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At least 3 million people living in North America are gluten intolerant, with 90% not even realizing it (1). 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.
What is Attention Deficit Hyperactivity Disorder—ADHD?
Nearly 10% of US children have been diagnosed with ADHD—an almost 22% increase from 2004 to 2007 (2)! Likewise, 50,000 children in Australia are prescribed medications to treat ADHD (3).
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 (4). 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 (5).
Connecting ADHD to Food
Compart and Laake contend 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” (6).
A 1985 research study published in the Lancet found that the majority of ADHD children are salicylate sensitive and that 90% of those children have other food intolerances (7). 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% in 70% of the test population (8). Over 48 foods may trigger hyperactivity in children, but cow milk, wheat, soy, corn, and eggs are the most common (9).
The Big Two: Gluten and Casein
In celiac disease, the intestinal border is worn down far enough to be recognized through a small bowel biopsy. Continuing to eat gluten while gluten intolerant may eventually result in celiac disease (1).
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 (10). Gluten and casein are the two proteins with the most common connection to mood disorders, behavioral disorders and ADHD, although there may be others (6, 11). More and more research is finding that gluten intolerance will manifest with neurological symptoms instead of the more traditional digestive complaints (12). A 2004 research study published in the “Journal of Pediatrics” found that celiac disease test subjects were over 50% more likely to develop neurological disorders, including ADHD (13).
In fact, 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 withdrawals (6).
Likewise, when gluten containing foods are consumed by a person that has non-celiac gluten intolerance or celiac disease, immune antibodies are triggered that release inflammatory cytokines that damage brain function and result in neurological symptoms (14).
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 certify that the product is “gluten free” and indicate how many parts per million it tests to, assume it to not be gluten free.
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”.
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 (6). There are many substitutes for milk and dairy products that are made of “milks” from nuts, seeds, or grains such as rice.
Food Elimination Test
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. ADHD children with one or more of those symptoms should go on a limited diet for a couple 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 the allergic symptoms return, that food should be entirely eliminated from the child’s diet indefinitely (9).
Elizabeth Strickland indicates that “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” (15). 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 (6). Diagnosis of celiac disease requires a blood test, but most blood tests only test for the gliadin protein (there are other proteins in wheat), false positives are common and may not catch people that 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” (6).
A Changed Child
Note provided by parents of child with neurological symptoms who had gluten and dairy removed from her diet: “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!” (14)
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. (6) A University of Sunderland, UK research study correlated a gluten- and casein-free diet with significant improvement within a year for children with ADHD. (16) That said, since there is no one cause of ADHD, there can be no one solution, but eliminating gluten and casein is 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.
Katie Bauer is the owner of Nourished Health Consulting which provides nutrition therapy internationally via Skype and the Founding Director of Nourished Health Center and owner of Nourished Health Cooking School in Denver Colorado. Katie specializes in digestive health, fatigue and brain fog and offers a complimentary Vitality Strategy Session to help you reach your health and wellness goals.
(2) “CDC Morbidity and Mortality Weekly Report”: Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children
(3) “THE Parental Intelligence Report on ‘ADHD’”; Bob Collier
(5) “Encyclopedia of Attention Deficit Hyperactivity Disorders”; Evelyn B. Kelly; 2009
(6) “The Kid-Friendly ADHD & Autism Cookbook: The Ultimate Guide to the Gluten-Free, Cassein-Free Diet”; Pamela Compart, MD, Dana Laake, RDH, MS, LDN; 2009
(7) “Lancet” journal; Controlled Trial of Oligoantigenic Treatment in the Hyper Kinetic Syndrome; Egger J, Carter CM, Graham PJ et, al.; Volume 1, 1985
(8) “European Child andAdolescent Psychiatry” journal; A Randomised Controlled Trial into the Effects of Food on ADHD; Pelsser LM, Frankena K, Toorman J, et al; January 2009
(11) “The Autism and ADHD Diet: A Step-By-Step Guide to Hope and Healing by Living Gluten Free and Casein Free (GFCF) and Other Interventions”; Barry Silberberg; 2009
(12) “The Lancet Neurology”journal; Gluten Sensitivity: From Gut to Brain; Marios Hadjivassiliou MD, David S Sanders MD, Richard A Grünewald phD, Phil,Nicola Woodroofe PhD, Sabrina Boscolo PhD, Daniel Aeschlimann PhD; March 2010
(15) “Eating for Autism: The 10-Step Nutrition Plan To Help Treat Your Child’s Autism, Asperger’s, or ADHD”; Elizabeth Strickland, MS, RD, LD; 2009