I would fully expect that a monotonous diet leads to a heavy skew in the gut microbiome as specific bacterial species that thrive on that diet are selected for, others against. It makes some sense that a fecal transplant could repair the damage. If the diet has shifted or expanded, the transplant could lead to long term benefits by restoring newly-viable bacterial species, perhaps by facilitating digestion of the new types of food.
I’d be curious to see a factoring out of the diet composition, gut microbiome, genetics, and severity of autism symptoms.
> About two-thirds of all scurvy is found in autistic people.
The theories for how gut-brain axis modulation works include altering the balance of nutrients that get absorbed and modulating the vagus nerve, primarily. For someone with autism it might be possible that altering some of these balances could make the condition better or worse, but that’s all theory without much foundation.
What is known, however, is that diet has a massive impact on the microbiome. Even the mechanism for that is obvious: Bacteria thrive on different foods, so if you eat more of one class of nutrients and less of another then the microbiome proportions will adjust based on which ones thrive on that diet.
They never successfully identified what happened. Just diagnosed it generally as failure to thrive.
which for many is not the case for a variety of social economic or behavioral reasons. Add in with explosions of bacterial populations due to alcohol or sugar and you can see how we can change our gut biome drastically from week to week.
autists have often a much much stronger need for habits and avoidance of change. This includes a change of, or a less repeting/habitual diet. The effect if applified due to autism being commonly comorbid with ADHD and hyper fixation on specific foods being a very common thing (not (mainly) caused by gut bacteria as the effect is too strong and too specific to be "just" a preference caused by gut bacteria)
but this can lead to a imbalance of gut bacteria and that can have an reinforcing effect on wanting a even more monotonous diet, but in the end this is AFIK "just" a secondary reinforcing reason not the root cause
just to play devil's advocate that it isn't an opposing possibility
Maybe I'm misinterpreting what the process of that daily transplant looked like, but I expect they ate a not insignificant amount of hospital food if there were 7-8 weeks of daily treatments.
Now that is something that should be done more often - especially in science journalism, but not only. We cruelly lack long-term vision - not only forward but backwards too.
Maybe science journalism should just adopt a wiki-model instead, where there is one article per "subject" then any new (confirmed?) information/data goes into that, and interested people can subscribe to updates there instead.
Wikis generally have much better long-term maintenance given the right individuals running it, compared to a "publication journal" where things tend to get out of date eventually, with no way of actually seeing when old articles get updated.
It is marked as having results submitted but quality review has not been completed.
N=60 and a placebo group, which is better than the N=18 and no placebo group of the first study.
There have been so many small scale trials showing amazing autism improvements that failed to replicate in larger, better controlled trials. I wouldn’t get excited yet.
The typical pattern is to show unbelievably good results in the first open-label trial with a small number of patients (their n=18 trial that claims to have cured severe autism in many children), squeak by with some marginal improvement in the next trial over placebo, then the third trial becomes a game of trying to keep the study small enough that they can hope to p-hack a result that the FDA might accept.
That's a slightly different clinical trial on adults, not children like the posted article. I think this is the clinical trial registration: https://clinicaltrials.gov/study/NCT02504554. Here's the followup report in 2019: https://www.nature.com/articles/s41598-019-42183-0
That said, your reasoning is probably still correct. There's no placebo group, and a lot can change over a 2-year follow-up, with participants aged 7-17. Maybe they went to speech therapy or just matured and learned more coping behaviors. The 2019 followup also notes that 12 of the 18 participants made other diet and medication adjustments. They claim the adjustments were minor but that's still more noise, and it doesn't account for unreported social/environmental changes.
> There have been so many small scale trials showing amazing autism improvements that failed to replicate in larger, better controlled trials. I wouldn’t get excited yet.
Unfortunately yeah, it's unlikely anything exciting will replicate in a larger RCT other than maybe the gut biome improvement since that seems directly mechanistic, but that's just a gut feeling.
From the comments in the article above, it sounds like it may have failed it's primary outcome (autism symptoms). They only say there was significant benefit for "average of all symptoms", but it isn't clear if that is the same thing.
> reduce autism symptoms
> chronic gastrointestinal issues are a harsh reality
> boosting microbial diversity
> when [...] treat those gastrointestinal problems, their behavior improves
Through my opinionated take is:
- gastrointestinal issue are a common comorbidity of autism
- fixing that help autistic people to mask better/easier
- which makes a lot of sense as gastrointestinal issue are very stressful and so is masking. It's quite common that autistic people under stress have a harder time masking
- and masking is removing many of the "symptoms" of autism at cost of stress and other risks (e.g. depression), and society(^1) is conditioning(^2) children to mask autism subconsciously all the time
(^1): Pretty much any society out there.
(^2): Both intentional and accidental. For most autistic people masking isn't a conscious choice, but something through live so strongly reinforced that it's done unconsciously even if they don't want to in any situation except a private one with at most some very trusted people around.
---
Through a much more disturbing implication from this article is that at least in US/Arizona children with gastrointestinal issues commonly do not get appropriate treatment... Or else they couldn't have done the test as they wouldn't have found a non highly selection biased sample of autistic children.
Like treating of gastrointestinal issues shouldn't be a thing you do to reduce autistic symptoms, but something you do anyway. Even if not for quality of live, then for the reason of such issues often causing much more server long term issues if they stay untreated for years.
I was a little surprised to see this.
So the university researchers use time and money from the university to make a discovery, extending on previous published research, and then patent it and start their own for-profit?
Excuse my ignorance, but is that how it's done generally? Where's the upside for all those who are potentially affected?
It kinda makes sense - Presumably the university is involved somewhere still, and it needs to be commercialised somehow, but..
https://skysonginnovations.com/startups/list/
It's interesting they got a lot of funding from over 100 families with autism children:
Don’t worry, the money is usually coming from taxpayers so the universities don’t have to dip into their endowments
The alternatives are lengthy court battles between universities and their best (e.g. most commercial) researchers. This creates bad PR for the university and uncertainty for the researcher & their startups because potential investors don't like open court cases.
So people came around to make this kind of license fee contract and researchers check it before deciding to join a certain university.
Not a fan of gene / bacteria patents though.
Pretty incredible if true!
But then I've met people not on "the spectrum" who have an amazing memory, such as a professor I recently met with who could remember the page numbers for certain phrases in books. Perhaps Asperger-level people just have the ability with the added challenges of autism?
who knows
Maybe think of this as removing a long-standing distraction or irritant. Like turning down the music from 120 decibels to 80 while you're trying to work.
I'm struck by this quote, which I'd be surprised if they could be explained fully by the distraction-reduction mentioned:
> "Evaluation of symptoms on the Parent Global Impressions found that the treatment group at the end of part 2 improved more than the placebo group in part 1 on nearly all symptoms, with statistically significant improvements in GI, receptive language, and average of all symptoms. There were also marginally significant improvements in tantrums, stimming/perseveration, and cognition."
They basically wiped the gut clean with antibiotics then started treating and saw improvements.
Could be that GI issues increase irritability which makes the measured autism symptoms more aggressive but it looks very promising for families.
Not affiliated just read the study.
What we currently don’t understand is why for some people they never got them (we have techniques to transport the biota from the mother during birth for non-natural procedures) or they loose them.
Even with the transplant, the microbes won’t stick around on those people (not taking about autistic people here, but people in general).
Diverse food really helps, just as not eating ultraprocessed (they won’t reach the end of the intestines).
Fermented and other pre or probiotics will really help too.
But none of those will recover the biota in some people.
2 questions:
1) Did your constipation start right after you did strict carnivore? Or was it after 4 years?
2) List all foods that you ate on strict carnivore. (Include salt, water etc. I presume it won't be a long list)
2) beef, butter, chicken, pork, lamb, eggs, bacon, for < 95%. I do indulge in some processed meats with seasonings. Salt is the only seasoning I add, so I've become a salt snob and get the premium stuff.
After that unspicy diet, full strength kimchi is an experience.
1) Do I detect a note of sarcasm?
2) List all times you’ve been sarcastic on the internet before. (Include social media, message boards, etc. I presume it won't be a long list)
I have IBS - which could lead to nutrient deficiencies - and I've passed the initial pre-screen gate for ADHD assessment (coming soon). I also suspect autism, but the reward to cost ratio for assessment of that doesn't thrill me at the moment.
A different gut microbiome might simply be a way to solve nutrient deficiencies.
> Our phase 2 study for adults with autism found that the treatment group improved more than placebo on the primary outcome (autism symptoms) and on a secondary outcome (daily stool record),
However they say they also have an adult trial running that seems to show similar effects, so there might be something more into it.
At the same time, gut microbiota is extremely complex to study.
So, this may be a plausible result. I cannot judge the plausibilities right away in the way you suggest it.
More like fecal food?
EDIT: looks like I was right, it can be done that way: https://en.wikipedia.org/wiki/Fecal_microbiota_transplant#Me...
An unexpected result for sure.
I understand a newborn gets its microbiota naturally by contact with the mom in the first days, maybe all the sterile environment involved in surgery changes that.
My slightly more serious experience is that in my late 20s I started getting digestive problems and gaining weight. I feel like my neurodiversity got worse, but that could easily be that environmental factors exposed it.
How does one take advantage of a study like this? I would be difficult to get medically sanctioned poo right now. So what can I do? Coprophilia seems high risk.
I mean I can eat Kimchi and oats, but that seems more about encouraging the bugs that are already there than replacing missing bugs. Are we close to over the counter poo pills?
Or is the problem that there are different sets of issues, and finding the right mix of bacteria to fix the issue is difficult?
Just stop eating chicken nuggets and french fries, kids. Have some vegetables.
All applicants will be fed recycled byproducts for free.
> my deepest fantasy is that one day I'll be in the hospital for some random thing, they'll take blood for some test, and then when they read the results, their eyes will go wide and they'll call for a consult. The other doctor will read the results and say "you don't have the nutrient?! How do you live? You're so brave". They give me a shot, and just like that, I'm able to conduct myself in society, understand social cues, hold my attention on anything i want for any length of time, etc
... so perhaps the Nutrient is a product of a gut bacterium.
I DONT NEED CURING. There’s nothing wrong with me.
It's like the medical community wants all high functioning autistics to get bullied like hell in their formative years. Similar irony to "lisp" being unpronounceable by the very people who have a lisp.
https://news.asu.edu/20190409-discoveries-autism-symptoms-re...
actual paper:
In fact it is the subject of the paper, not the MMR vaccine which was the cause of the "controversy".
> Prior to the study, 83% of participants had "severe" autism. Two years later, only 17% were rated as severe, 39% as mild or moderate, and incredibly, 44% were below the cut-off for mild ASD.
Emphasis mine. If you are below the cutoff for mild ASD you wouldn't be diagnosed at all.
(Without a control group, you have questions about how people of that age generally progress, and what other treatment/therapies they receive over those 2 years. The phase 1 trial was with children whose parents presumably sought ever possible way to help them, while the placebo controlled phase 2 was adults who may have plateaued.)
That makes sense, since ASD is a disorder classification and is mainly relevant for treatment and benefits. Plenty of autistic people are not diagnosed with ASD.
The article certainly could do more to differentiate between the autistic spectrum itself and the diagnosis of ASD, but as long as you know not to conflate the two, it seems perfectly clear to me.
(They run a tube through your nose, down your throat, through the stomach to the top of the intestines, and introduce the bacterial slurry there.)
Is kind of impressive.
Just kidding.
Reading HN has the benefit of making me wonder how brainwashed I am.
Reflecting now, maybe it's my deeply held belief that everything is propaganda[0] and nobody that appears smart is honest (with the possible exception of a handful of Finns I have met in person and Western Europeans that I have met online, plus a couple scions of the ultrarich or geniuses I have had the luck to uh hang out with, the last category of totally unknown autistic --compared to Demis-- and thus defying the assumption of "appearance"..? anyways.. )
.. so should I be absolutely terrified of myself "just appearing smart but in no way autistic" to others? A question to ask the therapist :)
[0] https://www.psypost.org/intelligence-makes-people-more-trust...
