Gluten-Free, Casein-Free (GFCF Diet)
What is the Gluten-Free, Casein-Free (GFCF) Diet?
The gluten-free, casein-free (GFCF) diet is one of the most common diets used for individuals with autism. It involves the avoidance of the food proteins gluten and casein, from certain grains and mammal milks.
Gluten is a protein found in grains like wheat, rye, and barley and any foods made with these grains.
For more on a gluten-free diet, see the Gluten-Free Diet note
Note: A gluten-free diet is different than a grain-free diet. A grain-free diet is more broad and removes all grains, whether or not they contain gluten.
Casein is a protein found in dairy, and any foods made with dairy.
For more on a casein-free diet, see the Casein-Free Diet note
Some people that have a sensitivity gluten are also sensitive to casein, because the two proteins have a similar molecular structure.
There is conflicting research showing the efficacy of the gluten-free casein-free diet. For many, the GFCF diet can be life-changing. For others, it may not make a difference. A gluten-free (and GFCF) diet should be strictly adhered to for at least 3-6 months to see full benefits.
Recommended Foods
All food groups may be included in the GFCF diet including vegetables, fruits, meat, poultry, fish, non-meat proteins (eggs, beans, nuts, seeds), and gluten-free grains (rice, quinoa, gluten-free oats, corn, millet, buckwheat).
Some examples of gluten-free convenience foods include:
Breads, tortillas, granola, and cereals that are labeled gluten-free
Rice and corn cereals
Rice crackers
Rice, corn, quinoa, lentil, or chickpea pasta
Rice cakes
Gluten-free baking mixes or baked goods labeled gluten-free
Ensuring intake of calcium rich foods is important for those eliminating dairy from their diet. Calcium-rich foods include:
Calcium fortified Milk Alternatives and non-dairy yogurts made from coconut, rice, cashew or almond milk
Calcium fortified juice
Calcium fortified cereals
Canned fish with bones (salmon, sardines)
Soy products (tofu, tempeh, edamame)
Almonds, sesame seeds and poppy seeds
Leafy greens (kale, collard greens, bok choy)
My Favorite Gluten-Free Brands
I find that shopping for gluten-free brands is easiest at health food stores, such as Whole Foods, Sprouts, and Natural Grocers. Trader Joe’s also has many gluten-free options. My favorite brands are listed below, though availability to these brands will vary per location. If you don’t have access to health food stores in your area, you could consider signing up for Thrive Market (exclusive discount through this link). I put a ⭐️ next to my personal favorites from a taste & ingredient perspective.
Breads/Bagels
⭐️ Canyon Bakehouse
⭐️ Simple Mills Artisan Bread Mix
Little Northern Bakehouse
Soozy’s
O’Doughs
Schar
Udi’s
Trader Joe’s Gluten-Free Bread
Glutino
Pastas
Chickpea, lentil, and bean-based pastas (these will pack in more protein and fiber per serving!)
⭐️ Banza (made from chickpeas)
⭐️ Pow! (made with lentils)
⭐️ Trader Joe’s has a yellow lentil spaghetti that is delicious! They also have red lentil penne and black bean rotini
Whole Foods brand also has many different GF pasta options
Other GF pastas (typically rice, quinoa, and/or corn-based)
Jovial
Ancient Harvest
Trader Joe’s has quinoa and rice noodles, as does the Whole Foods brand and 365.
Tortillas
⭐️ My favorite is Siete! They have a variety of tortillas made from chickpeas, almonds, cashews, and cassava. They have both soft and hard tacos (and tortilla chips!)
Baking Mixes
⭐️ Simple Mills
Glutino
Pamela’s
Sweet Loren’s
Other Brands with GF Items
⭐️ Lesser Evil
⭐️ Amy’s
Van’s
Glutino
Applegate
Food For Life
**Need a recommendation for a product? Post in the Community Forum!**
My Favorite Dairy-Free Brands
I find that shopping for dairy-free brands is easiest at health food stores, such as Whole Foods, Sprouts, and Natural Grocers. Trader Joe’s also has many dairy-free options. My favorite brands are listed below, though availability to these brands will vary per location. If you don’t have access to health food stores in your area, you could consider signing up for Thrive Market (exclusive discount through this link). I put a ⭐️ next to my personal favorites from a taste & ingredient perspective.
Milk
The following have the cleanest & fewest ingredients (i.e. no fillers, gums, etc), and may not be widely available
⭐️ MALK (my personal favorite)
⭐️ Make your own! Learn how here.
Three Trees
Beber
Elmhurst
The following are more available but may include additional ingredients than just “nuts and water”
⭐️ Ripple Milk
Made from pea protein. Contains a great serving of protein and calcium, comparable to cow’s milk
For more, read the Pea Milk note
Califia
Silk
Almond Breeze
Cheese
⭐️ Miyokos is my absolute favorite!
So Delicious
Daiya
Follow Your Heart
Violife
Siete has a delicious cashew-based queso
Butter
⭐️ Miyokos
Earth Balance
Melt
Ghee (though this is made from butter, it is typically tolerated by those on a dairy-free diet as it does not contain casein or lactose!)
Yogurt
Ice Cream
⭐️ Nadamoo
⭐️ Make your own “Nice Cream” with frozen bananas, maple syrup, cocoa powder, and a little cinnamon in a food processor or by using this Yonanas machine
⭐️ Cado (made with avocados)
So Delicious
Oatly
Ben & Jerry’s
Most sorbets will be naturally DF, just read the label
Others
Mac & Cheese —> Banza, Daiya, Amy’s
Pizza —> Daiya, Amy’s
Cream Cheese —> Kite Hill
Sour Cream —> Forager
Chocolate —> Enjoy Life
**Need a recommendation for a product? Post in the Community Forum!**
Foods to Avoid
All dairy products should be avoided including:
Yogurt
Cheese
Butter
Sour cream
Ice cream
All gluten-containing foods including:
Pasta, bread, pastries, bagels, pita, crackers, cookies, cereal, granola, breakfast foods like pancakes and waffles, flour tortillas, breadcrumbs, croutons, sauces, dressings and gravies that use flour as a thickener, brewer’s yeast and any foods that contain wheat flour as an ingredient.
Some surprising sources of gluten include:
Stuffings and packaged gravy mixes
Dressings and marinades
Soy sauce
Cream sauces or cream-based soups
Beer and malt beverages
Brewer’s yeast
Cross-contamination can occur in the fryers at restaurants or on other surfaces like cutting boards, knives, etc.
Medications, supplements
Communion wafers
It is important to note that lactose-free dairy products are those in which the milk sugar lactose has been removed. However, these items still contain the milk protein casein. Lactaid would not be an appropriate milk choice because it still contains casein.
Even foods that are labeled “dairy-free” or “non-dairy” may contain casein or derivatives of casein. To determine if a product contains casein, look at the ingredients list. Foods that contain casein will be designated on the ingredients list. Any ingredient that contains casein will be listed, followed by a parenthesis around the word “milk”. At the bottom of the ingredients list you may also see , in bold print, “CONTAINS: milk”. This is not required but many manufacturers include this in their labeling. If you do not see any of these indicators, you can feel confident that the product does not contain dairy.
Lifestyle changes
A gluten-free (and GFCF) diet should be strictly adhered to for at least 3-6 months to see full benefits.
Eating at Restaurants
Be sure to ask questions when eating out so you know how the food is being prepared.
Browse the menu online beforehand to ensure there are gluten-free options that would work for your child. Ask what items can be made gluten-free.
Meal Planning
Meal planning can be extremely helpful when trying to follow a diet like this. Find a good cookbook or blog with gluten-free meal ideas and map out your meals for the week.
Be sure to have gluten-free snacks available and accessible both at home and when you’re out and about. When hunger strikes for your child, you want to be prepared with a gluten-free option.
Full-Family Approach
This diet, like all diets with restrictions, may be difficult to implement with children that are old enough to make their own food choices both within and outside the home. Making the whole house gluten-free, at least for the duration of the trial, can be very helpful and contribute to success. If a child makes their own food choices outside the home it can be critical to demonstrate that success and improvements with the diet from the start so the child has a reason to continue choosing gluten-free options.
Recommended Supplements
Grains are a good source of fiber, B vitamins and minerals like magnesium. If the overall intake of grains in the diet is minimal, supplementation for these nutrients may be helpful.
Certain digestive enzymes can help break down dietary gluten. This should not be used as a band-aid to following a glutenous diet, but can be helpful after accidental exposure.
Calcium supplementation may be indicated if the diet is limited and adequate alternative sources are not included.
Adequate vitamin D levels are necessary to absorb calcium. It may be important to assess vitamin D status, especially if limiting access to calcium rich foods
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
GFCF Diet & Autism in the Research
Nutritional Impact of a GFCF Diet in ASD
Those on the GFCF diet had a lower weight, body mass index, total energy, pantothenic acid (vitamin B5), calcium, phosphorus and sodium intake. [15]
They had a higher intake of fiber, legumes, and vegetables. [15]
The GFCF diet group had a better quality of fat intake, but needed supplementation with vitamin D. [15]
GFCF Diet Is Effective for Some
While strong empirical support for the GFCF diet in ASD is currently lacking, studies point to the need for identifying subsets of individuals (e.g., those with documented gastrointestinal abnormalities) who may be the best responders to the GFCF diet. [1]
ASD behaviors, physiological symptoms, and social behaviors improved among children whose parents reported presence of GI symptoms, food allergy diagnoses and suspected food sensitivities. Parental report of strict diet implementation, indicated by complete gluten/casein elimination and infrequent diet errors also corresponded to improvement in ASD behaviors, physiological symptoms, and social behaviors. [2]
So far, the evidence for GFCF diets as an effective treatment for children with ASD is mixed, but it might be a beneficial intervention for a subset of children with ASD, particularly for those with comorbid gastrointestinal problems. [3]
Due to limited and weak evidence regarding effectiveness, a GFCF diet should be only used after the diagnosis of an intolerance or allergy to foods containing the allergens excluded in gluten-free, casein-free diets. [4]
GFCF Diet Is Effective
A modified Atkins diet and gluten free casein free diet regimens may safely improve autistic manifestations and could be recommended for children with ASD. [5]
A relationship between improved gut health and decrease of symptoms in autism has been reported, with gluten-free diets, casein-free diets, pre- and probiotic and multivitamin supplementation. [6]
For those with ASD, nutritional interventions are associated with symptom progress in some studies but there is little scientific evidence to support the use of nutritional supplements or dietary therapies in children and adolescents with autism. [7]
A few approaches, such as the gluten-free/casein-free diet, fatty acid supplementation, and pre/probiotics have generally demonstrated improved GI and associated behavioral symptoms in those with ASD. [8]
Gluten-free/casein-free and ketogenic diets, camel milk, curcumin, probiotics, and fermentable foods can play a role in alleviating ASD symptoms, consumption of sugar, additives, pesticides (like glyphosate), genetically modified organisms, inorganic processed foods, and hard-to-digest starches may aggravate symptoms. [9]
A comprehensive nutritional and dietary intervention is effective at improving nutritional status, non-verbal IQ, autism symptoms, and other symptoms in most individuals with ASD, with vitamin/mineral supplements, essential fatty acids, and HGCSF diet being the most beneficial based on parental report. [10]
The majority of published studies indicate statistically significant positive changes to symptom presentation following dietary intervention, particularly in areas of communication, attention, and hyperactivity. [11]
Studies Showing No Improvement With GF Diet
Some research does report there is no significant improvement using a GFCF diet for ASD. We must remember that these studies seldom test for any sort of food reaction before trialing.
“Most investigations assessing the efficacy of a gluten-free and casein-free diet in the treatment of autism are seriously flawed. The evidence to support the therapeutic value of this diet is limited and weak. A gluten-free and casein-free diet should only be administered if an allergy or intolerance to nutritional gluten or casein is diagnosed.” [16]
A 6-month GFCF diet did not induce significant changes in behavioral symptoms of autism and urinary beta-casomorphin concentrations. [12]
Overall, there is little evidence that a GFCF diet is beneficial for the symptoms of ASD in children. [13]
Implementation of a GFCF diet was safe and well-tolerated but dietary challenges did not have statistically significant effects on measures of physiologic functioning, behavior problems, or autism symptoms. [14]
The Bottom Line
The Gluten-Free, Casein-Free Diet is one of the most popular (and most researched) diets used in individuals with autism. Of course, some studies are better designed than others. Most review articles conclude that the jury is still out when it comes to the effectiveness of this diet for those with ASD. However, dairy and wheat are two of the most allergenic foods. There is evidence that ASD is linked to hypersensitivity to certain foods. [See the note on Food Reactions]
Some research studies specify that for those with a sensitivity, the diet is helpful. Since the GFCF diet combines both two relatively easy diets to follow (gluten-free & casein-free), it makes adherence a bit more tricky, though still doable. This diet is not overly costly to implement and the potential benefits outweigh the negatives.
Diet Rating
RATING SCALE = 1 - 5 stars ★
We rate the quality and quantity of the Research supporting the efficacy of the diet in improving symptoms as well as the Ease of Adherence, taking into account the cost, resources available, time required, social acclimation to the diet including options available in restaurants and grocery stores which assist in convenience and adherence
Ease of Adherence ★★★
This diet is moderately easy to follow.
Research ★★★
The research is mixed in regards to effectiveness of this diet.
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[1] Elder JH, Kreider CM, Schaefer NM, De laosa MB. A review of gluten- and casein-free diets for treatment of autism: 2005-2015. Nutr Diet Suppl. 2015;7:87-101.
[2] Pennesi CM, Klein LC. Effectiveness of the gluten-free, casein-free diet for children diagnosed with autism spectrum disorder: based on parental report. Nutr Neurosci. 2012;15(2):85-91.
[3] Ly V, Bottelier M, Hoekstra PJ, Arias vasquez A, Buitelaar JK, Rommelse NN. Elimination diets' efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry. 2017;26(9):1067-1079.
[4] Marí-bauset S, Zazpe I, Mari-sanchis A, Llopis-gonzález A, Morales-suárez-varela M. Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review. J Child Neurol. 2014;29(12):1718-27.
[5] El-rashidy O, El-baz F, El-gendy Y, Khalaf R, Reda D, Saad K. Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metab Brain Dis. 2017;32(6):1935-1941.
[6] Chidambaram SB, Tuladhar S, Bhat A, et al. Autism and Gut-Brain Axis: Role of Probiotics. Adv Neurobiol. 2020;24:587-600.
[7] Monteiro MA, Santos AAAD, Gomes LMM, Rito RVVF. AUTISM SPECTRUM DISORDER: A SYSTEMATIC REVIEW ABOUT NUTRITIONAL INTERVENTIONS. Rev Paul Pediatr. 2020;38:e2018262.
[8] Hartman RE, Patel D. Dietary Approaches to the Management of Autism Spectrum Disorders. Adv Neurobiol. 2020;24:547-571.
[9] Cekici H, Sanlier N. Current nutritional approaches in managing autism spectrum disorder: A review. Nutr Neurosci. 2019;22(3):145-155.
[10] Adams, J.B.; Audhya, T.; Geis, E.; Gehn, E.; Fimbres, V.; Pollard, E.L.; Mitchell, J.; Ingram, J.; Hellmers, R.; Laake, D.; Matthews, J.S.; Li, K.; Naviaux, J.C.; Naviaux, R.K.; Adams, R.L.; Coleman, D.M.; Quig, D.W. Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder—A Randomized, Controlled 12-Month Trial. Nutrients 2018, 10, 369.
[11] Whiteley P, Shattock P, Knivsberg AM, et al. Gluten- and casein-free dietary intervention for autism spectrum conditions. Front Hum Neurosci. 2012;6:344.
[12] González-domenech PJ, Díaz atienza F, García pablos C, Fernández soto ML, Martínez-ortega JM, Gutiérrez-rojas L. Influence of a Combined Gluten-Free and Casein-Free Diet on Behavior Disorders in Children and Adolescents Diagnosed with Autism Spectrum Disorder: A 12-Month Follow-Up Clinical Trial. J Autism Dev Disord. 2020;50(3):935-948.
[13] Piwowarczyk, A., Horvath, A., Łukasik, J. et al. Gluten- and casein-free diet and autism spectrum disorders in children: a systematic review. Eur J Nutr 57, 433–440 (2018). https://doi.org/10.1007/s00394-017-1483-2
[14] Hyman, S.L., Stewart, P.A., Foley, J. et al. The Gluten-Free/Casein-Free Diet: A Double-Blind Challenge Trial in Children with Autism. J Autism Dev Disord 46, 205–220 (2016). https://doi.org/10.1007/s10803-015-2564-9
[15] Marí-Bauset S, Llopis-González A, Zazpe I, Marí-Sanchis A, Suárez-Varela MM. Nutritional Impact of a Gluten-Free Casein-Free Diet in Children with Autism Spectrum Disorder. J Autism Dev Disord. 2016;46(2):673-684. doi:10.1007/s10803-015-2582-7
[16] Lange KW, Hauser J, Reissmann A. Gluten-free and casein-free diets in the therapy of autism. Curr Opin Clin Nutr Metab Care. 2015;18(6):572-575. doi:10.1097/MCO.0000000000000228
