Environmental Exposures, Autism and Developmental Delays — An Approach From an Integrative Psychiatrist

Story at-a-glance

  • Autism spectrum disorder (ASD) affects an estimated 1 in 50 American children. The number of children with autism has increased by an alarming rate over the last 20 years and will likely continue
  • A growing number of children also struggle with developmental and speech delays, as well as motor disorders. According to the latest statistics, developmental delays affect 1 out of 6 or 7 children
  • Environmental exposure are a significant factor that can contribute to the development of ASD and other developmental delays. There are many safe, gentle treatment options, including dietary changes and eliminating toxic exposures


This is an older article that may not reflect Dr. Mercola’s current view on this topic. Use our search engine to find Dr. Mercola’s latest position on any health topic.

By Dr. Mercola

According to a 2013 report by the U.S. Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC), 1 in 50 children between the ages of 6 and 17 has some form of autism spectrum disorder (ASD).1,2

A government survey issued in 2015 claims the ASD rate may be as high as 1 in 45 children between the ages of 3 and 17.3,4 There has been a dramatic and concerning increase in the rates of ASD over the last 20 years and experts' believe that the rates will continue to increase.

What is responsible for this epidemic? Dr. Suruchi Chandra, a Harvard-trained, board-certified psychiatrist, has focused her career on using a holistic and integrative approach to help children and adults with challenging emotional and behavioral issues, including autism and other developmental delays.

I met her at a training event with Dr. Lee Cowden, who is my physician-mentor, and Chandra uses many of Cowden's principles and healing tools on these autistic kids.

Chandra was prompted to look into integrative approaches after she completed her medical training at Harvard and Yale because she was confronted by many devastating psychiatric conditions for which there was often little hope.

"This is true for developmental delays as well as psychiatric disorders. As you know, these disorders can be truly devastating, whether it's bipolar, treatment-resistant depression, or autism. I wasn't satisfied. I thought, 'Perhaps we're missing something as a field.'

This really led me to start looking at integrative medicine. I came in highly skeptical, assuming perhaps that if these things weren't known by some of the better, more established institutions, they weren't likely to help.

But I saw children improving and I saw also adults improving in a way that I hadn't seen before. I thought, 'I have the responsibility and even a moral obligation to understand this field better.'

Now I've been in this field for about 12 years. Again, what keeps me in this field, what motivates me, is the type of improvements that I see on a day to day basis in children, and also this sense that there's more that we can learn to help these children and adults."

Autism Is Just the Tip of the Iceberg 

While autism numbers are radically increasing, Chandra believes it's just the tip of the iceberg. Aside from children with some form of ASD, a growing number of children also struggle with developmental and speech delays, as well as motor disorders.

According to the latest statistics from the Centers for Disease Control and Prevention (CDC), developmental delays affect 1 out of 6 or 7 children, Chandra notes.  

It's important to realize that most disease, be it autism, heart disease, cancer, diabetes, obesity, neurodegenerative diseases or anything else, are rooted in some form of imbalance; imbalance in the gastrointestinal (GI) tract, the immune system and/or mitochondrial dysfunction.

If you expertly address those, and do it early enough, it's quite possible to see vast improvement in virtually any disease. Sadly, many simply don't believe it's possible, and this goes for trained physicians and patients alike. The reason they don't believe it is because they've never been trained to think like that.

Most also have never or rarely seen radical recoveries in their clinical practice, which are possible when you treat the root cause of the disease rather than simply treating the symptoms with drugs.

Since there are no pharmaceutical medications that treat the core symptoms of autism, Chandra recommends using gentle and holistic approaches that are aimed at addressing possible underlying biomedical imbalances before psychiatric medications.

She also stresses that we should think about how the commonly used medications may affect these biomedical imbalances.

"For example, some of the psychiatric medications approved for autism actually affect the mitochondria in an adverse way. We should look for other resources before jumping to them because you don't want to affect the mitochondria in a negative way," Chandra says.

Factors Contributing to Autism

There are many theories about the origins of autism. Many still assume autism is a genetic disorder. Most psychiatrists have been taught that autism was 90 percent inherited and genetic, and that little can be done to address it other than psychiatric medications and behavioral therapies.

However, more recent research has supported that environmental exposures play a significant role in the development of ASD and scientists have started turning their attention to environmental factors.

Studies on twins suggest genetic factors may account for as much as 38 percent of autism, but the remaining majority is due to early environmental exposures. This makes common sense as well. As noted by Chandra, "there is no such thing as a genetic epidemic. Genes don't change that fast."

"Again, we have to look at the environment. By environment, we're not talking just about environmental toxins, although I think those are things we need to pay attention to. We need to look at everything surrounding a child during development.

This includes the microbial world, the microbiome, the bacteria that are around us; some pathogenic, some friendly. We also need to look at food. Food can either be a stressor or something that's healing.

[I also think] we need to question the increasing exposure to electromagnetic fields (EMF). We need to take a really broad view. It's unlikely that autism is going to be caused by one or two factors.

It's likely to be caused by this combination of many factors, and it's going to be unique for each child.

It's really challenging when you have this very individualized complex system, as studies aren't going to figure this out easily. If we just wait for studies, we may be waiting a long, long time to act."

Environmental Exposures and Developmental Delays

In the lecture5 featured above, Chandra discusses research findings showing how environmental toxins can influence ASD and other developmental delays, and reviews a number of safe, gentle natural treatment options that can be quite helpful. Overall, the approach Chandra uses is precautionary, beginning with identifying and reducing toxic exposures in your home. She has a handout she gives to parents, which you can download from her website, chandramd.com.

It's four pages long, covering aspects like air and water quality, pesticides, flame retardants and volatile organic compounds (VOCs) found in a range of products, including furniture.

"I think we have to look at all of these things because it's going to be really hard to know what is affecting a particular child. Rather than pinpointing one thing, I think we need to take a really comprehensive approach. I'm happy to share this handout with any parents that are interested, because it's a good place to start," she says.

Diet Is Key

Your diet can literally make or break your health. It can introduce toxins to your system or help remove them. Foods can change your gut microbiome in a very short amount of time, for better or worse.

Stephanie Seneff, Ph.D. is convinced part of the autism problem is related to the fact that virtually everyone is eating processed foods and/or foods contaminated with glyphosate-based pesticides like Roundup, both of which are extremely detrimental to your microbiome. Glyphosate also negatively impacts the mitochondria, so it really delivers a double whammy.

While genetically engineered (GE) crops like corn, soy and sugar are primary culprits, as they're heavily sprayed with glyphosate and used in most processed foods, conventional wheat can also be heavily contaminated, as glyphosate is used to desiccate wheat right before harvest.

Another factor Chandra sees in many autistic children is the overuse of antibiotics early in life, as well as the overuse of antibiotics in the mother's life. "Mothers who use a lot of antibiotics preconception at any point seem to have children that have serious gut issues, which often are correlated with behaviors," she says.

Chandra also believes that the microbiome is likely key in understanding ASD, similar to the views of Dr. Natasha Campbell-McBride, whom I've interviewed in the past about her Gut and Psychology Syndrome (GAPS) Diet. Campbell-McBride's basic thesis is that the autistic child's microbiome was disrupted by the mother's poor diet and use of antibiotics or birth control pills. The mother then transfers that poor microbiome to the child.

This early disruption in the microflora, combined with other environmental variables, ends up wreaking both physical and neurological havoc. Chandra, like Campbell-McBride, finds the greatest improvements are typically seen once strategies that help heal the microbiome are implemented.

"There's a saying that all disease begins in the gut," Chandra says. "When I first heard that, I thought, 'That's way too simplistic.' While it is a little reductionistic, I am finding myself thinking in that way. That's really where I start with each child: figuring out 'where is their GI tract?' We do tests to assess that.

Then as we heal the gut, that's where I often see the greatest gains for that subset of children. Again, that's not all the children. But for that subset of children where all the GI issues are predominant, that's where I see the greatest gains. I agree with her [Campbell-McBride]. The approach I use is a little different, but I agree with her basic principles."

Gluten-Free, Casein-Free Diet Benefits Many With Autism

One of the strategies many families with autistic children end up trying is the gluten-free, casein-free (GFCF) diet. And for good reason. Gluten and casein have opioid-like activity, thanks to gluteomorphin and caseomorphin, and you really do not want to stimulate the opioid receptors in your child's brain. I think it's a good strategy for everyone, but particularly for those with developmental delays or autism.

When I was treating autistic patients, I typically saw enormous improvements when we restricted sugars, grains, fruit juices and fruits — all sources of net carbs (total carbohydrates minus fiber) that disturb the gut microbiome, increase pathogenic yeast, fungi and viruses, and wreak havoc with the mitochondrial fuel structure.

"That's good advice," Chandra says. "Especially lowering added sugars, fructose and fruit juices. Fruit juices are immediate source of sugar for part of the microbiome that shouldn't be there. That's some of the advice that I give the kids early on. That certainly makes change. In terms of reducing grains, some of the children benefit.

There's some evidence that some of the children with autism don't have the enzymes to break down the disaccharides. Again, it's a subset of children that benefit from that. We need to take a more individualized approach. But again, looking at carbs and sugars can make a big difference."

The Case for a High-Fat, Low-Carb Diet

My current working theory for most diseases, certainly any neurodegenerative disease, and even brain traumatic injuries (BTI), is to provide optimized fuel for the body, specifically the brain, which is really more optimized for burning fat than glucose. Most people eat far too many net carbs. As a result of that, we burn fuel inefficiently and create a lot of unnecessary free radicals. So a high-fat, low-carb diet seems a reasonable strategy to try. Chandra agrees, saying:

"Many of the kids I see are not getting enough good-quality fats. I tell the parents the brain is predominantly fat and you need to get the right material for the brain development. Even things like cholesterol. There are quite a few children at my practice that have low cholesterol.

You need cholesterol for the brain to develop. The strongest genetic link to any mutation and autism is actually the inability to make adequate amounts of cholesterol ...

Some children do well on the higher-fat diets, but again it's individualized. But I agree with the basic principle of dramatically reducing free sugars, added sugars, simple carbs, processed carbs, and then looking at grains. Every child with autism that has any GI issues should have a trial, I think, of the gluten-free and casein-free diet to begin with, to see if they respond."

The Cell Danger Response

Chandra uses a model relating to the cell danger response, discovered by Dr. Robert Naviaux. He's created a "unifying theory" for autism that takes many disparate symptoms into account by explaining what happens at the cellular level.

By looking at the cellular level, he discovered the signaling mechanism that cells do when they're in danger. This cell response is instigated by the mitochondria. In many chronic illnesses — including autism — the cells are responding to each other as if they're in danger.

The question is: what's causing them to signal distress? It could be a response to an environmental toxin, a microbial exposure, or even something as simple as heat or cold. Naviaux is now investigating ways of stopping this signaling. However, "before we stop the signaling, we need to remove all the things that could be seen as a danger for the cells," Chandra says.

"What this model tells me is that the children who are developing now don't have an environment that allows them to feel safe. We've gotten so far from where we should be in terms of all the environmental exposures ... that the cells don't feel they're safe.

What Dr. Naviaux says is, if the cells don't feel like they're safe, they're going to take all their resources and put it towards survival rather than developing language, social skills, humor and all those higher-order functions.

So the first thing we do is remove all the things that could be seen as a danger ... We have to take a precautionary approach; we can't wait for those studies. We have to think: 'Is this safe?' That's my first question rather than, 'Has this been proven to be harmful?' We also look at infections.

These infections can be part of the microbiome or a systemic infection. Once the cells are in a safe place, we can look at mechanisms by which the cells can feel safe again. That's what Dr. Naviaux is looking at. I think many of the things we use, like supplements and herbs, actually are telling the cells, 'It's safe now. You can go back to a healing, growing mode.'"

Diagnostic Tools

So, to summarize Chandra's strategy, she looks beyond imbalances in neurotransmitters, with an emphasis on the gut, the immune system and the mitochondria. She, and others who work with this model, does not view autism primarily as a brain-based disease. Instead, she views it as a whole body disease, involving multiple systems that affect the brain. To assess these various systems, Chandra relies on a wide variety of diagnostic tools that most conventional psychiatrists would never think to use. 

GI function: to assess the child's GI tract, she begins by taking a family history and doing a physical examination. She also performs tests to assess the child's gut bacteria, level of inflammation and digestive function. If it's determined that the child cannot digest carbs, for example, she will recommend reducing or avoiding grains and using a digestive enzyme.

Immune function and chronic infections: many autistic children have evidence of immune dysfunction, such as autoimmune problems and/or excess inflammation, so she will also assess and prescribe support for the child's immune function. Diagnosing and treating chronic infections is a related component.

For example, the spirochete Borrelia can affect your brain and cause psychiatric symptoms. Unfortunately, few doctors or psychiatrists take the time to rule out Lyme disease when presented with a psychiatric case. Since Lyme disease can be exceptionally difficult to diagnose, when the history, exam and laboratory testing suggest a possible diagnosis of Lyme, Chandra will do a diagnostic trial with Banderol and Samento.

Eva Sapi, Ph.D. demonstrated in an in vitro study that these two herbs, Banderol and Samento, were effective against Borrelia burgdoferi, the bacteria that causes Lyme disease. NutraMedix sells very high-quality Banderol and Samento that Chandra uses in her practice and I personally use and recommend.

"Based on how the child responds, we know if it's a possibility or likelihood they have this infection. If it's likely they have it, because of what we call Herxheimer response, where they get dramatically worse, or in some cases, dramatically better, we just continue treating as it seems fit," Chandra says.

"If the disorder is caused by one of these infections, it can make all the difference to treat the infection. This is where you can take a child who may have chronic developmental delays and autism and you put him on a different life course if you treat in an appropriate way. That's why we were taught so emphatically in training: rule out reversible causes, treat infections."

Mitochondrial health: mitochondria are organelles inside nearly every one of your cells. "They are, we now know, kind of the canaries in the coal mine. When there's some danger or stress, they're the first things that respond to the damage," Chandra says. Studies suggest 60 percent of children with autism have mitochondrial dysfunction, so this is a significant factor.

There are tests that can indicate whether your child's mitochondria are affected. For example, low carnitine, coenzyme Q10 and certain amino acid ratios can signify mitochondrial dysfunction. If mitochondrial dysfunction is found to be part of the problem, there are holistic approaches to help heal them. This includes adding more healthy fats to the diet, "healing and sealing" the gut and addressing any infections.

Offering Hope for Autistic Children

Some believe it's impossible for autistic children to improve, but one study actually showed that up to 20 percent of children with autism do recover. "What keeps me in this field is that I see improvements every day," Chandra says. "I believe strongly that if you use an approach that uses behavioral therapies and this approach, you're more likely to see improvements."

Early intervention is important though. Children who get help by or before the age of 3 tend to make the most dramatic improvements, sometimes with relatively few interventions.

"Sometimes improvements are enough that they have what we call recovered," Chandra says. "For example, I saw a child at 4 and a half, which many people think is too late, because there's this idea that you have to do the interventions before age 5. The parents came to me not entirely hopeful.

We started with simple interventions. He had a lot of abdominal pain, constipation. We did a gluten-free diet. We removed sugars, excess sugars from the diet. We healed his constipation. We gave him lots of herbs and supported the mitochondria. This is ongoing work. It's not overnight. We continue doing this. We did therapies that are often not recommended by typical psychiatrists, including movement therapies that help regenerate the brain, we believe.

This child is now 10, in a mainstream small school that's academically challenging, getting all As and A+s, having no behavioral problems, needing no support. He still has a little bit of fine motor issues, but he's really motivated to play sports. He's out there doing lots of physical training and occupational therapy (OT) so he can handle that last obstacle. This is the type of healing that's possible. I wish it was for every child. It's not available I think for every child, but it is possible."

Early Signs and Symptoms

Chandra stresses that there's no need to wait until your child is 3 or older to start the biomedical approach. While most children with ASD and other developmental delays do not receive a diagnosis until age 2 or later, there are often earlier signs of a dysregulated system. Early signs that warrant further work up and treatment include GI disturbances (e.g. chronic spitting up), hypotonia (poor muscle tone) including weak control of head and neck at 6 months, and poor of eye contact.

"We have really safe, gentle interventions and dietary changes that we can use as a precautionary approach when there's a likelihood of these children being affected," Chandra says.

"Here's a story I think about a lot because this is something a mother taught me. A child came to see me at 11 months, which I'd never had before. This mother brought him at 11 months because she was an applied behavioral analysis (ABA) therapist. She knew what to look for and she also knew what would happen if she didn't take action ...

At 9 months, this child lost eye contact, stopped babbling and he developed something we call head lag, which a child at 9 months should not have. She did her research and she knew he was at a high likelihood for a developmental delay and possibly autism.

What did she do that was different from most moms? One, she had this knowledge and she said, 'I'm not going to wait' ... The second thing she did was she said, 'What's going on underneath? These are the behaviors, but what's going on at a metabolic level, physiological level?'

She, based on her research, decided he likely had mitochondrial dysfunction and gave him some carnitine and CoQ10 and other mitochondrial supports, and he developed language and good eye contact. But he was still kind of floppy and had some motor delays. She did some more research and brought him to see me.

I've now worked with him for two years. He likely has one of these chronic infections, which we treated. He now, at 3 years, speaks in seven-word sentences. He's developing not only on target but ahead in many areas, and there's no concern about a developmental delay.

Every time I see him — he comes in at about every three months — it's very bittersweet, because on one hand, I'm so happy for this child and his family, but every time I see him, I think about all the other children out there and what's not being done."

More Information

Stories like that demonstrate that there's plenty of hope. The key is to not sit around and hope for the best. If you notice warning signs, be proactive. In terms of resources, Chandra recommends:

Dr. Martha Herbert's book "The Autism Revolution." Herbert is a pediatric neurologist at Harvard. "It's a great book because it's based on sound science, but it also has practical advice and offers hope," Chandra says.

The Autism Research Institute offers free educational webinars for parents, covering strategies such as dietary and behavioral-based interventions. 

Talk About Curing Autism (TACA). This group was founded by a mother in Los Angeles whose child has autism. It now hosts an annual conference, and you can find local chapters in 30 different states.

"If you're fortunate enough to have one of these groups in your city, I encourage you to contact them, because they offer one-on-one mentoring by mothers who have been doing this type of approach for a while. There's nothing, I think, that can replace that," Chandra says. TACA also offers a lot of information online that you can peruse.

Documenting Hope. This is group of women who are making a documentary to show that recovery is possible for a number of childhood illnesses, including autism. They're also in the process of creating a grassroots effort. Chandra recommends contacting them to see whether they have any local meetings in your area as well.

You can learn more about integrative psychiatry, developmental delays and other complex chronic illnesses on Chandra's website, chandramd.com. There you can also sign up for her newsletter, and find her contact information, should you be interested in making an appointment.

Come See Me Speak With Dr. Cowden

Lastly, if you are a health care professional and interested in learning from Dr. Lee Cowden about many of the strategies Dr. Chandra is using, I am speaking at the annual Academy of Comprehensive Integrative Medicine in Orlando on September 22 and 23rd. We will be exploring how to apply these strategies in the treatment of cancer. So if you know someone with cancer it would be highly beneficial to attend this conference.

It promises to be one of the best events of the year and I am very excited to be sharing my latest insights on the metabolic treatment of cancer. Many of the leading experts in the field will also be there. If you have an interest in cancer, this is the go-to event of the year to get the latest insights on how to conquer cancer with diet. You can find out details at this link.


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