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Guide Getting Your Kid on a Gluten-Free Casein-Free Diet

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Diet modification is one of the most prominent alternative therapies. But there is currently little scientific evidence the gluten-free, casein-free GFCF diet has beneficial effects for children with autism.

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The theory most commonly associated with the use of the GFCF diet relates to proposed differences in the functioning of the gut of individuals with autism. Our bodies extract nutrition from food through the intestines, which is where small molecules cross the mucosal lining and enter our bloodstream. The GFCF diet is based on the theory that opioid peptides, formed from the incomplete breakdown of foods containing gluten and casein, may enter the bloodstream due to the increased intestinal permeability. From there they cross the blood—brain barrier and disrupt brain development and functioning.

The gut has its own nervous system, called the enteric nervous system, which is how we know when we are hungry and when we need to go to the toilet.


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The enteric nervous system is closely related to the development of the central nervous system, including the brain. The assumptions here are that the gut difficulties experienced by individuals with autism are causally related to the differences in brain development.

By using the GFCF diet, gut problems are reduced and autistic symptoms should improve. The first problem relates to testing the underlying theory itself. If an inability to break down gluten and casein leads to an excess in opioid peptides, then we would expect to find high levels of these molecules in children with autism. However, three studies have found no evidence of excessively high levels of opioid peptides in the urine of children with autism.

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Gluten Free/Casein Free Diets for Special Kids

The second problem is the results of studies that have tested the effectiveness of GFCF diets with children with autism. A systematic review found major methodological limitations of studies in this area. These included lack of a control group, poor definitions of inclusion criteria, and very small sample sizes. The studies that found a positive effect of GFCF diets on the behaviours of children with autism had the most significant flaws. Conversely, the studies that were considered to be most methodologically rigorous tended to find no benefits from the use of GFCF diets.

Unfortunately, some question marks remain over the safety of GFCF diets. Several studies have reported that a GFCF diet is associated with reduced bone density in both children with and without autism. Furthermore, given the uncertain safety profile, only when there is a clear intolerance or allergy to the foods that a GFCF diet eliminates would it be prudent to recommend the diet.

There's growing awareness about celiac disease and other conditions aggravated by gluten, a protein found in many common foods that contain wheat, rye, barley and other grains.

Getting Your Kid on a Gluten-Free Casein-Free Diet

But making sure the foods you select don't contain gluten—and do contain the nutrients children following gluten-free diets need—can still be a challenge. Fresh meats, vegetables, fruits, dairy, eggs, and legumes are always kept along the outer areas of the grocery store. When planning your meals, start with these items. Then all you should worry about are seasonings and snacks. Experiment with gluten-free grains like millet, amaranth and quinoa.

URMC nutritionists discuss gluten-free, casein-free diet

In addition to being high in protein and fiber, these grains contain micronutrients like magnesium, phosphorus, manganese, potassium, zinc, iron, folate, thiamin, copper, and riboflavin. Oats contain a protein called avenin, which is structurally like gluten. Once your child has been following a gluten- and oat-free diet and his or her symptoms have resolved — typically between months — talk with your child's doctor about gradually reintroducing gluten-free oats into your child's diet.

Note this must be done gradually as the increased fiber may cause constipation. Pre-packaged and "ready-made" items often contain additives to increase shelf life, and these additives can contain gluten. Flavoring, sauces including soy sauce, which is made from wheat and seasonings can all contain gluten. Gluten also may be added to some products such as breakfast bars to boost protein content. Even soups can have gluten from thickening ingredients. You just need to know the words to look for on the label. Since most gluten-free grains are unfortified, vitamin and mineral deficiencies are more common in children following a gluten-free diet.

Some potential deficiencies include fat soluble vitamins A, D, E, and K , calcium, vitamin B12, folic acid, zinc, magnesium, iron. Consider a multivitamin. A daily children's multivitamin can help, because it has calcium, vitamin D, and iron in it — nutrients not provided by the fortification of gluten-free grains. Note also that gummy vitamins do not contain the iron, B1, or B2 that children on a gluten-free diet may be missing. Check the brand's content at www.

Stock up on nutrient-rich foods. Many vegetables and fruits, meats and seafood, dairy foods and nuts and seeds are excellent sources of vitamins and minerals to help ensure children on a gluten-free diet get the nutrients they need. See table below for ideas. A common side effect of a gluten-free diet is constipation.

Getting Your Kid on a Gluten-Free Casein-Free Diet

Many gluten-free products use low-fiber substitutes like rice, corn, tapioca, and potato flour instead of wheat, and their lower fiber content may not be enough to keep a child regular. If you buy rice, make sure it's higher fiber, whole-grain brown rice.

Look for other high-fiber, gluten-free alternatives such as beans, amaranth, quinoa, chickpea, and millet. Manufacturers change ingredients and production methods frequently. This means a product that may have been gluten-free in the past no longer is. If you're ever in doubt, don't hesitate to contact the manufacturer with specific questions. As a consumer, you have every right to know exactly what's in your food.

Common Food Allergies. Gluten-Free Food Labeling. Ask the Pediatrician: When should I introduce wheat into my baby's diet? Ask the Pediatrician: My wife and I are on a gluten-free diet. Is it ok for our baby to also eat gluten-free?