Hemos visto que los trastornos funcionales digestivos no son exclusivos de los niños o adolescentes con Trastornos del Espectro del Autismo, incluso la prevalencia de estos trastornos en la población general son muy elevados, existen autores que inciden en que este porcentaje aumenta considerablemente en poblaciones con sobrepeso infantil, los casos de México(14) o EE.UU., donde la obesidad infantil es ya un problema de salud pública, los desordenes del aparato digestivo en la población general son muy elevados.
De hecho en la actualidad se está popularizando el trasplante fecal, que básicamente es poner heces de un paciente sano en los intestinos del paciente enfermo, asqueroso, pero bastante efectivo.
En el caso de los trastornos del espectro del autismo vemos como existen diversas vías de estudio: Por una parte la relacionada con la microbiota intestinal; Los desordenes sensoriales; y aspectos conductuales (tanto los relacionados por estrés, ansiedad o desordenes emocionales, como por los aspectos relacionados con hiperselectividad).
Sin embargo, estudios relacionados con la población general también advierten de problemas relacionados con la microbiota intestinal, o de como los malos hábitos alimentarios inciden en los desordenes gástricos. Aunque estos aspectos en los niños con autismo son siempre más evidentes y también más difícil de identificar.
Sabemos que existe una relación entre problemas de alimentación, problemas digestivos, problemas de sueño y finalmente irritabilidad. Que en suma, son problemas que se alimentan unos a otros.
No se puede afirmar que exista una sola causa, ya que podremos encontrar también a niños que tengan problemas físicos (deglución y/o masticado) o conductas restrictivas alimenticias o desordenes alimenticios relacionados con desordenes sensoriales o la combinación de varios. En cualquier caso es básico que la alimentación del niño sea lo más variada y adecuada a su edad.
Es muy habitual que muchos niños -que presentan problemas de alimentación- mejoren de forma considerable en el momento en que se trabajan los problemas de alimentación. Mejoran sus problemas físicos (dolores, malestar, estreñimiento, diarrea,…), disminuye la irritabilidad, aumentan la atención, duermen mejor,…, en suma, presentan grandes mejorías. Este es uno de los efectos más habituales que se suele encontrar ante niños que empiezan dietas restrictivas, quizá la más conocida sea la que no usa gluten ni lácteos.
En muchos casos, si el niño tiene un problema con algún alimento (ya sea por alergias, intolerancias o inmadurez del aparato digestivo), al retirárselo la conducta y predisposición del niño va a mejorar. Hay otros casos donde el sencillo hecho de que tenga una alimentación equilibrada y un cambio de actitud por parte de familiares y educadores, al tener una mejor alimentación su estado general de salud mejorará.
Pero si esa misma dieta la aplicásemos a un niño sin autismo, la probabilidad de que tuviera una mejoría general es muy elevada. Somos lo que comemos. Es importante poder diferenciar los problemas digestivos y de alimentación del autismo, aunque estén ligados, si resolvemos los problemas de alimentación obviamente la calidad de vida del niño va a mejorar, pero lo más probable es que los aspectos nucleares del autismo, de una forma u otra, sigan ahí.
Como hemos visto, muchos de los problemas relacionados con el aparato digestivo en la población general, están infradiagnosticados, pero en el autismo todo tiene un efecto magnificador. Un niño que presente pequeños problemas de conducta o de poca atención, no será motivo de preocupación por parte de los padres en muchos casos, o incluso pasarán totalmente desapercibidos. Pero en el caso de un niño con autismo esto siempre se va a tomar mucho más en cuenta, ya que la atención y observación es mucho mayor.
A una familia que tenga un niño con algún problema leve de conducta no se le ocurre hacerle una batería de pruebas y análisis (salvo que existan problemas visibles de salud claro está), pero en el caso de un niño con autismo, la necesidad de encontrar soluciones a algo, motiva una mayor preocupación y por tanto una mayor cantidad de pruebas médicas.
Y si a eso le sumamos la presión a la que la familia se ve sometida, ya sea propia o promovida por terceros, es lógico y normal que se busquen respuestas.
Esto no es óbice para que exista una evidencia clara, y es que los niños con autismo son más propensos a tener problemas en su aparato digestivo, lo que realmente no está tan claro es cual es el verdadero origen o si realmente hay muchos.
Sin embargo, la sensación existente entre las familias era que los problemas del aparato digestivo eran poco menos que algo exclusivo del autismo, cuando al realidad es que, aunque el porcentaje es mayor, ni es tan exageradamente mayor, ni es algo de por vida, ya que se puede resolver. Decir que los problemas gástricos son una comorbilidad del autismo, o en realidad son una comorbilidad del trastorno del procesamiento sensorial, que es a su vez una comorbilidad del autismo. Esto es como el dilema de “qué fue primero, ¿el huevo o la gallina?.
No obstante hay aspectos básicos, cuidar la alimentación del niño, en caso de niños con desorden de la alimentación, trabajar en la línea de resolver esa problemática a la mayor brevedad. Los reportes de las familias coinciden, una vez el niño mejora su alimentación, mejora a nivel general, ya esté haciendo una dieta restrictiva o no.
Al final, las dietas se convierten en algo anecdótico, lo importante es la calidad de la alimentación, si es adecuada, equilibrada y sana, pues es una buena dieta en tanto en cuanto provee de una buena alimentación. Hemos visto como los problemas relacionados con el gluten, van más allá del autismo, y que en países como Chile, los problemas relacionados con gluten y lácteos, en realidad afectan a una gran parte de la población, la diferencia es que en el niño con autismo que tenga intolerancias a un alimento determinado y que coincida con uno de los pocos alimentos que consume, la probabilidad de que al retirarle ese alimento el niño mejore es bien elevada.
Muchas familias solo hacen las pruebas a sus hijos, ya que en ocasiones el costo de las mismas es elevado, pero siempre es una buena idea que cuando se hagan pruebas de alergia o intolerancias, estas se extiendan al resto de la familia, ya que como vimos en el caso de América del Sur, existe un fuerte componente hereditario.
Es muy importante que controlemos si el niño o niña tiene estreñimiento o diarrea, si tiene gases más allá de lo normal, mal aliento o cualquier síntoma que induzca a pensar que existe algún problema físico. Es muy importante que el niño o niña tengan una dieta sana y equilibrada, y en el caso de niños con desorden de alimentación, seguir a la mayor brevedad posible un programa para resolver este problema.
En caso del uso de determinados fármacos (por ejemplo antibióticos), si fuese necesario su médico podrá aconsejarle probioticos o cualquier otro producto destinado a recuperar la flora intestinal.
Una buena salud general dará una buena calidad de vida, nos ayudará en el trabajo diario, tendremos un niño más saludable y por tanto con una mejor predisposición.
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