Understanding Probiotics for Autistic People

Gut issues commonly impact the daily lives of Autistic people. Treating gastrointestinal concerns with probiotics may improve their comfort and quality of life. In fact, researchers have cited an unhealthy gut as a contributor to certain unwanted symptoms that affect Autistic people and those with ADHD. 

Clinical studies have shown that Autistic children often have a lower than typical amount of beneficial species of bacteria in their gut microbiome, and higher amounts of pathogenic species, which results in digestive health issues. 

Specific strains of probiotics allow you to target not only gut health, but also neurological and mental health, potentially decreasing these unwanted symptoms and increasing comfort. While all the potential long-term benefits of a daily probiotic are not known, current data suggests great promise for probiotics in helping to improve the quality of life for Autistic people.

Table of Contents:

1. What are probiotics?
2. Types of probiotics
3. The gut-brain axis
4. How can probiotics help Autistic people?
5. How do I know if probiotics will help me?
6. Best probiotics for Autistic people
7. Are probiotics safe?
8. How to take probiotics

What Are Probiotics?

Probiotics are live microorganisms such as bacterial and yeast species. To be called a probiotic, a microorganism must provide a health benefit when taken at a sufficient dose. 

Some cultured and fermented foods, like yogurt and kombucha, contain potentially beneficial microorganisms, and may contribute to gut health. While getting “probiotics” from foods may seem more natural than taking a capsule, oftentimes the specific organisms present and the dosage provided are unknown and variable from batch to batch. 

Probiotics and medical probiotics have a well-defined strain composition and dosage listed on the package. They are packaged as capsules, powders, or liquids. Some products have a single probiotic strain, and others come as a mixture. Look for probiotics that have been scientifically studied in people, perhaps even Autistic people, and shown to be beneficial for gut health and/or another aspect of human health. 

Another way of supporting gut health is taking prebiotics such as inulin. Prebiotics are used as food by "friendly" bacteria, allowing them to thrive in the gut at the expense of pathogenic bacteria. When a person’s gut microbiome is properly balanced between beneficial microorganisms and less healthy ones, they typically experience less gut inflammation and GI issues. Prebiotics can help keep this balance.

Prebiotics can be very beneficial to your gut health, especially if you also take a probiotic. These special complex carbohydrates are found in many different fruits and vegetables. If you’re not sure how to incorporate high-fiber foods into your diet, see our guide to prebiotic superfoods for new ideas of foods to try.

Types of Probiotics 

Consuming beneficial bacteria by incorporating a quality probiotic into your daily routine can improve your digestive health. Some probiotic strains can even positively affect your immune health, mental health, and help you address common skin issues like acne. Different strains and species of probiotics can benefit your health in unique ways.

There are two types of probiotics that can be impactful for many Autistic people:

1. Gut health probiotics 
2. Psychobiotics 

Gut health probiotics primarily restore balance within the gut. They can also decrease systemic inflammation caused by poor gut health or a leaky gut. Because chronic inflammation may contribute to mental health challenges, gut health probiotics may indirectly help with mental health as well.  

Psychobiotics have a more direct effect on mental health. They appear to modulate levels of neurotransmitters that affect mood and influence other aspects of brain chemistry in a variety of ways. Importantly, psychobiotics can help people whether or not they also have GI symptoms.

Gut Health Strains

Factors such as bacterial exposure, antibiotics usage, genetics, and life experiences all play vital roles in the unique composition of bacteria in your gut. For a variety of reasons that require more research, Autistic people are more prone to gut dysbiosis: an imbalance between “good” and “bad” microorganisms in the gut microbiome. Some studies have also reported a correlation between more severe GI tract symptoms and the level of support needed by Autistic people.

Probiotics that are beneficial for gut health help protect people from viruses, support digestion, and synthesize vitamins. Probiotics can also reduce inflammation by displacing pathogenic bacteria and improving microbial balance in the gut. Reducing inflammation and GI symptoms with a gut health probiotic can have a big effect on overall physical and mental health.

Lactobacillus and Bifidobacterium are among the most commonly consumed and studied probiotics for gut health. 

Psychobiotic strains

The gut (stomach, small intestine, and large intestine) plays an active role in our mental and neurological health and wellness. The enteric nervous system and the microbes inside the gut affect the brain via the gut-brain axis (GBA). Because of the GBA, microbes in our GI tract are able to interact with neurons that connect the gut and brain, intestinal endocrine cells that regulate brain chemistry, and even immune receptors. 

Certain probiotic strains called psychobiotics appear to modulate neurotransmitter levels and activity and/or modify expression of genes in brain cells to elicit a mental or neurological health benefit. An example of a psychobiotic that can positively impact the quality of life of Autistic people is L. plantarum PS128. 

Lactiplantibacillus plantarum PS128 is a gut-brain probiotic strain that balances levels of the neurotransmitters dopamine and serotonin. This means that even though PS128 doesn’t leave the gut, it plays a role in mood, attention, and behavior via the GBA. There are studies that suggest this particular strain can help in decreasing repetitive behaviors in some Autistic children while also improving their attention span and communication. 

The PS128 psychobiotic may also help alleviate stress and anxiety that can be a large part of the Autistic lived experience. An 8-week study of 36 highly stressed adults showed a decrease in cortisol (our stress hormone), a 20% decrease in perceived stress, and reported improvements in mood, sleep, anxiety, and overall quality of life. 

While the main benefit of a psychobiotic strain such as PS128 is mental health and neurological health, some people find that these probiotics can positively affect gut health as well, by decreasing bloating, cramping and constipation. 

The Gut-Brain Axis

Our bodies contain nearly as many bacterial cells as human cells, and our gut microbiome does far more than just help us digest food. As you’re beginning to see, it has far-reaching effects —all the way to the brain, in fact. 

The gut-brain axis (GBA) is the bi-directional signaling between the central and enteric nervous systems. It links the emotional and cognitive centers of the brain with intestinal functions and the microorganisms within the gut, and allows them to communicate. 

The easiest way to think of the GBA is to visualize a scale (see above). When something happens to one side it affects the other. This means that when the emotional and cognitive centers of the brain experience a change, the intestinal functions follow in reaction, and vice versa. 

When the GBA is out of balance it can affect a person’s mood, cognition, sleep cycle, and stress levels. Supporting Autistic people in ways that bring their GBA into better balance may increase quality of life for them and their caregivers.  

The connection between the brain and the gut has been explored in many research studies, especially over the past 10 to 15 years. For example, in one human study, participants who took a fermented milk multi-strain probiotic for four weeks had notable changes in fMRI brain scans. Use of a probiotic led to differences in how their brain processed an emotional attention-related task.

How Can Probiotics Help Autistic People?

Autistic individuals are known to experience not only GI tract symptoms but also anxiety and low mood at higher rates than Neurotypicals. Safe and effective means to alleviate these stressors could greatly improve the quality of life of an Autistic person.  Thankfully, initial studies analyzing the impact of probiotics show promising results in improving not only “regularity” but also mood disorders and anxiety. 

Studies have also shown probiotics may strengthen the gastrointestinal barrier over time, which, as a result, may lessen the gastrointestinal discomfort that is often associated with ASD. A decrease in physical discomfort can help to “balance the scale” (as mentioned before), resulting in less emotional and psychological discomfort too.

While strong emotional reactions don’t always directly result from bad gut health, probiotics may aid in creating a more harmonious balance between the gut and brain, reducing the intensity of overstimulation.

Determining the dietary routine that works for yourself or your Autistic family member can help address both digestive and neurological health. Probiotics may also reduce symptoms of anxiety.  You may find that the stress responses caused by unpredictable stimuli may begin to lessen while taking a probiotic. 

Before starting a probiotic or probiotic medical food, consult your primary care physician. Those who have certain illnesses or have weakened immune systems may experience severe adverse effects from taking probiotics. 

How Do I Know If Probiotics Will Help Me?

Physical and emotional discomfort are known triggers of meltdowns, shutdowns and overall irritability in both Autistic adults and children. However, determining what triggers specific reactions to stimuli isn't always the most straightforward task. 

Looking for signs of pain or discomfort in the physical body either before, during, or after a meltdown, is important in any situation. If physical discomfort occurs in a person's stomach or GI tract, probiotics could be helpful. Probiotics may help in decreasing the GI symptom as well as the emotional distress that would have resulted from the gut discomfort. 

This correlation between the gut and behaviors is partially thought to be linked directly to the GBA. Repetitive actions are one example of a behavior thought to be triggered by gut difficulties.   

Encourage your loved one to tell you if they have belly pain, gas, or trouble toileting before or after experiencing overwhelm, emotional distress, or meltdown. By listening and being attentive, you may learn enough to suggest that a probiotic could help. 

If the Autistic person is not able to communicate verbally, looking for increased toileting frequency, changes in bowel patterns, holding their stomach, or changes in appetite can all be signs of gut discomfort. 

Please communicate with and defer to their medical provider for all verbally reported symptoms or any signs they are experiencing pain.

Best Probiotics for Autistic People

Establishing a healthy gut can be tricky, and it can feel like an uphill battle of trial and error. Some days, just eating a nutritionally balanced diet can be very challenging. Trying to incorporate prebiotic fiber and fermented foods regularly as well may be more than many Autistic people can realistically handle. Such foods may also cause sensory overload for some individuals because of texture, taste, and/or smell. 

Getting probiotics in therapeutic quantities through diet alone, therefore, is often not possible.  Fortunately, many probiotic strains have been shown to be beneficial in balancing gut health and reducing the symptoms of digestive health conditions. Reducing belly pain and stress about GI symptoms can have mental health benefits as well, such as better sleep and a less overwhelmed mind. 

To improve gut health, look for probiotics containing specific strains that have been isolated and observed for their gut health benefits. Lactobacillus reuteri and Bifidobacterium are two of the most recommended probiotics for ASD and serious GI difficulties. Here are other strains that are helpful for gut health:

• L. rhamnosus GG
• B. longum BB536
• L. paracasei PS23
• L. lactis A17 
• L. plantarum K37
• L. plantarum 299V

Keep in mind that the best gut health probiotic for an infant or child might be different from what works for their parent. Read labels carefully, and consider trying a probiotic mixture for a better chance of encountering a strain that works for you. You may also need to try more than one product to find one that helps. Your health care provider can help guide you. 

When possible, consuming foods with soluble fibers may also reduce symptoms of gastrointestinal issues. These prebiotic foods can be tried on their own or in combination with a gut-health probiotic.

Regardless of whether or not you or your loved one experiences chronic gastrointestinal issues, a gut-brain probiotic may also be very beneficial. Psychobiotics appear to reduce stress and anxiety, providing a mental health benefit that can be valuable to Autistic individuals. 

Lactobacillus reuteri ATCC-PTA-6475 is a probiotic strain that increases oxytocin levels and may aid in reducing anxiety and improving social behaviors and interactions. 

In addition, L. plantarum PS128 has provided many neurological health benefits in clinical trials for Autistic children. These include reducing anxiety and behaviors that are associated with high anxiety or sensory overload. The mental health benefits of PS128 may be due to an ability to influence the body’s levels of the “happy hormones,” serotonin and dopamine. It also appears to help some individuals with their gut health based on consumer surveys. 

L. plantarum PS128 is commercially available as Neuralli MP.

Are Probiotics Safe? Do They Have Side Effects?

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, seek medical attention and discuss the potential causes of these side effects with a knowledgeable health care professional.

Risks of experiencing harmful effects while taking probiotics increase for anyone with a compromised immune system or severe illness. These side effects include but are not limited to:

• Infections
• Antibiotic resistance
• Increased chances of the production of harmful substances

Please consult with your doctors or health care professionals before you add a daily probiotic. 

How To Take Probiotics

Taking probiotics is generally considered safe and beneficial to those who don't struggle with a compromised immune system. Consulting with your doctor about whether to add a specific probiotic strain to your routine and about the recommended amount for you. Your health care provider can help ensure that you are taking the right probiotic strain to achieve maximum health benefits or address any specific concerns you may have. 

Many people believe that probiotic products with multiple strains or species are more effective for gut health than single-strain products. However, you may find that a particular single-strain product, such as Neuralli MP, works very well for you or your loved one. 

Probiotics are available and sold as capsules, powders, and liquids. Some individuals who have trouble swallowing or have a feeding disorder open probiotic capsules and mix the powder into cold food or drink. 

Role of Probiotics for Autistic People

Every Autistic person is unique, and there is no one-size-fits-all probiotic. Some days will be better than others, but with the help of supplements such as probiotics, you can feel confident in having great support for your or your loved one’s gut and neurological health. 

Neuralli MP medical probiotic contains a unique psychobiotic strain that provides dietary support for autism and anxiety. Try it for yourself and see if it makes a difference for your mental health.

Recommended reading:

Neurodivergent Eating - Developing a Healthy Relationship with Food

PS128 and Autism - Benefits of a Gut-Brain Probiotic

My Experience with Neuralli MP- A Neurodivergent Nurse Weighs In