Gluten-Free Diet
What is the Gluten-Free Diet?
A gluten-free diet is a diet that excludes all foods that contain gluten. Gluten is a protein found in grains like wheat, rye, and barley and any foods made with these grains. Note that a gluten-free diet is different from a grain-free diet, as a grain-free diet removes all grains, whether or not they contain gluten.
The gluten-free diet is one of the most popular diets used among those with autism and often used in combination with a casein-free diet (the protein in dairy) and may be denoted as GFCF (Gluten-Free, Casein-Free). This is because those sensitive to gluten may also be sensitive to casein-containing foods as well.
It is thought that gluten is one of many factors that can lead to intestinal permeability, also known as Leaky Gut. [1] This can happen to many people, not just those with autism. This happens if gluten creates inflammation in an individual’s gut, which then causes the gut to become inflamed and “leaky”. Small gaps can form in the gut cells and allow gluten proteins to cross through the gut to the rest of the body and even cross the blood brain barrier, where they have an opiate-like effect by binding to opiate receptors in the brain. This is known as the opioid excess theory. [2] This would then cause inflammation through out the rest of the body and potentially behavioral issues, trouble focusing, hyperactivity, etc.
Is the Gluten-Free Diet Beneficial for Autism?
In many cases the gluten-free diet can be beneficial, especially for those that test positive for wheat sensitivity, gliadin protein antibodies, or those that notice reactions to foods that contain gluten.
There is some research to support the use of the gluten-free diet among children with autism. One study suggested that gluten intolerance with ASD occurs in 40-50% of children. [3] Non-celiac gluten sensitivity has been related to neuro-psychiatric disorders, such as autism, schizophrenia and depression. [4]. One meta-analysis showed that a GFCF diet can reduce stereotypical behaviors and improve the cognition of children with ASD. [5]. Another meta analysis reported that a gluten-free diet led to significant improvements in social behaviors. [6]
It is also important to note that GI symptoms seem to be a good indicator that gluten sensitivity may be present. One study found that 58% of ASD patients had a gastrointestinal disorder. In more than 20% of the patients who followed the gluten-free, casein-free diets or supplements, gastrointestinal severity decreased (mainly constipation, diarrhea, and abdominal pain). [7] Similarly, children whose parents reported the presence of GI symptoms, food allergy diagnosis, and suspected food sensitivities had greater improvement in ASD behaviors, physiological symptoms, and social behaviors with a gluten-free, casein-free diet, compared with children whose parents reported none of these symptoms. [8] Lastly, a relationship between improved gut health and a reduction in autism symptoms has been reported, with gluten-free diets, casein-free diets, pre- and probiotic and multivitamin supplementation. [9]
There are some studies in which a GFCF diet is not associated with symptom improvement. Many researchers emphasize the need for more well-controlled studies and have suggested that the gluten-free diet is likely appropriate for those that are sensitive to wheat and should not be used as a one-size-fits-all approach for every child with autism. [10]
BOTTOM LINE:
The gluten-free diet is best suited for those that have a sensitivity to gluten. If your child is displaying symptoms of food sensitivity and gluten is a big part of their diet, a gluten-free diet may be worth a try.
Should Everyone on the Autism Spectrum Go Gluten-Free?
There is no one diet, supplement, or lifestyle for everyone on the autism spectrum. Autism is called a spectrum for a reason, and your child’s body is so much more complex than that! That being said, we do see that a gluten-free diet can be life-changing for some individuals! This is because they have a gluten sensitivity or allergy or have leaky gut to begin with. If your child has one or some of the following symptoms, it may be worth trialing a gluten-free diet with the support of a dietitian:
Abdominal pain or cramping
Bloating and gas
Gas and bloating
Joint pain
Headaches or migraines
People who experience the above reactions to gluten-containing foods are most likely to benefit from this diet. These reactions indicate an inflammatory response within the body and removing the most likely offending foods may reduce these symptoms.
Wheat Allergy, Gluten Sensitivity, & Celiac Disease
It is possible to react to gluten in varying ways including a gluten sensitivity, a wheat allergy, or Celiac Disease. Celiac disease is the most severe and is an autoimmune condition in which gluten triggers a person’s immune system to attack their own intestines and cause major health and nutritional issues It’s more common for someone to have a non-celiac gluten sensitivity, which causes symptoms like constipation or diarrhea, migraines and headaches, eczema, and inflammation. A wheat allergy will cause more immediate skin rashes and even anaphylaxis. To learn more about the differences between food reactions, check out Food Reactions note. Adherence to this diet is absolutely necessary for those with a gluten allergy or who have Celiac disease. Those with gluten sensitivity may be able to tolerate small amounts of gluten.
Going Gluten-Free
Benefits of a gluten-free diet can be seen as early as 4-6 weeks but strict adherence is recommended for at least 3-6 months to see full benefits.
Recommended Foods
All food groups may be included in the gluten-free diet including vegetables, fruits, meat, poultry, fish, non-meat proteins (eggs, beans, nuts), and gluten-free grains (rice, quinoa, gluten-free oats, or corn).
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
→ Looking for brand recommendations? Check out our Round-Up of Our Favorite Gluten-Free Flours, Breads, Pastas, and More
Foods to Avoid
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.
Certain medications & supplements
Communion wafers
Top Tips for Going Gluten-Free
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, at school for example, it can be critical to demonstrate success and improvements with the diet from the start so the child feels better and is motivated to continue choosing gluten-free options. It may be beneficial to start the diet over the summer when the child is home and making gluten-free choices is easier.
