The Failsafe Diet Explained

An introduction to the failsafe diet for ADHD, with diet charts

Gluten and Casein Responders

The RPAH advise that individuals who have done a month's trial of the failsafe diet but continue to have some problems should try cutting out gluten and casein for at least two weeks.

Gluten and casein intolerances often occur together because they seem to be caused by a sensitivity to opioid-like peptides. Though there are a number of reasons why gluten and casein may affect people (such as insulin-like lectins and lactose intolerance), opioid-like peptides, along with genuine food allergies and undiagnosed coeliac (AKA celiac) disease, appear to be a common issue.

There is no scientific evidence that this is caused by "incomplete digestion" as has been put forward by some alternative theorists. Incomplete digestion of opioid-like peptides is actually normal. Rather this sensitivity appears to be related to the body's natural endorphin levels. Opioid-like peptides act on endorphin receptors throughout the body and can cause problems such as aches and pains, headaches, lowered pain threshold, digestive problems, nausea, abnormal hunger, motivational problems, mental/behavioural problems, brain fog, irritability, weight problems, cravings, and histamine release. Opioid-like substances that trigger endorphin receptors automatically impact on dopamine function, releasing a surge of dopamine which is then followed by a withdrawal reaction.

What appears to happen is that gluten and casein have the strongest effects in individuals who have naturally low levels of endorphins or who are 'resistant' to endorphins due to endorphin receptor polymorphisms. Gluten and casein appear to behave like endorphin substitutes and act as natural analgesics, providing a mild sense of relief and demotivation in the short term, but during withdrawal cause increased pain, anxiety, and negative symptoms. Gluten and casein also cause non-allergy mediated histamine release, and are problematic for those who are sensitive to histamine.

There is some indication that people with pale skin, red hair and/or freckles appear to be more likely to be affected by gluten and casein. This may be because the genes that cause red hair and freckles (such as MC1R and POMC variants) affect the proopiomelanocortin/endorphin production/receptor system. Individuals with red hair tend to require larger quantities of anaesthesia (around 20% more), but experience increased analgesia to morphine-6-glucuronide. They tend to experience heightened thermal pain but less pain from electrical stimuli. These differences may affect tolerance levels to the opioid-like peptides in gluten and casein.

It is not necessary for most people to cut out all gluten and casein unless they have a genuine food allergy. Because gluten and casein intolerance is not an allergy, just as with salicylates, amines and glutamates, limited quantities may be tolerable to less sensitive individuals.

It is important to distinguish between different types of casein. Most farmed cows such as holstein and friesian produce milk with a fragment of protein called A1 beta-casein. It is this A1 fragment that produces an opioid-like reaction in the body. Originally cows produced milk with a fragment of protein called A2 beta-casein. A2 beta-casein does not cause the same opioid-like reaction as A1 beta-casein. All ancient breeds of cattle such as zebu cattle produce A2 milk, along with buffalo, yak, goat and sheep. Guernsey cows produce milk with around 90% A2 content, and Jersey cows produce a moderate amount more A2 content than regular farmed cows. For more information on the science of A2 milk, visit the A2 milk website. Milk may contain some other much milder, weaker opioid-like peptides to which the most sensitive individuals may react, so A2 milk is not 100% safe, however, many individuals who do not tolerate cow's milk may tolerate goat's or sheep's milk very well.

A note on spinach. Spinach is not a failsafe food, however, it also contains opioid-like peptides in the form of rubiscolin. Individuals who are sensitive to the opioid-like peptides in gluten and casein are also sensitive to spinach in the same way. If you discover you can tolerate salicylates but are unable to tolerate gluten and casein, it would be wise to do a spinach trial.

Limiting Gluten and Casein - Stage One (Mild Intolerance)

Limiting Gluten and Casein - Stage Two (Moderate Intolerance)

This is a relatively casual level of dietary restriction. Occasional mistakes are allowed. Do not worry too much about trace amounts of gluten or dairy in ingredients lists, simply try to restrict the overall amount of gluten and A1 dairy products you consume each day.

Keep Avoid
Oats Gluten grains (wheat, barley, rye, spelt, kamut)
A2 milk (goat's milk, sheep's milk, branded A2 cow's milk, Guernsey cow (90% A2) milk) A1 milk (regular holstein, friesian, etc)
A2 yoghurt (if unavailable, you can make your own using a safe live commercial A1 brand as a starter) A1 yoghurt
All cream  
All butter  

Limiting Gluten and Casein - Stage Three (Strong Intolerance)

Before cutting out oats completely, it is worth trialling different preparation methods. Oats can cause hypoglycaemic/irritability reactions in some people that are not necessarily related to opioid-like peptides. This reaction might be related to either avenanthramides or insulin-like lectins. Lectins can often be destroyed by prolonged cooking, for example by baking oats into flapjacks, but are not destroyed by brief heating, for example, by heating oats for porridge.

Keep Avoid
A2 milk (goat's milk, sheep's milk, branded A2 cow's milk only) Gluten grains (wheat, barley, rye, spelt, kamut)
A2 cream Oats
All butter A1 milk (regular holstein, friesian, etc), Guernsey milk, A1 cream
  All yoghurt, both A1 and A2 (lactobacillus fermentation liberates opioid-like peptides, plus yoghurts can contain amines, potentially making reactions worse and confusing)

Limiting Gluten and Casein - Stage Four (Serious Intolerance)

Keep Avoid
Goat's and sheep's milk Gluten grains (wheat, barley, rye, spelt, kamut)
Goat's and sheep's cream Oats
Goat's and sheep's butter All other dairy products

Limiting Gluten and Casein - Stage Five (Severe Intolerance)

Keep Avoid
Goat's and sheep's butter Gluten grains (wheat, barley, rye, spelt, kamut)
  All other dairy

Limiting Gluten and Casein - Stage Six (Complete Intolerance)

Keep Avoid
Certified casein-free ghee Gluten grains (wheat, barley, rye, spelt, kamut)
  All other dairy

Gluten and Dairy Allergies

Genuine gluten and dairy allergies cannot be treated with the exclusion methods set out above. Individuals with true food allergies must avoid the foods they are allergic to completely because allergic reactions are not dose-related.

However, allergies are typically limited to one type of protein, for example, a gluten allergy is unlikely to prevent an individual from eating certified gluten-free oats. The same is true of dairy allergies – occasionally, an individual with a cow's milk allergy can safely consume goat's and sheep's milk without any adverse effects.

Gluten and dairy allergies work differently from opioid-peptide intolerances. In such cases, an individual with a genuine gluten allergy will likely tolerate both oats and dairy foods, and an individual with a genuine cow's milk allergy will likely tolerate gluten grains and dairy from other species of animal, such as goat's milk and sheep's milk.

Individuals with allergies should not unnecessarily avoid eating nutritious foods that they will tolerate, for example, there is no reason for someone with a cow's milk allergy to avoid drinking goat's milk in favour of less nutritious alternatives like rice milk or soy milk. Please thoroughly test your tolerances of various different types of foods before removing them completely from your diet, and do not remove foods unnecessarily.

Lactose Intolerance

Please note that lactose intolerance is a separate issue to casein intolerance, and lactose intolerance is not an allergy.

Lactose is a type of sugar found in milk products. Reactions to lactose are typically limited to digestive distress due to a poor ability to digest lactose resulting in the undigested lactose feeding bacteria in the gut.

If you have lactose intolerance, you will need to remove all regular animal milk products from your diet. You will be able to tolerate butter and hard cheeses, but otherwise you should choose milk, yoghurt, cream, and soft cheeses that are specifically advertised as "lactose free" such as Arla Lactofree products in the UK. Lactase enzyme tablets can help in an emergency, but should not be relied upon as their effects can be limited.