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January 21, 2020

Autoimmunity & the Gut Part #4: Predicting Autoimmunity

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

This week we continue to look at autoimmunity and gut health. This article focuses on possible ways of predicting autoimmunity by looking at specific gut bacteria.

Dr. Alessio Fasano, whom we wrote about last week, has said that the reason someone develops autoimmunity or AI later in life is due to gut bacteria and a change somehow in the composition of the gut bacteria (Fasano A., 2019).

Gut health has been found to affect the possibility of developing an AI disease (Felix KM, 2017). Dysbiosis (an imbalance between good gut bacteria and bad gut bacteria) is the key culprit as it can lead to leaky gut. Leaky gut is a significant contributing factor to Autoimmunity.

In our functional medicine clinic, we focus on testing for and resolving causes for dysbiosis. Examples of important tests we do include SIBO (Small Intestine Bacterial Overgrowth) Lactulose Breath Testing and a comprehensive stool analysis looking for parasites, helicobacter pylori, candida, viruses, worms, and more. To find out more about becoming a patient, click here.

Predicting Autoimmunity:

Most autoimmune diseases progress gradually over time, often without symptoms (Rose, 2016). During this time, serious tissue damage may occur (Rose, 2016). Ideally, it is important to diagnose autoimmune diseases as early as possible, to avoid irreversible tissue damage.

After genetic factors, autoantibodies are the best predictors of impending autoimmune disease, at this time (Rose, 2016). Autoantibodies are an antibody (a protein) produced by the immune system that is directed against one or more of the person’s own tissue or organs. These autoantibodies are the hallmark of autoimmune disease.

Multiple studies have found that these autoantibodies develop in a person’s body approximately 7 years before a diagnosis of AI is made (Rose, 2016) and (Arbuckle MR, 2003).

While autoantibodies are known to be a predictor of AI, research is also currently looking to specific gut bacteria to try to predict AI.

Because studies show blood markers can detect autoimmune tendencies before symptoms arise, testing for autoantibodies, even when free of symptoms, can be helpful. In our clinic, we do preventive and predictive comprehensive blood screening for autoimmune diseases. We measure what are called antibodies (molecules that tell us the immune system is attacking something) to different body tissues, like the thyroid as one example, to find out if there is a possible issue with autoimmunity. The common tests that we do for most patients to look for autoantibodies include Thyroid peroxidase (TPO) antibodies, Thyroglobulin antibodies (TGA), Antinuclear antibodies (ANA), Antiparietal cell antibodies (APCA), Rheumatoid Factor (RF), Anti-CCP3 (related to rheumatoid arthritis that can cause joint issues) and sometimes several ENA markers as well.

Have you been screened for antibodies? Do you have family history of autoimmune disease or unexplained symptoms but no one has thought to test for autoimmune issues? If so, get in touch with us to find out more about working with our clinic.

Different AI Conditions and Predictive Factors:

Many studies have found that people with various AI conditions (such as Type 1 Diabetes, Multiple Sclerosis, Rheumatoid Arthritis, Lupus or SLE, Celiac Disease, Autoimmune Arthritis, Asthma) have some degree of gut dysbiosis. Often, they will not have enough specific good gut bacteria and / or they will have too much specific bad gut bacteria. This is precisely what dysbiosis is. As we have mentioned, this state of dysbiosis will lead to leaky gut, which is one of three factors that contribute to autoimmunity, along with genetics and an environmental trigger. Please refer to our articles on AI, AI #1, AI #2 and AI #3, if you would like a deeper explanation.

Conclusion:

It is clear that dysbiosis exists in the gut of AI patients. More information is needed in order to use these findings for future diagnoses and therapeutic approaches.

One huge challenge ahead is to differentiate cause from effect: is the gut bacteria the cause of AI disease or a result of the disease itself?? (Felix KM, 2017). Is the presence of certain bacteria a predictor of AI or a result? Future research will have to focus on this question as the answer is not entirely clear at this time (Felix KM, 2017).

What is clear is that the importance of diet and the composition of the gut microbiome play a critical role in health (Rose, 2016).  This is why we always look at gut health in our clinic and in functional medicine. You can review some of our approaches to gut health here and here or you can read the whole Gut Brain Axis Series of blogs, starting here, that we have been working on for the past several months.

Or better yet, get in touch with us today! Book a free 15-minute discovery call to see how we can help you with any active or potential AI conditions.

 

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December 11, 2019

What is the Connection between Autoimmunity & the Gut ? Part 3

The Microbiome-Autoimmune Connection, Part 3: Dr. Alessio Fasano’s work on Autoimmunity

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

 

This week we will review the groundbreaking work of Dr. Fasano and autoimmunity. Autoimmunity is when the immune system becomes overactivated and attacks the body’s own tissue.

What causes this attack? Read on for more details.

These are three steps that can cause an autoimmune condition:

  • a genetic tendency
  • an environmental trigger
  • a leaky gut

To prevent and address an autoimmune condition, it is vital to work on improving your gut health. We can help you to do that.

Zonulin is a substance found in the gut that controls permeability or leakiness. There are tight junctions, which are like doors, on the gut lining. Zonulin opens these doors. Then food molecules, toxins and bacteria can get out of the gut tract and into circulation in the body. We call this condition, when the doors are open, leaky gut.

We want to avoid leaky gut because these food molecules and other things that escape from the gut into the body through these doors, cause an immune system reaction and inflammation. Over time, this immune system reaction becomes an overreaction and can lead to autoimmunity.

One thing that causes zonulin to increase and to open these doors is dysbiosis. Dysbiosis is when there is an imbalance in gut bugs in the microbiome. This happens when you have more bad gut bacteria crowding out the good gut bacteria. Gluten (anything containing wheat, rye, or barley or anything made from these contains gluten) also raises zonulin and opens these doors. Gluten is the main trigger for celiac disease, which is an autoimmune condition.

It is possible to improve dysbiosis, by reducing the bad gut bacteria and increasing the good gut bacteria. We can help you to do this. Then zonulin will not increase and your gut won’t be leaky, which reduces the chances of getting an autoimmune condition.

In scientific research, solutions to autoimmunity are being studied. One of these is a pill that would block zonulin from increasing. This would prevent the development of a leaky gut, one of the steps leading to autoimmunity. In other research, it was found that a certain probiotic can prevent leaky gut.

A healthy gut is so important for good health overall.

You might be wondering how you can improve your gut health. Is it as simple as taking a probiotic? Or what about prebiotics? Or how about stool testing or parasite treatments? What about Small Intestinal Bacterial Overgrowth? Or candida overgrowth?

In reality, any gut issues can cause leaky gut and contribute to autoimmunity. It is not as simple as taking a probiotic for most people. That is where functional medicine lab testing and targeted treatment for root causes of gut imbalance comes in. By following our functional medicine process, we have seen autoimmune markers in the blood like ANA (commonly positive with Lupus) become “negative” on multiple occasions after working for several months with people in our clinic. We have also seen dramatic reductions in thyroid antibodies (autoimmune conditions like Hashimotos and Graves) through our process at Medicine with Heart. If you would like to find out more about working with us (we work with people all over the world), please CLICK HERE to book a 15-minute discovery call.

Please stay with us for next week’s article when we will look at some ways of predicting autoimmunity. Read this article here for ways to address an autoimmune condition. Or better yet, call us and book a free discovery call to see how we can help you with an autoimmune condition and/ or to improve your gut health!

 

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November 12, 2019

Autoimmunity & the Gut Part 2: The Gut-Brain Axis Series, The Microbiome-Autoimmune Connection

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

Last week in Autoimmunity & the Gut Part 1, we introduced what is autoimmunity (AI) and discussed some gut issues that can contribute to autoimmunity; such as leaky gut and dysbiosis. This week we look at specific microbiome issues in common AI diseases and we will give you ways to manage and address an autoimmune condition.

As we saw last week in Part 1, certain pathological bacterial strains are found in dysbiosis and with certain AI conditions.

FURTHERMORE, THERE IS EVIDENCE OF MICROBIOME DISRUPTIONS IN COMMON AI DISEASES:

  • RHEUMATOID ARTHRITIS (RA): As we saw last week, patients with new-onset RA have higher levels of a pathological bacterial strain called Prevotella copri (Bo Li, 2018). A study comparing RA patients and healthy controls confirmed a disturbed microbiome i.e. dysbiosis, which was partially resolved after RA treatment (Bo Li, 2018). Other studies have distinguished patients with RA from healthy controls as having dysbiosis (Thomas S, 2017). Current treatments for rheumatoid arthritis target symptoms. However, by focusing on the role played by gut bacteria, new treatment options looking at reducing the spread of P. copri in the gut could delay or prevent the onset of this disease (Scher JU, 2013).
  • TYPE 1 DIABETES (T1D): Multiple studies have shown dysbiosis in individuals with preclinical T1D (Bo Li, 2018). Issues include a sharp decrease in microbiome diversity, low community stability, an abundance of the Bacteroides strain of bacteria, fewer Bifidobacterium species and a lack of butyrate-producing and lactate-producing species (Bo Li, 2018).
  • MULTIPLE SCLEROSIS (MS): Studies suggest a distinct alteration in the MS gut microbiome compared with healthy controls (Bo Li, 2018). A study of 60 MS cases has reported an increased abundance of Methanobrevibacter (Archaea) and Akkermansia and a reduction in Butyricimonas (Bo Li, 2018). These MS-associated bacteria in the gut predispose the body towards a pro-inflammatory profile (Bo Li, 2018).

In short, pathogenic bacteria can be highly problematic to overall gut health. In certain people with a genetic disposition, they can contribute to the development of autoimmunity. This is why is extremely advisable to be mindful of your gut health and consistently work on supporting a healthy gut.

WHAT CAN YOU DO TO ADDRESS AUTOIMMUNITY?

Once the AI disease process is activated, it does not have to be forever. It can be managed or even reversed by stopping the interaction between genes and the environment.

It is critical to reduce inflammation and calm the overactive immune response. Two steps are necessary:

IMPROVE GUT HEALTH AND HEAL LEAKY GUT

  • Address gut health with Functional Medicine. An experienced FM practitioner can order a stool test for you. A stool test can indicate the balance of bacteria in your gut microbiome and identify the good bacteria, the neutral bacteria and the bad. This tells if you have dysbiosis or not. Then you can work on reducing the bad bacteria and supporting the growth of good bacteria in your gut. Finding a good FM practitioner is crucial in achieving this.
  • SIBO or small intestinal bacteria overgrowth, alongside dysbiosis, is often a factor in leaky gut and in AI. With your FM practitioner, you can test for SIBO and address it if you have it.
  • Once you have treated any gut infections or overgrowths, it is critical to address leaky gut. There are therapeutic strategies aimed at re-establishing the intestinal barrier function and restoring leaky gut. These will downregulate or decrease the actions of zonulin and offer a way to manage AI diseases (Fasano, 2012).
  • Probiotics: Several trials show that the microbial changes caused by probiotics may improve gastrointestinal symptoms and inflammation in rheumatoid arthritis, ulcerative colitis, and multiple sclerosis (Liu Y, 2018). Probiotics are likely to be used in autoimmune diseases as a component of the treatment (Liu Y, 2018). However, one size will not fit all. The choice of optimal probiotic strains will differ for each AI disease (Liu Y, 2018). Work with an experienced FM practitioner to identify which probiotic strains will help improve your particular AI condition.
  • Prebiotics: Prebiotics are certain foods that feed the good bacteria of the gut. They are an important part of supporting overall gut health. Please see our dietary recommendations here for info on prebiotic foods.

TRY TO IDENTIFY YOUR ENVIRONMENTAL TRIGGER(S)

  • If you can identify the environmental trigger of your AI disease, you can eliminate or minimize your exposure to that trigger. A trigger is a specific antigen, or protein, that the immune system recognizes as a threat (real or not), that sets off the cascade of over-activation.
  • In the case of celiac disease, the trigger is gluten for example. However, in the vast majority of autoimmune diseases the trigger remains unknown.
  • It can be challenging to identify your trigger. The key autoimmune drivers usually fall into these six areas:
    • Diet
    • Leaky Gut & Dysbiosis
    • Infections
    • Toxins
    • Stress
    • Hormonal Imbalances

Your plan to manage and reduce AI symptoms should also include the following:

  • IMPROVE DIET: A few successful dietary approaches are being used to address AI. The two most common are the AutoImmune Paleo (AIP) diet and the Dr. Terry Wahls diet. The AIP diet was developed by Dr. Sarah Ballantyne. It does eliminate many foods and mainly focuses on meats and vegetables. Dr. Terry Wahls developed her Wahls diet which she used to greatly improve her MS. It focuses on high amounts of vegetables and other anti-inflammatory foods. Both diets support and improve gut health, reduce inflammation and remove problematic foods from the diet. Try one or both of these diets. You can work with your FM practitioner for more detail on the best diet for you.
  • RESOLVE INFECTIONS: Infections, bacterial or other, can be a trigger for AI. It is important to test for and address any infections. This could be bacterial like some of the overgrowths mentioned above that contribute to AI, viral like Epstein-Barr Virus, mycotoxin-related like Lyme disease or mold illness or other. Use an FM approach to resolve any infection you may have.
  • DECREASE EXPOSURES TO TOXINS: Pollution, chemicals, environmental toxins of all sorts are everywhere. We cannot escape exposure completely, but we can work to minimize our exposure to toxins. Eat a clean organic diet. Use clean, green household cleaning and other products. Switch to natural, non-chemical personal care products and use the EWG’s Skin Deep website (https://www.ewg.org/skindeep/search.php?query=fragrance&h=Search) to rate your products. Minimize EMFs from your phone and WIFI. Get an air filter for your home and a good water purification system. Avoid spending time in heavily-polluted areas or areas where chemicals are heavily used. Don’t smoke or drink excessive amounts of alcohol. Don’t use plastic containers for food or water storage. Switch to glass or stainless steel. Cook in clean safe cookware.
  • REDUCE / MANAGE STRESS: Stress can contribute to the development of leaky gut so reduce it wherever you can. Take on less commitments. Manage your stress through meditation, yoga, tai chi and time spent in nature.
  • ADDRESS HORMONAL IMBALANCES: Hormonal imbalances can also be an issue with AI. Address these with the help of your FM practitioner.

If you or someone you know is suffering from an autoimmune disease, get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

—-    Please follow our next article in the Autoimmune-Microbiome series    —-

We will provide more evidence of the effects that the microbiome has on autoimmunity.

 

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November 5, 2019

Autoimmunity & the Gut Part 1, The Gut-Brain Axis Series, The Microbiome-Autoimmune Connection

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

INTRODUCTION

Gut health is closely involved in autoimmunity (AI). In fact, there are three elements necessary for an autoimmune disease to develop. These are a genetic predisposition, a leaky gut and an environmental trigger (Fasano, 2012). This is commonly referred to as the triad of AI. Through intestinal permeability, or leaky gut, the gut becomes a critical factor in AI.

AI diseases are typically chronic and can require lifelong treatment. Conventional medicine says there is no cure for most AI diseases. But Functional Medicine has developed different approaches that can help to manage or improve an AI disease, and in some cases, to reverse an AI disease.

There are more than 100 different autoimmune diseases. Forty other additional diseases are thought to have an autoimmune component (The American Autoimmune Related Diseases Association, 2019). We cannot list them all here but common ones include multiple sclerosis, lupus, celiac disease, Crohn’s, Hashimoto’s, rheumatoid arthritis, fibromyalgia, type 1 diabetes, ulcerative colitis, vitiligo, Meniere’s disease and others.

AI diseases are becoming more and more common in our modern society.

• The National Institute of Health (NIH) estimates up to 23.5 million Americans suffer from autoimmune disease and that the prevalence is rising (The American Autoimmune Related Diseases Association, 2019). The NIH numbers only include 24 diseases for which good epidemiology studies were available (The American Autoimmune Related Diseases Association, 2019).
• The American Autoimmune Related Diseases Association (AARDA) says that 50 million Americans suffer from autoimmune disease when all AI diseases are included (The American Autoimmune Related Diseases Association, 2019).
• Autoimmune diseases are more common in women, and they often run in families.

AUTOIMMUNITY & THE GUT

Autoimmunity (AI) occurs when the body’s immune system attacks itself. The immune system protects the body by responding to invading microorganisms, such as viruses or bacteria, by producing antibodies or other types of immune cells. Normally, an immune response cannot be triggered against the cells of one’s own body. In some cases, however, immune cells make a mistake and attack the cells that they are meant to protect. Essentially, the person’s immune system attacks its own tissue. This can lead to a variety of autoimmune diseases.

Factors such as genetics, the environment, infections, and the gut microbiota all play a role in autoimmune disorders. The microbiome, meaning the specific bacteria in the gut, has a very important and long-term effect on the immune system, starting at birth. It also plays a significant role in autoimmune disease (Campbell, 2014).

It is not fully understood how the microbiome interacts with the immune system in either the development or the absence of an autoimmune condition (Thomas S, 2017). Microbial dysbiosis in early life can negatively affect how the immune system develops and provide the basis for allergic disorders or other health problems in later life (Thomas S, 2017). Dysbiosis may trigger intestinal permeability (or leaky gut) and consequently may trigger autoimmune diseases, given the right circumstances (Thomas S, 2017).

When leaky gut occurs, there are essentially small holes in the gut lining. Through these holes, various large protein molecules of undigested food can get into the bloodstream and travel all around the body. As this undigested food continues to pass through the holes of the gut lining, food intolerances will occur and the immune system will be triggered over and over into attacking these particles. Eventually, the immune system becomes excessively activated and goes into overdrive. Certain body tissue can look like undigested food molecules. This is called molecular mimicry.

The immune system can start to confuse a food or other foreign molecule with a particular body tissue, and start to attack its own tissue. This self-attack is what happens in an autoimmune disease. For example, Hashimoto’s is when the immune system attacks the thyroid. In MS, the attack is on the myelin sheath surrounding nerves.

WHAT CAUSES LEAKY GUT?

Several factors can lead to leaky gut:

DYSBIOSIS: Increased intestinal permeability is influenced by the make-up of the gut microbiota (Fasano, 2012). An unbalanced gut flora or dysbiosis, when more bad bacteria exist vs. good bacteria, can contribute to leaky gut. Dysbiosis has been associated with autoimmune diseases, particularly, rheumatoid arthritis (RA), type 1 diabetes (T1D), multiple sclerosis (MS) and autoimmune liver disease (AILD) (Li, 2018).

ZONULIN: Zonulin is a protein that regulates intestinal permeability by modulating the tight junctions of the gut lining (Fasano, 2012). Zonulin has been found to be higher in autoimmune conditions associated with a dysfunction of the tight junctions, including celiac disease (CD) and T1D (Fasano, 2012). Both animal studies and human trials have established that zonulin is involved in the development of autoimmune diseases (Fasano, 2012).

Zonulin is triggered or increased by small intestinal exposure to bacteria, as in the case of SIBO or small intestinal bacterial overgrowth, and gluten (Fasano, 2012). These have been identified as the two more powerful triggers (Fasano, 2012) for higher zonulin, which will lead to leaky gut. In the small intestine, when exposed to excessive bacteria, zonulin is secreted in genetically susceptible individuals (Fasano, 2012). This affects the intestinal barrier function by releasing zonulin and can cause leaky gut (Fasano, 2012).

POOR DIET: Diet dramatically affects gut health and the specific strains of gut bacteria. The US diet has changed dramatically since the 1950’s. We have new strains of grains, especially in wheat, rice, soy, and corn. The food supply contains GMO’s, chemicals, pesticides, fungicides, insecticides, antibiotics, heavy metals, such as arsenic, chemical ingredients such as artificial preservatives, colorings, and flavorings and plasticizers such as bisphenol A. Animal products contain the hormones and antibiotics given to the animals. In addition, antibiotics, antacids, proton pump inhibitors, histamine 2 blockers, and other drugs are widely used.

In line with these dietary changes, there has been a significant increase in autoimmune diseases, linking the quality of diet and autoimmune problems (Campbell, 2014).

The specific elements of our diet that contribute to leaky gut are:

• Refined and processed sugars
• Refined carbohydrates
• Genetically modified foods
• Vegetable oils
• Alcohol: Data indicate that alcohol is associated with dysbiotic changes in the gut microbiota, meaning that balance of good vs. bad bacteria tips into dysbiosis (Engen PA, 2015). Alcohol may also be associated with increased gastrointestinal tract inflammation and intestinal permeability resulting in systemic inflammation and tissue damage (Engen PA, 2015).
• Gluten: Gluten triggers the release of zonulin. Zonulin is a key factor in regulating tight junctions of the gut lining. Zonulin’s increase in genetically susceptible individuals may lead to immune-mediated diseases, i.e. autoimmunity (Fasano, Intestinal permeability and its regulation by zonulin: diagnostic and therapeutic implications., 2012).
• Dairy
• Packaged, processed, and junk foods: Glucose, salt, emulsifiers, organic solvents, gluten and nanoparticles are increasingly used by the food industry, allegedly to improve the quality of food. All of these additives are known to increase intestinal permeability by breaking down the tight junctions of the gut lining (Lerner A, 2015).
• Any food to which a person has a sensitivity or allergy

STRESS: Stress is a factor and can disturb the make-up of the microbiome and increase permeability (Camilleri, 2019).

MEDICATIONS: Certain medications can increase intestinal permeability. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), aspirin, Celebrex and others increase permeability (Camilleri, 2019). Other drugs, such as antibiotics and oral contraceptives disrupt the intestinal barrier (Bischoff SC, 2014).

Once a leaky gut is established in a genetically susceptible person, an AI disease may potentially develop.

CERTAIN, OFTEN PATHOLOGICAL, BACTERIAL STRAINS ARE FOUND IN DYSBIOSIS AND WITH CERTAIN AI CONDITIONS.

Dysbiosis should be identified, monitored and treated because it can contribute to autoimmunity. Most infectious agents, such as viruses, bacteria and parasites, can induce autoimmunity via different mechanisms (Kivity S, 2009). Bacterial infections in particular are associated with many autoimmune diseases involving chronic inflammation (Sherbet, 2009).

In many cases, it is not a single infection but rather the ‘burden of infections’ from childhood that is responsible for the development of autoimmunity. The development of an autoimmune disease after infection tends to occur in genetically susceptible individuals, often with intestinal permeability or gut dysbiosis (Kivity S, 2009).

ENTEROCOCCUS GALLINARUM: One study has linked autoimmune reactions to a bacterium in the gut called Enterococcus gallinarum (Manfredo Vieira S, 2018). The autoimmune response can be triggered when the bacterium spontaneously migrates from the gut to other organs in the body, such as the spleen, liver, and lymph nodes (Manfredo Vieira S, 2018). The results were confirmed when researchers compared cultured liver cells of healthy people versus those of people with an autoimmune disease and found traces of Enterococcus gallinarum in the autoimmune group (Manfredo Vieira S, 2018).

BACTEROIDES FRAGILIS: Another study has identified the bacteria Bacteroides fragilis to be involved in AI (Stewart L, 2018). A protein produced by this common gut bacteria may trigger the onset of autoimmune disease through the concept of molecular mimicry. Researchers found that patients with autoimmune disorders display higher-than-normal levels of a “mimic protein” produced by Bacteroides fragilis (Stewart L, 2018). This specific microbe in the gut produces protein molecules that mimic a human protein, which can cause the immune system to attack its own cells by mistake through molecular mimicry and this can contribute to autoimmunity (Stewart L, 2018).

KLEBSIELLA PNEUMONIAE: It has been known for some time that the pathogenic bacteria, Klebsiella pneumoniae, is linked to certain AI diseases (Rashid T, 2013). Studies have found that Klebsiella is the most likely triggering factor involved in the initiation and development of two autoimmune diseases; ankylosing spondylitis (AS) and Crohn’s disease (CD) (Rashid T, 2013). It appears that Klebsiella microbes can grow and thrive in the bowel of genetically susceptible people.

MYCOBACTERIUM AVIUM SUBSPECIES PARATUBERCULOSIS or MAP: MAP is a bacterium that is the known infectious cause of Johne’s disease, a chronic inflammatory bowel disease (IBD) in cattle (Dow, 2012). MAP is also involved in Crohn’s disease, which is very similar to Johne’s. MAP acts as a trigger of autoimmune disease and is associated with autoimmune diabetes, autoimmune thyroiditis and multiple sclerosis (Dow, 2012).

PREVOTELLA COPRI: In a study of 114 people, a bacterium named Prevotella copri was present in the gut of 75% of people with rheumatoid arthritis (RA) compared to only 21% of healthy control subjects (National Institutes of Health (NIH), 2013). In addition, an abundance of Prevotella copri has been identified in patients newly diagnosed with rheumatoid arthritis (Alpizar-Rodriguez D, 2019). The presence of P. copri corresponds to a reduced amount of other beneficial microbes (Scher JU, 2013). This indicates the role of intestinal dysbiosis in the development of RA (Alpizar-Rodriguez D, 2019).

PROTEUS: A strong link exists between Proteus mirabilis microbes and RA (Ebringer A, 2006). It is thought that sub-clinical Proteus urinary tract infections are the main triggering factor (Ebringer A, 2006). In addition, molecular mimicry between these bacteria and the specific tissue under immune attack in RA leads to the continuation of the disease process (Ebringer A, 2006).

In short, pathogenic bacteria can be highly problematic to overall gut health. In certain people with a genetic disposition, they can contribute to the development of autoimmunity. This is why is extremely advisable to be mindful of your gut health and consistently work on supporting a healthy gut.

Please follow us again next week when we will continue with Autoimmunity & the Gut Part 2. We will discuss specific microbiome issues in common AI diseases and we will give you ways to manage and address an autoimmune condition.

If you would like immediate assistance with an autoimmune condition, then get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

 

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October 29, 2019

Depression & the Gut: Are they linked & what is the link? Part 2: Depression The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

Last week in Part 1 of Depression and the Gut, we defined depression and outlined the potential causes of depression; genetics, a chemical imbalance in the brain, hormones, stress or trauma, blood sugar dysregulation, poor diet, medications, inflammation and gut health.

This week we provide specific ways to address depression through functional medicine.

In functional medicine, we look for the root causes and will always look at gut health and the underlying reasons for any potential inflammation.

WHAT YOU CAN DO TO ADDRESS DEPRESSION:

  • Balance Blood Sugar
  • Understand the Cause of your Inflammation and Reduce it
  • Improve Gut Health

These three key objectives can be achieved through:

DIET:

  • Adopting an organic, whole foods-based, anti-inflammatory diet is the best diet to balance blood sugar, decrease inflammation and promote gut health. Our food choices, alongside factors like stress, toxins, sleep and other lifestyle factors, determine the make-up of our gut bacteria and overall gut health. Diet is important for good gut health and for conditions like depression.
  • As a first step, we want to avoid the foods that are most damaging to gut health (Mu C, 2016):
    • Sugar & excess refined carbohydrates
    • GMOs
    • Highly processed foods
    • Lack of fiber
    • Excess caffeine
    • Excess alcohol
    • Vegetable oils high in omega 6 fatty acids
  • We recommend following the diet that we outlined in our article on anxiety, which is rich in omega 3 foods, fermented foods, prebiotics, polyphenols and tryptophan. See here for the full details
  • Prebiotics are foods that promote the growth of beneficial, health-supporting bacteria in the gut. They have been reported to improve inflammation and to alleviate psychological distress (Kim YK, 2018).  These foods contain non-digestible fibers that promote the growth of beneficial gut microbiota such as Lactobacillus and Bifidobacterium, benefiting the microbiome-gut-brain axis (Kim YK, 2018). Prebiotic foods include lentils, apple cider vinegar, dandelion greens, raw garlic, raw or very lightly cooked onion, leeks, raw asparagus, green bananas, green plantains, potatoes that have been cooked then cooled 24 hours (served cold or at room temperature, as is common in potato salad), apples and others.
  • Additionally, certain foods can be helpful when dealing with depression. One study looked at and identified twelve nutrients most effective for the prevention and treatment of depression (LaChance LR, 2018):
  • Folate
  • Iron
  • Omega-3 fatty acids (EPA and DHA)
  • Magnesium
  • Potassium
  • Selenium
  • Thiamine
  • Vitamin A
  • Vitamin B6
  • Vitamin B12
  • Vitamin C
  • Zinc
  • The study also came up with a list of anti-depressant foods. The highest scoring foods are: (LaChance LR, 2018)
  • Oysters, mussels, various types of seafood and organ meats
  • Leafy greens, lettuces, peppers and cruciferous vegetables
  • The categories of food that are most to least effective in reducing depression are: (LaChance LR, 2018)
  • Vegetables
  • Organ meats
  • Fruits
  • Seafood
  • Legumes
  • Meats
  • With grains, nuts, seeds and dairy being the least effective in fighting depression

SUPPLEMENTS:

  • Probiotics: Probiotics support the good gut bacteria, promoting better gut health. They also can significantly decrease depression (Huang R, 2016). Probiotics had an effect on both healthy people and on patients with major depressive disorder (Huang R, 2016).
  • Omega 3 fatty acids: Omega 3 fats are anti-inflammatory. They can inhibit many aspects of the body’s inflammation process (Calder, 2017). As we know, reducing inflammation is a critical piece in addressing depression. In addition, omega 3 fats can positively affect gut health. A few studies looking at omega 3 fats and the gut showed changes in the gut microbiome after omega 3 supplementation  (Costantini L, 2017). In particular, an increase in Bacteroidetes and butyrate-producing bacteria was found (Costantini L, 2017). The short chain fatty acid butyrate is known to reduce inflammation (Valles-Colomer M, 2019). Further, the relationship between gut bacteria, omega 3 fatty acids, and immunity helps to maintain the gut lining integrity, to avoid leaky gut. (Costantini L, 2017). Increasing evidence from various trials have identified that a deficiency in omega 3 fatty acids may contribute to development of mood disorders, and that supplementation with omega 3 may provide a new treatment option (Deacon G, 2017).
  • St John’s Wort: St John’s Wort is a popular herb used as a remedy for depression. It is widely used in many European countries. A large study found that for patients with mild to moderate depression, St John’s Wort is as effective as SSRIs (Ng QX, 2017). When compared specifically to the SSRI antidepressant drug, Paxil, in the treatment of moderate to severe major depression, St John’s Wort was found to be at least as effective as Paroxil, with fewer side effects (Szegedi A, 2005). A second study found that in the treatment of mild to moderate depression, St John’s Wort is equally effective as synthetic antidepressants (Schulz, 2002). Finally, it was found that St John’s Wort was equivalent to the SSRI Zoloft for the treatment of moderate depression (Gastpar M, 2005). It is not advisable to take St John’s Wort at the same time as other medications like antidepressants, anticoagulants and other drugs. It is best to work with an experienced functional medicine practitioner to help with the dosing and interactions of taking St John’s Wort for depression.
  • Vitamin D: One study found that a one-off dose of 100,000 IU of vitamin D improved depression better than light therapy, in patients with seasonal affective disorder (Gloth FM, 1999). The increased vitamin D levels were significantly associated with the improvement in depression symptoms (Gloth FM, 1999).
  • Magnesium: Magnesium is effective for mild to moderate depression in adults. In one clinical trial, positive effects were observed within two weeks of subjects taking magnesium chloride (Tarleton EK, 2017). Patients in the study had significant improvement in both depression and anxiety disorders (Tarleton EK, 2017). Magnesium works quickly and is well tolerated without the risk for toxicity (Tarleton EK, 2017).

It is also helpful to look at:

  • CHRONIC INFECTION such as Lyme, Epstein-Barr Virus, mold, or other bacterial or viral infection: A hidden chronic infection can often be an underlying cause of inflammation. As we know, inflammation is involved with depression given that depressed people exhibit all of the classic features of an inflammatory response (Miller AH, 2016). An inflammatory response is also the body’s reaction to an infection. Thus it follows that an infection, which creates inflammation, can be a contributing factor to depression. Furthermore, there is a hypothesis called the “infection-defense hypothesis” of depression, which suggests that the immune system helps regulate mood to increase the body’s defense against infection (Midori T, 2011). Moods, which can drive different physical and behavioral responses, play an adaptive role by helping to fight existing infections, as well as helping both individuals and their family to avoid new ones (Anders S, 2013). This “infection-defense hypothesis” proposes that immune vulnerability to infection elicits a depressed mood, which in turn stimulates behaviors that help protect vulnerable individuals against infectious diseases (Midori T, 2011).
  • DENTAL HEALTH: Poor dental health can be a source of inflammation and affect overall health. Tooth infection, oral bacteria, tooth decay and exposure to mercury through amalgam fillings can all contribute to inflammation and poor health. There is less research on dental disease as it relates to depression, yet it should not be overlooked (Kisely S, 2016).
  • EXERCISE: Many studies have demonstrated that exercise reduces symptoms of depression. One study specifically found that aerobic exercise, three times per week, at a moderate intensity, for a minimum of nine weeks was the most effective in the treatment of depression (Stanton R, 2014). Another older study done in 2005 found that exercising 5 times per week led to the disappearance of symptoms of depression in 42% of the study subjects (Dunn AL, 2005).
  • COGNITIVE THERAPY (CT): Research has found that cognitive therapy is as effective as antidepressant medications at treating depression (DeRubeis RJ, 2008). Furthermore, its effects are longer lasting as therapy reduces the risk of relapse even after it is discontinued (DeRubeis RJ, 2008). Patients treated with CT learn to apply the CT strategies whenever they are in a situation in which they could potentially fall back into the habit of thinking negatively (DeRubeis RJ, 2008). They learn and begin to put into practice new skills, which result in a change in the patient’s general beliefs about themselves and their reactions become less negative (DeRubeis RJ, 2008).
  • SLEEP: Sleep is critical for good mental health. One study found that insomnia increases the risk of subsequent depression amongst people with insomnia (American Academy of Sleep Medicine, 2008). Seventeen to 50% of subjects with insomnia lasting two weeks or longer developed a major depressive episode (American Academy of Sleep Medicine, 2008). It has also been found that there is a link between poor sleep and suicidal behavior (American Academy of Sleep Medicine, 2008). In a study of depressed patients, 8% had sleep disturbances (American Academy of Sleep Medicine, 2008). Sleep loss is a risk factor in the development of insulin resistance, impaired glucose tolerance and type 2 diabetes mellitus (Saner NJ, 2018). We saw earlier that blood sugar imbalances and insulin resistance can contribute to depression.
  • STRESS: We know that chronic stress and stressful life events can contribute to depression (Shadrina M, 2018). Therefore, it is important to reduce stress wherever possible, perhaps by taking on fewer obligations. Stress management is also key and activities like meditation, yoga, tai chi, listening to music and spending time outdoors can all be very calming and help to reduce the stress response of the body.

If you or someone you know is suffering from depression, get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

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October 24, 2019

Depression & the Gut: Are they linked & what is the link? Part 1: Depression, in the Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

We’ve written about the gut-brain axis and anxiety, ADHD and autism. In this week’s article on the gut-brain axis, we address depression and the gut. The gut and the brain are linked by the “gut-brain axis”, which regulates brain function and behavior (Chunlong Mu, 2016). For a full explanation of the gut-brain axis, please see our first article on anxiety and the gut.

The gut-brain axis plays a critical role in many neurological disorders. It affects neuropsychiatric disorders like anxiety, depression, schizophrenia and dementia (Kim YK, 2018), as well as neurodevelopmental disorders in children including autism, ADHD, learning disabilities, intellectual developmental disorder, motor disorders, and specific learning disorders (EPA, 2015).

In this article, we will explore the link between depression and the gut-brain axis. Major depressive disorder, usually just called ‘depression’, refers to a psychological state characterized by a low mood and an aversion to activity. Depression is a widespread chronic medical illness that can affect thoughts, behaviors, feelings, mood, physical health and overall sense of well-being. Typical traits of depression are low mood, lack of energy, sadness, insomnia, and an inability to enjoy life.

Key facts about Depression:

 CAUSES OF DEPRESSION:

A person’s susceptibility to depression and other mental health issues depends on genetic and epigenetic (i.e. social and environmental) factors. These factors are connected, as epigenetics can activate a genetic predisposition.

Like many of the complex conditions we have written about (anxiety, ADHD, autism, fibromyalgia, hypertension), there is not one single cause of depression. Instead many possible causes of depression exist. Conventional wisdom says that depression is genetic and caused by a chemical imbalance in the brain. This may be true but there are other, possibly surprising, causes of depression; for example, blood sugar imbalance, inflammation and poor gut health. Other factors may be stress, trauma, medications and illness.

  • GENETIC VULNERABILITY: Family and twin studies show strong evidence that genetic factors contribute to the risk of depression (Shadrina M, 2018). One study using twin research data shows that the heritability rate for depression is 37% (Shadrina M, 2018). Data from family studies show a 2 to 3-fold increase in the risk of depression in children of parents with depression (Shadrina M, 2018). Heritability is especially relevant in the more severe forms of depression (Shadrina M, 2018).The severity of a person’s depression depends on whether it is inherited from the mother or father’s side (Shadrina M, 2018).
  • A CHEMICAL OR NEUROTRANSMITTER IMBALANCE in the brain: Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining a stable mood may play a significant role in depression and its treatment (Mayo Clinic, 2019).
  • HORMONES: Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions (Mayo Clinic, 2019)
  • STRESSFUL LIFE EVENTS & TRAUMA: Chronic stress and stressful life events are strong predictors of the onset of depression (Shadrina M, 2018). Prolonged activation of the stress response system of the body can cause a higher risk of obesity, heart disease, depression and other disorders (Shadrina M, 2018). Many studies have looked at the link between Adverse Childhood Experiences (ACEs) and mental and physical health in later life as an adult. ACEs are defined as childhood abuse, neglect, psychological stress, being spanked as a child, sexual abuse, violence against mother, living with household members who were substance abusers and general household dysfunction (Felitti VJ, 1998). People who reported experiences of childhood adversity, compared to those who had experienced none, had increased health risks for alcoholism, drug abuse, depression, and suicide attempt; an increase in smoking, poor self-rated health, increase in physical inactivity, risky sexual behavior and sexually transmitted disease (Felitti VJ, 1998). Being spanked as a child was significantly associated with self-reported mental health issues (Merrick MT, 2017). Generally speaking, the more ACEs a person has experienced, the greater impact it has on health in adult life, with a higher incidence of mental health issues such as depression (Felitti VJ, 1998).
  • BLOOD SUGAR IMBALANCES: Blood sugar, or glucose, imbalances can cause mood issues. We have seen this clinically in our practice. Over time, a glucose imbalance will also lead to insulin resistance. Multiple studies have found that blood sugar disturbances and insulin resistance are closely associated with depression (Peng YF, 2017), (Lee JH, 2017) and (Timonen M, 2005).
  • POOR DIET: An unhealthy diet has recently emerged as a significant risk factor for depression (Dash S, 2015). Nutrition can play a key role in the severity and duration of depression as well as in the risk of becoming depressed in the first place (Sathyanarayana TS, 2008). Depressed people tend to have a poor appetite, skip meals, and eat excessive amounts of sweet foods. These dietary habits have been observed both during a depressive episode and before the depressive episode, indicating that poor nutrition is a risk factor (Sathyanarayana TS, 2008). Nutrient deficiencies can contribute to depression and are often seen in depressed people. The most common nutritional deficiencies seen in patients with mental disorders are: omega 3 fatty acids, B vitamins, minerals, and the amino acids that are precursors to neurotransmitters (Sathyanarayana TS, 2008). In addition to creating nutrient deficiencies and causing blood sugar highs and lows, an unhealthy diet causes systemic inflammation and is negative for gut health. As you read on, you will see that inflammation and gut health are key factors in the incidence of depression.
  • MEDICATION & MEDICAL PROBLEMS: Certain medications can have side effects that include mood disorders like depression (Harvard Health Publishing, 2019). Also, having serious medical problems, a life-threatening diagnosis or disease can affect one’s mood and be a potential epigenetic trigger that may bring on depression (Harvard Health Publishing, 2019).

Newer research has looked at inflammation and gut health as leading causes of depression:

INFLAMMATION:

There is ample data supporting the role of inflammation in depression (Miller AH, 2016). Patients with major depressive disorder exhibit all of the classic features of an inflammatory response, including increased amounts of inflammation-related cells of the immune system (Miller AH, 2016).

One study found that hs-CRP (high sensitivity C-reactive protein) is a reliable indicator of depression. Hs-CRP is a marker found in blood testing that indicates the level of systemic inflammation in the body. This study linked higher levels of hs-CRP in participants with depression (Pasco JA, 2010). Thus systemic inflammation is a risk factor for depression.

Further evidence was found in a study looking at post-mortem brain samples from suicide victims that had depression (Miller AH, 2016). Researchers saw an increase of various inflammatory proteins and other molecules in the brain samples (Miller AH, 2016).

In addition, giving inflammatory cytokines (inflammation-related molecules of the immune system) to non-depressed people causes symptoms of depression (Miller AH, 2016). In contrast, blocking these cytokines has been shown to reduce depressive symptoms in patients with medical illnesses, including major depressive disorder (Miller AH, 2016).

These inflammatory cytokines affect neurotransmitters and neurocircuits of the brain, leading to behaviors that are classified as depressive (Miller AH, 2016). Thus, the faulty brain chemistry observed in depression is, at least in part, a consequence of increased inflammation in the brain.

GUT HEALTH:

As we outlined in our first article of the Gut-Brain Axis series on anxiety, gut health is fundamental to brain health. The vagus nerve, the HPA axis, neurotransmitter status, short chain fatty acids and the immune system all impact the brain and can, if out of balance, cause mood-related issues. For a review of these factors, please see our anxiety article here.

One study looked at the specific bacteria strains found in the guts of depressed people and healthy, non-depressed people (Jiang H, 2015). There were material differences in the bacteria composition of the two groups. In the depressed patients, there was either a majority of some potentially harmful bacterial groups or a reduction in beneficial bacterial groups, when compared to non-depressed people (Jiang H, 2015).

Another study out this year, 2019, has found that people with lower levels of a specific gut bacteria called Bacteriodes enterotype 2 reported a lower quality of life and a tendency toward depression (Valles-Colomer M, 2019). People in the survey who reported a higher quality of life had higher levels of two other types of gut bacteria, Faecalibacterium and Coprococcus (Valles-Colomer M, 2019). These two bacteria strains produce the short chain fatty acid butyrate, which is known to reduce inflammation (Valles-Colomer M, 2019).

The gut is critical to depression as certain bacteria can reduce inflammation and, as a result, depression, given that depression is an inflammatory disorder.

Any GI infections or overgrowths will be an issue because they cause inflammation of the gut. This could be issues like dysbiosis, SIBO, candida, parasites, leaky gut, food sensitivities, histamine intolerance or others. We know that these issues cause gut inflammation, so therefore will potentially contribute to depression.

Improving gut health through probiotics can play a major role in the communication between the gut and the brain (Huang R, 2016). Multiple studies have looked at probiotics’ effect on mood and depression and probiotics were associated with a significant reduction in depression (Huang R, 2016).

TREATMENT:

Many treatment strategies for depression exist, including pharmaceuticals such as selective serotonin reuptake inhibitors (SSRIs) and lithium; medical technologies such as electroconvulsive therapy, deep brain stimulation, and bright light therapy, exercise, and music therapy.

However, approximately 33% of all patients with depression fail to respond to conventional antidepressant therapies (Miller AH, 2016). Medication may be significant in only the most severely depressed individuals (Huang R, 2016). There is other data suggesting that antidepressants are not as effective as the marketing of these drugs suggests (Ioannidis, 2008). Short-term benefits are small and the long-term balance of benefits and harms is not well documented (Ioannidis, 2008).

Side effects of antidepressants exist and can be serious. It has recently come to light that suicidal ideation and completion is a side effect of antidepressant drugs. One study found that as prescriptions of antidepressant drug have increased over time, so has the suicide rate (Larsson, 2017). In fact, 52% of the study subjects who committed suicide were prescribed antidepressants within a year of committing suicide (Larsson, 2017). Antidepressants were detected in 41% of the study subjects who committed suicide, indicating that they were under the influence of antidepressants at the time of death (Larsson, 2017).

Clearly, there is room for improvement in the treatment of depression. Please tune in next week to Part 2 of Depression and the Gut, where we will provide specific ways to address depression through functional medicine.

 

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October 15, 2019

Autism & the Gut: Are they linked & what is the link? Part 3 The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

Three weeks ago, we wrote a blog on Autism & the Gut Part 1 and covered some facts about ASD as well as some of the contributing factors as they relate to genes and the environment. Recently, in Autism & the Gut Part 2, we discussed all of the contributing factors including gut health and its important impact on ASD. This week, in Autism & the Gut Part 3, we will outline specific action steps that you can take with diet, supplements and lifestyle habits, to address ASD.

Autism Spectrum Disorder: What Can You Do?

Gut health

In the case of ASD, it is important to improve gut health. This can be done by addressing the issues discussed last week in Part 2. These are dysbiosis, leaky gut, food sensitivities, yeast overgrowth, imbalanced SCFA’s and NT balance. Also look for other GI issues that may exist (such as parasites, SIBO or other infections / overgrowths of the gut).

We strongly recommend working with a qualified functional medicine clinic to properly assess gut issues through lab testing. A good functional medicine practitioner can guide you through the process of finding the most significant gut issues and working on those, in addition to identifying toxins and other root causes we’ve discussed in this article. If you would like to book a free 15-minute discovery call with our clinic, please click here. We work with people all over the world.

Tools that can be used to modify the gut microbiome are diet, supplements, probiotics, prebiotics, fecal microbiota transplant (FMT), microbiota transfer therapy (MTT) and antibiotics (Kang DW, 2019).

Diet

  • Diet influences the composition of the gut bacteria and overall health of one’s gut. We talked about a general gut healing diet and what to avoid for gut health in our recent article on anxiety. The approach discussed is always recommended for good gut health.
  • A gluten-free and/or casein- or dairy-free (GF/CF) diet has been found to improve ASD behaviors, physiological symptoms, and social behaviors (Li Q, 2017). Gluten and casein increase zonulin, which is a protein that increases gut permeability. Removing gluten and casein from the diet will improve leaky gut. Two trials have demonstrated the benefits that excluding gluten and casein have for symptoms of ASD (Whiteley P, 2010).
  • Avoid glyphosate. By only buying and eating organic food, glyphosate can be avoided. In addition to being used on the obvious GM crops, it is now also used as a desiccant to facilitate harvest in many other non-GM crops, like wheat, legumes and others. It is commonly found in alcohol, namely beer and wine, as it is sprayed on the crops used to make the alcohol. By going strictly organic-only, glyphosate exposure can be eliminated.
  • The GAPS Diet (The Gut and Psychology Diet) may be helpful in some cases of ASD. It removes foods that are damaging to gut bacteria and are difficult to digest, replacing them with nutrient-dense foods that heal the gut lining thereby addressing leaky gut. It is a fairly strict elimination diet that requires removing grains, pasteurized dairy, starchy vegetables and refined carbs. It is particularly helpful for neurological issues such as autism (Campbell-McBride, 2019).
  • There is some evidence that the ketogenic diet (a high-fat low-carbohydrate diet) leads to decreases in the total gut microbial counts, increased sociability, reduced repetitive behaviors, and improved social communication in an ASD animal model (Li Q, 2017). Animal research does fail in human trials about 92% of time, so it remains to be seen whether this will be effective for humans.
  • Prebiotics encourage the growth of beneficial bacteria. We encourage adding them to the diet of someone with ASD. We list prebiotic foods to add here.
  • It is helpful to work with an experienced FM practitioner to see which dietary approach will work best as research shows this can be case-dependent. To book a complimentary 15-minute phone consultation to see whether functional medicine is a good fit for your child, please click here.
  • It can be challenging to change the diet of children with ASD. Children with ASD typically tolerate only a narrow range of foods and have more feeding problems than children without ASD. They tend to refuse more foods and eat a limited food repertoire than typically developing children. Many parents complain that their children with ASD are very selective, ‘picky’ eaters. Children with ASD will reject foods for different reasons, including issues with the food presentation, texture, the use of certain utensils, and the mix of different types of food on the same plate. It can require patience to get a child with ASD to adapt their diet. Dr. Campbell-Mcbride explores this topic and recommends how to handle this situation in her book The GAPS Diet, Gut and Psychology Syndrome.

Supplements

  • In the case of ASD, children typically eat fewer fruits, vegetables, and proteins than non-affected children (Li Q, 2017).
  • They have a significantly lower daily intake of potassium, copper, folate, and calcium (Li Q, 2017). Research has looked at folate, vitamin D, omega 3, iron and zinc deficiencies with some links to ASD (Modabbernia A, 2017) and another study finds that zinc, copper, iron, and vitamin B9 are specific micronutrients related to ASD (Nuttall, 2017).
  • Vitamin D deficiency seems to be quite common in children with ASD (Modabbernia A, 2017).
  • We would recommend supplements in the case of ASD:
  • A good multi-vitamin & mineral supplement can help cover the bases with vitamin and mineral deficiencies. Specific testing for micronutrients can help to target treatment much better so consider working with a FM practitioner for this type of testing. Unfortunately, most multi-vitamins contain some nutrients that are problematic so we recommend using professional brands. We recommend Mitocore by Ortho Molecular in our clinic and you can buy it from our online store here.
  • Increased intake of omega 3 reduces hyperactivity, increases good bacteria in the gut and reduces risk of brain disorders (Amminger GP, 2007). You can use Olde World Icelandic Cod Liver Oil from our online store here.
  • In addition, test for vitamin D and iron status and supplement these if necessary. Too much of either is a problem so we recommend working with a practitioner to find the right dosage.
  • Lactobacillus probiotics help treat dysbiosis by controlling Clostridia overgrowth and aid the digestion of casein and gluten (Pelto L, 1998). Probiotics help to prevent intestinal inflammation, regulate intestinal tight junctions and barrier function, thereby improving leaky gut (Li Q, 2017). Probiotic treatments have a proven ability to normalize the microbiota and improve gut symptoms (Li Q, 2017). You can use Ortho Biotic probiotic from our online store here.
  • L-glutamine has been shown to improve barrier function and reduce intestinal permeability (Foitzik T, 1997). Protocol for Life Balance is a good brand that you can get from our online store here.
  • Digestive enzymes can aid the breakdown of food proteins and can improve digestive function. We often use Digestzymes by Designs for Health in our clinic, found here.
  • Vitamin B6 and magnesium supplements improve social and language skills (Mousain-Bosc M, 2006). P-5-P is the active form of B6 and we like the product by the company Designs for Health. Magnesium Chelate contains the preferred glycinate form of magnesium and we like the product by Designs for Health. Both of these can be found in our online store here.
  • Manganese (Mn) is an important nutrient, required for multiple functions in the body. A recent study revealed that glyphosate, the active ingredient in the herbicide Roundup, has been shown to severely deplete Mn levels (Samsel A, 2015). Low Mn affects the gut brain axis and is associated with gut dysbiosis as well as neuropathologies such as autism, Alzheimer’s disease, depression, anxiety syndrome and Parkinson’s disease (Samsel A, 2015).

Fecal Microbiota Transplantation (FMT)

FMT is the transplant of healthy human feces to a patient with severe gut dysbiosis, in order to regulate the intestinal microbiota of the patient. When the normal gut microbiota are destroyed, for example by excessive antibiotic treatment or other negative substances like GMO foods, it can be challenging to recover a normal healthy bacterial flora. FMT can be extremely helpful in these situations (Kim YK, 2018). Unfortunately this is not FDA approved for ASD in the US at this time.

Microbiota Transfer Therapy (MTT)

MTT is a modified FMT protocol. It involves 14 days of antibiotic treatment followed by bowel cleansing and a high initial dose of standardized human gut microbiota for 7–8 weeks. An open-label clinical trial showed that MTT improved both GI symptoms (i.e., constipation, diarrhea, indigestion and abdominal pain) and ASD-related symptoms and normalized the microbiota of ASD patients (Kang DW A. J., 2017)

Heavy metals

Heavy metals, combined with an inadequate nutritional status and an impaired detoxification function, can increase the severity of ASD symptoms (Blaurock-Busch E, 2012). Eliminating exposure to heavy metals will help prevent neurodevelopmental disorders in children. In children with ASD, it is best to test for heavy metals. If there is an issue with metals exposure, then seek treatment by supporting the detoxification process of the body and/ or chelating heavy metals from the body if necessary. Seek out a skilled functional medicine practitioner for both of these approaches.

Support detoxification

ASD children have a reduced ability to detoxify toxins from the body (Blaurock-Busch E, 2012). It is therefore advisable to find a skilled FM practitioner to help support the detoxification process. This will help the body to eliminate toxins, metals, and the other chemical types we have discussed, which contribute to the overall ASD picture.

Avoid toxins

In addition to enhancing the detox function, it is important to minimize toxin exposures wherever possible. Avoid pollution, endocrine disruptors, plastics, pesticides, GMO’s, glyphosate, mold or mycotoxins. You can do this by eating a clean, organic diet, and avoiding toxins or chemicals as much as possible. This would include cleaning up the family’s personal care and household cleaning products, avoiding pollution wherever possible, minimizing plastics use especially in food preparation and storage, not smoking cigarettes and keeping alcohol consumption to a minimum.

Avoid stress

Stress is not named as a cause of ASD but a stressful situation can trigger a person with ASD. For this reason, it is advisable to reduce stress where possible and manage stress. Stress can be managed with meditation and other mindfulness practices. Practice mediation, yoga or tai chi and spend time outdoors in nature.

 

If you or someone you know is suffering from ASD, get in touch with our clinic today. Book a free 15-min discovery call to see how we can help you with your symptoms. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

 

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September 30, 2019

Autism & the Gut: Are they linked & what is the link? Part 2: Autism, in The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

Last week’s blog on Autism & the Gut Part 1 covered some facts about ASD as well as some of the contributing factors as they relate to genes and the environment. This week, in Autism & the Gut Part 2, we continue discussing the environmental factors that contribute to ASD, as well as cover gut health and its impact on ASD. Then in Autism & the Gut Part 3, we will outline specific action steps that you can take with diet, supplements and lifestyle habits, to address ASD.

In addition to what we covered last week, such as pre-natal factors, maternal nutrient deficiencies and environmental chemicals, these are Environmental Factors that can contribute to ASD:

  • Endocrine disruptors: These are chemicals that disrupt the endocrine (hormone) system of the body. Exposure to these chemicals pre-natally and in very early life can affect brain development.
    • It is thought that the effect of excessive testosterone on specific brain regions might be a key mechanism to push the brain to an extreme male pattern of more systematizing and less empathizing, which is in line with ASD characteristics (Modabbernia A, 2017). Therefore, factors that alter hormonal balance (and particularly fetal testosterone) might contribute to risk of ASD.  For example, flame retardants are both associated with an increased level of free testosterone and an increased risk of ASD (Modabbernia A, 2017).
    • Recent studies have shown that chemicals associated with lower testosterone levels are also associated with lower risk of autistic behaviors (Modabbernia A, 2017).
    • Another link between endocrine disruptors and ASD is alteration in thyroid function. Several studies have shown evidence of prenatal maternal thyroid dysfunction and ASD in the offspring (Modabbernia A, 2017). Many endocrine-disrupting chemicals that disrupt thyroid hormone function have also been hypothesized to increase the risk of ASD (Modabbernia A, 2017).
    • Studies of phthalate (an endocrine disruptor) exposure showed a significant association between phthalate exposure and risk of ASD (Modabbernia A, 2017).
  • Metals: Heavy metals, such as lead, cadmium, mercury, etc. are established neuro-toxins with documented impacts on cognitive and developmental outcomes (Lyall K, 2017).
    • Studies found an association between heavy metal concentration (mostly mercury and lead) and severity of ASD (Modabbernia A, 2017).
    • Twelve studies described improvement in symptoms of ASD following chelation therapy (a technique used to remove heavy metals from the body) (Modabbernia A, 2017).
    • In a genetically sensitive individual, toxic metals cause significant oxidative stress. This leads to impaired methylation/processing of folate and alters the capacity for synchronizing neural networks as a result of an impaired dopamine function (Modabbernia A, 2017). This affects epigenetic mechanisms, leading to abnormal gene expression. Both mechanisms, impaired synchronization of neural networks and epigenetic alterations related to methylation, are closely linked to ASD (Modabbernia A, 2017).
  • Glyphosate: Glyphosate is the active ingredient in Roundup Ready, the most widely used herbicide in the world (Samsel A, 2015). Glyphosate is liberally used on core food crops, because it is perceived to be non-toxic to humans. The adoption of genetically engineered “Roundup-Ready” corn, soy, canola, cotton, alfalfa, and sugar beets has made it relatively easy to control weeds without killing the crop plant, but this means that glyphosate is present as a residue in foods.
    • As weeds among GM Roundup-Ready crops are developing ever-increasing resistance to Roundup, use of the herbicide is increasing. In fact, its usage has increased steadily since 1987, in step with the rise in ASD rates (Samsel A, 2015).
    • In one study, the authors wrote: “Despite its relatively benign reputation, Roundup was among the most toxic herbicides and insecticides tested.” (Samsel A, 2015)
    • One paper states that this may explain the recent increase in incidence of multiple neurological diseases (Samsel A, 2015).
    • Glyphosate indirectly affects Lactobacillus, leading to increased anxiety via the gut–brain access (Samsel A, 2015). Both low Lactobacillus levels in the gut and anxiety syndrome are known features of ASD, and Lactobacillus probiotic treatments have been shown to alleviate anxiety and ASD (Samsel A, 2015).
    • Glyphosate indirectly results in mitochondrial damage, a hallmark of many neurological diseases and a factor in ASD (Samsel A, 2015).
    • This is a controversial topic, but glyphosate is frequently named as an environmental factor driving the rise in ASD that we see today.
  • Inflammation & immune system function: ASD is associated with an altered immune status, increased oxidative stress, and inflammation in the brain.
    • Concentrations of pro-inflammatory immune system molecules are increased in patients with ASD compared to those in healthy people (Modabbernia A, 2017).
    • A maternal autoimmune disease can increase the risk of ASD through the effect of maternal inflammatory mediators and autoantibodies on fetal neurodevelopment (Modabbernia A, 2017).
    • Substances such as lead, mercury, pollutants, or perinatal complications can cause inflammation and oxidative damage in the brain, which can impair neural growth and development (Modabbernia A, 2017).
  • Neurotransmitter changes and interference with signaling pathways in the brain: Neurotransmitters (NTs) are chemicals in the brain responsible for signaling. We wrote in some detail about NTs in our article on anxiety.
    • Abnormalities in the NTs glutamate, serotonin and GABA have been linked to ASD (Modabbernia A, 2017).
    • Some of the issues discussed already, like lead, environmental pollutants and flame retardants, disrupt the activities of NTs; NMDA, glutamate and GABA respectively (Modabbernia A, 2017).
    • Some environmental risk factors interact with intracellular signaling pathways and can impair neurodevelopment. For example, exposure to PCB and PBDE (chemicals used in plastics, construction, flame retardants, etc.) seems to alter a signaling pathway, leading to abnormalities in dendritic growth and neuronal connectivity, a key feature of ASD (Modabbernia A, 2017).

Gut health – As we have seen in our previous articles on the Gut Brain Axis (Anxiety, ADHD 1, ADHD 2, ASD 1), the gut microbiome is an important environmental factor that influences symptoms of various conditions, including ASD. Research has increasingly observed that children with ASD have distinctive gut microbiomes compared to neurotypical children (Kang DW, 2019). Thus through the microbiome-gut-brain axis, gut health influences ASD.

Gastrointestinal (GI) symptoms, such as abdominal pain, gas, diarrhea, constipation and flatulence, are common in people with ASD (Li Q H. Y., 2017). Constipation is found to be the most prevalent symptom (85%) in children with ASD (Li Q H. Y., 2017).

Other common symptoms are gut inflammation, intestinal permeability, low levels of digestive enzymes/ poor digestion, reflux esophagitis, impaired detoxification and dysbiosis (Horvath K, 1999). The prevalence of GI symptoms ranges from 23 to 70% in children with ASD (Li Q H. Y., 2017).

It has been found that improvements in GI and ASD symptoms are significantly correlated (Kang DW, 2019). In other words, attaining relief of GI symptoms may improve behavioral severity in children with ASD (Kang DW, 2019).

Dysbiosis, or an imbalance in gut flora with more bad bacteria than good in the gut, has been found in cases of ASD. Diversity, or the variety of gut bacteria found in people with ASD, is about 25% lower than in healthy people (Kang DW A. J., 2017). Their guts are missing hundreds of different species of bacteria, often ones that are important to fermentation and producing short chain fatty acids that influence health (Kang DW A. J., 2017).

For example, the guts of children with ASD exhibit lower levels of Bifidobacterium and Firmicutes and higher levels of Clostridium, Bacteroidetes, Desulfovibrio, Caloramator and Sarcina (Li Q H. Y., 2017). Children with autism who present GI symptoms have lower abundances of the species Prevotella, Coprococcus, and unclassified Veillonellaceae than that found in GI symptom-free neurotypical children (Li Q H. Y., 2017).

Clinical trials using fecal microbiota transplants (FMT) have shown promise with ASD. One trial using high-dose FMT for 1-2 days and then 7-8 weeks of highly purified oral solution dosing found significant GI and behavioral improvements (Kang DW A. J., 2019). A 2-year follow-up found that these positive changes continued to improve over time (Kang DW A. J., 2019). However, FMT is not FDA approved for ASD at this time, so it may be some time before this therapy is available in the US.

Re-establishing a healthy gut microbiome benefits the gut-brain axis that has become dysfunctional in ASD (Kang DW A. J., 2017). Also, simply removing the pain and distraction of a dysbiotic gut can help children concentrate better and benefit from speech, behavioral and other therapies they may be undergoing (Kang DW A. J., 2017).

In addition to dysbiosis, leaky gut is involved in ASD. A higher percentage of abnormal intestinal permeability, or commonly called leaky gut, was observed in 36.7% of patients with ASD compared with 4.8% of control children (Li Q H. Y., 2017).

In fact, the integrity of both the gut barrier and the BBB were impaired in ASD individuals (Li Q H. Y., 2017). Increased intestinal permeability results in the entry of the toxins and bacterial products into the bloodstream.

These circulating inflammatory molecules are then able to cross the blood-brain barrier, creating inflammation and immune responses in the brain (Li Q H. Y., 2017). For example, lipopolysaccharide (LPS), components of the cell wall of gram-negative bacteria, is increased in the serum of ASD compared with healthy individuals and is associated with impaired social behavior (Li Q H. Y., 2017).

Food sensitivities are often a problem, which ties back to a dysfunctional gut. Over 40% of children with ASD have food sensitivity issues, most commonly to wheat and milk products (Horvath K P. J., 2002).

The breakdown of gluten by pancreatic and intestinal enzymes produces ‘exorphins’ or undigested proteins.  When leaky gut is present, these undigested proteins can then enter into circulation and the central nervous system where they have a morphine-like effect (Reichelt K, 2003).

An increase in proteins, including opiates, has been linked to disruption in social awareness and behavior (Reichelt K, 2003). This sequence of events can occur with casein, from dairy products, as well (Reichelt K, 2003). Finally, gluten and casein increase zonulin, which is a protein that increases gut permeability i.e. leaky gut.

There is also a relationship between gut fungi or yeast and ASD. Yeast in the gut, particularly candida albicans, can result in less carbohydrates and minerals absorption and a higher release of toxins (Li Q H. Y., 2017).

A lower yeast rate of 19.6% was identified in non-autistic healthy volunteers (Li Q H. Y., 2017). It was found that in children with ASD, candida was two times more abundant than in normal individuals and that 81.4% of the yeast strains were candida, especially candida albicans (Li Q H. Y., 2017).

Candida can release ammonia and toxins that can induce autistic behaviors (Li Q H. Y., 2017). The changes in the bacterial microbiota in ASD individuals result in the growth of candida, which worsens the dysbiosis and can induce abnormal behaviors (Li Q H. Y., 2017).

SCFAs also play a critical role in patients with ASD. We talked about SCFAs here. SCFAs are products of the gut bacterial fermentation of carbohydrates and provide benefits to the human body.

Different SCFAs can be imbalanced in the gut of ASD patients. For example, proprionic acid, PPA, is a short-chain fatty acid that is mainly produced by Clostridia, Bacteroidetes, and Desulfovibrio bacteria, which are more frequently found with ASD, and can cross the BBB and induce ASD-like behaviors (Li Q H. Y., 2017). Higher PPA can lead to impaired social behavior, likely by altering some neurotransmitters, such as dopamine and serotonin (Li Q H. Y., 2017).

Finally, the impact of glyphosate on the gut is complex and multi-faceted. We cannot go into the tremendous amount of detail here but Stephanie Seneff has done so in this paper (Samsel A, 2015). There are multiple ways in which glyphosate can contribute to and worsen ASD. We advise avoidance and will explain how you can do that later in this article series on ASD.

Treatments used to date for ASD include behavioral therapy, speech and social therapy, diet / nutrition and medical treatments. However no medical treatment has been approved to treat core symptoms of ASD, such as social communication difficulties and repetitive behaviors (Kang DW, 2019). Considering the link between the gut and brain, the first approach should be to address gut health.

— To Be Continued —

Due to the complexity of ASD, we can’t cover everything that we want to say in one blog post. So please tune in again next week for ASD: Part 3, when we will outline specific action steps related to diet, supplements and lifestyle that you can take to address ASD.

If you want to address ASD sooner, then please get in touch with us today, by booking a free 15 minute discovery call here. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

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September 24, 2019

Autism & the Gut: Are they linked & what is the link? Part 1: Autism, in The Gut-Brain Axis Series

by Nicola Schuler, CNTP, MNT and Dr. Miles Nichols

In this week’s article on the gut-brain axis, we address autism and the gut. The gut and the brain are linked, with the gut-brain axis regulating brain function and behavior (Chunlong Mu, 2016). For a full explanation of the gut brain axis, please see our first article on anxiety and the gut.

The gut-brain axis plays a critical role in many neurological disorders. It affects neuropsychiatric disorders like anxiety, depression, schizophrenia and dementia (Kim YK, 2018), as well as neurodevelopmental disorders in children including autism, ADHD, learning disabilities, intellectual developmental disorder, motor disorders, and specific learning disorders (EPA, 2015).

In this article, we will explore the link between autism and the gut brain axis. Autism, or autism spectrum disorder (ASD), is a brain developmental disorder (Li Q, 2017).

ASD is defined by significant social, communication and behavioral challenges, often with a pattern of stereotyped repetitive behaviors, speech and nonverbal communication behaviors and challenges with communication and social interaction (Li Q, 2017).

As autism is classified as a spectrum disorder, it affects sufferers differently (Autism Speaks, 2019). Cognitive abilities of people with ASD range from extremely gifted to severely challenged. Some with ASD need significant support in daily life, while others need less and some can live entirely independently.

ASD is often accompanied by sensory sensitivities, gastrointestinal (GI) disorders, immune deficits, anxiety, depression, sleep disturbances, seizures and attention issues (Lyall K, 2017).

A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder (Centers for Disease Control and Prevention, 2018).

Important facts about ASD:

  • The prevalence is increasing (Autism Speaks, 2019). According to the CDC (Centers for Disease Control and Prevention, 2019):
  • In 2004, 1 in 166 children had ASD.
    • In 2006, 1 in 150 children had ASD.
    • In 2016, 1 in 68 children had ASD.
    • In 2018, 1 in 59 children had ASD, according to Autism Speaks, who used data from the CDC (Autism Speaks, 2018).
    • However, according to Pediatrics journal, using data from the 2016 National Survey of Children’s Health (NSCH), in 2018, 1 in 40 children had ASD (Kogan MD, 2018).
  • Some of this increase is due to better and earlier diagnosis, but there is debate about whether this explains all of the increase in ASD rates. This will become clear when we discuss causes. Our genes have not and cannot change so quickly, but our environment has. Thus some environmental changes or triggers are thought to be partially driving the increases seen.
  • Boys are four times more likely to be diagnosed with autism than girls (Centers for Disease Control and Prevention, 2019). Of the 1 in 59 children diagnosed with ASD in 2018: 1 in 37 are boys and 1 in 151 are girls.
  • However, the gender gap in autism has decreased (Autism Speaks, 2018). While boys were 4 times more likely to be diagnosed than girls in 2014, the difference was narrower than in 2012, when boys were 4.5 times more frequently diagnosed than girls (Autism Speaks, 2018). This is likely due to improved identification of autism in girls, who often do not manifest the stereotypical symptoms of autism seen in boys.
  • 31% of children with ASD have an intellectual disability (with an IQ <70), 25% are in the borderline range (IQ 71–85), and 44% have IQ scores in the average to above average range (IQ >85) (Autism Speaks, 2019).
  • ASD is one of the most serious neurodevelopmental conditions in the U.S. It has significant caregiver, family, and financial burdens. The annual total costs associated with ASD in the U.S. have been estimated to be approx. $250 billion (Lyall K, 2017). Lifetime individual ASD-associated costs are in the $1.5 to $2.5 million range (estimates in 2012 U.S. dollars) (Lyall K, 2017).

Most children are still being diagnosed after age 4, though autism can be reliably diagnosed as early as age 2 (Autism Speaks, 2019). Diagnosing ASD can be difficult. There is no medical test, such as a blood test, to diagnose it (Centers for Disease Control and Prevention, 2018).

Doctors look at the child’s behavior and development to make a diagnosis. It can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered to be very reliable (Centers for Disease Control and Prevention, 2018).

What are the CAUSES or Contributing Factors?

The causes of ASD are not completely understood. Studies on twins suggest that both genes and environment play roles in the development of ASD (Modabbernia A, 2017). The developing brain is vulnerable to environmental factors, which explains the causative association between environmental factors and ASD (Modabbernia A, 2017).

Some studies show ASD is primarily driven by genetic influences, and others report a nearly equal contribution from heritable genetic and non-heritable environmental factors (Lyall K, 2017). One study found that up to 40-50% of autism spectrum disorder (ASD) liability might be determined by environmental factors (Modabbernia A, 2017). Because environmental and epigenetic influences are not as well studied as genetic ones, there may be a much greater impact of environment than has appeared in studies so far.

Metabolism, gut, immune and mitochondrial dysfunction are frequent in ASD (Lyall K, 2017). Among children with ASD, gastrointestinal symptoms have also been associated with more frequent challenging behaviors (Lyall K, 2017).

It is clear that there are three areas to look at to explain ASD:

  • Genes
  • Environment
  • Gut health

Genes – It is possible to have a genetic disposition to the condition. The fact that genes partly contribute to ASD is strongly supported by twin and family studies (Lyall K, 2017). Several genes have been identified in ASD; post-synaptic scaffolding genes, i.e. SHANK3, contactin genes, i.e. CNTN4, neurexin family genes, i.e. CNTNAP2, and chromatin remodeling genes, i.e. CHD2 (Lyall K, 2017). The specific genes involved are part of common genetic pathways involved in ASD (Lyall K, 2017). The cumulative effect of multiple common gene issues, i.e. the polygenic risk, is now becoming recognized as an important risk factor for ASD and other psychiatric disorders (Lyall K, 2017).

Epigenetics is the study of gene-environment interaction. Unfortunately there is little information on gene-environment interaction in ASD causality, as only a few studies have been published to date (Lyall K, 2017).

Some epigenetic changes have been found in the brains of people with ASD, including hypo- and hyper-methylation, i.e. related to the MTHFR gene, and spreading of histone 3 lysine 4 trimethylation marks (Lyall K, 2017). We talked in detail about MTHFR here.

Research has found an increased risk of ASD associated with common mutations affecting the folate/methylation cycle i.e. the MTHFR mutation (El-Baz F, 2017). A significant association between severity and occurrence of autism has been found with two common MTHFR gene mutations, called C677T and A1298C (El-Baz F, 2017). Further studies are needed to explore other gene mutations that may be associated with autism, to establish the genetic basis of autism. (El-Baz F, 2017)

Other genetic variants for ASD implicate chromatin remodeling, another aspect of epigenetic regulation (Lyall K, 2017). Other reports suggest interactions between gene risk and prenatal exposure to air pollutants, genes in the one carbon metabolism pathway and maternal use of prenatal vitamins, and genetic variations and maternal prenatal infection (Lyall K, 2017).

Environment – This can be an outright cause or a trigger of ASD. Systematic reviews of the available research suggest more than 20 individual, familial, pre-, peri- and neo-natal factors with some evidence for ASD risk (Lyall K, 2017).

The maternal environment is especially important for the risk of developing autism spectrum disorders. In particular infections present in a mother during pregnancy, micronutrient deficiencies, obesity, and toxic exposures are likely to interact with genetic risk factors to disrupt fetal brain development (Nuttall, 2017).

One study suggests that approximately 75-80% of the observed increase in ASD since 1988 is due to an actual increase in the disorder rather than to changing diagnostic criteria (Nevison, 2014). It attributes the increase to environmental factors driving this increase (Nevison, 2014).

For example, polybrominated diphenyl ethers (used in flame retardants, building materials, electronics, furnishings, motor vehicles, airplanes, plastics, polyurethane foams, and textiles), aluminum adjuvants (used in vaccines), and the herbicide glyphosate have increasing trends that correlate positively to the rise in autism (Nevison, 2014).

Environmental factors driving ASD risk include:

  • Parental age: Every 10-year increase in maternal and paternal age increases the risk of ASD in the offspring by 18 and 21% respectively (Modabbernia A, 2017).
  • Inter-pregnancy interval: Increases in risk of ASD with a short (<12 months) period between pregnancies have been consistently reported. Reasons for this are not clear but relate to maternal nutrient deprivation, inflammation, and stress (Lyall K, 2017). Adequate recovery time between pregnancies is recommended.
  •  Pregnancy-related complications: Abnormal or breech presentation, cord complications, fetal distress, multiple births, low birth weight <1500 g, small for gestational age, congenital malformations, birth injury or trauma, hyperbilirubinemia, earlier birth (first vs. third born) and feeding difficulties at birth can all play a role (Modabbernia A, 2017).
  • Immune factors: Maternal hospitalization with infection (bacterial or viral) during pregnancy has been associated with increased risk of ASD (Lyall K, 2017). Familial history of autoimmune disease has also been associated with increased risk of ASD (Lyall K, 2017).
  • Medication use during pregnancy: Antidepressants, anti-asthmatics, and anti-epileptics (especially maternal valproate use for epilepsy and bipolar disorder) are associated with ASD in the children (Modabbernia A, 2017). Some association with SSRI anti-depressants exist but are not fully established in the research (Modabbernia A, 2017). However, these drugs can cross the placenta and blood brain barrier (BBB), as well as be transferred to the child through breast milk (Lyall K, 2017).
  • Nutrient deficiencies: Research has looked at folate, vitamin D, omega 3, iron and zinc deficiencies with some links to ASD (Modabbernia A, 2017). One paper finds that zinc, copper, iron, and vitamin B9 are specific micronutrients related to ASD (Nuttall, 2017). Specific toxins can induce a maternal inflammatory response which leads to fetal micronutrient deficiencies in these nutrients (Nuttall, 2017). The fetal deficiencies disrupt development of the early brain (Nuttall, 2017). Maternal micronutrient supplementation is advised as it is associated with reduced risk of ASD (Nuttall, 2017). Higher maternal intake of certain nutrients and supplements has been associated with reduction in ASD risk, with the strongest evidence for taking folate supplements before conception (Lyall K, Schmidt RJ, 2014). In later life, vitamin D deficiency seems to be quite common in children with ASD (Modabbernia A, 2017).
  • Environmental chemicals: We are exposed to a vast, almost countless, number of environmental and industrial chemicals in today’s world. Certain environmental chemicals exposures during the pre-natal period interfere with and disrupt normal brain development in the fetus. These chemicals can cross the placenta and the blood brain barrier, accumulating in developing brains (Lyall K, 2017). Others disrupt hormone pathways or act on inflammatory pathways that may have negative effects on brain development (Lyall K, 2017). Prenatal exposure to air pollution has emerged as a risk factor for ASD. These are hazardous air pollutants, such as chlorinated solvents, methylene chloride and diesel particulate matter and others (Lyall K, 2017). Chemicals in flame retardants can result in mitochondrial toxicity and lead to issues with energy balance in the brain (Modabbernia A, 2017). In general, chemicals can contribute to the mitochondrial dysfunction that is well documented in people with ASD (Modabbernia A, 2017).

— To Be Continued —

Due to the complexity of ASD, we can’t cover all of the factors contributing to ASD in one blog post. So please tune in again next week for ASD: Part 2 where we will continue with the environmental factors that contribute to ASD. We will also discuss gut health and how it contributes to ASD. Finally, in ASD: Part 3, we will outline what diet, supplements and lifestyle action steps you can take to address ASD.

If you want to address ASD sooner, then please get in touch with us today, by booking a free 15 minute discovery call here. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

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