A gluten-free casein-free diet (GFCF diet), also known as a gluten-free dairy-free diet (GFDF diet), is a diet that does not include

gluten Gluten is a structural protein naturally found in certain cereal grains. Although "gluten" often only refers to wheat proteins, in medical literature it refers to the combination of prolamin and glutelin proteins naturally occurring in all grai ...

(found most often in

wheat Wheat is a grass widely cultivated for its seed, a cereal grain that is a worldwide staple food. The many species of wheat together make up the genus ''Triticum'' ; the most widely grown is common wheat (''T. aestivum''). The archaeologi ...

barley Barley (''Hordeum vulgare''), a member of the grass family, is a major cereal grain grown in temperate climates globally. It was one of the first cultivated grains, particularly in Eurasia as early as 10,000 years ago. Globally 70% of barley p ...

, and rye), and

casein Casein ( , from Latin ''caseus'' "cheese") is a family of related phosphoproteins ( αS1, aS2, β, κ) that are commonly found in mammalian milk, comprising about 80% of the proteins in cow's milk and between 20% and 60% of the proteins in hum ...

(found most often in

milk Milk is a white liquid food produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals (including breastfed human infants) before they are able to digest solid food. Immune factors and immune-modula ...

and dairy products). Despite an absence of scientific evidence, there have been advocates for the use of this diet as a treatment for autism and related conditions.

Uses

Autism

The majority of the available evidence does not support the use of this diet in the treatment of autism. * American Academy of Pediatrics – Clinical Report (2007) In their report, the AAP did not recommend the use of special diets for children with autism spectrum disorder because of inadequate evidence. *

Cochrane Library The Cochrane Library (named after Archie Cochrane) is a collection of databases in medicine and other healthcare specialties provided by Cochrane and other organizations. At its core is the collection of Cochrane Reviews, a database of system ...

– Gluten and Casein-free diets in autism spectrum disorder (2008) The

Cochrane review Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions involving health profes ...

found that while relatively commonly used the evidence to support the diets use in children with autism was poor. All studies as of 2006 had issues with them. * '' Research in Autism Spectrum Disorders'' – Gluten-free and casein free diets in the treatment of autism spectrum disorders: A systematic review (2009) It concluded that the results "reveal that the current corpus of research does not support the use of GFCF diets in the treatment of ASD. Given the lack of empirical support, and the adverse consequences often associated with GFCF diets (e.g. stigmatization, diversion of treatment resources, reduced bone cortical thickness), such diets should only be implemented in the event a child with ASD experiences acute behavioral changes, seemingly associated with changes in diet and/or a child has allergies or food intolerances to gluten and/or casein." * Vanderbilt Evidence-based Practice Center – Therapies for Children with Autism Spectrum Disorder (2011) The review, commissioned by the

Agency for Healthcare Research and Quality The Agency for Healthcare Research and Quality (AHRQ; pronounced "ark" by initiates and often "A-H-R-Q" by the public) is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered i ...

, concluded that, "the evidence supporting GFCF diets in ASD is limited and weak." * '' Clinical Therapeutics'' – The relationship of autism to gluten (2013) This review found one double-blind study, which did not find any benefit from the gluten-free diet, and concluded that "Currently, there is insufficient evidence to support instituting a gluten-free diet as a treatment for autism." * '' Journal of Child Neurology'' – Evidence of the Gluten-Free and Casein-Free Diet in Autism Spectrum Disorders: A Systematic Review (2014) This review found that "...the evidence on this topic is currently limited and weak," and noted that only a few randomized trials had been conducted on the efficacy of gluten-free diets as an autism treatment. The review also noted that even these trials were of questionable scientific merit because they were based on small sample sizes. * '' Current Opinion in Clinical Nutrition & Metabolic Care'' – Gluten-free and casein-free diets in the therapy of autism (2015) This review found "limited and weak" evidence that this diet was effective as a treatment for autism, noting that most studies that had been done to assess its effectiveness were "seriously flawed". *'' Autism Research Institute'' – The Autism Research Institute recommends the GFCF/GFDF diet as a treatment for autism and related conditions. The organization believes that, "Dietary intervention is a cornerstone of an evidence-based medical approach, and there is convincing empirical evidence that special diets help many with autism."

Safety

The diet may have a negative effect on bone health, although there is debate over whether this is actually due to the diet or caused by issues associated with autism.

Mechanism

In the 1960s, Curtis Dohan speculated that the low incidence of

schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social wit ...

in certain

South Pacific Island Collectively called the Pacific Islands, the islands in the Pacific Ocean are further categorized into three major island groups: Melanesia, Micronesia, and Polynesia. Depending on the context, the term ''Pacific Islands'' may refer to one of se ...

societies was a result of a diet low in wheat and milk-based foods. Dohan proposed a genetic defect wherein individuals are incapable of completely

metabolizing Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...

and

as a possible cause for

. Dohan hypothesized that elevated

peptide Peptides (, ) are short chains of amino acids linked by peptide bonds. Long chains of amino acids are called proteins. Chains of fewer than twenty amino acids are called oligopeptides, and include dipeptides, tripeptides, and tetrapeptides. ...

levels from this incomplete metabolism could be responsible for schizophrenic behaviors. In 1979,

Jaak Panksepp Jaak Panksepp (June 5, 1943 – April 18, 2017) was an Estonian-American neuroscientist and psychobiologist who coined the term " affective neuroscience", the name for the field that studies the neural mechanisms of emotion. He was the Baily End ...

proposed a connection between autism and opiates, noting that injections of minute quantities of opiates in young laboratory animals induce symptoms similar to those observed among autistic children. The possibility of a relationship between autism and the consumption of gluten and casein was first articulated by Kalle Reichelt in 1991. Based on studies showing correlation between autism, schizophrenia, and increased

urinary The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, co ...

levels, Reichelt hypothesized that some of these peptides may have an opiate effect. This led to the development of the Opioid excess theory, expounded by Paul Shattock and others, which speculates that peptides with opioid activity cross into the bloodstream from the lumen of the intestine, and then into the brain. These peptides were speculated to arise from incomplete digestion of certain foods, in particular gluten from wheat and certain other cereals and from casein from milk and dairy produce. Further work confirmed opioid peptides such as casomorphines (from casein) and gluten exorphines and gliadorphin (from gluten) as possible suspects, due to their chemical similarity to opiates. Reichelt hypothesized that long term exposure to these opiate peptides may have effects on brain maturation and contribute to social awkwardness and isolation. On this basis, Reichelt and others have proposed a gluten-free casein-free (GFCF) diet for those with autism to minimize the buildup of opiate peptides. Reichelt has also published a number of trials and reviews concluding that this diet is effective.

Practical implementation

The implementation of a GFCF diet involves removing all sources of gluten and casein from a person's diet. Gluten is found in all products containing wheat, rye, and barley. Many gluten-free breads, pastas, and snacks are available commercially. Gluten-free cookbooks have been available for decades. Casein is found in dairy products such as milk,

yogurt Yogurt (; , from tr, yoğurt, also spelled yoghurt, yogourt or yoghourt) is a food produced by bacterial fermentation of milk. The bacteria used to make yogurt are known as ''yogurt cultures''. Fermentation of sugars in the milk by these bac ...

or cheese, but is also present in smaller amounts in many substitute dairy products such as

vegetarian Vegetarianism is the practice of abstaining from the consumption of meat (red meat, poultry, seafood, insects, and the flesh of any other animal). It may also include abstaining from eating all by-products of animal slaughter. Vegetariani ...

cheese substitutes and

whipped cream Whipped cream is liquid heavy cream that is whipped by a whisk or mixer until it is light and fluffy and holds its shape, or by the expansion of dissolved gas, forming a firm colloid. It is often sweetened, typically with white sugar, an ...

topping, which use casein to provide texture. Although advocates of the GFCF diet often recommend total elimination of dairy from the diet,

whey protein Whey protein is a mixture of proteins isolated from whey, the liquid material created as a by-product of cheese production. The proteins consist of α-lactalbumin, β-lactoglobulin, serum albumin and immunoglobulins. Glycomacropeptide also ma ...

is a different milk protein from casein.

References

External links

*
Gluten-Free Diet Consequences
{{Autism resources , therapies Diets Autism pseudoscience Alternative therapies for developmental and learning disabilities Gluten-free diet