Dysbiosis

Written By Brittyn Coleman, MS, RDN/LD

What is Dysbiosis?

  • Dysbiosis (dis-bi-oh-sis) is a term for disruption or imbalance in the microbiome that has a negative effect on health and generally refers to the gastrointestinal tract, though it can happen elsewhere (i.e. skin microbiome). While the term dysbiosis usually refers to bacteria, it can also involve yeast (see: Yeast Overgrowth)

  • Dysbiosis typically involves a decrease in beneficial microbes and an increase in detrimental microbes. Gastrointestinal dysbiosis has shown to be an important consideration for autism.

  • Two phyla (groups) of bacteria in the gut called Bacteroidetes and Firmicutes represent about 90% of the bacteria in the gut. When one or both of these phyla are low, they can cause issues in immune balance and weakened gut strength.

  • For chronic dysbiosis, treatment includes diet changes, supplements, and lifestyle changes to manage, treat, and prevent future reinfection. (See “Next Steps” below for considerations)

  • There is an ongoing discussion about whether dysbiosis is inherent to autism or if it might be causal. The research is still underdeveloped in this area. [1]

  • Research suggests that changes in gut bacteria can alter neurological and behavioral outcomes. [1-2]

  • Changes in the gastrointestinal microbiome are associated with diseases in humans and animals including inflammatory bowel disease, asthma, obesity, metabolic syndrome, cardiovascular disease, immune-mediated conditions, and neurodevelopmental conditions such as autism spectrum disorder. [3]

  • The overarching goal is to build up beneficial bacteria, improve immune function, strengthen the gut, and optimize digestion in order to prevent future reinfection.

 
 

Signs & Symptoms

Note: some of these symptoms are also symptoms of Yeast Overgrowth.

 
 

Causes of Dysbiosis

  • Exposure to pathogenic bacteria

  • Poor diet or picky eating (high in sugar, refined carbohydrates, artificial food additives, sweeteners, etc.)

  • Poor digestion or low stomach acid

  • Environmental toxins (especially lingering pesticides (like glyphosate) on unwashed produce)

  • Certain medications (like antibiotics or PPIs) can affect your gut flora

  • Poor dental hygiene

  • Immune dysfunction (can even be caused by high levels of anxiety or stress)

 
 

Testing for Dysbiosis

Dysbiosis can be detected via stool and urine, though stool tests are the gold standard in clinical practice. Diagnostic Solutions Laboratory offers a stool test called the GI-MAP which tests beneficial bacteria, overgrown bacteria, yeast and fungal growth, parasites, and digestive function, among other markers. You can ask your physician to order this for you, but they may need to be contracted with the lab. You can call Diagnostic Solutions Customer Service to find a provider in your area to order and review it with you.

Other labs such as Genova, Vibrant America, and Doctor’s Data also offer stool analysis. Some labs may also a Urinary Organic Acid Test (OAT) that measures bacterial metabolites (i.e. bacterial byproducts) in the urine. Labs that offer the OAT include Great Plains Labs, Vibrant America, and Doctor’s Data.

The labs listed above will often not take insurance, so if you prefer to use standard lab testing, you may be able to order a few of the markers that are on the other panels through your physician. If possible, we recommend ordering straight from one of the specialized labs (listed above) for the most accurate and extensive results.

The Role of Our Gut Bacteria

Beneficial Bacteria may…

  • Help keep pathogens and detrimental bacteria in line and protect us from other infection

  • Promote a healthy intestinal barrier (i.e. preventing leaky gut)

  • Contribute to immune balance (on a lab panel, look for Secretory IgA)

  • Extract nutrients and energy from our diets

  • Produce vitamins like vitamin B12, biotin, and vitamin K

  • Support the growth of other beneficial bacteria

    • They break down foods (like fiber) into smaller pieces that can feed other bacteria.

    • They convert these food particles into a variety of beneficial products, especially Short Chain Fatty Acids [5] including Butyrate, Propionate, and Acetate that are the fuel for intestinal cells

Harmful bacteria may…

  • Promote inflammation or autoimmunity

  • Damage the gut barrier

  • Produce a wide range of potentially harmful products

  • Cause or contribute to decreased beneficial microbes

  • Cause malabsorption (poor absorption of nutrients)

  • Contribute to hypochlorhydria (low stomach acid)

Next Steps

Diet

  • Increase high fiber foods (examples include plant-based foods like fruits, vegetables, whole grains, lentils & beans, legumes, nuts, and seeds).

  • Remove or reduce sugar, refined carbohydrates, and artificial ingredients (i.e. sweeteners)

  • The Gluten-Free, Casein-Free Diet appears to favorably influence gut microbiota populations and intestinal barrier function [2]

  • Consume fermented foods, if tolerated

  • Increase polyphenol foods such as berries, cocoa powder (no added sugar), non-berry fruits, nuts, and vegetables such as artichokes and spinach, which may inhibit pathogenic bacteria and the stimulation of beneficial bacteria. [6]

  • Choose organic produce to avoid pesticides that may negatively affect gut bacteria

  • Address picky eating, if applicable


Supplements

  • High dose probiotics (10-100 billion CFU depending on age and severity of the issue), which can tip the bacterial balance in the right direction

  • Prebiotics, which can feed and grow beneficial bacteria and starve detrimental bacteria

  • Herbals/botanicals can be very effective against dysbiosis. Some include:

    • Oil of Oregano

    • Olive Leaf Extract

    • Garlic Extract or Garlic Oil

    • Caprylic Acid

    • Berberine

    • Tea Tree Oil

    • MCT Oil

    • Herbal combinations

      • We love using herbal combinations, such as Biocidin, to treat dysbiosis. One round of treatment often lasts 2-3 months, and depending on the person, it may take 1-3 rounds.

  • It may be a good idea to also combine a Binding Agent at the same time as treating dysbiosis, as it can help reduce die-off reactions. Our favorite binder is GI-Detox as it contains both activated charcoal and bentonite clay. Doses will depend on size and age, but generally, 1/2 capsule is where we start.

    • *NOTE: Be sure to drink plenty of water because both activated charcoal and bentonite clay can be constipating!

  • Consider digestive enzymes to support proper digestion.

  • Supplement with “Postbiotics” such as butyrate or Short Chain Fatty Acids

Lifestyle

  • Identify and remove potential sources of contamination or re-infection (i.e. hygiene, washing produce, water filtration - read more in the Water note under “Water Filtration”.)

  • Get as much time outside as possible to increase vitamin D, which is a vital nutrient for the immune system and gut.

  • Find a registered dietitian or functional medicine practitioner that is knowledgable about autism and the gut-brain connection to support you during this journey and treatment

  • Be patient and consistent. Dysbiosis can take a long time to manage and may be a recurring issue long-term. Adopting lifestyle, diet, and supplemental changes to improve gut function, the immune system, and digestion can help prevent future imbalance.

  • Consider using Comprehensive Stool Analysis (our favorites mentioned above) to monitor gastrointestinal bacteria. We recommend testing every 3-6 months.

  • Use antibiotics only when absolutely necessary, as it can make issues worse in some cases. Some practitioners will suggest Rifaxamin, which remains in the GI tract. Consult your physician about your preferences and ask if there are other natural options.

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.

Dysbiosis & Autism in the Research

Dysbiosis and Autism

  • A meta-analysis suggests that there is dysbiosis in children with ASD which may influence the development and severity of ASD symptomatology. [7]

  • Prevalence and risk of functional gastrointestinal disorders is significantly higher in ASD children and correlates with the severity of ASD. Bacterial and fungal diversity differ between ASD and neurotypical children. [8]

  • Evidence of microbial dysbiosis in ASD has been growing in recent years. In addition to immune and GI dysfunction that may be linked to dysbiosis, there is some evidence that altering the microbiota in ASD can improve behaviors [9-11]

  • Children with ASD who experience GI symptoms have an imbalance in their immune response and may be at higher risk for impaired gut barrier function, which may contribute to their symptoms and clinical outcome. [9]

  • Data suggests that dysbiosis may be a feature of children with ASD who have GI symptoms, but the exact nature and specificity of the microbiota changes or whether these changes are also found in children with ASD without GI symptoms are still far from clear. [9]

Clostridia Overgrowth

  • Some of the earliest studies investigating the relationship of the microbiota and children with ASD proposed that excessive antibiotic use led to an overgrowth of spore-forming Clostridium, which researchers hypothesized might be exposing these children to high levels of microbial metabolites that were neurotoxic. [1]

  • Pro-inflammatory cytokines correlated significantly with Clostridia, previously reported to associate with ASD, as did tryptophan and serotonin. [12]

  • Clostridia can produce a neurotoxin that may reach the brain via the vagus nerve. Once there, the chemical impacts neurotransmitter release precipitating a range of behavioral deficits. Antimicrobial treatment against this disease partially alleviates the stereotypic behaviors observed in these patients. [2]

More Research is Needed

  • The gut-brain axis has been extensively studied in animal models, and it is clear that changes in gut bacteria can alter neurological and behavioral outcomes. However, findings in human studies are less abundant. Although there are several studies so far showing dysbiosis in ASD, the results are mixed. Intervention studies such as fecal microbiota transplant therapies show promise and lend credence to the involvement of the microbiota in ASD. [1]

  • There was a lack of consistency in the reported gut microbiome changes across ASD studies, except for distinguishable patterns, within limits, for Prevotella, Firmicutes at the phylum level, Clostridiales clusters including Clostridium perfringens, and Bifidobacterium species. [13]

  • [1] Hughes HK, Rose D, Ashwood P. The Gut Microbiota and Dysbiosis in Autism Spectrum Disorders. Curr Neurol Neurosci Rep. 2018 Sep 24;18(11):81. doi: 10.1007/s11910-018-0887-6. PMID: 30251184; PMCID: PMC6855251.

    [2] Rosenfeld CS. Microbiome Disturbances and Autism Spectrum Disorders. Drug Metab Dispos. 2015 Oct;43(10):1557-71. doi: 10.1124/dmd.115.063826. Epub 2015 Apr 7. PMID: 25852213.

    [3] Barko PC, McMichael MA, Swanson KS, Williams DA. The Gastrointestinal Microbiome: A Review. J Vet Intern Med. 2018 Jan;32(1):9-25. doi: 10.1111/jvim.14875. Epub 2017 Nov 24. PMID: 29171095; PMCID: PMC5787212.

    [4] Fabian, Tom. Understanding Common Dysbiosis Patterns in the GI-MAP. Diagnostic Solutions Laboratory: Education and Learning Resources for Clinicians. Accessed 28 Dec 2020. https://www.diagnosticsolutionslab.com/webinars/understanding-common-dysbiosis-patterns-gi-map

    [5] Hiippala K, Jouhten H, Ronkainen A, Hartikainen A, Kainulainen V, Jalanka J, Satokari R. The Potential of Gut Commensals in Reinforcing Intestinal Barrier Function and Alleviating Inflammation. Nutrients. 2018 Jul 29;10(8):988. doi: 10.3390/nu10080988. PMID: 30060606; PMCID: PMC6116138.

    [6] Ozdal T, Sela DA, Xiao J, Boyacioglu D, Chen F, Capanoglu E. The Reciprocal Interactions between Polyphenols and Gut Microbiota and Effects on Bioaccessibility. Nutrients. 2016 Feb 6;8(2):78. doi: 10.3390/nu8020078. PMID: 26861391; PMCID: PMC4772042.

    [7] Iglesias-Vázquez L, Van Ginkel Riba G, Arija V, Canals J. Composition of Gut Microbiota in Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Nutrients. 2020 Mar 17;12(3):792. doi: 10.3390/nu12030792. PMID: 32192218; PMCID: PMC7146354.

    [8] Lasheras I, Seral P, Latorre E, Barroso E, Gracia-García P, Santabárbara J. Microbiota and gut-brain axis dysfunction in autism spectrum disorder: Evidence for functional gastrointestinal disorders. Asian J Psychiatr. 2020 Jan;47:101874. doi: 10.1016/j.ajp.2019.101874. Epub 2019 Nov 12. PMID: 31785441.

    [9] Rose DR, Yang H, Serena G, Sturgeon C, Ma B, Careaga M, Hughes HK, Angkustsiri K, Rose M, Hertz-Picciotto I, Van de Water J, Hansen RL, Ravel J, Fasano A, Ashwood P. Differential immune responses and microbiota profiles in children with autism spectrum disorders and co-morbid gastrointestinal symptoms. Brain Behav Immun. 2018 May;70:354-368. doi: 10.1016/j.bbi.2018.03.025. Epub 2018 Mar 20. PMID: 29571898; PMCID: PMC5953830.

    [10] Vuong HE, Hsiao EY. Emerging Roles for the Gut Microbiome in Autism Spectrum Disorder. Biol Psychiatry. 2017 Mar 1;81(5):411-423. doi: 10.1016/j.biopsych.2016.08.024. Epub 2016 Aug 26. PMID: 27773355; PMCID: PMC5285286.

    [11] De Angelis M, Francavilla R, Piccolo M, De Giacomo A, Gobbetti M. Autism spectrum disorders and intestinal microbiota. Gut Microbes. 2015;6(3):207-13. doi: 10.1080/19490976.2015.1035855. PMID: 25835343; PMCID: PMC4616908.

    [12] Luna RA, Oezguen N, Balderas M, Venkatachalam A, Runge JK, Versalovic J, Veenstra-VanderWeele J, Anderson GM, Savidge T, Williams KC. Distinct Microbiome-Neuroimmune Signatures Correlate With Functional Abdominal Pain in Children With Autism Spectrum Disorder. Cell Mol Gastroenterol Hepatol. 2016 Dec 11;3(2):218-230. doi: 10.1016/j.jcmgh.2016.11.008. PMID: 28275689; PMCID: PMC5331780.

    [13] Ho LKH, Tong VJW, Syn N, Nagarajan N, Tham EH, Tay SK, Shorey S, Tambyah PA, Law ECN. Gut microbiota changes in children with autism spectrum disorder: a systematic review. Gut Pathog. 2020 Feb 3;12:6. doi: 10.1186/s13099-020-0346-1. PMID: 32025243; PMCID: PMC6996179.

Author

Brittyn Coleman, MS, RDN/LD, CLT

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