Friday, 1 July 2011

Brain and gut in autism: a historical perspective

History was always something of interest to me at school, particularly British history throughout the Industrial Revolution. I don't know why, but listening to the life and times of people like Richard Arkwright and inventions like the Spinning Jenny, stirred something in me, combined also with having a very enthusiastic teacher.  It is with history in mind that I offer this entry.

Whilst the primary aim of this blog is to look at the various contemporary research produced on autism, I also intend to go back thorugh the archives occasionally and look at some of the older research done, just to see if there is anything we can learn. In this post, I want to cover this paper* by Goodwin and colleagues first published in 1971; one of the first papers I've found that talks about the gut-brain connection in relation to autism. The paper was published in the Journal of Autism and Childhood Schizophrenia which has evolved to become the Journal of Autism and Developmental Disorders. Indeed, it was one of the very first papers to be published in the journal.

Nowadays there is quite a lot of discussion about the gut-brain axis in relation to autism and lots of other things. Neurotransmitters such as serotonin (5-HT to us Brits) are for example, found in both gut and brain. There is, therefore some good reason to suspect that what effects the brain may also affect the gut and vice-versa.

The Goodwin paper basically followed up a previous piece of research published by the same authors (Goodwin & Goodwin, 1969) where autism was found coincidental to coeliac disease. The aim of the follow-up research was to compare and contrast various parameters pertinent to the gut-brain relationship in children with autism (n=15) (and their siblings, n=14) compared to asymptomatic children (n=25) and adults (n=300) and adults with schizophrenia (n=200) and non-specific 'mental disorders' (n=6).

There are a few really interesting details to arise from this paper including:

  • They make mention of the work of the late Curt Dohan and his research on schizophrenia and cereal grains.
  • Several participants diagnosed with autism had siblings also diagnosed with autism.
  • Several somatic co-morbidities were noted in the autism group including anaemia (crescent cell which I think is better known as sickle-cell anaemia these days), eczema, asthma and hyperthyroidism.
  • There were quite a few cases of persistent co-morbid functional bowel problems noted in the autism group (6/15), as well as individual cases of coeliac disease and episodes of gastroenteritis.
  • Signs of early food intolerance (colic, milk intolerance, diarrhoea) were 'reported for all autistic subjects'.
  • A case of autism and co-morbid coeliac disease is described: 'A normal diet, ordered in error, produced a brief relapse with exacerbation of autistic symptoms' (corrected by reinstitution of a gluten-free diet). 
  • The authors note a novel way of introducing gliadin (gluten) and placebo to participants via a drink.
  • Gliadin introduction decreased cortisol levels and affected circadian rhythms.
  • The authors state that their results suggest childhood autism may be caused by a 'fundamental neurological dysfunction' but correlated with 'malabsorption and sensitivity to food'.
  • Finally, the authors suggest that there is as much a need for further investigations, as there is 'a need for meticulous medical care, correction of sensory and gastrointestinal defects, and sustained observation of the autistic child in an environment conducive to learning and growth'.

Bearing in mind that this was research conducted almost a decade before autism came into the mainstream psyche (as represented by Wing and Gould's seminal 1979 paper), I find myself most interested in the reported findings. Not only were functional bowel problems being reported and discussed as co-morbidities to autism, the early food intolerance signs follow a similar path to those initially reported by Kanner in 1943. The somatic co-morbidities are also of interest, and in particular, the case study on coeliac disease and autistic symptoms which mirrors that of the most recent findings by Genuis.

I highlighted the gliadin and placebo drink because one of the main problems with the research looking at gluten- (and casein-) free diets for autism is the lack of double-blind, placebo-controlled trials. Whilst some research has been done on looking at developing GFCF and placebo test foods for such a trial, Goodwin and colleagues offer an extremely easy alternative: put your gluten (and casein) into a drink! It just goes to show that not seeing the wood for the trees is not an exclusively 'autistic' trait.

The last point highlighted is perhaps something we need to work on: providing meticulous medical care for people with autism and in particular the GI problems that a proportion present with. I don't want to do any finger-pointing but certainly there is some indication that some people with autism are not receiving the care they should be in this and other areas, despite all the relevant guidance and documentation being available.

To finish, a song released in 1971 from someone who has already been mentioned in previous posts.

* Goodwin MS. et al. (1971) Malabsorption and cerebral dysfunction: a multivariate and comparative study of autistic children. Journal of Autism and Childhood Schizophrenia. 1: 48-62.