A wish-list for gluten and casein free diet autism research

I think that this is possibly the first time that I've actually talked about one of my own research papers as being central to a post on this blog. I'm not altogether sure of the wisdom and etiquette of how and indeed whether to do this - see this commentary bearing in mind I'm blogging post peer review publication - so fingers crossed that this works...

Hopefully not... @ Paul Whiteley  

It's actually been a year or two since I've been part of a peer-reviewed publication, mostly due to investigations being in progress and also having some other things running in the background.

This trend should hopefully be reversed over the coming months/year with other, more original research, almost ready for peer-review submission.

I don't want to make too much of a meal of our latest paper* (open-access) discussing use of a gluten- and casein-free (GFCF) diet with autism in mind because it is a review paper rather than introducing any novel, earth-shattering results or insights. That and the fact that the paper is free for all to view, applaud or criticise as they see fit.

The basic message that we wanted to put across in the paper is that despite some rumblings to the contrary, research on the potential effectiveness of such dietary intervention for some cases of autism has and continues to be undertaken, some of it even under randomised, controlled conditions albeit with some methodological gaps.

Assuming also that you see autism as being more of 'the autisms', said research with all its frailties and methodological incompleteness, suggests that at least for some people on the autism spectrum, there may be some merit in looking at the possibility of a dietary effect, even if not working on core symptoms and even if due to some other underlying comorbidity. Gut-brain axis anyone?

Interestingly, it was one of the reviewers for our paper who suggested that we might also want to put together a kind of wish-list of what we think should be included in further autism-diet research with the focus on determining potential best- and non-responders. A few factors came up based to quite a large extent on some of my previous mutterings on this blog including:

• Some investigation on the possible presence of known gastrointestinal (GI) conditions related to gluten and or casein such as coeliac (celiac) disease and its markers, its not-quite-coeliac-disease relations and lactose intolerance.
• Measurement of gut permeability and that favourite term, leaky gut, now also potentially featuring in mouse models of autism.
• Looking at any potential influence of those trillions of gut-dwelling bacteria who call us home.
• Examination of food-related enzymes including those used for chopping up peptides and more generally those involved in carbohydrate metabolism.
• Screening for potential inflammatory comorbidity, be it signs of central inflammation or more specific GI inflammation including everyone's favourite molecule of the hour, (General) zonulin.

Finally, another of the important messages that we wanted to present in the paper is that more emphasis is needed to examine the clinical outcomes when implementing things like dietary intervention for people with autism. It's all well and good reporting statistical results and p-values, but when it comes to something as invasive and life-changing as altering someone's diet, we should really be evaluating how that change impacts on their life and whether it makes a significant difference to their day-to-day quality of life or not. Something along the lines of what was looked at in the paper by Sarris and colleagues** (open-access) albeit in an area outside of autism research. Perhaps even a lesson for other interventions potentially indicated for autism there too...?

To close, since we're on the topic of 'me', how about a little Me First & the Gimme Gimmes? A choice of artist cover song for you: Carly Simon or Elton John?

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* Whiteley P. et al. Gluten- and casein-free dietary intervention for autism spectrum conditions. Front Hum Neurosci. 2013; 6: 344.

** Sarris J. et al. Participant experiences from chronic administration of a multivitamin versus placebo on subjective health and wellbeing: a double-blind qualitative analysis of a randomised controlled trial. Nutrition Journal. 2012; 11: 110.

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Paul Whiteley, Paul Shattock, Ann-Mari Knivsberg, Anders Seim, Karl L. Reichelt, Lynda Todd, Kevin Carr, & Malcolm Hooper (2013). Gluten- and casein-free dietary intervention for autism spectrum conditions Frontiers in Human Neuroscience, 6