Study of Effectiveness of Gluten- Free Casein- Free Diet in an Egyptian Sample of Autistic Children

Abstract

Autism spectrum disorder (ASD) is a biologically based neurodevelopmental disorder characterized by impairments in two major domains: 1) deficits in social communication and social interaction and 2) restricted repetitive patterns of behavior, interests, and activities. (American Psychiatric Association, 2013). The reported incidence of autism spectrum disorders has increased dramatically over the past two decades. (Schaefer , 2013) It is more prevalent in males, with a male : female sex ratio in the range 2:1 to 3:1. Most biological studies of autism have predominantly focused on males. (Lia et al., 2013) The pathogenesis of autism spectrum disorder (ASD) is incompletely understood. The general consensus is that ASD has a genetic etiology, which alters brain development, affecting social and communication development and leading to restricted interests and repetitive behavior. (Augustyn, 2014) Multiple lines of epidemiologic evidence support the strong role of genetics in the etiology of ASDs. (Schaefer , 2013) Although many genes and proteins have been implicated as causes of autism, too little is known about their functions or their role in brain development to generate a parsimonious hypothesis about the brain dysfunctions that underlie autism. (Augustyn, 2014). Neuroimaging and autopsy studies in patients with ASD suggest that brain abnormalities play an important role. These abnormalities include diffuse differences in total and regional gray and white matter volumes, sulcal and gyral anatomy, brain chemical concentrations, neural networks, cortical structure and organization, brain lateralization, and cognitive processing compared with individuals without ASD. (Volkmar and Pauls , 2003) Epidemiologic studies indicate that environmental factors such as toxic exposures, teratogens, perinatal insults, and prenatal infections such as rubella and cytomegalovirus account for few cases. (Muhle et al., 2004). Physiologically, mercury has been shown to have many harmful effects. It can bind to sulfhydryl groups on many proteins resulting in decreased enzyme function and loss of structural integrity. This may be contributing to or causing a “leaky gut” by damaging intestinal lining (mucosa). Mercury can impair cell-mediated immunity resulting in decreased ability to clear viral and yeast infections. It induces autoimmunity (the body attacks itself) resulting in the production of anti-brain antibodies. It can cause or worsen zinc deficiency and inactivate DPPIV (the enzyme that breaks down casein and gluten.) It alters the brain’s ability to clear unwanted brain cells or neurons (apoptosis), a process that is a normal and integral part of brain development. It affects the body’s anti-oxidation ability by depleting intracellular glutathione (a protein important in clearing toxins from the body.) The clinical effect on the CNS includes impaired motor planning, decreased facial recognition, blurred vision and constricted visual fields, insomnia, irritability, tantrums, excitability, social withdrawal, anxiety, difficulty verbalizing, altered taste, impaired short-term memory, slowed reaction time and difficulty with concentration. It has been shown to be the most toxic to infants and males. (Jepson, 2003)