

A gluten-free, casein-free diet may lead to improvements in behavior and physiological symptoms in some children diagnosed with an autism spectrum disorder (ASD), according to researchers at Penn State. The research is the first to use survey data from parents to document the effectiveness of a gluten-free, casein-free diet on children with ASD. Research has shown that children with ASD commonly have GI [gastrointestinal] symptoms, said Christine Pennesi, medical student at Penn State College of Medicine. Notably, a greater proportion of our study population reported GI and allergy symptoms than what is seen in the general pediatric population. Some experts have suggested that gluten- and casein-derived peptides cause an immune response in children with ASD, and others have proposed that the peptides could trigger GI symptoms and behavioral problems.

The team which included Laura Cousino Klein, associate professor of biobehavioral health and human development and family studies asked 387 parents or primary caregivers of children with ASD to complete a 90-item online survey about their children’s GI symptoms, food allergy diagnoses, and suspected food sensitivities, as well as their children’s degree of adherence to a gluten-free, casein-free diet. The team’s results appeared online this month in the journal Nutritional Neuroscience. Pennesi and Klein and their team found that a gluten-free, casein-free diet was more effective in improving ASD behaviors, physiological symptoms and social behaviors for those children with GI symptoms and with allergy symptoms compared to those without these symptoms. Specifically, parents noted improved GI symptoms in their children as well as increases in their children’s social behaviors, such as language production, eye contact, engagement, attention span, requesting behavior and social responsiveness, when they strictly followed a gluten-free, casein-free diet.

According to Klein, autism may be more than a neurological disease  it may involve the GI tract and the immune system. âThere are strong connections between the immune system and the brain, which are mediated through multiple physiological symptoms, Klein said. A majority of the pain receptors in the body are located in the gut, so by adhering to a gluten-free, casein-free diet, you’re reducing inflammation and discomfort that may alter brain processing, making the body more receptive to ASD therapies. The team found that parents who eliminated all gluten and casein from their children’s diets reported that a greater number of their children’s ASD behaviors, physiological symptoms and social behaviors improved after starting the diet compared to children whose parents did not eliminate all gluten and casein. The team also found that parents who implemented the diet for six months or less reported that the diet was less effective in reducing their child’s ASD behaviors. According to the researchers, some of the parents who filled out the surveys had eliminated only gluten or only casein from their children’s diets, but survey results suggested that parents who completely eliminated both gluten and casein from their child’s diet reported the most benefit. While more rigorous research is needed, our findings suggest that a gluten-free, casein-free diet might be beneficial for some children on the autism spectrum, Pennesi said. It is also possible that there are other proteins, such as soy, that are problematic for these children.

The reason Klein and Pennesi examined gluten and casein is because they are two of the most common diet offenders. Gluten and casein seem to be the most immunoreactive, Klein said. A child’s skin and blood tests for gluten and casein allergies can be negative, but the child still can have a localized immune response in the gut that can lead to behavioral and psychological symptoms. When you add that in with autism you can get an exacerbation of effects. Klein’s advice to parents of children with ASD? If parents are going to try a gluten-free, casein-free diet with their children, they really need to stick to it in order to receive the possible benefits, she said. âIt might give parents an opportunity to talk with their physicians about starting a gluten-free, casein-free diet with their children with ASD.

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  • Arorsa

    This article implicates casein, but Dr. Perlmutter advocates eating meats from grass-grazed animals (and dairy?). Please explain.

    • Aduladi

      grass is different than glutinous grain (wheat/rye/etc). cows do not consume dairy into adulthood. cows also have a different digestive system than humans.

      • Arorsa

        Thanks, but that wasn’t my point. This article says that a casein-free diet may result in improvements for children with autism and similar issues. Casein is in cow meat and dairy. If a person eats a casein-free diet, that means s/he eats no beef or dairy products. Yet Dr. Perlmutter advocates eating both, especially beef and butter.

        • kgriffen

          There is no casein in beef.

          • Arorsa

            Not so!!

          • Iacchus Dionysus

            Can you cite a study confirming that. My understanding is that casein is a specially shaped protein to “encase” calcium and phosphorus minerals to deliver to infant mammals in milk. Cheese works by denaturing the casein and trapping the fat globules within the matrix. Why would a cow make casein for muscles or organs? Why would a steer, the prime source of beef, make any casein at all?

          • Arorsa

            I believe I must stand corrected (thank you, Dionysus and kgriffen). Casein is only in milk, not meat. However, it is added to many processed meats (sausage, lunch meats). Moreover, if this animal protein is carcinogenic and may contributes to autism, I’m not sure why people would want to risk consuming other animal proteins. But at any rate, although Dr. Perlmutter’s new book does not seem to encourage the consumption of milk, it most certainly does encourage the consumption of cheese, which absolutely contains casein, and plenty of it.

          • Iacchus Dionysus

            Milk has a lot of sugar (lactose) and whey protein has a high insulin index. Cheese has little of no sugar or whey an d ots of healthy fats. And there are lots of fantastic artisan cheeses. So unless you react to the casein, cheese is good food for brain and general health. My working hypothesis is that many kids who have a lot of gluten can get bad leaky gut and develop immune responses to various casein peptides. There also seems to be a peptide in the casein or whey from type A1 cows (Holstein, Frisian, the black and white ones) which makes the calves docile but is neurotoxic for a lot of people. This problem often goes away switching to jersey or guernsey, or to sheep or goat milk which have different casein structure, closer to human casein.

            It seems every food has proteins to which someone reacts. My wife reacts strongly to temperate tree fruits and nuts, but not tropical. Apples, cherries, pears, apricots, peaches, almonds, hazelnuts, walnuts are all out. Citrus, mango, macadamia nuts, coconuts okay. Easy to detect. Her mouth tingles then gets numb and her throat starts closing up. I suppose each person has to figure out for themselves which foods cause problems.

          • Arorsa

            It sounds like you know what you’re saying with regard to allergies and such, but a deteriorated immune system leads to cancer (and, perhaps, death), and when that happens there’s no warning and no turning back. There have been so many cultures where the consumption of animal products has been very minimal and the rates of chronic disease and cancer have been extremely low. So in the meantime, before scientists figure out all the answers, this provides me with the most logical evidence that a plant-based (whole foods) diet, with little or no animal products, must be the healthiest one.

          • J L10

            If our ancestors consumed only plants, you would not be alive to troll a casein/gluten focused blog post :(

          • Arorsa

            It’s about balance. Our “hunter-gatherer” ancestors were not hunting for cows nor drinking their breast milk on a daily basis.

          • Yudron

            That’s a common allergy. I have it, too.

  • ross hoffman

    This data is indeed compelling. As a cardiologist, I am intimately familiar with the impact of inflammation on the development of this nation’s number one killer, heart disease. Dr. Perlmutter is taking the lead in helping us promote better health through holistic, evidence-based, and sensible approaches to wellness and health care delivery.
    Ross G. Hoffman, MD, Cardiologist, Associate Prof. of Medicine, University of Central Florida, College of medicine

  • Cynd

    Ugh the cost with a family of 7 is bank busting!

  • David Perlmutter

    While most people seem to tolerate casein, there is a growing body evidence that this protein may represent an issue in autistic patients as well as others. So beyond just going gluten free, the addition of casein restriction may prove beneficial in this particular clinical situation. we have also noted a relationship between casein sensitivity and headache disorders, so keep that in mind.

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  • Susan

    Regarding casein, would fermenting milk take care of some of the casein by reducing its ability to create harm?

  • ShoshanaSuz

    Would this also apply to ADD? Do you have articles that you can direct me to regarding diet and ADD? Thank you.

    • David Perlmutter

      In the “Science” section of my website, I have a whole host of studies on topics relating to ADD and ADHD. You should take a look there, here’s the link: http://www.drperlmutter.com/learn/studies/

  • de bear

    I want to come back to the question of fermented milk products like kefir or yogurt. Is the casein in those products any better, or does one need to stay clear of fermented milk products as well? How about milk or yogurt from goat and sheep? Any data for those products, whether they would generally cause problems, or be more widely tolerated than cow’s milk casein?

  • ohsquish

    Chronic bronchitis plagued me as a child and young adult, but finally in my mid-30′s, I figured out that my acne and bronchitis were related to casein. The reason it took so long to figure it out is that my symptoms (a scratchy throat that brought a low-grade fever within a day, which morphed into nasal congestion and post-nasal drip, and within 3 days, bronchitis) mimicked those of viral and bacterial infections, so my parents and doctors assumed it was one or the other and treated it as such. I grew up assuming they were right. When I finally figured out my acne and respiratory problems were related to milk, I tried organic milk from grass-fed beef, raw milk, lactose-free milk, and any other version of “healthy” milk but always with the same results. Once I began carefully restricting cow’s milk in any and all of its forms, the frequency of bronchial infections dropped from 4-5 a year to one every couple of years.

    During this discovery process, I ran a large preschool (125+ children) and became concerned that so many struggled as I did with respiratory problems. Anecdotal evidence isn’t very compelling but clinical evidence was scarce in the 70′s and 80′s, so I shared what I had of both with parents. A few began to restrict dairy in their children’s diets, and to a one, saw a marked decline in their children’s respiratory problems. Over the past 30 years, friends with severe acne and parents whose children had chronic respiratory problems and went dairy-free had convincingly positive results.

    At some point I came across John McDougall’s explanation of why the body reacts as it does to casein. That, information available at the time, and my own experience satisfied my need for information. Goat cheese and coconut milk satisfied my need for dairy substitutes.

  • Susan

    I too would like an answer to my fermented milk products/casein question, is there any good study you can refer me to, Dr. Perlmutter, or anyone? I don’t drink milk but make my own kefir from organic milk and would like to know about the casein in it, can the body handle it better. Thanks

  • Veronica

    Reading Grain Brain and curious why cheese is listed on good foods list, when other dairy isn’t. Can anyone explain?

    • David Perlmutter

      In cheese, the lactose sugar has been fermented and is no longer present. This dramatically reduces the carb content.

      • Hugo

        It is always a debate that milk is the best source of calcium. Can we find another alternative except from milk or soy product?

  • frank

    does this diet help with arthritis.