Dirty Jobs: The Power of Probiotics
I don’t want to be stinky poo poo girl, I want to be happy flower child.
Drew Barrymore
Welcome to the dirty job of getting a handle on your autistic child’s gastrointestinal problems. Inflammatory bowel disease, immune and autoimmune problems, ADHD, mood, and difficult behaviors can all be linked to gut health—and all can and do show up in a child with autism.
Don’t shy away from the task. You are about to greatly change his life for the better, and yours too.
Beneficial bacteria are the unsung heroes of our gastrointestinal system. Our friendly bacteria function like an organ1 (an acquired organ), are more metabolically active than our liver, and weigh more than our brain. Fully half of the contents of our colon are these important bacteria.
The foods we choose, the stress we feel, the life we live—all of these factors in turn affect this important organ. Our health and well-being are vibrantly intertwined with this microscopic world. When we talk about our friendly bacteria, however, most people picture the gut only. Take a look at Figure 4-1 and see where our microbiome really lives:
Figure 4-1
The GI Tract: A Nice Neighborhood
Ideally, our microbiome should be a large diverse population of beneficial and benign species, with few yeast or pathogens. Think of the GI tract as a neighborhood. That neighborhood “opens for business” the day you are born. Research has revealed that the first few days and weeks of life are when we acquire our most important permanent strains of beneficial bacteria—our citizen strains. Yet our modern style of birth and infant care leaves our babies to haphazardly colonize their GI tract, instead of the way Mother Nature intended.2 We have a high rate of C-sections these days (close to one in three births); babies don’t pick up the good bacteria from Mom’s birth canal when delivered via C-section and are then whisked away from Mom in the delivery room rather than enjoying immediate skin-to-skin contact; and in some hospitals babies spend a lot of time in the hospital nursery rather than in Mom’s room. All of this means the baby is left to collect initial strains of bacteria in a haphazard fashion, and research shows we don’t end up with the best bacteria this way.3
If your neighborhood is rather empty or thinly populated, then there is room for undesirable squatters to move in, set up shop, and create a “gut ghetto.” You want to create a neighborhood thriving with hardworking citizens where there isn’t an opportunity for undesirables. This is where probiotics come in.
I’m not going to wear you out with an exhaustive primer on the topic of probiotics—those books have been written. This chapter is about creating an Action Plan on how to use probiotics to help your child feel better and get better. We’re picking up where Chapter 3 left off, and delving further into the relationship between probiotics, gut health, the immune system, and the effects on a child with autism.
Why do so many children and adults have tummy troubles, and children with autism in particular?4 In Figure 4-2, we see how our modern world takes a big toll on our beneficial friends in the microbiome.
If our ASD children are more genetically vulnerable to the microbiome stressors shown in Figure 4-2, they may be at the center of a perfect storm for gastrointestinal problems. While research hasn’t settled this question yet, the good news is that this chapter includes a step-by-step protocol for properly adding probiotics to the Action Plan and restoring many of the benefits we have lost to modern stressors.
Probiotics: A Missing Piece in Helping Your Child
Probiotics are one of the missing pieces in most doctors’ approach to helping children on the spectrum. Sadly, many pediatricians seem at a loss to help an ASD child’s constipation, diarrhea, gassiness, foul odors, and poor digestion. Many repeat the standard advice of more fiber, water, and exercise, or they recommend a daily laxative and leave it at that (as if we haven’t tried it already!). Parents are left to search the Internet for ideas, and many are ready and willing to try anything and everything for relief from the daily agitation of GI troubles on the spectrum.
Figure 4-2
When I am consulted by colleagues on stubborn GI cases in infants and children, I find that the mere mention of a high-potency probiotic brings on a knee-jerk response. A dismissive wave of the hand and a “yeah-yeah-yeah, but how would you really handle it,” is the standard attitude. The answer for ASD children is often so simple no one hears it, not even health professionals. And that’s why probiotics remain a missing piece for vibrant health on the autism spectrum.
Certain myths contribute to our underuse and poor understanding of probiotics.
PROBIOTIC MYTH #1: MY CHILD’S YOGURT HAS PROBIOTICS IN IT, SO I FIGURE WE’RE GOOD.
A lot of parents think giving their child yogurt should do the trick. (How’s that working for you?) I’ll share a few guidelines that will help your child get the most out of probiotics.
PROBIOTIC MYTH #2: ALL PROBIOTIC SUPPLEMENTS ARE THE SAME.
The amount of research into probiotics is gratifying and growing. Now the hunt is on to discover each individual strain’s health benefits and limitations.
A conservative approach is to use a brand from a company that is fanatical about quality and viability. I am a fan of multispecies probiotic formulations. My favorite is Ther-Biotic Complete by Klaire Labs. (Just because a certain strain is “the most studied” doesn’t mean it is automatically the most effective.) I usually see better results when more than one strain of probiotics is supplemented.
PROBIOTIC MYTH #3: ONCE THE PROBIOTICS ARE INGESTED, THEY WILL LIVE IN THE GI TRACT PERMANENTLY.
I used to think that once I took a probiotic it would permanently replenish my beneficial bacteria: Turns out, ingested probiotics are more like visiting angels,5 only lingering a couple of weeks. This is another missing piece in your child’s probiotic protocols. I’ll provide you with a Maintenance Protocol to keep the great benefits of probiotics going—without breaking the bank.
PROBIOTIC MYTH #4: PROBIOTICS MAKE IT THROUGH THE STOMACH ACID.
There are some acid-resistant species and strains, such as lactobacillus and S. boulardii, that naturally survive the stomach acid. But beyond those, some reports claim that over 90 percent of the probiotic supplements we take may be destroyed in the acidic environment of the stomach. Great care must be taken to select a brand that has some type of specialized delivery system to protect the probiotics until they land safely in the small intestine. There are brands with enteric coatings and really cool space-age coverings to resist the stomach acid, and there is even one with a delivery system that contains prebiotics to nourish the bacteria once they arrive in the intestines.
PROBIOTIC MYTH #5: I HAVE TO STOP TAKING MY PROBIOTIC WHILE I’M ON AN ANTIBIOTIC.
That’s right, it’s a myth. Don’t put away that bottle of probiotics just because your child started an antibiotic. Many strains survive antibiotics, and we can help out even more by taking the probiotic two to three hours after taking the antibiotic. It will actually help the GI and immune system if you continue to take probiotics during and after the antibiotic.
When autism parents get together, the conversation often shifts to how to help with the daily struggle of bowel problems on the autism spectrum. If your autism life centers on your child’s painful, messy, or unpredictable bowel movements, you’ll want to add some high-powered probiotics to your child’s treatment approach.
You might be an autism parent if you can’t go a whole day without talking about poop!
Oftentimes in my practice I’ll meet a parent and child who obviously have a caring, thoughtful doctor helping with the child’s health. Yet, while the child is on many good supplements, there is no probiotic in sight. You need to hear this message: A broad-spectrum, high-potency probiotic that will survive the stomach acid has incredible benefits for most children on the spectrum. If you haven’t tried one yet, or if you’re just using a weak, low-potency probiotic with only a few million colony-forming units (CFUs), a brand with only one or two strains, or one without safe delivery through the acidic pH of the stomach, prepare to be wowed by the improvement your child may see.
Great News on Probiotics
Research on probiotics has exploded in the last two decades. Studies indicate that activities in our gut can modulate systemic inflammation and autoimmune conditions as well as mood, behavior, and emotions.6 As a matter of fact, in 2005, probiotics were suggested as a beneficial addition to therapy for major depression.7 Probiotics such as Bifidobacterium infantis and L. acidophilus have a confirmed positive effect on emotions and mood and are called “psychobiotics.”8 Although research is still ongoing, let’s look at what we know already about these powerfully beneficial bacteria:
Neurological Health 9:
May ease “autism-like” symptoms10
Enhance mood, behavior, and brain function11
Promote central nervous system maturation12
Produce neuroactive compounds13
Activate neural pathways14
Activate brain signaling systems15
Reduce inflammation16
Impact brain development and subsequent adult behavior17
Affect neuronal circuits that control motor function18
Influence anxiety and depression19
Gastrointestinal Health:
Reduce inflammation20
Relieves constipation21
Reduce abdominal pain22
Relieve bloating23
Attenuate stress-induced GI disorders24
Defend against opportunistic fungi25
Decrease pH of the gut26
Keep harmful bacteria from attaching to the intestinal wall27
Reduce undesirable bacteria in the gut28
May protect against parasites29
Reduce intestinal permeability30
Make beneficial short-chain fatty acids to nourish the cells lining the colon31
Immune Health:
Support the immune system32
Produce natural antibiotics33
Train our immune system to only attack pathogens
Strengthen the mucus barrier34
Th1 and Th2 represent different arms of our immune system. The Th1 to Th2 balance may be altered in ASD, leaving the immune system less efficient at recognizing and fending off viruses and fungi, as well as having a heightened allergy response.
Influence the Th1-Th2 balance35
Probiotics Protect Against:
Colds36
Viruses37
Infection38
Food poisoning39
Urinary tract infections40
H. pylori41
Clostridia difficile42
Cancer43
Probiotics Help Fight and Prevent Diarrhea Caused By:
Antibiotics44
Clostridia difficile45
Traveler’s diarrhea46
Other infections47
Probiotics Battle Toxins:
Neutralize toxic substances48
Chelate heavy metals49
Target bacterial toxins50
Probiotics Generally Help Around the “House”:
Enhance digestion51
Protect against environmental allergens52
Manage dietary toxins53
Down-regulate allergies,54 hives,55 hay fever56
Reduce eczema57
Improve oral health58
Potentially help prevent cavities59
Reduce symptoms of irritable bowel syndrome60 and arthritis61
Metabolize dietary carcinogens62
Make vitamins63
Enhance nutritional support64
That’s a lot of benefits! And for a child on the spectrum who struggles with GI problems, probiotics are a must for the health plan. With all this in mind, let’s take another look at our health goals for your child.
Short-Term Goals
Normal bowel movements
Better toilet training
Less gas
Improved odor of bowel movements and gas
Clearing of eczema and diaper rash
No more itchy bottom
Better sleep
Are you getting happy just reading this list? 
Improved immune system
Catch fewer colds
Better digestion
Fewer tummy aches
Improved eating patterns
Improved mood and behavior
Reduced aggression and irritability
Less fogginess, more clarity
Return a healthy glow and the missing “sparkle” to your child’s eyes
Long-Term Goals
Optimal maturation of the brain and immune system
Improved communication and language
Enhanced eye contact and socialization
Fewer allergies and less congestion
Eczema and Probiotics
Did you see that clearing of eczema is one of our short-term goals? Does your child keep a case of eczema or a rash around the privates going most of the time? Comes and goes, doesn’t it, but you can never really kick it? Did you know it may be related to imbalance in the microbiome?65 Listen to this mother’s story.
Jax’s Story
Paul and Mona brought Jax, their six-year-old son with ASD, to my office for a health support plan. He had a history of “lots and lots” of ear infections and subsequent rounds of antibiotics since two years of age. Although he wasn’t constipated, his bowel movements were very foul smelling and his gas was “very, very stinky.”
Mona sighed in exasperation about the constant rashes around his crotch, groin, and upper buttocks. Although a dermatologist told her they were due to “yeast,” his treatment plan did not include getting rid of the yeast. Mona claimed to have a drawer full of creams and powders, including prescription steroid cream, but the rashes always came back. We’ve all done this, haven’t we—rubbed in creams and lotions, soaked our kid in oatmeal baths, tried prescriptions—and yet seem surprised when the rashes come back? If rashes are the symptom of a yeast problem, why is no one treating the yeast?
My advice to start a high-potency probiotic was met with an uncomfortable silence and furtive looks darting between the parents. They clearly were not expecting this advice. A few short weeks later Mona was practically singing with joy: “Three weeks and I can’t believe all that clear skin I’m seeing!”
Jax did go through two predictable side effects of starting an effective probiotic: The foul odor of his gas got even more disgusting for a week or two, and he had a spike in defiance before his mood smoothed out for the better.
Jax had been riding the antibiotic merry-go-round for years, and probiotics helped him get out of that vicious cycle. In Chapter 7 (Why Is My Child Always Sick?), you’ll learn more about this cycle and how to break it—or avoid it altogether.
What Are the Drawbacks?
I have learned the hard way that many children and adults with autism may experience a big increase in the amount of gas they produce when first starting a high-potency probiotic, as well as changes in the odor of the gas and a temporary change in their mood. In other words, it’s likely they are going to fart their head off, it will stink like Pete, and they’ll be grump muffins for a few days to a few weeks. In the spirit of transparency, Table 4-1 shows some of the early, and let me stress temporary, side effects reported by parents at my center.
Liam’s Story
This story is about my own son Liam. His teacher got a good laugh and observed firsthand the power of starting a probiotic. She was seated behind him in the auditorium and knew he was off-gassing like road kill when she saw the boys on either side of him dive sideways for fresh air, while he remained upright in the middle. Luckily, she had been notified ahead of time that he was starting a probiotic and might experience some stinky gas. It paid off over the long run when Liam caught fewer colds and missed less school that year.
Over the years, each of my children has proudly confided he was voted the Best Farter in the class! #MustBeABoyThing
Getting Started with Probiotics
Here is what to look for in a probiotic:
Look for the “B” word—billions. I use a minimum of 25 billion CFUs.
Look for a brand that tests and guarantees the viability of its products. Just because a capsule contains probiotics does not mean they are alive.
Arrive alive! Look for a brand that features an excellent delivery system and guarantees its probiotic will arrive alive in the small intestine.
Until more research is done, include a multispecies product with a mix of at least four different species, preferably more, in your probiotic selections.
SUCCESS TIP 1: DO NOT GIVE A HIGH-POTENCY PROBIOTIC TO A CONSTIPATED CHILD OR ADULT. GET THE BOWELS MOVING FIRST.
Starting the enzyme protocol outlined in Chapter 3, or the GFCF diet plus enzymes, should be done first to relieve constipation, and then you can start a probiotic. Do not start the enzymes and the probiotics at the same time or else your child will be miserable, act out, and drive you crazy to the point where you will probably be tempted to quit.
SUCCESS TIP 2: NEVER START A PROBIOTIC:
At the beginning of the school week (better idea: start on a Friday)
Right before a field trip with the class
Right before an important party, celebration, or dinner
Right as you leave for vacation
Anytime crabbiness and unexpected farting is a no-no (you get the idea!)
SUCCESS TIP 3: ALWAYS GIVE PROBIOTICS WITH A MEAL.
You’ll find a collection of suggested probiotic protocols in Chapter 6, and you may choose one as a guideline for your own child. Keep your child’s pediatrician in the loop with anything you choose. Here, briefly, are some of the protocols I will discuss in Chapter 6.
Probiotic Support for Infants and Toddlers
It’s not uncommon for a newborn to receive an antibiotic at the hospital for various reasons. Give your baby the gift of a great start and use an infant probiotic starting on day 1. Again, a high-tech delivery system that gets the probiotic powder safely through the stomach acid so it is delivered alive is crucial, especially since infants cannot swallow a capsule. Bonus: Infants given probiotics experience less eczema, allergies, and asthma.
Probiotic Support for Ages 2 and Up
The “Go” Plan. Full speed ahead with probiotic support! I do break it in over two weeks to minimize side effects.
The “Slow” Plan. If your ASD child is this close to getting kicked out of school or daycare for difficult behavior, or is still struggling with constipation, we don’t want to rock that boat. Here’s a kinder, gentler, slower plan to minimize the initial irritability side effect of starting a powerful probiotic.
The “Whoa” Plan. Or how not to give probiotics.
Modified School-Year Approach. This approach is also known as the weekend method. Depending on the age and level of social function of your child and his school situation, you must consider how the initial temporary increase in gas and irritability may affect the school day. Use a modified weekend schedule during the school year if the die-off turns out to be a stinky or cranky one.
The “Detective” Schedule.
The “Already on a Probiotic” Plan.
The Maintenance Plan. What to do after gut balance is achieved.
How to take probiotics during a course of an antibiotic.
Whatever maintenance schedule you choose, I do not recommend just stopping probiotics altogether for a child with ASD. Early research seems to indicate a predisposition to dysbiosis, and probiotics are one piece of the health plan I would never give up.
Good-Better-Best
Let’s approach adding the probiotic piece to your child’s Action Plan from a good, better, best angle (see Table 4-2).
Table 4-2
Who Shouldn’t Take a Probiotic
Immunocompromised and immunodeficient, severely ill children and adults, including those with AIDS
Patients with short bowel syndrome (avoid Lactobacillus species, especially)
Those with pancreatitis
People who are hypersensitive to lactose and milk (avoid probiotic supplements that aren’t certified free of traces of dairy products)
Anyone undergoing surgery (stop taking probiotics a week before surgery, and until any open surgical wounds are healed)
Frequently Asked Questions About Probiotics
Q: Can I take the probiotic at the same time as the digestive enzymes?
A: Yes.
Q: Are probiotics safe for infants?
A: They are not only safe, they are beneficial, as research indicates they may reduce the risk of eczema, allergies, and asthma in infants receiving them.
Q: How long do I have to take probiotics?
A: There are no hard-and-fast rules, but I believe that everyone should take probiotics for life.
Q: I left my probiotic out on the counter overnight. Is it still good, or do I have to throw it away?
A: It’s still good. A good probiotic brand should be able to withstand a night or two on the counter, just don’t leave it in a hot car.
Q: The probiotic gave him diarrhea: What should we do?
A: Cut way down on the dose and only give the probiotic every two to three days until it is well tolerated. If the diarrhea doesn’t stop, discontinue it for a while and try again using mere specks as a starting dose.
Q: His eczema flared up after he started the probiotic. Should I stop?
A: Only if it’s severe. Just cut back on the dose and use it every two to three days until the rash settles down. Then gradually increase to the full dose as it is tolerated. It may be helpful to keep him in long pants and sleeves, and keep his nails trimmed until then.
Q: Can I open up the capsule and put the probiotic in his drink?
A: As long as it’s not a hot drink.
Q: How long is the drink good for after I put the probiotic in?
A: Although there are no studies on this, my expert sources seem to think the friendly bacteria will live for an hour or two. The liquid does “wake up” the flora, so it’s best to use right away if possible.
Q: Can I put the probiotic in his food?
A: Yes, as long as it’s not hot food, or food that will be cooked.
Q: We forgot to give him the probiotic during dinner. What should we do?
A: Go ahead and give it as soon as you remember. Food stays in the stomach for an hour and a half, or even longer.
Q: Are there any chewable probiotics?
A: Yes. Probiotics come in powder, capsule, gummy, and chewable forms. There is even a liquid form, although it is less common.
Q: My other children aren’t autistic, but have many of these signs and symptoms. Can they do these protocols?
A: Of course.
Q: My child is on an antibiotic. Should I wait until it is finished to start the probiotic?
A: No. It’s very important that you DO give the probiotic during a round of antibiotics. Just give the probiotic three hours after he takes the antibiotic. See Week 6 in the Chapter 9 Online Action Plan for antibiotic support suggestions.
Q: Can I take probiotics with my other medications?
A: Yes, there are no known interactions with medications.
Q: My pediatrician says I shouldn’t give children probiotics because not enough research has been done to say which strain should be taken for which problem. He says to wait until more research comes out.
A: Have your pediatrician babysit the poor wailing, gassy, rashy, shitty, sleepless thing for a week or two, and then ask him again.
Q: Should I take probiotics on an empty stomach?
A: Again, there are no hard-and-fast rules; however, the thinking is that taking a probiotic with food will help protect it from the stomach acid. If it has a strong delivery system that guarantees it will arrive alive in the small intestine, then it may not matter if it’s taken with or without food.
Q: My child’s lab results say she is high in lactic acid. Should I avoid probiotics?
A: No. According to Klaire Labs, “When elevated urine D(-)-lactate levels are encountered, the most effective approach is to resolve gut dysbiosis with pre- and probiotics, optimize digestion with enzymes, restrict excessive carbohydrate intake, provide nutritional mitochondrial support, and reduce elevated oxalate levels.”
Q: My child has PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections). Do I need to avoid probiotic products that contain streptococcus species?
A: According to Klaire Labs, “Group A beta-hemolytic streptococcus (GABHS) infection is believed to elicit production of antibodies that cross-react with neural tissues and thereby provoke the neurobehavioral symptoms associated with PANDAS. A review of the literature reveals no evidence that S. thermophilus promotes production of cross-reactive antistreptococcal antibodies and no indication that any streptococcal organism other than GABHS is associated with PANDAS or ASD.”
Q: Are soil-based probiotics safe?
A: Yes, if the proper strains are used. Choose products from a company like Klaire Labs that tests and guarantees the genetic purity of soil-based strains.
Want the Science
For sources of information found in this chapter, turn to the Endnotes.
You are deep into your child’s wellness journey now. Probiotics will be a great piece to add to your child’s plan, but they’re only part of what you need to restore vibrant health on the spectrum. Let’s go on to Chapter 5 for one of the most overlooked and poorly understood areas of GI health.