Autism spectrum comprises a complex set of behaviourally defined neurodevelopmental abnormalities in two core areas: deficits in social communication and fixated, restricted, repetitive or stereotyped behaviours and interests including food selectivity.
Frustrated by the lack of effective medical and complementary treatments for ASD many parents have turned to alternative treatments that are generally perceived as risk free. Among these the most widely used is the gluten free-casein free diet (GFCF diet). The opioid theory, which is the most commonly cited to justify the adoption of a GFCF diet, is related to neurotransmitters and concerns the release of peptides with opioid activity in the intestines. After digestion certain types of proteins could cross the intestinal mucosa intact if it were more permeable than normal, as is the case when impaired by immunological factors or by lesions in the case of coeliac disease. If these peptides, transported by the blood stream, were to cross the blood brain barrier and reach the central nervous system in large quantities, brain function would be affected. It is important to note that the foregoing point simply outlines a theory sketched by Amidon and Lee in 1994; there is no conclusive evidence to state that this theory is correct in the context of ASD diagnosis.
The theory continues by implying that the hydrolysis of proteins from cereals and milk would generate exogenous neuropeptides (exorphines) such as gluteomorphins from gluten and beta-casomorphins from casein. In relation to this, the elimination of gluten implies the exclusion of all food items containing wheat, oats, barley or rye, that is all flours, breads, rusks, pasta, pastries, and other bakery products made with these cereals, while the elimination of casein requires no intake of dairy products: milk, cheese, butter, cream, or ice-cream. However, as suggested and clearly outlined in numerous scholarly reviews, until conclusive evidence of the benefits of GFCF diets in ASD is available, these diets should only be introduced after the diagnosis of an intolerance or allergy to allergens in the foods that would be eliminated in such a diet.
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