Nicky Clark is a nutritional therapist in Australia who has been giving personalized nutrition advice to the parents of children with Down syndrome.
She's given talks about nutrition for Down syndrome, for instance when the World Down Syndrome Congress came to Brisbane, and for the Institute for Optimum Nutrition's Nutrition Talks series.
Clark also has a son with Down syndrome, called Michael. She told Newsweek that she gets "requests from around the world for information and insight" about nutrition for people with the condition—and she shared some of that knowledge with Newsweek.
Down syndrome, also known as Trisomy 21, is a condition where people, by chance, are born with an extra chromosome and as a result have some form of learning disability.
"There's really not very much research on diet and Down syndrome," Clark told Newsweek. "But if you start to connect dots, you can start to come up with ideas that would be really worth pursuing for people with Down syndrome."
Much of the advice that she gives to parents, Clark said, was just standard nutrition education that would apply to any children—but then, there were some specific focuses for Down syndrome. For instance, picky eating is common.
"There are just the problems that everyone experiences with kids being fussy eaters," she said. "Perhaps that's exacerbated with Down syndrome, because parents are constantly scared that their child is going to choke or can't breastfeed.
"It's an additional layer of worry, and I think that means parents pander to the child's needs even more, and so it creates a child that's got even more picky eating.
"But then you've also got all the sensory stuff that goes with the disability. So, they may not like the taste of fruit, or all their food has to be smooth."
Nutrition advice for picky eating tends to include providing food that the child will eat, while finding ways to boost its nutrition content and gradually encouraging them to eat slightly different things.
For instance, if a child will eat chicken nuggets and fries, parents could work towards introducing breaded chicken and roast potatoes, with some carrot sticks on the side.
Clark added that people with Down syndrome have low muscle tone, where relaxed muscles are more floppy than for people without the condition, and this may make chewing more difficult.
"Chewing can be a problem," she said. "Food is not chewed very well, and they tend to chew really quickly. That leads to digestive problems, and there seems to be a high prevalence of digestive problems [among people with Down syndrome]—but, in saying this, there's really very little research."
So, just like any child may stuff food into their mouths, impatient to leave the table and play, children with Down syndrome may not chew their food properly and this can cause digestive issues, such as tummy aches, burping, diarrhea and constipation.
The solution is a matter of encouraging slower, more mindful eating at sit-down mealtimes, with a focus on chewing food properly before swallowing.
Another area that can affect everyone, but may affect people with Down syndrome more keenly, is oxidative stress, Clark said.
"When I dived into the research and tried to make something of it, what I found was not much, but I did find stuff about oxidative stress," she said.
"People with Down syndrome can look old quite early, and they get Alzheimer's around the age of 40. That is because they seem to develop oxidative stress more quickly."
Oxidative stress is a normal process that happens in the body when byproducts of chemical reactions called free radicals damage cells—often referred to as "internal wear and tear"—that has been linked to aging and chronic diseases such as heart disease, dementia and obesity.
But foods that contain antioxidants are believed to neutralize free radicals and reduce oxidative stress in the body.
"The oxidative stress is a real thing," said Clark, adding that one of her main messages was that eating antioxidant-rich foods may help.
Antioxidants are in many plant foods, especially fruits and vegetables such as berries, citrus fruits and leafy greens, as well as nuts and seeds, oily fish, extra virgin olive oil, dark chocolate and tea.
Clark said that she recommended eating plenty of brightly colored fruits and vegetables, and limiting sugar intake, because too much sugar may cause extra oxidative stress—as well as increasing the risk of Alzheimer's, which she said is "a real problem" for people with Down syndrome.
"It's not just sugar, it's also carbohydrate," said Clark. Refined carbohydrates, such as white rice, white bread, pasta, mashed potatoes, and fruit juice, are all converted to glucose—sugar—in the body, so can have the same effect nutritionally.
Reducing the intake of both high-sugar foods and refined carbohydrates, Clark said, was a key piece of advice she gave to parents of children with Down syndrome, to reduce oxidative stress, the risk of Alzheimer's, and the risk of insulin resistance and weight gain—which is also higher in people with Down syndrome.
"Another thing is that methylation seems to be not quite right in people with Down syndrome," said Clark.
Methylation is one of the ways the body interacts with, reads, and interprets DNA. When methylation goes wrong, it can change the way a gene is expressed, potentially increasing the risk of certain diseases.
"There is research showing that, in newborns, methylation is a bit off," said Clark. "And there are pockets of research around methylation and B vitamins. So, another of my recommendations, from a diet perspective, is adding B vitamins."
B vitamins are a group of nutrients found in meat, fish, eggs, dairy products, as well as some legumes, seeds and leafy greens.
Clark said that there are supplements made for people with Down syndrome, that target methylation and oxidative stress, but she would not necessarily recommend them.
"They're very high doses of B vitamins and antioxidants, like selenium, so they fit those two patterns and make sense, but they're really high doses, and I have big concerns that they're pushed to all these parents who don't necessarily know better," said Clark.
"High doses of supplements for anyone are dangerous without an actual considered, educated reason for it. It's not a smart way to apply supplements.
"When I look at my Michael, he's the most physically healthy person. Why would I give a beautiful, perfect child a supplement? It doesn't make sense."
On the subject of specific nutrients, Clark would also recommend focusing on zinc, a mineral found in meat, shellfish, dairy, nuts and seeds.
"People with Down syndrome tend to suffer from immune problems and thyroid problems," she said, implying that zinc could help with both. "And zinc supports antioxidant systems."
Finally, she emphasized the importance of getting nutrition right for people with Down syndrome.
"I think it's the most important thing," she said. "For people with Down syndrome, there's swimming therapy, speech therapy, occupational therapy, physio, feeding therapy—all of these therapies where you have to consciously think to do them, but food is just a given.
"It's there, something you have to do three times a day, with repercussions for physical and mental health, so you might as well do it right.
"And when you do talk to parents who are invested in this stuff and already doing all the stuff that a nutritionist would be, their kids are really healthy, really well and really independent, and you think, there's got to be something in that.
"Anecdotally, you hear families saying, we changed the diet, we added this, and we did this, and they're better now—and you just think, food is medicine. It's so powerful."
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