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These conditions can lead to maldigestion, malabsorption, and dysbiosis. And, in fact, in the "Discussion" section of the paper, the authors do describe a chain of events where there are reduced enzymes and a vicious cycle of maldigestion and dysbiosis. The authors state: ". . . we propose a model whereby deficiencies in disaccharidases and hexose transporters alter the milieu of carbohydrates in the distal small intestine (ileum) and proximal large intestine (cecum), resulting in the supply of additional growth substrates for bacteria. These changes manifest in significant and specific compositional changes in the microbiota of AUT-GI children." We know that abnormal gut flora can affect the rest of the body by affecting the immune and central nervous systems, such as brain development and behavior; therefore, addressing this situation in an affected child is a matter of great urgency. This study reinforces what I, as a parent, can do. I can feed my child a healthful, special diet that excludes items that my child cannot process well, while consulting with a nutritionist to make sure that all nutrients are supplied from the diet or supplements, and I can use digestive enzymes to mitigate my child's lack of enzymes. By using the enzymes, I will reduce the amount of undigested food that festers and feeds additional bad bacteria, thereby halting additional damage to the gut in that manner and mitigating undigested substances from entering the blood stream, and I will increase digestion of good nutrients from food that my child does need to fuel the brain and body. Of particular note in my mind, the study reported that "[The study authors] examined transcript levels for three primary brush border disaccharidases (sucrase isomaltase [SI], maltase glucoamylase [MGAM], and lactase [LCT]) in ileal biopsies of AUT-GI and Control-GI children by real-time PCR. Levels of mRNA for all three enzymes were significantly decreased in AUT-GI children." This means that, optimally, I would want to use a supplemental digestive enzyme that had isomaltase activity. Kirkman exclusively provides that enzyme, which is offered under the trade name of Isogest. Isogest has the ability to split isomaltose into two molecules of glucose (and also to split palatinose into one molecule of glucose and one molecule of fructose). The result of this is better, more complete carbohydrate digestion (and fewer bad bugs!). Here's my summary of the article:
IF enzymes down THEN digestion down bad bugs up symptoms up (cognition down , behavior "down" ) GI pathology up behavior "down"
And the take-home message is, in my opinion, that since objective scientific evidence has revealed a problem, we can take positive measures to fix it that will improve health, happiness, and behavior for affected children and, by extension, their families.