How Gluten-Free Casein-Free Modified Ketogenic Diets Help Autism

What is the Autism Spectrum Disorder?

The expression of autism is different in each person. The spectrum disorder effects some mildly and others severely, with distressing effects to those directly impacted and those who love them; but what is autism?

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that impacts cognitive development and function. There are currently no known medically definitive, universal factors that predispose individuals to have ASD.

Although the ways each person with autism is affected by the disorder varies, many experience delays in speech, cognition and social development.

In addition to the challenges the disorder presents to development and cognition, many with ASD also experience gut health and additional neurological issues—with many also suffering from some form of seizure disorder in addition to autism. 

Fortunately, there is a lot of established and emerging research available to support the optimal health of those living with autism, in no small part to the tireless pressing of parents for answers and methods to help their affected children.

Although the disorder may impose certain limitations or areas that require significant support throughout a lifetime, some nutritional and behavioral therapy protocols can significantly improve one's quality of life.

Symptoms of Autism  

Delayed speech and missing developmental markers, or in some cases exceptionally exceeding them, may indicate neuropathic abnormalities.

Also, feeding and core strength or coordination issues are often present in children with autism.

Again, the ways each person with autism is impacted developmentally and physically will vary.

The following are common symptoms of autism:

• social impairments
• cognitive impairments
• communication difficulties
• repetitive behaviors

Early Signs: 

A person with ASD might:

• Not respond to their name (the child may appear hard of hearing or as if ignoring you)
• Not play “pretend” games (no imaginative play)
• Avoid eye contact
• Want to be alone (self-isolate or reluctant to engage with others)
• Have difficulty understanding what are abstract concepts like their feelings or feelings of others (often miss social cues; very literal and don’t understand sarcasm)
• Have no speech or delayed speech (speech apraxia)
• Repeat words or phrases over and over; or repeat back what someone else is saying rather than replying appropriately (echolalia)
• Get upset by minor changes to routine or environment
• Have obsessive interests
• Flap their hands, rock their body, or spin in circles (also known as stimming)
• Have unusual reactions (over or under-sensitivity) to the way things sound, smell, taste, look or feel (heightened sensory sensitivity)
• Have low to no social skills
• Avoid or resist physical contact or conversely have difficulty establishing socially-appropriate boundaries with others (e.g., stepping on people’s toes, reaching out and touching strangers in public spaces, etc.).
• Demonstrate little safety or danger awareness
• Line up toys or other objects
• Play with toys the same way every time
• Like parts of objects (e.g., wheels or tips and points, like the peak of a triangle)
• Become upset by minor changes in routine
• Have obsessive interests (e.g., watching the same shows or particular parts of plays over and over again)

Other Symptoms:

• Hyperactivity (very active)
• Impulsivity (acting without thinking of danger or consequences)
• Short attention span
• Aggression
• Causing self-injury
• Meltdowns
• Unusual eating and sleeping habits
• Unusual mood or emotional reactions
• Lack of fear or more fear than expected
• Unusual sleeping habits

The Environmental Risk Factors of Autism

There’s no founded singular environmental cause of autism, but elements in the environment, along with diet and nutrition, can impact someone with autism.

Most children are particularly susceptible to adverse effects of water, air, and soil pollution, as most suffer from digestive damage in the form of leaky gut syndrome—meaning they tend to have an unusually permeable intestinal wall which allows bacteria and toxins to “leak” through the wall and into the bloodstream.

Our gut, or our digestive system, is our biggest immune system organ and its health is central to our overall well-being—even referred to by some as our second brain and the idea behind the term “gut feeling.”

Poor gut health may result in bloating, cramps, aches, and pains, and can even cause food sensitivities.

Autism and the Brain-Gut Connection

Dr. Donald Kirby, MD, director of the Center for Human Nutrition at the Cleveland Clinic, recently noted that leaky gut syndrome isn’t a diagnosis taught in medical school and further asserts that traditionally-trained Western physicians don’t know enough about the gut to treat patients at this time.

As for what we do know, a relatively recent 12-year prospective population-based study found that gut health impacts anxiety as much as anxiety impacts gut health.

This is particularly important to those with autism as anxiety tends to be high in those with autism inherently, and the goal is always to remediate distress.

Our gut microbiome, or the vast ecosystem of bacteria found in the gut, can impact everything from immunity to digestion and even weight—with essential probiotics like serotonin, also known as the “happy hormone”, which helps regulate mood and mitigate anxiety and depression—predominantly made in the gastrointestinal (GI) tract.

With this being said, it’s clear that the health of our gut truly matters. The following are some natural and effective ways to regulate gut health and reduce the symptoms of leaky gut syndrome:

Bone Broth

The mineral and nutritive content of grass-fed bone marrow broth is an excellent source of gut-healing collagen, minerals, and vitamins. Bone broth is superior to consume to replenish hydration and electrolytes in the body.

Sugar-Free Living Yogurt

Yogurt is an excellent source of probiotics, but many store-bought options are loaded with sugar, with some containing as much sugar as candy.

Opt for a brand like CocoYo, a line made with no added sugar that provides a rich microbiome profile.

Exogenous Probiotics

It can be helpful to supplement with exogenous probiotics, or better still a Synbiotic, or probiotic-prebiotic hybrid, to improve gut flora and prevent the issues with digestion often associated with a leaky gut syndrome.

Eat Fermented Foods

Adding a little sauerkraut to your child’s hot dog or topping a burger with some pickles and fermented homemade ketchup isn’t just tasty, it’s healthy.

Fermented foods like sauerkraut, kombucha, pickles, and kimchi have long shown to improve and support gut health.

If your little one is a picky eater, and most of the spectrum with heightened sensory sensitivity usually are, find creative ways to sneak fermented foods into your kiddos’ diet—the health benefits make it worth the effort.

Things to Avoid:

Antibiotics

Although antibiotics can be life-saving tools to remediate an ailment when consumed short-term, overuse of antibiotics can cause harm to your gut’s microbiome because they kill both good and bad bacteria in the gut.

If someone already has a compromised gut barrier, the absence of good bacteria creates a highly-inflammatory environment that’s ideal for the proliferation of toxic microbes, no good.

Sugar

Again, leaky gut syndrome thrives when the intestines are in an inflammatory state, and the consumption of sugar is the primary cause of inflammation in the body.

Limit all artificial sweeteners, and even plant-based sugars like fructose found in fruit, to promote the growth of good bacteria and a fortified gut lining. 

Go Organic to Avoid Pesticides and Toxins

You might think you’re feeding your little one a healthy diet when you opt to add in lots of fruits and vegetables. However, unless you buy organic produce, you will also be inadvertently feeding them loads of toxins and pesticides.

Pesticides and toxins can produce some side effects including fatigue, bloating, depression and certain cancers, along with exacerbating behavioral, developmental, and cognitive issues in those with autism.

It’s also worth noting that current research shows a connection between gut microbiota and one’s potential risk for developing metabolic diseases, including insulin resistance, which has further health implications for those affected.

The Keto Diet vs. Other Diets

There are many popular dietary protocols in the autism community, and the right one for your child will have a lot to do with their full spectrum of needs and possible nutritional deficiencies.

However, the ketogenic diet and its neuroprotective properties could be ideal for children with autism.

Ketosis is a powerful metabolic state achieved by restricting carbohydrates which forces the body to run on ketones instead of glucose through a process called ketogenesis.

Also, the physiological state of ketosis, not to be confused with the dangerous state of ketoacidosis, has been used in therapeutic settings since the 1920s, specifically to treat children with epilepsy, another neurological disorder and one commonly experienced in children with autism, as well.

Although the gluten-free, casein-free diet (GFCF), the GAPS diet (a derivative of the Specific Carbohydrate Diet or SCD), and the Paleo diet are often used by parents to improve the symptoms of autism and other neuropathic disorders, the ketogenic diet exceeds them all because of its compounded nutritive and therapeutic benefits.

Elevated ketone bodies in the system coupled with the metabolic state of ketosis both work in unison to foster healthy brain development and function, as well as improved cognition and concentration.

Furthermore, the emerging research we referenced above that links insulin resistance to gut health is also helped on keto because the diet promotes eating an abundant amount of gut-healthy foods (e.g., bone broth, living yogurt without added sugar, and sauerkraut, etc.) to prevent spikes in glucose.

As you consider the safety of trying a ketogenic diet for your loved one with autism it is important to keep in mind that babies are born in ketosis.

Also, as expectant moms enter their last weeks of pregnancy, both mom and her unborn child enter ketosis more frequently to support their nutritional needs during this period of baby’s rapid growth—with baby eventually producing its ketones leading up to birth.

If you’re planning to conceive soon, you should take a look at our recent in-depth piece, Can I Do the Keto Diet When Pregnant? to learn more about ketones and how they nurture healthy neurodevelopment and cognitive development in utero and after birth.

There is a lot of exciting information to unpack related to the benefits of trying a ketogenic diet, and we intend to break down everything you need to know to get started, without feeling overwhelmed. We know life as a special needs parent can be challenging, and we’re here to help!

A Modified Keto Diet & Autistic Children

Although limited in scope, a preliminary study conducted in 2003 found that feeding children with autism a ketogenic diet, compared to a Standard American Diet, for six weeks resulted in reduced adverse behaviors in participants.

However, despite its efficacy, implementing and maintaining a ketogenic diet can prove a bit challenging for some.

Food reinforcers can be a powerful tool in an autistic child’s behavioral management plan and eliminating access to options that they enjoy will likely inspire push-back—mainly because those with autism are quite particular about details and tend to want their predictable favorites, exclusively.

It will likely take some trial and error to find equally-coveted food replacements for your little one’s current favorites, but the bright side is that there are delicious, healthy options that you and your loved one with autism will probably enjoy!

Unlike on a Standard American Diet, bacon and butter along with fatty cuts of meat are all on the menu now.

Also, the combination of salt and fat is always a winning duo, and there is an abundance of options that you can use on a keto diet to entice and keep your loved one thriving on the ketogenic diet.

Focus on a diet filled with low-glycemic vegetables—and don’t feel bad to hide some of those veggies in some low-carb, fatty meatballs for an easy and satisfying meal option.

Avocado is also an excellent food option on keto, but your sensory-sensitive child may not agree.

Try breading cubes of ripe avocado with a coating made of grated parmesan cheese and crushed pork rinds for a delicious, savory, crispy treat that’s sure to satisfy all the senses of even your picky little eaters—it’s at least as good as chicken nuggets!

Food Reinforcers, Medications, and Keto

A component worth highlighting again is the balancing act a special needs parent faces when looking to restrict certain foods that their child has come accustomed to in their diet.

Many kids on the spectrum have limited foods that they’re willing to eat, often based on a food’s texture, mouthfeel, or smell.

Many kids will mono-meal and want only to eat dishes that contain one food; or kids may wish to eat the same foods daily for extended stretches of time, to the exclusion of all else.

So, it’s understandable how the idea of rocking the boat by altering your child’s diet could seem daunting.

We understand the balancing act between using high carbohydrate foods to help your little one navigate a challenging visit to the doctor, versus curtailing their carb intake to achieve ketosis, is tough. We have some tips to share below that may assist with the transition.

Another thing, the impact of medications prescribed to manage neurological or behavioral issues on the spectrum (e.g., epileptic seizures, aggression, non-compliance, etc.) can significantly impact appetite, making children on those medications, insatiable.

Fortunately, a natural appetite-suppressing effect is another benefit of the keto protocol, and one not found on any other plan currently popular within the autism community.

Opting for a moderate ketogenic diet that provides a higher carb macronutrient ceiling along with the use of quality, certified-organic, exogenous ketones like Keto Activate are great tools to help facilitate nutritional ketosis.

Keto Activate helps to re-establish ketosis quickly after your child downs a higher-carb cupcake or food reinforcer by releasing increased, premium exogenous ketone bodies—and it’s effortless to mix into food and drinks, so your child will get extra health benefits without ever being the wiser.  

The Gluten-Free Casein-Free Ketogenic Diet

Removing gluten and casein from the diet may have benefits to children with autism who are allergic to either ingredient, but there’s no definitive medical research at this time to show that the diet mitigates the adverse behaviors or symptoms of those living with autism.

Those on the spectrum, and already more susceptible to the gut issues we discussed earlier, may be disproportionately affected when they consume gluten due to an inability to break it down and metabolize it properly.

Also, lactose, the sugar found in cow’s milk and a derivative of glucose, has been said to cause irritability and behavioral issues in those with an intolerance.

Although the omission of gluten and casein may have positive effects on symptoms and behaviors synonymous with autism, it on its own isn’t proven to provide any therapeutic impacts to our physiological, neurodevelopmental, or digestive health as is the case with those who follow a modified ketogenic diet.

Things get interesting when we combine the GFCF protocol and the ketogenic diet, more on that below.

How Gluten-Free Casein-Free Modified Ketogenic Diet Helps Autism

The anti-allergenic nature of the GFCF diet coupled with the neuroprotective nature of a keto diet is a compounded win for anyone with autism.

The addition of the moderate ketogenic diet creates more dietary flexibility to help make the approach more realistic and sustainable for your loved one with autism, long-term.

In addition to allowing a more relaxed approach to keto, the dietary protocol also fosters neurodevelopmental, brain, and musculoskeletal health in all humans.

Besides, the benefits of the ketogenic diet serve a dual purpose, as many with autism also suffer from some form of seizure disorder, it’s a common comorbidity.

Remember, the ketogenic diet was established to treat children with epilepsy, a possibly devastating seizure disorder, so keto offers a double therapeutic benefit to those who need to regulate said disorders.  

Gluten-Free Casein-Free Ketogenic Foods

There are a plethora of delicious GFCF foods to enjoy, so many great options. As a general guideline, focus on a dietary plan filled with lean proteins, healthy fats, and low-glycemic fruits and vegetables.

The kids will likely love low-carb, bunless cheeseburgers and fresh berries with a heaping dollop of homemade, organic whipped cream as a part of their weekly meal plan. Experiment and modify recipes your kids already love, just without the carbs.

The following are some excellent and organic food choices on a gluten-free, casein-free ketogenic diet:

• Grass-fed ground beef
• Chicken thighs with skin
• Dairy or nut-based cheese
• Heavy cream
• Wild-caught salmon
• Leafy greens (e.g., kale, spinach, chard, etc.)
• Low-glycemic berries (e.g., blueberries, blackberries, strawberries, etc.)
• Cruciferous vegetables (e.g., cauliflower and broccoli)
• Ghee (clarified butter, the milk proteins whey and casein are extracted from the butter making it GFCF-friendly)
• MCT oil
• Pasture-raised eggs
• Bacon (nitrate and nitrite-free)
• Avocado

There’s never been a better time to give the moderate ketogenic diet a try for your child with autism.

Whether it’s using pork rinds and parmesan cheese to bread and fry homemade chicken nuggets or making one of the many tasty keto-approved, sandwich wraps that are a snap to whip up in minutes, you may find that you love the diet as much as your little one.

Starting a Keto Diet If Someone You Love Has Autism

Plan ahead, be patient and remain nimble in your approach as you begin the moderate keto diet with your autistic child.

Any form of change poses varying levels of stress and anxiety in individuals with autism; while routine and order, commonly known, creates feelings of security in those on the spectrum—so easy does it.

Go at the pace your child can handle and know that you’re doing your very best.

Give the transition a few weeks, or more, and allow room to experiment and find recipes that your child loves.

This is a long game, don’t beat yourself up on higher-carb days if you opt to supplement with exogenous ketones.

These will help maintain a therapeutic ketotic state in your little one without completely losing your marbles—it's such a helpful tool when working to get children and other picky eaters fat-adapted.

Dietary Considerations  

The foods we feed our growing and developing  children is always vital, but this is even more so true when it’s someone with autism.

What’s empowering is the realization of the power we genuinely wield as parents, able to use nutrition as a means to heal some of what ails our children.

Also, if your child is free of allergies to gluten or casein, products containing either are perfectly fine on a moderate keto diet.

Most impressively, the ketogenic diet doesn’t just prevent allergic reactions, as is the case with a GFCF or GAPS protocol, the ketogenic diet facilitates healthy neurodevelopment, muscle tissue, and cognitive processing through the use of the body’s preferred form of fuel—ketones derived from fat!

Furthermore, it’s extremely promising to know that the century-old ketogenic protocol has shown to have significant beneficial effects on both cognitive and behavioral levels in those with autism.

Working with Your Doctor

Work with your doctor and trust your second brain, your gut, as you navigate the best nutritional protocol goals for your loved one with autism!

You may find a wide schism between peer-reviewed articles and the word on the street, so to speak, being shared by special needs parents and alternative medicine practitioners.

Consult with a trusted doctor, do your research, and decide what’s best for you and your child.

Summary

The moderate ketogenic diet is an ideal and therapeutic protocol that’s been used for about a century to treat a variety of physiological disorders, and there’s research to support the significant benefit keto provides to those with some neurodegenerative disorders like Alzheimer’s, dementia, epilepsy, and of course, autism!

Following a low-carb, high-fat lifestyle for your loved one is as delicious as it is remedial. Take your time and ease into the lifestyle.

Enjoy the keto journey and take advantage of all the fan-worthy YouTube tutorials available online, so you can be as much of a superhero parent in the kitchen, as you are in life.

Resources

• http://nationalautismassociation.org/resources/signs-of-autism/
• https://www.researchgate.net/publication/236038427_The_Role_of_Gut_Microbiota_on_Insulin_Resistance
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425030/
• https://www.ncbi.nlm.nih.gov/pubmed/12693778
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863039/
• https://www.cdc.gov/media/releases/2018/p0426-autism-prevalence.html