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As
I have discussed in Gastrointestinal
Issues in ASD, these
children suffer from a wide range of gastrointestinal issues. When I first
started treating my autistic son many years ago there was little information
available compared to what is available now. I did the best I could at the time.
I began reading reports of Dr Wakefield reporting consistent inflammatory
conditions within the gut of ASD children. Supplements that were showing
consistently beneficial results, diets that were showing benefit, and other
treatments (like secretin) that some parents were finding helpful.
As
a Medical Scientist and Naturopath, this led me to question why are there so
many vitamin and mineral deficiencies in these children? Why do children
sometimes get better on a supplement then regress? Why are some children more
hyperactive before a bowel movement? Why do children stop screaming, and stop
self injurious behaviour on some diets? Was this due to pain that has now
resolved? Why do children eat less and less variety of food? Are they trying to
tell us something? Do they know something that we don't? Why the loose bowel
movements or constipation? And many more questions as well.
I
began looking at the gastrointestinal tract in more detail trying to understand
better how all the components of the gut work. As a result I now have a greater understanding as to
why certain therapies, treatments, work. Interestingly, I also believe that
possibly some of the treatments are working for the wrong reason. But as a
parent, who cares, so long as it works. Yes, but the issue arises, what if
you try something new and it doesn't work or worse still your child
regresses.
Lets
look at why possibly healing the gut should be a priority in the treatment of
these children. I have outlined a basic understanding of the gut elsewhere (Understanding
Your Gut). The gut is a very complex organ interacting with its environment,
the gut flora, the immune system and the nervous system. When it becomes
injured, inflamed it simply will not work as intended. The absorptive surface of
the gastrointestinal tract is greatly increased by microvilli that project into
the gut lumen.
Microvilli protrude into the lumen
of the gut wall.
These
microvilli are responsible for the absorption of nutrients, production of
enzymes and a protective mucus layer. The enzymes that are required for proper
digestion are primarily found at the tip of the microvilli. What would be the
result if half of the microvilli pictured above were destroyed? Where are the
enzymes that we need to break down gluten/ casein, etc.? Half of the area
responsible for absorbing our nutrients has disappeared! Should it be a wonder
that our children are so low in vitamins, minerals, and amino acids. Would it be
a surprise that our children feel pain, nauseous or are uncomfortable after
eating? Having experienced the pain of diverticulitis myself, I can understand
why one would want to bang ones head against the floor to help with the pain.
If
the food is not being digested well what is happening to it? It becomes a great
source of food for resident bacteria. Add in an antibiotic and kill off some of
the friendly bacteria and the bad bacteria don't have anything to impede their
growth and small and large bowel overgrowths are reported.
Why
do our children self exclude so many foods? Possibly they are trying to tell us
something. If you eat a food and it gives you pain because you have an inflamed
gut, are you going to be silly enough to keep eating it? They are cautious with
new foods as they may possibly react to these foods as well. Why take the
chance? Possibly they crave some foods due to the opioid effect, so it dulls
their pain.
Special
Diets
Many
children improve on gluten/ casein, soy , corn free diets. Parents report
improvements on the Single Carbohydrate Diet, GAPS, low oxalate diet, etc. By
removing food sensitivities that may be irritating the gut, and giving the gut
time to heal, children increase in weight and begin to thrive. They begin to eat a wider
variety of foods. Interestingly, some parents report that after following a GF/CF
diet for at least a year, their children can then tolerate small amounts of
gluten, casein or other previously restricted food. I suspect that what in fact is happening is that changing the
diet and eliminating food sensitivities gives the gut a chance to heal. The
microvilli regenerate, the enzymes are now present and more nutrients can be
absorbed. The gut begins to work again and there are no unpleasant symptoms
after eating.
Supplements
We
often give a number of supplements, some in high dose. What effect do these
supplements have on a gut that is inflamed? I'll never forget a mother writing
on one of the discussion groups "When my son was diagnosed as autistic, I
promptly went and bought hundreds of dollars of the best gut inflaming
supplements I could buy". This mother realised that the supplements that
she was trying to give her son were actually inflaming his gut and making his
symptoms worse. This should be considered, especially if there are pre-existing
gut problems and nothing seems to be working.
Lemon
Juice
Some
parents on the online Low Oxalate discussion group report the beneficial effects
of giving their children lemon juice. Naturopaths have long recommended giving
lemon juice or apple cider vinegar to patients with poor digestion, especially
if they have low gastric acid. This helps to make the stomach more acid and
improve digestion. Why should a child have low stomach acid? This brings us to
zinc.
Zinc
The
cells within the stomach that produce hydrochloric acid for digestion need
adequate zinc. However, adequate stomach acid is needed to be able to absorb
zinc. Zinc is one of the primary supplements for our children. So by
supplementing zinc or increasing stomach acid we are helping to restore both
zinc status and stomach acidity. However zinc is also needed for the pancreas.
Pancreatic enzymes
Zinc
is needed for the proper functioning of the pancreas and production of
adequate pancreatic enzymes. A deficiency of zinc will decrease the available
pancreatic enzymes available to be released into the small intestine following a
meal. Also, the pancreatic enzymes are active over a narrow pH range. If the
conditions are not optimal for enzyme activity then they will work poorly at
best. Supplementing digestive enzymes that often have been selected to act over
a broader pH range is often found to be beneficial. However this does not
address the underlying issue of an under functioning gut. There is also some
concern about supplementing
enzymes specific for
phenolic compounds long term.
Vitamin
B12
Great
improvements are reported for those children that are given vitamin B12
injections. No doubt they are low and need B12, for the proper functioning of
the nervous system, methylation, carbohydrate metabolism and many other
functions. Importantly, vitamin B12 is absorbed in the ileum. This is the area
of the gut that is reportedly inflamed (lymphoid nodular hyperplasia), no wonder
that children do well on vitamin B12 injections as it bypasses the oral route.
Other factors that can impede vitamin B12 absorption include bacterial
overgrowth and pancreatic insufficiency.
Alkalisers
Maintaining
a urinary pH on the alkaline side is recommended to help remove heavy metals.
However, giving a bicarbonate based alkaliser after a meal will also help
stimulate the hormone CCK which also stimulates the pancreas to release
digestive juices and the alkaline pH is required for the digestive enzymes in
the small intestine to work.
Diarrhoea
/ Loose stools
Diarrhoea
or loose stools increases gastric motility so that food passes through the gut
at an increased rate, therefore there is insufficient time for proper digestion
to occur. Undigested food reaches the large intestine and there are considerably
more food particles for the resident bacteria to ferment, producing short chain
fatty acids that further irritate the gut lining.
Amino
Acids
Studies
have indicated that there are essential amino acid deficiencies in ASD children
consistent with poor nutrition. Undoubtedly children who self exclude high
protein foods will naturally be deficient in key amino acids. However if the
child's gut is unable to breakdown complex proteins into their amino acid
constituents and able to absorb them efficiently or has gut motility issues this whole problem will be
compounded.
Secretin
Secretin
has been used with mixed results in ASD children. Secretin is required for the
secretion of pancreatic juice by the pancreas. The hormone secretin is produced
in the tips of the microvilli in the gut. If there is inflammation within the
gut, there will be destruction of the tips of the microvilli, secretin release
will be compromised and the pancreas will not release adequate pancreatic
enzymes. Adding in secretin via injection or nasally activates the pancreas,
improves digestion and helps to control gut dysbiosis.
Probiotics
Probiotics
is an interesting issue. Many people use probiotics often in very high
concentrations. Some parents have reported that despite being on probiotics for
extended periods, they were surprised to find that a Complete Digestive Stool
Analysis (CDSA) has shown low levels of Lactobacilli or Bifidobacteria. All
micro-organisms within the gut have optimal conditions under which they will
thrive. Deprive them of these conditions and they simply will not grow. Low
levels of beneficial bacteria would indicate that the conditions within the gut
are not conducive for their growth. If this is the case simply adding in massive
doses of probiotics is not the answer. Changing the conditions within the gut,
would be a more obvious solution.
Regarding
using high doses of probiotics within the gut long term, is an issue that I have
some concern. We know that high dose probiotics produce chemicals that inhibit
and help crowd out unfriendly gut bacteria and pathogens. However we must
remember that the gut is also home to 400 species of other micro-organisms, many
of which we know little about. What effect will high dose probiotics have on
these other bacteria. For example, those that may have a problem with oxalates,
supplementing with high doses of a particular probiotic may inhibit the growth
of Oxalobacter forminges, the bacteria that helps breakdown oxalates in the gut.
What other beneficial bacteria are we inhibiting long term in the process?
Perhaps this is perhaps why the GAPS diet is beneficial for some children as it
is reintroducing naturally fermented products together with the food to help
them re-establish within the gut.
Antibiotics
Parents
have reported that their child improved while on an antibiotic, often to remove
a gut pathogen, however soon after finishing the course of antibiotics the child
regresses again. Antibiotics don't completely destroy all traces of a gut
pathogen, however it removes sufficient numbers that they can be kept under
control. If the conditions in the gut are not optimal for the growth of the
friendly bacteria, then the bad bacteria will simply once again take over.
Candida
Parents
seem to be constantly battling yeast issues in their children. Yeast can be
notoriously difficult to eradicate from the gut. Once again if yeast is given
the environment to grow it will grow rapidly. By limiting the environmental
factors for yeast growth, any therapy for yeast reduction will be more
effective. Sometimes we also need to consider the supplements that we are giving
as lipoic acid and N-acetyl-cysteine can be utilised by yeast and can exacerbate
gut symptoms
Hyperbaric
Oxygen Therapy
One
of the newer therapies being tried by parents to help recover their children is Hyperbaric
Oxygen Therapy (HBOT). HBOT is used for treating many conditions including
wound healing and brain injury. The ability of HBOT to help enhance wound
healing also has an important role in healing the inflamed gut. Indeed those
parents that report that their child's behaviour or symptoms were significantly
improved with HBOT, also report that gastrointestinal issues were also greatly
improved. I believe that this is yet another indication of the importance of
healing the gastrointestinal tract as being the primary issue that should be
addressed in these children.
But
my child has no gut symptoms
Some
interesting research
that has been done at Box Hill Hospital, Victoria, has shown that up to
1:100 people may be affected by coeliac disease in Australia.
Importantly they have found that 30% of patients were asymptomatic.
However, 82% of these asymptomatic patients had severe gut lesions with
villous atrophy. Consequently, these patients exhibit multiple
nutritional deficiencies (iron, folate, vitamin B12, zinc and vitamin
D). Therefore, just because your child does not have any obvious
gastrointestinal issues (loose stools, bloating, pain, heartburn, etc)
does not mean that damage is not being done to your child's gut lining.
A damaged gut lining, makes the gut "leaky", decreases
absorption of nutrients, and destroys the cells in the lining of the gut
that produce the essential enzymes required for digesting gluten and
casein proteins.
Concluding
Remarks
It
would seem obvious to me that if we help heal the child's gut then the
effectiveness of other therapies may be more obvious. No child will respond to
any therapy if their gut is inflamed and they are in pain or uncomfortable.
I
am only now beginning to hear doctors presenting at autism conferences the
importance of healing the gut first. Interestingly they are just finding out the
benefit of using medicinal herbs, something that Herbalists, Naturopaths, etc.
have a long tradition in the ability to treat the gut.
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