Gluten & autism: case study in Journal of Child Neurology

Teresa Binstock
Researcher in Developmental & Behavioral Neuroanatomy
July 02, 2009

A recent study has ramifications for some and perhaps many autistic children. University of Alberta researchers Genuis and Bouchard describe a case of "Celiac Disease Presenting as Autism" (1). They write, "After initial investigation suggested underlying celiac disease and varied nutrient deficiencies, a gluten-free diet was instituted along with dietary and supplemental measures to secure nutritional sufficiency. The patient's gastrointestinal symptoms rapidly resolved, and signs and symptoms suggestive of autism progressively abated." (1)

Improvements after a gluten free or casein free diet are not surprising for many parents, physicians, and researchers familiar with the Autism Research Institute. In an ongoing data-collection project, more than 60% among >2500 autism parents have reported improvements when their autistic child is on a gluten-free (GF) and/or casein-free (CF) diet (2). However, not all children fully recover from autism via a GF and/or CF diet.  In the book Children with Starving Brains, Jaquelyn McCandless, M.D., describes how a then eight year old girl who remains autistic no longer needed diapers within days of starting a GF diet (10).

Hypersensitivity to gluten is not limited to children with autism. Newly announced findings confirm an "increase in wheat gluten disorder", and "Blood samples from '50s show it isn't just improved diagnosis" (3).

Importantly, Genuis and Bouchard mention an important ramification of intestinal changes associated with hypersensitivity to gluten, stating that "This case is an example of a common malabsorption syndrome associated with central nervous system dysfunction and suggests that in some contexts, nutritional deficiency may be a determinant of developmental delay." (1)  This observation is somewhat consistent with previously announced findings of Jill James and colleagues, who concluded that "targeted nutritional intervention with methylcobalamin and folinic acid may be of clinical benefit in some children who have autism" (4).

For some and perhaps many individuals - whether or not they have autism or one of the other autism-spectrum disorders (ASDs) - the increase in hypersensitivity to gluten and other foods (eg, casein) may be etiologically linked with a plastics ingredient known as bisphenol A (5; see also 6). Moreover - and parents who read cite-7 may see parallels in their autistic children - many of the traits and symptoms reported in subgroups of children with an ASD may be a reflection of the child's hypersensitivity to gluten (eg, 7).

For many years, the concept of "classical celiac disease" has yielded to a realization that celiac disease has a spectrum of presentations (eg, 8).  A 2004 review provides an overview of celiac disease (aka coeliac in UK) (9).

Genuis and Bouchard state a fitting conclusion: "It is recommended that all children with neurodevelopmental problems be assessed for nutritional deficiency and malabsorption syndromes." (1)


References:

1. Celiac Disease Presenting as Autism.
Genuis SJ, Bouchard TP.  J Child Neurol. 2009 Jun 29.
http://jcn.sagepub.com/cgi/rapidpdf/0883073809336127v1

Gluten-restricted diets have become increasingly popular among parents seeking treatment for children diagnosed with autism. Some of the reported response to celiac diets in children with autism may be related to amelioration of nutritional deficiency resulting from undiagnosed gluten sensitivity and consequent malabsorption. A case is presented of a 5-year-old boy diagnosed with severe autism at a specialty clinic for autistic spectrum disorders. After initial investigation suggested underlying celiac disease and varied nutrient deficiencies, a gluten-free diet was instituted along with dietary and supplemental measures to secure nutritional sufficiency. The patient's gastrointestinal symptoms rapidly resolved, and signs and symptoms suggestive of autism progressively abated. This case is an example of a common malabsorption syndrome associated with central nervous system dysfunction and suggests that in some contexts, nutritional deficiency may be a determinant of developmental delay. It is recommended that all children with neurodevelopmental problems be assessed for nutritional deficiency and malabsorption syndromes.


2. Parent Ratings of Behavorial Effects of Biomedical Interventions
Autism Research Institute
http://www.autism.com/treatable/form34qr.htm


3. Study confirms increase in wheat gluten disorder
Blood samples from '50s show it isn't just improved diagnosis, and researchers wonder if diet is a factor.
Josephine Marcotty
Star Tribune July 1, 2009
http://www.startribune.com/lifestyle/health/49558522.html


4. Efficacy of methylcobalamin and folinic acid treatment on glutathione redox status in children with autism.
James SJ et al. Am J Clin Nutr. 2009 Jan;89(1):425-30.

BACKGROUND: Metabolic abnormalities and targeted treatment trials have been reported for several neurobehavioral disorders but are relatively understudied in autism. OBJECTIVE: The objective of this study was to determine whether or not treatment with the metabolic precursors, methylcobalamin and folinic acid, would improve plasma concentrations of transmethylation/transsulfuration metabolites and glutathione redox status in autistic children. DESIGN: In an open-label trial, 40 autistic children were treated with 75 microg/kg methylcobalamin (2 times/wk) and 400 microg folinic acid (2 times/d) for 3 mo. Metabolites in the transmethylation/transsulfuration pathway were measured before and after treatment and compared with values measured in age-matched control children. RESULTS: The results indicated that pretreatment metabolite concentrations in autistic children were significantly different from values in the control children. The 3-mo intervention resulted in significant increases in cysteine, cysteinylglycine, and glutathione concentrations (P < 0.001). The oxidized disulfide form of glutathione was decreased and the glutathione redox ratio increased after treatment (P < 0.008). Although mean metabolite concentrations were improved significantly after intervention, they remained below those in unaffected control children. CONCLUSION: The significant improvements observed in transmethylation metabolites and glutathione redox status after treatment suggest that targeted nutritional intervention with methylcobalamin and folinic acid may be of clinical benefit in some children who have autism. This trial was registered at (clinicaltrials.gov) as NCT00692315.


5. Food Hypersensitivity & Bisphenol A
Jun 30, 2009
http://www.generationrescue.org/binstock/090630-bpa-food-allergy.htm


6. 'Plastics, the environment and human health'
R. C. Thompson, C. J. Moore, F. S. vom Saal, S. H. Swan
http://rstb.royalsocietypublishing.org/content/364/1526.toc


7. Gluten encephalopathy with psychiatric onset: case report
Poloni N et al. Clinical Practice and Epidemiology in Mental Health 2009, 5:16 (26 June 2009)
{free online}
http://www.cpementalhealth.com/content/5/1/16

8: The widening spectrum of celiac disease.
Murray JA.
Am J Clin Nutr. 1999 Mar;69(3):354-65.
{free online}
http://www.ajcn.org/cgi/content/full/69/3/354

Celiac disease is a permanent intolerance to ingested gluten that results in immunologically mediated inflammatory damage to the small-intestinal mucosa. Celiac disease is associated with both human leukocyte antigen (HLA) and non-HLA genes and with other immune disorders, notably juvenile diabetes and thyroid disease. The classic sprue syndrome of steatorrhea and malnutrition coupled with multiple deficiency states may be less common than more subtle and often monosymptomatic presentations of the disease. Diverse problems such as dental anomalies, short stature, osteopenic bone disease, lactose intolerance, infertility, and nonspecific abdominal pain among many others may be the only manifestations of celiac disease. The rate at which celiac disease is diagnosed depends on the level of suspicion for the disease. Although diagnosis relies on intestinal biopsy findings, serologic tests are useful as screening tools and as an adjunct to diagnosis. The treatment of celiac disease is lifelong avoidance of dietary gluten. Gluten-free diets are now readily achievable with appropriate professional instruction and community support. Both benign and malignant complications of celiac disease occur but these can often be avoided by early diagnosis and compliance with a gluten-free diet.


9. Update on food allergy.
Sampson HA. J Allergy Clin Immunol. 2004 113(5):805-19.
{free online}
http://tinyurl.com/mh3t43


10. Children with Starving Brains: A Medical Treatment Guide for Autism Spectrum Disorder
http://www.starvingbrains.com/

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