A Probiotic/Colostrum Pilot Study in Autism…Which Likely Has Clinical Implications in Other Inflammatory Illnesses

Yesterday, I read a cool little pilot study[i] out of the University of California, testing the tolerability and efficacy of a probiotic and bovine colostrum on a small group of children with autism.  And while the results on this population were interesting, as I’ll describe, there are actually many generalized items of interest to be found in the paper as well, which I’ll also point out.

Firstly, a few facts:

Over half of all children with autism spectrum disorders (ASD) have gastrointestinal issues including diarrhea, constipation, abdominal pain, and symptoms of irritable bowel.  (I’d bet money that number is a gross underestimation, since many parents don’t realize that constipation is a major medical issue).  The severity of these symptoms has been correlated with the degree of dysbiosis. The trial, on 8 children (11 actually started in the trial, but 3 were discounted for various reasons (i.e. missing a stool sample)), was small, but was double blind and crossover.  (There was no control group, however).  It was also, sadly, quite short in duration:  one group started with both the colostrum and the probiotic, the other with the colostrum only, which they took for 5 weeks.  After a 2 week washout (i.e. on neither treatment), the groups were switched.

For those interested in what was used and how much:

1. The bovine colostrum used was dosed at .15 grams/lb of body weight per day. Colostrum, the first substance produced by mammary glands right after birth, is rich in prebiotics (oligosaccharides) and an abundance of great immune proteins.  It’s not dissimilar to the IgG protect (bovine immunoglobulins) which I have written about before.
2. The probiotic was 20 billion units of B.infantis, which has been shown to “…dominate the guts of healthy breastfed infants and thus is associated with numerous beneficial health outcomes. It has also been shown in vitro to improve gut barrier integrity and reduce expression of inflammatory genes in intestinal epithelial cells.”

A reminder of some significant findings in the autism population:

1. Children with ASD and GI issues also “…present with immune imbalances in the gut that could be associated with abnormal host responses to microbial dysbiosis and impaired gut barrier integrity.  These imbalances represent a unique gastrointestinal immunopathology that is characterized by ileal nodular lymphoid hyperplasia [inflamed lymph tissue in the gut] and immune cell infiltration throughout the GI tract.”  As this pathology differs from traditional inflammatory bowel disease, some refer to it as “autistic enterocolitis.”  My son, Alex, was a quintessential example, by the way.From Alex’s colonoscopy when he was 9 years old.  This is enlarged lymph tissue in the small intestine.

2.   Children on the spectrum have been shown to have epithelial damage (damage to the lining of the intestines, associated with “impaired gut barrier integrity” (i.e. leaky gut)), increased pro-inflammatory cytokines and low levels of regulatory cytokines, which turn off the inflammatory response.

3. Children on the autism spectrum have been found to have higher levels of allergy, both environmental and food.

Of course, many of these findings also apply to other inflammatory illnesses (i.e. allergic and autoimmune diseases, and so forth).

In spite of the study’s limitations, including the small sample size, the short duration, the lack of controls, and so forth, the results were still meaningful.  As a parent of a young man with autism, I was happy to read that at the end of the study, most of the children’s parents asked for help in finding commercially available substitutes for the treatments involved.  To me, that speaks volumes.

Results:

1. “All study participants experienced reduction in at least one gastrointestinal symptom on at least one treatment arm of the study, if not both.”
2. “We found significant reduction of certain aberrant behaviors, including irritability, lethargy, stereotypy [self-stimulatory behaviors], and hyperactivity…”
3. Of general interest: “The absence of global changes in the gut microbiota of the study participants with treatment indicates that changes in GI function are likely unrelated to major changes to existing gut bacterial taxa.”  The authors go on to explain that this finding is not unique, and that, for example, “…a recent systemic review of randomized controlled trials of probiotic supplementation in healthy adults showed that numerous probiotics show beneficial health effects without concurrent changes in fecal microbial composition…”  This is a pretty interesting finding, and you really do have to wonder why.  There are several hypotheses apparently.  One is that the probiotic helps maintain the stability of the existing gut bacteria by making it less susceptible to insult from stressors, like poor diet, antibiotics and psychological stress.
4. Another finding that I think might also be of general interest. At the start of the study, the scientists found the children had high levels of fecal ethanol and methanol, which were reduced by the treatments.  Pathogenic yeasts, like Candida, for example, can cause a rise in ethanol:  “…high fecal levels could be indicative of yeast overgrowth that is reduced by treatment.”  In the autism population, studies (including this one, which I wrote about awhile back) have shown that children on the spectrum have high levels of pathogenic yeasts (as do people with schizophrenia and other illnesses, like Crohn’s).  Thus, the finding that treatment with probiotics and colostrum may reduce this infection may be very significant.
5. Of general interest: “We observed significant changes in intracellular cytokine expression…”  In fact, most significant perhaps was the reduction of a particular chemical (IL-13) which is important in allergic responses and GI pathology, and which has been reported to be elevated in kids with ASD. There was also a significant decrease in other major proinflammatory cytokines (like TNF-alpha), which has also been found to be highly elevated in the autism population – and of course, many other autoimmune diseases as well.

Even with all the limitations of the study (I’ve only presented some in this post), the findings were significant, especially since many of the children’s GI issues had been resistant to previous treatment.  There were no significant side effects beyond mild gassiness really (which is common when starting any prebiotic). A larger study (or several studies) is, of course, called for to replicate the results.  Still, at least this gives people some ideas for potential treatments while we wait.

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[i] Sanctuary MR. et al. (2019) Pilot study of probiotic/colostrum supplementation on gut function in children with autism and gastrointestinal symptoms. PLoS ONE 14(1): e0210064.