GI issues of children with autism

What are the gastro-intestinal issues of children with autism? (include information about allergies, dysmotility, constipation, etc)

A recent study was completed by ATN (Autism Speaks Autism Treatment Network) that showed that GI problems occurred in 45% of children with Autism. The research was an online questionnaire that was completed by 1420 children, age 2-18.  GI information was received from 1185 children. GI complaints within 3 mo of the study were abdominal pain (59%), constipation (51%), diarrhea (43%), other (40%), nausea (31%), bloating (26%).  GI symptoms increased with age, 39% under age 5, 51% age 7+. Children with GI symptoms reported more problems with emotionally reactive, anxious/depressed, somatic complaints, sleep problems, internalizing problems, affective problems and anxiety problems compared to without GI problems.  GI problems did not differ by gender, ASD subtypes, race, or IQ. (Williams etal 2010).

Another study in MN-longevity study with 121 ASD and 200+control, discovered that constipation and food selectivity is higher in ASD but not celiac disease, or other GI diagnosis.   They reported that the “ritualistic tendencies, need for routine, and insistence on

sameness that are characteristic of children with autism may lead these children to choose and demand stereotyped diets that may result in an inadequate intake of fiber, fluids, and other food constituents.17 Thus, behaviorally related food selectivity may, in turn, lead to constipation.”

Treatment with stimulant medication to control hyperactivity, impulsivity, and inattention can cause appetite suppression (side effect) that could also change the eating habits/behaviors of ASD except Risperdal which increases appetite and may increase weight gain. Seizure medication affects the metabolism of calcium, vitamin D and folate.

Leaky Gut:

I am quoting Jody Goddard as I feel that she very nicely explains the leaky gut and its relationship to inflammation.

“Altered intestinal permeability was found in 43% of autistic patients, but not found in any of the controls (Harvard University). Intestinal permeability, commonly called "leaky gut", means that there are larger than normal spaces present between the cells of the gut wall. When these large spaces exist in the small intestine, it allows undigested food and other toxins to enter the blood stream.” The peptides have an opiod-effect on the body.  “When incompletely broken down foods enter the body, the immune system mounts an attack against the "foreigner" resulting in food allergies and sensitivities. The release of antibodies triggers inflammatory reactions when the foods are eaten again. The chronic inflammation lowers IgA levels. Sufficient levels of IgA are needed to protect the intestinal tract from clostridia and yeast. The decreasing IgA levels allow for even further microbe proliferation in the intestinal tract. Vitamin and mineral deficiencies are also found due to the leaky gut problem.”  The first vitamin deficiency in the leaky gut is Vitamin B12, as it is absorbed in the iliem (last section of the small intestines).  So it enters the bloodstream before it is absorbed. http://www.breakingtheviciouscycle.info/autism/autism_and_gi_problems.htm

The flora can become disrupted in children with GI problems, especially if they have a history of taking antibiotics.  This may allow bacteria and yeast microbes to enter the colon/intestines and disrupt digestion.  Probiotics have been shown to help maintain a balanced flora.  It is used for general GI health.

Dysmotility is the decreased ability to move tfood through the GI tract.  It is often due to abnormal muscle contractions of the gut wall.  Delayed gastric emptying, referred to as gastroparesis, is also known as dysmotility.  Dysmotility can lead to constipation. Dysmotility may happen from wheat intolerance and food allergy and present with gastroesophageal reflux and constipation.  (Gibney 2005)

Food allergies and hypersensitities (neg allergy test) will benefit from special diets. Multiple researches have not shown that children with autism have a higher rate of celiac disease or the need for a GFCF diet.  Although people may report that behaviors improve on GFCS diet there is no significant decrease in the urinary compounds secreted compared children eating gluten and casein.(Whiteley 1999)

Schematic summary of the
gastrointestinal abnormalities reported
in children with autism. (Horvarth)

Selective food preferences and dairy –free diets put children at risk for calcium and Vitamin D deficiencies.  A study was done on 75 boys with autism; age 4-8 that showed significant thinner bones than typically developing boys of the same age.    (Hediger etal 2008)

Gluten-free diet is at risk for deficiencies in these nutrients: iron, zinc, B vitamins and folate

Dairy-free diet is at risk for deficiencies in these nutrients: calcium, vitamin D, vitamin B2 and protein.

Many children have inflammation consistent with gastroesophageal reflux disease with symptoms of abdominal pain, nighttime awakening and sudden daytime irritability. Other findings included chronic colitis.  A consistency in inflammation is common in children with autism that have GI symptoms.  (Horvath 2002)

If a child is having GI difficulties, it is best to look at some form of treatment as it manifests all other health complications like sleeping and attention, not to mention difficulties years later.  Especially since children with autism have communication impairments, understanding unusual/atypical presentations of GI disorders including sleep disorders and problem behaviors is important.

 

Buie, T. Campbell, D., Fuchs lll, G., Furuta, G., Levy, J., VandeWater, J., Whitaker, A., Atkin, D. Bauman, M., et al, (2010) Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals with ASDs: A consensus report. Pediatrics 125: S1-S18.

Gibney, M., Elia, M., Ljungqvist, O. (2005) Clinical Nutrition 107

Hediger ML; England LJ; Molloy CA; Yu KF; Manning-Courtney P; Mills JL(2008) Reduced bone cortical thickness in boys with autism or autism spectrum disorder. Journal of Autism & Developmental Disorders, 2008 May; 38 (5): 848-56

Horvath, K., Perman, J. (2002) Autism and Gastrointestinal Symptoms. Current Gastroenterology Reports 4:251–258

Ibrahim, S.H., Voigt, T.G., Katusic, S.K., Weaver, A., Barbaresi, W. (2009) Incidence of Gastrointestinal Symptoms in children with Autism: A population-based study.  Pediatrics 124:680-686

Williams, K, Fucha, G., Furuta, M., Marcon, M., Coury, D. (2010) GI Symptoms in Autism Spectrum Disorders (ASD): An Autism Treatment Network Study. Symposium session for Pediatric Acedemic Societies Annual Meeting.