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Monday, July 27, 2009

Autistic Children Don't Have More Gastroenterologist Problems

The huge controversy in the autism community over whether the use of GFCF (gluten-free, casein-free) diets can help autistic children rages on. A new study in the journal Pediatrics, "Incidence of Gastrointestinal Symptoms in Children With Autism: A Population-Based Study," by Samar H. Ibrahim et al. won't stop it. You have to look at the study carefully to see that it really doesn't address whether a GFCF diet works. Instead it looks at the issue from the reverse angle. Do children with autism have more gastroenterological problems than children who don't.

The study got a good summary from Trine Tsouderos in the Chicago Tribune.

The study subjects were 121 autistic children and 242 other children. All were residents of Olmsted County, Minn., home to the Mayo Clinic. Comparing the cumulative incidence of gastrointestinal problems from birth until the late teens showed that the only significant differences were in constipation and feeding issues.

In addition, few specific conditions were diagnosed in the autistic children than in the control group, as reported by Roni Caryn Rabin in the New York Times.
[V]ery few of the autistic children had a specific diagnosis of a gastrointestinal disease. Only one autistic child had Crohn’s disease, and one had intestinal disaccharidase deficiency and lacked enzymes necessary to digest certain carbohydrates. None suffered from celiac disease, which some reports have linked to autism.

Two of the non-autistic children in the comparison group suffered from lactose intolerance, and one had a milk allergy.

Dr. Ibrahim suggested that the loss of appetite and difficulty gaining weight in autistic children may be related to the use of stimulant medications, which are often prescribed for the condition, and that the constipation may be due to children not consuming enough fiber or drinking enough water.

Dr. Ibrahim herself had no good words for followers of the GFCF diet.
"There is actually no trial that has proven so far that a gluten-free and casein-free diet improves autism," she said. "The diets are not easy to follow and can sometimes cause nutritional deficiencies."

This isn't the big study that will address the issue directly. There are studies ongoing that are testing the GFCF diet directly, but they haven't reported yet. This is just another medical point against the need for the diet. Medicine is like that. One single study is not enough. Like a jigsaw puzzle, it's the cumulative picture painted by many pieces, many studies that reveals the direction medicine moves in. That picture is not yet complete.

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