Mysteries of the Microbiome

A U of M associate professor explores the complex world of human microorganisms and the cures they may hold

When Bolte took Andrew to the new pediatrician for a check-up, the doctor noticed fluid in the child's ears and concluded they were infected. The doctor prescribed an antibiotic to clear them up.

Bolte had three older children; she knew what a child's ear infection was like, and questioned the doctor. Andrew had no fever, and had expressed no discomfort.

"I said, 'What are we treating?' and he said, 'If you value your son's hearing you'll give him these antibiotics,'" Bolte recalls.

Dr. Alexander Khoruts at the U of M is a leading researcher in the new science of the microbiome
E. Katie Holm
Dr. Alexander Khoruts at the U of M is a leading researcher in the new science of the microbiome
Ellen Bolte (left) dedicated herself to helping son Andy (middle) recover from autism-like symptoms
Ellen Bolte (left) dedicated herself to helping son Andy (middle) recover from autism-like symptoms

Despite repeated treatments with different antibiotics, the doctor saw no improvement in Andrew's ears. After four ten-day treatments over a two-month period, Andrew broke out in a facial rash. The pediatrician switched him to Sulfanomide antibiotics, and after a 10-day treatment, issued a 30-day maintenance dose. About a week into the maintenance dose, Bolte and her husband noticed a change in Andrew's behavior.

"He almost looked like a drunk toddler," Bolte says. "He was so happy and giddy, flinging himself around. As the days went by, the behavior was, well, disturbing in the sense he was laughing like a hyena."

It only got worse from there.

"After about a week of that he started to become real quiet and withdrawn," she continues. "He stopped interacting. Then it got to be he not only didn't want to be interacted with, but if you tried to interact, he screamed. At a certain point he started screaming all day long, a high-pitched siren scream."

Around the same time his behavior changed, Bolte noticed Andrew was also suffering from a host of gastrointenstinal issues. He had chronic diarrhea, and even though he was losing weight, his belly grew swollen and bloated.

Now he really was sick. So what did the pediatrician do? Prescribe more antibiotics. But Bolte wasn't satisfied, so she took Andrew to an ear, nose, and throat specialist, who quickly (and correctly) diagnosed the fluid in the ear as an allergic reaction to cow's milk.

Unfortunately, this was the least of Andrew's problems. Now 20 months old, Andrew was a holy terror. He couldn't be left alone — he'd eat the drywall or injure himself. In March 1994, he was diagnosed with severe autism.

The doctors told Bolte that she just must've missed the early signs — but she knew Andrew was okay until he was 15 months old. He'd begun to use language and had actually regressed.

One doctor broke down in tears telling Bolte that Andrew's affliction was so severe they should simply institutionalize him. A deeply religious person, Bolte refused to accept that.

"They kept telling me autism is incurable," she says. "First of all, I wasn't convinced he had autism. I could see where he met the autism criteria, but he wasn't born with it. So if you don't know what caused it, how can you say you can't fix it?"

Bolte began seeking her own truth. She read the popular press stories, then moved on to medical journals after a sympathetic doctor told her how to get a Medline account. She bought a medical dictionary and pored over articles for hours. She developed theories, which she'd take to skeptical doctors who batted them away like mosquitoes. That only sharpened her resolve.

Bolte ultimately decided the likely cause was a bacteria in the Clostridium family, home to C. diff, botulism, and tetanus, among others. Because they can exist as spores, they're able to survive antibiotics. They also create neurotoxins, which could explain Andrew's loss of language and social functioning. Bolte believes kids with regressive autism represent a different, non-genetic strain of the disease.

"It's hard to think of autism being caused by different things because the symptoms are always the same, but if you think of a fever — that's a symptom," Bolte explains. "There is nothing biochemical you can look at yet that says, 'This kid has autism, I can see it in their blood.'"

Bolte believes the carpet-bombing of Andrew's gut at a crucial stage in development permanently damaged him, and notes that anecdotal cases of miracle "cures" typically feature families who honed in on the gut early in treatment. Bolte points to a 2011 article entitled "It Takes Guts to Grow a Brain," which studied mice born without microbiota and found that certain epigenetic switches for brain development weren't thrown if the mouse wasn't exposed to a microbiome by a certain age.

Khoruts concurs that there may be something to this theory.

"I worry there is a developmental window, probably very early in life, where there is all of this critical interaction of microbes with the development of the immune system, nervous system, and the metabolism," he theorizes. "We know now microbiota take three years to become adult-like. That could be our window and, of course, our kids being bombarded with antibiotics for ear infections factor in that window. All of our effort should be focused on that population — our kids. It may be too late for the rest of us."

A seven-month old child crawls through the dirt, pressing his mouth against everything he sees — stones, old bones, charred wood from the fire the night before. The scene is contemporaneous, but could stand in for any of our ancestors. That's why Jeff Leach is in Tanzania with the Hadza bushmen.

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