Director of the Nutrition Clinic at the Johnson Center for Child Health and Development, Kelly Barnhill, MBA, CN, CCN, discusses gluten-free and casein-free diets (GFCF) in autism. She details research history, present findings, and future exploration pathways. Barnhill outlines multiple case studies and discusses what we do and do not know about GFCF diets. She presents nutrition concerns and practicalities associated with GFCF diets and advises listeners to seek medical support for such changes. She emphasizes the importance of understanding differences across subgroups and why they occur before closing with a Q&A session.

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3:00: Brief history of GFCF diets in autism
10:55 – 16:10: Case studies (2016), systematic reviews (2017, 2018), conflicting findings on behavioral response (2017, 2020)
17:30: Research shifts and present perspectives
20:15: Current medical knowledge of GFCF diets
25:43: Why and how to make dietary changes
29:38: Why to not change diets
35:25: Practicalities of dietary implementation
44:55: Overview
45:40: Q&A Session

The first gluten-free (GF) specific research published in the 1950s (3:00) spurred an ongoing exploration of the connections between specific protein elimination and neurological issues. Researchers have since realized that changes to the gut microbiome (via protein elimination and environmental factors) significantly impact immune response, mental health, and behavior. Barnhill highlights pivotal moments in the history of literature surrounding gluten-free and casein-free (GFCF) diets in autism (4:30). She cites a 2015 review article stating that future research should identify subtypes of individuals who may or may not respond to GFCF diets (9:00). To date, there have been no conclusive research studies that find a significant connection between GFCF diets and behavioral issues specific to autism (16:00)

However, clinical correlations cannot be ignored. Barnhill explains that we know certain individuals show behavior improvements on GFCF diets. Still, we do not know why (19:00). Therefore, contemporary research has shifted focus to the gut-brain axis, a bidirectional communication pathway between the gut and the brain which integrates information from the nervous, endocrine, and immune systems. The speaker asserts that understanding this connection will greatly impact what we do about dietary changes (17:30). 

Current medical knowledge of GFCF diets stresses that dietary manipulation is as much about exclusion as it is about including correct nutrients in the right amounts (14:35). It is crucial to replace the proteins and fats in gluten and casein with the proper nutrients. Barnhill states that substituting gluten and casein with packaged and processed GFCF items is not a healthy solution. Diets should “include a rich diversity of other foods to build gut biome strength” (21:25).  

The presenter outlines reasons for dietary changes (25:43) and limitations to be assessed before shifting diets (29:38). Barnhill suggests using professional support covered by insurance to make safe and healthy dietary changes (27:50). Collecting data and gathering baseline information is imperative, and any changes to diet should be implemented slowly and cautiously. Data should be collected continually and monitored (preferably with the help of a professional) to make ongoing adjustments based on verified physical, immune, and/or behavioral impact (28:30). The speaker outlines the biggest nutrition concerns for GFCF diets and provides helpful substitutes and ideas.

Major concerns for GF diets include fiber and fortified vitamins (35:25). Barnhill discusses how to replace them with certain foods (37:21) and high-quality vitamins (38:13). Critical concerns for CF diets (39:56) include deficiencies in healthy fats (40:32), proteins (41:47), calcium (42:36), and vitamin D (43:28). She discusses replacement strategies for CF diets and recommends only high-quality practitioner-recommended supplements. She notes that the vitamin/mineral supplement market is largely unregulated and urges listeners to research products before they are taken (38:13).

Barnhill re-emphasizes that GFCF diets are not proven to minimize symptoms in individuals with autism, but they do have “profound impacts” on some children. For this reason, it is essential to continue investigation into what mechanisms and connections work within subgroups and why (44:55). She closes with a Q&A where she discusses allergy testing, differences in oats and grains, where omega-six is found, best veggies for fiber and daily water quantity, the minimum timeline for baseline numbers (6 months), contradictory testing, and more (45:40).

About the speaker:

Kelly Barnhill, MBA, CN, CCN, is the Director of the Nutrition Clinic at The Johnson Center for Child Health and Development. She is a Certified Clinical Nutritionist, with over a decade of experience working with nutrition in children with autism and related disorders. At the Johnson Center she directs a team of dieticians and nutritionists that has served over 3000 children through this practice. In addition to her clinical practice, Kelly also serves as the Johnson Center Clinical Care Director, overseeing management and implementation of multidisciplinary care across the practices within the organization. In 2008, Kelly accepted the position of Nutrition Coordinator for the Autism Research Institute. In this role, she designs and manages curriculum and training for hundreds of nutrition practitioners each year, as well as providing direct training for thousands of parents. Kelly is a sought-after presenter, speaking at several national and international conferences each year. Her studies and work at JCCHD are the culmination of many years’ effort and expertise, with the last several years devoted to understanding the biological underpinnings of the disorder we know as autism. Her work has raised awareness of the need for these services for children with autism and related disorders. Kelly is a graduate of The University of Texas at Austin.

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