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Larry Newman is the Chief Operating Officer, Technical and Regulatory Affairs of Kirkman Group, Inc. (Kirkman). Contact Kirkman at 1-800-245-8282; 6400 Rosewood St., Lake Oswego, OR.

Monday, January 10, 2011

Gastrointestinal Problems Revisited

By Larry Newman

In last month’s newsletter, Kirkman® reported on a new study done by Autism Speaks’ Autism Treatment Network (ATN), which indicated that gastrointestinal symptoms occur in nearly halfof 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 in Vancouver, BC, Canada, on May 2, 2010.This study is extremely important in treating ASD patients both currently and in the future.  These patients are medically ill and deserve the care that the results of this study indicate they need.  Let’s review the important factors in gastrointestinal disturbances in sensitive and special needs individuals.

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 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
  • Inadequately digested food as often seen in stools
  • Inflammation
  • 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:
  • Prescription antifungals, antibiotics, or other drugs
  • OTC pharmaceuticals
  • Special diets including gluten-free/casein-free (gf/cf) or the Special 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 build in to the guit lining that help ensure that invading organisms from the outside are neutralized they can do potential damage inside the body.  It is postulated that up to 70 percent of the body's immune system is associated with the digestive tract.

When the specialized immune cells lining the digestive tract detect an unknown or possibly harmful substance (called an antigen), they signal the immune system to provide antibodies to help fight these antigens.  Another immune defender that is present in the lining of the gut wall is known as secretory immunoglobulin A (SIgA).  When antigens are present, SIgA can help to trap them in the mucous layer of the intestinal tract, thereby rendering them ineffective.  The immune system has an integral involvement with the digestive system, and imbalances of the gastrointestinal tract often occur concurrently with immune dysfunction.

Top Priority in Sensitive Individuals
Because of its involvement in the rest of the body processes, the gastrointestinal tract should be the top priority in getting proper care for sensitive individuals.  The ATN study further supports this critical medical care.  Without the proper functioning of the GI tract, trying to correct other areas may be futile.  Discuss this priority with your physician at your initial or next appointment.  Prior to an examination by a physician and/or a gastroenterologist, one can very safely try a good, comprehensive probiotic, a digestive enzyme or a special diet to help alleviate gastrointestinal discomforts.  Often these interventions improve the quality of life for the individual, improving health and gastrointestinal support, and managing the pain associated with these GI disturbances. 

The Role of Bacteria and Probiotics in GI Disturbances

A full spectrum of pathogenic bacteria, including Clostridium, Pseudomonas, Klebsiella, Becteroides, Staphylococcus, Streptococcus, Helicobacter, and others are recognized to cause many of the intestinal infections that affect individuals from time to time.  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.

The key to restoration and healing of the gastrointestinal tract is removing the pathogenic organisms and re-establishing appropriate levels of health-promoting bacteria that can be supplemented by using probiotic products.  Probiotics contain Lactobacillus, Bifidobacterium and other friendly flora that support the growth of beneficial intestinal flora while helping to crowd out the undesirable bacteria.  Hundreds of species of friendly bacteria flourish in the 25-28 feet 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 transient friendly 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 multi-strain product would probably be used.  For general gastrointestinal support, multi-strain probiotics such as Kirkman’s Pro-Bio Gold™, Multi-Flora Spectrum™ or Super Pro-Bio™ are most often utilized.

The Trial Period When Trying Probiotics

The trial period on probiotics should be about 2 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 Function

Closely related and sometimes concurrent with gastrointestinal discomforts are digestive irregularities.  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 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.  Elimination is, of course, the excretion of the body’s waste products.

Digestion begins in the mouth with salivary secretions, then continues in the stomach with secretions of hydrochloric acid and pepsin to form a material called chyme.  The pancreas then releases enzymes into the duodenum of the small intestine as the chyme also passes into the duodenum.  Digestion and absorption then continue and are essentially completed in the small intestine.  The final stage of digestion is completed in the large intestine and colon where waste accumulates and is then eliminated.

Digestive Enzymes

Digestive function irregularities are prevalent in sensitive individuals, and the majority of these are the result of the stomach not secreting enough hydrochloric acid or the pancreas not releasing enough pancreatic digestive 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 to which we are referring.  These are the 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.

Digestive Irregularities

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 and grains
  • Very odorous bowel movements
  • Undigested food in the stool
  • Oily, greasy, and/or floating stools
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 - specifically addressing fat digestion
  • Lactase - specifically aiding lactose intolerance
  • Peptidase/Protease - which digest proteins and peptides including casein and gluten
  • DPPIV (Peptidase) - targeting 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's Enzym-Complete/DPP-IV™ II with Isogest® formula and Maximum Spectrum Enzym-Complete /DPP-IV™ Fruit Free with Isogest® are the two products of choice.  The latter product is fruit free, which is important in those individuals sensitive to pineapple or papaya fruit.

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 4 weeks, enzyme supplementation can be stopped.

Special Diets

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 Explained

The GF/CF diet is simply eliminating gluten-containing foods, which are primarily sourced from grains such as wheat, oats, rye, barley and spelt, and casein-containing foods, which are primarily dairy products.  This diet sounds rather simple, but managing a GF/CF diet is not that easy.  One must learn what products contain gluten and casein as well as get used to carefully reading product labels.  In addition, one must learn where gluten and casein can “hide” from the consumer’s view on a label.  Prepared foods, baked goods, instant mixes, soups and gravies are notorious for having hidden gluten and casein.   Once the parameters are understood, what 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.  The main foods consumed on this diet are, therefore, protein, vegetables, fruits, seeds and nuts.  A book on this diet is available by the late Elaine Gottschall titled Breaking the Vicious Cycle:  Intestinal Health Through 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 and Gastromune AI Support are examples of these types of products.


We have touched on possible interventions that support improved gastrointestinal health.  There are other alternatives that your physician may recommend.  The important fact coming as a result of the ATN study is best summarized by Daniel Coury, MD, the medical director of ATN and professor at Ohio State University.  Dr. Coury states, “Primary care physicians and specialists should ask families about these [gastrointestinal] symptoms and address these as part of the overall management plan for the child or adolescent with ASD.”  If that occurs, significant progress will have been made.