In recent years, there has been growing interest in the relationship between gut health and Autism Spectrum Disorder (ASD). Children with ASD have been found to have significantly higher rates of digestive problems such as chronically altered bowel habits (constipation or diarrhea) or uncomfortable symptoms like excessive bloating, gas, or stomach cramps. They are also more likely to experience intolerances, allergies, or aversion to foods.

Any parent of a child with ASD will know that these problems, which signify poor gut health, unquestionably impact their child’s quality of life. Currently, researchers are focused on trying to understand whether gut health may play a role in more than just the occurrence of these digestive symptoms, looking closely at whether the relationship extends to the development and/or severity of ASD.

Gut Health & The ‘Microbiome’

Our digestive system, aka our ‘gut’, is a complex network of different organs that work together in synergy to provide an interface between the outside world and our internal environment. The health of our digestion can impact the health of our entire body as it regulates the energy and nutrition we are able to derive from the food we eat.

This, however, is only one aspect of our digestive system; our gut is home to trillions (yes, you read correctly – trillions!) of bacteria that not only support good digestion, but also impact a number of other important body systems. Over the last few decades, a growing body of research has lead to the understanding that these gut bacteria (collectively known as our ‘microbiome’) exert influence over the health of our immunity, brain and cognition, skin, hormones, metabolism and energy production, heart, lungs, and our susceptibility to allergies and intolerances[i]. And, they do all of this from their home in the digestive system!

Our microbiome is like a village of bacteria that live throughout our digestive tract (mostly in the large intestines) and is made up of a variety of different bacteria families, for example Lactobacillus and Bifidobacterium species, amongst many others. For the village to function at its best, the bacteria need to live in just the right balance with one another to support good health[ii]. This is sometimes referred to as symbiosis[iii]. When the bacteria village is upset by either an external or internal threat, bad bacteria may have the opportunity to move in and grow in number, or, the normally good bacteria may start to predominate, leaving less room for a diversity of families to flourish[iv]. Either way, the result is an imbalanced bacteria village, something that is called dysbiosis[v].

 

The Gut-Brain-Axis

Emerging research has revealed that there is a connection between our digestive system and our brains – a connection known as the ‘gut-brain-axis’. The pathway for communication between these seemingly separate body systems involves a complex interaction between the cells lining our digestive tract, our nerves, our immune system, and chemical messengers (for example, hormones and other hormone-like molecules). Many of the communication messages come directly from our village of gut bacteria; they produce and secrete molecules that send messages to our nerves and brain, impacting the activity, health, and development of our nervous system. If our bacteria village is happy and balanced, the messages are good. However, if the village becomes disturbed, the messages can get mixed up or worse, do harm.

Dysbiosis has been associated with a number of mental health and neurodevelopmental conditions, including depression, anxiety, bipolar disorder, ASD, and schizophrenia[vi].

 

The Gut-Brain Axis in ASD

ASD is a complex neurodevelopmental disorder and although the cause is not fully understood it is widely accepted to include both genetic and environmental factors. One potential factor that has been receiving considerable attention is gut health and the gut-brain axis. Preliminary research suggests that the developing bacteria village in infants and young children may contribute to neurodevelopment via the complex gut-brain axis pathways [vii] [viii] [ix]. This field of research is still developing and the true nature of this relationship continues to unfold.

It is also known that children with ASD have significantly higher rates of dysbiosis[x] [xi] [xii], digestive issues[xiii] [xiv], and food allergies or intolerances[xv], and that the experience of these digestive problems is associated with increased irritability, anxiety, and social withdrawal[xvi], and in some cases, with the severity of ASD[xvii]. While these findings should not be mistaken for a cause-effect relationship between gut health and ASD, they do suggests that gut health may play a central role in the disorder and highlight an important area that can be addressed to improve every day quality of life for children with ASD who experience digestive problems.

 

Probiotics & ASD

The first line treatment option for dysbiosis is probiotic supplements. Probiotics are nutritional supplements that contain live populations of bacteria that are known to be beneficial to human health. Although the body of research looking at the efficacy of probiotics specifically in children with ASD is in it’s early stages, probiotics have already been found to normalize bacteria balance[xviii], alleviate digestive problems[xix], and improve objective diagnostic measures[xx] in children with ASD.

Probiotics are much more widely researched in general digestive health conditions and show strong efficacy at reducing digestive problems in the general population[xxi]. Effective probiotic use requires the selection of therapeutic strength products that contains very specific bacteria strains for each condition and collection of symptoms, and advice from a trained health professional should always be sought to ensure that your get the most out of your product and money.

Supporting your microbiome

If your child demonstrates signs and symptoms of poor gut health (e.g. constipation, diarrhea, food allergies/intolerances, bloating, gas, food intolerances), then supporting the health of their gut bacteria may be an effective strategy to alleviate their discomfort and improve their everyday wellbeing.

The good news is that there are lots of ways that you can achieve this using dietary, lifestyle, and if appropriate, supplemental strategies. Try incorporating some of these strategies into your every day routine for healthier and happier gut bacteria:

 

Eat food high in fiber

Our gut bacteria get their energy from fiber, so try including more fresh fruits and veggies (with skin on wherever possible), nuts and seeds, beans, lentils, chickpeas, whole grains such as brown rice, oats, quinoa or buckwheat, or wholemeal options when choosing bread, crackers, pasta, etc. In particular, foods like bananas (especially ones that are only just ripe), asparagus, onions, jerusulum artichokes, garlic, and leeks contain super fiber molecules that our bacteria absolutely love. Caution is advised in children who are prone to bloating or gas after eating, as these foods can increase gas production – introduce small amounts at a time and monitor their response.

Include more fermented foods

Fermented foods contain live beneficial bacteria that can temporarily assist in restoring bacteria populations in the gut. These foods include natural yoghurt (not flavored varieties – avoid anything with added sugar), aged cheeses like natural cheddar, brie, or camembert, kefir drinks, Kombucha drinks, miso soup (check the packet for added preservatives – choose organic if possible), tempeh, sauerkraut, or kim chi. Some of these fermented foods are challenging for kids developing taste buds or for picky eaters, so introduce them slowly and in different forms and at various meals – you will often initially be met with defiance, so persist on multiple occasions with these new foods.

Avoid refined carbohydrates and high sugar foods

These foods promote the overgrowth of certain strains of bacteria, leading to dysbiosis, and also usually contain very little fiber or other valuable nutrients. Reduce foods ‘white foods’ like white bread, white pasta, white rice, processed crackers and chips, sweet biscuits, baked desserts and pastries, cakes and sweets, chocolate and lollies. A little treat every now and then is fine – everything in moderation!

 

Reduce stress in your child’s life as much as possible

Our gut bacteria dislike stress as much as we do!

  • Understand your child’s triggers and stresses and help them to develop good coping strategies using tools like mindfulness
  • Encourage them to take time out for relaxation and work on hobbies or activities they love
  • Spend time outdoors in nature
  • Have quiet family afternoons or days when you can all switch off together
  • Use breathing techniques or mini-meditation activities to calm the body and mind
  • Reduce screen time
  • Promote a calm environment at home
  • Make plans in advance when possible to avoid rushing or unknown events
Help your kids get enough sleep each night

Sleep deprivation and disturbances have a profound impact on our gut bacteria. They operate on a sleep-wake body clock cycle just like we do.

  • Babies need 14-18 hours
  • Toddlers need 12-14 hours
  • Primary aged children need 10-12 hours
  • Secondary aged children need 8-10 hours
Reduce any other possible triggers

Such as repeated antibiotic use or intake of caffeine (found in coke or cola soft drinks, energy drinks). Chocolate contains a caffeine-like substance, so be wary of high intake of chocolate or chocolate-containing foods and drinks.

When to seek help

Finally, for extra support you can always talk to your healthcare professional about possible treatment options, for example, using therapeutic probiotic supplements to restore good bacteria populations in the digestive system or to correctly identify food allergies or intolerances and make an effective plan to eliminate problem foods from the diet.

In fact, speaking to a naturopath would be a great place to start, since gut health is the cornerstone of a naturopathic approach.

References

[i] Susan V. Lynch and Oluf Pedersen, “The Human Intestinal Microbiome in Health and Disease,” ed. Elizabeth G. Phimister, New England Journal of Medicine 375, no. 24 (December 15, 2016): 2369–79, https://doi.org/10.1056/NEJMra1600266.

[ii] Jose C. Clemente et al., “The Impact of the Gut Microbiota on Human Health: An Integrative View,” Cell 148, no. 6 (March 16, 2012): 1258–70, https://doi.org/10.1016/j.cell.2012.01.035.

[iii] Clemente et al.

[iv] Clemente et al.

[v] Clemente et al.

[vi] G. B. Rogers et al., “From Gut Dysbiosis to Altered Brain Function and Mental Illness: Mechanisms and Pathways,” Molecular Psychiatry 21, no. 6 (June 2016): 738–48, https://doi.org/10.1038/mp.2016.50.

[vii] G. Clarke et al., “Priming for Health: Gut Microbiota Acquired in Early Life Regulates Physiology, Brain and Behaviour,” Acta Paediatrica 103, no. 8 (August 1, 2014): 812–19, https://doi.org/10.1111/apa.12674.

[viii] Rogers et al., “From Gut Dysbiosis to Altered Brain Function and Mental Illness.”

[ix] Emeran A. Mayer, David Padua, and Kirsten Tillisch, “Altered Brain-Gut Axis in Autism: Comorbidity or Causative Mechanisms?,” BioEssays 36, no. 10 (October 1, 2014): 933–39, https://doi.org/10.1002/bies.201400075.

[x] Jennifer G. Mulle, William G. Sharp, and Joseph F. Cubells, “The Gut Microbiome: A New Frontier in Autism Research,” Current Psychiatry Reports 15, no. 2 (February 2013): 337, https://doi.org/10.1007/s11920-012-0337-0.

[xi] Sydney M. Finegold, “State of the Art; Microbiology in Health and Disease. Intestinal Bacterial Flora in Autism,” Anaerobe 17, no. 6 (December 2011): 367–68, https://doi.org/10.1016/j.anaerobe.2011.03.007.

[xii] Xinyi Cao et al., “Characteristics of the Gastrointestinal Microbiome in Children with Autism Spectrum Disorder: A Systematic Review,” Shanghai Archives of Psychiatry 25, no. 6 (December 2013): 342–53, https://doi.org/10.3969/j.issn.1002-0829.2013.06.003.

[xiii] J. William Critchfield et al., “The Potential Role of Probiotics in the Management of Childhood Autism Spectrum Disorders,” Gastroenterology Research and Practice 2011 (2011): 1–8, https://doi.org/10.1155/2011/161358.

[xiv] Barbara O. McElhanon et al., “Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-Analysis,” Pediatrics 133, no. 5 (May 1, 2014): 872–83, https://doi.org/10.1542/peds.2013-3995.

[xv] Kristen Lyall et al., “Asthma and Allergies in Children With Autism Spectrum Disorders: Results From the CHARGE Study,” Autism Research 8, no. 5 (October 1, 2015): 567–74, https://doi.org/10.1002/aur.1471.

[xvi] Roumen N. Nikolov et al., “Gastrointestinal Symptoms in a Sample of Children with Pervasive Developmental Disorders,” Journal of Autism and Developmental Disorders 39, no. 3 (March 1, 2009): 405–13, https://doi.org/10.1007/s10803-008-0637-8.

[xvii] James B. Adams et al., “Gastrointestinal Flora and Gastrointestinal Status in Children with Autism – Comparisons to Typical Children and Correlation with Autism Severity,” BMC Gastroenterology 11 (March 16, 2011): 22, https://doi.org/10.1186/1471-230X-11-22.

[xviii] Aleksandra Tomova et al., “Gastrointestinal Microbiota in Children with Autism in Slovakia,” Physiology & Behavior 138 (January 2015): 179–87, https://doi.org/10.1016/j.physbeh.2014.10.033.

[xix] Rachel West et al., “Improvements in Gastrointestinal Symptoms among Children with Autism Spectrum Disorder Receiving the Delpro® Probiotic and Immunomodulator Formulation,” Journal of Probiotics & Health 1, no. 1 (April 21, 2013): 1–6, https://doi.org/10.4172/2329-8901.1000102.

[xx] West et al.

[xxi] Martin H. Floch, “The Role of Prebiotics and Probiotics in Gastrointestinal Disease,” Gastroenterology Clinics of North America 47, no. 1 (March 2018): 179–91, https://doi.org/10.1016/j.gtc.2017.09.011.