Transcript food and flora

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
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Family History-autoimmune, gastrointestinal (Valicenti-McDermott et
al, 2006)
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Single Nucleotide Polymorphisms
Increased Susceptibility (Herbert, 2005)
Neurologic Problems
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Altered Sensitivity
Abnormal Processing
Immune System Dysregulation
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Altered Sensitivity (decreased IgA, NK cells, increased TNF)
(Jyonuchi et al, 2005)
Abnormal Processing (autoantibodies, TH1 & TH2 skewing)
(Ashwood et al, 2006)
PATTERNS
Digestive Abnormalities
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Maldigestion (altered enzyme function) (Horvath et al,
1999)
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Dysbiosis (change in bowel flora)
Increased Permeability (antigens, peptides, toxins)
(Vojdani et al, 2004)
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Inflammation (enterocolitis, LNH, pro-inflammatory
cytokines) (Torrente et al, 2002)
Biochemical Peculiarities
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Impaired detoxification
Oxidative Stress (James et al, 2004)
Mitochondrial defects (Filipek et al, 2003
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
MTHFR
1
SAM
MS
B12
2
BHMT
5CH3THF
Betaine
Choline
2 Methionine Cycle
3 Transsulfuration
MTase
Cell Methylation
SAH
SAHH
Homocysteine
1 Folate Cycle
B6
3
Methylation
Potential
(SAM/SAH)
Adenosine
CBS
Cystathionine
B6
Cysteine
GSH
GSSG
Antioxidant
Potential
WHAT DO WE NEED TO GIVE TO
OR GET OUT OF OUR
CHILDREN?
Exercise/Activity
Basic Nutritional Changes
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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
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Remove:
Sugars, junk food, germs, toxins
GF/CF/SF/YF/SCD/LOD/BED/GAPS/LP
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Replenish:
Probiotics, enzymes, EFAs, antiglutamates
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Repair/Restore:
Detoxification
Anti-inflammatories (LDN, Actos, Spironolactone,
IG, HBOT)
Responsive to
SCD?
Food Allergen
Elimination?
Antifungal trial
I
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)
e
Gluten Free
Diet
Second tier
supplements
REMOVE
Foods
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Casein (sticky protein in dairy)
100% elimination for 3 weeks
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Gluten (protein in wheat, barley, rye, hidden sources)
Tests can be inaccurate
100% elimination for 3 months
Healthy alternative not just GFCF
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Food sensitivities (IgG reactive)
Specific Carbohydrate Diet (SCD)
Restricts all disaccharides (2 sugars) and polysaccharides
(starches)
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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
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Gut and Psychology Syndrome (GAPS)
Low Phenol (Feingold: faulty sulfation)
Apples, grapes, bananas, salicylates, artificial ingredients
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Low Oxalate Diet (LOD)
Leaky gut→oxalates not metabolized and absorbed→inflammation,
pain
Decrease leaves of plants; nuts; soy; berries
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Body Ecology Diet (BED)
Proper food combining, low acid formation, easily digested foods
Principles of anti-yeast diets including no sugars, fermented foods
GERMS
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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)
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Swedo et al, 1998
TREATMENT-STREP
Probiotics
Xylitol
Saccharomyces Boulardii/Alkalinization/Charcoal
Antibiotics (Snider et al, 2004)
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IM Bicillin (1.2 million units-perhaps monthly)
Penicillin, Omnicef, Zithromax
Antimicrobial herbs
Immune Modulators (March et al, 2004)
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Oral immunoglobulins
Transfer factor/colostrum
Mushroom extracts/plant sterols
LDN, Actos, Spironolactone, HBOT
IVIG
REMOVE
GERMS
Bacteria (history of positive response to
antibiotics)
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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)
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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)
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Blastocystis hominis (treat with Bactrim and Humatin)
Probiotics
Antiparasitics (Metronidazole, Paromomycin, Mebendazole)
Natural remedies (artemesia, pumpkin seeds, coconut)
TSO therapy
REMOVE
Germs
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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
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S.boulardii: 3 months (at least 3-6/day)
Nystatin: 1,000,000 units 4X day
Amphotericin B (oral)
Systemic
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Sporanox (Itraconazole)
Diflucan (Fluconazole)
Lamisil (Terbinafine)
Nizoral (Ketaconazole)
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
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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
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Detoxification (glutathione, ammonia)
Chelation (DMSA, DMPS, EDTA)
Homeopathy
REPLENISH
GLUTATHIONE! (oral, inhaled, transdermal, IV)
Enzymes (speeds disassembly of foods; -ase)
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Mixed (helps kids with poor digestion)
Plant based (papaya and pineapple)
Peptidase specific (helps specific peptide digestion)
Probiotics (between meals with room temperature water)
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Reflorestation is tough
Essential when treating dysbiosis
Miraglia del Giudice et al, 2004
Symptomatic (yeast die off)
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Activated charcoal (mop up toxins)
Alka Seltzer Gold (alkaline)
REPLENISH
Enzymes
Probiotics
Symptomatic
AntiGlutamates
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Pycnogenol (Trebaticka et al, 2006)
Chamomile
Taurine, GABA
Treat High Ammonia
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Charcoal
Fiber/Pectin
Yucca
Nutrients (MVI) (Carlton et al, 2000)
Methionine Transsulfuration to Cysteine and Glutathione
Methionine
THF
5,10CH2THF
MTHFR
1
SAM
MS
B12
2
BHMT
5CH3THF
Betaine
Choline
2 Methionine Cycle
3 Transsulfuration
MTase
Cell Methylation
SAH
SAHH
Homocysteine
1 Folate Cycle
B6
3
Methylation
Potential
(SAM/SAH)
Adenosine
CBS
Cystathionine
B6
Cysteine
GSH
GSSG
Antioxidant
Potential
NUTRIENTS
Zinc (Sturniolo et al, 2001)
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> 200 enzymatic functions; in energy metabolism, protein,
immunity, detox
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Acne, mouth sores, spots/lines on nails, pica, loss of smell, taste
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Deficiency causes language, attention and immune issues
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Best given alone, at night (piccolinate, acetate)
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Ratio with copper; taste test
Magnesium (Martineau et al, 1985)
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> 300 enzymatic functions; neuromuscular, neurotransmitters,
BP
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Deficiency causes hyperactivity, anxiety, twitches, insomnia
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Sighing/salt craving/constipation
Calcium
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Bone/tooth/muscle/nerve function; cell membrane permeability
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Deficiency causes rigidity, poor sleep, anxiety, teeth grinding
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Secondary deficiency
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Absorption vs taste
Nutrients Continued
Molybdenum
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With deficiency – poor detoxification, chemical sensitivity
With excess – high uric acid, low copper, anemia
Selenium
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Important for redox reactions, antioxidant
With deficiency – immune dysfunction, cell fragility
With excess – fatigue, brittle hair/nails, parasthesias
Chromium
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Important for glucose control, insulin/liver function
With deficiency – insulin resistance, Syndrome X, neuropathy
Iron
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Important for oxygen transport, cell differentiation
With deficiency – anemia, malabsorption, fatigue
With excess – liver and free radical damage
Nutrients - Vitamins
Vitamin A (retinol)
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Immunity, vision, cell differentiation, anti-CA
With deficiency – vision, immune dysfunction
Vitamin C (Ascorbic acid)
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Antioxidant, healing, neurotransmitter function
With deficiency – bruising, poor immune function, anxiety, depression
(diarrhea with excess)
Vitamin D
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Ca absorption, thyroid function, anti-inflammatory
With deficiency – scaling, muscle pain, restlessness, sweating
Vitamin E
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Antioxidant, prevents lipid peroxidation
With deficiency – jaundice, xs clotting, impaired reflexes
Folic acid (folinic, 5- THF)
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Methioneine/aa metabolism, growth/brain development
With deficiency – fatigue, weakness, immune/cognitive dysfunction
NUTRIENTS - B VITAMINS
B12 (cobalamin – cyano, methyl, adenosyl)
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Deficiency - decreased communication, anemia, memory loss,
poor balance
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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)
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Deficiency leads to poor communication
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Give with folate to decrease hyperactivity
Keratosis pilaris
NUTRIENTS - OTHER
EFAs (Richardson et al, 2006)
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Deficiency can cause keratosis pilaris, dry, coarse hair
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Cell communication
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Protection in bone, liver, lung, immune function
Amino Acids
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Taurine
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GABA
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AKG
Phosphatidylcholine-counteracts oxidative stress, replenish
glutathione
Carnitine/CoQ10/Biotin
Spironolactone/Aldactone-anti-inflammatory, ↓ testosterone
Oxytocin
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↓ anxiety/aggression; acts at amygdala
Melatonin (Reichenberg et al, 2001)
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Regulates serotonin balance
The Gut-Brain Axis of Pathology in Autism
Opioid peptides excess
Defective enzyme/
Microbial
environment
Dietary
Protein
Intestinal
permeability
In autism patient
Opioid peptides excess
Low active
tissue peptidases
with antagonism
endorphins
Systemic
carriage
Opioid receptors in brain
Low sensitivity
to pain
Repetitive
behaviour
Inflammation
Social
deficiencies
• 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
Some retardation in
Cognitive development
Putting It All Together
Diet
Baseline Nutrients
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MVI
Probiotics
EFAs
Enzymes
Look At Your Child
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Treat underlying dysbiosis
Treat underlying oxidative stress
Treat inflammation
Detoxification
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.