Skip to main content
    • Aa
    • Aa

Nutritional management of (some) autism: a case for gluten- and casein-free diets?

  • Paul Whiteley (a1)

Autism spectrum disorders represent a diverse and heterogeneous array of conditions unified by the variable presence of specific behaviours impacting social and communicative functions (social affect) alongside other presentation. Common overt characteristics may come about as a consequence of several different genetic and biological processes differentially manifesting across different people or groups. The concept of plural ‘autisms’ is evolving, strengthened by an increasingly important evidence base detailing different developmental trajectories across the autism spectrum and the appearance of comorbidity variably interacting with core symptoms and onwards influencing quality of life. Reports that dietary intervention, specifically the removal of foods containing gluten and/or casein from the diet, may impact on the presentation of autism for some, complement this plural view of autism. Evidence suggestive of differing responses to the use of a gluten- and casein-free diet, defined as best- and non-response, has combined with some progress on determining the underlying genetic and biological correlates potentially related to such dietary elements. The preliminary suggestion of a possible diet-related autism phenotype is the result. This review will highlight several pertinent aspects onwards to an effect of food in some cases of autism including research on the pharmacological activity of food metabolites, immune response, issues with gut barrier function and some contribution from the gut microbiota. These represent promising areas in need of far greater research inspection in order to potentially define such a diet-related subgroup on the autism spectrum.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Nutritional management of (some) autism: a case for gluten- and casein-free diets?
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Nutritional management of (some) autism: a case for gluten- and casein-free diets?
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Nutritional management of (some) autism: a case for gluten- and casein-free diets?
      Available formats
Corresponding author
Corresponding author: Paul Whiteley, email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2. JD Murdoch & MW State (2013) Recent developments in the genetics of autism spectrum disorders. Curr Opin Genet Dev 23, 310315.

3. S Rangasamy , SR D'Mello & V Narayanan (2013) Epigenetics, autism spectrum, and neurodevelopmental disorders. Neurotherapeutics 10, 742756.

4. HE Volk , T Kerin , F Lurmann (2014) Autism spectrum disorder: interaction of air pollution with the MET receptor tyrosine kinase gene. Epidemiology 25, 4447.

6. AJ Whitehouse & FJ Stanley (2013) Is autism one or multiple disorders? Med J Aust 198, 302303.

7. C Fountain , AS Winter & PS Bearman (2012) Six developmental trajectories characterize children with autism. Pediatrics 129, e1112e1120.

8. D Fein , M Barton , IM Eigsti (2013) Optimal outcome in individuals with a history of autism. J Child Psychol Psychiatry 54, 195205.

11. EW Viscidi , EW Triche , MF Pescosolido (2013) Clinical characteristics of children with autism spectrum disorder and co-occurring epilepsy. PLoS ONE 8, e67797.

12. C Gillberg & E Fernell (2014) Autism plus versus autism pure. J Autism Dev Disord (In the Press).

13. G Novarino , P El-Fishawy , H Kayserili (2012) Mutations in BCKD-kinase lead to a potentially treatable form of autism with epilepsy. Science 338, 394397.

14. S Kotagal & E Broomall (2012) Sleep in children with autism spectrum disorder. Pediatr Neurol 47, 242251.

15. BO McElhanon , C McCracken , S Karpen (2014) Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics (In the Press).

16. SJ Walker , J Fortunato , LG Gonzalez (2013) Identification of unique gene expression profile in children with regressive autism spectrum disorder (ASD) and ileocolitis. PLoS ONE 8, e58058.

17. S Chandler , I Carcani-Rathwell , T Charman (2013) Parent-reported gastro-intestinal symptoms in children with autism spectrum disorders. J Autism Dev Disord 43, 27372747.

19. C Millward , M Ferriter , S Calver (2008) Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev CD003498.

20. T Buie (2013) The relationship of autism and gluten. Clin Ther 35, 578583.

21. S Marí-Bauset , I Zazpe , A Mari-Sanchis (2014) Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review. J Child Neurol (In the Press).

22. P Whiteley , P Shattock , AM Knivsberg (2013) Gluten- and casein-free dietary intervention for autism spectrum conditions. Front Hum Neurosci 6, 344.

24. L Pedersen , S Parlar , K Kvist (2014) Data mining the ScanBrit study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders: behavioural and psychometric measures of dietary response. Nutr Neurosci 17, 207213.

25. P Whiteley , D Haracopos , AM Knivsberg (2010) The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutr Neurosci 13, 87100.

26. RJ Anderson , DJ Bendell , I Garnett (2002) Identification of indolyl-3-acryloylglycine in the urine of people with autism. J Pharm Pharmacol 54, 295298.

27. MS Goodwin , MA Cowen & TC Goodwin (1971) Malabsorption and cerebral dysfunction: a multivariate and comparative study of autistic children. J Autism Child Schizophr 1, 4862.

28. FC Dohan (1988) Genetic hypothesis of idiopathic schizophrenia: its exorphin connection. Schizophr Bull 14, 489494.

30. SJ Genuis , TP Bouchard (2010) Celiac disease presenting as autism. J Child Neurol 25, 114119.

31. IC Batista , L Gandolfi , YK Nobrega (2012) Autism spectrum disorder and celiac disease: no evidence for a link. Arq Neuropsiquiatr 70, 2833.

33. S Fukudome , Y Jinsmaa , T Matsukawa (1997) Release of opioid peptides, gluten exorphins by the action of pancreatic elastase. FEBS Lett 412, 475479.

34. TL Sahley & J Panksepp (1987) Brain opioids and autism: an updated analysis of possible linkages. J Autism Dev Disord 17, 201216.

35. C Gillberg (1995) Endogenous opioids and opiate antagonists in autism: brief review of empirical findings and implications for clinicians. Dev Med Child Neurol 37, 239245.

36. AM Knivsberg , KL Reichelt & M Nødland (2001) Reports on dietary intervention in autistic disorders. Nutr Neurosci 4, 2537.

39. LC Hunter , A O'Hare , WJ Herron (2003) Opioid peptides and dipeptidyl peptidase in autism. Dev Med Child Neurol 45, 121128.

40. BL Williams , M Hornig , T Buie (2011) Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances. PLoS ONE 6, e24585.

41. RI Kushak , GY Lauwers , HS Winter (2011) Intestinal disaccharidase activity in patients with autism: effect of age, gender, and intestinal inflammation. Autism 15, 285294.

42. P D'Eufemia , M Celli , R Finocchiaro (1996) Abnormal intestinal permeability in children with autism. Acta Paediatr 85, 10761079.

44. L de Magistris , V Familiari , A Pascotto (2010) Alterations of the intestinal barrier in patients with autism spectrum disorders and in their first-degree relatives. J Pediatr Gastroenterol Nutr 51, 418424.

45. L de Magistris , A Picardi , D Siniscalco (2013) Antibodies against food antigens in patients with autistic spectrum disorders. Biomed Res Int 2013, 729349.

46. N Dalton , S Chandler , C Turner (2014) Gut permeability in autism spectrum disorders. Autism Res 7, 305313.

48. H Jyonouchi , L Geng , A Cushing-Ruby (2008) Impact of innate immunity in a subset of children with autism spectrum disorders: a case control study. J Neuroinflammation 5, 52.

49. GA Mostafa , DF El-Sherif & LY Al-Ayadhi (2014) Systemic auto-antibodies in children with autism. J Neuroimmunol 272, 9498.

50. AC Brown & L Mehl-Madrona (2011) Autoimmune and gastrointestinal dysfunctions: does a subset of children with autism reveal a broader connection? Expert Rev Gastroenterol Hepatol 5, 465477.

51. P Ashwood , A Anthony , F Torrente (2004) Spontaneous mucosal lymphocyte cytokine profiles in children with autism and gastrointestinal symptoms: mucosal immune activation and reduced counter regulatory interleukin-10. J Clin Immunol 24, 664673.

52. H Jyonouchi , S Sun & N Itokazu (2002) Innate immunity associated with inflammatory responses and cytokine production against common dietary proteins in patients with autism spectrum disorder. Neuropsychobiology 46, 7684.

53. NM Lau , PH Green , AK Taylor (2013) Markers of celiac disease and gluten sensitivity in children with Autism. PLoS ONE 8, e66155.

54. JF Ludvigsson , A Reichenberg , CM Hultman (2013) A nationwide study of the association between celiac disease and the risk of autistic spectrum disorders. JAMA Psychiatry 70, 12241230.

55. EG Severance , A Alaedini , S Yang (2012) Gastrointestinal inflammation and associated immune activation in schizophrenia. Schizophr Res 138, 4853.

56. S Panda , F Guarner & C Manichanh (2014) Structure and functions of the gut microbiome. Endocr Metab Immune Disord Drug Targets (In the Press).

57. YE Borre , RD Moloney & G Clarke (2014) The impact of microbiota on brain and behavior: mechanisms and therapeutic potential. Adv Exp Med Biol 817, 373403.

59. EY Hsiao , SW McBride , S Hsien (2013) Microbiota modulate behavioral and physiological abnormalities associated with neurodevelopmental disorders. Cell 155, 14511463.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Proceedings of the Nutrition Society
  • ISSN: 0029-6651
  • EISSN: 1475-2719
  • URL: /core/journals/proceedings-of-the-nutrition-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 97
Total number of PDF views: 698 *
Loading metrics...

Abstract views

Total abstract views: 785 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd June 2017. This data will be updated every 24 hours.