Dr. Alok 'Dr. K' Gupta

Hey y'all, if you're interested in applying some of the principles that we share to actually create change in your life, check out Dr. K's guide to mental health.

It is a neurodevelopmental disorder characterized by persistent social deficits and restrictive repetitive patterns of behavior, interests, or activities.

The problem is that when we oversimplify it, we start to ignore all of those other things.

And if we start to ignore a lot of other risk factors like fever and respiratory infection that are associated with a 243% increase, this kind of policy will actually make autism worse.

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Until next time, take care of yourselves and each other.

So what does that mean?

What is a neurodevelopmental disorder?

If I set out to build a house,

There is a typical way that a house looks, and there is a typical set of tools that I will use to build a house.

I'll use a hammer, I'll use nails, and if everything works the way that it's supposed to, I end up with a typical house.

Now, how would that house end up differently if I started making changes to the materials that I used?

If I used, let's say, foam instead of wood, or if I used a hammer that was a little bit lopsided, how would that house end up looking?

And what we see in autism spectrum disorder is that there are probably all kinds of little things that when they compound over the course of the development of our brain result in this autism spectrum picture.

The second thing about autism spectrum disorder is that it is a spectrum.

So I know this is going to sound kind of weird, but autism spectrum disorder is not one disorder.

It is actually millions of individual disorders, individual pictures that we all lump together because they in the ballpark look the same.

So if we go back to our house analogy, we have a typical house, a cookie cutter suburban house that is built the same way every single time.

That's what neurotypical is.

But if we think about all of the ways in which a house can be atypical, if I mess with the measuring tape, it'll be crooked in this way.

If I mess with the nails, it'll be crooked in this other way.

If I use a different kind of wood or if I use wood instead of concrete, it'll be vulnerable to other things.

And so this is what autism is.

It's a high degree of variability.

And since it's not all one thing, it is not caused by one smoking gun.

And we also see this over the course of the spectrum, right?

There are some people on the autism spectrum who basically are very high functioning and can essentially lead normal lives.

And there are some people whose houses are very, very atypical.

The walls don't even support the roof and they struggle immensely.

Now that we understand the neurodevelopmental process, let's get back to Tylenol and autism.

The scary thing is that autism rates are definitely on the rise, but the question is why?

So Tylenol may actually be a part of it.

There was a tweet in 2017 where the Tylenol manufacturers actually said, we don't recommend the use of Tylenol in pregnancy.

And if we look at the actual quantitative data, we find that there is some data to support this.

So one meta-analysis found that the risk of autism goes up by about 20 to 30% when we use Tylenol.

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And on the one hand, that may sound like a lot, but it's actually really, really low.

So if Tylenol isn't super responsible for it, and we'll still get to that a little bit later, the question is what else could be contributing to the higher rates of autism that we're seeing?

And this is where I love it.

So XQC even talked a little bit about this, and he suggested that

Maybe the rates of autism were actually always the same, but we are now better at diagnosing it.

And we've seen multiple changes in our diagnostic criteria.

So we're catching autism.

So it's always been there, but now we're detecting or catching it way higher.

And that's absolutely part of the picture.

But if we look at larger data sets and meta-analyses for risk factors for autism, we see all kinds of things.

The first is that there are all kinds of prenatal or perinatal or even postnatal risk factors for autism spectrum disorder.

At the top of the list are things like maternal or paternal age.

And if we look at the age at which people are having their first child, that age is actually increasing over time.

Hey chat, welcome to the Healthy Gamer GG podcast.

so women are having their first children about five years later and they're continuing to have kids into their 30s and even low 40s the age at which people become fathers is actually increasing as well by closer to about three to five years and we know that maternal and paternal age account for about a 30 increase in risk but it's not just age if we look at a list of risk factors

I'm Dr. Alok Kanuja, but you can call me Dr. K. I'm a psychiatrist, gamer, and co-founder of Healthy Gamer.

For autism spectrum disorder, we see things like gestational hypertension increases the risk by about 30%.

Diabetes increases the risk by 50%.

And then we see some weird variables like college education and college graduate, which increase it by 50%.

And this is where there's a really, really important thing to understand.

correlation does not equal causation.

So here's the question that I have for y'all.

What do you think is the association between the age at which you have children and

whether you went to college and graduated or not.

So if we take college graduates, there is a greater likelihood that they had children when they were older.

So when we have this gigantic list of risk factors, what are the biggest smoking guns?

And this is one that I really want to highlight.

Respiratory infection increases the risk of autism by 264%.

Now we get to another really important principle that I want you all to understand.

which is something called a confounding variable.

So if we look at Tylenol and we say Tylenol increases the risk of autism, the other thing that we have to consider anytime we are looking at the effect of a medication, if a medication is a risk for something,

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One thing that we must do is ask ourselves, why is the person taking a medication in the first place?

Is there an association between taking Tylenol and being sick?

What is the effect of being sick on the risk of developing autism later in life?

And what we find from a deeper dive into the data is that respiratory infections increase the risk by about 264%, whereas the risk from Tylenol is about 20%.

This is a tenfold increase in the risk.

So it's not necessarily the medication that's causing the problem, but the underlying illness that is actually the largest contributor of risk to autism spectrum disorder.

And now things get even weirder.

So one of the big things that RFK is really focused on is chronic illness.

And I think actually this is great.

I think we don't approach chronic illness in the best way that we could in our system of health care that emphasizes very Herculean measures in the last like year or two years of practice.

Right.

So we have a system of health care that spends hundreds of thousands of dollars per patient on ICU care and heart transplants and things like that.

I think all those things are fantastic.

So let's dive right in.

We don't do enough for preventive care.

We don't do enough for chronic diseases.

I think this is great.

But here's the really nutty thing.

The better your medical system gets.

the more sick people you will have.

So I want y'all to look at some of these risk factors like threatened abortion, peripartum hemorrhage, brain bleeds.

So what would have happened to these children 60 years ago?

They would have just died.

Now what's starting to happen is we are having these high-risk things.

So like, what is the risk of autism if someone has bleeding in their brain?

That risk is pretty high.

Now we're actually able to save these children.

If we look at some of these things like hypertension or infections, as our medical system actually gets better, there were a lot of children who may have just passed away that may have resulted in abortion.

We may not have been able to save that kid.

And now we are able to save that kid who had a brain bleed during birth, who had a ruptured placenta right before they were born.

Today we are going to talk about the relationship between acetaminophen and autism.

And since there's some of these weird cytotoxic, anoxic kind of injuries to the brain, we see this house that should have been put together in this way.

Remember, it's a neurodevelopmental disorder, which means that now the brain is not growing in the way that it should.

And what we end up with is something like autism spectrum disorder.

So these are two huge things that I really want to focus on, which is that part of the reason we're seeing more autism is that we're getting better at diagnosing it.

There are a ton of people who have high functioning autism who 50 years ago would have just been odd, but we wouldn't have diagnosed them with anything.

The second thing is that we are able to keep people who are sick, especially pregnant mothers and children in the perinatal period and postnatal period, healthier.

This, combined with things like paternal and maternal age increasing, as well as a host of different medications that have an association with autism, I think all of these things put together explain why autism spectrum disorder is on the rise.

Dr. K has officially entered the fray.

And there are a couple of other risk factors that we understand.

One is that there are certain genes that are associated with an increased risk of autism.

We also know that certain environmental exposures like phthalates or nitrogen dioxide are associated with increased risk of autism.

Basically, there's all kinds of stuff that goes into building a typical house.

And if you look at all of the ways that you can interfere with that house ending up typical, all of those things can contribute to autism spectrum disorder.

I'm Dr. K and I have a purpose in life.

Earlier, I said a 20 to 30 percent increase in risk for autism spectrum disorder that acetaminophen gives is actually not that big of a deal.

Now, this is where things are going to get really, really weird.

OK, so there are other medications that increase the risk of autism and actually increase them way more than acetaminophen.

And these are medications that I think the current administration isn't a huge fan of.

The White House recently released a statement and held a press conference talking about the link between acetaminophen and autism.

And at the top of the list are SSRIs, selective serotonin reuptake inhibitors.

Now, RFK Jr.

has been saying that we overmedicate psychiatric patients way too much, has been sort of concerned about stimulants, concerned about SSRIs.

And I think this is another example of like, I'm not entirely disagreeing with the guy.

I do think that we tend to reach for psychotropic medications regularly.

way faster than we should.

But I think the real problem with things like SSRIs is that we sort of don't develop a comprehensive treatment plan that incorporates all kinds of other things.

I think SSRIs are great medications, and I think we overprescribe them.

So SSRIs increase the risk of autism spectrum disorder by about 80%.

Some studies show that they basically double the risk of autism spectrum disorder, which sounds really scary, right?

But when we look at the data, we see a lot of things around statistics that are counterintuitive.

And there's a lot of stuff in the statement that I think is actually pretty good.

Even though SSRIs basically double the risk, 99% of people who are on SSRIs during pregnancy will not have autistic children.

And about 99% of people who give birth to autistic children were not on SSRIs.

Now, how can that be?

So if we look at the data, let's just take a look at the actual numbers, okay?

So this is the group of people who are autistic, prenatally exposed to SSRIs, right?

They cite one study from the Harvard School of Public Health, which is, let's remember, liberal academia, that shows that there is a correlation between autism and Tylenol or acetaminophen use.

This is 14.

And prenatally unexposed to SSRIs.

So in this one study, there are 14 people out of 1,679 who were exposed to SSRIs who ended up with autism.

But 1,665 people

People who are autistic in this study were never exposed to SSRIs.

So this is where we have to understand that the basic risk is really small.

So the risk of having a child with autism is somewhere between one in about 33, 3%, all the way down to one in about 500.

So let's say that the baseline risk of autism is about 0.5%, right?

So one out of every 200 kids, I'm just averaging different epidemiologic studies, okay?

So you basically have a chance of one out of 200 to end up with a child on the spectrum.

So even if we double that risk from 0.5% to a whopping 1%, the actual risk is still pretty small, right?

Are you doubling your odds?

Yeah, but the odds are still really, really low.

If you sort of think about it, like if I were to double your odds of winning the lottery, what is the likelihood that you would win the lottery?

It's still really, really small.

And these kinds of statistical things are really hard to understand.

Our brain is not designed to understand these kinds of statistics.

And this is why some of these things like Tylenol increases the risk of autism by 20%, 30%, 50%, 100% is actually a very small contributor to the overall risk of being on the spectrum.

And so now I think we're getting a picture of what causes autism.

So here's the scary thing.

I don't think that the stuff in the White House statement is wrong.

I think that there are a lot of studies that show an association between Tylenol and autism.

I think the real danger is that it's woefully incomplete.

For example, one study from about one year ago in the Journal of the American Medical Association did a deeper dive into the link between autism and Tylenol.

And their conclusion, I know this sounds insane, is not wrong.

And what they found doing something called a sibling analysis of 185,000

A sample size basically found that Tylenol was not responsible for this increased risk, that there were these confounding variables.

And once you factor in those confounding variables, you find no association between Tylenol and autism.

They also did something really cool, which is a dose response analysis.

And the hypothesis here is that if Tylenol is causing a change to your brain that results in you having autism, the more Tylenol we give, the stronger the risk on autism should be.

I think the problem is that it is also not right.

But they actually found no dose response relationship.

There are some caveats to that, too.

You don't always see a dose response relationship.

But generally speaking, if something is bad for your brain, the more of we give it, the worse it's going to be for your brain.

And so some of these deeper analyses actually suggest that there isn't a strong link.

There's one part of my conspiracy theorist mind, which really gets a little bit.

Now in order to understand what we mean by that, we have to start by understanding what autism spectrum disorder actually is.

So this is the one thing that I wouldn't trust here is as a part of this statement, they sort of have this one line about Trump is approving a drug, right?

That will treat autism symptoms.

And that makes me wonder if there's some kind of like lobbying going on here.

I don't really know.

That's kind of outside of my wheelhouse, but I do wonder about that stuff sometimes.

But I think the biggest concern here is that when we make a statement like this and we leave out a lot of complexity, that is going to drive behavior.

And the really scary thing is that it could drive behavior in the wrong direction.

If we stop using Tylenol, we may be more likely to start using things like ibuprofen or NSAIDs, which have been shown to cause problems with infants' kidneys,

they have their own host of risks associated with it.

And the most insidious thing is that when we oversimplify a problem, when we make something that is incredibly complex and has genetic factors, environmental factors, SSRI contributions, potentially Tylenol contributions, paternal and maternal age, infections, fever, when all of these things are considered, then we can understand what really causes autism.