Dr. Schneider explains the rationale behind gluten and casein-free diets and other potential treatment options.
Individuals with neurodevelopmental disorders such as autism, PDD-NOS, Asperger syndrome, attention deficit disorders, and Down syndrome have an unusually high rate of food allergies and sensitivities. Many have found that the identification of food sensitivities through laboratory testing and/or elimination diets has alleviated not only the obvious symptoms of allergy such as chronic nasal congestion, recurrent ear infections, asthma, rashes, and diarrhea, but also the core symptoms of their neurological condition. Multiple food allergies are most likely to occur in individuals with increased intestinal permeability, or leaky gut, which is often associated with symptoms such as diarrhea, constipation, abdominal distension, or foul-smelling stools. The absence of gastrointestinal complaints does not rule out the possibility of food allergies or sensitivities, however, and should not preclude a dietary trial or formal diagnostic testing.
The most common food allergies in this country include dairy products, wheat, corn, soy, eggs, peanuts, tomatoes, tree nuts, citrus fruits, fish, and shellfish. It is the protein content of these foods and protein fragments called peptides that are most allergenic. Casein, for example, is the major peptide found in all dairy products. Gluten is the primary peptide found in grains such as wheat, rye, barley, spelt, and kamut. Under ordinary circumstances, these peptides would be digested down to their amino acid building blocks, which would then be absorbed into the bloodstream and utilized in various parts of the body for the construction of new proteins such as muscle. If only partially digested, they may not only trigger an immune response, but may also be biologically active. In spite of the diverse nature of the foods of their origin, gluten and casein both contain multiple repeats of certain amino acid chains, some of which are nearly identical to morphine. These compounds are often referred to as gliadomorphins and casomorphins and have been proven to cause a morphine-like response when injected into laboratory animals. Just as a person taking morphine or other opioid drugs would be likely to have impairments in concentration, judgment, motor skills, and cognitive reasoning, individuals unable to digest and metabolize gluten and casein may suffer these drug-like effects from seemingly healthy foods in their diet. Many, in fact, appear to be addicted to these foods and are likely to exclude most other nourishment from their diets. This observation has become known as the opioid excess theory, and a growing body of evidence supports this theory.
While other foods may also be problematic, strict elimination of all gluten and dairy products will lead to significant improvements in the majority of individuals with autism spectrum disorders, Down syndrome, attention deficit disorders, and many other conditions. 3-6 month dietary trial is required to achieve the full benefit of this intervention, as inflammatory changes in the bowel and nervous system will take weeks or months to reverse and allow the process of healing to begin. Even small dietary infractions can reverse this healing process. The elimination of all corn, soy, food dyes, artificial sweeteners, and monosodium glutamate (MSG) is also highly recommended, as these are often problematic as well.
An additional concern is the finding that antibodies directed against milk, gluten, corn, and eggs have the ability to cross react with brain tissue. In other words, if a person is unfortunate enough to be allergic to these foods, yet chooses to consume them, each exposure may stimulate his or her immune system to produce anti-brain antibodies. In the case of autism, several ant-brain antibodies have been identified both in children with autism and in their mothers. It is believed that this is one mechanism that is halted or diminished with the removal of these foods from the diet, leading to significant improvement. Research in the area of autoimmune autism has been a priority at CARE, as it is believed that this signifies an opportunity for both treatment in those already affected and for prevention in future generations of children.
When faced with the request to remove all gluten, dairy, corn, soy, and junk food from their child’s diet, most parents will state that their child eats nothing else and will undoubtedly starve. Many of these children eat very little in the way of fresh fruits and vegetables and quite a few have elected to become vegetarians. In these cases, there is almost certainly inflammation in the bowel. By eating these bland foods, a child initially neutralizes the acid in the stomach and may feel better for a short time. If reflux of this acid is occurring, these foods will also diminish this esophageal pain. Unfortunately, this perpetuates a cycle of inflammation, as the food is only partially digested, peptide fragments enter the bloodstream, the immune system becomes further stimulated to mount a response, and the anti-brain, anti-intestinal wall, and other antibodies are produced in even higher levels. In order to break this cycle and begin the healing process, several supplements will be recommended and a rotational diet will be prescribed. High quality probiotics, which are supplements that contain the strains of bacteria found in healthy individuals, are strongly recommended and are best taken at bedtime in order to optimize benefit. Vitamins such as the active form of folic acid called 5-methyltetrahydrofolate and the active form of B12 called methylcobalamin will enhance an individual’s ability to make new cells, which is almost universally impaired in these children either due to metabolic weaknesses, inadequate nutrition, and/or malabsorption due to intestinal inflammation. This inflammation is often caused by repeated rounds of antibiotics given for ear infections or other illnesses, food allergies, or yeast overgrowth in the intestine. Multiple interventions will be required to reverse this condition, but recovery is possible.
Adopting this diet as a family is optimal, both out of respect for the family member whose health is compromised, and out of concern for the nutritional status and health of the entire family. While not required, most family members who make these dietary changes find that they have more energy, better concentration, and fewer health concerns such as arthritis, asthma, eczema, and headaches. By not eating processed, boxed, canned, or fast foods, we dramatically increase the nutritional content of our meals and decrease our exposure to pesticides, food additives, and other chemicals that ultimately put more burden on our liver and kidneys. Whenever possible, organic meats and produce should be consumed rather than conventionally grown foods, as this further reduces our exposure to antibiotics, hormones, pesticides, chemical flavorings, and artificial ingredients that are often detrimental to health in many ways. Our bodies can heal if we give them the tools to do so.
Symptoms of Food Intolerance
- Abdominal pain
- Colic
- Formula intolerance as an infant
- Diarrhea
- Constipation
- Reflux
- Large volume stools
- Foul-smelling stools
- Self-limited diet high in carbohydrates and often low in protein
- Chronic nasal congestion
- Frequent ear infections/fluid in the ears
- Eczema/rashes
- Irritability/mood swings
- Headaches/migraines
- Hyperactivity
- Abnormal sleep pattern
- Poor concentration
- Dark circles (allergic shiners) under eyes
- Asthma
- Arthritis
- Autoimmune conditions
- Poor endurance
Potential Benefits of a Gluten-Free/Casein-Free Diet
- Reduction of gastrointestinal problems and expansion of diet as the gut heals
- Decreased self-injurious behavior
- Increased social interaction
- Decreased self-stimulatory behavior
- Improved sleep pattern
- Increased attention span and ability to concentrate
- Reduction in hyperactivity
- Decreased seizure frequency
- Improved gross motor skills and coordination
- Improvement in rashes, eczema, headaches, abdominal pain, and asthma
- Improvement in nutritional status
- Resolution of mood swings and irritability
- Decrease in autoimmune and inflammatory reactions
- Increased endurance
Initiating a Casein-Free Diet
Eliminate Dairy Products
- Milk, cheese, butter, ice cream
- Yogurt, sour cream, margarine
- Cream, cream cheese, cottage cheese
- Casein, caseinate
- Whey, milk solids, curds
- Lactose, lactalbumin
Learn to Avoid Hidden Sources of Casein
- Medication fillers
- Most soy cheeses
- Hot dogs and lunchmeats
- Flavorings
- Caramel coloring
- Goat milk
- Milk chocolate
Consider Milk Substitutes
- Almond milk
- Cashew milk
- Coconut milk
- Flaxseed milk
- Rice milk
Caveats
- Some brands are high in sugar
- Vanilla flavoring often contains gluten: choose plain rice milk unless verified GF
- Nut allergies and sensitivities are common
- Soy milk is not recommended
Casein-Free Diet: Concerns
- Calcium deficiency: Children need approximately 800 mg of calcium per day, but a combination of calcium, magnesium, and zinc is more likely to meet this requirement with greater benefit and fewer side effects. Most individuals can meet their dietary calcium requirements without consuming dairy products.
- Eliminating dairy in a vegetarian significantly decreases protein intake
- Withdrawal symptoms are possible, but usually resolve within one week
Recommendations
- Try organic rice, coconut, or nut milk
- Drink only filtered water, preferably from inert containers.
- Calcium/magnesium/zinc supplements as directed
- Monitor protein intake
- Consult a physician or registered dietician
Initiating a Gluten-Free Diet
Sources of Gluten
- Wheat
- Oats: Most oat products are not gluten-free, but many GF items are now available
- Rye
- Barley
- Spelt
- Kamut
Hidden Sources of Gluten
- There are many kinds of wheat: semolina, durum, graham, bulgar, kamut, etc.
- Vanilla and other flavorings (extracted with grain alcohol). GF vanilla is available from selected vendors
- Hydrolyzed vegetable protein and hydrolyzed plant proteins
- Malt flavoring
- Cake meal
- Vitamins and medication often contain fillers that are derived from grains
- Waxed fruits
- Some baking powders, rice syrups, and spices
- Raisins are sometimes dusted with flour to prevent sticking
- Processed meats (hot dogs, lunchmeat, sausages) sometimes have cereal fillers
- Soy sauce is derived from wheat
- Caramel coloring
- Grain vinegars (apple and rice vinegars are generally GF)
May Be Corn or Wheat
- Modified food starch
- Millet
- Starch
- Cereal fillers
Wheat Alternatives = 1 cup wheat flour
- 1/2 c ground nuts + 1/2 c tapioca flour
- Rice/potato/tapioca flour mixtures such as Betty Hageman
Gluten Free Flour Mix
Combine the following in a canister and measure as you would wheat flour in most recipes:
-
- 2 cups rice flour
- 2/3 cup tapioca flour
- 1/3 cup sorghum flour
Xanthan gum (up to 1/2 tsp per cup of flour) and guar gum prevent dry, crumbly texture.
Acceptable Gluten Free Flours
- Amaranth: Nutty flavor. May use for up to 25% of flour in baked goods. High in protein, calcium, and iron.
- Arrowroot: Good substitute for cornstarch as a thickening agent in gravies, etc.
- Bean flours*: Chickpea (garbanzo), garfava, soy, etc. High protein flours with heavy texture and strong flavor. Good thickeners. Not well tolerated due to gas.
- Buckwheat flour*: Strong flavor. Cross contamination with gluten common.
- Corn meal*
- Millet*
- Nut flours*: May use for up to 25% of flour in baked goods. Grind just before use to prevent meal from becoming rancid.
- Potato flour: Combine with lighter flours such as tapioca for baking.
- Potato starch: Similar to cornstarch. Does not work well in breads, but may use in gravies.
- Quinoa*: High protein flour with a nutty taste.
- Rice and sweet rice flours: Staples in baking and generally well-tolerated. Mix with other flours such as tapioca.
- Sorghum: Mixes well with rice flour for general baking needs.
- Tapioca flour: Use for 25-50% of total flour in baking. Adds light texture, bland taste.
- Teff*: Best for brownies and pancakes. Does not rise well. Rich in iron and calcium.
*Allergies to these flours are commonly reported. Use sparingly or not at all until bowel symptoms improve.
GFCF Recommendations
- Testing for gluten sensitivity and celiac disease prior to eliminating gluten
- False positives and negatives are common in urinary peptide testing in this country
- Eliminate dairy immediately, add GFCF foods, then eliminate gluten
- 3-6 month trial of 100% avoidance is advised
- Test for food allergies 2-3 months after eliminating gluten and casein
Getting Started
- Remove all dairy and casein
- Remove all wheat
- Remove oats, rye, barley, and malt
- Learn to read labels for 100% elimination of offending foods
- Buy organic produce and cook from scratch whenever possible
- Meat, rice, potatoes, fruits and vegetables will be staples of the diet
- Shop the perimeter of the store: avoid canned and processed foods
- Avoid foods packaged in plastic whenever possible
- Rotate foods to avoid the development of further allergies and sensitivities
- Avoid Nutra Sweet, food dyes, MSG, artificial flavorings, and preservatives
- Avoid environmental toxins such as pesticides, perfumes, fluoride, cleaning chemicals, air fresheners and other aerosols
Initiating a Corn-Free Diet
Sources of Corn
- Some forms of ascorbic acid (vitamin C)
- Artificial colorings and flavorings
- Aspartame
- Some brands of baking powder, bleached flours, and bleached sugar
- Caramel
- Corn flour, meal, oil, starch, and syrup
- Dextrin
- Dextrose (including some intravenous solutions, i.e., D5LR)
- Grits and hominy
- Hydrolyzed protein
- Maize
- Maltodextrin
- Modified food starch
- Monosodium glutamate (MSG)
- Powdered sugar (used as an anti-caking agent)
- Xanthan gum: tolerated by many corn-sensitive individuals, but not all
Hidden Sources of Corn
- Baby powder
- Glue on envelops and stickers
- Some lotions, makeup, and deodorants
- Packaging peanuts (dissolving type)
- Plastic-appearing food containers
- Play dough
- Powdered gloves
- Some toothpastes
- Many other foods, medications, and personal hygiene products
Foods Containing MSG (Monosodium Glutamate)
- Autolyzed yeast
- Bouillon
- Calcium caseinate and sodium caseinate
- Gelatin
- Glutamate/glutamic acid
- Hydrolyzed protein
- Textured protein
- Yeast extract, food or nutrient
- Watch for vague terms on labels such as “flavoring” and “seasoning”