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Celiac Disease, Gluten Sensitivity, and Autism: Complex Connections

Research into connections between autism, celiac disease, and gluten sensitivity is still in early stages. While there are some indications of possible links, the relationship is complex and not fully understood. Here’s an overview of what we know so far about how celiac disease, gluten intolerance, and autism may be connected.

Autism spectrum disorder (ASD) affects about 1 in 36 children in the United States. For parents of children with autism, finding ways to improve their child’s symptoms becomes a top priority. This has led many parents to try alternative treatments like the gluten-free, casein-free (GFCF) diet, hoping it can help with autism symptoms.

The suspected link between autism and gluten leads to questions about whether autism and celiac disease are connected. Celiac disease is an autoimmune disorder triggered by gluten. Could celiac disease cause or contribute to autism? Or could an intolerance to gluten explain why some parents report the GFCF diet improves their child’s autism symptoms?

Celiac Disease, Gluten Sensitivity, and Autism
Celiac Disease, Gluten Sensitivity, and Autism

What is Autism Spectrum Disorder?

Autism spectrum disorder is a developmental disorder characterized by challenges with social skills, communication, and restrictive/repetitive behaviors. The term “spectrum” refers to the wide variation in symptoms and support needs seen across individuals with ASD.

Some autistic people have mild challenges and can live independently, while others have more significant support needs. Autism symptoms typically become apparent between ages 2 and 3, and boys are close to 4 times more likely to be diagnosed than girls.

There is no known single cause of autism. Research suggests autism likely results from a combination of genetic and environmental factors. While there is no cure, behavioral therapies and medications can help reduce symptom severity. However, many parents also try alternative approaches like dietary changes hoping to find additional ways to help their children.

The Gluten-Free, Casein-Free Diet for Autism

The gluten-free, casein-free (GFCF) diet is one of the most popular alternative treatments parents use for autism.

Gluten is a protein found in grains like wheat, barley and rye. Casein is a protein found in milk and dairy products. The GFCF diet eliminates both gluten and casein.

The reasoning behind this diet is the claim that children with autism often have a “leaky gut” that allows gluten and casein proteins to enter the bloodstream. These proteins are believed to act like opioids in the brain and worsen autism symptoms.

Many autistic children also have digestive issues like diarrhea and constipation, which parents feel validates issues with gluten and casein. However, most studies show eliminating gluten and casein provides little to no improvement in core autism symptoms. Still, some parents stand by noticeable benefits from the GFCF diet for their child.

This has led to speculation about potential connections between autism and conditions triggered by gluten, like celiac disease. Could celiac disease or gluten intolerance help explain why a small subset of children may improve on the GFCF diet?

What is Celiac Disease?

Celiac disease is an autoimmune disorder affecting around 1% of people worldwide. When someone with celiac disease eats gluten, it triggers immune system damage to the small intestine. This can lead to symptoms like diarrhea, abdominal pain, malnutrition, and failure to thrive.

The only treatment for celiac disease is strictly and permanently eliminating gluten from the diet. This allows the intestinal damage to heal. Diagnosis of celiac disease requires an intestinal biopsy showing characteristic immune system damage caused by gluten exposure.

People with celiac disease also test positive for certain autoantibodies in their blood, like anti-tissue transglutaminase antibodies. However, some people test positive for these antibodies but have no intestinal damage from celiac disease. This indicates a sensitivity to gluten, but not full-blown celiac disease.

The Link Between Celiac Disease and Autism

Several studies have explored whether autistic individuals are more likely to have celiac disease compared to the general population. However, most research indicates autism and celiac disease do not directly overlap.

In one major Swedish study, autistic individuals were not more likely to later be diagnosed with celiac disease based on national health records. However, they were over 3 times more likely to test positive for celiac antibodies but not have intestinal damage meeting diagnostic criteria for celiac disease.

This pattern indicates an immune reaction to gluten in some people with autism, but not the same autoimmune reaction seen in celiac disease. The reason why is still unknown.

There are a few documented cases of autistic children also having celiac disease. In these cases, starting a gluten-free diet improved both their celiac symptoms and autism symptoms. However, such cases are very rare. Most autistic individuals do not improve on a gluten-free diet.

Based on current evidence, routine screening for celiac disease in autistic individuals is not recommended unless they show digestive or nutritional symptoms that warrant testing.

Non-Celiac Gluten Sensitivity and Autism

While full-blown celiac disease does not appear common in autism, research suggests gluten sensitivity could play a role for some individuals.

Non-celiac gluten sensitivity (NCGS) is a condition where gluten triggers symptoms like fatigue, headaches, pain and digestive issues, without the intestinal damage seen in celiac disease. NCGS is not yet well understood, but may involve a different immune reaction to gluten.

Several studies found the immune systems of some children with autism reacted to gluten – but in a different way than in celiac disease. This atypical immune response to gluten could potentially contribute to symptoms for a subset of autistic individuals.

Researchers have proposed gluten sensitivity might be the reason a small number of children improve on a GFCF diet. However, there are currently no biomarkers or tests available to confirm NCGS. This makes it difficult to study the links between gluten sensitivity and autism.

Maternal Autoimmunity and Autism Risk

Another area of research on autism and celiac disease explores whether maternal autoimmunity influences autism risk. Several studies found a family history of autoimmune disorders increased the chances of having a child with autism.

Specifically, women with celiac disease were found to have around a 3-fold increased risk of having a child with autism compared to women without celiac disease. Researchers have proposed exposure to gluten antibodies in the womb could potentially alter brain development.

However, the mechanisms are still not understood. More research is needed to confirm the links between maternal autoimmunity conditions like celiac disease and increased autism risk. Identifying specific factors that increase autism risk could open doors to new prevention strategies.

Takeaways on Celiac Disease, Gluten and Autism

In summary, here are some key takeaways from current research on the connections between autism, celiac disease and gluten sensitivity:

  • Celiac disease does not directly cause autism, nor is full-blown celiac disease common in individuals with autism. Routine screening for celiac disease in autism is not recommended.
  • However, some people with autism show immune reactions to gluten, suggesting NCGS could contribute to symptoms in a subset of individuals.
  • Maternal autoimmune conditions like celiac disease may increase autism risk in children, but more research is needed to confirm links and mechanisms.
  • For a small minority of autistic children, gluten sensitivity might explain improvements on a GFCF diet. However, this diet does not help most.
  • Research on connections between autism, celiac disease and gluten is still in early stages. Findings may eventually provide clues to new autism treatments, but more evidence is needed.
  • Parents should discuss pros/cons of a GFCF diet with their child’s doctor. It likely provides little benefit for most children but could potentially help those with gluten issues.

While intriguing, the links between autism, gluten sensitivity and celiac disease are still being unraveled. For now, these findings offer more clues than clear answers. But down the road, research in this area may open new doors for understanding autism causes and personalized treatment approaches.

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[7] Lau NM, Green PH, Taylor AK, et al. Markers of Celiac Disease and Gluten Sensitivity in Children with Autism. PLoS ONE. 2013;8(6):e66155. doi:10.1371/journal.pone.0066155

[8] Atladóttir HO, Pedersen MG, Thorsen P, et al. Association of family history of autoimmune diseases and autism spectrum disorders. Pediatrics. 2009;124(2):687-94. doi:10.1542/peds.2008-2445

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