"Pros and Cons of Gluten-Free,
Casein-Free Diets for Autism" When you read in
alternative medicine journals that there’s “a great deal of evidence that foods containing casein or gluten contribute significantly to [autism]
and should be eliminated from the diet”, almost always leading to
symptomatic improvement, they’re presumably talking
about the published anecdotes and case series that claim wild
success, but had no control group, though there were two
year-long controlled trials that also showed remarkable benefits,
but couldn’t discount placebo effects. The double-blind studies that
did control for placebo effects failed to find benefits, but
they only lasted a few weeks. This was to be the study
to break the logjam, a months-long, double-blind
controlled study. They put 14 kids with autism on a gluten-free, casein-free
diet for 4 to 6 weeks and then, for the next three months,
challenged them every week with double-blind, placebo
controlled food tests, secretly giving them gluten, just gluten, or just casein—or both, or neither, every week, month after month. Here’s what happened
to each of the 14 kids in terms of their social relationships
and their language skills throughout each of the challenges.
And, bottom-line? Nothing. No apparent impact on
behavioral disturbances or autism-related behaviors. So, does that mean case closed? Well, proponents of autism diets “might regard the 4–6 week
implementation phase prior to the challenges as too short for the gluten-free, casein-free
diet to take full effect.” In other words, one could
argue this is yet another double-blind
study that didn’t give the diet long enough time to work. And so, maybe the kids were
still feeling the effects of gluten and casein they consumed
more than a month previously. And so, no wonder extra gluten or
casein didn’t make them even worse? It’s possible, I guess,
which is why you'll see systematic reviews of
the sum total of evidence, like this one published 2017 in the journal of the American
Academy of Pediatrics, concluding that although
some studies showed benefits, the data are inadequate to
make conclusions either way, in other words, the “SOE”—
the strength of evidence — is considered insufficient
to endorse such diets.
What’s the harm in
giving it a try, though? Well, given the effort,
time, and money that a gluten-free,
casein-free diet requires, knowing whether it actually works,
would kinda be a good thing to know. I mean, there are downsides. “Being on a special diet
can have unintended negative social consequences, when children are not able
to participate conventionally in birthday celebrations
and class treats or eat in restaurants or other people’s homes.” Autism can be isolating
enough as it is. The overall evidence for the
effectiveness of these diets is weak. And thus, these diets cannot be
generally recommended as a treatment. Yet, parents continue to give it a try figuring, “Look, the drugs don’t work, in terms of helping the core symptoms. So, why not just give it a try
and leave no stone unturned.” I can understand that; however, there are
the potential downsides, like further stigmatization, diversion of resources
away from other treatments, and, they suggest, a concern
about nutritional deficiency. What they’re worried
about is bone health. Those with autism are at
elevated risk for bone fractures. Now, lower bone mineral density
in individuals with autism may be due to a variety of factors: lack of vitamin D, chronic use of medications
that can weaken bones, lack of weight-bearing exercise— but, maybe dietary restrictions
play a role.
Do children with autism on
gluten-free, casein-free diets have lower calcium intake? Yes, in fact, 9 times the odds of failing to meet recommended calcium intakes. Does this translate out to
reduced bone mass? Maybe so, as those
on casein-free diets appeared to have less
bone development. Now, there’s controversy
over whether dairy products are the best source of calcium, but that is where most
kids are getting their calcium. And so, if you remove dairy, you have to replace it with
other calcium-rich foods. As the study they cited points out, there’s lots of nondairy sources of calcium— but, they only provide calcium
if you actually eat them..
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