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    Does Combined Gluten-Free and Casein-Free Diet Improve Behavior in Kids with Autism Spectrum Disorder?

    Jefferson Adams
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    Reviewed and edited by a celiac disease expert.

      Alternative diets, including gluten-free, casein-free diets are popular with people looking to improve behavior in people with Autism Spectrum Disorders.

    Raising autism awareness. Image: CC BY 2.0--Sebastiaan ter Burg
    Caption: Raising autism awareness. Image: CC BY 2.0--Sebastiaan ter Burg

    Celiac.com 02/28/2020 - Because therapies for people with autism spectrum disorders (ASD) are limited, alternative approaches, including dietary treatments, such as gluten-free and casein-free diets receive a good deal of attention from people looking for ways to improve the condition. However, the data so far have not shown the gluten-free diet to be effective in changing behavior in people with autism spectrum disorder.

    A team of researchers recently set out to assess the effects of a gluten-free and casein-free diet on behavior disorders in children and adolescents diagnosed with autism spectrum disorder, and to look at the possible connection with levels of urinary beta-casomorphin. 

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    The research team included Pablo José González-Domenech, Francisco Díaz Atienza, Carlos García Pablos, María Luisa Fernández Soto, José María Martínez-Ortega, and Luis Gutiérrez-Rojas. They are variously affiliated with the Child and Adolescent Mental Health Unit, Virgen de las Nieves University Hospital, Granada, Spain; the Department of Psychiatry, University of Granada, Granada, Spain; the Department of Medicine, University of Granada, Granada, Spain; the Psychiatry Service, Hospital Clínico San Cecilio, Granada, Spain; and the CTS-549 Research Group, Institute of Neuroscience, Granada, Spain.

    Their team enrolled thirty-seven patients for the crossover trial. Each patient ate both a normal diet that included gluten and casein for 6 months, and a gluten-free and casein-free diet for another 6 months. 

    The diets were assigned randomly, so half of patients began with gluten-free diet, and half began with regular diet, then the two switched at six months. The team assessed patients at the beginning of the study, after the normal diet and after the gluten-free and casein-free diet.

    At each time period, the team measured urinary beta-casomorphin concentration, and  patients completed questionnaires regarding behavior, autism and dietary adherence. 

    The team found no significant behavioral changes and no connection with urinary beta-casomorphin concentrations after six months of gluten-free and casein-free diet. 

    The 6-month gluten-free and casein-free diet led to no significant changes in behavioral symptoms of autism spectrum patients, and no changes to urinary beta-casomorphin levels. 

    The team is not saying definitively that gluten-free and casein-free diets don't help some patients with autism spectrum disorder, but they are calling for further studies with a long follow-up period similar to ours and including placebo and blinding elements to help to identify patients who might improve on gluten-free and casein-free diets.

    Read more in the Journal of Autism and Developmental Disorders volume 50, pages 935–948 (2020)

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    I'm autistic and have been Gluten-free Casein-free by necessity.  I have celiac disease and lactose intolerance.  Too much cheese is bad for my cholesterol.  Guess what!  Going off milk and gluten had absolutely no effect on my neurology.  The Gluten-free Casein-free diet is really an example of the pseudoscientific "cures" to which we're subjected for something that is not a disease and a relatively innocuous one at that.  The one digestive risk that is well-established is Small Intestine Bacterial Overgrowth, which I may have.  SIBO can result in painful symptoms which can manifest as symptoms of autism.  Treating SIBO appears to alleviate autism, but it what is doing is relieving pain, a good in itself.

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    My thought on this is that kids whose behavioral symptoms are improved by a gluten-free/cf diet are not actually on the autism spectrum. Instead, they have issues that look superficially like the spectrum, but are really caused by food intolerance related inflammation. My daughter, for example, improved dramatically on a gluten-free/cf diet, but it turned out she had Lyme disease and several Lyme co-infections. The inflammation caused by the combined problems put her over the top. She had constant emotional breakdowns, oppositional defiant disorder, insomnia and aggressive rage. The diet reduced symptoms by half and treating theLyme&co did the rest. 

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    hmm interesting having done a  trawl through the research.  From what I have found.  In probably a number of children diagnosed with autism/adhd there is casein sensitiviy/allergy. I think that this might be due to casomorphins, acting like opiate drugs. So effectively to people who are sensitive to opiates they will experience all the side effects of taking an opiate and also become addicted to the "opiate". So effectively you have a" drugged " up child. This picture might be  confused with. Both my children have problems with Casein,  the youngest diagnosed at 3 months is extremely allergic, he has had to have strict elimination of all dairy in his diet. We as a family had very little milk intake until he left for university,  following his departure-we started to eat more dairy products. My daughter changed almost overnight, she started having severe mood swings, being rude and cheeky to adults, and in terms of behaviour regressed to about 6 years old. She is 12, she fell out with all her friends and was very argumentative. She then started to deteriorate physically- developing severe abdominal pains,  cramps,  and this woul not respond to paracetamol orv irritable bowel symptoms.  She also developed insomnia.  My husband has autistic traits, so I began to think that my daughter might be similar. I was researching around the internet about autism,  and found anecdotal reports that some childrens behaviour much improved with a dairy and gluten  free diet. This made me make the link wandering wether she might have a milder form of allergy to casein.  So after 2 or 3 days of dairy elimination we noticed a huge improvement of behavioural and bowel symptoms. 4 th day not so good irritable and bloated abdomen,  with mood swings and paranoia. We discovered she had eaten some milk chocolate.  She recognised that milk was a problem,  and is sticking to the diet. We will see how things progress. 


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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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