What I learned from autistic people and their families
You're reading The Checkup With Dr. Wen, a newsletter on how to navigate medical and public health challenges. Click here to get the full newsletter in your inbox, including answers to reader questions and a summary of new scientific research.
I received an outpouring of responses after my column last week correcting statements from Health and Human Services Secretary Robert F. Kennedy Jr. about autism. This newsletter features reader comments and what I learned from speaking with autistic people and their families.
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Pediatric HS Linked to Gut Microbiome Changes
Emerging evidence suggests the gut microbiome may play a contributing role in the development of inflammatory skin diseases — including hidradenitis suppurativa (HS). The evidence incudes a small prospective study recently published in JAMA Dermatology , which found significant differences in gut microbial composition in pediatric patients with HS compared with matched healthy control participants, offering new insights into possible disease mechanisms that may extend beyond the skin. This follow-up to prior microbiome studies included pediatric participants for the first time. 'Overall, we found significant differences in gut microbiome composition of pediatric patients with HS compared with pediatric control participants and adult patients with HS, suggesting that gut microbiome dysregulation may extend to pediatric patients with HS and should be investigated further,' wrote the authors, from the Department of Dermatology at Boston University School of Medicine, Boston. Gut Dysbiosis and Reduced Microbial Diversity in HS The study included 16 participants — eight participants with HS and eight matched control participants — half of whom were younger than 18 years. Although beta diversity (variation between individuals) was similar across groups, a decrease in alpha diversity (diversity within an individual's gut microbiome) was observed in participants with HS, as measured using Pielou evenness. 'This may indicate gut dysbiosis,' the authors noted. In pediatric patients with HS, there were notable shifts in microbial composition. Bifidobacterium adolescentis was present in all pediatric patients with HS but absent in all adults with HS. 'As B adolescentis abundance typically increases with age, its absence in adults with HS may indicate dysregulation in gut microbiome maturation,' the authors explained. Other notable findings in the pediatric patients with HS included increases in Ruminococcus , Clostridium , and Bilophila . An increase in the beneficial bacterium Faecalibacterium prausnitzii was also noted compared with pediatric control participants. Clinical Implications and Future Directions Asked to comment on this emerging research, Tamia Harris-Tryon, MD, PhD, associate professor of dermatology and immunology at UT Southwestern Medical Center in Dallas, said the results highlight a nutritional component to HS that warrants greater attention. 'HS patients often have diets that are deficient in fiber and other nutrients,' she explained. 'The gut microbiome is directly linked to diet. A diet low in fiber will be deficient in microbes that ferment fiber. Fiber fermentation influences the immune system.' Harris-Tryon added that the new findings, particularly in children, emphasize the need for diet-based interventions. 'HS patients, especially pediatric patients, need to be meeting with a nutritionist,' she said. 'The emphasis should be on increasing fiber and nutrient-dense foods in the diet, while dropping high-glycemic index foods such as candy, soda, fruit juice, sweet teas, and cutting packaged and ultraprocessed foods.' While microbiome-targeted treatments such as probiotics are often discussed in chronic inflammatory skin conditions, Harris-Tryon advised caution. 'There is no data for microbiome-directed therapies in HS yet,' she said. 'But there is significant data on the benefits of a nutrient-dense, fiber-rich diet in pediatric patients and the influence of diet on the gut microbiome. Diets from all over the world with components similar to the Mediterranean diet have been shown to be the most beneficial for human health, including skin health. Fermented foods are an excellent time-tested source of beneficial microbes — including low sugar yogurt, kimchi, and kefir.' In a recent episode of the Medscape InDiscussion podcast series on HS and the microbiome, Harris-Tryon emphasized that 'understanding how the gut, skin, and immune system talk to each other is going to be key to developing future treatments for HS' and noted that this area of research 'is really just beginning to open up.' The study authors also encouraged future studies to examine potential interactions between the gut and the brain. ' B adolescentis produces gamma-aminobutyric acid [GABA], a mediator of the gut-brain axis that has been associated with anxiety and depression disorders through direct modulation of neural signals from the gut,' they wrote. 'As HS can affect mental health, particularly in vulnerable pediatric populations, it may be worthwhile to incorporate mental health screenings in future studies and assess correlations with GABA-producing microbes.' Noting that the study had limitations, such as a small sample size and the lack of matching by BMI or disease duration, the authors concluded that there were significant differences in the gut microbiome of pediatric patients with HS compared with pediatric control participants and adults with HS. The authors also referred to their previous study, which observed an increase in Bilophila and a decrease in Pielou evenness alpha diversity in both pediatric and adult patients with HS compared to control participants, pointing to potential gut dysbiosis. Collectively, the authors noted these findings suggest that 'gut microbiome dysregulation may extend to pediatric patients with HS and should be investigated further.' The study was independently supported by institutional grants from Boston University. The authors reported having no conflicts of interest. Harris-Tryon disclosed serving or having served as a director, officer, partner, employee, advisor, consultant, or trustee for Mirofend and Johnson & Johnson; serving as a speaker or a member of a speaker bureau for Tamia; and receiving research grants from LEO Pharmaceuticals.
