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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?
