GLUTEN AND CASEIN-FREE DIET FOR AUTISM

The causes of Autism Spectrum Disorders such as Autism and Asperger's syndrome are the subject of much debate and research. Although a genetic cause is well established, many argue there are environmental causes as well. Gastrointestinal problems such as bowel disturbances, diarrhea or constipation are a common feature of Autism and Asperger's. According to one theory, some children are unable to digest the protein in many cereals (gluten) or in milk (casein) completely. Casein and gluten proteins aren't properly broken down and lead to a build up of opioids in the body, leading to high pain tolerance, repetitive behaviors and lack of concentration. A gluten and casein-free diet is believed by some parents of autistic children to aid in reducing symptoms of Autism, Asperger's syndrome and other Autism Spectrum Disorders.

History of the gluten and casein-free diet

Dr. Karl Ludwig Reichelt claims to have found peptides from casein and gluten that worsen the symptoms of autistic children, many of whom have gastrointestinal disorders. These peptides are casomorphines and gluten exorphins, which influence the brain. The primary proponent of the possible link between digestive disorders and autism is Dr. Andrew Wakefield, a United Kingdom gastroenterologist who has described the disputed condition as autistic enterocolitis. According to Dr. Reichelt, significant improvement has been seen in the symptoms of some of his patients with Autism or Asperger's who had been put on a diet that omits these peptides. The diet is called the gluten-free, casein-free diet. Some physicians see diet as a central part of the treatment, but in addition to many other treatments at the same time.

Theory behind the gluten and casein-free diet

The molecular structure of the partially undigested proteins, known as peptides, resemble opiates. It is thought that such peptides have an effect much like opiates (ie. morphine, heroin) in the brain and nervous system. From this premise it follows that long-term exposure to these opiate peptides can have many damaging effects on the developing brain and also affects behavior, just as any narcotic would. The opioid peptides involved are identified as casomorphines from casein, and gluten exorphines and gliadorphin from gluten.

Gastrointestinal problems are a common comorbid disorder on the autism spectrum and some people see this as proof for the "leaky gut" theory as a cause of Autism, while others see the gluten and casein-free diet as treating symptoms, not causes, of Autism Spectrum Disorders.

The "leaky gut" theory remains controversial with no rigorous scientific studies done as yet. A recent study of the role of diets in Autism Spectrum Disorders noted that significant design flaws in all the current studies make it difficult to rely on an conclusions reached ( Christianson & Ivany 2006).

Benefits claimed for the gluten-free casein-free diet

Anecdotal evidence suggests that some parents, though not all, find that removing casein and gluten from their child's diet increases eye contact, attention span, and general mood while decreasing problems like tantrums, self-stimulatory behavior (such as hand-flapping and rocking) and aggression. Others have reported that providing a diet free of casein and gluten aids children in successfully learning daily living skills like dressing, using the toilet as well as improving coordination and imaginative play activities. In a small number of cases, such dietary changes have been claimed to have a dramatic effect, enabling the child to attend mainstream educational programs in a matter of months. It should be noted that to date there has not been the rigorous research that would qualify the diet as an evidence-based treatment.

The gluten-free casein-free diet and Autistic children

Beginning the diet can be difficult but not impossible. Gluten is most commonly found in wheat, rye, and barley and may sometimes contaminate oats grown nearby or processed on the same equipment as gluten-containing cereals.

Casein is found in dairy products; wheat and dairy frequently make up a large proportion of the Western diet. One of the biggest obstacles parents face is that individuals needing gluten-free, casein-free diets often crave these foods much the same as an addict. In fact, parents often report withdrawal symptoms when gluten and casein are eliminated that are similar to addicts experiencing withdrawal from narcotic drugs.

Many parents worry about removing wheat and dairy because these foods are the only ones their child will eat, and because prevailing attitudes in Western culture consider them an essential staple. However, children who eat only or mostly wheat and dairy products may show remarkable improvement once a gluten-free, casein-free diet is underway. Many families have found from experience that their children's menu options actually increase after the effects of eating gluten and casein have subsided.

Some people experience immediate improvement although it may take as long as six months for gluten to clear out of the system and one month for casein to clear. Advocates of the diet recommend trying it for at least a year as it can take this long for some children to show improvement. The diet claims to make changes in the body at a cellular level and promote healing of the stomach and intestinal lining, both of which can take time.

DEBATE OVER the diet

The specifics of the gluten-free, casein-free diet were introduced to the general public through the combined publications of two women who researched interventions and crusaded for autism recovery. Information about the gluten-free, casein-free diet has since spread around the world and anecdotal evidence suggests it has helped some families.

Although this diet has been questioned by the medical community, many doctors and university research centers are suggesting to parents that they see if any results emerge from using the diet, but usually alongside the more proven behavioral and developmental interventions.

The gluten-free, casein-free diet has been supplemented with a number of new innovations. These include incorporation of the Feingold diet, the Specific Carbohydrate Diet, diets with reduced salicylates and phenols, etc. There are as yet few studies that prove or disprove the gluten-free, casein-free diet or other diets, but there is growing acceptance in the medical community that restrictive diets can affect pediatric and adolescent behavior in some cases.

The gluten-free casein-free diet and other disorders

Those suffering from celiac disease and/or dermatitis herpetiformis are instructed to avoid all forms of gluten, though their metabolic disorders are apparently distinct from the autism-related metabolic disorder hypothesized by gluten-free, casein-free proponents. There are anecdotal reports of this diet also being beneficial to sufferers of multiple sclerosis, schizophrenia, Tourette syndrome, chronic fatigue syndrome and attention deficit disorder. However, in some of these cases (e.g.; Tourette syndrome), there is no evidence that a gluten-free diet has any impact upon symptoms.

Should my child try the gluten-free casein-free diet?

A common problem in interventions for Autism and Asperger’s syndrome is the lack of rigorous research on new therapies. Anecdotal evidence for beneficial effects can be accurate, or in other cases mistaken by a wide range of confounding factors. Understandably parents will look at therapies such as a diet free of gluten and casein for their autistic child to see if it could have some benefit, even if it is not currently seen as an evidence-based treatment.

Autistic children can be notoriously fussy eaters, this diet may be very difficult to implement. Also, some supporters of this diet suggest parents stick with the diet for a year ideally, which can be a long time simply to evaluate this type of intervention, and children will usually make developmental advances over this time frame regardless of diet. Other pediatricians such as Dr Antony Underwood believe that three months of a strict trial is sufficient to see if a gluten and casein-free diet will reduce the symptoms of Autism and Asperger's syndrome.

Further reading: Brain chemistry and Autism

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This autism fact sheet is licensed under the GNU Free Documentation. It is derivative of an Autism and Asperger's syndrome-related articles at http://en.wikipedia.org