Registered dietitian Jackie Silver joins us to discuss nutritional approaches that are helpful for neurodivergence, why people with autism and ADHD are often the targets of wellness and diet culture, the kinds of wellness-culture messages she’s gotten as a person with a disability, and why the advice to cut out gluten for autism is often harmful. Behind the paywall, we get into why ultraprocessed food consumption doesn’t cause autism and why cutting out these foods doesn’t “cure” it, the harmful discourse around autism and ADHD in the culture right now, why it’s harmful to categorize foods as “good” and “bad,” and more.
The first half of this episode is available to everyone. To hear the whole thing, become a paid subscriber here.
Jackie Silver is a Registered Dietitian and founder of Jackie Silver Nutrition, a virtual private practice specializing in supporting neurodivergent kids, teens, and adults with ADHD, autism (ASD), and intellectual/developmental disabilities (IDD). Her team offers neurodiversity-affirming, nonjudgmental, and weight-inclusive care.
Jackie earned her Master of Health Science in Nutrition Communication from Toronto Metropolitan University and has specialized training in mindful eating and sensory-based feeding therapy.
She and her team support clients across Ontario, Canada, and several U.S. states, including New York, New Jersey, Pennsylvania, Connecticut, and Massachusetts, helping with meal planning, selective eating, food aversions, digestive health, chronic disease management, and more.
In her free time, Jackie enjoys rock climbing, yoga, pilates, swimming, traveling, visiting museums, and spending time with family and friends. Learn more about her work at jackiesilvernutrition.com.
Resources and References
Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being
Subscribe on Substack for extended interviews and more
Jackie’s website
My piece about ADHD and food dyes
Research showing limited diet in autism is likely the cause of microbiome changes
Christy’s online course, Intuitive Eating Fundamentals
Transcript
Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.
Christy Harrison: Here is my conversation with Jackie Silver.
You’re a dietitian specializing in neurodivergence and disability and I really want to dig into all of that, but first I’d love to know a bit about your background. How did you get into doing this work in the first place? And I’m curious if there was ever a personal connection for you or a personal history with diet and wellness culture that maybe led you to want to study nutrition in the first place.
Jackie Silver: It goes back to since I was a child because I was born with a condition that affected my left leg, a very rare vascular condition. And so my whole life I grew up doing physical therapy and going to osteopaths or massage therapists to make sure that I was as functional as possible. And I’ve always loved exercising, and exercise has always been a part of my life. To me, it’s a way to make sure that I’m not in pain and, and mobile and independent. And so I was always interested in health, nutrition, exercise.
And then when I was looking into different career paths, I just felt that nutrition would be a good fit for me because there’s no physical involvement in it. Being a physical therapist, I think would have been too difficult for me. You could involve a lot of creativity and there’s a lot of different ways that you could work in nutrition.
So my first undergraduate degree was in kinesiology, which is where I got that exercise piece, which I’m still very passionate about. And then my second undergraduate degree was in nutrition because growing up in Toronto, Canada, you had to have a Bachelor of Nutrition. And then I did a Master’s of Health Science in Nutrition Communication, which included the 10 months of dietetic internship rotations to become licensed.
And one of my rotations there was with Special Olympics Ontario. So I got to work with athletes with intellectual disabilities, which was really awesome. I did cooking classes and nutrition workshops for them. And I loved interacting with the athletes. And it was there that I started to see there’s a really big need to support this community because I was the first nutrition student that they had ever had, and it’s a huge organization.
And so then I finished my master’s degree about two weeks before the COVID lockdowns in 2020. And I found myself with all this extra time on my hands because I was at home and the job market was not great. So I just said, you know what? I’m just going to start my practice and see what happens. I have the time, so I’ll do it. I had studied for the licensing exams for Canada and the U.S. and then I decided to start my practice. And I originally wanted to focus on people with physical disabilities so I was interested in nutrition for spinal cord injury, that type of thing, but that part of my niece just never took off for some reason.
And when I was creating a profile on this healthcare directory, they had a list of “conditions,” and they had autism and ADHD. So I kind of naively checked that off because I had my experience with Special Olympics athletes. And then I started getting all these requests to work with autistic kids, autistic adults, or adults with ADHD. There was a need here and nobody else was really filling that need. So I decided to go all in. And I’ve done a bunch of extra training to be more confident in working with this community and it’s been really rewarding and fulfilling.
Christy Harrison: I wanna talk more about nutritional approaches for neurodivergence in a moment. But I’m also curious, for your personal history, just going back and thinking about your disability or condition. I know that you ended up having your leg amputated. I’m curious to hear more about that journey and whether you ever felt pressure to like fix it with food, especially when you were dealing with a vascular condition younger and going to physical therapy and sort of in those environments where maybe people were encouraging.
I don’t know if you experienced that, but I know certainly for me, when I’ve been in environments that are sort of not really alternative medicine, but like a little bit alternative adjacent, like physical therapy or massage therapy and things. Well, that’s more alternative, I guess. But like those communities kind of can sometimes start recommending supplements or diet changes and things like that. So I’m curious if that was ever on your radar.
Jackie Silver: Not really nutritionally, because my nutrition doesn’t change it. I mean, I do remember going to naturopaths telling me they could cure some things of it with supplements, which obviously was not true. It’s a chronic lifelong condition. I have had doctors look at me and assume that I don’t exercise and I’m not active, which is very far from the case. I’m more active than most of my friends who are able bodied. It’s really important not to make those assumptions about people.
I remember one doctor in the past, I was having lower back pain and it was because of my wheelchair positioning. And she said like, oh, if you lost a little bit of weight it would probably help. And I’m like, no. And then I went to a physical therapist and did the exercises and that got rid of the back pain. So I have definitely have been treated differently in the healthcare system.
Christy Harrison: Yeah. And it sounds like you had a sense of self or a sense of awareness about these things that you were able to say no to that and to not go down that rabbit hole. Was that always with you? Do you feel like you’ve always been sort of confident about your body or not concerned about weight in that way?
Jackie Silver: I wouldn’t say that I’ve never been concerned about weight, but I know that I’m very in tune with my body. And with what it needs. I know when my muscles are tight and I need a massage, for example, or I know when I’m having some pain, I need to go back to physical therapy, that type of thing. The fact that I’m very in tune with my body and I know how to advocate for myself and for what I need, that has helped.
Christy Harrison: Yeah, that’s huge. And it’s just interesting that you’ve been going through this for so long and had physical therapy for so long. I wonder if it did help you develop more of a sense of that. Because I know for me, I didn’t really have any chronic conditions until I was in my 20s, and now I have a whole slew of them. But I didn’t have that much experience with the healthcare system before that. I mean, on and off when I was sick and stuff as a kid. I actually did have a few chronic things, but they weren’t the sort of autoimmune and digestive and hormonal stuff that I have going on now, which is a whole other level of intensity.
I had this maybe less intense interaction with the healthcare system, I think, and I really was not aware of my body at all. I feel like I lived very much in my head, very cut off, even though I did sports and different things. I sort of would learn about body positioning in space for a particular sport or whatever, but I was not in tune with, like, oh, this hurts, or I need a rest, I need a massage, or I need to deal with this pain or whatever. I would have stomach aches from just stress and stuff and just be popping Tums all the time and, like, not really know what else to do with it.
So it’s just interesting to think about different ways people can sort of grow attuned to their bodies. And I think that actually developing whatever level of body attunement I have now, which is far greater than anything I experienced younger, I think is related to having all these chronic conditions, really having to think about them and advocate for myself and keep track of my symptoms and bring them to doctors and talk through them and see what’s working and what’s not.
And then also having gone through disordered eating in my 20s to early 30s, I think also was a way of so intensely disconnecting from my body. For so many people, I think recovery from disordered eating inevitably makes them have to get more in touch with their body and sort of stop just trying to entirely live in their head but actually take more care of themselves and have more self compassion for what’s going on physically. That was definitely my experience, I think, of coming into my body.
Jackie Silver: Yeah. Because I’ve been going to doctor since I was born, I guess I was forced to learn how to advocate and especially because my vascular condition is so rare, so many doctors have never known what to do with me. So I’ve just had to advocate, I’ve had to be in tune with my body and know when I need to go to a doctor. And so yeah, that’s interesting that how your experience started later with your later onset.
Christy Harrison: Yeah, and it’s interesting too, the different experiences of so many of us with chronic conditions or disabilities where doctors won’t know what to do and sort of what do we do with that? I think for me, when I was initially dismissed by doctors and also my different things, they weren’t diagnosed as quickly, some of them weren’t as easily sort of understood or doctors just also didn’t know what to do with me in certain ways. But I didn’t have an answer.
I wasn’t like, well, it’s this thing and here’s what we do. I was like, yeah, I don’t know either. Like, can you please help me? Sort of going from doctor to doctor to try to get answers. And that led me to like be more open to alternative stuff, I think too. Who knows? But I think maybe if I had had more concrete answers more quickly, I could have like shut those doors a little bit more easily.
Jackie Silver: Yeah, that makes sense.
Christy Harrison: I want to talk about nutritional approaches that are helpful for neurodivergent people because there’s so much unfounded advice out there. There’s so much influencer stuff and now the MAHA movement and sort of the way that it just stigmatizes so many forms of neurodivergence. And I’m sure it differs, the nutritional approaches you might use based on the different flavors of neurodivergence. But let’s start with just sort of the broad strokes of what role do you think nutrition can play in supporting neurodivergent people?
Jackie Silver: Yeah, so it’s very common in autism and I would say also ADHD, but more so in autism to have food aversions to different textures of food foods. When I’m working with clients, maybe it’s the parent of an autistic child or an autistic adult themselves, some of them might want to improve the quality of their diet within their safe food, of the textures that they feel comfortable eating. And so I work with them to support that goal. And some of them also want to expand their diet and try new and creative ways to eat foods that they are averse to.
So let’s say most common is a lot of my autistic clients have an aversion to fruits and veggies or specific fruits and veggies, because it’s a different texture every single time. Like if you think of a strawberry, it could be mushy one time, it could be firm one time, it could be sweet, it could be sour, it could have mold on it, it could be bruised. It’s not consistent. You never know what you’re going to get. Unlike with a cracker, it’s the same reliable texture every single time. So I’ll work with them if they want to expand, and I’ll work with them to expand and find new ways to increase the nutritional quality of their diet.
And I would say also for my ADHD clients, they’re often on stimulant medications which suppress their appetites. And they’re really not eating much during the day at all. And as a result, they’re feeling tired and it’s harder to focus, which is kind of counterintuitive. And then their appetite comes back at night and their bodies go, oh, my gosh, I have not eaten all day. I need to eat everything in sight now. So I work with them to come up with a way to be able to eat consistently during the day so that they have more energy and focus and feel better.
And then also interoceptive awareness is a big thing. So people who are neurodivergent, their ability to tell when they’re hungry or full is often dulled. And of course, that’s even more dulled with stimulant medications for ADHD. So I have training in mindful eating. So I bring in those skills to teach my clients how to become more aware of when they’re hungry and when they’re full. So that’s a big piece.
Christy Harrison: I definitely talk to a fair number of people just in my work as a journalist and stuff who say, oh, yeah, interoceptive awareness, I’m terrible at that. Or I have a really hard time knowing when I’m hungry, or I’ll just start working and look up and hours have gone by and I’m ravenous, but I don’t know what to eat or whatever. How do you help people to start working with that?
Jackie Silver: Typically, I have them starting to eat more on a schedule, so setting alarms or timers to remind themselves to eat breakfast, lunch, dinner, take that pause from their work and nourish themselves. And then that also helps to stimulate the appetite cues to start to come back. I have a worksheet that goes through signs that you’re hungry, signs of fullness, and I ask them to identify which ones they connect to, and then I have them practice tuning into it, because also, a lot of times I find it’s that we’re not paying attention to it. So once we start to pay attention, people often start to notice when they are hungry or when they are full.
Christy Harrison: Yeah, that was definitely my experience. I was coming at it from a more disordered eating place. But I feel like it’s similar with people with disordered eating, actually, they will become very cut off from their hunger and fullness or those subtler levels of hunger and go as long as they can without eating, or try to eat as little as possible or whatever, and then become ravenous later on. And it’s like, if we can start working with them to get more attuned to those subtler levels of hunger and take breaks and think about eating when they’re not starving or when it’s not an emergency, that actually helps a lot with sort of bringing that appetite back online and helping them feel more consistently nourished and satisfied and not as kind of up and down throughout the day.
Jackie Silver: Yes, absolutely.
Christy Harrison: Are there any key differences in nutritional needs based on the type of neurodivergence someone might be dealing with? You mentioned a little bit the sort of impact of stimulant medications for ADHD. Are there other things like that that are particular to ADHD or autism that people need to be kind of aware of?
Jackie Silver: So autistic individuals are more likely to have digestive issues. There’s a few different possible reasons for that. So I will often see people who have IBS or constipation, that people with ADHD are at higher risk for eating disorders, particularly binge eating. So I pay attention to that, and I also work with them on dopamine seeking around food and tips for managing that.
Christy Harrison: Can you explain that a little bit more with dopamine seeking around food is because I think a lot of people might be like, oh, God, do I have that?
Jackie Silver: Yeah. So people with ADHD, their brains don’t have as much dopamine and that’s a feel good hormone. So they’re often craving carbs or comfort foods or sweets as a way to get that stimulation and get that dopamine rush. I might recommend like that they include textures that they really crave throughout the day with their meals or come up with some alternative ways to get stimulation and dopamine, like exercise or going outside or having fidget toys.
Christy Harrison: I’m curious too, the intersection of eating disorders with that beause I’m sure that it can be really tricky for someone who maybe has some of that dopamine seeking tendency, but also is trying to restrict or is thinking of themselves as being bad when they’re doing the dopamine seeking behavior. How can you sort of navigate that tricky landscape there?
Jackie Silver: Yeah. So typically it does come back to making sure they’re eating enough during the day, eating consistently, because that is going to help to reduce that “binging” at night and also to reframe the way that we talk about food or think about food. So I’ll often tell clients we don’t need to label it as good or bad. You didn’t commit a crime by having ice cream and having self compassion and knowing that tomorrow is a new day and it’s okay, we can keep going.
Christy Harrison: Sort of on a related note to that disordered eating piece is this messaging from diet and wellness culture influencers about neurodivergence, about needing to restrict certain foods or certain foods being unhealthy. One of the biggest things I think people with autism or parents of autistic kids are told is to cut out gluten. Why is that advice problematic? And how do you work with people who maybe think that they need to cut out gluten or have been cutting out gluten and work with them to bring back a more nuanced approach and a more open relationship with food? Assuming that they don’t also have celiac disease, which means that they would need to cut out gluten.
Jackie Silver: Yeah. I do often have parents coming to me saying that they’ve put their three year old child on a dairy free, gluten free diet to try to get them talking or improve behaviors. And in the intro call I tell them that’s not my approach. There is not scientific evidence from large scale studies to show that it helps. And I find it’s even more damaging when the kid is already a selective eater or picky eater. I’ve seen that also, where it just eliminates so much more that they’re able to eat, and then the parents are left with three things that they could feed their child. That’s one piece that it just makes their eating even more restricted than it already is.
And also, eliminating the gluten, that takes away a lot of fiber. And the kid might already be struggling with constipation and then also taking out the dairy, they’re often not getting enough calcium, which kids need to grow. Their bones are growing and developing. That’s also where my neuroaffirming approach comes in, because I don’t believe that there’s anything wrong with being autistic or having ADHD. And diet cannot cure that. There’s no cure for them. I like to embrace neurodiversity and work in a way that works with their brains and not against it. So I don’t see neurodivergence as something that’s bad or that needs to be fixed. I will also get requests of people wanting to change their diet to get rid of their ADHD and there’s no evidence for that.
Christy Harrison: Right. There’s no evidence. And like you said, there’s no reason to, because these are just normal forms of human diversity and brain diversity that are something we can accept and celebrate. But I think there’s so much in the culture that pushes people to not accept those things and to want to “cure” them. We can talk in a minute about kind of the MAHA rhetoric around autism and neurodivergence in general and all that stuff.
But I think it is so problematic. I see in a lot of the wellness discourse around it, there is so much of this underlying idea that we can just cure it and it can go away if only we find this one toxin that’s in the environment that’s making people have these brain differences or whatever and they’re being seen as this horrible scourge when actually they’re just part of normal human diversity. But whenever someone is looking to kind of change their diet in order to address these conditions, I’m always like, what is the actual goal? What’s the underlying purpose here?
Another fairly common one that that people with autism need to fix their gut health. And there is some evidence that people with autism have some differences in the gut microbiome. But the question is why the sort of MAHA/not neuroaffirming approach to it would be like, well, they’re eating too much ultra processed food or they’ve been exposed to some toxin that has damaged their microbiome and that caused the autism so if we can just cut out these foods or find the toxin or whatever, it will fix the microbiome and therefore “cure” the autism.
I know when I’ve looked into the science on this any connection to the microbiome is again, largely based on correlation, not causation. And there’s even some evidence that there’s some potential reverse causation in the sense that microbiome changes are actually secondary to a more limited diet that people with autism have due to sensory sensitivities. So autism pre exists, is these differences in the brain that cause some sensory sensitivities that might create a more limited menu.
And one side effect of that can be changes in the microbiome. So it’s not like the microbiome really has anything to do with the autism other than just being a side effect of it. I’m curious if you see that in your practice too, a lot of patients worrying about gut health or wanting to cut out ultra processed foods or having this idea that if they can just heal the gut, that it can cure the autism or at least improve behaviors or something.
Jackie Silver: So interestingly,
