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Exerpted with permission from Children of the New Earth - Summer 2003. To subscribe, visit their site at: www.childrenofthenewearth.com or call (858) 268-9929.

Can eliminating certain foods from the diet improve autistic symptoms such as social withdrawal, repetitive behavior, communication difficulties, anxiety and hyperactivity? Most parents know that what they feed their children affects them in one way or another. Foods and chemicals do not just affect the digestive tract. They have a direct impact on our mood, brain and behavior. For example, caffeine can make us feel energized, whilst food dyes and food additives can cause hyperactivity, skin problems and asthma. From here it is not such a big leap to imagine how some foods may influence autistic behavior.

The inability to break down certain food is known to affect brain development and behavior. The foods that are typically associated with this are gluten (the protein in wheat, oat, spelt, kamut, rye and barley) and casein (the protein in milk products). Research has shown that avoiding foods containing gluten and casein may significantly improve symptoms associated with autism (1,2,3,4).

Most of us are able to digest proteins such as gluten and casein. We do this using enzymes that break the proteins down into peptides, and then into amino acids. Certain individuals that lack these enzymes cannot completely digest these proteins. They produce peptides that are eliminated harmlessly in the urine. Autistic children have large amounts of these peptides in their urine (5). It is believed that they are unable to completely digest gluten and casein, and that eating foods containing gluten and casein contributes to their autistic symptoms.

Living without gluten and casein
Although most of the resulting peptides are eliminated in the urine, some spill over into the blood and are transported to the brain. Once in the brain the peptides affect brain development and behavior, and may be responsible for some of the symptoms seen in autism (6,7).

The peptides produced by the incomplete digestion of gluten and casein are biologically active and have opiate-like effects similar to morphine. Along with disrupting normal brain activity they can produce feelings of well being and relaxation, and as such they are highly addictive and can cause chemical dependency. For this reason autistic children can become “addicted” to gluten and casein, and thus find it difficult to stop eating culprit foods such as wheat and dairy.

It is estimated that more than 50 percent
of autistic children have gastrointestinal
symptoms, food allergies, poor digestion
and poor absorption.

The action of gluten and casein described here is toxicological rather than allergic. The results are akin to poisoning rather than the extreme sensitivity that occurs in celiac disease. However, there is often an accompanying inflammatory or allergic reaction that can exacerbate the situation due to its effect on the intestinal integrity or “permeability”.

When the intestine becomes more permeable more of the opiate-like peptides are able to enter the blood steam and pass to the brain. The more opiate-like peptides that are present in the brain, the more severe the effects. For this reason it is important to identify and correct any factors that may compromise the intestinal permeability.

It is estimated that more than 50 percent of autistic children have gastrointestinal symptoms, food allergies, poor digestion and poor absorption (8). To maximize the benefits of a gluten and casein-free diet it is necessary to correct intestinal permeability, including food allergies, parasites, infections and poor sulphation. If this is not addressed improvements in autistic symptoms may be slow and the diet may be prematurely abandoned as ineffective.

The Research

The similarty between the symptoms of autism and the long-term effects of morphine has been known for a long time (9). It led to the theory that autistic children may have elevated levels of opiate-like compounds, which soon became evident when high levels of opiate-like substances were then discovered in the urine of autistic children (5). These opiate-like substances were identified as peptides, and due to the high levels present in the urine it is believed that they are derived from the diet, since the incomplete digestion of gluten and casein is known to produce opiate-like peptides (10).

If this opiate-peptide theory were correct we would expect to see an improvement in autistic symptoms if we were to remove the peptides. The opiate-like peptides can be removed using anti-opiate medication, such as naltrexone, or by eliminating gluten and casein from the diet. Studies with naltrexone show mixed results, although low doses can improve autistic symptoms (11). The elimination of gluten and casein from the diet looks promising as a treatment for autism. Various studies on the effects of following a gluten and casein free-diet have been published over the last 12 years (1,2). In all but one study a gluten and casein-free diet was found to be beneficial in reducing autistic behavior and in increasing social skills and communication skills. When gluten and casein were re-introduced to the diet there was a worsening of autistic traits (12).

This is strong evidence to support the use of a gluten and casein-free diet in autistic children. However, to be scientifically accepted, double blind crossover studies are needed. It is unlikely that these will be carried out for the opiate-theory in the near future since these studies are costly and time-consuming, and the treatment is relatively simple, cheap and available without prescription. Nobody is going to make money out of these expensive studies; therefore little research is going to go into scientifically proving the opiate-theory.

In the meantime, thousands of families have reported mild to dramatic improvements by following a gluten and casein-free diet, and the benefits are becoming recognized in the medical community. If you or your family suffers from autism there is nothing to lose and potentially a lot to gain by adopting a gluten and casein-free diet.

Where to start
A simple urine test is available to detect the presence of opiate-like peptides. In the US, the Urinary Peptide Test is available from Antibody Assay Laboratories (AAL Reference Laboratories Inc., 714-972-9979) and Great Plains Laboratory (913-341-8949). Be advised that these tests are not perfect, and that there are children with no detectable gluten or casein byproducts in their urine that still benefit from following a gluten and casein free diet.

If high levels of the peptides are found in your child’s urine then it is definitely worthwhile trying a gluten and casein-free diet. For some, improvements in autistic symptoms can be seen in a week, whilst in others it may take a full year. If you do not see immediate results do not despair. The opiate-like peptides are removed very slowly from the body and a six- to twelve-month trial may be necessary before you see an improvement.

In some children there is an initial worsening of symptoms, such as an upset stomach, anxiety, clinginess or ill temper. These are signs that your child is responding to the treatment and is like peptides. Remember - these peptides create feelings of well being and relaxation, and as such they are highly addictive and can cause chemical dependency. Since younger children experience more noticeable withdrawal effects it is best to remove gluten and casein from the diet slowly in children below the age of four.

Gluten and casein-free eating
The decision to follow a gluten and casein-free diet must be undertaken by both parents and also must be fully supported by both family and caregivers. Improvements are often slow, so be prepared to be patient. Allow at least six months to determine if the diet is successful. Improvements are quicker when the intestinal integrity and permeability are addressed.

We are fortunate in that many gluten and casein-free products are now available. We can buy gluten-free cereals, breads, pasta, baking powder, flours, pancake mixes and muffin mixes. Commercially available gluten-free breads are expensive and are not nearly as enjoyable as a homemade version so you may want to make your own. Zojirushi and Welbilt are brands of bread machines known for their good gluten-free bread results.

Brown rice flour and corn flour can be used to make excellent pancakes and waffles. Make extra and freeze them for those mornings when you have less time. For those avoiding sugar try serving the pancakes with 100% fruit jam or 100% pure vegetable glycerine. Glycerine is a coconut-based product that is very sweet. It can be mixed with maple flavoring to make a faux maple syrup.

Keep a gluten-free flour mix on hand. Either make it yourself (see recipe) or buy a gluten-free bake mix. When combined with xanthan gum they can be used to replace white flour in your favorite recipes. Xanthan gum gives gluten-free breads, muffins and cakes the body you get with wheat. It is expensive, but a little goes a long way. Storing the flour mix with the xanthan gum in it will make the flour rancid, so add it to the flour mix as you use it.

Although homemade versions taste better, gluten-free cookies, waffles and biscotti are available at health food stores such as Jimbos, Whole Foods, Henrys, Wild Oats and Mothers. If you do not have access to a good health food store then you can order direct from the company (see resources at end of article).

Likewise, frozen rice pizzas are available in some health stores, but be aware that their soy cheese toppings often contains casein. Either make your own gluten-free crust or use corn tortillas or gluten-free bread and top with vegan soy cheese or the topping of your choice.

The choice of gluten-free pasta is excellent. It comes dried in various shapes made from corn, lentil or rice. Be careful not to overcook the pasta. Use gluten-free spaghetti to make a delicious pasta crust: boil the rice spaghetti to al dente, add two beaten eggs, mix well and place in a pie pan. Fill as desired and bake.

Learn to use rice flour to thicken sauces and to cook with wheat free soy sauce. Avoid prepared foods containing “modified food starch” as this is a source of gluten. Rice syrup is a common sweetener but often has extracts from barley. Gluten can also be hidden in licorice, vinegar, mustard, tomato sauce, soy sauce, self-basting turkeys, French fries, taco shells, some cold cuts and many prepared stocks and soups.

Casein is found in all dairy products, including milk, buttermilk, yogurt, cheese, curds, whey, ice cream, cream and butter. It is also present in most commercial hot chocolate, protein bars, non-dairy creamers, margarines, salad dressings, lunchmeats, omelets, scrambled eggs, peanut butter and artificial sweetener. Anything containing hydrolyzed vegetable protein must be avoided because they are derived from dairy.

You must also be cautious with some of the dairy alternatives. Many soy and rice based cheeses contain casein. Most “vegan” soy cheeses are acceptable. Soy, rice and almond milk make good substitutes for milk, but many are sweetened with barley malt or rice syrup that contain gluten. Many people use Toffuti as a non-dairy “ice cream”, but be warned that it contains gluten. Rice dream non-dairy frozen desserts and sorbets are acceptable as long as they are not coated with carob or chocolate.

Also, be cautious with medications. Many contain gluten and lactose. Talk to your pharmacist or contact Stokes Medical Arts Pharmacy for gluten and lactose free medications.

Additional support for the gastrointestinal tract
As mentioned earlier, it is important to correct intestinal integrity and permeability. This can involve treating food allergies, toxicity and intestinal parasites. A nutritional program to support the entire digestive tract is important and may include digestive enzymes, good bacteria (probiotics) and healing herbs and amino acids.

Many parents have spent huge sums of money to have their children tested for allergies and vitamin and mineral deficiencies. These can give worrying results such as apparent allergies to over 50 different foods. The good news is that many of these are not “true” allergies and will resolve themselves once gluten and casein are removed from the diet. Similarly, many vitamin and mineral deficiencies will improve once the gluten and casein are removed from the diet. It is often advisable to perform these tests after the removal of gluten and casein.

Individuals suffering from food allergies often have poor digestion of foods. This can be corrected by giving digestive enzymes with meals. These enzymes help to break down and digest the proteins, fats, carbohydrates and fiber in the diet. Also, there are specialized digestive enzymes, such as SerenAid, that specifically break down the opiate-like peptides from gluten and casein. These are not intended to enable you to continue eating gluten and casein, but are designed to speed up the process of peptide elimination from the body and to handle the accidental ingestion of these foods.

The colon is home to billions of friendly bacteria that live in balance with us. They protect the colon wall and produce vitamins that our body needs. There are more than 500 different types of beneficial bacteria that can live in our digestive tract. Unfortunately, these bacteria are very sensitive to their environment and are killed by conditions resulting from food allergies and poor digestion. When the good bacteria die they are replaced by bad bacteria that produce toxins that cause damage to the colon. Taking a good quality probiotic supplement is beneficial to the health of the colon and can speed up the improvement in autistic symptoms.

In summary
Following a gluten and casein free diet has helped many families deal with autism. Following such a diet is a major commitment on behalf of the entire family and their commitment to the diet speaks volumes for their perceived benefits.

A gluten-free diet is a safe option in the search to improve autistic symptoms such as social withdrawal, repetitive behavior, communication difficulties, anxiety and hyperactivity. Although positive results cannot be guaranteed for every child many families have benefited by committing to a gluten and casein free diet.

REFERENCES

1 Whieley and Shattock. Biochemical aspects in autism spectrum disorders: updating the opiate excess theory and presenting new opportunities for biomedical intervention. Expert Opin Ther Targets. 2002; 6(2):175-183

2 Knivsberg et al. A randomized, controlled study of dietary intervention in autistic syndromes. Nutr Neurosci 2002;5(4):251-261) (Knivsberg et al. Reports on dietary intervention in autistic disorders. Nutr Neurosci 2001;4(1):25-37

3 Cadeet al. Autism and schizophrenia: Intestinal disorders. Nutr Neurisci 2000; March

4 Lucarelli et al. Food allergy and infantile autism. Panminerva Medica 37 (3):137-141

5 Reichelt et al. Biologically active peptides containing fractions in schizophrenia and childhood autism. Advances Biochem Psychopharmacol 1981; 28:627-643

6 Reichelt et al. The effect of gluten-free diet on glycoprotein attached urinary peptide excretion and behavior in schizophrenics. Journal Orthomology Medicine 1990; 5:223-239

7 Reichelt et al. Nature and consequences of hyperpeptiduria and bovine casomorphin found in autistic syndromes. Developmental Brain Dysfunction1994; 7:71-85

8 Buie et al. Preliminary findings in gastrointestinal investigation of autistic patients. 2002

9 Panksepp J. A neurochemical theory of autism. Trends Neurosci 1979; 2:174-177

10 Fukudome and Yoshikawa. Opioid peptides derived from wheat gluten: their isolation and characterisation. Fed Eur Biochem Societies Letters 1991; 412:475-479

11 Leboyer et al. Opiate hypothesis in infantile autism? Therapeutic trials with naltrexone. Encephale 1993; 19(2):95-102

12 Knivsberg Reichelt and Nodland. Reports on dietary intervention in autistic disorders. Nutr Neurosci 2001;4(1):25-37

RESOURCES
Authentic Foods
800-806-4737 • www.authenticfoods.com
Manufacturer of bean and specialty flours, baking mixes, cake mixes, coating mixes, xanthan gum and natural flavors. Manufactured in a gluten-free environment.

ENER-G Foods, Inc. 800 331-5222 • www.ener-g.com
Has the largest gluten-free product line in America. Offer breads, donuts, cakes, cookies, English muffins, pizza shells and soups.

Gluten-free Pantry
860-633-3826 • www.glutenfree.com
Gourmet gluten-free baking mixes created by a chef who is also gluten-free. Bread, bagel, brownie, cookie and piecrust mixes. Friendly and knowledgably staff.

Mr. Spice Health Foods
401 848-7700 • www.mrspice.com
The only line of delicious sauces that is gluten-free. Special Diets for Special Kids, by Lisa Lewis Ph.D. Excellent gluten and dairy free cookbook from Future Horizons Inc.

Stokes Medical Arts Pharmacy • 800-754-5222

SerenAid is available from
Klaire Laboratories Inc., 140 Marine View Ave., Suite 110, Solana Beach, CA 92075 Voice: 858-350-7880 · Fax: 858-350-7883 Toll Free: 800-859-8358 • www.Klaire.com

DR. DIANA FATAYERJI graduated from Sheffield University, England, with a Masters in Human Nutrition and a Doctorate in Clinical biochemistry. She has a private Nutritional Practice in San Diego, California where she treats both adults and children with specific nutritional issues. Diana’s background in biochemistry and physiology enables her to identify metabolic imbalances and to treat these using diet, nutritional support and traditional herbs.