The Evidence Behind a Gluten-Free, Casein-Free Diet

WE ARE A GLUTEN & CASEIN FREE (GFCF) HOUSE BECAUSE… 

1. My husband & son are insanely lactose intolerant 

2. I get armpit eczema when I eat gluten. Yes, armpit. Nowhere else. Just the armpit. Whatever.

3. When I was told there was ‘nothing’ I could do to lower my thyroid antibodies, going on a gluten free diet dropped them from “>800” (i.e. the lab STOPS quantifying the antibodies above 800) to 252 within 3 months. 

I have many other reasons for choosing to be a GFCF house, but that’s a talk for another time. 

WHAT I DO WANT TO TALK ABOUT IS THE LITERATURE & THE SCIENCE BEHIND A GFCF DIET.

I spent 2 years researching & writing a dissertation specifically on how a GFCF diet impacts children with ASD (Autism Spectrum Disorder) in terms of social behavior and communication skills. 

Let’s dive in…. 

The rate of children diagnosed with neurocognitive disorders, such as ASD (Autism Spectrum Disorder) and ADHD, has increased exponentially over the last 40 years. 1 in 10,000 children were diagnosed with ASD in the U.S. in 1978. Twenty years later, in 1998, this statistic was 1 in every 250 children. More recently, the Centers for Disease Control and Prevention (CDC) indicates that 1 in 54 children receive an ASD diagnosis.

I want to stop here and remind you that ASD, and other neurocognitive disorders, are multifaceted - complex interactions between genetics & the environment. There are layers upon layers upon layers. Diet is simply one of those layers I chose to focus on - one that not only impacts kiddos with ASD, but every single one of us. 

There is a direct correlation between diet & the severity of ASD symptoms, which has led to a growing body of evidence that a GFCF diet as an adjunctive treatment can improve the quality of life for children with ASD.

Let’s back up.

GLUTEN.

Gluten is a general name for the protein found in rye, wheat, & barley. It acts as a glue that maintains the shape of food and can be found in bread, pasta, cereal, baked goods, sauces, and soups, to name a few. One positive aspect of gluten proteins is their viscosity and elasticity, which allow dough and bread products to be more palatable. Due to their palatability, large-scale production ability, and the ease of cultivating and processing into numerous foods items, gluten-containing grains make up a large portion of today’s Western diet.

Although the genetics and characteristics of gluten-containing grains can be rapidly modified, the human body is not as malleable (i.e. our digestive systems are not naturally designed to keep up with today’s modified foods). After eating gluten, specific proteins, gliadin and glutenin, must be broken down & digested in the small intestine - both of these proteins have been linked to triggering & activating immune system responses (activating T-cells).

As genetic modification becomes more pronounced in modern agricultural practices, more immune-activating proteins are being found in foods that children are exposed to on a daily basis. Even for those without gluten-related diseases (i.e. celiac disease), it’s possible that the human intestinal tract has not evolved to properly handle & digest modern grain proteins. And, in turn, these gluten proteins cause adverse symptoms. Which we’ll talk about in a little bit.

CASEIN.

Casein represents 80% of the protein present in milk & is found in foods such as ice cream, cheese, yogurt, kefir, cookies, butter, and sour cream. It’s important to note that all casein is digested and absorbed in the body at a very slow rate. Partially contributing to this slow absorption process, high levels of the proteins are able to seep into the gastrointestinal tract, inducing an immune response that leads to autoantibody production

fancy way of saying... when we consume dairy, over time our bodies can start to create antibodies towards the protein in dairy

Multiple studies have concluded that kids with ASD have elevated levels of antibodies against dietary proteins compared to neurotypical kids, specifically, antibodies against casein and gliadin (gluten). These antibodies have the ability to cross react with human brain tissue proteins, eliciting an immune reaction, which may then cause damage to the neural tissue or exacerbate behavioral symptoms in children with ASD. 

It’s been found that 58-70% of kids with ASD have elevated levels of diet-related antibodies in their neural tissue. Additionally, for neurotypical as well as neuro-atypical children, the consumption of cow’s milk has been associated with higher rates of chronic GI issues such as constipation, bloating, flatulence, inflammation, & irritable bowel syndrome.

Why, you ask?

WELL, THERE’S DEFINITELY BEEN A SHIFT OF CURRENT RESEARCH.

In addition to researching the positive impacts of a GFCF diet, researchers are currently delving further into why certain diets seem to relieve kids with ASD of various symptoms. Dr. Paul Whiteley, a developmental psychology researcher, reports that the differing responses to the use of a GFCF diet among kids with ASD correlates with underlying genetic & biological factors. He calls this theory a possible “diet-related autism phenotype,” in which immune response & issues with gut barrier function and gut microbiota are contributing factors. 

OK, CECE. YOU’RE GETTING A LITTLE TECHNICAL HERE (LEGIT WHAT’S GOING THROUGH MY BRAIN AS I WRITE THIS).

So, to explain..

Gut issues are super common in kids with ASD (about 70% experience chronic constipation, belly pain, bloating, undigested foods, diarrhea, etc). These symptoms are just that - symptoms - that are occurring due to an underlying reason. In this case, symptoms are typically a result of gut inflammation in relation to an overactive immune response to those dietary proteins mentioned above (gluten & casein). 

Interestingly enough, the severity of these gut symptoms in kiddos has shown to be strongly connected with the severed of ASD - hence, the gut-brain connection.

worse gut symptoms = more severe ASD symptoms

The central nervous system & neural pathways can be activated by the bacteria in the gut. The gut-brain connection (or gut-brain axis) has a two-way communication system held between the intrinsic nervous system & the central nervous system, directly connecting the intellectual and emotional centers of the brain to peripheral gut functions.

WHAT DOES THIS MEANNNNN.

Welp, it means that your gut microbiome (i.e. the ‘good’ and ‘bad’ bacteria in your GI tract) can literally manipulate the communication between your belly and your brain. What’s the most significant modifying factor of that microbiome-gut-brain interaction?

DIET. OF COURSE.

Let’s get to the results of all my research, shall we?

AUTISM DIAGNOSTIC OBSERVATION SCHEDULE.

ADOS is an assessment tool that’s used to evaluate  language capability, communication, repetitive behaviors, & social interaction. Kids with ASD who are placed on a GFCF diet for 24-months have shown significant improvements in communication, with the most drastic improvements happening between day 1 & month 8. In comparison, participants of the same study who were placed on a regular diet, continued to experience worsening communication skills throughout the 24-month trial. 

GILLIAM AUTISM RATING SCALE.

GARS is a scale questionnaire with 56 questions. It evaluates core ASD symptoms, such as social interaction, communication, developmental disturbances, & stereotyped behaviors. Results of numerous studies have shown significant improvements for kids with ASD in all sub-categories of the assessment tool over 24 months. Such categories include: stereotyped behaviors & social interaction; reductions in staring episodes, the desire to smell objects, spinning or sudden movements, and food aversions; while improvements were seen in eye contact, defiance, aggression, & repetitive behaviors.

VINELAND ADAPTIVE BEHAVIOR SCALE.

VABS is a parent-report questionnaire that evaluates developmental ability based on socialization, communication, & daily living skills. According to the VABS analysis tool, kiddos placed on a GFCF diet for 12-24 months have shown steady improvements in socialization, communication skills, & daily living domains as compared to children on a regular diet. More specifically, there have been advancements in writing skills, interpersonal relationships, coping skills, expressive skills, receptive skills, community skill, & gross motor and fine motor skills.

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER-IV.

ADHD-IV is a tool that assesses inattention & hyperactivity of kids via a rating scale. Studies that utilized this assessment tool concluded kids with ASD who were placed on a GFCF diet for 12-24 months showed vast improvements in inattention & hyperactivity as compared to kids on regular diets.

CHILDHOOD AUTISM RATING SCALE.

CARS is a tool used to evaluate & assess behavior & symptom severity in many domains affected by ASD. Kids with ASD who were placed on a GFCF diet for 6-12 months, have shown marked improvements in overall CARS scores.

AUTISM TREATMENT EVALUATION TEST QUESTIONNAIRE.

ATEC evaluates how efficient treatment is for kids with ASD. Four subgroups are evaluated:

• Speech, communication, & language

• Sociability

• Sensory & cognitive awareness

• Health, physical, &behavior 

After using a GFCF diet, kids with ASD have been shown to improve in all of the major ATEC parameters.

I’m not done.

Through direct observation & questionnaires, it’s also been shown that kids with ASD put on a GFCF diet for 2-12 months have experienced: reduced need for sameness (routine); reduced hyperactivity, compulsivity, anxiety, fearfulness, or inappropriate speech; improved narrow interests and nonverbal IQ; and improvements in aggression towards self or others, focus, attention, sleep pattern, & the willingness to initiate socialization. Parents who’ve eliminated gluten & casein from their kid’s diet have also reported greater reductions in ASD behaviors, social impairments, & physiological symptoms. 

Still not done.

Parents have also reported seeing improvements in mood, behavior, & focus among children with ASD over the course of 1 year on a GFCF diet. AND. By the end of a 12-month study, kids on a GFCF diet have experienced 5 times the development (based on IQ points) compared to kids on a regular diet. 

I have more.

When kids with ASD follow a GFCF diet, their parents also report reductions in physical symptoms, including gut-related symptoms (i.e., diarrhea, constipation, bloating, belly pain, foul-smelling stool, digestion issues), allergies (sneezing, itchy/red/watery eyes, congestion), food allergy symptoms (hives, rashes), fatigue, & irritability. 

LAST BUT NOT LEAST: SENSORY SENSITIVITIES

My never ending research also showed reductions in sensory issues for kids with ASD when a GFCF diet is implemented. Including:

• tactile sensitivities

• auditory filtering

• visual or auditory sensitivities

• sensation seeking

• & taste or smell sensitivities

PHEW. 

WHAT IS MY POINT IN ALL THIS?

I have many. But to wrap it up… (lol, wrap it up- was I the only one?). 

All of our bodies are different. Our genetics are different. Our immune systems are different. Our triggers are different.

What hinders our health is different.

What improves our health is different.

But at the end of the day, the food we eat can 110% impact our well-being. Our body is interconnected. I find it to be such a shame that most conventional medicine doctors, despite the laundry list of evidence & literature, fail to make the connection between our gut and the rest of our body - particularly the brain.

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The Discovery Doc - Dr. CeCe Brooks - Atlanta Holistic NP