The Gluten-Free/Casein-Free Diet: A Double-Blind Challenge Trial in Children with Autism
- 5.1k Downloads
To obtain information on the safety and efficacy of the gluten-free/casein-free (GFCF) diet, we placed 14 children with autism, age 3–5 years, on the diet for 4–6 weeks and then conducted a double-blind, placebo-controlled challenge study for 12 weeks while continuing the diet, with a 12-week follow-up. Dietary challenges were delivered via weekly snacks that contained gluten, casein, gluten and casein, or placebo. With nutritional counseling, the diet was safe and well-tolerated. However, dietary challenges did not have statistically significant effects on measures of physiologic functioning, behavior problems, or autism symptoms. Although these findings must be interpreted with caution because of the small sample size, the study does not provide evidence to support general use of the GFCF diet.
KeywordsAutism Diet therapy Gluten-free Casein-free Treatment outcomes
The project described in this publication was funded by U54 MH066397 (NIH/NIMH Genotype and Phenotype of Autism, Principal Investigator: Patricia Rodier). It was also supported by the University of Rochester CTSA award UL1 RR024160 from the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We thank the children and families who participated. We also thank Eileen Blakely, R.D., for assisting with nutritional monitoring; Emily Healy for assisting with data collection; Patricia Rodier, Ph.D. (deceased), for her leadership of the STAART Center; Caroline Magyar, Ph.D., and her staff for conducting intake assessments of participants; Christopher Stodgell, Ph.D., for directing data management of the project; and Loisa Bennetto, Ph.D., for her advice. We are grateful to the following agencies who referred participants to the study, participated in study implementation, and advised us: Stepping Stones Learning Center (Mariellen Cupini, Director; Dr. John McEachin, EIBI Consultant) and the Center for Autism and Related Disorders (Fairport, NY branch, Director: Denise Rhine; Dr. Doreen Granpeesheh, Executive Director).
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
- Centers for Disease Control and Prevention (2014). National Health and Nutrition Examination Survey, 2013–2014. Retrieved from http://www.cdc.gov/nchs/nhanes/about_nhanes.htm.
- Conners, C. K. (1990). Conners’ Abbreviated Symptom Questionnaire: Parent version, teacher version manual. Toronto: Multi-Health Systems.Google Scholar
- Diggle, P. J., Heagerty, P., Liang, K. Y., & Zeger, S. L. (2002). Analysis of longitudinal data (2nd ed.). New York: Oxford University Press.Google Scholar
- ESHA Research (2014). Food Processor Nutrition Analysis and Fitness Software: Full Manual. Retrieved from http://www.esha.com/sites/default/files/documents/full_manual.pdf.
- Freeman, B. J., Ritvo, E. R., Yokota, A., & Ritvo, A. (1986). A scale for rating symptoms of patients with the syndrome of autism in real-life settings. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 131–136.Google Scholar
- GFCFDiet (2001). Parent survey GFCF diet. Accessed November 6, 2014, at http://www.gfcfdiet.com/dietsurveysept2.htm.
- Hollingshead, A. B. (1975). Four-factor index of social status. Retrieved from http://elsinore.cis.yale.edu/sociology/yjs/yjs_fall_2011.pdf#page=21.
- Interactive Autism Network (IAN, 2008). IAN Research Findings: Special Diets. Retrieved from http://www.iancommunity.org/cs/ian_treatment_reports/special_diets.
- Kemperman, R., Muskiet, F., Boutier, A., Kema, I., & Muskiet, F. (2008). Normal intestinal permeability at elevated platelet serotonin levels in a subgroup of children with pervasive developmental disorders in Curacao (the Netherlands Antilles). Journal of Autism and Developmental Disorders, 38, 401–406. doi: 10.1007/s10803-007-0399-8.PubMedPubMedCentralCrossRefGoogle Scholar
- Lewis, L. (2011). Special diets for special kids, Volumes 1 and 2 combined: Over 200 revised and new gluten-free casein-free recipes, plus research on the positive effects for children with autism, ADHD, allergies, celiac disease, and more!. Arlington, TX: Future Horizons.Google Scholar
- Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2003). Autism diagnostic observation schedule. Los Angeles, CA: Western Psychological Services.Google Scholar
- Matthews, J. (2008). Nourishing hope for children with autism: Nutrition and diet guide for healing our children. San Francisco: Healthful Living Media.Google Scholar
- Mullen, E. M. (1995). Mullen Scales of early learning. Circle Pines, MN: American Guidance Service.Google Scholar
- Reichelt, K. L., Knivsberg, A., Lind, G., & Nødland, M. (1991). Probable etiology and possible treatment of childhood autism. Brain Dysfunction, 4, 308–319.Google Scholar
- Reichelt, K. L., Knivsberg, A., Nødland, M., & Lind, G. (1994). Nature and consequences of hyperpeptiduria and bovine casomorphins found in autistic syndromes. Developmental Brain Dysfunction, 7, 71–85.Google Scholar
- Robertson, M., Sigalet, D., Holst, J., Meddings, J., Wood, J., & Sharkey, K. (2008). Intestinal permeability and glucagon-like peptide-2 in children with autism: A controlled pilot study. Journal of Autism and Developmental Disorders, 38, 1066–1071. doi: 10.1007/s10803-007-0482-1 PubMedCrossRefGoogle Scholar
- Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview-revised. Los Angeles, CA: Western Psychological Services.Google Scholar
- Seroussi, K. (2002). Unraveling the mystery of autism and pervasive developmental disorder: A mother’s story of research & recovery. New York, NY: Crown.Google Scholar
- Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). Vineland Adaptive Behavior Scales (Survey ed.). Circle Pines, MN: American Guidance Service.Google Scholar
- Stewart, P. A., Hyman, S. L., Schmidt, B. L., Macklin, E. A., Reynolds, A., Johnson, C. R., et al. (2015). Dietary supplementation in children with autism spectrum disorders: Common, insufficient and excessive. Journal of the Academy of Nutrition and Dietetics, 115, 1237–1248. doi: 10.1016/j.jand.2015.03.026.PubMedCrossRefGoogle Scholar
- Talk About Curing Autism (2010). Diet infringement or infraction help. https://www.tacanow.org/family-resources/diet-infringement-or-infraction-help/. Accessed 21 Aug 2015.
- Whiteley, P., Haracopos, D., Knivsberg, A. M., Reichelt, K. L., Parlar, S., Jacobsen, J., & Shattock, P. (2010). The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutritional Neuroscience, 13(2), 87–100. doi: 10.1179/147683010x12611460763922.PubMedCrossRefGoogle Scholar
- WHO Multicentre Growth Reference Study Group. (2006). WHO child growth standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva, World Health Organization, 2006. Retrieved from http://www.who.int/childgrowth/standards/Technical_report.pdf?ua=1.