Why Gluten Free Diet For Autism – Background: A gluten-casein-free diet (GFCF) has been shown by strong anecdotal reports from parents to significantly improve and even “cure” symptoms of autism spectrum disorders (ASD). But to date, there is little convincing empirical evidence to support its use.
Purpose: The purpose of this paper is to provide an overview of recent data on the use of the GFCF diet in the treatment of individuals with ASD.
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Methods: Five database providers (PubMed, Web of Knowledge, EBSCO, ProQuest, and WorldCat) were used to search 19 databases, yielding a total of 491 articles published in February 2015. Peer-reviewed articles published since January 2005 .through February 2015 were included for consideration if study participants were diagnosed with ASD and the study examined the effect of a GFCF diet on ASD behaviors or the relationship between diet and these behaviors.
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Results: Evaluation of the search results yielded eleven reviews, seven cohort studies, including five randomized controlled trials, five case reports, and four cohort observational studies published in the last 10 years. These studies represent a significant increase in the number of reported studies as well as an increase in scientific rigor in the study of GFCF diets in ASD.
Conclusion: Although strong empirical support for a GFCF diet in ASD is currently lacking, research suggests the need to identify subgroups of individuals (eg, those with documented gastrointestinal abnormalities) who may respond best to a GFCF diet. Defining these subsets is urgently needed to increase rigor in this area of research. Until definitive studies supporting the use of the GFCF diet are reported, clinicians should continue to exercise caution and consider several factors when counseling the implementation of a GFCF diet for individuals with ASD.
Autism, or the broader category of autism spectrum disorders (ASD), continues to pose challenges in determining the most effective and efficient treatment approaches for managing social, communicative, behavioral, and developmental symptoms.
Interventional approaches to autism are the subject of a large number of clinical reports and case studies; less often than intensive intervention trials. Recently, the idea of ASD has expanded from a single mental condition to a multisystem inflammatory disorder that includes systemic inflammation of the gastrointestinal tract (GI) that affects the brain, immune system, and metabolism.
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One common treatment for potential systemic inflammation is the gluten-casein-free (GFCF) diet.
Where a possible genetic defect can contribute to what is known as “leakage”, leading to an overload of gluten (from wheat) and casein (from dairy). This overload is thought to result in high levels of the peptide, which can cause an opioid-type effect that is reflected in the behavioral symptoms commonly seen in ASD.
Others believe that many people with ASD may have undiagnosed stomach conditions and sensitivities that may be caused or affected by casein and gluten intake. This discomfort can lead to externalizing behaviors (such as tantrums, screaming, and aggression), and in some cases, even severe pain and inattention to tasks due to pain-induced distraction.
Notes in its case report that a thorough review should consider case studies as well as clinical trial reports to provide a “complete picture of the landscape” of what is currently known about the GFCF diet. Such comprehensiveness is necessary to help families and clinicians make informed decisions about implementing the GFCF diet and to identify specific areas for future research.
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The aim of this document is to provide an overview of the latest evidence regarding the use of the GFCF diet for the treatment of people with ASD, as needed to guide future research and develop recommendations for clinical practice. Therefore, we reviewed the scientific literature published between January 2005 and February 2015 and organized our review into four parts: summaries of review articles, group trials of interventional studies including randomized clinical trials, case reports, and observational group studies. research.
We began the review with a literature review to obtain a broad overview of the current relevant literature. Table 1 details our search strategies created by the third author, a research librarian. Nineteen databases from five database providers (PubMed, Web of Knowledge, EBSCO, ProQuest, and WorldCat) were searched using subject headings and keywords, and the latter narrowed and/or phrase searched for different types of gluten, casein, essay GFCF food, catch autism. , ASD and Asperger syndrome. As a result of the search, 491 articles were found. Removal of duplicates and non-English-language articles left 290 possible articles whose titles (and abstracts, if applicable) were reviewed by two members of the research team. Additional verification was performed for 1) publication date prior to 2005; 2) type of publication, such as commentary, letter to the editor, book chapter, or thesis/dissertation; 3) publication in a non-reviewed periodical; 4) major ingredients not associated with a gluten- or casein-restricted diet; 5) major topics not related to ASD; 6) study participants without ASD; and/or 7) publications that are not English language publications. The full texts of the remaining 61 publications were read and sorted by article type (ie, review, experimental, case, observational group). Review articles on the GFCF diet in ASD were retained; all other articles were read to focus on the use of the GFCF diet in ASD. A reverse reference search of the eleven articles included in our review yielded one additional abstract to the publication, resulting in 27 publications included in our review. At each stage of the article reduction process, the two researchers discussed discrepancies in their independent assessments until consensus was reached; when necessary, a third member of the research team assisted in the discussion.
Abbreviations: AB, abstract; ASC, autism spectrum condition; ASSIA, Index of Applied and Abstract Social Sciences; ASD, autism spectrum disorder; CINAHL, Cumulative Index of Nursing and Allied Health Literature; DE, reporter; ERIC, Educational Resources Information Center; GFCF, gluten-free, casein-free; GFD, gluten-free diet; MH, subject heading; TI, name
Review articles, intervention studies, case reports and observational cohort studies were included if study participants were identified as having ASD and the study investigated the effect of a GFCF diet on ASD behavior or the relationship between diet and behavior in people with ASD. All articles included for review were published in peer-reviewed English-language journals between January 2005 and February 2015. Studies were excluded if they did not focus on GFCF diets in ASD. However, due to the paucity of randomized controlled trials (RCTs) reported in the literature and the rigor of the study, we chose to include the only double-blind RCT reported in the published abstract.
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Ten research groups were included in this review and summarized in Table 2. Hereafter, we will refer to these eleven review articles as ten reviews because one review article was written as an appendix.
Ten reviews were published during the last 2 years of our review period; five out of six reviews
Reporting of multidimensional considerations (eg, safety, compliance with evidence-based practice standards, dietary allergies) to inform the use of GFCF diets in the treatment of ASD.
Abbreviations: AB, 2-phase study, where phase A is the baseline phase and phase B is the intervention phase; ASD, autism spectrum disorder; GF, gluten only; GFCF, gluten-free, casein-free; EBP, evidence-based practice; gastrointestinal tract, gastrointestinal tract; RCT, randomized controlled trial.
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Limited their review to RCTs. Other reviews included uncontrolled studies, descriptive/observational cohort studies and case reports, as well as RCTs. The most rigorous review of GFCF diets in ASD is a 2008 Cochrane review by Millward et al.
They identified only two small RCTs (n = 35), making meta-analysis impossible. The authors concluded that despite the evidence of widespread use of this diet and other complementary and alternative medicines, there is insufficient evidence to support its effectiveness. A review of GFCF diet studies by Mulloy et al
14 reports published over 30 years, 1977-2007, were identified. These studies varied greatly in quality and scope; most of them lacked adequate controls, and the sample size varied from one person to a group of 30 people. These authors used predetermined criteria to rate the evidence as suggestive, circumstantial, or inconclusive; they found no studies that provided conclusive evidence for the level and only three studies that provided preliminary evidence for the level. In a recent literature synthesis (2014), Marie-Baucet et al
Reviewed a total of 32 studies of various designs published between 1971 and 2012, of which 24 reported the efficacy of the GFCF diet in the treatment of ASD and 8 reported the safety of the diet. Despite the breadth of evidence reviewed, these authors found that evidence supporting the efficacy and safety of GFCF diets for the treatment of ASD remains limited and weak.
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Testing the effect of the GFCF diet in ASD was included for review, six of which were prospective studies
Used a single-blind RCT in which parents provided the child with food and were supported by study staff with nutritional advice. Two studies
Used an uncontrolled design to examine the effects of GF-only, CF-only, and GFCF (by separate intervention) dietary conditions on child behavior using unblinded assessment of specific behaviors in the three intervention groups. Of the experimental group studies included for the review, there were only two
Age restriction of participants to an age range that includes ≤2 years; the remaining studies were able to examine the age ranges of the samples
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