Friday, 5 September 2014

Extremes of a self-limiting diet in autism

I'll draw your attention to three papers in today's post which represent the extremes of where self-imposed dietary restrictions can potentially lead in relation to the autism spectrum disorders (ASDs). Issues with diet - outside of use of diet as an intervention measure - are something which have been talked about quite a bit in the autism research literature (see here).
"You look like a gangster"

The first paper by Baird & Ravindranath [1] describes a case report of an 11-year old with autism who became "critically ill" as a consequence of a diet exclusively limited to a single fast food, "a particular type of fried chicken". Liver dysfunction and "severe lactic acidosis" were listed as clinical findings ascribed to a diet "deficient in multiple micronutrients, including the B vitamins thiamine and pyridoxine". The authors reported some resolution of symptoms as and when B vitamin supplements were given including positive changes to "status epilepticus-with low serum pyridoxine- [which] resolved rapidly with pyridoxine". I might add that issues with lactate, elevated in lactic acidosis, are no stranger to autism research (see here and see here).

The second paper comes from Gulko and colleagues [2] and talks about "MRI findings of scurvy in four patients with autism or developmental delay". Scurvy, a condition characterised by a lack of vitamin C, is something which has cropped up before on this blog (see here) and as per the Gulko findings: "Despite its rarity, the radiologist must consider scurvy in a pediatric patient with a restricted diet presenting with arthralgia [joint pain] or myalgia [muscle pain]".

The final paper comes from Keown and colleagues [3] and describes the experiences of a young boy "identified to have a restricted diet" characterised among other things by consumption of "excessive quantities of carrot juice". As a result: "Blood investigations showed a raised serum carotene level and vitamin D deficiency". Vitamin D is something of an emerging area in relation to autism (see here).

Combined, these papers suggest yet another set of physiological variables which may require further clinical scrutiny as and when a child or adult presents with an ASD particularly where diet is mentioned as potentially being an accompanying issue. As per the findings from Marshall and colleagues [4], finding appropriate strategies to increase food variety (and not just food volume) remains an area in some need of further research.

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[1] Baird JS. & Ravindranath TM. Vitamin B Deficiencies in a Critically Ill Autistic Child With a Restricted Diet. Nutr Clin Pract. 2014 Aug 11. pii: 0884533614541483.

[2] Gulko E. et al. MRI findings in pediatric patients with scurvy. Skeletal Radiol. 2014 Aug 12.

[3] Keown K. et al. Nutritional implications of selective eating in a child with autism spectrum disorder. BMJ Case Rep. 2014 Mar 20;2014. pii: bcr2013202581.

[4] Marshall J. et al. Efficacy of interventions to improve feeding difficulties in children with autism spectrum disorders: a systematic review and meta-analysis. Child Care Health Dev. 2014 Jun 25.

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ResearchBlogging.org Baird JS, & Ravindranath TM (2014). Vitamin B Deficiencies in a Critically Ill Autistic Child With a Restricted Diet. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition PMID: 25112945



ResearchBlogging.org Gulko E, Collins LK, Murphy RC, Thornhill BA, & Taragin BH (2014). MRI findings in pediatric patients with scurvy. Skeletal radiology PMID: 25109378




ResearchBlogging.org Keown K, Bothwell J, & Jain S (2014). Nutritional implications of selective eating in a child with autism spectrum disorder. BMJ case reports, 2014 PMID: 24654242