BIOMEDICAL BIOMEDICAL INTERVENTIONSINTERVENTIONSFROM A TO ZINCFROM A TO ZINC

Thursday, May 21, 2009Thursday, May 21, 2009Chicago, ILChicago, IL

Nancy O’Hara, M.D., M.P.H.Nancy O’Hara, M.D., M.P.H.150 Danbury Road150 Danbury RoadWilton, CT 06897Wilton, CT 06897www.drohara.comwww.drohara.com

Follow those who seek the truth but flee from those who have found it.

Yaclav Havel

Where To BeginWhere To Begin

One ChildOne Child

PatternsPatterns

PATTERNSPATTERNS

Genetic PredispositionGenetic Predisposition Family History-autoimmune, gastrointestinal Family History-autoimmune, gastrointestinal (Valicenti-McDermott et (Valicenti-McDermott et

al, 2006)al, 2006) Single Nucleotide PolymorphismsSingle Nucleotide Polymorphisms Increased Susceptibility Increased Susceptibility (Herbert, 2005)(Herbert, 2005)

Neurologic ProblemsNeurologic Problems Altered SensitivityAltered Sensitivity Abnormal ProcessingAbnormal Processing

Immune System DysregulationImmune System Dysregulation Altered Sensitivity (decreased IgA, NK cells, increased TNF) Altered Sensitivity (decreased IgA, NK cells, increased TNF)

(Jyonuchi et al, 2005(Jyonuchi et al, 2005)) Abnormal Processing (autoantibodies, TH1 & TH2 skewing) Abnormal Processing (autoantibodies, TH1 & TH2 skewing)

(Ashwood et al, 2006)(Ashwood et al, 2006)

PATTERNSPATTERNS

Digestive AbnormalitiesDigestive Abnormalities Maldigestion (altered enzyme function) Maldigestion (altered enzyme function) (Horvath et al, (Horvath et al,

1999)1999) Dysbiosis (change in bowel flora)Dysbiosis (change in bowel flora) Increased Permeability (antigens, peptides, toxins) Increased Permeability (antigens, peptides, toxins)

(Vojdani et al, 2004)(Vojdani et al, 2004) Inflammation (enterocolitis, LNH, pro-inflammatory Inflammation (enterocolitis, LNH, pro-inflammatory

cytokines) cytokines) (Torrente et al, 2002)(Torrente et al, 2002)

Biochemical PeculiaritiesBiochemical Peculiarities Impaired detoxificationImpaired detoxification Oxidative Stress Oxidative Stress (James et al, 2004)(James et al, 2004) Mitochondrial defects Mitochondrial defects (Filipek et al, 2003(Filipek et al, 2003

SOME GUIDING PRINCIPLESSOME GUIDING PRINCIPLES

WHAT DOES EACH CHILD NEED TO:WHAT DOES EACH CHILD NEED TO:

GETGET

GET RID OFGET RID OF

WHAT CAN I AS A PARENT DO?WHAT CAN I AS A PARENT DO?

SAM

SAH

MTase

SAHH

Homocysteine

CBS

BHMT

Choline

Betaine

Methionine Transsulfuration to Cysteine and Glutathione

Cystathionine

Cysteine

GSH GSSG

Methionine

Adenosine

B6

B6

5-CH3THF

THF

B12MS5,10-

CH2THFMTHFR

Cell Methylation1 2

3

1

2

3

Folate Cycle

Methionine Cycle

Transsulfuration

Methylation Potential(SAM/SAH)

AntioxidantPotential

WHAT DO WE NEED TO GIVE TO WHAT DO WE NEED TO GIVE TO OR GET OUT OF OUR OR GET OUT OF OUR

CHILDREN?CHILDREN?Exercise/ActivityExercise/Activity

Basic Nutritional ChangesBasic Nutritional Changes Fresh, unprocessed, unrefined, organic, whole foodsFresh, unprocessed, unrefined, organic, whole foods Varied and rotationalVaried and rotational Non allergenic (crave that which most sensitive to)Non allergenic (crave that which most sensitive to) Protein (every 4-5 hours)Protein (every 4-5 hours) Avoid excitotoxins (caffeine, MSG, dyes); phenolics Avoid excitotoxins (caffeine, MSG, dyes); phenolics

(grapes, strawberries)(grapes, strawberries) Juicing; raw foods; fermented foods (kefir); good fatsJuicing; raw foods; fermented foods (kefir); good fats

WHAT DO WE NEED TO GIVE TO WHAT DO WE NEED TO GIVE TO OR GET OUT OF OUR OR GET OUT OF OUR

CHILDREN?CHILDREN?3 R’S3 R’S Remove: Remove:

Sugars, junk food, germs, toxinsSugars, junk food, germs, toxins GF/CF/SF/YF/SCD/LOD/BED/GAPS/LPGF/CF/SF/YF/SCD/LOD/BED/GAPS/LP

Replenish: Replenish: Probiotics, enzymes, EFAs, antiglutamatesProbiotics, enzymes, EFAs, antiglutamates

Repair/Restore:Repair/Restore:DetoxificationDetoxificationAnti-inflammatories (LDN, Actos, Spironolactone, Anti-inflammatories (LDN, Actos, Spironolactone, IG, HBOT)IG, HBOT)

Responsive to SCD?

Food AllergenElimination?

Antifungal trial

Casein Free Diet

Methyl B12Clean up gut

(food and flora)

Digestive Enzymes

TransdermalTTFD/GSH Gluten Free

Diet

Detoxificationtherapies

Supplements (start low and

slow)

Second tier supplements

Start Here

Start Here

Start HereStart Here

REMOVEREMOVE

FoodsFoods Casein (sticky protein in dairy)Casein (sticky protein in dairy)

100% elimination for 3 weeks100% elimination for 3 weeks Gluten (protein in wheat, barley, rye, hidden sources)Gluten (protein in wheat, barley, rye, hidden sources)

Tests can be inaccurateTests can be inaccurate100% elimination for 3 months100% elimination for 3 monthsHealthy alternative not just GFCFHealthy alternative not just GFCF

Food sensitivities (IgG reactive)Food sensitivities (IgG reactive) Specific Carbohydrate Diet (SCD)Specific Carbohydrate Diet (SCD)

Restricts all disaccharides (2 sugars) and polysaccharides Restricts all disaccharides (2 sugars) and polysaccharides (starches)(starches)

Not able to digest carbs due to mucosal damageNot able to digest carbs due to mucosal damage→germ overgrowth →germ overgrowth feeds on unabsorbed sugars→enzyme destruction→further inhibition feeds on unabsorbed sugars→enzyme destruction→further inhibition metabolism and microvilli damagemetabolism and microvilli damage

Watch nut and nut floursWatch nut and nut flours

REMOVEREMOVE

FOODSFOODS Gut and Psychology Syndrome (GAPS)Gut and Psychology Syndrome (GAPS) Low Phenol (Feingold: faulty sulfation)Low Phenol (Feingold: faulty sulfation)

Apples, grapes, bananas, salicylates, artificial ingredientsApples, grapes, bananas, salicylates, artificial ingredients Low Oxalate Diet (LOD)Low Oxalate Diet (LOD)

Leaky gut→oxalates not metabolized and absorbed→inflammation, Leaky gut→oxalates not metabolized and absorbed→inflammation, painpainDecrease leaves of plants; nuts; soy; berriesDecrease leaves of plants; nuts; soy; berries

Body Ecology Diet (BED) Body Ecology Diet (BED) Proper food combining, low acid formation, easily digested foodsProper food combining, low acid formation, easily digested foodsPrinciples of anti-yeast diets including no sugars, fermented foodsPrinciples of anti-yeast diets including no sugars, fermented foods

GERMSGERMS Bacteria (history of positive response to antibiotics)Bacteria (history of positive response to antibiotics)

Strep (tics, OCD, tantrums, PANDAS)Strep (tics, OCD, tantrums, PANDAS)

Daniel- 8 years oldDaniel- 8 years old

Sudden change in behaviorSudden change in behavior

Uncontrolled agitationUncontrolled agitation

OCD behaviorOCD behavior

HyperactivityHyperactivity

Recurrent sore throatsRecurrent sore throats

Yeast? Taurine? Drugs?Yeast? Taurine? Drugs?

Strep (PANDAS)Strep (PANDAS)

ASO Ab- 452 (nl < 200)ASO Ab- 452 (nl < 200)

DNase Ab – 960 (nl < 120)DNase Ab – 960 (nl < 120) Swedo et al, 1998Swedo et al, 1998

TREATMENT-STREPTREATMENT-STREP

ProbioticsProbioticsXylitolXylitolSaccharomyces Boulardii/Alkalinization/CharcoalSaccharomyces Boulardii/Alkalinization/CharcoalAntibioticsAntibiotics (Snider et al, 2004)(Snider et al, 2004)

IM Bicillin (1.2 million units-perhaps monthly)IM Bicillin (1.2 million units-perhaps monthly) Penicillin, Omnicef, ZithromaxPenicillin, Omnicef, Zithromax

Antimicrobial herbsAntimicrobial herbsImmune Modulators Immune Modulators (March et al, 2004)(March et al, 2004)

Oral immunoglobulinsOral immunoglobulins Transfer factor/colostrumTransfer factor/colostrum Mushroom extracts/plant sterolsMushroom extracts/plant sterols LDN, Actos, Spironolactone, HBOTLDN, Actos, Spironolactone, HBOT IVIGIVIG

REMOVEREMOVE

GERMSGERMS

Bacteria (history of positive response to Bacteria (history of positive response to antibiotics)antibiotics) Strep (tics, OCD, tantrums, PANDAS)Strep (tics, OCD, tantrums, PANDAS) Clostridia (aggression, agitation, foul mucousy Clostridia (aggression, agitation, foul mucousy

stools, diarrhea)stools, diarrhea)

TREATMENT FOR BACTERIATREATMENT FOR BACTERIA

Probiotic/Prebiotic/SaccharomycesProbiotic/Prebiotic/Saccharomyces

Antibiotics (Vancomycin, Metronidazole, Antibiotics (Vancomycin, Metronidazole, Alinia)Alinia)

Homeopathic/Herbals/HBOTHomeopathic/Herbals/HBOT

REMOVEREMOVE

GERMSGERMSBacteria (history of positive response to antibiotics)Bacteria (history of positive response to antibiotics)

Strep (tics, OCD, tantrums, PANDAS)Strep (tics, OCD, tantrums, PANDAS) Clostridia (aggression, agitation, foul mucousy stools, diarrhea)Clostridia (aggression, agitation, foul mucousy stools, diarrhea)

Parasites (have to treat; bizarre behavior, insatiable Parasites (have to treat; bizarre behavior, insatiable appetite, picking/biting/itching/grinding/smearing)appetite, picking/biting/itching/grinding/smearing)

Blastocystis hominis (treat with Bactrim and Humatin)Blastocystis hominis (treat with Bactrim and Humatin) ProbioticsProbiotics Antiparasitics (Metronidazole, Paromomycin, Mebendazole)Antiparasitics (Metronidazole, Paromomycin, Mebendazole) Natural remedies (artemesia, pumpkin seeds, coconut)Natural remedies (artemesia, pumpkin seeds, coconut) TSO therapyTSO therapy

REMOVEREMOVE

GermsGerms BacteriaBacteria ParasitesParasites Fungus (spacey, moody, crave sugar, Fungus (spacey, moody, crave sugar,

frequent urination, inappropriate laughter)frequent urination, inappropriate laughter)Diet-limit carbs, sugarDiet-limit carbs, sugarProbioticsProbioticsHerbalsHerbalsMedicationsMedicationsBiofilmBiofilm

Yeast Free DietYeast Free Diet

Refined carbs (sugar) feed yeast (soda has 38 Refined carbs (sugar) feed yeast (soda has 38 gm, grape juice has 57 gm of sugar)gm, grape juice has 57 gm of sugar)CondimentsCondimentsLeftovers or aging foods (aging cheeses)Leftovers or aging foods (aging cheeses)Juice (all commercial juices have started to age Juice (all commercial juices have started to age and ferment)and ferment)Dried fruits or fruits too small to peelDried fruits or fruits too small to peelSpecific Carbohydrate DietSpecific Carbohydrate DietBody Ecology DietBody Ecology Diet

Herbal RemediesHerbal Remedies

Garlic (1-2 fresh cloves or pills/day)Garlic (1-2 fresh cloves or pills/day)

Caprylic acid (500-1000 mg with meals)Caprylic acid (500-1000 mg with meals)

Oregano oil (0.2 ml 2x/day)Oregano oil (0.2 ml 2x/day)

Grapefruit or citrus seed extract (1/3 adult Grapefruit or citrus seed extract (1/3 adult dose)dose)

Saccharomyces boulardii (3-6 Saccharomyces boulardii (3-6 capsules/day)capsules/day)

Saccharomyces BoulardiiSaccharomyces Boulardii

Yeast against yeastYeast against yeast

Like swallowing the pharmaceutical Like swallowing the pharmaceutical companycompany

Promotes good floraPromotes good flora

Potential for very severe die-offPotential for very severe die-off

Theoretically increases secretory IgATheoretically increases secretory IgA

Is indistinguishable in lab from S.cerevisaeIs indistinguishable in lab from S.cerevisaeCzerucka et al, 2002Czerucka et al, 2002

The Antifungal ParadeThe Antifungal Parade

Non-absorbableNon-absorbable S.boulardii: 3 months (at least 3-6/day)S.boulardii: 3 months (at least 3-6/day) Nystatin: 1,000,000 units 4X dayNystatin: 1,000,000 units 4X day Amphotericin B (oral)Amphotericin B (oral)

SystemicSystemic Sporanox (Itraconazole)Sporanox (Itraconazole) Diflucan (Fluconazole)Diflucan (Fluconazole) Lamisil (Terbinafine)Lamisil (Terbinafine) Nizoral (Ketaconazole)Nizoral (Ketaconazole)

Die-offDie-off

Occurs when yeast dies, releasing toxins.Occurs when yeast dies, releasing toxins.

Antidote: activated charcoal up to 6X per Antidote: activated charcoal up to 6X per day.day.

Also treats the acidosis accompanying Also treats the acidosis accompanying stress/illness: Alka Seltzer Gold, one tablet stress/illness: Alka Seltzer Gold, one tablet in water several times daily.in water several times daily.

GEORGEGEORGE3 year old with ASD3 year old with ASD

Constipation/Hard Constipation/Hard stoolsstools

Craved sweetsCraved sweets

Red cheeks/earsRed cheeks/ears

No interaction with No interaction with peerspeers

9 courses of 9 courses of antibiotics for chronic antibiotics for chronic OMOM

Mood Mood swings/sensitivitiesswings/sensitivities

Breath smelled of Breath smelled of breadbread

Rashes/toe Rashes/toe peeling/nail ridgespeeling/nail ridges

Ridged, Discolored NailsRidged, Discolored Nails

Peeling FeetPeeling Feet

GEORGE TREATMENTGEORGE TREATMENT

Elevated yeast metabolites on urine Elevated yeast metabolites on urine organic acid testorganic acid test

Fluconazole, Terbinafine, KetaconazoleFluconazole, Terbinafine, Ketaconazole

Better communication, engagement, social Better communication, engagement, social interactioninteraction

Specific Carbohydrate Diet – “normal”Specific Carbohydrate Diet – “normal”

Saccharomyces, probiotic, trisalts, CLOSaccharomyces, probiotic, trisalts, CLO

““Misdiagnosed” according to neurologistMisdiagnosed” according to neurologist

REMOVEREMOVE

GermsGerms BacteriaBacteria ParasitesParasites FungusFungus Virus (regression after live viral vaccines, viral infection, fatigue, Virus (regression after live viral vaccines, viral infection, fatigue,

cold sores, warts, visual issues)cold sores, warts, visual issues)Antiviral agents (vitamin A, olive leaf extract, monolaurin)Antiviral agents (vitamin A, olive leaf extract, monolaurin)Antiviral medications (valacyclovir, acyclovir, famvir)Antiviral medications (valacyclovir, acyclovir, famvir)Immune modulators/supportImmune modulators/support

ToxinsToxins Detoxification (glutathione, ammonia)Detoxification (glutathione, ammonia) Chelation (DMSA, DMPS, EDTA)Chelation (DMSA, DMPS, EDTA) HomeopathyHomeopathy

REPLENISHREPLENISH

GLUTATHIONE! (oral, inhaled, transdermal, IV)GLUTATHIONE! (oral, inhaled, transdermal, IV)Enzymes (speeds disassembly of foods; -ase)Enzymes (speeds disassembly of foods; -ase)

Mixed (helps kids with poor digestion)Mixed (helps kids with poor digestion) Plant based (papaya and pineapple)Plant based (papaya and pineapple) Peptidase specific (helps specific peptide digestion)Peptidase specific (helps specific peptide digestion)

Probiotics (between meals with room temperature water)Probiotics (between meals with room temperature water) Reflorestation is toughReflorestation is tough Essential when treating dysbiosisEssential when treating dysbiosis Miraglia del Giudice et al, 2004Miraglia del Giudice et al, 2004

Symptomatic (yeast die off)Symptomatic (yeast die off) Activated charcoal (mop up toxins)Activated charcoal (mop up toxins) Alka Seltzer Gold (alkaline)Alka Seltzer Gold (alkaline)

REPLENISHREPLENISH

EnzymesEnzymesProbioticsProbioticsSymptomaticSymptomaticAntiGlutamatesAntiGlutamates

Pycnogenol (Pycnogenol (Trebaticka et al, 2006)Trebaticka et al, 2006) ChamomileChamomile Taurine, GABATaurine, GABA

Treat High AmmoniaTreat High Ammonia CharcoalCharcoal Fiber/PectinFiber/Pectin YuccaYucca

Nutrients (MVI) Nutrients (MVI) (Carlton et al, 2000)(Carlton et al, 2000)

SAM

SAH

MTase

SAHH

Homocysteine

CBS

BHMT

Choline

Betaine

Methionine Transsulfuration to Cysteine and Glutathione

Cystathionine

Cysteine

GSH GSSG

Methionine

Adenosine

B6

B6

5-CH3THF

THF

B12MS5,10-

CH2THFMTHFR

Cell Methylation1 2

3

1

2

3

Folate Cycle

Methionine Cycle

Transsulfuration

Methylation Potential(SAM/SAH)

AntioxidantPotential

NUTRIENTSNUTRIENTSZinc Zinc (Sturniolo et al, 2001)(Sturniolo et al, 2001)

> 200 enzymatic functions; in energy metabolism, protein, immunity, > 200 enzymatic functions; in energy metabolism, protein, immunity, detoxdetox

Acne, mouth sores, spots/lines on nails, pica, loss of smell, tasteAcne, mouth sores, spots/lines on nails, pica, loss of smell, taste Deficiency causes language, attention and immune issuesDeficiency causes language, attention and immune issues Best given alone, at night (piccolinate, acetate)Best given alone, at night (piccolinate, acetate) Ratio with copper; taste testRatio with copper; taste test

Magnesium Magnesium (Martineau et al, 1985)(Martineau et al, 1985) > 300 enzymatic functions; neuromuscular, neurotransmitters, BP > 300 enzymatic functions; neuromuscular, neurotransmitters, BP Deficiency causes hyperactivity, anxiety, twitches, insomniaDeficiency causes hyperactivity, anxiety, twitches, insomnia Sighing/salt craving/constipationSighing/salt craving/constipation

CalciumCalcium Bone/tooth/muscle/nerve function; cell membrane permeabilityBone/tooth/muscle/nerve function; cell membrane permeability Deficiency causes rigidity, poor sleep, anxiety, teeth grindingDeficiency causes rigidity, poor sleep, anxiety, teeth grinding Secondary deficiencySecondary deficiency Absorption vs tasteAbsorption vs taste

Nutrients ContinuedNutrients ContinuedMolybdenumMolybdenum

With deficiency – poor detoxification, chemical sensitivityWith deficiency – poor detoxification, chemical sensitivity With excess – high uric acid, low copper, anemiaWith excess – high uric acid, low copper, anemia

SeleniumSelenium Important for redox reactions, antioxidantImportant for redox reactions, antioxidant With deficiency – immune dysfunction, cell fragilityWith deficiency – immune dysfunction, cell fragility With excess – fatigue, brittle hair/nails, parasthesiasWith excess – fatigue, brittle hair/nails, parasthesias

ChromiumChromium Important for glucose control, insulin/liver functionImportant for glucose control, insulin/liver function With deficiency – insulin resistance, Syndrome X, neuropathyWith deficiency – insulin resistance, Syndrome X, neuropathy

IronIron Important for oxygen transport, cell differentiationImportant for oxygen transport, cell differentiation With deficiency – anemia, malabsorption, fatigueWith deficiency – anemia, malabsorption, fatigue With excess – liver and free radical damageWith excess – liver and free radical damage

Nutrients - VitaminsNutrients - Vitamins

Vitamin A (retinol)Vitamin A (retinol) Immunity, vision, cell differentiation, anti-CAImmunity, vision, cell differentiation, anti-CA With deficiency – vision, immune dysfunctionWith deficiency – vision, immune dysfunction

Vitamin C (Ascorbic acid)Vitamin C (Ascorbic acid) Antioxidant, healing, neurotransmitter functionAntioxidant, healing, neurotransmitter function With deficiency – bruising, poor immune function, anxiety, depression With deficiency – bruising, poor immune function, anxiety, depression

(diarrhea with excess)(diarrhea with excess)Vitamin DVitamin D

Ca absorption, thyroid function, anti-inflammatoryCa absorption, thyroid function, anti-inflammatory With deficiency – scaling, muscle pain, restlessness, sweating With deficiency – scaling, muscle pain, restlessness, sweating

Vitamin EVitamin E Antioxidant, prevents lipid peroxidationAntioxidant, prevents lipid peroxidation With deficiency – jaundice, xs clotting, impaired reflexesWith deficiency – jaundice, xs clotting, impaired reflexes

Folic acid (folinic, 5- THF)Folic acid (folinic, 5- THF) Methioneine/aa metabolism, growth/brain developmentMethioneine/aa metabolism, growth/brain development With deficiency – fatigue, weakness, immune/cognitive dysfunctionWith deficiency – fatigue, weakness, immune/cognitive dysfunction

NUTRIENTS - B VITAMINSNUTRIENTS - B VITAMINS

B12 (cobalamin – cyano, methyl, adenosyl)B12 (cobalamin – cyano, methyl, adenosyl) Deficiency - decreased communication, anemia, memory loss, Deficiency - decreased communication, anemia, memory loss,

poor balancepoor balance Methyl B12- SQ, IN, TD, oral; need adequate folateMethyl B12- SQ, IN, TD, oral; need adequate folate

B1 (thiamine- deficiency can cause ataxia, enuresis, sensory loss)B1 (thiamine- deficiency can cause ataxia, enuresis, sensory loss)B2 (riboflavin- deficiency can cause mouth fissures, photophobia)B2 (riboflavin- deficiency can cause mouth fissures, photophobia)B3 (niacin- deficiency can cause dermatitis, diarrhea, dementia)B3 (niacin- deficiency can cause dermatitis, diarrhea, dementia)B5 (pantothenic acid- deficiency can cause toe walking, grinding, B5 (pantothenic acid- deficiency can cause toe walking, grinding, restlessness, insomnia)restlessness, insomnia)B6 (P5P- deficiency can cause immune dysfunction, anemia, B6 (P5P- deficiency can cause immune dysfunction, anemia, sensory issues, tantrums)sensory issues, tantrums)B15 (DMG/TMG)B15 (DMG/TMG)

Deficiency leads to poor communicationDeficiency leads to poor communication Give with folate to decrease hyperactivity Give with folate to decrease hyperactivity

Keratosis pilarisKeratosis pilaris

NUTRIENTS - OTHERNUTRIENTS - OTHEREFAs EFAs (Richardson et al, 2006)(Richardson et al, 2006)

Deficiency can cause keratosis pilaris, dry, coarse hairDeficiency can cause keratosis pilaris, dry, coarse hair Cell communicationCell communication Protection in bone, liver, lung, immune functionProtection in bone, liver, lung, immune function

Amino AcidsAmino Acids TaurineTaurine GABAGABA AKGAKG

Phosphatidylcholine-counteracts oxidative stress, replenish Phosphatidylcholine-counteracts oxidative stress, replenish glutathioneglutathioneCarnitine/CoQ10/BiotinCarnitine/CoQ10/BiotinSpironolactone/Aldactone-anti-inflammatory, Spironolactone/Aldactone-anti-inflammatory, ↓ testosterone↓ testosteroneOxytocinOxytocin

↓ ↓ anxiety/aggression; acts at amygdalaanxiety/aggression; acts at amygdalaMelatonin Melatonin (Reichenberg et al, 2001)(Reichenberg et al, 2001)

Regulates serotonin balanceRegulates serotonin balance

The Gut-Brain Axis of Pathology in AutismThe Gut-Brain Axis of Pathology in Autism

Intestinal permeability

Inflammation

In autism patient

• 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

Systemic carriage

Low activetissue peptidaseswith antagonism

endorphins

DietaryProtein

Defective enzyme/Microbial

environment

Opioid peptides excess

Opioid peptides excess

Low sensitivity to pain

Repetitive behaviour

Social deficiencies

Some retardation inCognitive development

Opioid receptors in brain

Putting It All TogetherPutting It All Together

DietDietBaseline NutrientsBaseline Nutrients MVIMVI ProbioticsProbiotics EFAsEFAs EnzymesEnzymes

Look At Your ChildLook At Your Child Treat underlying dysbiosisTreat underlying dysbiosis Treat underlying oxidative stressTreat underlying oxidative stress Treat inflammationTreat inflammation DetoxificationDetoxification

What Is It That My Child Needs:What Is It That My Child Needs:

To GetTo Get

To Get Rid OfTo Get Rid Of

Keep an open mindKeep an open mind

Not a labelNot a label

Find clues and clustersFind clues and clusters

Keep Your Faith in All Beautiful Things: In the sun when it is hidden, in the

spring when it is gone.