Today’s post was developed in response to an article that originally appeared in the Austin American Statesman. You may read it here. You may read the original research article discussed in the paper here. This post is the original opinion letter that we sent to the editor at the Statesman. We were ultimately asked to shorten the letter and it appeared as a simple Letter to the Editor.
Ms. Roser’s recent article highlighting the Malloy and colleagues’ new study regarding gluten- and casein-free diets for children with autism spectrum disorders (ASD) puts special diets in the spotlight once again. Special diets are not new and they are not solely for children with ASD. In fact, special diets are necessary for many people.
For example, people diagnosed with phenylketonuria (PKU) require a highly specialized diet to prevent the development of mental retardation. PKU is a genetic condition wherein individuals lack an enzyme to digest certain amino acids. This is such a serious issue that every child in this country is screened for PKU via a heel prick at birth. Those who test positive during the test are required to follow a life-long reduced-protein diet.
A second example of a condition requiring a specialized diet is celiac disease. Those affected are allergic to gluten, a protein found in grains such as wheat and barley, and they must refrain from consuming gluten throughout their lifetime. Consumption of gluten can have many harmful side effects including anemia, osteoporosis, and intestinal cancers.
Finally, individuals with food allergies must also follow specialized diets. For those who are allergic to nuts, exposure to them may be deadly. Such was the case when a young woman with peanut allergies died after kissing her boyfriend shortly after he ate a peanut-butter-and-jelly sandwich. The most common food allergies for children include milk, egg, soy, wheat, peanut, tree nut, and seafood. If any of us had to give up these foods, particularly without effective guidance, we would feel restricted! Unfortunately, for people with food allergies, food restriction is the only way to prevent negative side effects.
Unfortunately, what Ms. Roser, as well as Malloy and colleagues, failed to mention in their writings was the fact that children with ASD often go on specialized diets because of gastrointestinal (GI), nutrition, and/or immune disorders, not because of the condition or diagnosis of ASD. The GI disorders that children with ASD often experience may be related to food allergies or intolerances, autoimmune conditions, or other environmental variables. Among physicians and psychologists who regularly treat individuals with autism, there is an understanding that such individuals may experience gastrointestinal disorders and lack the communication skills to express their discomfort. In response to this growing recognition, a team of 27 medical doctors and doctoral-level psychologists published a consensus report in the journal Pediatrics (Buie et al., 1/4/2010)”. The team stressed the importance of completing a proper and thorough work-up in determining the cause of GI symptoms for children with ASD. Instead of discussing the GFCF diet as a medical treatment for children with ASD, Ms. Roser, as well as Malloy and colleagues, imply that the specialized diets for children with ASD are designed to “normalize autism.” In fact, on page 4 of the Malloy paper, the authors actually state that they included only studies that examined “the amelioration of ASD symptoms.” It is no wonder their review of 14 studies found only 4 studies with positive effects from the diet; the authors excluded all the studies that examined changes in GI functioning!
To those parents of children with ASD, heed not the advice of the researchers who merely summarized a small set of studies. Instead, if your child displays symptoms of GI disorders (e.g., reflux, diarrhea, constipation, stomach distension, etc.) or other health concerns, schedule an appointment with a knowledgeable clinician for appropriate treatment of symptoms.