Kelly Barnhill, MBA, CN, CCN, summarizes emerging research on nutritional approaches and supports for autistic people. She outlines recent investigations on sensory processing and nutrition, dietary changes, and supplementation. The speaker discusses recent systematic reviews, highlighting general consensus and gaps in research. Barnhill describes several ongoing studies and future avenues of investigation before the Q&A session.

In this webinar: 

1:30 – Goals and objectives
2:45 – Critical aspects of current discourse
5:28 – Sensory processing and diet
9:15 – Dietary changes
13:40 – Dietary supplements
14:30 – Systematic reviews and meta-analyses
19:00 – Significant findings from the last year
22:00 – Ongoing and future research
29:03 – Q&A

Current discourse and recent publications

Barnhill outlines presentation goals and objectives and highlights the challenges faced by researchers during the COVID-19 pandemic before diving into research updates (1:30).

She summarizes a study that found that 43 autistic participants had significantly higher histamine and lower thiamine than non-austic controls. The speaker asserts that these findings suggest the need for further research into potential interventions and screenings that target these biomarkers (2:45). A study on the impact of dietary quality on executive function found a correlation between poor dietary quality (high intake of processed carbohydrates) and impaired working memory, executive function, and organizational skills (3:58). Barnhill states that dietary factors impact development trajectories and that improving diet quality can improve educational outcomes (4:25). 

Sensory processing and nutrition

The presenter summarizes a study that found autistic children exhibit higher sensory sensitivity to food than their non-autistic peers. Study data also showed lower levels of calcium and vitamin D in the autistic group compared to non-autistic controls. These findings, she continues, reinforce the clinical perspective of food sensitivity in autism, which also emphasizes the impact these sensitivities have on food choices and eating aversions (5:28).

Barnhill cites a study that revealed family units of individuals with food sensitivities also present with different eating profiles (6:00). Another sensory study on BMI found that almost 60% of participants met units for being overweight, and 12% met criteria for thinness or failure to thrive (7:00). These and other studies show autistic children have different eating and feeding styles than non-autistic controls. Barnhill notes that a lot of work is being done to profile how autistic children participate in feeding environments, what their preferences may look like, and appropriate interventions (8:00). 

Dietary changes and supplements

Barnhill explains that a growing body of evidence supports dietary changes and vitamin supplementation in autism. A study involving 400 males and 130 females across multiple facilities in the UK tracked nutrition and development over time. Results showed that adopting a ketogenic diet, with professional support, can be a feasible and appropriate intervention for autistic children (9:15). The speaker cites a survey study that revealed no significant differences in routine while starting a ketogenic diet and that it is easy to assist children in starting the diet if necessary (11:00). Barnhill suggests screening for autism in children who present with significant feeding disorders. 

The speaker describes two animal model studies examining the effect of ketogenic diets on mouse behavior. The first study found that mice on ketogenic diets had reduced social and cognitive deficits and repetitive behaviors and an increased abundance of beneficial microbes in the gut, with no adverse side effects reported. A second study found similar results and also indicated that ketogenic diets may restore histone balances in affected mice (12:15). A third mouse model that tested zinc supplementation saw improvements in social interaction and fear but had no effect on social novelty, or the initiation of new circumstances (13:40).

Systematic reviews and meta-analyses

Barnhill presents a review that found low choline and B vitamins and abnormal amino acids in autistic children compared to non-autistic groups (14:50). Another review on probiotic supplementation found evidence that dietary change can increase oxidative stress. The presenter suggests monitoring oxidative stress as a mark of microbiome changes in the future (16:05). Clinical literature reviews assert that autistic individuals are often deficient in vitamins A, C, B6, and B12. Across reviews of gluten-free/casein-free (GF/CF) diets, there is consensus that GF/CF diets are quite feasible and carry few adverse effects (17:03). Barnhill highlights a review of dietary interventions by Amadi et al. as an excellent source for big picture concepts and detailed questions (18:23). 

The speaker highlights significant studies from the last year that looked at nutrients/probiotics as anti-inflammatories/modulators (19:00), prenatal diets as a modifier for environmental risk factors for autistic traits (19:50), and assessment and data collection methods across studies (20:35). She explains that to best represent typical dietary intake, three-day real-time collection across weekdays and weekends is needed (21:22). 

Ongoing and future research

Barnhill outlines an ongoing study in Florida that explores the impact of eating program interventions (22:25). She also highlights an ongoing longitudinal study assessing the effect of therapeutic GF/CF diet and physiotherapy on the gross motor and cognition of autistic children (23:18). Enrollment is currently open for another exciting study that looks at using folic acid to promote language development (24:01). Finally, the first large study on the impact of mitochondrial function and nutrient intervention is also currently being conducted (25:31). These studies, the speaker asserts, represent a continuous efforts to advance our understanding of autism and identify targeted interventions. 

Barnhill considers future avenues of research and underscores that the most significant barrier to nutritional research is a lack of funding. Contemporary research, she continues, should focus on targeted dietary intakes and anti-inflammatory factors. While GF/CF diets are feasible and effective, she warns against having tunnel vision and reminds viewers that we must always consider more than one avenue (26:30). 

Q & A

During the Q&A (29:03), Barnhill discusses picky eating and nutrition in adulthood (31:40), feeding therapy and dietary changes (36:00), paleo diets and multivitamins (38:00), and Celiac and autoimmune diseases in autism (44:50). She also considers good sources for protein (51:45), vitamins (55:15), and multivitamins (57:05).

Vicki Kobliner, RDN, CD-N, describes nutritional and lifestyle strategies for improving sleep and overall health for autistic people. She discusses circadian rhythm and balancing cortisol and melatonin cycles throughout the day. The speaker considers screen time restrictions, environmental adjustments, and relaxation techniques that assist with sleep onset and quality. Kobliner emphasizes the connection between diet and sleep and highlights critical nutrients for balanced sleep cycles. She lists valuable herbs and supplements and summarizes the presentation before the Q&A. 

Handouts are online HERE (.pdf)

In this webinar: 

1:35 – Sleep
5:36 – Circadian Rhythm
7:36 – Lifestyle and sleep
11:30 – Journaling and relaxation
16:20 – Nutrition and sleep
18:10 – Carbs, melatonin, and vitamin D
21:30 – Magnesium and B vitamins
23:49 – Amino acids
26:45 – Herbs and supplements for sleep
33:46 – Adaptogens
36:18 – Summary
37:40 – Q&A

Sleep cycles and circadian rhythm

Kobliner outlines recommended sleep times (total length of sleep) for different age groups and notes that lack of sleep leads to impulsivity, attention deficits, forgetfulness, learning deficits, obesity, impaired immune function, anxiety, and depression in both children and adults (2:30). Circadian Rhythm, the speaker continues, is a cycle maintained by the body that influences the balances of cortisol and melatonin throughout the day. She highlights that healthy sleep patterns, or balanced cortisol and melatonin cycles, are associated with benefits to mental health, cognition, and development (5:36). 

How lifestyle affects sleep cycles

The speaker discusses several aspects of lifestyle and how they affect sleep patterns. For example, you must decrease your core temperature by two or three degrees to initiate and maintain sleep. Kobliner suggests taking a hot shower 60 – 90 minutes before bed or wearing socks to sleep to support radiation of heat through the extremities, thus cooling the body (7:36). Upon entering sleep, she continues, cortisol levels should be at their lowest, so winding down before bed is important (8:40). Some common techniques for winding down include avoiding electronics one to two hours before bed, stretching/relaxing body movements, and meditation (10:20). Kobliner discusses the correlation between gratitude journals and sleep quality, noting that research shows a 50% decrease in sleep onset in those who journal (11:30). 

To ensure sleep-supportive lighting, the presenter suggests avoiding LED, dimming the lights an hour or so before bed, using sleep masks, and eliminating blue wavelength light (from screens), which shuts off melatonin production (12:00). Kobliner recommends not eating within three hours of sleep to regulate body temperature and emphasizes the importance of consistent bedtimes (13:40). Exercise should be done earlier in the day and not less than 2 hours before bed because it can raise cortisol levels and increase core temperature (14:40). The presenter notes typical consequences of sleep obstruction including apnea, snoring, daytime fatigue, and attention deficit, among others (15:20). 

How nutrition affects sleep cycles 

Kobliner outlines research showing that a lack of crucial nutrients like calcium and magnesium, as well as vitamins A, C, D, E, and K, are associated with sleep problems. Nutrient consumption affects circadian hormonal pathways, making diet a critical aspect of balanced sleep cycles (16:20). Carbohydrates support melatonin production but can also increase time to sleep and drowsiness. Therefore, the speaker states, carbs should be consumed three to four hours before bed and should be whole grain, not processed (18:10). Calcium is necessary to convert tryptophan to melatonin and can be found in dairy, boned fish, almonds, broccoli, and sesame seeds. Deficiencies in vitamin D, which can be absorbed from sunlight, egg yolk, and fatty fish, are linked to insomnia (20:28). 

The presenter explains that magnesium supports neurotransmitter production, reduces restless leg syndrome, makes it easier to fall asleep, and improves sleep quality. Good sources of magnesium include leafy greens, nuts, seeds, whole grains, and soy (21:30). Vitamins B6 and B12 are necessary for melatonin production. Kobliner emphasizes balanced vitamin B levels, highlighting that deficiencies are linked to insomnia and depression while high doses are not safe. Sources for B6 include bananas, carrots, spinach, potatoes, eggs, fish, whole grains, milk and cheese. B12 can be absorbed from dairy, eggs, meat, fish, and shellfish (22:45). 

Amino acids are proteins’ building blocks, and some are critical to sleep. For example, tryptophan turns into serotonin, which ultimately turns into melatonin. Therefore, Kobliner asserts that we need to support this pathway with the food we eat. She lists some foods that support healthy sleep, including eggs, fish, peanuts, pumpkin seeds, tofu, and more (23:49). All of these foods are highlighted in the Mediterranean diet, which the speaker repeatedly notes as supportive of sleep. Other crucial amino acids include GABA and L-TEHTANINE, which work together to reduce anxiety, time to sleep, and overall sleep quality (25:49).

Herbs and supplements for sleep

Kobliner outlines potential melatonin doses and comments on its long-term use (26:45). She lists herbs and supplements that support sleep, noting specific qualities for each: valerian (28:40), lemon balm (29:09), Zyziphus (jujube) (30:08), passion flower (30:45), chamomile (31:15), skullcap (31:44), and lavender (32:20). 

Adaptogens are compounds that help our bodies deal with stress (33:46). Stress medications are often one way, meaning they reduce stress but then may keep the stress response from acting appropriately overall. However, adaptogenic herbs support and improve the body’s stress resilience and, because stress induces cortisol production, positively affect sleep cycles and quality (34:45). Kobliner highlights three adaptogenic herbs and their benefits to sleep: Rhodiola, ashwagandha, and holy basil (tulsi) (35:00). 

The speaker summarizes her presentation, reiterating the importance of circadian rhythm and balanced cortisol and melatonin cycles. She reminds viewers that poor sleep affects everything from energy to blood sugar to hormonal balance. Lifestyles, including diet, should aim at reducing stress and modulating cortisol to enhance sleep onset, duration, and quality. She notes that all of this can seem overwhelming and recommends starting with the “low-hanging” fruit or changes that are easier to implement (e.g., electronic schedules, bedtime snacks, adding protein to the diet) (36:18). During the Q&A the speaker discusses sources for essential nutrients, strategies for relaxing before sleep, and much more (37:40). 

Vicky Kobliner answers questions about nutritional strategies for regulating mood in autism. She covers constipation, hydration, food sensitivities, inflammation, vitamin D, food-chaining, and much more. The speaker discusses general information on these topics and asserts that her suggestions do not replace individualized professional medical advice. 

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Playback of the lecture “Mood and ASD: Nutritional Strategies” (Feb 2019), referred to in this Q&A, is online at: HERE

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In this webinar:

1:30 – Mood changes and constipation
3:45 – Keratosis pilaris and other rashes
5:40 – Hydration and mood
7:05 – What about soy?
9:35 – Diets for low mood and depression
12:15 – Vitamin D
13:50 – How to regulate mood
14:34 – Fruits, rice, potatoes, and quantities
17:30 – How to change diets and simultaneously control rage
20:38 – Nutritional support for seizures
25:03 – Stomach bulges and fermentation
27:50 – Meltdowns, inflammation, and vitamin D
33:30 – Specific food focuses, allergies, and phenol
36:00 – Food chaining
38:00 – What do red ears indicate?
41:00 – Food sensitivity tests
43:45 – Diet disruptions and mood effects
45:35 – Resources for evidence of gut and mood interaction
48:04 – Do food sensitivities change over time?
49:15 – Tips for prenatal diets
50:43 – Low-histamine diets and fermented foods
52:00 – Fecal transplant as a potential treatment

Are mood changes associated with constipation the result of physical discomfort caused by constipation or the biological issues that lead to constipation? 

Timestamp – 1:30

Gastrointestinal (GI) dysfunction is common in autistic people and is known to impact mood significantly. Constipation is associated with inflammation and other disruptions to gut microbiota. Kobliner notes that a lot of research affirms that depression and anxiety are results of inflammation as well. She explains that when fecal matter is not expelled, toxins from the waste are reabsorbed into the body. This, in turn, causes more inflammation and, therefore, increased gut disturbances and low moods (2:45). 

What does the presence of keratosis pilaris and other rashes indicate, and how is it connected to issues with constipation? 

Timestamp – 3:45

The presentation of keratosis pilaris (or other skin rashes) alone does not indicate anything. However, they are associated with Omega-3 fatty acids essential for regulated mood and cognition. Kobliner suggests increasing Omega-3 intake to help keratosis and mood. Beyond this, she urges listeners to seek guidance from a medical professional. 

How does hydration affect mood? 

Timestamp – 5:40

Kobliner explains that even our cells need water/fluid to keep the biochemical pathways functioning. Symptoms associated with insufficient hydration include fatigue, irritability, and constipation. Staying hydrated is a critical aspect of every diet. 

Why is it recommended to avoid soy, and is organic soy okay to eat? 

Timestamp – 7:05; 24:03

Soy is a common cross reactor with dairy products; their protein structures are similar enough that the body reacts to them similarly. Kobliner, therefore, asserts that individuals with dairy sensitivities should not substitute with soy products. Most soy products, she continues, are genetically modified and processed. If you want to add soy to your diet, she recommends consuming soy in whole organic forms like nuts and legumes (8:00). 

Is there a diet recommended for those suffering from low mood and depression?

Timestamp – 9:35

Inflammation is significantly implicated in mood disorders, so determining the cause of inflammation is paramount. A critical relationship exists between processed foods and sugars and elevated bodily inflammation processes. Therefore, Kobliner suggests reducing starchy, processed foods, and pesticide intake (11:20). She also notes the importance of supplementing vitamin D in the winter months. In the brain, serotonin (a happy mood neurotransmitter) interacts with vitamin D and Omega-3s. If either of these is deficient, the brain cannot correctly process serotonin (12:15). She highlights reducing inflammation and ensuring the gut can absorb nutrients well as the two most essential things for regulating mood. The speaker suggests a diet low in processed foods and high in fruits and vegetables, good-quality animal protein, and high-quality fats (13:50).

Which are the best fruits, and in what quantities should they be consumed? What are the best quantities for rice and potatoes?

Timestamp – 14:34; 31:47

Kobliner suggests assessing gut health even in children who do not outwardly present with symptoms. She reiterates the importance of an anti-inflammatory diet and suggests starting with berries and other fruits rich in antioxidants. It’s best to keep servings of rice, corn, and potatoes to one per meal. Fruits, she continues, do not need to be limited. Instead, she advises listeners to pay attention to how each fruit makes them or their loved ones feel (16:20). She constantly emphasizes the need to add foods slowly, one step at a time. 

Context: Son only eats carbs and recently started having blind rages. Q: What can stabilize his craving for carbs so I can manage the changes in their diet?

Timestamp – 17:30

There is no one way to do this, as individual needs differ. The speaker proposes mixing foods (e.g., cauliflower blended into mashed potatoes or muffins made with 1/2 nut flour) to slowly change the balance of foods that they’re focused on. A shake or smoothie with vegetables and protein before a meal ensures proper nutrient intake before eating carbs. Kobliner touches on binders like activated charcoal that can help with rages and underscores the need for holistic assessment of what’s causing the rage behavior (19:45). 

Is there a way to support seizure patients through nutrition?

Timestamp – 20:38

The Ketogenic diet has been beneficial for some individuals with seizures. Kobliner warns that this diet is particular and must be medically monitored as it is not nutritionally adequate. She also notes the Specific Carb diet, which is not specific to seizures, but is protein and fat based. This substantially decreases carbohydrate intake, and many clients do well on this track (22:45). The modified Atkins Diet for Epilepsy is also available, but with clinical support. Outside of specific diets, she reminds listeners to limit carbs and concentrate on vegetables. 

What do you recommend for stomach pains and bulges?

Timestamp – 25:03

Bulging is generally a sign of fermentation, meaning an undesirable bacteria or pathogen is in the gut. These microbes feed on carbohydrates, while good bacteria feed on vegetables. Therefore, removing complex processed carbohydrates and adding probiotics while changing the diet is vital. Kobliner notes that naturally lacto-fermented foods are good for gut health (27:00).

Context: Son recently started having meltdowns. Q: What diet recommendations or actions do you suggest?

Timestamp – 27:50

Kobliner refers to the answer for question 7 and reiterates the importance of vitamin D. She notes the negative impact of inflammation on vitamin D uptake and suggests magnesium as a supplement. The speaker advises listeners to understand and differentiate between different types of magnesium and what they do in the body (30:30). 

Context: Son stopped eating fruits and vegetables and now only eats bananas, meat, and carbs. Q: How do I add these fruits and vegetables to his diet?

Timestamp – 33:30

Specific focus on certain foods is often associated with addiction, which frequently happens with bananas. Observing how one’s body and behavior react after eating a banana is essential. Red face, red ears, and extreme hyperactivity are signs of reactions to phenolic food. Kobliner suggests it may be best to remove bananas altogether in case he is allergic. You can also add vegetables and fruit by mixing them into other foods or experimenting with various presentations (e.g., frozen fruit and berry sauces). The speaker outlines the process of food-chaining as another long-term option for changing diets (36:00). 

What do red ears indicate?

Timestamp – 38:00

Red ears are generally indicative of either phenols or yeast. The presenter suggests minimizing phenolic foods and normalizing gut function via dietary changes. She also advises testing for phenols, yeast, and food sensitivities (39:18). She discusses the difference between allergies and sensitivities (41:00). 

Having tried many diets, we have seen no improvement in behavior. What testing would you suggest for finding food sensitivities so we can avoid any diets he cannot do? 

Timestamp – 41:48

There is no one test for food sensitivities, and different diets work for different individuals. The speaker suggests seeking professional medical guidance and assessing GI health to determine the best diet options. “A food sensitivity test is like a bad map in the forest… they’re never 100% accurate. Better than no map, but you will make tons of wrong turns.” This, unfortunately, Kobliner continues, is part of the process, and there is no way to get around it (43:20). 

How long is mood affected by disruptions in diet and how can we mitigate the effects? 

Timestamp – 43:45

Kobliner suggests digestive enzymes or binders help with mood control and detoxification. Acetylcysteine can also help detoxify but sometimes exacerbates yeast problems (45:05). Herbs and berries are excellent detoxifiers. 

Do you know of any great studies explaining why diet changes work and why it matters?

Timestamp – 45:35

While there are fewer studies than Kobliner and her colleagues would like, you can find some significant research on Google Scholar. Jim Adams has several studies on this topic, and research consistently finds that diet is one of the most effective interventions for low mood. 

Can food sensitivities change over time? 

Timestamp – 48:04

100% yes – the gut and the GI tract change over the lifetime, directly affecting food sensitivities. However, changes are not always rooted in diet, and Kobliner suggests also considering infection. 

What are some tips for prenatal diets? Can we use inulin? 

Timestamp – 49:15

A medical practitioner should only recommend inulin after a complete medical history. Kobliner has seen inconsistent findings and recommends developing an individualized diet with prenatal professional guidance. 

We are on a low-histamine diet for mastocytosis, but behavior is also impacted by foods. Do you have any suggestions? 

Kobliner suggests considering things outside of histamine and looking into additional ways to minimize histamine load. She notes that fermented foods and bone broth often have glutamine or histamine and should be avoided. 

What about fecal transplant?

Timestamp – 52:00

Fecal matter transplant is still in trial phases, but results show immense potential for GI treatments. Kobliner stresses that such treatments must be done in sterile environments and under medical supervision. 

Vicki Kobliner is a Registered Dietitian and owner of Holcare Nutrition (www.holcarenutrition.com). She practices a functional nutrition approach to help the body heal itself, and has extensive experience using various diet modalities to help children with autism and related disorders. Vicki works with infants, children, and adults with chronic illnesses, digestive disorders, food allergies, ADHD, and autism, and provides fertility and prenatal nutrition counseling. She is a contributing author to A Compromised Generation: The Epidemic of Chronic Illness in America’s Children.