This month I am conducting a short Question and Answer session with Paul Shattock from the Autism Research Unit (ARU) based at Sunderland University here in the UK.
I contacted Mr Shattock as he is widely regarded as one of the leading commentators on diet and autism.
The former is a subject which has long fascinated me, but one that I know little about with autism in a number of ways. Liaising with the ARU has gone quite a way to rectifying this.
MJ: Mr Shattock, a general question to start with if I may? How did you become interested in the impact of diet and the autistic spectrum and what were your specific motivations to exploring the subject further?
PS: My son (now 38) has autism. For years I had taught Pharmacognosy (drugs from plants) to undergraduate students and so had some analytical experience and access to appropriate equipment. When I first heard about dietary manipulations, I did not believe a word of it. Only the obvious integrity and honesty of the Norwegian researchers looking at these possibilities kept us involved. Gradually, as knowledge developed, the unconnected pieces of information began to make sense. However, these observations remain largely unproven, but potentially very important so we became very involved.
MJ: you talk about Chronic Fatigue Syndrome (CFS) and the deleterious effect it exerts. One of the difficulties that I have with eating and the work context is that, after I have eaten, I invariably feel tired which impacts on my ability to work productively.
For this reason, I always eat little during the day but more in the evening to satisfy my appetite. This means that I often have difficulty sleeping in the evening. This, in turn, sometimes has the knock on effects such as the 24 hr sleep cycle you refer to which leads to sleep deprivation.
Do you have any suggestions about how this conundrum may be ameliorated or rectified?
PS: I first became interested in CFS about 15 years ago. I was watching a programme on the TV about Gulf War Syndrome GWS) and it occurred to me that many of the people I saw had hints of Asperger Syndrome. Either people with AS were more prone to getting GWS or something happened to them that caused the problems.
I contacted the lawyers working for the veterans and they made contact with a few of the locally based members. They were splendid people who were prepared to give up their lives for their country and now that they were clearly unwell, no-one wanted to know.
We took some urine samples for analysis and got similar results to those seen in Autism/Asperger Syndrome and suggested dietary changes. I then realised that the symptoms of GWS and CFS were largely similar and so our studies progressed.
We have not looked at sufferers from CFS as systematically as we would have liked but some of them do have, what appears to me, to be traits of AS. At the same time, many people with AS do seem to have fatigue symptoms. I suspect that they are present a lot more than is reported, but because the symptoms of AS are so diverse and affect life so much that they are not noticed or are just ignored.
MJ: I was fascinated by your observations about how opioids can affect motivation, namely: how a certain level is required as a source of motivation.
The latter is something that I often find hard at work. Can you shed any further light on these two subjects and how they are intertwined?
PS: When we complete a task well, we get a reward in terms of a burst of a naturally occurring feel-good hormone. The effects of this are, in some respects at least, rather like morphine. The chemical is, effectively, an endogenously produced morphine which was shortened to “endorphin” and a number of such compounds have been found naturally in human beings.
The suggestion is that, for some reason, the levels of such compounds are naturally elevated in people with ASDs, so that the small amounts secreted normally have little effect and the reward mechanism works only poorly and motivation is a real problem.
MJ: you also refer to how breaking the food down efficiently is a necessity so that it is fully digested through the walls of the stomach.
You also talk about how people with autism may eat faster than most as a result of “pharmacological highs”. I can certainly relate to this. I have always eaten quickly and felt that I need more food than most to satisfy my hunger.
I have tried to digest food more slowly, but am not sure that it has had that much affect. What could also possibly be related I feel, is that I have mentally conditioned myself to feel I need to eat more. At a business lunch, I need to be very conscious of the detrimental impression this can cause.
Do you have any practical suggestions as to how this can be controlled more effectively?
PS: Compounds similar to these endorphins are produced during the digestion of proteins milk (casein) and wheat and some other cereals (gluten). Chemically speaking, these compounds are termed peptides and consist of short chains (3-8) of amino-acids.
Some of these peptides are known to have morphine like activity and so are termed exogenous morphines or “exorphins”. These would normally be broken down further into their constituent amino-acids, but if there is something wrong with this digestion process or if the intestinal wall is more permeable that is normal, elevated levels of these would cross into the bloodstream and some would end up in the brain and affect transmission in all the systems there. Additionally, they could have very pronounced effects on the functioning of the immune system and of the intestines.
The obvious thing to do, would be to eliminate (or seriously cut down on) such foods from the diet for a trial period. If you feel better – keep doing it. If not, pack it in.
There are other things which may toughen up the intestinal wall or which may aid digestion and many of the unusual dietary approaches which people use are based on these procedures. Vitamins, minerals, omega 3 fatty acids, organic diets, Epsom Salt bathy, supplementary glutamine can all be helpful for some (but not all) people. Take a look at our website (http://osiris.sunderland.ac.uk/autism) and, in particular, the Sunderland Protocol which is found there. This will give a lot of ideas.
MJ: I have always liked fish and prefer it to meat. I do like the latter, though I find that it leaves me feeling heavier; however, I feel that it is not a food that puts excessive weight on me.
It does, though, leave me feeling satisfied or full, something which fish tends not to. My intuition tells me to eat more of the latter, and I would do in preference to meat if I felt it had the capacity to sate. Do you have any suggestions as to other foods which could be added to fish to resolve this?
PS: You are quite right about fish v meat. I had never thought about it before. I am going to guess that it is something to do with the fat content – more saturated and omega 6s in the meat, but I really don’t know. It could be some protein material as yet unidentified. No suggestions I am afraid. Catfish, Cowfish and Dogfish are still fish!
MJ: I have taken quite a bit of interest in diet in general over the years. I have recently become aware recently of the harm that additives or artificial flavourings or colourings may have on people with autism.
For this reason would you recommend going on a completely organic based diet?
PS: At this stage of knowledge I am not prepared to say that. In the first place, we don’t actually recommend people do anything, but we do suggest that they consider it whilst checking out the possibilities. I am aware of people who have gone along that route and found it to be helpful and others who have not. It cannot do us any harm to minimise some seriously toxic compounds though. Consider it – definitely.
MJ: leading on from the previous question, I have also read how antioxidants can enhance diet and its beneficial effects.
With regard to autism you say that they would help reduce hyperactivity. In a work context I often experience the latter. Are there any related substances – herbal tea for example – that could deliver the same effect and which could be consumed less conspicuously in a work setting?
PS: I am aware of a lot of physicians in the United States who are encouraging people to try antioxidants such as reduced glutathione. There is logic to this and preliminary evidence that they are beneficial, but since the potential for harm is virtually nil you could give them a try without disrupting your lifestyle. Vitamins E and C will be helpful and there are a lot of other possibilities that really would not impinge upon your life and could make you feel or cope better.
MJ: you don’t talk about alcohol in your paper but, in a way, it is also part of ones’ diet as it is a fluid we consume.
Alcohol is an integral part of the business world, both at formal occasions and social events. Have you looked at its effect in relation to people with autism and, if so, what are its effects?
PS: That is a fascinating question. I know some people with AS who are virtually alcoholics and cannot have one drink without going on a bender. However, I know others who loathe and detest alcohol and lecture those of us who enjoy a beer or two on the evils of drink. I know others who wish to socialise at meetings or even at football matches but can only do so if they have had a few drinks.
There does seem to be considerable overlap between AS and alcoholism in terms of possible metabolic mechanisms and medications which are used in both conditions. At the moment the data are contradictory and we don’t really know what it means. Remember, “If it doesn’t make sense, it is probably important.” This does not make sense.
MJ: from my experience diet is not something that the Occupational Health departments of companies include in their programmes or advice they afford.
Do you have any different experiences of this and is there any legislation that you are aware of that relates to this area?
PS: Our medical systems are geared to giving a drug in response to a set symptom or set of symptoms. Those physicians advocating dietary interventions attract derision and it takes a brave physician to go along this route. I believe it is changing but this change is not in the interests of the Pharmaceutical companies. If you are sitting on a tack it takes an awful lot of Ritalin to make it feel good. Let’s see about removing the tack! The same possibly applies to corporate Occupational Health Departments.
MJ: finally I have seen a number of outlets locally who are advertising “food tolerance tests”. I have been meaning to undertake one of these for a while.
Are they something you would broadly recommend or would you suggest – as somebody else has – visiting a GP and undergoing a blood test?
PS: As far as I am concerned, there is only one test that is reliable and that is to remove a food or situation and see what happens. The blood tests performed by physicians (IgE) will pick up only the most severe problems. IgG and RAST tests are probably better but show up a lot of things which are not really clinically relevant.
The tests you are talking about are probably based upon skin conductance and typically show up too many things that are not really relevant. Cytotoxic testing involves taking a little bit of your blood and seeing what happens to some of the cells when the suspect food is present. Some people swear by these tests because they are a bit nearer to nature but there could be a problem about consistency.
Whatever form of “testing” is performed, just treat it as a guide and not something that must be slavishly adhered to.
The ultimate test can only be a trial by removing the offending food for 10 days and see what happens. If pressed I would probably go for the IgG test, but you will get some false negatives and positives whatever method you employ.