Gut-Brain Connection? Leaky Gut? No longer “Crazy Talk” says AAP

By Dr. Bob Sears, Pediatrician and TACA Physician Advisory Member

The American Academy of Pediatrics (AAP) has just taken a giant leap toward recognizing the association between gastrointestinal problems and Autism Spectrum Disorders (ASD.) The November 2012 issue of their journal, Pediatrics, has a 200-page supplement entitled Improving Health Care for Children and Youth With Autism and Other Neurodevelopmental Disorders (Note: this guide was not currently available online.) As I perused the various articles to see what the AAP was up to, one particular gem caught my eye: Gastrointestinal (GI) Conditions in Children With Autism Spectrum Disorder: Developing a Research Agenda. Curiously optimistic, I decided to pause the Saturday-afternoon college football game and read the article. After a mere three sentences, my jaw dropped. “Many individuals with ASDs have symptoms of associated medical conditions, including seizures, sleep problems, metabolic conditions, and gastrointestinal disorders (the italics are mine), which have significant health, developmental, social, and educational impacts.” A few lines later I found there is a “lack of recognition by clinicians that certain behavioral manifestations in children with ASDs are indicators of GI problems (eg, pain, discomfort, or nausea).”

My first thought was that someone from ARI or MAPS had snuck into the AAP and switched a few words in the article before it went to press, and no one had noticed. But as I read the entire piece, I was shocked to see other crazy ideas such as:

  • “Clinical practice and research to date indicate the important role of GI conditions in ASDs and their impact on children as well as their parents and clinicians.”
  • “Gut-brain connection, immune function, and genome-microbiome interaction.” Yes, it actually said gut-brain connection!
  • “Increasingly, evidence supports a combination of changes in gut microflora, intestinal permeability (intestinal what?), inappropriate immune response, activation of specific metabolic pathways, and behavioral changes.”
  • “Endoscopic analyses of children with ASD and GI symptoms have revealed the presence of a subtle, diffuse inflammation of the intestinal tract.”
  • “Autoimmune responses in children with ASDs and a familial history of autoimmunity have been reported.”
  • “Autoantibodies could indicate the presence of inflammatory processes and/or an autoimmune component that could affect the integrity of the mucosal barrier and contribute to decreased mucosal barrier integrity.”
  • “Leaky gut.” Yes! It actually used those two foreign words that have been scoffed at for so long, and explains the research supporting this theory so that we general pediatricians can understand and begin to believe it.
  • “Nutritional status and nutrient intake are inextricably related in children with autism.”
  • A table on “Biomarkers as potential outcome measures” includes testing for: intestinal permeability to assess leaky gut, calprotectin for intestinal inflammation, celiac disease serology tests to assess gluten sensitivity, food allergy panels (not sure what for . . . maybe food allergies play some sort of role in all this?), organic acid testing for B12 or folate deficiency, and analysis of gut microbiota.

The article ends with a discussion on the lack of accepted treatments for GI problems specific to children with ASD and outlines six key research objectives:

  1. Determine the pathology of GI conditions in ASD.
  2. Increase animal research in this area.
  3. Identify biomarkers to guide treatment.
  4. Better evaluate nutritional status.
  5. Identify behavioral phenotypes related to poor nutritional status.
  6. Develop evidence-based algorithms to help guide clinicians in the evaluation and treatment of GI problems in ASD.

By the time I finished reading, the cynical frame of mind with which I usually read mainstream articles about autism treatment was replaced with optimism. Finally, mainstream research is planning to look at the gastrointestinal and nutritional aspects of biomedical treatment for autism. For twenty years or more, biomedical physicians have been treating GI problems in autism without much support from thorough mainstream research, and we’ve endured much criticism for doing so. Even worse, parents of children with autism have been begging pediatricians for help, will little acknowledgement that there is any possibility of a gut-brain connection in autism. The tide began to turn in January 2010 with Dr. Tim Buie’s consensus report on GI problems in autism (Pediatrics. 2010;125(suppl 1):S1-S18). And now the tide is actually surging in our favor.

This article doesn’t actually support any particular treatments for GI problems in autism, and we are many years away from mainstream medical research coming to fruition in this area. But it is nice to know that mainstream help is on the way, and that if any doctor tries to ridicule parents for asking for help with their child’s GI problems, you now have the AAP on your side. You can waive this article in the doctor’s face. We pediatricians love that. But seriously, the full text of this article will likely become available online soon. You can view the first part of it here: http://pediatrics.aappublications.org/content/130/Supplement_2/S160.extract?cited-by=yes&legid=pediatrics;130/Supplement_2/S160 . If you have an open-minded pediatrician, and need help, hand he or she this article, and you may be able to get your doctor to test and treat some of your child’s GI problems.

As a side note, this same edition of the journal has an article on the importance of evaluating and treating constipation in ASDs. Definitely a good read for your pediatrician if your child struggles with this, and it even suggests testing such kids for thyroid disease, lead overload, and, get this . . . celiac disease! Here’s a link: http://pediatrics.aappublications.org/content/130/Supplement_2/S98.abstract

Thank you AAP!!!

Dr. Bob Sears

Pediatrician and TACA Medical Advisory

Pediatrician and author of The Autism Book: What Every Parent Need to Know About Early Detection, Treatment, Recovery, and Prevention and The Vaccine Book.

http://www.amazon.com/The-Autism-Book-Detection-Prevention/dp/B004Y6MW4I/ref=sr_1_1?ie=UTF8&qid=1334013357&sr=8-1

http://www.amazon.com/The-Vaccine-Book-Decision-Parenting/dp/0316180521/ref=sr_1_1?ie=UTF8&qid=1352136591&sr=8-1&keywords=the+vaccine+book

Resources:

1) AAP Standards of care for Autism https://www.tacanow.org/family-resources/aap-standards-of-care/

54 Comments Add yours

  1. Michelle K. says:

    My child with autism was recently diagnosed with celiacs… After 15 YEARS of symptoms including severe chronic constipation! I am so glad to see information about this being put into the hands of the mainstream medical community. Slowly, it WILL make a difference.

  2. I’ve had doctors laugh right in my face! They’ve told me time and again “there is no correlation between GI issues and autism symptoms!” The “GAPS” theory and GFCF might help but aren’t science.

    “Leaky Gut doesn’t exsist”…….

    1. Elisea says:

      The link was discover 1904 or something has been re-discovered(???) many time since then has been published in many medical mags and scientific journals. Docs still have no knowledge of it (???) Maybe the trillions of dollars that are made by docs and drug companies keeping these diseases present so they can treat(?) them has something to do with it. Heal yourself with a good naturopath, a good health shop and a thick skin when talking to your doctor.’
      I had bleeding bowel for years told nothing to do with food. Went to many specialists. Also had candida, eczema,asthma,high BP , fatty liver. chronic migraines and allergies. Finally went to homeopath/naturopath told to do detox and stay off of gluten/dairy & fix leaky gut.
      Now NONE OF THE ABOVE. Finally went to doc -for regular smear test. I told him all symptoms gone and why. Told not possible that this could work. They are the willing conspiritors in this sickness epidemic. Listen to your body, go to get wellness help.
      GET YOUR LIFEBACK>
      SAVE YOUR KIDS!

  3. TACA families have known about autism and gut issues for decades. Most families have been living and managing all along. The are leading the way for science and treatments.

    What I am worried about are all the families not yet connected to TACA. I hope this announcement drives families to life changing treatments. I hope that the AAP listens to parents, examines the patients and drives solutions.

  4. Jenny Allan says:

    Amazing- this is exactly what my poor autistic grandson was being treated for at the Royal Free Hospital, London, by those wonderful but persecuted physicians, Professors Walker-Smith and Murch, 1998-2002. My grandson’s inflamed and impacted bowel required regular monitoring, medications and interventions. He also has gluten and casein intolerance. He is now twenty and still suffers terribly from bowel pain and discomfort.

    The Royal Free ‘special’ clinic which treated, amongst others, the Wakefield et al 1998 Lancet 12 children, was ruthlessly disbanded by the medical director at UCL, which took over the Royal Free Hospital shorty afterwards. The MD’s first ‘task’ was to effectively ‘sack’ researcher Dr Andrew Wakefield. Literally thousands of suffering children were left with no access to proper continuing care for their bowel conditions, now officially dismissed as ‘chronic constipation’. They are all still suffering. Let’s hope this belated AAP acknowledgement, of the absolute ‘rightness’ of the Royal Free research and care regimes, more than 15 years ago, leads to some proper research and treatment for this terrible life long condition.

    1. penelope says:

      wow Jenny thanks for sharing. its so heartbreaking when so many childrens’ health is disregarded for an ideological fight. Lets hope that this research helps them get help for thier “chronic constipation”. If it was the US, someone would probably sue.

  5. AKR says:

    Great news!!! It’s all so frustrating that “people” aren’t more open to new ideas. Recently, I found a 9-inch ascaris roundworm in my 4 year old daughter who has primary motor stereotypies which started around age 2.5…I told my pediatrician I thought there was a relationship between the two…his answer, “I’ve never heard of primary motor stereotypies AND I highly doubt there is a relationship…” End of discussion. Some drs can be very close minded and only knowledgeable in what they are told to do (vaccinate, for example). AAP open your eyes and ears and start listening to the parents! This article is a glimmer of hope. Fingers crossed.

  6. Rachel Bruce says:

    Sad that they plan to increase animal research in this area…we ALREADY. KNOW. what causes leaky gut. Glad for this acknowledgement by the AAP, but seriously, folks, we are still light years ahead of the AAP. AMA and AAFP also need to get off their duffs and make the same connection between chronic illness and leaky gut. Happy and discouraged at the same time.

    1. julie says:

      Amen to that!

    2. Ronda says:

      I agree. Animal research seems cruel, unnecessary and costly.

  7. Maria ONeil says:

    You are the Best Dr. Sears so grateful to have you in this journey of recovering my son with ASD!!!

  8. PS Teoh says:

    What? No!!!! They ACKNOWLEDGE that Andy Wakefield was right? 😮 What have they done??? Someone was asleep at the wheel! This paper will be retracted in no time! The author will be sued and found to be a fraud! Dr. Proffit will publish more ‘safe’ studies! The CDC will increase the number of recommended vaccines and push for ‘better diagnoses’!

  9. Simela says:

    Is that not what Dr.Wakefield & Co said years ago? Wonderful that Prof.Walker Smith is still alive to witness this.
    So now, please explain somebody why we need animal testing ?
    Why does the AAP not just start listening to the parents.They know when their children started regressing.
    Why are they not ones and for all compare Autism between vaccinated and not vaccinated children?Is that not the most logical thing to do first?
    How many more children must be harmed ?
    Are they waiting for 1 in 5 , or 1 in 2 ?
    Can they actually sleep at night?

  10. Christina Waldman says:

    The AAP is slow to acknowledge what is already in medical textbooks. If I recall correctly, In the transcript of one of the more recent cases before the US vaccine court, a textbook by a Dr. Zuckerman (not Ari) which discussed the GI connection with autism was given in evidence for the clainant. And of course, there are plenty of research papers on the topic, some duplicating Dr. Wakefield’s 1998 “Lancet study”‘s results.

    Dr. Wakefield et al’s research was trying to get to the root of this connection: why was this happening? Maybe in another ten years the AAP will get with that program, too. I have no faith in the AAP ever since years ago a relative worked for them and was told that, even though the AAP knew that cow’s milk was bad for children, they would continue to promote it so as not to alienate the farmers’ financial support. This was very disturbing to my relative.

  11. Christina Waldman says:

    Cedillo was the name of the case I was trying to think of–it may have been that one (re my former comment.) Sorry about typos.

  12. Reblogged this on Recovery Road and commented:
    I’m so excited about this! Validation! This is my Friday Science post. Because, sound the trumpets, the November issue of Pediatrics has a 200-page supplement “Improving Health Care for Children and Youth with Autism and Other Neurodevelopmental Disorders.” The mind boggles. Oh wait, this is all stuff I’ve been hearing from the ARI/alternative/naturupathic arena for 11 years. High Five to Pediatrics! High Five for our kids!

  13. jzinius says:

    YES! Finally!!!!

  14. Berl says:

    A Dr? Wrote this? Doesn’t understand the similarities between IBS and Celiacs? Or is this a parent? Autism children have many anxieties, of course they can suffer common stomach ailments and malnutrition even Colitis. These things junk up the blood stream and the brain. What we really need to watch is the studies done on Mercury now. Mercury may be the main culprit.

    1. All heavy metals that are unable to be detoxed. Of course. Detox the heavy metals and you see recovery! 🙂

  15. Christy says:

    Both of my children have recently been diagnosed with ADHD and SPD. Both have been tested for spectrum. My oldest is deemed to have symptoms but not enough to be deemed ‘on the spectrum’. My youngest his testing was inconclusive but he too was deemed to have symptoms but perhaps not enough to fall on the spectrum. Both children had severe infant re-flux, my youngest would projectile vomit across a room at 6 weeks of age. My oldest had urinary re-flux and lots of gastrointestinal issues they attributed to the urinary re-flux (?, how?), he continues to have chronic constipation. My youngest had what the pediatrician referred to as ‘toddler gut’, watery stool that came so fast it would run right out of a diaper or when he was potty training didn’t allow for him to make it to the toilet. It was so bad the pediatrician had to write a letter to the daycare telling them of his ‘condition’ so that he wasn’t sent home every other day for diarrhea. The pediatrician had us institute the BRAT diet to ‘regulate’ his digestive track, which made him constipated – chronically. A regular diet still gives him extremely loose stool. I’m not sure the Gut-Brain Connection is limited to issues such as ASD, of course I say this knowing for at least one of my children ASD hasn’t been completely ruled out. However, ADHD and ASD affect the same area of the brain.

    1. Jordan says:

      Christy, I was just wondering if you have removed wheat and all gluten containing foods from his diet? Refined sugar as well as several preservatives can also be very irritating to the gut. Also, are you familiar with GMO foods and their negative role associated with many stomach / bowel conditions? Many Dr.’s are having success treating bowel / gut issues by removing all GMO (Genetically modified organism) foods from the diet. This includes corn, soy, vegetable oil (canola), and sugar from GM sugar beets which make up most of the refined sugar in packaged “foods”. Mostly all prepackaged foods will contain at least 1 of these ingredients if not 2,3 or all of the above. Also, I was wondering if you have tried increasing the fermented foods in his diet and supplement with probiotics? One of the most potent fermented (probiotic rich) foods / liquids is coconut kefir. I’ve made a video on how to make it here

      Increasing the gut flora is very important to gut health. Other powerful gut healers are Liquid aloe Vera juice and slippery elm bark powder.

      1. Sim says:

        Thank you for sharing that 🙂

  16. A Table in the Sun says:

    The gut-brain connection is definitely not just applicable to ASD. I am an adult with MTHFR and SHMT variances (among many other variances), who is not ASD, but suffers terribly from gut issues, even after being gluten free for 8 years. It is so tricky to get the gut in order! My symptoms didn’t arrive until I was approaching 50, but are now surprisingly ASD textbook.

  17. julie says:

    Ummmmm, Yeah “thank-you AAP”, took you long enough. Why don’t you hire us moms to be your research team? You’ll be one step ahead of the game.

  18. Angel says:

    The allergy test has to do with the damaged gut leaking the food particles into the body. Wherever the food lands, the immune system attacks the food particles AND the organ. Sensitivities then can turn into full blown allergies from what I’ve read. I was just diagnosed with Hashimoto’s and have been slowly moving towards the GAPS and SCD diet (breastfeeding so I can’t completely jump on it and detox everything). A lot of the information on diet included the gut-brain barrier and leaky gut. Hashimoto’s is an autoimmune disorder and hereditary. My children are now on my diet and we have seen amazing results in all of us. We strayed on accident and had such an absolutely horrible week with anger issues, bodily pain, etc. This stuff is very real and I’m so glad to see it recognized. I’m hoping that this gets Wakefield an apology and gets our country on track to make refusing vaccines easier!

  19. anna says:

    It is very frustrating when doctors do not believe. I went to a “textbook” allergist. I wanted to have my son’s food allergies tested. I knew he had some but couldn’t figure out what all. He basically told me I was stupid. He said if my son had a food allergy, I would know, I wouldn’t need him to tell me. He also said that allergies had nothing to do with my son’s behavior or tics. He said he couldn’t count the number of parents that came in wanting their child tested in hopes of it changing the child’s behavior but he didn’t waste his or their time with that. Anyway, I found a doctor 4 hrs away who is not a “textbook” doctor. We went to him and he ordered blood tests to test for food allergies. Turned out my son has 38 allergens. His greatest was Bakers yeast, brewers yeast, casein, dairy,….. The doctor said my son has a leaky gut and if he heals his leaky gut, he could get rid of all or most allergens. I am very thankful there are doctors who do help… it’s just hard to find good ones.

  20. just another mommy warrior says:

    Jordan’s video on coconut kefir is excellent – these kids need fermented foods in their diets to heal the digestive tract.

    It’s so nice to see mainstream medicine catching up to what many of us parents already knew. Here’s an excellent discussion on the topic of gut-brain connection and how to heal and prevent these issues – written by some enlightened mommy warriors four years ago:

    http://archive.tcoyf.com/forums/t/9083.aspx

  21. While I applaud this medical connection, I have to say I am totally offended by someone in the medical profession misusing the term ‘crazy’ . This does nothing to help remove the stigma associated with mental illness. For more than 60 years, mental health advocates have been working to help people better understand mental illness, how to take care of their own mental health, and how to act as caregivers for others. More importantly, by focusing on helping people to understand mental illness, they have been working to shatter the stigmas associated with being “crazy”. Mental illness isn’t “crazy”. It’s not a disease; it’s a dis-ease, and together we can work to decrease the prevalence of mental illness in our society. If our own medical professionals continue talking and writing with terms like this, we do nothing to help those live with a mental health challenge. http://home.earthlink.net/~durangodave/html/writing/Stigma.htm . We need to start using a more respectful language, stop using terms like fruitcake, nut case, freak, crazy and lunatic. Mental Illness can strike anyone at any given time. Mental health issues, like physical health issues occur on a spectrum. Certain situations (like handling a loss) are like the common cold – we can deal with them on our own. Other conditions, like severe depression, are more like treating diabetes or cancer – they require more significant treatment. Because of the stigma associated with mental illness, many of us do not seek out the help we need – let’s stop misusing terms like ‘crazy’ and that needs to start with our medical professionals.

  22. Ann says:

    Our 4.5 yr old daughter has ASD & is on a Gluten Free diet as when she has Gluten her behaviours can’t be controlled. I’m also Gluten Free after years of symptoms. It was my asking the GP if I could try her on my GF diet to help her bowels that got the result in lessened behaviours & a daughter who was much happier. We’ve had to trial her on a standard diet twice & after 2 days out of the 7 I’ve had to ring the paeditrician & say screw that I need my happy daughter back.

  23. Jennifer says:

    I am encouraging all of my therapy families to consider fullerton the GAPS nutritional protocol to try & heal their GI issues.

  24. Finally medical science will be able to confirm the link between intestinal permeability – autoimmunity – autism. Now how long will it take to get this understood by mainstream health care?

  25. Connie says:

    My grandson has high functioning autism and suffers from acid reflux and constipation. He rarely eats balanced meals.

    1. Connie says:

      My grandson has ASD and suffers from reflux and constipation

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