Dhru Purohit Show - The Role of Mitochondria, Gut Health, Exercise, and Inflammation in Autism, and What Parents Can Do To Support Autistic Children with Dr. Suzanne Goh

Episode Date: July 14, 2025

This episode is brought to you by Vuori and Ollie. One in 36 children is diagnosed with autism, and families are often overwhelmed with information but receive little guidance. Today’s guest, Dr. Suzanne Goh, shares her expertise, groundbreaking research, and how it’s transforming the lives of her patients diagnosed with autism. Today on The Dhru Purohit Show, we’re revisiting one of our most talked-about moments with Dr. Suzanne Goh, as we dive deep into the role of dietary changes for families navigating an autism diagnosis. She shares the top lifestyle factors that support overall and brain health post-diagnosis, along with the most common myths. Dr. Goh also discusses the latest research on autism, as well as the clinical protocol she uses to support families in her practice. Dr. Suzanne Goh, MD, BCBA, is cofounder and chief medical officer of Cortica, the largest provider of comprehensive health services for autism in the United States. She is the former Co-Director of Columbia University’s Center for Autism and the Developing Brain, where she researched the biological causes of autism and used brain imaging to identify patterns of neural circuitry and brain chemistry. Dr. Goh is currently a faculty member of the Medical Academy of Pediatric Special Needs and is a frequent speaker for parent advocacy organizations.  In this episode, Dhru and Dr. Goh dive into: Resistance to the role of diet in children with autism (2:34) How casein and gluten can trigger inflammation in the body (5:00) Why diet and exercise have an even greater impact on children with neurodevelopmental conditions (8:00) The role of nutritional supplements in helping children thrive (10:06) How lifestyle factors can influence the expression of the diagnosis (16:42) Patient stories from Dr. Goh’s practice (18:55) Cutting-edge device therapies used by Dr. Goh (25:02) Common co-occurring conditions with autism (27:17) The role medications can play as part of a broader treatment plan (32:50) Final thoughts (35:02) Also mentioned: Full episode with Dr. Suzanne Goh This episode is brought to you by Vuori and Ollie.  Right now, Vuori is offering my listeners 20% off their FIRST purchase. Get yourself some of the most comfortable and versatile clothing on the planet at vuori.com/DHRU and discover the versatility of Vuori Clothing.  Want to give your dog the best in clean eating? Take the online quiz and introduce Ollie to your pet. Right now, Ollie is offering 60% off your first box of meals when you subscribe today! Just head to Ollie.com, use the code DHRU, and you’ll get 60% off your first box of meals in your subscription. Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi everyone, Drew Prode here. There's more awareness about children and the journey that they go through on the autism spectrum than ever before. And yet there are so few actual true subject matter experts that are out there that are giving practical advice to families who love their kids and also want their kids to have better health outcomes. So I had the opportunity to sit down with Dr. Suzanne Go a little a while ago, co-founder and chief medical officer of Kortica, the largest provider of comprehensive health services for children on the autism spectrum in the United States. And we talk specifically about the complex journey of supporting a child on the autism spectrum. Now, a little bit about Dr. Goh. She's the former co-director of Columbia University's Center for Autism and the

developing brain. And at Columbia, she researched the biological causes of autism and used brain imaging to identify patterns of neural circuitry and brain chemistry. She also was part of the pivotal team, previously I believe at Harvard, that discovered that children who had autism had a higher likelihood of having, I believe it was 80%, mitochondrial dysfunction. And as part of our approach to supporting children on the autism spectrum, we have to get to the root issue in addition to all other treatments that are there and address mitochondrial dysfunction. In my conversation with Dr. Go, I shared that in my community, the Drew Prode Show, I've had several anecdotal stories from parents of children with autism who have found that making small but meaningful changes like shifting their child's diet towards more whole foods, which also supports their mitochondria. They discovered something surprising.

Their child seemed to feel better and it was noticeable. Maybe they were sleeping more soundly, having fewer gastrointestinal issues, which is something that a lot of families talk about when it comes to their child. who's on the spectrum, or showing more engagement and connection. But what's actually going on here? Is there actual scientific truth behind these stories? Is there scientific truth, too, cleaning up a child's diet, and especially getting them away from a lot of the plethora of ultra-processed foods that are out there?

So I asked Dr. Go, these questions, and I'm sharing her answer with you here today. Let's dive in as Dr. Goh explains how powerful dietary changes can be for children. especially on the autism spectrum. Early on, there was, I think, some resistance. There was some resistance to the idea that changing the diet could help with something like autism. But we now know that it can. It can help in very significant ways.

But children are all different, so some respond more than others. But the way that I think, nutrition ought to be approached is to look at the child and, you know, in autism, often there's a tendency to want to pursue an elimination diet. So there's a lot of... Where certain things like dairy, gluten, and other things are removed. Right. They'd be called like a medical elimination diet or elimination diet. Right. So, you know, most people have heard of, you know, a gluten-free diet or casing-free diet.

and various other types of diets where you remove one or more food types. In autism, there is some evidence to suggest that some of those diets may be helpful for certain children and maybe worth trying. I think for most children, because of the picky eating, that's so common, it often makes sense to work to expand the nutrient density of the child's diet first. because if you take a diet that's already very limited and you begin removing foods, you really do risk nutrient deficiency. And so one of the things that we support families to do is to gradually expand a child's diet to increase the intake of whole foods, nutrient-dense whole foods. And then we can begin to look at what foods might be eliminated.

I do think gluten and Casey and are a good place to start. We do know that celiac disease is actually more common in autistic individuals. So there's a lot of rationale to do a trial off of gluten. But again, sometimes removing a certain element from the diet can then lead to the greater intake of more processed foods that are quite inflammatory. So you really have to be thoughtful about how you approach dietary changes. What could be happening that casein, which is, you know, part of and what could be happening that gluten, you know,

a protein and like, you know, bread, right? What could be happening that those things would be making symptoms around autism worse? Yeah. The link is almost certainly related to inflammation. That for some people, those components of food can activate an immune response in the body that can and have downstream consequences for brain development

and brain function. There is also quite compelling research evidence that for some people, there can exposure to certain food components like gluten can cause inflammation in the gut, which can disrupt the barrier leading to what's called leaky gut, where then certain things that are in the gut then can then be absorbed to enter the bloodstream

and travel to the brain. So that's one additional way that some of these components of food might influence the developing brain in adverse ways. I believe it was one of your lectures that you gave at the Cleveland Clinic, where you were talking about a high percentage of children and adults that are diagnosed with autism,

that there is a large percentage of them that have certain challenges like children. GI issues, right? Those are pretty common that are there. And previously, you mentioned that initially there was a lot of resistance around the fact that diet could make changes or improvements, especially, you know, in a child's symptoms or, quote, unquote, behavior that was being expressed. You also inside of the book, you talk about how it's important for parents and families to understand that by improving these co-occurring diagnoses like GI issues that are there, that some of that behavior is not fixing, it's not about fixing the child,

but just simply about giving them some relief. And that some of their, again, you know, what could be seen from the outside as like an outburst or obsessive behavior or their ability to not be compliant with sort of modern societal rules or what typically a family might do or not do, that improvements there that come from improving their co-occurring diagnoses like GI issues that's providing an individual with relief. Wouldn't you feel better if you had some pain and you'd be less irritable if somebody helped you address that pain?

And I think that's an important thing to highlight because what I'm hearing that you were sharing earlier and correct me from wrong. is that the pushback on the idea that diet could play a role is the idea that some people were feeling that, hey, my child doesn't need to be fixed with some other diet. Is that an accurate understanding? Yes. So we know now, diet has a profound effect on health for all people,

without question. And sometimes people think, well, maybe the, that's not the case for a child with a neurodevelopmental condition. In fact, the opposite is true. It's even more the case for a child with a neurodevelopmental diagnosis like autism. They are more influenced by things like diet, by things like exercise. You know, some of these things that we know benefit health overall are, in fact, even more important for a child with a neurodevelopmental condition.

And interestingly, some of the most compelling research in autism has been focused on exercise. So that exercise is an intervention which improves in autism, improves social abilities, communication, executive function, sleep, overall quality of life, emotion regulation, not to mention, of course, endurance, coordination, physical stamina. all of these benefits from exercise in autism, there's no other single intervention that has as many benefits. So we're recognizing that many of these important lifestyle changes that matter for health for all people are actually even more important for children with neurodevelopmental differences.

You mentioned that in addition to diet and you've added in exercise, that in some cases addressing like deep nutritional deficiencies, can be part of what ultimately ends up lowering inflammation in the body and supporting the mitochondria and a whole host of other functions that are there. What do you know and what have you guys seen in your clinical experience and in the research that's there about the role that supplements could play on top of the foundational things that you mentioned, you know, exercise and diet?

And of course, there was other areas that you mentioned that are not, you know, lifestyle-related. But we're just talking about lifestyle for right now. We'll come back to those other things in a minute. I am so excited to tell you guys about one of my favorite brands to wear Viori. They make the most versatile clothing, whether you're working out, running errands, hopping on a Zoom call, or grabbing dinner with friends. Personally, I'm obsessed with their Sunday performance joggers. I've been wearing them for years, and they're part of their Sunday collection and hands down

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everything else feels like a downgrade. You'll wonder how you ever wore anything else. Yeah. So nutritional supplementation is, in my view, one of the, I think of approaches to autism care in kind of six categories. So diet is one. Second is nutritional supplementation. Third is medications.

Fourth is neuromodulation or what are called device therapies. lifestyle changes we've talked about, and then developmental and behavioral approaches. That's a huge category as well. We can go into that in more detail, of course. But nutritional supplementation is a really, really important one. And the way I think it's best to approach that is first to say, do we think this child is at risk of clear nutritional deficiencies, like iron deficiency, for example, zinc, vitamin B12,

vitamin D, those are some of the more common ones. If a deficiency is present, then that becomes a priority. And supplementation to correct that is hugely important for brain health and brain development. Beyond that, we can also use nutritional supplements to target certain symptoms. So, one, for example, sleep disturbance. We know that about 80% of autistic people will have disrupted sleep at some point in their lives. and that sleep is so critical to health and for children, so critical to brain development. And melatonin is a supplement that is very effective to enhance sleep.

There are others, too, like magnesium, glycine, altheonine. So there are many different options for sleep in particular, but there are nutritional supplements that can help with a whole range of different co-occurring symptoms in autism. Another, so one of the most common chronic GI conditions in autism is chronic constipation. We know how much that can be disruptive to a person's ability to participate, certainly in learning activities, to focus. Chronic constipation can be such a source of pain.

And something like magnesium citrate, again, a nutritional supplement, extremely effective for constipation, probiotics. So all of these things have a very good. very important role and can really be tailored well to suit the individual. What's the source of the chronic constipation in most of the patients that you guys are seeing? Is it that their diet lacks fiber and diversity? Is it the primary reason? Are there overgrowth of certain types of other bacteria that are preventing their sort of native or healthy bacteria from playing the role that they want to play? Well, it's multifactorial. So yes, both of those

are great examples. One is, of course, healthy bowel movements depend tremendously on fiber and water intake. And so in autism, many children have a more restricted or limited diet because they have sensitivities to certain tastes or textures, also because they, as part of autism, might be less flexible, you know, in terms of the food that they find appealing and will eat.

So that's part of it. There's been some very interesting research showing that in autism, there's reduced diversity of the gut microbiota. So just fewer species of bacterial species. And so that difference in the gut microbiome is believed also to potentially play a role. And then we know that part of autism is also a state of relative dysfunction of the autonomic nervous system. So the part of the nervous system that kind of helps to regulate sort of a state of stress, sometimes called fight or flight, and a state of relaxation or calm, sometimes called a state of rest and digest.

And so the nervous system is balancing these. And in autism, there tends to be heightened fight or flight response. So the body's in a state of chronic stress more of the time. And we can talk more about the reasons why that might be. But to have bowel movements, to have good gut motility, requires a state of rest and digest. So that's yet one additional factor that's probably playing into chronic constipation. So like so many of autism's features, there are many possible inputs, but knowing about all them then allows us to take steps to help in the most effective ways.

I think one of the questions that families that might have somebody that has a diagnosis present in the family, autism diagnosis, I think they're wondering, you know, with all these latest advancements that are there and centers like yourself that you and your team are running, what's actually possible in terms of the category of improvement, right? Do these things lead to measurable improvements that you can notice, that families can notice that improve the quality of life and maybe improve how the disease is, the diagnosis is being expressed, right? So it's obviously there's a whole range of individuals and it goes all over. You know, there's a large range of how things can show up.

But yeah, what's possible when it comes to the category of improvements? You know, I think there's so much reason to be extremely optimistic. I mean, we're very fortunate in the work that we do that we get to see improvements and progress on a daily basis that is truly transformative. Now, so much, as you say, depends on the child. Every child is different. There are about, research suggests that about 10% of children diagnosed with autism will at some point on their journey lose that diagnosis,

meaning they'll no longer meet criteria for autism. So that's, I think, a source of a lot of hope for families. But even if that's not the case, there's just tremendous growth learning and health and well-being that's possible. And, you know, the autism spectrum is vast. So, for example, you know, there are some children who don't speak and may never speak in their lifetime. Whereas there are other children who are highly fluent with language and have really no difficulty with language. That's just one example of the VASCOPE.

There are some who have many, many chronic GI conditions and some who have none. You know, there are some who have genetic and metabolic conditions or epileptic. and others who don't. So it very much is about understanding the individual child and what progress and optimal growth looks like for that child and then supporting them to achieve. You know, in the book, you have a bunch of stories of different individuals that, you know, you or your team have taken care of.

Does any story come to mind here that might be appropriate to share for our audience? Yeah, you know, maybe I could share too to kind of illustrate sort of two very different paths, but both of which are extremely hopeful and uplifting. You know, so one is a young boy that I took care of. I met when he was just two years old. And he was a child who had genetic diagnosis, had epilepsy, and so some pretty significant

co-occurring conditions. he happened to have a type of epilepsy that was curable. And it turned out that those seizures that he was having that were part of his autism condition were actually disrupting his brain development to such as significant degree that they were causing the autism. And so by successfully treating that, he within a few years then no longer had the autism diagnosis. and so within just a few years was developing on a neurotypical trajectory. So that's one example. And when you said to treatment, what were some of the, you know, of course it's so multifactorial,

but what were some of the key levers that made the difference in this unique patients area? Yes. For him, it was successful treatment of the seizures using medications. And that only required medication treatment for a few years. and then we were able to come off of those medications. For him also, dietary changes were very important. And he, in particular, benefited from what we call a low glycemic index diet, which is very good for balancing the brain's electrical function and reducing seizures.

And sort of on a kind of a different example, there is a young man who came to me at age 18, non-speaking, with severe aggression and self-injurious behaviors, destructive behaviors at home. And so his parents really came to me as a last resort. They didn't know how they would be able to keep him at home. And over the next few years, we were able to make significant lifestyle changes. Exercise became a huge, huge part of his life. he was able to run 5K and 10K races to hike every day.

He began to communicate through typing, so an alternative form of communication. And then really, even though he was not speaking fluently, his life was transformed. He could live at home. He had interests, was able to travel with his family. And so those are just two examples of how different it can look, but how transformative changes can be.

And I'm sure it made a massive difference for the family as well. Yes, yes. And so the parents, you know, quality of life, vastly improved and yeah. Yeah, it's so stressful for families who, of course, are lovingly taking care of a family member, but they go through their own stresses. And, you know, based on the literature that's out there, you know, we know some of the work from like Dr. Appel about shortened telomere link, you know, for caregivers, right? It's a very stressful thing.

So, you know, any improvements in, especially a child, is going to improve the quality of life for everybody, that child and the families as well. That's right. So you mentioned six of these areas. You said, you know, diets, supplements, medications, devices, and then the behavioral. You know, components are there. Touching on the devices side, that's a unique, new, innovative category. What have you been seeing and what have you guys been implementing at your clinic? Today's episode is brought to you by Ali, the dog food brand that treats your pup-like family because they are.

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day. And they sort of fall into two categories. So one, you can think of as administering something. So in this case, electrical, some type of electrical stimulation to the brain or magnetic stimulation to the brain. In that category, the one that we use the most in our practice is one that delivers a tiny electrical current to the brain through electrodes that are placed on the ears. so kind of like euclips. And that tiny electrical microcurrent stimulates nerves that then travel to the vagus nerve, which is a nerve, a major nerve in the body that helps to regulate the body's stress response. And by stimulating the vagus nerve in this way, you can increase its activity

and therefore help to support what's called the parasympathetic nervous system and help to put the body in a state of rest and digest. And by doing that, you can improve anxiety, irritability, agitation, aggression, self-injury, sleep, constipation, so a whole host of benefits from that type of intervention. And in the second category of device therapies are those that really more mimic kind of video games. So those are approaches that basically by a child engaging with a device, like a tablet, playing a video game, can, there are certain skills can be enhanced, especially related to executive function. So some of these very interesting software platforms have been designed in order to help

enhance things like attention to reduce hyperactivity and impulsivity. And so that's also very exciting and innovative area of the field. Let's go back to these co-occurring issues. Just broadly speaking, we've chatted about it a little bit, but what's important for people to understand about these most common issues that individuals who have autism or a diagnosed with autism have. What's important for people to understand about these co-occurring issues? So, you know, we talked about how autism itself is defined by what are called its core

features related to socialization, communication, behavior. But autism comes with a set of co-occurring conditions. And those are conditions that happen more often in autistic than non-autistic people. And I like to think of those co-occurring conditions in a few different categories. So one is medical. So there are a whole set of different medical conditions that occur more often, like genetic conditions, metabolic disorders, epilepsy, which is present in an estimated 15 to 20 percent of autistic individuals, and sleep disturbance, gastrointestinal disturbances,

and immune dysfunction. Those are kind of medical co-occurring conditions with autism. There are also mental health co-occurring conditions like ADHD, OCD, anxiety, depression. And then there are some developmental like motor differences, so differences in person's coordination, sometimes called dyspraxia or apraxia. There can be emotional differences in emotional development and the ability, for example, to identify emotions in oneself or others. So understanding all of these potential co-occurring features

or co-occurring conditions is really important because we know that 90% of autistic individuals have at least one and 50% have four or more and that the co-occurring condition can have even a greater impact on the person's quality of life than the autism itself. So it's just extremely important to know about them and then to support the individual if they have them. You know, when I was reading the section in the book,

the thing that really struck me as a reminder for everyone reading is that is very these co-occurring diagnoses are so interweaven with so much of what people think oh this is just this child has autism or has an autism diagnosis or this adult has an autism diagnosis like this is just something they're going through and also in a bigger picture a lot of the research that's out there being funded around autism, some of it is maybe looking for this, you know, silver bullet of like, how are you going to exactly, you know, what's going to, you know, cure, treat, or fix autism. And this section of the book really was a reminder that it's multifactorial with all these

other diagnoses that are a part of it. So sometimes you can't fully separate what is the autism and what is. is what are these co-occurring diagnoses? That's right. Which is super important, again, and gives optimism and should give, should make families feel optimistic that if you can get to the root of these issues, again, sleep issues you mentioned are very common, GI issues, extremely common, mitochondrial disease, which we've spent a lot of time, and mitochondrial dysfunction.

Mitochondrial disease, initially, as I understand, you know, people thought, okay, hey, a lot of children especially have mitochondrial disease. And then it was found out that they didn't. But then your paper showed that, well, 80% of them have mitochondrial dysfunction. And that's still an important part of the equation. And then nervous system dysfunction and immune system. Let's talk about immune system for just a second, right? How could that be playing a role in how autism expresses itself or how it's seen from the outside is expressing itself?

Yes. So what's interesting about, well, the immune system is so complex. It has so many different components to it. And in autism, some individuals seem to be more prone to excess activity of the immune system, so inflammation or autoimmune types of conditions. Whereas others tend to be more prone to immunodeficiency. They seem to have a less active immune system and maybe have frequent infections. So it's just incredibly very very very very.

varied. But one of the ways that it may show up is a child who gets sick a lot. Conversely, it may show up as a child who doesn't get sick at all. There are some children, very interestingly, whose autism features get better during illness or when they have a fever. So that's something that has been observed. So that tells us about their unique and unusual immune system. There are some children who have allergic symptoms, may have multiple food allergies, may have environmental allergies, and sometimes they benefit from treatments for their allergy symptoms, and then you see improvements in their socialization, their behavior, their communication. So all of this is interconnected, because the brain and the body are connected, of course.

We sometimes forget, you know, the head is attached to the body. we sometimes how treat them as being different, but they're not. And so the body and all these other systems have a profound effect on the brain. Super important. We didn't touch on medications, but have there been advancements in medications or what medications are used that would be important for our audience to understand? Is it worth touching on in this category here? I think so because I think people have sometimes pretty extreme views about medication,

either in favor of or against. And in my view, we should be more balanced. We should think of medications as just one more tool in our toolbox and understand for whom it might be the right, you know, the right step to take for whom it might not be to really carefully weigh potential benefits with potential risks and to target our use of medications to what we know about that child's unique physiology. So the two most common medications use in autism are, I think they are viewed somewhat you know, controversially, certainly by families, because they fall in the antipsychotic category of

medications. They're called aeropipypropypricol and risperidone. A lot of research evidence showing that they can help quite a lot with certain aspects of autism, specifically what's called irritability in autism, but they can come with really, very significant side effects. But those side effects can be managed if the medications are used really carefully. So I think it's important to be open-minded. And knowing what we do about all of the co-occurring conditions and also the deeper underlying biology of autism then opens up a whole new set of medications that we know could have potentially significant benefit. So, as I just mentioned, medications that might help to reduce in some of the body's allergic

responses, medications that might help with ADHD for example. example. There's stimulant and non-stimulant medications, medications that could help with anxiety. So there are lots and lots of different medications to consider, but really the use of those medications should be tailored to what we know about the child. If there's one takeaway from my conversation with Dr. Goh. It's that autism is not a one-size-fits-all diagnosis. Every child is different. And families navigating this diagnosis can often be inundated with information without proper guidance from a trend. trusted source, but foundational lifestyle interventions like nutrition, exercise, and targeted

supplementation can often be extremely powerful in improving how autism symptoms and co-occurring conditions are expressed. If you've enjoyed today's conversation, I encourage you to listen to my full-length conversation with Dr. Suzanne Go, where we explore the top myths about autism, the process and protocol that Dr. Go's clinic follows, the impact of environmental toxins as it's played a role in the increase of autism that we've seen over the years and much, much more. You can find a link to that conversation in today's episode show notes. And if there's someone in your life who you think would benefit from this information, please consider sharing this conversation with them. Until next time, thanks for tuning in.