Summary of Biomedical Treatments for Autism, by James B. Adams, Ph.D.
page 5Gluten-Free, Casein-Free Diet
(and often Corn-Free and Soy-Free)
Rationale: Human digestive systems have not evolved on a diet containing high amounts of wheat and dairy products. Humans are the only animal who drink milk as adults, and the only animal to drink the milk of another animal. Cows milk is a perfect food for baby cows, but not for humans, especially past age of nursing.
Over the last several hundred years, wheat has been bred to greatly increase its gluten content, and a typical US diet contains far higher amounts of wheat than humans were eating 1000-10,000 years ago. Gluten (in wheat, rye, barley, and possibly oats) and casein (in all dairy products) can cause two problems:
- They are common food allergens (see previous section), especially in children and adults with autism.
- Certain peptides from gluten and casein can bind to opioid-receptors in the brain, and can have a potent effect on behavior (like heroin or morphine), causing problems including sleepiness, inattention/”zoning out”, and aggressive and self-abusive behavior. Like opioids, they can be highly addictive, and a lack of them can cause severe behaviors.
These problems appear to be due to:
- A failure of the digestive tract to fully digest the gluten and casein peptides into single amino acids
- Inflammation of the gut, allowing the gluten and casein peptides to enter the bloodstream and reach opioid receptors in the brain.
Explanation of Treatment:
- Total, 100% avoidance of all gluten products and all dairy products. Even small amounts, like a bite of a cookie, can cause allergic and/or opioid problems. Many foods have trace contamination with gluten, such as dusting French fries and raisins with wheat powder to keep them from sticking, so it can be very difficult to avoid all foods and contaminated foods.
- Digestive enzymes can also be helpful, especially if there is an accidental exposure, but they are probably not as helpful as a total avoidance of casein and gluten.
- Many children with autism also benefit by removing corn and/or soy products.
Benefits: Children who most crave dairy and/or wheat, and who eat a lot of it, are most likely to benefit. Casein-free diets usually produce benefits within a month, and sometimes within a week. Gluten free diets usually take 1-3 months to produce benefits. In some children there is a worsening of symptoms for a few days (similar to a drug withdrawal) followed by improvement.
| % worse | % no change | % better | # of reports | |
| Gluten & Casein-Free Diet | 3% | 32% | 65% | 1446 |
| Casein-Free Diet | 2% | 49% | 49% | 5574 |
| Wheat-Free Diet | 2% | 50% | 48% | 3159 |
Duration: At least until problems in the gut are addressed, and possibly lifelong.
Safety Note: It is important that a calcium supplement be taken while on a dairy-free diet unless a child has an exceptionally nutritious diet rich in calcium.
Testing: There are tests available for allergies to wheat and dairy. However, a negative allergy test does not mean that dairy and wheat are ok, as they can also cause problems due to opioid action. A trial of avoiding the foods is the best test.
Research:
Reichelt has conducted several studies which have found abnormal peptides in the urine of people with autism, and he has conducted long-term treatment studies which found significant improvement from a GF/CF diet. Cade found that long-term use of digestive enzymes was beneficial, but that the GFCF diet was even more helpful.
Cade’s large study of 150 children with autism found that 87% had IgG antibodies (allergy) to gluten, vs. 1% of the age and gender-matched controls, and 90% had IgG antibodies to casein, vs. 7% of the controls. He also studied 70 autistic children who followed a GFCF diet for 1-8 years, and found that 81% improved significantly by the third month, with improvements continuing over the next 12 months. Large improvements were observed in social isolation, eye contact, mutism, learning skills, hyperactivity, stereotypic activity, and panic attacks. Among the 19% who did not improve, about 1/3 of them were not following the GFCF diet, and had lots of gluten and casein peptides still in their blood. Cade R, Privette M et al. "Autism and Schizophrenia: Intestinal Disorders" Nutr. Neurosci 3 (2000) 57-72. Published by Overseas Publishers Association, (OPA) N.V.
Reichelt et al., Biologically active peptide-containing fractions in schizophrenia and childhood autism. Adv Biochem Psychopharmacol. 1981;28:627-43. Review.
Knivsberg AM, Reichelt KL, Nodland M. Reports on dietary intervention in autistic disorders. Nutr Neurosci. 2001;4(1):25-37. Review.
Single-blind study of 10 children with autism found that 8 benefitted from a GFCF diet. Knivsberg AM, Reichelt KL, Hoien T, Nodland M. A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci. 2002 Sep;5(4):251-61.
A 12-week, double-blind, cross-over study of a GFCF diet in 15 children with autism did not find significant benefits, but parents reported benefits that were not identified by the testing. Elder et al, The gluten-free, casein-free diet in autism: results of a preliminary double blind clinical trial. J Autism Dev Disord. 2006 413-420.
Other Diets:
Several other diets are being investigated currently. One alternative diet is the Specific Carbohydrate Diet (SCD), which involves avoiding all carbohydrates and most sugars (except monosaccharides in fruit). For more information on this diet, see www.pecanbread.com
For more information, go to:
Autism Network for Dietary Intervention: www.autismndi.com
Summary of Biomedical Treatments for Autism:
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