Clinical Nutrition

Additional Practice Areas


Humans need certain essential nutrients for their bodies to function, including vitamins, minerals, essential fatty acids, and amino acids A balanced diet rich in vegetables, fruits, protein, and certain fats is important to help provide those key nutrients. However, some children may not be able to absorb, orlack these nutrients in their diet. Moreover, because of the over processing of food, the addition of preservative and chemicals in the food chain, and exposure to toxins in the environment their bodies may have become sanitized to common foods. The Children’s HOPE Center uses a biomedical approach. The Biomedical approach is an individualized, patient-centered, science-based approach that empowers families and practitioners to work together to address the underlying causes of the child’s disease and promote optimal wellness. It requires a detailed understanding of each patient’s genetic, biochemical, nutrition, and lifestyle factors and use that information to direct personalized treatment plans that lead healing and resolution of underlying problems.

This involves a detailed history and physical exam, but also may involve biomedical testing. Such things as yeast overgrowth, complete blood count, environmental toxins, heavy metals, food allergies, microbiome analysis and other metabolic and functional studies may be needed to get a a glimpse at the biomedical challenges in the child’s case and determine the specific nutritional needs of the child.


Implementing a Gluten-Free, Casein-Free, Soy-Free Diet for Children with Autism Spectrum Disorder


Recent international research has highlighted the significant benefits of a gluten-free, casein-free, and soy-free (GFCFSF) diet for children with Autism Spectrum Disorder (ASD). A study involving 70 participants over six months observed notable improvements in gastrointestinal symptoms and behavioral aspects of children with ASD when following this diet alongside nutritional supplements and digestive enzymes.

Understanding the Diet

The GFCFSF diet excludes all sources of gluten (found in wheat, rye, barley, and some oats), casein (found in dairy products), and soy, which is often genetically modified. This diet is not just a temporary change but a complete lifestyle adjustment, focusing on viewing food as nourishment for both body and brain.

Benefits Observed

  1. Gastrointestinal Improvements: Participants showed significant relief from abdominal discomfort, bloating, constipation, and other related symptoms.
  2. Behavioral Enhancements: Notable improvements in social skills, eye contact, sleep quality, and reduction in self-stimulatory behavior were observed.
  3. Holistic Treatment Approach: The study underlined the importance of nutritional interventions in ASD, especially for individuals with concurrent gastrointestinal issues.

Dietary Guidelines

  • Foods to Include: Focus on natural, whole foods like fruits, vegetables, nuts, legumes, seeds, meat, and fish. Gluten-free grains such as corn, rice, quinoa, and buckwheat are recommended. For dairy substitutes, options like coconut, almond, and hemp milk can be used.
  • Foods to Avoid: Eliminate all sources of gluten, casein, and soy, regardless of quantity. This includes most bread, pasta, cereals, dairy products like cheese and ice cream, and soy-based products.

Important Considerations

  • Eggs do not contain casein and are allowed in the diet.
  • Lactose-free milk still contains casein and should be avoided.
  • Organic labeling does not necessarily mean gluten and casein-free.
  • Minimize sugar intake and avoid food coloring and additives.

Tips for Implementation

  • Transitioning: Start by introducing simple and uncomplicated meals like gluten-free tacos, casein-free spaghetti, or smoothies with coconut milk.
  • Reading Food Labels: Look for hidden sources of gluten, casein, and soy. Be vigilant about cross-contact in food preparation.
  • Supplementation and Testing: Consider supplementing essential nutrients that might be missed due to dietary restrictions. Food allergy and sensitivity testing can be beneficial in understanding individual needs.

Addressing Picky Eating in ASD

Selective eating is common in children with ASD. This can be due to sensory issues, delayed oral motor function, swallowing difficulties, or pain. Approaches to address picky eating include:

  1. Feeding and Occupational Therapy: To help with oral motor skills and sensory issues.
  2. Nutritional Supplements: Particularly for essential minerals and vitamins.
  3. Food Chaining and Creative Cooking: Gradually introducing new foods and incorporating nutritious ingredients into familiar meals.
  4. Behavioral Techniques: Using rewards, food games, or social stories to encourage trying new foods.
  5. Osteopathic Treatment; Osteopathic treatment to the mouth, hyoid bone and muscles of chewing can greatly enhance the child's willingness to eat.


The GFCFSF diet, when correctly implemented, can lead to significant improvements in both gastrointestinal health and behavioral symptoms in children with ASD. This diet requires careful planning and a holistic approach to ensure nutritional needs are met while avoiding triggering foods. With the right support and resources, transitioning to a GFCFSF diet can be a transformative step in managing ASD symptoms and improving overall quality of life.






What is a gluten-free, casein-free diet?

Often called a GF/CF diet, this eating plan avoids foods that contain gluten (found in many breads and cereals) and casein (found in milk products). Eliminating gluten and casein may help to change symptoms and behaviors of autism. Some parents have started their child with autism on a version of the GF/CF diet for a different reason, and later noticed improvement in behavior, social skills, and learning.

Will a gluten-free, casein-free. Gluten and casein are a big part of our usual diet. Because the diet does not contain milk products, or many breads and cereals, your child may not get enough:

  • calcium
  • fiber
  • vitamins A, D, and B complex
  • calories

Be sure to ask your doctor about calcium and vitamin supplements, and keep regular appointments to watch for proper growth.

Before starting this diet, please discuss it with your child's doctor. Tests should be done for celiac disease and gluten sensitivity before starting the diet. Once the diet is started, the test results may not be accurate.

How do I start the GF/CF diet?

Start the diet slowly. Don't try to take out all gluten- and casein-containing foods at once. Add new gluten-free and casein-free foods gradually, about one food every 3 to 7 days. If a new food causes a problem, you will know which one it was. It may take 3 months to become fully gluten- and casein-free.

Buy small amounts of the new foods. Buy them in bulk only when you know your child likes them.

Read all food labels. Gluten and casein are found in many forms and go by many different names.

Keep a food and behavior journal. Write down what your child eats and any behavior changes that occur. If there is a connection between certain foods and behaviors, keeping a journal will help identify it.


Attempt to stick with whole foods as much as possible and use this as an opportunity to eat more veggies and whole grains.


Because calcium and vitamin D are limited on this diet, encourage other calcium-rich beverages, such as:

  • calcium-fortified orange juice.
  • calcium-fortified potato milk.
  • calcium-fortified rice milk.
  • calcium-fortified soy milk.

This sheet provides lists that will help you identify sources of gluten and casein.


Nutrition for Autism shown 5x Beneficial for Children - 12 Month University Study RESULTS


Foods that contain gluten

Breads and cereals made with:
Abyssinian hard wheat
Barley flour
Barley malt
Barley hordeum vulgare
Bleached all-purpose flour
Bread flour
Brown flour
Durum flour
Enriched flour
Fu (dried wheat gluten)
Gluten flour
Graham flour
Granary flour
Hard wheat
High protein flour
High gluten flour
Kamut wheat
Oat flour
Wheat flour
White flour
Whole meal flour
Vital gluten

Other sources of gluten:
Alcoholic beverages
Bouillon cubes or powder
Bread crumbs
Bulgur (bulgur wheat/nuts)
Broth (packaged)
Cereal extract
Cereal binder
Cracker meal
Edible starch
Einkorn wheat
Glutamic acid
Gravy cubes
Gravy mixes (unless homemade with cornstarch)
Herbs with wheat fillers
Hydrolyzed oat starch
Hydrolyzed plant protein (HPP)
Hydrolyzed vegetable protein (HVP)
Non-dairy creamer (coffee creamer)
Pearl barley (Job's Tears)
Soba noodles
Teriyaki sauce
Vegetable starch

These foods may contain gluten.
If the item is not labeled GF/CF, check with the manufacturer.

Baking powder
Baking soda
Chorizo sausage
Gelatinized starch
Ground spices
Hot dogs
Lactic acid
Luncheon meats
Modified food starch
Natural flavoring
Soy sauce (shoyu)
Monosodium glutamate
Rice malt
Rice syrup

Check for gluten-free baking soda, baking powder, vanilla, xanthan or guar gum at health food stores or via online sources:

Foods that contain casein

Acidophilus milk
Condensed milk
Evaporated milk
Dry milk
Goat milk
Low fat milk
Malted milk
Milk chocolate
Milk powder
Milk solids
Non-fat milk
Powdered milk
Skim milk
Whole milk

Other sources of casein:
Artificial butter flavor
Butter fat
Butter flavoring
Butter oil
Cheese (hard and soft)
Cottage cheese
Cream cheese
Delactosed whey
Half and half
Ice cream
Lactate solids
Rennet casein
Ricotta cheese
Sour cream
Sour cream solids

These foods may contain casein.
If the item is not labeled GF/CF, check with the manufacturer.

Brown sugar flavoring
Bavarian cream flavoring
Caramel coloring
Coconut flavoring
Hot dogs
Luncheon meats
Natural chocolate flavoring

What can my child eat?

Many foods do not contain gluten or casein, such as:

  • chicken, fish, meat
  • fruits, vegetables
  • potatoes, rice, infant rice cereal
  • cereal and pasta labeled "gluten-free"

Guten-free flours:
Amaranth flour
Buckwheat flour
Corn meal flour (and polenta)
Garbanzo bean flour
Garfava flour
Lentil flour
Millet flour
Nut flours (such as almond, cashew)
Potato starch flour
Potato flour
Quinoa flour
Rice flour (brown or white)
Sorghum flour (Jowar)
Sweet potato flour
Tapioca flour or tapioca starch
Teff flour
Yucca (cassava flour)

Milk substitutes:
Almond milk
DariFree® potato milk
Rice milk
Soy milk

Butter substitutes:
Use non-dairy margarine such as:

  • Coconut Oil
  • Homemade Coconut Cream
  • Willow Run® margarine

If a recipe calls for 1 cup of margarine or butter, you can substitute ¾ cup of oil:

  • coconut
  • olive
  • safflower
  • sunflower

What else do I need to know?

Gluten is also found in many non-food items, but some brands are gluten-free.

Contains gluten


Lip balm

Burt's Bees®

Laundry detergent

Arm and Hammer® Baking
Soda detergent

Soap, shampoo

Young Living Kidscents shampoo

Spices (ground)



Banana Boat® Children's


Young Living Kidscents Toothpasre

Young Living kids Product  l

Stickers, stamps, and envelopes have gluten in the glue. Some medicines and antibiotics contain gluten, so check with your doctor or pharmacist before giving them.

Be careful not to mix GF/CF foods with other foods when using household appliances such as toasters, ovens, microwaves, and waffle irons. Use a separate toaster. When using ovens or microwaves, keep GF/CF foods in separate containers from other foods.

Implementing a gluten-free, casein-free (GFCF) diet for children with autism can offer numerous potential benefits for their health and well-being. Here's a condensed summary of why parents should consider and implement this diet:

  1. Improved Health and Behavior: A GFCF diet has shown promise in improving various aspects of health and behavior in children with autism, including cognition, language skills, sleep quality, behavior, and immune function.
  2. Folate Deficiency and Brain Development: Gluten and casein can contribute to a functional folate deficiency, which is crucial for proper brain development.
  3. Gut Health and Inflammation: Gluten can cause leaky gut, leading to increased sensitivity to food components and inflammation, while casein fuels inflammation. Removing these substances can alleviate gastrointestinal issues and reduce inflammation.
  4. Neurotransmitter Balance: Gluten and casein can affect neurotransmitter levels in the brain, leading to symptoms like anxiety and restlessness. Eliminating these proteins can help balance neurotransmitter levels.
  5. Scientific Support: Numerous studies support the effectiveness of a GFCF diet in improving gastrointestinal symptoms, behavior, cognitive function, and overall quality of life in children with autism.


The major scientific evidence supporting a casein and gluten-free diet includes:

  1. Effect on Gastrointestinal and Behavioral Indices: Studies such as the 2016 randomized clinical trial have indicated that a gluten-free diet may effectively control gastrointestinal symptoms and improve behavioral disorders in children with autism.
  2. Comprehensive Nutritional and Dietary Intervention: Research from a 2018 12-month trial demonstrates how nutritional interventions, including a healthy gluten and casein-free diet, can significantly improve the quality of life for individuals with autism, with improvements seen in nonverbal IQ, interpersonal skills, coping skills, and communication.
  3. Potential Benefits of a Ketogenic Gluten-Free Diet: Studies, such as the 2018 research on a modified ketogenic gluten-free diet with supplemental MCT, suggest that for some children with autism, a modified gluten-free diet beyond just eliminating gluten and casein may provide additional benefits in improving core features of autism.
  4. Biological Explanation for Wheat Sensitivity: Recent research confirms that individuals with non-celiac wheat sensitivity can experience systemic immune responses after ingesting wheat, supporting the idea that gluten can cause reactions beyond celiac disease.
  5. Comparative Studies: Studies such as the case-control study comparing a ketogenic diet with a gluten-free, casein-free diet demonstrate significant improvements in autism symptoms with both dietary interventions, suggesting the effectiveness of gluten and casein-free diets in managing autism.

These studies collectively provide robust scientific evidence supporting the implementation of a gluten and casein-free diet for individuals, particularly children, with autism


Parents can find resources and support at the HOPE CENTER to navigate the transition to a GFCF diet effectively, ensuring the best possible outcomes for their child's health and well-being.





  • This 2018 study suggested that a modified gluten-free ketogenic diet with supplemental MCT is a potentially beneficial treatment option to improve the core features of autism.
  • This study tells us that, for some kids, we need to go further than just gluten and casein free to see excellent results. The carbohydrates in gluten-free foods may still be problematic.



  • This new research is very pertinent to our kids who may not have celiac disease but react to gluten nonetheless.
  • “People with non-celiac wheat sensitivity have a weakened intestinal barrier, which leads to a systemic immune response after ingesting wheat and related cereals, new research confirms.”
    • This tells us that you can react to gluten without having celiac disease.



  • Patients (aged 3-8) were equally divided into 3 groups:
    • Ketogenic diet as modified Atkins diet (MAD)
    • Gluten-free, casein-free (GFCF) diet
    • Balanced nutrition which served as a control group
  • Both diet groups showed significant improvement in ATEC and CARS scores in comparison to control group, yet ketogenic scored better results in cognition and sociability compared to GFCF diet group.
  • The reason this study was important is because it emphasized the idea that sometimes diet change is bigger than just removing gluten and casein. It is also about including nutrient dense, nourishing foods.



  • “Indeed, strict implementation of the diet has resulted in substantially greater improvement ASD behaviors, physiological symptoms, and social behaviors. In addition, there are likely other dietary proteins that are similarly difficult to digest that have not been considered and need to be minimized in cases of a fragile gut.”
  • Regarding conflicting studies:
    • “Overall, dietary intervention studies in these children have not been able to address the multiple, integrated consequences of inappropriate proteins in the diets of individuals with ASD, including dietary protein digestion, gut-associated immune responses, and potential perturbations to the intestinal microbiota, much less provide the diagnostics to build tailored solutions.”





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