These days, children are facing all kinds of health concerns that we have not been exposed to in such numbers in the past. For this reason, children need all the immune support they can, as a protective measure, and as a way optimize their development, health, and wellbeing.
The role of the gut microbiome and its interaction has been shown to be related to both short and long term infant health and bio-behavioural development (Cong 2016).
What is a gut barrier?
The gut barrier is a one cell thick epithelial lining which is linked together by tight junction proteins.
An intact and functional gut barrier supports the growth of a healthy and balanced gut microbiome, tight junctions, and various other cell regulators.
What about immune function in children?
Almost 70% of the entire immune system resides in the gut-associated lymphoid tissue (GALT), which is why the gut is responsible for regulating immune function (Vighi 2008).
The bowel flora/barrier protocol has a rational basis in the treatment of all disorders in children and adults.
If a child falls ill all the time, gut integrity should be considered as part of the treatment plan in order to boost immune function.
How do tight junctions work?
Tight junctions are proteins that offer protection to what is allowed to pass through the gut into the bloodstream, which is a difficult balance of allowing through vital nutrients and not opportunistic microbes or metabolites.
What is translocation and how is the gut linked to autoimmune conditions?
Bacterial translocation is a key indicator of impaired intestinal integrity. That means that bacteria, toxins, antigens may all enter the circulation from the gut lining due to the dysfunction of tight junctions.
These very small particles that should not be allowed through to the bloodstream are then able to enter. This wreaks havoc for the immune system, over time causing inflammation, weakened immunity, and potentially triggering behavioural changes or autoimmune reactions.
If there is unwanted bacteria in the bloodstream, the body has no choice but to produce an antibody response.
In March of 2018 the journal Science released an article The Enemy Within: Gut Bacteria Drive Autoimmune disease; an article outlining Yale research showing that gut bacteria translocated to the lymph nodes, liver, and spleen due to impaired gut barrier function which in turn triggered an autoimmune response in the body.
The bacterial translocation caused hyper-inflammation, an increase in cytokines and interleukins. So here we have a scientific journal supporting the naturopathic philosophy of healing the gut in order to heal autoimmune conditions (Kashef 2018).
We now recognize that gut-related activity including the movement of endotoxins into the bloodstream via a ‘leaky gut’ play an enormous role in health and is linked to the development of autoimmune conditions (Mu 2017).
Children are particularly susceptible, as their immune systems are not yet fully developed.
Issues of leaky gut can play out in a huge number of health related issues and neurological disorders – autism, Paediatric autoimmune neuropsychiatric disorder (associated with streptococcus) (PANS/PAND(AS), and ADHD are just a few.
How is gut barrier integrity and gut dysbiosis linked to conditions such as PANDAS and Autism Spectrum?
In conditions such as PANS or PANDAS, inflammation occurs in the brain resulting in symptoms such as behavioural and cognitive regression, tics, obsessive compulsive behaviour, aversion to food, anxiety, hyperactivity, bed wetting, motor or sensory abnormalities, sleep disturbance, or urinary frequency.
A pre-requisite of PANS and PANDAS is sudden onset of symptoms, where the neuro-typical baseline of the child is vastly different than it was just weeks before.
This condition results in ongoing transient exacerbation of symptoms called ‘flares’ which are linked to the trigger. In PANDAS the trigger is a streptococcal infection, however in PANS these symptoms may follow a number of triggers such as food allergies, intolerances, or environmental triggers.
We encounter antigens every day, however with a permeable gut lining, these ‘triggers’ cross into the bloodstream and cause inflammation.
Treatment therefore involves minimizing inflammation, regulating the immune response, and most importantly healing the permeable gut lining and supporting a healthy microbiome.
Several studies have shown that children with autism have a much higher rate of dysbiosis and altered bacterial numbers in the bowel (Hechtman 2011).
Symptoms such as abdominal distension, constipation, diarrhea, asthma, allergies, recurrent infections are often found in children with autism, and opportunistic microbes such as Candida, Clostridia, and Staphylococcus are found in elevated numbers.
Without enough beneficial bacteria, yeasts and other opportunistic microbes implant in the mucous membrane of the digestive tract.
Yeasts produce alcohol from any digested sugar or carbohydrate which in a permeable gut lining, may cross into the bloodstream and result in damaging effects to neurological development of the child.
How does gluten impact?
Essentially gluten puts fuel on the fire. Gluten is an anti-nutrient which is harsh on the digestive tract, making it difficult to digest for nearly all people, regardless of whether they have a gluten sensitivity or not.
Multiple researchers have described neurological issues related to gluten sensitivity. These include headache, movement disorders, cognitive disorders, and mood disorders, and these health issues are activated by mechanisms that relate to gluten exposure such as a permeable gut lining and autoimmune activation.
Gluten also has the capacity to activate the production of zonulin. When the protein Zonulin is inappropriately up-regulated, it plays a role in increased intestinal permeability by causing small openings to form along the tight junctions. For more on this, read here
How do antibiotics impact?
The use of antibiotics threaten the diversity of the microbiome causing a detrimental effect to immune health of the child. Antibiotic use may be absolutely necessary in some instances, however antibiotics are in use more than ever before, and often patients are not educated on the detrimental effects of antibiotics, particularly repeated use.
How do we improve immunity and minimize the risk for autoimmune reactions with nutritional therapy?
Hippocrates, the father of modern medicine had said that all disease begins in the gut, and he was correct. Healthy diversity in gut flora, alongside an intact and thriving gut mucosa, which is vital for a healthy immune response.
Richness and diversity of bacterial species is vastly important. Information on over-representation or under-representation of specific strains of bacteria that correlate with particular health issues is just coming to light, and research in this area continues.
Nutritional therapy for encouraging the growth of healthy bacteria and improving gut barrier function involves the incorporation of fiber (such as beta glucan, pectin, and guar gum or acacia gum), use of traditional herbs such as licorice, meadowsweet, chamomile, gotu kola, slippery elm, and the incorporation of probiotics, zinc and glutamine for healing of the gut wall, as well as the improvement of innate immune responses with vitamin D and herbal medicines such as Echinacea and Astragalus.
Prebiotics and probiotics are important, and our probiotic bacteria require adequate amounts of prebiotic fibre in order to create short chain fatty acids and encourage the growth of healthy bacteria in the gut.
As always, the naturopathic approach supports bio-individuality and each case will require a different nutritional or herbal approach often based around the results of functional testing. A relatively inexpensive lab test can show gut permeability function including zonulin levels and gluten sensitivity.
It’s imperative that we restore barrier function and healthy gut bacteria diversity as a means to restore good health for our children and provide a preventative approach to the onset of autoimmune conditions.
The good news is that children respond very well to naturopathic and nutritional treatment. Nutritional supplementation and herbal medicine can have dramatic effects on a child’s recovery. Establishing healthy eating habits at an early age have long lasting impacts into adulthood and beyond.
Yvette is a qualified Melbourne-based Naturopath and Nutritionist, MINDD Practitioner, member of the Naturopaths and Herbalists Association of Australia, and Complementary Medicine Association. Yvette specialises in the treatment of conditions commonly affecting women and children, with a key interest in children’s digestive and neurological conditions, as well as women’s hormonal concerns, digestive issues, fatigue, anxiety, and skin concerns. Yvette consults in South Yarra, Melbourne, as well as Australia-wide via skype/zoom/phone.
Hechtman, L. (2011). Clinical naturopathic medicine. Sydney, Australia: Churchill Livingstone/Elsevier.
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The Naturopathic Co. Melbourne Naturopath 2020