 When you read in alternative medicine journals that there's a great deal of evidence that foods containing casein or gluten contribute significantly to autism and should be eliminated from the diet, almost always leading to symptomatic improvement, they're presumably talking about the published anecdotes and case series that claim wild success, but had no control group, though there were two year-long controlled trials that also showed remarkable benefits, but couldn't discount placebo effects. The double-blind studies that did control for placebo effects failed to find benefits, but they only lasted a few weeks. This was to be the study to break the log jam, a months-long double-blind controlled study. They put 14 kids with autism on a gluten-free casein-free diet for four to six weeks, and then, for the next three months, challenged them every week with double-blind placebo-controlled food tests, secretly giving them gluten, just gluten, or just casein, or both, or neither, every week, month after month. Here's what happened to each of the 14 kids in terms of their social relationships and their language skills throughout each of the challenges, and bottom line, nothing. No apparent impact on behavioral disturbances or autism-related behaviors. So, does that mean case closed? Well, proponents of autism diets might regard the four to six week implementation phase prior to the challenges as too short for the gluten-free casein-free diet to take full effect. In other words, one could argue this is yet another double-blind study that didn't give the diet long enough time to work, and so maybe the kids were still feeling the effects of gluten in casein. They consumed more than a month previously, and so no wonder extra gluten or casein didn't make them even worse? It's possible, I guess, which is why you'll see systematic reviews of the sum total of evidence, like this one published 2017 in the Journal of the American Academy of Pediatrics, concluding that although some studies showed benefits, the data are inadequate to make conclusions either way. In other words, the SOE, the strength of evidence, is considered insufficient to endorse such diets. What's the harm in giving it a try, though? Well, given the effort, time, and money that a gluten-free casein-free diet requires, knowing whether it actually works would kind of be a good thing to know. I mean, there are downsides. Being on a special diet can have unintended negative social consequences, when children are not able to participate conventionally in birthday celebrations and clashed treats, or eaten restaurants or other people's homes, and autism can be isolating enough as it is. The overall evidence for the effectiveness of these diets is weak, and thus these diets cannot be generally recommended as a treatment, yet parents continue to give it a try, figuring, look, the drugs don't work in terms of helping the core symptoms, so why not just give it a try and leave no stone unturned? I can understand that. However, there are the potential downsides, like further stigmatization, diversion of resources away from other treatments, and they suggest a concern about nutritional deficiency. What they're worried about is bone health. Those with autism aren't elevated risk for bone fractures. Now, lower bone mineral density in individuals with autism may be due to a variety of factors, lack of vitamin D, chronic use of medications that can weaken bones, lack of weight-bearing exercise, but maybe dietary restrictions play a role. Do children with autism on gluten-free, casein-free diets have lower calcium intake? Yes, in fact, nine times the odds of failing to meet recommended calcium intake. Does this translate out to reduced bone mass? Maybe so, as those on casein-free diets appear to have less bone development. Now, there's controversy over whether dairy products are the best source of calcium, but that is where most kids are getting their calcium, and so if you remove dairy, you have to replace it with other calcium-rich foods. As the study they cited points out, and there's lots of non-dairy sources of calcium, but they only provide calcium if you actually eat them.