Gluten-Free Diet in Children with Autism Spectrum Disorders: A Randomized, Controlled, Single-Blinded Trial

Abstract

To determine whether a gluten-free diet (GFD) compared with a gluten-containing diet (GD) influences functioning of children with autism spectrum disorders (ASD), we performed a randomized, controlled, single-blinded trial. Sixty-six children (36–69 months) with ASD, within the normal IQ (> 70) range, who had been on a GFD for at least 8 weeks before enrollment were eligible for inclusion. After an 8-week run-in period on a GFD, the GFD group continued this diet and the GD group consumed at least one normal meal containing gluten per day for 6 months. There were no differences between groups in autistic symptoms, maladaptive behaviors, or intellectual abilities after the intervention. A GFD compared with a GD did not affect functioning of children with ASD.
Trial registration ClinicalTrials.gov, number NCT02280746.

Full text

Vol:.(1234567890)
Journal of Autism and Developmental Disorders (2020) 50:482–490
https://doi.org/10.1007/s10803-019-04266-9
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ORIGINAL PAPER
Gluten‑Free Diet inChildren withAutism Spectrum Disorders:
ARandomized, Controlled, Single‑Blinded Trial
AnnaPiwowarczyk1· AndreaHorvath2· EwaPisula3· RafałKawa3· HaniaSzajewska2
Published online: 28 October 2019
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract
To determine whether a gluten-free diet (GFD) compared with a gluten-containing diet (GD) influences functioning of
children with autism spectrum disorders (ASD), we performed a randomized, controlled, single-blinded trial. Sixty-six
children (36–69months) with ASD, within the normal IQ (> 70) range, who had been on a GFD for at least 8weeks before
enrollment were eligible for inclusion. After an 8-week run-in period on a GFD, the GFD group continued this diet and the
GD group consumed at least one normal meal containing gluten per day for 6months. There were no differences between
groups in autistic symptoms, maladaptive behaviors, or intellectual abilities after the intervention. A GFD compared with a
GD did not affect functioning of children with ASD.
Trial registration ClinicalTrials.gov, number NCT02280746.
Keywords Randomized controlled trial· Autism spectrum disorder· Children· Gluten
The gluten-free and/or casein-free (GFCF) diet addresses
the hypothesis that children with autism spectrum disorders
(ASD) absorb peptides as a result of a leaky gut (Whiteley
etal. 1999), thus, use of a GFCF diet may ameliorate behav-
ioral symptoms. Excessive activity of peptides derived from
the metabolism of gluten and casein (Israngkun etal. 1986;
Shattock and Whiteley 2002; Christison and Ivany 2006) is
thought to impair neurotransmission (Knivsberg etal. 1995).
However, data on the efficacy of a GFCF diet as a treat-
ment for ASD in children are limited. Our 2018 systematic
review identified 6 relevant randomized controlled trials
(RCTs) (214 participants) (Piwowarczyk etal. 2018). With
few exceptions, there were no significant differences in ASD
core symptoms between groups, as measured by standard-
ized scales. The remaining differences, if present, referred to
parent-based assessment tools or other developmental/ASD-
related features. We concluded that, overall, there is little
evidence that a GFCF diet is beneficial for the symptoms of
ASD in children. However, methodological limitations in the
included trials may invalidate the results. Furthermore, 4 of
6 of these trials compared a GFCF diet with a “regular” diet
(presumably gluten-containing as there was no reporting on
no specific effort to ensure gluten was consumed) and few
trials included a GFD or GFCF diet run-in/washout period.
Data on the effects of a gluten-free diet (GFD) only are
even more limited. Despite such uncertainty, avoidance of
gluten, initiated by caregivers or clinicians, in preschool
children with ASD is highly prevalent (Rubenstein etal.
2018). Only one previous trial has investigated the effects
of a GFD on gastrointestinal (GI) symptoms and behavio-
ral indices in children with ASD, with results suggesting
that gluten elimination affects these outcomes (Ghalichi
etal. 2016). However, this trial compared a GFD with a
“regular” diet and did not include a GFD run-in period. We,
therefore, aimed to further assess the effect of gluten on the
functioning of children with ASD by comparing use of a
GFD and gluten-containing diet (GD). In accordance with
guidelines (National Institute for Health and Clinical Excel-
lence 2009), each child receiving the GD diet consumed
some gluten-containing foods (e.g., bread, chapattis, pasta,
biscuits, or cakes) in more than one meal every day. In real
* Hania Szajewska
hania@ipgate.pl
1 Department ofPaediatrics withClinical Assessment Unit,
The Medical University ofWarsaw, Zwirki i Wigury 63a,
02-091Warsaw, Poland
2 Department ofPaediatrics, The Medical University
ofWarsaw, Zwirki i Wigury 63A, 02-091Warsaw, Poland
3 Department ofHealth andRehabilitation Psychology,
Faculty ofPsychology, University ofWarsaw, Stawki 5/7,
00-183Warsaw, Poland
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