dietary intervention some time to see what improvements unfold.

Conclusion

This research is further proof that a special diet helps people with autism. And it shows: both a GFCF diet and a keto diet were effective.

I hope this study helped you see how ketogenic can be a wonderful option for certain children with autism. And further proof that a GFCF diet is very helpful.

It’s an exciting time (as always) in the field of nutrition.

Reference:

El-Rashidy, O., El-Baz, F., El-Gendy, Y., Khalaf, R., Reda, D., & Saad, K. (2017). Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metabolic brain disease32(6), 1935-1941.

Gastrointestinal Disorders Prevalence

If you’re a nutrition or health practitioner, you’ve certainly had your fair share of clients with a gastrointestinal disorder or symptoms. 

I’m certain of that. That’s because digestive disorders are incredibly common. They affect 60-70 million people in the United States alone. IBS has a prevalence 15.3 million people, that 11.6% in the population.

And the gut is a major factor in health or disease. The gastrointestinal tract is often the first system damaged in chronic disease. We need digestion to break down and assimilate our food and nutrients. Digestive disturbances are common in: neurological disorders, fibromyalgia, chronic fatigue syndrome, skin disorders, autoimmune conditions, and.

And food is a major factor in gut health… as food is in contact with the digestive tract every time we eat. And food can be irritating, inflammatory, and imbalance the microbiome. Or food can be nourishing, healing, and supportive to our beneficial bacteria.

As such, it’s important to know how food affects the gastrointestinal tract and which therapeutic diets can help (which is the purpose of my article today). 

But before we talk about special diets, I wanted to share more on the gut-brain connection, as neurological disorders are one of the most common manifestations of GI issues that you’ll likely run into in your practice, if you haven’t already.

The Gut-Brain Connection

The gut and the brain are connected so when the gut is not working well, we can have difficulty with cognitive function and mood.

Let’s take serotonin, for example. Serotonin is a key neurotransmitter in the brain-gut axis. Ninety percent of serotonin is produced in the gut. The microbiome influences the level of serotonin and the functioning of the gut brain axis. It is very important for digestive functioning including motility. And it’s crucial for good mood and happiness When the gut is not working well, neither is the brain.

In fact, 30% of people with IBS have depression (vs. 18% of the healthy population), and 16% have anxiety (vs. healthy population). 

Digestive disorders are also very common in autism, ADHD, and related developmental disorders.

The good news is: As we heal the gut, neurological disorders improve, often dramatically.

Gastrointestinal Problems and Developmental Delays

Gastrointestinal problems and developmental delays are often connected. According to one study, children with autism, as well as ADHD and other developmental delays, have higher rates of medical conditions than their peers. These medical diagnoses include: diarrhea or colitis, food allergies, asthma, eczema, headaches and earaches.1 It’s a substantive finding, involving a large sample size: 41,000 children aged 3 to 17 years. 5,469 children had one or more of the following diagnoses: autism, intellectual disability, ADHD, learning disability or other developmental delay. 

The study found children with developmental disabilities were 3.5 times more likely to have had frequent diarrhea or colitis during the past year. As well as 1.8 times more likely to have had a food allergy during the past year. They were also significantly more likely to have skin allergy, asthma, ear infections, and severe headaches.

When they compared the developmental disability groups to each other they discovered: “Children with autism were twice as likely as children with ADHD, learning disability or other developmental delay to have had frequent diarrhea or colitis during the past year. They were seven times more likely to have experienced these gastrointestinal problems than were children without any developmental disability.”

These findings are important because parents are routinely told one has nothing to do with the other. However, the gut and brain are closely connected, such that the gut is often called “the second brain.” 

When the gastrointestinal system is not functioning properly, children and adults struggle with mood, behavior, focus, and thinking.

Your client may not be able to:

  • Break down and absorb nutrients properly, leading to deficiency that can affect cognition, mood, and behavior.
  • Digest the protein in wheat, dairy, and soy, which form opioid (morphine-like) compounds that negatively affect attention, learning, and behavior.
  • Maintain a healthy gut microbiome – pathogenic microorganisms can negatively affect our neurotransmitter levels and cause hyperactivity, aggression and other mood related symptoms.

One of the most important ways to address digestive issues is to look at the foods that are going into the gastrointestinal tract: i.e. “the diet.”

Also there are supportive supplements and other nutritional tools that can help your client:

  • Digestive enzymes – digests food to relieve the burden on digestion and help reduce irritation.
  • Probiotics – helps supply needed beneficial bacteria.
  • Prebiotics – feeds the growth of beneficial bacteria.
  • Anti-inflammatory supplements – reduces inflammation throughout the body for symptom relief and healing of the gut.

But without looking at the food going in and whether it’s causing inflammation, harm, and havoc to the underlying biochemistry and system, we cannot make full progress and help your clients improve their health.

Some foods are generally inflammatory to most humans like gluten, for example.2 Whereas others – most grains, salicylates or oxalates – are only a problem for certain people based on their bioindividual circumstance.

Problematic Foods and Therapeutic Diets for Gut Healing

Some of these strategies are more advanced and others more introductory. I’ll start with the foundation stones for families at the beginning of their journey before covering other diets that can be helpful for more diet-experienced individuals.

Gluten-Free, Casein-Free and Soy-Free Diet

Gluten, found in wheat and other grains, casein, found in dairy, and soy are all inflammatory proteins. The proteins are hard to digest, and when not properly broken down can form opiate compounds. Opiates (just like morphine) can slow motility of the gut causing constipation and further digestive discomfort, and cause inflammation. Constipation is very common with dairy intolerance – one study of children with constipation revealed that 80% of the patients had a cow’s milk allergy. 3 A gluten-free, casein-free and soy-free diet is a great diet to start with when chronic digestive issues are present.

Grain-Free Diets

Grains are hard to digest, as they require large amounts of carbohydrate digesting enzymes. And we know that people with autism are often low in the correct enzymes.4 The starch in grains also feed pathogens and small intestine bacterial overgrowth (SIBO), resulting in irritation and damage to the gut, causing diarrhea, constipation, pain, and distress.

There are several grain-free diets that can be helpful with digestive problems:

  • Specific Carbohydrate Diet (SCD)
  • GAPS Diet
  • Paleo Diet

Low Salicylate Diet

Salicylates occur in plant foods, including berries, grapes, tomatoes, almonds, herbs, and spices. But salicylates are also present in honey. In addition to behavioral symptoms, salicylates can cause digestive symptoms such as diarrhea, and can increase digestive pain when consuming FODMAPs.5 6

Low salicylate diets include:

  • Feingold diet
  • FAILSAFE diet

Low Oxalate Diet

Oxalates are inflammatory molecules that are found in certain foods, including: Nuts, spinach, Swiss chard, chocolate, and beans. Oxalates can kill good bacteria and perpetuate yeast and gut microbiome imbalance. And create inflammation in the gut.

Low FODMAPS Diet

FODMAPS is an acronym for various fermentable carbohydrates including oligosaccharides found in the onion family and polyols found in prunes. Fermentable carbohydrates feed bacteria, but when there is an imbalance such as small intestine bacterial overgrowth (SIBO) it can cause gas, bloating, pain, diarrhea and constipation. Studies have shown a Low FODMAPS diet can be helpful for IBD.7

Body Ecology Diet

The Body Ecology diet avoids sugar and foods that feed and perpetuate candida overgrowth, and includes foods that are healthy – while supplying good bacteria through fermented foods. It’s often used to address candida overgrowth and other “inner ecology” imbalances.

Low Histamine Diet

There are a variety of low amine and histamine approaches. As the name implies, histamine is one type of amine. You find amines in: bone broth, sauerkraut, fermented foods, wine, beer, chocolate, and cheese. Histamine and other amines can cause intestinal and systemic inflammation, diarrhea, and abdominal cramps. 

Low Glutamate Diet

Glutamate is an excitatory neurotransmitter – think the opposite of calm! Glutamate is often present in food. Glutamate often occurs in similar foods to histamine ike: sauerkraut, fermented food, bone broth – and occurs in high amounts in soy sauce and parmesan cheese, and additives like monosodium glutamate (MSG) and autolyzed yeast extract. Glutamate can affect the nervous system and can cause reactions such as inflammation systemically. Glutamate can also cause diarrhea, constipation, and gut issues.

Ketogenic Diet

The Ketogenic diet is a very low carbohydrate diet that uses ketones/fat for energy instead of glucose/sugar. Though very restrictive, keto can help with balancing the microbiome and supply the proper energy for the gut to heal for the right individual. Remember, this diet is very strict and high fat diets can often lack the beneficial fiber for the microbiome – so more studies are needed to find out when this diet supports or imbalances the microbiome. 8

Underlying Considerations for Choosing a Special Diet

Now that you know a little about the diets, let’s tackle four considerations that arise with gut health, including their potential implications, and possible dietary choices for these gastrointestinal issues.

Inflammation 

Inflammation affects the gut by aggravating the gut wall, causing leaky gut, leading to food sensitivities, and often contributing to chronic disease or autoimmunity, affecting every system. Symptoms can include diarrhea, constipation, gas, bloating, and pain. 

Dietary considerations: Food allergies and sensitivities, oxalates, salicylates, amines, histamine, FODMAPs, and grains.

Mitochondrial dysfunction

Mitochondria are the powerhouses of the cell responsible for making energy, and if they aren’t functioning well, it can lead to constipation, but also fatigue, pain, and disease in any organ or system of the body. 

Dietary considerations: oxalates, a ketogenic diet, or adequate carbohydrates.

Poor sulfation

Sulfation is a set of biochemical processes that use sulfate, and it’s a necessary process for intestinal barrier integrity (to avoid leaky gut) and aid digestion. An imbalanced gut microbiome can contribute to poor sulfation. Poor sulfation can cause reactions to phenols, salicylates, and amines – many are present in foods traditionally considered “healthy” like berries, spices, almonds, fruits and vegetables.

Additionally, when sulfate the building block for sulfation is low, problems with oxalates can result,

Dietary considerations include salicylates, amines, and other phenols, plus oxalates.

Microbiome imbalance

Good bacteria is essential for good digestive health, while pathogens contribute to digestive issues and disease. Eating a diet that supports good bacteria while starving out the bad pathogens can be tricky to balance. For example, high fiber foods are good for beneficial bacteria but cause reactions for clients with SIBO. Additionally, if there is an imbalanced microbiome these reactions to foods that might otherwise be healthy can result in reactions to salicylates, amines or oxalates.

Dietary considerations include: FODMAPS, salicylates, oxalates, and amines.

The key is eating foods that support digestion and feed beneficial bacteria, while not causing another reaction. Determining which foods your client or patient needs while avoiding those that cause or contribute to underlying problems is essential to helping them improve.

Understanding the Relationship Between Symptoms and Foods

Complicating matters further, practitioners often recommend many healthy foods for “gut healing diets” – such as bone broth, sauerkraut, spinach, and almonds. Such foods contain natural food compounds that can cause or exacerbate the exact GI issue the practitioner is working to resolve!

So as a practitioner, it’s important to understand the big picture of diets and gut health for your client.

Understanding the relationship between symptoms and foods will allow you to help your clients find the right healing diet.

Of course, if you are looking to take your knowledge to the next level, check out our BioIndividual Nutrition Training program.

Share what diet strategies have helped you help your clients – I love to hear success stories!

Explore Enrollment into the BioIndividual Nutrition Training

…CLICK THROUGH….

High gluten intake during pregnancy linked to increased risks of diabetes in children

Although more research is needed, a recent study suggests that maternal gluten consumption during pregnancy could increase the child’s risk of type 1 diabetes. 

Findings from this study also suggest that:

  • The risk of type 1 diabetes in the children increases proportionally per 10g/day increased gluten intake.
  • Over an average follow-up period of 15.6 years, children of women who consumed at least 20g of gluten per day had twice the risks of developing type 1 diabetes compared to children of women whose daily gluten intake was less than 7g.

Since celiac disease and type 1 diabetes “share” some HLA genes, pregnant women or those intending to conceive may want to consider swapping gluten-containing foods (such as wheat, rye, spelt, and barley) for other gluten-free nutritious foods. 

Study reference: Antvorskov, Julie C., Thorhallur I. Halldorsson, Knud Josefsen, Jannet Svensson, Charlotta Granström, Bart O. Roep, Trine H. Olesen, Laufey Hrolfsdottir, Karsten Buschard, and Sjudur F. Olsen. “Association between maternal gluten intake and type 1 diabetes in offspring: national prospective cohort study in Denmark.” bmj 362 (2018): k3547.

Prenatal fish oil supplementation may improve children’s growth

A mother’s diet during pregnancy can have a profound effect on the fetus and the results can last through childhood.

A new study investigating the effects of prenatal fish oil supplements shows that children born of women who took the supplements were more likely to have healthier growth during the first six years of life.

The study involved 736 pregnant Danish women who either took daily fish oil supplements (the experimental group) or olive oil supplements (the control group). The women started the supplements from week 24 of their pregnancy until one week after delivery.

The researchers assessed the children’s height, weight, head and waist measurements 11 times from birth to age six. They found that the children’s whose mothers took the fish oil supplements had a higher body mass index throughout their first 6 years of life compared to those whose mothers received the olive oil supplements.

The higher BMI was due to a higher percentage of lean muscle and bone mass, and not extra body fat, indicating that fish oil supplements may exert a general growth-stimulating effect in utero.

Study reference: Rebecca Kofod Vinding, Jakob Stokholm, Astrid Sevelsted, Tobias Sejersen, Bo L Chawes, Klaus Bønnelykke, Jonathan Thorsen, Laura D Howe, Martin Krakauer, Hans Bisgaard. Effect of fish oil supplementation in pregnancy on bone, lean, and fat mass at six years: randomised clinical trial. BMJ, 2018; k3312.

Babies born at home may have a healthier gut microbiome

New research indicates that babies born at home have a more diverse gut and fecal microflora compared to those born in hospitals. 

The researchers followed 35 infants and their mothers until the babies were 1 month old. 14 of the babies were born at home (four of them in water) and 21 in the hospital. 

Stool samples indicated that the hospital-born babies had greater inflammatory gene expression in epithelial cells which cover organ linings, skin, and mouth. Moreover, hospital-born infants had lower levels of Bacteroides, Bifidobacterium, Streptococcus, and Lactobacillus, and higher Clostridium and Enterobacteriaceae compared to babies born at home.

Why these differences in gut microbiota between infants born at home versus hospitals? 

Well, the scientists speculate that common hospital interventions, such as infant bathing and antibiotic eye prophylaxis, and the aseptic hospital’s environment could be involved. 

Although more research is needed, this study’s findings favors the idea of home births and/or revamping the hospital environment to mimic home conditions for non-high-risk births. Since the gut flora affects the immunity and metabolism, a healthy microbiome could reduce the babies’ risks of obesity, diabetes, asthma, and gut disorders later in life.

Study reference: Combellick, Joan L., Hakdong Shin, Dongjae Shin, Yi Cai, Holly Hagan, Corey Lacher, Din L. Lin, Kathryn McCauley, Susan V. Lynch, and Maria Gloria Dominguez-Bello. “Differences in the fecal microbiota of neonates born at home or in the hospital.” Scientific reports 8, no. 1 (2018): 15660.

Mom’s microbiome during pregnancy linked to child’s autism risk

Cutting-edge research suggests that the mother’s gut health during pregnancy plays a critical role in determining the child’s risk of developing ASD.

The researchers hypothesized that, in mice, an immune reaction to interleukin-17a (IL-17a), a molecule produced by the immune system, could trigger ASD-like behaviors. 

To test their hypothesis, the team used Jax and Tac mice from two different laboratories. Unlike the Jax mice, the Tac mice had gut microbes that made them susceptible to an IL-17a inflammatory reaction. 

Both groups were exposed to a virus designed to create an immune response. Only the Tac mice (the ones susceptible to inflammation) had pups that developed ASD-like behaviors.

To prevent an inflammatory response, the researchers then artificially blocked the IL-17a molecule in the Tac mice. The pups born did not show ASD-like behavior. 

Finally, the researchers exposed the Jax mice to the gut flora of Tac mice (making them more susceptible to inflammation). Interestingly, they found that pups born after this intervention showed ASD-like behavior. 

Practical tip: Although these findings may not be applicable to humans, pregnant women and those planning to conceive could opt for a gut-friendly (and microbe-friendly) diet and lifestyle. Probiotics (or fecal transplants, when medically necessary) may also positively influence the mother’s microbiome.

Study reference: Lammert, Catherine R., Elizabeth L. Frost, Ashley C. Bolte, Matt J. Paysour, Mariah E. Shaw, Calli E. Bellinger, Thaddeus K. Weigel, Eli R. Zunder, and John R. Lukens. “Cutting edge: critical roles for microbiota-mediated regulation of the immune system in a prenatal immune activation model of autism.” The Journal of Immunology 201, no. 3 (2018): 845-850.

The gut-brain axis is a well established connection suggesting that the intestinal microbiota (the good bacteria in our gut) signal to the brain in a myriad of ways. This delicate balance of gut microbes can influence emotional development, modulation of stress and pain, mental health, and neurotransmitter systems in the brain. 

The gut-brain axis is a well established connection suggesting that the intestinal microbiota (the good bacteria in our gut) signal to the brain in a myriad of ways. This delicate balance of gut microbes can influence emotional development, modulation of stress and pain, mental health, and neurotransmitter systems in the brain. 

Research encourages that improvements in our gut microbiome can improve overall mood, anxiety-like symptoms, pain, and more in people with autism. 

There is substantial evidence that using prebiotics and probiotics, such as strains of Lactobacillus, can have a positive effect on the gut-brain axis, but is there something more at play? 

In this article I share the results of a cutting edge study that examines the gut brain axis in autism. I give you my analysis, what’s lacking, and key takeaways for those wanting to be informed.

The researchers propose amino acids as a potential treatment. 

Today, I take a closer look at the ins and outs of this new study, a review paper entitled, The Gut-Immune-Brain Axis in Autism Spectrum Disorders; A Focus on Amino Acids. I explore its findings and discuss practical implications for therapeutic intervention.

How the Gut-Brain Axis Influences Autism

I’ve written previously on how dealing with your child’s digestive issues can address both gastrointestinal and neurological symptoms of autism. It’s no secret that children with autism spectrum disorder are significantly more likely to have food allergies than those without it.

However, a startling statistic is that children with autism are seven times more likely to experience frequent diarrhea and colitis than those without a developmental disability. 

The link between digestive problems and autism is undeniable, and it’s related to inflammatory bowel issues, acid reflux within the gastrointestinal tract, and possibly more. This is partially due to the inflammation that food allergies and digestive issues can bring on, which can be painful and influence behavior negatively.

This brain-gut link also puts these children at risk of nutritional deficiencies, which can aggravate cognition problems and adversely affect immune responses.

Early life environmental factors can also play a part in the development of autism spectrum disorder. The study cites prenatal and postnatal diet, gut microbiota, and immune system triggers as contributors to the disorder’s prevalence.

Furthermore, it addresses the inflammatory responses that are so common in autism spectrum disorder. It proposes they may be linked to the aforementioned common food allergies, causing increased production of pro-inflammatory cytokines and allergy-associated Th2 cytokines.

This study also suggests that microglia and astroglia (certain brain cells) are deregulated in the brains of people with ASD, altering their immune-like responses. An impaired ability to remove toxins that’s commonly found in individuals with autism can play an important role in a compromised immune system.

A look at the weakened ability to detoxify and a less responsive central nervous system makes it clear: the gut brain axis has a profound effect on autism. While you’re reading, be sure to look into my guide on where environmental toxins are commonly hiding and what to do about them.

These behavioral, digestive, inflammatory, and immunological issues all play a part in the nervous system’s role throughout the body. Patients with ASD have a nervous system battered with these issues, playing a complex role in the disorder. While we know that psychobiotics (gut-supporting supplements that positively influence the gut-brain axis) can be of some help with microbial composition and brain interactions, what about amino acids?

The mTOR Pathway and Amino Acids

Preclinical and mouse model studies have indicated that when mice are allergic to their food intake, their reaction produces many similar symptoms to those seen in individuals with autism and alters processing in the prefrontal cortex.

As mast cells and T cells are unusually activated in the brains of those with ASD, the study suggests that their hyperactivation is linked to symptoms associated with autism. If so, food allergies may be a driving force of the symptoms and behaviors associated with ASD, along with increased intestinal permeability.

So, how can amino acids help these digestive woes? Well, it starts with the mTOR pathway. The activation of the mammalian target of rapamycin (mTOR) is reported frequently in cases of autism. 

This activation is also noted in many other health problems, such as insulin resistance and tumor formation, and is increasingly studied for its overarching effects on health, neural communication, brain function, and immune cells. Mutations in mTOR pathway-related genes are widely associated with ASD.

While the first instinct to treat these mutations may be pharmacological, the severe immune system detriments can make mTOR inhibitors an extreme prescription to write. This drug can hamper cell growth, and in other cases, increase unwanted cell signaling. 

This study proposes that a safer, nutritionally-based approach using amino acids is possible. For me, this type of research is vital — I believe improving nutrition is hope in action. 

Amino acids show a promising effect on the mTOR pathway. They do an excellent job at modulating the function of the proteins that translate both global and specifically selected mRNA for mTOR.

While the research isn’t exactly conclusive, it seems that the amino acid’s transporters enter through the plasma membrane, interact with and activate a multi-protein complex, and activate mTOR at appropriate levels. 

A promising trial showed that a developed amino acid diet was able to normalize or reduce mTOR signaling in ASD mice, reducing repetitive behaviors and improving social interactions. 

Just as exciting, the potential issues in this dietary change do not have the severe side effects that rapamycin dosages have shown. However, the study notes that proof of principle clinical studies are still needed to see the effects of a diet that specifically adds helpful amino acids.

Can amino acids be used to improve symptoms of autism?

It seems likely. Multiple studies have pointed to reducing inflammation as an effective means of improving the symptoms of autism. This evidence further shows just how impactful the gut microbiome is in autism. Used properly, combinations of amino acids can be helpful in combating not only this inflammation, but harmful mutations as well. 

A promising preclinical trial mentioned above developed a combination of relatively higher amounts of histidine (His), lysine (Lys), and threonine (Thr) and relatively lower amounts of leucine (Leu), isoleucine (Ile), and valine (Val) for further studies in ASD, and saw a reduction in mTOR hyperactivity.

Another in vitro study found that dosages of Leu, Ile and Val individually reduced the mRNA and protein levels of the pro-inflammatory cytokine IL-6. It can be inferred from the results of amino acid tests that increasing the availability of amino acids has a positive, anti-inflammatory result on immune cells.

Conversely, some evidence points to a lowered amount of amino acids as a detriment to antibody production. Immunologically speaking, it seems that certain amino acids reduce inflammatory response and assist in antibody production.

In rats with colitis, a condition seen seven times more frequently in those with ASD than neurotypical individuals, amino acid mixtures were seen to positively affect intestinal function and balance gut microbiota composition.

So, what does this mean for nutrition and patients with ASD? Well, with guidance from a doctor or nutritionist, here’s what we may be able to implement:

  • Leu, Ile, and Val raise mast cells and epithelial cells in mTOR pathways, while His, Thr, and Lys all lower it while also negatively affecting brain function when used in tandem. These latter three amino acids have a “synergistically negative effect.” Both of these groupings affect the brain in converse ways, which is why it’s important to work on this type of therapy with a licensed doctor or nutritionist/dietician.
  • Leu, Ile, and Val also lower pathogenic bacteria levels in the microflora. However, these same three also lower the neuroprotective factor microglia.
  • There are many more amino acid combinations, but as we can see, supplementing amino acids must be done mindfully and with proper healthcare supervision. Some can have unintended effects that augment undesirable symptoms in individuals with autism. However, keeping in mind possible negative or synergistic effects, we can begin to formulate the best ratios of potentially helpful amino acid mixtures.

Areas of Further Research and Conclusions

While I find this study to be rather comprehensive in its approach, there is still much more to be done. Firstly, almost all of the current research on amino acid interaction with the gut brain axis and its effect on autism is still in germ-free mice. This is certainly a limitation.

Progression to clinical trials at some point will tell us much more about the possibilities for the future.

I’d also like to hear more from this research about the practical implications for nutritionists and parents seeking to make dietary adjustments. While there are some takeaways, I felt there were limitations in how to apply our current understanding of the link between amino acids, mTOR, inflammation, and brain development.

It is also worth further exploring how to balance each amino acid in combination — some can have extremely neuroinflammatory effects when out of balance. This is the opposite of our goal in helping those with ASD.

Even with its limitations, this study provides us an important look into mTOR in autism and how amino acids may be helpful in improving the gut-brain axis.

In Summary

  • The gut brain axis is a significant issue in patients with ASD. Outside of behavioral issues, this is not only a sign but also an aggravation of ongoing symptoms associated with individuals with autism.
  • Rectifying an imbalance in gut bacteria can positively affect not only behavior, but also inflammation and digestive symptoms.
  • The studied amino acids show promise of modulating negative mTOR pathway signaling, which may reduce a great number of issues that present with ASD.
  • If administered properly, neuroactive amino acids show great promise of treating the gut brain axis imbalance in autism, with far fewer side effects than rapamycin medication.
  • These findings call for a closer look into amino acids and their properties in relationship to ASD. There are many possible uses for nutritional interventions and alleviation of symptoms within this study.

Sources

  1. Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of gastroenterology: quarterly publication of the Hellenic Society of Gastroenterology, 28(2), 203. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367209/
  2. Mayer, E. A., Tillisch, K., & Gupta, A. (2015). Gut/brain axis and the microbiota. The Journal of clinical investigation, 125(3), 926-938. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362231/
  3. Cryan, J. F., & Dinan, T. G. (2012). Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nature reviews neuroscience, 13(10), 701. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/22968153
  4. Mazzoli, R., & Pessione, E. (2016). The neuro-endocrinological role of microbial glutamate and GABA signaling. Frontiers in microbiology, 7, 1934. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127831/
  5. Liu, X., Cao, S., & Zhang, X. (2015). Modulation of gut microbiota–brain axis by probiotics, prebiotics, and diet. Journal of agricultural and food chemistry, 63(36), 7885-7895. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/26306709
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