Anne Strainchamps: Martha, you've been on the front lines of autism research, seeing patients for years. What have you observed in your patients that has made you rethink the conventional approach to autism?
Martha Herbert: I observed some things and there are some things that I thought I would observe that I didn't observe. What I observed was that these kids were sick. They were sick with mundane, ordinary things like diarrhea or constipation or constant ear infections or rashes and itching and not sleeping and so forth. These are not problems unique to autism but these kids seem to have it a lot. What I didn't observe was what I was trained to look for which was specific, rare genetic disorders that might underlie the condition.
Strainchamps: Well, for example, you open your book with a story of a boy you call Caleb who seems to have had a remarkable recovery from autism. Can you describe what Caleb was like when he was first diagnosed with autism and what he's like now?
Herbert: He was miserable. I mean, he was the epitome of miserable. He couldn't tolerate anybody being anywhere near him. He would scream. He would tantrum. His parents could hardly approach him to even touch him or feed him. He was withdrawn. He was difficult and just to be able to handle him was overwhelming. And he also had rashes and he had gut problems. I mean, he was just a massive pile of problems that started before the autism word could possibly have come up. It started in his first year of life. Many, many ear infections, a lot of antibiotic treatments and it's just like he was never off antibiotics and then he crashed into autism, but it wasn't like he was well before that.
Strainchamps: And what's he like now?
Herbert: He's in school. He doesn't need an aid. He wants to be a zoologist. He's articulate. He has a little bit of attentional issues. They seem to be getting better. The cup is ninety percent full. It's an enormous change and it took a number of years of hard work.
Strainchamps: The most moving moment is when Caleb turns to his mother and says "Mom, I'm not autistic anymore."
Herbert: Yeah, you know it still gets to me even when I hear it now. It's amazing. And she, there's a part of her story was early on she would have to go lock herself into a closet so she could cry, so she wouldn't go out of her mind and then when she heard him say this, she had to cry again, and could still not quite believe it for several months. And then finally it came to her that, wow, we really did it.
Strainchamps: So the issue, of course, isn't that there's one miraculous case, but the issue is how many Calebs are out there or could be out there?
Herbert: That's right, and I think that's a giant question. I think in medical research we settle for improving someone's symptoms a certain percent so that have less anxiety or less irritation or less depression. But there are people who are going for the whole recovery and that's a horizon that I think is where we need to go. And I've recently started a small foundation, basically to bring this issue of yes, people can recover. And what are the common features between the ways people recover in autism and other conditions. And if you don't mind my making it even bigger, I have friends who work in restoration ecology. They're recovering ecosystems from damage, and I think what we're doing in all of these cases is taking a complex system that's been degraded and giving it back its complexity and integration that it lost. And once you look at it that way, you can induct strategies to actually get there.
Strainchamps: Let's talk about what you think can make this kind of difference. In your book, you're fingering things like immune system issues, food allergies, infections, viruses even. What do you think is going on?
Herbert: Well, the brain in autism, what we've learned over the past number of years, first with the pioneering research group at Johns Hopkins, Carlos Pardo's group with Andy Zimmerman, who was a child neurologist, they found indications of innate immune activation in the brain. The immune system was reacting, we don't know to what. When the immune system is activated that way, immune of infectious triggers in the body can be transmitted to the brain through the blood-brain barrier. This is well known in the epilepsy field to increase your vulnerability to seizures because the brain gets hyper-excited. And then the next little trigger will trigger it to go into a seizure. But what I'm saying is that on a milder level, you can have this excitation in the brain, not necessarily have a seizure, but it will change the way you experience sensory input. The sensory input can be irritating, it can be painful. What you and I who don't have this problem would take to be ordinary sound can be very disruptive. Many people with autism can't stand the hum from florescent lights that other people don't even notice. It's like their brain is on high alert, on high vigilance.
Strainchamps: And you think this might be caused by an immune problem?
Herbert: Well, immune problems lead to increased brain excitation and also something called excitotoxicity, where the chemicals in our brain that excite stimulation, like glutamate, there's too much of it and there's not enough of the inhibitory ones to create a balance to calm it down. There's a lot of things that can contribute to that process. There's a lot of chemicals, there's a lot of illnesses that promote that. So it's not a specific thing. This is, to slightly diverge here, why i don't think we're going to find any one thing that's the sole cause of autism. You can get brain inflammation from air pollution. We're actually pretty delicate beings and it's amazing we do so well. But once you're on the path of being more vulnerable, a lot of things can pile on and make it worse.
Strainchamps: So it's not, you're not necessarily saying that some children are born with immune system disorders that then turn into autism. It's possible that there are also children who are born quote-unquote "healthy" and something happens that compromises their immune system?
Herbert: Or a series of things. There was an amazing study published in 2007 that if you trigger an inflammatory reaction in a rat by injecting a substance called LPS, which acts like it's from bacteria and it makes the body think it has an infections, you'll get a substance called TMF Alpha, which is pro-inflammatory. It subsides in the blood in 9 hours, it subsides in the liver in about a week but it persists in the brain for ten months. This suggests that the brain, once it's in that state, it's exquisitely vulnerable to be triggered to stay in that state. So anything that comes along that would promote more excitation could just keep that process going, and I think that's why autism is so stubborn and how it takes a while to accumulate enough good effects to really see a profound difference.
Strainchamps: How do you do that? So, let's say you have a child who is autistics and you suspect that some kind of immune system compromise might have played a role, and it's possibly still being playing a role. What can you do about it?
Herbert: The most fundamental thing is high-nutrient-density food. What I recommended in the book was a rainbow diet, and this way you're making sure that the body has a full plethora of choices so it can pick what it needs for whatever challenges it happens to be facing that day. So a high-nutrient-density, plant-based diet, I'm not against meat, just that you have to have a lot of plants. And...
Strainchamps: But how can that make a difference in autism. I mean, I have to say, we all by now have gotten the message that we're supposed to eat a good rainbow diet and lot's of different fruits and vegetables. How can that have such a profound effect on a disease as serious as autism?
Herbert: Well, first of all, something you need to know about so many people with autism, not everybody, is that they tend to self-restrict their diets. They tend to eat something that people call the "beige diet." Macaroni and cheese, goldfish crackers, chicken nuggets, maybe pizza. And that's an extremely restricted diet. It's highly allergenic. Many of these kids are sensitive to wheat or dairy. And so, it's not just that they're eating better, but that they're eating better for the first time, in years, some of them. So you're simultaneously giving them things they weren't getting and you're taking out things that were apparently actively making them worse. Children with autism or even adults with autism can go on elimination diets and eliminating some of these allergens will often feel substantially better very quickly, and then over time continue to feel more solidly better. So it's a combination of giving people things that they're starved for because of how they were restricting themselves and getting allergens and triggers out of the way. And...
Strainchamps: Do we know why autistic children tend to restrict their food so severely?
Herbert: I don't think we know with a capital K, but we have some indications, so let me give you what those indications are. One of them is that they can find the textures of other foods difficult to tolerate. They may not like the smell. This has to do with what I was saying before, that their sensory systems are hyper-activated. They're also nutrient-deficient, and one nutrient in particular, zinc, is very important for the optimal functioning of your taste buds, and there's a number of papers that suggest that people with autism tend to be bottomed out in zinc. So one of the things you can do to get a child more interested in other foods is to start giving him some zinc supplementation. They might notice that things are interesting.
Strainchamps: What kinds of transformations have you seen in kids with autism based just on dietary changes?
Herbert: Well I'll tell you a story. I had a child who came to me who had already been put on a diet by his parents before he came to see me. He was twenty months old and he was non-verbal, covered with rashes and eczema and had diarrhea and they put him on a gluten, casein-free diet and the rashes went away and he started looking at people and being more present. And that went on for two weeks and he abruptly got all his problems back, the rashes, the withdrawnness and everything, and they didn't, they hadn't changed his diet. They had no idea. They found him crawling around on the floor, eating the cat kibble. Cat kibble is loaded with flour and powdered milk, and so for. It's like a junky. There is an addictive quality to this sort of a thing. But when you do pull these things away, the first thing you can notice is kind of a brightness and a presence. After a while, people can start to interact and be more interested. In milder cases, with people with other conditions, sometimes I've had a kid who's been on detention multiple times per week for acting out. And I remember one kid, I put him on fish oil and immediately the detention stopped. I had another child whose mother figured out that he was sensitive to corn, and she took him off corn. And he was really great, and then he went to a church party and had some cornbread and within two days he had gotten into two fights, got kicked out of school and had a seizure. So I think that there are sensitivities. I also think that it's known that allergy testing is not always sensitive. You can have a serious peanut allergy that makes you vulnerable to anaphylactic shock and yet still have a negative peanut allergy test. So we don't have a test that is a hundred percent sensitive to these types of problems.
Strainchamps: A lot of what you're talking about, food, also has to do with the gut, and you noticed that a lot of autistic kids also have a lot of gut-based problems. What do you think is the connection between the brain and the gut?
Herbert: If you start putting your email alerts onto gut-brain interactions, you get a lot of new science. There's a nervous system connection. The biggest nerve, brain to gut. There's peptides in the gut that talk to the brain. The gut microbes, the enormous variety of organisms that we have in our gut, make things that communicate with the brain. they tune the immune system, they make substances that regulate the brain. And we have ben oblivious to the care and maintenance of our gut bugs. We're just starting to wake up a think "Oh my goodness. Oh, I should take some probiotics or have some yogurt." But our diet doesn't have the same kind of fermented products in it that even some of our grandparents had. Part of my family came from a rural place in Europe and they were always making pickles and fermented things, and it was just a natural part of the diet. There's things that we can do now to approximate a better ecology in the gut. What I'm advising in the book is to do those things, but what I'm also saying is not doing them comes at a big cost and can be related to a lot of mood and attentional, as well as immune and irritation and rash and other kinds of issues.
Strainchamps: Take a lot of probiotic supplements?
Herbert: Yeah, probiotics are good. It's good to have them in food because what you get in the food, it's not just the bugs, but the various proteins and other substances that the bugs make which your immune system also recognizes as information.
Strainchamps: I want to ask you - we're almost out of time, but I want to just back up and look at this as a kind of big picture. You know, we're talking about a paradigm shift in how we see autism, but I would guess in how we see a lot of other mental issues and mental diseases. What you're describing is a system in which the brain and the body are intimately connected and interbound in a way that I think is new.
Herbert: Well, there are two key things here. One of them is that you can affect the mind through the body and the other is that you can affect it a lot, and that's it's foundational for really, really overcoming chronic, nagging problems that are problems that are making your life less than what it could be. There's a remarkable videotape on YouTube by a woman named Terry Wahls, T-E-R-R-Y W-A-H-L-S, who is an internal medicine doctor in the Midwest, had severe Multiple Sclerosis, read assiduously about treatment, was still not getting better, started looking at functional medicine and taking supplements and then realized that food was medicine and was aggressive in treating her mitochondria through what she called a "paleo diet." Paleolithic, which basically means lots of fruits and vegetables, meat, seaweed to really optimize nutrients and within eight months she became able, she did an eighteen-mile bike tour. And just, this is not autism, but it's such a compelling story to see the power of food to help somebody dig out of something which by any other predictive schema would have been impossible to pull out of. So I think we're looking at something extremely powerful here. The more powerful, and it can be more powerful the more you understand and pursue it.
Strainchamps: Sounds like we're just at the beginning. Martha, thank you so much for talking.
Herbert: Thank you.