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Autism and a Gluten Free Diet

Should Your Child with Autism Avoid Gluten?

The Atkins Diet. Weight Watchers. Paleo. Coconut oil. Gluten Free. Casein Free. You may be familiar with some of these diet trends. People are constantly on a quest for the perfect diet that will shed the pounds and keep them off. Others are looking for diets that regulate their digestive systems and keep their stomach calm. And if you are a parent of a child with autism, you may have heard people maintain that a gluten-free or casein-free diet can be used to help manage behaviors associated with autism.

With the idea of placing a child on a diet for management of symptoms, many questions arise. Does aShould Your Child With Autism Eat a Gluten Free Diet? gluten-free diet make a difference for children with autism? What does the research say? How do you know if it’s working?

Let’s back up a little bit and look at why specific diets for children with autism are being considered. Gastrointestinal problems are often described in children with autism, however the prevalence of these issues has not been consistently proven to be higher than in the general population.

Unfortunately for the sake of determining benefits of a gluten free diet, every child with autism presents differently and will likely have different responses to dieting. Also, unfortunately, the literature is extremely limited and providing conclusive evidence that a specific diet improves behaviors associated with autism has yet to be done. Some studies have yielded positive results (improvements in symptoms), while others have yielded negative results (no improvements noted). It is important to note that none of these studies have provided conclusive evidence; studies reporting positive results were merely suggestive (the lowest level of certainty).

Now you may be thinking, what will it hurt to place my child on a gluten-free or casein-free diet? According to Mulloy et. al, these diets may put children at risk for nutritional deficiencies. Further, this population of children often encounters challenges to ingesting a typical diet to begin with, such as sensory processing difficulties that lead to limited food intake and restricted diets. This can make feeding your child difficult if they are already only accepting chicken nuggets and string cheese. Additionally, implementing a diet of this type is costly and time-consuming.

Should you decide to try a gluten-free diet for your child with autism, here are some important things to remember:

  • Keep objective measures: It will likely be hard for your child to accurately report how they feel given commonly associated language deficits in children with autism. Ask yourself, “How do I know that my child’s sleep is improved?”, or “How do I know that attention is improved?” Find a way to measure data for these questions, such as counting naps taken each day or minutes spent engaged in a task.
  • Involve others: Ask for help from people that spend a lot of time with your child. Ask them to objectively measure behaviors as best they can, and seek their results.
  • Keep a food diary: Track what your child eats for every meal, and any notable behaviors or improvements for each day. This ensures accurate implementation of the diet and gives you the ability to reflect on the weeks and months.
  • Be committed: In a systematic review, more positive results were yielded with longer implementation of the diet.  For example, studies yielding negative results were implemented for an average of 5 weeks while studies yielding positive results were implemented for an average of 18 months.
  • Keep other factors in mind: It is challenging to prove that improvement is due to one factor vs another. For example: If your child experiences improved sleeping patterns, perhaps eliminating sugary foods in general is the cause  as opposed to the removal of gluten. Always think twice before determining cause, and consider all potential variables at play.

If you are exploring diet options for your child, seek the guidance of a dietitian or nutritionist to ensure healthy implementation.

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References:

  • Mulloy, A, et al. Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders (2009), doi: 10.1016/j.rasd.2009.10.008
  • Buie, T. (2013). The relationship of autism and gluten. Clinical Therapeutics, 35, 578-583.

Is Gluten Bad For You?

Recently a colleague asked me: “is gluten bad for you”? I know this question is stemming from the popularity of gluten-free diets. My guess is that many people do not know what exactly gluten is and when a gluten-free diet is actually appropriate. So to answer the question, no, gluten is not bad for you inherently, although it does make some people sick.

Gluten is a protein fraction found in wheat. Yes, gluten is actually a protein. Gluten itself is not a carb. Gluten is found in a carb, and wheat is a major staple carb source in most Americans’ diets multiple times per day. This is why sometimes people lose weight when they go gluten-free, because they are cutting out lots of starchy calories.

How Gluten May Make People Sick:

As I said, gluten can make some people sick. Gluten is the protein culprit that causes the devastating autoimmune response in the gut for people with Celiac disease. Our gut is lined with tiny villi that look like millions of fingers, and these villi contain important enzymes for digestion and also absorb all of the vital nutrients from food that our body needs to function. When someone with Celiac eats gluten via wheat, the gluten causes an immune reaction where the villi are destroyed. On a biopsy under a microscope, the villi will actually look flat and blunted.

gluten diet

Photo from www.marquettenutrition.com

This causes significant symptoms, which vary by person, but can include nutritional deficiencies such as iron deficiency anemia, weight loss, growth stunting, diarrhea, abdominal pain, and vomiting. Celiac disease is also genetic. Some people live with Celiac disease and the accompanying symptoms for years before getting diagnosed. There is more awareness now of Celiac disease, so more people are getting diagnosed. The gold standard of diagnosing Celiac is with a biopsy of intestinal villi by a gastroenterologist. The treatment is life-long strict avoidance of all gluten, and education is provided by a registered dietitian.

What is a Wheat Allergy:

Wheat allergy is one of the top 8 most common food allergies diagnosed in children. A wheat allergy is different than Celiac in that it is not a genetic, auto-immune mediated response, but rather an immune response where IgE antibodies react to wheat proteins as foreign antigens, and mount a response that produces symptoms. These can include eczema, diarrhea, abdominal pain, vomiting, and more. A registered dietitian can help families navigate the difficult wheat-free diet in this case as well.

Finally, many people try a gluten-free diet because they suspect gluten or wheat intolerance. With a gluten intolerance, the immune system is not involved as with allergies or Celiac. But nevertheless, people find that consuming wheat products makes them sick in one way or another. When they stop eating wheat for a couple weeks, they notice many positive changes in their health and the way they feel. For some people this can mean fewer headaches, or less stomach aches, or more energy, or rashes that disappear, and so on.

To reinforce the point, gluten is not bad for you or your kids to eat, unless one of the above scenarios applies. Wheat should be eaten in moderation however, and I recommend rotating different types of grains into your family’s diet for well-rounded nutrition and to prevent over-exposure to one particular food. Some different grains to experiment with include quinoa, amaranth, rice, buckwheat, and millet.

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