The suggested time frame for the gluten elimination diet is four months. Foods to avoid include those containing wheat, rye, barley, oats, bread products (such as muffins, cakes, cookies, pasta, pizza and stuffing), and breaded items such as chicken nuggets and fish sticks. Gluten can be challenging to eliminate from the Western diet since many people eat it three times a day – cereal in the morning, sandwiches at lunch, and bread, pasta or pizza at dinner. Nonetheless, rice based cereals, breads and noodles can be found. If food is prepared at home, the diet can be healthy and balanced with no gluten or dairy at all.
Face recognition is a core deficit of social impairment in autism. A number of studies indicate that norepinephrine (NE) and dopamine (DA) modulate and reduce behavioral responses to changes in the social environment [35,36]. In addition, serotonin (5HT) transporter binding appears to be reduced in certain brain regions known to play an important role in social cognition and behavior , and 5HT binding potential is negatively correlated with social impairment. Therefore, recording Pb as a correlate to severity of SRS and CARS scores in the present study is consistent with the recent findings of El-Ansary et al.  in which a positive association was observed between chronic Pb toxicity and lower levels of neurotransmitters as markers of neurologic injury in autistic brains in a Saudi population. Alternately, the biochemical correlation between Pb and the severity of autism is in agreement with other studies. Szkup-Jabłońska et al.  and Blaurock-Busch et al.  reported a significant correlation between Pb and fear, nervousness, verbal and nonverbal communication, social activity level, and consistency of intellectual response. Moreover, the positive correlation between elevated Pb toxicity and both autistic scales could be supported by the fact that Pb exposure affects multiple health outcomes and physiological systems . These include behavioral/cognitive/IQ effects, nerve conductive effects, hearing loss, reproduction and development effects and death from encephalopathy. Long-term trends in population exposure to Pb (indexed through use of leaded petrol and paint) were remarkably consistent with the link between IQ and social behavior .
GST activity was assessed in the plasma using an assay kit (Biovision, USA). The kit is based on a GST-catalyzed reaction between GSH and the GST substrate, CDNB (1-chloro-2, 4-dinitrobenzene). The GST-catalyzed formation of GS-DNB produces a dinitrophenyl thioether, which can be detected by a spectrophotometer at 340 nm. GST activity was expressed as μmole/min/ml plasma.
To calculate a score for the Social Responsiveness Scale, a questionnaire was completed in 15 to 20 minutes. A total score of 76 or higher was considered severe and strongly associated with a clinical diagnosis of autistic disorder. A score of 60–75 was interpreted as falling in the mild to moderate range of social impairment .
Chelation therapy is a process involving the use of chelating agents to remove heavy metals from the body. For the most common forms of heavy metal intoxication, those involving lead, arsenic or mercury, the standard of care in the USA dictates the use of DMSA. This, in addition to other chelating agents such as DMPS and alpha lipoic acid (ALA), are used in conventional and alternative medicine.