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TreatmentSummary

DevelopmentalIntake

• Parentsneedtotelltheirstory• Regression/diagnosis}manyparentsaregrieving

• TreatmentneedstobeginwithACCEPTANCE

Pregnancy/L&D

• Pregnancy– Infection,fever,antibiotics,IVF,thyroid,iron– Stress,mentalhealth– Environmentalexposures– Tylenol,valproic acid,SSRIs– Pre-eclampsia

LabourandDelivery

• #weeks• Antibiotics– GBS+• Headtrauma• APGAR• Jaundice

EarlyInfancy

• Formula/breastmilk• Didformulahavetobechanged?• Colic• Reflux– Rx– depletesB12• Jaundice• Latchingissues• Quietbabies• Unusuallyeasybabies• Infantsortoddlerswhocryinlargergroupsofpeople

EarlyInfancy• Missedmilestones– latewalking• Difficultycrawling– armycrawl,bumscooting,backwardscrawling

• Clumsy• Difficultytransitioningtofoods– gagging,stickingtongueout,textureissues,difficultychewig

• Trackingandeyecontact• REGRESSION – alwaysaREDFLAG}notnormal

Communication

• Non-verbal– Crying,behaviour,leading

• Expressive• Receptive• Echolalia- percentage• Scripting- percentage• Spontaneous• Articulation/clarity}upperlipneutrality

Communication• #ofwords• #wordsinsentence• Pickpreferredoptionifofferred• Answeryes,no?• Answer/askWquestions?• Reporting• PECS– stage?• Prologquo2go• Dragon• Visualschedules

Social

• Toleratesotherpeople• Parallelplay• Understandssharing• Toyplay– liningup,categorizing,dumpingbins,causeandeffect,spinningwheels,watchingtoysclosely

• iPad/screens– stim’goncredits,repeatingpartsofshowoverandover

• Pretendplay

Social

• Willjoinifsomeoneelseinitiates• Willinitiateplay– chase,tickles,wrestling,tag• Toleratesaffections• Initiatesaffection

Social

• Eyecontact• Visualstim’g• Sideglancing• Watchingscreensclosely• Turninghead– differentangles• Camera“lensing”

Social

• Jointattention• Toleratesothers• Joinsinitiatedplay– tag,wrestling• Initiatesplay• Understandssharing• Pretend/imaginaryplay• Boundaries/socialcues• Veryblackandwhite?

Behaviour

• Self-stimulatingbehaviour– Jumping,spinning,running– Flapping,watchingcreditsoverandover– Anythingrepetitive

• Self-injury• Aggression• Hyperactivity• Bolting

Digestion• Constipation• Diarrhea– mucous,undigestedfood• Bloating– afterage2flatbelly• Fecalsmearing• Reflux• Frequency,smell,size,colour• Pain• Celiac?EE?IBD?• Appetite– picky.,gags,cravescarbs

Sleep

• Onset• Waking– whataretheydoing,whattime?• Dotheynap• Screensbeforebed?• Headsweating• Fear– dark,beingalone• Restless• Nightmares,nightterrors

GrossMotor

• Milestones– Holdingheadup,rolling,sitting,crawling– Walking,stairs,running,jumping– Ridingbike,swimming,tyingshoes

• Clumsy?• Gait• Motorplanning– solvingproblems(ex.Pushingchairtomiddleoftheroomtoreachballoon)

FineMotor

• Eyes,mouth,hands• Latching,feedingself• Helpinggetselfdressed,gettingdressed• Pencilgrasp,writing• Finemotorisusuallyaresidualsymptomevenafterlongtermtreatment.

Sensory

• Tactile– bodymaps,fingers– Oral,touch,clothes

• Auditory– aggression/irritability– StanfordStudy– NAC

Sensory

• Visual– Gprotein– Sideglancing,lensing– Stim’g

• Taste– Supertasters– Firsttimex100

• Smell– Fecalsmearing

Immune,skin

• Eczema,excesscerumen• Rasharoundmouth• Psoriasis,hives,acne,vitiligo• Frequentillnesses– GI,GU,URTI,coldsores?• Nevergetssick?• #antibiotics• Asthma– coldinduced,cough,exercise

FamilyHistory• Mentalillness

– OCD,anxiety,depression,schizophrenia• Neurodenerative – Alzheimer's,parkinsons• Infertility• ADHD,AutismSpectrumDisorder,DownSyndrome,DCD

• Speechdelay/latetalkers– methylation• Dyslexia• Clumsy• Autoimmune• Birthdefects

Airpollution,organictoxicants,seasonalfactors,psychologicalstress,migration,birthorder,andnutritionmayhaveacloserelationshipwiththeincidenceofASD.

Testing

• OAT• HeavyMetalTesting• Bloodtesting– RBCfolate,ferritin,thyroid,lactate,ammonia,liverenzymes,pyruvate,creatine,ASOtiters,MCV,sIgA,zinc,copper,cholesterol.

Mitotoxins

• Antibioticstoavoid:– Linezolidandotheroxazolidinone antibiotics– Rifampin– Tetracycline– Chloramphenicol– Imipenem– Cephalogycin– Beta-lactam(penicillinandcephalosporin

PharmaceuticalManagement

• Digestion– Restorolax /PEG/Miralax– PPIs(depleteB12,increaseriskofURTI)

• Anti-psychotics– Risperidone

• SSRIs• StimulantMedications

– Vyvance,Biphentin,Ritalin,concerta etc.

PharmaceuticalManagement

Restorolax /PEG/Miralax

• Toxicity:preservativetoxicity(it’saplasticandnotagoodone...rememberBPA)

• Nointeractionsknown

PharmaceuticalManagementPPIs(Protonpumpinhibitorssuchas:(depleteB12,increaseriskofURTI)PPIs(depleteB12,increaseriskofURTI)

Availableprotonpumpinhibitorsinclude:● omeprazole (Prilosec,PrilosecOTC)● aspirin andomeprazole(Yosprala)● lansoprazole (Prevacid,Prevacid IV,Prevacid 24-Hour)● dexlansoprazole (Dexilent,Dexilent Solutab)● rabeprazole (Aciphex,Aciphex Sprinkle)● pantoprazole (Protonix)● esomeprazole (Nexium,NexiumIV,Nexium24HR)● esomeprazolemagnesium/naproxen (Vimovo)● omeprazole/sodiumbicarbonate (Zegerid,Zegerid OTC)

PharmaceuticalManagement

ProtonpumpinhibitorsNutrientsdepleted:Magnesium,vitaminB12,

DrugInteractions:Monitorfordecreasedefficacyofdrugsrequiringanacidicmediumfordissolutionorabsorption(e.g.itraconazole).EsomeprazolemayinterferewithcytochromeP-450-metabolismofotherdrugs(e.g.diazepam,phenytoin,warfarin).Adjustdosagesasneededwhenesomeprazoleisaddedordiscontinued.

PharmaceuticalManagementSSRIs(SerotoninReuptakeInhibitors)

Citalopram(celexa),escitalopram(Cipralex),Fluoxetine(Prozac),Fluvoxamine(Luvox),Paroxetine(Praxil),Sertraline(Zoloft)

AdverseEffects: Nausea,drymouth,sleepdisturbances,somnolence,sweating,sexualdysfunction,increasedriskofGIbleeding,SIADH,dose-dependentQTcprolongation,discontinuationsyndrome,suicide,tremors,sexualdysfunction.

PharmaceuticalManagementSSRIs(SerotoninReuptakeInhibitors)

Druginteraction: UsewithMAOleadstopotentiallyfatalreactioninitallypresentingwithtremor,agitation,hypomania,hyperthermiaand/orhypertension.

IncreasedriskofGIbleedingwithNSAIDs,antiplateletagents.InhibitorsofcytochromeP450enzymessuchascimetidine,clarithromycin,erythromcyin,fluconazole,indinavir,isoniazid,itraconazole,ketoconazole,quinidineorritonavirmyincreaseSSRIlevels.

PharmaceuticalManagementSSRIs(SerotoninReuptakeInhibitors)

Druginteractioncon’t:AllSSRIsinhibitcertaincytochromeP450isoenzymesandcanreducetheclearanceofmanydrugssuchasclozapine,methadone,mexiletine,phenytoin,pimozideorpropafenoneordecreasetheenzymaticconversionofaprodrugsuchasclopidogrel,codeineortamoxifentoitsactiveform.InducersofcytochromeP450enzymes(e.g.carbamazepine,phenobarbital,phenytoin,rifampin)canicnreasetheclearanceofSSRI.

AvoidcombinedusedrugsassociatedwithprolongedQTcinterval/torsagesdepointes,suchasaminodarone,azithromycin,clarithromycin,domperidone,erythromycin,haloperidol,methadone,pimozide,quinine,sotalol,ziprasidone.

PharmaceuticalManagementStimulantMedication:Risperidone

DrugInteractions: InhibitorsofCYP2D6,CYP3A4suchasclarithromycine,erythromycine,grapefruit,fluoxetineorparoxetinemayincreaseeffectandtoxicityInducersoftheseisoenzymes,suchascarbamazepine,phenytoinorrifamptinmayreduceeffect.

PharmaceuticalManagementStimulantMedication:Atomoxetine

DrugInteractions: InhibiotorsofCYP2D6,fluoxetine,paroxetineorquinidinemayincreaseeffectandtoxicity

SlowmetabolizerssuchassomeAsianpopulationsmayhaveextenedeliminationhalf-lives.

Concurrentuseofsalbutamolmayincreaseheartrate.

PharmaceuticalManagementStimulantMedication:Methylphenidate(Ritalin)

DrugInteractions: UsewithMAOleadstopotentiallyfatalreactioninitallypresentingwithtremor,agitation,hypomania,hyperthermiaand/orhypertension.MAOssuchasphenelzineortranylcypromine.Canalsoincreasehypertensiveeffectofstimulant.Reducesthemetabolismofwarfarin,resultinginincreasedINR.

Concurrentuseoftheophyllinemayincreaseriskoftachycardia,palpilations,dizziness,weakness.

PharmaceuticalManagementStimulantMedication:Methylphenidate(Ritalin)

DrugInteractionscon’t:Mayincreaseplasmalevelsofphenytoin,phenobarbital,TCAs

Otherstimulantsinclude:Biphentin(controlledreleasemethylphenidate,Concerta(methylphenidatebilayercontrolledrelease),Dexedrine(dextroamphetamine),Vyvanse(lisdexamfetamine),Adderall(mixedsaltamphetamine)

Mitotoxins• Harmfulsubstances

– Heavymetals– Alcohol}yeastmakesaldehydes– PPA}clostridiaresearch– Mold– Lyme– Cigarettesmoke– Acetaminophen– Antipsychotics– Fasting– Dehydration– Sleepdeprivation– Valproicacid

PracticalPearls

• Parentmanagement• Youaredrivingthebus• Longterm,systematicapproach• Emailaccess?• Aggravations

CBSpathwayindicators

● Sulfationsymptomssuchasitchy,hives,rashes,headaches,headacheswithredwine.

● OranxietyandagitationwhenaddinBvitamins● MostclinicallyimportantCBS’sslowdownthepathway● CBSupregulation– oxidativestress,BHMT,CBSC699T

CLNICALPEARL – Mosttrickycasesarekidswithsulfationpathwayimpairments.Takingbeefoutofthedietisoftenveryhelpful.Usuallykidshaveanelevatedheavymetalload.

CBS– teeter-totter• Environmentaltoxinsaremoredifficulttodetoxify• Heavymetalprovocationtestwilloftenshowhighleadandmercury

• YeastbyproductsdepleteB6• YeastcreatesphenolswhichjamPST(betternoP5P)

Toomuchsulfiteimpairsdetoxification

***keyfunction

Whatweknowistrue

• Toptworiskfactorsarepre-natalviralinfectionandaparentwithanxietyand/ordepression(methylation!)

• Familyhistoryofautoimmunedisorders,geneticdysfunctionindetoxificationand/orgene-relatedvitamin,antioxidantandotherdeficiencies

Parentsandbirtharekey• Incase-controlanalysis,asignificantincreaseinthereducedfolatecarrier(RFC1)Gallelefrequencywasfoundamongcasemothers,butnotamongfathersoraffectedchildren

• MaternalGallelewasassociatedwithsignificantincreaseinriskofautismwhereastheinheritedgenotypeofthechildwasnotFurther,maternalDNAfromtheautismmotherswasfoundtobesignificantlyhypomethylated relativetoreferencecontrolDNA

OurfindingssupportaroleforthepolymorphismSLC19A1geneasariskfactorforASD.

Obstetricalcomplicationsassociatedwithhighriskofdevelopmentaldisorder

Prematurity(before36weeks)

Lowbirthweight(lessthan2500grams)

RespiratoryDistressSyndrome

RhesusIncompatibility(Rhogam)

C-section

Resuscitation

Severefetal/neonatalinfection

Hemolyticanemia/transfusionforanemia

Severebirthtrauma

Oneexampleofmanagingriskfactors

Maternalriskfactorsforlowbirthweightinfant

Preeclampsia(homocysteineelevationriskfactor– methylation!)

Nutrientdeficiencies– zinc,B12,methylfolate

Irondeficiency

Nausea/Vomiting– B6deficiency?

Thyroiddysfunction– subclinicalhypothyroidism,autoimmunity

Folatehandling– onecarbonmetabolism

PretermlabourandEFAs

• EuropeanandNorthAmericanpopulations,haveshownthatomega-3fattyacids,whetherfromdietarysourcesorothersupplementation,causeasignificantincreaseinthedurationofpregnancy

• Mostsignificantpredictorofinfanthealthisageatbirth• Essentialfattyaciddeficiencyisariskfactorforpretermlabour,

prolongedlabourandlabourcomplications• EFAdeficiencyisalsoariskfactorfordevelopmentaldisorders

PretermLabourisariskfactorforautismandotherdevelopmentaldisorders

Essentialfattyacidsdecreasesriskofpretermlabour

Wheredoyoustart!!!????

1. Repairmethylationandgut

2. StopCELLDANGERRESPONSE

3. RepairMitochondria

MethylB12– language,social,cognitive,improvedbehaviours

▪ Hyperactivity,difficultysleeping▪ Increasedstim’g,sensoryaggravation▪ Mouthingofobjects▪ Diarrhea/constipation/rashes▪ Aggression/irritability

FirstVisit– treatmethylationandgut

• RNAandDNAØ geneticmaterialresponsiblefor

everyfunctioninthebody• Immunesystemregulation• Detoxificationofheavymetalsandotherharmful

substances• MakingGLUTATHIONE(thebody’smaindetoxification

enzymeresponsibleforremovingmercury,lead,cadmium,arsenic,nickel,tin,aluminumandantimony)

• Productionandfunctionofproteins• Regulatinginflammation

Whatismethylationresponsiblefor:

BenefitsofMethyl-B12What are the benefits of MB12 treatment?Enhancement in executive function:

● Awareness● Cognition● Appropriateness● Eye contact● Responsiveness● Normalized behaviours and interaction

Promotion of speech and language● Spontaneous language● More complex sentences● Increased vocabulary

Improvements in socialization, understanding and expressing emotion● Initiation and interactive play● Understanding and feeling emotions● Affection and tolerance to touch

Methlycobalamin

JamesNeubrander Protocol:

• Concentration:2500mcg/0.1mlor25000mcg/1ml

• 65mcg/kgevery3days(usually0.05ml)

• SuggestedsyringesareBDUltrafine3/10thCC

SuggestedSyringe

• BDinsulinsyringewiththeBDUltra-Fine6mmneedle

• 3/10ML6MM(15/64”)X31G

Methyl-B12injectionlocation

Positive/NegativesUndesiredeffectstoareagoodsignoftreatmentsuccess.Theyarenotuncommonandinclude:

• Hyperactivity• SelfStimulatingBehaviour• Increasedmouthingofobjects• Sleepdisturbances– whichcanbemanagedwithother

treatments• Aggression,hittingandbiting– causedbyfrustrationdueto

increasedawareness

*Sideeffectscanbemildtosevereandareconsideredtransientwhichmeanstheywillpassastreatmentprogresses*

Paleodiet– ONLYTREATMENTforyeast,clostria etc.,IDOpathway,methylation

▪ Lethargy,Herx rxn,reducedappetite,frustration,irritability▪ Diarrhea/constipation/rashes

Codliveroil– celldangerresponse,visualprocessing,motorplanning,sensory

▪ Increasedstim’g▪ Smellinglikefish/oily“poops”}needforcarnitine▪ Hyperactivity/difficultysleeping

FirstVisit– treatmethylationandgut

1. MethylB12safety– Bvitamins

▪ ManychildrendonottolerateP5P

1. ReviewOAT/addressaggravations

1. Probiotic– toaddressOATresults

1. Mitochondrialsupports▪ ClaudiaMorris– vitaminE,carnitine,omega6,PC▪ Vitamin“cocktail”

Secondvisit

1. MethylB12safety– Bvitamins

▪ ManychildrendonottolerateP5P

1. ReviewOAT/addressaggravations

1. Probiotic– toaddressOATresults

1. Mitochondrialsupports▪ ClaudiaMorris– vitaminE,carnitine,omega6,PC▪ Vitamin“cocktail”

Secondvisit

1.VitaminE– mixed(1600mcg-3200mcg)2.Acetyl-L-Carnitine(50mg/kg)3.GLA- >200mg4.Phosphatidylcholine- (3000mg-5000mg)5.Melatonin- 3mg-5mg6.CodLiverOilwithnaturalvitaminA2TBSP

DosagesforSupport

Methyltetrahydrofolate:folate

Injectableconcentration:2500mcg/1mlDoseis100mg3timesaweek

Notdonerightaway.StartwithB12first

Oraldose:often5000mcgmethyltetrahydrofolate

OrganicAcidTesting• 72plustestsincluding:

ü 48strainsofyeastandmoldü 22strainsofclostridiaüMitochondrialfunctionü Essentialfattyacidmetabolismü Neurotransmittersü Glutathioneü IDOpathwayupregulationü Vitamindeficienciesü Vitaminconversionimpairment

• Watchformold• Bacteriaandmoldcompeteforspace,follow-upmayhavemoremoldwithlessbacteria

• Multi-strainprobtioics withnoFOS,rhamnosus

• TestsforClostridia• Killherbs• Grainfree

• NeedB6,NeedMagnesium• Associatedwithgut,ifhigharabinosethenhighoxalatesasoxalatesarebrokendowninthegut

• CBSpathwayjammed• Lowoxalatediet• Needsfats

Mitochondrialmarkers

• Howyouactuallytestformitochondrialfunction

• Acetly-L-Carnitine,B2,Co-Q10,ALA

• Glutamatebasedmitochrondia markers

• lowlevelsneurotransmittersindicatelowmethylation

• Methly-B12• 5-HTP,SaMe,cucumin• B6/Mg• HighKyurenic andhighQuinolinic arehighwhen

ID01isjammed

• folatefunction• highlevelsindicatedneedforfolateorpoorabsorption

• Methyltetrahydrofolate injectableororalorvegetables

• highvaluesindicateessentialfatdeficiency• Acetyl-L-carnitine• FATS….omega3,omega6,vitaminA,D,E,K,ALA,

Co-Q10,phosphatidylcholine,phosphatidylserine

• detoxificationmarkers• increaseneedforNAC,and/orliposomal

glutathione• HighammoniaindicatedjammedCBSpathway

andtheneedforfatstoopenthepathway!!!!• 61duetoGIbacteria

• Highamountsindicatedstarvationandphosphorusduetoboneloss

• Lowcreatininecanindicatelowcreatine levels.Creatine ismadefrommethylunitssolowvaluesindicatelowmethylation

• Lowvaluescanalsomeanlowmuscleturnover

OtherTreatments• 5-formyl-folate– DON’TASKIFTHISISA

SUPPLEMENT– eatyourgreens!• Inulinrichfoods• Phosphatidylcholine• Phosphatidyserine• Creatine• Liposomalglutathione• Innositol• Arginine• Taurine• Botanicals– gingko,curcumin,St.John’s

Wort,Echinacea,Bacopa,Pycnogenol• SAMeandTMG• PulsingMTHF• HighdoseCoQ10trial• HBOT• HighdosevitaminA• Biofilmprotocol• Testingformetals?• Treatingviruses?• Testingformold?