Presentation on theme: "Elimination Diets The Gluten and Casein Free Diet Presented by Jennifer Wertalik, Diana Kelly, and Cindy Romero."— Presentation transcript:
Elimination Diets The Gluten and Casein Free Diet Presented by Jennifer Wertalik, Diana Kelly, and Cindy Romero
What is a gluten and casein free (GFCF) diet? Most popular 8 in 10 children with autism may benefit Consists of eliminating the intake of the naturally-occurring proteins gluten (found naturally in wheat, barley, and rye) and casein (found in milk).
The Background… In the 1960s, Dr. Curtis Dohan proposed that an inherited defect interacting with an environmental trigger of gluten precipitated schizophrenia in some individuals. The possible relationship between gluten, casein, and autism was first articulated by Karl Reichelt, M.D. in 1991.
Who is Karl Reichelt? A pediatric medical doctor. Director of Clinical Chemistry for the Department of Pediatric Research at a hospital in Oslo, Norway Conducts research on the impact of gluten and casein intolerance in individuals with developmental delays.
The Leaky Gut Theory… The theory is that many if not all children with autism have a damaged intestine/gut. This "leaky gut" allows some food proteins to pass through into the bloodstream only partially digested, particularly gluten and casein. These proteins form peptides which have an opiate-like affect. They can bind to the receptors and cause harmful effects in the brain just like a regular opiate. Opiates can either cause or magnify autistic symptoms.
How does a GFCF diet improve the symptoms of autism? The opiates travel to the brain, where they induce a state similar to that of a drug-induced "high. When wheat and casein are removed from the diet, the child no longer experiences the high, and his or her behaviors and abilities radically improve.
Who is a good candidate for this diet? Does the child: have a "blotchy" complexion over his entire/part of body? seem to be "healthier" and perform better in the summertime? have sessions of "shakiness" (NOT of a seizural nature) in the hands, etc. when hungry or immediately after eating? need to eat something sweet before he will eat anything else? lick salt off chips, crackers, pretzels, etc.? consume large quantities of liquids over the course of the day? have an irregular stool pattern? have a history of illness in infancy and/or early childhood that occurs in "cycles?" For example, vomiting, diarrhea or upper respiratory infections, colds, etc. every 3, 6, 8 weeks?
…continued have a constantly running nose? urinate more at night (quantitatively) than for the same length of time during the day? suffer from numerous ear and/or sinus infections? have a history of prematurity, postmaturity, hyper-bilirubinemia, or other neonatal traumas? have psoriasis or eczema, or other "unexplained" rashes? appear to have cycles of dramatic behavioral changes (good or bad) that recede after 3-4 days? seem to have "headaches?" i.e., like to have his head rubbed or pressed hard against an object or person, burrowed or be held upside down? have excessive flatulence? jump or bounce for an extended period of time?
…continued have certain times of the day when he is more "hyper" than others? i.e., before or after meals? have a preference for chicken, fish, or pork over beef or lamb? prefer extremely bland or excessively spicy foods? have a history of reflux? (burping up acids, vomitus) have small raised "bumps" similar to "goose bumps" or little white bumps that remain unchanged all over his/her body? have a "furrow" between his brow? have a "colicky" infancy? have a strong smelling urine or breath? have a thick "inner tube" of fat build-up around his neck? have a history of being extremely "difficult" to burp as an infant?
What behaviors are supposed to improve? Language Less impulsive behaviors More focused Improved eye contact Socialization Fewer bouts of diarrhea and loose stools
More claims… Sleep better Less stereotypy Less tantrums Happier
Whats the downside? Expensive Difficult to find GFCF foods May be hard to find foods your child likes You must be 100% gluten and casein free… no cheating ever!!
Suggestions… Start the diet gradually. Add more foods to your child's diet that are acceptable BEFORE you start the diet. Avoid cross-contamination. Read all ingredients carefully. Tell everyone in your childs life.
So what CAN they eat? Rice Potatoes Fruits and vegetables Meat, poultry, and fish Soy, nuts, and eggs
Success Stories Since he has been on the diet, he is a completely different child. After 3 days without dairy, WOW! All of a sudden we had an alert child! He was talking more, making sense of the world more, and engaging us! On the second day he started making eye contact. Within a week he could recognize and recite the entire alphabet. Significantly less difficult tantrums and sleeping well through the night for the first time in his four year old life. His language has increased greatly and echolalia is virtually gone.
More success stories… Within 4 months of starting the diet, he was potty trained, started reading, started saying long and sophisticated sentences, he lets us cut his hair without any problem, hand flapping has gone down to a minimum. He started talking ten days after we began the diet. On the second day, he looked me straight in the eyes and smiled, as if he had never seen my face before! Just last week he told me I love you. We cured our son's autism.
Research The Gluten-Free, Casein-Free Diet in Autism: Results of a Preliminary Double Blind Clinical Trial Jennifer Harrison Elder, Meena Shankar, Jonathan Shuster, Douglas Theriaque, Sylvia Burns, & Lindsay Sherrill Journal of Autism and Developmental Disorders, Vol. 36, No. 3, April 2006
Research Purpose: This study tested the efficacy of a gluten-free and casein-free diet in treating autism using a randomized, double blind repeated measures crossover design.
Research Participants: 15 children aged 2-16 yrs with ASD (Autism Spectrum Disorder) 12 boys and 3 girls 13 of the children completed the 12- week protocol
Research Method: Used CARS (Childhood Rating Scale) & Autism Diagnostic Interview- Revised (ADI-R) to describe subjects The following instruments were used to measure dependent variables: CARS, Urinary Peptide Levels (UPL), Ecological Communication Orientation (ECO) Language Sampling Summary, & In-Home observations
Research Method cont.: In-home observation: A research assistant trained in videotaping techniques & maintaining unobtrusiveness during home visits, videotaped each child interacting with his/her primary care-taking parent for 15 minutes during unstructured sessions.
Research Method cont.: In-home observation cont. Trained coders obtained behavioral counts of parent and child behavior. Coders did not know the status of the subjects with regard to treatment phase. Data were collected at 3 points in time: immediately before diet began, at the end of 1 st dietary condition (week 6) and at the completion of study (week 12).
Research Method cont.: GCRC (General Clinical Research Center) data manager randomly assigned participants to either the GFCF or a placebo diet Children, parents, & all of the investigative team except for the data manager and dietician were blind to dietary order Participants were provided all meals & snacks from the GCRCs Metabolic Kitchen for 12 weeks
Research Method cont.: Each participants regular diet was provided during baseline and for 6 weeks as the control diet The experimental diet consisted of gluten- and casein-free counterparts food items in the control diet to insure parents & observers were blind
Research Design: Randomized, double blind repeated measures cross over design of 13 children comparing two diets (regular diet vs. GFCF diet) in terms of autism symptoms measured by the CARS, ECOS, frequencies of social initiating, social responding, intelligible words spoken, and non- speech vocalizations
Research Design cont.: Primary measure of efficacy was the CARS, which was measured at baseline, week 6 (at the end of regular diet) and week 12. Urinary peptide levels were measured at 5 points (day 1, week 3, week 6, week 9, week 12)
Research Results: No significant differences in grouped data for urinary peptide levels of gluten and casein No significant differences with CARS, ECOS, or behavioral frequencies No statistically significant differences in observed parent behaviors
Research Results cont.: Some anecdotal reports varied from the non- significant findings Parents of 7 children reported that there were marked improvement in childs language, decreased hyperactivity, & decreased tantrums Parents of 9 children decided to keep their child on the GFCF diet even though there was no empirical support for continuing
Research Results cont.: Before unblinding, parents were asked to comment on whether they thought their child was on the GFCF diet the 1 st or 2 nd 6 weeks: 5 were correct 2 had no idea 6 were in correct
Research Conclusions: Statistically non-significant findings may be the effect of small sample size, and/or large with-in group variance Even though grouped data was non-significant for each dependent variable, behavioral & language improvements could be seen in individual children
Research Conclusions cont.: 8 parents were unable to correctly distinguish the placebo & experimental diets This indicates that the study was able to successfully produce & implement a GFCF placebo diet & has important implications for future dietary research
Research Limitations: Sample size was small & heterogeneous Several reports of children sneaking food from siblings or classmates Labels should be carefully read as there is some indication that soy products may affect urinary peptides and introduce confounds
Research Limitations cont.: CARS was a useful screening instrument, but it may not have detected some of the more subtle changes reported by families Some speculation regarding parental placebo effects related to the GFCF diet effectiveness
Research Future Research: Use larger, more homogeneous samples Replicate study in a more controlled educational or inpatient setting and/or extend data collection for a longer period of time Include a combination of direct observational methods as well as several additional instruments suited to repeated measures designs that have well-established psychometrics
Research Other studies: Effects of a Dietary Intervention on Autistic Behavior (2003). Ann-Mari Knivsberg, Karl-L. Reichelt, Torleiv Hoien, and Magne Nodland Focus on autism and other developmental disabilities (2003)
Research Other Studies cont.: Knivsberg, Reichelt, Hoien, and Nodland (2003) and others conducted a randomized single blind study with 20 subjects to assess the effect of a gluten- casein-free diet on children with autistic syndrome and urinary peptide abnormalities.
Research Other Studies cont. Children in the control & experimental group were matched according to severity of autistic symptoms, age, & cognitive level Professionals outside the project randomly assigned participants to diet group or control group Dietician gave all parents of children in diet group oral and written information about gluten-free and casein-free diet Experimental period was 1 year, after which observations and tests were repeated
Research Other studies cont.: Changes were observed in both the control and experimental group; however the experimental group showed more significant changes Experimental group had improvement in autistic behavior, non-verbal cognitive level, and motor problems
Research Other studies cont.: Limitations Monitoring compliance with diet was not carried out When evaluating changes in childrens behavior, it is difficult to decide if changes are due to intervention or maturation Placebo effect- assumption that diet could have a positive effect could have altered the attitude of parents toward children
Current Research Diet and Behavior in Young Children with Autism The Autism Research Centers of Excellence: The STAART Program Primary Site: University of Rochester Susan Hyman, M.D., Principal Investigator Study start: January 2004; Expected completion: April 2008 Purpose: This study will determine whether a gluten- and casein-free diet has specific benefits for children with autism
Current Research Method: 30 children will be following a gluten- and casein-free diet for 18 weeks All subjects will have 6 weeks of baseline followed by 12 weeks of randomized, double- blind, placebo-controlled, challenge snacks with careful behavioral observation and evaluation All subjects will receive a standard vitamin supplement
Current Research Method cont. Receiving uniform educational and behavioral services through their provider Standard autism evaluation methods, weekly diet and sleep diaries and scheduled laboratory tests will be used to assess subjects Follow-up assessment will be completed at 30 weeks after the start of study
Current Research Eligibility: Ages Eligible for Study: 30 Months - 54 Months Genders Eligible for Study: Both Criteria Inclusion Criteria: Autism spectrum disorder or pervasive developmental disorder Participation in applied behavioral analysis classes for at least 4 months, with at least 20 hours per week of service, and at least 1 hour of service in the home
Current Research Eligibility: Inclusion criteria cont. A score higher than 30 on the Mullen Early Learning scale Ability to maintain a gluten- and casein-free diet during the study In order to maintain study integrity, and due to frequent child assessments, enrollment is limited to a select population within the Rochester area
Statistics and the Internet According to The Clinical Manual for the Treatment of Autism, a Google search for the terms autism and alternative medicine yielded 600,00 sites. As of November 16, 2007, my Google search for diet and autism yielded 1,920,000 sites.
Alternative Therapies and Autism One important caveat must be noted when dealing with theories that are not supported by scientifically derived empirical data. Hype changes over time.
The Elimination Diet – From One Whos Been There & Done That The most well-known proponents of the elimination diet are: ARI – via the DAN! Protocol, first published in 1994; Karyn Seroussi (parent); Lisa Lewis, PhD (parent).
Autism Research Institute The Autism Research Institute (ARI), a non-profit organization, was established in ARI is primarily devoted to conducting research, and to disseminating the results of research, on the triggers of autism and on methods of diagnosing and treating autism. We provide research-based information to parents and professionals around the world.triggers of autism methods of diagnosing and treating autism -ARI website, autism.com
Dr. Bernard Rimland Degree in Psychology from San Diego State University; Degree in Experimental Psychology, Penn State University Son, Mark, born in 1956, with obvious developmental problems diagnosed as autistic at age 2 Was a naval psychologist until retiring in 1985.
Rimland, continued Early champion of Applied Behavior Analysis as initially developed by O. Ivar Lovaas. By the early to mid-1960s, believed autism to be a biological disorder caused by external insults. In 1967 founded ARI with Drs. Sid Baker and Jon Pangborn to investigate alternative interventions. - The Independent, London ( November 28, 2006): autism.com
Jon Pangborn Jon Pangborn, Bachelors degree (1963), Ph.D. (1967) in Chemical Engineering from Syracuse University. Parent of an autistic son. Until 1981, Dr. Pangborn employed full-time in researching alternative fuels and catalytic processes involving natural gas. In 1981, he left to engage full-time with ARI on autism and metabolic processes. -Pangborn, J., Baker, S. (2005; 2007 Supp.). AUTISM; Effective Biomedical Treatments.
Sidney MacDonald Baker, MD Sidney Baker, MD (Yale University). Residency in Pediatrics. Full-time faculty post as Professor of Medical Computer Practices began full-time family practitioner. Director of Gesell Institute of Human Development becomes interested in biomedical aspects of chronic illness returns to private practice. -Pangborn, J., Baker, S., (2005) AUTISM: Effective Biomedical Treatments.
DAN! Protocol What is a DAN! doctor? c.htm c.htm
Insert from p. 183 of DAN! Protocol guide
DAN! Tools The DAN! Protocol is contained in 318 pages of Autism: Effective Biomedical Treatments, ARI (2005) plus another 56 pages in a 2007 supplement. The original protocol was first published in ATEC, ATEC Internet Scoring Program
DAN! Protocol Among its many biomedical interventions, the DAN! Protocol advocates the use of the GFCF diet (as well as chelation, vitamins, enzymes, and many other interventions.)
ARI Guidance on Efficacy of Treatment ARI article on How to Determine If a Treatment Really Helped
Karyns Journey Karyns book, Unraveling the Mystery of Autism and Pervasive Developmental Disorder, A Mothers Story of Research and Recovery, (Broadway Books, New York, 2000 & 2005) chronicles the interventions she used with her son, Miles.
Seroussis Background Karyn Seroussi, formerly the owner of two retail businesses, is now a freelance writer, and the cofounder (with Lisa Lewis) of ANDI, the Autism Network for Dietary Intervention. Her husband, Alan, was a scientific researcher in clinical diagnostics in the Ortho division of Johnson & Johnson.
Miles History Miles was born in January According to Seroussi, he develops normally until 11 months old, although he has a history of reflux and chronic ear infections.
Miles &Vaccinations Miles health had never been vigorous,; had severe reactions to his vaccinations, particularly the DPT and MMR About 12 mos. Old, Miles has a bad virus after which he is chronically cranky At 15 months, after his MMR, Miles begins to slip in development. At 19 months, psychologist advises Miles is ASD and suggests a formal evaluation and Karyn begins researching autism.
Finding the Diet While awaiting outcomes of Speech and Hearing evaluations Karyn finds books A Parents Guide to Autism by Charles Hart, Fighting for Tony by Mary Callahan, Is This Your Child? By Doris Rapp, and Let Me Hear Your Voice by Catherine Maurice. Meanwhile, Alan, her husband, finds something called Lavois.
Beginning of the Diet First, Karyn reads the Callahan and Rapp books. Both are based upon the allergy to milk theory. Tony had a rare cerebral allergy to milk. Rapp suggests that allergies result in behavioral as well as physiological symptoms. Karyn immediately removes dairy from Miles diet and reports that within 3 weeks she sees less screaming & better eye contact. We could really see a difference.
Diet Continued: Karyn now begins to contact the opiod theorist, Dr. Stephen Bauer. Miles begins Sensory Integration Therapy, Speech Therapy, and is evaluated for Early Intervention services from the county. Then, Karyn reads Let Me Hear Your Voice.
ABA Karyn immediately adds a Lovaas based ABA program to Miles therapies.
Seroussi Finds Lewis Karyns internet research brings her into contact with Dr. Paul Shattock, University of Sunderland, England, who subscribes to Reichelts theory of opiods. Shattock mentions Lisa Lewis.
Seroussi - Lewis Connection She also comes into contact with Lisa Lewis, another parent who advocates gluten free, casein free, phenolic free diets plus digestive enzymes and Gamma Linoleic acid supplementation.
Seroussi and ARI Karyn links up with Dr. Bernard Rimland at ARI. (Dr. Rimland earned his Ph.D. in experimental psychology and research design from Penn State University). Dr. Rimland who is putting together a collaboration of like- minded scientists to create the first DAN! (Defeat Autism Now) Conferences and to generate the DAN! Protocol Manual.
Diet Continued: Karyn also researches Dr. William Crook, author of The Yeast Connection (1983) and William Shaw, Ph.D., who later authors Biological Treatments for Autism and PDD (1998).
MD from the University of Virginia Fellow, American Acad. Of Pediatrics; American College of Asthma, Allergy & Immunology; American Academy of Environmental Medicine Dr. William Crook
William Shaw, Ph.D. Ph.D. in Biochemistry, board certified in Clinical Chemistry & Toxicology. Founder of The Great Plains Laboratory in Kansas that tests for IgG food allergies, and for blood and urine peptides.
Karyns Journey continued: Over the next three years, Karyns research takes her into the area of gluten free diet, the yeast connection and supplements. Her husband, Alan, uses J&J facilities to isolate dermorphin in addition to gluten and casein opiod urinary peptides. Posits that diet is not enough, need anifungals, and other biomedical interventions as well.
Karyns Journey continued: Miles continues with the GFCF diet, ABA, multivitamins, Nystatin, Flagyl, DMG, EFAs, probiotics, SI, and, (after meeting Dr. Andrew Wakefield) Secretin. By age 4 ½, Miles enters a neurotypical kindergarten. All his biomedical interventions, however, continue.
Karyns Explanation For Miles Recovery As much as the discrete trial therapy and the physical therapy helped Miles to catch up, neither of them would have been one-tenth as effective if he had not been on the diet. I simply knew this to be true.
Why Did Maurice Children Recover Without Diet? Seroussi (and Shattock) believe that the Maurice children recovered with only ABA and no diet because it might have been triggered by mumps virus, with temporary damage reversible by intensive therapy, or if measles based, the missing enzymes are somehow triggered and the problem goes away. This would explain the spontaneous recoveries you sometimes hear about without use of the diet. (p.191).
Karyns Diagnosis of Miles Now [A]utism describes behavior. I am not afraid to say that my son has a [biologically based] disease [autistic enterocolitis as a result of persistent measles virus infection of the ileum] that causes autism, but it would be inaccurate to say that he is autistic. He is not.
Lisa Lewis, PhD Biography
ANDI Seroussi and Lewis found ANDI, the Autism Network for Dietary Intervention.
Lewis Journey With Sam Son, Sam, has normal development, but by 2 years, lagging badly. At age 3 ½, a neurologist confirmed husbands diagnosis of Sam as PDD-NOS, and an evaluation by the Eden Institute recommends an educational placement more specific to autism than Sams current pre-school handicapped program. Sam placed at the Douglass Developmental Disabilities Center the following fall. Pending his start at Douglass, Sam becomes aggressive. Lewis decided to remove dairy, and although behavior improved, it remained a significant problem.
Journey Continued: Sam does very well at Douglass with ABA, including mild aversives to eliminate aggression. Lewis not comfortable with use of aversives and felt that they in fact escalated the behaviors, so permission for their use if withdrawn. Sams aggressions increase.
How Lewis Treats Sam Not knowing what else to do I decided to experiment again with Sams diet. I chose to remove wheat because I knew it was a common allergen. After five days, Sams aggressions dropped dramatically. Shortly thereafter, she finds Reichelts and Shattocks papers and determines that gluten is the culprit and eliminates them.
Lewis Results: Result – Within a week, Sams language improves, his attention span increases, and he responds more quickly to lessons at Douglass, home, in private speech and occupational therapy. Sam is then placed on strict anti-yeast diet. Dr. Sidney Baker orders extensive blood, urine, saliva and stool testing. He adds vitamins, calcium, and zinc. Lewis later adds molybdenum, magnesium, EFAs, DMG, L- Carnitine, probiotics, inositol, ginkgo extract, pycnogenol, and octocosanol.
Diet Continued: No benefits seen from DMG, L-Carnitine, pycnogenol or octocosanol, so removed. Sam continued at Douglass, and this year was transitioned into regular school. He is in a self- contained class for academics with a 1:1 aide trained by Douglass.
Lewiss Explanation: Sams diet and nutritional supplements are certainly not the only things that have helped Sam. He spent four years at an excellent school [Douglass], and attended weekly speech and sensory integration therapy for five years. For two years he wore yoke prism glasses and visual therapy prescribed by Dr. Melvin Kaplan of Tarrytown, New York. Sam also takes Risperidal during the winter to combat increased tantrums and difficult behavior seen on a seasonal basis.
Lewis Second Son & Diet: Sams brother, Jake, was born when Sam was 3 (pre- Sam diet). At 9 months, Lewis concerned about his little pre-verbal development. Milk made him fussy so she substituted soy. Within days she reports he was saying Mamammamama and dadadada and the like and his development has since been normal. Did I save him from autism? From some other developmental disability? Ill never know.
Nonfalsifiable Hypothesis Karyn Seroussi is careful to point out in her book that a professor of hers who taught Pseudoscience and the Paranormal warned about Nonfalsifiable hypotheses and emphasized the need for careful scientific experimentation. Seroussi credits this emphasis in causing her to be objective in her evaluation and assessments of changes in her son.
Deficits in Seroussi & Lewis Evaluations: In the case of the elimination diet, neither Seroussi nor Lewis, nor anyone else, for that matter, can scientifically prove or disprove its impact. Neither Seroussi nor Lewis limited their interventions strictly to diet. There was no way to account for maturation, history, or any other variable, given so many things were done at once.
Nutritional Dangers: Elimination of dairy and gluten runs the possible risks of inadequate proteins, minerals and vitamins in the diet. Preliminary scientific research studies have shown that the diet has been associated with decreased bone density. (Brudnak et al Hediger et al. 2005).
Dangers continued: Parents may be unsupervised by physicians and/ or nutritionists in implementing the diet.
Dangers continued: Parents may be easily convinced that they need to use additional interventions: e.g. enzymes, supplements (regulated and unregulated), homeopathics, etc. O%202007%20presentation.ppt O%202007%20presentation.ppt ee9e bc ee9e bc8-81
Dangers continued: Parents have unrealistic expectations about the purported effects of alternative treatments. Parents ignore validated interventions or dilute commitment to validated treatments. - The Road Less Traveled: Charting a Clear Course for Autism Treatment;
The ABA Community and The Biomedical Community At least one ABA based website has taken a position with respect to Biomedical Treatments. Does not discredit biomedical notions, encourages scientific designs; however, allows for concurrent interventions.
Epilogue The skepticism raised in this presentation is not to suggest that there is not some biologically based cause or confluence of causes (genetic or otherwise) resulting in Pervasive Developmental Disorders. However, it has yet to be empirically demonstrated with scientific rigor.
The Parent Trap – False Hopes Can Be Deadly The danger in all the hype created by unproven treatments can best be seen in a recent article in The New York Times.
References Elder, J. H., Shankar, M., Shuster, J., Theriaque, D., Burns, S., & Sherrill, L. (2006). The Gluten-free, casein-free diet in autism: resluts of a preliminary double blind clinical trial. Journal of Autism and Developmental Disorders, 36, Green, V., Pituch, KA, Itchon J., Choi, A., OReilly, M., Sigafoos, J. (2006). Internet survey of treatments used by parent of children with autism. Research in Developmental Disabilities, 27, Hollander, E., Anagnostou, E. (2007). Clinical Manual for the Treatment of Autism, Virginia: American Psychiatric Publishing, Inc. Jacobson, J. W., Foxx, R. M., Mulick, J. A. (2005). Controversial therapies for developmental disabilities: fad, fashion, and science in professional practice. New Jersey: Lawrence Erlbaum Associates, Inc.
References Knivsberg, A., Reichelt, K., Hoein, T., & Nodland, M. (2003). Effects of a dietary intervention on autistic behavior. Focus on Autism and Other Developmental Disabilities, 18, Lewis, L. (2005). Special diets or special people. Texas: Future Horizons, Inc. Pangborn, J., Baker, S.M.,(2005, Supp. 2007). Autism: Effective Biomedical Treatments. California: Autism Research Institue Publications. Seroussi, K. (2002). Unraveling the mystery of autism and pervasive developmental disorder. New York: Broadway Books). [originally published 2000, New York, Simon & Schuster]. Shaw, W. (1998). Biological Treatments for Autism and PDD. Kansas: The Great Plains Laboratory.
References 4bc8-81www.sagemedlab.com/ads/autism.html?_kk+autism&_kt+4692ee9e bc
References ww.autismone.com/uploads/Devin%20Houston%20AO%202007%20presentat ion.ppt 4bc8-81www.sagemedlab.com/ads/autism.html?_kk+autism&_kt+4692ee9e bc en.wikipedia.org/wiki/Gluten-free,_casein-free_diet autism.about.com/od/ specialdietsandautism/a/startgfcf.htm