Wheat
Wheat contains the protein, gluten, which is often not recommended for individuals with autism. Many (but not all) children with ASD see improvements in gut health and decrease of symptoms by following a gluten-free diet in combination with other nutrition approaches. There is research supporting opioid-like reactions to gluten, possibly causing brain fog or psychosis.
Quick Facts
Wheat is a great source of carbohydrates and B-vitamins, though it’s suspected that many individuals with autism may be reactive to the main protein, gluten.
Wheat is one of the top 8 allergens worldwide. It is possible to have a wheat allergy, Celiac Disease, or non-celiac gluten sensitivity.
Celiac disease is an autoimmune disorder and is triggered when eating gluten, the protein in wheat and many other grains like barley and rye.
Wheat is often enriched with iron and folic acid. Individuals with the MTHFR mutation or with methylation issues should avoid wheat products that are fortified with folic acid and choose unfortified products instead.
In a case report of a young girl with autism, the researchers were able to correlate gluten ingestion and psychotic symptoms.[2]
A relationship between improved gut health and decrease of symptoms in autism has been reported, with gluten-free diets, casein-free diets, prebiotics and probiotic and multivitamin supplementation showing promising results. [5]
Gluten (similar to dairy) may have opioid-like effects in some people and could mask the negative effects of gluten protein on gastrointestinal lining and function. [11] This may be the case in asymptomatic celiac disease and may be especially detrimental in those who also have a leaky gut.
Nutrient Breakdown
Wheat is a source for many essential nutrients such as:
B vitamins such as folate, thiamin, riboflavin, and niacin.
Some individuals are sensitive to some of the added vitamins, since they are often unmethylated. If this is a concern, unenriched wheat is available (just read the labels). Wheat is often enriched with iron and folic acid and may not be appropriate for those with the MTHFR gene mutation.
Foods Containing Wheat
Flour
Bread
Pasta
Crackers
Pizza
Breaded & battered foods
Baked goods
Cookies
Cereals
Canned soups
Sauces & condiments
Gravy
Certain spices
Beer
Certain candies like licorice
Wheat/Gluten Alternatives
Be sure to incorporate food groups like fruit, vegetables, meat, nuts, etc.
Gluten-free grain alternatives:
Gluten-free flour alternatives
Almond flour
Oat flour (oats are naturally gluten-free, but may be contaminated if not marked gluten-free)
Cassava flour
Coconut flour (warning: coconut flour can not be substituted 1:1 for regular flour)
Rice flour
Chickpea flour
Gluten-free pasta alternatives
Supplements
Certain digestive enzymes can help break down dietary gluten. This should not be used as a bandaid to following a glutenous diet, but can be helpful after an accidental exposure.
Examples:
You may also consider supplementing with additional B vitamins such as folate, thiamin, riboflavin, and niacin when avoiding grains such as wheat.
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
Reactions to Wheat
The body can respond to foods in many different ways and is not limited to food allergy. For wheat, in particular, the body can respond in the following ways:
Wheat Allergy
The body responds to the proteins in wheat with an IgE antibody reaction. This may cause reactions like hives, sneezing, or even life-threatening reactions like anaphylaxis.
Food allergies can be tested by your PCP by requesting an IgE RAST panel or a Skin Prick Test (SPT)
Wheat Sensitivity:
The body responds to the proteins in wheat with other reactions than IgE (such as IgG, IgA, or IgM, to name a few). This may cause more of a delayed inflammatory reaction and may cause symptoms like brain fog, gut inflammation, migraines/headaches, eczema, dark circles under the eyes, mood swings, and behavioral issues. This reaction may also be called Non-Celiac Gluten Sensitivity (NCGS).
Food sensitivities can be tested via a food sensitivity panel. While there are many options available, my most recommended panel is the Mediator Release Test (MRT) by a Registered Dietitian who is also a Certified LEAP Therapist (CLT).
Celiac Disease:
Celiac disease is an autoimmune disorder and is triggered when eating gluten, the protein in wheat and many other grains like barley and rye. The body overreacts to gluten and can damage the gut lining and the intestinal villi. This may cause malnutrition, malabsorption, and even neurological issues.
Diagnosing Celiac Disease is a two-step process involving blood tests and a follow-up endoscopy. Learn more here.
DISCLAIMER: Always consult with your pediatrician and/or your Registered Dietitian to help you test for a food reaction or to aid you in making individualized dietary changes.
Wheat & Autism in the Research
Most of the research surrounding wheat and autism is the study of gluten in particular. The studies listed below study gluten unless otherwise specified:
PSYCHOSIS & OPOID REACTIONS with gluten intake
Gluten can be degraded into several morphine-like substances, named “gluten exorphins”. These compounds have proven opioid-effects and could mask the deleterious effects of gluten protein on gastrointestinal lining and function. [11] This may be the case in asymptomatic celiac disease and may be especially detrimental in those who also have a leaky gut.
Restricted antioxidant capacity, caused by wheat- and milk-derived opioid peptides, may predispose susceptible individuals to inflammation and systemic oxidation, partly explaining the benefits of gluten-free or casein-free diets. [8]
Some food-derived opioid peptides have been reported to cause diseases, such as gastrointestinal inflammation, celiac disease, and mental disorders. Selected strains of bifidobacteria may be used as probiotic microorganisms to eliminate food-derived opioid peptides and contribute to overall health. [12]
Strategies based on use of probiotics have resulted in improvements in symptoms of autism and Parkinson´s disease [13]
In a case report of a young girl with autism, the researchers were able to correlate gluten ingestion and psychotic symptoms. [2]
Celiac Disease
There is no known association between autism and Celiac disease [3]
Maternal autoimmune disease is significantly associated with a modest increase in odds of developmental disorders overall [4]
Celiac disease is an immune-mediated disease that can cause oxidative stress in the body, decrease the effectiveness of antioxidants in the body, and contribute to impairment in the brain. This is a possible link between contributors to both ASD and CD. [9]
Non-Celiac gluten sensitivity (ncgs)
Non-celiac gluten sensitivity (NCGS) is a syndrome diagnosed in patients responsive to gluten-free diet after ruling out celiac disease and wheat allergy. [14]
The association between gluten-related disorders and psychiatric diseases has been firmly demonstrated, though the pathogenesis of neuropsychiatric disorders in NCGS is unclear. [14]
Efficacy Gluten-Free, Casein-Free Diet
See the Gluten-Free, Casein-Free Diet note for more information and research
For information on the gluten-free diet alone, see the Gluten-Free Diet note.
References
[1] Zilić S, Barać M, Pešić M, Dodig D, Ignjatović-micić D. Characterization of proteins from grain of different bread and durum wheat genotypes. Int J Mol Sci. 2011;12(9):5878-94.
[2] Lionetti E, Leonardi S, Franzonello C, Mancardi M, Ruggieri M, Catassi C. Gluten Psychosis: Confirmation of a New Clinical Entity. Nutrients. 2015;7(7):5532-9.
[3] Juneja M, Venkatakrishnan A, Kapoor S, Jain R. Autism Spectrum Disorders and Celiac Disease: Is there an Association?. Indian Pediatr. 2018;55(10):912-914.
[4] Lyall K, Ashwood P, Van de water J, Hertz-picciotto I. Maternal immune-mediated conditions, autism spectrum disorders, and developmental delay. J Autism Dev Disord. 2014;44(7):1546-55.
[5] Doenyas C. Novel Personalized Dietary Treatment for Autism Based on the Gut-Immune-Endocrine-Brain Axis. Front Endocrinol (Lausanne). 2019;10:508.
[6] Kawicka A, Regulska-ilow B. How nutritional status, diet and dietary supplements can affect autism. A review. Rocz Panstw Zakl Hig. 2013;64(1):1-12.
[7] USDA: 2020. [online] Available at: <https://fdc.nal.usda.gov/fdc-app.html#/food-details/781089/nutrients> [Accessed 10 August 2020].
[8] Trivedi MS, Shah JS, Al-mughairy S, et al. Food-derived opioid peptides inhibit cysteine uptake with redox and epigenetic consequences. J Nutr Biochem. 2014;25(10):1011-8.
[9] Di liberto D, D'anneo A, Carlisi D, et al. Brain Opioid Activity and Oxidative Injury: Different Molecular Scenarios Connecting Celiac Disease and Autistic Spectrum Disorder. Brain Sci. 2020;10(7)
[10] Lonsdale D, Shamberger RJ, Obrenovich ME. Dysautonomia in autism spectrum disorder: case reports of a family with review of the literature. Autism Res Treat. 2011;2011:129795.
[11] Pruimboom L, de Punder K. The opioid effects of gluten exorphins: asymptomatic celiac disease. J Health Popul Nutr. 2015;33:24. Published 2015 Nov 24. doi:10.1186/s41043-015-0032-y
[12] Sakurai T, Yamada A, Hashikura N, Odamaki T, Xiao JZ. Degradation of food-derived opioid peptides by bifidobacteria. Benef Microbes. 2018;9(4):675-682. doi:10.3920/BM2017.0165
[13] Rueda-Ruzafa L, Cruz F, Cardona D, et al. Opioid system influences gut-brain axis: Dysbiosis and related alterations. Pharmacol Res. 2020;159:104928. doi:10.1016/j.phrs.2020.104928
[14] Palmieri B, Vadala' M, Laurino C. Gluten-free diet in non-celiac patients: beliefs, truths, advantages and disadvantages. Minerva Gastroenterol Dietol. 2019;65(2):153-162. doi:10.23736/S1121-421X.18.02519-9
Authors
April Allen, RDN
