TOP FOODS To Eat To Boost Energy & REDUCE Brain Inflammation | Suzanne Goh

Autism has been misunderstood, thought to be primarily psychological, and in some parts of the world still thought to be psychological, not neurological. This young boy was eight years old when I met him, and I met him at the time I was co-director of the autism program at Columbia University. And I remember being so moved by him and his mother because of how much they had done along their journey with autism. So he was first diagnosed young, around 18 months, and had received a lot of very important therapies like behavior intervention and speech language therapy. But it wasn't until he started to receive mitochondrial therapy at the age of three and a half that things really started to change. So at that time, he wasn't speaking, he had difficulty walking, he wasn't able to run. His mother took him to Johns Hopkins University to have additional testing and mainly metabolic and mitochondrial testing. It was there that a diagnosis of mitochondrial dysfunction with autism was made and he was started on a series of vitamins and supplements that over the course of weeks and months radically changed his developmental trajectory. He began to speak, began to interact socially, his gross motor and fine motor skills improved dramatically. He continued those therapies up until when I met him, which was at age eight. And at that point, he had been doing well. He was mainstreamed in school, but he was beginning to refuse to take the large quantity of vitamins and supplements. And so he'd been inconsistent with that, and he was having a period of regression. So his symptoms were worsening. So he'd made dramatic progress, and now he was struggling again. He was struggling in social interaction, high levels of anxiety, headaches, daily migraine headaches, and obsessive compulsive behaviors. So severe that he had trouble walking down a sidewalk because he was retracing his steps. It was hard to get out of the house in the morning. This was of course alarming to his parents. With resuming mitochondrial therapy through L-carnitine, coenzyme Q10, B vitamins, some very basic supplements, he began to improve again. And now he's a thriving junior high school student, plays competitive travel soccer, is in a mainstream school, and is doing incredibly well.

It's an extraordinary story. And yet when you go to the doctor, most of the time they don't know how to diagnose mitochondrial dysfunction and probably never heard of mitochondrial therapy. So tell us about your work in mitochondrial discovery of how this is connected autism because, you know, mitochondria is a place where we make energy and it seems like a lot of his symptoms were an energy deficit.

Yes. He had very low tone, fatigue, delayed milestones, all of which are associated with mitochondrial impairment.

What are mitochondria?

Anyway. So mitochondria, if you think about the cells of the body, nearly all the cells of the body have inside of them mitochondria. And mitochondria are, they're classified as a subcellular organelle. So they're tiny structures inside of cells. Like a cell within a cell? Yes. And a cell can have dozens or up to thousands of mitochondria. And mitochondria are sometimes called the powerhouse of the cell because one of their main functions is to generate energy. And they do that in the form of ATP, which is thought of as the currency or the fuel, the energy currency for the body. Mitochondria are a powerhouse. They do a lot of other things. It's interesting that they're called the powerhouse because in fact they're actually very delicate structures and they're very sensitive to environmental factors, stress, toxins, oxidative stress. They're easily damaged. They're easily damaged, but they're so important for all of the body's functions and the brain is particularly dependent on the function of mitochondria because it has such a high energy demand. So, the developing brain is hugely impacted by mitochondrial function.

It's like you run out of gas, right? Your brain doesn't work. And so, you know, the brain doesn't have a lot of ways of responding to insults. And when you lose mitochondria, you get all sorts of problems. There's Parkinson's, Alzheimer's, autism. And, you know, as you said, the mitochondria are really sensitive to insults.

So, what have you found are the worst offenders in damaging the mitochondria? There's a term that sometimes used called secondary mitochondrial dysfunction, meaning not due to a genetic cause but due to other factors like inflammation, physiological stressors, medications. So there are some medications that are known to be toxic to mitochondria.

Like statins.

Yes, yes. Very widely used medications. Some antibiotics, some commonly used psychiatric medications. that are commonly used in children, in young children with autism, like risperidone.

It's antipsychotic, right?

Yes, and it's very, very widely used in the treatment of autism. Mitochondria can be impacted by so many different factors.

And you mentioned toxins in your work, that you discovered a load of environmental toxins. You talk about the work of Phil Landrigan, who's an amazing scientist who's really connecting the dots between environmental insults and autism and ADD and people issues.

So important that there are many industrial chemicals and pesticides that are widely used that we know clearly have toxicity to the developing brain. Many of those chemicals impact the function of mitochondria. So it's very likely that at least one mechanism by which they harm the brain is by impairing mitochondria.

And also the mitochondria essentially are the processing factories for the food we eat. and they respond differently to different foods. So one of the big insults we know is that sugar is a mitochondrial toxin and it's ubiquitous. The average kid has 34 teaspoons of sugar a day. So how does that impact the mitochondria?

Well, nutrient intake or the lack of certain key nutrients is probably one of the biggest factors that affect mitochondria. So, we know a lot about the machinery, the delicate machinery inside mitochondria, and that a lot of that is impacted by oxidative stress. So, when there are these molecules in excess called free radicals, they can do damage to mitochondria.

It's like rusting.

Yes.

Yeah, it's like a car rusting or apple turning brown, and that process happening inside of us.

Yes, and the things that we eat day to day, even within the course of a day, impact. It's that dynamic. The system is that impact.

So what are the kinds of foods that actually hurt the mitochondria? And what are those that help the mitochondria?

So we think that the foods that are helpful to the mitochondria are foods that are rich in antioxidants, that have a natural source of, for example, B vitamins. They're foods that are natural sources of coenzyme Q10. Coenzyme Q10 is key in one aspect of the mitochondria called the respiratory chain that is directly involved in the generation of ATP.

So what would that be that has CoQ10?

A lot of foods that we may not want to eat. So liver has cut.

Yeah, liver's good. Liver's got B vitamins. Liver's a mitochondrial food. Yes.

Carnitine, for example, which is in high concentration in meat products.

Yeah, particularly lamb.

Is important for shuttling fats into mitochondria.

Where they can then be metabolized into energy. Let's talk about fats. You mentioned fats. So, you know, we've seen a lot of literature come out that fats really are an important fuel for the mitochondria. Certain kinds of fats actually help the mitochondria work better, like MCT-UL.

What do you have to say about that research? Well, I think we know that the importance of lipids in, for example, cell membrane integrity, And the mitochondria have their own membrane. The integrity of that membrane is very important for the function of mitochondria. In fact, many of the prop key processes happen along the inner mitochondrial membrane. So lipids from fats are important for those types of things. We understand that mitochondria are very sensitive to inflammation and that healthy lipids can help regulate the body's inflammation.

What about the actual burning of fuel because it seems like there's this metabolic therapies that are emerging around ketogenic diets.

Right.

And it's been very effective in these kids. I had a patient with autism recently who was having a lot of violent behavior, aggressiveness, was eating a lot of starch foods and sugar and we put him on a ketogenic diet and all that went away almost overnight.

So, the ketogenic diet is a type of diet that helps provide the body with a different source of fuel to burn. So it allows the body to generate high levels of ketones for fuel. So it's sort of a way to shift the body into a different biochemical metabolic state. The ketogenic diet and a related diet, the low glycemic index diet, are known to be effective treatments for epilepsy. So they reduce seizures, they stabilize the electrical patterns of electrical firing in the brain. We know that in those with autism, somewhere probably around 20 to 30% have seizures at some time in their life. They have epilepsy. Somewhere between 60 to 80% of those with autism have abnormal EEGs. Whether or not they have seizures, they have an EEG. They have a brain, the EEG is a way of collecting electrical data about the brain. That shows that parts of the brain are firing in abnormal ways. and show excessive firing. So diets like the ketogenic diet and low glycemic index diet can help to stabilize and improve those patterns.

I mean, what you're saying is pretty radical, 'cause we for decades thought, first that it was a bad mothering that caused autism, and then second that it was a fixed static brain disorder that could never change. What you're talking about is actually being able to change the brain in ways that help these kids recover, which is kind of heresy.

Autism has been misunderstood. from the time that it was first described in the 1940s until now, it's really been misunderstood, thought to be primarily psychological, and in some parts of the world still thought to be psychological, not neurological. And so we've come a really long way. We know that it's not due to bad parenting, refrigerator mothers. We know that's not the case. We know that's not static. We know that it has a lot to do with the body's biochemistry, which is impacted by the environment. We know that it has to do with the brain's metabolism and that a lot of that can be influenced and changed.

That's amazing. It's really hopeful. It's a very hopeful message. So tell us about this groundbreaking research you've been involved with at UC Davis.

Sure. I had the good fortune during my postdoctoral research fellowship and then as a faculty member at Columbia University to be mentored by Dr. Salvatore DiMauro, who's thought of as one of the founders of the field of mitochondrial medicine. And he and I worked together along with Dr. Bradley Peterson, who was the chief of child psychiatry at Columbia at the time, to do a brain imaging study to look at whether we could identify markers of mitochondrial dysfunction in the brain in children and adults with autism. That had not been done before. There had been studies showing that peripheral markers like blood or muscle or other tissues showed markers of mitochondrial problems, but had never been shown in the brain in living individuals. So we used brain MRI in particular brain magnetic resonance spectroscopy to look for lactate, elevated levels of lactate, which is a biomarker of myoclonus.

That's what you accumulate in your muscle when you exercise too hard, right?

Yes, and it accumulates in the brain when the brain Mitochondria aren't functioning well. It accumulates during sleep deprivation in the brain. So those types of different stress states. And so what we were able to show is that there is elevated lactate in the brain of a proportion of individuals with autism. And we were able to show the parts of the brain that can be affected. And the part of the brain that seemed to show elevated lactate the most is a part called the cingulate gyrus, which we know is so important for the integration of higher level thoughts. thought, emotion, behavior, and has been implicated in autism and many other neuropsychiatric conditions. There have been many other important research studies of mitochondrial dysfunction in autism, one out of UC Davis, where they showed increased markers of mitochondrial dysfunction in children with autism. So that was in 2010.

Based on blood or based on lymphocytes?

Based on blood and lymphocytes. So what would you be looking for.

To see if you have, I mean, how do you, how do people know if they, everybody's listening, wondering, how do.

I know if I have mitochondrial dysfunction? So there are a lot of different tests that can give us insight. In the clinic, they're primarily tests of blood and urine, but they're routine tests that can be done really at any lab. It's the interpretation of those test results that's important. What kind of tests? Things like plasma amino acid profiles. or urine organic acids. These are all ways of giving us insight into the body's metabolism, how we're processing the things that we've taken from the outside world. Even things like liver function tests, total and free carnitine levels, coenzyme Q10 level, vitamin E level, those are all important signs. But you don't need to necessarily have abnormal lab test results. There are signs from a child's medical history and physical exam. that even if the lab tests aren't perfect, so we rely a lot on those.

What kind of things would you find in a history or exam?

Probably the most important is a history of a child having lost skills at some time in their life. So a history of developmental regression, especially between the ages of 18 months to three years, and especially in the setting of a physiological stressor. So for example, a very common History that I hear is that a child was ill, or a child received an immunization, or the family took a trip to India or to China or Europe, or the child under daycare. So there was something, or they moved home. There's something that-- Some insult. Some insult, but it can come in so many different forms or the child had needed to be under anesthesia for ear tube placement or correction of an inguinal hernia, some fairly minor procedure, but that required sedation and put the body into a state of stress. And after which the parents noticed the child wasn't saying the things they used to say. They were more clumsy. They weren't looking at them the same way. And it's just, it's a story that I hear over and over and over again and is very classic for mitochondrial dysfunction. You sort of notice in your work.

That there's a correlation. And again, like mitochondria, it's not something that doctors learn about. Doctors don't understand how to diagnose and treat mitochondria. They don't understand the load of environmental toxins or how to diagnose it or treat it. So how do you apply that emerging science into clinical practice?

Well, I think a first step is exposure, so trying to reduce exposure. And there are a lot of ways to do that. But fortunately, there are a lot of great resources. So one of the things that I'm and my team is sensitive to is that there are so many things being asked of families with children with autism. There's so much, so many therapies, so many interventions, and that making changes in diet and in environmental exposures is a lot of work. So we try to kind of guide them and help them take things one step at a time, thinking about the environment in the home, air quality, food quality, whether they use pesticides in the home or not. So simple steps like that to try to reduce exposures where we can get a lot of bang, you know, get a lot of yield without a lot of effort.

It should be good for everybody.

Yes.

Yes. But how about the diagnosis? Because how do you tell the body burden of a kid? I mean, we all should reduce those exposures, but how do we know what we actually have, whether there's metals or pesticides or chemicals?

So we do basic testing for metals. We do some, and I think this is the area where there's certainly not a lot of consensus, especially in the pediatric and pediatric special needs field, what testing do you do? And it's taken a long time for me, as I've I've had to, because the answer is not out there, I've had to evaluate the options and have decided on what I think are the highest quality tests available. So we do tests from some of what I think are the leading laboratories in functional medicine, and we use those test results to guide us. So are they pointing towards excess burden of specific toxins or heavy metals? and if so, what can we do to help the body to eliminate those in a way that's, I think, as natural as possible and gentle. If you're too heavy-handed and too aggressive in your approach, the child may worsen. And when things worsen, it really puts the family into panic. Sort of working relationship is really important. And ongoing working relations, a lot of this takes time.

And you can also set expectations.

Yeah.

So you're doing challenge testing or just blood or urine?

I don't do challenge testing and largely because I feel like it's an area of my own education that is still to come. So I don't really know how to do it, how to do it well.

Yeah, I read a paper once in the New England Journal and they were like talking about mercury and they said they measured it in the blood. And I'm like, well, that's interesting because they said it's easy to measure. And I was like, it's like the guy who lost his keys on the street and looking under the lamppost and his friend says, why are you looking under the lamppost? I said, what are you doing? I'm looking for my keys. He says, Where'd you drop them? I dropped them down the street. The light's better here. So the body burden, these substances are cleared. They're stored in muscle and brain and organs, pesticides and chemicals in the environment and food are stored in fat tissue.

So I think it's really important to ask the right questions and think about this. I'm always trying to improve. I think we've come a long way in my medical practice, but I'm always seeing the ways that we're not, I think we're not doing enough.

Yeah.

And trying to figure out how to do that. So great. So great.

This is impressive. In major medical institutions, you're helping these children detoxify, you're doing mitochondrial therapy. So let's talk about mitochondrial therapy. Because how do you, one, if you're healthy, keep your mitochondria healthy. And two, if your mitochondria aren't working, what are the options available to people to actually enhance their mitochondria? Which, by the way, or throughout your whole body. So it's not just you're treating the brain, you're treating everything. And energy deficits are a huge driver of so many illnesses, everything from Alzheimer's to Parkinson's to autism, to cancer, to diabetes, obesity, they all play a role.

Yes. You know, sometimes in Western allopathic medical training, we're taught to distinguish how different disease states are really different, how radically different they are.

They're the same.

They're the same. They're the same. And so it starts, that's why I feel that the functional medicine approach is so, it's simple and elegant in a way. And the same is true for when you're thinking about mitochondrial function in autism. Nutrition, diet, nutrition, lifestyle, exercise, activity. And then you can think about nutritional supplementation.

That's why they're called supplements. They're not replacements.

Yes, yes. And there really aren't medications. There are some devices that may have a role. But I think exercise and nutrition. And then thinking about exercise, you know, how do you, for a child with autism, how do you approach an exercise regimen? And so that's where things like occupational therapy, physical therapy, music therapy. So music can be very motivating. So there are all these other tools.

Is it dance to music?

Yes. Or sort of similar to how music can be used in Parkinson's, it primes the motor system.

Yeah.

And so we find that it's there are all these tools that can help us. They're non-medical tools, but they help us with this fundamental aspect of.

They are medicines. Music is medicine, light is medicine, movement is medicine.

Yeah.

Yeah, those are drugs. And they often work better than the other drugs.

That's right. That's right. So, so I found that approach to be very effective.

And what about the supplement side of things? What are the kind of drivers of mitochondrial function.

Yes. So a basic sort of a backbone of mitochondrial supplementation would include L-carnitine, coenzyme Q10, B vitamins, creatine, so another good energy source. There are many others, and acetyl cysteine. So there are sort of direct things, nutritional supplements that you might think of as direct, for example, supplementing carnitine or CoQ10. we think can help in a more direct way. But perhaps antioxidants or anti-inflammatories or helping increase glutathione, for example, or supplementing with N-acetylcysteine. There are other ways that can support mitochondria.

What about sort of new research on nicotinamide riboside, which is a supplement that's been touted to be helpful with fatigue and brain function?

I think there's very compelling research that that's also a beneficial approach. Fairly new, so not one that I use in my clinic as a treatment.

Yeah, yeah.

Flint Beal from Cornell has done a lot of work in this set of mitochondria and Alzheimer's, the other end of the spectrum. You know, and I'm a family doctor, and I had the insight by treating and looking at the biology of Alzheimer's in patients and autistic patients, that they were almost the same. They had often the same methylation in SNPs, the glutathione SNPs, variations in their genes that were the same. They had often the same problems with the same biochemical pathways and the same results on their organic acids. And I just thought, wow, this is like this underlying issue that's going on across the spectrum. I was remembering a patient I had recently who had a mitochondrial disease. We didn't exactly know what it was. The genetics weren't clear. And he had severe symptoms of inability to exercise, and he would get severe muscle muscle damage and his muscle enzymes would go through the roof. His CPKs would go to thousands. It should be less than 200. And he, I didn't know what was really wrong, but I said, well, let's just treat your mitochondria and see what happens. So I gave him carnitine and CoQ10 and lipoic acid and N-acetyl cysteine and ribose and. And he just was completely cured. Like he could exercise, he could work out. His muscle enzymes weren't elevated. His muscles didn't hurt. Wow. You know, and so just working from first principles, you know, which is what you're doing. You're really going back to first principles and sort of revolutionizing your thinking about.

How we deal with autism. One of the exciting lines of research related to mitochondria and autism has come from University of California, San Diego and the laboratory of Bob Naviaux. So it's taking it one step further even to say, well, mitochondrial dysfunction encompasses a lot of different things. So there can be sort of, we classically think of it as impairment of the respiratory chain. So, and a depletion of ATP and energy. But for a subset of those with autism, it may be an upregulation of certain elements of the mitochondria and the state that Dr. Naviaux has called the cell danger response. And he's finding similarities between autism and Alzheimer's and other neurodegenerative diseases. Really?

Because I just noticed this clinically, yeah.

Yes, in terms of metabolomic profile.

So.

We'Re still at the beginning of understanding mitochondrial autism. We know it's critically important, but they're going to be, I think, more subtlety and more options for treatments soon.

So you talked about the role of diet, talked about the role of exercise, talked about the role of mitochondria, of environmental toxins, but there are other factors that are potentially driving autism. Dale Bredesen talks about the 36 holes in your roof and you just fix one of them, it's still gonna be raining or if you fix 10 of them, it's still gonna be raining in your house. So it's similar with autism and I think one of the areas we're discovering is the gut microbiome playing a role in autism. how we can think about changing the gut flora as a way of changing the brain. How have you found that in your work?

Well, I'll say that that was certainly not something that was ever part of my training. That was something that I've learned more recently. And I think the research is also more recent, but I think just the idea, newer understandings about how connected the brain and the gut are, have helped us understand that there's a relationship between gut health and developing brain and autism.

95% of autistic kids have gut dysfunction.

Yes, and maybe more. Right, maybe more than that.

Maybe all.

It's hard to imagine that they wouldn't, given how the abnormal brain development affects the gut and how the gut, so the bidirectionality of that. So we want, I think, a basic way to think about the mechanism by which the gut is impacting the brain and autism. is that when there is gut inflammation, it impacts the integrity of the intestinal lining. And so things enter into the systemic circulation that stimulate inflammation and inflammation in the brain as well. And we know that there's microglial activation. We know that there's a degree of.

Chronic-- In other words, the brains of autistic kids are inflamed.

Right.

Yeah.

In sort of a chronic low-grade inflammation. And so that's one way that gut health impacts autism.

And they can also affect the mitochondria, right? Because any source of inflammation can alter the mitochondria.

Yes.

So tell us about some of the extraordinary cases. You mentioned Jake, but I'm sure there's other patients you've seen since then and you've refined your approach. What are you seeing?

Well, I would say the most common and probably most rewarding are when children come early. So when they come to my clinic and they're younger than three years of age, and when we identify the pattern of the child having lost skills in the setting of some type of stressor, especially if the child can come to us quickly, so when that occurs, the pediatrician recognizes it and sends them to us early, we can do the appropriate lab testing to identify the mitochondrial markers and start treatment early, remove the stressors and the harmful exposures, begin mitochondrial therapy early, the turnaround is just incredible. We have dozens and dozens of children recently who've come to us where that's been possible.

So wait a minute, you're saying that we can actually now start to reverse autism?

Yes, and I think there's no question now that for some, not all, but for a proportion of children with autism, It's possible with the right therapies at the right times that within six months a year they would no longer meet the diagnostic criteria for autism.

That's extraordinary. I mean, we, you know, when most patients or parents bring their kid with autism to the doctor, they say, this is incurable. This state is going to be for the rest of his life. You can do behavioral therapy to help. with a few things, but essentially, you know, your child is going to be locked in forever.

Yeah.

So I think the message is changing. I also think it's important to say that there are different, there's so many different subtypes within autism. So, yes. So not all have mitochondrial disease. Not all have mitochondrial disease or dysfunction for a portion, and we don't know what that percentage is, but for a portion, reversal of symptoms is possible. Probably because what they have is a reversible metabolic syndrome or reversible metabolic encephalopathy. For some children, the cause of their autism is a little bit harder to change. It may be problems in synapse formation or a more severe type of brain injury. But even in those cases, tremendous progress is possible.

Yeah, it's true.

So there's no case where you can't do something. I mean, there may be rare genetic cases, but even in those cases, you can still modify the whole metabolic processes and see improvements.

Absolutely. And there's a reason why, for example, in Down syndrome, children with Down syndrome have very different levels of intelligence and levels of social interaction and why they.

Have the same gene.

Right.

So they have the same underlying genetic chromosomal abnormalities.

They also have mitochondrial issues and they get Alzheimer's and that. Yeah, interesting. We mentioned that there are other causes, not just mitochondrial dysfunction, and that's so subset of patients. How do you approach those kids?

Well, we do a comprehensive evaluation to try to see, initially to get a better understanding, because there can be many different factors, many different causes. As one example, there are types of-.

There's no such thing as autism. There are autisms.

That's right. That's right. It's just an umbrella sort of label that we've developed, but it actually within that there are so many different unique types. And it's important to identify. If you can help identify that early on with the right testing, you can target therapy and be much more successful.

So what are the different types?

So there are a subset of children for whom epilepsy is one of the main causes of their developmental problems. So the cause of their autism symptoms, the cause of their language delay and maybe cognitive disability. So identifying the epilepsy and treating it properly can lead to dramatic improvements. So that's one example. There are some individuals who have difficulty in the stabilization information of synapses. They have gene mutations that affect that specific process. And there are supplements and medications now that affect and can help with the process of synapse formation and stabilization. And so if you identified that, you could then target therapies in that way.

This is sort of going where the rest of medicine is going, which is personalized medicine. There's no such thing as autism. It's a whole series of different insults. that can cause the same symptoms.

That's right.

So we've been coming out through the.

Symptoms instead of the causes. That's right. And so identifying the autism is not.

The end, it's just the beginning.

Right.

I always say, you know, in medicine we call what we do naming and blaming. We name the disease and we blame the name. The reason for your symptoms is you have autism. It's actually to doubt that it's not the cause, it's just the name of the symptoms. Instead of what I call thinking and linking. So in functional medicine, The thinking starts when you make the diagnosis. It doesn't end. And that's a huge shift in our approach in medicine.

Isn't that amazing?

That's why I call it the medicine of why, not what. Not what disease do you have, what drug do I give, but why is this happening and how do I deal with that?

Yeah.

I do, I see too often that once the label of autism is given...

Incurable disease with no real treatment. Yeah. And it's such a discouraging message, you know. and those of us in the front line, you have to believe what you see, not see what you believe. A lot of physicians just see what they believe instead of believing what they see, which is, you've seen it, I've seen a case of autism regressing or reversing. Not all the kids get 100% better, but they can be functional, better lives, some get cured. It's really extraordinary. The younger you get them, the better it is.

If it's, you know, When I think of there are lots of possibilities for improvement when children are young, but even we work with a lot of young adults who can also show really meaningful gains and improvement in quality of life. There's another we recently worked with a young adult who came when he came to us, he was 19, and he was living at home but on just the sort of the edge of needing to be placed in a residential institution because he was aggressive and destructive and the parents were having a very hard time keeping him at home. And so the path that typically that leads to for a young adult with autism is one of living in an institution and polypharmacy. Multiple psychiatric medications and all of the side effects that lead to and the medications often aren't that effective. So when we have the opportunity to work with an adolescent or young adult like that, we can provide the types of therapies that can send the child or young adult down a totally different path where we begin to target the causes. We look at their biochemistry, we look at their nutritional status and exercise, and provide therapies like physical therapy, occupational therapy, music therapy, speech language therapy because the brain still has the capacity. It's not that at age 18, the brain somehow stops being able to learn. The capacity is still there. And so one of the most gratifying aspects of the work that I do and my team does is to be able to change that trajectory even for adults.

That's extraordinary. So it's never too late. That's right. Yeah, I've seen this over and over again and it's pretty extraordinary when you look at the metabolic factors. And, you know, when you see kids who literally can't talk, won't look in the eye, won't interact, won't hug, and within days of instituting various therapies, they're connecting, they're talking. I mean, I had one physician who had an autistic kid and he read my book, the UltraMind Solution, which is about how to address these root causes. and he said they changed his diet and got off gluten and dairy, and all of a sudden the kids started talking. So I think the idea that there's all these things that are outside the brain that are affecting the brain. Now, Martha Herbert calls it, instead of a brain disorder, a disorder that affects the brain. So we're talking about dealing with gut flora, we're talking about mitochondria, we're talking about environmental toxins, we're talking about nutritional status. These are systemic therapies.

Yeah.

And not just targeting the brain.

Yeah.

And I think the research clearly supports that, but it's hard to, the research has to be interpreted. And I think it's sometimes not, there are barriers to allowing us to interpret it properly, I think. And the barriers are our conventional ways of thinking.

Yeah.

No, it's an extremely important point because most physicians will say, There's no evidence that this is true. And I think the evidence is that they haven't read the literature. And the literature is there, if anybody's curious, to go down that rabbit hole and you start to see the patterns and connections. And if you just focus in one line of thinking, you'll miss stuff and you'll miss the connections between everything. And I think that's really the beauty of functional medicine, is it connects the dots.

It's the medicine that connects the dots. For autism in particular, what I found over the course of my training and my early practice was that what allopathic medicine had to offer was really, really limited.

Diagnose and adios.

And so you have to look elsewhere. But then when you start to look elsewhere, you realize how rich the resources are, whether it's in different types of therapies, movement-based therapies, sensory motor therapies, whether it's from the functional medicine integrative medicine world.

Is there anything else you want to share about your work or the future of where this is all going?

In the work that I do, the parents of the children I work with have been a real inspiration to me because of their dedication, how they educate themselves, and how they are the ones pushing physicians a little bit out of our comfort zone. And I think that's great. I think it's so important.

So great that you have a mind that is willing to listen to what presents to you.

Yeah.

Sort of like not seeing what you believe, but believing what you see. When you hear these stories over and over again, you can't help but be wondering why and asking new questions. And, you know, Very few of us though have actually done the hard work of asking the hard questions and doing the research and putting the evidence behind it. And that's what you've done, which is such an incredible contribution to the field.

Thank you. It feels like a privilege to be able to do it.

In the 60s and 70s, the rates of autism were about one in 5,000 kids. One in 5,000 kids. Now, it's one in 54. kids and boys at a much higher rate.

1 in 35 and girls 1 in 145.

It's terrifying and I can't keep up with that. Every year it's getting worse and boys are four times more likely to be diagnosed. So, you know, I get going from 1 in 5,000 to 1 in 2,000 or 1 in 1,000, but not 1 in 5,000 to 1 in 35 boys. That doesn't make any sense as a genetic problem. No, because our genes don't change that fast. But you know what's changed? Our environment. So what are the real drivers and causes of autism?

Number one of my list.

It's not a random event.

No, it's not random at all. And I think that as you just brought out, there's something more going on. I think pretty clear we're suffering the effects of very modern society. And one of the things we have in our society that is really dangerous is the food that we feed ourselves. so it really starts with food that in many ways is toxic from the, you know, the glyphosate that's in it and the GMO seeds that are used, our food supply damages us, it's information, as you've said so many times. And not only does it have direct impact on our gut microbiome, but it has information actually changes and can impact our genes. And so from one generation to the next, you can actually turn genes on that will impact the next generation and the generation after that. So, food has a direct impact on our gut microbiome, has an inflammatory autoimmune impact, and it has a genetic impact. So, I would start with food followed by toxins, heavy metals.

Yeah, absolutely. Heavy metals, pesticides, chemicals. You know, Dr. Phil Landrigan, who's an incredible scientist, has really documented how the increase in toxic load in our society has really affected these kids. And, they're like the yellow canary in the coal mine. You know, the canary was put in the coal mine with the coal miners. So when the canary drops dead, you know the air was bad and you.

Had to get out of there.

Well, these kids are genetically susceptible and we always say the genes load the gun, the environment pulls the trigger.

Yes.

And what's changed dramatically is our food supply. Not only have we added all these agrochemicals, pesticides, herbicides, glyphosate is a microbiome destroyer and now it's on 70% of all crops. and it not only destroys the microbiome of the soil, but it destroys our own human microbiome, which is critical for our health. And 95% of autistic kids have gut issues, have real gut issues. Not only that, we've changed the kind of food we're eating. For example, the gluten that we're eating now is not the wheat that we ate that our ancestors ate. It's a hybridized form of wheat that has much higher levels of gliadin proteins, much more likely to cause issues with kids. We are born by C-sections, we give antibiotics, we're not breastfed, all these things tend to get these kids immune systems deregulated. And one of the things we know about autism is that it's an immune disorder. If you do an autopsy on these kids' brains, they're just riddled with inflammation. Riddled with inflammation. They actually done brain scans and they see these brains are bigger. Why? Because they're swollen. And why are they swollen? It's all the same things we think about in functional medicine. that cause inflammation. It's food, it's food sensitivities, it's toxins, it's leaky gut, it's all these factors, allergens, microbes, infections, all these things are driving it. And we don't approach autism in that way in this country. We don't treat it as a systemic disorder. I always say that, you know, is it a brain disorder? Or is it a disorder that affects the brain? Is it a systemic disorder that affects the brain? It is not a brain disorder. And the manifestations are in the brain, right? But the actual causes are things we can do something about. So when parents, I mean, I see this all the time, George, it just makes me so heartbroken. When these parents get a child with autism, it gets diagnosed, and essentially what they're told is your child has autism, there's really not much treatment. You can use what we call ABA, behavioral therapy. and get ready for a difficult life. Get ready to put your kid in an institution someday and we're sorry. That just is unconscionable in my mind given the amount of science we now have about autism, about the inflammation, about how to treat these things. And it's just devastating to these families and yet they're not given any pathway to help these kids improve the quality of their health of their life.

They're given a pathway but it's a limited pathway. Yeah, I mean it's a pathway that you just mentioned. using applied behavioral analytic therapy. And that's just to change the behavior, right? Which is just a symptom of the neuroinflammation that the child is experiencing. A lot of their behaviors become the focus, but those behaviors are really in response to the neuroinflammation that the child's experiencing. And so one of the latest ways of trying to treat children with autism is actually diagnose them sooner. because data has shown that children with autism will do better socially if you treat them more intensively early on with these therapies, speech therapy, occupational therapy, physical therapy, and then applied behavioral analytics. Therapeutic model by itself doesn't work. That's why I think- It helps them.

Adjust a little bit. It's been so crude.

Well, when I say it doesn't work, it doesn't give the mother that child that she knows that her child can be, a child that can interact, a child that can feel, a child that can fulfill all their neurologic capability, that those behavioral changes aren't enough. And that's why, as I've said to you before, I think every kid with autism should have a functional medicine workup because we do look at the systemic impacts, the systemic causes of this brain disorder. and it's in doing so that we've been able to see as many changes as we do in the children that we treat with autism here at the Ulster Wellness Center.

It's really true. I mean, I hate to say this because it sounds terrible, but I love seeing kids with autism because there's so many things you can do.

Absolutely.

They almost all have immune dysregulation. They almost all have gut issues. Most of them have toxin lows that are high. Most of them have nutritional deficiencies. Many of them have mitochondrial issues, which are energy production. And these are all things that we know how to approach with a functional medicine approach.

And they're not that hard to figure out or find in testing.

No, and I'm not saying we can cure autism, although I've had cases of complete reversal, which is dramatic. But we can improve the quality of life, we can improve their functioning, we can improve their speech. I remember I met this one doctor.

Who.

Was an incredible physician and he told me this incredible story of his son who was autistic. And I'd written this book years ago called the UltraMind Solution, which was about how to fix your broken brain by fixing your body first, by healing your body first. Because it was very clear to me that most brain disorders were systemic issues where there was imbalances in the body that affected the brain. and one of the simple things I, you know, when I talked about some of these cases of autism in the.

Book.

This doctor read the book and saw that I had recommended to get off of gluten and dairy, and we're going to talk about why that's important. And he said he just tried it with his son who was five years old and hadn't said a word his entire life. And he got him off gluten and dairy, and a short while later, the kids started talking, started chatting, and he heard, he was learning language. He had receptive language, but he had no expressive language. And he just literally started crying. And when I hear these stories, you know, sometimes it's that simple. Now, it's not always that simple. No, but we know a methodology, really a system of evaluating patients using the model of functional medicine, understanding the body as a system and being able to map out where the imbalances and dysfunctions are and fix those and get these patients to get better.

And I think it's important to know that it's now been changed to the terminology autism spectrum disorder because it's not autism, it's autisms. It's a spectrum. Every child is different. We have no protocol, but we know where to look and every child is going to have a puzzle a complex puzzle pieces of puzzles that we're going to have to put together that might be it is different for every kid. One of the things that I do first when a family comes to me is I let them talk and I let them tell me their story and I listen because they haven't been listened to for a long time. Most of the families that come to me have not been heard and they've been given tools that don't work. and they come discouraged and disappointed. And I can see the apprehension on their face of whether or not they're going to be heard. And so the one of the most important things I do is I make that connection with moms and dads and help them understand that they've come to a place that they're going to be heard and that they're going to be helped. And the things that seem to be Two of the really hot buttons for parents are sleep and behavior and gut issues, diarrhea, constipation, and then the behavior and the lack of sleep.

What I want to sort of underscore is that in traditional medicine, when you get a diagnosis of autism, it's a brain disease. Yeah. And you need to use psychological tools to fix it. You use psychiatric drugs to suppress the symptoms, which they give them antipsychotics and all kinds of stuff.

Anti-seizure meds, antidepressants, antioxyltics.

Yeah, terrible. And when these kids come in, if you take a good history, you find so many other physical problems with these kids. Like you said, gut issues. 95% have gut issues. They have congestion in their nose, they've had earaches and ear infections and taken lots of antibiotics. They've had eczema, they've had dry spots all over their skin, their hair and scalp, they might have dandruff. They have all these immune and gut issues. And it's so well described in the science, this is not stuff we're just hypothesizing, this is really there. They're documented. And then the question is, why are they ignored? Why do we ignore all these things which are clues? They're like breadcrumbs that tell you what's going on.

Right?

Or if the kids, you know, it's shocking. It's shocking to me.

It is shocking.

And like you, the other thing I want to just underscore what you said, which is so important, George, is that when you see someone with a disease like autism, they're all treated uniformly. Okay, you have these descriptive behaviors, you know, you have no expressive language, you're socially disconnected, you have sort of repetitive behaviors. There's like if you look at the DSM-5 criteria, which is a psychiatric manual, these are the criteria that you have to meet to meet the definition of autism. But there are 100 ways to get to those symptoms and there are 100 different ways to treat these patients. And if you've seen one kid with autism, you've seen one kid with autism. It doesn't mean you can. I mean, yes, there are common themes and there are things that you will do, but in each kid it's different. Some kid it's a mitochondrial issue, some kid it's a heavy metal issue, some kid it's a gut issue. It's so different. Some kids have severe methylation issues and B vitamin issues, some kids have other issues that really are related to infections that are untreated.

Toxins.

Yeah, toxins. So there's really an individual level. Yeah, I mean we had a professor from I was trained at Harvard and Oxford, a pediatric neurologist who came to Cleveland Clinic. They did ground round, Suzanne Goh, who has done some incredibly nuanced research published in JAMA and major medical journals on mitochondrial dysfunction in these kids. Their brain can't produce energy and they.

Give them mitochondrial support, which is basically supplements that we use to support the energy production. And guess what happens?

They get better. You start to see immediate improvement. Hey everybody, it's Dr. Hyman. Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses. to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. So George, let's go kind of deep in. So, you know, if you have a kid comes in with autism, you know, what's the initial approach to evaluating these kids? Like how do you start to think about what's going on? You do a deep history, right? What are you looking for in the history?

So in the history, I'm looking for, you know, any familial history of autism just to make that any neurodevelopment disorders. Then I'm looking specifically at Mom, what was her nutrition like when she went into pregnancy? What was her stress levels going into pregnancy? Getting a really good understanding of how she was in pregnancy, because that has a big impact on the child.

Did she have feelings? Did she get vaccines with mercury in them?

Exactly. Did she get antibiotics prenatally or antenatally, which can impact the child's microbiome, 'Cause a lot of these kids, just as a quick aside, they come out of the womb with gut issues. They have diarrhea from day one. Then I wanna know about what were the child's early days like? Did they have feeding issues? Did they have hypotonia, meaning that they didn't have the muscle tone that a baby should have? Did they meet developmental milestones?

Did they have colic? Did they have ear infections?

Anybody have c-section?

Birth.

Did they get immunizations early in life? Hepatitis B vaccine can have some yeast proteins in it and that can maybe possibly sensitize a child to yeast and create some inflammatory processes early on.

I want to be clear about vaccines. I don't think vaccines cause autism. I do think that there's a whole field of vaccinomics. Mayo Clinic and others have departments of vaccinomics which looks at the the variability in responses. And we know that, you know, certain kids who are sick when often they get vaccines can have adverse immune responses. And we know that autism is an inflammatory disorder. So there is some something going on. Yeah. But it is not that vaccines cause autism.

There are many things that can trigger an immune response.

So I just think I want to be clear about that. I think that we do we do have to look at these these bigger issues of what is driving the inflammation. And so you take that history and then we want to dive into the testing.

Right.

One of the first tests that we do is we look at the gut microbiome. And so we're going to do a complete diagnostic stool evaluation and we're going to be looking for the things that you've mentioned. Candida, which is a mold, is one of the major things that we typically will find in the gut. But we're also looking for an imbalance of good and bad bacteria that can be caused by the nutrition that they had, the nutrition that their mom had, any antibiotic use, we're gonna be looking for parasites. You know, kids can develop these parasites that can, you know, can be autoimmune triggers and that will need to be eradicated. So the gut is the first place.

And then we look at the immune markers. I've seen kids who have really high markers of inflammation.

Or really low.

Like you would see in someone with colitis. Yeah. But, you know, it was sticky, smelly, mucousy, weird stools that are pasty and weird.

Yeah, we see these.

Awful. And, that's telling you that something's rotten down there and you have to deal with it.

Yeah, yeah, yeah.

And, that causes leaky gut, right?

And leaky gut. And so, yeah, we're, you know, we, leaky gut is just basically a part of almost every conversation when we're talking about, you know, people in the functional medicine world are coming over any, any, Immune disorder or immune dysfunction. So we're, that's the first place I look because that's one of the most, commonly one of the most concerning areas for parents is, you know, they're just, they have stinky, smelly poops that I'm changing the diaper every day, all day, you know, and, and can, can we do something about that? I know that that has to be part of the problem.

Yeah.

And they're right. It is. And 60 of the immune systems in the gut and the gut and the brain are connected.

And, right.

And if you have a lot of toxic bugs in there, those toxic bugs produce metabolites that are toxic to the brain and can interfere with brain function.

Yeah, and so we're, you know, so the next, you know, the next place that I'll look will be at might, you know, at the nutrient, you know, looking at nutritional evaluation, finding out specifically are they getting all the nutrients they need for the mitochondria to function as well as they should. Yeah, because mitochondrial dysfunction has a huge role to play in how our brains are going to function. And so, we look there.

It's an energy deficit. These kids can't make enough energy in their brains to work. And you can do testing like organic acids, but you look at the mitochondrial function and you can look at the.

Way you process energy. And this is not a test you normally see at your regular doctor's office. And then we do heavy metal testing. Again, because a lot of these children may have difficulties with their toxification genes. They may not be able to detox as well. So the normal toxins that we're all exposed to, they can't process. So looking at their physiology of detoxification and also at their single nucleotide polymorphisms as variations in genes that impact how well an enzyme is going to function. We look at those because if we can identify some of those genes aren't working well, that clues us in to what specific nutritional plan and targeted nutrients that they need.

Yeah, and these kids often have genetic variations in also the B vitamin genes that affect B12, folate, and B6, and they might need really high doses of certain nutrients. They might need special forms of these nutrients. And so these are things you really can understand by looking at their unique genetics.

Absolutely.

The other thing obviously we look at is food sensitivities and food reactions. And there's a couple in in autism that are so important.

Gluten and dairy.

Gluten and dairy.

Right off the bat, it's gluten and dairy. And the reason why we focus so much on gluten and dairy, because they can, when they are broken down, you know, certain people will break them down into peptides called caseinomorphins and gliadinorphins. And peptides are just small proteins. They're usually 50 amino acids or shorter. And that these can actually cross the blood-brain barrier and they can have a deleterious effect on how the brain will function. They can actually impair cognition, they can impair neurotransmitter communication.

So, these are like little molecules of heroin running around your brain and they make you spaced out. And one of these kids are- They slow cognition, they can't connect.

They have an opiate-like effect. I've had mothers say to me, I can't take him off gluten because, It makes everything worse. You just have to really batten down.

The hatches, lock the cabinets, lock the fridge. It's true, it's really true. And the gluten also causes a leaky gut too. So you get more inflammation, more reactions, and the dairy has an interesting effect as well. In a subset of these autistic kids, there is these folate receptor blocking antibodies that are caused by dairy. So, when you eat dairy, your body creates an antibody against the dairy, but it binds to the folate receptor. Now, folate is one of the most important nutrients to create neurotransmitters and make your brain work. And, when you can't get folate working, your entire cycle of what we call methylation, which is this B vitamin cycle, is blocked and your entire cycle of detoxification is blocked because they're like cogwheels.

That will together and they don't work.

And that's why these kids can't detoxify. They can't make neurotransmitters.

They can't function. And it has a huge impact on.

Energy production in mitochondria as well. Yeah, and getting these people off dairy and then boosting up this special form of folate called methylfolate, these kids can really pop up and come alert. And so, you know, there's not like one treatment. for autism. This kid might do well with no dairy and a high dose of methylfolate. Another kid might need to fix their gut. Another kid might be a gluten issue. Another kid might be a mitochondrial problem. And so you have to sort of dig into this. And this is the beauty of functional medicine is we don't treat all patients the same. We look at them as individuals. We look at real personalized medicine, personalized nutrition, and we do very sophisticated diagnostics which allow us to really map out what's going on with these kids.

Kids.

So you're like, you go, wait a minute, if there is actually lab tests that help us identify and map out what's disordered in these kids biology, like why aren't pediatric neurologists doing this? Why aren't pediatric psychiatrists doing this? It's like, it makes me crazy. I am sorry, it makes me crazy. Because after treating literally hundreds of these kids with everything from dyslexia to ADD to autism to behavioral issues, It's all the same stuff at different, you know, different things are going on in different kids, but it's all the same approach. It creates a really deep dive to help these kids. If you loved that last video, you should check out the next one for sure on getting to the root cause of all disease.

They start to have degeneration in local areas of the brain. And then as those areas of the brain degenerate, they tend to lose function. And most people obviously blame that on aging, but it's really neurodegeneration.