Foods For Thought: An Insight Into Special Diets

Diets: caveman, paleo, “ape,” low carb, low glycemic, zone, ketogenic, specific carbohydrate, GAPS, “grain brain,” “wheat belly”diet — why is there so much interest in these diets? What are they targeting? Is it gut dysbiosis/inflammation or food allergies, or insulin dysregulation, or gluten intolerance, the optimal primate food, or something else? Is there perhaps a unifying explanation for their widespread applicability?

These diets all emphasize whole foods which are low on the glycemic index and high in good fats. There is good evidence that these diets present a potent way to help many children with autism and other conditions. Regardless, we need to always remember that therapies for children with autism must be individualized, and approached gently and systematically, in order to properly assess their impact. Some children need to follow a low oxalate, or phenol-free, or FODMAPS diet, and even so, there is still good reason to follow the general dietary principles discussed below, while following these special diets. Also know that the diets discussed below have effects which go well beyond what is commonly understood, for example: food allergies, weight loss, gut repair—psychological restoration. As I will discuss below, there is a wide variety of medical issues which may improve in people who follow this dietary approach. 

One common feature with all of these diets is resistance to their acceptance by organized medicine. Reflecting on the history of these diets, this is likely due, in part, to unclear mechanisms of action, collisions with prevailing “wisdom” about healthy eating (e.g., the food pyramid and the low fat, low cholesterol diet), and a strong food lobby for processed, sugary foods. Take a walk through the middle aisles of the grocery store and make a count of the breakfast cereals, chips and crackers, breads and desserts, sweetened beverages and juices if you doubt the influence of these foods in our personal and national economy. 

With deeper research into nutritional and digestive physiology, the human microbiome, and neuroimmunoendocrinology, a solid conceptual basis for these similar diets is being established, and their value is gradually “seeping in” to ordinary medical thinking and therapeutics. A second common feature of these diets is their emphasis on simple unprocessed foods, particularly vegetables and meats.

Another common feature is that they are labor intensive, requiring home preparation of most of the foods (thus giving the consumer good knowledge of the actual ingredients, and also the touch and energy of a person known to the one eating). Yet another common feature is the physical and emotional difficulty in making the required dietary changes. Often, children crave foods to which they have allergies or intolerances, and may experience painful, addictive-type withdrawal when these foods are removed from their diet. After briefly discussing some of these diets, I’ll return to consider the above questions, and some general thoughts about diet and health.

My first experience with these diets was with the caveman diet (and I’ll here include paleo and ape diets as almost identical), taught to me by the Society for Clinical Ecology in 1981. This diet was developed as a diagnostic approach to food allergies, aiming to eliminate the most common food allergens: grains, dairy, eggs, legumes, nuts, sugar, potatoes, yeast, food additives. Persuading patients to try this diet for two weeks was not easy. However, I well remember one of my first patients who took on the diet for the recommended trial period. At our two week follow-up, she enthusiastically reported the clearing of her headaches, fatigue, digestive disturbances and achiness. She asked if she could remain on the diet long term, instead of challenging the foods she’d been avoiding. She received my approval, recognizing that this diet has been well tested over the history of primates and stone age, pre-agricultural man. The understanding at that time was that the diet was treating food intolerances, with symptomatic improvement attributed to removal of offending foods. This is often true, as it eliminates the most common food allergens, but it also eliminates the rapid-acting and high carbohydrate foods.

The low carbohydrate diet, popularized by Robert Atkins, has been followed by millions of people with many different health conditions. I would include the ketogenic diet, Zone diet, low glycemic diet as close relatives of the Atkins diet. This diet focuses particularly on carbohydrates, as the source of health problems, and aims for a very low (Atkins or ketogenic) or low (Zone, low glycemic and many others—SouthBeach, Protein Power, Rosedale) carbohydrate intake.

The first recorded publication on this dietary approach was in 1863 (Letter on Corpulence Addressed to the Public), by William Banting, a carpenter and eminent undertaker, who struggled with obesity from a young age. He rigorously followed many different exercise and dietary programs without success, including twenty hospitalizations for treatment of obesity. After decades of unsuccessful efforts, and being told by a famous physician that his obesity was normal, he finally encountered William Harvey MD. Inspired by the work of Claude Bernard (one of the fathers of the science of physiology), Dr. Harvey advised him to undertake a low carbohydrate diet (eliminating sweets, potatoes, grains, beer and sweet alcoholic drinks). In six months he lost 25% of his body weight, returning to normal weight, and also found lasting relief of a panoply of chronic symptoms. Despite Banting’s success, the publication of his book and development of a foundation to promote the diet, this diet met huge resistance from the medical profession, and Dr. Harvey was criticized and ostracized.

The general failure of acceptance of their findings is perhaps attributable to the lack of an accepted theory on why the diet worked, despite the fact that it did work for many obese people at that time. Today, the ketogenic diet and the modified Atkins diet are recognized as effective in control of seizures, and as potentially beneficial in neurodegenerative diseases (and possibly one form of brain tumor, the astrocytoma). However, these diets still face tremendous opposition from cardiologists and nutritionists, who preach the importance of low fat diets for weight loss and heart protection.

The specific carbohydrate diet (SCD, and GAPS, an updated version) was developed by Sidney V. Haas (author of 1951 textbook: The Management of Celiac Disease). It was popularized by Elaine Gottschall, (Food and the Gut Reaction 1987, second edition: Breaking the Vicious Cycle 1994) whose daughter was cured of ulcerative colitis by following Haas’ diet. The SCD was initially directed toward treatment of inflammatory bowel disease (Crohn’s and Ulcerative Colitis) and celiac disease. It has produced remarkable benefit, even clearing of their disease in some IBD patients in my practice, since I began collaborating with Elaine in the mid-1990’s. The conceptual basis for the diet is that it produces positive changes in gut flora, reduction in fermentation of undigested carbohydrates, and resultant decrease in bowel inflammation. The excluded foods are grains, potatoes (and a few other starchy roots), sugars except honey, most legumes, lactose. Allowed foods include unprocessed meats, nuts, fruits, vegetables, eggs, oils, honey, simple spices (and cultured dairy in non-autistic people, if tolerated). SCD and GAPS approaches have been extended to patients with autism, bringing tremendous benefit to thousands of these children.

On the other hand, Wikipedia’s article on SCD concludes: “…however, scientific evidence of the diet’s effectiveness is lacking, and the diet may pose a health risk due to lack of nutritional quality.” We hear these comments, despite seminal work at Harvard Medical Center by the GI team which has demonstrated that a very substantial portion of children with autism lack the intestinal disaccharidase enzymes required to digest starch, lactose and sucrose. In addition, several recent studies (one from U Mass Medical Center, one from Seattle Children’s Hospital) have shown clinical improvements in patients with inflammatory bowel disease who have been treated with this diet.

The “wheat belly” and “grain brain” diets are again very similar to the low carb dietary approaches, adding a particular focus on gluten and gliadin constituents of wheat. We have found in autism that many children have an opiate-like response to gluten (and to casein from milk products), with improvements in brain and gut function (and often a painful withdrawal period at first) after removing these foods strictly from their diet. As mainstream medical awareness of gluten intolerance expands, we are learning that many autoimmune diseases are aggravated by gluten intolerance whether or not the patient has celiac disease. In addition, patients with autoimmune thyroiditis, rheumatoid arthritis, lupus, type 1 diabetes, and even MS, may be encouraged to avoid gluten. Also, it is now recognized that the risk of neurodegenerative diseases such as Alzheimer’s, Parkinson’s Disease, and Amyotrophic Lateral Sclerosis is increased in people with insulin resistance or type 2 diabetes.

These diets have been referred to as anti-inflammatory; how might this be so? There are a number of considerations to explore. 

First and perhaps foremost, is that these diets emphasize whole foods, which are best eaten fresh and homemade. This reduces exposure to additives and processed foods, which themselves add toxic and inflammatory influences to our diet.

Vegetables and many fruits (especially berries, which are incidentally the lowest carbohydrate fruits) are rich in many phytonutrients, which stimulate our antioxidant defenses and help reduce inflammation. People who consume increased amounts of these foods, versus the nearly empty calories found in processed foods, have reduced risk of cancer, heart disease and other chronic illnesses.

Processed foods commonly contain toxic substances: food additives, hydrogenated fatty acids, amino acids which can be isomerized by processing—these substances and others (such as synthetic vitamins which function poorly or not at all as intended) may contribute to inflammation and tissue degeneration.

Producers of processed foods, in order to increase “cravability,” add large amounts of fat, salt, sugar, other sweeteners, in excess of what we commonly use in homemade food. Also, consumption of high concentrations of fructose (found particularly in corn syrup and agave syrup) is associated with increased insulin resistance, which contributes to chronic inflammation.

In general, the processing of foods removes nutrients found in the whole food—such nutrients as fiber, essential fatty acids, trace minerals and fragile vitamins as folic acid. Reduced dietary fiber contributes to intestinal disturbances, essential fatty acids are important in regulating inflammation and cellular function, and trace nutrients are involved in many body functions including immune activities, neurotransmitter function, energy production, and cellular communication.

Food producers have attempted to compensate for nutrients removed in processing by “fortification” with synthetic vitamins and selected minerals. However, these do not begin to replace the incredibly rich and complex variety and balance of nutrients found in whole foods. For example, people with high blood levels of antioxidants have significantly reduced risk of vascular disease and cancer, but only if these antioxidants are obtained through diet. In fact, when the same antioxidants are supplemented, rather than being obtained through diet, the observed protective effect is lost. Terry Wahls MD’s experience with MS is instructive. Her progressive MS proved unresponsive to a vigorous vitamin and mineral supplementation program, but then responded dramatically to a rigorous whole food diet which emphasized large amounts of nutrient rich foods, including nine cups per day of specific fruits and vegetables.

Processing of foods tends to increase the caloric density, thus increasing the tendency to ingest more calories. This issue, along with the effects of food additives such as MSG, which directly stimulates insulin release, may contribute directly to obesity, and the increased inflammation inherent to obesity.

High glycemic foods (foods which raise the blood sugar quickly and extensively) stimulate insulin release. It is now recognized that insulin is a pro-inflammatory molecule, and that insulin resistance (with higher insulin levels, as is found in most overweight people, in metabolic syndrome, and in type 2 diabetes) is associated with increased risk of dementia and other inflammatory conditions (such as joint disease). Related to these effects is the documented benefit of the diabetic drug, Actos, in autism, which acts as an anti-inflammatory through NFkappaB and PPAR gamma signaling modulation. In essence, diets which minimize the rise in blood sugar occurring after eating also reduce insulin levels and thus may reduce inflammation. This is an important consideration in autism, where gut and brain inflammation are strong contributors to the pathology and symptoms children experience.

In summary, it makes sense, in children with autism and related conditions, to move beyond the first step of eliminating gluten and casein from their diet. Next, begin to focus on increasing consumption of healthy fats and reducing consumption of carbohydrates, particularly the quick acting and concentrated carbohydrates. These are found in large amounts in all grains and grain substitutes, potatoes, sugars, dried fruits and fruit juices, and in certain fruits (bananas, watermelon, dates, etc.). Healthy fats are found in coconut, olives, avocadoes, eggs, nuts and seeds, moderate meats, and clean fish {which are difficult to find}. Include moderate amounts of protein (meats, legumes, if tolerated, plus above mentioned protein sources), and 1-3 servings of fruit (especially berries, if not phenol/salicylate sensitive). There is strong convergent evidence supporting the value of these dietary approaches in children with autism and special needs. 

A good way to start would be the low glycemic diet, which aims to avoid foods with a glycemic index above 50 and a glycemic load above 10. 

Harvard Health Publications presents a table of glycemic index and load values for 100 foods, which will help you to begin evaluating food choices for your child. A much longer list of over 2400 international foods can be used to research less common foods your child may be willing to consume. Remember, this diet is very similar to the foods which primates have consumed since time immemorial. There is a reason why we are told not to feed the monkeys at the zoo—our diet can make them sick, as, in fact, our diet is making us sick!

Clearly, modifying the diet of a child with special needs is a daunting and sometimes terrifying proposition. Their eating habits, addictions, sensory issues, and in many cases, poor health and vitality all contribute to immense difficulties in accomplishing desired changes. In addition, it is difficult to help special needs children to understand the reason for removing favorite foods, as they will generally prefer to stay with the status quo. However despite all the challenges, we have seen immense progress in children whose parents succeed at major dietary interventions; it is worth all the effort in order to maximize their chances to make good progress. I have found it often very helpful if the whole family follows a similar program, and all may benefit from doing so, in addition to the emotional support provided to the child of special concern by doing this. 

May you be rewarded with a healthy, happy child and family!

About the Author

Since the beginning of his practice in 1975, John A. Green III, MD has worked with children and adults with chronic health problems which have not responded to conventional therapies. His patients frequently experience significant improvements by exploring and modifying diet and nutrition, toxic load factors, allergies and sensitivities, hormones and psychological influences. In the late 1990′s, Dr. Green was led by several of his early autistic patients to the Autism Research Institute. In the past 14 years, he has evaluated and treated more than 2,500 children with autism spectrum disorders from all over the world.

In addition to seeing patients individually, Dr. Green has mentored doctors in Italy, Hungary and Poland and participated in numerous roundtables including the Autism Research Institute’s Clinician’s Training and Thinktank, and the Northwest Physicians Autism Forum. He has also served as the editor for the AHMA quarterly member letter, authored two chapters in Recovering Autistic Children and made numerous presentations to DAN!, as well as other venues such as the Washington and Hawaii TACA (Talk About Curing Autism) meetings. In addition, his office regularly participates in research related to preventing and reversing symptoms associated with autistic spectrum disorders.

Dr. Green’s practice is located at The Evergreen Center in Oregon City, Oregon. He offers in-person visits and also offers support via email or Skype for individuals and families who reside out of the area.

NOTE:  The views and opinions expressed in this article are solely those of the guest author and other contributors.  These views and opinions do not necessarily represent those of Autism Key and/or any other contributors to this site.