Dr. Lucy Qiao is a retired medical research scientist who received her MD degree from Beijing Medical College. Shortly after moving to the United States, she began to explore the field of neuroscience in order to achieve a deeper understanding of her son’s autism. She obtained a PhD degree in Neuroscience at the Baylor College of Medicine and has remained an active participant of the FCSN community up to this day. 

In this interview, Dr. Qiao discusses the prevalence of gastrointestinal (GI) issues in individuals with special needs. She breaks down the three major types of GI issues and explains why they are so common within the special needs community. She also shares intriguing discoveries from current research on the gut-brain axis, a topic found to have strong links to autism and special needs. 

*Note: Dr. Qiao’s insights are solely based on her expertise as a medical doctor and her experiences as a parent of a child with special needs. She is not a certified expert in child nutrition.

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What are GI Issues?

The gastrointestinal (GI) tract plays an important role in the human digestive system, working to break nutrients down into a more absorbable form for the body¹. When a person has GI issues, they may experience unpleasant symptoms such as bloating, constipation, and diarrhea. According to Dr. Qiao, there are three major types of GI issues: food allergies, food intolerances, and GI infections.

Food allergies are distinct from food intolerances as they are abnormal responses to food caused by the immune system. As Dr. Qiao explains, “Food allergies [are] usually…because certain protein components trigger immune response in our body…Presumably, the immune system is designed to attack viruses and bacteria, but when they attack the food, it can cause a lot of problems in the GI system.” Allergic reactions can be severe, which makes it important to identify what type of GI issue someone is experiencing.

Meanwhile, food intolerances are genetic, with causes rooted in the GI system. When someone is intolerant to a type of food, they lack a particular enzyme necessary for digesting the molecules in those foods. A common food intolerance is lactose intolerance, which means that the person does not have the lactose-digesting enzyme, lactase, in their GI system. Dr. Qiao and her son are both lactose intolerant, and they prevent symptoms by drinking lactose-free milk and taking lactase pills prior to consuming dairy products.

As for gastrointestinal infections, individuals may experience a range of symptoms, from nausea to diarrhea. These infections may be triggered by sensitivity towards contaminated food, or even factors related to a condition called “Leaky Gut Syndrome.” 

Why are GI issues more common in the Special Needs community?

Although the answer to this question remains unclear, Dr. Qiao suggests that difficulties with self-expression, “Leaky Gut Syndrome,” and the gut-brain axis could be contributing factors. Individuals with special needs find it “difficult to express themselves…so they [can’t] tell you when they have a little discomfort,” Dr. Qiao said. “For example, like my son, he’s autistic, and when [neurotypical people] don’t feel good, we stop eating. We will tell and we will start taking medicine earlier, but in special needs people, they [can’t] do that. They try to pretend that nothing’s wrong [and] keep eating. That can make things worse when your GI system is already very uncomfortable. You’re still loading [it] with a lot of food down, and it will cause diarrhea and throw[ing] up.”

Another hypothesis is that special needs is associated with a condition called “Leaky Gut Syndrome.” Normally, the transport of substances into the bloodstream is regulated by the intestinal tract. In “Leaky Gut Syndrome,” the intestinal lining is weakened, and proteins and pathogens can leak into the body, causing infection or allergic responses². As Dr. Qiao explains, “Our skin and our GI system [act as] our barriers [in] preventing foreign bacteria, viruses, and/or antigens [from] getting into our body, protecting us. But if you have a leaky gut…some foreign bodies, like proteins or bacteria or even viruses can leak into our bloodstream. You can tell if these things get in [when] they are not supposed to: they will trigger [an] immune response, and they will make people sick.”

Finally, recent findings indicate that people with autism tend to have defects in the gut-brain axis, contributing to GI issues. The human gut hosts a rich variety of microbes that aid in digestion, synthesize vitamins, and promote overall health. Studies have found that the gut microbiome in children with autism is distinctly different from the gut microbiome of neurotypical children, suggesting that neurological factors play a role in GI health³. However, further research is needed to confirm if these differences are due to autism itself or the limited diets children with autism tend to have⁴.

Recent Discoveries in Gut-Brain Axis Research

Research exploring the connection between the gut and the brain has received significant attention in recent years. “Studies indicate [that] maybe some of the symptoms, for example, anxiety, [are] not necessarily because of brain problems – maybe [it is] the GI properties [that are] causing the anxiety behavior in autistic [children],” Dr. Qiao said. “That may or may not be everything – some may be caused [because] the brain [chemistry] is different – but now there is evidence showing this could be linked to [the gut].”

Because hundreds of gene mutations have been linked to autism, researchers have created mouse models to study the effects of these genes. According to Dr. Qiao, “When you have a gene mutation, it’s usually a global gene mutation, meaning [in] every cell in your body, that gene is missing, mutated, or has some kind of defects. But in a lab, you can try to sort out what is the cause and…whether this anxiety behavior is caused by a problem in the brain or a problem in the GI system.” In a mouse model studying the CHD8 gene, a gene strongly associated with autism when mutated, researchers “only knocked out this gene in the GI…so the brain and other body parts [had] normal genes…but they still [saw] anxiety behavior,” Dr. Qiao said. “So that tells you very strongly, it is a GI problem causing behavior. We think that usually, anxiety is a neurological behavior problem.”

Dr. Qiao notices how the gut affects her son’s health on a daily basis. She observes that her son is more susceptible to diarrhea, and he is more sensitive to bacteria than she is. “Sometimes it’s inevitable,” Dr. Qiao said. “We ingest some harmful bacteria, and you go to eat in a restaurant and the food gets a little bit contaminated. I suspect…the threshold for him to have diarrhea [is] probably lower than me…And then to the other extreme, he’s also very easy to get constipation. Constipation is also linked to microbiome issues.” 

To promote regular bowel movement, Dr. Qiao tries to increase his fiber intake and has him take prebiotics and probiotics. “You need to feed [the] microbiome in your gut,” she said. “You eat not only for yourself; you need to feed [your microbes] as well. When they are happy, you’re happier, healthier…That’s why we are relying on [microbes] to be healthy – feeding them, and also feeding yourself.”

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