The American Academy of Pediatrics (AAP) has joined our fight against Autism. This months’ edition of PEDIATRICS®, the official journal of the AAP, has a major article entitled, “Gastrointestinial Conditions In Children With Autism Spectrum Disorder: Developing a Research Agenda” (the article is available online here) acknowledges many of the gastrointestinal problems our children on the spectrum face each day.
The first paragraph of the article cuts deeply into issues our children face daily: “Many individuals with ASDs have symptoms of associated medical conditions, including seizures, sleep problems, metabolic conditions, and gastrointestinal (GI) disorders, which have significant health, developmental, social, and education impacts.” Later in the same paragraph, “Despite the magnitude [italics mine] of these issues, potential GI problems are not routinely considered in ASD evaluations.” This is huge in many ways. Did I say HUGE? First of all, it moves ASD from a “psychiatric” diagnosis (you know, the “Prozac” people) to a medical one. This change immediately validates what moms and dads have been witnessing medically: that their children are indeed, FEELING miserable. Second of all, it empowers pediatricians to look BEYOND the word “autism” and not only inquire about other medical concerns but to implement treatment. Yes, you are witnessing the transition of mindset from an “untreatable” diagnosis to one that is TREATABLE.
Following this wonderful introduction, we get into the nitty-gritty of the article: outlining problems that have been documented in previous peer reviewed articles and suggestions where further research should go, all with the purpose of enabling physicians to diagnose and treat. Let me illustrate how this works in a medical article. First, the authors of the article review previous publications as they relate to GI concerns: Abdominal pain/discomfort, constipation, diarrhea and persistent diarrhea, and establish that they collectively indicate, “unusually high rates of GI disorders or certain GI symptoms in children with ASDs.” Next, they outline studies that may further help with key elements such as identification of risk factors, unusual presentation of GI disease, identification of special populations that missed GI disease, and development of any biomarkers (lab tests) that can help further guide the physician in treatment. If that was where this article ended, that in itself, would be huge. But as they say, “but wait, there’s more!” I would also like to share with you more of their “findings.”
Let’s break down what they are acknowledging as true and correct, or at least very likely:
GUT-BRAIN connection: Oh this is a good one, one they have denied for decades: “There is, however, emerging evidence relevant to ASDs in the areas of immune function, the relationship between signaling pathways of the gut and brain, the genome-GI microbiome interactions.”
Gut inflammation: Now this is huge. For years, the idea of gut inflammation was not only ignored, but put down. Think about Wakefield, Krigsman, and others. From this article, “Mucosal immune cells make up [about] 70% of the immune cells within the body, and dysfunction in these cells may have adverse consequences for GI function.” Further, “Endoscopic analyses of children with ASD and GI symptoms have revealed the presence of subtle, diffuse inflammation of the intestinal tract.”
Autoimmunity: The concept that autoimmunity can play a role in autism is a huge breakthrough for the mainstream medical community. It now starts to establish in the minds of the AAP that there is not ONE cause of Autism, but actually, the potential for multiple causes of Autism, which later in the article, they refer to as “autisms.” Let me illustrate, “Autoimmune responses in children with ASDs and a familial history of autoimmunity have been reported. Among the most common findings in ASD subjects and their mothers is an increased presence of autoantibodies directed toward the central nervous system proteins.”
Environmental factors: This admission is especially sweet for me personally. You see, up to now, the lion’s share of research money has gone toward finding the elusive genetic cause of the recent autism epidemic, with very little results and of course no plausible treatment options. Environmental factors suggest that there is some external cause(s) responsible for our current and ever increasing numbers of children on the spectrum – and remember, this IS A WORLDWIDE epidemic. Here’s what they say, “Several environmental factors that increase the risk for development of autistic features, including maternal infection…have been used successfully in rodents to generate animal models of these ASD environmental risk factors.”
Altered Intestinal Permeability: This is what we have called the “LEAKY GUT.” Actually, the AAP called it “Leaky Gut” as well. Yep, the idea of “leaky gut” will soon be preached at all main line medical conferences within the next 5 -10 years (ok, they move slowly, but it is better than no movement!) Leaky gut results when the intestinal border breaks down and allows substances that should be eliminated in the stool into the blood stream instead. The article acknowledges the potential role of elevated bacterial strains and gluten. Yes, they said gluten. “Small-intestinal exposure to bacteria and gluten are two of the more powerful triggers for zonulin induced tight junction disassembly.” This statement, in other words, means the breakdown of the gut’s ability to keep foreign things out of the blood stream and become more like a leaky sieve. Allow me two more quotes here. “Enteric [gut] infections have been implicated in the pathogenesis of several pathologic conditions, including allergic, autoimmune and inflammatory diseases by causing impairment of the intestinal barrier.” And, “Moreover, there is increasing evidence of supporting an association of gut microbiota with behavioral abnormalities such as anxiety and emotional reactivity…” They have come a very long way in a short amount of time!
Nutrition: Most of the children I see in my clinic have a very limited diet. That is, they become very self-selective and will only eat a handful of foods, usually NOT vegetables. This article addresses this point as well, “Collectively to date, these studies indicate a trend for clinically suboptimal nutrient intake in children with ASDs, with particular concern related to bone health nutrients.”
Now, from this article, there are a lot of investigations proposed to substantiate the above findings. Moving forward from this point, clinical trials will have to be done to evaluate treatments in this “evidence-based” medical environment…so true change is years away, especially if funding through the current Administration is limited (what, you thought it would come from big pharma?). Let me quote, again, from this article, “Evidence-based algorithms specific for ASD should be developed for each of the most common diagnoses that would address both management as well as treatment outcomes, tested rigorously, and subsequently refined to optimize outcomes.”
I believe that the AAP is on the cusp of understanding that today’s autism is a collection of metabolic systems that have gone awry, with no TWO individuals exactly the same. This article is a much needed CALL TO ACTION in the area of research! The AAP can now at least relate to why we clinicians are treating:
• Gut infections that include yeast, bacteria, and parasites
• Recommending healthy bacteria (Probiotics)
• Treating constipation/diarrhea
• Referring to GI specialists for management of inflammatory bowel disease
• Recommending nutrition and dietary supplements
• Managing chronic inflammation
• Treating sleep dysfunction
• Addressing neurologic issues such as epilepsy
• Evaluating for metabolic dysfunctions
• Trying to normalize immune system function
…AND SEEING POSITIVE CLINICAL RESPONSES IN OUR CHILDREN!