For anyone with small children with Autism, this article is my Christmas present to your child.
There is growing scientific evidence that an imbalance of intestinal bacteria called SIBO (Small Intestinal Bacterial Overgrowth) is responsible for triggering Autism.
Small numbers of bacteria live in the upper, small intestine with larger numbers of bacteria down in the colon. SIBO happens when colonic bacteria migrate up into the small intestine and cause symptoms.
SIBO symptoms include heartburn after particular foods such as tomatoes, spices, bell peppers, or lettuce. SIBO also causes IBS, anxiety, eczema, and it can trigger many autoimmune disorders or cause inflammatory pain in joints and muscles.
SIBO is being linked through a variety of studies to cause a chemical inflammatory state within the brain often referred to as metabolic inflammation. This inflammatory process is triggered by the priming (a state of permanent activation) of the primary white blood cell within the brain, microglia.
Primed microglia are being linked to a phenomena referred to as cumulative brain injury or CBI. Under normal healthy conditions, the human brain is designed to fully recovery from most physical, emotional and inflammatory injuries. But once the microglia are primed, some residual damage is left behind after each of these injuries and is added to prior residual damage leading to CBI.
This same microglial inflammatory state slows down synaptic pruning during childhood development and is responsible for most developmental delay as well. The underlying neuroinflammation in children with Autism greatly contributes to their developmental delay, unresolved autonomic damage from head injuries that lead to ADD and ADHD, and frequent seizures.
And finally, SIBO bacteria also produce a chemical called propionic acid. In autistic children, propionic acid levels are high. In animal studies, high propionic acid leads to the development of antisocial behaviors, increased sensitivity to sound, light, and touch, as well as gait abnormalities.
By eliminating the propionic acid production from SIBO and reversing the microglial inflammatory state in the brain, I have successfully reversed the major features of Autism in many small children.
I use a prebiotic fiber called inulin to reverse and control SIBO, and high doses of omega-3 fatty acids to normalize microglial function and normalize the inflammatory state within the brain. Cooking with extra virgin olive oil also helps reduce inflammatory from excessive omega-6 fatty acid (linoleic acid) exposure from vegetable oils.
Inulin is a natural fiber found in onions, garlic, artichokes, and chicory root. You can buy powdered inulin online. I prefer Fiber Choice gummies that can be found at local pharmacies and grocery stores. Remember, the first ingredient must be inulin. 2-4 inulin gummies a day often reverses SIBO propionic acid enough to allow a preschool age, non-verbal autistic child, to begin speaking within 4-6 weeks.
This is equal to ¼ to 1 teaspoon of powdered inulin daily. If the children do not like the gummies or they are not available, I recommend pure powdered inulin (without additives such as enzymes or probiotics). Inulin is heat-tolerant and can be mixed or sprinkled over any form of liquid or food. NOW Foods makes a reasonably priced pure organic inulin and is found at many online retailers.
My patients take 2 Nordic Omega-3 Fishies (made by Nordic Naturals), a dose of 600 mg of omega-3 fatty acids per day. This equals about 600 mg of omega-3 (DHA + EPA).
If the Nordic Fishies are not available, it can be replaced with other forms of fish oil liquid or capsules. I recommend buying a high-quality brand that has been verified by an outside agency as there is a very high level of fraud in the supplement industry.
All families are asked to cook their foods in extra virgin olive oil (EVOO). EVOO contains 70% oleic acid, and oleic acid reverses the underlying inflammation coming from excessive linoleic acid toxicity. Linoleic acid is most commonly found in the unnatural vegetable oils added to the foods we purchased. See my other post about omega-3/omega-6 rebalancing for more information.
Reversal of SIBO with inulin results in a drop of propionic acid and can result in a sudden improvement in function within a few weeks. But many children don’t fully return to normal because they still have an underlying developmental delay (some quite severe) as well as ADD, ADHD, chronic depression or anxiety/aggressive states.
These remaining conditions take longer but week by week things will slowly improve. If there is no significant improvement within 2 months I generally increase the dosage of omega-3 fatty acids and even add vagus nerve stimulation if necessary.
Omega-3 fatty acids reduce neuroinflammation and have been associated with a significant reversal of delays and seizure activity. I have witnessed inulin fiber and high dose omega-3 put autism in near-complete remission in small children.
The brains of older kids have experienced prolonged SIBO and stress and take longer to show improvement, but I have seen significant progress in older kids as well but children older that 8 often require more effort to reverse Autism.
I escalate the dose of omega-3 fatty acids up to a total of 3,000 mg (total of EPA and DHA) depending on weight with the top end of 3,000 mg being for a 160 lbs. or heavier teenager. Likewise, sometimes younger children need a higher dose if they don’t respond to the 600 mg dose after 2 months.
The inulin dose in older, larger children can safely go up to 2 teaspoons per day. Beyond that I haven’t seen any improve and it just seems to cause too much gas.
To gain better control of SIBO in older children I often treat with a 10-day course of Rifaximin (Xifaxan in U.S.). Rifaximin is a non-absorbable antibiotic that is only used for other SIBO conditions (hepatic encephalopathy and IBS with diarrhea).
Follow-up use of inulin after Rifaximin is sometimes used if intestinal symptoms are still present. If inulin doesn’t make any significant difference as follow-up therapy, I stop it. I never add probiotics after reset with Rifaximin because they can easily make things worse even if they helped prior to the use of Rifaximin. (Read more about my thoughts on Probiotics.)
The brains of older kids have experienced prolonged SIBO and stress and take longer to show improvement, but I have seen significant progress in older kids as well. I have some teenage non-verbal autistic boys (14 and 16 years of age) and they took about 4-5 months to begin speaking.
More recent is a remarkable case of a 23 year old non-verbal autistic child with frequent seizures. Within 8 months her seizures had reduced from 5-7 per day to 2-3 per week and she can write her name and speak in both Spanish and English (dual language family).
For Autistic children, consistent anti-SIBO efforts and fish oil consumption will need to be daily and possible forever. Just remember, the benefits are life changing, inulin fiber, omega-3 fatty acids and olive oil are from natural sources, are commonly consumed by most of us every day, and are available without a prescription.
I am an internal medicine physician and my private office is located in the greater Phoenix, Arizona area. For more information on my work with Autism, SIBO, and the Autonomic Nervous System you may call my office at 623-208-4226 or go from my website www.autonomicmed.com
Happy holidays from Jean and Patrick Nemechek.
Addendum March 8, 2017 – In response to “Isn’t autism a genetic disorder?”
This is where the recent surge of “genes-associated with autism” is causing great confusion. There is no evidence these genes themselves cause any of the features of autism.
Furthermore, if autism is a genetically-derived disorder or disease (the semantical difference misses the point), why was it very uncommon prior to 1950 and why is it increasing in frequency? There is no evidence that we are rapidly developing more mutations within 2-3 generations.
Autism is an inflammatory condition (from SIBO, microglial priming, linoleic acid exposure, AGE exposure) combined with a toxic encephalopathy from SIBO (production of propionic acid).
The propionic acid makes the kids act a little drunk and when the gut is stabilized, they can improve a little or a lot from this within just a few week. What remains is the developmental issues and overlapping neurological damage from the brain’s inability to prune synapses correctly and fully repair brain injuries (bumps on the head, vaccines, surgery, emotional trauma).
The inflammatory component is driven mainly from excessive priming of microglia to a M1-phenotype, and induces varying degrees of developmental delay depending on the intensity and the time of increase (in utero vs 12 months for instance). The same inflammatory process also inhibits recovery from physical and emotional traumas and is being demonstrated in a variety of animal models.
So my approach is quite straightforward. Rebalance gut bacteria (this lowers propionic acid production and reduces inflammation) along with a reduction in inflammation with omega-3 fatty acids supplementation and the supplementation with oleic acid (main constituent of olive oil) to reduce additional inflammation from linoleic acid toxicity.
Addendum March 23, 2017 – Notes on Recovery
My Experience with Autism Recovery:
Uniformly all the kids under my care (50-60 to date) seem to be improving in significant ways.
In terms of speech, some younger kids start speaking within a few weeks while kids in the teens might take 4-6 months. Our 23-year-old patient didn’t start speaking until after 8-9 months of treatment.
Importantly, even the most severe cases have a noticeable improvement in their awareness of heir surroundings within a week or 2. I interpret this as a decline in the toxic effect of the propionic acids on their brains. Parents report more eye contact, awareness or acknowledgement others have entered the room. They also seem more tolerant of being touched or held, or are more willing to approach someone and be physically close to them.
After the first few weeks, recovery rates are highly variable, and I believe this is due to the degree of developmental delay underlying the toxic state. If the inflammatory cytokine process has been going on since birth, there can be so much developmental delay as to be labeled mentally retarded. But if the developmental delay is simply mild, kids may seem very functional quickly.
The important point to remember is that your child’s brain and an enormous capacity to continue the path of development once the inflammation is controlled. Neuronal/synaptic pruning will re-initiate, and according to the developmental delay literature, they can catch-up about 2-3 months of development for every 1 calendar month. In my estimation, it seems to advance this fast if not faster.
The underlying wild card is what gene has been activated by the inflammation and what might it do to the neurological impairment of your child’s brain. The inflammatory environment that prevents normal synaptic pruning and recovery from brain injury also triggers the litany of genes being found in autism.
Inflammatory cytokines abnormally produced by the mother are affecting the child’s nervous system within the womb, and then the imbalance of intestinal bacteria of the child as well as high omega-6 food sources continue to fuel the inflammatory process within the child after birth.
These inflammatory cytokines are the primary process through which the genes within the DNA that had been dormant for 1,000’s of years in the child’s ancestors are finally activated, begin altering how cells function, and contribute to the overall variety of neurological, behavioral characteristics that manifest in autism.
Here’s the potential for recovery in the autistic brain. A 23-year old non-verbal autistic female (Lennox-Gastaut Syndrome), was having 6-8 seizures per day and had never held her parents gaze for her entire life. She did not like to be held, could not color or write, and sat curled up in a chair most of the day rocking.
Within 2 months’ of starting our protocol (rifaximin, high dose omega-3 fatty acids, and mother cooking with California olive oil), her seizures had dropped to 1-2 a day, she would sit upright in a chair and she slept through the night.
At month 4 she started looking her parents in the eyes and holding their gaze, and was more able to be touched and hugged.
At her month 6 office visit, she started smile at me, her seizures had reduced to 1-2 per week, she could now write her name (although she had never been shown previously) and could draw objects that were recognizable.
At 8 months, she began speaking rudimentary Spanish and English (dual language household) but emotionally is behaving as if she is 3 years old.
At 18 months, she speaks very clearly in full sentences, her seizures have declined to 1-2 per month (despite discontinuation of 2 seizure medications), and her emotional maturity has risen to about that of a 4-5-year-old.
But don’t despair. No matter how badly the developmental delay has slowed brain maturation, the potential for an unbelievable recovery is present. We are beginning to understand that once human genes are turned on by inflammation, they can ultimately be shut back off again once the inflammatory environment within the body is significantly reduced.
Do your best to be patient and give this approach a chance. Because the path to recovery over all things medical is 3 steps forward, and 1-2 back, compare today’s behavior to last month’s, not yesterday’s. The neurons within the human brain, like your hair, can only grow and change only so fast.
Every month, your child’s brain has the ability to “catch-up” 2-3 months in development. That means every calendar year, they may catch-up 2-3 years. I believe once the inflammation is suppressed, all that is required for recovery is a good solid inflammation suppressing regimen and patience.
© Copyright 2015-2017. Dr. Patrick M. and Jean R. Nemechek. All rights reserved.