Feasibility of millet-based gluten free and casein free diet in children with autism spectrum disorders: A 12-week pilot study in India

Background Autism spectrum disorder (ASD) is often associated with selective eating, nutritional deficiencies, and gastrointestinal (GI) disturbances. Gluten-free, casein-free (GFCF) diets are popular but inconsistently supported by evidence. Millets, naturally gluten and casein-free, are nutrient-dense traditional grains that may offer a culturally relevant alternative. Aim To assess the feasibility, acceptability, adherence, and nutritional impact of a millet-based GFCF dietary intervention in children with ASD. Methods A 12-week single-arm pilot study enrolled children aged 4 to 6 years with confirmed ASD. A millet flour blend (foxtail, little, pearl millet) was developed into three recipes: Foxtail Millet Upma, Little Millet Biscuits, and Pearl Millet Nachos. Pre and postintervention dietary intake was measured using 3-day recalls. Sensory acceptability was rated on a nine-point hedonic scale; adherence was tracked through caregiver logs; and structured interviews explored feasibility. Summary All millet-based recipes were well accepted, with Foxtail Millet Upma receiving the highest acceptability scores. Significant improvements were observed in cereal and pulse intake, along with a reduction in fat consumption. Caregivers reported improvements in GI comfort (70%), sleep quality (60%), and reductions in hyperactivity (55%). Adherence to the dietary intervention was high (80%), although challenges related to ingredient availability and preparation time were reported. Millet-based GFCF diets are feasible, acceptable, and nutritionally balanced at the food-group level in children with ASD. Findings highlight their potential as culturally appropriate dietary interventions, warranting larger controlled studies to evaluate long-term outcomes.