Dhru Purohit Show - The Top Causes of Autism & How to Reduce its Risk - What Every Parent Needs to Know with Dr. Suzanne Goh

Episode Date: April 8, 2024

This episode is brought to you by Momentous, Lumebox, and Air Doctor. One in thirty-six children is diagnosed with autism. While 50% of the increase in diagnoses is due to increased awareness about autism, at least 50% of those diagnoses are based on an actual increase in the number of cases. Families navigating this diagnosis can often be inundated with information without proper guidance from a trusted source. Today’s guest, Dr. Suzanne Goh, joins us to break it down. Today, on the Dhru Purohit Show, Dhru sits down with Dr. Suzanne Goh to dive deep into autism. Dr. Goh shares the factors that can lead to a diagnosis of autism, how it is diagnosed, and what the research shows about brain changes in individuals diagnosed with autism. She also shares the top lifestyle factors, including diet and exercise, that support overall health and brain health after diagnosis, as well as the top myths. Additionally, she shares the research on environmental toxins' role in leading to a diagnosis and the protocol she follows in her clinic to support families. 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 (audio version / Apple Subscriber version): What factors can lead to an autism diagnosis (0:00:07 / 0:00:07) Is the rise in autism cases related to increased awareness or an increase in actual cases (3:40 / 3:40) Diagnosing autism and brain changes in children (13:11 / 7:52) Reducing the risk of an autism diagnosis and what the research shows (17:00 / 13:05) The role of mitochondrial dysfunction (24:30 / 20:36) What traditional practitioners believe about autism (31:00 25:15) Top myths about an autism diagnosis (37:00 / 31:00) The process and protocol that Dr. Goh’s clinic follows (39:00 / 33:00) The impact of a whole foods diet on behavior (45:00 / 39:15) The powerful benefits of exercise and supplements for children with autism (52:00 / 46:16) Lifestyle factors and improving how the diagnosis is expressed (59:00 / 53:00) Dr. Goh’s patient stories (1:02:00 / 55:00) Co-occurring conditions that are common with autism (1:08:00 / 1:01:20) What role can medications play in the toolbox (1:13:00 / 1:07:00) The impact of environmental toxins (1:22:00 / 1:16:40) Final Thoughts (1:31:00/ 1:25:00) Also mentioned in this episode: Dr. Goh’s new book, Magnificent Minds  To learn more about Dr. Goh, follow her on Instagram or her website.  Optimize your Omega-3 levels by choosing a quality fish oil made by and used by the best. Go to livemomentous.com and enter promo code DHRU to get 20% off any order.  Lumebox is offering my community $260 off their FDA-registered portable Red Light device! That's over 40% off! Go to thelumebox.com/dhru and get your Red Light device.  AirDoctor is offering my community $300 off. Just go to dhrupurohit.com/filter/ to clean up your home’s air and feel better today. Learn more about your ad choices. Visit megaphone.fm/adchoices

Today, around 1 in 36 children in the United States is diagnosed with autism. And this is a very complex subject. But what does the latest research say about what is at the cause of autism? Well, thank you so much for having me. So we're fortunate in that research has come such a long way. So we really do understand the factors that increase the likelihood of autism. So one set of those factors are in the category of genetic factors. And we now know there are over 100 different ways that a person's genes might be altered that could increase the likelihood of autism.

And so, of course, those are called genetic variants. Those can include things like a missing or an extra chromosome or a part of a chromosome called chromosome multiplications and deletions, certainly certain gene mutations. And then there's a whole other category. We like to refer to as environmental. So those are non-genetic factors. They include things like exposures to certain toxins in the environment. So among those would be like medications. You know, certain medications can affect how a fetus develops and affect fetal brain development. There are even certain industrial chemicals now in the environment that can have an adverse effect on the developing brain.

So studies have even shown some of those chemicals to be present in cord blood, in the cord blood of newborns. So we know these things are, they surround us and they are in our bodies. Certain factors like a brain injury that might occur, you know, to a fetus or newborn, reduction of oxygen flow, blood flow. And then there are even certain maternal health factors like autoimmune conditions, even things like gestational diabetes, so metabolic conditions. And then we also know parental age over 40. So there are a whole set of these environmental factors. And what we also know is that is typically not just one genetic or one environmental factor, but rather many and how they interact. So those are referred to as complex gene environment interactions. And what that tells us is that

really for each person, it's a unique combination of those different genetic and environmental factors. So that means each person is actually quite unique in terms of the causes that have then led to differences in brain development with autistic features. So there's genetic factors, there's environmental factors. Those two together create the unique situation based on a child's development that some individuals may be more predisposed in one way. And some individuals because of their environment, their environment could literally, you know, tip them over the edge to having a diagnosis.

That's correct. That's exactly right. So there may be a sort of a genetic susceptibility or vulnerability based on a person's genetic makeup and then other certain environmental factors that can then kind of shift the balance. And it's really that sort of unique constellation that can give rise to autism. So you know the stats better than me, but I'll just share them to make sure I have a correct understanding for my audience.

So I mentioned on the top that today it's estimated. made of about one in 36 children. And from what I've read, that this is a significant increase from 2021, where we were looking at 1 in 44, which was a significant increase from 1 in 110 around 2006. Is that trend accurate? And if it is, what do you believe the rise in this trend is related to? Yes. So the data tells us that this is the trend.

And there are a number of factors that seem to be contributing to this rise in prevalence. Certainly, on the one hand, there's increased awareness, therefore increased detection and diagnosis. So that likely explains part of it, but does not explain all of it. The other part very likely has to do with some of those environmental risk factors that I talked about. So we don't know exactly what proportion of increased diagnosis is related to greater awareness. But we know that that doesn't account for all of it. Seeing as you have a clinic that is deep in the weeds on this, and you're probably the top expert in this space when it comes to putting all these aspects together,

at least how I see it. You may not see it that way, but that's how I see it. Where, you know, you are being careful in your language, which is appropriate. For my audience to get a sense of an understanding, and I want you to be careful, what percentage of you had to say would be related to increased diagnosis? and what percentage would be, it could even be a range that is related to environmental factors. Because I think that autism can be a very confusing subject for a lot of people and, you know, both for families that have a child that would be on the spectrum, but also for everybody who

knows somebody who's diagnosed. And so people are trying to get a sense of, you know, how do these percentages lie? Yes. So the best data I've seen has come out of Columbia University. and it suggests that about half of the rise and increase has to do with greater awareness and about half has to do with other factors. So that lead to what we might call a true increase in prevalence. The thing to me that's a little bit, you know, I would say wild about that, right, a little shocking is I don't think that most people know that. I don't think that most people on the street, if we did a man on the street style interview,

went down to Hollywood Boulevard, Times Square, wherever. And you asked individuals, you said, what percentage of this is increased awareness and what percentage is lifestyle factors, right? To imagine that 50% of the increase, you know, these big jumps, one in 110 in 2006, you know, then going up to 1 in 44, now 1 in 36 is being at least, you know, and it sounds like a conservative estimate is 50%. I don't know why that's not on the front page news of every magazine. I know you are deep in this field. When you step back and you look at that and you look at this trend of these increased rates in autism diagnosis, do you ever feel shocked and blown away? Well, I mean, yes. And I think what it speaks to is how profoundly our bodies and our brains are

affected by our environment, especially in utero, especially for children, for the developing brain. And something that really truly is quite shocking is that so many of the chemicals in our environment that are used for, you know, the modern world that we live in, are tested for safety only in adults and not in the developing brain. And, there's been a lot more attention drawn to this. There are some really good research studies from the public health perspective, looking at what are the industrial chemicals now in our environment that have evidence for negative effects to the human developing brain.

And there are a lot. There are a lot. So it's not something new as researchers. It's nothing new for us. But I think, as you say, there isn't the level of awareness. awareness, you know, amongst the more, the general population, and then the pressure, I think, to do something about it. Yeah.

It's fascinating. Let's take a step back and start off with the basics around this. You know, give us an idea of what is the current approach to even diagnosing autism? So autism currently is defined in terms of differences in a person's behavior. So, and the differences that lead to a diagnosis of autism fall into two categories. So one relates to differences in social interaction, social communication. The other relates to differences in what are called restricted and repetitive patterns of behaviors, interests, and activities.

The way I like to frame that second category is really differences in terms of a person's flexibility. and that can relate to behavior's thoughts or sensory responses to the environment. So these two major categories are considered what are called the core features of autism. Now, you'll see that neither of them points to biology. So really, definition diagnosis of autism relates to just what we're observing about a person's behavior. And I think it's very important to point out that when an autism diagnosis is made, it truly is just a starting point. it's not by any means the end of the diagnostic process.

It's not an answer even because there's so much additional investigation that needs to happen to better understand biological factors and a person's truly, you know, their unique physiological profile. When a developing brain is diagnosed as having, you know, autism, and I think part of this is also to making sure that I get the language correct. I think in the past we used to say sometimes autism spectrum. Yes. Is that still?

Yes. Okay. So let's say a child is diagnosis being on the autism spectrum. What is actually happening inside of the brain that would be leading to some of these behaviors that would be diagnosis being different or abnormal from a scientific lens? Yes. So it's fascinating. There have been thousands and thousands of brain imaging studies of autism, electrophysiology studies,

so we really do understand quite a lot now. And what we know is that differences in the brain are present even before birth. So there are differences in how the fetal brain is developing in autism. And what happens is that part of fetal brain development is this intricate migration of cells to different parts of the brain, to establish the brain's architecture, that is different in autism. So the brain's micro-architecture is already different at the time of birth. And then from about birth to two years of age, there's an acceleration of growth. So in autism, the brain is growing more quickly compared to a non-autistic brain.

There's greater neurons in the cortex. There are greater connections between neurons, which are called synapses. So that unique trajectory is present very early on, but then appears to slow down so that by adolescence and adulthood, the brain actually appears to be similar size and maybe even slightly smaller for some. So we know that aspect of sort of a different trajectory of brain development and growth in autism. But we also know there are electrophysiological differences.

So if you do an EEG, for example, to measure the brain. brain's electrical function, we know that somewhere probably around 50 to 70% of autistic individuals have what we call atypical electro-electro or epileptiform discharges, so that parts of their brain seem to be firing in a more active and hypersynchronous way. So there are differences in the fundamental electrophysiology of the brain and autism. And then we also know that there are differences in what we call connectivity. So, you know, the brain forms networks that underlie our skills. And the connections between parts of the brain and autism that are farther apart seem to be somewhat reduced, whereas connections between parts of the brain that are closer together

seem to be enhanced. So that's sometimes referred to as reduced global or reduced long-range connections and enhanced local connectivity or increased short-range connections. So these are some of the basic differences that we now understand about the brain and autism. Before we continue on, just connecting your answer that you just shared to our opening questions, knowing that there are changes in the brain, even in utero, and this might be a controversial question, but are there ever recommendations that are given to women and families that are expecting or families that are trying to conceive and seeing the rates of autism continue to increase in terms of our population? Are there recommendations that are given to women and families

about reducing the likelihood that your child would be born with an autism diagnosis? Well, this is an area that I feel deserves a lot more research. So we still don't know how much those kinds of interventions or modifications during pregnancy might influence the brain. My personal view, based on all that I know, is that it could influence it a lot. And so a good starting point are the recommendations that generally are offered to women during pregnancy around nutrition, around exercise, stress reduction. I think those are all a great place to start.

There probably is more that we could and should be doing. But it hasn't been an extremely active area of research, though I think it should be. So more research needed, but it's safe to say that because of what is known about the chemicals in our environment, reducing or greatly minimizing the use of certain chemicals that might be seen as being disruptive for just your overall health. but definitely a developing brain in utero. Yes, absolutely. And we also know that certain maternal health factors like metabolic disturbances and autoimmune conditions can increase the likelihood of autism.

And so steps that might help to regulate or modulate the mother's immune system could, in theory, have a beneficial effect. So what's fascinating is that one of the, in scientific research on autism, one of the mouse models that is most commonly used is called the maternal immune activation model, where they can create differences in the brain of the newborn mice and mimic autism by activating the mother's immune system. Now, of course, in research settings, this is done artificially to create the mouse model of autism, but it just goes to show you that maternal immune activation truly is known to be one factor that increases the likelihood of autism. And by immune activation, you're literally meaning like injecting the mouse mouse with something that basically causes some sort of disease.

That's right. And gets their immune system to fire up. Correct. And that's how they create baby mice. that end up having similar to, you know, autism. That's right. That's exactly right. That's fascinating.

Yeah. You know, in your new book, Magnificent Minds, you talk about so many of the layers that are here in this conversation that I just want to acknowledge at the beginning of this interview. Fundamentally, we're not here, and you're not here in writing about your book saying that, you know, anybody's brain is broken, right? That's first and foremost. And while we're highlighting the latest research that you've pointed out in your book related to autism and neurodivergence, it's important for people to understand that this is part of the ongoing evolution of science to help families learn how they can be better supported, children in some instances, to get better treatment for some of their associated issues that might be there.

in addition to autism. And for families and children to feel like they have some sense of relief and progress that could be there, some sense of, you know, I don't want to use this word, but it truly is some sense that there is a little bit of hope beyond the standard medical, typical treatments that are there. And a big part of that here is also acknowledging that as we talk about these things like how do we reduce the risk of women in utero for their child to have all? autism, we're wholeheartedly acknowledging that there's like, there's no blame that's here

and there's no putting blame on anybody. It's more talked about from a medical lens because the more that everybody, including myself, can understand what plays a part in autism and how to support families that are there, the more that we learn and grow as a society. Yes. Yes. So I, that's a really important point, which is that when we think about autism, it's important that we're important that we recognize that for so many it is a valued part of their identity. Yes. And every person should be able to choose their identity. And part of a person's identity should never be treated as something that needs to be fixed or

cured. So that I feel is very important. But at the same time, we understand that autism can bring with it both strengths, but also challenges. It can bring with it both it can be a source of disability but also gifts. And I think it's important we hold those two together because there is a, you know, neurodivergence is the term that comes from the neurodiversity movement that refers to neurological differences. So another way of thinking about it is neurological minorities. So people who have neurological features that are placed them in sort of a neurological minority group

we might then use the term neurodivergence to refer to that. I think it's a very powerful and positive term, and it came out of the neurodiversity movement, which is all about recognizing the natural neurological differences that exist in all people that lead us to experience and engage with the world in different ways, and that every person brings unique gifts to the world because of that. So I think it's important both to honor a person's neurodivergence,

and to recognize that equity and high-quality health care is also essential and that the two are not at odds. Super important. You know, another thing, before we continue further, that is an important part of this conversation. I have pulled a few statistics referencing the fact that with a child that is diagnosed with autism, that their lifespan typically would be shortened. Is that accurate? Yes, so the research is a little bit unclear, but for some, the autism spectrum is so vast.

For some, yes, there are co-occurring medical conditions that could impact lifespan. For others, there aren't. So it really is individual. It's individual. But why it's important for me to acknowledge is that piggybacking on the answer that you just shared is that these co-occurring diagnoses, and we're going to talk about them all in support of this interview is that if you can pay, if a little bit more attention can be given to these things, these diagnoses that come along with, you know, could be associated to somebody

having autism and they get appropriate treatment. You're also improving the quality of life and potentially the lifespan of individuals who are diagnosed with autism. That's right. So hugely important. Hugely important. You know, something very important that is a big part of this conversation, here, where your research has greatly contributed to the conversation around autism, is you found that approximately 80% of individuals diagnosed with autism have some form of mitochondrial dysfunction. Can you talk about mitochondria and its role when it comes to autism? Sure. So mitochondria, as you know, are tiny structures inside of most of the cells of the body, and they play

critical role in metabolism. So the way our bodies take in nutrients, convert them into the energy that we need for all of the body's functions, and get rid of waste and toxins, things that the body doesn't need. And so mitochondria are really at the heart. They place so many different and essential functions in the body. But what has come to light more recently is that mitochondria are affected in many, many different types of chronic health conditions, and now we know autism is one of them. And so some of the research that I have done has been to use brain imaging to look directly in brain tissue of children and adults with autism. And we were able to map out regions of the brain where mitochondrial dysfunction seems to be

present. And there's been a number of other research studies looking not just at brain tissue, but looking at blood and other body biomarkers that have found these very high rates of mitochondrial dysfunction in autism. Talk about that finding in the history of sort of the understanding of what played a role in autism and what didn't. As I understand it, you know, that finding that you and your team were a part of, it was a pretty major advancement in our understanding of autism. because over the years, going all the way back to 1943, when autism was first, you know, kind of highlighted in the medical literature, there's been a better and better understanding of

what actually plays a role. So why is it such a big deal that you found that mitochondrial dysfunction was a part, or at least associated with autism? And how does that fit into the landscape of what we thought autism was over the years? Well, one reason why it's so important is because for decades, so as you said, you know, autism was first described in the medical research literature in the 1940s. But then through up until the 1970s, we really didn't understand much about autism. And the prevailing theories within the healthcare profession were that autism was caused by poor parenting. And so the term refrigerator mothers was used to essentially blame mothers who had children with autism.

It was intended to describe sort of a cold, aloof parenting style. There have since been books and documentary films made about this topic to give voice to the families who were really traumatized and blamed. And so looking back, I think it's so important for us to remember that because we want to make sure we as healthcare professionals don't cause that type of harm again. That's one of the reasons why understanding the biology of autism is so important, things like mitochondrial. because it's really shifting our understanding in my view the right direction, which is really understanding the underlying biology, physiology that is really the root of autism and represents such an important evolution away from the mistaken ideas that we've had as a profession in the past.

What percentage of current practitioners that are helping families? you know, really get that mitochondrial dysfunction is a major part of the autism conversation. Unfortunately, I don't think nearly as many healthcare professionals understand that as I think should and that I hope would one day soon. What is their primary belief around the causes of autism? Are they still feeling largely that, hey, this is almost all, genetically driven. I think that's the case. I think it's felt to be something that's static, something that's in the genes, in the brain that can't be changed. And nothing could be farther

from the truth. You know, there's so many ways that we can influence brain development and function. And so my hope is that magnificent minds and a lot of the work that we do at Kordica can help to get that message out. I think it's worth repeating, you know, in the current approach when it comes to treating autism, so many of the people that are in charge of the treatment have a belief in some version of another that largely autism is static, that it's baked into the body, that it's baked into the genes, and that the causes are complex, which is true, the causes are complex, but that largely there's not too many levers that can be pulled on to help, you know, those that are diagnosed, you know, with it and the families that take care of them. Why is that

a dangerous belief to sit on and also to actively fight people to preserve. Because when I look at the community, I see a lot of well-intentioned physicians who want to shut down the conversation that autism is anything other than a static, baked in thing in the body. Why is that dangerous? Well, one of the big reasons why it's so dangerous is that it can delay diagnosis and delay appropriate medical investigation, medical therapies, and other types of therapies, sensory motor therapies, behavior therapy. So that view often leads to delays in a referral for diagnostic evaluations. we actually know that the wait times for autism evaluations,

tests, treatments is longer than really almost any other field of medicine. So children in that really early vulnerable period where interventions can make a huge difference are often now weightless that are six to 18 months long. If you look at an academic medical center where children are waiting for developmental evaluations, sometimes the wait list are 18 months long. And then from there, even once a child has a diagnosis of autism, many wait a very long time for the initiation of services like behavior therapies, occupational therapy, speech language

therapy. Many still today are not referred for medical evaluations. So these essential genetic, metabolic, tests, tests like an EEG that give incredibly important information about the brain's electrical function are often not being done at all. Even when they are done, they're often done at a much later time than they should be. So, again, this idea that the autism is somehow static can cause great harm. We know that it's profoundly dynamic. The brain is incredibly dynamic. And one of the areas where I think we've come a long way as a society is understanding that

the dynamic nature of brain conditions for many other conditions, like anxiety, like depression, like OCD, ADHD. But for some reason, when it comes to neurodevelopment, conditions like autism, cerebral palsy, intellectual disability, people still are very very. very much, very much have the tendency to think of those as being static. It's understandable in the field of neurology for decades and decades those were referred to as static. Encephalopathopathies, that's a neurological term. Encephalopathy just means a condition of the brain. But just the fact that they were labeled in that way for such a long time, I think, has kind of held us back

from recognizing just how dynamic they are. Generally speaking, the longest, that a developing brain goes unsupported with the latest science and research that's known that you guys practice in your clinic and that you talk about many of these interventions inside of the book, the longer that a developing brain goes without getting the support that it needs that are out there, which could be including treating these co-occurring issues, you know, sleep issues, GI issues, mitochondrial disease, nervous system, there could be mental health components that are there, getting the right family support and community support for the family. The longer that it goes untreated, the harder it would be generally to see an improvement

with some of these interventions. Is that accurate or is that inaccurate? It is accurate. And that's an important point to make while also making sure that people realize it doesn't mean that progress can't be made at later times. You know, it certainly can. But understanding what's happening early and taking appropriate steps early is so important. So there's a phrase from the field of neurology that time is brain. Now, that phrase came about to describe stroke, an entirely different neurological condition where we know it's how important it is to intervene to make your blood flow is, you know,

can resume in the brain for stroke. But I think it applies to neurodevelopment too. And so we have to act more quickly than we are today. And that means we need to create a better understanding of why that's important. And then we need to take active steps to improve access. And part of that means having more healthcare professionals who understand neurodevelopment and can provide these services. before we go into some of these co-occurring medical conditions and describing a little bit about that, I want to give you an opportunity.

Are there any other top myths or misunderstandings that are there that don't account into the latest science that are part of having a whole child approach to treating autism, right? So one of the things that we addressed, that you addressed, was that the still lingering belief, even though it's not shown in the medical literature, that all, Autism is static. It's there. It's baked in. You can't do much or you can't do anything in some instances. Are there any other myths, beliefs that you think that are there that are also hindering and preventing us from stepping into this whole child approach? I would say another like, so yes, the idea that autism static is probably the biggest misunderstanding. Another, I would say, is that somehow once you have an autism diagnosis, things stop, that you somehow have found the answer.

And that is not at all the case. Once an autism diagnosis is made, it's actually in my view when things actually start, when you really start looking deeper and gaining a better understanding. And there's so much from there because there are tests that we can conduct, observations of the child, evaluations that give us some information, and then from there will

want to take steps and try things based on what we understand about the child's physiology. And then their response to those initial interventions then guides us on what to do next. So it is a stepwise process that is long term. And I think it's really that understanding of autism, I think, is also very important. When a family steps into your clinics today, and if you wouldn't mind just talking a little about your clinic, the name, you know, where they're located, because we're always trying to provide resources for people that are out there. Walk us through that approach. You know, many of the families come in already having had a diagnosis of autism. So now they've stepped in the door.

Tell us how the journey starts from there. Yes. So about 10 years ago, I started my own private practice in San Diego, California. focused on autism and related neurodevelopmental conditions. And from that initial sort of one-room, small private practice, we've now grown into a set of clinics around the country. So Cortica is the name of our healthcare services organization. And we have 24 centers around the country in seven states from West Coast to East Coast.

And each of our centers is dedicated to providing whole child care for neurodevelopment with a very, very strong focus on autism. And so we have a team of about 2,500 professionals now delivering this care, including pediatric neurologists, pediatricians, psychologists, behavior therapists. We have mental health professionals. We have developmental therapists. So this is a clinical team all working together integrated to provide the highest standard of care for children with neurodevelopmental differences.

So when a family comes to us, the path that they begin on really is intended to bring all of these components together in a way that makes it as easy as possible for them and to get services as quickly as possible for every child. So the first visit they'll have is with one of our nurse practitioners that's done virtually, and it can be scheduled within two weeks of them contacting us. And that's for the nurse practitioner to get a sense of what are the families? these priorities, what diagnoses have already been made, and from there to as quickly as possible triage a child to downstream services, to minimize the weight. Because, as we said earlier, time is brain. So we want to get children as quickly as possible to the services that will help them. And then those services could include, if appropriate, applied behavior analysis or behavior therapy. It could include developmental services like occupational therapy,

speech language therapy, music therapy, or physical therapy. For almost all children, it does include an evaluation with a physician. And that's to do a very thorough neurological exam, medical history, and to make decisions about what medical tests could be helpful. And so start down that medical part of the journey. And then, of course, one extremely, extremely important piece that's often overlooked is support for the family. And so my view is that in today's modern world, every person would benefit from having a mental health counselor. And certainly, if you have a child with a neurodevelopmental diagnosis, the parents' well-being in mental health is even more important because that will directly translate into really

mental health and quality of life of the child. I want to come back to mitochondria for a second. Can you talk a little about mitochondria and just how sense? and fragile they are, and how they're, the insults that we're all surrounded by can impact them, but how in particular for the developing brain, how important it is to protect the quality of the mitochondria. Yes. So one of the most important functions of mitochondria is that they generate energy for the body

in the form of the molecule ATP. And we know that certain times of life and certain organs in the body, you know that certain organs in the body are extremely energy dependent. They just require a lot of energy to function and to grow. And the brain is one of them. So when mitochondria aren't functioning well, the brain is one of the most sensitive organs and especially the developing brain. And even during childhood, there are certain phases in which the brain is changing and

growing the most rapidly. So for example, from birth to age six, and then again at puberty, massive changes are happening in the brain, and those changes require energy. So when mitochondria aren't functioning well, the brain at those periods of life is particularly susceptible. And mitochondria, as you say, are very sensitive. So they can be disrupted by things, the term that sometimes used is a physiological stressor. So anything that's stressing the body could take a toll on mitochondria. So it could be things like exposure to toxins, inflammation, just a state of chronic stress in the body. And often it's downstream so that there may be an initial cause, sometimes it's genetic

or metabolic condition, that as a downstream consequence, mitochondria are then affected. But what's really promising is that there are things you can do to support mitochondrial function. And primarily those things relate to nutrition, diet, and nutrition supplementation. And there's some growing research evidence that if you support mitochondria, then they can function better. And therefore, then the body can grow and function better, especially the brain. Well, let's just touch on that for a minute, if that's okay. Let's talk about the role that diet could be playing inside of not. Not so much, you did mention when it came to some of the causes that are there, a mother's

diet and making sure in particular to be mindful of like avoiding preclampsia, gestational diabetes, you know, essentially having good metabolic health, right, which largely comes from avoiding an ultra-processed diet and a lot of liquid calories and a lot of high calories from ultra-refined foods that are there. So generally speaking, regardless of what diet people choose, if a family and a mother is going to be moving towards a whole foods diet, that's generally going to be a better way to exist for her brain, as well as the child's brain as well.

When a child has a diagnosis of autism, one of the things just anecdotally, we've heard from a lot of our community, is that they have noticed that just simply by making some changes, that their children were often very maybe picky eaters, and that by slowly and with support getting to a place where they could get their child to gradually move towards a more whole food diet, there's a lot of anecdotal accounts that people have shared with me,

having different experts in this field like yourself on, that they have noticed an improvement in how their child feels, right? Is there any truth to that? There is. There is. And so this is another area that's, we've learned a lot about in autism. And 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,

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 part of middle, milk, 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 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 can then be absorbed in the end of

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 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, you know, 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 this 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 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. 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. A 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 the 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 they're 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 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 taste 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 flight 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. 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 some who have genetic and metabolic conditions or epilepsy 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. 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. But 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 a 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 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 patient's 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's 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 to do. 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? Yeah, so I would say device therapies to help the brain is probably one of the most exciting innovations in the field today. 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 earclips. And that tiny electrical microcurrent stimulates nerves that then travel to the vagus nerve, which is, 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 are diagnosed with autism have. What's important for people to understand about these co-ocommune issues? Yeah. 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 be 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 interweave in 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 that's 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 are these co-occurring diagnoses, 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 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 some Sometimes they benefit from treatments for their allergy symptoms, and then you see improvements in their socialization, their behavior, their communications. 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 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 more tool in our toolbox and

understand for whom it might be the right, you know, the right step to take for whom it may 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 controversially, certainly by families, because they fall in the antipsychotic category of medications. They're called aeropipypigrisal and rospadone. A lot of research evidence showing that they can help quite a lot of little.

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, there's stimulant and non-stimulent 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. There's a section in the book that is all about community and the importance of family, you know, families getting the right community and the right support system that's there. And that was one of the first things that you mentioned in the beginning when you were talking about how to effectively, you know, support and be there for these families and children's that have diagnoses. What do you want to say about community? Yeah. Well, you know, there's a child development framework that we use acortica

that's in the shape of a tree to kind of remind us that a child is like a tree growing and has huge potential for growth. The roots of that tree, community is one of them. And we've done that very intentionally because we consider the roots of that child development tree to be home, community, and school, the three key environments that a child is in. And so community is so important because a child's experiences in the community are an essential part of their life. And so often those experiences are curtailed or reduced when a child has autism. And it shouldn't be that way.

So I believe very strongly we need to have environments and experiences in the community that are really tailored to a child and help to foster their learning. So as an example, one of the things that I certainly have seen tremendous benefit from is when children can access community recreational activities. And these can be things like various sporting activities, musical, arts, those kinds of experiences are incredibly enriching. And the thing to know is that you have to be a little bit careful about how you choose them. And it's important to understand the child's, what we call their sensory profile, to see how they'll respond to different types of environments. Because some experiences in the community can be quite overwhelming. Imagine a place with crowds, lots of loud noises. This can overwhelm a child's sensory processing capabilities.

And so we just want to be careful about how we approach those. You know, we didn't touch on this, but I want to come back to it because it was one of the questions that I listed, you know, you mentioned that a certain percentage of autistic diagnoses, they suffer with epilepsy. And one of the things that you highlight in the book is that, you know, there's a lot known about the ketogenic diet when it comes to supporting especially seizures, epilepsy, and how even in some instances, there are individuals that have autism diagnosis. that could benefit from a therapeutic like that, diet like that.

It may not be the diet that they're on long term, but that there could be benefits to implementing ketogenic diet or other metabolic therapies to support them. I think you mentioned the child that you gave the example of when on a low glycemic diet. I guess the ketogenic diet would be even a little bit further than that. Can you mention a little bit of the sort of the hope around what that diet could be and who could be used for?

Sure. So we know that, we've known for a very long time, that there's certain diets that are very effective treatments for epilepsy. And as we discussed earlier, epilepsy is one of the co-occurring conditions with autism. And an estimated 15 to 20 percent of autistic individuals have epilepsy. And even more, somewhere around 40 to 70 percent, have atypical electrical discharges if you do an EEG. So there's a lot of good rationale for considering these diets in autism. So the ketogenic diet is one. Another is a low glycemic index diet. There's one called the Modified Atkins Diet.

And then there's a medium chain triglyceride diet. They have their differences, but they have a lot in common. So they're very much about reducing simple carbohydrates, increasing fat and protein in the diet. And for some individuals, the diet cures their epilepsy, which is just remarkable. Sometimes it's even curative for types of epilepsy where medications have not been effective. So given the co-occurrence of autism and epilepsy, it is really worth considering these diets as interventions. You know, coming back to that topic of mitochondrial dysfunction, you know, and all the different

ways that mitochondria can say, ouch. You know, mitochondria are very sensitive to light, for example. And we know that, you know, a lot of people are recommending for us today, you know, getting our morning light and our evening light. My cardiologist continuously reminds me that, you know, the heart has one of the largest concentrations of mitochondria inside of the body. And things like photobiomodulation are important for heart health, red light therapy in some instances, things like that.

And so mitochondria are sensitive, as we mentioned before. And I think that anytime there's an interview on my podcast that we talk about, you know, autism, what it's related to, the increased rates, how to go about treatment. My audience naturally is, you know, just curious about all the things in the zeitgeist that people are talking about, whether that's people bringing up the topic of, you know, certain therapeutics or medications or other things. And I think that, you know, you and I were chatting a little bit beforehand. And I really felt that one of the things that I got from your work and all the incredible content that you and your team have put out at Kortica is that it's important to understand that when it comes to autism and asking ourselves, well, what is the cause? First of all, that's going to require a lot of research that's out there.

And a part of that is understanding that there can be a lot of things that can damage the mitochondria, right? And that is a vast spectrum of components. I'd love to just touch on some of these. You mentioned some of them. I'll reiterate and I'll add in a couple others that we haven't talked about that could be part of the equation that are there. So you mentioned that certain chemicals, especially heavy industrial chemicals that are in the environment, we know now that there was a few chemicals that were deeply linked to Parkinson's disease and neurological disruptions there. And then there's been some concerns that some of these chemicals that are very popular used in dry clean.

cleaning, might have some link to other neurological issues that are there and other mitochondrial disruptions of which autism could be a part of. You mentioned nutrition, right? We know the importance of having the appropriate amounts of EPA and DHA in the brain and how certain fats are important for the health of mitochondria that are there. We also know on the flip side that super refined fats, things like trans fats, you know, there's no clarity on, you know, other more refined fats like seed oils. That's a hotly debated sort of area.

I don't know if you have a perspective on that, but that we know that high-quality fats are important and low-quality fats can damage mitochondria as well. Air pollution is another one that you write about inside of the book, right? And in addition to those, there could be other areas that might be things that could play a role. that should be on people's radar. It's not about fear mongering. It's just saying anything that makes mitochondria say, ouch.

So one of the ones that's increasingly getting a little bit more attention is also a very controversial topic is mold and mycotoxins, right? Has that been something that's come up in your clinical practice or that you guys have referred externally or have educated families about the dangers about living in an environment where both families and kids are exposed to high micotoxone, toxins, these mold toxins that are there from primarily like building contamination? It has come up. And, you know, like so many things, so many of the families I work with are just incredibly

committed, dedicated, and knowledgeable. And so often as family is coming to me with these questions or with new research or information. And I don't consider myself a mold specialist, but I do refer to people who specialize in this area. But I'll say probably the most important thing is that we take these seriously, that we also, that we recognize people will respond differently to these different potential insults. So whereas one person might not be affected by much by mold in their environment, another person could be extremely ill because of mold in their environment. And so is it worth investigating? Absolutely. And I'll add to that one additional because I think this is an area that's, from my point of view, quite obvious, but people often

don't think of it, is that, you know, we use so many pesticides in our environments. And pesticides are designed, most of them, to harm the nervous system of living beings, in this case, pests or insects. But unfortunately, they have the same effect on us as humans, especially for children. So that's an area where I think avoiding that particular exposure is also very important in addition to remediation, you know, when there are things like mold and other types of factors in the environment. So in the case of pesticides, it could be, you know, first and foremost, doing your best to, you

know, choose food that would be lesser sprayed or not sprayed, which may, if you can afford it, organic. And organic food is getting cheaper and cheaper. You know, that's a good thing. in certain instances also being aware of whether, you know, certain families that might be living in very agricultural-based areas. I've had families that anecdotally reached out and said, the more that we dug down this pathway and that we were investigating what was part of both our own health issues as well as our children's health issues, one child in particular having autism,

we felt that we're going to take the precautionary principle, and we're going to move to an area that's further away from a farm that they were next to, just to minimize exposure through runoff and air pollution of pesticides that leaked over. We've had individuals on this podcast like Dr. Terry Walls, who's talked about that she believes that growing up on a farm and literally going in and scooping pesticides without wearing a hazmat suit as a young child and dumping them in and mixing them with water sometimes with their hand, and spraying them around the farm was one of the contributing factors to ultimately what led to

her multiple sclerosis diagnosis. So these things can all play a role inside of there. So being mindful of where your children might play. I know here in California there is some growing awareness and some concern about even things like astroturf that's there and the high levels of lead and heavy. metals that might be there. And if your child is rolling around on that or playing in that on a daily basis, it's one thing to go to the playground once. But these astroturfs are primarily made by taking old tires and recycling them. And there's a lot of chemical exposure that's there.

In one of your lectures, I was just curious, you know, there's this is an area that doesn't have a lot of research, but there's a growing concern about it, both in ways that I would say are, seemingly well-intentioned concern in some areas that might feel a little bit more fear-mongering, and it's hard for even me to kind of separate, but that area would be EMFs. And I heard you mentioned at one point in time that that is on your list as one of the things, again, needs more research, that could be a mitochondrial damager that's there. Can you mention it all why or how EMFs came on your radar? Well, you know, I think of, I think about this very broadly.

And I always think in terms of, you know, risk benefit and recognize that there's so much in our environment that we're exposed to that we may or may not be able to control and that families only have so much reserve or resources, you know, to put forward. And so when you think of something like EMF or, you know, avoidance of some of these other potential stressors in the environment. For me, the way I counsel families is very much about what do we think could have, where could we direct our efforts to have the biggest impact? And I do think that for some children, if you get a very detailed medical history

and you really take the time to understand what parents have observed about the different environments and how their child has responded to them, you can get a sense of which children seem to be more vulnerable and more susceptible to factors in their environment. and with children aren't. And then you can help direct the family's efforts in that way. I'm not an expert on EMF, but from what I've read about it, it does seem to me that there are certain people who are susceptible to it and that taking steps to try to reduce EMF exposure would be worthwhile.

I think that's an important reminder that you mentioned is that part of this whole mitochondrial conversation is that some people are more susceptible than others. We don't all, we're not all born into this world. with the same level of strength in our mitochondria. There's a lot of things that can put us into a place where we are predisposed, even starting, you know, in utero, where certain things that might make my mitochondria say, ouch, you know, they don't make your mitochondria say, out.

And I think that personalization piece is so important. The more that personalized care is brought into every spectrum of treating disease and health, The more that we don't have to villainize or blame things as this one thing is the cause for the reason that everybody has autism, right? Or this one thing is the reason why these individuals have diabetes or multiple sclerosis or other things. As you've shared, it's multifactorial for a lot of people. And then even for some people, this area could be more of a challenging thing for them. And it's not as much of a challenging thing for other people. I've had two friends live in a household that they later on found out was, you know, infested with black mold and deep into the walls, you know, couldn't see it.

And one of them had, you know, severe neurological issues. And the other one just felt like they had, you know, allergies. And so this is how human beings all respond as kids would to different inputs that are there. But most importantly is to know that the old way. of approaching medicine, which is one size fits all, is no longer going to be working for us. If right now we're at a place where one in 36 is diagnosed with autism, if that trend continues because we're trying to treat everybody the same, you know, what does that look like in another 10, 20 years? It doesn't look good. And that's why I truly feel that, you know,

your work and your book and your clinics are so important because they're ushering in not just the latest science, but also this personalized approach to. getting to the root of what each individual needs to support their autism diagnosis. Yeah. I mean, one of the things that is really interesting in the field of autism research is that there have been a lot of attempts to identify what we call subtypes or subgroups. Like how do we think of different types of autism? And largely, I feel the struggle to do that. And I think it's because truly each individual is their own unique subtype.

And that's how we go about approaching it. We really want to understand, you know, every aspect of that child's health and development. And in doing so, that's really how I think you personalize care and achieve the best outcomes. As we're winding down for today's interview, what are some final messages or topics that you might want to, you know, leave our audience with or anything that you feel that we didn't give justice to an interview? Well, it's been terrific talking with you. And I mean, I think if there's one place for us to end, I think it really should be on the neurodiversity movement. Please, yeah.

We didn't give as much attention to that. But the book talks about that quite at length. I think it's just so important. I certainly view my work and the work you do at Kortica as being in service of the neurodiversity movement. And that's, as you know, civil rights movement, a social justice movement for neurodiversion individuals. And I think we're at a really exciting place now where, you know, so much. of, you know, so much of the work in the disability rights movement in, you know, many of these

civil rights movement has really paved the way for the neurodiversity movement. And I think, again, it's just about recognizing that no matter what diagnoses are present, what challenges might be, that each neurodivergent person is whole and complete as they are. And our job is just to reach as thorough and understanding, as deep an understanding as we can, so that we can support them to thrive. And could you just expand a little bit further on that? You know, our audience may not be familiar like, okay, Dr. Goh is saying it's a civil rights movement.

What is going on that was leading to a situation where people who were neurodivergent or families that had somebody that was neurodivergent, a part of it felt that, hey, we don't have the rights that we want in society. So can you give us a little background story? Yeah. I mean, it's really based in what's, you know, we sometimes call. called the social model of disability. And that's understanding that disability is not biological destiny.

It really is at the interface of a person's biology and how the environment is constructed. And so we should be creating an environment where that is accepting and that provides the same learning opportunities for people regardless of their biological makeup. And so that is... You know, it's about recognizing that it's our negative attitudes, discriminatory and exclusionary practices that lead to the experience of disability. And so we can change those. And we should change those.

It's part of that that I'm reading between the lines, a little bit of, you know, people who were, you know, were identified or self-identified as neurodivergent, that they felt that people were looking at them and saying, hey, something's wrong with. with you, right? And they're speaking up to the world and saying, hey, look, nothing is fundamentally wrong with me as an individual. I may learn, speak, express, think in a way that seems different than you, but we're just different, right? I don't want to be seen as something is, you know, wrong with me. Exactly. And this idea of normal, that somehow there's a normal brain or a normal way to behave or a normal way to engage or experience with the world is a myth. There is no normal. There may be an average, but there is no normal or right way of being. And so neurological

differences should not be viewed as deficits. They should not be viewed, you know, as making a person less than whole or inferior in some way. And I also think it's important. It can be hard to wrap your mind around because it's so ingrained in us to think of typical abilities. or neurotypical abilities as superior in some way. But again, that's just a set of ideas around or expectations around how people should be. And that set of ideas causes a lot of harm, causes a lot of damage. And I think as a society has led us to not recognize or utilize the strengths of neurodivergent people and the contributions they have to make.

So I think that's the challenge that we face as a society. I'd love to ask a question on that, kind of related to the, the question I was asking about autism earlier, you mentioned when it comes to autism, 50% in the increase can be go back to diagnoses. And again, these are conservative, you know, statements that are there. And 50% is, you know, these environmental factors and lifestyle factors that could be, you know, a part of it, which in itself is mind-blowing, right? Again, a lot of people don't know that. When it comes to neurodivergence, do you think the expression of neurodifference, do you think the expression of neurodivergence has increased over the last, you know, 500 to a thousand years.

Is this something new that we're seeing? Or has it always been there, you know, even at the same percentages that are there right now, but society hasn't been as maybe open to it? What are your thoughts about that? Like, is there an increase in neurodivergence now for the same reasons that we're seeing an uptick in autism, which 50% of it could be? the environmental factors that are there? Again, pesticides, other things that are there? Like, do these play a role in neurodivergence? Such a good question. So we don't know for sure. And it depends in part how you define neurodivergence. So I will say yes. I think that there are more factors in our world today that are leading to greater diversity in terms of neurological

function. So yes, I do believe in that sense that there is more neurodivergence today. But I also think in the past it was less recognized, less documented, and it was probably different. So it would be hard to say there was less, but certainly a different pattern or different, you know, different set of neurological differences or conditions in the past than there today. I think that's an important way to look at it. You know, I always like to allow for the opportunity on this podcast for, like, we should all have the deepest sense of compassion for everybody that exists. You know, if we were in their shoes, you know, if you had to roll the dice and you had no idea, you know, you're going to be reborn on Earth and you had no idea, what kind of society do you want to create that is the most fair and optimal, knowing that you could end up anywhere in any situation. And I think also, too, a big part of these, you know, wellness, root cause, functional medicine,

you know, podcast is that there is that truth can be true. And the other truth that can be there is that, hey, we don't want to intentionally create an environment where we see an explosion of any kind of condition or diagnosis that's there, right? even though we have so much compassion for somebody who has autism or again, neurodivergence is a broader spectrum of things that could be a part of it. We don't want to unintentionally do things that would be causing a society or leading a society to be more of these conditions and diagnoses because forget the fact of, you know, forget just autism.

And, you know, forget just the label of neurodivergence. If these things are associated with, you know, poor sleep issues, GI issues, mitochondrial disease, potential shortened lifespan, in the case of autism, nervous system, dysfunction, immune system, you know, we want a healthier society. So can both of those things be true? Can we have the deepest compassion, create a society that is so well accepting of everybody that's out there regardless of what type of diagnosis they have or disability if they had a disability, but also not want to encourage a society or an environment of ultra-processed foods, tons of

pesticides, untreated or unfundered, you know, mitochondrial disruptors that are in the environment, whether through therapeutics or mold or whatever. You know, I see both of those is true. Can both of those be true? Wholehearted, yes, yes. I see things very much the same way. And the way I frame it sometimes is that there's both, we can both adopt. a stance of complete acceptance and understanding and compassion and a stance of being very proactive

and taking action to, as you say, to try to optimize health, to try to give people, you know, mental and physical health and well-being. The two are not at odds in my view. In fact, I think they're extremely connected. They're extremely connected. Yeah. And it just takes awareness and education on all sides of the spectrum, right? It takes awareness and education for families who are suffering who well intentionally feel that they have to fight others, you know, to preserve their identity and they see that, you know, personalized approaches as maybe

threatening that identity. You know, there can be something to learn there, which is that we just want to create a healthier world. And for those individuals, that may not have somebody who's neurodivergent in their family or has autism and don't understand how tough it is to just navigate and accomplish the most basic of functions throughout the day and the stressors that are placed on families. So we all have a lot of learning to do. And your book is definitely not only giving us that learning, but it's also giving us that sense of optimism. And potentially with optimism and with your own family and getting the right treatment, that can lead into a little bit of hope through action, right? Not false hope,

because that's not helpful, but hope through action that you can make slight changes here and there and start to see that you see improvements in yourself or your loved ones. So Dr. Go, I want to thank you for putting together an incredible book and your years of research in this field, as well as building these incredible clinics because we need an alternative to the traditional system that's out there. We cannot have families waiting 16, 18 months to get basic treatment that's there. Time is brain and families need support. So thank you so much for writing your book. Where can our audience keep in touch with you?

And if they wanted to recommend your clinic to a friend or family member or take their own family there, can you remind us of some of the locations that you have? Yeah. So online, Cortica has a wonderful website with all the information about our services. It's corticacare.com. My website, Dr. Suzanne Go.com. I'm on Instagram. And yeah.

Yeah, I was excited to see you on Instagram. I think a long, how long ago did you join? Oh, fairly recently. Fairly recently. I was looking you up. I wanted to tag you on something that I wrote in my stories. I was like, oh, I guess she's not on Instagram. Welcome to the club.

I'm excited to pull some fun clips from today's episode and tag you so we can help spread the word. The book is out there, magnificent minds. It's the whole child approach to autism. Thank you for your work done. Thank you for having me. Hi everyone, Drew here. Two quick things.

Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share it with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter, and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more.

If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole-body health and optimization, Click the link in the show notes that's called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says, try this.