According to the reference book "Midwifery: Best Practices" by Sara Wickham, 24 million Americans suffer from a food sensitivity, allergy or intolerance. As per Dr. Keith Berndtson, writing in "The Autism and ADHD Diet," at least 3 million people living in North America are gluten intolerant, with 90 percent not even realizing it. Although some dairy and gluten intolerance symptoms manifest in the digestive tract, other symptoms are neurological, affecting mood, attention span, cognitive capabilities, behaviors and sometimes even manifesting as attention deficit hyperactivity disorder or ADHD. As a result, the gluten and casein free diet for ADHD children is becoming more common and widespread. As with any major dietary changes, consult your health care provider first.
What is ADHD?
The Centers for Disease Control and Prevention released new documentation in November 2010 that nearly 10 percent of U.S. children have been diagnosed with Attention Deficit Hyperactivity Disorder, or ADHD---an almost 22 percent increase from 2004 to 2007. ADHD is not diagnosed by blood tests but through recognition of at least six of the eighteen core symptom patterns persistent enough to impair normal functioning. "The Encyclopedia of Attention Deficit Hyperactivity Disorders" indicates that ADHD is connected to lower academic performance; impulsiveness; forgetfulness; problems with emotional regulation and interpersonal communication manifesting in higher levels of aggression, anger and sadness; and may even lower life expectancy. For the most up-to-date list of symptoms, review the "Diagnostic and Statistical Manual of Mental Disorders."
Connecting ADHD to Food
Pamela Compart, MD, and Dana Laake, RDH, MS, LDN, write in the "Kid-Friendly ADHD & Autism Cookbook" that, "Unfortunately, diet and nutrition are often overlooked or dismissed, when, in fact, many of the symptom presentations in ADHD or autism are directly related to nutritional deficiencies, disturbances in nutrient metabolism, poor diet and the negative effects of specific foods."
A 1985 research study published in the journal Lancet found that the majority of ADHD children are salicylate sensitive and that 90 percent of those children have other food intolerances. A rigorous 2009 research study validated those results and found that limiting the diet of ADHD children to only a few non-allergenic foods resulted in improved behavior by at least 50 percent in 70 percent of the test population. According to Leo Galland, a leading integrative physician, over 48 foods may trigger hyperactivity in children, but cow milk, wheat, soy, corn and eggs are the most common.
The Main Two: Gluten and Casein
Celiac disease is further along the same spectrum as gluten intolerance, only the intestinal border is worn down far enough with celiac disease to be recognized through a small-bowel biopsy. Continuing to eat gluten while gluten intolerant will eventually result in celiac disease. A 2006 research study by the Regional Hospital of Bolzano in Italy strongly correlates ADHD symptoms with untreated celiac disease and indicates that a gluten-free diet should improve symptoms quickly. Compart and Laake, along with Barry Silberberg, the author of the "Autism and ADHD Diet," indicate that gluten and casein are two proteins that are the most common connection to mood disorders, behavioral disorders and ADHD, while recognizing there may be others.
According to Dr. Maios Hadjivassiliou, a world-renowned gluten researcher, more and more research is finding that gluten intolerance will manifest with neurological symptoms instead of the more traditional digestive complaints. A 2004 research study published in the "Journal of Pediatrics" found that celiac disease test subjects were over 50 percent more likely to develop neurological disorders, including ADHD. In fact, Compart and Laake explain that in some people gluten and/or casein can mimic opiates, such as morphine and heroin. When a food sensitivity or allergy is present, combined with poor intestinal integrity and poor digestion, the gluten or casein opiate-like peptides can travel through the blood stream and to the brain, resulting in some of the common symptoms of autism and ADHD. As a result, children may intensely crave gluten and/or dairy containing foods, and when those foods are removed from their diets, kids may initially become crankier and angrier, as they are, in essence, going through drug withdrawal. Additionally, Dr. David Perlmutter reports that when gluten-containing foods are consumed by a person who has gluten sensitivity or celiac disease, immune antibodies are triggered that release inflammatory cytokines that damage brain function and result in neurological symptoms.
What is Casein?
Casein is the main protein in dairy and may be listed on ingredient lists as dairy, milk, milk solids, lactose, galactose, lactalbumin, lactoglobulin, casein or caseinate. Breast milk is safe, as human casein protein is a different molecular structure than the casein protein in non-human animal milk. There are many substitutes for milk and dairy products that are made of "milks" from nuts, seeds or grains such as rice.
What is Gluten?
Gluten is the protein in some grains, including wheat, barley, spelt, kamut and rye. Gluten is what holds breads and pastries together and provides elasticity for dough to rise. Gluten is found in most packaged and processed foods, especially breads, pastries, soups, sauces, dressing and pastas and may be hidden on ingredient lists under the following names: wheat, gluten, natural flavoring, fillers, whey protein concentrate, whey sodium caseinate, white vinegar or white grain vinegar, rice malt (contains barley or Koji), rice syrup (contains barley enzymes), dextrin, malt, maltodextrin, hydrolyzed plant protein (HPP), hydrolyzed vegetable protein (HVP) unless from soy or corn, modified [food] starch (unless from arrowroot, corn, potato, tapioca or maize), mustard powder (may contain gluten), monosodium glutamate (MSG), vegetable gum (unless from carob bean, locust bean, cellulose, guar gum, gum Arabic, gum aracia, gum tragacanth, xantham gum or vegetable starch) and gelatinized starch. When in doubt, if the label doesn't explicitly claim, "gluten free," assume it isn't.
There are many non-gluten grains, including amaranth, teff, quinoa, Montina, millet, corn and buckwheat, that can be used in place of gluten-containing grains. There are also wide varieties of gluten-free flours that can be made from gluten-free grains or the grinding of beans, nuts, seeds or potatoes. Xantham gum, guar gum and starches such as potato, corn, tapioca and arrowroot add binding and elasticity capacity to gluten-free breads and pastries. However, even when using non-glutinous grains, nuts, seeds, beans and flours, there is a risk of cross-contamination with gluten if the product isn't certified as "gluten free".
Food Elimination Test
Dr. Galland finds in his clinical practice that food allergies are almost always implicated in the kids with ADHD that also have one or more of the following symptoms: 1) eczema, hives, hay fever and/or constant runny nose; 2) family member with allergies and/or migraine headaches; 3) patchy tongue with irregularly flattened patches; 4) abnormally red ears; 5) food cravings. He suggests that ADHD children with one or more of these symptoms go on a limited diet for a couple of weeks, eliminating gluten, dairy, corn, soy, eggs, artificial colors, artificial flavors and preservatives. At the end of two weeks, one food at a time should be added back in, and if behavioral or allergic symptoms return, that food should be entirely eliminated from the child's diet indefinitely.
Elizabeth Strickland, MS, RD, LD, writes in "Eating for Autism: The 10-Step Nutrition Plan To Help Treat Your Child's Autism, Asperger's, or ADHD," "The right nutritional interventions can have a huge impact on your child's brain function, memory, learning, attention, focus, mood, behavior, growth and overall health." According to Compart and Laake, even without a diagnosis of ADHD, your child may find improvement in behavioral and cognitive problems through an elimination diet, starting with the elimination of gluten and casein. Diagnosis of celiac disease requires a blood test, but the blood tests only test for the gliadin protein (there are other proteins in wheat), false positives are common, and blood tests don't catch people who have a sensitivity to gluten but do not (yet) have celiac disease. Compart and Laake reason that, "The best test is the child's own body.... The gold standard for food reactions is the child's response to elimination of a food. It is better than any blood test. The goal of treatments is not to make the blood tests better; the goal is to make the child better."
A Changed Child
Note provided by parents of a child patient of Dr. David Perlmutter with neurological symptoms: "Karen is completing third grade this year. Prior to removing gluten from her diet, academics, especially math, were difficult. As you can see, she is now soaring in math. Based upon this test, entering the fourth grade next year, she would be at the top of her class. The teacher indicated that if she skipped fourth grade and went to fifth grade, she would be in the middle of her class. What an accomplishment!"
Compart and Laake find that providing optimal nutritional support and the elimination of problematic foods ensures that kids will also respond more effectively to more traditional medications and with fewer side effects. A University of Sunderland, UK, research study correlated a gluten- and casein-free diet with significant improvement within a year for children with ADHD. Compart and Laake and also Silberberg all recognize that since there is no one cause of ADHD, there can be no one solution; eliminating gluten and casein is only a start.
Luckily, a gluten-free and casein-free diet can still be bountiful, delicious and simple. With the increase in food sensitivities and food allergies, the choices have increased. Many restaurants have gluten-free menus with dairy-free options and there are many gluten- and casein-free products on the market. There are also organizations that support people living gluten free, such as the Celiac Sprue Association and the Gluten Intolerance Group. Additionally, gluten-free cooking classes are becoming more available; check with your local natural foods market to see if they offer them.
References
- "Midwifery Best Practices," Volume 5; Sara Wickham; 2008
- "Park Ridge MultiMed White Paper: Celiac Disease and Gluten Intolerance
- Centers for Disease Control and Prevention: Increasing Prevalence of Parent-Reported ADHD
- National Center for Biotechnical Information: Facts, Values, and ADHD
- "Encyclopedia of Attention Deficit Hyperactivity Disorders"; Evelyn B. Kelly; 2009
- "Diagnostic and Statistical Manual of Mental Disorders"; American Psych. Assoc.; 2000
