During the last 2 months I have found myself traveling on a weekly basis. As I post this blog, I am leaving for Toronto to attend a meeting/think tank sponsored by Autism Canada and the Autism Research Institute (ARI). I may not be able to answer comments while I am away, nor publish my usual blog on Monday. As a passing note, if you like the blog, please consider following me by going to the main page (https://corticalchauvinism.com/) and clicking on the “follow” button. Thanks
While attending an autism congress in Burgos, Spain one of the parents approached me regarding the symptoms of constipation in their son. In this particular case, behavioral problems had caused the patient to be treated chronically with antipsychotic medications. Although this was well known to his treating physicians, they seemed to be at a loss in trying to explain the reason for his constipation. There are many side effects to antipsychotic medications like weight gain, diabetes, and sedation. However, first generation antipsychotic drugs also have prominent anticholinergic effects such as postural hypotension, sexual dysfunction, cardiac arrhythmias, and constipation. The latter is a common and serious problem with this type of medication. In a series of schizophrenic patients that had been treated chronically with antipsychotic medications (some 22 months) 36.3% (n=99) of them received at least once a pharmacological treatment for constipation. Furthermore, in severe cases, those non-responsive to initial treatment, a plain x-ray of the abdomen revealed fecal impactation (i.e., a solid immovable bulk of feces in your colon) in over two thirds of cases (http://www.biomedcentral.com/1471-230X/11/17).
Digestive problems in autism are common. A study by the CDC found that children with autism are 3.5 more likely than neurotypicals to suffer from chronic constipation and/or diarrhea (http://www.ncbi.nlm.nih.gov/pubmed/22119694). Other digestive symptoms commonly reported in autism spectrum syndromes include vomiting, bloating and abdominal pain/stomach cramps. It is easy to presume that major gastrointestinal symptoms cascade and reflect themselves in other areas of daily living as when partaking in social intercourse or at school where it could influence learning receptivity (see more on symptoms below).
In some occasions, constipation may cause concomitant diarrhea. In effect, the bulk of constipated feces may cause the backlog of watery contents behind them to spill over the sides of the constipated material and cause loose stools. The frequency of bowel movements (e.g., less than 3 bowel movements in 1 week) is clearly an indication of constipation. However, constipation in children with deficits in verbal communication may also manifest itself in behaviors like arching of the back, a child that keeps pressing his/her abdomen against a blunt object (see figure) and self-stimulatory/problem behaviors.
Besides medications autistic individuals may be at risk for gastrointestinal disorders due to a combination of factors like inadequate sleep, limited exercise, emotional stress, poor nutrition/restrictive diets and the use of supplements (e.g., iron magnesium). I have often seen children that eat the same type of food whether due to a sensory issue with its consistency or even a color preference. Most of the digestive process occurs within the small intestine. By way of contrast the large intestine controls fluid balance. Some food types in susceptible individuals may act as GI irritants that cause diarrhea and water loss from the large intestine. Concentrated solutions can cause a dumping syndrome pulling water along the large intestine in an attempt to keep the concentrated solution in a manageable form. Inflammatory bowel disease, food poisoning, or antibiotic use may flatten the villae of the small intestine and promote changes in the bacterial flora of the large intestine. Autistic individuals on antibiotics should probably eat yogurt or probiotics to get good bacteria for their GI tract. Some autistic children may suffer from iron deficiency for which they may receive supplements. Iron has local effects in the gastrointestinal tract that promote constipation. Another widely used mineral supplement in autism (also found in laxatives) has been magnesium -used alone or in combination with vitamin B6. You do not get a magnesium overdose from eating food (green vegetables) only from zealous supplementation. Signs of magnesium overdose include nausea, fatigue, muscle weakness and diarrhea.
Autistics that only eat processed foods stand at risk for constipation as they lack the proper amounts of fiber in their diets. Even if you try to correct the GI problems by giving fibers, constipation may lead to impaction if fibers are not given with ample water. I would also emphasize doing exercise while receiving fiber therapy and enough water to go with it.
Besides preventing constipation there are many benefits to a high fiber diet. It lowers blood cholesterol and sugar levels. It helps you feel satiated thus preventing gaining weight from overeating. If you decide to try a fiber diet emphasize whole grains and cereals, celery, nuts, and vegetables. It is the insoluble fiber that provides the most effective results. Eat fruits and vegetables with their peels. Choose high-fiber cereal food and use brown rice instead of white rice.
Finally, as I have seen colonic cleansing advertised in different congresses aimed at the parent’s of autistic individuals, please use fibers, not an enema. This is Nature’s way of doing a colonic cleaning. Also remember that minerals, although necessary, are only needed in minor amounts. Mineral and vitamin oversupplementation may be at the source of clinical symptoms. For those interested in receiving additional information Autism Speaks has a management guide for helping parents of children who suffer from constipation (http://bit.ly/1ojmuqP).