By Derrick MacFabe MD FACN, American Nutrition Association Scientific Advisory Board; Director: Kilee Patchell-Evans Autism Research Group 

Despite extraordinary advances in modern medicine, a troubling paradox defines our time: in many ways, we are sicker than ever. 

Rates of chronic disease—obesity, diabetes, cardiovascular disease, immune conditions, certain cancers, and mental health disorders—continue to rise worldwide. The COVID pandemic further exposed vulnerabilities in world health, while long COVID added a new and lasting burden. In parallel, societies are facing a profound mental health crisis marked by impaired coping, addiction, despair, and erosion of social trust. 

These trends affect nearly every sector—healthcare, education, workforce participation, and economic stability. Furthermore, as developing regions adopt Westernized diets and lifestyles, similar disease patterns are emerging, suggesting that modernization itself may be reshaping human health in unintended ways. 

One of the most vulnerable—and least supported—groups within this crisis are individuals with developmental disabilities and their families. This is most evident with autism, where current rates have skyrocketed nearly 150-fold in the last half century, approaching even one in thirty, a scale that cannot be fully explained by genetics or improved diagnosis alone. All of us are justifiably concerned. We are told what does not cause autism, but it is unclear what does cause or contribute to this devastating condition. While greater acceptance of neurodiversity is an important and overdue step forward, far less attention has been paid to the elevated lifelong risks this population faces, including anxiety, depression, social isolation, and reduced quality of life, preventing these individuals from reaching their true potential. 

 Without clear explanations or evidence-based solutions, families—often exhausted and desperate—are vulnerable to oversimplified narratives or unproven interventions. This gap between lived experience and credible guidance creates both harm and missed opportunity. 

Expanding research points to a factor long underestimated: the gut microbiome. The trillions of microorganisms that live within us play a central role in regulating immunity, metabolism, inflammation and even brain function. When we eat, we feed not only ourselves, but this microbial ecosystem—and its metabolic byproducts act as powerful biological signals throughout the body. 

When microbial communities are diverse and stable, they support resilience and health. When disrupted—by diet, antibiotics, environmental exposures, or early-life factors—they may contribute to many chronic diseases. This framework helps connect conditions once viewed in isolation, including gastrointestinal disorders, immune and metabolic diseases, and neurobehavioral changes. 

Diet is a key driver of this process. Over the past several decades, ultra-processed, nutrient-poor foods have displaced traditional whole-food diets across the globe. These products are often high in refined carbohydrates, additives, emulsifiers, and preservatives, while lacking the fiber and essential nutrients that support microbial diversity. 

Importantly, this is not a simplistic “calories or sugar alone” argument. Research increasingly suggests that how food is processed—and how it alters microbial metabolism—matters deeply. Certain microbial metabolites are associated with inflammation, insulin resistance, mitochondrial dysfunction, epigenetic changes and altered brain signaling. Others, produced when diets are rich in fiber-containing whole and fermented foods, appear protective. 

This microbial–metabolic signaling has profound implications. Mitochondria—the energy-producing structures in our cells—are particularly sensitive to these signals. Because the brain, immune system, and gut are highly energy-dependent, disruptions here can manifest as cognitive, inflammatory, and gastrointestinal symptoms seen across many chronic conditions throughout life. 

Critically, some of these effects appear dynamic and, in certain contexts, reversible. This creates an opportunity for prevention and intervention strategies that are comparatively low risk, scalable, and cost-effective—especially when integrated with established medical and behavioral therapies. 

Diet and the microbiome are not the sole causes of chronic disease or mental illness. But the convergence of evidence suggests they are foundational contributors with common mechanisms we can no longer afford to ignore. 

In the United States and globally, the growing willingness to examine scientifically established contributors to chronic disease—including the Western diet—is both encouraging and urgently needed. At a time when healthcare systems are under unprecedented strain, this openness and potential for collaboration creates a rare opportunity to translate emerging evidence into meaningful prevention and intervention. 

History reminds us why this matters. Just over a century ago, Frederick Banting and Charles Best transformed diabetes from a universally fatal disease into a manageable condition by uncovering the link between nutrition, sugar metabolism, and insulin. Even before our understanding of DNA and modern genetics, that breakthrough reshaped medicine—and millions of lives—by reframing how we understood the relationship between food, biology, and disease. 

Today, we may be at a similar inflection point. The once-underappreciated role of diet and the microbiome in shaping metabolic, immune, and brain health is coming into focus, offering renewed hope that we can foster healthier bodies, healthier minds, and more resilient societies. While no single factor holds all the answers, the convergence of evidence suggests that collaboration—across disciplines, sectors, and communities—will be essential. 

If, like the microbes that sustain us, we act collectively rather than in isolation, meaningful change is not only possible—it is well within reach. 

Dr. MacFabe’s piece is an abridged version from Helen: The Journal of Human Exceptionality. For further information see his website .