Thursday, April 22, 2010

Study Shows Gluten-Free Casein-Free Diet Works?

According to a recently published study, the gluten-free casein-free (GFCF) diet may work.  I did not read this study yet so I am not sure of all of the details, but I do know that this is the longest (2 year) and largest (72 children) of the GFCF diet done so far.  And, according to the abstract, the study authors are tentatively saying that the group on the diet showed a significant improvement on a number of measures.

It will be interesting to see what this study actually says.

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The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders.
Whiteley P, Haracopos D, Knivsberg AM, Reichelt KL, Parlar S, Jacobsen J, Seim A, Pedersen L, Schondel M, Shattock P.

Abstract
There is increasing interest in the use of gluten- and casein-free diets for children with autism spectrum disorders (ASDs). We report results from a two-stage, 24-month, randomised, controlled trial incorporating an adaptive 'catch-up' design and interim analysis. Stage 1 of the trial saw 72 Danish children (aged 4 years to 10 years 11 months) assigned to diet (A) or non-diet (B) groups by stratified randomisation. Autism Diagnostic Observation Schedule (ADOS) and the Gilliam Autism Rating Scale (GARS) were used to assess core autism behaviours, Vineland Adaptive Behaviour Scales (VABS) to ascertain developmental level, and Attention-Deficit Hyperactivity Disorder - IV scale (ADHD-IV) to determine inattention and hyperactivity. Participants were tested at baseline, 8, and 12 months. Based on per protocol repeated measures analysis, data for 26 diet children and 29 controls were available at 12 months. At this point, there was a significant improvement to mean diet group scores (time*treatment interaction) on sub-domains of ADOS, GARS and ADHD-IV measures. Surpassing of predefined statistical thresholds as evidence of improvement in group A at 12 months sanctioned the re-assignment of group B participants to active dietary treatment. Stage 2 data for 18 group A and 17 group B participants were available at 24 months. Multiple scenario analysis based on inter- and intra-group comparisons showed some evidence of sustained clinical group improvements although possibly indicative of a plateau effect for intervention. Our results suggest that dietary intervention may positively affect developmental outcome for some children diagnosed with ASD. In the absence of a placebo condition to the current investigation, we are, however, unable to disqualify potential effects derived from intervention outside of dietary changes. Further studies are required to ascertain potential best- and non-responders to intervention. The study was registered with ClincialTrials.gov, number NCT00614198.

PMID: 20406576 [PubMed - in process]

14 comments:

  1. what were all the kids eating though? Were the ones not on GFCF living on junk or one food group or did they have a varied healthy diet? I wish we knew all these details before they decide how diet affects those with ASD (as it does human beings in general).

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  2. The study doesn't say what exactly the children were eating who were not on the diet, or on the diet, for that matter, other than to say it was a "strict" GFCF diet.

    But, there were trained nutritionists looking at the children and all of the children received a dietary assessment at the start of the study. The children in the diet group were given a multivitamin and calcium to help prevent nutritional problems due to the diet.

    It also looks like the nutritionists monitored the participants during the course of the study to make sure that there were no problem. Although that might have just been for the diet group, the text isn't completely clear on that point.

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  3. Hi MJ
    I am very interested on this study. However my main complain about this kind of studies is that only nutritional aspects are considered (and only Calcium and not for example vitamin D3 status).What about Mg?
    Besides, it is important to know what calcium ( total and ionic in blood and or in urine?)
    I wonder why the GFCF diet is not done with further clinical studies to know in the baseline other CMPs to the diagnosis. This way the importance of combination of treatments more than only one approach would be more evident.
    For example, what percentage of children were IgA defficient? What percentage had proper testing of fungal /bacterian infections- including Heliocobater pylori and GERD? What about agression, self aggresion in different subgroups?
    The importance of the Combination of approaches- based on the need of combination of therapies to address a group of problems has not been properly explored. Without the nutritional support plus the candidiasis treatment plus the probiotics plus the GFCF diet my son would have not shown improvement, especially because his candidiasis demonstrated to be very severe and resistant.

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  4. Hi Maria,

    You are right, this study didn't really look at the nutritional or immune system at all, expect to make sure that the children maintained proper nutrition (at least going in). Although, eating the right amounts of something and having your body be able to process what you have eaten are different and children with autism have been shown to have issues with the later.

    But, at the same time, the researchers did select study participants based on a urine analysis, looking for "exogenous opioid peptide standards and/or trans-indolyl-3-acryloylglycine", which is something that no other major trial of the GFCF diet has done. Also, the researchers weren't trying to find out how the diet works, just whether it does work.

    And, after reading the study, it seems the researchers did manage to show that the diet can make a difference, which is a good place to start.

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  5. Just found your site. I do love the name. The media seems to have made a 3-ring circus out of all off it. I've pretty much have learned not to get my info from the media. I spend my lunches in the medical journals (PubMed) to learn more of the mechanics behind why this happened. I guess I can view the media as soap opera style entertainment. But I would love for the medical side of it to be treated seriously, rather than argueing if it even exists. I think I'll appreciate any such news/viewpoints more from someone like yourself.

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  6. Read the study. Its pretty clear. There isnt much evidence that it helps.

    "Based on the results of this review, it would appear that evidence in support of Opioid-Excess Theory and the resulting
    treatment of ASD with the GFCF diet is limited and weak. Adverse consequences potentially associated with GFCF diets (e.g.,
    stigmatization, diversion of treatment resources, reduced bone cortical thickness) further the argument against the diet’s
    therapeutic use."

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  7. M - you are referring to a a different study, not the one I am quoting above. The one you are referring to is here -

    http://www.auburn.edu/~lal0011/autism/mulloy.pdf

    and is not original research but a review of other, earlier studies. I think it is also worth noting that this meta review does not include the study that I am talking about in the post.

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  8. Hi MJ
    That study, besides, does not include the criticism of the reports and the analysis of the design of these studies in terms of what confounders may be acting. No clinical studies included for amino acids for example.
    There is a new study from Rochester with several problems Page of the study and analysis here
    http://www.autismweb.com/forum/viewtopic.php?f=6&t=22394&p=155082#p155082
    My main issue is that if a child has a gluten/casein intolerance- sometimes only presented by behavioral aspects and no biomarkers present- WITH other concomitant medical problems the diet is NOT going to be shown useful.
    If you have a child with 20 medical problems , being gluten /casein intolerance on of them what is the impact the diet is going to have if
    a) is not done enough time- at least 28 weeks for some authos
    b) confounders are not taken into account (aminoacids , fatty acids, vitamins and mineral imbalances) plus other (fungal, parasitic and bacterial infections)

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  9. Maria,

    I think the things that bothers me the most about that study are that facts that the study doesn't seem to be in pubmed and that the lead author was a doctoral student at University of Texas -

    http://www.webmd.com/brain/autism/news/20100505/can-special-diets-treat-autism

    I don't have a problem with PhD students doing studies (if I did, I would have to throw out most research), but it strikes me as somewhat strange that a meta review like this was done by a grad student.

    I am not a fan of meta reviews in the first place but I prefer them to be done by people with more experience in the field rather than someone who just ran a couple of searches. After reading the study, I get the feeling that it falls in the later camp.

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  10. Hi MJ
    Are your interested to discuss here what testing is published as relevant to explore if the GFCF- and soy free- diet may help and in what autism subgrops and how? I am interested on several aspects on these topics, that IMO are in the begining of being explored.
    Please let me know.

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  11. About the last study of the Rochester University
    http://nutritioncare.net/blog/?p=73
    from Judy Converse

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  12. I have talked in extense with parents of celiac children and with their doctors- specialists in celiac disease. Besides the diagnosis, the good ones are very concerned about thyroides fucntioning, Vitamins, minerals (calcium, magnesium, zinc, selenium, copper
    ) and aminoacids status, they test for IgA and IgG, IgE, metabolic acidosis, liver and renal functioning, and fungal and bacterial infections as routine in a celiac child.In childrem, the results of the diet may be of different intensity at short time, but they test for these in baseline and at 6 and 12 months, with re-testing once a year to monitor evolution. The results of the diet are very individual in nature and depends on the results. Some children in my country have a very complex presentation of celiac disease, with even epilepsy and cerebral calcifications. There is silent celiac disease- no biomarkers except behaviors- and the doctors in cases when they suspect this recommend the challenge diet as an approach to know, with full clinical studies.

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  13. On the diet
    Anecdotal reports that restricted diets
    may ameliorate symptoms of ASDs in
    some children have not been supported
    or refuted in the scientific literature,
    but these data do not address
    the possibility that there exists a subgroup
    of individuals who may respond
    to such diets. Professional supervision
    of restricted diets is recommended to prevent nutritional inadequacies

    I do think that the current manuscripts of Buie et al are balanced on the topic.
    http://pediatrics.aappublications.org/cgi/reprint/125/Supplement_1/S1

    http://pediatrics.aappublications.org/cgi/reprint/125/Supplement_1/S19

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