I’ve been reading about probiotics for relieving GI distress – and even improving behavior – in individuals with autism. Should I buy them? What’s the best kind?
Guest post by Alessio Fasano, MD, chief of the division of pediatric gastroenterology and nutrition and director of the Mucosal Biology and Immunology Research Center and the Center for Celiac Research at the Massachusetts General Hospital for Children. Dr. Fasano is conducting Autism Speaks-funded research on GI issues and autism.
I love talking about probiotics because they are a promising potential treatment for addressing GI distress associated with autism spectrum disorders (ASD). However, I also want to caution that research does not yet support their indiscriminate use in treating autism. Having said that, I and other researchers are actively studying probiotics, and here’s why.
In the last five years or so, we have developed technology that allows us to better study the composition and the genetics of the bacteria that reside in the gut. What we’ve found is that there are a number of conditions, including ASD, associated with imbalances in the gut’s bacterial “village.” Certain types of bacteria may overgrow to create imbalances that we call dysbiosis. This has been hypothesized for years. Now we have preliminary evidence to suggest that indeed there is an imbalance of bacteria in a subgroup of individuals with autism. If we can confirm this, then in theory, probiotics, or “good” bacteria, may help bring back equilibrium and health.
But there’s a lot we don’t know. In particular, we are trying to answer three key questions: Which bacteria are over-represented in these imbalanced systems? How abundant are they? And how do they interact with the host—the person with autism?
In animal models, we have identified certain kinds of bacteria that are abundant in mice with autism-like symptoms. Now, by studying the stool of children with autism, we are trying to confirm what we’re seeing in animals. We are also looking at whether dysbiosis causes inflammation in the gut. This could represent the immune system’s response to the overgrowth of these bacteria. If this inflammation travels to the brain, it can, in theory, affect learning and behavior.
I think we may find that, for some individuals, the inflammation is local, causing only GI symptoms. For others, the immune cells, once activated, travel to other parts of the body including the brain.
At the same time, we’re studying the effects of probiotics. We see them as potential peace makers that can help restore balance in the gut’s normal bacterial community. For example, we have evidence that giving probiotics to mice with autism-like symptoms improves their behaviors as it improves their dysbiosis. But such findings are preliminary. We can’t automatically apply them to people.
While I’m extremely sympathetic to parents who want to help relieve their children’s distress, I think we have yet to reach the point where we can say, “Yes, let’s give probiotics a try in children.” Currently, there are only two scenarios where science provides solid support for using probiotics. They include helping relieve food allergies and treating inflammatory bowel disease.
I have a great concern about widespread use of probiotics. We don’t want to make the mistakes we did in the past with penicillin, for example. We overused this antibiotic and others to the point that many types of bacteria became resistant to them. If we use probiotics the same way as we used penicillin, we may weaken thier usefulness as a treatment tool.
I have other concerns with the probiotics sold today. The Food and Drug Administration (FDA) does not regulate them as medications because they are considered supplements. As a result, there’s little to no quality control. The product you buy may contain ridiculously low levels of probiotics or no “live” probiotics at all. Worse, the probiotics may be mixed with potentially harmful bacteria.
In addition, there are different kinds of probiotics, including many types of lactobacilli and bifidobacteria, to name just two popular groups. I don’t believe all probiotics are equal. Each has specific effects in specific situations. So like different types of antibiotics, the clinician should select them wisely – perhaps based on the specific type of dysbiosis a patient has.
If you want to give your child probiotics, I recommend you avoid concentrated supplements and instead give your child a probiotic yogurt. (Check the label for the “probiotic” designation.) If you are intent on giving probiotic supplements, check the label for the amount of viable microorganisms in the supplement. The number should be in the billions. Finally, if you don’t see a clear improvement in a few weeks, stop using it. In other words, if there’s no clear benefit, don’t risk potentially negative side effects.
And stay tuned for further research findings! Thanks to the support of Autism Speaks and other organizations and federal agencies, we are continuing to advance our understanding of autism, inflammation and the role of gut bacteria, both good and bad.
Autism Speaks is funding a number of studies on gastrointestinal issues and inflammation as they concern autism. You can explore these and other funded research projects using this website’s Grant Search.
Dear Autism Speaks
Really interesting article regarding research on probiotics… if only it were that simple!
My son is ten years old, mentally five, speech language and communication disorder, clearer description is Pathological Demand Avoidance Syndrome (PDA/ASD), a subtype of PDD. I investigate extensively into what may be behind the cause which leaves this group of children suffering from the highest levels of anxieties, resulting in aggressive spontaneous outbursts.
I believe this group of children are the most excluded children from mainstream schools in the UK; I believe these children are the most misunderstood in our society; I believe these children are at very high risk of causing injury to themselves and/or others; I believe that there has been very little research into PDA.
To-date, I have come across thousands of very sad stories from parents who have children with PDA; parents are continually suffering blame for their childs aggressive behaviours; schools refusing to take these children or repeatedly excluding them; in two recent cases where the children have been removed from the home; other cases where children have to live in other counties in residential settings to be able to access a school; these children and their parents are excluded from society and even ignored by many of the autistic groups. PDA children are the vulnerable ones.
From my experience – I have noted my sons aggressive behaviours increase before a bowel movement, calming down dramatically afterwards. He suffers from bouts of constipation, other times his stools are soft pale and pasty in colour. He was given a bowel biopsy at nine months old believed to have ‘Hirshsprung disease’, which was negative. So yes I believe something is going on in the gut causing spasms, excess wind, irritants to certain foods which may possibly have an impact on the brain.
What do I think may be contributing factors? I believe there may be an imbalance of something during pregnancy… I know that I became anaemic, I was low in iron and vitamins, I was given anaesthetic, my labour was induced, birth was ventouse assisted, he suffered high distress during birth. All of this may have contributed to how my son is today.
From the hundreds of books, autism research and studies, reports on; B6/fenfluramine/magnesium/acidophilus/wheat/gluten/dairy/synthetic hormone/DMG/SOS/tetanus/lead/pitocin/famotidine etc.
So my question is… What’s next, where are we today?
I hope 2013 proves to be the year for answers.
Thank you for your time
Thank you for getting in touch and for sharing your thoughts. We’re glad to hear you enjoyed the probiotics blog. While we can’t answer all questions personally, we will try to address your issue in an upcoming “Got Questions?” blog post or find someone to get back to you. You can receive our biweekly digest of “Got Questions?” blog posts and other science content by subscribing here:https://secure.autismspeaks.org/site/c.8hKPL7NMLpJ4G/b.8238917/k.7EEC/Science_Digest_Signup_Form/apps/ka/ct/contactus.asp
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Best wishes, The Science Team
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