AUTISM: Topic Two - The Microbiome
In the past, research on autism spectrum disorder has been very trenched in genetics yet in more recent years research is turning significantly to the digestive tract aka the second brain.
Because this topic alone is so multi faceted, I want to focus on a few different areas for the time being: how the gut is connected to the brain, what is inflammation and how does this play a role in an autism diagnosis, and lastly the microbiome and its role in autism. I will go through assessment and treatment for these areas as well.
Gut Brain Connection
Its like the gut and the brain started dating and found out they were twins…
Well that’s a bit twisted.
The gut has its own nervous system called the enteric nervous system. It is often termed the ‘second brain’. The enteric nervous system actually shares many neurotransmitters with our main brain and the two communicate. Areas of the main brain that are responsible for such things as sociability and human connection which can be areas of concern in an autism diagnosis, are a couple of examples of areas that do communicate. Coles notes: how we treat our gut effects our brain which in turn effects autism and a child’s individual symptoms.
Enter Microbiome
The term microbiome refers to alllllll the bacteria, viruses, arachea, fungi and protists that live inside humans. It’s like an entire other universe such that the research behind this is extensive yet also, at this point, only scratching the surface! And to relate how this differs in patients with autism is then a whole other ball game.
This dysbiosis can ultimately lead to inflammation and a build up of toxins that work their way into the blood stream…So we’ve got ourselves a bit of a situation on our hands.
Who Invited Inflammation to the Party?
The digestive tract holds 85% of our immune system ie. the cause of inflammation in the body or lack thereof. When there is low grade chronic inflammation in the body the brain is all, ‘say wha?’ and can’t function properly. What do you mean cant function properly?
When inflammation is present in the brain, connections (synapses) that help brain cells to communicate, as well as the actual cells themselves die or loose proper function. Thus, causing symptoms (in autism) such as repetitive behaviors, inability to speak and hindered social interactions.
So Where do we go from here: Assessment
Trial and Error with Diet
Multiple studies across the board do not show evidence that reducing common inflammatory foods such as gluten or dairy, help in reducing symptoms of autism. And furthermore, other studies have shown that going on a gluten free/dairy free (GFDF) diet can reduce key vitamins and nutrients in children. Well that’s not a good thing.
So here’s what I find interesting and where my thoughts go on this…
Foods that cause inflammation in the gut are called food sensitivities (IgG is the immunoglobulin that lives in our guts and ‘reacts’ to certain foods if they don’t sit well with you. This, in turn, increases the size of pores in our gut, allowing food particles, bacteria, yeast etc, to get through into the blood stream, that aren’t very welcome. This causes the systemic inflammation we are talking about above with respect to the brain)
Then my brain goes here…If we eliminate these foods, reduce inflammation in the gut, aren’t we then providing a stronger environment for those synapses to do their job as well as the neurons to fire in the brain?
And the most fascinating piece of information here is what I see clinically. Here are examples (very short summaries as these are complicated cases):
2 year old male walking on tippy toes, no eye contact, no words, no serve and return in communicating non verbally, no social interaction with others – comes in 6 weeks later post elimination and has started playing with parents and sibling and hugging
3 year old female with lots of rocking and repetitive hand motions. Made dietary changes as a first step – elimination of the rocking and a reduction in frequency of the repetitive hand motions
See ‘treatments’ for what a solid diet without these two potential inflammatory foods look like in order to not cause deficiencies in important nutrients.
Stool Analysis
In some cases depending on medical history of their review of systems, I will look at performing a stool analysis. This is where we can assess specific phyla (groups) of bacteria, fungi, parasites, and the imbalance (or not!) of each. A meta-analysis came out in March 2020 explaining what phyla (groups) of bacteria that are more prevalent in children with autism, is mind blowing. This helps to curtail the treatment of dysbiosis (imbalance of good and bad bacteria in the system), more on this later…
Organic Acid Testing
This is another way I like testing for potential dysbiosis. It’s a urine test where they are assessing different metabolites produced by multiple bacteria, yeast, and other fungus. Not only does this test look at the microbiome, it also looks at the function of mitochondria, the body’s toxic load, nutrient levels, and more.
Treatment
Often times treatment plans for patients with autism can be multi layered as we support the various systems that need it (not just the microbiome). So this information is specific to the microbiome portion.
Diet
Eliminating certain potentially inflammatory foods from the diet can be helpful from what I have seen practically speaking. The absolute key part to this, and I focus on this more and more, is not so much what you eliminate yet moreso what you are adding to the diet!
So if you’re eliminating gluten – this doesn’t mean you are taking out all pastas and bread, for example – it means you are looking for alternative sources to these two. Spelt, buckwheat, rice (within reason), nut breads – there are a lot of incredible whole food delicious alternatives out there chalked full of nutrients.
In general, regardless of elimination, adding in the following to the diet is helpful:
Good fats! Omega threes contain DHA (good for the brain) and EPA (reduces inflammation) so finding sources of these to put in their diet daily is beneficial for both factors. Sources such as wild fatty fish, nuts, oils (olive and coconut), avocados. If this is occurring already, I like offering this information so parents can become intentional about what they are feeding their children!
Whole food! Not only due to the microbiome and inflammation in the digestive system, we want these whole foods as once we get into processed we have additives that can set off imbalances in children’s body’s if their detox pathways are not working properly (often they are not when diagnosed with autism).
Well rounded – all the mamas and papas rolling their eyes at this one or suggesting this is not doable….I GET IT! There is pickiness that can occur, there are cravings or repetitive foods that can come into play (depending on the type or item of food, this can be indicative of a part to their constitution, so make sure you note what you observe!). So on that note, getting creative on how you serve things might just be your way out of the pickiness. For example – cooked oatmeal large flake, vs small flake, vs oatmeal cookies (these can be healthy), hidden as flour – there are multiple ways you can sneak oatmeal into them!
Antimicrobials
Often times when I see overgrowth of some commensal (neutral) bacteria, ‘bad’ bacteria and/or fungus and parasites, I will go in and use herbal treatment (and often refer for pharmaceutical treatment) to ‘kill them off’. To be clear, my intention to treat this dysbiosis is not because a parasite ‘causes’ autism. My train of thought is that these bad bugs cause inflammation, in turn effecting autism. In sifting through research I did find this piece in which they were looking at the actual relationship between autism and blastocystis.
Balancing Gut Bugs - Probiotics
Probiotics – I love how much research is coming out on this topic daily! For example in this article, its explaining what genera are found in abundance in autism, one being clostridium. Knowing that saccromyces boulardi play an important role in reducing this genera (read this review article), we can then curtail what probiotic strain will be beneficial (after running an OAT or stool analysis to assess microbiome). This article here showed positive results in the treatment of autism with lactobacillus rhamnosus. I dont necessarily run testing to prescribe probiotics. I’ll understand all underlying digestive issues along with any other system giving us clues to the state of the gut, and often times prescribe from there.
Like I mentioned before – research in this area is just scratching the surface. I do believe the further we kick the ball down this microbiome field and its effects on autism, the more we are going to be able to support our children facing this disorder!
Stay tuned on next topic – Anthroposophical medicine – a funky way of viewing children with autism, that can bring about incredible shifts!
