Transcript Biomedical_Update_(Oct_2013) - Fern

Scott Clack, BSc, ND
Touchstone Naturopathic Centre
Oakville, ON
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Tonight’s Subjects
 Mitochondrial Dysfunction vs Disorder
 Cerebral Folate Deficiency
 How do we know Biomedical is working?
 Supplementation trials (suspending use)
 Increasing focus & attention
 Heavy metal toxicity & treatments
 New Research
 Food reactions: Histamine (DAO)
 Caring for Care-Givers
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
The Triggers:
Metabolism, Environment & Lifestyle:
 Oxidative Stress & Inflammation
 Methylation, Transulfuration deficits, GSH
 Metabolic Dysfunction/Mitochondrial Dysfunction
 Infections/Immune Deficiency/Autoimmunity
 Nutritional deficiencies
 Food Allergies & Intolerances
 Excitotoxicity
 Heavy Metal Toxicity
 Genetic anomolies  phenotypic expression (“autisms”)
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Emerging Model of Autism
source: Elizabeth Mumper, MD
 Exposures:
 Infections
 Heavy metals
 Pollutants
 Pesticides
 Food sensitivities
 Food preservatives &
additives
 Biologic Effects
 Neurologic impairment
 Gut dysfunction
 Metabolic disorders
 Immune dysregulation
 Regulatory problems
 Cellular damage
 Prevention efforts
 Treatment efforts
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Who can
help us?
Drugs and bad
nutrition
Oxidative
Norman
The Neuron
stress
Compromised
Metabolism
Excitotoxicity
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
10 Americans : EWG
 2003 study: detecting toxins in umbilical blood
 Medical theory: umbilical circulation/placenta
protects fetus from toxins
 Findings: on average, over 212 known chemicals,
including carcinogens, banned for 30+ years, were
present in the blood samples
 Conclusion: children are exposed to harmful toxins
throughout their prenatal lives, during various stages
of organ development, contributing to the onset of
neurodevelopment problems
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Government concedes vaccines cause autism in
Poling case. March 6, 2008
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
•19 month old girl, normal development, 20 word vocabulary
•chronic ear infections delayed many vaccinations
•After 9 immunizations (diphtheria, tetanus, and pertussis;
Haemophilus influenzae B; measles, mumps, and rubella; polio; and
varicella (Varivax)), the following developed with 48 hours: fever to
38.9°C, inconsolable crying, irritability, and lethargy and refused to
walk.
•Four days later, the patient was waking up multiple times in the
night, having episodes of opisthotonus (arching), and could no
longer normally climb stairs. Instead, she crawled up and down the
stairs. Low-grade intermittent fever was noted for the next 12 days.
•Ten days following immunization, the patient developed a
generalized erythematous macular rash beginning on the abdomen.
The patient’s pediatrician diagnosed this as due to varicella
copyright: Scott Clack, BSc, ND/Touchstone
vaccination.
Naturopathic Centre
For 3 months
•the patient was irritable and increasingly less responsive verbally
•clear autistic behaviors, such as spinning, gaze avoidance
•disrupted sleep/wake cycle
•perseveration on specific television programs
•all expressive language was lost by 22 months
Four months later, an evaluation with the Infant and Toddlers Early
Intervention program for possible autism was initiated.
her appetite remained poor for 6 months, body weight did not
increase. This resulted in a weight decline from the 97th to the 75th
percentile.
•Muscle biopsy revealed deficiencies of the mitochondrial
respiratory chain (3 of 4 complexes, and technically the 4th)
Poling JS, et al. J Child Neurol 2006;21(2):170-172
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Respiratory complexes I-V
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Defective respiratory complexes (I,II,III,IV) in Hannah
Poling’s biopsy
E
n
z
y
m
e
A
c
t
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v
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IVb
1600
III
1400
IVa
1200
1000
800
Poling
Control mean
II+III
600
400
200
0
Ia
Ib
I+III
I
+
I
I
I
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
E
n
z
y
m
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A
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t
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Signs of Mitochondrial dysfunction
Cleve Clin J Med. 2001 Jul;68(7):625-6, 629-42.
 Muscles-low muscle tone, weakness, low exercise
tolerance, muscle pain, cramps
 Brain-developmental delay, mental retardation,
autism, dementia, seizures, migraines, stroke
 Nerves-nerve pain, absent deep tendon reflexes, lack
of or excessive sweating, abnormal temperature
regulation
 Gastrointestinal problems-reflux, constipation
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Mitochondrial Disorder (MD)
 Primary (genetic) and Secondary (impaired function)
 Primary MD estimated at 1 in 200 (Elliot, 2008)
 Synaptic neurotransmitter release decreases 50% when
MD exists
 Decreases GABA that contributes to seizures, regression
 Increases with age –mtDNA mutations, w/ maternal
inheritance
 Most common cause of MD is defects in nDNA
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Secondary MD
 Medications: Valproic acid, salicylates, antiretroviral HIV


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
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meds
Estrogen increases mitochondrial efficiency, testosterone
decreases (thus predominance in males)
Oxidative stress, lowered Glutathione
Hypoxia
Heavy metals: Hg, Pb, Arsenic, Cd, Al
Pesticides
Diesel exhaust
Proprionic acid from Clostridia
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Evidence of mt Dysfunction
Am J Biochem Biotech 2008; 4:208-217 (Rossignol & Bradstreet)
 “Environmental toxins ... directly damage the mitochondria and reduce
their efficiency, or impair functional activity by increasing body burden
of free radicals and resultant oxidative stress (e.g. Thalidomide;
Valproic Acid).
 mercury, arsenic, cadmium, lead, pesticides, and industrial chemicals
inhibit mitochondrial function
 Propionic acid produced by Clostridia in the ‘GI’ tract ...impairs
mitochondrial function by directly inhibiting oxidative
phosphorylation
 By increasing oxidative stress and lowering glutathione levels, MtD
may actually lead to problems in detoxifying environmental
contaminants and consequently increase susceptibility to metal
toxicity.
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Mitochondrial disease in autistic
spectrum disorder: a cohort analysis.
J. Weissman et al; PLOS One: 3:e3815
Most common abnormal symptoms in children with
Autism and mitochondrial disorders:
 Prenatal complications-52%
 Gastrointestinal dysfunction-64%
 Exercise intolerance-68%
 Multiple regressions-36%
 Delayed walking-32%
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Treatment of Mitochondria disorder
 Coenzyme Q-10 (5-15 mg/Kg)-slow acting, months
for improvement-divided dosages
 Idebenone: 45-360 mg/day (or ubiquinol)
 Carnitine or acetyl carnitine 50-100 mg/Kg/day (adult
1-3 g per day)-divided dosages
 Carnitine: helps transport long chain fatty acids into
mitochondria for beta-oxidation. Neutralizes free radicals,
incl. those from ETC. High doses can cause diarrhea.
 Thiamine, Riboflavin & Vit. B5:15mg/Kg/day
 Antioxidants: Vitamin E, Vitamin C, Selenium, Lipoic
acid
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Treatment of Mitochondrial Disorder
Methylation Support:
 Folate -1000-10,000 mcg/day
 Vitamin B12 (methylcobalamin)
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Vitamin K3: 5-80 mg/day
Creatine monohydrate: 5-10 gram/day
Succinate, Ginkgo biloba
D-Ribose: 0.5-1 gram bid
Chelation/Heavy metal detox – include Lipoic Acid
HBOT
Outcomes: Varies by person; usually good but can be gradual.
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Cerebral Folate Deficiency
Frye RE et al, Molecular Psychiatry (2012): 1-13
 A syndrome described as a neurometabolic disorder
characterized by low concentrations of 5MTHF in the
cerebrospinal fluid despite normal levels elsewhere in
the body
 Impaired transport of folates across the BBB
 1st case: spastic paraplegia, cerebellar ataxia,
dyskinesia, seizures, developmental regression,
acquired microcephaly; vision disturbances and
hearing loss developed later
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Cerebral Folate Deficiency
 Involves a subset of ASD children, typically low
functioning w/ significant neurological problems
 Folate deficiencies promote methylation deficits
(frontal cortex) and oxidative stress (several cortical
regions including speech, emotion and social areas)
 Folate is essential for production of purines &
pyrimidines for RNA, DNA  reduced cellular
proliferation, reduced transcription & translation,
DNA instability and chromosome breakage
 Folate receptor protein  (FRA) is important for repair
and regeneration of CNS after injury
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Cerebral Folate Deficiency
Diagnosis:
 Cerebral spinal fluid from lumbar puncture
 Blood test for FRA concentrations (SUNY, Brooklyn
NY, Dr. Edward Quadros PhD)
Outcomes
 Leucovorin or Folinic acid (0.5-2.0 mg/kg) 
improvements ranging from partial improvement in
communication, social interaction, attention,
stereotypical behaviours, to complete recovery of both
neurological and ASD symptoms
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
How to know if Biomedical is
working?
 Repeat labwork where possible – confirm the
metabolism is changing
 Labwork cannot tell how great certain deficiencies have
been
 Consider genomic testing: identify blockages that
prevent treatments from achieving results
 Lack of obvious improvements does not mean
biomedical isn’t working – treatment may not have
progressed far enough, or key treatment(s) might not
have been implemented
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Knowing if Biomedical is working
A.M. 3.5 y.o. at first visit
Complaints: ASD, Diarrhea, Food
Allergies
 also sinus congestion, dermatitis,
speech d/o, lethargic (with bouts of
hyperactivity)
Extensive testing pursued by parents:
 Clostridia, Enterococcus, Yeast & 2
parasites (contracted from daycare
provider)
 Organophosphorus pesticide
exposure & toluene
 Poor detox: abnl sulfate,  free
radicals & lipid peroxide, 
SOD/GSH/cysteine
 Was on comprehensive treatment
list: Multivitamin, enzyme,
probiotic, 5-HTP, AminoPlex, SacB, chelation, BioCidin/Rx
antifungals
 GF/CF diet; later SCD
 IV treatments – chelation, GSH
 Weekly allergy desensitization
treatments (NAET method)
All treatments were implemented
over a 6-8 month period,
continued for 2-3 years
Today this child is a ‘recovered’ 15 y.o.
teenager in school, playing sports
Therefore: lots of treatments are
needed to achieve recovery, and
sooner than later
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Improving Attention
 Finding the cause will require trials
 Potential causes include:
 Reactions to foods or food additives (excitotoxins; see
Dr. Russel Blaylock for more information)
 Nutrient deficiencies: Iron, Zinc, Acetyl-L-Carnitine,
Tyrosine, Vitamin B6 & C – all support Dopamine
 Infections – yeast, virus
 Heavy metals – if not treated, this is probably the root
cause
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Improving Attention
 Herbal medicines as
short term solutions
 Ginseng (Korean, panax




ginseng)
Rhodiola
Bacopa moniera
Lemon Balm,
Passionflower, Skullcap
Pycnogenol (Pinus
maritima)
 Other options
 Omega-3 fatty acids
 Vinpocetine
(Periwinkle)
 L-Theanine (green tea
extract, lowers anxiety,
improves sleep,
increased alpha waves)
Altern Med Rev. 2011 Dec;16(4):348-54.
Asia Pac J Clin Nutr 2008;17 Suppl 1:167-8
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
L-Theanine & Attention
 Brain Topogr. 2009 Jun;22(1):44-51.
 Conclusions This pattern of results implies that L-
theanine plays a more general role in attentional
processing, facilitating longer-lasting processes
responsible for sustaining attention across the
timeframe of a difficult task, rather than affecting
specific moment-to-moment phasic deployment
processes.
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Heavy Metal Toxicity
 Lead, Mercury, Cadmium, Aluminum, Arsenic are all
toxic to the nervous system
 Lead intoxication is known to develop in fetuses and
infants during pregnancy, lactation
 Mercury – fish, meat, fructose (HFCS), corn
 Lead – comes from remodelling of bones during
pregnancy
 Food, water and air are the main routes or sources for
metals
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Heavy Metal Toxicity
 The severity of autism is associated with toxic metal
body burden and red blood cell glutathione levels.
 J Toxicol 2009; Epub 2009 Aug 26 PMID 20107587
 Adams JB et al
 Assessing urine levels of metal before and after oral
DMSA (dimercaptosuccinic acid)
 Conclusion: severity of autism increased with the
level/burden of heavy metals.
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Heavy Metal Toxicity
 Safety and efficacy of oral DMSA therapy for children
with autism spectrum disorders: part B – behavioral
results.
 BMC Clin Pharmacol 2009 Oct 23; 9:17
 Adams JB et al. PMID 19852790
 65 children received one round (3 days) or 7 rounds (if
they excreted high levels on first round)
 DMSA was tolerated and possibly helpful in reducing
some of the symptoms of autism
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Heavy Metal Toxicity
 Cutler Protocol
 Andrew Cutler has a PhD in biochemistry
 Developed his approach from personal experience and
research
 Websites for more information
 www.livingnetwork.co.za
 www.curezone.com
 Groups.yahoo.com/group/frequent-dose-chelation
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Cutler protocol
 DMSA & ALA dose – 1/8 to ½ mg per pound per
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


capsule
1 capsule every 3-4 hours for up to 3 hours
Night-time doses are necessary
Mineral replacement recommended – especially zinc,
chromium, manganese and molybdenum
Cilantro, Chlorella or Laminaria recommended to
increase elimination of metals, preventing them reimplanting in other parts of the body
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Cutler protocol
 Minimal side-effects: spacey, disoriented
 Can be done every weekend
 Doesn’t seem to affect school/therapies

Mondays might be a little shaky
 Other treatments to integrate:
 Infrared sauna
 Epsom baths and Clay baths
 Liver and kidney support on a quarterly basis
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Natural Chelators
In cases of mild/low level intoxication:
 Glutathione – preferred products are MAX-GXL or
HMS 90/Immunocal
 Curcumin
 Metagenics Metalloclear
 Laminaria or Chlorella
 Be sure to check source – could be contaminated
 Optimize B6, magnesium, N-Acetylcysteine, as well as
MeB12/Folinic Acid/TMG or DMG
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
New Treatments to Watch
 Oxytocin – social enhancement
 Curcumin – inhibiting seizures; stimulating nerve
growth or regeneration
 Histamine & DAO (diamine oxidase) food reactions
 Laminaria, Garlic – heavy metal detox/ chelators
 Restoring Cellular Communication Pathways protocol
(from Physica Energetics) – homeopathic & herbal
program to support/kickstart the healing processes
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Caring for the Care-Givers
Take care of yourself so you can take better care of your
children!
 Eat according to the GF/CF diet, like your child – you will
feel better too
 Multivitamin, fish oil and antioxidants – core supplements
 B12 injections – boost your energy, feel better
 Green tea – 2 or 3 cups/day
 Regular liver/kidney cleanses (spring & fall)
 Epsom baths – 2X/week – and take a fun book!
 Massage therapy
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Care for the Care-givers
 Sleep!!
 In your own bed, without children (get help for this if
your children are having problems)
 Avoid or minimize internet searching late at night (or
the early morning): if you’re doing this, you’re not using
your Biomedical practitioners properly
 Adrenal support – reduces your risk for burn out
 Take a break (aka Respite care): 24/7 care, 365 days a
year will burn you out – ask for help from family or the
community. Respite care is available.
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre
Thank you!
Scott Clack, B.Sc., N.D.
Touchstone Naturopathic Centre
2390 Bristol Circle, Suite 4A
Oakville, ON L6H 6M5
Tel: 905-822-2046
www.touchstonecentre.com
Email: [email protected]
copyright: Scott Clack, BSc, ND/Touchstone
Naturopathic Centre