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

Dr. Mark Hyman 0:00
Coming up on this episode of the doctor's pharmacy.

Dr. Suzanne Goh 0:02
We need to look deeper. So I I think of autism as an autism diagnosis a starting point because there's so much more to understand and learn about a child.

Dr. Mark Hyman 0:12
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So I'm I'm just this is an incredible interview for the doctor's pharmacy podcast with doctor Susango, who's a pediatric neurologist, a pioneer in autism, and is really revolutionizing our way of thinking about the brain and the body and treating kids with autism, which is a huge problem. And we talked about a whole range of things that are often outside the mainstream of autism thinking like the role of mitochondrial health, the role of nutrition, gut health, toxins, the causes, and how families can deal with this in a comprehensive way. So I I just love this conversation on your gonna love it too. Well, Susanna, it's so great to see you again and have you on the doctor's Pharmacy podcast.

Dr. Suzanne Goh 2:35
Thank you so much. Thrilled to be here.

Dr. Mark Hyman 2:36
Yeah. So we, you know, you were part of our broken rain documentary series where we talked about all this epidemic we have of broken brains from autism to Alzheimer's and oppression. And you shared a lot about the work you've been doing at the time. This was years ago on autism and help to sort of frame a a picture of autism is very different than we think of and can Financial Medicine. And then you came to Cleveland Clinic and presented at our Center for Functional Medicine and gave a very academic presentation about your findings and discoveries in the field of autism that are really shaking things up.

You know, we see an enormous increase in autism. And we went from 1 to 10,000 to now. I 1 in 36 kids. I don't know. It keeps getting worse every time I look, it was 169.

I was 1 in 36. And I I don't think it's just better diagnosis. Something's going on. And, and your work has really been unusual because, typically, in in an autism care, neurologists or pediatric neurologists will simply, you know, diagnose the problem, and then they'll prescribe, behavioral therapy. You call it APA And it's a form of behavioral therapy proautism.

And it can be effective Yeah. An important part of the overall treatment plan, but they don't really ever think about other things that are often found in these kids, like 95% of them have terrible gut issues. 75% have immune dysregulation. Right? They may have different nutritional things going on Yeah.

Toxic load, things that really are not looked at. And and I'm really curious, you know, someone who sort of comes from your pedigree, you know, Harvard Medical School, your Rhodes scholar, you know, University of Oxford graduate school as a pediatric neurologist, How did you first come to understand that the traditional paradigm of autism was flawed and and you needed to think differently about it?

Dr. Suzanne Goh 4:17
Well, You know, so much of my current understanding of autism I gained from working with really remarkable researchers at different stages of my career, So, when I was on faculty at Columbia University, about 10 years ago, 15 years ago, I had amazing mentors whose specialty was mitochondrial disease and dysfunction and looking at a childhood condition. That really lead to this. And so very early on, I was exposed to the mitochondrial disturbances that are associated with different neurodevelopmental diagnoses, like autism some and ADHD and intellectual disability. So, it was through that process of my training and working with, amazing clinicians, researchers, who specialized in understanding mitochondria metabolism, immune dysfunction, and brain development, that then I was able to to take that and go even further to then understand how other body systems like the gut, and, you know, the immune system and so forth influence brain development in profound ways.

Dr. Mark Hyman 5:23
Yeah. So when you pull on a thread, it's connected to everything else. Right? You have to code down that rabbit hole and you have to keep going because you keep understanding that there's this intersection of all these different phenomena that are contributing to this brain dysfunction.

Dr. Suzanne Goh 5:34
That's right.

Dr. Mark Hyman 5:35
That that I think could be fairly described as a meta encephalopathy. Mhmm. And in English, that basically means encephalopathy means you're a a brain pathology. So it's some type of metabolic disturbance in the brain. Yes.

And and we talk about metabolism, we're talking about basically energy production Mhmm. In the mitochondria. So mitochondria are the little factories in your cells. That take oxygen and food and combust it and turn into energy in the form ATP. So if you have a brain energy problem, you're gonna have a brain function problem.

Dr. Suzanne Goh 6:04
That's right.

Dr. Mark Hyman 6:04
And that can lead to a whole host of things. And we've had Christopher Palmer on the podcast who's a psychiatrist from Harvard. You know him?

Dr. Suzanne Goh 6:10
I do. His work,

Dr. Mark Hyman 6:11
he wrote a book called Brain Energy. Where he sort of accidentally discovered that by giving people a ketogenic diet, which optimizes mitochondrial function, he was able to cure skin zephania, which is an incurable disease. And and in in the same way, you've kinda discovered by working on mitochondria and med bolic health and gut health and immune health and nutritional status, you've been able to help these kids with autism improve, and in some cases, actually reverse autism. Now, you're you're, again, a highly pedigree neurologist, and I think, you know, many of your colleagues would consider it quackery to say that you could reverse autism. It's just it's it's a false hope.

You shouldn't be telling patients this. And and yet, that's exactly what you're doing. Can you tell us about how that's going? Like, what what that

Dr. Suzanne Goh 6:57
Well, we know that, you know, autism is defined by a set of descriptive criteria. You know? So it's not in self a biological diagnosis or biological cause. It's descriptive. It's descriptive.

And, and so That is really just a starting point. We need to look deeper. So I I were I think of autism as an autism diagnosis is a starting point because there's so many there's so much more to understand and learn about a child, about their unique biology their unique neurodevelopmental profile, all aspects of their of their health, brain and body. So we sometimes forget head is connected to the body. Yeah.

Absolutely. Absolutely. So, as a neurologist, I, you know, when I first went into my training, I was fascinated by the brain, and I thought nothing's more interesting than how the brain develops in children. But very quickly you realize that the brain is so profoundly influenced by the rest of the body Yeah. That as a neurologist, you can't just think about the brain.

You have to be thinking about every other part of the body and about the child's environments, you know, their home, their school, their community, what they're encountering out in the world, how they spend their time, their social connections Yeah. Everything because all of it influences the brain.

Dr. Mark Hyman 8:14
It's so true. I mean, what you're saying you're saying it's so important. And and I just wanna highlight a couple of things you said. The first is that the diagnosis is just a starting point. And in medicine, this is so true across every specialty.

We're really good at naming diseases and then blaming the name for the problem. I know why you don't have good social skills and have stimming problems and have no speech. It's because you have autism. Well, autism isn't the cause of those symptoms. It's just the name we give to people who share those collection of symptoms, and there may be a myriad of causes I don't think there's any such thing as autism.

They're autism.

Dr. Suzanne Goh 8:51
That's right.

Dr. Mark Hyman 8:51
Each kid is unique and different. If you've seen one kid with autism, you've seen one kid with autism. There are similarities in their commonalities, but You have to really think differently. And and I think the other thing you said I just wanna highlight is that it's something really radical. Is that is that your body affects your brain.

We know about the mind body effect, but what about the body mind effect?

Dr. Suzanne Goh 9:09

Dr. Mark Hyman 9:09
And and so I wrote my book Ultra Mind solution 15 years ago, basically saying, you how to fix your brain by fixing your body first. Right? And I think, you know, your your your discoveries around mitochondrial health and the gut have really helped you treat patients in a very different way. So you do a comprehensive approach. You have a an amazing clinic called Cortica that's a company that is across the country providing services in a 360 way to families and children with autism.

And in that, it's it's it's not just behavioral therapy. It's not just family support. It's just not developing the social framework for these kids and Thrive. It's dealing with these biological issues. So I'd love to dive into some of the biology because Yeah.

You know, most people don't talk about the biology of autism. They talk about the symptoms, and that's it. It's it's kinda naming and blaming

Dr. Suzanne Goh 9:55

Dr. Mark Hyman 9:55
And and and, I always say, you know, this from, my mentor, Sid Baker, he says, we have a problem in medicine, it's a naming and blaming game. He named for the we blame the name for the problem. And then we think what is wrong we know what's wrong with you. Mhmm. But if you know the name of your diagnosis, it doesn't mean you actually know what's wrong with you.

Dr. Suzanne Goh 10:09
Yeah. I think that's the biggest mistake, certainly in autism. The biggest mistake is is attributing any feature or symptom or characteristic of a child to autism. It doesn't make any sense. Because autism is just that set of descriptors.

Dr. Mark Hyman 10:23
Right. And

Dr. Suzanne Goh 10:24
so we really, really have to look deeper. And we know so much more now about some of these root causes. And contributing factors. Yeah. And and as you said too, you know, we there's a lot of research trying to understand what we call subtypes or subgroups of autism.

But at this point in time, I really think we need to treat every child as their own unique subtype and really seek to learn as much as possible, as we can about their biology.

Dr. Mark Hyman 10:49
Yeah. So, in in your investigations of this, what what are the kinds of things you actually look at when you're assessing a patient? Mhmm. You make the diagnosis and and, you know, I think I call it thinking link thinking and link Yeah. You know, I suppose it's supposed to be naming and blaming me.

We have to think in length. In other words, think about why Yes. Causes. And and maybe you could speak to the this incredible growth in in the epidemic of autism from 1 in 10000 to 1 in 36, maybe getting worse every day. Yeah.

Some of it may be better diagnostic criteria, better diagnosis, but it doesn't explain the magnitude of that change. So Right. What do you think the causes Mark, and how do you start to investigate what those Mark? And the impact of these positive factors on these little kids biology who are so sensitive. And what does it do to them?

Dr. Suzanne Goh 11:33
Yeah. Well, so the in just the past you know, 20 years alone,

Dr. Mark Hyman 11:39

Dr. Suzanne Goh 11:39
prevalence of autism has risen 400%. 400%. 400%. And Sure. We know part of it is related to changing diagnostic criteria, greater awareness, but there's a big part of that increase that isn't you know, it can't can't be attributed just to greater awareness or a changing diagnostic criteria.

And we know actually a lot about the different causative contributing factors. So the way I like to explain it, to professionals and to caregivers is that there are a set of factors related to genetics. So we know genes matter. But they also aren't the entire story. So there aren't over a 100 different genetic variants that we know can influence brain development in a way that can lead to autism.


Dr. Mark Hyman 12:26
not fun. Acceptabilities.

Dr. Suzanne Goh 12:27
Genetics acceptabilities is usually a complex interaction of many.

Dr. Mark Hyman 12:31
Many genes. Right. Right. And then

Dr. Suzanne Goh 12:33
on the other side, there are also, you know, non genetic factors or environmental type factors. And usually it's not just one as many. And those interact with genetic factors and complex. Ways. Yeah.

So it's a complex picture, but those non genetic factors are really interesting because many of them give us insight and talk to biology. And some in a sense are modifiable too. So we know that there are a set of, parental health factors, that are increasingly common over time and are are very likely contributing to the rise in autism, things like, parental age, things like maternal health factors, maternal metabolic conditions, maternal autoimmune conditions. We even know there are certain they fall in the category of toxins. You know, things in our environment like industrial, chemicals, pesticides, a whole range of things that are now really widespread in the environment.

And a lot of research has been done showing that they affect brain development and brain health.

Dr. Mark Hyman 13:32
So so how that influences our approach at Cortica is that,

Dr. Suzanne Goh 13:32
we really seek to understand a child medical history.

Dr. Mark Hyman 13:41
So we get a lot

Dr. Suzanne Goh 13:42
of information about, the pregnancy, the birth, family history, family health conditions. And then We also do a deep dive into the child's own biology by

Dr. Mark Hyman 13:55
looking at a range of

Dr. Suzanne Goh 13:55
different test results. So These might be done on saliva, on blood, on stool, on urine, always in addition to a very thorough physical and neurological exam, of course. Yeah. But these are all ways to try to gain insight into what is happening for that child.

Dr. Mark Hyman 14:12
And many of these tests are not things you'd get when you go to your regular doctor and neurologists. They're things that are kinda outside of mainstream. Yeah. You're looking at, you know, toxic load and urinary organic acids and nutritional levels. Methylation and all these genes that are in combination of, often said that environment, is is a big factor, but genes load the gun, the environment pulls the trigger.

Dr. Suzanne Goh 14:33
Yeah. So

Dr. Mark Hyman 14:34
it's just sort of interplay environment across across these kids genetics. And I've seen this, you know, I've seen all these different genetic patterns of loglutophyone genes and methylation genes and detoxification genes that are that are really common in these kids. And they tend to be sort of at risk. You know, and I think, you know, one of the things that really struck me when I started for learning about this was the work of Martha Herbert. Mhmm.

And I'm sure you know, it was another Harvard Yes. Neurologists who studied autism and

Dr. Suzanne Goh 15:01
brain imaging?

Dr. Mark Hyman 15:02
Yeah. And she, you know, she talked about these biopsy studies on kids who accidentally died with autism. And and all these kids have massive amounts of neuroinflammation. Their brains are on fire. And and when your brain is on fire, it's hard for it to function.

And Alzheimer's is a brain on fire. Depression we now know is a brain on fire.

Dr. Suzanne Goh 15:23
Right? Mhmm.

Dr. Mark Hyman 15:24
Schizophrenia we now know is a brain on fire. So What's causing the fire?

Dr. Suzanne Goh 15:28
Yeah. Well, we actually so, you know, prior to, establishing Cortica, I was on faculty at Columbia University. And we did We had an NIH funded research program using multimodal brain MRI to study autism in children and adults. And, one of the research studies that we published showed that there was a pattern of neurochemistry essentially that really pointed to both mitochondrial dysfunction and inflammation in the brain. And when as a neurologist, when I think about inflammation in the brain, there are kind of, you know, 2.

There's there's sort of a a set of maybe more acute or sudden onset full moon and types of brain inflammation. And then there's this other category of more low grade.

Dr. Mark Hyman 16:14

Dr. Suzanne Goh 16:15
Smoldering types of inflammation. And the research is really pointing to autism falling within that second. Sure.

Dr. Mark Hyman 16:21
Yeah. It's not encephalitis that you get from, like, a virus, like Yes. Meningitis. It's it's really a a much more slow and Yeah. Insidious Yes.

That inflammation.

Dr. Suzanne Goh 16:30
And harder to detect. Some of our tech, you know, it it may not show up on a routine MRI, for example. Sometimes it does, though. And, I certainly have seen that in my practice. So, yeah,

Dr. Mark Hyman 16:42
it's this the the mitochondrial dysfunction, which is linked to, in this chronic

Dr. Suzanne Goh 16:42
low grade inflammation is, influencing the the function of the brain

Dr. Mark Hyman 16:51
and autism, and it's also quite dynamic.

Dr. Suzanne Goh 16:51
So it's not There was a term used for a very long time in pediatric neurology called static encephalopathy. Mhmm. And that couldn't have been we know it couldn't be farther from the truth. Yeah. The brain is not at all static.

It's extremely dynamic and influenced by so many factors. Mhmm. And so we you know, we do as much as we can in our practice to try to understand what those factors are for a particular child. And then we we can take steps that can really be very impactful, like, I'm making changes to so I I think of these interventions as falling in 6 categories. Yeah.

The 1st lifestyle change So things like making changes to sleep routine, movement, you know, what part exercise plays. Really fascinating is that there's now a lot of research and autism showing that exercise improves the core features of socialization, communication, executive function, anxiety, not to mention endurance, stamina, physical health. Just tremendous benefits to some of those lifestyle changes.

Dr. Mark Hyman 17:59
And it's an anti inflammatory for the brain. Yes. And it increases your brain connections. We call

Dr. Suzanne Goh 18:03

Dr. Mark Hyman 18:04
But beating up. Right. Brain derived neurotrophic factors like miracle grow for the brain.

Dr. Suzanne Goh 18:08

Dr. Mark Hyman 18:08
So, yeah, that's really exercise.

Dr. Suzanne Goh 18:09
Huge, huge benefits.

Dr. Mark Hyman 18:11
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Dr. Suzanne Goh 19:17
The 2nd category changes to the diet. 3rd related to that dietary supplementation.

Dr. Mark Hyman 19:22
Anyways, before you go in off the diet, go poke. Don't don't just, like, bump right over that. What role does the nutrition play? Cause I I wanna I wanna go slow with these 6 things because

Dr. Suzanne Goh 19:30
I think you've got

Dr. Mark Hyman 19:31
a lot in there that's really powerful and very unique. So What what is the role of nutrition and diet in autism?

Dr. Suzanne Goh 19:37
Well, there's a really very big role. I mean, there's a a very big role for a nutrition and diet in health for all humans. Yeah. Yeah. And for, in autism, there's a lot of interest in in diet.

There always has been. But I think some of that

Dr. Mark Hyman 19:53
interest just to be healthy, but as a therapeutic tool.

Dr. Suzanne Goh 19:55
Yes. Yeah. The emphasis in the past has been on various types of elimination diets. So diets where you remove something from, the diet.

Dr. Mark Hyman 20:05
Like gluten or dairy Yep. Which is almost common. Right?

Dr. Suzanne Goh 20:08
Yes. And then see how that might affect a child's behavior and their learning. What I found in clinical practice is that because many autistic children tend toward a more restricted diet anyway because of sensory Right.

Dr. Mark Hyman 20:23
Sensitivities. Right.

Dr. Suzanne Goh 20:24
Or what this reduced flexibility You know?

Dr. Mark Hyman 20:28
Yeah. Picky eaters, basically. Yeah.

Dr. Suzanne Goh 20:30
And so the diet often is very, very limited already to begin with. Mhmm. And also often limited to highly processed foods. So if you remove Mark

Dr. Mark Hyman 20:39
and cheese diet.

Dr. Suzanne Goh 20:40
That's right. Or a Goldfish or potato chips, French fries

Dr. Mark Hyman 20:43

Dr. Suzanne Goh 20:44
You know, a standard American diet, unfortunately. But if you remove something from a diet that's already very restricted, you risk some serious nutrient deficiencies. So we we find it's almost always a better approach to work on first expanding the diet. So expanding whole foods, nutrient, dense foods.

Dr. Mark Hyman 21:02
Like, you add. Right?

Dr. Suzanne Goh 21:03
Yeah. And so we have a nutrition and feeding program that's a collaboration between our medical providers and our feeding therapists, our speech therapists, our occupational therapists who help a child. So it's both what you eat, the nutrition side, and how to eat the feeding side. And then once you've, increased a child's diet, to a degree where you then feel comfortable eliminating things.

Dr. Mark Hyman 21:25
And there

Dr. Suzanne Goh 21:26
are a lot of elimination diets worth exploring.

Dr. Mark Hyman 21:29

Dr. Suzanne Goh 21:30
So we do know that, for example, celiac disease Yep. Gluten allergy is more common. It's actually a considered a co occurring condition. Yeah.

Dr. Mark Hyman 21:39
Isn't it like 6 or 17% of kids with autism have elevated gluten antibodies?

Dr. Suzanne Goh 21:44
I I don't know the exact percent.

Dr. Mark Hyman 21:45
Yeah. But

Dr. Suzanne Goh 21:46
The it definitely is more of forensics. It's Yeah. Yeah. It's more common in autism. And and the signs may be a little bit harder to detect.

Yeah. Also, in in child who has behavioral differences already who may may have a harder time communicating.

Dr. Mark Hyman 22:01
We call these co occurring or comorbidities, but that's really a false term. Now these are things that are all interrelated.

Dr. Suzanne Goh 22:06
They are very interrelated. Yeah. The it's been a huge step just to get to this to the stage of thinking of co occurring conditions. But you're right. Why why do they co occur?

Yeah. Because they all have common underpinnings.

Dr. Mark Hyman 22:18
Yeah. And the and the and the gluten triggers leaky gut, which creates, you know, inflammation in the body, then inflammation in the brain. So We know that that gluten can be really a problem for a lot of brain issues. Mhmm. So sometimes that's a big factor.

And then you can measure antibodies in these kids enough, and they're high. And you're just like, wow. I didn't know that. And you you see a big change when you get rid of it. I've seen this in my patients.

What about dairy?

Dr. Suzanne Goh 22:40
Yeah. So it was very interesting about dairy is that there's some research suggesting that, it can interfere with folate metabolism. Mhmm. Yeah. That's right.

So, so there are some tests available to look at a folate receptor antibodies, for example. Yes. And that was for years. I might be asking. On a dairy free diet.

So Yeah. All of that's very important information to get for a child.

Dr. Mark Hyman 23:04
Yes. So so what she just said in English for everybody was basically what happens when you eat dairy, There there are antibodies that form your immune system produces antibodies that attack the receptors for a vitamin called folate or folic acid. And this is a critical nutrient in regulating mitochondrial function, detoxification, neurotransmitter function, inflammation, glutathione production, It's so critical. It's called methylation. And when that doesn't work, and these kids almost all have these methylation issues, they get pretty significant dysfunction.

So, you know, what you're saying is it's not one thing. There's, like, no one thing to do, but there's many things to do that is personalized based on you find in each kit.

Dr. Suzanne Goh 23:43
Exactly. Exactly. And so you'd it means looking at a lot of things. You know, we we do pretty intensive, for with genetic testing because those genetic markers are very helpful information.

Dr. Mark Hyman 23:53
And just to be clear, the genetic markers are like, I have the gene for autism. It's this maybe you have these methylation genes that are off or glutathione genes or other genes that relate to oxidative stress or other that you're looking at. Right? Yep.

Dr. Suzanne Goh 24:05
Related to mitochondrial dysfunction genes that relate to ion channels in the brain and different. So, yes, there are a whole host of different genes that can be really informative.

Dr. Mark Hyman 24:15
And you can modify treatment based on those genes. Right?

Dr. Suzanne Goh 24:19
That's right.

Dr. Mark Hyman 24:19
They're not fixed. You can actually improve their function by giving them nutrients or changing different things in their diet or lifestyle or environment or maybe medications. Right?

Dr. Suzanne Goh 24:28
That's also a huge misconception. I sometimes parents will say to me, well, why should we test genes? We can't change them. Well, we can change the effects the genes have. We can influence gene expression.

Dr. Mark Hyman 24:39

Dr. Suzanne Goh 24:39
And there are, as you know, lots of technologies now that actually do change genes in various ways. And so it's that the the future of, gene mod modification gene therapy is on the horizon. And

Dr. Mark Hyman 24:50
Yeah. Pretty exciting.

Dr. Suzanne Goh 24:51
Yeah. Yeah. So you

Dr. Mark Hyman 24:53
combine these sort of sort of genetic testing with Yeah. Other things that look at nutritional factors and dietary testing.

Dr. Suzanne Goh 25:00

Dr. Mark Hyman 25:01
So you mentioned, set up the spend the whole time to die because I I think that plays real. I actually had a kid. I remember who, you know, many kids respond to gluten dairy free diets, and you're right. You have to add in real food. You have to kinda get That's really important point.

But but, one kid was really violent. He was, like, a a eight year old autistic kid and was just really aggressive, really violent. The parents didn't want to do. I said, well, Why don't we try ketogenic diet? And they did.

He ate it and completely changed him. Oh. Completely changed him. Became more normal, no violence, got Mark speech. You know, all the autistic features kinda regressed.

I wouldn't say he was perfectly normal, but he went he went from, like, a non functioning, non, verbal kid to a more kind of normal kid. And and so, you know, that that taught me a lot. It's like, wow, you know, these these kids something in these kids' diets can be playing a role.

Dr. Suzanne Goh 25:53
Yes. Well, diet, I mean, just has such a profound influence on the body's metabolism, biochemistry

Dr. Mark Hyman 25:59

Dr. Suzanne Goh 25:59
And therefore behavior and learning.

Dr. Mark Hyman 26:01
And Yeah.

Dr. Suzanne Goh 26:01
So it's it's hugely important, but it's also an area that can be hard to to change.

Dr. Mark Hyman 26:05
Change is very hard. Yeah. Particularly is kids because they're so picky. Yeah. You mentioned the next step which Mark supplements.

Dr. Suzanne Goh 26:11
Yeah. So dietary supplementation, can be very impactful as well. So, there's so much to potentially say about this area too. But I think as it relates to, you know, my area of specialization around mitochondrial function, There are, a lot of blood tests that we can do to look at, to give us insight into a person's mitochondrial function. Or Like, carnitine level.

Co enzyme q 10. Yeah. Liver function, lactic acid, mesal carnitine profiles, urinorganic acids, amino acids, Yeah. So there are a lot of markers A lot

Dr. Mark Hyman 26:45
of what you're gonna get at your typical checkout with your regular doctor. So if you go to your regular neurologist, they're not gonna know what you're talking about. But but there are biologists and doctors like you were around the country and your centers do all this, which is really revolutionary.

Dr. Suzanne Goh 26:56
And fortunately, more and more, you know, I think the based because the research has has really

Dr. Mark Hyman 27:01
Cut up.

Dr. Suzanne Goh 27:02
Yes. So there's more awareness now, but it's still, you're right. It's still work in progress.

Dr. Mark Hyman 27:06
So you're actually testing their mitochondrial function through tests that are available.

Dr. Suzanne Goh 27:11

Dr. Mark Hyman 27:11
And then you're customizing the treatment based on what

Dr. Suzanne Goh 27:14
you find. That's exactly Right? So, for example, if there are levels that are low so so, you know, there's so much, you know, mitochondria Mark are complex. You gave a really nice description earlier. So they they, you know, one of their major functions is to fuel the body.

They were sort of an energy currency or a powerhouse. But there are things like, low carnitine levels or, even, supplementation with carnitine, supplementation with creatine, It's

Dr. Mark Hyman 27:41
like what bodybuilders use. Yes. But it's a mitochondrial cofactor.

Dr. Suzanne Goh 27:44
Mhmm. B vitamins. Yep. It can be really helpful antioxidant vitamins. So there are dozens of different dietary supplements that we might think about for a particular child that could help help a lot with, with their learning and their development.

Dr. Mark Hyman 27:58
I know. And and when I first learned about your work, I, you know, I read some of your papers that looked at brain imaging. Mhmm. And the metabolic function of the brain, meaning the mitochondrial function of the brain, and you're some of the first to show, in addition, neuroinflammation, there was mitochondrial dysfunction.

Dr. Suzanne Goh 28:12

Dr. Mark Hyman 28:13
And that led you to kinda go, well, maybe if we tried to correct some of these mitochondrial pathways, which we learn about, you know, with these inherited metabolic mitochondrial diseases that are really rare. You actually could help these kids. It was a hypothesis, and you actually studied it, and it worked. Yes. And so tell us a story about what what you've done in in a patient that you know, use this approach for diet and mitochondrial therapy.

Dr. Suzanne Goh 28:37

Dr. Mark Hyman 28:37
And what what do you find?

Dr. Suzanne Goh 28:38
Well, there are some, so myocardial dysfunction is actually very common in many different neurological conditions, very common in autism. There are now research studies showing that in blood, in muscle in brain. So some of the research that we did using brain imaging, showed patterns of which parts of the brain, even are affected by mitochondrial dysfunction in them. And, and then there's also, a lot of research showing the value of certain supplements like the ones I mentioned and and many others. And so as part of You

Dr. Mark Hyman 29:11
mean supplements just don't cause expensive urine, most doctors say.

Dr. Suzanne Goh 29:16
No. They can for the when they're matched, when you have the right supplement for the right person.

Dr. Mark Hyman 29:20
Exactly. Right. They can just Personalized nutrition.

Dr. Suzanne Goh 29:22
Yeah. Yeah.

Dr. Mark Hyman 29:23
So So You use these compounds in Yeah.

Dr. Suzanne Goh 29:26
So so as an example, you know, children, there's, a pattern of regression, developmental is quite common in autism Mhmm. Where a child loses developmental skills. As you can imagine, it's it's really frightening, you know, for parents see, very often that regression in autism happens between 18 months to 3 years of age. Mhmm. And it also is often associated with what we think of in medicine as a physiological stressor.

So, you know, an illness of some kind or a surgical procedure or even something like starting a new school or new day care or the birth of a sibling or moving moving to a new city.

Dr. Mark Hyman 30:04
So I'm I'm gonna jump into a really, controversial topic. Which I'm sure you know is is coming that, I've seen in my practice and is is, is almost heresy to say in medicine, but you know, is there a role of vaccines in in maybe being one of these triggers? And the reason I say that is I had a a kid who was, 22 months perfectly normal kid. His mother worked for a major pharmaceutical company, and he had a vaccine at 15 months, and started to progress and lost all his developmental milestones became non verbal and fully autistic. And, you know, and and so I I don't know if that was a cause, but it was it was a moment where things and I've heard the story so many times from so many patients that there's gotta be something there.

And I'm not seeing vaccines cause autism, but Yeah. They they may affect a kid who's vulnerable. Mhmm. Because this kid, you know, typically see they're born by C section. They don't breastfeed.

They've had lots of ear infections. They've had lots of antibiotics and microbiomes messed up. So they're kinda sitting ducks and maybe they have all these polygenic risks for getting into trouble when they have

Dr. Suzanne Goh 31:14
an insult.

Dr. Mark Hyman 31:15
So it could could this play a role? What's what's your take on this?

Dr. Suzanne Goh 31:18
Well, I will say and you're right. Vaccines is a topic that unfortunately is so polarized thing

Dr. Mark Hyman 31:23

Dr. Suzanne Goh 31:23
In autism.

Dr. Mark Hyman 31:24
Pro Library. Like, it's so

Dr. Suzanne Goh 31:26
it's like, it's

Dr. Mark Hyman 31:26
not really it's not religion. Let's talk about the science. You know?

Dr. Suzanne Goh 31:29
So it it is an area where I certainly wish there could be much more open discussion and and less controversy, less heated, debates. But I will say, you know, when it comes from the point of view of mitochondria, it actually a stressor is a stressor. You know? And, like, all this that I just mentioned, whether it's a psychosocial stressor, you know, or, whether it's an illness, In many ways, the mitochondria respond in the same way. Yep.

So, and I think as physicians, we all have very, when a patient comes to us and the the parents have observed something, we really I I think it's important believe. It's important to believe the parents and what they've seen and understand their experience. And then to really That's

Dr. Mark Hyman 32:18
a radical idea as a doctor. We know how it's supposed to go. So That doesn't fit my theory. So it's not relevant. But, actually, it may be very relevant.

Dr. Suzanne Goh 32:26
I think now doctors are partners. Doctors shouldn't be viewed as authorities or those who have the answers.

Dr. Mark Hyman 32:32

Dr. Suzanne Goh 32:32
So yeah. So, yeah. So when when especially when children go through a period of developmental plateau or regression. For it is a red flag. It is an emergency.

And so I think of, you know, there's a terminology. Time is brain.

Dr. Mark Hyman 32:52
Time is brain.

Dr. Suzanne Goh 32:52
Is brain. Mhmm. And it first developed around stroke to get people to act more urgently around stroke. But I think time's brain really applies also to autism.

Dr. Mark Hyman 33:04

Dr. Suzanne Goh 33:05
And why is it that a child might be diagnosed with a thought? Sometimes a child will have the first signs of autism at a year or 18 months.

Dr. Mark Hyman 33:11

Dr. Suzanne Goh 33:11
Not get a diagnosis until they're 3 or 4. Yeah. Knock any medical testing until they're 6, 7, or 8, or 15, or 21, I've certainly seen I know you've seen that too. And so we have to be much more quick to identify when the brain is struggling, when it's not getting the energy it needs, when it's, under excessive stress, and then be much more quick to act. And Action means doing the appropriate tests and then taking steps in lifestyle changes, dietary changes, dietary supplementation, or some kind of very interesting newer approaches like neuromodulation.

So there are different ways of using electrical and magnetic stimulation. To to improve brain function. There are certainly medications, but not just, you

Dr. Mark Hyman 33:58
know Doctor Barrett oxygen, I've seen you

Dr. Suzanne Goh 34:00
Yeah. There Mark there are variety of some some of these novel interventions that, are really exciting. So, in the in the area of neuromodulation, One that we use is, a form of tiny microcurrent electrical stimulation that stimulates the vagus nerve, which is the major nerve of the body of the parasympathetic nervous system. And we know that it helps to then counter the body's chronic stress response. Yeah.

And sympathetic overstimulation, which is so common, you know, in in many, conditions and including autism. So that's yet another really exciting category. And then the final one of the 6 is what I call developmental behavioral approaches. This is a huge, huge category, including things like occupational therapy, speech therapy, dance movement therapy, art therapy. You know, it's all these ways that we can teach children, and create those, you know, learning opportunities.

Dr. Mark Hyman 34:57
Yeah. I mean, all this is just so important. And your book, Magnificent Mines, which has just come out. It's it's really a a incredible contribution to the field from someone who's really in the weeds on this. And not just sort of a kind of fringe doctor, but someone who's trained in top institutions who's doing really hardcore research and has actually found the things that I I I'm so happy to talk to you because, you know, for decades, I've been out there doing this.

Seeing these patients kind of in the wilderness, seeing the smoke signals in the scientific literature that were pointing in this direction, actually paying attention to what was being found in these patients. They would come to Malawi. I don't know. I've really never treated autism before, but You want to try. Let's work together and see what we find.

And we started digging. We do talks and load testing. We're looking at heavy metals. We'll look at microbiome in the gut. We'll look at mitochondrial function, nutritional levels, genetics, and we'll start to look at inflammatory pathways to see all these things going on.

And then start to just kind of, like, tailor it to meet the patient's particular unique set of findings And these kids, you know, would come back from oblivion. I mean, it literally would come back from being completely locked in kinda locked in. I mean, the the extreme case of autism or, like, they're locked in. A lot of people walk around with Asperger's like Elon Musk. I mean, but but there there there's, like, kids who are just locked in.

They can't talk They can't communicate. They have no social skills. They can't really function very well. And to see these kids come out of that is a miracle. Now now we we don't think there's, quote, survivors of autism, but, there are.

So can you talk about that?

Dr. Suzanne Goh 36:35
Yeah. Well, we know There's a certain percentage of children who are diagnosed with autism. There's a certain percent depending on what research study you look at it varies, but it's probably somewhere around 10%. Who, over time, lose the diagnosis of autism, meaning they no longer meet those diagnostic criteria.

Dr. Mark Hyman 36:52
Just naturally?

Dr. Suzanne Goh 36:53
Yes. Without treatment. No with with treatment. With treatment. Yeah.

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

Dr. Mark Hyman 37:05
No. I had a case. It was this it was this case I was telling you about from this this little boy. It was 22 months when I saw him, and he started getting regressive autism at 15 months. And and, you know, we looked at his gut.

And these kids typically have really smelly, stinky, bad poops, constipation, and They have really bad dysbiosis. They have usually bacterial or used overgrowth, which affects them in many ways because the metabolized from the microbiome caused brain inflammation and leaky gut. He had, you know, organic acids. He had really significant mitochondrial dysfunction. He had, got inflammation with elevated calprotectin, which is a biomarker used for colitis.

It was but he didn't really have colitis. And we found all these methylation genes with ion genes were abnormal. We found, you know, elevated levels of of of, heavy metals like mercury and lead, And and so we basically just built a program to address the things that we found. I wasn't treating autism. I was basically helping his basic systems get back in balance.

And, you know, within 10 months, this kid just dramatically changed. We redid all these biomarkers almost completely reversed most of them. The mercury in was a little longer to get out of his system. And, you know, the kid became completely normal. And, you know, father sent me this video of him when he was ten years old, just playing baseball and being a normal kid.

And I was like, and this kid when he came into my office, you know, just wasn't verbal, wasn't talking, was just sitting on the floor, steaming himself. And I'm like, if it's possible once, like, if it's possible just one time, Shouldn't the entire scientific community, the NIH, and scientists be going, what is going on here? How do how do we take this insight. And actually Yeah. It's true.

One patient could be between another and another and another. So that's kind of the work you've done. It's really tried to sort of make what has been really on the margins of medicine Mhmm. Central to how we think about autism. And it's really revolutionary.

Dr. Suzanne Goh 39:00
Well, you know, so many of the the basic principles that in medicine are foundational, it's really applying them to autism. Yeah. And and seeing the power that that has.

Dr. Mark Hyman 39:13
So Yeah. Like, one one example that I read about, which I thought was crazy but and it sounds crazy, but it's fecal transplants.

Dr. Suzanne Goh 39:19

Dr. Mark Hyman 39:20
You know, do you know anything about fecal transplants where they take the poop out of a healthy kid and put it in a kid with autism and what it does?

Dr. Suzanne Goh 39:25
Well, I know about the research studies that have been done. And, in my own practice, the patients of mine who have had it done, who have gone most who have participated in research study. And so I've been able to see the the changes.

Dr. Mark Hyman 39:37
And what do you see?

Dr. Suzanne Goh 39:38
Yeah. Well, it varies, but in some some children, no change. But in other children, their stool quality improves

Dr. Mark Hyman 39:46
dramatically, language, communication, social

Dr. Suzanne Goh 39:46
skills, learning behavior, so the, attention. Yeah. So, in some children where that's an important factor. It really can can change things because we know the microbiome has a profound influence on on the brain. And so it can, yeah, It can really lead to some some dramatic improvements.


Dr. Mark Hyman 40:14
It's pretty amazing. And I think, you know, like I said at the beginning, our 95% of these kids have some type of gut dysfunction. And yet, you know, typical neurologist will not even pay attention to that. Well, that's their gut or whatever. It's not the brain.

Dr. Suzanne Goh 40:27
Yeah. But

Dr. Mark Hyman 40:27
it's one system. Right? And so your work has really helped us to understand that whole child approach. And that's what you write about in magnificent minds, which Definitely everybody should get a copy. And if you know anybody with autism or have a friend or a kid or, in in any way or connected to anyone, this is gonna be a profound frame shift and how to think about the disease and how to think about treatment.

Because because it's kind of a hopeless condition. I mean, this this woman I was telling you about who brought her kid in, was basically told, well, your kids got autism due to behavioral therapy. He's gonna be institutionalized. We're sorry. Good luck.

You know, and that's the message a lot of parents get. And it's it's really disheartening and he's, you know, I think I think, How how do you see this approach sort of getting more traction in medicine? I mean, you you're doing the research. You're pushing this out there. You've created these clinics all around the country with Cortica, but Are you seeing your colleagues start to wake up and pay attention and start to incorporate some of these things?

Dr. Suzanne Goh 41:22
Yes. I mean, what's really been a a very positive change in our field is that there is a lot more understanding of the medical basis of autism. And, Another really exciting, I think, direction for the field is that even those, you know, I so I self, I'm a behavioral analyst, I'm a BCBA. And the field of ABA therapists, even within that, discipline, there lot more recognition of the medical basis and the medical contributors to autism. And so a lot more collaboration partnerships are happening between behavior specialists and medical specialists.

And I think it's our job to to teach, you know, to to spread the word to make more known about the what the research really does show now. And, and so the way that we at Cortic Mark trying to do this is to 1st grow our team. You know, to set up more clinics, to serve more and more families, and to publish research. So we have a a part of Cortica is our Cortica Innovation Network. And we conduct clinical trials.

Dr. Mark Hyman 42:30

Dr. Suzanne Goh 42:30
So we've done over a dozen clinical trials already. Some looking at, you know, interventions for the gut. Others looking even looking at, virtual reality. So we're looking at a virtual reality platform to to enhance behavior therapy. But it's really, about contributing to the research and then also making the quality, the standard of clinical care available to as many families as possible.

Dr. Mark Hyman 42:55
Yeah. I mean, you know, the clinical research, I'd love to explore with you a little bit because, you know, one of the challenges I I encountered this one as a Cleveland Clinic. We wanted to study dementia, which, you know, I think autism and Alzheimer's are almost two sides of the same coin. We see a lot of the same biological things going wrong. Gut issues, mitochondrial issues, neuroinflammation, methylation issues, detox issues, toxic fluid.

I mean, it's just I I I I'm a family doctor, and I'm basically everybody from birth to death. And so I see the whole spectrum. Yeah. And I was seeing these patterns of, like, this similar phenomena in many different brain disorders. So, anyway, I was at Cleveland Clinic, and I was we were trying to do a research project on Alzheimer's.

And dementia, we were working with the leading neurologist there who was in charge of the Alzheimer's Clinic And he got this. He understood all this, but we went to the head of research. And, she said, well, look, you know, you can't do everything at once. You have to study one thing at a time. You wanna study diet.

You wanna study this vitamin. You wanna study this approach. You wanna and I'm like, well, Actually, that's not really how the body works. It's like you if you wanna treat a problem, you have to deal with all the factors that are causing and you can't just do one thing. So how do you kind of address your clinical trials?

Because you wanna optimize their diet. You wanna optimize their nutritional You wanna fix their mitochondria. You wanna fix their gut. You wanna reduce inflammation. You wanna detox their bodies from toxic clothe.

You wanna do the behavioral therapies. All of it's needed. Right. You can't just do one thing. Yeah.

So how are you approaching clinical research using this? Because it's it's you you won't see the result Like, you see one thing. You might not see a thing.

Dr. Suzanne Goh 44:26
It's a real challenge. Yeah. It's a real challenge. And it's it's one of the reasons I think that a lot of very promising therapies, autism, have have not made it past those early clinical trials. Yeah.

Because we're not sure. Maybe we're we're isolating. Yeah. Therapy. And in fact, we need a a set of therapies together.

Dr. Mark Hyman 44:42

Dr. Suzanne Goh 44:43
Or we're not, selecting the right children. There's, you know, phenotyping type differences. So maybe some subgroups will respond to another's phone, but we don't so we don't right? We're we're a bit stuck.

Dr. Mark Hyman 44:52
Yeah. Yeah. We don't have a vitamin D deficiency. Vitamin D doesn't do anything. Right?

Yeah. So you have you have to have If you're mitochondrial, great. Well, you can always mitochondrial therapy. So not gonna see

Dr. Suzanne Goh 45:00
a change. Right. Right. So we're doing 2 things. One is, yes, we're we're studying, novel, you know, innovative therapies for autism, in our, research program and clinical trials and doing our best to select appropriate subgroups And, and recognize that, you know, by isolating certain therapies, maybe we're then missing out, you know, the benefits they could have.

But we're trying to contribute to the to that part of the innovation in the field. Simultaneously, what we're doing is we're studying our own population of children who are getting whole child comprehensive care. Where we as clinicians are able to use all of the tools at our disposal and we're tracking outcomes in a very careful holistic way. Comparing them to community standard of care.

Dr. Mark Hyman 45:44

Dr. Suzanne Goh 45:45
And the initial data we have in over 800 children already shows, much more rapid progress. Yes.

Dr. Mark Hyman 45:50
That's amazing.

Dr. Suzanne Goh 45:51
On, you know, the Vineland scale, for example. So some of these standardized assessments, they're very well accepted in the field. We're seeing better power with the whole child model.

Dr. Mark Hyman 45:58
That's amazing. So you're publishing this data. We'll link to some of the research papers that you published. I think you worked just so important because it It it's it's it's not just around autism because chronic disease in general has multiple causes and need multiple types of therapies which you basically laid out as a treatment model for a whole child autism care, but it really applies to anything that you have as a chronic cause for the autoimmune disease or whether dementia or heart disease or diabetes. These are things that that all are very similar at the root root cause.

And and and and there are inflammatory issues. There's gut issues. There's mic mitochondrial issues. There's detoxification issues. There's hormonal regulation, things.

These are things that we we deal with all the time in functional medicine. But but are not really recognized as features that that should be looked at even And, you know, one of the we were talking earlier before the podcast about my mentor, Sydney Baker, who's really, I think, one of the leading thinkers in medicine in the 20th century You know, he said there there's certain principles. Right? You know, take out the bad stuff, put in the good stuff, which essentially what you're doing. But but then he also said there's the attack rules.

If you're standing on attack, taking one out doesn't make you 50% better. So, basically, if you are gluten sensitive and you're having all this in your inflammation from gluten and give mitochondrial therapy because the mitochondria networking, the patient probably won't get better. Right? The other rule is if you're standing on 2 attacks, taking one of them out doesn't make you 50% better. You gotta get rid of all the tax.

And so that's the problem with traditional medicine is we just do one pack at a time and try to see the difference, but we have to do this multimodal interventions. Yeah. Because we have multiple factors and multiple causes.

Dr. Suzanne Goh 47:36
Yeah. Yeah. So interesting. So how that translates into, my clinical practice is that there are times where so as you know, in in a lot of medicine, the approach will be try one thing, see if it helps. It doesn't take it away.

Try something else. It's like one at a time kinda But, really, what I found is sometimes you have to do many things at once, get the child to a better place, and then maybe slowly remove one at a time. What they really need and what they don't do.

Dr. Mark Hyman 48:03
Exactly. Right. That's kinda how my approach is. Like, how do you hit the factory reset button? Yeah.

And, like, or when your computer's just, like, on the Fritz. You wanna just hit restart?

Dr. Suzanne Goh 48:11

Dr. Mark Hyman 48:12
How do you do that? And I think it it is to me, you know. Yeah. I think You know, what I've seen clinically, and it's not always easy for people to do is the more intensive initial therapy we can do. You'll see a massive change Right?

So if someone's drinking 12 cokes a day and you have them drink 6 cokes a day, not probably gonna help them that much. Right? So you you really you and so I tend to do, an approach that really eliminates a lot of the bad food ads and all the good food optimizes all these basic systems Yeah. And then see what happens and see what's left over. And then you can start to add things back and kind of adjust.

But that seems like what you found as well.

Dr. Suzanne Goh 48:51
Yeah. And I will say You know, one of the one thing to keep an eye on too with with fam with families when autism is is part of their experience is, there are many potential places to start. And sometimes there's some family who can and wanna do it all at once and will do well with that approach. And then others for whom they're already in a state of stress, maybe things of home are fragile, maybe resources are constrained. Yeah.

Sure. And so for me, it's very important to meet them where they're at and say, we're weird with do they feel comfortable and confident starting? And we can start there.

Dr. Mark Hyman 49:28

Dr. Suzanne Goh 49:29
You know? And these other pieces are important, and we'll get to them. So it very much is about tailoring, not just to the child, but to the family. Yeah.

Dr. Mark Hyman 49:35
I know. I know. I mean, I had autism in my own family, you know, my my cousin who was about a year or so older than I was when I was growing up. I was fully autistic. And, back then, there wasn't that many cases of it, but this is in the early sixties.

And I got to witness, you know, the difficulties that No. We're experienced by his family, by my aunt and uncle, and how tough that was for them and how, you know, the care they had to give him and disrupted their own lives and you know, a lot of the work you do also helps really this whole family approach. It's not just about the biology. It's also about the social fabric that they live in, about how to how to help the parents and help sort of greater ecosystem the kid lives in. So would you mind just chatting a little bit about that?

Cause I think it's it's an important piece because in order for actually people to follow these things. It's, you know, and that's a part of the problem with autism. The interventions can be challenging. You better add this, take that, take these supplements, change the diet, do these therapies, you know, detox from this, picture god. It's like, it's a lot of work.

Dr. Suzanne Goh 50:33
Yeah. It is a lot of work.

Dr. Mark Hyman 50:35
Yeah. And and so it's hard on families.

Dr. Suzanne Goh 50:36
Yeah. Well, I There's a a young man by the name of Joy Fleming who, is a a young autistic man who's also a Rhodes scholar. Wow. So I I had the opportunity, the great privilege to to meet with him and talk with him. And, and he provided a, a quote for my book saying that he wished he had had this information as he was growing up because it would have helped him to understand himself.

And then his mother also provided a quote saying she wish she had had this information when Jory was a boy.

Dr. Mark Hyman 51:08

Dr. Suzanne Goh 51:08
And that was for me the most meaningful feedback I could have got because really the idea behind all of this knowledge and the reason for me for putting the time and effort into writing magnificent minds was to empower autistic people and those who love them. And so I think this knowledge in the hands of parents will be so powerful because it sets them off wherever they are in the journey, I think it will equip them to to find ways to enhance their loved one's health well-being and ultimately to bring more joy into life.

Dr. Mark Hyman 51:42
Yeah. I mean, it's It's such a hard diagnosis. It's, you know, it just breaks my heart when I see, you know, families and parents have to deal with this. You know, my sister had a kid who who, you know, was on the spectrum and and the challenges he's had. It's it's been hard to watch and how little services we have, how little understanding we have, how Few practitioners actually understand how to approach this in a more systemic way.

And, you know, your your work is just it's just so pioneering, and it's it's so heartening because there's a bunch of us crazy people have been on the fringe doing this for a long time, but to have someone in your pedigree and your training and your expertise to kinda dive deep into the science and actually show that this there is a biological basis to this. It's not just refrigerator mothers or bad parenting or You know, and it's complex. It's not it's not one thing. You know? And and then sort of you mentioned, you know, the the mitochondrion, you know, are are kind of the the the the the the the the organelle and the cells that that seem to be the victims of a lot of insults.

Right? So they're they're in kind of an effect not necessarily a cause.

Dr. Suzanne Goh 52:45
That's right.

Dr. Mark Hyman 52:45
So so I think, you know

Dr. Suzanne Goh 52:47

Dr. Mark Hyman 52:47
That's right. I would love to speak for a minute with you. What what you think are the major causes. We talked briefly about it, but know, I I have my own theories, but I I love to sort of see, you know, it's obviously interplay between genetics and environment. One of the one of the biggest causes that are being revealed in the literature and in your experience that that maybe triggers for autism.

Dr. Suzanne Goh 53:05
Yeah. Well, ultimately, there's, you know, term complex gene environment interactions, I think captures most of it. And as you were asking that question, my mind immediately went to a a slide that I have in some of my presentations that is so where it's so well laid out. And this is from a research article in a very reputable you know, peer reviewed journal.

Dr. Mark Hyman 53:27

Dr. Suzanne Goh 53:28
An understanding of the brain and autism and then all of the different factors, you know, there's like a dozen different arrows, you know, that kind of can can then influence, how that brain is is functioning. But, I do think that the concept of load,

Dr. Mark Hyman 53:45

Dr. Suzanne Goh 53:45
know, the overall burden, like, what are all the things that a brain, which is so fragile and vulnerable and it, you know, so easily influenced. What are all the the different things that are affecting it? And then what resilience does it have? Like, what what maybe protective fact or what does it have in his favor? And it really is that delicate balance.

So, you know, it's a hue, a lot of different genetic factors that influence things like the brain's neurochemistry

Dr. Mark Hyman 54:14

Dr. Suzanne Goh 54:14
Electrical patterns of firing. And Could

Dr. Mark Hyman 54:19
be more prone to inflammation?

Dr. Suzanne Goh 54:20
Yes. Inflammatory, how inflammation and and metabolism even the genetic factors around the gut, all of those set up the brain substrate in a way. And then

Dr. Mark Hyman 54:34
vulnerable brain.

Dr. Suzanne Goh 54:35
Yes. And then what is the environment presenting the brain with? And it could be in the form of, unfortunately, you know, toxins in our environment various other types of

Dr. Mark Hyman 54:46
creditors, inspections.

Dr. Suzanne Goh 54:48
Well, there are well, we know, for example, led heavy, certain heavy metals. We also know that there there was a very, influential research study out of Harvard School Public Health about 10 years ago, showing that there were over a dozen different industrial chemicals. So so pesticides, things that are widespread in our environment, that are now even detectable in cord blood.

Dr. Mark Hyman 55:13
Yeah. You

Dr. Suzanne Goh 55:13
know, so they're in our bodies.

Dr. Mark Hyman 55:14
This was, I think, this was, the environmental working group did a study, like, 10 newborn studies. It was 287 don't toxins. And I think 210 or something were neurotoxin.

Dr. Suzanne Goh 55:24
And that these are all being used without first being tested on Yeah. You know, for their developmental effects. So, and a lot of these, we know that they, have an effect on mitochondria. Like, that is you know, pesticides, for example, they're neurotoxins. That's how they kill, pests.


Dr. Mark Hyman 55:46

Dr. Suzanne Goh 55:47
So so really, it it is a complex interplay of all those factors.

Dr. Mark Hyman 55:51
Yeah. It is. It's true. And you never know what it's gonna be. I remember what kid I had with autism.

Hyman, you know, it turned out we did a stool test, and he had giardia. Oh. And I gave him a drug that we used to treat giardia called flagel, and it's like a parasite. And The kid woke up. I was like, wow.

That was easy. You know? Yeah. Sometimes there's something simple like that, or it could be a kid who's really sensitive to gluten. And sometimes it's just one big thing.

Yeah. But often, you know, it's a it's a it's a load of it's the total load concept, which is really important that we don't really think much about in medicine. We're looking for that silver bullet, that one explanation, that one pathway that one target of a receptor to work on her Medicaid, but it's just not on the body's design. So we kinda have to rejigger our whole paradigm.

Dr. Suzanne Goh 56:32
It's all connect Yeah. It's all connected.

Dr. Mark Hyman 56:34
It's all connected. Wow. Well, Suzanne, your your work is just so inspiring. I've been following you for years. Your book, Magnificent Mind, the new whole child approach to autism is out now.

Everybody should, for sure, get a copy. And they should check out your centers if if they have any family members or anybody who is struggling with autism that they know. It's Cortica, c o r t I c a. You can find it online along with her work. Doctor Sands goes website is doctor suzannegogh.comforward/magnificentdashmines.

If you wanna check out our book, you can get everywhere. Thank you so much for what you've done and what you're doing and what you keep doing to help us understand this very perplexing condition that I think for the first time is being actually understood. And then we provide a window into the rest of medicine. So thanks so much for everything you do. Any final thoughts or words you wanna share with families or the audience

Dr. Suzanne Goh 57:27
Oh, just to say there's, well, thank you, Mark. It's, just wonderful to have this time with you, and I've learned so much from you. And I I think as a closing thought, often autism is framed as, tragedy. And I just wanna say when you really get to know autistic individuals and their stories. These are triumphs, not tragedies.

And so there's so much, to be celebrated and so much that we can do. And so I think it's really a message of hope.

Dr. Mark Hyman 57:57
Yeah. And and and they can have extraordinary skills. Right? They like they can be genius levels or anything. Like, my My nephew is is an incredible musician and can listen to a song and just sit down and play it on the piano and Amazing.

Can't read music, but he just knows It's quite it's quite remarkable. So

Dr. Suzanne Goh 58:13
It gives such insight into the brain. The the remarkable things the brain

Dr. Mark Hyman 58:17
can do. Yeah. It's it's really just a whole new frontier of understanding the brain for the first time. So Thanks again for being on the podcast, and we'll get you back on when we have more to talk about.

Dr. Suzanne Goh 58:25
Thank you.

Dr. Mark Hyman 58:27
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