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The Complete Autism Spectrum Disorder Health & Diet Guide

April 21, 2014

Autism is a spectrum, and for those of us who have worked with these children and adolescents for more than 20 years, we can attest to the accuracy of this description. I have seen children and adolescents with autism spectrum disorder (ASD) who were aloof and pedantic, self-assured and indifferent to the opinion of others, and others who were withdrawn and timid and appeared to be “in their own world.”

I have also seen a young patient who, when given my birth date, in seconds told me the day of the week I was born. One such patient always arrived in my office with a novel challenge for me. “Dr. Smith,” he asked me, “please tell me all of the countries of the world in alphabetical order, with their capitals.” He already knew that I could not answer and took great pleasure in expounding his phenomenal rote memory while I listened in awe! He taught me many things, including all the different types of jellyfish and what they dined on, and the different types of sharks and whales. He also taught me about the ecosystem and how I could help preserve it.

 Not all autistic children have such a wealth of esoteric knowledge. Some are creatures of habit, ritualistic in their routines, and, like a blind person, dislike change in meal schedules and bedroom organization. Others have been collectors and hoarders of rocks, seashells, receipts, and bubblegum wrappers. An explosive “meltdown” would ensue if their parents ever attempted to purge their room of any of these collections.


Many patients eat the same breakfast religiously for weeks on end and demonstrate extreme inflexibility to change. Then, just as their parents were starting to adjust to this ritual, they would change abruptly from eating pancakes every day, for example, to eating only Cheerios. One patient ate a particular brand of canned spaghetti and tomato sauce and french fries for breakfast, lunch, and supper for a year, and refused to take vitamins or supplements. This resulted in him developing a severe anemia and his serum ferritin (iron storage) and vitamin B12 were both close to zero. His hemoglobin was 4 grams per deciliter (4 g/dL, or 40 g/L)! He required admission to hospital, where further investigations were conducted to rule out bowel-related disorders, such as celiac disorder and inflammatory bowel disease. His blood zinc level was also critically low, and we recognized that this could further contribute to selective intake through poor taste sensation, or hypogeusia.


Many children with autism suffer with sleep-related disorders, anxiety, ADHD (attention deficit hyperactivity disorder), and sensory dysfunction. Many are also diagnosed with “intellectual disability” although we recognize that children with ASD are often not as interested in pleasing others or performing optimally “on demand,” which affects the interpretation of the cognitive assessment.


Despite our efforts to understand the causes of ASD, the incidence of this condition is apparently increasing. Is this due to increased awareness among parents and in society? Is it the result of broadening the definition over the years? Is it because of overdiagnosis and the clouding of the margins of so-called “normality”? Where does eccentricity end and ASD begin? How is “impairment” defined objectively? Is there an “environmental” contribution — a Hurricane Katrina and ice storm phenomenon? Does increased maternal stress in our modern society play a role? Autistic kids seem to have a significant affinity for technological devices, even those kids with apparent intellectual disability. Our society is becoming more technological. Are kids with ASD evidence of an epigenetically directed evolutionary mechanism to meet the needs of our future societies? The current epigenetic research certainly gives us food for thought. 


So why this book? There is clearly a paucity of practical, easy-to-read, yet evidenced-based books that cover the nutritional and gastrointestinal issues in ASD and how to manage them. Many of my patients are picky eaters and react adversely to food textures, food tastes, and even food appearances. We also hear and read about the high rate of gastrointestinal issues that these children experience. In my office, I am frequently bombarded with questions about gluten-free, casein-free diets, fish oil supplements, and probiotics.


In response to these questions and concerns, we decided to write this book, bringing together the experience and expertise of an ASD research assistant, a childhood dietitian, and a developmental pediatrician. We believe we have gathered the best evidence available to date and put it together in an accessible and practical format that parents, nutritionists, dietitians, pediatricians, counselors, and others caring for kids with ASD should find useful. I believe we have achieved this goal, for the ultimate good of children with this challenging disorder.


~Dr. Garth Smith, author of ASD: The Complete Autism Spectrum Disorder Health & Diet Guide




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The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment, or disability, that children with ASD can have. Some children are mildly impaired by their symptoms, but...

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