The Surprising Causes of Autism & Why It's On The Rise

Coming up on this episode of the Doctor's Pharmacy.

We need to look deeper. So I think of autism as an autism diagnosis as a starting point because there's so much more to understand and learn about a child.

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Thank you so much.

Thrilled to be here. Yeah, so we, you know, you were part of our Broken Brain documentary series where we talked about all this epidemic we have of broken brains from autism to Alzheimer's to depression. And you shared a lot about the work you had been doing at the time. This was years ago on autism and helped to sort of frame a picture of autism. It's very different than we think of in conventional medicine. And then you came to Cleveland Clinic and presented at our Center for Functional Medicine and gave a very academic presentation about your findings and discoveries in the field of autism that are really shaking things up. You know, we see an enormous increase in autism. I mean, we went from 1 to 10,000 to now 1 in 36 kids. I don't know, it keeps getting worse. Every time I look, it was 1 in 69, I was 1 in 36. And I don't think it's just better diagnosis, something's going on. And your work has really been unusual because typically in an autism care, neurologist or pediatric Trick neurologists will simply diagnose the problem and then they'll prescribe behavioral therapy, we call it ABA. And it's a form of behavioral therapy for autism. And it can be effective, an important part of the overall treatment plan, but they don't really ever think about the other things that are often found in these kids. Like 95% of them have terrible gut issues. 75% have immune dysregulation, right? They may have different nutritional things going on, toxic load, things that really are not looked at. And I'm really curious, you know, Someone who sort of comes from your pedigree, Harvard Medical School, you're a Rhodes Scholar, University of Oxford, Graduate School, as a pediatric neurologist, how did you first come to understand that the traditional paradigm of autism was flawed and you needed to think differently about it?

Well, you know, so much of my current understanding of autism, I gained from working with really remarkable researchers at different stages of my career. So when I was on faculty at Columbia University, About 10 years ago, 15 years ago, I had amazing mentors whose specialty was mitochondrial disease and dysfunction, and looking at childhood conditions that related to this. And so very early on, I was exposed to the mitochondrial disturbances that are associated with different neurodevelopmental diagnoses like autism and ADHD and intellectual disability. So it was through that process of my training and working with amazing clinicians, researchers, who specialized in understanding mitochondria, metabolism, immune dysfunction, and brain development, that then I was able to take that and go even further to then understand how other body systems like the gut and the immune system and so forth influence brain development in profound ways.

Yeah, so when you pull on a thread, it's connected to everything else. That's right. You have to go down that rabbit hole and you have to keep going. because you keep understanding that there's this intersection of all these different phenomena that are contributing to this brain dysfunction. That's right. That I think could be fairly described as a metabolic encephalopathy. And in English, that basically means encephalopathy means you're a brain pathology. So it's some type of metabolic disturbance in the brain. Yes. And when we talk about metabolism, we're talking about basically energy production in the mitochondria. So mitochondria are the little factories in your cells that take oxygen and food and combust it and turn into energy in the form of ATP. So if you have brain energy problem, you're going to have a brain function problem. That's right. And that can lead to a whole host of things. We've had Christopher Palmer on the podcast who's a psychiatrist from Harvard. You know him? I do. His work, he wrote a book called Brain Energy where he sort of accidentally discovered that by giving people a ketogenic diet, which optimizes mitochondrial function, he was able to cure schizophrenia, which is an incurable disease. And in the same way, you've kind of discovered by working on mitochondria and metabolic health and gut health and immune health and nutritional status, autism. You've been able to help these kids with autism improve, and in some cases actually reverse autism. Now, you're, again, a highly pedigree neurologist, and I think, you know, many of your colleagues would consider it quackery to say that you could reverse autism. It's just, it's, it's a false hope. You shouldn't be telling patients this. And, and yet that's exactly what you're doing. Can you tell us about how that's going?

Like, what, what that, well, we know that Autism is defined by a set of descriptive criteria. So it's not in itself a biological diagnosis or biological cause. It's descriptive. It's descriptive. And so that is really just a starting point. We need to look deeper. So I think of autism as an autism diagnosis as a starting point because there's so much more to understand and learn about a child. about their unique biology, their unique neurodevelopmental profile, all aspects of their health, brain and body. So we sometimes forget the head is connected to the body. Yeah, absolutely. So as a neurologist, when I first went into my training, I was fascinated by the brain and I thought nothing's more interesting than how the brain develops in children. But very quickly you realize that the brain is so profoundly influenced by the rest of the body that as a neurologist you can't just think about the brain, you have to be thinking about every other part of the body and about the child's environments, their home, their school, their community, what they're encountering out in the world, how they spend their time, their social connections, everything, because all of it influences the brain.

It's so true. I mean, what you're saying is so important and I just want to highlight a couple of things you said. The first is that the diagnosis is just a starting point. And in medicine, this is so true across every specialty. We're really good at naming diseases and then blaming the name for the problem. I know why you don't have good social skills and have stimming problems and have no speech. It's because you have autism. Well, autism isn't the cause of those symptoms. It's just the name we give to people who share those collection of symptoms. And there may be a myriad of causes. In fact, I don't think there's any such thing as autism. They're autisms.

That's right.

Each kid is unique and different. Have you seen one kid with autism? You've seen one kid with autism? There are similarities and there are commonalities, but you have to really think differently. And I think the other thing you said, I just want to highlight, is that it's something really radical, is that your body affects your brain. We know about the mind-body effect, but what about the body-mind effect? And that's why I wrote my book, UltraMind Solution, 15 years ago, basically saying how to fix your brain by fixing your body first. And I think your discoveries around mitochondrial health and the gut have really helped you treat patients in a very different way. So you do a comprehensive approach. You have an amazing clinic called Cortica that's a company that is across the country providing services in a 360 way to families and children with autism. And in that, it's not just behavioral therapy, it's not just family support, it's just not developing the social framework so these kids can thrive. It's dealing with these biological issues. So I'd love to dive into some of the biology because you know, most people don't talk about the biology of autism. They talk about the symptoms, and that's it. It's kind of naming and blaming. And, and, and I always say, you know, this from my mentor, Sid Baker, he says, we have a problem in medicine. It's a naming and blaming game. We name for the, we blame the name for the problem, and then we.

Think what is wrong, we know what's wrong with you. But if you know the name of your diagnosis, it doesn't mean you actually know what's wrong with you. Yeah, I think that's the biggest mistake. Certainly in autism, the biggest mistake is, is attributing any feature or symptom or characteristic of a child to autism. It doesn't make any sense because autism is just that set of descriptors. And so we really, really have to look deeper. And we know so much more now about some of these root causes and contributing factors. And as you said, too, there's a lot of research trying to understand what we call subtypes or subgroups of autism. But at this point in time, I really think we need to treat every child as their own unique subtype and really seek to learn as much as possible as we can about their biology.

Yeah. So in your investigations of this, what are the kinds of things you actually look at when you're assessing a patient? You make the diagnosis and I call it thinking and linking.

Yeah.

I suppose the naming and blaming, we have to think and link. In other words, think about why causes and maybe you could speak to this incredible growth in the epidemic of autism from from 1 in 10,000 to 1 in 36, maybe getting worse every day. Some of it may be better diagnostic criteria, better diagnosis, but it doesn't explain the magnitude of that change. So what do you think the causes are and how do you start to investigate what those are and the impact of these causative factors on these little kids' biology who are so sensitive and what does it do to them?

Yeah, well, so in just the past 20 years alone, the prevalence of autism has risen 400%.

400%.

400%. And sure, we know part of it is related to changing diagnostic criteria, greater awareness, but there's a big part of that increase that isn't. It can't be attributed just to greater awareness or changing diagnostic criteria. And we know actually a lot about the different causative contributing factors. So the way I like to explain it to professionals and to caregivers is that there are a set of factors related to genetics. So we know genes matter, but they also aren't the entire story. So there are over a hundred different genetic variants that we know can influence brain development in a way that can lead to autism. It's usually not just one gene.

Genetic susceptibilities.

Genetic susceptibilities is usually a complex interaction of many.

Many genes, yes.

And then on the other side, there are also, you know, non-genetic factors or environmental type factors. And usually it's not just one, it's many, and those interact with genetic factors in complex ways. so it's a complex picture. But those non-genetic factors are really interesting because many of them give us insight into autism biology and some in a sense are modifiable too. So we know that there are a set of parental health factors that are increasingly common over time and are very likely contributing to the rise in autism. Things like parental age, things like maternal health factors, maternal metabolic conditions, maternal autoimmune conditions, We even know there are certain, they fall in the category of toxins, you know, things in our environment like industrial chemicals, pesticides, a whole range of things that are now really widespread in the environment. And a lot of research has been done showing that they affect brain development and brain health. So how that influences our approach at Cortica is that we really seek to understand a child's medical history. So we get a lot of information about the pregnancy, the birth, family history, family health conditions. And then we also do a deep dive into the child's own biology by looking at a range of different test results. So these might be done on saliva, on blood, on stool, on urine, all ways in addition to a very thorough physical and neurological exam, of course. But these are all ways to try to gain insight into what is happening for that child.

And many of these tests are not things you get when you go to your regular doctor or neurologist. They're things that are kind of outside of mainstream. You're looking at toxic load, urinary organic acids, at nutritional levels, methylation, and all these genes that are in combination. Often said that environment is a big factor, but genes load the gun, the environment pulls the trigger. So it's this sort of interplay environment across these kids' genetics. And I've seen this, I've seen all these different genetic patterns of low glutathione genes and methylation genes and detoxification genes that are really common in these kids and they tend to be sort of at risk. And I think one of the things that really struck me when I started learning about this was the work of Martha Herbert, and I'm sure you know, she's another Harvard neurologist who studied autism and brain imaging. Yeah, and she talked about these biopsy studies on kids who accidentally died. with autism. And all these kids have massive amounts of neuroinflammation. Their brains are on fire. And when your brain is on fire, it's hard for it to function. And Alzheimer's is a brain on fire. Depression, we now know, is a brain on fire. Schizophrenia, we now know, is a brain on fire. So what's causing the fire?

Well, we actually, so prior to establishing Cortica, I was on faculty at Columbia University, and we had an NIH-funded research program using multimodal brain MRI to study autism in children and adults. And one of the research studies that we published showed that there was a pattern of neurochemistry, essentially, that really pointed to both mitochondrial dysfunction and inflammation in the brain. And when, as a neurologist, when I think about inflammation in the brain, there are kind of, you know, two-- there's sort of a set of maybe more acute or sudden onset fulminant different types of brain inflammation. And then there's this other category of more low-grade smoldering types of inflammation. And the research is really pointing to autism falling within that second category.

Sure, it's not encephalitis that you get from a virus like meningitis. It's really a much more slow and insidious kind of inflammation.

And harder to detect. Some of our tests, you know, it may not show up on a routine MRI, for example. Sometimes it does, though. And I certainly have seen that in my practice.

So.

Yeah, it's this, the mitochondrial dysfunction, which is linked to this chronic low-grade inflammation is influencing the function of the brain and autism, and it's also quite dynamic. So it's not, there was a term used for a very long time in pediatric neurology called static encephalopathy, and that couldn't have been, now we know it couldn't be farther from the truth. The brain is not at all static. It's extremely dynamic and influenced by so many factors. And so we do as much as we can in our practice to try to understand what those factors are for a particular child. And then we can take steps that can really be very impactful, like making changes to... So I think of these interventions as falling in six categories. The first, lifestyle changes. So things like making changes to sleep routine, movement, you know, what part exercise plays. Really fascinating is that there's now a lot of research in autism showing that exercise improves the core features of autism. So socialization, communication, executive function, anxiety, not to mention endurance, stamina, physical health. So just tremendous benefits to some of those lifestyle changes.

And it's an anti-inflammatory for the brain. Yes. And it increases new brain connections. That's right. with BDNF, brain derived neurotrophic factors like miracle grow for the brain. Yes.

So yeah, that's amazing exercise.

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Episode of the Doctor's Pharmacy. The second category changes to the diet. Third related to that dietary supplementation.

Wait, before you go off the diet, don't just bump right over that. What role does nutrition play? Because I want to go slow with these six things. so I think you've got a lot in there that's really powerful and very unique. So what is the role of nutrition and diet in autism?

Well, there's a really very big role. I mean, there's a very big role for nutrition and diet in health for all humans. For all of us, yeah. And for in autism, there's a lot of interest in diet. There always has been. But I think some of that interest--.

I just to be healthy, but as a therapeutic tool.

Yes. The emphasis in the past has been on various types of elimination diets. So diets where you remove something from the diet.

Like gluten or dairy, which are the most common, right?

Yes, and then see how that might affect a child's behavior and their learning. What I found in clinical practice is that because many autistic children tend towards a more restricted diet anyway, because of-- sensory sensitivity.

Right.

Or what this reduced flexibility, you know, picky eaters basically. And so the diet often is very, very limited already to begin with and also often limited to highly processed foods. So if you remove-- Mac and cheese diet. That's right. Or a goldfish or potato chips, french fries, you know, a standard American diet, unfortunately. But if you remove something from a diet that's already very restricted, you risk some serious nutrient deficiencies. So we find it's almost always a better approach to work on first expanding the diet, so expanding whole foods, nutrient, dense foods. What you add, right?

Yes.

And so we have a nutrition and feeding program that's a collaboration between our medical providers and our feeding therapists, our speech therapists, our occupational therapists who help a child. So it's both what you eat, the nutrition side, and how to eat, the feeding side. And then once you've increased a child's diet to a degree where you then feel comfortable eliminating things, then there are a lot of elimination diets worth exploring. So we do know that, for example, celiac disease, gluten allergy, is more common. It's actually considered a co-occurring condition.

Isn't it like 6 or 17% of kids with autism have elevated gluten antibodies?

I don't know the exact percent. It definitely is.

It's like 20% of schizophrenics.

It's more common in autism. And the signs may be a little bit harder to detect also in a child who has behavioral differences already, who may have a harder time communicating.

We call these co-occurring or comorbidities, but that's really a false term. These are things that are all interrelated.

They are very interrelated, yeah. It's been a huge step just to get to the stage of thinking of co-occurring conditions. but you're right. Why do they co-occur? Because they all have common underpinnings.

Yeah, and the gluten triggers leaky gut, which creates inflammation in the body, then inflammation in the brain. So we know that gluten can be really a problem for a lot of brain issues. So sometimes that's a big factor. And you can measure antibodies in these kids and often they're high and you're just like, wow, I didn't know that. And you see a big change when you get rid of it.

I've seen this in my patients. What about dairy? Yeah, so what's very interesting about dairy is that there's some research suggesting that it can interfere with folate metabolism.

That's right.

So there are some tests available to look at folate receptor antibodies, for example.

Yes.

And they've been doing those for years. Produce on a dairy-free diet. So all of that's very important information to get for a child.

So what she just said in English for everybody, basically what happens when you eat dairy, There are antibodies that form, your immune system produces antibodies that attack the receptors for a vitamin called folate or folic acid. And this is a critical nutrient in regulating mitochondrial function, detoxification, neurotransmitter function, inflammation, glutathione production. It's so critical, it's called methylation. And when that doesn't work, and these kids almost all have these methylation issues, they get pretty significant dysfunction. So, you know, as you're saying, it's not one thing. There's like no one thing to do, but there's many things to do that is personalized based on what you find in each kit.

Exactly, exactly. And so it means looking at a lot of things. We do pretty intensive, for example, genetic testing because those genetic markers are very helpful information.

And just be clear, the genetic markers aren't like I have the gene for autism. Maybe you have these methylation genes that are off or glutathione genes or other genes that relate to oxidative stress or Yeah, other things that you're looking at, right?

Yep, relate to mitochondrial dysfunction genes that relate to ion channels in the brain and different... So, yes, there are a whole host.

Of different genes that can be really informative. And you can modify treatment based on those genes, right? That's right. They're not fixed. You can actually improve their function by giving them nutrients or changing different things in their diet or lifestyle or environment.

Or maybe medications, right? That's also a huge misconception. Sometimes parents will say to me, well, why should we test genes? We can't change them. Well, we can change the effects the genes have. We can influence gene expression. And there are, as you know, lots of technologies now that actually do change genes in various ways. And so it's that the future of gene modification, gene therapy, is on the horizon.

And it's pretty exciting. So you combine these sort of genetic testing with other things that look at nutritional factors and dietary testing. So you mentioned that we could spend the whole time on diet because I think that plays a role. I actually had a kid, I remember, who many kids respond to gluten-free diets. And you're right, you have to add in real food. You have to kind of get them. That's a really important point. But one kid was really violent. He was like an eight-year-old autistic kid and was just really aggressive, really violent. The parents didn't know what to do. I said, well, why don't we try a ketogenic diet? and they did. He ate it and completely changed him. Completely changed him. He became more normal, no violence, got some more speech, you know, all the autistic features kind of regressed. I wouldn't say he was perfectly normal, but he went from, like, a non-functioning non-verbal kid to a more kind of normal kid. And. And so, you know, that taught me a lot. It's like, wow, you know, these. something in these kids' diets can be playing a role.

Yes, well, diet, I mean, it just has such a profound influence on the body's metabolism, its biochemistry, and therefore behavior and learning. So it's hugely important. But it's also an area that can be hard to change. Change is very hard.

Particularly in children. Particularly in kids because they're so picky.

You mentioned the next step, which was supplements. Yeah, so dietary supplementation can be very impactful as well. So there's so much to potentially say about this area too. But I think as it relates to my area of specialization around mitochondrial function, there are a lot of blood tests that we can do to look at, to give us insight into a person's mitochondrial function. Like carnitine or? Like carnitine levels, coenzyme Q10, liver function, lactic acid, acylcarnitine profiles, urine organic acids, amino acids, yeah. So there are a lot of markers.

Not what you're gonna get at your typical checkup with your regular doctor. So if you go to your regular neurologist, they're not gonna know what you're talking about.

But there are neurologists and doctors like you around the country in your centers do all this, which is really revolutionary. And fortunately more and more, you know, I think the base, because the research has really-- Caught up. Yes.

So there's more awareness now, but it's still, you're right, it's still a work in progress. So you're actually testing their mitochondrial function through tests that are available.

Yes.

And then you're customizing the treatment based on what you find.

That's exactly right. So, for example, if there are levels that are low-- so, you know, mitochondria are complex. You gave a really nice description earlier. So they-- you know, one of their major functions is to fuel the body. They're sort of an energy currency or powerhouse. But there are things like low carnitine levels or even supplementation with carnitine, supplementation with creatine.

It's like what bodybuilders use.

Yes.

But it's a mitochondrial co-factor.

B vitamins can be really helpful, antioxidant vitamins. So there are dozens of different dietary supplements that we might think about for a particular child that could help a lot with their learning and their development.

I know, and when I first learned about your work, I read some of your papers. that looked at brain imaging and the metabolic function of the brain, meaning the mitochondrial function of the brain. And you're some of the first to show, in addition to neuroinflammation, there was mitochondrial dysfunction. And that led you to kind of go, well, maybe if we tried to correct some of these mitochondrial pathways, which we learned about with these inherited metabolic mitochondrial diseases that are really rare, you actually could help these kids. It was a hypothesis, and you actually studied it, and it worked. so tell us a story about what you've done in a patient that used this approach for diet and mitochondrial therapy.

Yes.

What did you find?

Well, there are some, so mitochondrial dysfunction is actually very common in many different neurological conditions, very common in autism. There are now research studies showing that in blood, in muscle, in brain, so some of the research that we did using brain imaging showed patterns of which parts of the brain even are affected by mitochondrial dysfunction in autism. And then there's also a lot of research showing the value of certain supplements, like the ones I mentioned and many others. And so as part of-- you- mean.

Supplements just don't cause expensive urine, like most doctors say?

No, they can-- when they're matched, when you have the right supplement for the right person.

Exactly. Right. There can just be personalized nutrition.

Yeah, yeah.

So you use these compounds in kids?

Yes, so as an example, you know, children, there's a pattern of regression, developmental regression, that's quite common in autism, where a child loses developmental skills. As you can imagine, it's really frightening for parents to see. Very often that regression in autism happens between 18 months to three years of age. And it also is often associated with what we think of in medicine as a physiological stressor. So, you know, an illness of some kind or a surgical procedure or even something like starting a new school or new daycare or the birth of a sibling or moving to a new city.

I'm going to jump into a really controversial topic, which I'm sure you know is coming, that I've seen in my practice and is almost heresy to say in medicine, but is there a role of vaccines in maybe being one of these triggers? And the reason I say that is I had a kid who was 22 months old, perfectly normal kid. His mother worked for a major pharmaceutical company and he had a vaccine at 15 months and started to regress and lost all his developmental milestones, became non-verbal and fully autistic. and so I don't know if that was the cause, but it was a moment where things changed. And I've heard the story so many times from so many patients that there's got to be something there. And I'm not saying vaccines cause autism, but they may affect a kid who's vulnerable, because this kid typically you see they're born by C-section, they don't breastfeed, they've had lots of ear infections, they've had lots of antibiotics, their microbiome's messed up. And so they're kind of sitting ducks and maybe they have all these polygenic risks for getting into trouble when they have an insult. So could this play a role? What's your take on this?

Well, I will say, and you're right, vaccines is a topic that unfortunately is so polarizing in autism.

Pro-life or pro-choice. It's not really, it's not religion. Let's talk about the science. Yeah.

So it is an area where I certainly wish there could be much more open discussion and less controversy, less heated debates. But I will say, when it comes from the point of view of mitochondria, it actually, a stressor is a stressor. And like all this that I just mentioned, whether it's a psychosocial stressor or whether it's an illness, in many ways the mitochondria respond in the same way. So, and I think as physicians, we all have very, when a patient comes to us and the parents have observed something, we really, I think it's important to believe, it's important to believe the parents and what they've seen and understand their experience. And then to really take that's a.

Radical idea as a doctor. We know how it's supposed to go, so that doesn't fit my theory. So it's not relevant, but actually it may be very irrelevant.

I think now doctors are partners. Doctors shouldn't be viewed as authorities or those who have the answers.

Amen. So, yeah.

So when children, especially when children go through a period of developmental plateau or regression, it is a red flag. It is an emergency. And so I think of, you know, there's a term in neurology, time is brain. Time is brain. Time is brain. And it first developed around stroke to get people to act more urgently around stroke. But I think time is brain really applies also to autism. And why is it that a child might be diagnosed with, sometimes a child will have the first signs of autism at a year or 18 months, not get a diagnosis until they're three or four, not get any medical testing until they're six, seven, or eight, or 15 or 21. I've certainly seen that. I know you've seen that too. And so we have to be much more quick to identify when the brain is struggling, when it's not getting the energy it needs, when it's under excessive stress, and then be much more quick to act. And action means doing the appropriate tests and then taking steps in lifestyle changes, dietary changes, dietary supplementation, or some kind of very interesting newer approaches like neuromodulation. so there are different ways of using electrical and magnetic stimulation to improve brain function. There are certainly medications, but not just--.

And hyperbaric oxygen I've seen used.

Yeah, there are a variety of some of these novel interventions that are really exciting. So in the area of neuromodulation, one that we use is a form of tiny microcurrent electrical stimulation. that stimulates the vagus nerve, which is the major nerve of the body of the parasympathetic nervous system. And we know that it helps to then counter the body's chronic stress response and sympathetic overstimulation, which is so common in many conditions, including autism. So that's yet another really exciting category. And then the final one of the six is what I call developmental behavioral approaches. this is a huge, huge category, including things like occupational therapy, speech therapy, dance movement therapy, art therapy. You know, it's all these ways that we can teach children and create those, you know, learning opportunities.

Yeah. I mean, all this is just so important. And your book, Magnificent Minds, which has just come out, it's, it's really a incredible contribution to the field from someone who's really in the weeds on this and. not just sort of a kind of fringe doctor, but someone who's trained in top institutions, who's doing really hardcore research, and has actually found the thing that I, I'm so happy to talk to you because, you know, for decades, I've been out there doing this, seeing these patients kind of in the wilderness, seeing the smoke signals in the scientific literature that were pointing in this direction, actually paying attention to what being found in these patients, they would come to me like, I don't know, I've really never treated autism before, but you want to try, let's work together and see what we find. And we started digging, we do toxin load testing, we're looking at heavy metals, we'll look at microbiome in the gut, we'll look at mitochondrial function, nutritional levels, genetics, and we'll start to look at inflammatory pathways and see all these things going on, and then start to just kind of like tailor it to meet the patient's particularly unique set findings and these kids would come back from oblivion. I mean, they literally would come back from being completely locked in. It's kind of locked. I mean, the extreme case of autism are like they're locked in. A lot of people walk around with Asperger's like Elon Musk, but there's like kids who are just locked in. They can't talk, they can't communicate, they have no social skills, they can't really function very well. And to see these kids come out of that is a miracle. Now, we don't think there's survivors of autism. But there are. So can you talk about that?

Yeah, well we know that there's a certain percentage of children who are diagnosed with autism. There's a certain percent, depending on what research study you look at, it varies, but probably somewhere around 10% who over time lose the diagnosis of autism, meaning they no longer meet those diagnostic criteria.

Just naturally.

Yes, without treatment. No, with treatment. With treatment.

Yeah.

With treatment. with the right interventions, medical as well as developmental behavioral. Yeah.

I had a case, it was this case I was telling you about from this little boy, it was 22 months when I saw him and he started getting regressive autism at 15 months. And we looked at his gut and these kids typically have really smelly, stinky, bad poops, constipation, and they have really bad dysbiosis, they have usually bacterial or yeast overgrowth which affects them. in many ways because the metabolites from the microbiome caused brain inflammation and leaky gut. He had organic acids. He had a really significant mitochondrial dysfunction. He had gut inflammation with elevated calprotectin, which is a biomarker we use for colitis. But he didn't really have colitis. And we found all these methylation genes, the thion genes that were abnormal. We found elevated levels of heavy metals like mercury and lead. And so we basically just built a program to address the things that we found. I wasn't treating autism. autism. I was basically helping his basic systems get back in balance. And, you know, within 10 months, this kid just dramatically changed. We redid all these biomarkers, almost completely reversed most of them. The Mercury was a little longer to get out of his system. And, you know, the kid became completely normal. And, you know, his father sent me this video of him when he was 10 years old, just playing baseball and being a normal kid. and I was like, and this kid, when he came into my office, you know, just wasn't verbal, wasn't talking, was just sitting on the floor, simming himself. And I'm like, if it's possible once, like, if it's possible just one time, shouldn't the entire scientific Community, the NIH and all scientists be going, what is going on here? How do, how do we take this Insight? And actually, it's true. In one patient, could it be between another and another and another? So that's kind of the work you've done, is really trying. to sort of make what has been really on the margins of medicine central to how we think about autism. And it's really revolutionary.

Well, you know, so many of the basic principles that in medicine are foundational, it's really applying them to autism.

Yeah.

And, and seeing the power that that has.

So, yeah, like one example that I read about, which I thought was crazy, but, and it sounds crazy, but Fecal transplants. Do you know anything about fecal transplants where they take the poop out of a healthy kid and put it in a kid with autism and what it does?

Well, I know about the research studies that have been done and in my own practice, patients of mine who have had it done, who have gone, most who have participated in research study and so I've been able to see the changes.

And what do you see?

Yeah, well, it varies, but in some children, no change, but in other children, their stool quality improves dramatically. Language, communication, social skills, learning, behavior, so the attention. So in some children where that's an important factor, it really can change things because we know the microbiome has a profound influence on the brain. And so it can yeah, it can really lead to some dramatic improvements. Yeah, it's pretty amazing.

And I think, you know, like I said at the beginning, 95% of these kids have some type of gut dysfunction and yet, you know, typical neurologists will not even pay attention to that. Well, that's their gut or whatever, it's not the brain, but it's one system. And so your work has really helped us to understand that whole child approach. And that's what you write about in Magnificent Minds, which definitely everybody should get a copy. And if you know anybody with autism or have a friend or a kid or in any way you're connected to anyone, this is going to be a profound frame shift in how to think about the disease and how to think about treatment. Because it's kind of a hopeless condition. I mean, this woman I was telling you about who brought her kid in was basically told, well, your kid's got autism, do behavioral therapy, he's going to be institutionalized, we're sorry, good luck. And that's the message a lot of parents get. It's really disheartening. I think how do you see this approach sort of getting more traction in medicine? I mean, you're doing the research, you're pushing this out there. You've created these clinics all around the country with Cortica, but are you seeing your colleagues start to wake up and pay attention and start to incorporate some of these things?

Yes. I mean, what's really been a very positive change in our field is that there is a lot more understanding of the medical basis of autism. and another really exciting, I think, direction for the field is that even those, you know, I, so I myself am a behavior analyst. I'm a BCBA and the field of ABA therapists, even within that discipline, there's a lot more recognition of the medical basis and the medical contributors to autism. And so a lot more collaboration and partnerships are happening between behavior specialists and medical specialists. And I think it's our job.

To.

Teach, to spread the word, to make more known about what the research really does show now. And so the way that we at Cortica are trying to do this is to first grow our team, to set up more clinics, to serve more and more families, and to publish research. So we have a part of Cortica is our Cortica Innovation Network. and we conduct clinical trials. So we've done over a dozen clinical trials already, some looking at interventions for the gut, others looking at virtual reality. So we're looking at a virtual reality platform to enhance behavior therapy. But it's really about contributing to the research and then also making this quality, the standard of clinical care, available to as many families as possible. possible.

Yeah. I mean, you know, the clinical research, I'd love to explore with you a little bit because, you know, one of the challenges, and I encountered this when I was at Cleveland Clinic, we wanted to study dementia, which, you know, I think autism and Alzheimer's are almost two sides of the same coin. We see a lot of the same biological things going wrong. Gut issues, mitochondrial issues, neuroinflammation, methylation issues, detox issues, toxic load. I mean, it's just, I, I, I'm a family doctor, and I basically treat everybody from birth to death. And so I see the whole spectrum. and I was seeing these patterns of, like, these similar phenomena in many different brain disorders. So anyway, I was at Cleveland Clinic, and I was, we were trying to do a research project on Alzheimer's and dementia. We were working with the leading neurologist there who was in charge of the Alzheimer's Clinic, and he got this. He understood all this. But we went to the head of research, and she said, well, look, you know, you can't do everything at once. You have to study one thing at a time. You want to study diet, you want to study this vitamin, you want to this approach you want to, and I'm like, well, actually that's not really how the body works. It's like you, if you want to treat a problem, you have to deal with all the factors that are causing it. You can't just do one thing. So how do you kind of address your clinical trials? Because you want to optimize their diet, you want to optimize their nutritional status, you want to fix their mitochondria, you want to fix their gut, you want to reduce inflammation, you want to detox their bodies from talking toxic load. You want to do the behavioral therapies. All of it's needed. You can't just do one thing. So how are you approaching clinical research using this? Because you won't see the results. You see one thing, you might not see a thing.

It's a real challenge. It's a real challenge. And it's one of the reasons I think that a lot of very promising therapies in autism have not made it past those early clinical trials because we're not sure maybe we're isolating that therapy. In fact, we need a set of therapies together or we're not selecting the right children, there's phenotype differences. So maybe some subgroups will respond in others won't. So we don't, right?

We're a little bit stuck. Yeah, I guess if you don't have a vitamin D deficiency, vitamin D doesn't do anything, right? So you have to have the thing.

If you're mitochondria, great. Well, you give all these mitochondrial therapies, they're not going to see a change. Right, right. So we're doing two things. One is, yes, we're studying novel, innovative, therapies for autism in our research program and clinical trials and doing our best to select appropriate subgroups and recognize that by isolating certain therapies maybe we're then missing out on the benefits they could have. But we're trying to contribute to that part of the innovation in the field. Simultaneously, what we're doing is we're studying our own population of children who are getting whole child comprehensive of care, where we as clinicians are able to use all of the tools at our disposal and we're tracking outcomes in a very careful, holistic way and comparing them to community standard of care. And the initial data we have in over 800 children already shows much more rapid progress on the Vineland scale, for example. So some of these standardized assessments that are very well accepted in the field, we're seeing better progress with the whole child model.

That'S amazing. So you're publishing this data. We'll link to some of the research papers that you've published. I think your work is just so important because it, it's, it's, it's not just around autism because chronic disease in general has multiple causes and need multiple types of therapies, which you basically laid out as a treatment model for whole child autism care. But it really applies to anything that you have as a chronic class, whether autoimmune disease or whether dementia or heart disease or diabetes. These are things that all are very similar at the root cause. And there are inflammatory issues, there's gut issues, there's mitochondrial issues, there's detoxification issues, there's hormonal regulation things. So these are things that we deal with all the time in functional medicine, but are not really recognized as features that should be looked at even. And one of the, we were talking earlier before the podcast about my mentor, or Sidney Baker, who's really, I think, one of the leading thinkers in medicine in the 20th century. You know, he said there's certain principles, right? You know, take out the bad stuff, put in the good stuff, which essentially what you're doing. Don't forget, there's a way to listen completely ad free with Hyman Plus on Apple Podcasts. You can enjoy every episode without any breaks. Just open Apple Podcasts and tap try free to start your seven day free trial. But then he also said there's the TAC rules. if you're standing on a tack, taking one out doesn't make you 50% better. So basically, if you are gluten sensitive and you're having all this neuroinflammation from gluten and you just give mitochondrial therapy because the mitochondria not working, the patient probably won't get better. The other rule is if you're standing on two tacks, taking one of them out doesn't make you 50% better. You got to get rid of all the tacks. And so that's the problem with traditional medicine is we just do one tack at a time. and try to see the difference. But we have to do this multimodal interventions because we have multiple factors and multiple causes.

Yeah, yeah. So interesting. So how that translates into my clinical practice is that there are times where, so as you know, in a lot of medicine, the approach will be try one thing, see if it helps. If it doesn't, take it away. Try something else. It's like one at a time kind of thing. But really what I found is sometimes you you have to do many things at once, get the child to a better place, and then maybe slowly remove one at a time, see what they really need and what they don't.

Exactly, right. That's kind of how my approach is, like how do you hit the factory reset button? Or when your computer's just on the fritz, you want to just hit restart. How do you do that? And I think it is, to me, you know, I think, you know, what I've seen clinically, and it's not always easy for people to do, is the more intensive initial therapy we can do, you'll see a massive change. So if someone's drinking 12 Cokes a day and you have them drink six Cokes a day, not probably gonna help them that much. So you really, and so I tend to do an approach that really eliminates a lot of the bad food, adds in all the good food, optimizes all these basic systems, and then see what happens and see what's left over, and then you can start to add things back and kind of adjust, but that seems like what you found as well.

Yeah, and I will say, you know, one thing to keep an eye on too with families, when autism is part of their experience, is there are many potential places to start, and sometimes there are some families who can and want to do it all at once and will do well with that approach, and then others for whom they're already in a state of stress, maybe things at home are fragile, maybe resources are constrained. And so for me, it's very important to meet them where they're at and say, Where do they feel comfortable and confident starting? And we can start there. And these other pieces are important and we'll get to them. So it very much is about tailoring, not just to the child, but to the family.

Yeah, I know. I mean, I had autism in my own family. My cousin, who was about a year or so older than I was when I was growing up, I was fully autistic and back then there wasn't that many cases of it, but this is in the early 60s and I got to witness, you know, the difficulties that were experienced by his family, by my aunt and uncle and how tough that was for them and how, you know, the care they had to give them disrupted their own lives. And so, you know, a lot of the work you do also helps really this whole family approach. It's not just about the biology, it's also about the social fabric that they live in about how to help the parents and how sort of greater ecosystem the kid lives in. So would you mind just chatting a little bit about that? Because I think it's an important piece because in order for actually people to follow these things, it's, you know, that's a part of the problem with autism. The interventions can be challenging. You've got to add this, take that, take these supplements, change the diet, do these therapies, you know, detox from this picture. God, it's like, it's a lot of work.

Yeah, it is a lot of work.

And so it's hard on families.

Yeah. Well, there's a young man by the name of Joy Fleming who is a young autistic man who's also a Rhodes scholar.

Wow.

So I had the opportunity, the great privilege to meet with him and talk with him. And he provided a quote for my book saying that he wished he had had this information as he was growing up because it would have helped him to understand himself. and then his mother also provided a quote saying she wished she had had this information when Jory was a boy. And that was for me the most meaningful feedback I could have gotten because really the idea behind all of this knowledge and the reason for me for putting the time and effort into writing Magnificent Minds was to empower autistic people and those who love them. And so I think this knowledge in the hands of parents will be so powerful because it sets them off wherever they are in the journey. I think it will equip them to find ways to enhance their loved ones' health, well-being, and ultimately to bring more joy into life.

It's such a hard diagnosis. It just breaks my heart when I see families and parents have to deal with this. My sister had a kid who who was on the spectrum and the challenges he's had. It's been hard to watch and how little services we have, how little understanding we have, how few practitioners actually understand how to approach this in a more systemic way. And your work is just so pioneering and it's so heartening because there's a bunch of us crazy people who have been on the fringe doing this for a long time, but to have someone in your pedigree and your training and your expertise to kind of dive deep into the science, and actually showed that there is a biological basis to this. It's not just refrigerator mothers or bad parenting, and it's complex. It's not one thing. And as you mentioned, the mitochondria are kind of the organelle and the cells that seem to be the victims of a lot of insults. So they're kind of in effect, not necessarily a cause.

That's right.

So I think, you know, I would love to explore a minute with you, what you think are the major causes. We talked briefly about it, but I have my own theories, but I love to sort of see, you know, it's obviously interplay between genetics and environment. What are the biggest causes that are being revealed in the literature and in your experience that maybe triggers for autism?

Yeah, well, ultimately there's the term complex gene environment interactions. I think captures most of it. And as you were asking that question, my mind immediately went to a slide that I have in some of my presentations that is so where it's so well laid out. And this is from a research article in a very reputable, you know, peer reviewed journal.

Yeah.

An understanding of the brain and autism and then all of the different factors, you know, there's like a dozen different arrows, you know, that kind of can then influence how that brain is functioning. But I do think that the concept of load, the overall burden, what are all the things that a brain which is so fragile and vulnerable and so easily influenced, what are all the different things that are affecting it? And then what resilience does it have? What maybe protective factors or what does it have in its favor? and it really is that delicate balance. So, you know, it's a lot of different genetic factors that influence things like the brain's neurochemistry, electrical patterns of firing, and... Dr. Could be more prone to inflammation. Dr. Yes, inflammatory, how inflammation and metabolism, even the genetic factors around the gut, all of those set up the brain substrate in a way. A vulnerable brain. Yes. And then what is the environment presenting the brain with? And it could be in the form of, unfortunately, toxins in our environment, various other types of toxins. What kind of toxins? Well, there are, well, we know, for example, lead, certain heavy metals. We also know that there was a very influential research study out of Harvard School of Public Health about 10 years ago showing that there were over a dozen different industrial chemicals, so pesticides, things that are widespread in our environment, that are now even detectable in cord blood.

Yeah.

So they're in our babies.

287. I think this was the Environmental Working Group did a study, like 10 newborn studies. It was 287 known toxins and I think 200 10 or something were neurotoxic.

And that these are all being used without first being tested for their developmental toxic effects. And a lot of these, we know that they have an effect on mitochondria. That is, you know, pesticides for example, they're neurotoxins. That's how they kill pests.

Right.

Exactly. So, So really it is a complex interplay of all those factors.

Yeah, it is. It's true. And you never know what it's going to be. I remember what kid I had with autism and, you know, turned out we did a stool test and he had Giardia. And I gave him a drug that we use to treat Giardia called Flagyl and it's like a parasite and the kid woke up. I was like, wow, that was easy, you know? Sometimes it's something simple like that or it could be a kid who's really sensitive to gluten. And sometimes it's just one big thing. but often, you know, it's a load of it's the total load concept, which is really important that we don't really think much about in medicine. We're looking for that silver bullet, that one explanation, that one pathway, that one target of a receptor to work on or medicate. But it's just not how the body's designed.

So we kind of have to rejigger our whole paradigm.

It's all connected. Yeah, it's all connected. It's all connected. Wow. Well, Suzanne, your work is so inspiring. I've been following for years. Your book, Magnificent Minds: the New Whole-Child Approach to Autism, is out now. Everybody should for sure get a copy. They should check out your centers if they have any family members or anybody who is struggling with autism that they know. It's Cortica, C-O-R-T-I-C-A. You can find it online along with her work at Dr. Sans-Goe's website is drsuzangoe.com/magnificent-minds if you want to check out her book. You can get everywhere. Thank you so much for what you've done and what you're doing and what you keep doing to help us understand this very perplexing condition that I think for the first time is being actually understood and in a way provides a window into the rest of medicine. So thanks so much for everything you do. Any final thoughts or words you want to share with families or the audience?

Oh, just to say there's, well, thank you, Mark. It's just wonderful to have this time with you and I've learned so much from you. And I think as a closing thought, often autism is framed as tragedy. And I just want to say, when you really get to know autistic individuals and their stories, these are triumphs, not tragedies. And so there's so much to be celebrated and so much that we can do. And so I think it's really a message of hope.

Yeah, and they can have extraordinary skills, right? They can be genius level. certain things. Like my nephew is an incredible musician and can listen to a song and just sit down and play it on the piano. Amazing. Can't read music, but he just knows. It's quite remarkable.

Yeah, it gives us such insight into the brain, the remarkable things the brain can do.

Yeah, it's really just a whole new frontier of understanding the brain for the first time. So thanks again for being on the podcast and we'll get you back on.

When we have more to talk about.

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