Breaking the Diet
By Dr. David Berger - TACA Physician Advisory
One of the more frequent questions we are asked by families of special needs children is if a special diet is forever; and if not, how and when should the family test to see if a diet is still needed. As there are many different restricted diets that are utilized as a treatment for improving the symptoms of Autism and related conditions, some of these may truly be life long, but unless the suspected reaction from a food is potentially life threatening (such as severe peanut allergies) a family from time to time may wish to try and break the diet and see how the child responds.
I often will teach a family that if a child is placed on a diet and it works, unless other measures are taken to change the biochemistry and physiology of the patient, I would expect that coming off of the diet would not likely bring a successful outcome. But if other issues are addressed, such as eliminating pathological intestinal yeast or bacteria; restoring normal intestinal flora; providing proper nutrition , vitamins, minerals etc; by reducing inflammation (by both removing things that increase inflammation such as oxidative stress and using antioxidants); removing toxins; and properly balancing the immune system, then a patient could be successful with a break in the diet. Extreme caution should be taken for the patient who has a history of more severe intestinal disease, especially if serious findings were present on endoscopy/colonoscopy . These patients may take much longer to heal and are probably less likely to be successful off of the diet (assuming that particular foods were contributing to the symptoms in the first place). If a patient did have an abnormal scope, it may be prudent to repeat the test to make sure the intestines have healed before trying to bring back the foods.
A family should be aware that while most of the time if a break in the diet is not successful, negative symptoms should improve within a few days of removing the offending foods. But there are rare cases where it can take months for symptoms to improve. The longest I have seen for a patient to return back to where he was at before the diet was broken is 6 months (this after 1 week of goldfish crackers that a new therapist was giving him without the parents being aware of this). This knowledge alone has scared some parents into not being comfortable breaking the diet. As I am a strong believer in a parent’s instincts to choose what is right for the child, I will tell the family that they should follow their instincts and let that determine if they feel ready to try breaking the diet.
As different children are following different dietary restrictions, there is not one specific order to introduce foods back into the diet. But the most important thing is to introduce one food back at a time. Although most food reactions will take place within 1 day of exposure, it can take up to 72 hours for reactions to occur. I therefore instruct families to wait 4 days between each new food. The food should be tested in its purest form to watch for reactions (ie, when trying back dairy, use plain milk, not cheese which has other ingredients). If a food does not cause a reaction, then it can be continued. If there is a negative reaction, the food should be stopped immediately and symptoms must return to normal before the next new food is introduced. Otherwise, a reaction to the next food could be obscured by the first negative reaction. I also recommend not adding or taking away any other treatments during the time of these food challenges, so that only 1 variable is changed for the child at a time.
There is a wide range of negative reactions that can occur from a food exposure, so a family needs to observe very closely for these reactions. Some children may have altered sleep, either in time to fall asleep or wakening at night or earlier in the morning. Some children will manifest negative behaviors (increased stimming, aggression, self-injury, etc). Others can become socially withdrawn or can lose eye contact or attention/focus. Yet other children will have physical symptoms such as rashes, bowel or urine changes, or symptoms of allergy such as congestion, circles under eyes, coughing, wheezing, red eyes, etc.
Although many patients have undergone blood IgE and/or IgG testing to explore possible food reactions, these tests are not overly accurate, and some studies estimate that there is only 50% accuracy for negative results. Positive results from a respectable lab are much more accurate. If a patient had a positive food IgE or IgG test and removal of those foods seemed to correlate well with improved symptoms, I would consider repeating these tests prior to bringing back the foods. If the levels are still high despite clinical improvement, I would be more hesitant to bring the food back. If these tests normalize but then over time symptoms return, blood antibody tests would be revealing, especially if there is a documented increase in the food antibody level over the previous test. I would also be particularly concerned about bringing back foods that had high IgE levels in the first place, where the risk of an anaphylactic reaction is high. In such cases, the parents should strongly consider challenging those foods in a doctor’s office, where urgent medical care can be provided if there were a severe allergic reaction.
Once a child has healed from a restricted diet and foods are brought back into the diet, it is very important to maintain a high quality diet with minimization of additives, junk food and simple carbohydrates. Whenever possible, children should be fed clean, organic, non GMO foods, utilizing a strategy of mostly protein, fresh fruits and vegetables.
Finally, if a break in the diet is not successful, if other biomedical are then utilized successfully, another attempt to break the diet could be tried after another 6-12 months. Consulting with a practitioner with knowledge of biomedical therapies could provide more assistance to the family on when to try again but the family should ultimately follow their instincts when determining what they should do.