1. Gluten-Free, Casein-Free Diet as a Treatment for Autism Spectrum Disorder How Alpert SPED 655 September 23, 2010

2. The Gluten-Free, Casein-Free Diet A restrictive diet – Precludes foods with two similar proteins Gluten – from grains Casein – from dairy

3. The Gluten-Free, Casein-Free Diet Based on one or more of several similar theories – ASD or symptoms caused or worsened by poor digestion of gluten and casein. Poor digestive enzymes Increased gastrointestinal permeability Absorption of toxic byproducts of incompletely digested proteins – Opioid-Excess Theory – Celiac Disease.

4. Implementation

5. GFCF Diet Overview, continued

6. Implementation Widely adopted – GFCF or other alternative diet was tried with 10% of children with Aspergers syndrome, 30% of children with autism – Advocacy Web sites – Popular health and wellness

7. An Even-Handed Look at the Research: Mulloy et al. 2010 14 studies. Poor scientific construction. All studies reporting positive results had the lowest certainty (suggestive). Reduced distress from foods allergies may account for behavior changes better than the Opioid-Excess Theory.

8. On the Other Hand: Whiteley et al. 2010 n=72 at start – n=55 at 12 months; n=25 at 24 months 5-11 years old 24 month trial Danish children diagnosed with ASD Stratified randomization – Control group assigned GFCF diet after 12 months. Significant improvement at 12 months Some evidence of sustained effect at 24 months – May indicate a plateau.

9. On the Other Other Hand: Elder et al. 2006 n=15 children 2-16 years old Diagnosed with autism spectrum disorder 12 week trial One of two diets provided double blind. Group analysis showed no significant differences. – No significant differences with formal behavioral and functional measures. – No significant differences for urinary peptide levels of gluten and casein (though casein was close). Parents of seven children reported marked improvements in language, hyperactivity, and tantrums. Other observers claimed language and behavioral improvements in two children. Parents of nine children decided to keep the children on the GFCF diet despite lack of scientific evidence.

10. On the Fourth Hand: Genius 2010 Case study (n=1) 5 years old Diagnosed with autism Within 1 month, the participant’s gastrointestinal symptoms were relieved and his behavior had changed dramatically. The mother reported that for the first time, her son was more communicative and told her that he loved her. Within 3 months, he no longer required special education plan and was placed in a general education classroom with no aide.

11. On Yet Another Hand: Goday 2008 Essay arguing against the use of restrictive diets, including GFCF “First do no harm.” Studies of children on the GFCF diet show – essential amino acid deficiencies – vitamin deficiencies – reduced bone cortical thickness. Long-term nutrition studies have not been done – Other problems associated with the GFCF diet may emerge.

12. However: Percy and Propst, 2008 Essay arguing for a link between celiac disease (CD) and ASD. CD may increase developmental delay, LD and ADHD. 15-20% of people with ASD have gastrointestinal problems. CD in 3.3% of children with autism versus <1% in general population.

13. Limited Supporting Information Some relationship. Weak relationship. Direction of relationship? – Does sensitivity result from ASD? – Does ASD result from sensitivity? – Are the effects of GFCF diet due to neurological relief? relief from the discomfort?

14. Implementation in Your Classroom Banished: – Wheat, rye, barley – Oats and millet too, because of processing facilities Substitutes: – Corn, rice, buckwheat, potatoes, and tapioca – Amaranth, arrowroot, montina, lupin, quinoa, sorghum, sweet potato, taro, teff, chia seed, yam – Bean and nut flours

15. Implementation: GFCF Bread Noah’s Bread 1/2 cup brown rice or sorghum 2/3 cup tapioca flour 1/3 cup corn or potato starch 2 tsp xanthan gum 2 tsp baking powder 1/2 tsp salt 1 egg (or sub) 1/3 cup oil 1/2 cup milk (or water) 1/3 cup sparkling water Preheat oven to 400 degrees Mix all ingredients well, except the sparkling water. Once the batter is well mixed, add the sparkling water to make the batter rise. Work quickly and form batter into buns, bagels, roll, etc. The batter should be thick and look somewhat lumpy. Don't use too much batter or form too high. The bread will puff and rise and settle back down once cooled. Bake for 20-25 min until the crust is golden brown. The crust will be hard out of the oven but will soften once cooled.

16. Implementation: GFCF Mac n Cheese 1 cup cooked rice elbow macaroni ¼ cup finely chopped onion 1 tablespoon margarine 1 tablespoon tapioca or corn starch Dash black pepper 1 ¼ cup Rice Milk 2 cups shredded American/cheddar cheese Cook rice macaroni according to directions. In a saucepan, cook onion in margarine until tender. Stir in flour and pepper. Add rice milk. Cook and stir until thickened and bubbly. Add cheese. Stir until melted. Stir macaroni into cheese. Transfer to a 1 quart casserole. Bake uncovered in 350 degree oven for about 20-25 minutes – until bubbly.

17. 1 cup plus two tablespoons Darifree powder 3/4 cup powdered sugar 1.5 cups very hot water 2 tablespoons shortening 1/2 tablespoon guar gum OR 1/2 teaspoon xanthan gum Put all into the blender and blend well for a couple of minutes. Stop and scrape down the sides to free any powder or clumps stuck to the side. Blend again until smooth. Put into a freezer safe container and freeze. You could also make this using an ice cream maker. Implementation: GFCF ice cream

18. References http://gfcfrecipes.blogspot.com http://bodyecology.com/autism.php http://gfcf-diet.talkaboutcuringautism.org/autism-diet-gfcf-foodlist.htm http://en.wikipedia.org/wiki/Gluten-free_diet http://www.youtube.com/watch?v=EmZczwtsbVc Elder, J. H., Shankar, M., Shuster, J, Theriaque, D., Burns S., and Sherrill, L. 2006. The gluten-free, casein-free diet in autism: Results of a preliminary double blind clinical trial. Journal of Autism and Developmental Disorders, Vol. 36, No. 3. Goday, P. 2008. Whey watchers and wheat watchers: The case against gluten and casein in autism. Nutrition in Clinical Practice, vol. 23 no. 6, pp. 581-582. Mulloy, A., Lang, R., O’Reilly, M., Sigafoos, J., Lancioni, G., and Rispoli, M. 2010. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. In Press. Percy M. and Propst, E. 2008. Celiac Disease: Its many faces and relevance to developmental disabilities. Journal of Developmental Disabilities, Volume 14, Number 2, pages 105-110. Whiteley, P., Haracopos, D., Knivsberg, A., Reichelt, K. L., Parlar, S. Jacobsen, J., Seim, A., Pedersen, L., Schondel, M., 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, Volume 13, Number 2, pp. 87-100.

19. References http://gfcfrecipes.blogspot.com http://bodyecology.com/autism.php http://gfcf-diet.talkaboutcuringautism.org/autism-diet-gfcf-foodlist.htm http://en.wikipedia.org/wiki/Gluten-free_diet http://www.youtube.com/watch?v=EmZczwtsbVc Elder, J. H., Shankar, M., Shuster, J, Theriaque, D., Burns S., and Sherrill, L. 2006. The gluten-free, casein-free diet in autism: Results of a preliminary double blind clinical trial. Journal of Autism and Developmental Disorders, Vol. 36, No. 3. Genius, S. J. 2010. Celiac disease presenting as autism. Journal of Child Neurology, Vol. 25, No. 1 pp. 114-119. Goday, P. 2008. Whey watchers and wheat watchers: The case against gluten and casein in autism. Nutrition in Clinical Practice, Vol. 23 No. 6, pp. 581-582. Mulloy, A., Lang, R., O’Reilly, M., Sigafoos, J., Lancioni, G., and Rispoli, M. 2010. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. In Press. Percy M. and Propst, E. 2008. Celiac Disease: Its many faces and relevance to developmental disabilities. Journal of Developmental Disabilities, Vol. 14, No. 2, pages 105-110. Whiteley, P., Haracopos, D., Knivsberg, A., Reichelt, K. L., Parlar, S. Jacobsen, J., Seim, A., Pedersen, L., Schondel, M., 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, Vol. 13, No. 2, pp. 87-100.