My guest today is Dr. Kristen Lyall.
Dr. Kristen Lyall is an associate professor in the Modifiable Risk Factors Program at
the A.J. Drexel Autism Institute at Drexel University.
She earned her doctorate in epidemiology from the Harvard School of Public Health, followed
by postdoctoral training at the UC Davis Mind Institute.
Subsequently, she served as a research scientist in the Environmental Health Investigations
Branch of the California Department of Public Health.
Her research is dedicated to exploring the modifiable factors that influence autism development.
Dr. Lyall's work focuses on understanding how parental factors, prenatal exposure to
environmental chemicals and maternal dietary elements interact and correlate with autism
and other neurodevelopmental outcomes.
She also employs continuous quantitative measures to explore traits related to neurodevelopmental
diagnosis.
Offering a nuanced view of the autism phenotype.
Dr. Lyall plays a pivotal role in leading and participating in large-scale collaborative
epidemiological studies.
These studies aim to uncover insights into autism and various child health outcomes, leveraging
her expertise to shape the field's understanding and approach to these conditions.
With specialties in psychiatric, reproductive, and nutritional epidemiology, her research
delves into broad spectrum of risk factors for autism, including exposure to air pollution,
maternal prenatal, hormone, and protein levels, gestational diabetes, infertility treatments,
and maternal, autoimmune, or other medical conditions.
And now, my conversation with Dr. Kristen Lyall.
Dr. Lyall, I would just love to understand about your medical journey or your education
journey, and could you take me through that and just touch on the different stops you
had and different interests?
Sure.
Well, first, I'll also start off by saying thank you for inviting me to your podcast.
So yeah, I did my undergraduate degree at Middlebury College up in Vermont, and new going
in, I was interested in science and really started out as a biology major.
I was very interested in human genetics and kind of patterns of genetics, I guess, but
wasn't someone that necessarily wanted to be in the lab.
And then in the latter years of my undergraduate, I got really interested in psychology.
And I also started working as a part-time job, as a behavioral aid for a family who had
a child with autism.
And that was really my introduction to autism and getting to know that family, and also
the counselor who worked with that family.
And then after school, I worked for several years as a research assistant at Massive Chuset's
General Hospital in a very research active group with great people.
And I think that's kind of a theme across my career is just getting to work with wonderful
people.
And again, got the opportunity to learn more about autism and to directly work with families.
And I was administering various different assessments and tests.
And so that was really interesting.
And it also was my first introduction to epidemiology.
So I had never even, I don't know that I'd heard the word epidemiology until my experience
in that research group where one of the investigators was an epidemiologist.
And the more that I learned about that field, the more it really kind of spoke to me and
seemed like it could be a fit for my interests and kind of bringing together the different
substantive areas that I was interested in, but applying the methods and the research
design and the statistics.
And so that was when I applied to a couple of epidemiology programs to get a doctorate
or PhD and ended up going to Harvard School of Public Health.
And there I got really interested in.
So I was in the psychiatric epidemiology track.
I also got interested in there are all these other subfields of epidemiology.
It's not just infectious diseases.
It's not just cancer epidemiology.
And it's really kind of using those methods to study a whole range of different things
from a kind of population perspective.
And so I got interested in nutrition as well there.
And then following my time in graduate school, I did a postdoc at UC Davis Mine Institute.
And by that time, I had done quite a bit of work.
My dissertation was focused on autism.
Again, working with really great mentors, I was given the opportunity to help kind of
lead a study while in graduate school.
And so had learned so much about autism, done a lot of research kind of as a student.
But the MIND Institute was a really wonderful postdoc experience because it had a much kind
of broader training across areas that I didn't really previously have training in.
So things like immunology, neurology, neuroimaging, all these other aspects, and then also the
clinical exposure because I wasn't trained in kind of clinical assessments.
I'd done some different measures, but hadn't been trained in diagnosing autism.
And so there was really that kind of well-rounded training.
And then from there, actually went to work as an epidemiologist at the California Department
of Public Health, again, working with great people in an environmental group.
And then after about a year there, I switched to my current role, which is at the A.J.
Drexel Autism Institute of Drexel University.
And I'm currently an associate professor.
And I've been at Drexel for about eight years now.
Yeah.
What took you to Drexel?
Well, it was wonderful living in California, I will say that.
But most of my family is on the East Coast.
And then I was also, so there was the family and the personal component, but there were
really great people at the Autism Institute at Drexel.
And I was really excited about the opportunity to work with them.
And I think also I've kind of always been drawn to the academic environment where you're
doing the research, but you also get to work with students and mentor students.
And so those were some big reasons, but it definitely wasn't easy to leave California.
Yeah.
Tell me about the role of an epidemiologist with autism, because it doesn't, one, I just
should say that I love this because it adds a little bit of diversity into the research,
which I think anytime that happens in science is a huge bonus.
But it's not something that you often hear about or see.
Yeah.
So there are different kind of aspects to epidemiology.
So one, that I would say plays a big role in autism is kind of the descriptive epidemiology
side.
And that might sound kind of very basic.
We're basically counting numbers, how many people have a given condition.
And for autism, a huge factor, of course, is that the prevalence has increased so much
over the past several decades.
So when I began in the early 2000s, autism was still considered a very rare condition.
The prevalence had been increasing since about the early 1990s, but was really on a
very sharp upward trajectory that has continued.
And epidemiology is the reason why we have those numbers.
It's the methods that go into the counting and obtaining accurate estimates of autism.
And so those surveillance efforts are kind of one side of the autism epidemiology piece.
And of course, when we know that the prevalence has been increasing so much, that can also
help to stimulate research into kind of what I would consider the other side of epidemiology
or another portion of it is trying to figure out why a given outcome or condition is occurring.
Are there people who are more susceptible to given conditions or what are the risk factors
or contributing causes to a given condition?
And so that's the other kind of portion of where epidemiology comes in is trying to understand
causes of a condition, where and why and how it's occurring.
And the last thing I would say is that, and as you mentioned, science is really better
when we bring people together from different fields.
And so while I'm an epidemiologist and I work with a lot of other epidemiologists, I've
always working also with people from other fields too.
And I think that's what keeps the work moving forward and helps make sure that, okay, I'm
not an expert in immunology.
I've had a little bit of training on it, but I'm going to work with this person over here
that is an expert so that we can help try and learn more.
Yeah, that's wonderful.
In science, we have that silo.
We often hear about the silo, which is a good thing because for that specific subject, we're
increasing our knowledge and data set about that.
But something especially as so broad as autism, it's good to have expanded edges outward and
upward, I think.
Yeah, for sure.
We always try and work in interdisciplinary teams so that we're not looking at things
from only one perspective.
Yeah.
Tell me about modifiable risk factors.
Sure.
So, you know, I mentioned having an early interest in human genetics.
And so we know, of course, autism is something with a very high genetic contribution to it.
There's a high heritability to autism.
But we also know that that heritability and genetic background is very complex.
And I spent some time working in some laboratories and doing some lab work.
I think learning more about nutrition and environmental chemicals and sort of all these
things in the environment that we're exposed to, I get really interested in, okay, what
are the pieces of this puzzle that we have some control over or that can be modified
or that, you know, shift different aspects of, you know, how outcomes present or co-occurrence
of outcomes.
And so I think it's, to some extent, it's that idea of being able to change and modify
things.
So, when we talk about modifiable risk factors, I think more on the environmental side, things
that we have control over to change.
It doesn't always mean that there are easy changes, you know, when we look at various
environmental toxicants, oftentimes those require policy and regulation to change.
So we're not always talking easy modification, but that's kind of one component there to
thinking about factors that are possible to change.
And then I'm also growing increasingly interested in kind of interactions across different factors.
So, you know, are there dietary components that mitigate the effects of some of these
environmental chemicals that we're exposed to?
And there is some growing evidence that that's occurring.
So, you know, maybe we can't really control our air pollution levels, but we can take
a prenatal vitamin that might help mitigate some of the effects of some of those air pollutants.
Okay.
That's something that I'm curious about.
If whatever it is that we have in our biology that is used to kind of fight off of these
environmental risk factors.
Is it that we're declining in our ability to fight off disease or these risk factors?
Or are they these risk factors just increasing?
In other words, I guess, is it we're lacking what we used to before the 1930s?
Or is it just an overwhelming amounts of the environmental risk factors?
I don't know the answer to that, but it is very fascinating to me.
Yeah, it is.
I mean, it's a good question.
I don't know the answer necessarily, but I do know, you know, there were exposed to
tens of thousands of chemicals in the environment, many of which are not very well regulated.
And oftentimes when we do find evidence that a given chemical or class of chemicals does
have adverse effects on health, you know, not just neurodevelopmental outcomes, but
kind of broadly hormone disruption and all these other different impacts on health.
Oftentimes those chemicals are replaced with other chemicals, even if that one class or
chemical is banned.
And so this is a situation that's called regrettable substitutions.
So it's a little bit of an ongoing challenge in trying to make sure that, you know, all
the different things that we are exposed to in our environment are actually safe for health
and regulated.
Yeah.
But for sure, you know, the number of things that we've been exposed to in our environment
with increasing industrialization, use of plastics has certainly increased exposures
that have the potential to adversely impact health.
Yeah.
That's exactly what I was wondering or think about is the industrialization because it
fits the timelines.
And I mean, everything about it just makes sense.
But I don't have data on it.
But there are some things that you mentioned that I've already listed out for some questions.
And I would, one of them, the most pressing one is since you mentioned diet, but maybe
other prenatal vitamins and such, are there certain diets that can mitigate the risk of
autism?
I guess what I'm trying to say is or ask is, is there like an approach or preparation
that families can take to kind of reduce the risk going into pregnancy?
Yeah.
So that's a really good question.
I think my first response is to remember how complex autism is.
And so I always get a little bit worried when we focus on one risk factor in trying to pitch
it as something that is going to be the one factor that is going to be going to reduce
risk for a given individual.
But that said, there are over a dozen studies, at least now, that have found an inverse association
between taking a prenatal folic acid supplement, a prenatal vitamin that is rich in folic
acid, especially in that early part of pregnancy.
There are a number of studies that have examined other dietary factors.
And you mentioned a specific diet, right?
And so that brings to my mind what we call dietary patterns.
So these are routine ways of eating across a whole series of foods and nutrients.
And so there have been a handful of studies that have looked at these kind of broader
patterns of eating during pregnancy.
And we haven't really found very strong associations there.
We've done a couple of studies where we've looked at specific foods and in particular
fish intake.
Now fish are interesting because they're the primary source of polyunsaturated fatty acids.
And there's a particular PUFA or polyunsaturated fatty acid that is of real interest for brain
development and that's DHA.
It's the most abundant fatty acid, omega-3 fatty acid in the brain.
And it's really important in all of these ongoing neurodevelopmental processes that are occurring
while the baby is growing inside the womb.
And so we found in a couple studies that the more fish you eat or that eating fish at all
in pregnancy has been associated with a reduced risk or likelihood of having a child with
autism.
That's not to say that's the only factor that's important.
But it could be one contributing cause in some cases.
So fish in pregnancy and reducing odds.
And that may be because that fish is a good source of these brain healthy facts.
The other thing, I guess I should take a step back and mention because I've been talking
about mom diet or prenatal diet during pregnancy.
And the reason why I've been talking more about the prenatal or pregnancy period is
because we know one that's a really critical sensitive time period of the baby's development.
It's also when the brain structures and early neurodevelopment is being set up.
And then lastly, when we look to our experts in other fields, we've seen evidence that
that's when some of the pathways to develop autism really begin early in gestation or
during gestation.
And that's not to say that autism can be diagnosed prenatally or at birth.
But it's to say that some of the differences that we see in the brain are beginning during
pregnancy.
And so when we think about likelihood of developing autism, we're all often studying prenatal
factors.
And that's not at all to suggest that what happens after pregnancy doesn't matter for
child development.
It very much does.
There's a ton of great research to show that early interventions really make huge impacts
on children and their outcomes.
But often when we're talking about risk factors or factors that are involved in etiology,
we tend to be focusing on the very early periods of gestation.
Okay.
It's a very, it's a big region of interest, especially for my curiosity is that that time
frame that you just described there.
Yeah.
Tell me a little bit about and correct me, as I say this about some of those, I don't
want to call them biomarkers, but I'm going to have to about how you kind of quantify
these and kind of establish the risk about each one.
Sure.
So I'll follow through with kind of the fish example as one exposure of interest.
And so when we're doing these studies, there's lots of different ways that you can try and
you know, say, is this exposure associated with autism?
So we could collect a sample of families who have a child with autism and then try and
collect a sample of comparison families who have a child who does not have a diagnosis
of autism and then say, what did you eat during pregnancy?
And that was, you know, five years ago.
And then we could compare.
That's called the case control study.
And there's some concerns with, you know, one remembering back, well, what did I eat
during pregnancy?
Or what were the different things that I was exposed to?
That's not to say that that study design isn't useful for some questions.
But that's a concern with that.
So another type of study design is enrolling women when they're pregnant and asking them
about, okay, what are you eating in pregnancy?
What products are you using?
And collecting biospecimens from them.
So can you give us a urine sample?
Can you give us a blood sample?
And then waiting over time to see how their child develops.
And that's called a cohort study.
And so that they introduced a couple of different study designs, but also to kind of note that
there are, in addition to different ways we can collect information from people and group
people, there are different ways that we can get information about exposure histories.
And so when we collect urine samples or blood samples, we can measure all sorts of things
in these biospecimens or samples that are provided.
And so again, to get back to fish so we can collect those, those questionnaires asking
about dietary intake, we can also measure those fats that I mentioned, the omega-3 fatty
acids in people's blood.
And that is another way that we can say, oh, well, this person has really high DHA levels
in their blood.
How does that relate to these outcomes of the child?
And it's a nice, subjective way to compare to the reported data and get an actual biological
assessment that is associated or not with the outcome that we're studying of interest.
And so we've done some studies where we've measured these different fats in samples collected
from moms and also from newborn heel sticks and measured these fats in the blood spots
that are collected routinely from babies for neonatal screening processes and tried to see
are these different levels of these fatty acids associated with autism.
And like for most things with neurodevelopment, the answer is a little complicated.
We haven't seen very clear patterns of associations, but we did find some evidence that, well,
maybe there are certain levels that are associated, maybe very low levels are associated with
a certain subtype of autism with co-occurring intellectual disability, but that's a sort
of preliminary finding that needs a follow up.
But those biomarkers can be really useful in different research studies that we're doing
to try and get that objective measure of exposure.
Okay.
It's like whenever I hear you describe that.
It's like putting, I don't want to say percentages, but I'm going to have to, I think, just because
my inability to really explain what I'm thinking, but like certain percentages of risk associated
with this item or in a combination of these items, is that accurate?
Yes.
Yeah.
And actually, I would say that's a pretty good summary.
So we have different ways of trying to assign risk associated with a given factor that we're
studying.
So one way we can think about it is attributable risk.
So what are the, if we've removed this risk factor from the population, what would be
the corresponding reduction in cases associated with that?
And there are a lot of assumptions that go along with making those, determining those
statistics.
But essentially, yes, you're trying to determine, okay, like how much of the case load is this
one factor contributing?
Is this factor contributing to the rise in autism prevalence?
And so those are different things that we try and tease out.
And when we're doing these estimates and trying to look for associations between one factor,
so I mentioned, we know it's never just one factor, right?
Autism is so complex.
And in addition to having multiple causes or risk factors within any one individual, it's
also highly likely that we have different kind of sets of factors, so different combinations
of factors going in to different cases.
But when we're looking at any one individual factor at a time, we also try and say, okay,
well, what else do I need to account for when I'm looking at this association and this outcome?
Even if it's like a so-called weak association, if you have multiple weak associations, it
kind of like builds up and strengthens the ability to maybe have actionable steps into
reducing the risk.
Yeah.
So what you mentioned is kind of thinking about the multiple hits or combinations of
risk factors.
So we can think about, are there two risk factors that act on the same pathway that then increase
susceptibility to this outcome?
Or is there one factor that exacerbates the effect of another factor?
I like to think about factor.
What are other factors that mitigate the effects of risk factors?
And so we're trying, more people now that we have more large-scale studies and databases
with autism information, I think we're kind of in the era now where we're going to see
more consideration of combinations of risk factors.
In the past, we've been kind of limited by smaller sample sizes often, not always, but
it can be hard to look at combinations of risk factors together when you have a small
sample because then it gets to statistical power.
And do you have enough people in each category to be able to do what you were talking about?
Like, what's the percentage increase or decrease associated with this factor?
So that's where a lot of these research efforts that are bringing together participants from
all around the country have been really helpful.
So I'm involved, for example, in one study that's a national consortium.
It's called the Environmental Influences on Child Health Outcomes or ECHO study program.
And it has brought together existing studies across the country and it has pooled data
and is now collecting new data all under the same common measure.
But what that has done has been, it's allowed us to have much larger sample sizes than have
typically been seen in any one study of autism.
It's like you're evolving a biomarker, in my opinion.
We can take a biomarker from a test, lab test, whatever, however the method, but you're
evolving it and a little bit of making it a step farther in for understanding, I think.
And I just love that so much.
And I hope more will get on to this because I think this is a very promising outcomes.
It seems to me.
I was reviewing your paper, I just love this paper, annual reviews of public health where
there's many items listed and parsed out.
Can you tell me a little bit about, maybe I'll start with immune factors or hormone and protein
factors?
Sure.
Well, so I should note that as with all work I do, that paper was definitely a team effort.
And I've mentioned how grateful I am to all the mentors I've had, but also to all the
collaborators that I get to work with.
And these are people who are experts in their own fields.
And so the immune piece of autism and immunology in itself is very interesting.
And so one thing that I've learned a lot along the way is actually during gestation,
the immune system really has a lot of cross talk with neurodevelopment, which is something
that I didn't know before I was a postdoc.
And so there have been a lot of studies that have shown various maternal immune activation
factors.
So autoimmune diseases, fever during pregnancy, infection during pregnancy, and related those
different factors to an increased risk of autism or likelihood of the child developing
autism.
There have also been some studies that have made use of biomarkers and looked at patterns
of cytokines or pro-inflammatory markers and different immune markers and found some
specific associations.
And I've been lucky to get to work with some colleagues in California who've led a population
based case control study that have really focused on a lot of immune markers and autism
and learned a lot about how those relate to autism.
And one interesting finding there is that there did seem to be kind of a general pattern
of associations with some of these immune markers, specifically for autism with co-occurring
intellectual disability.
And I think that's sort of an example of we know how complex and diverse autism is.
We have this one diagnostic label for what really represents a very broad phenotype and
diversity of strengths and challenges.
And I think it is interesting when we can pull apart factors that might put a child
or an individual on a pathway to one kind of subgroup of that broader category because
it helps us learn a little bit more about kind of the underlying biological pathways.
Another thing you mentioned, so hormone influences in autism.
And so there's been a lot of interest in thyroid hormones.
So we know thyroid hormones are so important in neurodevelopment.
All babies are screened and moms during pregnancy for their thyroid hormone levels.
And so there have been a number of studies that have looked at both mom thyroid hormone
levels and there are a couple different ones that are measured during pregnancy as well
as baby in those newborn heel stick and other biospecimens and examined associations with
those.
And the results have been a little bit inconsistent.
So I don't think we have necessarily a clear picture there.
But I have a student who is using some different statistical methodologies and there seem to
be some differences kind of across levels of autism traits.
So it may be important to consider again kind of what are those subgroups or sub phenotypes
within autism.
Do we get a clearer picture of how this biomarker, this exposure might be related to this outcome?
Thyroid is a region of interest.
And you're right, it is across data.
Yeah.
And that's been one reason why there's a lot of interest in a class of chemicals called
endocrine disrupting chemicals.
And these are EDCs because we know that they, as the name implies, disrupt hormone levels.
And so there's been a lot of interest in those chemicals and whether they relate to autism
specifically and also neurodevelopment more broadly and evidence that these are important
chemicals to be considering and regulating.
Yeah.
The tyrosine, synthesizing it from tyrosine is a very fascinating story, I think, because
it's an aromatic amino acid.
It's a very strange or rare special type of amino acid.
And yeah, there's only three of them.
And how they're synthesized is very unique.
And we can see that there's a lot of people that's on thyroid medicine now that have disrupted
thyroid, which is very problematic and goes back to the environmental risk factors that
we're talking about.
It's very much in line with this modern life, I think.
Something I was wanting to talk to you about is you mentioned something as simple as a
fever or something that's really even acute within pregnancy might increase the risk of
this neurodevelopment at this time frame that really disrupts the progression or the process
of the neurodevelopment, being a typical development.
Is something so brief like that known to play a factor in maybe this child will now develop
autism?
Yeah, so it's a great question.
I think there are a couple of different threads in there.
And so one is the piece of critical windows.
When is this specific factor happening?
And can something so acute actually have such a big impact on development?
And so we take, for example, folic acid and neural tube defects.
So if you're really low deficient in folic acid, if that's occurring in what we call
the periconceptional window when the neural tube is forming, then the baby can end up
with these neural tube defects, which are catastrophic.
And so that's the reason why we fortify and we recommend folic acid supplementation in
the early part of pregnancy.
And so that's the critical window aspect.
And so we do have evidence, yes, that certain exposures that timing really matters.
They have a much stronger effect.
And that's because of the neurodevelopmental processes that are happening.
It's lining up the exposure just at the right or wrong window of when these developmental
processes are happening and when they're most susceptible to some sort of environmental
insult.
Now, the other piece can fever once during pregnancy actually cause autism.
And that's kind of a loaded question.
And so I think the other piece that's important to remember there is there's the genetic background.
And so not everyone who gets fever during pregnancy develops a child, their child goes
on to develop autism.
And so we have to remember maybe it's fever combined with something else or maybe it's
fever combined with a genetic background plus three other factors.
And so it's this whole kind of interaction.
And we call them causal pie as an epidemiology.
It's all the different pieces that come together.
But interestingly for both infection and fever, there have been suggestions that when we look
at fever in the, I think it's the third trimester, I might be saying that wrong.
I can't remember it's the first or third.
But there have been stronger signals or evidence for an association and a specific trimester
with those.
So that's kind of another component there.
And then there's also, we have to consider, the mom's health matters too, right?
So mitigating the effects of that fever, it's important to get the fever under control.
So anytime we're looking at a medical condition, of course, you have to consider, you know,
what's the impact on the mom's health too?
And is the mother taking some sort of medication for that condition?
And then we get into questions about, well, is the medication causing any sort of impacts?
And then there's this kind of balancing of risks and benefits.
And I think we're still learning more about, you know, all these different components.
But certainly evidence that when a mother does have a fever, it's important to, you know,
address that.
Wow.
It could be so sensitive.
I had a doctor, a surgeon on from Duke, who's now doing umbilical cord sim cells on autistics.
And he done it on his son.
And his son was almost nonverbal.
And the way he describes it is about two weeks later, two, three weeks later, I mean, now
he's completely, he lives independent.
You know, he has like a girlfriend.
It just like helped him so much.
And I'm thinking as I hear more about this, it's like that umbilical cord is rescuing
whatever insults from the placenta to womb that probably occurred during pregnancy.
I'm not super familiar with that research.
Um, yeah, I mean, it's certainly interesting.
And I know there's a lot of interest in stem cells.
I think for, you know, when we're looking at things in epidemiology studies, we're trying
to get those population level effects.
So, rather than, you know, is this something that has impacted one person?
It's more looking at large groups of people and trying to glean and determine what at
the population level are contributors to this outcome.
Yeah, it's like what we mentioned earlier about maybe this thing is weak, but as you
build up, it kind of just strengthens whatever it is, the topic of interest there.
That's incredible.
Air pollution is something that's heavily researched.
There's been an explosion of air pollution studies over the past decade, one to two decades.
I think the first paper looking at air pollution and autism, I think was 2012.
So not that long ago.
And I think, you know, the reason why there's a lot of interest in air pollution is everyone's
exposed to it, right?
So even if the effects are small, you know, or the only impacts for certain individuals,
whatever the case may be, it is this ubiquitous factor that is really everywhere.
And we know that there are certain pollutants in the air that do have impacts on development,
neurodevelopment, all kinds of outcomes, asthma and airways, overall health.
So it's certainly an exposure that people have been paying a lot of attention to.
And I believe there's some emerging and ongoing animal studies that have demonstrated some
biologic pathways that actually help to support the association, things like oxidative stress,
inflammation.
Oxidative stress.
Yeah.
Oxidative stress is definitely a question.
And that's related, of course, also to input.
Those are two kind of interlinked pathways.
And so we did a study actually trying to measure biomarkers of oxidative stress and mothers.
And this was in a relatively small study.
But some colleagues of mine developed this study where families who already had a child
with autism were contacted and asked if they were going to be getting pregnant again.
And so then those families were followed through their next pregnancy to allow for that kind
of cohort model and prospective follow-up from pregnancy through early development.
And just wonderful participation in these studies that really help drive the research.
And the mothers provided biological specimens.
And we've been able to measure all sorts of different things in these samples.
And so we measured isoprostanes and other markers of kind of generalized oxidative stress
to try and see are these biomarkers during pregnancy that are indicators of increased
oxidative stress?
Are they related to later outcomes of autism?
And again, didn't see very strong associations, but some potential kind of signals for different
patterns.
So something that I think could be expanded upon in larger studies and trying to tease
apart, do we see different associations with different subgroups?
What is something recently that you're most excited about?
Well, I'm really excited.
I mentioned the ECHO program, that large consortium.
I'm really excited about getting to participate in that network.
One because it allows for things that we haven't always been able to do yet in autism research
with the larger numbers, at least for the type of work that I do, focus on nutrition
and environmental chemicals.
And then I'm really excited about looking at interactions and thinking about not just
one factor at a time, but can we get a little bit more of a holistic picture about how all
these puzzle pieces fit together?
Not just one at a time, but what's the effect of this one and this one?
Especially if we have some kind of pathway that we think they're both acting on or one
is going to resolve the impacts of this factor on another pathway.
And so we have a study now that is looking at does prenatal diet modify the effects of
air pollution exposure on autism?
And that's a study funded by NIEHS.
And so we're delving into those results now.
But I'm really interested in kind of expanding that line of work and then also trying to
learn more about all the good and bad things in diet.
So we've got these beneficial nutrients, but we also have highly packaged and processed
foods that it can be a source of chemical exposures.
What can we learn about their intake in children and how that's impacting child health?
So I've focused mainly on prenatal diet, but what about the child diet side and how does
that modify?
We know that children with autism and individuals with autism can often have food sensitivities
and highly restricted diets.
And that presents all sorts of challenges in its own right.
I think any parent can tell you that it can be hard to get their kid to eat vegetables
and to eat a healthy diet.
I think when you're working within the realm of autism, that whole kind of landscape changes
even further.
And so what can we do to help support the lives of these families and individuals in
a way that improves supports and outcomes?
And so I'm excited to learn more about kind of the ongoing child pieces and how that may
kind of modify different outcomes within autism.
And we've also kind of been expanding in different ways to think about learning more about kind
of the health and well-being of the family unit and supporting mom health.
When you've been in autism research for a long time, you really get a lot of great interaction
with families and really are grateful for the research participation and for hearing
back from families.
And so I think it's important to think about ways that we can give back and help support
as well.
So Pam?
Autism is a very pressing topic for many people and for good reason.
Yeah, I'm glad that people are like that and participating.
It's just so pressing.
The rates are pressing.
But the food sensitivity, it's like there's so many autism and XYZ conditions always.
There's so many comorbids and GI problems is one that's really high and like the food
sensitivity and so forth.
It's like finding out how to fix this is incredible.
And I'm so looking forward to the data that you just described.
Is there a place that we can look for your research and this data in the future?
That's a great question.
Yeah, so again, I'm going to shout out the ECHO Network again.
I think they do a really nice job of providing research.
This is not just my work.
There's a whole list of wonderful collaborators.
But there's a large focus on, okay, let's not make science so hard to access and understand.
Right?
And so there's a whole page that summarizes research study across everything that ECHO
is looking at.
And so that's a site that I would direct people to.
It's echochildren.org.
And it provides one-liner summaries of research summary studies that have been recently published
as well as longer summaries.
And so that's one place.
The more maybe scientific or technical side of things PubMed is searching on there, but
those are often kind of more directed at the researcher side or scientist side audience.
And although I will say some journals do a really nice job of making sure that there's
a lay summary that we're not just directing results and findings to one audience only,
but really trying to make sure that they're accessible and reachable and understandable
to anyone who wants to access that information.
Yeah.
I mean, individual studies.
So I mentioned that one cohort, the early study has its own website.
And I'm sure I'm forgetting other different resources to find these things, but those
are kind of some of the major ones.
And the NIH also lists summaries, which also includes lay summaries of different projects
that they're funding.
And that can be another resource to find out about what are some ongoing projects that
are going on in autism addressing these topics as well as others.
Yeah, I just appreciate your actionable tools that you're providing for families.
I think it's very incredible.
And a lot more work to do, that's for sure.
And yeah, hoping that we can provide some information that can be useful to people.
Yeah.
I'm hoping for the day that we can have this preparation, like preparing, going into pregnancy,
and it will just do great wonders to the risk or the rates, I should say.
I can't thank you enough.
I'm very excited about your role, the epidemiology aspect of this.
And I think this is just incredible information.
Well, thank you so much, and I'm always happy to answer questions and again, really appreciate
the invitation to come and spend time with you and talk about my work a little bit.
Yeah, it's very valuable information.
So I'll put some links in the show notes and promote it on social media, the little social
media that I'm on.
But yeah, I just want to get your message out.
Great.
Well, thank you so much.
It's been so nice to get to talk to you.
Yeah, I appreciate you interacting with me.
If you're listening to the podcast or listening to the episode, please feel free to leave
a review or ratings.
In podcasting, review and ratings are crucial, and I very much appreciate your feedback.
You can contact me on X at RPS, 47586, or click on the hop link so you can have links
to all the show platforms and contact information.
You can email me info.fromthespectrum at gmail.com.
And thank you for listening to From the Spectrum podcast.