Constipation on the Autism Spectrum

HOUSTON

By Dr. Janet Lintala

gandalfYou might be an autism parent if you think Gandalf the Grey’s famous line, “You shall not pass!” is referring to your child’s bowel movements.

 But seriously, You might be an autism parent if:

  • Your child has four or less bowel movements a week
  • You wonder how your child passed something that enormous
  • Your toilet is frequently clogged
  • Your child whines and cries, and is afraid to poop
  • Constipation is making your child anxious, grumpy and irritable

What you see isn’t always what you get on the Autism Spectrum, and although the struggles with social communication and behaviors that children and adults may have are well known, very little is devoted to associated conditions such as constipation.

Constipation is a monumental fact of daily life for up to 70% of folks on the autism spectrum 1,2 and doesn’t always respond to the time-tested advice of increasing fiber, fluids and exercise.  With most of us on a tight budget, it gets awfully expensive to go to the pediatrician, get an x-ray or even have our child admitted to the hospital for painful bouts of constipation.

 Vicious Cycles in Constipation:

 Today’s Special: Constipation with a Side of Reflux!

As an autism mother, I know our children are vulnerable to some pretty vicious cycles.  Constipation can contribute to and cause acid reflux, which can create discomfort and pain, irritability and difficulty falling asleep. (Sound familiar?)  They often take medications to help with these problems, which ends up in a predictable cycle:constipation cycle

And here’s another cycle they get caught in:  Does your child hold in his bowel movements, or have messy smears in his underpants?  Constipation cause hard dry stools that may be painful to pass, and many children hold off going to the bathroom as long as possible out of fear.  This is called encopresis and sets up another vicious cycle of constipation as illustrated below:constipation cycle2

What’s an autism parent on a budget to do?

Here are 15 Ways to Help ASD Constipation (And avoid expensive trips to the doctor!):

Laxatives are cheap and easy to use, but don’t actually cure constipation and are only for short-term use.  In fact, long term use of stimulant laxatives can have serious side effects 39,30,41,42, decrease bowel function and lead to…constipation!  Ouch, not fair! They can also reduce the effect of medications if taken too closely together, and cause inflammation of the lining of the intestine. Of course, be sure to tell your doctor if abdominal pain is severe, or you notice bloody stools and unexplained weight loss.

Let’s explore some other options:

gluten free#1.  Gluten-free, Casein-free DietIt’s a myth that the GFCF Diet is very expensive, but it can be a budget buster if you purchase lots of prepackaged specialty items.  I love making simple delicious meals for my children, and the GFCF Diet is budget-friendly for the thrifty home cook.  Click here for some great tips to serve up yummy gluten-free, casein-free meals that won’t break the bank.

When pennies really count, check out this link for how to do the diet on public assistance:  http://www.tacanow.org/family-resources/gfcfsf-diet-on-food-stamps/).  I have seen hundreds of cases of constipation clear up within a few weeks of introducing either the GFCF Diet, enzymes with DPP-IV or both.

Tip for Success:  The diet and enzymes must be introduced gradually, as the children will actually experience a withdrawal from these opiate peptides. Note:  Some blends contain cellulase, and this ingredient should not be used if your child is on time-release medications.

#2.  Enzymes with DPP-IVfor best results, choose a broad-spectrum blend with DPP-IV.  Dipeptidyl peptidase IV is the key to breaking the cycle of constipation and it attacks the opioids creating the problem.  You will not see success if your blend doesn’t have any DPP-IV enzyme. Be sure to introduce both the GFCF Diet and the digestive enzymes with DPP-IV gradually, as your child may experience an opiate withdrawal with these methods. Houston Enzymes makes a great tasting chewable if your child has trouble swallowing pills.

Vitamin-C#3.  High Dose Vitamin CIf you’re like me, you prefer a natural healthy approach, rather than harsh chemical choices.  The laxative effect of higher amounts of Vitamin C is well known 34,35. By gradually increasing the amount, you can find a dose that gets your child’s bowels moving without causing any blowouts.  This gradual increase is called “titrating to bowel tolerance”.  Vitamin C is safe, natural and has many health benefits 33.  It’s a fact that children on the autism spectrum are often low in antioxidants 38, so this is a supplement they need anyway!

aloe#4.  Aloe Juice – Wouldn’t it be great if there was some remedy you had to give your child tasted, smelled and looks like spring water?  Well, look no further – aloe vera to the rescue!  Aloe Vera and Aloe Barbadensis not only have a laxative effect on the bowels 34, but calm down inflammation 37 and have healing properties for the intestinal tract 35.  It’s easy to grow Aloe even if you don’t have a green thumb, and you can really save some money by making your own:

If you don’t want to make your own, Premier Research Labs Aloe Pro is a great organic, preservative free option.

Falling in love with Aloe?  Here’s a review of the health benefits of this amazing plant.

#5.  MagnesiumThis cheap home remedy has a bonus – magnesium is very calming!

#6.  Fermented foods We don’t eat as many fermented foods like foods like yogurt, kefir, kimchee or sauerkraut these days, and it’s a shame because they help keep bowels moving thanks to their load of beneficial organisms.  Making fermented foods at home is surprisingly easy, but kids may not appreciate the new flavors at first. Hang in there!

chia seeds#7.  Chia Seeds – Soak 2 tablespoons of Chia seeds in water, hemp milk, coconut milk, or rice milk overnight in the fridge. In the morning they will have formed a “Chia Gel“. Eat and drink this first thing in the morning. This Chia gel or Chia drink (depending on how thick or runny you prefer it) works as a broom for your intestines! To make a delicious breakfast, add fresh chopped peaches, pears, apples or berries and nuts and seeds in the morning.

#8.  Fiber – If you have tried fiber, and it only increased the constipation, perhaps your child wasn’t drinking enough water.  Fiber absorbs water and will absorb fluids from the bowels if not taken with enough water.   better if from the diet: fruits, vegetables, flax and sesame seeds, beans.

#9.  Choose a multivitamin that doesn’t contain iron.

#10.  Castor Oil – This one is cheap, but is for short term use only, and might cause stomach pain and cramping.

#11.  Check out the side effects of your child’s medications:  Many of the meds used for ASD have constipation as a potential side effect! Discuss medication-related constipation with your pediatrician.

#12.  If you use antacids, give ones that contain magnesium, not aluminum or calcium.

#13.  Fish oil Be sure to get a purified form. Fish oil is rich in Omega 3 which is beneficial for language and brain function and is a natural anti-inflammatory. If your kids struggle with the taste or smell of fish oil, you have to try Barlean’s Omega Swirls. They are delicious with a smooth creamy texture and not a hint of fishiness.

#14.  Probiotics – entire books are written about the health benefits of probiotics. Choose a  high potency blend of colonizing and transient strains. This combination will provide broad coverage to support a healthy balance of microflora across the entire gastrointestinal tract.

#15.  Senna – Fasten  Your Seat Belt! – This one is not for young children and is strictly for short-term use.  It can be explosive and you may even need a seatbelt for the toilet!  Check out the side effects before using 39,40,41,42.

Although cost and ease of use are always important to an autism mom, safety is my number one concern in the long-term management of ASD constipation.   My top picks are the GFCF Diet and the enzymes with DPP-IV – they actually address the root cause of the problem.

I can’t resist one last “crack”…Did you hear about the new movie, “Constipation”?   It hasn’t come out yet!

 


DON’T FORGET!

Children and adults with frequent or chronic constipation often benefit from digestive enzymes with DPP-IV. Digestive enzymes are a safe and effective way to help break down the tough to digest protein, such as gluten, casein, and soy; as well as starches, carbohydrates, sugars (including lactose) and fats. Take advantage of this special offer from Practitioner Select!

HOUSTON2

Houston Enzymes are extremely high quality and meet with the Practitioner Select Quality Standards:

  • Independent laboratory tested (for quality/impurities)
  • No fillers
  • Vegan
  • Gluten-free
  • Non-GMO
  • No yeasts
  • No sugars or sugar alternatives
  • Soy protein-free
  • Known origin of ingredients
  • No egg
  • No nuts
  • No hydrogenated oils
  • Allergen screening for cross-contamination
  • No added coatings, shellacs, binders, excipients, artificial flavors, artificial sweeteners or colors

About the author:

Dr. Janet Lintala is the mother of three boys with a variety of issues such as Asperger syndrome, Tourette disorder, OCD, anxiety and ADHD. She holds a B.S. in Genetics, and graduated as a Doctor of Chiropractic Salutatorian, summa cum laude, from The National University of Health Sciences, a postgraduate program near Chicago, IL.


SUBSCRIBE TO OUR FREE WEEKLY NEWSLETTER AND RECEIVE MORE GREAT ARTICLES AND EXCLUSIVE DISCOUNTS FROM PRACTITIONER SELECT!


 

References

  1. Buie T, et al. “Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals with ASDs: A Consensus Report,” Pediatrics (2010): Vol. 125, Supplement No. 1, pp. S1–S18.
  2. Pediatrics. 2014 Apr 28. [Epub ahead of print] Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-analysis. McElhanon BO1, McCracken C, Karpen S, Sharp WG.
  3. Eur J Gastroenterol Hepatol. 2005 Jan;17(1):109-12. The perceived effect of various foods and beverages on stool consistency. Müller-Lissner SA1, Kaatz V, Brandt W, Keller J, Layer P.
  4. Koch, G; Wiedemann K; Teschemacher H (1985). “Opioid activities of human β-casomorphins”. Naunyn-Schmiedeberg’s Archives of Pharmacology 331 (4): 351–354 doi: 10.1007/BF00500818.
  5. Becker, A., Hempel, G., Grecksch, G. and Matthies, H. 1990. Effects of beta-casomorphin derivatives on gastrointestinal transit in mice. Biomed Biochim Acta 49 (11): 1203-7.
  6. Kurek M, Przybilla B, Hermann K, Ring J (1992). “A naturally occurring opioid peptide from cow’s milk, beta-casomorphine-7, is a direct histamine releaser in man”. Int Arch Allergy Immunol 97 (2): 115–120. doi:10.1159/000063326. PMID 1374738.
  7. Stanislaw Kaminski, Anna Cielinska, Elzbieta Kostyra (2007). “Polymorphism of bovine beta-casein and its potential effect on health”. Journal of Applied Genetics 48 (3): 189–198. doi:10.1007/BF03195213
  8. Bell SJ, Grochoski GT, Clarke AJ, 2006. Health implications of milk containing beta-casein with the A2 genetic variant. Crit Rev Food Sci Nutr 46: 93–100.
  9. Sienkiewicz-Szapka, E, et. al. “Contents of Agonistic and Antagonistic Opioid Peptides In Different Cheese Varieties” International Dairy Journal. April 2009, pgs. 258-263.
  10. De Noni, I, et. al. “Review of the Potential Health Impact of Beta-Casomorphins and Related Peptides” European Food Safety Authority. January 2009. URL: http://www.efsa.europa.eu/en/efsajournal/doc/231r.pdf
  11. Stanislaw Kaminski, Anna Cielinska, Elzbieta Kostyra (2007). “Polymorphism of bovine beta-casein and its potential effect on health”. Journal of Applied Genetics 48 (3): 189–198. doi:10.1007/BF03195213. PMID 17666771.
  12. Taylor, Jenna. “Addiction to Cheese is Real Thanks To Casomorphins” Yum Universe. August 25, 2011 URL: http://www.yumuniverse.com/2011/04/25/dr-jenna-taylor- addiction-to-cheese-is-real-thanks-to-casomorphins/
  13. Zhongjie Sun; J. Robert Cade ,A Peptide Found in Schizophrenia and Autism Causes Behavioral Changes in Rats; doi: 10.1177/1362361399003001007 Autism March 1999 vol. 3 no. 1 85-95
  14. Nutr Neurosci. 2003 Feb;6(1):19-28. Can the pathophysiology of autism be explained by the nature of the discovered urine peptides? Reichelt KL1, Knivsberg AM.
  15. Hunter, L. C., O’Hare, A., Herron;, W. J., Fisher, L. A. and Jones, G. E. (2003), Opioid peptides and dipeptidyl peptidase in autism. Developmental Medicine & Child Neurology, 45: 121–128. doi: 10.1111/j.1469-8749.2003.tb00915.
  16. Williams, B. L., Hornig, M., Buie, T., Bauman, M. L., Cho Paik, M., Wick, I., Bennett, A., et al. (2011). Impaired Carbohydrate Digestion and Transport and Mucosal Dysbiosis in the Intestines of Children with Autism and Gastrointestinal Disturbances. (S. Jacobson, Ed.) PLoS ONE, 6(9), e24585. doi:10.1371/journal.pone.0024585.t008
  17. Jinsmaa Y, Yoshikawa M, 1999; “Enzymatic release of neocasomorphin and beta-casomorphinfrom bovine beta-casein”; Peptides 20:957-962
  18. Püschel G, Mentlein R, Heymann E (1982). “Isolation and characterization of dipeptidyl peptidase IV from human placenta”. Eur J Biochem 126 (2): 359–365. doi:10.1111/j.1432-1033.1982.tb06788.x. PMID 6751824.
  19. Converse PJ, Hamosh A, McKusick VA (2005). DIPEPTIDYL PEPTIDASE IV; DPP4. Online Mendelian Inheritance in Man.
  20. Hartrodt B, Neubert K, Fischer G, Schulz H, Barth A: [Synthesis and enzymatic degradation of beta-casomorphin-5 (author’s transl)]. In: Pharmazie. 37, Nr. 3, März 1982, S. 165–9. PMID 7100234.
  21. Goodwin MS, et al. “Malabsorption and Cerebral Dysfunction.” Journal of Autism & Childhood Schizophrenia. 1971;1:48-62.
  22. Reichelt KL, et al. “Childhood Autism: A Complex Disorder.” Biological Psychiatry. 1986 Nov;21(13):1279-90.
  23. Shattock P, Lowdon G. “Proteins, Peptides and Autism: Part 2: Implications for the Education and Care of People with Autism.” Brain Dysfunction. 1991;4: 323-334.
  24. Knivsberg AM, et al. “Autistic Syndromes and Diet: A Follow-up Study.” Scandinavian Journal of Educational Research 1995; 39: 223-236.
  25. Cade R, et al. “Autism and Schizophrenia: Intestinal Disorders.” Nutr Neurosci. 2000; 3, 57–72.
  26. Knivsberg AM, et al. “A Randomised, Controlled Study of Dietary Intervention in Autistic Syndromes.” Nutritional Neuroscience. 2002 Sep; 5(4):251-61.
  27. Lucarelli S, et al. “Food Allergy and Infantile Autism.” Panminerva Medica. 1995 Sep;37(3):137- 41.
  28. Jyonouchi H, et al. “Evaluation of an Association Between Gastrointestinal Symptoms and Cytokine Production Against Common Dietary Proteins in Children with Autism Spectrum Disorders.” Journal of Pediatrics. 2005 May;146(5):605-10.
  29. Jyonouchi H, et al. “Dysregulated Innate Immune Responses in Young Children with Autism Spectrum Disorders: Their Relationship to Gastrointestinal Symptoms and Dietary Intervention.”Neuropsychobiology. 2005;51(2):77-85.
  30. Cass H, Gringras P, March J, et al. (September 2008). “Absence of urinary opioid peptides in children with autism”. Arch. Dis. Child. 93 (9): 745–50. doi:10.1136/adc.2006.114389. PMID 18337276.
  31. Christison GW, Ivany K (2006). “Elimination diets in autism spectrum disorders: any wheat amidst the chaff?”. J Dev Behav Pediatr 27 (2 Suppl 2): S162–71. doi:10.1097/00004703-200604002-00015. PMID 16685183.
  32. J Autism Dev Disord. 2006 Apr;36(3):413-20.  The gluten-free, casein-free diet in autism: results of a preliminary double blind clinical trial. Elder JH1, Shankar M, Shuster J, Theriaque D, Burns S, Sherrill L.
  33. Cathcart, R.F. Clinical use of large doses of ascorbic acid. Presented at the annual meeting of the California Orthomolecular Medical Society, San Francisco, February 19, 1976.
  34. http://dx.doi.org/10.1016/0306-9877(81)90126-2. Medical Hypotheses Volume 7, Issue 11, November 1981, Pages 1359–1376. Vitamin C, TITRATING TO BOWEL TOLERANCE, ANASCORBEMIA, and ACUTE INDUCED SCURVY Robert F. Cathcart
  35. Ishii Y, Tanizawa H, Takino Y. Studies of aloe. V: Mechanism of cathartic effect. Biol Pharm Bull. 1994;17:651–3. [PubMed]
  36. Aloe vera review with lots of references: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2763764/#!po=73.5294
  37. Hutter JA, Salmon M, Stavinoha WB, Satsangi N, Williams RF, Streeper RT, et al. Anti-inflammatory C-glucosyl chromone from Aloe barbadensis. J Nat Prod. 1996;59:541–3. [PubMed
  38. Bratisl Lek Listy. 2009;110(4):247-50. Plasma concentrations of selected antioxidants in autistic children and adolescents. Krajcovicova-Kudlackova M1, Valachovicova M, Mislanova C, Hudecova Z, Sustrova M, Ostatnikova D
  39. Xing JH and Soffer EE, Adverse effects of laxatives, Diseases of the Colon and Rectum 2001; 44(8): 1201-1209.
  40. Blumenthal M, California requires warning labels for products containing stimulant laxative herbs, HerbalGram 1997; (39): 26-27
  41. Kurtzweil P, Dieter’s brews make tea time a dangerous affair, FDA Consumer 1997: 6-11.
  42. Yang Yufu, A report on 21 cases of addiction to senna induced by chronic use, Chinese Journal of Chinese Materia Medica 1992; 17(3): 184-185

 

Advertisements

One thought on “Constipation on the Autism Spectrum

Tell us what you think!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s