The Gut Microbiome And Autism: Exploring the Connection

Autism influences how people communicate, interact with others, and perceive the world. While genetics play a major role, researchers are increasingly recognizing that environmental factors, including the gut microbiome, may also play important roles in how autism is experienced by different individuals.

This emerging field of research is helping us learn about how to support the health and wellness of autistic people, particularly in addressing some of the co-occurring conditions that many experience, such as gastrointestinal disturbances. By understanding these connections, we may be able to develop better ways to support overall health and wellness for the autistic community.

How gut health is related to autism

Co-occurring gastrointestinal symptoms in autism

One major discovery in autism research is that gastrointestinal symptoms occur frequently in autistic individuals [1], [2]. These symptoms can significantly impact daily life and overall well-being, yet they were historically overlooked.

Autistic individuals are 1.5-3 times more likely to experience gastrointestinal symptoms than their neurotypical peers [2], [3]. This can include: 

• Acid reflux 
• Nausea and vomiting 
• Constipation 
• Diarrhea 
• Abdominal pain and bloating

These patterns led scientists to investigate whether gut microorganisms might affect not just digestive health but also brain function—a connection explored through research on the gut-brain axis.

The gut-brain axis: A two-way communication highway

The gut-brain axis is a communication system that connects our digestive system with our brain and nervous system. It creates constant back-and-forth dialogue between our gut and brain through several pathways.

• The vagus nerve acts as a direct connection between the gut and the brain
• Gut bacteria produce chemicals that can influence how our brain works and how we behave
• The immune system also plays a role, since gut bacteria can trigger inflammation that affects both gut and brain health

 To learn more, check out From Belly to Brain: The Gut-Brain Axis. 

How autistic microbiomes are different

Several studies examining the gut microbiome in autistic individuals have found differences compared to those in neurotypical individuals. Here's what researchers observe:

• Differences in composition [4]-[8]: Autistic people have distinct microbiome communities. While findings across studies differ, they often report higher than typical levels of the genera Lactobacillus and Faecalibacterium, and lower levels of bacteria within the Bacteroidetes phylum, such as the genera Prevotella, Parabacteroides, and Alistipes. 
• Reduced bacterial diversity [7]-[10]: Many autistic people have fewer kinds of bacterial species, which can affect the overall stability and resilience of the gut microbiome.
• Altered short-chain fatty acid production [11]-[14]: Microbial metabolites like short-chain fatty acids are altered in the stool of autistic people. 
• Higher p-cresol levels [15]-[17]: This bacterial metabolite is detected at higher concentrations in both stool and urine samples from autistic people and has been associated with negative effects throughout the body.

Why diet matters

While these microbiome differences are interesting, there's an important factor to consider. Diet plays a major role in shaping gut bacteria, and many autistic individuals have different eating patterns that could change their gut microbiome [18].

One key study looked at the relationship between autism and the gut microbiome and found that diet accounted for nearly all the differences in the microbiomes of autistic individuals [19]. Autistic individuals in the study often had diets that were less varied, included less meat protein, and were sometimes lower in overall nutritional quality.

Diet is clearly important, but that doesn't mean the differences in gut bacteria aren't real. Instead, it shows why scientists need more detailed research to separate out the many factors affecting the microbiome in autism.

Therapeutic interventions

Could microbiome interventions help support autistic people? Researchers have tested several approaches to modify gut bacteria, with encouraging results. The goal isn't to "treat" autism, but to address gastrointestinal symptoms and potentially support overall health. 

Probiotic and prebiotic supplements: Probiotics with Lactobacillus and Bifidobacterium add beneficial bacteria to your microbiome, and prebiotics support their growth. 

• A probiotic containing 12 bacterial strains significantly reduced gastrointestinal distress after 3 months of use. Along with fewer stomach problems, autistic people also felt better emotionally and were more social [20].
• Taking probiotics with Lactobacillus and Bifidobacterium bacteria, plus a prebiotic called fructo-oligosaccharide, improved digestive symptoms—benefits not seen in people taking a placebo [21].
• A small pilot study found that a combination of B. infantis and bovine colostrum improved gastrointestinal symptoms in 100% of autistic participants [22]. 

Fecal microbiota transplantation (or FMT): FMT is a more intensive approach that essentially resets the entire microbiome by transferring gut bacteria from healthy donors to recipients. While it might sound unusual, the results in autism research have been promising.

• Fecal microbiota transplantation over 8 weeks increased microbiome diversity and the abundance of beneficial bacteria. These changes were linked to lasting improvements in digestive and social symptoms, with effects lasting up to two years [23], [24]. 
• In some cases, results may not be as long-lasting. One study found that while gastrointestinal symptoms remained improved, social symptoms returned to their original levels 8 weeks after treatment ended [25]. 

It’s important to note that in the United States FMT is mostly used for research or specific medical purposes, and is not available in a conventional medicine setting as a treatment for autism at this point. 

Targeted dietary changes: Working with qualified healthcare providers to optimize nutrition while respecting food preferences and sensitivities may improve gastrointestinal symptoms.

• Following a gluten-free diet has shown promise for reducing gastrointestinal symptoms in autism [26]. 
• Try adding fiber-rich foods to support your beneficial microbes [27].
• Diet diversity goes hand-in-hand with microbiome diversity so, whenever possible, include a mix of colorful fruits, vegetables, legumes, and whole grains in your meals [28]. 

What does this mean for autistic people and their families? 

The link between autism and the gut microbiome provides a new perspective on supporting the health of autistic individuals, especially for those experiencing ongoing gastrointestinal challenges. 

It’s important to recognize that autism involves complex interactions between genetics, neurodevelopment, and environmental factors such as the microbiome. Understanding these connections doesn't change what autism is, but it could help us better support autistic people’s overall health and quality of life.

To support your or your loved ones' gut health, a Tiny+ Family Membership provides detailed insights to guide discussions with your healthcare team about microbiome interventions you can track over time.