Is a GFCF diet for autism inherently unhealthy?

In answer to the question posed by the title of this blog post about whether the adoption of a gluten- and casein-free (GFCF) diet for some cases of autism is inherently unhealthy and detrimental to physical health, the paper by Graf-Myles and colleagues* carries an interesting detail. To quote: "Children in the AUT [autism] group not following a restricted diet received significantly worse Healthy Eating Index-2005 scores than those following a restricted diet and typical controls".

Now eat your greens... @ Wikipedia 

The Healthy Eating Index-2005, according to the USDA Center for Nutrition Policy and Promotion, represented a measure of dietary quality and how closely an individual's diet - well, a snapshot of their diet - adheres to the US Government expected standards (see here). All the main food groups are there including grains and milk/dairy products which are in the most part excluded when a GFCF diet is followed.

The 2005 guidance has to some degree been superseded by some updated guidance (see here**) so one needs to be mindful that the Graf-Myles paper might be subject to some challenge in subsequent years. Having said that, the changes between the 2005 and 2010 versions don't seem to be indicative of an entire overhaul of dietary policy, rather the inclusion of a few more categories and the renaming of others.

This is not the first time that evidence has been produced suggesting that the horror that is a GFCF diet (I jest of course) might not actually leave people with autism deficient in many essential vitamins and minerals, assuming that correct dietetic advice is taken and followed. I would direct you to the paper by Liz Cornish*** for example and, yet another quote: "Fruit and vegetable intakes were higher and cereal, bread and potato consumption were lower in those children using gluten and/or casein free diets". It appears that 'eating your greens' is a message embraced by quite a few people taking on the GFCF diet. Indeed, one wonders if this might be part and parcel of any effect??

And just in case you're going to pull the calcium deficient card out at me as a result of the specific adoption of a casein-free diet, I'll refer you to another couple of posts I've written about research on the casein-free diet and calcium (see here and here). Indeed how one should avoid sweeping statements about casein removal and lower calcium levels without thinking about how good dietetic advice**** and important factors like vitamin D might also come into play. Such advice might also include supplementation of various nutrients; which from the available [peer-reviewed] evidence produced by the likes of Jim Adams and colleagues (see here) might have some interesting actions all of their own.

Whilst in some quarters the mere suggestion that a GFCF diet should be the source of further autism research brings about a scowl or a scoff - indeed TED have branded this area a 'red flag topic' -  the issue of dietary intervention being potentially useful for some on the autism spectrum does not seem to be going away as evidenced by the recent 'it's not coeliac disease but might be something else' paper. I've talked quite a bit about it on this blog, particularly this year (2013) when we've seen some really rather interesting data being published on potential mechanisms (see here and here) and some research with my own input on the issue of responders / non-responders (see here). Even some potential impact on comorbidities too (see here) bearing in mind my caveat about not giving medical or clinical advice on this blog.

It goes without saying that I wholeheartedly endorse the need for proper medical and dietetic advice should anyone be thinking about this option for their child or themselves. The range of feeding and eating issues which can and do present alongside a diagnosis of autism make for some interesting times if and when this type of dietary approach is selected. That and the hype which often surrounds the GFCF diet with autism in mind, sometimes going above and beyond the available experimental data it has to be said, perhaps unfairly applying pressure on some people that diet is 'absolutely the intervention approach for them'.

OK science bit finished but just before you go, and quite coincidental to the publication of the Graf-Myles paper, I want to introduce an initiative that I've been involved with for a few months now aimed at those who are using or thinking of implementing a GFCF diet. Teaming up with a chef and UK state-registered dietitian, we've produced a website called The Autism Food Club (see here).

Whilst it's not quite Calico (yes, Google vs. death), for the foreseeable future The Autism Food Club is a free resource which aims to provide some practical information and recipes which are suitable for those following a GFCF diet. It's not intended to replace talking to your physician and/or dietitian/nutritionist about the GFCF diet and the often valuable advice they give, merely a site where we'll post a monthly newsletter with GFCF recipes and a bit of science covering autism and nutrition-related studies. The idea for the club was born out of the gap between me talking about all this wonderful autism research on things like dietary intervention and the reality of parents or people with autism finding suitable foods and recipes to implement such a strategy. From bench to bedside I think they call it.

All are welcome to mosey on over and have a look.

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* Graf-Myles J. et al. Dietary adequacy of children with autism compared with controls and the impact of restricted diet. J Dev Behav Pediatr. 2013 Sep;34(7):449-59. doi: 10.1097/DBP.0b013e3182a00d17.

** Guenther PM. et al. Update of the Healthy Eating Index: HEI-2010. J Acad Nutr Diet. 2013 Apr;113(4):569-80. doi: 10.1016/j.jand.2012.12.016.

*** Cornish E. Gluten and casein free diets in autism: a study of the effects on food choice and nutrition. J Hum Nutr Diet. 2002 Aug;15(4):261-9.

**** Bowers L. An audit of referrals of children with autistic spectrum disorder to the dietetic service. J Hum Nutr Diet. 2002 Apr;15(2):141-4.

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