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With Autism, Diet Restrictions May Do More Harm Than Good

Study finds no increase in gastrointestinal problems in kids with the disorder

Posted July 27, 2009

By Gardner

HealthDay Reporter

http://health.usnews.com/articles/health/healthday/2009/07/27/with-autism-diet-r\

estrictions-may-do-more-harm.html?PageNr=2

MONDAY, July 27 (HealthDay News) -- Children with autism do not have a higher

incidence of gastrointestinal problems than other children, a new study has

found.

However, autistic children do have a higher rate of constipation and eating

issues, such as eating the same foods over and over, according to the study. But

any number of factors, including medication, could cause these issues, the

researchers said.

The findings appear in the August issue of Pediatrics.

Dr. Manning-, medical director of the O'Leary Center for

Autism Spectrum Disorders

at Cincinnati Children's Hospital Medical Center, said that the study is an

important one because it was the first to scientifically compare the incidence

of gastrointestinal (GI) problems in an autistic population with incidence in

children who are developing normally.

Even so, it's unlikely to quell a controversy that has been raging for more than

a decade.

" A couple of highly publicized cases of autism and loose stools in the late

1990s led to an impression that children with autism had a higher rate of GI

dysfunction, " she said. " It wasn't well characterized, but that got the story

onto the national scene. "

This, in turn, led to theories that diets free of gluten and the milk protein

casein might help the problems, along with treatment with the hormone secretin.

Some even proposed that problems with the gut might be the cause of autistic

symptoms, giving the matter added urgency.

But the evidence in favor of these hypotheses was " fuzzy, " Manning-

said.

For the new study, researchers followed 124 children with autism and 248

children without autism until they turned 18.

Gastrointestinal diagnoses were classified into five groups: constipation;

diarrhea; abdominal bloating, discomfort or irritability; gastroesophageal

reflux or vomiting; and feeding issues or selectivity (people with autism often

stick with the same food choices and have other " ritualistic tendencies " in

eating).

The frequency of GI symptoms was about 77 percent in the autism group and 72

percent among the others, not considered a statistically significant difference.

However, almost 34 percent of the autistic children, compared with nearly 18

percent of the others, had constipation. Feeding issues were present in about 24

percent of the autistic children and 16 percent of those who weren't autistic,

the study authors found.

Those differences could stem from what the researchers called neurobehavioral

issues connected with autism, such as the ritualistic practices, they said.

" Many patients with autism insist on eating the same thing and might not consume

enough fiber, " said the study's lead author, Dr. Samar H. Ibrahim, a fellow in

gastroenterology and instructor in pediatrics at the Mayo Clinic. " We think this

may be contributing to the constipation. "

Medications that autistic children take can also interfere with appetite and

eating.

" In our study, around 50 percent of children were on stimulant medications, and

those might affect appetite and might have something to do with issues with

food, " Ibrahim said.

A. Young, vice chairman for research in the psychiatry and behavioral

science department at Texas A & amp;M Health Science Center College of Medicine,

said he thought " the really interesting thing they found was that there wasn't

any indication of celiac disease. "

In the group studied, the researchers found just one case. A possible link

between celiac disease and autism was proposed as far back as 1961.

" The only difference was the constipation, which they kind of dismiss, " Young

said. " And I tend to agree with their conclusion that constipation might be

related to the dietary habits of autistic kids. "

The constipation and feeding difficulties identified in the study, though, are

not the symptoms that people have been buzzing about, Manning- pointed

out. It's mostly been about diarrhea and loose stools.

But the study was a small one and did not rely on rigorous, comprehensive

diagnoses of autism for the participants, so it may just stir the pot for people

on both sides of the debate.

The researchers, however, are urging parents away from restrictive diets.

" Patients with autism should be investigated the same way as normal patients

when they have GI symptoms, " Ibrahim said. " And doctors should do a thorough

investigation before labeling them with any GI disorder because the overall

incidence of any GI disorder did not differ from that of the overall

population. "

Manning- concurred. " For me, this study lends support to the

recommendation I make to a lot of families that there is no evidence to support

restricted diets, " she said. " They're dangerous and risky. You have to think

long and hard before you, as a parent, make that choice. "

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