Autism, an extreme challenge to integrative medicine. Part II: medical management - Autism - Brief Article

Alternative Medicine Review, Dec, 2002 by Parris M. Kidd

Reichelt et al studied 15 ASD subjects (5 girls and 10 boys, age 3-17 years) for one year after implementing casein and gluten restriction. (16) They reported that 13 of 15 showed some degree of behavioral improvement and none got worse, as judged from parent-teacher consensus. Seizure activity was decreased in 3 of 4 subjects; gross motor behavior improved in 13 of 15; social contact increased in 10 of 15; eye contact improved in 9 of 15; ritualistic behavior decreased in 8 of 11; language improved in 10 of 13; and sleep patterns normalized in 9 of 11. These investigators concluded that incomplete digestion of casein or gluten-gliadin by digestive peptidase enzymes could be a biochemical cause of autistic syndromes.

Since abrupt simultaneous removal of casein and gluten from the diet can cause withdrawal symptoms, a two-step phased withdrawal is appropriate. The first phase is removal of casein via removal of milk and other dairy products. From a 1995 trial, Lucarelli et al reported 66 percent of subjects showed benefits from this intervention. (17) Benefits can manifest quickly--usually within 2-3 days in young children or 10-14 days in adults. However, a much longer period is required for casein to be fully cleared from the body.

Shattock and Whiteley documented the known metabolic dangers to children from consuming cow's milk. (14) Milk consumption is linked to increased autism incidence among the immigrant population in Sweden as compared to the indigenous population. (18) Some children are clearly addicted to cow's milk and will drink large quantities. Symptoms linked to casein intake include projectile vomiting; eczema, particularly behind the knees and in the crook of the elbow; white bumps under the skin; ear discharges and infections; constipation, cramps, and/or diarrhea; and respiratory disorders resembling asthma. Shattock and Whiteley report that casein withdrawal symptoms can be severe, especially in young children. (14)

Some higher-functioning ASD children voluntarily cease casein intake, apparently sensing it is not good for them. Gluten products, on the other hand, stir strong cravings and children are less likely to refuse them. (19) Gluten exclusion requires the removal of several common cereals from the diet, wheat, barley, rye, and oats, in particular; but many other foods contain hidden gluten. (19-21) The elimination process usually takes a minimum of 3-4 weeks, and a trial period of three months is appropriate. The urinary gluten profile persists for much longer than does the casein profile, and correspondingly the withdrawal effects are usually milder in severity than casein's, but typically more prolonged.

Full clearance of dietary casein-gluten symptoms is a long-term process. Withdrawal can be evident for three months or longer. (16) Whiteley's group (19) found a mere 26-percent reduction in urinary levels of gluten after a five-month exclusion diet. In some cases dramatic improvement emerged a full 7-9 months after initiating the diet, but maximal improvement can require up to two years of rigid dietary exclusion. Shattock and Whiteley advise against adding these foods back into the diet, since severe opioid symptoms could result. (14)