The Role of Diet, Nutrition and Lifestyle in Autism Management (Autism and Diet)

According to the World Health Organization (WHO), around 1 in 100 children has autism. Although signs are likely present in early childhood, many individuals go undiagnosed until later – often even into adulthood. Though the causes of the condition are unknown, research suggests that several factors make a child more likely to be autistic. These include genetic and environmental factors. 

Due to some of the sensory difficulties and sensitivities that come with autism, diet can be a problem. Autistic people are also more likely to have gut problems and food hypersensitivity. As such, this article aims to explore the role of diet, nutrition and lifestyle in autism. By exploring common dietary concerns such as selective eating, food sensitivities and gastrointestinal issues, we hope to shed light on the significance of dietary interventions and nutritional needs in autism management. But diet is just one aspect. 

Lifestyle factors also have a role to play in supporting those with autism, as we’ll explore. However, it’s important to recognise that every autistic person is unique and needs an individualised approach. Consulting with healthcare professionals like dietitians, nutritionists and other healthcare providers, is essential in tailoring interventions to meet the specific needs of individuals.

In an era where evidence-based practices are crucial, it’s important to concentrate on peer-reviewed research and expert guidance when considering dietary and lifestyle interventions for autism. 

Understanding Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition. It is characterised by persistent challenges in social communication and interaction, as well as restricted, repetitive patterns of behaviour, interests or activities. Autism was first identified in the 1940s and there is still a lot we don’t understand about it. What we now know is that it is a spectrum disorder with a wide range of ‘symptoms’ and challenges.

At its core, ASD manifests differently in each individual. This causes a diverse array of experiences and challenges. While some autistic individuals may have exceptional abilities in certain areas like mathematics or music (called ‘savant’), others may struggle with basic communication and daily living skills. This heterogeneity highlights the complexity of autism. And it shows the importance of recognising the unique strengths and needs of each individual.

Common characteristics of autism include:

• Difficulties in understanding and responding to social cues.
• Challenges in maintaining eye contact and engaging in reciprocal conversation.
• A preference for routines and sameness.
• Sensory sensitivities are also prevalent, with some being hypersensitive to light, sound, touch or certain textures. This causes potential dietary issues.

Beyond the core features of autism, individuals with autism may also experience a range of co-occurring conditions. These include attention deficit hyperactivity disorder (ADHD), anxiety, depression, developmental coordination disorder (DCD), epilepsy, obsessive-compulsive disorder (OCD), sleep disorders, hypermobility and intellectual disabilities. Having comorbidities further complicates the clinical picture of autism and can make challenges to lifestyle and diet worse.

The Role of Diet in Autism Management

Diet is important in the management of autism. The condition often causes parents in particular to have various dietary concerns about food intake. It’s important to recognise that being autistic doesn’t mean you need different nutritional intake from those without the condition. However, there are dietary considerations like:

• Needing routine for mealtimes – this can mean specific seating, specific cutlery and specific plates. It might also mean the individual wants to eat alone.
• Being sensitive to smell and other sensory inputs like the sound or sight of food can impact eating.
• Having an upset stomach – gut sensitivities like bloating, diarrhoea or constipation are common with autism.
• Food hypersensitivity – the body reacting to certain foods.
• Eating a limited diet – concentrating on ‘beige’ foods or foods that are similar in taste and colour (often heavily processed foods).

Common dietary concerns

Autistic individuals often face dietary concerns. Besides gastrointestinal issues, food sensitivities and gastrointestinal issues, many autistic people have selective eating. This is characterised by only eating a limited range of foods, referred to as ‘safe foods’. At the extreme end, this can lead to nutritional deficiencies. Those whose food intake is a concern may also be diagnosed with avoidant restrictive food intake disorder, or ARFID. Though this is common in autism, it is also possible to have ARFID without being autistic. 

Many people believe that food sensitivities like reactions to dairy or gluten may also exacerbate autistic traits and gastrointestinal issues like diarrhoea and constipation can affect well-being and comfort. 

Gluten-free and casein-free (GFCF) diet

For those with food sensitivity, many people are drawn to try the gluten-free and casein-free (GFCF) diet. This involves eliminating gluten-containing grains and dairy products from the diet. Despite its popularity within the autism community, scientific evidence supporting the effectiveness of the GFCF diet remains limited, with mixed results from research studies. The National Institute for Health Care Excellence (NICE) advises against exclusion diets for children as they may affect their growth. 

Low phenol diet, ketogenic diet and other approaches 

In addition to the GFCF diet, various other dietary approaches have been explored in the management of autism. These include the low phenol diet, which restricts foods high in phenols. These are compounds found in certain fruits and vegetables. 

The ketogenic diet, on the other hand, is a high-fat, low-carbohydrate diet. This has also gained attention for its potential benefits in reducing seizure activity and improving cognitive function in individuals with autism. Small studies show that the ketogenic diet may have some effect, although the sample sizes for the research were small. However, the studies also recognise the difficulty in getting autistic individuals to eat a ketogenic diet.

Other approaches often talked about in the autism community are: 

• The specific carbohydrate diet (SCD): This was originally designed for inflammatory bowel disease (IBD). It is a diet free of gluten, soy, artificial colours, additives and most carbohydrates.
• The reduced excitatory inflammatory diet (REID): This is named after Dr Katie Reid and is a diet based on whole foods that are free from inflammatory agents like glutamate.
• Failsafe or RPAH diet: This diet eliminates glutamate, amines, salicylates and additivities.
• Low histamine diet: This helps with various gastrointestinal symptoms. It eliminates high histamine foods like cured meats, fermented foods, slow-cooked broths, aged cheeses, alcohol and vinegar.
• Low FODMAP diet: This is a diet low in sugars that cause GI upset.

While these dietary approaches hold promise, further research is needed to elucidate their efficacy and safety in the context of autism management.

Nutritional Considerations

Ensuring balanced nutrition is paramount for individuals with autism spectrum disorder (ASD). A well-rounded diet provides essential nutrients necessary for proper growth, development and cognitive function. However, individuals with ASD may be at an increased risk of nutrient deficiencies due to their selective eating habits, food sensitivities and gastrointestinal issues.

Nutrient deficiencies need to be addressed as they can exacerbate existing symptoms and hinder optimal functioning. Common deficiencies observed include vitamins D, B6 and B12, as well as minerals such as magnesium and zinc. 

Trying to include a variety of nutrient-dense foods into the diet can help mitigate the risk of nutrient deficiencies and support overall health. Fruits, vegetables, whole grains, lean proteins and healthy fats should form the foundation of a well-rounded diet for autistic individuals. Additionally, incorporating foods rich in omega-3 fatty acids, such as fatty fish, flaxseeds and walnuts, may offer benefits for cognitive function. 

In some cases, dietary supplements may be recommended. This is especially true when a diet is restricted due to autism. However, you should always consult with healthcare professionals before supplementing. This is because the excessive intake of certain nutrients can have adverse effects.

Food Sensitivities and Allergies

For autistic individuals, who may already experience challenges with communication and sensory processing, food sensitivities and allergies can exacerbate existing symptoms and cause additional difficulties.

Identifying and managing food sensitivities and allergies is essential in autism management. Issues may manifest in various ways, including gastrointestinal disturbances, skin rashes, respiratory problems and behavioural changes. For children, particularly those who are non-verbal, it can be difficult to understand and explain the effects foods are having on your body. 

The process of identifying food sensitivities and allergies often involves careful observation of symptoms following the consumption of specific foods, as well as diagnostic tests such as skin prick tests or blood tests for IgE allergies. Additionally, elimination diets, where potential trigger foods are removed from the diet and gradually reintroduced, can help pinpoint problem foods and guide dietary modifications. However, it is important to recognise the challenges that this may bring with the restricted diets and desire for ‘sameness’.

Lifestyle Factors and Autism

Lifestyle factors such as exercise, sleep hygiene and stress-reduction techniques are crucial for promoting overall health and well-being.

Regular exercise and physical activity offer numerous benefits for autistic individuals. It can help improve motor skills, coordination and physical fitness. Physical activities like swimming, cycling or yoga can also help regulate sensory processing. They may even reduce hyperactivity and repetitive behaviours. Exercise also releases endorphins, which can enhance mood and alleviate anxiety. This can contribute to better emotional regulation and overall well-being.

Sleep hygiene

Quality sleep is essential for individuals with autism, as adequate rest supports cognitive function, emotional regulation and overall health. However, it is common for autistic individuals to experience difficulties with sleep initiation, maintenance and quality. This could be due to sensory sensitivities, anxiety or irregular sleep patterns.

Most people do better with a consistent bedtime routine, a calming sleep environment and minimising screen time before bed. In extreme cases, doctors can treat sleep disorders with melatonin to promote sleep. 

Stress reduction

Due to the difficulties the condition presents for many people, stress and anxiety are common. These both contribute to dysregulation. Teaching autistic individuals stress-reduction techniques, such as deep breathing exercises, progressive muscle relaxation and mindfulness practices, can help them develop coping skills and regulate their emotional responses. Additionally, creating structured routines, providing sensory adjustments and offering opportunities for breaks and self-regulation can support individuals in managing their stressors more effectively.

Individualised Approaches

As the common saying goes, ‘if you know one person with autism, you know one person with autism’. What this means is that it is important to recognise the diverse needs of autistic individuals. As such, any approach used should be tailored and individualised. 

Factors such as sensory sensitivities, dietary preferences, medical conditions and co-occurring disorders can significantly impact the effectiveness of any interventions. Therefore, a one-size-fits-all approach is often ineffective and may even be counterproductive.

Individual approaches to diet, nutrition and lifestyle mean assessing each person’s needs, preferences and challenges. This may mean conducting thorough assessments like nutritional evaluations, dietary histories and sensory profiles.

Tailored interventions to meet the needs may involve modifying dietary choices, adjusting mealtime routines and implementing sensory adjustments. Factors like cultural background, family dynamics and environmental influences will also play a role.

Consulting Professionals

When considering significant dietary and lifestyle changes for individuals with autism spectrum disorder (ASD), families and caregivers need to seek guidance from healthcare professionals. Consulting with dietitians and nutritionists can provide invaluable support. This will also ensure that interventions are tailored to meet the specific needs of the individual.

Registered dietitians and nutritionists have specialist knowledge in nutrition and dietary management. This allows them to assess dietary habits, identify nutritional deficiencies and develop personalised meal plans. By collaborating with these professionals, families and caregivers can receive practical recommendations for optimising dietary intake.

Healthcare providers, including doctors, psychologists and occupational therapists, are important. They can offer comprehensive assessments, monitor progress and provide guidance on lifestyle modifications. However, depending on your area, it can be quite difficult to get such support easily through the NHS. 

By consulting with healthcare professionals, families and caregivers can make informed decisions regarding dietary and lifestyle changes. This also ensures that interventions are evidence-based, safe and effective. 

Evidence-Based Practices

When dealing with the challenges of autism, it can be easy to end up reading ideas that are not proven or evidence-based. Many people seek a cure for autism – often these are worried parents. However, lots of autistic people embrace their condition, despite its challenges. Many feel that it does not need to be cured; rather, it should be accepted and accommodated. 

It is important to prioritise evidence-based practices that have been supported by peer-reviewed research as this will be reliable and provide insights into the safety and efficacy of any lifestyle interventions. 

By using practices that have been researched properly, you reduce the risk of adverse effects. Since it can be challenging to change autistic diets or routines, trying something that hasn’t been properly researched can be problematic and not worth it if it isn’t going to have an effect.

Conclusion

In summary, in this article, we have explored the role of diet, nutrition and lifestyle in the management of autism spectrum disorder (ASD). There are diverse dietary and lifestyle challenges faced by autistic individuals, which can have an impact on their overall health and functioning. It is crucial to approach any changes to diet with caution and under the guidance of healthcare professionals. While diet, nutrition and lifestyle interventions can offer benefits, they must be tailored to meet the specific needs of each individual and implemented in a safe and evidence-based manner.