Gluten- and casein-free diet and autism spectrum disorders in children: a systematic review
Effective treatments for core symptoms of autism spectrum disorders (ASD) are lacking. We systematically updated evidence on the effectiveness of a gluten-free and casein-free (GFCF) diet as a treatment for ASD in children.
The Cochrane Library, MEDLINE, and EMBASE databases were searched up until August 2016, for randomized controlled trials (RCTs); additional references were obtained from reviewed articles.
Six RCTs (214 participants) were included. With few exceptions, there were no statistically significant differences in autism spectrum disorder core symptoms between groups, as measured by standardized scales. One trial found that compared with the control group, in the GFCF diet group there were significant improvements in the scores for the ‘communication’ subdomain of the Autism Diagnostic Observation Schedule and for the ‘social interaction’ subdomain of the Gilliam Autism Rating Scale. Another trial found significant differences between groups in the post-intervention scores for the ‘autistic traits’, ‘communication’, and ‘social contact’ subdomains of a standardized Danish scheme. The remaining differences, if present, referred to parent-based assessment tools or other developmental/ASD-related features. No adverse events associated with a GFCF diet were reported.
Overall, there is little evidence that a GFCF diet is beneficial for the symptoms of ASD in children.
KeywordsRandomized controlled trial Autism spectrum disorders Children Gluten Casein
AH initially conceptualized this study. AP and JŁ were responsible for data collection. HS and AH assumed the main responsibility for the writing of this manuscript. All authors were responsible for data analysis and data interpretation. All authors contributed to (and agreed upon) the final version of this manuscript.
Compliance with ethical standards
Conflict of interests
AH and AP are the recipients of a grant from the Fundacja Nutricia (Nutricia Foundation) under Grant RG8/2013 to carry out the study on ASD and a gluten-free diet. Other authors declare no conflict of interests.
- 1.American Psychiatric Association (2013) Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association, Arlington, p 50Google Scholar
- 2.World Health Organization. Autism spectrum disorders. http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/en/. Accessed 31 Aug 2016
- 4.Salomone E, Charman T, McConachie H, Warreyn P (2015) Working group 4, COST action “Enhancing the Scientific Study of Early Autism”: prevalence and correlates of use of complementary and alternative medicine in children with autism spectrum disorder in Europe. Eur J Pediatr 174:1277–1285CrossRefGoogle Scholar
- 5.Horvath A, Łukasik J, Szajewska H (2016) Omega-3 fatty acids and autism spectrum disorders in children: a systematic review and meta-analysis. J Nutr. Accepted for publicationGoogle Scholar
- 6.Reichelt KL, Knivsberg A, Lind G, Nødland M (1991) Probable etiology and possible treatment of childhood autism. Brain Dysfunct 4:308–319Google Scholar
- 8.Millward C, Ferriter M, Calver S, Connell-Jones G (2008) Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev 16:CD003498Google Scholar
- 9.First MB (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
- 10.American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. Text Revision (DSM-IV-TR), 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
- 11.World Health Organization (2016) Manual of the International Statistical Classification of the Diseases and Related Health Problems. 10th edn. http://www.who.int/classifications/icd/en/. Accessed 3 Sept 2016
- 12.Schünemann H, Brozek J, Guyatt G, Oxman A (2016) GRADE handbook for grading quality of evidence and strength of recommendations. http://www.guidelinedevelopment.org/handbook. Accessed 3 Sept 2016
- 19.Rutter M, Le Couteur A, Lord C (2003) Autism diagnostic interview-revised manual. Western Psychological Services, Los AngelesGoogle Scholar
- 20.Lord C, Rutter M, Di Lavore P, Risi S (1999) Autism diagnostic observation schedule: manual. Western Psychological Services, Los AngelesGoogle Scholar