Gluten-free, casein-free diet

Gluten-free casein-free diet (GFCF diet), also known as gluten-free dairy-free diet (GFDF diet, is a diet that does not include the proteins gluten (found most often in wheat, barley, and rye), and casein (found most often in milk and dairy products).

Despite an absence of scientific evidence, there have been advocates for the use of this diet as a treatment for autism and related conditions.^[1][2]

Uses

Autism

The majority of the available evidence does not support the use of this diet in the treatment of autism.

• American Academy of Pediatrics - Clinical Report (2007) In their report, the AAP did not recommend the use of special diets for children with autism spectrum disorder because of inadequate evidence.^[3]
• Cochrane Library - Gluten and Casein-free diets in autism spectrum disorder (2008) The Cochrane review found that while relatively commonly used the evidence to support the diets use in children with autism was poor.^[2] All studies as of 2006 had issues with them.^[1]
• Research in Autism Spectrum Disorders - Gluten-free and casein free diets in the treatment of autism spectrum disorders: A systematic review (2009) It concluded that the results "reveal that the current corpus of research does not support the use of GFCF diets in the treatment of ASD. Given the lack of empirical support, and the adverse consequences often associated with GFCF diets (e.g. stigmatization, diversion of treatment resources, reduced bone cortical thickness), such diets should only be implemented in the event a child with ASD experiences acute behavioral changes, seemingly associated with changes in diet...and/or a child has allergies or food intolerances to gluten and/or casein."^[4]
• Vanderbilt Evidence-based Practice Center - Therapies for Children with Autism Spectrum Disorder (2011) The review, commissioned by the Agency for Healthcare Research and Quality, concluded that, "the evidence supporting GFCF diets in ASD is limited and weak."^[5]
• Clinical Therapeutics - The relationship of autism to gluten (2013) This review found one double-blind study, which did not find any benefit from the gluten-free diet, and concluded that "Currently, there is insufficient evidence to support instituting a gluten-free diet as a treatment for autism."^[6]
• Journal of Child Neurology - Evidence of the Gluten-Free and Casein-Free Diet in Autism Spectrum Disorders: A Systematic Review (2014) This review found that "...the evidence on this topic is currently limited and weak," and noted that only a few randomized trials had been conducted on the efficacy of gluten-free diets as an autism treatment. The review also noted that even these trials were of questionable scientific merit because they were based on small sample sizes.^[7]
• Current Opinion in Clinical Nutrition & Metabolic Care - Gluten-free and casein-free diets in the therapy of autism (2015) This review found "limited and weak" evidence that this diet was effective as a treatment for autism, noting that most studies that had been done to assess its effectiveness were "seriously flawed."^[8]
• Autism Research Institute The Autism Research Institute recommends the GFCF/GFDF diet as a treatment for autism and related conditions.^[1][2] The organization believes that, "Dietary intervention is a cornerstone of a evidence-based medical approach, and there is convincing empirical evidence that special diets help many with autism."^[9]

Safety

The diet may have a negative effect on bone health, although there is debate over whether this is actually due to the diet or caused by eating habits or bowel issues associated with autism.^[10]

Mechanism

In the 1960s, Curtis Dohan^[11] speculated that the low incidence of schizophrenia in certain South Pacific Island societies was a result of a diet low in wheat and milk-based foods.^[12] Dohan proposed a genetic defect wherein individuals are incapable of completely metabolizing gluten and casein as a possible etiology for schizophrenia. Dohan hypothesized that elevated peptide levels from this incomplete metabolism could be responsible for schizophrenic behaviors. In 1979, Jaak Panksepp proposed a connection between autism and opiates, noting that injections of minute quantities of opiates in young laboratory animals induce symptoms similar to those observed among autistic children.^[13]

The possibility of a relationship between autism and the consumption of gluten and casein was first articulated by Kalle Reichelt in 1991.^[14] Based on studies showing correlation between autism, schizophrenia, and increased urinary peptide levels,^[15] Reichelt hypothesized that some of these peptides may have an opiate effect. This led to the development of the Opioid excess theory, expounded by Paul Shattock and others,^[16] which speculates that peptides with opioid activity cross into the bloodstream from the lumen of the intestine, and then into the brain. These peptides were speculated to arise from incomplete digestion of certain foods, in particular gluten from wheat and certain other cereals and from casein from milk and dairy produce. Further work confirmed opioid peptides such as casomorphines^[17] (from casein) and gluten exorphines and gliadorphin (from gluten) as possible suspects, due to their chemical similarity to opiates.

Reichelt hypothesized that long term exposure to these opiate peptides may have effects on brain maturation and contribute to social awkwardness and isolation. On this basis, Reichelt and others have proposed a gluten-free casein-free (GFCF) diet for sufferers of autism to minimize the buildup of opiate peptides.^[2] Reichelt has also published a number of trials and reviews concluding that this diet is effective.^[18][19]

Practical implementation

The implementation of a GFCF diet involves removing all sources of gluten and casein from a person's diet. Gluten is found in all products containing wheat, rye, and barley. Many gluten-free breads, pastas, and snacks are available commercially. Gluten-free cookbooks have been available for decades. Casein is found in dairy products such as milk, butter or cheese, but is also present in smaller amounts in many substitute dairy products such as vegetarian cheese substitutes and whipped cream topping, which use casein to provide texture. Although advocates of the GFCF diet often recommend total elimination of dairy from the diet, whey protein is a different milk protein from casein.

See also

• Gluten-related disorders
• Opioid excess theory
• Autism therapies
• List of diets
• List of alternative therapies for developmental and learning disabilities

References

1. Christison GW, Ivany K; Ivany (2006). "Elimination diets in autism spectrum disorders: any wheat amidst the chaff?". J Dev Behav Pediatr. 27 (2 Suppl 2): S162–71. doi:10.1097/00004703-200604002-00015. PMID 16685183.
2. Millward C, Ferriter M, Calver S, Connell-Jones G; Ferriter; Calver; Connell-Jones (2008). Ferriter, Michael, ed. "Gluten- and casein-free diets for autistic spectrum disorder". Cochrane Database Syst Rev (2): CD003498. doi:10.1002/14651858.CD003498.pub3. PMC 4164915. PMID 18425890.
3. Myers, S.M.; Johnson, C.P.; Council on Children with Disabilities (2007). "Management of children with autism spectrum disorders". Pediatrics. 120 (5): 1162–82. doi:10.1542/peds.2007-2362. PMID 17967921. Lay summary – AAP (2007-10-29).
4. Mulloy, Austin; Lang, Russell; o’Reilly, Mark; Sigafoos, Jeff; Lancioni, Giulio; Rispoli, Mandy (2010). "Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review" (PDF). Research in Autism Spectrum Disorders. 4 (3): 328–339. doi:10.1016/j.rasd.2009.10.008.
5. Warren, Z.; Veenstra-VanderWeele, J.; Stone, W.; Bruzek, J.L.; Nahmias, A.S.; Foss-Feig, J.H.; Jerome, R.N.; Krishnaswami, S.; Sathe, N.A.; Glasser, A.M.; Surawicz, T.; McPheeters, M.L. (2011). Therapies for children with autism spectrum disorders (PDF). AHRQ Publication No. 11-EHC029-EF, Comparative Effectiveness Review No. 26. Rockville, MD: Agency for Healthcare Research and Quality.
6. Buie T (May 2013). "The relationship of autism and gluten". Clin Ther. 35 (5): 578–83. doi:10.1016/j.clinthera.2013.04.011. PMID 23688532.
7. Marí-Bauset, S; Zazpe, I; Mari-Sanchis, A; Llopis-González, A; Morales-Suárez-Varela, M (2014-04-30). "Evidence of the Gluten-Free and Casein-Free Diet in Autism Spectrum Disorders: A Systematic Review". Journal of child neurology. 29 (12): 1718–27. doi:10.1177/0883073814531330. PMID 24789114.
8. Lange, KW; Hauser, J; Reissmann, A (November 2015). "Gluten-free and casein-free diets in the therapy of autism.". Current Opinion in Clinical Nutrition and Metabolic Care. 18 (6): 572–5. doi:10.1097/MCO.0000000000000228. PMID 26418822.
9. Whiteley, Paul; Shattock, Paul; Knivsberg, Ann-Mari; Seim, Anders; Reichelt, Karl L.; Todd, Lynda; Carr, Kevin; Hooper, Malcolm (2013). "Gluten- and casein-free dietary intervention for autism spectrum conditions". Frontiers in Human Neuroscience. 6: 344. doi:10.3389/fnhum.2012.00344. PMC 3540005. PMID 23316152.
10. Whiteley, P; Shattock, P; Knivsberg, Ann-Mari; Seim, Anders; Reichelt, Karl L.; Todd, Lynda; Carr, Kevin; Hooper, Malcolm (2012). "Gluten- and casein-free dietary intervention for autism spectrum conditions". Front Hum Neurosci. 6: 344. doi:10.3389/fnhum.2012.00344. PMC 3540005. PMID 23316152.
11. "Curtis Dohan, M.D., A.B., Associate Professor, The University of Tennessee Health Science Center".
12. Dohan, F. C. (1966). "Cereals and schizophrenia data and hypothesis". Acta Psychiatrica Scandinavica. 42 (2): 125–132. doi:10.1111/j.1600-0447.1966.tb01920.x. PMID 5335008.
13. Panksepp, Jaak (1979). "A neurochemical theory of autism". Trends in Neurosciences. 2: 174–177. doi:10.1016/0166-2236(79)90071-7.
14. Reichelt KL, Knivsberg A-M, Lind G, Nødland M. (1991). "Probable etiology and possible treatment of childhood autism". Brain Dysfunction. 4 (6): 308–19.
15. Reichelt, K. L.; Hole, K; Hamberger, A; Saelid, G; Edminson, P. D.; Braestrup, C. B.; Lingjaerde, O; Ledaal, P; Orbeck, H (1981). "Biologically active peptide-containing fractions in schizophrenia and childhood autism". Advances in Biochemical Psychopharmacology. 28: 627–43. PMID 7010949.
16. Shattock, P; Whiteley, P (2002). "Biochemical aspects in autism spectrum disorders: Updating the opioid-excess theory and presenting new opportunities for biomedical intervention". Expert Opinion on Therapeutic Targets. 6 (2): 175–83. doi:10.1517/14728222.6.2.175. PMID 12223079.
17. Sun Z, Cade JR; Cade (1999). "A peptide found in schizophrenia and autism causes behavioral changes in rats". Autism. 3 (1): 85–95. doi:10.1177/1362361399003001007.
18. Knivsber, A. M.; Reichelt, K. L.; Nødland, M (2001). "Reports on dietary intervention in autistic disorders". Nutritional neuroscience. 4 (1): 25–37. PMID 11842874.
19. Knivsberg, A.M.; Reichelt, K.L.; Høien, T.; Nødland, M. (2002). "A Randomised, Controlled Study of Dietary Intervention in Autistic Syndromes". Nutritional Neuroscience. 5 (4): 251–61. doi:10.1080/10284150290028945. PMID 12168688.

External links

• Gluten-free, casein-free diet at DMOZ