A gluten-free casein-free diet (or GFCF diet) is a restrictive diet which entirely eliminates intake of the naturally-occurring proteins gluten (found naturally in wheat, barley, and rye), and casein (found in milk). The GFCF diet is recommended by advocacy groups, such as the Autism Research Institute, to reduce the prevalence of certain behaviors associated with pervasive developmental disorders, especially autism. While multiple success stories have been published and circulated, results from clinical trials and double-blind studies have produced little to confirm the diet's efficacy.

Background and theory

In the 1960s, Dohan speculated that the low incidence of schizophrenia in certain South Pacific Island societies was a result of a diet low in wheat- and milk- based foods.^[1] Dohan proposed genetic defect as a probable etiology for schizophrenia, wherein individuals were incapable of completely metabolizing gluten and casein. The consequence of incomplete metabolism is excess peptide levels in the gastrointestinal tract, which Dothan hypothesizes are responsible for schizophrenic behaviors.

The possible relationship between gluten, casein, and autism was first articulated by Kalle Reichelt, M.D. in 1991.^[2] Based on studies showing correlation between autism and increased urinary peptide levels, Reichelt hypothesized that some of these peptides may have an opiate effect. Further work determined opioid peptides such as casomorphines^[3] (from casein) and gluten exorphines and gliadorphin (from gluten) as probable suspects, due to their chemical similarity to opiates. Reichelt hypothesizes that long term exposure to these opiate peptides may have effects on brain maturation and contribute to social awkwardness and isolation. On this basis, Reichelt and others have proposed a gluten-free casein-free diet to minimize the buildup of opiate peptides and promote typical development of brain function.

Reichelt's hypothesis is not generally regarded as a definitive etiology for autism, nor is the GFCF diet advocated as a "cure". While considerable attention has been given to metabolic and/or gastrointestinal factors related to autism,^[4], Reichelt's hypothesis is regarded as either incorrect, incomplete, or requiring further investigation.^[5]

Effectiveness of the GFCF diet

Reports on the effectiveness of the GFCF diet come overwhelmingly from testimonials of individual parents or teachers. Reported results range from reports that the diet has no discernible effect to claims of complete recovery following implementation of a gluten-free casein-free regimen.^[5] A more common report suggests that removing casein and gluten from an autistic child's diet increases eye contact, attention span, and general mood while decreasing problems like tantrums, self-stimulatory behavior (such as hand-flapping and rocking) and aggression.^{[citation needed]}

Results of controlled studies and clinical trials are less clear-cut. A small single-blind study has documented fewer autistic behaviors in children fed a gluten-free, casein-free diet but noted no change cognitive skills, linguistic ability or motor ability.^[6] This study has been criticized by medical practitioners^[7] for its small sample size, single-blind design (which may skew results on the basis of a "parent placebo effect"), and other unspecified design flaws.

A 2006 double-blind short-term study found no significant differences in behavior between children on a gluten-free, casein-free diet and those on regular diets.^[5] The study draws no certain conclusions, but suggests practices and methods for a well-designed long-term study to correct perceived flaws in previous work. A long term double-blind clinical trial sponsored by the National Institute of Mental Health is scheduled for completion in April 2008; preliminary results are not yet available.

Practical implementation

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Gluten-Free

The implementation of a GFCF diet involves removing all sources of gluten and casein from the child's diet. Gluten is found in all products containing wheat, rye, and barley and may sometimes contaminate oats grown nearby or processed on the same equipment as gluten-containing cereals.^{[citation needed]} Because a gluten-free diet is a well-established treatment for other disorders, such as celiac disease and dermatitis herpetiformis, there are many gluten-free breads, pastas, and snacks available commercially. Gluten-free cookbooks have been available for decades. Casein is found in dairy products such as milk or butter, but is also present in smaller amounts in many substitute dairy products such as margarine (in the form of whey) or vegetarian cheese substitutes, which use casein to provide texture.

While testimonials vary, a significant fraction report symptoms similar to withdrawal in the early stages of GFCF diet implementation. Positive testimonials also vary in the time required to see improvements in autistic behaviors; some reports claim an immediate reduction in such behaviors while others take up to a year or more to achieve noticeable results. These observations are the result of parent and teacher reporting and have not been substantiated in terms of formal diagnostic criteria or quantitative behavioral assessments.^{[citation needed]}

Other indications

Those suffering from celiac disease and/or dermatitis herpetiformis are instructed to avoid all forms of gluten, though their metabolic disorders are apparently distinct from the autism-related metabolic disorder hypothesized by GFCF proponents.^{[citation needed]}

See also

• Biomedical intervention for autism
• Gluten-free diet
• Raw food diet
• Quinoa

References

1. ^ Dohan, F.C. (1966) Cereals and Schizophrenia, data and hypothesis Acta Physiologica Scandinavica, 42, 125-132.
2. ^ Reichelt KL, Knivsberg A-M, Lind G, Nødland M. Probable etiology and possible treatment of childhood autism. Brain Dysfunct 1991; 4: 308-19
3. ^ Sun, Z. and Cade, J.R. (1999) A peptide found in schizophrenia and autism causes behavioral changes in rats. Autism, 3(1), 85-95.
4. ^ White, John F. (2003) "Intestinal Pathology in Autism" Experimental Biology and Medicine, 228, pp. 639-649.
5. ^ ^{a b c} Elder, J., et al. 2006. "The Gluten-Free, Casein-Free Diet in Autism: Results of a Preliminary Double Blind Clinical Trial." Journal of Autism and Developmental Disorders 36:413-420.
6. ^ Knivsberg, A.M., et al. 2002. "A randomised, controlled study of dietary intervention in autistic syndromes." Nutr.Neurosci. 5(4):251-261.
7. ^ Christison, George W. and Ivany, Kristany "Elimination diets in autism spectrum disorders: Any wheat amidst the chaff? Journal of Developmental & Behavioral Pediatrics. 27(2) Supplement 2:S162-S171, April 2006.

External links

• GFCFDiet Support Group
• Gluten free/ Casein Free Recipes and Menus
• Healing Thresholds provides daily summaries of research on GFCF diet and other therapies for autism
• More Information
• One Family's GFCF Story
• AutismWeb Diet Info
• Diet Resources
• Gluten Grains
• Teenage Celiac
• Gluten Free Support Club
• GFCF Lunchbox Ideas
• Biomedical interventions for Autism and Asperger's syndrome