Gastrointestinal Issues

Written By Brittyn Coleman, MS, RDN/LD
 
 

What are Gastrointestinal Issues?

  • Children with ASD are nearly 8 times more likely to have at least one GI symptom, though constipation is the most common. GI issues were directly linked to increased problem behaviors such as self-injurious behaviors, restricted stereotyped behaviors, aggressive behaviors, sleep problems and attention problems. Autism severity can be correlated to the severity of GI issues. Addressing the gut can be foundational in addressing underlying nutrition issues for autism.

  • Having regular and healthy Bowel Movements (BMs) is very important for your health! Healthy BMs promote colon health, aid in detoxification, and nourish the cells of your gut lining.

  • Gastrointestinal symptoms in children with autism have been shown (by many studies - see research below) to correlate with autism severity and many core autism symptoms such as self-injurious behaviors, restricted stereotyped behaviors, aggressive behaviors, sleep problems and attention problems.

  • The Gut-Brain Axis (GBA) is an important consideration in autism. This shows a connection between a healthy gut and a healthy brain, or an unhealthy gut and an unhealthy brain. Children with autism are shown to have an abnormality in their gut bacteria.

  • Our bowel movements are made up of 75% water and 25% solid matter (such as dead bacteria and indigestible food). This is a major reason why hydration is important! (The more fluids the better!)

  • Fun fact: It takes about three days for food to pass through your gastrointestinal system and become a full bowel movement.

 
 

Common 💩 Questions

  • What is a “healthy bowel movement”?

    • Easy to pass without straining

    • Medium to dark brown

    • May smell, due to bacterial gasses

    • Passed once or twice daily

    • Consistent in its characteristics

    • Generally a “4” on the Bristol Stool Chart

    • No more than 10-15 minutes to pass

  • What does the color of the bowel movement mean?

    • Medium to dark brown → Typical (anything outside of “typical”, consult your doctor!)

    • Light-colored or pale → Possible sign of infection, inflammation, or poor fat digestion

    • Red → Blood in the stool (from GI bleeding or hemorrhoids) or excessive intake of beets, red berries, or tomatoes

    • Black → Various things - could be serious, like a GI bleed in the upper GI tract, or could be harmless and just a side effect of eating black licorice, blueberries, or taking certain iron supplements

    • Green → Could be due to an increase in green leafy vegetables, could also indicate excessive bile or gut infections such as a virus or bacteria

  • How many bowel movements/day?

    • The number of bowel movements will vary person-to-person, and age can be a factor.

      • Toddlers may have bowel movements as many as three times per day

      • The number of BMs generally decreases as you age, but three times per day can still be typical, as long as they meet the criteria of a healthy BM above.

    • Anywhere from 3 times per day to 3 times per week can be considered normal.


 
 

Common GI Issues

Children with autism have a variety of gastrointestinal issues including:

 
 

Common Causes of GI Issues

Each GI issue listed above will have its own root causes. Some general causes of GI issues include:

 
 
 

Next Steps

Nutritional Considerations for Gastrointestinal Issues

When it comes to gastrointestinal issues, finding the root cause is key, rather than just treating symptoms. The following approaches can help address underlying gut imbalances or inflammation:

Supplement Considerations for Gastrointestinal Issues

  • Add in a high-quality probiotic

  • Consider supplementing with prebiotics if the child is a picky eater

  • Trial digestive support supplements such as digestive enzymes

  • Trial magnesium citrate to ease bowel movements

  • Consider different combinations of herbals depending on the underlying issue (speak to your doctor or Registered Dietitian before implementing)

DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.

 
 

Lifestyle Considerations for Gastrointestinal Issues

  • Consider the following:

    • Witholding stool, which may make constipation worse. See more on this in the constipation note.

    • Increase physical activity (at least 60 minutes/day, preferably outdoors) to keep gut motility in check

    • If the child is using medications that are at high risk to cause GI issues (such as anti-epileptics, diuretics, medications used to treat depression, pain medications, psychiatric medications, allergy medications)

    • Conditions such as thyroid, hormone or metabolic disorders

    • Short-term consideration: Travel or a change in typical routine

    • Increasing restful sleep

    • Stress management such as meditation, yoga, and deep breathing (all of these can be great for kids with ASD!)

    • Implement hygiene standards and increased hand washing

    • Focus on both dental and oral health, as issues like Candida overgrowth can also occur in the mouth

 
 

GI Issues & Autism in the Research

Prevalence of GI Symptoms in Autism

  • Children with ASD are nearly 8 times more likely to have at least one GI symptom [1]

  • Compared to TD children, those with autism and developmental delay were more likely to have at least one frequent GI symptom. [1]

  • Children with ASD experience significantly more general GI symptoms than typically developing peers. [2]

  • 24% percent of the sample of children with ASD experienced at least one type of chronic GI problem (constipation, abdominal pain, bloating, diarrhea, and/or nausea lasting three or more months). [5]

  • 65% of children and adults with autism experienced constipation, 48% experienced stomachaches or stomach pain, 23% experienced nausea, and 30% experienced diarrhea. [6]

Common GI Issues in ASD

  • Frequent gastrointestinal manifestations of mitochondrial disorders include constipation, poor appetite, gastroesophageal sphincter dysfunction, dysphagia, vomiting, gastroparesis, GI pseudo-obstruction, diarrhea, or pancreatitis and hepatopathy. [7]

  • Children with ASD tended to have higher rates of diarrhea, constipation, and abdominal pain. [2]

  • Among research studies on gastrointestinal symptoms and children with ASD, constipation is consistently among the most frequently reported GI symptoms [3, 8-11]

Side Effects of GI Issues

  • Increased GI symptoms are associated with increased problem behaviors like self-injurious behaviors, restricted stereotyped behaviors, aggressive behaviors, sleep problems and attention problems in both ASD and typical children. [1,4]

  • Heightened stress and anxiety, rigid-compulsive behavior, and sleep problems have been shown to be associated with GI symptoms in ASD, especially constipation. [6]

  • Children with autism and GI issues had more anxiety problems, somatic complaints, externalizing and total problems than children with ASD without GI issues. Children without autism, but with GI issues did not show more behavioral problems than other children without autism and without GI issues. [12]

  • The results indicate that anxiety, sensory over-responsivity and GI problems are possibly interrelated phenomenon for children with ASD, and may have common underlying mechanisms. [5]

  • Results suggest that the presentation of externalizing problem behavior and internalizing symptoms associated with GI problems differs between young children and older children with ASD. [6]

GI Issues Associated with ASD Severity

  • GI symptom severity is strongly correlated with ASD symptom severity. [1]

  • The strong correlation of the 6-GSI and the ATEC (r = 0.59) strongly suggests that gastrointestinal problems are associated with autism severity. The autism group with fewer GI problems had much lower scores on the ATEC and each of its four subscales compared to the the autism group with high GI problems. [13]

  • Parents report significantly more GI problems in children with ASD, than in their children without autism. Increased autism symptom severity is associated with increased odds of having GI problems. [14]

  • ASD children with GI symptoms reported more severe ASD core symptoms than others. Autistic children's GI symptoms were associated with child's 0-6 month food sources and picky eating [14]

Unhealthy Gut, Unhealthy Brain

  • Gut dysbiosis has been associated with a number of brain pathologies, including autism spectrum disorder, Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS), suggesting a direct or indirect communication between intestinal bacteria and the central nervous system (CNS). [15]

  • Even though the evidence is mainly associative, it has been suggested that bacterial dysbiosis could contribute to an adverse neuroinflammatory state leading to increased risk of neurodegenerative diseases. [15]

  • The impairment of gut microbiota plays a key role in the development of autism and mood disorders [16]

  • Abnormalities of host-microbiota interactions or of gut-microbiota composition have been associated with central nervous system disorders, such as autism, anxiety, depression and the integrity of intestinal microbiota may be considered a potential therapeutic goal to treat these conditions. [17]

The Gut and the Immune System

  • Overall our findings suggest that children with ASD who experience GI symptoms have an imbalance in their immune response, possibly influenced by or influencing metagenomic changes, and may have a propensity to impaired gut barrier function which may contribute to their symptoms and clinical outcome. [18]

  • [1] Chaidez V, Hansen RL, Hertz-Picciotto I. Gastrointestinal problems in children with autism, developmental delays or typical development. J Autism Dev Disord. 2014;44(5):1117-1127. doi:10.1007/s10803-013-1973-x

    [2] McElhanon BO, McCracken C, Karpen S, Sharp WG. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics. 2014;133(5):872-883. doi:10.1542/peds.2013-3995

    [3] Holingue C, Newill C, Lee LC, Pasricha PJ, Daniele Fallin M. Gastrointestinal symptoms in autism spectrum disorder: A review of the literature on ascertainment and prevalence. Autism Res. 2018;11(1):24-36. doi:10.1002/aur.1854

    [4] Restrepo B, Angkustsiri K, Taylor SL, et al. Developmental-behavioral profiles in children with autism spectrum disorder and co-occurring gastrointestinal symptoms. Autism Res. https://doi.org/10.1002/aur.2354

    [5] Mazurek MO, Vasa RA, Kalb LG, et al. Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders. J Abnorm Child Psychol. 2013;41(1):165-176. doi:10.1007/s10802-012-9668-x

    [6] Ferguson BJ, Dovgan K, Takahashi N, Beversdorf DQ. The Relationship Among Gastrointestinal Symptoms, Problem Behaviors, and Internalizing Symptoms in Children and Adolescents With Autism Spectrum Disorder. Front Psychiatry. 2019;10:194. Published 2019 Apr 9. doi:10.3389/fpsyt.2019.00194

    [7] Finsterer J, Frank M. Gastrointestinal manifestations of mitochondrial disorders: a systematic review. Therap Adv Gastroenterol. 2017;10(1):142-154. doi:10.1177/1756283X16666806

    [8] Ofei SY, Fuchs GJ. Constipation Burden in Children with Autism Spectrum Disorder: Emergency Department and Healthcare Use. J Pediatr. 2018;202:12-3.

    [9] Lefter R, Ciobica A, Timofte D, Stanciu C, Trifan A. A Descriptive Review on the Prevalence of Gastrointestinal Disturbances and Their Multiple Associations in Autism Spectrum Disorder. Medicina (Kaunas). 2019;56(1):E11.

    [10] Liu S, Li E, Sun Z, et al. Altered gut microbiota and short chain fatty acids in Chinese children with autism spectrum disorder. Sci Rep. 2019;9(1):287.

    [11] Martínez-González AE, Andreo-Martínez P. The Role of Gut Microbiota in Gastrointestinal Symptoms of Children with ASD. Medicina (Kaunas). 2019;55(8):E408.

    [12] Fulceri F, Morelli M, Santocchi E, et al. Gastrointestinal symptoms and behavioral problems in preschoolers with Autism Spectrum Disorder. Dig Liver Dis. 2016;48(3):248-254. doi:10.1016/j.dld.2015.11.026

    [13] Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA. Gastrointestinal flora and gastrointestinal status in children with autism--comparisons to typical children and correlation with autism severity. BMC Gastroenterol. 2011;11:22. Published 2011 Mar 16. doi:10.1186/1471-230X-11-22

    [14] Wang LW, Tancredi DJ, Thomas DW. The prevalence of gastrointestinal problems in children across the United States with autism spectrum disorders from families with multiple affected members. J Dev Behav Pediatr. 2011;32(5):351-360. doi:10.1097/DBP.0b013e31821bd06a

    [15] Spielman LJ, Gibson DL, Klegeris A. Unhealthy gut, unhealthy brain: The role of the intestinal microbiota in neurodegenerative diseases. Neurochem Int. 2018;120:149-163. doi:10.1016/j.neuint.2018.08.005

    [16] Mangiola F, Ianiro G, Franceschi F, Fagiuoli S, Gasbarrini G, Gasbarrini A. Gut microbiota in autism and mood disorders. World J Gastroenterol. 2016;22(1):361-368. doi:10.3748/wjg.v22.i1.361

    [17] Casella G, Pozzi R, Cigognetti M, et al. Mood disorders and non-celiac gluten sensitivity. Minerva Gastroenterol Dietol. 2017;63(1):32-37. doi:10.23736/S1121-421X.16.02325-4

    [18] Rose DR, Yang H, Serena G, et al. Differential immune responses and microbiota profiles in children with autism spectrum disorders and co-morbid gastrointestinal symptoms. Brain Behav Immun. 2018;70:354-368. doi:10.1016/j.bbi.2018.03.025

Brittyn Coleman, MS, RDN/LD https://www.autismdietitian.com
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