Is It More Than Just Registered & Licensed Dietitian - PDF document

11/9/2018 Brittyn Coleman, MS, RDN/LD, CLT Is It More Than Just • Registered & Licensed Dietitian Nutritionist “ Picky Eating ”? • Certified LEAP Therapist • LEND (Leadership Education in Neurodevelopmental Disabilities) Fellow • Sibling of an individual on the Spectrum Brittyn Coleman, MS, RDN/LD, CLT • Private Practice: Autism Dietitian Brittyn Coleman, MS, RDN/LD, CLT • Registered & Licensed Dietitian Nutritionist • Certified LEAP Therapist • LEND (Leadership Education in Neurodevelopmental Disabilities) Fellow • Sibling of an individual on the Spectrum • Private Practice: Autism Dietitian Conflicts of Interest Agenda 1. Describe selective eating in autism No conflict of interest to declare. 2. Identify reasons for selective eating in ASD 3. Highlight differences between picky eating and problem feeding 4. Identify problems associated with selective eating 5. List common nutrient deficiencies 1

11/9/2018 Selective Eating in Autism Why is Selective Eating Common in ASD? • Children with ASD more likely to avoid foods and exhibit neophobia than their • Sensory Processing Disorder typically developing siblings and children without ASD (Schreck, 2004) • Eating is one of the most sensory-rich activities! • Children with ASD on average ate fewer foods (33.5 vs 54.5 foods) (Zimmer, 2012) • Oral dysphagia (refers to problems with using the mouth, lips and tongue to control food or liquid) • 70 ‐ 90% of parents who have a child with ASD report problems with food selectivity • Nutrient deficiencies and limited intake of foods (Mulle, 2013) • Food sensitivities & other gut issues • Odds of children having a feeding problem are five times greater in a child with ASD (Sharp, 2013) • Certain medications Picky Eaters vs Problem Feeders • Most parents with children with selective eating refer to them as “picky eaters” due to the lack of terminology • In children with ASD, they are more likely to be problem feeders • Is there a difference? YES! 2

11/9/2018 Food Selectivity in ASD Food Selectivity in ASD • “Blonde Foods” Problems Associated with Food Selectivity in ASD Selective Eating • “Blonde Foods” 1. Increased inflammation • What do all of these have in common? • GREAT sensory profile! 2. Nutrient deficiency • Highly processed • Extremely low fiber 3. Gut issues (predominantly constipation) • Void of many nutrients • Pro-inflammatory 4. Behavioral and cognitive issues, increased autistic symptoms • High in carbohydrates • Contain top allergens (milk and wheat, among others) Problems Associated with Pro/Anti ‐ Inflammatory Foods Selective Eating 1. Increased inflammation Anti ‐ Inflammatory Pro ‐ Inflammatory 2. Nutrient deficiency Fruits Meats Vegetables Sugar Legumes Refined Grains 3. Gut issues (predominantly constipation) (beans, lentils, nuts, etc) Chemicals Whole Grains Saturated & Trans Fats Unsaturated Fats Omega-6s 4. Behavioral and cognitive issues, increased autistic symptoms Omega-3s & 9s 3

11/9/2018 Pro/Anti ‐ Inflammatory Foods Pro/Anti ‐ Inflammatory Foods Anti ‐ Inflammatory Pro ‐ Inflammatory Anti ‐ Inflammatory Pro ‐ Inflammatory Fruits Meats Fruits Meats Vegetables Sugar Vegetables Sugar Legumes Refined Grains Legumes Refined Grains (beans, lentils, nuts, etc) Chemicals (beans, lentils, nuts, etc) Chemicals Whole Grains Whole Grains Saturated & Trans Fats Saturated & Trans Fats Unsaturated Fats Unsaturated Fats Omega-6s Omega-6s Omega-3s & 9s Omega-3s & 9s Fried foods Problems Associated with Nutrient Deficiency in ASD Selective Eating • Children with a more limited food repertoire had inadequate intakes of a greater 1. Increased inflammation number of nutrients including vitamin A, vitamin D, and calcium (Bandini, 2010) 2. Nutrient deficiency • Nutrient intake is below recommended amounts for calories, protein, carbohydrates, fat, fiber, vitamin A, vitamin D, vitamin C, calcium, and iron (Attlee, 2015) 3. Gut issues (predominantly constipation) • Children with ASD aged 4 to 8 years consumed significantly fewer calories, vitamin A, vitamin C, and zinc ; ages 9 to 11 years consumed less phosphorous 4. Behavioral and cognitive issues, increased autistic symptoms (Hyman, 2012) Nutrient Deficiency • Vitamin D • High dose vitamin D therapy reversed autistic behaviors in severely deficient children • Low vitamin D can cause fatigue and anorexia • Vitamin D is involved in decreasing chronic inflammation • Low levels can induce anxiety or depression • Low levels can reduce lung capacity in asthmatics and increase severity of asthma • Deficiency can play a role in pulling calcium from bones 24 4

11/9/2018 Nutrient Deficiency Nutrient Deficiency • Folate • Vitamin B12 • Deficiency can cause irritability, impaired cognitive function, anorexia, fatigue, and GI • Deficiency can cause fatigue, breathlessness, numbness, poor balance, and memory disturbances trouble • Chronic low folate impairs methylation which can cause neurological damage • Chronic low B12 impairs methylation which can cause neurological damage • Oral folate therapy can resolve symptoms of autism in some cases, particularly in • Modulates melatonin and plays large role in Circadian Rhythm individuals with genes that impair folate dependent enzymes (MTHFR) • Look in the mouth! Symptoms can be swollen gums, tongue, or angular dermatitis • Lower folate levels can cause increased depression symptoms in some individuals 25 26 Nutrient Deficiency Nutrient Deficiency • Vitamin A • Zinc • One cause of autism may be a defect in a retinoid receptor protein (G-alpha protein) • Zinc deficiency can cause loss of appetite, impaired immune function, delayed growth which is critical in language processing, attention and, sensory perception • Helps eliminate toxic mercury from brain tissue • Evidence suggests natural vitamin A fixes this protein deficit • Low zinc impairs a protein that removes heavy metals from the body • Vitamin A plays a major role in vision, immune function, bone formation, and health of • Infantile zinc deficiency may epigenetically contribute to the development of autism the cells in our respiratory, intestinal, and urinary tracts (Yasuda 2011) • Deficiency alters brain waves in non-REM sleep causing sleep to be less restorative 27 28 Nutrient Deficiency Nutrient Deficiency • Vitamin B6 • Magnesium • Cofactor for serotonin and dopamine (can cause decreased appetite and fatigue) • Cofactor for neurotransmitters that affect social reactions and emotion • Supplementation trials with B6 result in better eye contact, speech, and fewer self- • Common for individuals with ASD to be low stimulatory behavior • Low levels may cause low energy and fatigue • Deficiency impairs conversion of omegas (ALA to EPA and DHA) • Deficiency can induce anxiety and emotional hyper-reactivity • Deficiency can cause cognitive impairment • Physical and emotional stress may increase urinary magnesium excretion 29 30 5

11/9/2018 Nutrient Deficiency Nutrient Deficiency • Iron • Fiber • Low iron can cause fatigue & anorexia (loss of appetite) • Constipation (!!!) • Deficiency can cause pica (eating non-food items) • Bloating • Deficiency can have cognitive, social, and emotional effects • Intestinal dysbiosis • Iron deficiency can cause negative outcomes on psychomotor and behavioral • Yeast overgrowth development in infants and young children and increase autistic behavior • Increased likelihood of obesity • Development of chronic disease 31 32 Identify Nutrient Deficiencies Medications • Important to test nutrients inside the cell vs outside the cell to • Many medications used in autism or ADHD/ADD can cause loss of show functional deficiency appetite • Test a wide range of nutrients to ensure comprehensiveness • Some medications can cause nutrient depletions, and long-term use could cause deficiency • SpectraCell tests 35 different micronutrients and shows deficiencies and borderline deficiencies • Antibiotics can cause many gastrointestinal issues due to their effect on the bacteria in the gut • Identify deficiencies and correct them with a dietitian or physician Problems Associated with Common Medications in ASD Selective Eating Medication Nutrient Depletions 1. Increased inflammation B Vitamins Iron Vitamin K Antibiotics Vitamin B6 Calcium Zinc Magnesium 2. Nutrient deficiency SSRIs Vitamins B1-B9 Chromium Melatonin CoQ10 (Fluoxetine, Sertraline, etc.) Vitamin D Vitamin B1 3. Gut issues (predominantly constipation) Calcium Vitamin K Anti ‐ Convulsants Folate Copper (Dilatin, Tegretol, Mysoline, etc) Biotin Selenium Vitamin B12 Zinc 4. Behavioral and cognitive issues, increased autistic symptoms Vitamin B12 Antacids Folate Iron Vitamin D Zinc (Pepcid, Zantac, Prevacid, etc) Calcium 6