2008-03 Louisville Autism Lecture

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Information about 2008-03 Louisville Autism Lecture

Published on April 5, 2008

Author: drdavid999

Source: slideshare.net

Biomedical Treatments for Neurodevelopmental, Autoimmune and other Chronic Disorders David Berger, MD Medical Director Wholistic Pediatrics Tampa, FL (813) 960-3415 www.wholisticpeds.com

Is there an Autism Epidemic? Before 1985, the total incidence of Autism was 3-5 per 10,000 Births (1:2000-3000). Most cases were from acute medical problems, present since birth, and caused by known genetic disorders By 1997, the rate of autism had increased to 30 per 10000 births (1:333), with 80% regressive type, after a period of normal development In 2004, the AAP reported the incidence of ASD at 1:166 In 2007, the CDC has revised the incidence to 1:150 Many people refuse to call this an epidemic, saying that this is just due to better diagnosis and awareness The DSM-IV criteria for Autism has NOT changed since the early 1990s

Before 1985, the total incidence of Autism was 3-5 per 10,000 Births (1:2000-3000). Most cases were from acute medical problems, present since birth, and caused by known genetic disorders

By 1997, the rate of autism had increased to 30 per 10000 births (1:333), with 80% regressive type, after a period of normal development

In 2004, the AAP reported the incidence of ASD at 1:166

In 2007, the CDC has revised the incidence to 1:150

Many people refuse to call this an epidemic, saying that this is just due to better diagnosis and awareness

The DSM-IV criteria for Autism has NOT changed since the early 1990s

Autistic Spectrum Disorders ADHD Asperger’s PDD Autism Syndrome In many of our patients, there are multiple biological abnormalities

ADHD Asperger’s PDD Autism

Syndrome

In many of our patients, there are multiple biological abnormalities

Discover Magazine, 3/14/07

Intestinal Abnormal flora (dysbiosis) Abnormal permeability (leaky gut) Illeal lymphoid hyperplasia Persistent Measles virus

Abnormal flora (dysbiosis)

Abnormal permeability (leaky gut)

Illeal lymphoid hyperplasia

Persistent Measles virus

Immune System Th1 Th2 type of WBC Low TH1 can cause susceptibility to infections, with potential increased exposure to antibiotics. Related Yeast Overgrowth in Intestinal Tract as well as Clostridia and Parasites High TH2 can lead to inappropriate antibody formation Auto-antibodies Food antibodies

Th1 Th2 type of WBC

Low TH1 can cause susceptibility to infections, with potential increased exposure to antibiotics.

Related Yeast Overgrowth in Intestinal Tract as well as Clostridia and Parasites

High TH2 can lead to inappropriate antibody formation

Auto-antibodies

Food antibodies

Biochemical Abnormalities Low sulfur amino acids Low zinc levels Low selenium levels High copper to zinc ratios Low omega – 3 fatty acids High ammonia levels Abnormal methylation metabolism High microbial metabolites Elemental Toxins: Mercury, Lead, etc

Low sulfur amino acids

Low zinc levels

Low selenium levels

High copper to zinc ratios

Low omega – 3 fatty acids

High ammonia levels

Abnormal methylation metabolism

High microbial metabolites

Elemental Toxins: Mercury, Lead, etc

Robert Cade, MD, Professor, University of Florida Medical School “ A gluten and casein free diet resulted in significant improvement in 81% of children with autism within three months.”

Rationale for Casein/Gluten Free Diet Gluten and casein have immune, as well as neurotransmitter impacts. Many ASD children have food hypersensitivities Improper digestion leads to buildup of opiate-like peptides. These can be identified in the urine of many children with ASD. Dr Cade at UF recently injected rats with casomorphin, causing the rats to develop autistic-like behaviors

Gluten and casein have immune, as well as neurotransmitter impacts.

Many ASD children have food hypersensitivities

Improper digestion leads to buildup of opiate-like peptides. These can be identified in the urine of many children with ASD.

Dr Cade at UF recently injected rats with casomorphin, causing the rats to develop autistic-like behaviors

DPP-IV Dipeptidyl Peptidase IV, carboxypeptidase A, and aminopeptidase are some of the main enzymes that brake down the opiate peptides. Some of the enzymes are zinc dependent, and it’s activity can be inhibited by mercury, among other things. A first generation enzyme containing DPP-IV is available from Kirkman Labs. Although for most children it can not serve as a sole replacement for the C/G free diet, giving it with these foods allow some children to take c/g foods with out negative reactions, and it can be administered in cases of accidental exposure

Dr. Lewis’ book is the essential starting point for a gluten and casein free diet.

Milk: It does your body good? Frank Oski - Past chairman of Johns Hopkins Department of Pediatrics and Past-President of the American Academy of Pediatrics

Frank Oski -

Past chairman of Johns Hopkins Department of Pediatrics and Past-President of the American Academy of Pediatrics

Causes of Autism? Genetic Predisposition Persistent measles infection in the GI Tract Vitamin A deficiency following Pertussis Metallothionein Deficiency/Dysfunction Mercury Poisoning Inadequate Detoxification Nutritional Deficiencies

Genetic Predisposition

Persistent measles infection in the GI Tract

Vitamin A deficiency following Pertussis

Metallothionein Deficiency/Dysfunction

Mercury Poisoning

Inadequate Detoxification

Nutritional Deficiencies

Evaluating Children Urine and Stool Studies Thyroid profile Toxic Metals Inborn Errors of Amino Acids Fragile X, Chromosomal Analysis Metallothionein analysis RBC Fatty Acids Brain auto-antibodies Immunoglobulins, WBC activity Detoxification Metabolism Hormone Profiles

Urine and Stool Studies

Thyroid profile

Toxic Metals

Inborn Errors of Amino Acids

Fragile X, Chromosomal Analysis

Metallothionein analysis

RBC Fatty Acids

Brain auto-antibodies

Immunoglobulins, WBC activity

Detoxification Metabolism

Hormone Profiles

Autism Speaks Launches Pediatrician Outreach Initiative to Increase Awareness about the Diagnosis and Treatment of Gastrointestinal Problems Consensus Statement Developed by Expert Panel Includes Recommendations for Care Specific to Children with Autism February 28, 2007

Abnormal Stool & Urine Findings Best, and in some cases imperative to treat these prior to starting more advanced therapies such as chelation Stool : Yeast (Candida), Parasites (Giardia, Dientameoba, and others), Malabsorption, Blood, etc. Urine : Yeast and Bacterial metabolites, abnormal Kreb’s cycle metabolites, oxalates, opiate peptides, etc

Best, and in some cases imperative to treat these prior to starting more advanced therapies such as chelation

Stool : Yeast (Candida), Parasites (Giardia, Dientameoba, and others), Malabsorption, Blood, etc.

Urine : Yeast and Bacterial metabolites, abnormal Kreb’s cycle metabolites, oxalates, opiate peptides, etc

Treat Stool & Urine Findings Yeast Killers: Nystatin, Diflucan, Sporonox, Uva Ursi, MCT, goldenseal, Garlic, Candex (digestive enzyme) and others. Clostridia Killers: high dose lactobacillus, Metronidazole (benzoate by compounding), Vancomycin Parasites: the ones we see most often are also sensitive to Metronidazole Benzoate, other specific natural and pharmacological agents used depending on the particular organism

Yeast Killers: Nystatin, Diflucan, Sporonox, Uva Ursi, MCT, goldenseal, Garlic, Candex (digestive enzyme) and others.

Clostridia Killers: high dose lactobacillus, Metronidazole (benzoate by compounding), Vancomycin

Parasites: the ones we see most often are also sensitive to Metronidazole Benzoate, other specific natural and pharmacological agents used depending on the particular organism

OAT test

OAT After Culturelle and Nystatin

Nicholas (8 y/o)After Culturelle and Nystatin (3 months later) Attention span has definitely improved since the last visit. getting very good reports fro the teachers more "with it", not spacey now will respond much faster when spoken to. Reading skills vastly improved, with good comprehension skills. Reading instruction manuals and understanding it. Wants to keep reading on and on. performing skills at school that he never did before. Amazing memory for spelling. Learned how to tell time. Can perform addition. less problems with interactions with his peers, but he prefers solitary play when in his house. When visiting others he will interact more. He does much better in small and quiet groups getting better balance of his body.

Attention span has definitely improved since the last visit.

getting very good reports fro the teachers

more "with it", not spacey

now will respond much faster when spoken to.

Reading skills vastly improved, with good comprehension skills. Reading instruction manuals and understanding it. Wants to keep reading on and on.

performing skills at school that he never did before. Amazing memory for spelling.

Learned how to tell time.

Can perform addition.

less problems with interactions with his peers, but he prefers solitary play when in his house. When visiting others he will interact more. He does much better in small and quiet groups

getting better balance of his body.

Sulfation Sulfur is an element critical to the structure and functioning of body mechanisms. Dr. Rosemary Waring reports that most autistic children show a deficiency of sulfates in their plasma. Of the autistic children she tested, 92% had sulfate levels that were only 12% of normal Low sulfates can lead to a leaky gut, as well as a weakness in the phenolsulfotransferase (PST) system. the PST pathway is important in removing toxins A weakness in the PST system is often characterized by night sweats, red face and ears, allergies, and keratosis pilaris (red bumps on back of arms) Tx: Epsom Salt by bath or transdermal application, or oral sulfates such as glucosamine sulfate and MSM

Sulfur is an element critical to the structure and functioning of body mechanisms.

Dr. Rosemary Waring reports that most autistic children show a deficiency of sulfates in their plasma. Of the autistic children she tested, 92% had sulfate levels that were only 12% of normal

Low sulfates can lead to a leaky gut, as well as a weakness in the phenolsulfotransferase (PST) system.

the PST pathway is important in removing toxins

A weakness in the PST system is often characterized by night sweats, red face and ears, allergies, and keratosis pilaris (red bumps on back of arms)

Tx: Epsom Salt by bath or transdermal application, or oral sulfates such as glucosamine sulfate and MSM

 

After Epsom Salt Baths

Eric’s (6 y/o) Response to Epson Salt Baths Making new statements. Becoming more creative with language. Responding to answers appropriately still needs help focusing for long periods of time, but paying more attention echolalia is gone showed much more interest in presents that he received for the holidays. getting more involved with his brother, they are fighting a bit now.

Making new statements. Becoming more creative with language. Responding to answers appropriately

still needs help focusing for long periods of time, but paying more attention

echolalia is gone

showed much more interest in presents that he received for the holidays.

getting more involved with his brother, they are fighting a bit now.

Ammonia Ammonia is a known toxin to the brain. High enough levels can cause can cause neurological symptoms, even coma. This is usually associated with liver disease About 5-10% of ASD patients we check have mild to moderate elevations in Ammonia levels (in the presence of normal liver tests) Proposed mechanism: Proteins >> Amino Acids >>Ammonia >>liver fuses 2 ammonia molecules to form urea >> excreted in urine. Gut pathogens >> leaky gut. Urease enzyme made by certain gut pathogens >> Urease enters the bloodstream >> splits urea back to ammonia at a pace faster then urea can be formed.

Ammonia is a known toxin to the brain.

High enough levels can cause can cause neurological symptoms, even coma. This is usually associated with liver disease

About 5-10% of ASD patients we check have mild to moderate elevations in Ammonia levels (in the presence of normal liver tests)

Proposed mechanism: Proteins >> Amino Acids >>Ammonia >>liver fuses 2 ammonia molecules to form urea >> excreted in urine. Gut pathogens >> leaky gut. Urease enzyme made by certain gut pathogens >> Urease enters the bloodstream >> splits urea back to ammonia at a pace faster then urea can be formed.

Connor’s original Ammonia level

Connor’s ammonia after 2 capsules of alpha ketoglutaric acid Increased speech, repeating everything socializing better, especially with sister Separation still a problem when school starts When peer tantrums, Conor gets upset. He did approach a crying child instead of running away, and when sister was crying he sought help instead of withdrawing

Increased speech, repeating everything

socializing better, especially with sister

Separation still a problem when school starts

When peer tantrums, Conor gets upset. He did approach a crying child instead of running away, and when sister was crying he sought help instead of withdrawing

Connor After 4 capsules of Alpha Ketoglutaric Acid No more episodes of the rapid eye blinking or enlarged pupils interacting better with sister less melt-downs when others tantrum speech improving on a weekly basis sound sensitivities seem to no longer be a problem

No more episodes of the rapid eye blinking or enlarged pupils

interacting better with sister

less melt-downs when others tantrum

speech improving on a weekly basis

sound sensitivities seem to no longer be a problem

Essential Fatty Acids The Omega Factor

 

 

Omega-3 Fatty Acid Depletion in Post-Partum Women After one child: low DHA After two children: lower DHA After three children: lowest DHA Lactation: At 16 weeks, significant decrease in DHA

After one child: low DHA

After two children: lower DHA

After three children: lowest DHA

Lactation: At 16 weeks, significant decrease in DHA

Omega 3’s in Autism Replacing and Omega-3 deficiency (source independent) Vs. Addressing Omega deficiency and Supplementing with natural Vitamin A (Cod Liver Oil)

Replacing and Omega-3 deficiency

(source independent)

Vs.

Addressing Omega deficiency and Supplementing with natural Vitamin A

(Cod Liver Oil)

 

Immunity is complex and impacts every system in the body. It isn’t surprising that it effects child behavior and development.

Immune System TH1 TH2 type of WBC Viral Stimulation Inappropriate antibody formation Auto-antibodies Food antibodies Frequent Infections - Especially Ear Related Yeast Overgrowth in Intestinal Tract w/ Clostridia and Parasites

TH1 TH2 type of WBC

Viral Stimulation

Inappropriate antibody formation

Auto-antibodies

Food antibodies

Frequent Infections - Especially Ear

Related Yeast Overgrowth in Intestinal Tract w/ Clostridia and Parasites

PPARS (Peroxisome Proliferator-Activated Receptors) Used in DM type II to increase insulin responsiveness 2 ° effect decreases Th0 moving towards Th1 and away from Th2. Boris et al at NYU studied 350 ASD children using ACTOS, showing significant increases in cognition, calmness, verbal skills and socialization, with decreases in aggression and diarrhea. 22 of these kids had hyperactivity, 9 had periorbital edema, 34 had weight gain, 0 had hyperglycemia or hyperinsulinism Cytokines pre and post treatment have been measured, improvements in MBP autoantibodies and thyroid autoantibodies have been documented.

Used in DM type II to increase insulin responsiveness

2 ° effect decreases Th0 moving towards Th1 and away from Th2.

Boris et al at NYU studied 350 ASD children using ACTOS, showing significant increases in cognition, calmness, verbal skills and socialization, with decreases in aggression and diarrhea. 22 of these kids had hyperactivity, 9 had periorbital edema, 34 had weight gain, 0 had hyperglycemia or hyperinsulinism

Cytokines pre and post treatment have been measured, improvements in MBP autoantibodies and thyroid autoantibodies have been documented.

IMMUNIZATIONS I am not suggesting that we abandon our vaccination policy I am concerned about the growing number of chronically ill children There are more children with learning disabilities and autoimmune disorders then there has ever been in the history of medicine.

I am not suggesting that we abandon our vaccination policy

I am concerned about the growing number of chronically ill children

There are more children with learning disabilities and autoimmune disorders then there has ever been in the history of medicine.

Concerns about Vaccines Are we unnaturally stressing underdeveloped immune systems beyond their capabilities in our effort to keep the children from becoming ill? There are inadequate safety studies for the vaccines that are currently on the market Are we giving too many vaccines over a short time span? We do not have a clear understanding of the effects of some of the vaccine components such as thimerosal, aluminum, formaldehyde, and human fetal tissue.

Are we unnaturally stressing underdeveloped immune systems beyond their capabilities in our effort to keep the children from becoming ill?

There are inadequate safety studies for the vaccines that are currently on the market

Are we giving too many vaccines over a short time span?

We do not have a clear understanding of the effects of some of the vaccine components such as thimerosal, aluminum, formaldehyde, and human fetal tissue.

What’s Going On? Social deficits, shyness, social withdrawal Repetitive, perseverative, stereotypic behaviors; obsessive-compulsive tendencies Irritability, aggression, temper tantrums Lacks eye contact; impaired visual fixation Loss of speech, delayed language, failure to develop speech Speech comprehension deficits Sound sensitivity; mild to profound hearing loss Abnormal touch sensations; touch aversion Flapping, myoclonal jerks, choreiform movements, circling, rocking, toe walking, unusual postures Poor concentration, attention, response inhibition Self injurious behavior, e.g. head banging ADHD traits Sleep difficulties Diarrhea; abdominal pain/discomfort, constipation ALL SIGNS AND SYMPTOMS OF… MERCURY TOXICITY

Social deficits, shyness, social withdrawal

Repetitive, perseverative, stereotypic behaviors; obsessive-compulsive tendencies

Irritability, aggression, temper tantrums

Lacks eye contact; impaired visual fixation

Loss of speech, delayed language, failure to develop speech

Speech comprehension deficits

Sound sensitivity; mild to profound hearing loss

Abnormal touch sensations; touch aversion

Flapping, myoclonal jerks, choreiform movements, circling, rocking, toe walking, unusual postures

Poor concentration, attention, response inhibition

Self injurious behavior, e.g. head banging

ADHD traits

Sleep difficulties

Diarrhea; abdominal pain/discomfort, constipation

ALL SIGNS AND SYMPTOMS OF…

MERCURY TOXICITY

The developing fetus and young children are thought to be disproportionately affected by mercury exposure, because many aspects of development, particularly brain maturation, can be disturbed by the presence of mercury. Minimizing mercury exposure is, therefore, essential to optimal child health ….. Mercury in all of its forms is toxic to the fetus and children, and efforts should be made to reduce exposure to the extent possible to pregnant women and children as well as the general population . _______________________________________________________________ Vaccine inserts would typically say “0.01% thimerosal as a preservative”, which to anyone would sound like an extremely small amount. When called to testify in front of the Institute of Medicine, an independent group formed by our government to monitor safety issues, Dr. Neil Halsey of Johns Hopkins University, and head of the vaccine recommendation committee that reports to the CDC, went on record as saying “No one ever did the math…. No one knows what dose of mercury, if any, from vaccines is safe. We can say there is no evidence of harm but the truth is no one has looked” MERCURY Statement: Pediatrics 2001 Jul, American Academy of Pediatrics: Committee on Environmental Health.

Mercury/Thimerosal Thimerosal is Ethylmercury, a neurotoxin Mercury was found in the blood of newborns even before Hepatitis B shot, and higher levels after the shot. Journal of Pediatrics, May 2000 In some pre-term infants, mercury levels were 10 times that of term infants Pre-term babies are vaccinated according to chronological age, not gestational age.

Thimerosal is Ethylmercury, a neurotoxin

Mercury was found in the blood of newborns even before Hepatitis B shot, and higher levels after the shot.

Journal of Pediatrics, May 2000

In some pre-term infants, mercury levels were 10 times that of term infants

Pre-term babies are vaccinated according to chronological age, not gestational age.

Mercury/Thimerosal Intrauterine sources may include: maternal fish consumption mercury amalgam fillings Rhogam (given to Rh (-) mothers, no longer present) Influenza vaccine (still present)

Intrauterine sources may include:

maternal fish consumption

mercury amalgam fillings

Rhogam (given to Rh (-) mothers, no longer present)

Influenza vaccine (still present)

Mercury/Thimerosal Hepatitis B vaccine was introduced in 1991- with most newborns getting the first dose before leaving the hospital Hep B vaccine had contained 12.5 mcg of thimerosal = 6.25mcg mercury EPA established the “safe limit” at 0.1 mcg/kg/day, approximately 0.4 mcg/day for an 8 pound newborn

Hepatitis B vaccine was introduced in 1991- with most newborns getting the first dose before leaving the hospital

Hep B vaccine had contained 12.5 mcg of thimerosal = 6.25mcg mercury

EPA established the “safe limit” at 0.1 mcg/kg/day, approximately 0.4 mcg/day for an 8 pound newborn

Mercury/Thimerosal Typical Thimerosal Exposure for 2 month old infant: Hep B 12.5 mcg DTaP 25 mcg Hib 25 mcg Total 62.5 mcg of which 50% is ethylmercury = 31.25mcg Total “safe” dose for 10 pound (2 month old) baby by EPA standards: 0.5 mcg. The average 2 month old received ~60x the EPA limit

Typical Thimerosal Exposure for 2 month old infant:

Hep B 12.5 mcg

DTaP 25 mcg

Hib 25 mcg

Total 62.5 mcg

of which 50% is ethylmercury = 31.25mcg

Total “safe” dose for 10 pound (2 month old) baby by EPA standards: 0.5 mcg. The average 2 month old received ~60x the EPA limit

Mercury/Thimerosal By 6 months of age, a fully vaccinated infant would have received: 3 DTP 75 mcg thimerosal 3 Hib 75 mcg thimerosal 3 Hep B 37.5 mcg thimerosal Total 187.5 mcg thimerosal 93.75 mcg mercury 1999 FDA Center for Biologics Evaluation and Research

By 6 months of age, a fully vaccinated infant would have received:

3 DTP 75 mcg thimerosal

3 Hib 75 mcg thimerosal

3 Hep B 37.5 mcg thimerosal

Total 187.5 mcg thimerosal

93.75 mcg mercury

1999 FDA Center for Biologics Evaluation and Research

Mercury/Thimerosal Thimerosal was used as a preservative in all multiple dose vaccines (10 doses/vial) Shaken vs. Stirred: The 10 th child may receive 125-250 mcg per dose if the mercury has settled In 1999, the CDC called for Thimerosal to be removed from all vaccines. Physicians were told it is OK to use up the vaccines that they already have

Thimerosal was used as a preservative in all multiple dose vaccines (10 doses/vial)

Shaken vs. Stirred:

The 10 th child may receive 125-250 mcg per dose if the mercury has settled

In 1999, the CDC called for Thimerosal to be removed from all vaccines.

Physicians were told it is OK to use up the vaccines that they already have

Heavy Metal Exposures After exposure to mercury, the length of time to be eliminated varies for different organs: Blood and Hair: 4-6 months Non CNS organs: several years Brain: 20 years (Boyd Haley, PhD, University of Kentucky, Dept of Chemistry) Lead typically deposits into brain and bone. After exposure to lead, within several months the blood and urine levels will be normal even if the lead is still in the bone and brain (Clarkson, 2002)

After exposure to mercury, the length of time to be eliminated varies for different organs:

Blood and Hair: 4-6 months

Non CNS organs: several years

Brain: 20 years

(Boyd Haley, PhD, University of Kentucky, Dept of Chemistry)

Lead typically deposits into brain and bone. After exposure to lead, within several months the blood and urine levels will be normal even if the lead is still in the bone and brain (Clarkson, 2002)

Who’s looking into all of this?!?!?! Mark R. Geier, MD, Ph.D. (Submitted to the Institute of Medicine, of the US National Academy of Sciences, January 2004 There was a 6-fold statistically significantly (p < 0.05) increased incidence rate of autism reported to VAERS following thimerosal- containing DTaP vaccines in comparison to thimerosal-free DTaP vaccines. (analyzing data comparing thimerosal vs. thim-free DTaP) In analyzing the Vaccine Safety Datalink: In the group receiving a minimum of three doses of thimerosal-containing DTaP vaccine only in comparison to our group receiving a minimum of three doses of thimerosal-free DTaP vaccine only, that there was statistically significantly increased risk for autism (relative risk = 27.6, attributable risk = 3.81 per 10,000 children, p < 0.0001). What does the AAP conclude about Geier’s research? “ Study Fails to Show a Connection Between Thimerosal and Autism ” from the AAP webpage, Posted May 16, 2003

There was a 6-fold statistically significantly (p < 0.05) increased incidence rate of autism reported to VAERS following thimerosal- containing DTaP vaccines in comparison to thimerosal-free DTaP vaccines. (analyzing data comparing thimerosal vs. thim-free DTaP)

In analyzing the Vaccine Safety Datalink: In the group receiving a minimum of three doses of thimerosal-containing DTaP vaccine only in comparison to our group receiving a minimum of three doses of thimerosal-free DTaP vaccine only, that there was statistically significantly increased risk for autism (relative risk = 27.6, attributable risk = 3.81 per 10,000 children, p < 0.0001).

What does the AAP conclude about Geier’s research?

“ Study Fails to Show a Connection Between Thimerosal and Autism ” from the AAP webpage, Posted May 16, 2003

Who’s looking into all of this? Boyd Haley, PhD, Department of Chemistry Chairman, University of Kentucky. Dr Haley is considered one of the leading researchers in America on Heavy Metal toxicity He reports that exposing neurons to thimerosal rapidly results in the stripping of tubuluin from the nerve axon, and also reduces the viability of actin. Actin and tubulin are proteins that are critically important for the growth of dendrites and to maintain the structure of the axon. On exposing neurons grown in culture for 24 hours, then exposed to vaccines with thimerosal and thimerosal-free vaccines. There was significantly more cell death in those exposed to thimerosal vaccines. The most concerning part about this was that there was an extremely low amount of thimerosal used in the study, 10K less then the concentration found in most vaccines

Boyd Haley, PhD, Department of Chemistry Chairman, University of Kentucky. Dr Haley is considered one of the leading researchers in America on Heavy Metal toxicity

He reports that exposing neurons to thimerosal rapidly results in the stripping of tubuluin from the nerve axon, and also reduces the viability of actin. Actin and tubulin are proteins that are critically important for the growth of dendrites and to maintain the structure of the axon.

On exposing neurons grown in culture for 24 hours, then exposed to vaccines with thimerosal and thimerosal-free vaccines. There was significantly more cell death in those exposed to thimerosal vaccines. The most concerning part about this was that there was an extremely low amount of thimerosal used in the study, 10K less then the concentration found in most vaccines

Who’s looking into all of this?!?!?! When cultures of the same were then co-exposed to thimerosal and aluminum, and those cells died much faster then those with thimerosal alone The same neurons were then taken and half received thimerosal and estrogen, and half received thimerosal and testosterone. Those with estrogen co-administered were protected against thimerosal-induced neuron death. Those co-administered with testosterone had a very large increase in neuron death. This may explain the 5:1 ratio of boys:girls. His conclusion, as presented to the Institute of Medicine Immunization Safety Review committee: “To date the data has been very consistent: the toxicity of the vaccines is primarily dependent on the presence of thimerosal, and in my opinion, thimerosal containing vaccines would be classified as severely toxic to numerous brain proteins

When cultures of the same were then co-exposed to thimerosal and aluminum, and those cells died much faster then those with thimerosal alone

The same neurons were then taken and half received thimerosal and estrogen, and half received thimerosal and testosterone. Those with estrogen co-administered were protected against thimerosal-induced neuron death. Those co-administered with testosterone had a very large increase in neuron death. This may explain the 5:1 ratio of boys:girls.

His conclusion, as presented to the Institute of Medicine Immunization Safety Review committee: “To date the data has been very consistent: the toxicity of the vaccines is primarily dependent on the presence of thimerosal, and in my opinion, thimerosal containing vaccines would be classified as severely toxic to numerous brain proteins

Who’s looking into this (cont) The following are excerpts from posters presented at the November 2002 International Meeting for Autism Research Hornig et al, Center for Immunopathogenesis and Infectious Diseases, Mailman School of Public Health, Columbia University, demonstrated that early postnatal administration of thimerosal using doses and timing that mimic the childhood immunization schedule induces mouse strain-specific effects on weight gain, locomotor and exploratory activity, stereotypic behaviors, and size of certain regions of hippocampus. SJL/J mice, a strain with heightened sensitivity to autoimmune disease, show the most prominent behavioral and neuropathological effects. In this strain, male gender is associated with a more severe outcome. ( This associates a potential genetic predisposition may give way to a subset of subjects that are biologically susceptible to toxic effects on the brain .)

The following are excerpts from posters presented at the November 2002 International Meeting for Autism Research

Hornig et al, Center for Immunopathogenesis and Infectious Diseases, Mailman School of Public Health, Columbia University, demonstrated that early postnatal administration of thimerosal using doses and timing that mimic the childhood immunization schedule induces mouse strain-specific effects on weight gain, locomotor and exploratory activity, stereotypic behaviors, and size of certain regions of hippocampus. SJL/J mice, a strain with heightened sensitivity to autoimmune disease, show the most prominent behavioral and neuropathological effects. In this strain, male gender is associated with a more severe outcome. ( This associates a potential genetic predisposition may give way to a subset of subjects that are biologically susceptible to toxic effects on the brain .)

Who’s looking into this (cont) Holloway et al, Arizona State:Oral antibiotics have been shown in rats to increase the half-life for excretion of mercury from 10 days to over 100 days. ( Doctors have been told it is OK to vaccinate children as long as they are not seriously sick, with high fevers, and there is no recommendations not to vaccinate children on antibiotics ) Holloway et all, Arizona State 2002 carried out a DMSA challenge study involving 15 children with autism and 15 typical children. The children received a single dose of meso-2,3-dimercaptosuccinic acid (DMSA), at a dose of 10 mg/kg, followed by a 10-hour urine collection. The DMSA resulted in a much greater increase in heavy metal excretion in the children with autism compared to the controls. Many of the children with autism excreted high levels of one or more heavy metals, although there was wide variation in the amount and type of metal excreted. (The data suggests that many children with autism have a greatly diminished ability to excrete heavy metals, and thus would be unusually vulnerable to exposures to those metals)

Holloway et al, Arizona State:Oral antibiotics have been shown in rats to increase the half-life for excretion of mercury from 10 days to over 100 days. ( Doctors have been told it is OK to vaccinate children as long as they are not seriously sick, with high fevers, and there is no recommendations not to vaccinate children on antibiotics )

Holloway et all, Arizona State 2002 carried out a DMSA challenge study involving 15 children with autism and 15 typical children. The children received a single dose of meso-2,3-dimercaptosuccinic acid (DMSA), at a dose of 10 mg/kg, followed by a 10-hour urine collection. The DMSA resulted in a much greater increase in heavy metal excretion in the children with autism compared to the controls. Many of the children with autism excreted high levels of one or more heavy metals, although there was wide variation in the amount and type of metal excreted. (The data suggests that many children with autism have a greatly diminished ability to excrete heavy metals, and thus would be unusually vulnerable to exposures to those metals)

Mercury Testing As there is a relative short half life of mercury in serum , blood and urine testing will often be negative if more then 6 months have passed between exposure and testing Hair tests can be falsely positive if there are metals in shampoos, conditioners, or water. Also, there is evidence that mercury levels in the hair of autistic children is less than in controls (Cave and Holmes) For me, the best test is an oral chelation challenge, extracting the heavy metal and excreting it in the urine. This can document that the metal is present, it is not being excreted under normal circumstances, AND that the chelation agent and the route of administration given works for the individual

As there is a relative short half life of mercury in serum , blood and urine testing will often be negative if more then 6 months have passed between exposure and testing

Hair tests can be falsely positive if there are metals in shampoos, conditioners, or water. Also, there is evidence that mercury levels in the hair of autistic children is less than in controls (Cave and Holmes)

For me, the best test is an oral chelation challenge, extracting the heavy metal and excreting it in the urine. This can document that the metal is present, it is not being excreted under normal circumstances, AND that the chelation agent and the route of administration given works for the individual

Mercury Removal: Chelation Agents EDTA, Dimercaprol (BAL), DMSA, DMPS, and DMPA all have heavy metal binding activity Marked specificity for heavy metals, but also can cause decreases in trace elements and micronutrients (and these should be tested for periodically) Mercury is essentially irreversibly bound to DMSA, so mercury is not deposited in other tissues, even the kidney. DMSA/DMPS works through increasing urinary excretion. DMSA/DMPS does not cross the blood-brain barrier, so no risk of delivering bound mercury to the brain Very low toxicity. Side effects may include anorexia, nausea, vomiting, diarrhea, rash and a transient increase in liver enzymes. There are no known adverse drug interactions with DMSA/DMPS. EDTA: disodium vs Calcium disodium. Disodium EDTA given rapidly by IV can suddenly drop serum calcium levels. Only should use CaNa2 EDTA

Agents

EDTA, Dimercaprol (BAL), DMSA, DMPS, and DMPA all have heavy metal binding activity

Marked specificity for heavy metals, but also can cause decreases in trace elements and micronutrients (and these should be tested for periodically)

Mercury is essentially irreversibly bound to DMSA, so mercury is not deposited in other tissues, even the kidney.

DMSA/DMPS works through increasing urinary excretion.

DMSA/DMPS does not cross the blood-brain barrier, so no risk of delivering bound mercury to the brain

Very low toxicity. Side effects may include anorexia, nausea, vomiting, diarrhea, rash and a transient increase in liver enzymes.

There are no known adverse drug interactions with DMSA/DMPS.

EDTA: disodium vs Calcium disodium. Disodium EDTA given rapidly by IV can suddenly drop serum calcium levels. Only should use CaNa2 EDTA

Mercury Removal: Chelation oral (DMPS and DMSA) IV (DMPS and CaNa2 EDTA) Rectal (DMPS, DMSA, CaNa2 EDTA [detoxamin]). best to have stool passage before insertion CaNa2 EDTA seems to cause less yeast exacerbation TD – emu oil seems the best vehicle seen very little benefit/movement with DMPS seen some positive excretions with DMSA CaNa2 very difficult to keep in suspension without precipitation

oral (DMPS and DMSA)

IV (DMPS and CaNa2 EDTA)

Rectal (DMPS, DMSA, CaNa2 EDTA [detoxamin]).

best to have stool passage before insertion

CaNa2 EDTA seems to cause less yeast exacerbation

TD – emu oil seems the best vehicle

seen very little benefit/movement with DMPS

seen some positive excretions with DMSA

CaNa2 very difficult to keep in suspension without precipitation

Single dose chelation challenge baseline urine taken before dose given 8 hour urine collection regardless of type/route empty bladder before giving dose DMSA (oral or rectal 25mg/kg) DMPS (3mg/kg for IV, 10mg/kg for rectal, 5-10mg/kg oral) CaNA2 EDTA (25-50mg/kg regardless of rout, maximum of 1500mg) May need to do more than 1 challenge with different agents/routes (DAN! 2005 Consensus Paper)

baseline urine taken before dose given

8 hour urine collection regardless of type/route

empty bladder before giving dose

DMSA (oral or rectal 25mg/kg)

DMPS (3mg/kg for IV, 10mg/kg for rectal, 5-10mg/kg oral)

CaNA2 EDTA (25-50mg/kg regardless of rout, maximum of 1500mg)

May need to do more than 1 challenge with different agents/routes

(DAN! 2005 Consensus Paper)

Antonio (7 y/o) on first chelation challenge with DMSA

Antonio, after 4 cycles of DMSA

Antonio, after 8 cycles of DMSA

Antonio After Chelation with DMSA Has bad gas during the DMSA days, and is moody, then this goes away when the DMSA is finished. Doing better and better in speech therapy If he does not want to do things he cries. Teachers are reporting improvements seen on a month-to-month basis More hand gesturing In a more advanced class. The mimicry behavior has stopped. At this point language is the major barrier, behaviors and stemming are under control

Richard (6 y/o) on first DMSA Challenge

Richard after 2 mo of DMSA

Richard After Chelation Using the bathroom appropriately Will sit still for haircuts Focus and attention significantly improved Knows his letter, numbers and colors Excelling in all areas of education except for verbal speech, though is vocalizing more then every before Richard Before Chelation No self help skills No bathroom skills No attention span No learning anything at school

Using the bathroom appropriately

Will sit still for haircuts

Focus and attention significantly improved

Knows his letter, numbers and colors

Excelling in all areas of education except for verbal speech, though is vocalizing more then every before

No self help skills

No bathroom skills

No attention span

No learning anything at school

Baseline

DMPS/Glutathione-IV

DMPS/Glutathione-Rectal

Urine Porphyrins Porphyrins represent a group of uniquely structured compounds that can surround different types of ions/metals. Each has a specific biological function Hemoglobin Myoglobin Chlorophyll

Porphyrins represent a group of uniquely structured compounds that can surround different types of ions/metals. Each has a specific biological function

Hemoglobin

Myoglobin

Chlorophyll

Biochemistry 101 Enzymes – the keys to life A + B 0 C 0 D A & B are substrates, the ingredients being “mixed” together 0 is the enzyme, the catalyst that makes the reaction proceed. C & D are products made by the reaction, which can then go on to be substrates (ingredients) in other reactions Some enzyme reactions can go both directions

Biochemistry 101 Not enough or particular substrate The genes that code for the enzyme are abnormal, creating a damaged or inefficient enzyme Something “poisons” the enzyme so it won’t work Too much of a product (D) drives the reaction in the other direction What can cause an enzyme not to work? A + B 0 C 0 D

Not enough or particular substrate

The genes that code for the enzyme are abnormal, creating a damaged or inefficient enzyme

Something “poisons” the enzyme so it won’t work

Too much of a product (D) drives the reaction in the other direction

Certain toxins, such as heavy metals and pesticides can inhibit certain enzymes in the heme porphyrin pathway, leading to specific porphyrin profiles being excreted into the urine. If an enzyme is inhibited, the substrate “upstream” can build up. Aluminum and dioxin inhibit uropophyrin decaboxylase. Mercury inhibits coproporphyrinogen oxidase. Lead inhibits coproporphyrinogen oxidase and aminolevulinic acid dehydratase. (Woods, 1996) Second urine void of the day is the best collection, as supplements that cause oxidation if mixed with the porphyrins overnight in the bladder can change the structure of the porphyrin lead to false values (Martin, 1996) Urine Porphyrins

Certain toxins, such as heavy metals and pesticides can inhibit certain enzymes in the heme porphyrin pathway, leading to specific porphyrin profiles being excreted into the urine. If an enzyme is inhibited, the substrate “upstream” can build up.

Aluminum and dioxin inhibit uropophyrin decaboxylase.

Mercury inhibits coproporphyrinogen oxidase.

Lead inhibits coproporphyrinogen oxidase and aminolevulinic acid dehydratase.

(Woods, 1996)

Second urine void of the day is the best collection, as supplements that cause oxidation if mixed with the porphyrins overnight in the bladder can change the structure of the porphyrin lead to false values (Martin, 1996)

Coproporphyrin (copro) is a general marker for overall toxic metal burden. It is seen elevated in the presence of mercury, lead and arsenic Precoproporphyrin (preco) – an atypical porphyrin that only appears in the presence of mercury Heptacarboxyporhyrin and uroporphyrin is high on exposure to pesticides, PCBs, arsenic and aluminum (Woods, 2005) Urine Porphyrins

Coproporphyrin (copro) is a general marker for overall toxic metal burden. It is seen elevated in the presence of mercury, lead and arsenic

Precoproporphyrin (preco) – an atypical porphyrin that only appears in the presence of mercury

Heptacarboxyporhyrin and uroporphyrin is high on exposure to pesticides, PCBs, arsenic and aluminum

(Woods, 2005)

Children with autism have significantly higher levels of copro and preco porphyrins compared to controls (Nataf, 2006; Geier, 2006) Nataf also found that the severity of autistic symptoms correlated with the copro level, and that children with autism and seizures had the highest copro levels. Urine porphyrin levels decrease with chelation (Pingree, 2001) Urine Porphyrins

Children with autism have significantly higher levels of copro and preco porphyrins compared to controls (Nataf, 2006; Geier, 2006)

Nataf also found that the severity of autistic symptoms correlated with the copro level, and that children with autism and seizures had the highest copro levels.

Urine porphyrin levels decrease with chelation (Pingree, 2001)

 

I only send to Dr Nataf’s lab in France. They are the only commercial lab that has ranges for children and that autistic children has been studied at. The large US labs are not calibrated to test for levels under that which is seen in genetic porphyrin diseases which produce much higher porphyrin levels I prefer using the chelation challenge test, as it also tells me if the chelation agent/route of administration is working, not just if the metals are present. I order this test for: families who do not wish to expose their children to a chelation agent unless there is proof of metals. If chelation challenge tests are negative but we still suspect metals are present Once chelation challenge tests are negative after cycles of chelation, if we still suspect metals are present Urine Porphyrins ( how/when I use the test)

I only send to Dr Nataf’s lab in France. They are the only commercial lab that has ranges for children and that autistic children has been studied at. The large US labs are not calibrated to test for levels under that which is seen in genetic porphyrin diseases which produce much higher porphyrin levels

I prefer using the chelation challenge test, as it also tells me if the chelation agent/route of administration is working, not just if the metals are present.

I order this test for:

families who do not wish to expose their children to a chelation agent unless there is proof of metals.

If chelation challenge tests are negative but we still suspect metals are present

Once chelation challenge tests are negative after cycles of chelation, if we still suspect metals are present

SAM SAH MTase SAHH Homocysteine B6 THF MS CBS MB12 Protein synthesis BHMT Choline Betaine Overview of The Methylation / Transsulfuration Pathway THF: tetrahydrofolate Betaine:TMG 5-CH 3 THF Methylation of DNA, RNA, proteins, membrane phospholipids, creatine, neurotransmittors Cystathionine Cysteine Glutathione Methionine Adenosine AK ADA Inosine AMP MAT B6 MTHFR

The Methylation / Transsulfuration Pathway The Enzymes: MS: Methionine synthase MAT: Methionine adenosyltransferase MTase: Methyltransferase MTHFR: Methylenetetrahydrofolate Reductase SAHH: S-adenosylhomocysteine Hydrolase CBS: Cystathione beta synthase BHMT: betaine-homocysteine methyltransferase

SAM SAH MTase SAHH Homocysteine THF MS MB12 Protein synthesis The Methionine Cycle: Remethylation of Homocysteine THF: tetrahydrofolate 5-CH 3 THF Methylation of DNA, RNA, proteins, histones, membrane phospholipids, neurotransmitters Methionine Adenosine AK ADA Inosine AMP MAT

SAM SAH MTase SAHH Homocysteine THF MS B12 Protein synthesis The Methionine Cycle: Remethylation of Homocysteine THF: tetrahydrofolate 5-CH 3 THF Methylation of DNA, RNA, proteins, histones, membrane phospholipids, neurotransmitters Methionine Adenosine AK ADA Inosine AMP MAT

SAM SAH MTase SAHH Homocysteine THF MS B12 Protein synthesis BHMT Choline Betaine The Methionine Cycle: Remethylation of Homocysteine Betaine: TMG 5-CH 3 THF Methylation of DNA, RNA, proteins, histones, membrane phospholipids, neurotransmitters Methionine Adenosine AK ADA Inosine AMP MAT

SAM SAH MTase SAHH Homocysteine B6 THF MS CBS B12 Protein synthesis BHMT Choline Betaine Methionine Transsulfuration to Cysteine and Glutathione Transsulfuration Pathway THF: tetrahydrofolate 5-CH 3 THF Methylation of DNA, RNA, proteins, membrane phospholipids, creatine, neurotransmittors Cystathionine Cysteine Glutathione Methionine Adenosine AK ADA Inosine AMP MAT B6

SAM SAH MTase SAHH Homocysteine B6 THF MS CBS B12 Protein synthesis BHMT Choline Betaine Effect of Oxidative Stress on Methionine Transsulfuration THF: tetrahydrofolate 5-CH 3 THF Methylation of DNA, RNA, proteins, membrane phospholipids, creatine, neurotransmittors Cystathionine Cysteine GSH GSSG Methionine Adenosine ( AK and/or ADA) MAT B6

Neurotoxicity of Thimerosal in Human Brain Cells is Associated with Glutathione Depletion: Protective Effect of Cysteine or Glutathione Supplementation S. Jill James, William Slikker, Elizabeth New, Stefanie Jernigan, Stepan Melnyk Department of Pediatrics University of Arkansas for Medical Sciences Little Rock, AR

WORKING HYPOTHESIS Ethyl mercury in Thimerosal binds to cysteine thiol (–SH) groups on intracellular proteins and inactivates function. The cysteine-rich antioxidant, glutathione, binds mercury and protects essential proteins from functional inactivation. The neurotoxicity of Thimerosal is associated with depletion of glutathione, the major intracellular antioxidant. Neurotoxicity of Thimerosal in Human Brain Cells is Associated with Glutathione Depletion: Protective Effect of Cysteine or Glutathione Supplementation

WORKING HYPOTHESIS

Ethyl mercury in Thimerosal binds to cysteine thiol (–SH) groups on intracellular proteins and inactivates function.

The cysteine-rich antioxidant, glutathione, binds mercury and protects essential proteins from functional inactivation.

The neurotoxicity of Thimerosal is associated with depletion of glutathione, the major intracellular antioxidant.

0 2.5 5 10 20 VIABILITY OF GLIOBLASTOMA AND NEUROBLASTOMA CELLS WITH INCREASING DOSE OF THIMEROSAL Viability (MTT OD) Glioblastoma Cells Neuroblastoma Cells ( 48 hr Exposure ) ( 3 hr Exposure ) 0 2.5 5 10 20 0 2.5 5 10 20  M Thimerosal  M Thimerosal

Control Thimerosal +GSH + Cystine +NAC + Methionine O.D. (Viability) Viability of Glioblastoma cells exposed to 15  M Thimerasol in the presence of GSH-ester, Cystine, N-acetylcysteine (NAC), or Methionine

Control Thimerosal +GSH + Cystine +NAC + Methionine O.D. (Viability) Viability of Neuroblastoma cells exposed to 15  M Thimerosal Pretreated with 100  M GSH-ester, Cystine, N-acetylcysteine (NAC), or Methionine

Methyl-B12, Folinic Acid, and Betaine Supplementation in 8 Children with Autism Injectible Methyl-B12 (75 µg/Kg b.i.d.) was given to the 8 children who had been taking folinic and and betaine supplements for 3-4 months Plasma thiol profile was repeated in the 8 children after 4 weeks of combined folinic acid, betaine, and methyl B12

Control Before Folinic Folinic Betaine Betaine Me-B12 Methionine S-Adenosylmethionine S-Adenosylhomocysteine Adenosine Control Before Folinic Folinic Betaine Betaine Me-B12 Control Before Folinic Folinic Betaine Betaine Me-B12 Control Before Folinic Folinic Betaine Betaine Me-B12 Transmethyation Metabolites after addition of Methyl-B12 to Folinic Acid and Betaine Supplementation in 8 Autistic Children

Control Before Folinic Folinic Betaine Betaine Me-B12 Control Before Folinic Folinic Betaine Betaine Me-B12 Control Before Folinic Folinic Betaine Betaine Me-B12 Control Before Folinic Folinic Betaine Betaine Me-B12 Homocysteine Cysteine Cystinyl-Glycine Total Glutathione tGSH) Transsulfuration Metabolites after addition of Methyl-B12 to Folinic Acid and Betaine Supplementation in 8 Autistic Children

Total Glutathione (tGSH) Control Before Folinic Folinic Betaine Betaine Me-B12 Oxidized Glutathione (fGSSG) GSH/GSSG Ratio Glutathione Redox Potential after addition of Methyl-B12 to Folinic Acid and Betaine Supplementation in 8 Autistic Children Control Before Folinic Folinic Betaine Betaine Me-B12 Control Folinic Folinic Before Betaine Betaine Me-B12

So, Why is this happening? Certain toxins such as mercury can inhibit the enzymes of this pathway. Dr James has looked at the DNA sequences that code for the proteins that make up these enzymes and has found that autistic children have up to 3 times as many single DNA mutations (polymorphisms, SNPs) as do children without autism We have identified these SNPs in children with other neurodevelopmental disorders

Certain toxins such as mercury can inhibit the enzymes of this pathway.

Dr James has looked at the DNA sequences that code for the proteins that make up these enzymes and has found that autistic children have up to 3 times as many single DNA mutations (polymorphisms, SNPs) as do children without autism

We have identified these SNPs in children with other neurodevelopmental disorders

JAMES A. NEUBRANDER, M.D., F.A.A.E.M. EDISON, N.J. 08837 OPEN CLINICAL TRIAL METHYLCOBALAMIN STUDY

OPEN CLINICAL TRIAL METHYLCOBALAMIN STUDY Total number of children included in the data: 85 • 71 males •14 females • 84% males •16 % females 51 males responded 12 females responded 74.1 % of the children responded positively!

OPEN CLINICAL TRIAL METHYLCOBALAMIN STUDY THE TOP TEN Symptoms Parents Reported Were Helped Most Often Language 71% Awareness 65% Cognition 52% Engagement 43% Eye Contact 37% Better Behavior 35% More Focused 35% Understanding 35% Vocalization 35% Trying“New Things” 33%

Side Effects Parents Reported OPEN CLINICAL TRIAL METHYLCOBALAMIN STUDY Hyperactivity 10% Sleep Patterns Disrupted Or W orsened 6% Uncontrolled Or Unusual Laughter 3% Increased Aggression 2% Biting Objects 2% More Distractible 2% Eczematous Symptoms W orse 2% Increased Stimming 2% Silliness, Unusual And Unexplained 2% Teeth Grinding 2% Tongue Tingles 2% All reported side effects faded upon stopping therapy Most parents chose to resume therapy b/c benefits outweighed the side-effects

All reported side effects faded upon stopping therapy

Most parents chose to resume therapy b/c benefits outweighed the side-effects

Oxalates Oxalates are small carbon and oxygen containing molecules that are found in certain types of fruits and vegetables. Also most nuts and seeds have oxalates. For most people, oxalates in the diet are not absorbed in great amounts into the bloodstream. They are usually metabolized by intestinal flora and excreted in the feces. In the presence of intestinal inflammation and leaky gut, larger amounts of oxalates can get into the bloodstream and be transported to tissues Under certain conditions they can crystallize and become deposited in tissues. The crystals can grow and become stones (kidney stones are calcium oxalate) When lodged in tissues, these crystals can produce irritation and pain.

Oxalates are small carbon and oxygen containing molecules that are found in certain types of fruits and vegetables. Also most nuts and seeds have oxalates.

For most people, oxalates in the diet are not absorbed in great amounts into the bloodstream. They are usually metabolized by intestinal flora and excreted in the feces.

In the presence of intestinal inflammation and leaky gut, larger amounts of oxalates can get into the bloodstream and be transported to tissues

Under certain conditions they can crystallize and become deposited in tissues. The crystals can grow and become stones (kidney stones are calcium oxalate)

When lodged in tissues, these crystals can produce irritation and pain.

Oxalates Oxalates seem to accumulate more in conditions of glutathione deficiency and oxidative stress. Vitamin B6 (pyridoxine) is a necessary cofactor for enzymes that help prevent the formation of oxalates When sulfur is deficient, it becomes extremely difficult to keep the body from making excess oxalates. High oxalates are associated with certain conditions like vulvodynia, prostatitis, irritable bowel syndrome, fibromyalgia, interstitial cystitis, and skin sensitivity. Some people may get a sense of urinary urgency and frequent urination, and sometimes the patient would have trouble urinating (Solomon, VP Foundation) High oxalates are often seen in patients with recurrent/resistant yeast infections and glycine intolerance.

Oxalates seem to accumulate more in conditions of glutathione deficiency and oxidative stress.

Vitamin B6 (pyridoxine) is a necessary cofactor for enzymes that help prevent the formation of oxalates

When sulfur is deficient, it becomes extremely difficult to keep the body from making excess oxalates.

High oxalates are associated with certain conditions like vulvodynia, prostatitis, irritable bowel syndrome, fibromyalgia, interstitial cystitis, and skin sensitivity. Some people may get a sense of urinary urgency and frequent urination, and sometimes the patient would have trouble urinating (Solomon, VP Foundation)

High oxalates are often seen in patients with recurrent/resistant yeast infections and glycine intolerance.

Testing for High Oxalates There is no perfect test right now. Urine testing is most often used. If high values are seen then this is a strong indicator, but people secrete oxalates in their urine at different times of the day (it may be most accurate to collect multiple urine specimens during the day), and relative to food intake so there can be false negatives. Great Plains Lab full organic acid test reports a spot oxalic acid value. They also report other substances that are high when there are oxalate issues: glyceric and glycolic acid Quest Labs has both random and 24 hour urine oxalate tests, both as an individual value as well as relative to oxalate. I usually get 24 hour collection with oxalate.

There is no perfect test right now.

Urine testing is most often used. If high values are seen then this is a strong indicator, but people secrete oxalates in their urine at different times of the day (it may be most accurate to collect multiple urine specimens during the day), and relative to food intake so there can be false negatives.

Great Plains Lab full organic acid test reports a spot oxalic acid value. They also report other substances that are high when there are oxalate issues: glyceric and glycolic acid

Quest Labs has both random and 24 hour urine oxalate tests, both as an individual value as well as relative to oxalate. I usually get 24 hour collection with oxalate.

Treating High Oxalates The low oxalate diet. Full information can be found at several sources: Yahoo Group: Trying_Low_Oxalates

The low oxalate diet. Full information can be found at several sources:

Yahoo Group: Trying_Low_Oxalates

Treating High Oxalates The Low Oxalate Cookbook is published by the Vulvar Pain Foundation, contains over 250 recipes. The book has lists of foods with actual amount of oxate per serving of a food. Aim to keep oxalate intake down to under 40-60mg oxalate a day. Food Lists and summary can be found on “Medical Topics” section of my webpage Probiotics: VSL#3: 1/2 to 1 capsule daily or ¼ to ½ packet of the unflavored powder daily Reduce vitamin C to 250mg or less a day, including foods (oxalates can be converted to vitamin C) Calcium citrate supplementation - given with meals to help bind and excrete the oxalates.

The Low Oxalate Cookbook is published by the Vulvar Pain Foundation, contains over 250 recipes.

The book has lists of foods with actual amount of oxate per serving of a food.

Aim to keep oxalate intake down to under 40-60mg oxalate a day.

Food Lists and summary can be found on “Medical Topics” section of my webpage

Probiotics: VSL#3: 1/2 to 1 capsule daily or ¼ to ½ packet of the unflavored powder daily

Reduce vitamin C to 250mg or less a day, including foods (oxalates can be converted to vitamin C)

Calcium citrate supplementation - given with meals to help bind and excrete the oxalates.

Elevated Male Hormones/Androgens Several studies have demonstrated that children with Autism Spectrum Disorders have elevated androgens, including testosterone, dihydrotestosterone, androstendione and DHEA (Torjman, 1997; Knickmeyer, 2005; Geier,2006) Although not exclusive, increased androgens have been associated with increased masturbation and genital rubbing, aggressiveness, hyperactivity, self-stimming, and increased body hair (legs and back), Elevations have been seen in male and female patients I use LabCorp for my testing. They have the most specific reference ranges for both sex and age of patient.

Several studies have demonstrated that children with Autism Spectrum Disorders have elevated androgens, including testosterone, dihydrotestosterone, androstendione and DHEA (Torjman, 1997; Knickmeyer, 2005; Geier,2006)

Although not exclusive, increased androgens have been associated with increased masturbation and genital rubbing, aggressiveness, hyperactivity, self-stimming, and increased body hair (legs and back),

Elevations have been seen in male and female patients

I use LabCorp for my testing. They have the most specific reference ranges for both sex and age of patient.

Elevated Male Hormones/Androgens The enzyme that converts DHEA to DHEA-S (storage hormone) is sulfotransferase, which is glutathione dependant. When this enzyme is not working, there is a build up of DHEA which then gets sent to androstenedione and then testosterone

Treating elevated Androgens Geier – Lupron. belongs to a class of drugs called gonadotropin-releasing hormone (GnRH) agonists. It is used to decrease the body’s production of specific hormones, natural chemicals that influence the behavior of certain cells. Because Lupron Depot can reduce the production of both male and female hormones, it is used to treat specific conditions in men, women, and children ( www.lupron.com ) Bradstreet – Spironolactone, a potassium sparing diuretic, also has action of blocking the receptor for dihydrotestosterone. Androgen levels should not go down with this treatment, but the effects of the hormone are blocked.

Geier – Lupron.

belongs to a class of drugs called gonadotropin-releasing hormone (GnRH) agonists.

It is used to decrease the body’s production of specific hormones, natural chemicals that influence the behavior of certain cells. Because Lupron Depot can reduce the production of both male and female hormones, it is used to treat specific conditions in men, women, and children ( www.lupron.com )

Bradstreet – Spironolactone,

a potassium sparing diuretic, also has action of blocking the receptor for dihydrotestosterone.

Androgen levels should not go down with this treatment, but the effects of the hormone are blocked.

Treating elevated Androgens Berger (VERY NEW) Glycyrrhizin – the active ingredient in licorice root decreases testosterone level by inhibiting the enzyme which converts of 17-OH progesterone to DHEA (Armanini, 1999) Inhibits the enzyme that converts Androstendiaone to Testosterone (Fukui, 2003). High doses can affect blood pressure and fluid retention, but doses < 0.2mg/kg/d should not cause these side effects (van Gelderen, 2000). Current trials underway. In addition to monitoring the androgens, also monitoring cortisol, ACTH and blood pressure

Berger (VERY NEW)

Glycyrrhizin – the active ingredient in licorice root

decreases testosterone level by inhibiting the enzyme which converts of 17-OH progesterone to DHEA (Armanini, 1999)

Inhibits the enzyme that converts Androstendiaone to Testosterone (Fukui, 2003).

High doses can affect blood pressure and fluid retention, but doses < 0.2mg/kg/d should not cause these side effects (van Gelderen, 2000).

Current trials underway.

In addition to monitoring the androgens, also monitoring cortisol, ACTH and blood pressure

Armanini D et al. N Engl J Med 1999;341:1158 Serum Hormone Concentrations in Seven Men Given Licorice for Seven Days

Risperdal 1st medicine specifically approved for Autism For use in children with aggressiveness, extreme hyperactivity Specific weight dosing is known Effects are immediate, often seen the first day Pretty easy to titrate for affective dose Pretty easy to get kids off of once the underlying reason is uncovered Fewer incidences of side effects compared to other psychotropic drugs

1st medicine specifically approved for Autism

For use in children with aggressiveness, extreme hyperactivity

Specific weight dosing is known

Effects are immediate, often seen the first day

Pretty easy to titrate for affective dose

Pretty easy to get kids off of once the underlying reason is uncovered

Fewer incidences of side effects compared to other psychotropic drugs

Vaccine Update (time permitting)

Varicella / Chicken Pox Vaccine Brand Na

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