Dr. James Adams is an autism researcher and father of an autistic child. He has published a wealth of research on diet, vitamin and gut-bacteria therapies for autism. Today we expand upon what steps you can take to help someone you love with autism.
Dr. Michael Ruscio, DC: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here with Dr. Jim Adams who has partaken in a very interesting study that may show, or seems at least to provide preliminary evidence that FMT (fecal microbiota transplant) could be efficacious for autism. And I was excited when I saw this study and even more excited when he agreed to come on the show. So Jim, welcome to the show. And thanks for being here.
ASD children are missing about 20% of normal flora
Isolated bacteria were administered – not a traditional FMT – highly purified frozen liquid made up of 99% bacteria
Improvements in GI symptoms, ASD symptoms (20% reduction in ASD), and the microbiome all persisted for at least 8 weeks after treatment ended, suggesting a long-term impact.
Repeat FMTs may be needed
Prevotella is much lower in kids with autism – a bacteria that consumes fiber and turns it into butyrate (short-chain fatty acid) – butyrate is the main food for cells that line the gut (60% of the energy for the gut) 5% of the energy for the body.
Why are SIBO and fungal overgrowth common in Autism patients?
A number of studies have found that children with Autism have much higher oral antibiotic use during infancy
Especially low in Biotin and vitamin K
Lack of good bacteria
Studies – SIBO and fungal overgrowth correlate with Autism
The mineral supplement they created as well as fish oil were two of the most critical factors in improvements
Found a 7 point gain in IQ
10 month gain in development
The positive results of this study suggest that a comprehensive nutritional and dietary intervention is effective at improving nutritional status, non-verbal IQ, autism symptoms, and other symptoms in most individuals with ASD. Parents reported that the vitamin/mineral supplements, essential fatty acids, and HGCSF diet were the most beneficial.
Focus less on what to avoid and more on what to include
Whole fruit and whole vegetables
Fish oils high in Omega 3s (most people are underdosing)
How can parents access this kind of FMT therapy?
The FDA has not yet approved it for Autism
The treatment would still need to go through phase 2 and phase 3 studies
*On this episode of the Dr. Ruscio Radio, I humbly apologize to our listeners about the less than optimal audio quality on the guest audio. When recording remotely, it is sometimes difficult to avoid these technical issues but I believe that you will still be able to take away some good information from our conversation.
Dr. James Adams: Thanks, Michael.
DrMR: Would you mind telling people a little bit about your background? Because you’re fairly plugged in. Your bio is pretty impressive in terms of—I’m looking at a note here from your CV of over 150 peer-reviewed, scientific articles published. And I know you’re deeply involved in autism and Asperger’s research. So tell people a little bit about your background.
DrJA: Sure. I have a little bit of an unusual background because I’m a materials engineer by training. And I used to be the chair of materials engineering at Arizona State University.
But 20 years ago, I switched over to focus on autism because of my daughter with autism. Then we published over 40 studies looking at causes of autism and biological factors in it and how to treat it.
DrMR: Great! Well, I guess great and not great. Oftentimes, we have our own personal journeys that bring us here. And I was included in that in my own personal health struggles that brought me into my focus on GI. But it’s terrific that you were able to leverage your scientific background into what you’re currently doing.
And one of the things that was noteworthy here I found was part of your conclusion, which was the autism spectrum disorder symptoms persisted for eight weeks after the FMT therapy ended, so suggesting some kind of long-term impact. And I’m curious if maybe you’ve been following even further since the study concluded and if you have any follow up on that. But definitely curious to hear your thoughts on this study.
Microbiota Transfer Therapy
DrJA: Sure. I’ll try to give you the big picture first. Then we can dive into details if you want. The big picture is that we have done previous studies finding that children with autism were missing about 25% of the normal gut bacteria. A normal person has, depending on how you want to count it, close to a thousand species. Kids with autism were missing several hundred species.
And so our thinking is that we wanted to go ahead and try to restore their normal gut bacteria by transplanting gut bacteria from very healthy individuals. Unlike with C. diff. where one dose, one time seems to be enough, we had worked with a clinician, a gastroenterologist in Australia, Tom Brody. And he found that GI problems in kids with autism were much, much harder to treat than C. diff.
Instead of one dose, he found that he needed to treat them daily for about three months to be able to improve their symptoms. And surprisingly, he found it also improved autism symptoms. That was his clinical experience. He guided us in doing the study.
In the U.S., microbiota transplant is regulated tightly by the FDA. So we asked the FDA. And they approved us to do a treatment study for children with autism. So we used two weeks of vancomycin, an antibiotic to kill off harmful bacteria. Previous studies showed it was temporarily helpful for kids with autism.
And then we did a bowel cleanse, like you do for a colonoscopy, to try to remove any remaining bacteria. And then we did a high-dose implant, a day or two, and then seven to eight weeks of low-dose, daily dosing. And we did that long treatment because slowly, after about five weeks, we saw very good improvement in GI symptoms, eventually about an 80% reduction in GI problems. And kids with autism commonly have chronic constipation, chronic diarrhea. Or they alternate between the two.
We were dealing with kids ages 7 to 16. And every one of them has had GI symptoms since infancy. So for the first time in their lives, they were getting huge improvements in their GI symptoms. And surprisingly, we also were pleased to see about a 25% reduction in autism problems.
So then we stopped treatment and held our breath. Would these benefits be long-lasting or not? Standard probiotics, as soon as you stop taking them, benefits disappear within a few weeks or less.
We found eight weeks later the GI benefits were still holding just fine. The autism benefits were still doing well. And we also looked at the microbiota. And we found that, sure enough, from 25% lower than normal numbers of bacteria, to normal levels. They stayed normal eight weeks later.
DrMR: That’s fantastic. And so much there falls in alignment with what I have observed also, loosely termed this gut-brain connection. The better we get someone’s digestive symptoms, oftentimes the better their anxiety or depression or brain fog or what have you. So it’s not surprising, at least in my mind, seeing this beneficial impact neurologically that corresponded with both symptomatic improvements in the gut and, I guess you could say, a resurrection of the missing flora in the gut.
And I guess a couple of follow-up questions for you there. What was the method of administration? Were you using the frozen capsules? Was it an enema? Was it a nasogastric tube?
DrJA: We worked with a company that’s now known as Finch Therapeutics. They’re making material for C. diff. patients. And at the time, we were using an earlier version which was a frozen liquid.
And so it was highly purified gut bacteria from very healthy, carefully screened donors. So doing all the standard screening that you do for a blood donor for the Red Cross, also checking for GI health, making sure they have a normal BMI (not too fat, not too skinny). So lots of checks as well for any pathogens.
And then after they donate, checking with them again a couple weeks later that they weren’t just coming down with some illness.
So the bottom line is 90% of the general population screens out. Only the top 10% healthiest are used for the donations. And then it was highly purified and then provided as a frozen liquid. The children just thawed it and mixed it with juice and drank it down.
DrMR: So this frozen bacterial liquid, would this not be considered traditional FMT, and the bacteria were just isolated out? Or was this more frozen fecal matter? And because it was frozen it was, I guess, permissible to be administered orally, and it unfroze as it made its way down the intestinal tract? I’m sure people are wondering.
DrJA: So rather than calling it fecal transplant, we call it microbiota transplant because we’re purifying it to 99% bacteria. All the waste matter and other stuff is removed so it’s just bacteria that we’re providing. And then it’s provided in a liquid form. So it’s stored frozen. It was then thawed. And just after being thawed, the children drank it down with juice.
We did give a stomach acid suppressant. And that’s a pretty effective suppressant. So that way, the bacteria could survive passage through the stomach into the GI tract.
DrMR: Gotcha. Okay. So this sounds like something promising in terms of the user-friendliness and lack of invasiveness. Of course, if someone is using a nasogastric tube, that’s fairly invasive. And enemas, especially in children, are something that I think we’d like to avoid if we could. So that’s exciting to see that there’s this method that is being studied and showing to have effect. Is this something that other researchers are using and is starting to be studied more thoroughly?
DrJA: Well, in general, FMT type approaches are being used more and more for treating a variety of GI issues. And I think also people are starting to shift towards more intensive approaches rather than using a single dose, which is fine for C. diff. But for other issues like ulcerative colitis, Crohn’s disease, IBS, then it seems probably multiple doses work better.
For autism, we’ve since been approved and have since started another study. This is a million dollar project from the federal government to do a similar study for adults with autism. But unlike our first study that was open-label, so there’s some placebo effect, this study is a randomized, double-blind, placebo-controlled study.
DrMR: Great. Great. Fantastic.
Let’s talk about one of my favorite tests for digestive health, the GI-MAP from Diagnostic Solutions, who has helped to make this podcast possible. Now if you’ve been reading any of the case studies that I’ve published in The Future of Functional Medicine Review clinical newsletter, you’ve likely seen that this test, the GI-MAP, is a test I frequently use in my practice.
Why? Well, one of my favorite things about this test is it has excellent insurance coverage. So this is a few hundred dollars I save patients. This lab is also CLIA certified, which is essentially the quality assurance bureau for labs. So it’s important that these labs are being monitored, not cutting any corners. That’s where you get your CLIA certification.
Now, this test uses quantitative PCR technology. So it’s a DNA test. And you’ll get a good read on dysbiosis with this test because they will assess and report out various types of bacteria, yeast, and parasites including protozoa, worms, and amoeba.
They also have some valuable and helpful clinical markers like calprotectin which can help rule in or out irritable bowel disease, and zonulin, a marker of leaky gut.
DrMR: Now, I’m wondering what your thoughts are on why this is benefitting. And I’m looking at two studies in front of me here, one Trusted SourcePubMedGo to source that found that small intestinal bacterial overgrowth was more prevalent in cases of autism versus healthy controls and another study Trusted SourcePubMedGo to source looking at intestinal yeast and finding that intestinal yeast overgrowth was more common in about 57% of autism subjects compared to healthy controls.
And I’m wondering if your thoughts are, at least in part, the mechanism is these bacteria that are being administered orally, in this case, are combating overgrowths. And I know that you mention a 20% reduction or absent component of the microbiota.
And I should maybe clarify. I’m wondering if you think there could be lower levels of colonic bacteria and potentially higher levels of small intestinal bacteria, and perhaps that’s how we account for some of these research findings of bacterial and fungal overgrowth in autism. Your findings showing a reduction or absence of 20% of bacteria in autism. But irrespective, it seems that adding additional bacteria to the system is helping.
So wondering if you think it’s rectifying dysbiosis or if there are other mechanisms that are akin to that at play.
DrJA: Yeah, so I think there are multiple issues going on. First of all, just even what’s the cause of this? And one of the causes, there have been a number of studies that children with autism had much higher oral antibiotic use during infancy. So that’s one factor.
But in terms of what the mechanism is, we had done one study where we measured levels of every vitamin in children with autism. We found children with autism were especially low in biotin. And when we gave them a vitamin/mineral supplement, we found that we could predict most of the improvement based on their initial level of biotin and initial level of vitamin K.
And those two vitamins have very different functions. But what they have in common, those two vitamins you get partly from your diet. But in large extent, they’re made by your gut bacteria. So we think children with autism are missing some of the important beneficial bacteria that produce vitamins.
So it’s not just pathogens that are present. But it’s also a lack of the beneficial bacteria that’s a problem as well. So the vancomycin kills off the bad bacteria. And in fact, we found that roughly two-thirds of the children in our study got worse for a few days right at the start of vancomycin. They had worsening of hyperactivity and irritability. And that’s what had been found in a previous study with vancomycin for autism as well. But it only lasted a few days. And then they got better.
So killing off the harmful bacteria that are releasing toxins causing irritability and hyperactivity is part of the problem. And then restoring normal gut bacteria is part of the problem to produce vitamins.
Another key factor we think is very important is when we looked at all the bacteria, 2000 bacteria, there was one that really stood out, Prevotella. And Prevotella is a bacteria that consumes fiber and turns it into butyrate. And butyrate is a short chain fatty acid that’s the food for the cells that line the gut. And this provides about 60% of the energy for the gut, about 5% of the energy for the entire body.
So we found that Prevotella levels were much lower in kids with autism. After being on FMT, they went up 200 fold. And that probably means that there was more butyrate being produced which allows the gut to slowly get enough energy to begin functioning normally as opposed to being starving and sick.
So we think that restoring the gut intestinal lining helps the health of the cells and reduces intestinal permeability. And so then there are probably fewer toxins leaking from the gut into the rest of the body as well as fewer food allergens. There are probably factors as well in re-regulation of the immune system. So it’s very complex as to what’s going on.
And so it seems you’re building on that here but looking if you can rectify low vitamin status by improving, I guess we could say here, probably two mechanisms that fold one local production in the intestines by the microbiota and then also facilitate absorption by ostensibly reducing leaky gut and improving just the natural absorption of nutrients through the gut. Would you agree with that?
Nutritional and Dietary Intervention for Autism
DrJA: Yes, I think that that’s very much the case. In that study you mentioned, we found that a vitamin/mineral supplement we created as well fish oil were two of the most important factors in improvements in children with autism. We found a 7 point gain in IQ, an 18 month gain in development versus 4 months in the control groups.
So these factors, these nutrients are very important. And part of the role of those nutrients is to restore normal gut function. And that in term can improve digestion by the body.
DrMR: And we’ll make sure to put that link to your other study in the transcript for the audience in case you’re wondering about that.
Jim, something else I’m wondering. I’ve seen a handful of cases where there seemed to be—and I can’t say that I tested to verify this. But there seemed to be this histamine sensitivity, potentially this accompanying DL-lactic acidosis, this syndrome of overproduction of certain bacteria metabolites that have psychoactive characteristics.
And addressing that has been helpful in some of these cases that I’ve seen in the office. And more so for the parents out there, what I’ve seen a handful of times—so this is an early observation. It may just be a coincidence that I’m observing. But a family would get their child on something like a GAPS diet that was very high in fermented foods. And the child seemed to initially respond very well to that. And then they regressed.
And my theory is they were saturating their child’s system with histamine, potentially also with DL-lactate. Both of these loosely stated may elevate when someone is consuming high amounts of probiotics. And getting them off the GAPS diet and even steering them in more of a low FODMAP diet direction was very helpful in this handful of cases.
And so, Jim, I’m wondering. Have you looked at anything related to histamine and/or D or L lactic acidosis?
DrJA: We haven’t looked at histamine or DL-lactic acidosis. I think it’s an interesting area to look at. I’m aware of some studies that are relevant for chronic fatigue. And that may be a factor there. The problem with the D form of lactic acid is that they almost cannot metabolize that. That’s a potentially significant problem.
So coming back to the diet, we did find in that diet study I mentioned, we often just put children on a healthy allergen-free diet. So avoiding gluten, dairy, soy. And we found that was overall beneficial. So I think that there’s good evidence for that.
The GAPS diet, it would be nice to see some research on. But I haven’t seen any formal of research studies on it yet.
DrMR: Sure. And I like what you’re saying. And I think there’s maybe a message here to echo which is parents may not necessarily need to put their child on the most healthy diet—meaning you have to go to these great lengths.
We may be able to get a lot out of some general practices that are seen in healthy diets—gluten reduced or gluten-free, also avoiding sugars and processed foods and focusing on healthy meats, fats, vegetables, fruits, nuts, seeds. At least, that’s what I see in adult populations. I certainly don’t profess to be an autism expert.
But the thing I try to provide people with here on the podcast is knowing how far they have to go to get the result that they’re looking for because, of course, as parents, I’m sure there’s enough to worry about as is. And we don’t want to necessarily encumber someone with having to adhere to a stricter diet than they need to.
So how do you look at diet in terms of, do people need to go all the way to something like GAPS? It’s sounding like, again, you’re not necessarily saying that which is very hard to do. Or can they get away with some more simplified dietary maneuvers?
DrJA: Right. I think people often focus too much on what to avoid and not enough about what to include. So a common mistake we see is people going from Oreos to gluten-free Oreos. Not a very good improvement.
DrMR: Good point.
DrJA: So we really focus on whole fruits and whole vegetables because that’s a great source of fiber. Dietary fiber is, again, so important. It’s the primary food for the cells that line the gut. And so diets that are high fiber by whole vegetables, whole fruits we think are very important. Getting sufficient protein, doesn’t have to be excessive. And having good healthy oils. So those are really the major components along with fish oils that are going to be high in omega-3s. Most of the omega-3 studies for children with autism were underdosing. They were dosing 100 mg whereas, for heart health, we know we need to go to about 4000 mg.
So that’s why we in our study were using about 2500 mg. We found fish oil was very beneficial at that level. But I think having enough fish oil is important. Too many people are underdosing.
DrMR: Gotcha. Okay. Now, I’m wondering. With this microbiota transfer that you have used, is this something that parents have access to? If someone is listening to this saying, “My gosh! I’d love to do this with my child,” how can they go about getting the ball rolling in that direction?
DrJA: The problem is that the FDA classifies microbiota transplant as a drug. And so we have to go through phase 1, phase 2, and phase 3 trials. So a phase 1 trial, we’ve done. We’ve published, showing it’s safe in a small cohort. We’re now doing a phase 2 study, meaning it’s randomized double-blind. If that study is successful, then we’d have to go to a phase 3 study, meaning order 20 sites, order 500 to 1000 participants around the country. So if I had about $100 million dollars, we could do those studies and get approval from the FDA.
Until then, the FDA has a very unusual status for FMT. It is allowed for C. diff. but not approved for C. diff. That means you can only use it for C. diff. But you cannot use it off-label for any other condition except in a research study. So the FDA is really looking at this very cautiously.
DrMR: Yep, it does seem that way. And I suppose on the one hand I understand their reservations. On the other hand, especially for irritable bowel disease, the data there is looking really compelling. In fact, there was recently a paper published showing that FMT would actually be cost-effective compared to standard therapy. I believe it was for somewhat moderate to severe in severity irritable bowel disease.
And there have been meta-analyses looking at the safety profile. And they generally tend to show very low incidences of adverse events. So I think we’re seeing a body of data amass here that’s really showing the utility, the safety. Could we learn more with longer-term studies? Yeah.
And perhaps that’s where some of their reservations are coming from. Or it just could be the stigma of FMT being something that’s hard to swallow for regulators. What are your thoughts in terms of why the wheels are turning slowly with the FDA?
DrJA: Well, it is such a complex product because we’re dealing with over 1000 bacteria, many different levels of every one. So it’s very complicated. So I understand why the FDA wants to be cautious and do study after study.
The last review I remember was over 25 articles showing just generally very safe, very well tolerated, no one getting seriously ill. The worst conditions I’ve heard of are a temporary flare-up of ulcerative colitis or Crohn’s disease followed by getting better. So it seems to be very safe in general.
But there’s the potential for transmitting an infection. That’s why it’s so important to use carefully screened material from very healthy, carefully screened donors. Now, it’s saving thousands if not tens of thousands of lives of C. diff. patients. C. diff. is killing 29,000 Americans a year. And FMT is a 90%+ cure rate. One dose, one time. In two to three days, you go from a debilitating disease to being near normal. It’s amazing.
And so I think it makes a lot of sense to continue work in this area. And I’m so excited by all the progress I’m seeing in it.
DrMR: Same here. No, I completely share your excitement. And I’m hoping that potentially, as one additional condition gains FDA approval, that we’ll see a few others follow suit fairly quickly. But I’m glad that there are people like you out there doing this research to help advance us in that direction.
Jim, what do you think parents should know? If there’s a parent with an autistic child listening to this and they’re saying, “Oh gosh! This therapy sounds great.” But perhaps it’s a bit out of reach right now. What would you say are some of the therapies to really consider and should be part of someone’s care plan for their child for autism?
Therapies to Focus On
DrJA: On my website I have a 50-page handout describing in detail about 18 different treatments and the research behind them.
DrMR: And I’ll ask you for this again in a moment. But the website, just so people have that?
DrJA: It’s AdamsAutismResearch.com. So if they go there, there’s a summary that covers about 50 pages on about 18 different treatments. For gut therapies, probiotics can have some limited benefit. There are a couple open-label studies suggesting there is something benefit there.
Certainly checking for yeast infections and treating those with antifungals, we think makes good sense. But even they have to be long term. Checking for other bacterial overgrowths makes sense. Unfortunately, commercial testing is pretty limited because most tests use culture. And most bacteria can’t be observed by culture. So we’re very limited.
One of the best tests is what we call the toilet test. Just look at the stool. Is it reasonably shaped? Is it medium brown in color? Are you having a stool once a day? If your stool looks abnormal, if it smells abnormal, half of that stool—half of it!—is gut bacteria. So I think that’s the cheapest and probably one of the most reliable tests of, do you have abnormal gut bacteria? And do you need to do something about it?
DrMR: Yep. I think that’s actually very reasonable. And I think it’s tempting to get pulled into testing. But as I have said in the podcast before, even with the best available tests, we’re only getting a slice of what’s happening in the gut. So it’s a little bit foolish to think that we can just test our way into understanding everything that’s going on in the gut and, further yet still, to know exactly what treatments should be used.
But rather, it’s a better idea in most cases to use someone’s symptoms. And in this case, a non-well-formed stool and a smelly stool would be a couple of symptoms. Combine with how they respond to different therapies to really let you know if you’re on the right track.
Of course, I would definitely recommend people get the e-book from your website. But are there other therapies that you think are noteworthy?
DrJA: Yeah, so another thing to consider is that there are now three major studies showing that there is a subset of children with autism who have decreased digestive enzymes, especially the enzymes for carbohydrates, and especially the enzyme for the sugar in milk called lactose.
So many children with autism have low levels of lactase, the enzyme needed to digest lactose, the sugar in milk. And that’s why they’re lactose intolerant. And that’s a good part of the reason why they do better on a dairy-free diet as well as those foods being common allergens.
So I think certainly checking for common allergens and trying to avoid those is important. Food allergies are very common. And I think it makes sense to check for those and to avoid foods that are allergenic.
DrMR: Fantastic. Fantastic. And is there anything else you’d like to share with our audience as we transition to a close? And then also, you mentioned your website. Please mention that again. And if there is anywhere else you would like to point people, please do so.
JA: Yeah, so our website for our autism research is AdamsAutismResearch.com. We have done studies on vitamin/mineral supplements, three studies. And we’ve now, based on that, created a nonprofit that produces a vitamin/mineral supplement for research. And there’s a link to it from my website. And so that’s also something we recommend and found is helpful for some GI problems but really more so for overall general functioning.
But I can’t emphasize enough just a good, healthy diet. We had one child in our study with severe Pica, eating nonfood items (things like dirt, sand, newspaper). He’d had that problem for years. That’s usually a sign of a nutritional deficiency. Within one week of putting him on a healthy, balanced diet, the Pica totally disappeared. And he’s been cured since.
DrMR: And explain what Pica is for people who may not have heard of that condition before.
JA: So Pica is just eating nonfood items. So he was eating things like dirt, sand, newspaper. So when children do that, it’s usually a sign of major nutritional deficiency. It could be iron, zinc. It could be other minerals are deficient. So they just search for strange things to put in their mouths.
DrMR: Sure. Okay. All right. Well, thank you, Jim, for taking the time. I really love what you’re doing. I wasn’t fully aware in terms of the breadth of the research that you’ve been publishing. And that’s why I wanted to dig in on this call. And again, I love what you’re doing. For anyone listening, I’m hoping that this will be a great resource for you.
And the audience knows I’m a big fan of people who are participating in research because one of the things that can happen in the integrative field is there can be a lot of promises and not a lot of delivery. And so how do we suss that out? Well, research is a great way to do that. And so gentleman and people like Jim who are performing research will hopefully give you recommendations that will land you the closest to the effective therapies as possible.
And so just, Jim, thank you again. Everyone, check out his work. And if anything comes up, Jim, that you feel is very important, please feel free to let me know. And we’ll have you back on the show to expound upon it.
I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!
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