Talk:Gluten-free, casein-free diet

WPFood assessment
C-class rated low importance article on a controversial medical/dietary theory.

This article needs attention on:
 * NPOV
 * Citations

--Jeremy ( Blah blah... ) 01:27, 24 June 2008 (UTC)

This article needs help
This is a reasonably weasely article, filled with lots of non-statements like "many parents report that..." and "the vast majority of professionals...". It also swings back and forth between paragraphs suggesting that the casein/glutein->opiate theory is fact and paragraphs noting that little research supports its efficacy.

The truth of the matter is that the GFCF diet is advocate-driven science with little solid research working in its favor. That being said, the medical community is not "opposed" to the GFCF diet. The professionals who work with my autistic children have told us the same thing repeatedly: "go ahead and try it - it can't hurt. We don't expect it will make a difference, though."

If I have time I will try to digest the "advocate" piece and the "no research support" piece and come up with something NPOV. Irene Ringworm 23:28, 1 March 2007 (UTC)
 * for now i have removed all the weaselworded paragraphs, not much left though. i like your defintion, can you put that in?trueblood 01:22, 4 March 2007 (UTC)


 * Trueblood, you turned the article into a nonsensical hash. I happen to think that this diet is most likely bunk, but doing things like removing the lead (!) and not at least saying what proponents think of the diet is doing a disservice.  Note that there are some External links at the bottom which confirm trivially that this is what advocates think happen, and that's not under dispute; the question is if the article can say it actually works. SnowFire 01:41, 4 March 2007 (UTC)


 * sorry, it's true i stopped short of deleting the article, that is what i wanted to do. 212.194.193.90 07:19, 4 March 2007 (UTC)


 * Done and done. Removed the tags.  Explained the controversy without resorting to "some people think" and "some people say".  Referenced objections from the medical community.  Got rid of the dubious history of "two women taking the GFCF diet to the world.  Irene Ringworm 04:39, 7 March 2007 (UTC)

Gluten in Rice?
This article says that gluten is found in rice, however the article on gluten says that there is no gluten in rice. One or the other should be changed by someone who knows. 24.7.254.33 14:11, 6 March 2007 (UTC)
 * Good, I see it is fixed. 24.7.254.33 20:39, 13 March 2007 (UTC)

Recent add moved to talk page for sorting out, fact checking

 * This recently added section is redundant with information already in the article and doesn't appear to fit the flow of the article otherwise. The only new information is the introduction of the "leaky gut" hypothesis but the data included is factually incorrect. Leaky Gut Syndrome  is one suggested root cause for peptide buildup but other sources hypothesize a simple metabolic disorder unrelated to instestinal permeability.  I think that Leaky Gut might be worked into the article but needs some clarity.


 * I have moved this section to the talk page in case consensus decides that it belongs in the article. Irene Ringworm 19:58, 12 March 2007 (UTC)

Autism and the GFCF diet
Gastrointestinal problems are a common comorbid disorder with Autistic Spectrum Disorders and some people see this as proof for the "leaky gut" theory as a cause of Autism, while others see the gluten and casein-free diet as treating symptoms, not causes, of Autistic Spectrum Disorders. The molecular structure of the partially undigested proteins, known as peptides, resemble opiates and are claimed to have damaging effects on the developing brain and also affects behavior, just as any narcotic would.

The "leaky gut" theory remains controversial with no rigorous scientific studies done as yet. A recent study of the role of diets in Autism Spectrum Disorders noted that significant design flaws in all the current studies make it difficult to rely on an conclusions reached (Christianson & Ivany 2006).

A restrictive diet is not the cure
Diet alone is not the cure for austistic children, The only way you can cure the intolerances is to reduce the gut infection and floral imblance seen in children with autism spectrum discorders. Current research points to the fact that many austistic children definently have a Enterocolitis like illness, which means that have an inflammatory like disease in their guts. recommend you read gut and mental illness —Preceding unsigned comment added by 211.30.235.237 (talk) 00:58, 18 September 2007 (UTC)


 * That's a giant spam link which will never go on the page. Your statement would require reliable sources to impact the page.  WLU

23:32, 19 September 2007 (UTC)


 * check this out:
 * i do not know how to edit pages very well, but this information really needs to be included. —Preceding unsigned comment added by Bella stranger (talk • contribs)
 * Of debatable use on this page since it doesn't mention GFCF specifically, but could probably be used on other autism-related pages. WLU (talk) 18:26, 29 November 2007 (UTC)
 * Also, see WP:MEDMOS and WP:MEDRS regarding relying on media reports in scientific articles; peer-reviewed sources are preferable, as the media often gets it wrong. Sandy Georgia  (Talk) 19:22, 29 November 2007 (UTC)

GF/CF isn't curebie
I wouldn't say GF/CF necessarily is a sub-topic from the Autism Cure Movement, some Autism Rights Movement people use the diet as well.

I suggest someone take away that Autism Cure Movement box. It might even contribute to further polarization in the autism debate. —Preceding unsigned comment added by 85.166.146.68 (talk) 15:37, 12 January 2008 (UTC)

Decided to do the change.

The article generalize well-designed studies based on the only one that has been done
While I am personally sceptical of the GF/CF diet, I doubt that this sentence is warranted:

"Adequately designed, controlled studies and clinical trials show the GFCF diet is ineffective.[2] "

Indeed, one well-designed study has found no stastical differences between the group on the diet and the controls. This sentence however, could appear to generalize this in a way that its citation, from what I've read of it, has not. IvarTJ (talk) 09:56, 10 June 2009 (UTC)

Background, opioid peptides
I believe these studies might be of interest to the background section:

http://www.ncbi.nlm.nih.gov/pubmed/17520243

http://www.ncbi.nlm.nih.gov/pubmed/12578238

http://www.ncbi.nlm.nih.gov/pubmed/18337276

Background, opioid peptides
I believe these studies might be of interest to the background section:

http://www.ncbi.nlm.nih.gov/pubmed/17520243

http://www.ncbi.nlm.nih.gov/pubmed/12578238

http://www.ncbi.nlm.nih.gov/pubmed/18337276 IvarTJ (talk) 03:38, 4 September 2009 (UTC)

GFCF Clinical Study References
'''Elder JH, Shankar M, Shuster J, Theriaque D, Burns S, Sherrill L. College of Nursing, University of Florida, Gainesville, 32610, USA. elderjh@nursing.ufl.edu'''

This study tested the efficacy of a gluten-free and casein-free (GFCF) diet in treating autism using a randomized, double blind repeated measures crossover design. The sample included 15 children aged 2-16 years with autism spectrum disorder. Data on autistic symptoms and urinary peptide levels were collected in the subjects' homes over the 12 weeks that they were on the diet. Group data indicated no statistically significant findings even though several parents reported improvement in their children. Although preliminary, this study demonstrates how a controlled clinical trial of the GFCF diet can be conducted, and suggests directions for future research.

Ferriter M, Calver S, Connell-Jones G.

BACKGROUND:

It has been suggested that peptides from gluten and casein may have a role in the origins of autism and that the physiology and psychology of autism might be explained by excessive opioid activity linked to these peptides. Research has reported abnormal levels of peptides in the urine and cerebrospinal fluid of people with autism.

OBJECTIVES:

To determine the efficacy of gluten and/or casein free diets as an intervention to improve behaviour, cognitive and social functioning in individuals with autism. SEARCH STRATEGY: The following electronic databases were searched: CENTRAL(The Cochrane Library Issue 2, 2007), MEDLINE (1966 to April 2007), PsycINFO (1971 to April 2007), EMBASE (1974 to April 2007), CINAHL (1982 to April 2007), ERIC (1965 to 2007), LILACS (1982 to April 2007), and the National Research register 2007 (Issue1). Review bibliographies were also examined to identify potential trials.

SELECTION CRITERIA:

All randomised controlled trials (RCT) involving programmes which eliminated gluten, casein or both gluten and casein from the diets of individuals diagnosed with an autistic spectrum disorder.

DATA COLLECTION AND ANALYSIS:

Abstracts of studies identified in searches of electronic databases were assessed to determine inclusion by two independent authors The included trials did not share common outcome measures and therefore no meta-analysis was possible. Data are presented in narrative form.

MAIN RESULTS:

Two small RCTs were identified (n = 35). No meta-analysis was possible. There were only three significant treatment effects in favour of the diet intervention: overall autistic traits, mean difference (MD) = -5.60 (95% CI -9.02 to -2.18), z = 3.21, p=0.001 (Knivsberg 2002) ; social isolation, MD = -3.20 (95% CI -5.20 to 1.20), z = 3.14, p = 0.002) and overall ability to communicate and interact, MD = 1.70 (95% CI 0.50 to 2.90), z = 2.77, p = 0.006) (Knivsberg 2003). In addition three outcomes showed no significant difference between the treatment and control group and we were unable to calculate mean differences for ten outcomes because the data were skewed. No outcomes were reported for disbenefits including harms.

AUTHORS' CONCLUSIONS:

Research has shown of high rates of use of complementary and alternative therapies (CAM) for children with autism including gluten and/or casein exclusion diets. Current evidence for efficacy of these diets is poor. Large scale, good quality randomised controlled trials are needed.

PMID: 18425890 [PubMed - indexed for MEDLINE]

Blake32509 (talk) 18:51, 6 September 2009 (UTC)blake32509

The glutein and casein derived peptides DO NOT resemble opiates
The theory was recently debunked by a well done study that no one is citing. The glutein and casein peptides happen to be the same size as some opiate-like peptides but they are NOT the same molecules. We should add this ref to the article.

Cass H, Gringras P, March J, McKendrick I, O'Hare AE, Owen L, Pollin C. Absence of urinary opioid peptides in children with autism. Arch Dis Child. 2008 Sep;93(9):745-50. Epub 2008 Mar 12. —Preceding unsigned comment added by 148.177.0.100 (talk) 13:49, 15 September 2009 (UTC)

discussion of article

 * The article mentioned by 148.177.0.100 can be found at . It appears to debunk not the opioid theory, but Paul Shattock's method of studying it. It's an interesting study, so let's talk about it:


 * What is 'opioid peptiduria'? The majority of the 32 google results for this term link back to the article, and 'peptiduria' isn't listed in the OED Online.


 * The study uses a very strict definition of 'opioid peptide'.


 * "There are many problems with this hypothesis, including major weaknesses in terms of biological and clinical plausibility. [13] Children with autism do not have an increased rate of coeliac disease. [14] Neither are they more likely to present to their general practitioner with chronic inflammation of the gastro-intestinal tract, food intolerance or recurrent gastro-intestinal symptoms. [15]"
 * —why does a lack of an increased rate of coeliac disease make the theory less plausible?
 * —it's asserted in unciteworthy parts of the internet that there is a link between autism and coeliac disease. Is this unfounded? I can't find a citation in anything that looks reliable.
 * —children with autism are less likely to present to their general practioner in general


 * "Where HPLC analysis of a urine sample indicated the presence of high and well-defined peaks exhibiting the correct retention time for one or more of the suspect opioid peptides cited in previous studies [8–12], the sample was classified as a candidate for further analysis. Samples from all groups showed such peaks, but only those from the autism and Asperger syndrome group were reanalysed, as being the most likely to present opioids given the assumptions of the leaky-gut hypothesis."
 * —this seems a slightly odd decision
 * —I wish data were included on proportions of these peaks control group to autism group


 * "25 urine samples from the autism/ Asperger group were selected as showing peaks in approxi- mately the correct locations to be opioid peptides. For all 25, MALDI-TOF MS analysis of the relevant fraction found no instances of ions of m/z corresponding to opioid peptides. These results indicate that the peaks observed on the HPLC trace were not opioid peptides."
 * —no attempt seems to have been made to determine what they were
 * Njál (talk) 14:24, 12 September 2010 (UTC)

Washington Post article
An interesting article:


 * Autism and diet: Many questions to digest

The article itself isn't a WP:MEDRS source, but it is a RS and may contain links or or mentions of MEDRS. -- Brangifer (talk) 03:34, 10 February 2010 (UTC)

"wheat, barley, rye, and several other grains"
In the opening paragraph: "gluten (found naturally in wheat, barley, rye, and several other grains)". Presumably this is a reference to oats and the nebulous triticale — but it's misleading, so I've changed it to: "gluten (found in wheat, barley, rye, and commercially available oats)". Let's keep this discussion space open for these other grains and their gluten status, please add to the list: Njál (talk) 13:31, 12 September 2010 (UTC)

Oats
Pure oats have uncertain gluten status. Commercial oats tend to be grown in rotation with wheat/barley/rye, which means gluten-containing cereals grow up around them and get harvested with them. They're all also usually processed on the same equipment. Njál (talk) 13:31, 12 September 2010 (UTC)

Triticale
A wheat-rye hybrid, contains gluten. Njál (talk) 13:31, 12 September 2010 (UTC)

Spelt
A species of wheat, contains gluten. Njál (talk) 13:31, 12 September 2010 (UTC)

Kamut
A variety or cultivar of wheat, contains gluten. Njál (talk) 13:31, 12 September 2010 (UTC)

focus is on everything except specs on the indicated diet
This article discusses autisim and other issues prevalantly while giving little to the person who was looking for information on the named diet. Perhaps the article should be renamed to better describe its focus and another page should be created which gives more comprehensive information on the diet itself, and no the hype surrounding it.

Spiralamok (talk) 20:47, 18 November 2010 (UTC)

Scientific Validity of Negative Result Studies?
"Among studies reporting negative results, none were longer than 6 weeks, with two out of four studying effects of the diet for 4 days and 9 days" Science does not progress with mere cursory efforts at examination. I do not find the length of a 9 day study, especially on matters of dietary alterations to be notable in regards to validity in disapproval. In regards to chelation studies, the necessary data points must be in regards to metals excreted via a Spectrometer analysis of the bodily wastes. 30 days for a human study would be sufficient, 9 would not. Were we studying animals to later be dissected on a part-by-part basis, a few days would be acceptable, though biopsy of a living human for mere dietary changes would not. I give higher validity to the longer studies not merely because I favor or disfavor the results. 75.134.100.125 (talk) 04:49, 7 March 2012 (UTC) Gridlock

The problem is there are no double-blind studies reporting positive affects of the diet, so as the paper concludes-

''4.5. Summary and implications for practice ''Based on the results of this review, it would appear that evidence in support of Opioid-Excess Theory and the resulting treatment of ASD with the GFCF diet is limited and weak. Adverse consequences potentially associated with GFCF diets (e.g., stigmatization, diversion of treatment resources, reduced bone cortical thickness) further the argument against the diet’s therapeutic use. Controversy and conﬂicting research ﬁndings concerning the Opioid-Excess Theory renders other explanations for observed beneﬁts plausible (e.g., biological motivating operations inﬂuence behavior).'' []

Even if the negative results are discounted, there is no scientific evidence that the diet is useful for autismBhny (talk) 21:10, 7 March 2012 (UTC)

Revolving around autism?
The article seems to entirely revolve around autism and associated skepticism, as if there were no other reason to quit wheat and milk. Vitaken02 (talk) 22:34, 5 April 2012 (UTC)

I think the diet was invented by Kalle Reichelt to possibly ease symptoms of autism (not that this was proven to help). Is there any other published reason for this combined GFCF diet? Bhny (talk) 22:55, 5 April 2012 (UTC)