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Larry Newman is the Chief Operating Officer, Technical and Regulatory Affairs of Kirkman Group, Inc. (Kirkman). Contact Kirkman at 1-800-245-8282; 6400 Rosewood St., Lake Oswego, OR.

Thursday, January 13, 2011

A Scientific Model for Approaching Special Needs Conditions

By Larry Newman

Physicians' and nutritionists' opinions on how to approach special needs conditions are always changing. Some of the current clinical work centers on developing a certain basic model as the most logical way of implementing biomedical and nutritional interventions.  This model should help parents just getting started to set priorities and initiate a plan.

In a recent study done by the Autism Speaks' Autism Treatment Network (ATN), Management of Children with Autism Spectrum Disorders, it was reported that gastrointestinal symptoms occur in nearly half of children with ASD, and that the prevalence increases as children get older.  The results of this study were presented at the Pediatric Academic Societies annual meeting in Vancouver, BC, Canada, on May 2, 2010. David Humphrey, president of Kirkman Group, Inc. was a cofounder of ATN.

This study is extremely important in helping to set priorities in approaching special needs conditions presently and in the future. These individuals are medically ill, and addressing their gastrointestinal problems needs to be a top priority.

Priority One -- Evaluating Gastrointestinal Health
Physicians have known for centuries that a well-functioning gastrointestinal tract and digestive system are crucial to good health. When digestion is working optimally, other organs and systems in the body have a better chance of working optimally as well. This is because the digestive system is responsible for processing the nutrients in our food, which in turn are used for growth, reproduction, development, tissue repair, healing, and for the normal functioning of every organ in the body. Therefore, the digestive system is very much responsible for supporting the health of the body as a whole. In addition to providing fuel for the body through nutrition, the intestinal tract also plays an integral role in the functioning of the immune and nervous systems. This association is often referred to as the gut-brain connection.

Signs of Gastrointestinal Disturbances

There are many distinct, recognizable signs of gastrointestinal disturbances, but as is often the case with individuals who can't communicate, these are not always obvious to the parent or caregiver. Examples of these are:
  • abdominal discomfort or crampling (often includes crying, screaming or holding abdomen)
  • constipation or diarrhea indigestion, bloating, gas
  • inadequate digestion often seen in stools 
  • inflammation 
  • serious food sensitivities 
  • yeast or bacterial overgrowth
When gastrointestinal disorders are suspected, a thorough examination by a gastroenterologist is called for. That examination very well may include an endoscopy and/or colonoscopy. Based on this exam, the physician has many options to help support whatever conditions are present in a patient's gastrointestinal disorder. These options may include: 
  • prescription antifungals, antibiotics or other drugs 
  • over-the-counter pharmaceuticals
  • special diets including the gluten-free/casein-free (GF/CF) diet or the Specific Carbohydrate Diet (SCD) 
  • probiotics to support good flora and crowd out undesirable organisms 
  • products that support tissue healing 
  • digestive enzymes to support proper food digestion 

Priority Two — Trying Special Diets

During the gastrointestinal evaluation, the physician or the health professional may suspect a sensitivity to casein, gluten, soy or complex carbohydrates. If that is the case, a special diet would become priority two. Special diets can be very useful in alleviating gastrointestinal symptoms. There are often hidden sensitivities that are a contributing factor to the GI problems. The most popular diet with the greatest success rate is undoubtedly GF/CF. All of Kirkman's products are casein and gluten free for this reason.

The Gluten-Free/Casein-Free Diet Explained

The GF/CF diet means simply eliminating casein-containing foods, which are primarily dairy products, and gluten-containing foods, which are primarily sourced from grains such as wheat, oats, rye, barley and spelt. This diet sounds rather simple, but managing a GF/CF diet is not that easy. The consumer must learn what products contain gluten and casein as well as learn how to carefully read product labels for "hidden" sources of gluten and casein in the ingredients listed. Food labels must be read regularly since manufacturers sometimes change their recipes. Prepared foods, baked goods, instant mixes, soups and gravies are notorious for having hidden casein and gluten. Once the parameters are understood, what seemed like an impossible diet to comply with becomes much more tolerable and manageable.

The Specific Carbohydrate Diet

This diet has been tried on individuals who have severe gastrointestinal discomforts such as bloating, gas, diarrhea and constipation.

The SCD diet limits the intake of sugars to simple monosaccharides such as honey, fructose and dextrose, and eliminates the intake of disaccharides and polysaccharides such as sucrose, molasses, mannitol, sorbitol, xylitol and inulin. It also greatly restricts the consumption of starches and other types of carbohydrates. The theory behind the diet is based on the assumption that toxic organisms present in the gut thrive on disaccharides and starches, with the elimination of these serving to starve out the toxic organisms. Therefore, the main foods consumed on this diet are protein sources, vegetables, fruits, seeds and nuts. Abook on this diet is available by the late Elaine Gottschall titled Breaking the Vicious Cycle: Intestinal Health Through Diet.  Kirkman® has a long list of supplements that are legal when on the SCD diet.

Priority Three — Improving Nutritional Status
Following gastrointestinal evaluation and utilizing special diets as appropriate, improving nutritional status should become the next focus.  This should be done by combining the proper healthful, nutritious foods with nutritional intervention using supplements.  Poor nutrition is very prevalent in special needs and sensitive individuals for numerous reasons.  A balanced diet for these individuals is usually not the rule.  First, special diets such as GF/CF or SCD may be in place and may not be balanced nutritionally.  Second, a person's tastes and attitudes can be such that an individual's diet is very deficient in vitamins, minerals or others nutritional necessities.  Third, a facet of biochemistry can be irregular (e.g., metabolism), making the absorption of nutrients suboptimal.  A certified nutritionist can be of significant help here by reviewing an individual's typical diet and making suggested changes and/or recommendations for needed supplementation.

Poor nutrition can be often (though not always) recognized by:
  • vision issues 
  • unhealthy skin tone
  • extreme tiredness, lethargy or lack of energy 
  • behavioral issues 
  • failure to thrive 
  • frequent illness 

Correcting poor nutrition is crucial to maintaining the good health of special needs individuals.  For those on a casein-free/dairy-free diet, calcium supplementation is critical to 

ensure proper bone development and growth.  In addition, a comprehensive vitamin and mineral supplement is essential when the diet is unbalanced and deficient, which is often the case if all food groups including protein, fruits, vegetables and carbohydrates are not being consumed.  Cod liver oil and omega-3 fatty acid supplements can help support good vision and healthy skin.  Irregularities in biochemical pathways are often supported by B-6/magnesium supplements, folic or folinic acid, or sulfation aids.
Certain nutrients are essential for proper support of the immune system.  Zinc, vitamin A, vitamin C, vitamin D, vitamin E and selenium are examples of nutrients that improve immune response.  Suboptimal levels of these nutrients can sometimes lead to a weak immune system, which can lead to frequent illnesses.

Products to Improve Nutritional Status
There are several options, the selection of which will be determined by the individual's overall health status or by the degree of aggressiveness one wishes to employ. If the individual is extremely sensitive or seems to have severe gastrointestinal issues, the less aggressive approaches would be recommended. Regardless of which approach is utilized, always start with about a 1/4 dose for a few days and gradually work up to the recommended dose.  This will minimize any potential side effects or sensitivities.

The most aggressive approach to correct poor nutritional status when accompanied by behavioral and social skills issues would be to introduce a form of Super Nu-Thera®, the high B-6/magnesium multivitamin/mineral developed by the late Dr. Bernard Rimland.  Many clinical studies with positive outcomes have been done on this type of product using a variety of individuals.  This product comes in liquid, powder, capsule and caplet forms, some flavored and some hypoallergenic.  It is generally recommended to try to use the hypoallergenic forms due to the extreme sensitivity of many individuals to flavoring agents and sugars.  Some children, however, need the product flavored in order to get compliance, so those forms are also offered.  If more moderate B-6 supplementation is desirable, Kirkman's Thera Response is another very comprehensive supplement recommended by many physicians. 

A less aggr
essive approach may be tried utilizing a condensed form of Super Nu-Thera® called Nu-Thera®.  It consists of the same basic nutrients at lower potencies in an easy-to-swallow, small #3 capsule.   This product is hypoallergenic and has a milder taste than some other products when the capsule is opened and the powder is mixed in food or drink.

The least aggressive plan for improving nutritional status would be utilized when improving nutrition is the only goal and when behavior and social issues are not as urgent.  In 
these cases, one would use a standard multivitamin/mineral product such as Kirkman's Children's Chewable Vitamin/Mineral Wafers - Hypoallergenic or Children's Chewable Vitamin/Mineral Wafers with Xylitol.  These products are daily multivitamin/mineral supplements supplying basic nutrients and potencies.  They do not have a high vitamin B content. 

Results of Priorities 1, 2, and 3
Gastrointestinal evaluation and support, a special diet as appropriate, and improved nutrition should give noticeable, favorable results in the special needs individual within several weeks to several months. Once those improvements are noted and continuous support is established, there are other interventions that can be tried for numerous symptoms.

Additional Biomedical Interventions -- Sleep Issues
Sleep issues in sensitive individuals are not much different than sleep problems in neurotypical people. These can include:

  • trouble falling asleep
  • periodic night waking
  • restlessness
  • nightmares
  • failure to thrive
  • frequent illness
It must be remembered, however, that these sleep tendencies could be due in part or entirely to underlying conditions such as gastrointestinal pain from irritation, ulceration, or inflammation, digestive discomforts such as reflux, or other causes of pain.  The dietary supplements often useful in supporting restful sleep include:
All of these supplements are safe and usually without side effects. They should be tried one at a time for about a week in the order listed above. If one does not seem to help, then stop and try the next one.

Behavioral Considerations and Social Skills
There are other conditions requiring biomedical or nutritional intervention such as sulfation problems, methylation issues, and toxic body burdens, but these are too complicated to address without a physician’s involvement. By following the above priorities and addressing the other conditions unique to the individual, a dramatic improvement in these special needs conditions should be evident. This is the model that the most recent medical information seems to support.