Are there any side effects or deficiencies when eliminating casein and gluten from the diet of an autistic patient? How long should a diet trial continue if symptoms persist?—STACIE KUNAS, FNPc, Auburn, Maine

Aside from your patient’s being very unhappy, the only side effects are those that occur in the event that adequate vitamin and calcium supplementation is not maintained. Since breads and dairy products are important sources of B vitamins and calcium, these nutrients need to be supplemented or accounted for in other aspects of the patient’s diet. Typically, if symptoms remain unchanged after a three-month trial, there is no need to continue the diet.—Sherril Sego, MSN, FNP (133-12)