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Nutrition, Supplements, and Biomedical Therapies
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Notes from Conference on Nutrition Therapy for ADHD, Learning Disabilities, Sensory Processing Disorders, and Autism Spectrum Disorders:
by Elizabeth Strickland, MS,RD,LD www.ASDpuzzle.com
Nutrition and its impact on Learning and Brain and Body Functions:
Nutrition is essential to normal brain function
Neurotransmitters (brain chemicals) are traveling to the next brain cell sending the message triggering the next behavior or motor output.
Amino acids make up the NTs and come from protein, which comes from foods we eat. Cofactors also needed (vitamins and minerals)
Myelin sheath also fed by essential fatty acids.
30-50% of calories eaten are used in the brain alone...
There are no quick cures. Nutrition helps to maximize brain function, so that therapy can be maximized!
From the American Academy of Pediatrics: Prevalence of Autism, LD, ADHD, Aspergers, PDD, PDD-NOS is ALARMINGLY RAISING!
In 10 years see the difference: 1994 = 1 in 10,000 and 2004 = 1 in 166 for AUTISM ALONE!
Now it is 1 in 88! The causes are complex but include factors such as gut flora, toxins, the
ability to chelate naturally, and genetic. READ THE BOOK AUTISM REVOLUTION by Harvard
Press to learn more! GAPS diet is also an excellent resource on how the gut effects
Nutrition Interventions may include from a trained biomedical doctor or clinical nutritionist:
1. Basic Daily Supplements: every day they need multivitamin and minerals
2. Essential Fatty Acids: Omega 3 and ALA, DHA therapy
3. High Dosage: Vitamin B6 and Magnesium and Vitamin A
4. Special Diets- GAPS or SCD most common
BE CAREFUL...not every child needs all the nutrients recommended forever...some are good at periods of life, some are good forever...
Vitamin and Mineral supplements are vital to all children!
Statistics in America: only 1% of children's diet met all dietary requirements set by the US government standards.
If a child is obese, they can still be and usually are malnourished! Children with autism, LD, ADHD , etc. are even at more risk. Limited variety of foods, mealtime behaviors, elimination diets, food allergy, sensitivities, intolerance, chronic GI disorders...
Subclinical Nutrition Deficiency is the global subtle effects of lack of nutrition
Preliminary: depletion of tissue stores
Biochemical: reduced enzyme activity
Physiologic/Behavior: subclinical behaviors
Clinical: you know you have a problem
Subclinical behaviors: anxiety, moody, poor concentration, loss of appetite, depression, sleep problems, irritability. Try going without lunch, go without a meal for a few days, see how you feel!
How to select a vitamin and mineral supplement:
1. Passed a lab test (USP, Consumer Lab, NSF international) go to these websites and look up the vitamins and minerals and these independent labs test them and tell you what is really in them! (For example: the newest and most advertised vitamins for children are the new "gummy bear" multivitamin, when tested by these labs they found LEAD in them. Why are they still on the market? Money talks.)
2. Read the label and avoid: artificial flavors and colors, known allergens, herbs, copper, iron
*artificial colors can worsen: irritability, runny nose, asthma, mood changes, attention problems,
*Herbs: the problem is that herbs are medicine. You don't need them every day. They aren't essential nutrients.
*No copper: higher levels of copper found in autism children and it has a redox property, highly reactive O2 molecules that can damage DNA in our cells...
*Iron: same as above, too much can cause redox property, generate excess O2 molecules, damaging DNA in our cells.
Ask your doctor to check the ferrotin levels of your child. This is a sensitive blood test to check for iron deficiency, test again 6 months later. Take iron out if they aren't deficient, especially boys because they can't get rid of iron monthly like girls.
**Drop vitamin in a cup of vinegar for 15 minutes, if it dissolves completely then it is biogradable and dissolves in your system, if not then it is not good. Go to Consumer Labs website and see results: www.consumerlab.com, www.nsf.org, www.usp.org
3. Make sure that the vitamin is comprehensive: don't use baby vitamins for growing children...
What is needed in a multivitamin?
Fat soluble vitamins (A, D, E, K)
Vitamin B complex (B1,B2,B3,B5,B6,B12, folic acid, biotin)
Minerals - calcium (hard to get enough, and you will need a separate supplement), magnesium, zinc, selenium, manganese, chromium, molybdenum
Specialized Supplements: you write out what the patient needs and have it compounded at a pharmacy. Ask the dietician to do this! Write a letter to the insurance company from dietician and they state that it is medically necessary that the patient have this, some insurance will pay for compounding. Appeal, appeal, appeal!
Medicaid will cover vitamins, minerals, and all kinds of supplements, and most patients aren't aware of this. Contact Medicaid at the state level, and ask for a copy of the OTC product list... Village Green can do it very inexpensively because they buy in bulk! www.the-apothecary.com
How do you get these into the child? Gradually and slowly! Mix in with juices, fruit smoothie, Rice Dream, fruit sorbet, pudding, peanut butter, jelly, honey, ketchup, cooked foods, homemade juice pops....Go to the health food store to buy smoothie mixes, and let them choose which one they want!
ESSENTIAL FATTY ACIDS: extensive studies have been done on these and they are ESSENTIAL!
Neurodevelopmental Disorders and EFA's: numerous studies indicate that Omega-3 fatty acids are deficient in ADHD, dyslexia, and dyspraxia (poor muscle coordination and speech). Abnormalities in fatty acid metabolism may account for many features common in these conditions.
"Reported DHA 23% reduced, total Omega-3 20% reduced, and Omega-6 unchanged in blood plasma levels in children with autism."
Functions of EFA (Omega-3):
- Brain development of the fetus, infant, and young child through life
- Maintenance of normal brain function
- Vital for brain cell signaling
- Prominent structural fatty acid in the gray matter of the brain and retinal tissue and is
- Very important for visual processing (deficient in reading disabilities)
Differences between Omega-6 and Omega-3... Plenty of Omega-6 in the form of linoleic acid in vegetable oils. This gets converted to Prostaglandin-2 ,which is addictive, and causes heart disease.
American diet is 20:1 Omega 6 to Omega 3.
EFAs : World Health Organization recommends the following intake daily for ALA ,DHA ,EFA:
ALA-Alpha-Linolenic Acid 800-1100 mg/day (high in Flaxseed oil, flaxseed, walnuts and wheat germ)
EPA & DHA (300-500 mg day) (found high in white tuna, sardines, herring, salmon farmed in Atlantic, trout, Mackerel)
Formula for children: take the weight of the child (4 year old 35 lbs/150=.23 * 500= 117 mg.) To know how much they need of these.
EATING PROBLEMS: TEXTURE PREFERENCES and mealtime issues:
GI disorders show up as: refusing foods, limit variety of foods, tantrums, self abuse, poor sleep cycles.
Dr. Wakefield studied the correlation of chronic enterocolitis and regressive developmental disorder.
69% have Esophagitis reflux
58% low enzyme activity
In children with autism the damage is deeper in the tissue and higher up into the esophagus than even adults with GI problems. They found a new form of inflammatory bowel disease called Autistic enterocolitis.
Medications used: antifungal meds (nystatis, diflucan, nizoral, sporanox)
Antibiotics: vancomycin, flagyl
Secretin: not research-supported now
DIGESTIVE ENZYMES are good! They help heal the gut...
PROBIOTICS: these are very beneficial, especially when they can't take milk. Studies are very supportive of PROBIOTICS. These help to relieve loose stools and viruses that affects the stomach.
Essential fatty acids: decrease inflammation in the GI track and the whole body!
Not recommended right away: L-glutamine or antifungal herbs until they have already done the above and only for more severe GI problems.
This protocol comes right after the multivitamin and essential fatty acids, before the B6 and DMSA, to fix the gut first!
Don't refer out to GI MD until you have tried all of this, because they are only going to put medicines that are a band-aid to the problem, that don't fix the problem but just cover it up for a while.
Then you end up with more than one medicine, and another one for side effects of the first medicine, beginning a vicious circle.
Feeding problems: it is a no-brainer that these children have feeding problems and gut digestion problems. Think about the connection they have to food, not a pleasant experience! Psychologically, feeding is a bad time for them...
Common problems: a limited number of foods, texture preferences and aversions, unusual mealtime habits (self stimulation, has to be in a certain container, has to be from a certain restaurant, rituals)
How to help:
- Get them comfortable with the environment first. Sit at the table and color, play, watch the noise level, the stimulation, etc.
- Gradual progression (put the table in a more comfortable environment). The goal to sit for longer periods at the table, without food, gradually add in things such as utensils, plate, cup, then last is food! Don't overwhelm or overstimulate them at meal times; gradually add in everything.
- Reward for food acceptance, sitting at the table, touching foods for fun, etc. NOT with junk food!
- Play time with foods is essential...
- Let the child be in more control of the situation (learn to feed themselves and be in control)
- Don't feed a 5 year old and watch what you feed them (mush: oatmeal, baby food, etc.)
"If a child is hungry enough he will eat." Not true with Autism and SID problems. A therapist in Denver is being sued because she recommended that the mom take away foods and the child should eat what everyone else is eating. The child did not eat for 3 weeks, in hospital for renal failure.
Difference in Picky eater and a problem feeder:
Picky eater: decreased variety of foods less than 30 foods. Foods lost due to burn out regained after 2 weeks, able to tolerate new foods on plate, touch, and taste. Eats at least 1 food of each texture, adds new foods after 15-25 tries or seeing the food.
Problem eater: less than 20 foods eaten, foods not regained once burned out, falls apart when presented with new foods, refuses entire category of textures, adds new foods in more than 25 tries.
Problem eaters are this way because of:
Physical: pain, discomfort, nausea, stool issues, allergies, sensitivities, intolerance
Motor: delayed self feeding, over stuffing, choking, delayed chew, tongue, swallow coordination
Sensory: texture hypersensitivity, oral hypersensitivity, oral aversion, sensory processing problems, auditory (hurts to hear the crunching sounds, or the sounds in the meal room), too stimulating
Behavioral: hyperactive, low frustration tolerance, highly distractable, need for routine, impaired social interactions. If they can't sit in a chair any other time, why would they sit there to eat for 15 minutes or longer?
Impaired social skills: eating meals is very social, they have to answer questions, look at others, possibly touch one another...
- Poor reinforcement. Use positive reinforcement only!
- Social modeling (parents must be sitting for the meal and making good food choices as well)
Be consistent. They need structured meals (PECS or visual calendar is very helpful of course) and an organized household
- Do NOT allow them to graze all day long
Home based treatment:
identify and treat GI problems (without medicine or band-aids, get to the real problem)
Evaluate motor, oral motor and swallowing skills and treat this area
Evaluate and treat Sensory Integration processes
Conduct a Behavioral Functional Assessment
Get the parents involved in doing it themselves to model your therapists behavior
Develop an individualized intervention plan
General tx strategies: with any child these can be done!
1. Social modeling: the family eating together, not the child eating separately from the child. Have the family come for part of the meal, so there is an overlap of time together if SI issues.
2. Structure meal and snack times: NO MORE GRAZING. Sit down for eating together at set times in the day.
3. Manageable foods: look at the plate, don't put more than 3 foods at a time, 1 tblsp for each year of age and no more! They become visually overwhelmed!
4. Positive reinforcement: don't say "Don't ____,", say, "Do this...."
5. Appropriate mealtime language: words mean a lot. Don't beg them to take foods (they will take control and say "no"). Children with disabilities will control with their mouth.
6. Prevent "food jags": That's a real problem with these children they eat the same thing over and over, then all of a sudden they stop eating that food and never go back to that food. When it comes back they see it as all new food again, so they get smaller diets. Suggested that from early on, do not give the same food more often, maybe every other day, and change the food's shape, what is with it, etc.
Kay Toomey has a great 2-day course on this!
Steps to eating: Introduce food in play away from meal time first...one food at a time...
1. Tolerate: the food is in the room with them, the food is on the other side of the table, being 2 way on table, with food in front of the table, look at the food directly in front of food.
2. Interact: assists in preparation, uses utensils to stir or play with the food, uses utensils, etc.
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