Dietary Interventions in Autism Spectrum Disorders: Why They Work When They Work, Why They Don't When They Don't, by Kenneth J. Aitken, provides a discussion of the history of special diets for symptom management in autistic people. Despite the rather blunt title, the book seems to be aimed at healthcare professionals. However, a layperson such as myself can follow the gist of the matter without understanding the specific formulas and chemical interactions described.
I'll preface this review by informing you, sadly, that there is no one proposed diet that solves all autistic ills. This won't surprise you if you're familiar with the saying, "If you've met one person with autism, you've met one person with autism."
Also, when the word "diet" is used in this book, it is not referring to the typical USian understanding of the word, which refers to the fad weight loss diets that come and go like the wind. These diets are undertaken to lose weight, and, without assuming that goal is even accomplished, dropped quickly. The book does not, in fact, give any care for weight loss at all. Apparently a significant portion of the autistic population is rail thin instead of obese. That sounds nice to me, but the author insists this is as much as problem as obesity.
At any rate, the book's intention with the word "diet" hearkens back to an older understanding of the word: the food and drink regularly consumed. In short, these diets are meant to be undertaken in the long term. They are lifestyle changes, not temporary measures to appease one's guilt or prop up one's body image. (I have a deep dislike of "dieting," can you tell?)
The first section of the book discusses ASD and special diets. It contains good background knowledge, some of which is helpful to understanding the how and why of the diets. It also covers how food and nutrition has shifted in the development of humanity and technology, which I thought was quite interesting and helpful. To cap it off, it contains information about particular toxins whose effects are particularly obvious in autistic people, as well as protective factors against these toxins.
The second section is the meat of the title: Nine diets are analyzed and summarized in brief (sometimes "less than 10 pages" brief). Factors considered in each analysis include the evidence for and against each diet, possible health problems associated with the diet, and practical difficulties with following the diet.
I was particularly impressed with the author's choice to have that last criteria in each section. It strongly suggests he's aware of the challenges that come with making these changes. The specific sections, too, suggest his awareness of the differing situational challenges any given family might come up against. Not every family is going to be able to find farro to cook with, for example.
Each analysis also includes a Resources section, which tends to include a healthy mix of books, websites, organizations, and scientific research. This is in additon to the Resources section at the end, which contains all the same info but centralized. The information in this book is about ten years old, so it's quite possible that some resources may not work. However, the author has listed enough of them that at least one should serve to get you further information and likely other resources.
Part three of the book is the author's answer to "but which of these diets should I do!?" He proposes a 10th diet (the Simple Restriction Diet), drawing on the best parts of the most effective diets previously described. He includes a proposed plan, complete with worksheets, a table to help you match problem foods with toxins, and a suggested timetable with which to implement the diet and subsequent re-introductions of food categories.
In all honesty, I kind of want to try this Simple Restriction Diet. It seems distinctly promising in terms of both weight loss and narrowing down whatever keeps wrecking my guts. Maybe even whatever's wrecking my spouse's guts. In practicality, I'm... dubious of my ability to convince my spouse to try this diet. "Restriction" is a very apt descriptor, because this diet has you eliminate or heftily reduce quite a bit of commonly consumed foods. Feasibility is a serious concern.
The suggested timeline for implementing the diet is actually only three weeks, after which you start adding in carbohydrates to a point, and watching for adverse reactions. And then, assuming none, you move onto transitioning off the next category, and so on. If adding a category back in causes a reaction, then you can take that to your doctor and get more specific tests.
As such, it's still a significant expenditure of time and energy... but you aren't necessarily bound to a particular diet for life. The author even stresses testing your final resulting diet every once in a while, because none of these are perfectly scientifically sound. Improvements might be seen while on a gluten-free/casein-free diet, but not actually be related to the diet itself, and the person may find some years hence that they don't need to adhere to it but still remain healthy.
I have a couple complaints. The first is that no mention is made of the difficulties of transitioning off a typical USian diet. Sugar addiction is a very real and very miserable thing to detox off of. I have done so several times and will need to do so again at some point soon, because Halloween candy and Christmas sweets exist and I only have so much patience with not eating them.
The second is that I don't feel there are sufficient resources for the author's pet diet, the Simple Restriction Diet. There are resources in plenty for the other nine he looks into, and one could, I suppose, research the relevant ones and try to combine them with a great deal of effort. I would much rather have links to directly relevant cookbooks, with no guesswork about whether I'm failing at this or that aspect.
All in all, I was impressed with this book. It's analytical and healthily skeptical while remaining positive and hopeful. It acknowledges the shortcomings of the science without disallowing their effectiveness. It explains the science in detail without being overly verbose, and you needn't truly understand the chemical formulas to follow the rest of the discussion.
Read This Book If
You're an interested care provider, interested parent, or interested autistic. This is a pretty focused book. It's written well, in a manner that seems aimed at healthcare providers but is accessible to laypeople (except maybe the chemical formulas). It discusses the science (or what exists of the science) as well as providing feasibility information and potential positives and negatives to each diet. In short, this is a good resource for anyone looking into special diets, and I'm glad my local library has it in their collection.
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