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Nutrition
What I eat makes a massive difference to my energy levels, alertness and mood.
Disclaimer
Before I go into further details about my approach to nutrition, I must confess that I am not a doctor, dietician, naturopath etc. My specific approach to nutrition is probably not appropriate for the vast majority of people. Some of the general principles of identifying intolerances, developing a healthy emotional connection with food and maximising nutrient density are relevant for everyone but the way you’ll implement it will be different.
Intolerances
Over the years, I’ve discovered that I’m intolerant to many different types of food. This is pretty common: a recent meta analysis found that autistic children are ~2.8 times more likely to have food intolerances than non autistic children. My particular intolerances are:
- Gluten: I get “brain fog” and irritable bowel symptoms if I consume wheat/oats
- Soy: small amounts make me feel unwell, anything more than that makes me puke
- Legumes: if I eat too much chickpeas/lentils etc. my immune system is negatively affected (I get sick easily) and my digestive system complains.
- Fructose: I get acid reflux if I eat certain types of fruit - one piece of low fructose fruit per day is ok but more than that is problematic.
- Dairy: I can handle cheese and small amounts of yoghurt but don’t feel great if I drink milk. Lactose free milk is a bit better but still leaves a bad taste in my mouth.
- Highly processed foods: this probably applies to most people - I don’t feel great if I eat heavily processed foods. They tend to have a lot of sugar and the insulin spike isn’t great for my mood or energy levels.
There is a nutritional risk in cutting food groups out so I would not recommend a blanket no-gluten + no-casein diet or going full paleo without thorough formal testing or rigorous self experimentation.
I haven’t been formally tested for celiac disease or fructose intolerance because the test involves “challenging” your gut with gluten or fructose and I don’t want to put myself through that. I did an elimination diet ten years ago where I only ate vegetables for a few weeks and noticed that I felt much better. When I added back bread, I instantly felt awful again. I saw a dietician at the time who recommended avoiding FODMAPs (essentially the list above plus some extras like onions and garlic). I stuck to that for some time but have been able to loosen up the restrictions in recent years after reintroducing animal products into my diet.
The journey away from veganism
Not being able to eat legumes was a difficult realisation to “stomach” as I had been vegan for 7 years and had a strong philosophical leaning towards plant based diets. I persisted with eating legumes daily even though my gut symptoms were worsening. It took being admitted to hospital with a suspected bowel obstruction/celiac axis compression syndrome for me to realise that it just wasn’t possible for me to be vegan anymore. After changing my protein sources to incorporate eggs, dairy and meat, my gut symptoms immediately improved. I went from experiencing vomiting and diarrhoea a few times per week to having a pretty settled stomach the vast majority of the time.
When I first switched to consuming animal protein, I was eating a lot of cheese as I still didn’t want to eat much meat. Over time, I’ve found that too much dairy isn’t great for me and have started eating more meat. I do feel physically better eating this way but have philosophical qualms about the environmental and animal rights impact of my diet. I wish I could eat fake meat/meat alternatives but the products I’ve seen are soy or legume based.
Binge Eating and bulimia
Compared to ten years ago, the biggest change to my diet aside from eating more animal protein is that I don’t binge eat anymore. I’ve discovered that for me, highly palatable foods are a bit dangerous. In my late teens and early twenties, I was using food as an anti-anxiety tool. I’d feel stressed about my year 12 exams and mindlessly eat a whole loaf of bread. When I discovered that I was gluten intolerant, I stopped eating bread (I would sometimes have gluten free bread but that’s expensive) but I’d still eat huge amounts of food to quench difficult feelings. When I say huge amounts, I mean kilograms of food at one sitting. It was probably a combination of the taste and also the texture - I found the texture of certain foods very soothing (particularly soft foods) and would eat chewy foods (e.g. carrots) when I was bored or stressed.
I was afraid of gaining weight so I mostly scarfed vegetables or legumes (probably why I developed intolerances). I’d cook up a big batch of chickpeas intending for it to last a whole week, eat a bowl and then have an out of body experience where I’d walk back to the stove, scoop out another bowl and gulp it down without any conscious thought. This would continue until the pot was empty or until I was so physically uncomfortable that I couldn’t eat anymore. For the rest of the evening, I’d have to lie down because I had consumed so much food that doing much more would make me want to vomit.
At times I did vomit. The binge eating pattern probably reached its peak in my early twenties when I started doing extreme amounts of exercise (30hrs per week). Again this was an effort to deal with anxiety. At first it worked, but like anything you build up a tolerance and then more is needed to get to the same state of mind. I would exercise more to feel calm and then eat more because I was legitimately hungry. Because I was afraid of gaining weight, I’d only eat low calorie foods which meant I had to consume kilograms and kilograms to actually satisfy my hunger. After a few years of this pattern, it became hard to eat less on days that I didn’t exercise much. If I had time, I’d go out for a run (not pleasant when you have kilos of vegetables in your gut). If I didn’t, I started to use other methods to purge.
The throw-up bulimia brought me to my knees (literally). I only did it a few times but the feeling of stomach acid eroding my esophageal lining felt so wrong that I knew I needed to get help. Through a series of chance events, I met someone who was part of an eating disorder support group and was able to get into recovery in June 2012. I haven’t binged and purged since then. I’ll touch more on the tools I now use to deal with anxiety later in the book.
What I eat now
I've now found a food plan that keeps my gut and my brain quite happy. I’ll preface this by mentioning that my palate is not typical and I’m perfectly content to eat very similar food (#autisticsamefood) from day to day. I’m not advocating this precise meal plan for anyone else but I do think that there is value in everyone identifying food intolerances and navigating the psychological relationship with food.
Meal Timing
At a high level, I have settled on a three meal per day food plan with no snacks. I usually have my breakfast at 9am as I don’t feel particularly hungry in the morning and also like the idea of intermittent fasting. I've tried a strict 11am to 6pm feeding window but found that my mood was negatively affected if I waited too long after exercising in the morning to eat. I have my lunch at 1pm and dinner at 6pm.
Portion control
I weigh my food using kitchen scales most of the time which is probably a bit whacky for most people but I find it helpful to make sure I am eating the right amount. There’s a movement around “intuitive eating” - it seems nice in theory but I feel slightly uncomfortable not knowing how much I’m eating. A 2023 research paper found that the standard intuitive eating approach is based on neurotypical norms and may need to be adapted for autistic people. I’d agree with that. Without context, my use of scales might be perceived as “orthorexia”. But actually I find it eliminates my stress around eating rather than adding it. I don’t have to deal with the mental game of “is that enough or too much?” at every meal.
If I’m at a restaurant or a friend’s house, I of course don’t bring out my scales, but at home I always weigh. I’ve followed this approach for close to 13 years and feel relaxed around food as a result.
A typical meal plan looks like this. (Note: I weigh in ounces for idiosyncratic reasons even though grams is more standard in Australia).
Breakfast (9am):
- 2 eggs
- 3oz sheep milk yoghurt
- 0.5oz nuts
- 4oz mixed carb (black/red/white rice + quinoa + buckwheat + millet)
- 6oz vegetables/fruit (normally small proportion of fruit)
- 1oz extra virgin olive oil
Lunch (1pm):
- 8oz fish/meat or 4oz of cheese and nuts
- 5oz mixed carb (black/red/white rice + quinoa + buckwheat + millet)
- 12oz cooked vegetables
- 1oz extra virgin olive oil
Dinner (6pm):
- 4oz fish/meat
- 1oz cheese
- 5oz mixed carb (as above or sometimes potato/sweet potato)
- 12oz vegetables
- 1oz extra virgin olive oil
Ingredients
I had a poverty mentality for many years and would buy the cheapest ingredients possible. Carrots and pumpkins were a staple because they’re typically the cheapest vegetable per kg. At one stage, I ate so much that my skin took on an orange hue (all that beta carotene!). This made me realise I probably needed more variety so I started eating frozen beans as well (the cheapest frozen vegetable available apart from peas which I can’t eat). My skin returned to a normal colour but I don’t think this focus on saving money on my food bill was wise.
Since meeting my wife, I’ve changed my mindset on food. Her attitude is “fresh is best” and while I used to argue that “frozen is fresher”, the truth is that I went for frozen vegetables because they require less preparation (no peeling or chopping). She’s gently convinced me that most of the time, fresh produce is better especially if we get it from a known source. In recent years, we’ve decided to predominantly buy organic fruit and veg. We follow the Clean 15/Dirty Dozen list published by the Environment Working Group. The basic idea is that vegetables/fruit which you eat directly without peeling off the skin (lettuce, spinach, strawberries, apples) should be organic - the pesticide residues are very high from conventionally grown crops. However, it’s fine to eat conventionally grown produce with a thick skin (pumpkins, onions, avocados, bananas) because you normally peel the skin off. Buying organic produce is a lot more expensive (at least double) but I justify it to myself that the micronutrient density is higher and therefore I’ll save money on vitamin supplements.
Cooking
Since I’m perfectly happy to eat bland food, I don’t put a lot of effort into cooking. When I was single, I’d microwave frozen vegetables, heat up some precooked rice and have cheese, nuts or tinned tuna as my protein for most meals. Now that I’m married, my wife has slightly higher expectations. However, due to my predilection for burning pots, I only allow myself to use certain appliances:
- Rice cooker
- Benchtop Steamer
- Nut milk maker
All of these devices have built in kill switches/loud alarms if they run out of water making them safe for my inattentive ADHD symptoms 😅
The induction cooktop is only allowed if we’re cooking together and one of us will remain there to rescue the frypan/pot down if it runs out of liquid. Since I find it very boring to stand there and wait for the cooking process to complete, I mostly use the steamer.
Groceries
I find shopping pretty tedious. I don’t like being in shopping centres and the logistics of getting to supermarkets can feel overwhelming. We now live within walking distance of a supermarket, but I find the range of organic produce is limited. Given that grocery delivery is pretty affordable these days, I almost always opt for online ordering. I buy most of my groceries from a community run organic produce market (CERES Fair Food). It saves time and I like being able to support organic farmers (even though it costs a lot more than conventionally grown produce).
On weekends where we have more time, my wife and I will go to farmers markets. There are a few in the area and it’s nice being able to talk to the person who grew the food. It tastes a lot better than what you get from the supermarket too!
Fermented Foods
Research suggests that fermented foods may help rebuild your gut microbiome. I quite enjoy eating sauerkraut and kefir (sometimes at the same time) so have gladly incorporated these into my diet. Until recently, I didn’t realise that the cheap sauerkraut made with vinegar has none of the microbiome boosting benefits (there might be some probiotic benefit from the roughage in the cabbage but unless you buy it from the refrigerated section, there’s no live bacteria in it). It’s relatively challenging to find live ferments in Australia so I’ve been making my own sauerkraut. It takes a bit of time (~30 minutes per batch) and effort (squishing the cabbage to get the juice out requires some muscle) but it’s very satisfying to end up with a jar full of sour goodness a few weeks later.
There are plenty of recipes online. Here’s the one I follow:
General principles to follow:
- Don’t let the cabbage be exposed to air (all the chunks should be completely submerged) as it will go mouldy
- Add the correct amount of salt (2.5% by weight)
- Don’t cut the cabbage too finely as it will float to the surface of the brine otherwise
- Remove any mould quickly before it spreads
Ingredients:
- 1 large cabbage (preferably organic)
- High quality, non-iodised, additive-free salt (e.g. sea salt or pickling salt)
Materials:
- A metal bowl/saucepan that can fit 1kg of cabbage
- A wooden cabbage pounder (a rolling pin might do)
- Mason jar
- A silicon air lock or a lid (you’ll have to “burp” the kraut if you don’t have an air lock)
- Glass weights
- Clean zip lock bag
Steps:
- Chop the cabbage in half so you have roughly 1kg of kraut (if you have a larger bowl, you might not need to do this) and set the other half aside
- Peel off any yucky leaves on the outside
- Peel off two non-yucky leaves - you’ll use these to stop the smaller bits of cabbage from floating up
- Roughly cut the half cabbage into large strips - make sure not to cut it too finely because otherwise the small bits float to the top when you put it in the brine.
- Weigh the cabbage (zeroing out the bowl/saucepan)
- Calculate 2.5% of the weight and add that much salt to the cabbage. E.g. if you have 1kg of cabbage, you need 25g of salt
- Mix the salt around
- Bash the cabbage with the wooden pounder until you start seeing cabbage juice come out (you’re crushing the cell walls and releasing the intracellular liquid). This normally takes me about 10 minutes.
- Scoop the cabbage into the mason jar, using the pounder to squash it down. The cabbage juice should completely cover the cabbage.
- Put the two leaves you saved from step 3 on the top of the mixture and squash them down. These will act as the first defense against the smaller bits floating up.
- Put the glass weight on top of the leaves to keep everything squashed down in the brine.
- Fill the zip lock bag partly with water and put it on the top of the weight. This will make it almost impossible for the cabbage to float up.
- Put the airlock on the jar and seal it (or put the lid on if you don’t have an airlock).
- Put the jar in a cupboard.
- Check the jar every day or two - remove mould immediately if you spot it. If any small chunks of cabbage float to the surface, remove them.
- Wait for the ferment to be done - in warmer climates it might only take 2 weeks. In colder climates, you’ll need a month. You can smell the brine when you take off the lid - it should smell a bit tangy when it’s ready.
- Put the jar in the fridge and start eating 😋
Supplements
I’ve gone through episodes of vitamin deficiency (iron deficiency anaemia and pernicious anaemia from B12 deficiency) so do see a role for supplements. They were particularly important when I was vegan. Now that I am eating animal protein, supplements seem less crucial. I still take a few supplements (magnesium, zinc, omega 3) but I’m now leaning towards the philosophy of eating a nutrient rich diet.
DNA/Gut microbiome tests/blood tests
The “quantified self” movement has always appealed to me. I like collecting data about my sleep, resting heart rate, activity levels etc. The next level that “biohackers” often go to is frequent blood tests and less frequent DNA sequencings and gut microbiome tests. (qqq rewrite after fitgenes test)Although I have had my SNPs (genetic markers) sequenced and have done a gut microbiome test, I’m not sure it’s worth the money. Maybe in the future, the cost will come down and it will be a no-brainer but for now, I’m not convinced.
Blood tests do seem important for making sure that deficiencies aren’t emerging but they probably don’t need to be done that often. The reason is partly cost: they can be expensive if you pay for them privately and your doctor won’t approve excessively frequent tests in the public system. The other reason is that it takes time for dietary changes to kick in (e.g. 2 months for red blood cells to turn over qqq) and checking more often is probably not helpful unless there’s an urgent issue (e.g. B12 deficiency or haemochromatosis) in which case your doctor would be pushing you to get tested.
Final thoughts on changing diet
Nutrition is a big topic and I’ve personally found it quite overwhelming to deal with. What works best for me is to make small changes and gradually layer other changes on top once the first change has been bedded down. Changing things gradually also makes it possible to see whether the change actually worked. If you change 10 things at once, it could be that two things made a positive difference and the other eight things actually made the problem worse.
Hi I'm Jeremy, and I understand the challenges of living with ASD and ADHD.
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