In this episode, Harold Reitman, M.D. speaks with Derrick MacFabe, M.D., assistant professor and director of The Kilee Patchell-Evans Autism Research Group. Dr. MacFabe discusses his findings regarding the influence of gut bacteria over brain activity, how controlling and adjusting them could mitigate negative symptoms related to autism and other neurodiverse conditions, and how doing so might start with even simple adjustments to a diet.
For more information about Dr. MacFabe, and to find out more about The Kilee Patchell-Evans Autism Research Group, visit: www.kpearg.com
An historical review of their work, by Dr. MacFabe: http://www.ncbi.nlm.nih.gov/pubmed/24416709
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HACKIE REITMAN, M.D. (HR)
Hi, I’m Dr. Hackie Reitman, welcome to another episode of Exploring Different Brains. Today we are delighted to be talking with my new friend from up in Canada–Ontario to be specific–Dr. Derrick MacFabe, and I’m going to have to read this because Derrick’s got a lot of stuff going on. He’s the assistant professor of the Kilee Patchell-Evans autism research group; departments of psychology, neuroscience and psychiatry division of developmental disabilities at the Schulich School of Medicine and Dentistry in Ontario, Canada. He’s also a core member of the I Target Autism Initiative at the University of British Columbia. Derrick’s research examines the role of the gut-brain interactions on the identification and possible treatments of autism spectrum disorders. And he does a lot of other stuff too. Derrick, welcome. Welcome to Exploring Different Brains.
DERRICK MACFABE, M.D. (DM)
It’s a great pleasure to be here, Hackie. Thanks for having me.
Please introduce yourself to our Different Brains audience today.
Hi, my name is Dr. Derrick MacFabe, I am the assistant professor and director of the Kilee Patchell-Evans Autism Research Group at the University of Western Ontario in London, Ontario, Canada. This is a multi-disciplinary research group that has been looking at the impact of environment–specifically largely gut bacteria and diet–on the causes of treatments of autism spectrum disorders. My background is in basic science and clinical neurological sciences in neurology.
Now look, let’s cut right to the chase. Before I met you through Dr. Steve Perlman of the AADMD, I had no clue as to this whole gut-brain thing going on. And it really opened my eyes, not only to the gut-brain, but also to all of the factors that go into the rewiring of our brain. So why don’t you tell our audience about the gut-brain and where you’re coming from on this, and say it a lot more articulately than I did.
You’re too kind. You’re not alone. This was a very emerging field in developmental disorders, particularly autism. and a lot of the implications of the link between the gut and the brain, parents were actually telling us for years. And they were saying particularly in cases with autism. That a good sub group of these children. When they were young, they had a lot of gut issues. They didn’t know why, but then as their gut issues got worse, a lot of their children’s behaviors got worse. They had constipation and diarrhea, bizarre food cravings–they’d eat things like bread and pizza dough and sweets–it’s an exclusion of all else–and their behaviors got worse. And their autism-associated symptoms got worse–including their gut pain, their sleep disturbances and everything. And some people empirically just sort of said, “You know, maybe if we change their diets, some of these kids might improve.” And they did.
But the key question was they didn’t know how. How could something in your gut effect your brain? Was it just that they had an upset stomach? We didn’t think so. There was a lot of emerging research, understanding–in the last 10 or 15 years understanding that we’re not alone. We have gut microbes that outnumber our cells 10 to 1. And now what we’re finding the nervous system of the gut is as big as all the nerves in your spinal cord. And a lot of research now is from fields that you would never believe related to neurology and psychiatry: Microbiology, infectious disease, immunology. What we’re finding out is these bugs might be partly running the show. What we know is they affect our brain development, our immune system, how we interact with the outside world, what we consider to be foreign or good for us, and a lot of work that we found is that when we eat and feed these bacteria, their waste products are actually tinkering around with our brain development, our energy function, and even our behavior. So again, the families were telling us this link, but there wasn’t the technology and the good science done to try to figure out what was happening. And this gut’s burned on. As you all know, with the disease of autism that was 1 in 10,000 in the 1950’s. And when we started the Kilee Patchell Evans autism research group in 2004–it was 1 in 180. And now were talking its 1 in 50. So something is going on that cannot just be explained by genetics. And so we started, in our small way, to focus how could things in the gut, specifically gut bacteria, contribute to autism and autism-associated symptoms.
Not only how we get autism, but how do the folks that have autism now who suffer tremendously, as you well know, in spite of having very good restricted interests, and even being gifted in some way, they have huge anxiety. Huge depression. They have huge problems with their gut, and they suffer a lot. As you well know, they have higher incidences of depression–event a recent study on suicide–and a lot of us have to not only deal with the causes of autism but also help the folks that are here live a better life. Because a lot of the symptoms they’re having are drastically impairing their ability to have a good life.
So the first pearl we hear from you is what I used to tell the first year medical students and Boston University for 36 years when I commuted up there from Florida–is listen to your patient. The patient and the parents and the family. Listen to them. Even if you’re a dumb orthopedic surgeon like me, listen to what they have to say. So that’s number one. As you say, they’ve been telling us and we haven’t been listening. Number two is the whole concept of neuroplasticity, that our brains–at any age, but especially when you’re younger–but at any age, they have the ability–they do in fact actually physically rewire themselves. And that, in the June 23rd article in the New York Times of last year in 2015, that was very heavily e-mailed for the New York Times–it was clear that some things up that Dr. Derrick MacFabe, you are onto. And that we’re talking about how the brain rewires itself.
So let’s step back a minute before we get further into the flora and the gut and the relationship to the brain–let’s try to welcome everybody–who is also–who also might be thinking it’s genetics, no its this environmental factor–no its vaccines–no, wait a minute. It’s all of the above everything has a role to play because were in an interactive world, and one of the problems I’m finding that a great neuroscientist who’s objective like you does not have, is you are welcoming all points of view, and we want to get everyone in the tent. That’s what we try to do at Different Brains. All of the neurodiversities, all the different theories, let’s take the good from each and try to figure it out. So now, I want from Dr. Derrick MacFabe, because you’re giving Nobel lectures over in Europe, you’re all over the world; tell us from your point of view before we go further into the gut-brain, how you see the big picture?
Well, you hit the nail on the head, because what’s been happening is you see an illness that’s 1 in 10,000 and gradually increasing, and, like we said, up to 1 in 30 in some populations. And the old way of just looking at autism; and again, it’s not people that are right or wrong. They’re looking at part of the picture. It’s like the blind man and the elephant. Experts who are in genetics, behavioral, all the other things we mentioned about immune system gut; they’re all giving a part of this illness, but the standard initial way of looking at this this was that this was just a hard wire condition, it’s largely genetic. You have genes from one or both parents and they contribute to kind of a hard-wiring issue. Nothing can change and the way to treat it is solely more behavioral effects or some medications that we use to help some of the symptoms. They help with aggression; they help with irritability; they don’t do a lot for the behavioral effects. And this field is changing. Not because somebody was wrong, but because science moves forward–there are new techniques available. There’s more information.
So when we see this increase, we have to acknowledge that it can’t just be genetics. Genetics can be sensitivity to an environmental factor, but it can also be genetics that make you smart in a certain way; that can also make you sensitive to something in the environment. Like there are a lot of illnesses like that. If you are a light skinned Scot, you’ve got light skin so you can get Vitamin D, but one of the tradeoffs is you’re sensitive to getting skin cancer when you’re in the sun. And what we found, when we’re looking at these effects in autism, that there are broad effects whole-body issues that are effecting people with autism. They have altered immune systems, they have altered guts, as I mentioned before. They even have altered gut bacteria, and they have abnormal waists, slightly different waists that may be good to a certain level of having maybe a hyper-efficient nervous system as far as learning and plasticity, but it kind of overreacts because of the change in the environment. So again, genetics are part of it, you know–but we’re trying to look at how does environment affect our particular genes in some individuals and not others. And we’re finding out that the environment, specifically how it’s affecting the gut bacteria, which have been changed, because we mentioned the super bugs that people know this in other parts of medicine, in the hospitals, you as an orthopedic surgeon know that the bacteria have been changing because we’ve used a lot of antibiotics, which we need, but it’s also changing the bacteria that come into a newborn when they’re born. The bacteria of the mother go into the normal gut of the child and we think this has a huge effect on priming the brain development and the immune system.
And if that can get skewed, and a lot of the examples of getting skewed is if maybe the baby has to have a C-section. Now let’s be clear, maybe for a life-threatening condition, maybe the child is on antibiotics for a life-threatening condition that will change those little bacteria growing in the gut, or they’re in the hospital. All of those things together start changing the bacterial populations in some of these kids and they affect, subtly, brain development. So now you’re bringing in groups from different views, that you would never–like as you would say, a gastroenterologist or a neurologist or a psychiatrist may just say hi on the golf course. They don’t talk to each other. But now what we’re trying to do with our group, is bring lots of people together to understand autism. And the work that we’ve been doing, also with the human populations, particularly some that migrate from other parts of the world in here and get our bugs to collectively, with the Kilee Patchell Evans Autism Research Group, we’ve found some remarkable abilities of these bacteria that were found that are associated with patients with autism to produce compounds that have huge effects on learning and memory and immune function. Some of which are good, which involve literally some of the things we see in people with autism and their families. They are highly bright folks. They can have Asperger’s and be very bright in certain fields, but there is a downside to that in that you can have sensitivity to sounds; very rigid responses to interests; some phobias in social interaction; problems with light and noise. These are the things where these people that are here with autism suffer, and we’re literally finding that some of these things, relating to what we eat by feeding these bacteria, what the bacteria produce may be contributing to these symptoms that are causing autism early on but also worsening the lives of folks that have autism spectrum disorders throughout their life. And we think there is an awful lot we can do to actually–prevent is the wrong word. Probably improve the trajectory of the life these folks that are already here and improve their quality of life.
Now, your work was among the top 50 scientific discoveries in Canada, and you’re going to be speaking at the Nobel Forum in Sweden on this topic. It looks to me, Derrick, like since I’ve met you–not because I’ve met you a couple of years ago–but coincidentally, it seems to be that you’re getting more recognition of your work and with exactly the logic as you’re saying. And that’s worldwide. That’s all over the world.
Thanks for your kind words, because, you know, what is happening now–particularly this ongoing meeting in Sweden. So you’ve got the Scandinavians–it’s like you’re talking about neurodiversity, you’ve got scientific diversity. My folks–the folks in Scandinavia do really good work on microbes and have figured out how to understand–you know, there’s only one-to-two percent of the bugs in your gut we ever used to know about. Remember in medical school and we went and just thought about E. Coli? That’s not even a real player in the gut. So the people that understand microbiology and systems biology are being able to figure the thousands of chemicals that are produced in the gut and how they interact with out brain function, our immune function, basically us, completely. The other interesting thing they’ve done is follow people–they had the foresight, over the last 15 years, to take kids that were born–some were born with a C-section, some got antibiotics, some didn’t, some were off to a rough start. So they didn’t do anything to these kids, but they followed their bacteria every few months all the way until they were 10 or 15 years old.
And you can see if you have a thousand kids, you’ll have kids that are healthy, kids that have asthma, all these other illnesses are related to bugs–asthma, obesity, autoimmune diseases, and now the real kicker is all of these developmental disorders, they’ve found that these bacteria, early in life, usually mostly in the first few weeks but not exclusively, guts skewed somewhat. As I mentioned, antibiotics, they are lifesaving but if you think of your gut bacteria like a rainforest, the antibiotics can be indiscriminant. It’s like clear cutting a rain forest. So this change in these bacteria–think of these bugs as running the show and then getting somewhat skewed, and then sending mixed signals to our immune system in our brain. And so here are these people working in a very divergent field, that’s seemingly completely unrelated to brain and behavior, are finding these differences of bacteria can lead to differences in behavior.
Now it’s not just the human studies where you follow hundreds of patients, then you get the basic sciences–my background is neurology but also basic science–and people have shown, if you change the bugs in new born animals, you change their immune system, their behavior; so you’re kind of getting away from correlation to real proof showing that these early changes that occur can set people up, in some cases, to have these illnesses that may show like in autism in the first three years of life, but may also show up in things like depression, anxiety, autoimmune diseases, as you know as an orthopedic surgeon, when you have people that have inflammatory diseases, they feel yucky. They have horrible effects that we just used to equate like they are in a lot of pain. But there is more to it than that. These inflammatory conditions are effecting our mood, our thinking, our sleep–and as you know with the folks of neurodiversity groups, these guys have a lot of problems with gut symptoms, gut pain, chronic pain, anxiety, depression–all of these things–that’s the last place you would ever think that would be partly contributors to the gut bacteria. So you have all of these groups working together now. This is like our consortium that we have. Then you get the guys that are working on brain and fat and energy metabolism, my buddy Richard Frye in your country has shown that the little things called the mitochondria, the little beans in your cell that are the energy producers, that the gut bacteria produced chemicals that we’ve been working on, not only that caused autism-associated behavior, but change your energy in your whole body, particularly your brain, and affect your fats. We know we have good and bad fats, knowing the field from cardiology that’s where we sort of learned this stuff, but the good and bad fats can affect your brain development. So now you see these people that are gut-bug people, epidemiology people, people that work with brain energy–people like I mentioned before that work with the immune system, and then not to get too technical but we’re also finding these little compounds that we’re studying, they’re called short-chained fatty acids–they are the things that the gut-bacteria make.
When you eat the carbs, you feed the bugs. The bugs ferment this, kind of like making beer, and these little molecules effect all brain functions and behaviors but they’re also switching on and off all the autism genes. So you can have a broken gene, which a geneticist would say, “You have a defective gene, you’ve got an extra copy of a gene or you’ve got a gene missing,” as an analogy like a lightbulb in this room being on or off, being broken, if you will, but were finding out that our compounds are twitching on and off these genes like a dimmer switch. That’s very encouraging, because by changing the levels of these gut-bacteria, or what they produce–partly by diet, partly by certain things that are probiotics and other things that are being done to help the body handle the effects that the bacteria produce. Now we’re not advocating things yet but it’s starting to show that this is the direction where nutrition and gastroenterology and infectious disease and metabolic experts are going to be affecting these autism spectrum disorders, which is extremely encouraging, because here is a new venue for improving the lives of these folks–preventing people, like I said, that are born–I’m kind of sticking out on a limb at a level but I just think a lot of these kids, when we know their chemistry and their relatives, they’re off to a really good start, but they can be much more sensitive to these environmental factors that I mentioned in other people.
So by smoothing things out when they’re born, we’re not taking these people away from who they are, we are preventing something really good from being more sensitive; like I said, a light skinned person being sensitive to sunlight. If you keep away a lot of sunlight, you let that person live a normal life. And that’s what we think is happening with these early gut-related factors in these folks with autism. And a lot of futures for new therapies, medications–the things that we’re doing now, understanding about the superbugs that I mentioned, that we normally deal with in your field with surgery, being more careful with these things–having C-sections, trying to reduce them unless they’re needed, breastfeeding–the diet is much more vegetables. All of these things are going to go a long way to reduce a lot of chronic illnesses but also psychiatric diseases, depression, anxiety and autism. So they all may be coming from something very simple.
Derrick, why is it that we’re focused on autism with this as opposed to everything else? I’m not saying it’s a good or bad thing, but what I mean is the object of research that you’re doing is more focused on autism as opposed to all of the other different kinds of different brains. How do you perceive that, that its focused on autism?
Well that’s a very good point. My particular view is these conditions are very similar, and as you know, they kind of overlap into each other. So the autism picture is more–not totally just special, it’s just more obvious early on in life, right? The symptoms are initially more severe. But what we showed, you know, in layman’s terms we’ve shown that what these gut bacteria can produce can cause anxiety, obsession, being more interested in objects, being very rigid–being very sensitive–
And by the way, let me interrupt you to say this: When you and I first met, long-distance, one of the things that grabbed me after speaking to you was you sent me a video of these rats who were getting along just fine, they were doing just great–and then you messed with their flora in their gut, and all they would do after that is run backwards. At first, I thought maybe he just put the film in reverse, but you didn’t do that. All they could do is run backwards–that was worth more to me, in my brain–the way my brain works, that a million pages of dissertations–I saw it.
Now actually–we are a not-for-profit, you can go on our web page, do autism and MacFabe and you can see some of the lectures and videos, but we were shocked when we gave these compounds to these animals. They were hyperactive, they didn’t interact with each other socially, they did the same thing over and over again, they had the ticks, they were anxious–they could learn things like crazy but they wouldn’t un-learn them. It’s kind of like us going to England and saying we refuse to drive on the left side of the road. So the biggest level, with your question, is these abnormal gut-bacteria are producing things that aren’t just causing autism. In higher amounts, we think its dose and timing while the brain is growing are critical periods, but not the only period. So, you know, anxiety, obsession, different interests, obsessive compulsive behavior–kind of getting “stuck,” if you will, is over a broad number of conditions, as you said. Autism, post-traumatic stress disorder, obsessive compulsive disorders, eating disorders, the tick disorders, you know, Tourette’s syndrome, general anxiety, and depression. So you hit the nail on the head, where we focused on the autism picture but what we’re finding is these gut bacteria are sculpting broadly our brain and behavior. And the neat thing is it’s reversible.
Now say I’m the family of an autistic individual, or I have Asperger’s and I might get a little defensive about this. I might not have heard what you were saying carefully because I noted what you were saying. You were saying we want to keep the gifts–we just want to help everyone maximize their potential for health, happiness, safety, productivity, socialization–in a world that’s very social–and we don’t want to ram anything down anybody’s throat.
There’s so much information and misinformation in autism, and again were trying to bring a lot of groups together to exchange the information. Again, diversity. Diversity of different expertise, diversity of different types–but I also want to be clear what we’re not saying, but I’m also saying just–if people from different background on our webpage, we have about 30 peer review papers that have embedded that that is important, a scientific fact for our research, you can see a lot of information. And I don’t want to–this is more of a conversation than a science thing–but let’s look at anything, saying, “We have different sorts of people, don’t we? And that’s part of society.” Let’s look at it as an example that you mentioned there’s different kinds of horses. You have plow horses, race horses, they all do different things. You have show-horses. But let’s take the idea of one type of horse, like a race horse as an analogy and look at that kind of look as the difference between giftedness and having problems and this amazing overlap between autism and giftedness and severe illness and problems. With a race horse, you breed them–I would say that its partly their genetics, its partly what you feed them and you would argue, from our stuff, its partly their bugs. Now when you breed a race horse, that race horse is very specific. And one would look at it in some ways as the pinnacle of horses, how great it is–but it’s not a plow horse. We need plow horses too. But in a race horse, you want a horse that loves to run, so you want a horse that’s brain works really fast, its nervous system works fast, you want it to have a big heart so it can beat, cause it’s got to beat to be a good athlete, and you want it to have a very thin body and thin legs.
But the problem with those race horses is they need handlers. They are not good at plow horses, and we need plow horses, so they need handlers, and they need horse therapists, if you will, to get them to do what they do. Think of the breeding of that race horse. Hang on with this analogy–we like making analogies. The problem with having a horse that loves to run and doesn’t–if it doesn’t run, it has severe anxiety. And some horses are so skittish, even though they have all of their genes and bugs and training and food to make them run, they can’t run. They have mood and anxiety problems, sounds familiar? Other horses have a big heart–and this is a medical fact, you want a big heart to be able to pump, but if it’s too big, your heart electrical activity can short circuit, and this is why some race horses die. Gifted race horses can die. And you want to have thin legs, but if the legs are too thin, they break. So this is similar to the picture of all of the biology that seems to make us have good memories, fast nervous systems, very good in certain fields, also in those individuals and their relatives, make them sensitive to having a lot of problems. We see this in a lot of people that are very gifted. They also suffer tremendously with mood disorders, depression, overlaps in their families of, you mentioned, all these illnesses–bipolar, schizophrenia, anxiety disorder.
So you can see, when we’re dealing with this spectrum of autism, we–the very things that are good about it can also get them into trouble. So here what I would respectively say about any behavior that happens in autism. One–and I don’t want to put words in my mouth, I just want to show why our view is a little different. People can go with, say, a neurodiversity response, which I agree, that we are all individuals. We have different kinds of people, and part of these people have to be enriched and they need to be able to live their lives as they see fit, and that’s fine. But there are people within that group, like those race horses, that are suffering tremendously. They have high–even though they are high-functioning Asperger’s, and many of them write to me. And they have taught me so much, in Skyping and emailing, how they are very aware of their incredible fear and phobia, when they’re very bright and they have to give a public talk or even try to have a relationship with someone–how it’s absolutely paralyzing for them. And how, I think you see there’s a paper that’s just out in the news, how folks in these conditions have high incidences of depression and suicide, because of their symptoms. Not who they are as a person, but the symptoms associated with them. They’re suffering tremendously–and then you have other examples that–I didn’t touch on this earlier–but people with autism have higher amounts of self-injury, they have higher amounts of seizures, so we have to treat these people. We’re not changing who they are, were giving them the same rights as a patient that we would give anybody that came in, like one of your folks for a hip replacement. We have to deal with that. So, you know–behavior is an extension, but it’s like anything else in medicine.
There are extremes of that behavior–or processes that we have to treat. As an analogy, we could say blood pressure–everybody’s got different blood pressures. And we need to have high blood pressure and we need to have low sometimes. We’d agree with that, that’s part of medicine. But we don’t say, “Don’t treat the very very high blood pressure,” because we know if the blood pressure is really high, you’ll have a heart attack, you’ll have a brain bleed–we treat the very, very low blood pressure. We don’t disregard and say everyone has different blood pressure. So that’s my plea to the groups that people that know me understand–were not in the business of trying to take someone away. We want to alleviate the suffering. I would be–also, from my view in neurology, a lot of these children, there’s a spectrum as you know, and everyone’s suffering is unique. It’s not anyone’s better than someone else. But you see people that have severe self-injury, will hit their head 300 times a day–that’s some of the patients we see, in neurology, they’ll have uncontrollable seizures, they’ll bite off their fingers and toes. We have to treat those people, because they’re suffering. We don’t say that’s part of the behavior. But the–so what we have in our research is we’re trying to–we realize that the genetics of autism is not something that is as simple as a prenatal test. It’s multiple genes and environment. And it’s not that we’re trying to prevent people from being here. We’re here to say that here’s an individual that has the biology and immune system and neuro-circuitry and neuroplasticity that has great promise, but he’s kind of like a race horse. We have to be a bit more careful how we’re handling an individual with that kind of chemistry. Not to get rid of them, not to prevent them from being themselves; to help them and to nurture them.
You wouldn’t deprive a person with diabetes of insulin if they needed it, and you’re not changing the person, you’re enabling the person to be themselves, and this is our view on the Kilee Patchell Evans Autism Research Group. We’re trying to prevent the environmental factors that these folks are sensitive to. We’re trying to protect them from that. That’s different from preventing them from being here. We’re also trying to devise these newer medications and dietary things that are dealing with the stuff–immune system, gut-and-brain development–that are going to improve the lives of these folks. So this is a very different philosophy, and I don’t want to put words in the mouth of other groups, that’re saying were just trying to prevent someone from existing or just kind of medicate them. So I don’t–it’s a bit of a speech, but do you see the–this is the view, and I commend you reaching out to us seeing that that’s the kind of work were trying to do–to improve the lives of people here. I have views, and I’ve seen–if I could take some of those patients that are very severe in a different way, and improve them to be people like in the neurodiversity groups, I’m very happy. But if–even for the folks that are here, the people that have a preferentially less autism-associated symptoms, right–they’re verbal, they’re in the Asperger’s group–it’s not like they ain’t suffering. They have huge phobia and problems that they–and again, everyone’s an individual, but I see many that we were dealing with that are lonely, that they wanted to be able to have relationships, would like to go in a room that they’re not having a massive panic attack, would like to be able to concentrate on what they were doing and not have all of these obsessions and compulsion to kind of railroad them from being able to do the things they want.
So I really commend you with what you’re trying to do and to let us know in our way that what we’re doing may be somewhat different than what some people might perceive our research is about. And again, it’s got to be people coming together, not disregarding people. Like taking a step back in the micro-biome, if the bacteria are very complex, it’s stable; there’s interactions–and we think society and science has to be that way, too. People at the table not saying you’re right I’m wrong, were looking at parts of these groups–that’s our research set up, that we have to start in basic science because it seems very radical–we have to exchange and share information. What I can say at general levels–we have to be careful because as I said, a lot of these treatments in the future are in evolution. But there’s a lot of things you can see on our research and lectures and website that people are finding out that a healthy diet that is low in refined sugars and certain kinds of refined carbohydrates that feed these bugs, helps. Eating a diet that has–when you’re eating your carbohydrates, having–this may sound really over-simplistic, but having diets that are more vegetable-based rather than grains and breads and sugars. And the hidden sugars that are in the refined foods, and in the juices–you know, juice has a lot of hidden sugars. Eating foods like that, we have less refined sugars–eating more fermented foods which help these bacteria in your gut stabilize–so your real yogurts, your fermented cabbage–it sounds like something out of what your grandma would say, but these are huge things that are relating to improve the well-being of these folks. There are medications that are in evolution in larger groups that are not medications that are blocking aggression, like a major tranquilizers, which are the traditional treatments. But there are things that are coming, not just with us, but with others. The omega-3 fatty acids that are used in fish oils and a compound that we’ve been working with called Carnitine, long story short, its low in autism and the gut-bacteria seem to be preventing its activity. These are medications that are working on metabolism and immunity. Now, again, we can–the publications of our work and others are all on the webpage. We’re not involved in industry, our job is to share and develop information. But these are the things that are coming down the pipe to help these folks.
Was there an “A-Ha” moment that brought you into this arena of the gut brain where you started to put it together and you said “A-Ha! This is what it is!” Was there such a moment for you?
That’s a really good point because as you know, a lot of things happen from a series of accidents, and I actually was asked to write a paper on it–I can send you the link to it–on how we ended up thinking something as absurd as something produced by a gut bacterium could be controlling brain function and behavior. And just on the side, when I was younger I was working with a lot of special needs kids. I had a long standing interest working–doing medicine and I saw a lot of these children with autism spectrum disorders and I was amazed that a lot of these kids were in there. Like you had one person non-verbal, and all of a sudden the mother would bring him in and they’d play Rhapsody in Blue by Gershwin on the piano, and another girl with autism and blind would be singing all of these songs. There I was, like a teenager, pretty ignorant and I was just shocked by this. Again, we learned this more in neurology, you know, it’s the schism between part of the brain having a problem and everything else not working or even working better.
So I was always interested in stuff, and I did a lot of work as an undergrad in Canada, looking at brain development and behavior and stuff, and then I thought this is how basic science researched and I did a lot of work in Epilepsy and Brain Development, Alzheimer’s disease–and I went through medical school and then I saw a lot of–you know, like in the training like you had, we did our traditional stuff. My training was in neurology and neurosurgery, but I’d see all these people when I did my gastro having all these gut problems, and be really smart and intelligent but a part of their behavior–you know–like I was saying–huge anxiety, huge pain, very obsessional. Kind of Woody Allen-esque in their giftedness but also all these other symptoms. And I was wondering, hey, you know, could something in the gut be doing this? And then people, as you mentioned, typical in our training, they’ll say, “Well we didn’t find anything in the gut and everything, just ship them off to psychiatry, it’s all in their head.” But I started wondering, again, musing between patients, is there something in the gut? And then, in my training, I saw a lot of people that had toxicity problems, their thyroid was a mess there was a lot of cases in alcoholism in university hospitals where I worked, and I saw these people with liver problems and brain problems completely–you know, metabolic problems–be completely, for one of a better word, out of it, psychiatrically, and then finding that it’s a metabolism problem.
And you know, right at that time during my residency–this would have been back in the 80s–then all of those Clostridium Difficile Superbug infections were occurring. And just as a step back for those not in medicine, what it was is a patient would have gut surgery, been given a lot of antibiotics while meaning to clean up the gut, and as I mentioned earlier, you would clean out all the good bacteria and then these weird super bugs would come in and patients would have horrible gut problems, and many died. So here, you had an idea–like I mentioned earlier, that metabolic things and the people with autism could be in there in some ways and very good in some others. People could have gut problems and have problems that made them also smart but also have other symptoms that got in the way of their life, and then all of these gut–super bugs were occurring. And then, when I was doing this kind of research, I had this weird idea, “Hey, could something–could a weird gut bacteria produce something to lead to autism?” Because all of the autism cases were just skyrocketing, as you know–like it was doubling around that period of time. And all of these kids were having these gut problems, there was an increase, people were looking at a lot of environmental factors, you know, at some level with somewhat tunnel vision, people–you know, the vaccine hypothesis. The people forgot there were other things happening at the same time, the kids–as I mentioned earlier–they were in hospitals, they had C-sections, they were sick, they had antibiotics for either early on they were up to a rough start or they were on antibiotics for ear infections. And we saw that in a lot of other folks that had dual diagnosis–Down’s Syndrome as well.
What do you say, Derrick, what do you say to some of the writers and some of the authors who are saying, “There’s no increase in it, we’re just diagnosing it more?” What would you say to them?
I’d say respectfully, you know, when you see something–at the very least, it’s a lot more common than people thought. But I could show some very good studies around the world particularly some excellent epidemiological work in your own–in California. People would–as you would say–they’d say, “Oh we’re just more aware of it than before, and the California case they’re saying, well we’re just calling another illness autism and I’m not saying that couldn’t be part of it, but others were saying oh everyone was moving to California for the Quasi Canadian healthcare system. So the epidemiology work done there with one of your best epidemiologists, Dr. Hertz Pikoto, she found there was a 700% increase in autism and in the epidemiology they did in California. 1/7th was due to migration or change in diagnosis. So I believe this is a very real increase.
Could you please give us a little piece on one of the exciting new developments that is a little bit controversial–the fecal-transplants?
Now, it’s a fascinating field, and in Layman’s Terms, what this means at a broad level, is, as we mentioned before, if these patients that have gut problems–and this is for a lot of illnesses–are so dysregulated–is there a way that we–like the rain forest if it will, the gut is so clear cut that it’s so unstable. Can we put normal bacteria in to try to stabilize the gut? Now this, this is the short answer. This is the future of the restoring of the microbiome will be the future of a lot of illnesses. But I have to caution; it depends on which illness you’re talking about. You have to understand something before you can do it. And like I told you, its location, location, location, timing, and not in excess. So taking a step back, this idea of putting healthy stool, which sounds really crazy, into a person that had this disease Clostridium Difficile, where they’re–we know what caused it. The high amounts of antibiotics before surgery wiped out the normal bugs. It’s kind of like completely killing everything in a rain forest, and all of a sudden, all of these–you know, weird animals, one kind of animals, mice just start showing up. So this was done with patients with Clostridium Difficile.
In our country and yours, were elderly, they were near death–again we knew what the disease was, we knew the cause of it. We knew that we had nothing else to offer them because the antibiotics wouldn’t work. And so these people had remarkable cures in these limited studies, and that is being looked at in a lot of the severe disease. Now that is a big jump, even though we think this is the future of saying do we do this for patients with autism? I’ll tell you why. We have to understand it first. One is, we are understanding it more, we are looking at the–not ourselves, our collaborators, are looking at using normal bacteria from humans for inflammatory bowel disease–those are ongoing studies–again, it’s a very severe disease, we sort of have more knowledge of what’s occurring, and other sever infectious diseases. That’s a big step between trying this, even though it’s the future–we’ve written position papers on if it were to be done, how is it supposed to be done and the proper research. In children that you–don’t forget, in many cases this is a child that does not have informed consent. We are in our evolution of understanding what the bacteria are involved. One has to be honest to know whether the long-term consequences? Do you want to possibly improve autism but give someone bowel cancer later? Not that it will. These are just real ethical concerns. So these are things that need to be figured out in proper studies that a number of good groups are looking at. You have to be dealing with people that are experts. So people could say it could be abhorrent with using feces in a healthy person to treat an illness, but I could say what if somebody says you have a bad heart and were going to cut your heart out and we’re going to put a dead guys heart in you, that seems terrifying, but that is lifesaving. But the point is, that is done, not in your basement, not on your own. So having said that, this is a very exciting future for a lot of illnesses. Not just the autism spectrum, but those of us also doing animal research are showing the capacity that changing the bacteria can change the behavior of these animals later. There’s another third option–people about probiotics, that’s being done too, it’s safer–but there are a lot of collaborators in Scandinavia.
Dr. Tormenda, he’s a world expert in microbiology, and what they have done is a different view. Because of the risk, I should have mentioned, if you’re taking normal stool from somebody, you don’t really know what you’re getting. You could be getting things that could give you resistance to an infection, you could be getting a virus–there’s all potential risk with that. Having said that, it’s been quite safe for the illnesses, the Clostridium Difficile infections. But the other guys are saying why can’t we take all the flora from a human being, grow it, understand it, study it for 25 years, be able to make sure that there are no nasties in there–you see this is the future of probably treating some of these illnesses. And again, this is in evolution. There are a number of trials that are being done. It’s not the same as a fecal transplant, its human-cultured intestinal bacteria, defined. So now its stable, its understood. So, again, these things are being done in proper studies. These have to be done scientifically. We don’t want to make it worse and we want to be able to understand an animal in very well-done studies, how we’re improving these folks for a whole host of illnesses, including autism. The good news is, in the studies that this has been done, they’ve been remarkably safe. For these severe illnesses, that are life threatening. And the direction is starting to consider using these things in the future. I caution because I’m not knocking things, but there are people that say I’ve tried this and–do it yourself–I can’t, in good conscience–I can understand it, I sympathize with it, but medically and scientifically I can’t condone it, unless things are being done correctly.
Well, you know, Derrick, that’s what’s one of your strongest points is that you are a researcher; you are a scientist; you are an object of scientists.
But a doctor, too.
That’s the point. You’re a doctor and a scientist and a researcher and you’ve maintained your objectivity throughout this, in very emotional areas. Really. in our conversations–in our conversations, you’ve expressed your own anxiety over your concern that the profiteers are going to come in and say, “Take this pill,” or “Take this particular probiotic,” so you’ve done a good job starting out now. I like to give our viewers real tools they can use, okay? And you started out with what constitutes a “good diet” from your point of view and give them some of the specifics that if I’m in a family with someone whose brain is different, or I’m just anyone who wants to eat a healthy diet–tell us some of the hallmarks and some of the takeaways.
Eat less food, mostly plants–not exclusively. You know, a complete vegan–that’s another topic, but it can run into trouble long-term. Short-term probably helps. But this biggest thing we’re eating–we’re eating too much refined sugars. And mostly a lot of the sugars that are refined, they’re hidden. So if you’re buying something that’s frozen like a TV dinner, to keep it from tasting like cardboard, its full of salt and its full of hidden sugar. So when you’re eating your fresh foods, its mostly lean meats–fish–more of that. A lot more vegetable-based carbs rather than the bread and the potatoes and the rice. I’m not saying don’t eat it, because some people are completely advocating it, and to be clear, there are some subgroups with gluten-celiac disease and gluten sensitivities that this an evolving field. But you’re asking me about everybody. We eat way too much of the sugars and we way too much of the refined breads. If you’re going to eat breads, eat whole-wheat, and eat breads that are a rock at the end of the day. They’re not the ones that have a lot of preservatives. That’s–and aside–the compounds that these bacteria we’ve been studying, it’s called propionic acid, but it’s also–not only do these autism-associated gut bacteria make it, it’s a food preservative in a lot of these foods. That’s not saying it should be stopped, I’m just saying, it’s a caution.
So people eating far more vegetables so your squashes, so your spinach, your kale, your beets, your root vegetables, your zucchini’s, Mediterranean eggplant–eating a lot of–you know, you don’t have to be a great chef–slather it with olive oil and a little bit of spices and throw it on the barbecue, throw it in the oven, eat it–make soup out of it. It doesn’t have to be fancy. And like I said, getting into the fermented foods–then it gets also confusing, because I mentioned before, all of the gluten-casein free foods are also loaded with sugar, to make them taste okay. So eat the whole foods. You get into the yogurts, I told you fermented foods and stuff, but–not knocking companies because this isn’t what were in the business of doing, but sometimes they’ll say oh, it’s a fat-free yogurt–know what, they’re actually good fats in the yogurt. So if its fat free, again, to keep it from tasting like cardboard, its full of sugar. So, again, real yogurts. Like the ones that have different cultures–and mix it up. If you’re eating one particular brand and has a particular bacteria, in some cases it’s not entirely clear that’s worse twice the price, but if you’re going to eat different types of fermented foods, you’re going to make it more complex. So you’re going to help your bugs in a level.
The other thing that’s very important is, even medically, antibiotics are lifesaving and it’s–were not against them, they save lives. Hell, they saved my life when I was a kid. They’re not bad but there are consequences in children early on and later in life to take large amounts. So again, consult with your physician, all of this I’m saying, don’t go at it alone. Consult with the physicians, the microbiome and the immunity stuff is really coming down the pipe. We’re changing education in medical schools. This isn’t fringe anymore. So eating a lot of these fermented foods your cabbages your kimchi–you know, your yogurts, and you know, alcohol, low amounts, in moderation. Or none. You know there’s a lot of hidden calories with higher amounts. And there’s some examples of people that have overlapping Asperger’s and mood disorders and certainly the overlaps of people that have seizure disorders, you can get into trouble. So the diet that I’m saying people should eat is like what I eat, and what everyone should eat. And it doesn’t mean, you know, are you going to go nuts and have a piece of cake once in a while? Of course you will. But you will not eat it every day. 60 years ago, people had a roast once a week. And they had soups and they had other stuff. And we have to sort of get back to that. We can’t go completely back to the old way. But there is a lot of hidden high-fructose corn syrup. The biggest thing is the refined sugars. So in Layman’s Terms, these refined sugars, we’re eating them and we’re feeding these–were not just absorbing it. We’re feeding these bacteria to produce these agents that effect inflammation and a lot of illnesses. Inflammation, immune function and brain. So this is why a lot of us feel like, pardon my French, crap. Because the crap, the bacteria, is literally having a huge role in broad diseases. Obesity–don’t forget obesity–metabolic syndrome, inflammatory diseases. You know, from your background in orthopedics, these people are suffering more than just a sore joint. They have major depression; they have chronic pain.
And again, we used to just think, well they’re in pain–just like in autism–you know, they’re in pain because their joints hurt, or they’re in pain in autism because their stomach hurts. But now, its showing that there’s stuff in the gut that is producing compounds largely worsened by our western diet, that is effecting our long-term health. Like I said, early in life, it can stem from whether or not you breastfeed and have a C-section or are in the hospital. Again, these are things that are life-saving. They are absolutely necessary, but using these things with antibiotics for 60 years have had consequences. So I’m more of the middle of the road rather than the radical view that we all have to run. Like we can’t run back and live like our ancestors did 100 years ago. We had less antibiotics–may have had less autism, but we also have 50% infant mortality. So these are the–its the middle of the road, moderation, and understanding the most important levels are people–women about to get pregnant, newborns–these are a big picture. Not exclusively–this is a big picture about these chronic illnesses.
Derrick, would you mind giving our audience a way to get ahold of you and the actual websites to go to so our audience can get ahold of you?
Sure. So if you just do my name MacFabe plus autism–just Google it and you’ll see the Kilee-Patchell Evans Autism Research Group. on my webpage, you can see a lot of our research, the publications are there for free downloads–other publications that were doing–now, again–and lectures–there’s different levels that can be for family members but also clinicians, basic scientists and researchers. What I would urge, constructively, is there are some very good publications and reviews again, discuss this with your or your child’s doctor. That’s the most responsible way to deal with this.
Well Derrick thank you very much for being a guest with us. I think one thing I learned today is were going to have to have your back because I don’t think we scratched the tip of the iceberg here. And thank you very much for taking the time to be with us, Derrick.
I want to thank you enough–I can’t thank you enough, Hackie, for what you’re doing, because you’re handling the very difficult issue where a lot of people are suffering, a lot of people have, quite understandably, fear–but there is so much misinformation and soundbites. And you’ve allowed us to just talk and exchange this information, and know that, in order–all these people from different views of autism, they all want to help people. And they are all using their diverse expertise–like all of us, good in some things than others. You were a boxer, you’ve got an efficient nervous system–I was a goalie, I can react to stuff–so that probably makes us a little different too, but at the same time–you know, I apply this–you have this–when you start meeting people from other backgrounds in expertise and you take all of the preconceived notions away, you’d be surprised with what you’re trying–you wouldn’t be, but others may be surprised at how really good things happen. And I think what we’re doing and what you’re doing right now is going to bring a lot of people together. So thank you very much. I’m happy to come any time and I’m honored to have you as a friend.
Likewise, We’ve been speaking Dr. Derrick MacFabe of the Kilee Patchell-Evans Autism Research Group up there in Ontario, Canada.
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