Gluten-Free, Casein-Free Diets and Children with Special Needs
Evelyn Frazier, MD
A number of you have asked about alternative treatments in children with special needs, and in particular the gluten/casein-free diet. First off, I’m so glad to have interested readers! Secondly, I want you to know that you are not alone. I am asked about alternative and complementary therapies almost daily in my practice, and I truly welcome the conversation.
A national study found that 87% of pediatricians report being asked about complementary and alternative therapies. Vitamins and nutritional supplements are among the most commonly used complementary therapies in children.
What are Gluten and Casein?
- Gluten: describes a protein found in wheat, rye, and barley. Many popular foods such as cakes, pastas, even sauces contain gluten. Fruits, beans, vegetables, meats, and flours made without wheat such as almond and potato flours are examples of common gluten-free items.
- Casein: is a protein found in milk and milk products. It also often acts as a food binder so it is also seen commonly in many processed foods. Examples of casein-free alternatives to milk products include soy milk, and coconut butter.
What is the Evidence behind Gluten/Casein-Free Diets and Children with Special Needs?
Rational: The thought behind using a gluten and casein free diet to treat autism stems from The Opioid-Excess Theory. This theory proposes that individuals with autism have “leaky guts” and/or inadequate quantities of digestive enzymes to break down gluten and casein, resulting in excess circulating quantities of these proteins. It is alleged that gluten and casein then cross the blood brain barrier and attach to opioid receptors in the brain, causing many of the symptoms seen in autism.
Research: The research into alternative treatments and autism are limited, but some work has been done in this area. To begin, there is little evidence behind the proposed Opioid Excess Theory. In fact, there are no scientific studies showing a causal relationship between gluten/casein peptide attachment to brain opioid receptors and symptoms of autism in humans.
Furthermore, there have been several studies which showed no improvement in activity levels, social skills, communication, or sleep in children with autism on a gluten-free, casein-free diet. Despite the lack of evidence, many parents wish to continue to implement this diet.
Concerns/Summary: Many children who have autism inherently have very limited diets; thus, imposing further restrictions could cause deprivation of key nutrients. Therefore, the overarching recommendation is that unless your child has gluten intolerance such as found in Celiac disease, these dietary changes many case more harm than benefit. It is important to discuss any limitations in diet with your physician so that she can ensure your child is receiving adequate nutrition for proper development and growth.
What Should You Consider Before Starting an Alternative/Complementary Therapy:
Dietary changes are just a subset of alternative therapies available. With so many options touted about online and in other sources, it is important to consider certain factors before deciding what may be right for you or your child.
- Is this therapy safe? Be sure to do your research. Your physician, either primary care or specialty, can be of help with this too. Just as in the gluten/casein free diet example, sometimes therapies can be risky depending on the child in particular, and others are merely unsafe for anyone.
- Is this therapy sensible? Consider if the proposed therapy is something that can be reasonably implemented in your lifestyle as a family.
- Is this therapy effective? Look into any research, beyond anecdotal stories, about possible benefits of the therapy.
- What are your measures of success? It is important to treat any alternative therapy just as your would a traditional medication. Decide what specifically you would like to improve. Is it eye contact in your child with autism for example? Then, do an adequate trail for a set length of time, generally 6-8 weeks. If you are doing dietary changes for example, ensure the diet is truly followed, don’t let unapproved foods sneak in at school or daycare. Write down progress and re-evaluate at the end of the trail period to determine if the time, expense, and sacrifices were worth any changes you’ve noted.
- Have the conversation. Discuss your motivations and thoughts with your doctors and therapists. Let us help guide you in your decision making of risks and benefits, as well as monitoring of possible success or harm.
Take Home Points.
Deciding on an alternative therapy can be overwhelming. Let your doctors and therapists help you determine if and what therapy might be right for your child. Remember that just because a therapy is “alternative” doesn’t mean it’s inherently safe.
Also, while there can be a great deal of pressure to try the newest and latest alternative therapies, don’t feel guilty if that particular method doesn’t work for your child or your family and schedule. Being fully present with your child, and supporting him emotionally is one of best therapies available…with no side effects.
References:
American Diabetes Association
Food and Drug Administration
The Association for Science in Autism Treatment
American Academy of Pediatrics
Mari-Bauset, et al. Evidence of the Gluten-Free and Casein-Free Diet in Autism Spectrum Disorders: A Systematic Review. J Child Neurol. 2014 April 30.
Kemper, O’Conner. Pediatricians’ Recommendations for Complementary and Alternative Medical Therapies. Abul Pediatr. 20014 Nov-Dec 4(6): 482-7.
Evelyn Frazier, MD
Developmental and Behavioral Pediatrician| Developmental and Special Needs Pediatrics
Bon Secours Virginia Health System: St. Mary’s Hospital
5875 Bremo Road | MOB South Suite 104 | Richmond, VA 23226
Clinic: 804-287-7463|Fax: 804-287-7722|Direct Line: 804-287-4775 evelyn_frazier@bshsi.org
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