Editor: This feature is adapted from an article by Larry Newman (Kirkman Labs). ACN is not a sponsor of the lab, but this could be helpful for many of our readers. It provides an overview of many issues that affect digestive difficulties, which are often a problem for children with neurological issues. All items mentioned in this article are available through Kirkman Labs.
The question I still get asked most often by parents of special needs children are “Where do I begin?” and “What do I do first?”
In the early era of biomedical and nutritional interventions, that was a difficult question to answer. Physicians often varied their starting points based on a patient evaluation and the symptoms they exhibited. Several interventions were often started at the same time, and when success or failure became evident, it was hard to pinpoint what was successful and what was not.
Now, after over a decade of experience in biomedical and nutritional interventions by treating physicians plus related clinical studies, that question has become easier to answer. It is now almost universally accepted by doctors and clinicians that the first phase of biomedical and nutritional intervention should be cleaning up the gastrointestinal tract. The reason this is so essential is because without a healthy gastrointestinal tract, other interventions may not work as efficiently or may not work at all.
A study done recently by Autism Speaks’ Autism Treatment Network (ATN) reported that gastrointestinal symptoms occur in nearly half of children with ASD, and the prevalence increases as children get older. The results of this study were presented by ATN at the Pediatric Academic Societies annual meeting, which was held in British Columbia, Canada, on May 2, 2010. This study helps substantiate the current trend of examining the gastrointestinal tract first.
In an announcement by researchers at Columbia University, which was released on January 14, 2012, it was reported that special needs children with gastrointestinal disturbances exhibited a high level of a bacteria called Sutterella in their gut. More research is necessary to determine the significance of that finding because it is unknown at this time whether that bacteria is pathogenic to humans.
The Importance of Gastrointestinal Health
Cleaning up the gastrointestinal tract is imperative in sensitive and special needs individuals. Physicians have known for centuries that a well-functioning gastrointestinal tract and digestive system are crucial to overall good health. When digestion is working optimally, other organs and systems in the body have a better chance of working optimally as well. This is because the digestive system is responsible for processing the nutrients in our food, which, in turn, are used for growth, reproduction, development, tissue repair, healing, and for the normal functioning of every organ in the body. Therefore, the digestive system is very much responsible for supporting the health of the body as a whole. In addition to providing fuel for the body through nutrition, the intestinal tract also plays an integral role in the functioning of the immune and nervous systems. This association is often referred to as the gut-brain connection.
Signs of Gastrointestinal Disturbances
There are many distinct, recognizable signs of gastrointestinal disturbances, but, as is often the case with individuals who can’t communicate, these are not always obvious to the parent or caregiver. Examples of these are
- abdominal discomfort or cramping (often includes crying, screaming or holding the abdomen)
- constipation or diarrhea
- indigestion, bloating, gas
- inadequate digestion often seen in stools
- yeast or bacterial overgrowth
- serious food sensitivities
When gastrointestinal disorders are suspected, a thorough examination by a gastroenterologist is called for. That examination very well may include an endoscopy and/or colonoscopy. Based on this exam, the physician has many options to help support whatever conditions are present in a patient’s gastrointestinal disorder. These options may include the following:
- prescription antifungals, antibiotics, or other drugs
- OTC pharmaceuticals
- special diets including gluten-free/casein-free (GF/CF) or Specific Carbohydrate Diet™ (SCD™)
- probiotics to support good flora and crowd out undesirable organisms
- products that support tissue healing
- digestive enzymes, which will be discussed in more detail later.
The Intestinal Immune System
The intestinal tract represents an important barrier between the external world and the internal environment, and there are a number of immune mechanisms built into the gut lining that help ensure that invading organisms from the outside are neutralized before they can do potential damage inside the body. It is postulated that up to 70% of the body’s immune system is associated with the digestive tract.
The Role of Bacteria and Probiotics in GI Disturbances
A full spectrum of pathogenic bacteria and yeasts, including Clostridium,Pseudomonas, Klebsiella, Bacteroides, Staphylococci, Streptococci,Helicobacter, Candida and others are recognized to cause many of the intestinal infections and overgrowths that affect special needs and sensitive individuals. For some people, these can become chronic situations and, in certain cases, can even become life-threatening.
Antibiotics and antifungal drugs can certainly be very helpful in controlling or eradicating bad bacteria, but two negative aspects of these agents have to be considered. First, these drugs can further deplete the good bacteria residing in the intestinal tract; so, as soon as the drug therapy is completed, the lack of friendly flora is at such a low level that reoccurrence is common. Second, if used too often, the bad bacteria can become resistant to the drugs, rendering them ineffective against subsequent bacterial infections. Discuss these factors with your physician before starting these drug therapies.
The key to restoration and healing of the gastrointestinal tract is removing the pathogenic organisms and re-establishing appropriate levels of health-promoting bacteria, a process which can be supplemented by using probiotic products. Probiotics contain Lactobacillus, Bifidobacteriumand other friendly flora that support the growth of beneficial intestinal flora, while helping to crowd out undesirable bacteria. Hundreds of species of friendly bacteria flourish in the 25- to 28-foot-long intestinal tract when it is healthy. Some of these species, such as Lactobacillus acidophilus,Lactobacillus rhamnosus, Lactobacillus casei and Bifidobacterium bifidum, are resident microorganisms that are always present. These resident bacteria attach to the mucosal lining and colonize. This colonization helps keep out the unfriendly organisms that try to invade the intestinal tract. When the numbers of the resident flora are lowered or depleted, the undesirable organisms can take over, which can lead to a number of gastrointestinal disturbances.
In addition to the resident microorganisms, there are also transientfriendly flora. These beneficial organisms don’t set up residence in the gut; instead, they travel through the intestines and exert many positive effects such as promoting good digestion, producing enzymes, or producing lactic acid that creates an optimal environment for the resident flora.
Supplementing with probiotics can keep the good flora in balance, thereby promoting good health and a healthy gastrointestinal tract. There are many types of probiotic supplements available, some containing individual strains of organisms and some containing multiple strains. A person’s individual gastrointestinal situation will dictate what type of product is needed. If the offending pathogenic bacterium has been identified through laboratory testing, a single strain product specifically effective for that bacterium might be utilized. If the bacteria have not been identified, then a multistrain product would probably be used. For general gastrointestinal support, multistrain probiotics are most often utilized, such as Kirkman’s Pro-Bio Gold™, Multi-Flora Spectrum™, or Super Pro-Bio™.
The Trial Period When Trying Probiotics
The trial period on probiotics should be about two months because it takes time for the organisms to set up residence and begin crowding out the unwanted organisms. As a result, the improvements can be quite gradual and subtle. Improved stools and fewer digestive symptoms should be evident after the trial period.
Digestive irregularities are closely related and sometimes concurrent with gastrointestinal discomforts. These are often present when the gastrointestinal tract is not healthy.
The primary function of the digestive tract is to break down the large particles of food that we eat into small molecules that can cross over the intestinal lining, enter the bloodstream, and become fuel for the various metabolic processes in the body. In order to accomplish this function, the intestinal tract is involved in four primary activities: digestion, absorption, assimilation, and elimination. Digestion is the breakdown of the food particles into usable nutrient forms. Absorption is the stage where those usable nutrients cross the gut wall and pass from the intestine to the bloodstream. Assimilation is utilization of the products of digestion for energy and the body’s metabolic processes, while elimination is, of course, the excretion of the body’s waste products through the intestines and kidneys.
Digestive function irregularities are prevalent in sensitive individuals, and many of these are the result of the stomach not secreting enough hydrochloric acid or the pancreas not releasing enough pancreatic digesting enzymes. When these situations occur (and they often occur together), supplemental digestive enzymes are often tried to help support the insufficiencies.
When we talk about supplementing with digestive enzymes, it is the pancreatic enzymes that we are referring to. These are enzymes that have specific jobs and act only on specific types of food substrates. When digestive enzyme supplementation is called for or recommended by a health professional, it is imperative that the proper combination of enzymes is chosen so as to address the problems at hand. For example, lipase only digests fats; it does not act on protein or sugar. Sucrase only digests sugars; it has no effect on fat or protein. Proteases and peptidases act on protein, casein and gluten; other enzymes do not.
There are many recognizable indicators that digestive discomforts are present in an individual. Some of these can be
- bloating and/or abdominal pain or cramping
- irregular bowel habits or abnormally loose or mushy stools
- constipation or diarrhea
- discomfort after eating
- excessive gas
- extreme sensitivity to dairy, grains or soy
- oily, greasy, and/or floating stools
- undigested food in the stool
- As discussed earlier, a specific enzyme combination must be selected based on an individual’s specific needs. There are many different enzyme products in the marketplace including:
- lipase, which specifically addresses fat digestion
- lactase, which specifically aids lactose intolerance
- peptidase/protease, which digest proteins and peptides, including casein and gluten
- DPP-IV (peptidase), which targets casein and gluten
- multi- or broad-spectrum enzymes, which digest all food groups
- carbohydrate digesting enzymes
If you know specifically that a person needs a specific enzyme, such as lipase for fats, you can look for that specific enzyme containing product. Usually, however, individuals are not sure, in which case a multi-spectrum digestive enzyme would be the product of choice. Multi-spectrum enzyme products help digest all food groups including proteins, fats, starches and other carbohydrates, sugars, celluloses and fiber. Kirkman® has advanced digestive enzyme products containing Isogest®, a patent pending enzyme component with isomaltase activity. No other commercially available enzymes contain the Isogest® fraction. Kirkman Enzym-Complete/DPP-IV™ II with Isogest® formula and Maximum Spectrum Enzym-Complete/DPP-IV™ Fruit Free w/ Isogest® are the two products of choice. The latter product is fruit free, which is important in those individuals sensitive to pineapple or papaya.
How Long Should the Trial Period be on Enzymes?
Improvements of the digestive symptoms should be quite rapid. If no improvements are noted in about four weeks, enzyme supplementation can be stopped.
Special diets can be very useful in alleviating gastrointestinal symptoms. There are often hidden sensitivities that are a contributing factor to the GI problems. The most popular diet with the greatest success rate is undoubtedly the gluten-free/casein-free (GF/CF) diet. All of Kirkman’s products are casein and gluten free for this reason.
The Casein-Free/Gluten-Free Diet
Implementing the GF/CF diet means eliminating casein-containing foods, which are primarily dairy products, and gluten-containing foods, which are primarily sourced from grains such as wheat, oats, rye, barley and spelt. This diet sounds rather simple, but managing a gluten- free/casein-free (GF/CF) diet is not that easy. One must learn what products contain casein and gluten and get used to carefully reading product labels. In addition, one must learn where casein and gluten can “hide” from the consumer’s view on a label. Prepared foods, baked goods, instant mixes, soups and gravies are notorious for having hidden casein and gluten.Once the parameters are understood, what once seemed like an impossible diet to comply with becomes much more tolerable and manageable.
The Specific Carbohydrate Diet™ (SCD™)
This diet has been tried on individuals who have severe gastrointestinal discomforts such as bloating, gas, diarrhea, constipation, and severe food intolerances.
The SCD diet limits the intake of sugars to simple monosaccharides such as honey, fructose, and dextrose and eliminates the intake of disaccharides and polysaccharides such as sucrose, molasses, mannitol, sorbitol, xylitol, and inulin. It also greatly restricts the consumption of starches and other types of carbohydrates. The theory behind the diet is based on the assumption that toxic organisms present in the gut thrive on disaccharides and starches and that their elimination will starve out these organisms. Therefore, the main foods consumed on this diet are protein, vegetables, fruits, seeds and nuts. A book on this diet by the late Elaine Gottschall titled Breaking the Vicious Cycle: Intestinal Health Through Diet provides good information regarding this diet.
Products that Support Tissue Healing
GI problems often result in inflamed or otherwise unhealthy mucosal tissue. There are certain herbal products that can support these conditions. L-Glutamine, quercetin, slippery elm, ginger, turmeric, cat’s claw and marshmallow root are examples of such herbs. Kirkman® offers products with various combinations of these ingredients. Gastro Support, Gastromune AI Support, and Colostrum are examples of these types of products.
Other interventions that should be considered are:
- improving nutritional status
- improving sleep patterns
- improving behaviors, cognition and social skills
- improving immune response
- improving biochemical pathways such as sulfation and methylation
- improving detoxification
Healing the gut may be the key to resolving other health issues. Consult your physician to determine a course that is best for you.
Larry Newman is the Chief Operating Officer, Technical and Regulatory Affairs, Kirkman Group, Inc.