Skip to main content

Effect of gluten free diet on gastrointestinal and behavioral indices for children with autism spectrum disorders: a randomized clinical trial



Genetic and environmental factors are both responsible for the etiology of autism spectrum disorders (ASD). Although epidemiological studies have been conducted to clarify the association between restriction diets and ASD, the conclusion remains unclear. This study was undertaken to investigate the effect of gluten free diet (GFD) on gastrointestinal symptoms and behavioral indices in children with ASD.


In this randomized clinical trial, 80 children diagnosed with ASD by the Autism Diagnostic Interview-Revised (ADI-R) were assigned into GFD (n=40) and regular diet (RD) (n=40) groups for 6 weeks. At the beginning and end of the intervention, the ROME Ш questionnaire for evaluating gastrointestinal symptoms and Gilliam Autism Rating Scale 2 questionnaire (GARS-2) for assessing psychometric properties were completed.


Of the 80 children, 53.9% had gastrointestinal abnormalities. In the GFD group, the prevalence of gastrointestinal symptoms decreased significantly (P<0.05) after intake of GFD (40.57% vs. 17.10%) but increased insignificantly in the RD group (42.45% vs. 44.05%). GFD intervention resulted in a significant decrease in behavioral disorders (80.03±14.07 vs. 75.82±15.37, P<0.05) but an insignificant increase in the RD group (79.92±15.49 vs. 80.92±16.24).


This study suggested that GFD may be effective in controlling gastrointestinal symptoms and ASD behaviors.

This is a preview of subscription content, access via your institution.


  1. 1

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM5), 5th ed. Washington, DC: American Psychiatric Press, 2013.

  2. 2

    CDC. Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders. MMWR Surveill Summ 2012;61:1–18. Available at: ss6103a1.htm (accessed September 11, 2013).

    Google Scholar 

  3. 3

    Samadi SA, Mahmoodizadeh A, McConkey R. A national study of the prevalence of autism among five-year-old children in Iran. Autism 2012;16:5–14.

    Article  PubMed  Google Scholar 

  4. 4

    Santaella ML, Varela Y, Linares N, Disdier OM. Prevalence of autism spectrum disorders in relatives of patients with selective immunoglobulin A deficiency. P R Health Sci J 2008;27:204–208.

    PubMed  Google Scholar 

  5. 5

    Whiteley P, Shattock P, Knivsberg AM, Seim A, Reichelt KL, Todd L, et al. Gluten-and casein-free dietary intervention for autism spectrum conditions. Front Hum Neurosci 2013;6:344.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6

    Randolph-Gips M, Srinivasan P. Modeling autism: a systems biology approach. J Clin Bioinforma 2012;2:17.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7

    Genuis SJ, Bouchard TP. Celiac disease presenting as autism. J Child Neurol 2010;25:114–119.

    Article  PubMed  Google Scholar 

  8. 8

    Barcia G, Posar A, Santucci M, Parmeggiani A. Autism and Coeliac Disease. J Autism Dev Disord 2008;38:407–408.

    Article  PubMed  Google Scholar 

  9. 9

    Buie T. The Relationship of Autism and Gluten. Clin Ther 2013;35:578–583.

    CAS  Article  PubMed  Google Scholar 

  10. 10

    Rostami Nejad M, Rostami K, Emami M, Zali M, Malekzadeh R. Epidemiology of celiac disease in iran: a review. Middle East J Dig Dis 2011;3:5–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. 11

    Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA. Gastrointestinal flora and gastrointestinal status in children with autism—comparisons to typical children and correlation with autism severity. BMC Gastroenterol 2011;11:22.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12

    Harris C, Card B. A pilot study to evaluate nutritional influences on gastrointestinal symptoms and behavior patterns in children with Autism Spectrum Disorder. Complement Ther Med 2012;20:437–440.

    Article  PubMed  Google Scholar 

  13. 13

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

    Article  Google Scholar 

  14. 14

    Panksepp J. A neurochemical theory of autism. Trends Neurosci 1979;2:174–177.

    Article  Google Scholar 

  15. 15

    Reichelt K, Knivsberg A, Lind G, Nødland M. Probable etiology and possible treatment of childhood autism. Brain Dysfunction 1991;4:308–319.

    Google Scholar 

  16. 16

    Whiteley P, rodgers J, savery D, shattock P. A gluten-free diet as an intervention for autism and associated spectrum disorders: preliminary findings. Autism 1999;3:45–65.

    Article  Google Scholar 

  17. 17

    Shattock P, Whiteley P. Biochemical aspects in autism spectrum disorders: updating the opioid-excess theory and presenting new opportunities for biomedical intervention. Expert Opin Ther Targets 2002;6:175–183.

    CAS  Article  PubMed  Google Scholar 

  18. 18

    Mulloy A, Lang R, O’Reilly M, Sigafoos J, et al. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Res Autism Spect Dis 2009;217:2–12.

    Google Scholar 

  19. 19

    Mari’-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Sua’rez-Varela M. Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review. J Child Neurol 2014;29:1718–1727.

    Article  Google Scholar 

  20. 20

    Hunter LC, O’Hare A, Herron WJ, Fisher LA, Jones GE. Opioid peptides and dipeptidyl peptidase in autism. Dev Med Child Neurol 2003;45:121–128.

    CAS  Article  PubMed  Google Scholar 

  21. 21

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

    Article  PubMed  Google Scholar 

  22. 22

    Goodwin MS, Cowen MA, Goodwin TC. Malabsorption and cerebral dysfunction: a multivariate and comparative study of autistic children. J Autism Child Schizophr 1971;1:48–62.

    CAS  Article  PubMed  Google Scholar 

  23. 23

    McCarthy DM, Coleman M. Response of intestinal mucosa to gluten challenge in autistic subjects. Lancet 1979;2:877–878.

    CAS  Article  PubMed  Google Scholar 

  24. 24

    Pavone L, Fiumara A, Bottaro G, Mazzone D, Coleman M. Autism and celiac disease: failure to validate the hypothesis that a link might exist. Biol Psychiatry 1997;42:72–75.

    CAS  Article  PubMed  Google Scholar 

  25. 25

    Cade R, Privette M, Fregly M, Rowland N, Sun Z, Zele V, et al. Autism and schizophrenia: Intestinal disorders. Nutr Neurosci 2000;3:57–72.

    CAS  Article  PubMed  Google Scholar 

  26. 26

    Lau NM, Green PH, Taylor AK, Hellberg D, Ajamian M, Tan CZ, et al. Markers of Celiac Disease and Gluten Sensitivity in Children with Autism. PLoS One 2013;8:e66155.

    Article  Google Scholar 

  27. 27

    Samadi A, McConkey R. Indicators of Autism in Iranian Children. Intech 2013;1:29–48.

    Google Scholar 

  28. 28

    Sasanfar R, Toloie A. Standardizing and normalizing the autism diagnostic interview-Revised on Iranian Population. The Iranian Special Education Organisation, Tehran, Iran, 2006.

  29. 29

    Samadi SA, McConkey R. The utility of the Gilliam autism rating scale for identifying Iranian children with autism. Disabil Rehabil 2014;36:452–456.

    Article  PubMed  Google Scholar 

  30. 30

    Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006;130:1527–1537.

    Article  PubMed  Google Scholar 

  31. 31

    Safaee A, Moghimi-Dehkordi B, Pourhoseingholi MA, Vahedi M, Habibi M, Pourhoseingholi A, et al. Bloating in irritable bowel syndrome. Gastroenterol Hepatol Bed Bench 2011;4:86–90.

    PubMed  PubMed Central  Google Scholar 

  32. 32

    Jyonouchi H. Food allergy and autism spectrum disorders: is there a link? Curr Allergy Asthma Rep 2009;9:194–201.

    Article  PubMed  Google Scholar 

  33. 33

    Levy SE, Souders MC, Ittenbach RF, Giarelli E, Mulberg AE, Pinto-Martin JA. Relationship of dietary intake to gastrointestinal symptoms in children with autistic spectrum disorders. Biol Psychiatry 2007;61:492–497.

    CAS  Article  PubMed  Google Scholar 

  34. 34

    Prince Y. The association between children with Autism and gastrointestinal symptoms. McNair Scholars Research Journal 2013;6;88–104.

    Google Scholar 

  35. 35

    Whiteley P, Haracopos D, Knivsberg AM, Reichelt KL, Parlar S, Jacobsen J, et al. The ScanBrit randomised, controlled, singleblind study of a gluten-and casein-free dietary intervention for children with autism spectrum disorders. Nutr Neurosci 2010;13:87–100.

    CAS  Article  PubMed  Google Scholar 

  36. 36

    Millward C, Ferriter M, Calver S, Connell-Jones G. Glutenand casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev 2004;2:1–12.

    Google Scholar 

  37. 37

    Millward C, FerriterM, Calver S, Connell-Jones G. Glutenand casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev 2008;2:1–24.

    Google Scholar 

  38. 38

    Seung H, Rogalski Y, Shankar M, Elder J. The Gluten-and Casein-free diet and Autism: communication outcomes from a preliminary double-blind clinical trial. J MED SPEECH-LANG PA 2007;15:337–345.

    Google Scholar 

  39. 39

    Pennesi CM, Klein LC. Effectiveness of the gluten-free, caseinfree diet for children diagnosed with autism spectrum disorder: Based on parental report. Nutr Neurosci 2012;15:85–91.

    CAS  Article  PubMed  Google Scholar 

  40. 40

    Mulloy A, Lang R, O’Reilly M, Sigafoos J, Lancioni G, Rispoli M. Addendum to “gluten-free and casein-free diets in treatment of autism spectrum disorders: A systematic review”. Res Autism Spect Dis 2011;5:86–88.

    Article  Google Scholar 

  41. 41

    Lucarelli S, Frediani T, Zingoni AM, Ferruzzi F, Giardini O, Quintieri F, et al. Food allergy and infantile autism. Panminerva Med 1995;37:137–141.

    CAS  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Alireza Ostadrahimi.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ghalichi, F., Ghaemmaghami, J., Malek, A. et al. Effect of gluten free diet on gastrointestinal and behavioral indices for children with autism spectrum disorders: a randomized clinical trial. World J Pediatr 12, 436–442 (2016).

Download citation


  • autism
  • behavior disorders/problems
  • gastrointestinal system
  • gluten free diet