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Gluten- and casein-free diet and autism spectrum disorders in children: a systematic review

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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.

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  1. American Psychiatric Association (2013) Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association, Arlington, p 50

  2. World Health Organization. Autism spectrum disorders. Accessed 31 Aug 2016

  3. Rybakowski F, Chojnicka I, Dziechciarz P et al (2016) The role of genetic factors and pre- and perinatal influences in the etiology of autism spectrum disorders—indications for genetic referral. Psychiatr Pol 50:543–554

    Article  Google Scholar 

  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 174:1277–1285

    Article  Google 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 publication

  6. Reichelt KL, Knivsberg A, Lind G, Nødland M (1991) Probable etiology and possible treatment of childhood autism. Brain Dysfunct 4:308–319

    Google Scholar 

  7. Whiteley P, Shattock P, Knivsberg AM et al (2013) Gluten- and casein-free dietary intervention for autism spectrum conditions. Front Hum Neurosci 6:344

    Article  Google 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:CD003498

    Google Scholar 

  9. First MB (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  10. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. Text Revision (DSM-IV-TR), 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  11. World Health Organization (2016) Manual of the International Statistical Classification of the Diseases and Related Health Problems. 10th edn. 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. Accessed 3 Sept 2016

  13. Elder JH, Shankar M, Shuster J, Theriaque D, Burns S, Sherrill L (2006) The gluten-free, casein-free diet in autism: results of a preliminary double blind clinical trial. J Autism Dev Disord 36:413–420

    Article  Google Scholar 

  14. Knivsberg AM, Reichelt KL, Høien T, Nødland M (2002) A randomised, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci 5:251–261

    Article  CAS  Google Scholar 

  15. Johnson CR, Handen BL, Zimmer M, Sacco K, Turner K (2011) Effects of gluten free/casein free diet in young children with autism: a pilot study. J Dev Phys Disabil 23:213–225

    Article  Google Scholar 

  16. Navarro F, Pearson DA, Fatheree N, Mansour R, Hashmi SS, Rhoads JM (2015) Are ‘leaky gut’ and behavior associated with gluten and dairy containing diet in children with autism spectrum disorders? Nutr Neurosci 18:177–185

    Article  CAS  Google Scholar 

  17. Pusponegoro HD, Ismael S, Firmansyah A, Sastroasmoro S, Vandenplas Y (2015) Gluten and casein supplementation does not increase symptoms in children with autism spectrum disorder. Acta Paediatr 104:e500–e505

    Article  CAS  Google Scholar 

  18. Whiteley P, Haracopos D, Knivsberg AM et al (2010) The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutr Neurosci 13:87–100

    Article  CAS  Google Scholar 

  19. Rutter M, Le Couteur A, Lord C (2003) Autism diagnostic interview-revised manual. Western Psychological Services, Los Angeles

    Google Scholar 

  20. Lord C, Rutter M, Di Lavore P, Risi S (1999) Autism diagnostic observation schedule: manual. Western Psychological Services, Los Angeles

    Google Scholar 

  21. Charman T, Taylor E, Drew A, Cockerill H, Brown JA, Baird G (2005) Outcome at 7 years of children diagnosed with autism at age 2: predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. J Child Psychol Psychiatry 46:500–513

    Article  Google Scholar 

  22. Murray JA (2006) Gluten-free diet: the medical and nutrition management of celiac disease. Nutr Clin Pract 21:1–15

    Article  Google Scholar 

  23. Greenlee JL, Mosley AS, Shui AM, Veenstra-VanderWeele J, Gotham KO (2016) Medical and behavioral correlates of depression history in children and adolescents with autism spectrum disorder. Pediatrics 137:S105–S114

    Article  Google Scholar 

  24. Knivsberg AM, Reichelt KL, Nødland M, Høien T (1995) Autistic syndromes and diet: a follow-up study. Scan J Educ Res 39:223–236

    Article  Google Scholar 

  25. Lord C, Wagner A, Rogers S et al (2005) Challenges in evaluating psychosocial interventions for autistic spectrum disorders. J Autism Dev Disord 35:695–708

    Article  Google Scholar 

  26. Masi A, Lampit A, Glozier N, Hickie IB, Guastella AJ (2015) Predictors of placebo response in pharmacological and dietary supplement treatment trials in pediatric autism spectrum disorder: a meta-analysis. Transl Psychiatry 22(5):e640

    Article  Google Scholar 

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Authors and Affiliations



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.

Corresponding author

Correspondence to Andrea Horvath.

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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.

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Piwowarczyk, A., Horvath, A., Łukasik, J. et al. Gluten- and casein-free diet and autism spectrum disorders in children: a systematic review. Eur J Nutr 57, 433–440 (2018).

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