Breast milk protects against GI symptoms in high risk autism?

Happy house @ Paul Whiteley

"Late weaning and EBM [exclusive breast milk] were associated with protection against GI [gastrointestinal] symptoms in High-risk infants."

That was one of the conclusions presented in the paper by Alexander Penn and colleagues [1] who asked some pretty important questions when it comes to the increasingly strong relationship between bowel issues and autism spectrum disorder (ASD) (see here).

"Using questionnaires, diet history and gastrointestinal problems were tracked prospectively and retrospectively in 57 High-risk infants, and for comparison, in 114 Low-risk infants (infants from families without ASD history)." The main aims of this study were to examine whether those at an enhanced risk for autism by virtue of having a sibling already diagnosed were at any greater risk of presenting with functional bowel symptoms, and whether such bowel issues were "associated with diet and age at weaning from breast milk."

Early weaning - the introduction of solid foods to an infant - seemed to be more frequently present in high-risk infants with bowel issues as did "a no breast milk (NBM) diet" compared with an exclusive breast milk diet. This was particularly true for the bowel symptom constipation and especially for those who were weaned earlier than 6 months of age.

The authors suggest that their data indicate that weaning and breast milk diet practices might have some bearing for the presentation of bowel symptoms in those at high-risk for autism. Further: "The greater prevalence of GI symptoms in High-risk infants suggests that GI dysfunction during early infant development may be a part of the ASD endophenotype." That all sounds rather important.

I'm drawing back from making too many sweeping statements about this research bearing in mind the participant number, the use of the term 'high-risk' and elements of the questionnaire design of the study. There is quite a bit more research required in this area.

That all being said, I do think there are more than a few future studies that might come from such findings. So, thinking back to the paper by Afzal and colleagues [2] and the idea that "consumption of milk to be the strongest predictor of constipation" among their cohort diagnosed with autism, is the suggestion that more attention might be needed for specific elements of the diet such as cows milk. Added to the findings from Kushak and colleagues [3] (see here for a past post on this work) regarding lactose intolerance as being pretty rife in their cohort with autism (importantly, "not identified by clinical history"), and clues start to emerge alongside possible alternative strategies (see here and see here)...

Music: Stevie Wonder - Superstition.

----------

[1] Penn AH. et al. Breast Milk Protects Against Gastrointestinal Symptoms in Infants at High Risk for Autism During Early Development. J Pediatr Gastroenterol Nutr. 2015 Jul 29.

[2] Afzal N. et al. Constipation with acquired megarectum in children with autism. Pediatrics. 2003 Oct;112(4):939-42.

[3] Kushak RI. et al. Intestinal disaccharidase activity in patients with autism: effect of age, gender, and intestinal inflammation. Autism. 2011 May;15(3):285-94.

----------

Penn AH, Carver LJ, Herbert CA, Lai TS, McIntire MJ, Howard JT, Taylor SF, Schmid-Schönbein GW, & Dobkins KR (2015). Breast Milk Protects Against Gastrointestinal Symptoms in Infants at High Risk for Autism During Early Development. Journal of pediatric gastroenterology and nutrition PMID: 26230900

Early infant feeding practices

Feeding babies, or more precisely, what to feed babies and young infants has been quite a long-running debate.
I don't think anyone would really argue with the fact that breast milk is nature's way of providing everything a young infant needs to grow in those tentative early days, weeks and months, packaged up at just the right temperature with no late-night sterilisation of bottles or teats required. Perfect also for the groggy husband who grumbles to himself as he patters downstairs at 3am to do his paternal preparation duties.
Whether or not new mums want to, or can use this 'natural' option is another matter entirely.
I approach this subject with caution being, as I am, the wrong gender to make such a choice. I do however follow quite closely the various guidelines and debates on 'breast vs. bottle' and 'when to start weaning' as a matter of professional interest. Not least because of the link between very early weaning and increased risk of coeliac disease. Not least also because of the possible link between early feeding issues and autism as described in my posts here and here.
In recent times the question of 'when to start weaning' has been the source of some debate. One of the main issues is the age at which infants should start eating solid food and the conflicting advice being offered in this area. Here in the UK the official guidance is very clear: recommending exclusively breast / bottle feeding (or combined) for the first 6 months of life and weaning on to solid foods thereafter. This advice is backed up by the World Health Organisation (WHO) no less.
That would be all well and good if a report from the European Union hadn't mixed things up a little by suggesting that for some children, earlier weaning (from about 4 months onwards) might be OK and possibly advantageous. Added to that an article appearing in BMJ questioning our 6-month rule and again suggesting that there may be a case for revising guidance (backed up by the British Dietetic Association, BDA).
A case perhaps of the head saying do one thing, and the arms and fingers perhaps wanting to do something else.
I have thought about this issue quite a bit. Working backwards from the notion that all babies are different; have different constitutions, raised under different environments, raised by different parents one could argue that the n=1 principle might apply. Thinking also to what happens when research and guidelines get too generalised to a population there may be perhaps some scope for taking on board some of the suggested revisions at least for some infants (although please do not base your decision on my analysis, speak to your physician and healthcare provider about this).
The idea also that there is a window of opportunity for developing tolerance to foods is also an interesting concept. Readers may know of my interest in all things diet and gut-related, and in particular, the concept of the hyperpermeable gut (leaky gut) in connection to lots of things. One of the most interesting parts of how gut hyperpermeability might tie into weaning patterns is trying to ascertain when the gut is 'unpermeable' enough to tolerate food without permeability potentially leading to allergy or intolerance. The infant gut is quite permeable on purpose because: (a) it is still maturing, and (b) it has to allow the passage and absorption of all those goodies in breast milk (and formula) into the CNS, some of which are quite large molecules. Gut hyperpermeability may also have a role to play in producing that lovely soporific effect that babies love following their milk from all those warming opioid peptides and how this may relate to neural growth.
I will be interested to see where this debate goes eventually and how it may (may not) influence guidance and practice.