We commonly think of autism spectrum disorders (ASD) affecting mostly boys. While it’s true ASD affects more boys than girls, it turns out that many girls go undiagnosed because their symptoms are much different than that of boys. Girls with autism may behave socially more like neurotypical (aka, normal) males than boys with autism. Female autism may also be misdiagnosed as anorexia, obsessive compulsive disorder (OCD), or attention-deficit/hyperactivity disorder (ADHD).

The diagnostic criteria for autism — difficulties with socialization and communication and repetitive, inflexible behavior patterns — come from studies on boys. A 2012 study of 15,000 twins found that girls needed to exhibit more extreme behavioral problems and intellectual disability to receive a diagnosis. This means that many girls on the milder side of the ASD spectrum go undiagnosed.

Girls with autism closer to typical boys

Brain scans, genetic testing, and other measures show that girls with autism disorders not only present differently than boys, but also that the understanding of autism has been overly narrow by primarily studying boys.

For one thing, brain scans show a girl with autism processes social information much differently than neurotypical girls, but also differently than boys with autism. Instead, their brain operates very much like that of a neurotypical boy. Furthermore, research assessing friendship quality and empathy showed autistic girls score about the same as neurotypical boys.

Girls are better able to hide autism

Girls often go undiagnosed also because they can excel at suppressing their symptoms and studying and mimicking neurotypical girls. However, it’s an exhausting and stressful process for autistic girls, who show a much greater desire to connect than boys.

Girls also exhibit less repetitive behavior and more typical types of play as children, although researchers can pick out subtle differences — obsessively lining up their Barbies, for instance, or being more engaged in staging a scene than the story line.

Female autism can present as anorexia or OCD

Autistic girls also differ from their neurotypical peers by being extreme in their traits, such as “too sensitive” or “too intense.” Their single-minded intensity is believed to underlie anorexia in some who channel those traits into dieting and body obsession. The extreme aversion to certain tastes and textures common with autism also lends itself to anorexia. It’s estimated about 20 percent of women with anorexia also have autism.

The same can be said for autism and OCD, as obsessive-compulsive behavior, fear of change, and being overly rigid are hallmark traits of both OCD and autism.

Autism can make girls vulnerable to predators

Sadly, the autistic girl’s traits of taking things literally combined with social isolation makes her more vulnerable to sexual predators and abusive relationships.

Autistic girls are more apt to suffer from anxiety, low self-esteem, social isolation, and depression. Although people with mild autism are ten times more likely to be suicidal than the general population, the rate is highest in women — 71 percent of women with Asperger’s report suicidal thoughts.

The role of maternal testosterone in autism risk

Autism risk is linked with higher levels of fetal testosterone. A mother with polycystic ovary syndrome, a hormonal disorder that causes high testosterone, has an almost 60 percent higher risk of giving birth to a child with autism. This is why having a female brain offers protective barriers to this tendency.

However, researchers have found girls with autism have a higher number of genetic mutations than autistic boys. In other words, a girl’s brain may need more genetic and environmental “hits” in order to develop autism. 

Although the autoimmune diet is a well known foundation for managing chronic health issues, some people are dismayed to find embarking on it makes them feel worse. What gives? The sudden change in diet can temporarily upset your chemistry and reveal hidden health problems.

If you have been accustomed to eating gluten, dairy, grains, sugars, and processed foods, going cold turkey off those foods is a radical shift. Likewise, adding in lots of vegetables can also shock a digestive system unaccustomed to ample plant fiber.

Most people feel significantly better on the autoimmune diet. If you’re not one of them, however, don’t give up on the diet. Instead, look for the underlying reason why.

Feeling temporarily worse on the AIP diet

Following are common adverse reactions to the autoimmune diet. Knowing why you react negatively can further help you on your wellness journey.

Low blood sugar. Symptoms of low blood sugar and adrenal fatigue can worsen on this diet. This is usually caused by not eating enough or frequently enough. The general recommendation is to eat every two to three hours, however, some people may initially need a bite or two every hour until blood sugar stabilizes and they can go longer without eating. Avoid sugary fruits and investigate what else may be taxing your adrenal function, such as brain-based issues, autoimmunity, or chronic infection.

New food sensitivities. When gut damage is bad and inflammation high, it’s possible to develop food sensitivities to new foods on the autoimmune diet. This is very frustrating for people as the diet is already so limited. This can be a complex situation that requires concerted effort to tame inflammation and repair the gut.

Opioid withdrawal reactions. Opioids are morphine-like chemicals made by the body that reduce pain and create a feeling of euphoria and well-being. Some people become dependent on foods that release opioids in the brain, namely gluten and dairy. They can initially experience depression, anger, lethargy, and agitation on the autoimmune diet. For those with serious opioid addictions to gluten and dairy, withdrawal can be intense.

Brain chemical imbalance. A diet high in processed carbohydrates affects brain chemicals that influence our mood, particularly serotonin and dopamine. Suddenly switching to a lower carbohydrate diet can disrupt the balance of brain chemicals and cause temporary changes in mood, behavior, and personality. If this sounds familiar, you may need to gradually lower carbohydrate consumption.

Insomnia and anxiety. Some people report irresolvable insomnia and anxiety if carbohydrate consumption is too low. If these symptoms persist long after an adjustment period, you may simply need to use trial and error to find the carbohydrate “sweet spot” that lets you sleep but also keeps blood sugar in check.

Difficulty digesting fiber. The autoimmune diet is heavy on vegetables. For those with compromised digestive function, this can overwhelm the gut. Concerted gut repair nutritional therapy can ease you into a higher fiber diet.

Histamine intolerance. This is a reaction to aged or fermented foods that causes myriad symptoms, including rashes, runny nose, or headaches. Avoiding these foods for a while can help the gut heal so you can eat them later.

Yeast and bacteria die-off reactions. Going cold turkey off processed carbs, gluten, and dairy can cause a sudden and uncomfortable die off of harmful yeast and bacteria in your gut. This is especially true in the case of poor liver detoxification and constipation. Supporting the body’s pathways of elimination can help.

These are a few of the issues that can arise when you switch to the autoimmune diet. Don’t forget to consider the grief and anger you may feel about missing your favorite foods. However, if you weather the transition and ferret out sources of discomfort, your newfound health will more than make up for the rough legs of the journey.

Hypothyroidism has received a lot of attention online since the publication of Why Do I Still Have Thyroid Symptoms? by Datis Kharrazian in 2009. While many facets should be addressed in managing hypothyroidism, one of the most important continues to be a gluten-free diet.

Research shows ninety percent of hypothyroidism cases are due to an autoimmune disease that attacks and destroys the thyroid gland. This disease is called Hashimoto’s.

Most doctors do not test for Hashimoto’s because it does not change treatment, which is thyroid medication. Also, many cases of hypothyroidism go undiagnosed because Hashimoto’s can cause the lab marker TSH to fluctuate.

Where does gluten fit in with this? Numerous studies have linked an immune reaction to gluten with Hashimoto’s hypothyroidism. Whether it’s a gluten sensitivity or celiac disease, gluten triggers an autoimmune attack on the thyroid gland in many people. Most of these people do not even know they are sensitive to gluten.

Going off gluten is the first step with Hashimoto’s

Studies, clinical observation, and patient stories make a very strong case for the benefits of going gluten-free to better manage your Hashimoto’s hypothyroidism symptoms.

A number of studies from several countries show a link between Hashimoto’s and gluten. This is because the protein structure of gluten closely resembles that of thyroid tissue. When your immune system reacts to gluten, it may start erroneously reacting to thyroid tissue as well. This will cause the immune system to attack and destroy thyroid tissue in a case of mistaken identity.

Studies also show patients improve on a strict gluten-free diet. One study showed as many as 71 percent of subjects resolved their hypothyroid symptoms after following a strict gluten-free diet for one year.

Why you may need to stop eating other foods too

Sorry to say, going gluten-free alone doesn’t always work. Many people with Hashimoto’s hypothyroidism also need to go dairy-free. Dairy, whether it’s cow, goat, or sheep, is the second biggest problem food for people with Hashimoto’s hypothyroidism.

Many people simply have an immune intolerance to dairy and aren’t aware of it until they stop consuming it. However, in an immune sensitive individual, the body may also mistake dairy for gluten and trigger an immune reaction that ultimately ends up targeting the thyroid.

For those serious about managing their Hashimoto’s hypothyroidism, a gluten-free and dairy-free diet frequently results in profound alleviation of symptoms, if not total remission.

Many find they may need to eliminate additional foods, such as certain grains, eggs, or soy. An elimination/provocation diet can help you figure out what your immune system reacts to, or a comprehensive food sensitivity test is another option.

What is there left to eat?

If you’re used to eating without restrictions, eliminating gluten, dairy, and possibly other foods to manage your Hashimoto’s hypothyroid symptoms may seem overwhelming and too restrictive. Many people are left wondering, what is left to eat?

Rest assured there is more than enough to eat. Most people fare well on a paleo diet that is primarily vegetables (a diverse array of plenty of vegetables helps create the healthy gut bacteria that improve immunity.)

More importantly, symptoms and general health improves so dramatically that people come to love their new diet and despise the way they feel after they cheat.

Ask my office for more information about implementing a gluten- and dairy-free diet.