Google+ “Innovation of Food Technology as Import Substitution”: Dietary Recommendation for Normal and Autistic Children in Indonesia

Pages

“Innovation of Food Technology as Import Substitution”: Dietary Recommendation for Normal and Autistic Children in Indonesia

                                  by Maria Prihtamala Omega

There are differences among normal and autistic children in their ability to understand complex ideas, to adapt to the environment, to learn from experiences, to engage in various reasons, to overcome obstacles by taking thoughts and solutions. Therefore, the child’s intellectual performance is various depending on different occasions and criteria. For example, intelligence is attempts to organize the complex set of phenomena and systems of abilities which can be captured by standard psychometric tests (Neisser, et al., 1996). The psychometric approaches include the Peabody Picture Vocabulary Test (a childhood verbal intelligence) and Raven’s Progressive Matrices (a non-verbal inductive reasoning about perceptual patterns). Another psychometric analysis of Halstead-Reitan Categories test (a non-verbal abstract thinking ability) and Wechsler Memory Test used by Goodwin, et al. (1983) to analyze the worse scores of the result tests, due to depressed cognitive function caused by malnutrition and reduced nutrient intake of vitamin C, vitamin B12, riboflavin or folic acid. Moreover, inadequate childhood nutrition (low protein and high carbohydrate intakes) during brain development can have a strongly negative impact on long-term outcomes, such as decreased number of brain cells, deficits in behavior, learning and memory, lower verbal IQ at school age, higher incidence of frank cognitive and neuromotor impairment, developments of obesity, insulin resistance, hypercholesterolemia, hyperlipidemia, and diabetes (Hay, et al., 1999).  Others emphasize on the primary roles of nature (inheritance of intelligence genes) and secondary roles of nurture (cultures, environments and nutrition influencing the acquisition of intellectual skills).

Therefore, the diet factor (nutritional needs) must be met by intake from the environment codified for Recommended Dietary Allowance (RDA) in America (Figure 1), Dietary Standards for Canada, Recommended Daily Intake (RDI) in Indonesia/other countries for safe intakes recommended by WHO (Williams-Hooker, 2013) as well as five main food groups in Australia such as fruit, vegetable, dairy, meat and meat alternatives, and cereals (Australian National Children’s Nutrition and Physical Activity Survey, 2007).


Figure 1. 5-8 Year Olds Nutrition



An example of essential dietary intake is fatty acid i.e. omega-3 polyunsaturated fatty acids (eicosapentaenoic acid and docohexaenoic acid) from fish and marine, which was associated with a reduced risk of cholesterol and saturated fat with an increased risk of impaired cognitive performance, for memory, psychomotor speed, cognitive flexibility (higher order of information processing), and logistic functions (Kaljimn, 2004). Another example of essential dietary intake for healthy brain vascular systems is flavonoid-rich cocoa such as tea and wine beverages. Fisher, et al. (2003) studied that after 5 days consumption of flavanol-rich cocoa, there were vasodilator response to ischemia via the activation of nitric oxide synthase providing the protection mechanism against coronary events in healthy humans. There are nutritional sources (preferably organic foods) for increasing the intelligence in normal children, as follows:
  1. Oily fish (mackerel, sardines, salmon) or krill oils, nut oils, rapeseed oils, raw butter and raw cream contain omega-3 fatty acids including DHA and AA for brain maintenance, then, shellfish (oysters, clams, shrimp) or wholemeal bread, algae, wheat germ contain vitamin B12, lysine protein, manganese, copper, lithium, zinc, iodine for brain function (Mercola & Droege, 2003).
  2. Pulses (lentils, chick-peas) contain glucose for brain energy, bananas or prunes (dried food) contain vitamin B6 for a calm brain, berries (blackcurrants, strawberries, raspberries, blueberries, blackberries, cherries, gooseberries) or kiwi fruit, orange and garlic contain vitamin C, anthocyanins, polyphenols, flavonoids for happy brain cells (Benton & Owens, 2003).
  3. Liver (veal, beef, chicken, ham) or nutritional yeast supplement contain vitamins B9, B12, B1 and B6 for intelligence, then, raw eggs, raw milk or fish contain protein, lecithin, phospholipid, acetylcholine, tyrosine and phenylalanine for brain connectivity (Fisher, et al., 1993)
  4. Raw spinach, watercress, lamb’s lettuce, iceberg lettuce, broccoli, rosemary herbs, cauliflower, green beans, asparagus, mushrooms, celery contain vitamin B9 or folates, flavonoid or apigenin, potassium and protein for good memory as well as providing fiber to prevent constipation, obesity/diabetes (Kranz, et al., 2012).
  5. Cocoa, tea and weak coffee or caffeine contain flavonoids, theobromine, theophylline, phenylethylamine, tyramine and magnesium for brain stimulation, and avocado or oleaginous fruits (nuts, hazelnuts) contain vitamin E for keeping the brain young (Smith, et al., 1991; Goodwin, et al., 1983).
    This ASD has not been caused by only genetic factor but also environmental and dietary factors, via neurotoxicity and immunoexcitotoxicity mechanisms, such as:
    1). The administration of aluminium ethylmercury as vaccine adjuvant, or thiomerosal as preservative in childhood vaccines may trigger the increase development of debilitating disorders of 1%  of the UK population (Paterson & Peck, 2011).
    2). Gut dysbiosis caused by genetically modified food crops i.e. soy, corn, cottonseed oil, canola, sugar beets, papaya, zucchini, yellow crock neck squash, alfalfa hay resulting in the improper balance of intestinal microbes and deformities of digestive gastrointestinal tracts of autistic kids (Freeman, 2009).
    3). Food allergies of gluten protein (gliadin in wheat, secalin in rye,  hordein in barley), casein protein (in milk), food additive/artificial colors/preservatives/mineral salts/antioxidant/flavors such as monosodium glutamate (MSG), quinolic acid and high fructose corn syrup (HFCS) cause an autoimmune response, the hyperactivity and minimal brain dysfunction (MBD) (Raymond, et al., 2006; Buist, 1986). The effects include the damage of small intestine lining, the blunt of the villi, the malabsorption of nutrients, the loss of zinc, calcium, and the accumulation of toxic metals e.g. arsenic, cadmium, mercury and organophosphate (Rattue, 2012). There are no medications that can cure ASDs or treat the core symptoms. However, there are therapies that can help some people with ASDs function better. Many children with autism receive some types of therapy such as behavioral and communication therapy, medications (risperidone and aripiprazole antipsychotic drugs to treat severe tantrums, aggression, and self-injurious behaviors), complementary and alternative therapies, or special diet therapies (CDC, 2009). The autism diets such as gluten-free or casein-free are claimed to improve the autistic children with their behavior and/or speech, because many autistic children have allergies, eczema or diarrhea (McCharty, 2009). However, the real causes and therapies for autisms are still on the race. Research reports suggested that ASD children are selective eaters who restrict their food intake based on texture and food presentation, so many research have focused on nutritional adequacy of diets (Leckham, 2007). Moreover, human memory of words recalled in a Wehcler test and a logical reasoning task were increasing significantly by increasing blood glucose levels, taking drinks containing 50 g of glucose simple carbohydrate and 60 mg of lower dose caffeine (Benton & Owens, 1993; Smith, et al., 1991). Thus, many biomedical interventions suggested changes in diet, by removing certain types of foods from autistic children’s diet and using vitamin or mineral supplements based on food allergies or lack of vitamins and minerals. The parents claimed that the dietary changes make a difference in how their child acts or feels although it was about six times higher costs for ASD children than the costs for children without an ASD (CDC, 2009). There are diets for reducing the symptoms in autistic children, as follows:
  1. The researchers suggested the importance of a high-fat simple carbohydrate diet or a low-fat complex carbohydrate diet and drinks containing 50 g glucose or 60 mg caffeine to improve human memory, logical thinking and regulate diet-induced obesity or autism (Benton & Owens, 1993; Smith, et al., 1991).
  2. It is suggested that nutritional therapy for autism is by improving digestion and  nutrition (by reducing broad spectrum antibiotics and increasing probiotics) via the growth of gut microbiome and neurobehavioral development (Mulle, et al., 2013).
  3. ASD therapy includes balancing blood sugar, checking for intake of brain-polluting heavy metals, excluding food additives (MSG) and including organic food, increasing intake of essential omega-3 fatty acids (EPA), increasing ample fiber, vitamins and minerals (vitamins B6, C, D, calcium, and magnesium supplement), identifying food allergies, e.g. gluten-free/casein-free or GFCF diet and lactose-free diet and  avoiding these foods found in barley, rye, wheat, oats, malt, dairy products including milk and yoghurt (Rimland, 1997). Gluten-free whole grains i.e. corn, rice, millet, sorghum, teff and wild rice are available for autism diets and celiac diets to reduce chronic diseases including cardiovascular, type-2 diabetes, osteopenia/osteoporosis, infertility, neurological problems, dental enamel abnormalities, dermatitis herpetiformis, irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia (Pagano, 2006; Raymond, et al., 2006).
  4. If children with autism have GFCF diet and feeding difficulties or unusual eating patterns, the RDI intake of 200 IU vitamin D and 800 mg Calcium supplement is needed for 5-8 year old children (Williams-Hooker, 2013). GF diet may be lacking in vitamins B, fiber, calcium, and other nutrients, so nutrient dense GF foods and supplements are needed to cover the deficiencies (Raymond, et al., 2006).
  5. Autism children aged 4-8 years old need 400 mcg of Vitamin A obtained from animal sources (liver, whole milk, and fortified food products) and plant sources such as carrots, spinach, kale, peas, and tomatoes, which have important roles in  vision, bone growth, reproduction, cell division/differentiation, preventing coeliac disease, Crohn’s disease, pancreatic disorders and chronic diarrhea (Shabayek, 2004). The recommended daily intake of natural vitamin A for 6 months (less than 250,000 IU) can be used to treat potential alpha-G protein defects in the brain and may reconnect the retinoid receptors for vision, sensory perception, language processing and attention in children with autism (Megson, 2000).
  6. The usage of Indonesian natural food preservatives from Kalimantan (sokai leaves) as the substitutes of MSG that can cause ASDs and singkah rua leaves to reduce the blood sugars as the complementary foods for salads/pare which are not yet commercialized (personal communication with Dayak Tribe: Mr. Alue Dohong).
    In conclusion, the dietary recommendation for children in Indonesia have to be regulated and advised to support educational and health systems by enhancing the healthy local food consumptions (“Go Pangan Lokal” and Local Food Commercialization of National Programs).
References
Adams JB. (2012). “Summary of Dietary, Nutritional and Medical Treatments for Autism – based on over 150 published research studies.” Retrieved from http://autism.asu.edu on 16 April 2013.

Adams JB, et al. (2011). “Effect of a vitamin/mineral supplement on children with autism.” BMC Pediatrics 11: 111.

Adams JB, et al. (2011). “Gastrointestinal flora and gastrointestinal status in children with autism – Comparisons to neurotypical children and correlation with autism severity.” BMC Gastroenterology 11: 22.

Adams JB, et al. (2011). “Nutritional and metabolic status of children with Autism vs. Neurotypical children, and the association with autism severity.” Nutr Metab (Lond) 8(1): 34.

Adams JB, et al. (2009). “Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A and B behavioral results.” BMC Clin Pharmacol 9: 16-17.

Adams JB, et al. (2009). “The severity of autism is associated with toxic metal body burden and red blood cell glutathione levels.” J Toxicol Epub: 532640.

Adams JB, et al. (2006). “Analyses of toxic metals and essential minerals in the hair of Arizona children with autism and associated conditions, and their mothers.” Biol Trace Elem Res 110(3): 193-209.

Adams JB, et al. (2004). “Pilot study of a moderate dose multivitamin-mineral supplement for children with autistic spectrum disorder.” J Altern Complement Med 10(6): 1033-1039.

Alarcon M, Abrahams BS, Stone JL, Duvall JA, Perederiy JV, Bomar JM, Sebat J, Wigler M, Martin CL, Ledbetter DH, Nelson SF, Cantor RM, & Geschwind DH. (2008). “Linkage, association and gene-expression analyses identify CNTNAP2 as an Autism-susceptibility gene.” Am J Hum Genet 82(1): 150-159.


Arnold GL, Hyman SL, Mooney RA, & Kirby RS. (2003). “Plasma amino acids profiles in children with autism: potential risk of nutritional deficiencies.” J Autism Dev Disord 33(4): 449-454.

Australian National. (2007). “Children’s Nutrition and Physical Activity Survey: Fact Sheet – Key Findings.” Retrieved from http://www.health.gov.au on 8 April 2013. 

Australian Institute of Health and Welfare. (2002). “Chronic diseases and associated risk factors in Australia.” Canberra: National Capital Printing, pp. 98-103.

Bakkaloglu B, O’Roak BJ, Louvi A, Gupta AR, Abelson JF, Morgan TM, Chawarska K, Klin A, Ercan-Sencicek AG, Stillman AA, Tanriover G, Abrahams BS, Duvall JA, Robbins EM, Geschwin DH, Biederer T, Gunel M, Lifton RP, & State MW. (2008). “Molecular cytogenic analysis and resequencing of Contactin associated Protein-Like 2 in Autism Spectrum Disorders.” Am J Hum Genet 82(1): 165-173.

Bandini LG, Anderson SE, Curtin C, Cermak S, Evans EW, Scampini R, Maslin M, & Must A. (2010). “Food selectivity in children with autism spectrum disorders and typically developing children.” J Pediatr PMID: 20362301.

Bell JG, et al. (2010). “The fatty acid compositions of erythrocyte and plasma polar lipids in children with autism, developmental delay or typically developing controls and the effect of fish oil intake.” Br J Nutr 103: 1160-1167.

Belloso JM, Bache I, Guitart M, Caballin MR, Halgren C, Kirchoff M, Ropers HH, Tommerup N, & Tumer Z. (2007). “Disruption of the CNTNAP2 gene in a t(7;15) translocation family without symptoms of Gilles de la Tourette syndrome.” European Journal of Human Genetics 15, 711-713.

Benton D, & Owens DS. (1993). “Blood glucose and human memory.” Psychopharmacology 113(1): 83-88.

Benyamin B, Pourcain B, Davis OS, Davies G, Hansell NK, Brion MJ, Kirkpatrick RM, Cents RA, Franic S, Miller MB, Haworth CM, Meaburn E, Price TS, Evans DM, Timpson N, Kemp J, Ring S, McArdle W, Medland SE, Yang J, Harris SE, Liewald DC, Scheet P, Xiao X, Hudziak JJ, de Geus EJ, Jadoe VW, Starr JM, Verhulst FC, Pennell C, Tiemeier H, Iacono WG, Palmer LJ, Montgomery GW, Martin NG, Boomsma DI, Posthuma D, McGue M, Wright MJ, Davey Smith G, Deary IJ, Plomin R, & Visscher PM. (2013). “Childhood intelligence is heritable, highly polygenic and associated with FNBP1L.” Mol Psychiatry. doi: 10.1038/mp.2012.184.

Bernard S, et al. (2001). “Autism: a novel form of mercury poisoning.” Med Hypotheses 56(4): 462-471.

Blaylock RL. (2008). “A possible central mechanism in autism spectrum disorders, part 1.” Alternative Therapies in Health and Medicine 14(6): 46-47.

Boris M, Goldblatt A, & Edelson SM. (2005). “Improvement in children with autism treated with intravenous gamma globulin.” Journal of Nutritional & Environmental Medicine 15(4): 169-176.

Boyce JA, et al. (2010). “Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report.” J Allergy Clin Immunol 126: 1105-1118.

Buchner DA, Geisinger JM, Glazebrook PA, Morgan MG, Spiezio SH, Kaiyala KJ, Schwartz MW, Sakurai T, Furley AJ, & Kunze DL. (2012). “The juxtaparanodal proteins CNTNAP2 and TAG1 regulate diet-induced obesity.” Mammalian Genome 23(7-8): 431-442. 

Buist D. (1986). “Food Chemical Sensitivity.” Sydney: Harper & Row Publishers, pp. 32-98.

Bule T, et al. (2010). “Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report.” Pediatrics 125 Suppl 1: S1-18.

Burks AW, et al. (2012). “ICON: Food Allergy. “ J Allergy Clin Immunol 129: 906-920.

Cabot S. (2006). “Your personal survival guide.” Camden: WHAS Pty Ltd, pp. 57-107. 

Cade R, Privette M, et al. “Autism and Schizophrenia: Intestinal Disorders.” Nutr Neurosci 3: 57-72.

CDC. (2009). “Data & Statistics of Autism Spectrum Disorders (ASDs).” Retrieved from http://www.cdc.gov/ncbddd/autism/screening.html  on 16 April 2013.

Cornis E. (1998). “A balanced approach towards healthy eating in autism.” Journal of Human Nutrition and Dietetics 11: 501-509. 

Cornish E. (2002). “Gluten and casein free diets in autism: a study of the effects on food choice and nutrition.” Journal of Human Nutrition and Dietetics 15: 261-269.

D’Adamo P, & Whitney C. (1998). “Eat Right for Your Type.” London: Century, pp. 324-328.

Davies G, Tenesa A, Payton A, Yang J, Harris SE, Liewald D, Ke X, Le Hellard S, Christoforou A, Luciano M, McGhee K, Lopez L, Gow AJ, Corley J, Redmond P, Fox HC, Haggarty P, Whalley LJ, McNeill G, Goddard ME, Espeseth T, Lundervold AJ, Reinvang I, Pickles A, Steen VM, Ollier W, Porteous DJ, Horan M, Starr JM, Pendleton N, Visscher PM, & Deary IJ. (2011). “Genome-wide association studies establish that human intelligence is highly heritable and polygenic.” Molecular Psychiatry 16: 996-1005.


Duchesnay E, et al. (2011). “Feature selection and classification of imbalanced datasets: application to PET images of children with autistic spectrum disorders.” Neuroimage 57(3): 1003-1014.

Filipek, et al. (2004). “Relative carnitine deficiency in autism.” J Autism Dev Disord 34(6): 615-623.

Finegold SM, et al. (2010). “Pyrosequencing study of fecal microflora of autistic and control children.” Anaerobe 16(4): 444-453.

Fisher ND, Hughes M, Gerhard-Herman M, Hollenberg NK. (2003).”Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans.” J Hypertens 21(12): 2281-2286.

Freedenfeld S, et al. (2011). “Biochemical effects of ribose and NADH therapy in children with autism.” Autism Insights 3: 3-13.

Freeman, S. (2009). “What is the autism diet?” Retrieved from http://health.howstuffworks.com/mental-health/autism-diet.htm  on 8 April 2013.

Ganz ML. (2007). “The lifetime distribution of the incremental societal costs of autism.” Arch Pediatr Adolesc Med 161(4): 343-349.

Geier DA, et al. (2011). “A prospective double-blind, randomized clinical trial of levocarnitine to treat autism spectrum disorders.” Med Sci Monit 17(6): P115-P123.

Geier DA, & Geier MR. (2003). “An assessment of the impact of thimerosal on childhood neurodevelopmental disorders.” Pediatr Rehabil 6: 97-102.

Ghanizadeh A. (2012). “Hyperbaric oxygen therapy for treatment of children with autism: a systematic review of randomized trials.” Med Gas Res 2: 13. 

Ginther A, & Decher N. (2012). “Tips to cut costs and thrive on a gluten-free diet.” CNSC UVA Nutrition Services 2: 1-3. 

Goodwin JS, Goodwin JM, & Garry PJ. (1983). “Association between nutritional status and cognitive functioning in a healthy elderly population.” JAMA 249(21): 2917-2921.

Gregor A, Albrecht B, Bacler I, Bijlsma EK, Ekici AB, Engels H, Hackmann K, Horn D, Hoyer J, Klapecki J, Kohlhase J, Maystadt I, Nagi S, Prott E, Tinschert S, Ullmann R, Wohlleber E, Woods G, reis A, Rauch A, & Zweier C. (2011). “Expanding the clinical spectrum associated with defects in CNTNAP2 and NRXN1.” BMC Medical Genetics 12: 106-117.

Gupta, et al. (1999). “Treatment of children with autism with intravenous immunoglobulin.” J Child Neurol 14(3): 203-205.

Harch P, et al. (2012). “A phase I study of low pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder.” J Neurotrauma 29(1): 168-185. 

Hardan AY, et al. (2012). “A randomized controlled pilot trial of oral N-acetylcysteine in children with autism.” Biol Psychiatry 71(11): 956-961.

Hay WW, Lucas A, Heird WC, Ziegler E, Levin E, Grave GD, Catz CS, & Yaffe SJ. (1999). “Workshop Summary: Nutrition of the Extremely Low Birth Weight Infant.” Journal of the American Academy of Pediatrics 104(6): 1360-1362.

Hediger MK, England LJ, Mollow CA, Yu KF, Manning-Courtney P, & Mills JL. (2008). “Reduced bone cortical thickness in boys with autism or autism spectrum disorder.” J Autism Dev Disord 38(5): 848-856.

Herndon AC, DiGuiseppi C, Johnson SL, Leiferman J, & Reynolds A. (2009). “Does nutritional intake differ between children with autism spectrum disorders and children with typical development?” J Autism Dev Disord 39: 212-222.

Ho HH, & Eaves LC. (1997). “Nutrient intake and obesity in children with autism.” Focus on Autism and Other Developmental Disabilities 12: 187-193.

Hollowell JG, et al. (1998). “Iodine nutrition in the United States. Trends and public health implications: iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971-1974 and 1988-1994).” J Clin Endocrinol Metab 83(10); 3401-3408.

Horvath K, & Perman JA. (2002). “Autistic disorder and gastrointestinal disease.” Curr Opinion in Pediatrics 14: 583-587.

Huett A, Ng A, Cao Z, Kuballa P, Komatsu M, Daly MJ, Podolsky DK, & Xavier RJ. (2009). “A novel hybrid yeast-human network analysis reveals an essential role for FNBP1L in antibacterial autophagy.” The Journal of Immunology 182: 4917-4930.

James SJ, Cutler, et al. (2004). “Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism.” Am J Clin Nutr 80(6): 1611-1617.

Johnston, et al. (1993). “Vitamin C elevates red blood cell glutathione in healthy adults.” Am J Clin Nutr 58(1): 103-105.

Kalmijn S, van Boxtel MPJ, Ocke M, Verschuren WMM, Kromhout D, & Launer LJ. (2004). “Dietary intake of fatty acids and fish in relation to cognitive performance at middle age.” Neurology 62(2): 275-280.

Katoh, M, Katoh M. (2004). “Identification and characterization of human FNBP1L gene in silico.” Int J Mol Med 13(1): 157-162.

Kern JK, et al. (2011). “A clinical trial of glutathione supplementation in autism spectrum disorders.” Med Sci Monit 17(12): CR677-CR682.

Kinachi N, et al. (2009). “The Effects of Hyperbaric Oxygen Therapy in Children with Autism Spectrum Disorders, Abstract of the Undersea and Hyperbaric Medical Society Annual Meeting, Las Vegas, USA. Undersea and Hyperbaric Med 36(4). 

Knivsberg AM, Reichelt KL, & Nodland M. (2001). “Reports on dietary intervention in autistic disorders.” Nutr Neurosci 4(1): 25-37.

Kranz S, Brauchla M, Slavin JL, & Miller KB. (2012). “What do we know about dietary fiber intake in children and health? The effects of fiber intake on constipation, obesity, and diabetes in children.” American Society for Nutrition Adv Nutr 3: 47-53.

Kushak RI, et al. (2011). “Intestinal disaccharides activity in patients with autism: effect of age, gender and intestinal inflammation.” Autism 15(3): 285-294. 

Leckham SR, et al. (2007). “Describing the sensory abnormalities of children and adults with autism.” J Autism Dev Disord 37: 894-910.

Leiter V, Wyngaarden-Krauss M, Anderson B, & Wells N. (2004). “Effects of Mothering a Child with Special Needs: The Consequences of Caring.”  Journal of Family Issues 25(3): 379-403.

Lockner DW, Crowe TK, Skipper BJ. (2008). “Dietary intake and parents’ perception of mealtime behaviors in preschool-aged children with autism spectrum disorder and in typically developing children.” J Am Diet Assoc 108(8): 1360-1363.

Lucas, A. (1998). “Programming by Early Nutrition: An Experimental Approach.” The Journal of Nutrition 128: 401S-406S.

McCann, et al. (2007). “Food additives and hyperactive behavior in 3 year-old and 8/9 year-old children in the community: a randomized, double-blinded, placebo-controlled trial. Lancet 370(9598): 1560-1567.

McCarthy, J. (2009). “Gluten-Free/Casein-Free Diets for Autism.” Retrieved from http://www.webmd.com/brain/autism/gluten-free-casein-free-diets-for-autism?page=2 on 16 April 2013.

Megson MN. (2000). “Is autism a G-alpha protein defect reversible with natural vitamin A?” Med Hypothesis 54(6): 979-983.

Meguid, et al. (2008). “Role of polyunsaturated fatty acids in the management of Egyptian chidren with autism.” Clinical Biochemistry 41: 1044-1048.

Mehl-Madrona L, et al. (2010). “Micronutrients versus standard medication management in autism: a naturalistic case control study.” J Child Adolesc Psychopharmacol 20(2): 95-103.

Mercola J, & Droege R. (2003). “The top five foods to increase your intelligence.” Retrieved from http://mercola.com on 8 April 2013.

Montes G, & Halterman JS. (2008). “Association of Childhood Autism Spectrum Disorders and Loss of Family Income.” Pediatrics 121(4): 821-826.

Montes G, & Halterman JS. (2008). “Child care problems and employment among families with preschool-aged children with autism in the United States.” Pediatrics 122(1): 202-208.

Mulle JG, Sharp WG, & Cubells JF. (2013). “The gut microbiome: a new frontier in autism research.” Current Psychiatry Reports 15(2): 337.

Nakabayashi K, Scherer SW. “The human contactin-associated protein like-2 gene (CNTNAP2) spans over 2 Mb of DNA at chromosome 7q35. Genomics 73: 108-112.

Neisser U, Boodoo G, Bouchard TJ, Boykin AW, Brody N, Ceci SJ, Perloff R, Sternberg RJ, & Urbina S. (1996). “Intelligence: Knowns and Unknowns.” The American Psychologist Association 51(2): 77-101.

Niehus R, & Lord C. (2006). “Early medical history of children with autism spectrum disorders.” Journal of Developmental and Behavioral Pediatrics 27(2): S120-S127.

Nir I, et al. (1995). “Brief report: circadian melatonin, thyroid-stimulating hormone, prolactin and cortisol levels in serum of young adults with autism.” J Autism Dev Disord 25(6): 641-654.

Okoroigwe FC, & Okeke EC. (2009). “Nutritional status of preschool children aged 2-5 years in Aguata L.G.A of Anambra State, Nigeria.” International Journal of Nutrition and Metabolism 1(1): 009-013.

Pagano AE. (2006). “Whole grains and the gluten-free diet.” Practical Gastroenterology 2: 66-78.

Parracho HM, et al. (2005). “Differences between the gut microflora of children with autistic spectrum disorders and that of healthy children.” J Med Microbiol 54(Pt10): 987-991.

Paterson H, & Peck K. (2011). “Sensory processing ability and eating behavior in children with autism.” Journal of Human Nutrition and Dietetics 24: 277-310.

Patrick L, & Salik R. (2005). “The effect of essential fatty acid supplementation on language development and learning skills in Autism and Asperger’s syndrome.” Autism/Asperger’s Digest: Research Article Jan/Feb.

Poliak S, Gollan L, Martinez R, Custer A, Einheber S, Salzer JL, Trimmer JS, Shrager P, Peles E. (2000). “Caspr2, a new member of the neurexin superfamily is localized at the juxtaparanodes of myelinated axons and associates with K+ channels.” Neuron 24(4): 1037-1047.

Poliak S, Salomon D, Elhanany H, et al. (2003). “Juxtaparanodal   clustering of Shaker-like K channels in myelinated axons depends on Caspr2 and TAG-1.” J Cell Biol 162: 1149-1160.

Rasband MN. (2004). “It’s juxta potassium channel.” J Neurosci Res 76: 749-757.

Rattue P. (2012). “Autism linked to industrial food or environment.” Retrieved from http://medicalnewstoday on 16 April 2013.

Raymond N, Heap J, & Case S. (2006). “The gluten-free diet: an update for health professionals.” Practical Gastroenterology 1: 67-91.

Rimland, B. (1997). “About Autism.”  Retrieved from http://www.foodforthebrain.org on 16 April 2013.

Roberts EM, et al. (2007). “Maternal residence near agricultural pesticide application and autism spectrum disorders among children in the California Central Valley.” Environ Health Prospect 115(10): 1482-1489.

Rossignol DA, & Frye RE. (2012). “Mitochondrial dysfunction in autism spectrum disorders: a systematic review and meta-analysis.” Mol Psychiatry 17(3): 290-314.

Sander, et al. (2000). “Short-term benefit from oral vancomycin treatment of regressive-onset autism.” J Child Neurol 15(7): 429-435.

Rossignol DA, et al. (2012). “The effects of hyperbaric oxygen therapy on oxidative stress, inflammation and symptoms in children with autism: an open-label pilot study.” BMC Pediatr 7: 36.

Rossignol DA, & Frye RE. (2011). “Melatonin in autism spectrum disorders: a systematic review and meta-analysis.” Dev Med Child Neurol 53(9): 783-792. 

Rossignol DA, et al. (2009). “Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial.” BMC Pediatr 9: 21.

Sasaki M, et al. (2010). “Brain perfusion SPECT and EEG findings in children with autism and mental disorders and medically intractable epilepsy.” Brain Dev 32(9): 776-782.

Scriver CR. (1977). “Medical Intelligence: Diets and Genes, Euphenic Nutrition.” The New England Journal of Medicine 297(4): 202-203.

Shabayek MM. (2004). “Assessment of the nutritional status of children with special needs in Alexandra: I. Nutrient intake and food consumption.” J Egypt Public Health Assoc 79(3-4): 225-241.

Sharrett MK, & Cureton P. (2007). “Kids and the gluten-free diet.” Practical Gastroenterology 6: 49-65.

Smith AP, Rusted JM, Savory M, Eaton-Williams P, & Hall SR. (1991). “The effects of caffeine, impulsivity and time of day on performance, mood and cardiovascular function.“ J Psychopharmacol 5(2):120-128.

Smith JM. (2012). “Are genetically engineered foods promoting autism?” Retrieved from http://www.responsibletechnology.org/autism on 8 April 2013.

Smith-Spangler C, et al. (2012). “Are organic foods safer or healthier than conventional alternatives?” A Systematic Review Ann Intern Med 157.

Stipanuk MH, & Ueki I. (2011). “Dealing with methionine/homocysteine sulfur: cysteine metabolism to taurine and inorganic sulfur.” J Inherit Metab Dis 34(1): 17-32.

The American Heart Association. (2009). “Dietary recommendations for healthy children.” Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/Dietary-Recommendations-for-Healthy-Children_UCM_303886_Article.jsp  on 8 April 2013.

The Dietary Guidelines for Americans. (2005). “5-8 Year Olds Nutrition.” Retrieved from http://www.heathierus.gov/dietaryguidelines on 8 April 2013.

Traka M, Goutebroze L, Denisenko N, Bessa M, Nifli A, Havaki S, Iwakura Y, Fukamauchi F, Watanabe K, Soliven B, Girault JA, & Karagogeos D. (2003). “Association of TAG-1 with Caspr2 is essential for the molecular organization of juxtaparanodal regions of myelinated fibers.” The Journal of Cell Biology 162(6): 1161-1172.

Vernes SC, Newbury DF, Abrahams BS, Winchester L, Nicod J, Groszer M, Alarcon M, Oliver PL, Davies KE, Geschwind DH, Monaco AP, & Fisher SE. “A functional genetic link between distinct developmental language disorders.” N Engl J Med 359(22): 2337-2345.

Vojdani A, et al. (2004). “Immune response to dietary proteins, gliadin and cerebellar peptides in children with autism.” Nutr Neurosci 7(3): 151-161.

Waring RH, & Klovrza LV. (2000). “Sulfur metabolism in autism.” J Nutritional & Environmental Medicine 10: 25-32.

WHO. (2000). “Global database on child growth and malnutrition.” WHO Geneva in ACC/SCN 2000 4th report on the world nutrition situation 5-96, Jan.

Wiest, et al. (2009). “Plasma fatty acid profiles in autism: a case-control study.” Prostaglandins Leukot Essent Fatty Acids 80(4): 221-227.

Williams BL, et al. (2011). “Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances.” PLoS One 6(9): e24585.

Williams-Hooker R, George O, Levy M, Morgan C, Smith TL, & Bittle JB. (2013). “Calcium and Vitamin D Intake of Boys who have Autism.” ICAN: Infant, Child & Adolescent Nutrition 5(2): 113-117.

Yui K, et al. (2012). “Effects of large doses of arachidonic acid added to docosahexaenoic acid on social impairment in individuals with autism spectrum disorders: a double-blind, placebo-controlled, randomized trial.” J Clin Psychopharmacol 32(2): 200-206.