Responding to a blog post written last month on the discovery of a common viral trigger of celiac disease in humans (“Turning On Celiac Disease” — “The PediaBlog, August 18, 2017), Dr. Tony Kovatch (Pediatric Alliance — Arcadia) provided this insightful commentary:

The pathophysiology of celiac disease — genetic predisposition with environmental trigger — is likely the same for type 1 diabetes mellitus. In both conditions there seems to be an interval of “autoimmune barrage” which precedes the clinical symptoms germane to the disease. Research is focusing on intercepting this barrage of auto-antibodies to the beta cells of the pancreas before damage is complete.

I think this same process occurs in a more gradual, but in a more diffuse, way in autism — the many components of the brain being the targets. Many different “invaders” are involved which the developing brain perceives as “allergens” or foreigners and sets off the cascade known as microglial activation. The multitude of potential “invaders” is reflected in the diverse clinical presentations of autism — many with accompanying gastrointestinal dysfunction.

Research has implied that the personal microbiome is a determinant of whether an at-risk individual develops clinical diabetes. It makes eminent sense to conclude that the same is true for celiac disease.

While it may be a stretch to extrapolate this to autism, I think regulation of the microbiome of every infant and child is something that every parent should strive for.


A reader responds to Dr. Kovatch’s commentary by asking:

Dr. Kovatch, would you explain how you believe the microbiome should be regulated? What should we be doing that hasn’t been done in the past?


Dr. Kovatch responds:

Thank you for your question. The microbiome has taken top billing in the burgeoning field of epigenetics, the study of the many variables which can modify the expression of our innate genes.

I think creation of a health-promoting microbiome begins at birth (vaginal delivery is ideal) with exclusive breastfeeding, if possible, and with skin-to-skin contact with the mother and father, who have themselves fostered healthy individual microbiomes. While we focus on the gastrointestinal tract, an organism’s microbiome also includes that of the oral cavity (site of dental caries), the skin (site of eczema), the respiratory tract (asthma, allergies), and the urinary-genital tract (kidney infection, STDs). Prolonged breastfeeding, even of a donor nature, creates a positive environment for all of these systems.

Although I cannot quote evidence-based research, my impression is that breast milk consumption well into the second or third year of life is protective against immunologically-mediated conditions, especially autism spectrum disorders. Although pediatricians no longer delay staring solid foods for the purposes of preventing food allergies and obesity, the BLISS approach (Baby-Led Introduction of Solids, discussed here on the PediaBlog on August 15, 2017) is widely accepted. This newer philosophy, which leaves the timing of the start of solids up to the baby’s developmental readiness, has been documented to encourage self-feeding and enjoyment of a wider variety of foods at 12 months of age.  This method intrinsically promotes the healthier choices — vegetables and fruits — before the less desirable cereals and animal fats in meats.  I suspect that parents who endorse this approach are more likely to extend  breastfeeding beyond the first year of life.

Sustaining a healthy microbiome after infancy takes perseverance and the commitment of the entire family unit. Probiotics have been and remain the cornerstone, but additionally valuable are prebiotics, those substances in the host’s diet which “feed” the healthy bacteria, like Firmicutes and Lactobacillus; these are found predominantly in fruits and vegetables.

On the flip side, avoiding antibiotics and high glycemic index treats (such as candy and pop) prevent the emergence of deleterious bacteria, such as Bacteroides, and overgrowing yeast, such as Candida. It is fundamental for good, harmonious intestinal motility to avoid this imbalance between “good” bacteria and “bad” bacteria (called dysbiosis) and to promote regular, rhythmic evacuation with a diet rich in fiber and H2O and low in trans-saturated fats.

Maintaining a healthy microbiome is a life-long endeavor. Polyphenol-rich foods (berries, cinnamon, and dark chocolate, to name a few) and beverages (green tea, red wine, and even coffee) supply the anti-oxidants necessary to counteract the free radicals which cause damage to our cells and mitochondria throughout our lifetime. Fermented foods (such as sauerkraut, and kim chi — an Asian cabbage dish) and drinks (apple cider vinegar, kombucha, kefir) furnish a symbiotic blend of benevolent bacteria and yeast to promote “eubiosis” and, consequently, immunologic integrity throughout the body. This regulation of a well-fermented gut has become a popular enterprise among the millenials and, I suspect, evidence-based research is forthcoming. I will try to keep our readers posted.

So as the saying goes: We are more bacterial (and fungal) than human!


Kombucha with SCOBY (“Symbiotic Colony Of Bacteria and Yeast”). Health claims cited on Wikipedia:

Kombucha has been promoted with claims that it can treat a wide variety of human illnesses, including AIDS, cancer, cardiovascular diseases, and diabetes, and that it provides other unproven beneficial effects such as stimulation of the immune system, boosting the libido, and reversal of gray hair. People drink it for its many putative beneficial effects, but there is no high-quality evidence of beneficial effects from consuming kombucha.