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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 inChildren withAutism Spectrum Disorders:
ARandomized, Controlled, Single‑Blinded Trial
AnnaPiwowarczyk1· AndreaHorvath2· EwaPisula3· RafałKawa3· HaniaSzajewska2
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 (36–69months) with ASD, within the normal IQ (> 70) range, who had been on a GFD for at least 8weeks 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 6months. 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
etal. 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 etal. 1986;
Shattock and Whiteley 2002; Christison and Ivany 2006) is
thought to impair neurotransmission (Knivsberg etal. 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 etal. 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 etal.
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
etal. 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 ofPaediatrics withClinical Assessment Unit,
The Medical University ofWarsaw, Zwirki i Wigury 63a,
02-091Warsaw, Poland
2 Department ofPaediatrics, The Medical University
ofWarsaw, Zwirki i Wigury 63A, 02-091Warsaw, Poland
3 Department ofHealth andRehabilitation Psychology,
Faculty ofPsychology, University ofWarsaw, Stawki 5/7,
00-183Warsaw, Poland
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