Anxiety Disorders in Autism (and Not in Autism) and Things You Can Do Now

On Thursday, I have an appointment with an orthopedist to look at a hand injury I sustained a couple of weeks ago, working with one of my adult students with autism.  Unknowingly, I said a word which ended up triggering a massive attack of PTSD which involved him biting my hand severely for probably a good 20 seconds.  No blame attached to him: PTSD is not within the cognitive control of the sufferer. It is blind panic, brought about by anything the reptilian brain perceives as a “threat” after a traumatic event.  My own son, Alex, suffers from massive anxiety and panic attacks.  For 26 years, searching for answers to his anxiety issues have been front and center for me.

In fact, every person I know, or have ever known, with autism has some form of severe anxiety disorder.  I have spent a massive amount of time reading about this over the years.  If you remember, I have written several times about the effects of gut biome alterations – including high levels of propionic acid – adversely affecting the development of the amygdala, which is the emotion center of the brain.   Dr. Derrick MacFabe has published about this more than once.  Here’s one example. From that blog post:  “Dr. MacFabe and other scientists published another 2019 study that showed that in rats, ‘…the data indicate that even low dose of propionic acid produces in adolescent rodents immediate changes in social behavior, and structural/ultrastructural alterations in amygdala.’”

The toll anxiety, PTSD, panic attacks, and OCD take on those who suffer from them, and their families, is beyond telling.  It is debilitating – and it is unbearable.

In a post from July on antibiotics early in life and brain development I actually referenced today’s paper,[i] which I have decided is worth a post of its own because it does suggest a few potential things you can do now.  My favorite! Please bear in mind that while this paper focuses on autism, all this is relevant to anyone who suffers from anxiety related disorders.

A few highlights:

1. “Recent work shows alterations in the gut microbiome have a significant impact on amygdala development in infancy, suggesting that the alterations in the gut microbiome may act to modulate not only amygdala development but how the amygdala modulates the development of the frontal cortex and other brain regions.”
2. As mentioned above, the amygdala is the area of the brain that is “…most strongly associated with emotional regulation and, within the lateral amygdala, with the storage of fear/trauma memories…” and consequently, it is highly relevant “…to anxiety, fear, eye avoidance and other affective symptoms that can be evident in ASD.”
3. The authors proposed that dopamine plays a major role in altered signals between the amygdala and the cortex, where higher reasoning takes place. These differences mean that these individuals cannot just “reason” their way out of the fear and panic – the “negative feedback” loop is broken:  “This has relevance to some of the alterations that can be evident in ASD, including on fear and anxiety processing, as well as the increased risk of hallucinations and PTSD-like flashbacks.”
4. “Strong correlations have been found among sensory over-stimulation, anxiety and gut problems in ASD.”
5. Another common feature found in autism related to this: night terrors.  (As I type this, I am awaiting a call from our hospital’s sleep center to schedule my son for a study.  His night terrors, sleep walking, etc. are closely related to his anxiety levels, I believe, and his doctors agree this requires more investigation.)
6. Things that might help (all of which I have tried, and will try again upon reading this, perhaps in combination since individually, they weren’t enough):
   1. Oxytocin: “Decreased oxytocin levels in ASD correlate with ASD symptom severity and decreased serum melatonin levels.”  Oxytocin, the social hormone, can decrease amygdala activation – and decreased levels of it are known to be the result of microbiome alterations.
   2. Taurine: This amino acid has anti-inflammatory, gut regulatory and antioxidant properties, plus it positively affects mitochondrial function.  According to this article, 1 in 3 people with ASD have significantly decreased serum taurine levels, again, likely the result of microbiome alterations,  and this is known to be a factor in causing heightened levels of anxiety and stress.  Stress, of course, adversely affects the microbiome and increases gut permeability (leaky gut), so these individuals become stuck in a vicious cycle.  Taurine directly modulates amygdala activity.  Whether or not those with ASD with low serum levels have increased levels of anxiety disorders and night terrors remains to be determined.  Can’t hurt, could help though, giving supplemental taurine another try, as far as I’m concerned.
   3. Butyrate: this short chain fatty acid comes up all the time in my posts.  Check out this one on Parkinson’s disease, for example. It has already been established that individuals on the autism spectrum have low levels of butyrate-producing bacteria and if you recall, it is a short chain fatty acid that is critical in maintaining gut barrier integrity. Remember that “leaky gut” leads to bacteria, bacterial metabolites, and undigested food making their way out of the gut and into the blood stream, causing an abnormal inflammatory response.  According to these scientists, “…butyrate may be of particular importance,” its effect is so profound that this has led to “…butyrate being proposed as a useful dietary supplementation in ASD.”  Butyrate also has a direct effect on calming the immune system of the brain.
   4. Melatonin: this hormone is created in the pineal gland in the brain at night, when it’s dark, from serotonin.  You can read more about it here.  Like so many “brain” hormones, it is also very important in the digestive tract in maintaining gut barrier integrity.  Yet again, it is found at low levels in those on the autism spectrum. Butyrate and melatonin also work together synergistically to promote normal mitochondrial function.
   5. Vagal nerve stimulation: stress inhibits the vagal nerve, leading to higher levels of sympathetic nervous system (fight or flight) activity.  Another vicious cycle. Alterations in the gut microbiome certainly play a role here, with metabolites of gut bacteria sending aberrant signals to the brain via the vagus nerve.

The authors conclude that the impact of microbiome alterations on early development, including via the placenta, affect the amygdala in particular and thus, the rest of the brain.  These can be attributed to “…variations in microbiome-derived butyrate, ” altered mitochondrial functioning and altered melatonin pathways, among others:  “Alterations in immune-inflammatory activity can also be readily linked to changes in the gut microbiome, as in ASD risk factors, such as heavy metals and formula feed.  This is likely to have treatment implications, with the most readily applicable being the use of sodium butyrate as a dietary supplement in ASD.” So there you have it:  something we can all try now if we want, to see if it helps.

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[i] Seo M, Anderson G. Gut-Amygdala Interactions in Autism Spectrum Disorders: Developmental Roles via regulating Mitochondria, Exosomes, Immunity and microRNAs. Curr Pharm Des. 2019;25(41):4344-4356. doi:10.2174/1381612825666191105102545