In this episode: “The Autism Doctor” Brian Udell, M.D.
(23 mins) Dr. Udell is a leader in the healthcare industry with forty years of experience. Presently, Dr. Udell is practicing behavioral pediatrics in Davie, FL where he has focused on children with developmental disabilities including ADHD and Autism. Dr. Udell discusses his history with treating at-risk newborns, the gut-brain connection with kids on the spectrum, and why he thinks the current concept of autism comorbidities is incorrect.
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Brian Udell, M.D.: The Autism Doctor
HACKIE REITMAN, M.D. (HR): Hi I’m Dr. Hackie Reitman, welcome to another episode of Exploring Different Brains and today was are so lucky to have a returning guest my friend Dr. Brian Udell, “The Autism Doctor”; yes you can find him at theautismdr.com. He’s controversial, we don’t always agree but he’s in the front lines and he’s devoting his life to this and so without further Doctor Brian Udell, thanks for joining us today.
BRIAN UDELL, M.D. (BU): Thanks for having me again Hackie, it’s a pleasure it’s an honor
HR: Why don’t you do an introduction better than the one I just did.
BU: I’ve been a pediatrician for 45 years and I’ve always been interested in epidemics and and younger children where there isn’t placebo effect. That’s the beauty of taking care of premature babies and babies and toddlers you can’t tell a baby that they’re going to talk or they’re going to walk. What you do results in Improvement and that I like that combination. as far as epidemics go I was involved in the drug and alcohol baby epidemic in the 1970s and 80s then I saw those children until they were three years old at the follow-up clinics, and then I was involved mostly with AIDS babies in the eighties and nineties and if they survived I saw those children in the follow-up Clinics. All those very rough pregnancies, very difficult deliveries and those rough first years I saw those children for the city until they were three years old. And my first case of autism was in 1975 so I would have recognized it and these children who had very rough starts didn’t have autism they had maybe a lot of ADHD especially drug and alcohol babies or small size if they were drug babies, fetal alcohol syndrome, ADHD. Autism didn’t appear on my radar until 2009 when I started the autism clinic here down in Broward County and we were seeing approximately 5 children a week getting evaluated for that. Now in the clinic that I do in Davie near Nova University we’re seeing approximately 15 children a day and a waiting list of six months or more in to see doctors like me.
Misconceptions About Autism
HR: Tell us from your point of view the biggest misconceptions about autism out there now.
BU: Well I think the first misconception that I always want to get a chance to say is didn’t you make the wrong diagnosis, we don’t really have more autism they just used to be called retarded that one really gets me because I take it personally I took care of the sickest babies on the planet for 25 years in the last century. So I got all those babies that I called mentally retarded that that’s not the name now too so you know, challenged IQ, but in those days it was called mental retardation, cerebral palsy, and didn’t I really just miss diagnose it and now it would be called autism. My point about all that is the incidence of mental retardation 30 years ago was 1 in 2,000. So if even if I got every single child wrong and I called them mentally retarded or developmentally challenged and I was wrong about every single one of them and they really had autism how did it go from 1 in 2000 to 1 in 59 kids 69 kids 2% of boys. 80,000 children will be born this year who will eventually get a diagnosis of some kind of developmental delay including autism. I didn’t get it wrong, I didn’t miss it, we’ve got an epidemic happening it’s rolling over us and I believe that the pediatrician’s of today the neurologist took today are more worried about the epidemics of the last century than they are of the epidemic of this century.
Autism Over the Years
HR: Why don’t you say how you really feel. How have things changed from your point of view because everything is different now okay, and the biggest factors you see you; do you just want to touch on a couple of them that have changed because you have a 40-year stretch.
BU: It is actually 45 years. The biggest thing that I’ve seen that’s different is antibiotics. I always want to point that out there’s an antibiotic you every time a kid sneezes they get a course of antibiotics, there’s antibiotics given so you won’t get a bacterial infection which is bizarre because if you give antibiotics prophylactically you’re going to get a resistant bacterial infection. Every time you sneeze and it’s a virus, viruses aren’t killed by antibiotics. In the last century if I had a child under the age of three maybe one or two times that required antibiotics that was unusual. In this Century a mother will tell me they have been on an antibiotic five or six times okay and that is so huge change. What we’re eating is huge change we have antibiotics in all the food that we are eating, we have antibiotics in the animals and and they don’t necessarily tell the truth that the organic foods don’t have antibiotics in them that you know, That is the number one thing that I see it’s different for children in this Century than the last century the way overuse of antibiotics and the second thing is positioning of children. I said this a lot that in 1990 we used to put children on the front for 300,000 years or however long man’s been around, we put children on the front when they went to sleep and it was discovered, rightly so, in the 1990s that if you put the child on their back they would have less incidence of Sids which is true, the incidents of sids has gone way way done aroung 100 time since we’ve done that. But the price we’ve paid is reflux, and if you reflux here the doctor start giving Nexium and Prilosec and Prevacid which I never was able to give in the last century every single premature baby has reflux.
If you’re taking care premature babies you’re taking care of reflux and I didn’t have Prilosec and I didn’t have Prilosec and I didn’t have autism. So now they just give Nexium I just give Nexium and where where is the study on Nexium given to babies and what’s the work up that you’re doing; premature babies get reflux why are term dated babies getting reflux so that’s the second thing. So both reflux and the treatment of the reflux and the extension of the reflux if you’re not just refluxing up here you’re refluxing into your ears so the incredible increasing number of otitis media is and treatment of otitis media and tubes that they need tympanostomy tubes to sure the recurrent otitus media. I would say those are the top two things that I see is the difference in this century. And the third thing would be the 85,000 or more chemicals in the air food and water that weren’t there when we were kids. So susceptible individuals, why are boys more susceptible than girls I don’t know, but in the newborn Intensive Care Unit I would much rather take care of a girl they are stronger I guess that’s why they can have kids that that girls are stronger and so boys, just being a boy is susceptible. Having minor genetic problems that wouldn’t have shown up in the last century are showing up now because we can’t detoxify all the chemicals that are even in the water; there’s Prozac levels who said that’s okay how did we evolve you know with this going on while you are a fetus. So those are the top three things on my list.
Autism and the Gut-Brain Connection
HR: You know that this is kind of a segue to the gut the whole gut-brain why don’t you give us your thoughts on that. You know we’ve been so lucky here at Different Brains to have met you know Derek McFadden up in Canada who certainly is one of the Pioneers in this area and everything but just the way of looking at the connection as you have from the gut to the brain and vice versa.
BU: Well the first thing that comes to mind is the fact that his name is Dr. Kershen and he was at Columbia University in 1990 who first described who first described the gut brain interaction. That was 29 years ago and and doctors will talk about that today like it’s religion do you believe in the gut-brain connection, do you believe in it? I mean how many years does something have to be around and it and it constantly gets the the follow-up studies showing it is true. So how come we have nearly 30 years of follow-up studies to show that there are more there are more a neural cells in your gut than in your brain okay, that what affects your gut that does affect your brain why do we say butterflies in your stomach? You don’t have butterflies in your stomach just about every analogy that you use for anxiety you’ll be using your stomach okay. And so it’s not just coincidental and the second thing is you know we have changed the biome, we have changed what’s growing in us, And so when one wants to look at who what’s the reason for the increase in the developmental problems it’s interesting if you tell somebody there’s more asthma in the world there’re like yeah yeah more asthma in the world, it a poison world. There’s more thyroid in the world, yeah there’s more certain cancers in the world. You say there’s more autism in the world and that there’s an autoimmune or gut relation to that because we have poisons, I don’t know what you’re talking about it couldn’t affect those organs, it can only affect any other organs except your gut and your brain. And mostly for me 60% of my babies of my patients have a GI abnormality in some way.
Most people don’t know that in the first series of autistic children from a Dr. Leo Connor 1939 and 1940 11 children that had autism 8 of those 11 children, because he described each case in detail, and 8 of those children had a gastrointestinal problem. They either had a lot of diarrhea or vomiting or feeding problems 8 of 11. Only 6 of 11 had what you’d call a refrigerator mom, the mom wasn’t interested in the kid. So I always think that Dr. Conner was gastroenterologist rather than a true Freudian psychiatrist which she was, from Austria that it wouldn’t have been found in the diagnostic and statistical manual for psychiatric disorders it would be found in the pediatric manual or gastric intestinal manual. And good news for my patients is that if 60% of them have a gastrointestinal issue that I can address, that means a lot of the signs and symptoms that we call autism go away. Aggression in my world aggression always starts in the gut, there is no reason for a kid to hit his head it is absolutely bizarre for person to hit their self in the head. It is absolutely impossible to believe when I see your mom with arm and bite marks, and punch marks; okay this is starting in the gut and when you recognize that the aggression is a combination of gut dysbiosis, something’s going wrong in the gut, and the child’s inability to communicate you get this thing together you’re going to get disruptive children and you’re going to get behaviors that we call repetitive behaviors, restricted interests, social isolation, and these people want anything but to be socially isolated, they just don’t have the skills to do that so all these kind of symptoms that we call autism can very much be ameliorated by addressing the gut issues. And the most important thing to me is speech okay that speech apraxia is interfered with, the mother says the kid hate the speech therapist every time they come they are not paying attention.
The child doesn’t know he can talk and if all he’s doing is worrying about his gut the whole time and he doesn’t feel so good and he hasn’t taken a poop in 3 days or he’s taking three Poops by the time she sees them that day nobody’s in the mood to you know to take tests and to be and to be learning things. So before I actually address the signs and symptoms that would be related to communication and speech apraxia or speech delay or Rocco Lally or scripting or whatever the speech problem is at the time, you have to address the gut issues first so that the child will pay attention.
HR: And when you stress this in your practice and when you speak, and when you everything you doing it’s met with resistance isn’t it?
BU: Okay at best, I’m marginalized at best and you know derided at worst. You know they’re just trying to make this up. I grow up in the world of regular doctors on a regular docking and I might not have believed in any of this 10 years ago and I started seeing more and more children with autism. Well if it’s a genetic problem where is the genetics to prove it, it’s the 21st century I have neurologist today that still don’t do a genetic workup on a the kids, You said it was genetic you told the parent it was genetic Well she’s not going to have any more kids well because you really can’t do anything about genetics. Well wouldn’t you want to know why the kids showing autism I mean we are marginalized with all these thoughts that we have the gut-brain, they believe in the gut brain everything’s gluten-free everything’s grain-free, of course you can go overboard but in my world when a parent sees that by doing certain diets okay that are medically indicated because we do scientific testing to say what diet you’re supposed to be on, or we make up whatever nutritional deficiency that they may have and the child starts talking, that what I’m talking about, there isn’t no placebo effect in that.
I say if you go on this diet okay and if you would just do the diet for two months and in three months you see the child eat the wrong thing you will never give that child that food again and it happens a hundred percent under the age of 6 years old because the parents starts to believe the grandparents starts to believe that this gut brain connection is a real thing it must be because the child got better they been doing the same therapy speech therapy for three years that the child’s now 5 years old that doesn’t talk. Well the neurologist says well you got to get more therapy. Well if you don’t talk under the age of six different parts of our brain learn speech under 6th and over six which is why when people learn a second language for example they’ll always have an accent unless they practice, if they learn me in the language too late there’s a very specific time in our brain that it is supposed to learn language and it’s getting interfered with a lot because of either infections or autoimmunity, And again the special thing for me is gastrointestinal. So it’s not hard to get people to believe it when it’s little kids it’s a lot harder when they’re older and it’s very difficult.
Autism and Comorbidities
HR: This is kind of a Segway also to what people you may think mistakenly call comorbidities with autism can you expound on that?
BU: Right my view is that autism is a number of signs and symptoms that we call autism it not a comorbidity it’s the morbidity okay. A Child who has speech apraxia is being defined by the speech apraxia and it might be defined at another time by their problems with their gut, it might be defined it another time especially as they get older by their sensory issues okay they have to press on things, distractibility with sound or visual sensory things from lights above your head you know. These aren’t comorbidities it is communication problems in the central nervous system. They represent functional connections, functional connectivity problems and that Downstream they are being manifested in this way in signs and symptoms of what we call autism. I think that’s a more elegant way to look at the problem as a constellation of morbidities okay, that lead to a downstream diagnosis of autism then you’ve got Autism and ADHD and sensory processing disorder and oppositional Defiance disorder okay and sleep problems okay. It’s all the same thing because when you get to therapies that address these connections they get better.
HR: Where do you see the state of medical education and education of our Frontline doctor’s, family practitioners, pediatricians, where do you see the state of education for autism?
BU: I think that if we’re going to wait for randomized controlled prospective double-blind studies to answer you know any therapy that we give we’re going to be waiting a real long time. And that at the present time it is my experience with pediatric residents that I talk to is woefully inadequate for this epidemic; they don’t understand what I’m doing. Again my my beef is that I’m in the last medical journal American Medical Association pediatric review okay there were zero articles, okay zero articles on the epidemic of our time. When I was taking care of premature babies there be three or four articles on respiratory distress syndrome and necrotizing enterocolitis and bleeding in the brain every month one or two of these articles. Where is the research, unfortunately most of the money is going into the Magic, this stem cell transplants they are doing at duke university okay for the fecal transplants that they’re doing in Arizona. Let’s understand why people have autism first before we start looking at what Magic’s going to make that turn around. And for example when I read studies about monkeys and mice they can genetically engineer monkeys and mice that have repetitive behaviors, they’re run on the track all the time or they’ll have a restricted interests and social isolation these animals are are social animals and you can genetically engineer animals that are you know have these signs and symptoms that people call autism. And my answer is when the monkey talks I’ll read the study. Monkeys don’t talk and we don’t understand why monkeys don’t talk and we do. So until we understand why monkeys don’t talk and we do that’s when I’ll believe it.
It’s not just the teaching that’s going on, the research is geared towards the wrong the end; speech apraxia get a kid who that who doesn’t speak and he’s 4 years old and he’ll be seeing that the speech therapist for the first time in like a year and they say you know your child has speech apraxia. Well he wants to talk and he can’t, I think he does you know. They say it was such authority like they just told me what part of the brain isn’t working, when an old man has a stroke we know where the problem is, it’s in the temporal lobe I think what the problem is we know they need repetitive therapy to get to get blood flow back to that area. We don’t understand anything about speech apraxia and autism not the least bit. And that defines the most affected children because you reach the age of 10, 11, 12 and you’re not speaking your rage can go real really high you know your inability to communicate with people your social isolation and now they’re talking about all these behaviors and by the age of 18 you can be graduating to into schizophrenia you know because since he was thirteen you started giving crazy drugs to the kid who wasn’t crazy in the first place and now you made him crazy by the time his was 18 because he didn’t talk.
The interesting thing about not talking in autism is that a deaf kid will be playing with other by the time they’re three or four or five years old. It’s not speech okay it’s communication and it is socialization and communication so I’m off and frustrated when parents are saying that the teachers you know that teachers say that the kid is not attending or not focusing, well he isn’t talking I don’t care about all that stuff you want to make them talk. And so to me it starts with the research and the end of it is that these pediatric residents I can’t even get them interested to do a chart review prove that I’m wrong that I can’t increase the chance that a child is going to escape autism and which is what I call it when I see children that are better. They’ve escaped it if you’re in a car accident and your hand looks like this and 10 years later your hand is fine people say there was no way you were in the car accident your hand looks fine. But if I have a kid who is 10 years old and doesn’t have any signs or symptoms left a little social problems a little communication they say well they couldn’t have had autism. That’s what you hear that’s how how strong the university look at autism is. That if you if you got better you couldn’t have had it.
HR: Doctor Brian Udell thank you so much for being with us here at Exploring Different Brains. The Autism doctor and where can people learn more about you?
BU: At theautismdr.com or childDev.Org which describes the other services that we provide for people because everybody that presents with signs and symptoms of autism doesn’t have it they deserve a medical workup.
HR: And the name of the organization is?
BU: The Child Development Center of America is my organization
HR: The Child Development Center of America Brian thank you so much for being here.