On a recent episode of the popular “Dr Oz Show,” which was devoted to autism, Mehmet Oz asked his panel of physicians if a gluten and casein free diet really helped. Before the panelists could respond, there was a resounding chorus of yeses from the parents in the audience. Following that reaction, a number of the guest physicians also confirmed that they have seen benefits in patients with autism when they adopt a gluten and casein free (GFCF) diet. However, if you try to research GFCF diet, you will find multiple parent testimonials lauding the effects of the diet, and a comparable number of research and newspaper articles quoting healthcare professionals who believe it is little more than snake oil. As for other diets that are gaining popularity for children with autism, there is little research at all, and even less support from the medical community.
This is a sad and confusing state of affairs for parents trying to navigate the overwhelming myriad of treatment choices for a child with autism to choose the best course of action. When it comes to diets, it helps to understand why they help, and which child may be the best candidate.
While autism is certainly a spectrum, with each child exhibiting a mix of characteristics, there are some symptoms and behaviors that are consistent. A large number of Autism Spectrum Disorder (ASD) kids suffer from chronic diarrhea or constipation. Parents will report that their child has almost never had a normal bowel movement. Many children exhibit bowel distress in non-verbal ways such as leaning their belly over the arm of a sofa, or otherwise placing pressure on the abdomen. They are frequently picky eaters with very limited diets, often consisting of mostly “white” foods such as processed grains, starchy vegetables and dairy products. What this indicates is a child with a digestive disorder. If a typical child experienced these symptoms, it would never be considered acceptable, and no child on the spectrum should have to suffer because poor digestion is just “a part of autism.” A special diet should be primarily used to address the digestive problem, but in many cases will lead to functional improvements as well.
Some of the common digestive issues seen in children on the spectrum are food sensitivities, inadequate digestive enzyme production, and an imbalance of good bacteria and pathogens in the intestinal tract. Beneficial bacteria are necessary for digestion, immune function and neurotransmitter production, and a deficiency can lead to dysfunction in any of those areas. It can cause intestinal permeability or “leaky gut,” which allows toxins and pathogens to pass into the bloodstream that should have been filtered out. Any diet intervention that resolves some of these issues can be healing to the child.
The gluten and casein free diet is most well known and frequently implemented. This diet completely removes any foods containing the proteins gluten (found in wheat, barley and rye) and casein (found in milk and milk products). There are a number of reasons why this diet is believed to improve not only bowel irregularities, but improve function in ASD. One concept called the “opioid theory” notes that the molecular structure of the proteins gluten and casein are quite similar to that of morphine, which can cross the protective blood-brain barrier, and may in fact be “drugging” the developing brain. The presence of a leaky gut allows these proteins to pass into the bloodstream, while a well functioning digestive tract would prevent it. It is interesting to note that autism used to be called “childhood schizophrenia,” and many research studies have implicated gluten in the onset or increase in schizophrenic symptoms.
To get the best results from this diet, it is important to find alternate sources of calcium and Vitamin D, which usually come from dairy products. In addition, most gluten containing grains are fortified with B vitamins and iron, so these nutrients must be provided elsewhere. A common mistake when adopting this diet is to replace all the gluten containing crackers, cereals, cookies, and cakes with gluten free versions. A better plan is to slowly incorporate more fruits, vegetables and other nutritious foods to replace some of the gluten. Bean-based flours, dried fruits and veggie chips are a few ways to do that. In addition, with any special diet, the quality of the food matters. Food that is organic, toxin-free, and without artificial additives will reduce the overall toxic burden on the body.
Another diet used for autism is the Specific Carbohydrate Diet (SCD). This diet was originally designed for people suffering from Crohn’s and Colitis, and completely removes all sources of starches. While the diet is restrictive, it can also be tremendously effective in normalizing digestion. When implemented correctly it is quite nourishing, but can be deficient in multiple nutrients if not done carefully.
Other diets such as low phenol, low oxalate and food sensitivity diets are also used. Each one requires careful planning for nutrient adequacy, but can be nourishing when planned well.
Those who decry the safety or efficacy of the special diets sound the alarm that a child can become malnourished on such a diet, but these children are often eating nutritionally barren diets already. In truth, it is the Standard American Diet (SAD) of even a typical child (high in calories, fat and sugar, while devoid of nutrient dense fruits, vegetables, legumes and high quality fats and protein) that should have the medical community up in arms. For many children, when done correctly, the switch to a GFCF or other special diet actually improves their nutritional status.
The bottom line is that if a dietary intervention can be followed in a way that provides adequate nutrition for the growing child, and does not overwhelm the family’s capacity to implement it, this can be a safe, non-invasive and potentially very beneficial adjunct to other therapies. Any family considering a special diet for Autism should be encouraged to find a knowledgeable nutrition professional to guide them through the process and ensure the menu is balanced.
Vicki Kobliner MS RDN, CD-N is a Registered Dietitian and owner of Holcare Nutrition (www.holcarenutrition.com). Vicki works with infants, children and adults with digestive disorders, food allergies, ADHD, autism and other chronic illness, and provides fertility and prenatal nutrition counseling. Vicki has extensive experience in using dietary modification, appropriate supplementation and functional lab testing to achieve optimal wellness. She can be reached at 203.834.9949 or vicki@holcarenutrition.com.