Selecting the Best Diet For Autism (And Other Chronic Conditions)

Navigating Salicylates, Oxalates, & More with Nutritionist Julie Matthews

A new study into autism and diet, published last year—which combined six different nutritional interventions in children—yielded impressive results in the treatment group. They saw an almost 7-point increase in non-verbal IQ, developmental age improvement, and more. Findings in the study, and in nutritionist Julie Matthews’ clinical practice, show benefit in testing a diet that eliminates common allergens: a healthy gluten-free, casein-free, soy-free diet (HGCSF). Vitamin/mineral supplements and essential fatty acids also showed benefit in the treatment group. With certain symptoms, salicylates and oxalates may be other food elements to consider reducing. These interventions may not need to be permanent, and tolerance may also improve with gut healing.

Nourishing HopeToday I’m joined by my guest Julie Mathews, author of Nourishing Hope For Autism. Julie provides some interesting insights on how to choose the best diet for Autism and other chronic conditions. She was an integral part of a recent Autism study that was published last year. You won’t want to miss her breakdown of the study results.

In this episode Julie and I discuss diet protocols and a cascade approach that often helps practitioners and patients identify the best possible diet for healing. The protocols we discuss, like starting with a gluten/dairy/soy free diet and cascading to other diets like low histamine, low FODMAP, low salicylate diet and low oxalate diet are not limited to Autism treatment, this approach can be used for many different chronic diseases.

[Continue reading below]

Dr. R’s Fast Facts Summary

Autism Study  Included a Layered Approach

  • Gluten free, Dairy Free, Soy Free Diet
  • Digestive enzyme
  • Carnitine for mitochondrial support
  • Fatty acid Omega 3’s

How to choose the best diet for treatment?

  • Start with Gluten/Dairy/Soy Free diet
    • Evaluate symptoms from there
    • If symptoms remain, progress to other diets that correlate with symptoms
  • Low Salicylates Diet
    • When patient displays aggression, hyperactivity, sleep issues, irritability, etc.
    • Salicylates can also affect the gut and skin
    • Can see benefit from diet in a few days to a week
    • Some Foods that are high in Salicylates
      • Apples, grapes, berries, raisins
      • Honey and almonds
      • Herbs and spices
  • Low Oxalate Diet
    • Reduce consumption of high oxalate foods such as certain greens, beans and legumes, and nuts to help reduce inflammatory symptoms.
    • When patients display symptoms like genital irritation or burning, burning eyes, burning feet, a chronic injury that won’t go away, fatigue, cloudy or crystals in the urine etc. Or prior history of elevated kidney markers or dysfunction
    • Removing oxalates too quickly makes symptoms worse, reduce them slowly
    • Can see benefit from oxalate reduction in a few days or it may take up to a month or more
  • Don’t forget that bacterial and fungal imbalances (dysbiosis) and infection may need to be addressed also
    • There is rarely a singular approach to chronic illness
    • Diet is a great starting point but stay open to needing other therapies

Where to learn more?

DrR Feature JuleMatthews
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In this episode…
Episode Intro … 00:00:40
Note on Healthy Morning Routines … 00:01:20
Study on Autism & Nutrition … 00:05:24
Gut’s Influence on Conditions Like Autism … 00:09:27
What Diet Is Best for You or Your Child? … 00:12:32
Salicylates: Foods & Intolerance Symptoms … 00:22:40
Oxalates: Figuring Out If You Have an Issue … 00:27:30
Are Lectins Really Problematic? … 00:37:55
When to Move Beyond Dietary Intervention … 00:40:44
Episode Wrap-up … 00:45:47

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Episode Intro

Dr. Michael Ruscio, DC: Hey everyone, welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here with Julie Matthews, who has published some information regarding dietary interventions for autistic children and also seems to be a very well-versed clinician in how to find the right diet for the right individual.

So I’m exceedingly excited about this conversation. I think it’s going to be akin to the conversation we had previously with Heidi Turner, who really laid out the different diets, when to use them, and how to select what patient or person subgroup they may work best for. Julie, very excited to dig in, and welcome to the show.

Julie Matthews: Thank you so much. I’m really glad to be here.

DrMR: It’s a pleasure to have you here.

Note on Healthy Morning Routines

Pardon me while I blow a little bit of hot air here, because I want to share with our audience—as I was telling you just a moment ago—about some modifications I’ve made to my morning routine. I have to say, wow, what a difference it’s made in how I feel. I’m sure people listening to this can relate to how it feels to feel as if you’re chasing your day. You’re doing stuff all day. You never feel like you get enough done, or you never feel like you get enough done quickly enough. There’s always one more thing to do, one more thing on the list. And that can lead to a very yucky feeling of this hamster wheel-like life.

I decided this morning to really just say, “Eff it.” I didn’t care how much I had to do. I said, “I’m going to meditate for 10 minutes. I’m going to play piano for 20 minutes, and this is a non-clinic day for me, so I can work remotely. And I’m going to do 15 minutes of brain games at the coffee shop, first thing.” I typically go down to the local coffee shop. So really, the first 30, 35, 40 minutes of the day was dedicated all to me and getting myself straightened out in terms of meditation, expressing myself with some art, some music, and also doing a little bit of training for my brain.

What more important resource do we all have in this world than our brains? What an absolutely great way to start the day. Gives you some peace, gives you some solitude. Not only that, but I do feel when you change your outlook and your vibration a little bit, you tend to attract or at least notice things around you in a deeper way.

coffee shopAnd there were two gentleman next to me having a conversation at the coffee shop. One was an atheist, one was more of a Christian. They were having this theological debate, which is something I love to get into, but there are so few people—at least that live close to me—that enjoy that kind of thing. We ended up getting into this 20-minute conversation where nobody wanted to walk away. And we all exchanged numbers and decided to grab coffee another day, so that we could go into this back-and-forth of the merits of theology compared to atheism.

So the point I’m trying to make is, if you’ve been putting off allocating time to your own development as part of your morning routine, please, please put some time, effort, and energy into it. I can say this is one of the best mornings I’ve had in a long time. I think the main antecedent to that was just putting some time toward myself.

JM: I love that. It’s funny, I really was just on the phone with a friend and she was telling me all about her self-care routine, and we were just talking about meditation. Actually, she’s my fire-dancing teacher, so we do a lot of mindfulness around dance, and it’s so good. Anyway, what I’m hearing is, it’s almost like you’re balancing your right and left hemispheres to some extent: you’re doing the music, the art side, and the brain side, which I think is really great. I’m so glad to hear your experience.

DrMR: Awesome. And what is fire dancing? I’ve never heard of that.

JM: Well, I do something called Poi. I also do something called Contact Staff. Basically Poi is two balls on two chains. You light them on fire, and you spin them around.

DrMR: Wow, that’s cool.

JM: Yeah, I’ve been doing that for maybe more than ten years now. It’s really my mediation, my mindfulness practice. I’m not as great at meditation, although I do try to do that as well because I don’t think there’s a substitute. But this is a way of doing a mindfulness practice. To me, it’s all about flow. And for me, flow is really getting in touch with that point between order and chaos, and expressing it in a physical sense. Anyway, I usually don’t do it with fire anymore because it’s really toxic. I’ve graduated past that. I do it mostly with lights and things that I can do in my house, that also don’t burn the house down. So it’s a double win.

Study on Autism & Nutrition

DrMR: Awesome. So you need this to counterbalance the other side of your brain, which is pretty accomplished in the nutritional field. I know you published a study in the journal Nutrients. Why don’t we start there and sneak in some of your background, along with that, to get people up to speed on who you are?

Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder—A Randomized, Controlled 12-Month TrialJM: Yeah, I would love to. My name is Julie Matthews. I’m a certified nutrition consultant and I’m the author of a book called Nourishing Hope for Autism. And I’ve spent the last 17 years working with families as a nutritionist. I’m also doing research into the topic of diet and nutrition intervention. Primarily, autism has been my focus for this time. And you know how long it takes to get research done. So about six years ago we started working on a study that was just published last year in the journal Nutrients. It’s an open-access study so you can read the entire paper.


  • Six nutrition interventions layered on top of each other, one by one.
  • One intervention, and followed the children for a year.
  • It was a long-term study, a randomized controlled trial.
  • Study looked at a multivitamin mineral formula; a fatty-acid blend; a digestive enzyme, carnitine; epsom salt baths to supply some sulfate; and a healthy, gluten-free, casein-free, and soy-free diet.

Results:

  • There was almost a 7-point increase in non-verbal IQ
  • Developmental age improvement: had a 4-and-a-half times developmental increase over the non-treatment group.
  • Benefits in GI health, GI symptoms.
  • Significant improvement in anxiety, depression, irritability, play, language.
  • The list goes on and on

And I’m really excited about the results, because we took six nutrition interventions and layered them on top of each other, one by one. They all had good results in independent trials. So we decided to see what it would be like if we put all of these things together in one intervention, and followed the children for a year. It was a long-term study, a randomized controlled trial. And we looked at a multivitamin mineral formula; a fatty-acid blend; a digestive enzyme, carnitine; epsom salt baths to supply some sulfate; and a healthy, gluten-free, casein-free, and soy-free diet.

And we found results that I think were really exciting. There was almost a 7-point increase in non-verbal IQ, which to me is really amazing. We had developmental age improvement: so during a one-year period you’d expect kids to develop a year (but they’re delayed, so they develop four months of development in that year), whereas the treatment group had 18 months of development. So they had more than a year of development. They started catching up to their peers and had a 4-and-a-half times developmental increase of the non-treatment group.

There were benefits in GI health, GI symptoms. We know—and we’ll talk about GI stuff—that the severity of autism is correlated to the severity of their gastrointestinal symptoms. So that’s really a big thing.

I just presented at the Anxiety and Depression (Association of America) conference this weekend, because our study also found significant improvement in anxiety, depression, irritability, play, language. The list goes on and on.
So that was our study. Like I said, it’s available for people to read and it’s been downloaded fifty-some thousand times.

DrMR: Fantastic. And one of the main reasons I wanted to get you on the podcast was stumbling across that paper, which I thought was excellent. There is certainly a time and place for isolating variables and studying those in a randomized controlled trial, yes, but there’s this other need to expand upon assessing just one variable and see what happens when we have a multifactorial intervention.

JM: Exactly.

DrMR: And you can still do that in an organized fashion, where you’re isolating for a number of variables, and then you’re saying, “Well, when we manipulated these four variables compared to none, was there a significant impact?” So I think that’s commendable. I think it’s a terrific study that you published. And what a fantastic impact to be able to make for these parents really trying to help optimize the neurological function of their children. I just think that’s absolutely fantastic, so my sincere thanks for publishing that. I’m sure it wasn’t easy getting it off the ground. I can totally relate to the labor.

JM: Yes. Thank you.

The Gut’s Influence on Conditions Like Autism

DrMR: So did you want to mention anything regarding gut specifically? Because that I think is something that the autism community is aware of. Maybe not everyone in the autism community is aware of that, but why don’t we start there. Is there anything you feel to be novel, in terms of observations from that study, or just your work at large, in terms of how the gut affects people’s neurological function?

autismJM: Absolutely. So whether you take autism or anxiety or depression or ADHD—as we know and as your work shows—the gut is really central to this. And this is no different in autism. We see a lot of challenges with the microbiome. They’re different. We often have less good bacteria in autism and more pathogenic bacteria, more clostridia, just a variety of different pathogenic bacteria, as well as decreased levels of carbohydrate-digesting enzymes. We see more inflammation. We see more opiates in the urine, where gluten and dairy aren’t able to be broken down. And these proteins are formed into opioid-peptide chains because digestion is not able to break them down, so it’s literally like being on morphine. That creates a lot of significant brain issues and challenges there.

We obviously know that if the gut’s not digesting our food, we can’t access the nutrients we need, whether it’s for our brain to function or for our digestive enzymes to be made or whatever it might happen to be. So there is a big connection in autism to the gut, just as I believe there is in most chronic conditions. One of the ways I look at intervening into autism is, how can we support the gut? So in our study, we did a gluten-free, dairy-free, and soy-free diet as part of that picture. We also added digestive enzymes in. We added carnitine for mitochondrial function, which is important for every cell in the body, but also the gut. Oh, and fatty acids. We found that omega-3s, particularly, in studies have been helpful for people with autism to reduce inflammation in the gut.

So while the study wasn’t just looking at gut function and support, a lot of the things we do to support overarching health and improvement are things that, not surprisingly, are also used to and can support the gut.

DrMR: Mm-hmm. Are you familiar with the work of Dr. James Adams?

JM: He was the lead on our studies. I’m very familiar with Dr. Adams, I absolutely love his work.

DrMR: Okay, I must have missed that… in my defense, at that time of me reading this paper, I don’t think I was aware of Dr. Adams’ work. Now, when I see his name, I’m like, “oh, okay,” Dr. Adams. Pretty impressed with the narrative that he has on autism. And I was going to say, there sounds like a lot of overlap in the models.

JM: Yes! Haha.

What Diet Is Best for You or Your Child?

DrMR: So one of the things I’d like to dig into—because I feel this is something we can always use more elaboration on— is the landscape of gluten-free, dairy-free, low-oxalate, paleo, keto, low-FODMAP, low-histamine. Of course, doing all of that is maddening. The real goal is trying to figure out who is going to need what.

JM: Yes.

240F210362258af7xhTBbQ2LuWjhhSIF2GeMcxeqGQ4PrDrMR: And I’m sure you have a certain selection criteria or algorithm you go through in your head. Let’s discuss some of what you’re looking at in terms of patient presentation, history, or conditions that would lead you to say, “Okay, we want to start maybe more on the end of lower carb, like keto or paleo,” or, conversely, go into something like low-FODMAP. Do you have any ways you start to partition people into selecting what diet they should be moved towards?

JM: Yes, absolutely. And I would say that this really is my specialty in the world of autism. So when I helped with the study, my primary job there was helping with the implementation of the gluten-free, casein-free, and soy-free diet in that case. But I don’t just work with that diet.

What I found was—this is my experience, starting 17 years ago—the gluten-free and dairy-free diet was the only diet that people really even knew about for this, so people were on that diet. Then we heard about how the low-salicylate diet was really helpful, for hyperactivity and various things. So where did that come into play? And then the specific carbohydrate diet came out, then the paleo diet, then the GAPS diet… it went on and on. There would be certain people that would say, “Ah, everybody needs this diet. This is the diet that healed my child. This is the diet everybody needs. If you don’t do this diet, your child’s not going to heal.” But then, I would see people come into my practice who did a different diet and did very well, and some who did that very same diet and did very poorly.

So I’m not a dogmatic person. I started to think, “Okay, well, there’s some truth in every one of these statements, which is why they worked for some people.” How do I figure out what that truth is? How do figure out who is helped by this diet? And who is not helped by this diet? What symptoms are most commonly associated with this? What labs and underlying bio-chemistry are most associated with reactions to these foods? What would that look like based on conditions they present with? And I went down and down and down and down to figure out, out of all these diets, when should I apply which diet to my autism client?

So that’s basically my approach. To answer that question… this is something that I train practitioners in my bio-individual nutrition program on. And this is really the number one question, which is, how do you figure out what diet your client, or the individual, needs to do?

I use a seven-phased approach—I just mentioned some of them, food reactions, food cravings, common foods that they eat most frequently, symptoms, conditions, labs, genetics—to figure out what that looks like. But we can piece some of that apart now.

7 Phase Approach

  • Food reactions
  • Food cravings
  • Common foods that they eat most frequently
  • Symptoms
  • Conditions
  • Labs
  • Genetics

I guess I use a combination of a couple things. I’ll often start out with the most simple diet first, and see what symptoms remain. Then I’ll figure out which direction I want to go from there. So, often, I’ll start with a gluten-free, dairy-free, and soy-free diet, see what that improves, and then see what symptoms I have from there, and which place I’d like to go.

Then I often have my own way of starting again with the ones that are either the most likely suspects in my mind or the easiest ones to do a trial, given what they’re presenting with. And some of that will depend. So, I’m trying to think of how I want to describe this process further to you. But before I do–

DrMR: I have an idea here I’d like to throw into the mix, just to get your perspective.

JM: Yeah, go ahead.

DrMR: It’s challenging to try to articulate the framework. I agree with you completely with what you’ve said thus far, which is, you start with what I would term just your common allergens; gluten, soy, dairy, your most commonly inflammatory or allergenic foods, and then you reevaluate.

JM: Mm-hmm.

Low FODMAPDrMR: And what I see as the next viable option, for a lot of people, is concerning the fermentability of the foods or, perhaps, next considering a low-FODMAP diet. And this is one of the things I develop in Healthy Gut, Healthy You. There are two general directions we can look at first: allergens or fermentability. So I think the first place to start with most people is the allergens: your gluten, your dairy, your soy.

Then, the next maneuver I often like, the next thing that we may consider—it’s not an absolute rule, but if I’m trying to say that the majority of people would follow this path—is FODMAPs and fermentability. Would you modify that? Do you see that trend also?

JM: Great question. I think, in part, it would depend on the person I was seeing. So, yes, most of them have gut issues and I’m going to look at a gut issue. But it depends for me. And it might depend on what the child was presenting with. So if their primary thing was irritability, aggression, hyperactivity, and that kind of thing, I might not start there. I might start with what I know to be big factors there, which are things like salicylates, or amines and histamines, and things like that.

But I hear what you’re saying, in that, if I had a gut person—where the first thing they’re telling me that they need some immediate relief from is that they’re suffering from a gut-inflammatory thing—I would probably, like you said, go down the route of what is irritating the gut.

Now, I might do grain-free or I might do low-FODMAP. Again, it depends on a couple of things. It depends what their diet looks like now, and what I suspect is in their diet. If they don’t have a lot of FODMAPs, maybe I would go with grain. But it depends a little bit. Generally speaking, if we’re going to go down that, we’re going to start with the gut, which is usually the primary place I would start. But in my world, first I’m probably going to take care of whatever symptoms are debilitating their current situation, right?

It’s always different from person to person. But yeah, grains and FODMAPs are two of the big guys that I think really impact gut health, so I think that’s definitely a reasonable approach.

DrMR: I’m so glad you mentioned that piece about histamine, because there’s something I’ve been toying with based upon one study that found a low-FODMAP diet has led to an eightfold decrease in histamine. I think by starving bacteria via the low-FODMAP diet—if we reduce that bacterial colony, and that bacterial colony is ostensibly both directly and indirectly producing histamine—we may be able to really achieve an alleviation of the histamine burden. And then, the next step after that would be considering an actual direct low-histamine diet.

Now, sometimes I’ll employ the low-histamine plus low-FODMAP diet. It just depends on how severe their symptoms are. Maybe if they’ve come in and already done low-FODMAP, then we may say, “Okay, you’ve already done that, so we’ll go right to low-histamine.” Any thoughts on that observation?

JM: I think that’s a great observation and I would agree. In the end, we’re shooting for the same goal. With my salicylate example, a bunch of pathogens in the gut can cause us not to be able to process salicylates well. So after I remove some of those salicylates to get rid of the aggression and the hitting or the biting, or whatever emergency we’re dealing with, I’m going to look at how I heal up the gut so I can get more more capacity to handle those salicylates (or, in this case, the histamine). Salicylates, by the way, are in this category of phenolic. Histamines aren’t phenolic, but same kind of thing there. So I guess I go about it slightly differently, in that I look to relieve the immediate urgency and the burden.

But then, I’m definitely going to do what you just said, which is, don’t leave it there. Like you said, these diets get so restrictive over time and you lose a lot of good nutrients. What I’m going to then look to is, now that we’ve gotten the fire under control, how do we heal up the underlying systems so we can have more capacity for these foods? Because we don’t really want to give up a lot of these foods in the long run, if we don’t have to.

DrMR: Great point. Completely agreed.

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Salicylates: Foods & Intolerance Symptoms

Regarding salicylates, I’ve tinkered with this just a little bit, but I haven’t got that into it. I have two questions here for you. One, is there a good low-salicylate handout that we could direct people to? And two, what does that diet look like? Are there some keystone foods that people avoid and are there some accompanying symptoms? It sounds like neurological symptoms are the main ones you are looking to, but can you color that in a little bit for us?

JM: Yes. Salicylates are probably one of my favorite areas, particularly for kids. Hyperactivity, sleeping issues, aggression, irritability, behavioral things. They can affect the gut, they can affect the skin, but I find a lot of behavioral and other types of challenges associated with salicylates.

And is there a good list? This is complicated, because there are a lot of diets out there that do salicylates, but all of their lists are different. I’ve created, in a way, my own conglomeration of all of these lists, for what I tend to see in practice, which is probably a blend between the super-restrictive versions of some and super-lax versions of others. I don’t know if I have a good one out there to point you to outside. But people can always go to my website nourishinghope.com. I’ve got articles on salicylates they can look at and the symptoms. And I’m going to be coming out with more and more handouts on some of these that are more comprehensive in that way.

Some of the foods, for people who are listening, are things like apples, grapes, and berries, as well as herbs and spices. One of the issues that I see sometimes is that someone will get healthy (they’re going to be working towards that goal) and they give up, let’s say, gluten and dairy. Now they’re eating more produce, which is wonderful… more fruits and more vegetables. The challenge is that a lot of the fruits can be really high in salicylate. Also, the really wonderful anti-inflammatory herbs and spices, like rosemary and thyme and turmeric and all of these things, are loaded with large amounts of salicylates.

Again, in the end, I’d like them to be able to come back to consuming these. But in the short term, sometimes if we take the burden off the system a little, it can help. What I see, where people can get tripped is, let’s say they’re doing a gluten-free and dairy-free diet. So they’re eating more apples and grapes and raisins. They might not see the benefit from that diet if they’ve added a bunch of these other foods that might add to some of these issues. Or let’s say they’re doing a grain-free diet, and they add almond flour and honey. Those are also really high salicylate foods. Almonds are also high oxalates—which we can talk about—which is another big issue I find. The point is that there’s a way to eat a healthy, well-balanced diet, but sometimes we have to restrict it, do some healing, and get to it. I’d say that those are some of the symptoms, some of the foods, and the implications.

The Plasma Cysteine/Sulphate Ratio: A Possible Clinical BiomarkerAnd let me just add, I mentioned this to be an issue for kids. This was first brought forward by Dr. Ben Feingold in San Francisco in the seventies, for hyperactivity. But now with the work of Rosemary Waring and Margaret Moss, we’ve found that poor sulfation,which is behind poor issues with salicylates, is found in IBS, in depression, in a variety of neurological conditions way outside of the issue of autism and ADHD, and it has wide-ranging implications. In fact, in their paper, they postulated that faulty sulfation was at the foundation of chronic disease. So they felt that that was a huge marker, just in general, probably for many conditions. Anyway, that’s a little aside.

DrMR: Okay. Well, I’m going to send you an email afterwards. What I’d like to do, if we can reasonably do so, is try to pool our resources and see if we can put together a moderate-intensity starter’s guide for a low-salicylates diet. Heidi Turner and I did this for a low-sulfur diet handout. It’s been really nice to have something that we can just give a patient and say, here’s the parameters for the low-sulfur, one-week interim trial period and here’s the foods. So perhaps we’ll be able to develop that to give people something easy to point to.

JM: Great! Sounds good.

Oxalates: Figuring Out If You Have an Issue

DrMR: So you said oxalates. That’s one of the next things I wanted to ask you. After our conversation with our oxalate specialist we had on the podcast, Sally Norton, I’ve been thinking more about this. And one of the things I struggle with is—and I’m curious if you agree with this—according to Norton, it may take a couple of months before someone notices improvements on a low-oxalate diet. So I’m looking for markers that may predict if they will respond. Because a couple of months is a long time to ask someone to do something, with no barometer to say, “Well, I seem to be improving,” or “I don’t seem to be improving.”

JM: Mm-hmm.

DrMR: Heidi Turner put forth the idea of looking at urinary oxalates. And this is something I’ve been assessing in patients who I suspect. I also look for any prior indication of kidney malfunction. So I’m wondering, one, do you find any predictive marker for oxalates to be helpful? Two, do you notice there is a lag in terms of how long it takes for someone to respond?

JM: So a couple of things. On the marker, yeah, oxalic acid is a great marker in that, if it’s high, that is going to tell you something really helpful… they likely have high oxalate in their system. The challenge is that that marker is based on whether you happen to be “dumping” oxalate in the urine at that time. Not everybody does it well. In fact, interestingly, in the research they did on the paper with autism, they found that some kids had high levels in the urine but not high in plasma. Others, high in plasma, not in urine. And you can’t really test plasma these days, commercially. So if you were looking just at a lab value, you might miss some people that do have oxalate issues. I think it’s good if it comes up. It’s telling you something. But if it doesn’t come up, it doesn’t always tell us there isn’t an issue.

I have a very good friend and colleague that’s quite open about this. We were talking, and I had recognized that oxalate might be an issue for her burning feet and problems that she was having. It turns out her oxalate level did not show high, but she absolutely got relief when she did low-oxalate. And it came back when she went off of it. So she knew she had an issue, but it wasn’t showing up. So I would say that’s a good place I like to look at and start from. But I also do a lot with symptoms. I’ve been working with the low-oxalate diet for more than, I’d say, 10 years now, so I’ve found a lot of commonalities with symptoms that can really help out.

stressNow, there are certain symptoms like fatigue that really don’t help much, because every single condition known to man probably has fatigue in it. So it, in and of itself, isn’t a good one. But one of the things I try to teach practitioners is to look for symptom clusters. If that fatigue was associated with pain, and, let’s say, associated with a lot of oxidative stress, or feelings of cyclically feeling good and then not feeling good, that might lead me more to thinking about oxalates. Again, I like to look at symptoms. In addition, genital irritation or burning, burning eyes, burning feet, a chronic injury that won’t go away. Those are just some of them. It can affect the mitochondria, it really could affect any system in the body, so that’s what makes oxalates tricky.

Then, the second part of it is, the issue with noticing it is absolutely true. So if I remove salicylates, usually I’ll see benefit, really positive results. Could be the next day, three days, five days. But usually you relieve that burden, and you feel great. With oxalates, if you remove them too quickly, you feel worse. That’s where it’s tricky, because you don’t want to remove oxalates really quickly or you could get problems associated with it. So part of the issue is, you can’t really do an elimination diet like you would with something else like gluten or salicylates. I don’t recommend removing them all at once or quickly like that because you’ll see worse before you see better. In a way, it sometimes takes months just to reduce them. So that can make it tricky.

The other thing is that even once you do reduce them, it can take some time before you feel better because all of that burden is being relieved by the body. So the body goes through a bit of a challenging process for a little while.
However, it’s not always true for everybody. Sometimes people feel great. My friend that I talked to you about felt better fairly early on. I have another friend, who is also a colleague, with hip pain and she felt a lot better. I’d say 50 percent better with just removing them. It’s not always that you’re going to feel worse. But sometimes you do, and you’re not able to do that same sort of elimination provocation that you do with other diets. That’s why, before I get started, I look a lot to what can I find out about whether I think this is really at the bottom of it. Because like you said, it’s a commitment if you’re going to go down that road.

At the same time, I don’t want to discourage people. Sometimes reducing them even just a little bit or by a certain percent does start to show some benefit, and it doesn’t always take a long time.

DrMR: So this one sounds like maybe the most tricky out of all the dietary modifications.

JM: I think so, for that reason. Because everything else, like FODMAPs and things, you can pretty much remove them and you’ll either see something or you won’t. And this is one of those tricky ones where if you remove them, the body says, “Thank goodness, I’m free of this burden that keeps pouring into my system. Let me get them out.” And that’s where it gets a little trickier than other things.

DrMR: All right. That’s very reassuring to hear from you because, admittedly, when I hear someone say, “This is complicated, it takes a long time for a response,” I’m always open, but a bit circumspect that they maybe making things harder than they have to be.

JM: Yes.

DrMR: So, now that three people have corroborated that—yourself, Heidi Turner, and Sally Norton—I feel it’s pretty confident a conclusion to come to, and pretty tenable. One or two other questions there… have you found bubbly urine to indicate or predict that someone may have a problem with oxalates?

JM: I would say I’ve seen a variety of urinary things. Again, we can’t use them definitively or as we would with a lab result, per se, but we do see the commonality among people with oxalate issues. What I tend to hear is cloudy urine, crystals or sediment in the urine. I’ve also heard, black specks in the stool or sandy stool. In the oxalate community we haven’t necessarily tested these substances to see exactly what they are, but I have heard that many times from oxalate people. So if someone notices that, it’s one of the factors I will put in that bucket to suspect maybe they have an oxalate issue.

DrMR: Right. And just for the audience, the mechanism there is, oxalates may irritate the kidneys. And if kidney function is not optimal, you may see bubbly urine or other urinary issues.

JM: Mm-hmm.

DrMR: Would you have an estimated percentage of people that you feel the oxalates affect?

kidneyJM: Oh gosh. That’s such a good question. When that study was published for oxalates and autism, it almost didn’t get published because the scientists—the experts in oxalates at the time—believed that you must have a kidney issue, kidney disease, some sort of kidney stones, or kidney thing going on, in order to have an issue with oxalates. In that case, we could come up with a prevalence rate of what it is for people with, let’s say, kidney issues. In the study, we still found an enormous issue with oxalate, after screening all the people out for kidney problems.

This is brand new science that the experts didn’t even know at the time. I really think we are going to be learning a lot very quickly in this area, as to when you might have an oxalate issue and what factors they are. And I think they’re well outside of the issue of the known kidney-type stuff. I don’t think anybody has been able to identify how far-reaching this is yet.

I think, at first, people thought, “Okay, this is just a really small percentage of people who have kidney issues,” but we’re now finding out that it’s much broader than that. There are some autoimmune implications for this, some concerns about it disrupting the microbiome, killing off good bacteria, activating the inflammasome (which could affect autoimmune issues). I don’t know if we know yet how much of the population really might have an issue with these.

We also know that B6 deficiency can cause endogenous oxalate production, so now you can look into the world of mental health, pyroluria, and all of these conditions. These might have some issue as well. Sulfation issues—when you don’t have enough sulfate—can get oxalate into the cell on the sulfate transporter. Again, I think we’re going to find out that they’re more far-reaching than what we originally thought. So that’s the tricky part!

DrMR: I can appreciate that.

Are Lectins Really Problematic?

There’s one other question on diet that I wanted to pose, regarding lectins. I am open to the need to pull lectins out of the diet. But I have to say, just succinctly, I’m suspicious that there’s not really great evidence to back that up, and that may not be as helpful as it’s been portrayed by the main champion of that movement, Dr. Gundry. I remain open, but my thought is that people are removing a bunch of foods that are problematic for other reasons, and when you, say, avoid lectins you end up cutting out a lot of bad foods anyway.

JM: Right.

DrMR: And it doesn’t seem that many clinicians who are really studious with diets and attentive to their patients are finding lectins to be a big issue. It didn’t come up with Heidi. It hasn’t come up with a few of our other guests. Are you in agreement with that? Are you finding lectins to be helpful?

keto dietJM: Hmm, that’s a great question. And sometimes… you’re right, it’s like, how do we know? It’s almost like the keto diet too, right? It takes all grains, all potatoes, and stuff, so how do we know that it wasn’t the grains and the potatoes? In this case, the same thing. We’ve got grains and beans, legumes. Those kinds of things are a problem for a lot of people anyway. How do we know it’s not just taking out those things that’s the help, and not other things?

There was actually a group of moms—I want to say, 13 or 14 years ago—that really felt lectins were an issue in autism. And they did a bunch of really interesting digging into the research. I think it’s like everything: there are some people that might be more impacted than others. There are also some really interesting theories about lectins. For example, that the problem with gluten is the lectins, and that when you ferment gluten, you get rid of the lectins and then people can handle gluten.

Now, I’m not suggesting anybody goes out and does that. But there is a little bit of research suggesting that the issue with gluten might be the lectins themselves. So I think that there is some science there. I tend to use it as a refinement tool after I’ve gone through a bunch of the bigger diet principles we’ve talked about. I would have most likely taken out grains, legumes, and things like that, probably looking at grain-free diets or things like that before I got there anyway. So when I get to that point I might think, “Okay, if we’re still dealing with issues, could the rest of our issue be that?” And I do think there are some times that that could be a factor. But I would agree that on my list of dietary priorities, it’s not in my top list.

Deciding When to Move Beyond Dietary Intervention

DrMR: Okay. And then, one other question here. This is, I think, a fairly major question. When have we reasonably exhausted the diets, and now it’s time to say, “Okay, there is likely dysbiosis that requires direct treatment,” or there’s a need for a good well-rounded probiotic protocol or a need for a cocktail of nutrients that help rebuild the lining of the gut? Because that’s the other thing: sometimes, we’re trying to inadvertently force a dietary solution to what may not be predominantly a dietary problem. And I think knowing when to make that adjudication is an important factor.

“@nourishinghope shares her thoughts on diets and Autism. Start with Gluten/Dairy/Soy Free Diet if symptoms persist choose a diet that addresses particular symptoms like a Low Salicylate or Low Oxalate Diet. Find out how in this episode.”tweet e1540485375388

JM: Absolutely. Great question. Before I get there, I just want to clarify something I said earlier for the keto people. I don’t want anybody upset. When I made that comment about how the taking out of grains or potatoes might be the factor, I absolutely believe that the keto diet has a place. And very often, people will do a keto diet where they will step their way in. They’ll maybe do a paleo diet first, and they’ll already have taken those things out. Then they’ll go to a keto diet, so they’ll see further improvement.

So I don’t want to say all improvement with the keto diet is based on taking out grains and starches. I’m just saying that there’ve been studies in, let’s say, autism, where they compare the GFCF diet to a keto diet. And they went from GFCF that had grains, to keto that didn’t have grains. In that case, we didn’t know. Was it just because they jumped straight to it? It was hard to know along the way. It wasn’t isolated in the study enough to know. So that’s all I want to clarify there. I do think there is a great place for keto.

DrMR: The GFCF is just dairy-free, casein-free, just to clarify for people.

JM: Thank you for that. So to go to your question, I think all of these things are important. I don’t feel that diet is the only thing someone would need to do to heal their autism, or whatever they’re dealing with. Although I have seen that be the case, I’ve seen it be the primary thing that has provided healing. But the body is very complex. So my feeling is that the diet is a foundational component. It helps to relieve the burden from the body, it helps us to supply good nutrients and other things that the body needs. Then we need to also look at what else might be going on.

For example, dysbiosis is a great one. People will often say, “Well, you don’t need to do a low-oxalate diet because all you need to do is handle dysbiosis.” That’s not my experience, and not what the research shows, because oxalates can actually kill good bacteria. So you might need to take those things out before you can even address the dysbiosis. Whereas if you just go straight in with probiotics you might not get the healing you’re looking for, because the oxalates can be counteracting all of that other good stuff.

pathogenI think that a balance of the two is important. But I do think there are times where, if you’ve got a serious pathogen, just taking out the foods that feed it may not be enough… likely wouldn’t be enough for some of these strong pathogens, to get rid of them. So then it comes to looking at what you need to do. Do you need to add probiotics? Do you need to add prebiotics? Do you need to add some herbs? What is going to address that?

Whether it’s autism or other things, there are medical issues, infections, and other things going on, and they sometimes require more than diet and nutrients to solve the problem. So I absolutely believe that those are things that should be looked at as well.

DrMR: So, maybe in short, don’t forget that you may need to shift from solely focusing on diet to other gut therapies.

JM: Correct. Exactly.

DrMR: I’m just trying to get people the easy takeaway, in addition to making sure we explore the nuance, which is absolutely fantastic. And this has been very informative.

View Dr. Ruscio’s Additional Resources

Episode Wrap-Up

So you have an ebook out and we’re setting up a URL just to make it easy for people to find their way there. It’s a URL on our site but it’ll redirect to your ebook page directly. The URL is drruscio.com/julie. And tell people about this ebook, because I think this is a fantastic resource for people who are trying to heal the guts of their children, and also improve their diet and reap the massive benefits for behaviors that one can reap from making these changes.

JM: Yes. So for April, which is Autism Awareness month, I’m actually launching a program. In my new nutrition program—which is really built on 17 years of this, it’s just my latest incarnation of my program—there are 12 steps. So this first ebook that we’re talking about is the first six steps of my program. And it’s not just for autism, ADHD, allergies, asthma, Down’s syndrome. The truth is it’s not only for kids. What I’ve discovered is that what underlies autism, inflammation, oxidative stress, gut issues, immune-system dysregulation, are things that are going on with pretty much all chronic disease. So the principles that you can apply to autism, you can really apply anywhere.

The guide was written for families, so I could support them with whatever their kids might be going through. But really, it can be helpful—I think there’s solid foundations—for anything. These are the first six steps. Then, there is a second ebook that goes into the second six steps. Once you get that ebook, we’ll get you information on how you get the second ebook. And that will paint the entire picture of how I support individuals, with what I call a bio-individual nutrition approach, and what I teach my practitioners as well. So the guide is the first six steps, and an actionable step that people can do inside each one of those.

DrMR: Awesome. And I agree with you completely. There’s this old saying that, philosophically, the closer you come to truth, the more commonalities you find. As someone who is by no means an autism specialist, we’ve had a handful of cases of autism come into the office, and we’ve had pretty darn good results just because we’re applying these fundamentals of gut health.
So it runs both ways, in my opinion. So, certainly, I wouldn’t say it’s only for people who are with a child on the spectrum or something like that.

JM: Yes. Great!

DrMR: Any other resources you want to point people to?

JM: If they are a parent, they can go to nourishinghope.com and I have tons of resources and information there. If they are a practitioner and they’re interested in what I do, I have bioindividualnutrition.com, which is training I do for doctors, nutritionists, and those kind of people (if people are looking for more of the science, the nitty gritty, and all that good stuff).

DrMR: Awesome. Any closing thoughts for everyone?

JM: I think that’s it. I would just say that when we’re looking at gut health, addressing diet is a key foundation. But also going with your gut instinct, your intuition, on what that best approach might be for you. If something doesn’t feel right to you, then there’s probably a different dietary approach that might be a better choice. So instead of abandoning all diet, figuring out what the best dietary approach that can support you would be, in my opinion, a really solid way to go.

DrMR: Agreed. That’s great advice. Julie, thank you so much for taking the time. This has been a terrific conversation.

JM: Thank you so much. I really enjoyed it.

DrMR: Been a pleasure.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

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