Autistic individuals frequently experience mental health stress for a number of reasons. Sensory overload, lack of accommodations, and simply living in a world set up for neurotypical people can all contribute to this stress. Further, many Autistic children and adults experience uncomfortable gut issues like stomach pain and constipation on a daily basis. These stressors can compound and negatively impact overall well-being.
If you or a loved one are managing stressors like these, you may be searching for safe and effective options for support. Emerging research in autism suggests that specific probiotics may help - some for supporting mental health and others for supporting gut health.
Here we explore recent research studies of the best probiotics for Autistic people, highlighting probiotics for mental health. We will first introduce you to probiotics clinically shown to be beneficial for autism followed by a fresh look into probiotic definitions, safety, and use.
Best probiotics for autism
Clinical studies have recently revealed that probiotics may help Autistic persons manage several challenging aspects of daily life, like anxiety-related stress and gut problems.
These studies have shown that some probiotics may help to improve mood and positively impact brain behavior and function. These are known as psychobiotics: clinically-studied probiotics that confer a mental health benefit when taken in adequate amounts. Other probiotics work directly on gut health and may help relieve gastrointestinal (GI) discomfort and other related issues in Autistic people.
Here we discuss the three best probiotics for Autistic people and the studies that support their benefits. These studies reveal the therapeutic potential of probiotics, especially in helping to improve mental health (i.e., anxiety-related symptoms) in autism.
L. plantarum PS128 - a gut-brain medical food
Backed by four clinical studies, L. plantarum PS128 is currently the most clinically studied autism probiotic. These include one real-world study and three randomized, double-blind, placebo-controlled trials (the gold standard in clinical research). PS128 was well tolerated with no severe adverse events, gastrointestinal issues, or allergic reactions reported in all four studies.
All of the PS128 studies showed promising results for the dietary management of mental health issues in autism. These benefits are known as psychobiotic effects - a unique quality of some probiotics due to their influence on neurological health.
Psychobiotic effects of PS128 in autism
Studies suggest that Autistic individuals may have differences in gut dysbiosis (altered gut microbiome) and levels of neurotransmitters as compared to non-Autistic individuals. While the exact mechanism (or mechanisms) are still unknown, scientists hypothesize that PS128 may work by influencing bodily processes possibly linked to these observed differences. For example, PS128 led to an increase in the amount of beneficial Bifidobacteria in a preclinical study, which suggests it may help with gut dysbiosis.
In four clinical studies of PS128, however, Autistic children were included regardless of their gut health status. And while gut health was measured in one study, the primary focus of the studies was on behaviors and mental health.
How might a probiotic influence the brain like this? Previous preclinical studies with animals suggested PS128’s ability to act as a psychobiotic. Researchers therefore hypothesized that PS128 influences the central nervous system via the gut-brain connection in people too.
Clinical studies have shown that PS128 promotes psychological well-being in some children with autism spectrum disorder (ASD). In some studies, results included reducing anxiety or behaviors associated with anxiety or sensory overload. In one study, the researchers noticed improvements in behaviors such as hyperactivity and impulsivity.
Study 1: Effects of Lactobacillus plantarum PS128 on children with autism
In this clinical trial, 71 Autistic children ages 7-15 were given PS128 alongside a primary treatment. The study was randomized, placebo-controlled, and double-blind - the “gold standard” of clinical study types.
Before the intervention, the researchers evaluated different social skills and behaviors using certain measures in both groups. Then, the children and adolescents took either PS128 or a placebo over four weeks. When the study was concluded, the researchers repeated these scoring measures and compared the results.
After four weeks of the Autistic children taking PS128, researchers made the following observations:
- Better use of body parts and objects
- Decreased anxiety and rule-breaking behaviors
- Improved attention and hyperactivity
The younger children (ages 7-12) in the PS128 group showed greater improvements in oppositional/defiant behaviors and attention when compared to the 13–15-year-olds in the study.
Study 2: PS128 probiotic intervention in young children with autism
In this double-blind, placebo-controlled study, researchers explored the mental health benefits of PS128 over a four month period. For the first two months, 86 Autistic children (ages 2½-7) were randomly assigned to a PS128 group or placebo. In the last two months of the study, all the children were given the probiotic PS128 (no placebo intervention).
The results of the studies were promising. Anxiousness and depressive mental health symptoms were significantly improved in the psychobiotic PS128 group in the first 2-month intervention period as compared to placebo.
VISBIOME - probiotic for gut symptoms
In a small randomized pilot trial, researchers hypothesized that a probiotic known as VISBIOME could improve quality of life in autism by improving GI symptoms.
VISBIOME is a multi-strain probiotic medical food used for the dietary management of certain intestinal diseases. The formula contains eight probiotic species, mostly beneficial bacteria from the genera Lactobacillus and Bifidobacterium. These genera are frequently found in probiotics.
In the study, 13 children aged 3-12 years were given either VISBIOME or a placebo over 8 weeks. After a 3 week wash-out period, they took the other for another 8 weeks. The probiotic and the placebo were both given in powder packets.
At the end of the study, the study authors noted that VISBIOME relieved GI symptoms and improved quality of life in some of the individual participants. However, there was not a statistically significant difference between VISBIOME and placebo when the children were compared as a group. This is possibly because the sample size was so small (only 10 participants ultimately completed the study).
L. reuteri (ATCC PTA 6475 and DSM 17938)
In a randomized, double-blind, placebo-controlled study, researchers tested the effects of a combination of two strains of L. reuteri in 43 Autistic children between the ages of 2-8 years old.
Before and after the intervention, the researchers assessed social responsiveness, social communication, behavior, and parental stress scores. They also recorded gut symptoms and observed “restricted, repetitive behaviors.”
After 6 months, researchers observed improvements in social functioning in the probiotic group. Other behavioral and parent stress scale scores, as well as gut symptoms and restricted repetitive behaviors, did not appear to change significantly.
How probiotics might help Autistic people
It’s important to understand that probiotics do not make anyone “less Autistic”. However, certain probiotics have been shown in several clinical and preclinical studies to be beneficial for improving quality of life in Autistic people.
From a mental health standpoint, there are many challenges that pop up on a daily basis for Autistic individuals. These challenges often arise because of the lack of awareness and accommodations prevalent in a world designed for neurotypical people.
There are also a number of biochemical and microbiome differences present in Autistic individuals (as compared to non-Autistic individuals) that can further complicate mental and physical health. These differences can be associated with metabolism, balance of neurotransmitters, and gut health in general. Fortunately, certain probiotic strains or products may help.
Neurotransmitters and mental health
The gut microbiome in autism is associated with differences in metabolism which can affect brain neurotransmitters like dopamine and serotonin. These good-feeling chemicals have been shown to be imbalanced in some Autistic individuals.
For example, increased serotonin levels in the bloodstream and reduced dopamine activity has been observed in Autistic people. Both dopamine and serotonin play pivotal roles in mood regulation, behavior, and cognitive functioning.
Certain probiotic strains can influence neurotransmitters in the brain via the gut-brain axis. For example, L. plantarum PS128 balanced dopamine and serotonin in a set of preclinical studies. This result may explain the impact that PS128 can have in addressing mental health for Autistic individuals.
Gut health - dysbiosis and leaky gut
Gastrointestinal symptoms, like diarrhea, constipation, and abdominal pain, are often common in autism. For instance, studies report that Autistic children are more likely to develop GI issues than non-Autistic children.
GI problems, however, are not specific to children. They occur at all ages, from childhood to adulthood, and can range from mild to severe. These problems can cause great discomfort and impact quality of life.
Scientists have also observed that the amount of intestinal permeability is increased in Autistic individuals relative to their allistic peers. This condition is commonly called “leaky gut” because it allows more molecules to move across the intestinal barrier.
These extra molecules are not always great for the body or brain. In fact, scientists have detected an increased amount of bacterial toxins in the bloodstream of some Autistic individuals because of this increased permeability.
This increased permeability may be helped by certain probiotics such as VISBIOME. Beyond relieving GI symptoms in some Autistic children, this multi-strain probiotic has been shown to improve leaky gut and other GI conditions in other clinical studies.
What does “probiotic” really mean?
You may have heard that cultured fermented foods like sauerkraut or yogurt are rich in beneficial probiotics. This is a rather popular notion. However, few, if any, fermented foods will actually fit the criteria needed to be called a probiotic.
In order to earn the “probiotic” designation, a living microorganism must be proven to be beneficial to human health in at least one randomized controlled trial. A probiotic must also be defined at the strain level through genetic sequencing. Lastly, the probiotic in the product must be administered in adequate amounts.
While live microbe intake has been connected to better health outcomes, there is a set standard that needs to be followed before these microorganisms can be officially classified as a probiotic. A probiotic is a specific type of microbe known to be beneficial to health as determined through clinical studies. Thus, a live microbe found in a food may, yes, be beneficial to health - yet they do not meet the scientific standards that classify them as probiotics.
So, when you are looking for a probiotic that serves a health purpose, let’s say, improving anxiety-related issues in autism, be sure to confirm that it fits these qualifications. This probiotic should be clearly labeled as a strain or multiple strains, backed by clinical research specific to the benefit you need, and taken in sufficient quantities.
Some people assert that probiotic products with multiple strains or species are more effective for health than single-strain products. However, many single probiotic strains - like PS128 in Neuralli MP - have demonstrated benefits in scientific research all by themselves.
Should I take a probiotic or rely on fermented foods?
The advantage that probiotics have over microbe-rich foods is that you know exactly what you are taking. You have a defined dosage, you know which strains you’re getting, and you know what benefits those microbes are associated with in studies. This does not mean, however, that you can’t get beneficial benefits from foods that may contain probiotic strains.
Take sauerkraut, for example. Fermented foods like sauerkraut may contain natural, live, microbial strains known and printed on the label. Keep in mind that these strains may be chosen for their ability to ferment the food, not to influence human health.
If you think they might be beneficial, do some research on your own. Check the label for the specific strain and amount, and then check to see if there is clinically-backed research that suggests it is beneficial for your health.
Probiotics/prebiotics/postbiotics: Definitions, safety and use
Here are the definitions of several “biotic” terms that you may encounter as you look for helpful products for yourself or your loved one:
Probiotics
Probiotics are live microorganisms, like bacteria and yeast, that are shown through clinical research to confer a health benefit when taken at a specific dose.
Keep in mind that these benefits are not always gut-related. In fact, some probiotic strains have been shown in research to exert positive influences apart from improving gut health. For instance, in this article, we explored PS128, a probiotic strain that may positively influence brain behavior and mental health specifically for Autistic people.
As summarized above, not all foods with live cultures are “probiotics” according to this definition. In addition, not all species in our gut’s ecosystem of microbes - the microbiome - are “probiotics”. This scientific definition of probiotics can help clarify some confusion that often arises when we read or hear about popular ideas about probiotics.
Many people assume that probiotics are only useful for helping with digestive problems. Some probiotics, however, have been shown in studies to improve mood, promote stress regulation, and improve social communication. In these cases, when a probiotic confers a mental health benefit that is, it is known as a psychobiotic.
Psychobiotics
Psychobiotics are probiotics that provide brain-related benefits (i.e., reduced anxiousness in Autistic people using PS128) when ingested in appropriate quantities.
Similar to the classification of a probiotic, a bacterial or yeast strain should be supported by clinical research to be titled a psychobiotic. This research must suggest a beneficial effect on a brain-related condition at a specific amount.
Psychobiotics may benefit mental health by influencing the biochemistry of our brains via the bidirectional communication system known as the gut-brain axis. Here the central nervous system and the gut communicate with each other via neural, endocrine, and immune pathways.
Psychobiotics appear to exert this influence both in the absence and presence of gut health problems. Lactobacillus plantarum PS128 is a prime example - as you read earlier in the trials that showed improved mental health-related behaviors in Autistic children.
Prebiotics
Prebiotics can be likened to healthy foods for the microbial inhabitants of your gut. They can include compounds like polyphenols, but more typically are non-digestible fibers present in foods like nuts, vegetables, fruits, and grains. While we are not able to digest them, the beneficial microbes that inhabit our body can. They, in turn, produce metabolites from those fibers that benefit us, the hosts.
Prebiotics have been shown to positively influence the composition of our microbiota, increase levels of beneficial bacteria, and increase microbe-derived signaling molecules vital for health.
There are quite a few foods that contain prebiotics, such as asparagus, honey, banana, barley, tomato, soybeans, peas, and beans. But, here is where an issue arises for some Autistic people, especially children. Autistic individuals often have sensory sensitivities that may keep them from incorporating a variety of fiber-rich foods in their diet.
An overly selective diet could affect the gut microbial community due to the diet’s direct impact on gut composition and function. It’s not likely, however, that dietary differences alone explain the altered gut microbial composition in autism.
Postbiotics
Postbiotics can be thought of as inanimate “leftovers” of live microorganisms that, like the other biotics, are beneficial to health. These pieces or whole remainders of microorganisms are not alive, but they still retain their biological activity.
Scientists have known for a while that these “dead” or inert microorganisms may have health benefits. And, like the other biotics we have learned about, postbiotics are classified according to specific standards. They must be a preparation of inanimate microorganisms and/or their components that confers a health benefit.
Because the microbes in postbiotics are not alive, a safety benefit of a postbiotic is that there is no risk of a microbial infection. Another positive aspect of a postbiotic is that they are likely to be more stable to heat and stomach acid than live counterparts (because they are essentially “dead”).
Are probiotics safe?
Please consult with a doctor or health care professional before adding a daily probiotic.
Anyone with a compromised immune system or severe illness could be at risk of experiencing harmful effects while taking probiotics. These side effects include but are not limited to:
- Infections
- Antibiotic resistance
- Increased chances of the production of harmful substances
However, for most people, probiotics are beneficial microorganisms that are generally recognized as safe for consumption. Some people may experience slight gastrointestinal effects such as gas, bloating, minor diarrhea, or bowel movement frequency changes. These alterations typically subside as the body adjusts to the probiotics.
Should symptoms become unbearable or persistent, stop taking the probiotic and seek medical attention. Discuss the potential causes of these side effects with a knowledgeable health care professional.
How to take probiotics
There are many kinds of probiotic products, in many forms. You may find probiotics as capsules, powders, or liquids. Some of these methods are flexible, too. If you have trouble swallowing, or struggle with a feeding disorder, in some cases it may be ok to open probiotic capsules and mix the powder into cold food or drink. In other cases the probiotic strains inside may be too sensitive to stomach acid to allow this.
Kids typically aren’t big fans of capsules, so it’s always good to check if the product can be taken as a powder. Neuralli MP has this option.
Role of probiotics for Autistic people
Current data suggest great promise for specific probiotic strains in helping to improve the quality of life for Autistic people.
Probiotics are clinically-studied microorganisms that confer a health benefit identified as a specific strain and in adequate amounts. This health effect, yes, may be something that benefits gut health and improves GI issues commonly experienced in autism. But this beneficial effect may also be distinct from gut health issues (influencing neurological health, for instance).
Some probiotics claim to help your mental health by reducing gut problems. However, there are also psychobiotics that help with mental health in a different way. For example, someone who has no problems with their gut could experience a mental health benefit from a probiotic such as PS128. Likewise, someone with a gut problem could see little change in their gut health, but still get a worthwhile mental health benefit from it.
PS128 is a unique psychobiotic strain that provides dietary management of autism. It’s available as Neuralli MP probiotic medical food at a clinically studied 60 billion CFU per day. Try it for yourself and see if it makes a difference for your experience of anxiety in autism.
Recommended reading:
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