Friday, February 10, 2012

Fried Potatoes or Why a Self-Limited Diet Is a Problem

Did you know that eating only fried potatoes and rice balls can lead to dietary deficiencies? I found that out this morning when browsing through some newly published studies and ran across this one-
Fried-Potato Diet Causes Vitamin A Deficiency in an Autistic Child.
A 5-year-old boy with autism developed dry eye and xerophthalmia. Serum vitamin A was undetectable. Dietary history revealed a markedly altered intake consisting of only fried potatoes and rice balls for 2 years. Fried potatoes contain no vitamin A. Autism is a multifaceted developmental disorder infrequently accompanied by abnormal eating practices. To the authors' knowledge, most children with autism who develop dietary vitamin A deficiency have consumed an excess of fried potatoes. Attention to possible vitamin A deficiency is essential when fried potatoes are consumed exclusively
However, as mildly amusing as the title and text of the study are, it is talking about what is a extremely serious problem for many children with autism - self-limited diets.  There are many children with autism who will self-limit what foods they will eat and will refuse to eat anything but a few very specific items.

For those of you who have not seen this first hand, let me just say that when food becomes one of the rigidities of autism you are in for a very bad time.  At best, the child will favor a few foods and simply refuse to eat anything but those favored foods.  At worst, it will not only have to be a specific food but a specific food that is prepared and presented in a specific way.  In the worst of the worst cases, if you so much as change one ingredient, one step in the preparation process, or put the dish or utensil even a millimeter out of place, then the child will have a meltdown and refuse to eat - sometimes for the rest of the day.

We have been very fortunate in that our children have never gotten this bad with their eating problems.  The youngest has no real food issues but her older sisters are limited in what they will eat.  They will only eat certain things and will refuse to try anything new but we can (and do) push them on the food issue without triggering any undesired behaviors.

But even in the best of cases a self-limited diet causes problems.

For one thing your ability to go anywhere with the child becomes restricted.  You either spend your time carting around the food that they will eat (if you can) or you try and schedule every trip out of the house around meal times.  Going on vacations or traveling becomes even more challenging than it is with a typical child who has autism.

Another, more serious, problem is that a limited diet can lead to nutritional deficiencies. There are a number of basic nutrients that come only from what you eat.  If you don't eat enough of the proper types of food then you are going to have problems.  A case in point is the child mentioned in the abstract above.  He was deficient in vitamin A because he only ate two types of food and that food did not contain vitamin A.

Although, I have to caution against the widespread assumption that all (or even most) nutritional deficiencies in autism are due to self-limited diets.  My children have problems maintaining basic nutritional levels even when the foods they eat give them plenty of the nutrients or when they receive daily supplements of the nutrient.

For example, all three girls have chronic problems with being iron deficient even though they eat a diet that is high in iron.  The twins have problems maintaining an appropriate level of zinc even though they get daily zinc supplements.

So when you are looking at nutritional problems, you have to not only consider whether the diet is a problem but also whether there might be something else going on that needs to be addressed.

This is one area where, in my opinion, mainstream medicine falls flat on its face.  Given all of the documented nutritional problems and picky eating in autism, doctors should do regular nutritional screening in every child with autism as a matter of course.  It doesn't matter whether there are any obvious physical signs or any specific complaints, the problems are widespread enough that some simple testing can go a long way towards stopping problems before they start.

References
Tanoue K, Matsui K, Takamasu T. Fried-Potato Diet Causes Vitamin A Deficiency  in an Autistic Child. JPEN J Parenter Enteral Nutr. 2012 Feb 7. [Epub ahead of print] PubMed PMID: 22318966 DOI: 10.1177/0148607111436280

4 comments:

  1. Our son was very severe in his restrictive eating. He went four weeks one time only drinking from a sippy cup. Many weeks he would only eat a handful a night of whatever brand of cracker he was hooked on at the time. We couldn't get anyone to aknowledge us when we would bring this up. Doctors, nurses and relatives would say "Oh, he'll eat when he's hungry". Our concerns fell on deaf ears. His weight stayed at 24 pounds for almost 8 mos and no one batted an eye. When we put him on the SCD diet he added several foods to his repertoire. He was still picky, but muffins, jello, dehydrated strawberries, and hamburger patties were a huge leap for this kid. But here's the kicker..Suddenly everyone was SOOO concerned about his nutritional status on a "resticted" diet. They all frwoned on it because they just KNEW we were starving our child.

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  2. I've heard that exact line used on other parents - "Oh, he'll eat when he's hungry" - which, as you said, is not always true. If food becomes an obsession/rigidity then there is a good chance that the child won't eat - even if they are hungry.

    This is another one of those lines that I would love to be able to get rid of. It is right up there with "he's just being a boy, give him time" and "what's your child's gift".

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  3. Jean, while I appreciate that your product might be something worthwhile, your comment looks suspiciously like an advertisement for your product. So I am removing your comment.

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  4. "For those of you who have not seen this first hand, let me just say that when food becomes one of the rigidities of autism you are in for a very bad time."

    Haven't we been there! From age 3 to well even now, but it has got much much better. All I am gonna say is that I am so glad my kid wasn't the ones who spit out or throw up food that is forced down their throat. He kind of kept it in there in defiance and it took me hours and hours to get through a meal.

    My daughter is also a "picky" eater - but in the more typical sense. Which now of course since we have my son to compare her with, is really not even a problem. I find it amusing listening to parents of typical children complaining about their picky eaters, many books have been written on the subject :D and I have been given endless advice about how to make the food more appealing for my son. Even if you dress up a piece of chicken to look like a thomas the tank engine, an autistic kid with food rigidities is not going to eat it.

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