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What’s the deal with Gluten Free diets, especially when prescribed for children with Autism or Down Syndrome?
Do they work?
Are they needed?

Should everyone be on a GF diet?

Is it a “cure”?

All this and more on this short and as-always packed episode!

 

 

Audio Transcription: 

What’s the deal with gluten? Does your child need to be gluten free if they have a diagnosis of Down syndrome or autism? Welcome to functional nutrition and learning for kids. I am Dr. Vaishnavi Sarathy, a chemist and nutrition educator. And I am passionate about on base on ways of using diet, vegetables, even greens and fruit, bring balance into our lives. More than that I’m also an educator in that I teach chemistry and math to kids of all abilities.

I’m super passionate, extra passionate, extremely passionate, that we all assume competence. Every kid can learn anything. Let’s just give everyone a fair chance at life. Now, when you’re on the healing path, and I say that within quotes, often the first thing that you’re asked by a holistic practitioner is to drop gluten and dairy from your diet. Perhaps you’ve been there.

The seeming rationale behind this idea is that when you want to make progress, you want to remove things that impede your progress. Now, gluten and dairy are thought to be intensely inflammatory, and removing them is often the first step in clearing inflammation. In fact, this idea is so firmly entrenched in functional medicine practice that it is often considered by many as it’s often considered that it’s impossible to go ahead if a person is deleting gluten and dairy. And perhaps you’ve heard of this idea. But it’s possible that the clarity behind why this is being done is not apparent to you. And perhaps you’ve heard studies about where this doesn’t work. And of course in regular medicine, Psych circles, this is dismissed as yet another fad right now I’ve met many who have observed no changes after being gluten free for a while and every included gluten in their diet, and so on seen no changes then either. So today I want to talk about four questions broadly.

First, is that are we on a healing path? I said healing path? What does that even mean? Right? Number two, why is gluten inflammatory? Number three, why do studies show that removing gluten doesn’t help kids that have autism, that that doesn’t help their symptoms? Number four, perhaps you think that you’ve ditched gluten for a while and didn’t see anything? What’s up with that? Right? Why didn’t you see anything when you did?

Now these questions are the most common objections that I’ve come across when talking about whether to gluten or not to gluten. And of course, they’re all terribly valid questions. So shall we tackle them one by one? Okay, first, I started this whole thing off by mentioning this controversial thing healing path. Okay, what is this healing path? Obviously, in the context of Down syndrome, we’re not trying to heal anything, or at least not Down syndrome. When we’re talking about autism, this becomes a controversial idea even more on social media. Sometimes they’re firmly drawn battle lines between neurodiversity advocates who are advocating for respect for inclusion and complete acceptance of neuro divergence. And on the opposite side, if you want to even think of it as the opposite side, sometimes there are parents who are looking at the children through the lens of medicine, of biochemistry of something that has shifted for the wrong.

Now, I am often on both sides of this fence, I firmly advocate for respect beyond anything else. But at the same time, if there is neuro inflammation, if there are got gastrointestinal GI issues, if there are immune issues, and they’re often all three, in many children with disabilities, we have to address them, right. So this so called healing journey, let’s call it moving towards a best version of health. Moving towards a state of good immunity, have a functioning digestive system of a brain that is not on fire, independent of whether a child has Down syndrome is autistic or not.

Now every child deserves some work and research into health, right? So this is where we are now, if you feel that your child is not functioning to the best of their ability, this is when you might consider a healing journey, or back then, what are we healing? Well, of course, that depends on the child, but more often than not, so it’s one of these three are all of these three, it’s GI issues, chronic inflammation, which is basically an immune response. Neuro inflammation in severe situations, this gut immune neuro axis. Now studies vary, but a 2019 study indicated that up to maybe 90% of kids with autism can have GI or gastrointestinal issues. Okay. So it’s obviously something that we want to consider. Does your child have any of these? Do we want to move further? Do we want to step into this journey?

Once you’ve gotten there? Question two, what is the deal with gluten? Is it inflammatory why and why should we specifically worry about our kids with autism? My take on the issue is no it’s not about autism. Okay. It’s not about Down syndrome. It is about internal gut information. It is about neuroinflammation if that is the case with their child. Now non celiac gluten sensitivity is the official term the idea that some people cannot tolerate gluten, even though they do not have celiac disease. Since this is a sensitivity and not an allergy symptoms are not immediate, and it requires a few weeks to even a few months to see improvements.

In GI and neuro symptoms. There are a number of questions that have plagued researchers and clinicians alike. Is it the gluten? Is it some other component of the wheat? Is it the extent of hybridization of the wheat? Is it post Harvest, harvest processing? Or is it the glyphosate that’s used so much in conventional wheat agriculture? Now, truth be told, it’s most likely a combination of agricultural processing, agriculture, you know, of processing and have digestive issues that are rampant in everybody.

Dr. Alessio Fasano is one of my favorite researchers. He’s the Chief of Pediatric Gastroenterology and gastroenterology if I can say that right at Mass General Hospital, and has done much of the cutting edge work on gluten in the gut. Now, he actually specializes according to his profile in treatment of patients of all ages, with gluten related disorders, including celiac disease, wheat allergy and gluten sensitivity. Okay, so this I think, Dr. Fasano his work is fascinating because he started working on cholera. And then he moved to studying this molecule called Zonulin, which we’ll talk a little bit about. And then he works right now with a lot of patients with celiac disease, but also non celiac gluten sensitivity. And he does a lot of work in the intersection of these disorders and inflammation, including neuro inflammation.

Now, he has a number of papers, and I highly recommend you just go to Google and search Dr. Alessio, Fasano, FSA, no, and just PubMed. Okay. And he has a 2012 paper in the annals of the New York Academy of Sciences. And there he talks about the sharp increase in autoimmune disorders. Now, I don’t know if you’ve noticed that, but there is like the numbers vary, okay. So and they’re significantly higher, apparently, in women and teenagers.

I don’t actually remember the percent now, but it is a significantly higher percent than even a few years ago. And there’s also interestingly, a significant overlap of autoimmunity with autism and Down syndrome. Okay. And Dr. Fasano in this paper says that autoimmunity can be traced back to three routes. Now, what are these three routes genetics, right? So that’s obvious. That’s all the research we’re seeing mostly right. So and that doesn’t help us because then what do you do about it, right. But it’s important to know that’s a factor.

Number two environmental triggers. And we sort of know this, right? Number three is intestinal permeability. If that sounds like a fancy term, and perhaps it doesn’t, but it’s popularly known as leaky gut. intestinal permeability is terribly important because it dictates what molecules are allowed to pass from your gut into your bloodstream. It dictates the permeability of what might be the most important barrier in your body. Now, I talked about Zonulin and Dr. Fasano steam also discovered this guy, this molecule, right the Zonulin in 2000. And this Zonulin is a guard molecule. It’s a regulator of these tight junction. I like this terminal NPR article that I read, and it said that Zonulin literally regulates the leakiness of the gut. So it’s standing there and telling the gut to be more leaky or going away and being less leaky, and so on. Now, if you’re wondering, why do we even need a molecule that does this, it’s usually triggered by some bacterial infections.

Like I said, Dr. Fasano steam was working on studying the mechanism of cholera. And these infections are short term. And apparently, it’s thought that the fact that the gut opens up actually helps you to get rid of the bacteria, then the Zonulin is also gone, the gap closes up. And it’s done and dusted with right? Nothing like what we’re seeing. So, in fact, if you think about the primary difference between today’s diseases and the diseases of 100 or 50, even 50 years ago, I think it can be encapsulated in the terms chronic and acute. Okay. Bacterial infections were acute short term, something happened and then it went away.

Today everything is chronic. Now in a perfect world, if you fully digested wheat or gluten into its component amino acids, and that’s the whole idea, in the presence of a well functioning stomach acid, well functioning pancreas and an a, you know, non inflamed, integral gut, protein should be digested into their amino acids, then nothing would happen because there would be nothing to triggers Zonulin. The gluten, the Gliadin peptide has been digested. Okay, so the combination of amino acids has been broken down. However, Dr. Fasano says that nobody can fully digest gluten, and I suspect this is more true today, okay. And in a few people, this triggers Zonulin release. We don’t know how many people but we’ll talk about that in a little bit.

Zonulin causes leaky gut, which has said that it opens up these type they call type gap junctions, it opens up these type gap junctions. It makes the intestinal barrier permeable. This is the one barrier that we need in its full integrity so the body can decide what to allow inside. I want you to just reframe and think about what is this inside, inside is your blood. Outside is your gut, right? So it is the one barrier that tells you what to allow inside. Okay, once you have leaky gut, the gods guarding outside the city have opened up your gates, the gates have failed, they’re too wide, the enemy can enter inside and your inner city guards are overwhelmed. Your immune system is overwhelmed. And it can lead to a host of immune dysfunction is not only overwhelmed, it can get confused in order to differentiate between self and not self. Okay, that’s where we go from regular immunity to autoimmunity.

The other confusion is differentiating between an enemy and a benign outsider, which is where your body starts reacting against things like pollen and benign foods, right. So so what can happen immune dysfunctions including autoimmunity, allergies and extreme food and chemical sensitivities. And this is my mind is one of these vicious cycles that shows up again and again in functional medicine is that gluten sensitivity can cause a leaky gut, leaky gut can cause immune dysfunction, which can cause more food sensitivities. which obviously means more gluten sensitivity, right? So this which is why in functional medicine when you are diagnosed with immune disorders, especially autoimmunity, going gluten free is a no brainer. Okay, dairy free also, but we’re not talking about dairy today.

Now the two main triggers for Zonulin release, I repeat, well, actually, it’s not I am repeating Dr. Fasano repeats are bacteria and gluten. Okay, infections, and gluten. So strange. Serum Zonulin levels were found to be higher in children. So now I’m throwing out a statistic for you in case you want one or not as well, a study at least were higher in children with autism when compared to the neurotypical controls in a 2017 study in the Journal of Pediatrics. Okay, so we’re tying this in is that we actually know, if we know that Zonulin level, it was a small study, but if we know that Jonathan levels were higher in children with autism, we now know that there’s a significantly higher chance that they have a leaky gut.

Right? Now, there is a fantastic 2020 article again by Dr. Fasano called all disease begins in the leaky gut. Okay, now here Dr. Fasano provides a review of several metabolic disorders, gut disorders, neuro inflammatory disorders, autoimmune disorders, including type one diabetes, and of course, celiac, right? Everything tying into Zonulin. So he quotes a bunch of studies, and this is a must read, okay? If you’re interested in that kind of thing. Now, what does this bring us back to? Let’s tie it in, right? We’re not just reading random studies here, let’s tie it in.

When you have an inflamed gut or a confused immune system or neuro inflammation, okay. And it is not that hard to know if that is the case. Sometimes it is okay. But for the most part, most parents have an intuition of if there’s something going on getting the gluten out in these cases, in my practice, but there’s also what most pick most clinicians think is a no brainer. So that obviously brings us to question three as to why do some studies show that taking gluten out does not help relieve symptoms of autism? Okay, so here we get deep in the controversy. I love this quote by Dr. Sid Baker, and it explains a lot of the work that we do if you are sitting on attack, I think it’s called the to tax approach or something like that rules. Rule number one, if you’re sitting on attack, it takes a lot of aspirin to make it feel good.

Right? Rule number two, if you’re sitting on two tax removing one tech isn’t gonna make you feel 50% Better. Is that awesome? I just have to say that one more time. If you are sitting on to tax No, actually, that’s not rule number one. That’s rule number two. If you’re sitting on one tack, it takes a lot of aspirin to make it feel good. Why are we eating the aspirin? Let’s pull out the tack. Okay, so you pulled out the tack rule number two. If you’re sitting on to tax removing one tack is not going to make feel 50% Better. In fact, it may not make you feel better at all. Gluten sensitivity is not the cause of autism. Removing gluten will not cure autism. Removing gluten alone is likely to help only celiac disease and bloating that is specifically caused by non celiac gluten sensitivity.

The question is how many tax are we sitting on? We talked about the importance of an anti inflammatory diet last week. And if you haven’t tuned into that episode, that is episode 29. Or 39. I’m sorry. Oh, wow. This is episode 40. Awesome. Many of the studies that removed gluten and didn’t talk about what the part they didn’t talk about what the participants ate instead. Now I must tell you that it’s incredibly common practice to have clients eat a highly processed high sugar, even more junky diet, and it’s not clinical practice. It’s just what happens it’s commonly what people do is that they transition into a much more process much more sugar, much more junky diet when off gluten. Because what are we trying to do? We are trying to replace gluten and trying to get rid of one thing, and trying to replace it with another thing has never been a good idea in our history. Right?

This actually reminds me of the time when I first became vegan in the early 2000s. I was trying to replace everything as never much of a meat eater to begin with. In fact, I’d only sampled meat a few times in my life. And because my family was strict vegetarians, it wasn’t something that people looked kindly towards. In fact, I was acutely ashamed of my meat excursions. But when I became vegan in the early 2000, that’s like, proof that I’m even better than you vegetarian, right.

I heartily sampled mock meat, which I must tell you was nothing like the excellent vegan meat alternatives available today. So I had weed Satan, and soy curls and all that sort of heavily processed never should go into your mouth stuff right? Now some vegans I knew subsisted primarily on doughnuts and fake meats. And if my mom hadn’t been with me at the time, I might have done the same.

I was vegan for only two years after which I’ve been vegetarian with Pesco outings when I visit India because my in laws have the best fish. But we’re talking about substitution, right? That is how many times you know, that’s how. That’s how the gluten free diet works out many times for children. We live in a culture so saturated with gluten, every staple meal that is offered to a child is made with wheat. When people turn to gluten free pancakes and waffles. They’re often overdosing on heavily processed rice and tapioca flour and starches added to keep the thing together.

In fact, I have read up ingredients on gluten free foods that I have never noticed before. It’s not that processed food that’s not gluten free is any better. It’s probably equally bad. But a lot of times these kids are not eating processed food in the first place. They’ve been eating a reasonably okay diet. And they now move to processed food because we need to we need to make the we need to come from an What do you say compensate? We need to compensate right now very soon, maybe next week, or maybe a bit later, I would love to discuss how to do a gluten free diet, right. But in short, it’s a mindset shift.

You don’t go in there eating poor worse versions of the same food. In fact, kids often end up eating tons more syrup to make this new pancake more palatable. And I think that may be where the problem lies in many of the studies done that we haven’t removed all the tags. In fact, we removed one tag the gluten tag, and replaced it with a different one that have a high sugar high GI diet that completely messes up blood sugar. And Gi is not gastrointestinal here.

A high GI is a glycemic index diet that completely messes up blood sugar even more than before. And if you remember from Episode Two, and I believe I’ve done a few more episodes on blood sugar, the symptoms of high blood sugar and low blood sugar so closely mirror symptoms of lack of focus ADHD, or learning disabilities and hyperactivity even that that is actually my primary non negotiable. So it not only defeats the purpose to take off gluten and go into high glycemic index died. It’s significantly worse your second tak is much, much worse. Right? Now if you have ditched gluten, and if you’ve seen no results, and I know many parents have said that to me that we tried a gluten free diet and it didn’t work. Or maybe my child became worse.

I would strongly encourage you to think about what did you replace it with? What else did you do? Okay, this is where my previous podcast number 39 About an anti inflammatory diet is really important. Because when we get in Whole Foods, I’m not going into Pacific’s about should we be grain free or have grains and all that those may be more tax that you need to think about maybe okay. But when you go to a basic anti inflammatory whole foods diet that is rich in vegetables in colors, even in fruits and grains, okay in nuts and in seeds that is it’s hard to go wrong there. In fact one study that did show fantastic results.

This is a 2018 study, and the authors include James Adams and Julie Matthews. Here they did a healthy gluten and casein that is steroid free. It was also soy free, and they added some critical components including essential fatty acids and some B vitamins. Now, they even did Epsom salt baths, which is so cool to support magnesium levels and detox pathways. And so a significant improvement in I quote, nonverbal intellectual ability, and also in other artisanal autism.