BIOMEDICAL INTERVENTIONS FROM A TO ZINC

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BIOMEDICAL INTERVENTIONS FROM A TO ZINC
Thursday, May 21, 2009 Chicago, IL
Nancy O’Hara, M.D., M.P.H. 150 Danbury Road Wilton, CT 06897 www.drohara.com
Follow those who seek the truth but flee from those who have found it. Yaclav Havel
Where To Begin
One Child Patterns
PATTERNS
Genetic Predisposition

Family History-autoimmune, gastrointestinal (Valicenti-McDermott et
al, 2006)
 
Single Nucleotide Polymorphisms Increased Susceptibility (Herbert, 2005) Altered Sensitivity Abnormal Processing Altered Sensitivity (decreased IgA, NK cells, increased TNF) (Jyonuchi et al, 2005) Abnormal Processing (autoantibodies, TH1 & TH2 skewing)
(Ashwood et al, 2006)
Neurologic Problems
 
Immune System Dysregulation
 
PATTERNS
Digestive Abnormalities

Maldigestion (altered enzyme function) (Horvath et al,
1999)
 
Dysbiosis (change in bowel flora) Increased Permeability (antigens, peptides, toxins)
(Vojdani et al, 2004)

Inflammation (enterocolitis, LNH, pro-inflammatory cytokines) (Torrente et al, 2002) Impaired detoxification Oxidative Stress (James et al, 2004) Mitochondrial defects (Filipek et al, 2003
Biochemical Peculiarities
  
SOME GUIDING PRINCIPLES
WHAT DOES EACH CHILD NEED TO: GET GET RID OF WHAT CAN I AS A PARENT DO?
Methionine Transsulfuration to Cysteine and Glutathione
Methionine THF 5,10CH2THF
Methylation Potential (SAM/SAH)
SAM
MS
BHMT
1
5CH3THF
MTHFR
B12
2
Betaine Choline
SAH
SAHH
MTase Cell Methylation
Adenosine Homocysteine
B6
1 Folate Cycle 2 Methionine Cycle 3 Transsulfuration 3
CBS
Antioxidant Potential
Cystathionine
B6
Cysteine GSH GSSG
WHAT DO WE NEED TO GIVE TO OR GET OUT OF OUR CHILDREN?
Exercise/Activity Basic Nutritional Changes
    

Fresh, unprocessed, unrefined, organic, whole foods Varied and rotational Non allergenic (crave that which most sensitive to) Protein (every 4-5 hours) Avoid excitotoxins (caffeine, MSG, dyes); phenolics (grapes, strawberries) Juicing; raw foods; fermented foods (kefir); good fats
WHAT DO WE NEED TO GIVE TO OR GET OUT OF OUR CHILDREN?
3 R’S

Remove:
Sugars, junk food, germs, toxins GF/CF/SF/YF/SCD/LOD/BED/GAPS/LP

Replenish:
Probiotics, enzymes, EFAs, antiglutamates

Repair/Restore:
Detoxification Anti-inflammatories (LDN, Actos, Spironolactone, IG, HBOT)
Responsive to SCD?
Antifungal trial
Food Allergen Elimination?
Start Here
Methyl B12
Start Here
Clean up gut (food and flora)
Start Here Casein
Free Diet
Start Here
Transdermal TTFD/GSH Digestive Enzymes Detoxification therapies Supplements (start low and slow)
Gluten Free Diet
Second tier supplements
REMOVE
Foods

Casein (sticky protein in dairy)
100% elimination for 3 weeks

Gluten (protein in wheat, barley, rye, hidden sources)
Tests can be inaccurate 100% elimination for 3 months Healthy alternative not just GFCF
 
Food sensitivities (IgG reactive) Specific Carbohydrate Diet (SCD)
Restricts all disaccharides (2 sugars) and polysaccharides (starches)


Not able to digest carbs due to mucosal damage→germ overgrowth feeds on unabsorbed sugars→enzyme destruction→further inhibition metabolism and microvilli damage Watch nut and nut flours
REMOVE
FOODS
 
Gut and Psychology Syndrome (GAPS) Low Phenol (Feingold: faulty sulfation)
Apples, grapes, bananas, salicylates, artificial ingredients

Low Oxalate Diet (LOD)
Leaky gut→oxalates not metabolized and absorbed→inflammation, pain Decrease leaves of plants; nuts; soy; berries

Body Ecology Diet (BED)
Proper food combining, low acid formation, easily digested foods Principles of anti-yeast diets including no sugars, fermented foods
GERMS

Bacteria (history of positive response to antibiotics)
Strep (tics, OCD, tantrums, PANDAS)
Daniel- 8 years old
Sudden change in behavior Uncontrolled agitation OCD behavior Hyperactivity Recurrent sore throats Yeast? Taurine? Drugs?
Strep (PANDAS)
ASO Ab- 452 (nl < 200) DNase Ab – 960 (nl < 120)

Swedo et al, 1998
TREATMENT-STREP
Probiotics Xylitol Saccharomyces Boulardii/Alkalinization/Charcoal Antibiotics (Snider et al, 2004)
 
IM Bicillin (1.2 million units-perhaps monthly) Penicillin, Omnicef, Zithromax
Antimicrobial herbs Immune Modulators (March et al, 2004)
    
Oral immunoglobulins Transfer factor/colostrum Mushroom extracts/plant sterols LDN, Actos, Spironolactone, HBOT IVIG
REMOVE
GERMS Bacteria (history of positive response to antibiotics)
 
Strep (tics, OCD, tantrums, PANDAS) Clostridia (aggression, agitation, foul mucousy stools, diarrhea)
TREATMENT FOR BACTERIA
Probiotic/Prebiotic/Saccharomyces Antibiotics (Vancomycin, Metronidazole, Alinia) Homeopathic/Herbals/HBOT
REMOVE
GERMS Bacteria (history of positive response to antibiotics)
 
Strep (tics, OCD, tantrums, PANDAS) Clostridia (aggression, agitation, foul mucousy stools, diarrhea)
Parasites (have to treat; bizarre behavior, insatiable appetite, picking/biting/itching/grinding/smearing)
    
Blastocystis hominis (treat with Bactrim and Humatin) Probiotics Antiparasitics (Metronidazole, Paromomycin, Mebendazole) Natural remedies (artemesia, pumpkin seeds, coconut) TSO therapy
REMOVE
Germs
  
Bacteria Parasites Fungus (spacey, moody, crave sugar, frequent urination, inappropriate laughter)
Diet-limit carbs, sugar Probiotics Herbals Medications Biofilm
Yeast Free Diet
Refined carbs (sugar) feed yeast (soda has 38 gm, grape juice has 57 gm of sugar) Condiments Leftovers or aging foods (aging cheeses) Juice (all commercial juices have started to age and ferment) Dried fruits or fruits too small to peel Specific Carbohydrate Diet Body Ecology Diet
Herbal Remedies
Garlic (1-2 fresh cloves or pills/day) Caprylic acid (500-1000 mg with meals) Oregano oil (0.2 ml 2x/day) Grapefruit or citrus seed extract (1/3 adult dose) Saccharomyces boulardii (3-6 capsules/day)
Saccharomyces Boulardii
Yeast against yeast Like swallowing the pharmaceutical company Promotes good flora Potential for very severe die-off Theoretically increases secretory IgA Is indistinguishable in lab from S.cerevisae
Czerucka et al, 2002
The Antifungal Parade
Non-absorbable
  
S.boulardii: 3 months (at least 3-6/day) Nystatin: 1,000,000 units 4X day Amphotericin B (oral) Sporanox (Itraconazole) Diflucan (Fluconazole) Lamisil (Terbinafine) Nizoral (Ketaconazole)
Systemic
   
Die-off
Occurs when yeast dies, releasing toxins. Antidote: activated charcoal up to 6X per day. Also treats the acidosis accompanying stress/illness: Alka Seltzer Gold, one tablet in water several times daily.
GEORGE 3 year old with ASD
Constipation/Hard stools Craved sweets Red cheeks/ears No interaction with peers 9 courses of antibiotics for chronic OM Mood swings/sensitivities Breath smelled of bread Rashes/toe peeling/nail ridges
Ridged, Discolored Nails
Peeling Feet
GEORGE TREATMENT
Elevated yeast metabolites on urine organic acid test Fluconazole, Terbinafine, Ketaconazole Better communication, engagement, social interaction Specific Carbohydrate Diet – “normal” Saccharomyces, probiotic, trisalts, CLO “Misdiagnosed” according to neurologist
REMOVE
Germs
   
Bacteria Parasites Fungus Virus (regression after live viral vaccines, viral infection, fatigue, cold sores, warts, visual issues)
Antiviral agents (vitamin A, olive leaf extract, monolaurin) Antiviral medications (valacyclovir, acyclovir, famvir) Immune modulators/support
Toxins
  
Detoxification (glutathione, ammonia) Chelation (DMSA, DMPS, EDTA) Homeopathy
REPLENISH
GLUTATHIONE! (oral, inhaled, transdermal, IV) Enzymes (speeds disassembly of foods; -ase)
  
Mixed (helps kids with poor digestion) Plant based (papaya and pineapple) Peptidase specific (helps specific peptide digestion) Reflorestation is tough Essential when treating dysbiosis Miraglia del Giudice et al, 2004 Activated charcoal (mop up toxins) Alka Seltzer Gold (alkaline)
Probiotics (between meals with room temperature water)
  
Symptomatic (yeast die off)
 
REPLENISH
Enzymes Probiotics Symptomatic AntiGlutamates
  
Pycnogenol (Trebaticka et al, 2006) Chamomile Taurine, GABA Charcoal Fiber/Pectin Yucca
Treat High Ammonia
  
Nutrients (MVI) (Carlton et al, 2000)
Methionine Transsulfuration to Cysteine and Glutathione
Methionine THF 5,10CH2THF
Methylation Potential (SAM/SAH)
SAM
MS
BHMT
1
5CH3THF
MTHFR
B12
2
Betaine Choline
SAH
SAHH
MTase Cell Methylation
Adenosine Homocysteine
B6
1 Folate Cycle 2 Methionine Cycle 3 Transsulfuration 3
CBS
Antioxidant Potential
Cystathionine
B6
Cysteine GSH GSSG
NUTRIENTS
Zinc (Sturniolo et al, 2001)  > 200 enzymatic functions; in energy metabolism, protein, immunity, detox  Acne, mouth sores, spots/lines on nails, pica, loss of smell, taste  Deficiency causes language, attention and immune issues  Best given alone, at night (piccolinate, acetate)  Ratio with copper; taste test Magnesium (Martineau et al, 1985)  > 300 enzymatic functions; neuromuscular, neurotransmitters, BP  Deficiency causes hyperactivity, anxiety, twitches, insomnia  Sighing/salt craving/constipation Calcium  Bone/tooth/muscle/nerve function; cell membrane permeability  Deficiency causes rigidity, poor sleep, anxiety, teeth grinding  Secondary deficiency  Absorption vs taste
Nutrients Continued
Molybdenum
 
With deficiency – poor detoxification, chemical sensitivity With excess – high uric acid, low copper, anemia Important for redox reactions, antioxidant With deficiency – immune dysfunction, cell fragility With excess – fatigue, brittle hair/nails, parasthesias Important for glucose control, insulin/liver function With deficiency – insulin resistance, Syndrome X, neuropathy Important for oxygen transport, cell differentiation With deficiency – anemia, malabsorption, fatigue With excess – liver and free radical damage
Selenium
  
Chromium
 
Iron
  
Nutrients - Vitamins
Vitamin A (retinol)
 
Immunity, vision, cell differentiation, anti-CA With deficiency – vision, immune dysfunction Antioxidant, healing, neurotransmitter function With deficiency – bruising, poor immune function, anxiety, depression (diarrhea with excess) Ca absorption, thyroid function, anti-inflammatory With deficiency – scaling, muscle pain, restlessness, sweating Antioxidant, prevents lipid peroxidation With deficiency – jaundice, xs clotting, impaired reflexes Methioneine/aa metabolism, growth/brain development With deficiency – fatigue, weakness, immune/cognitive dysfunction
Vitamin C (Ascorbic acid)
 
Vitamin D
 
Vitamin E
 
Folic acid (folinic, 5- THF)
 
NUTRIENTS - B VITAMINS
B12 (cobalamin – cyano, methyl, adenosyl)  Deficiency - decreased communication, anemia, memory loss, poor balance  Methyl B12- SQ, IN, TD, oral; need adequate folate B1 (thiamine- deficiency can cause ataxia, enuresis, sensory loss) B2 (riboflavin- deficiency can cause mouth fissures, photophobia) B3 (niacin- deficiency can cause dermatitis, diarrhea, dementia) B5 (pantothenic acid- deficiency can cause toe walking, grinding, restlessness, insomnia) B6 (P5P- deficiency can cause immune dysfunction, anemia, sensory issues, tantrums) B15 (DMG/TMG)  Deficiency leads to poor communication  Give with folate to decrease hyperactivity
Keratosis pilaris
NUTRIENTS - OTHER
EFAs (Richardson et al, 2006)  Deficiency can cause keratosis pilaris, dry, coarse hair  Cell communication  Protection in bone, liver, lung, immune function Amino Acids  Taurine  GABA  AKG Phosphatidylcholine-counteracts oxidative stress, replenish glutathione Carnitine/CoQ10/Biotin Spironolactone/Aldactone-anti-inflammatory, ↓ testosterone Oxytocin  ↓ anxiety/aggression; acts at amygdala Melatonin (Reichenberg et al, 2001)  Regulates serotonin balance
The Gut-Brain Axis of Pathology in Autism
Opioid peptides excess
Dietary Protein
Defective enzyme/ Microbial environment
Opioid peptides excess
Intestinal permeability
Inflammation In autism patient
Low active tissue peptidases with antagonism endorphins
Systemic carriage
• High TNF-α titre • High IL-1 and IL-6 titre • Skewing to Th2 • Depression of Th1 immunity
- Decreased NK cell - Decreased Th1 CD cell - Decreased Ig A
Opioid receptors in brain
Low sensitivity to pain
Repetitive behaviour
Social deficiencies
Some retardation in Cognitive development
Putting It All Together
Diet Baseline Nutrients
   
MVI Probiotics EFAs Enzymes Treat underlying dysbiosis Treat underlying oxidative stress Treat inflammation Detoxification
Look At Your Child
   
What Is It That My Child Needs:
To Get To Get Rid Of Keep an open mind Not a label Find clues and clusters
Keep Your Faith in All Beautiful Things: In the sun when it is hidden, in the spring when it is gone.