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“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).
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