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Two years ago a study was published showing good results in 18 children with autism who received fecal transplants. Fecal transplants involves giving stool (along with all the microbes in the stool) from a healthy donor to a recipient. After getting fecal transplants, the children (ages 7 to 16) had significant improvements in their gastrointestinal symptoms (e.g. abdominal pain, indigestion, diarrhea, and constipation, and stools), autism related symptoms, and in their gut microbes.

But how did they do long-term? The short answer: great. In fact, the children continued to improve over the next 2 years. Most of their gut symptoms continued to improve, their autism symptoms continued to improve, and their gut microbes kept improving over time - with significant increases in bacterial diversity (considered good), and with more Bifidobacteria and Prevotella. A professional evaluator found an average 45% reduction in core autism symptoms (language, social interaction and behavior) at two years after the initial treatment (compared with before the original treatment).

It has long been known that many persons with Autism Spectrum Disorders (ASD) experience chronic gastrointestinal (GI) symptoms, and research shows that children with ASD have distinctive gut microbiomes (as compared to neurotypical children). Researchers believe there is a link between the gut and brain (the gut-brain axis), so a therapeutic approach could be to "modify" the gut microbes. Which is what the researchers did - in a 10 week process they call Microbiota Transfer Therapy (MTT). First they gave antibiotics, then a bowel cleanse, a stomach-acid suppressant, a fecal transplant (FMT) followed by many days of low purified doses taken orally.

From Science Daily: Autism symptoms reduced nearly 50 percent two years after fecal transplant

According to the Centers for Disease Control and Prevention, about one in every 59 children in the U.S. is diagnosed with autism, up from one in every 150 in 2000.  ...continue reading "Reductions In Autism Symptoms Two Years After Fecal Transplants"

For years it has been known that most children with autism spectrum disorder (ASD) have all sorts of gastrointestinal (GI) problems (e.g., constipation, diarrhea, stomach pain, food intolerance), and the more severe the autism, the more severe the GI problems. Recent studies suggested that a major factor in this are abnormal gut bacteria, with the gut microbial community out of whack (dysbiosis). Previous studies looking at the gut microbiome of children with autism have shown lower diversity and lower amounts (abundances) of certain bacteria in children with autism compared to neurologically normal (neurotypical) children.

A recent study of children with autism spectrum disorder found that giving the children a fecal microbiota transplant (FMT) led to significant and lasting improvements in both gastrointestinal (GI) symptoms and autism-related behaviors and symptoms. A fecal microbiota transplant (FMT) is a transplant of fecal matter from a healthy donor to the recipient. A fecal microbial transplant contains approximately a thousand bacterial species that live in a healthy gut, as well as other microbes such as viruses and fungi. FMTs have so far been an amazingly successful treatment for recurrent Clostridium difficile infections, and are now being looked at as promising treatments of chronic inflammatory diseases such as inflammatory bowel disease.

The researchers were surprised to see an 80% improvement in gastrointestinal symptoms, especially abdominal pain, indigestion, diarrhea, and constipation. They also saw about a 25% improvement in autism related behaviors and symptoms which persisted for 8 weeks after treatment stopped, which is when the study ended. One measurement of adaptive behaviors (such as communication, daily living skills, and socialization) found that the average developmental age increased by 1.4 years after treatment. The researchers also found that there was a "rebalancing" of the gut microbes following treatment. They found evidence of "successful partial engraftment of donor microbiota and beneficial changes in the gut environment" - meaning they could see that donor microbes were living in the gut. Also, overall bacterial diversity increased (which is good) and the abundance of certain bacteria increased (including Bifidobacterium, Prevotella, and Desulfovibrio), and these changes persisted until the end of the study.

The researchers caution that this was a small trial, that there could be placebo effects, and so the results should be "cautiously interpreted and viewed as preliminary." But nonetheless, the results are exciting. Really exciting. From Science Daily:

Autism symptoms improve after fecal transplant, small study finds

Children with autism may benefit from fecal transplants -- a method of introducing donated healthy microbes into people with gastrointestinal disease to rebalance the gut, a new study has found. Behavioral symptoms of autism and gastrointestinal distress often go hand-in-hand, and both improved when a small group of children with the disorder underwent fecal transplant and subsequent treatment. In the study of 18 children with autism and moderate to severe gastrointestinal problems, parents and doctors said they saw positive changes that lasted at least eight weeks after the treatment. Children without autism were included for comparison of bacterial and viral gut composition prior to the study.

Previous research has established that children with autism typically have fewer types of some important bacteria in their guts and less bacterial diversity overall -- a difference that held true in this study. That could be because many of them are prescribed a lot of antibiotics in the first three years of life, the research team wrote in the study.

Parents of the children not only reported a decrease in gut woes including diarrhea and stomach pain in the eight weeks following the end of treatment: They also said they saw significant changes for the better when it came to behavioral autism symptoms in their sons and daughters, who ranged from 7 to 16 years old....One of those tools showed the average developmental age increased by 1.4 years after treatment. 

Researchers also were able to document a rebalancing of the gut following treatment. At the end of the study, the bacterial diversity in the children with autism was indistinguishable from their healthy peers. The study also included a unique viral analysis by Ohio State scientists, made possible because of previous work in the world's oceans. Gregory, who is particularly interested in the interplay between viruses and bacteria, used genetic testing to examine the viral diversity in the guts of the treated children. It rebounded quickly, and became more similar to the donor's microbiome. "Those donor viruses seemed to help," she said.

Fecal transplantation is done by processing donor feces and screening it for disease-causing viruses and bacteria before introducing it into another person's gastrointestinal tract. In this study, the researchers used a method called microbiota transfer therapy, which started with the children receiving a two-week course of antibiotics to wipe out much of their existing gut flora. Then, doctors gave them an initial high-dose fecal transplant in liquid form. In the seven to eight weeks that followed, the children drank smoothies blended with a lower-dose powder[Original study.]

A big concern nowadays is why some children develop autism, specifically autism spectrum disorder (ASD). Autism spectrum disorder is considered a life-long neurodevelopmental disorder that is thought to affect 1 out of 68 American children. While the causes of ASD are unknown in most cases, some studies report an association (higher risk) between a pregnant woman's infections and fever during pregnancy and risk of ASD in the baby, while other studies don't find such an association. Some studies also looked at the timing of infections during pregnancy, but again results have been mixed. A viral infection during the first trimester is associated with increased risk in some studies, while other studies report an increased risk with a second- or third-trimester bacterial infection.  So it has been unclear whether a flu (influenza) infection or flu vaccination during pregnancy is linked to autism spectrum disorder or not. Is there a link or not?

Why are pregnant women encouraged to get a flu shot (flu vaccine)? This is because pregnant women have an increased risk of complications from the flu infection. Studies also show that getting a flu vaccine during pregnancy reduces the risk of a preterm birth, a small-for gestational-age child, and a low-birth-weight child, and prevents influenza infection in newborns for up to 6 months.

The researchers of a large study done in California found no association between autism spectrum disorder (ASD) risk and flu (influenza) infection during pregnancy or flu (influenza) vaccination during the second to third trimester of pregnancy. However, there was a suggestion of increased ASD risk among children whose mothers received flu vaccinations during the first trimester (though the researchers say the association was perhaps due to "chance". Bottom line: the study results were reassuring for pregnant women, but if one wanted to be ultra-cautious, then delay getting a flu shot until the second trimester of pregnancy. From Science Daily:

No association between mother's flu in pregnancy, increased child autism risk

A study of more than 196,000 children found no association between a mother having an influenza infection anytime during pregnancy and an increased risk of autism spectrum disorders (ASDs) in children, according to a new study published online by JAMA Pediatrics. The study by Ousseny Zerbo, Ph.D., of Kaiser Permanente Northern California, Oakland, and coauthors included 196,929 children born in the health system from 2000 through 2010 at a gestational age of at least 24 weeks.

Within the group, there were 1,400 mothers (0.7 percent) diagnosed with influenza and 45,231 mothers (23 percent) who received an influenza vaccination during pregnancy. There were 3,101 children (1.6 percent) diagnosed with ASD. The authors report no association between increased risk of ASD and influenza vaccination during the second and third trimesters of pregnancy. There was a suggestion of increased risk of ASD with maternal vaccination in the first trimester but the authors explain the finding was likely due to chance because it was not statistically significant after adjusting for multiple comparisons. The study cannot establish causality and has several limitations, including ASD status determined by diagnoses on medical records and not validated by standardized clinical assessment for all cases. [Original study.]

This study found impressive results - improvement in autistic behaviors in children diagnosed with autism spectrum disorder (ASD) with four months of daily vitamin D supplementation. Children in the placebo group did not show improvement. A nice aspect of the study was that the children were randomly assigned  to a placebo or a vitamin D group (so that the groups were not self-selected) and it was double-blinded (so no one knew who was getting the vitamins - again to prevent bias). This was a preliminary study - meaning more studies are needed, but it would be amazing if these results hold up... From Science Daily:

Vitamin D supplements may benefit children with autism spectrum disorder

Studies have shown an association between the risk of autism spectrum disorder and vitamin D insufficiency. In this latest study, 109 children with autism spectrum disorder were randomized to receive four months of vitamin D3 supplementation or a placebo."Autism symptoms -- such as hyperactivity, social withdrawal, and others -- improved significantly following vitamin D3 supplementation but not after receiving placebo," said Dr. Khaled Saad, lead author of the Journal of Child Psychology and Psychiatry study.

Excerpts from the original study from  The Journal of Child Psychology and Psychiatry: Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder

Autism spectrum disorder (ASD) is a frequent developmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and nonverbal communication, and stereotyped patterns of interests and activities. It has been previously reported that there is vitamin D deficiency in autistic children; however, there is a lack of randomized controlled trials of vitamin D supplementation in ASD children.

This study is a double-blinded, randomized clinical trial (RCT) that was conducted on 109 children with ASD (85 boys and 24 girls; aged 3–10 years). The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children. ASD patients were randomized to receive vitamin D3 or placebo for 4 months. The serum levels of 25-hydroxycholecalciferol (25 (OH)D) were measured at the beginning and at the end of the study. The autism severity and social maturity of the children were assessed by the Childhood Autism Rating Scale (CARS), .... 
Supplementation of vitamin D was well tolerated by the ASD children. The daily doses used in the therapy group was 300 IU vitamin D3/kg/day, not to exceed 5,000 IU/day. The autism symptoms of the children improved significantly, following 4-month vitamin D3 supplementation, but not in the placebo group. This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD.   

Recently, Wang et al. (2016) performed a systematic review and meta-analysis of all studies on serum concentration of 25 (OH)D in ASD (Wang et al., 2016). Eleven studies were included, accounting for a total of 870 ASD patients and 782 healthy controls. Serum levels of 25 (OH)D in participants with ASD were significantly lower than those in controls. They concluded that low vitamin D might serve as a risk factor for autism spectrum disorder (Wang et al., 2016). 

In a recent survey, our research group measured 25 (OH)D in 122 ASD children (3–9 years old) and 100 healthy children as controls (Saad, Abdel-Rahman, et al., 2015). The ASD group showed a significantly lower level of serum 25 (OH)D compared with the control group (p < .0001). The study found highly significant inverse correlations between serum 25 (OH)D levels and autism rating scales. In the second part of the previous study (Saad, AbdelRahman, et al., 2015), an open-label trial of 83 subjects who completed a 3-month therapy with high daily doses of vitamin D (300 IU/kg/day) was performed. Collectively, 80.7% of the children with ASD had significantly improved outcome, which was mainly in the sections of the CARS and ABC subscales that measure behavior, stereotypy, eye contact, and attention span (Saad, Abdel-Rahman, et al., 2015). 

This raises the question  of how to lower BPA levels. The absolute quickest and easiest is to buy (whenever possible) loose foods (fresh fruits, vegetables, breads, etc) or foods in glass containers (and not plastic bottles, jars, or containers), store food in glass, porcelain, or stainless steel containers, and microwave in glass dishes (and not plastic containers). In other words, think glass and not plastic. BPA is in polycarbonate containers or packaging. Lower your use of canned foods and avoid soda in cans. This is because cans have a lining that contains BPA or a BPA substitute (and research suggests it has the same effects as BPA). By the way, clear cling wrap made from polyethylene is considered safe to wrap and store food in. From Medical Express:

New study links BPA exposure to autism spectrum disorder

A newly published study is the first to report an association between bisphenol-A (BPA), a common plasticizer used in a variety of consumer food and beverage containers, with autism spectrum disorder (ASD) in children. The study, by researchers at Rowan University School of Osteopathic Medicine (RowanSOM) and Rutgers New Jersey Medical School (NJMS), shows that BPA is not metabolized well in children with ASD. The research appears online in Autism Research.

"It has been suspected for a lot of years that BPA is involved in autism, but there was no direct evidence," said T. Peter Stein, of RowanSOM and the study's lead author. "We've shown there is a link. The metabolism of BPA is different in some children with autism than it is in otherwise healthy children."

The research team – which included Margaret Schluter and Robert Steer, of RowanSOM who were responsible for laboratory analysis, and child neurologist Xue Ming, of NJMS who recruited and ascertained the study populations – examined urine specimens from 46 children with ASD and 52 healthy control children for both free BPA and total BPA concentrations. Like many chemicals, BPA becomes water soluble when it is bound to glucose in the liver – a process called glucuronidation. Conversion to a glucuronide and then excretion of the glucuronide in the urine is a major pathway for removing toxins from the body.

The researchers also conducted a metabolomic analysis to screen for all the chemicals found in the children's urine. The metabolomics analyses showed the mean number of statistically significant correlations between metabolites detected and total BPA excreted to be approximately three times greater with the ASD group than the controls, and the number of statistical significant correlations with fraction of BPA bound was approximately 15 times higher in the children with ASD (p<0.001).

"Other studies involving rodent data have shown that BPA functions as an endocrine disruptor, but ours is the first to show this in humans and the first to associate it to autism," Stein said. "The observations show that for some children there was a relationship between intermediary metabolism, the ability to conjugate BPA and symptoms of autism."

Although the study involves a relatively small number of subjects, Stein said, "The key point is that the study seems to link BPA to autism and creates an open area for further research. One implication of our study is that there might be a benefit to reducing BPA exposure for pregnant women and for children with autism."