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
 Family History-autoimmune, gastrointestinal (Valicenti-McDermott et
al, 2006)
 Single Nucleotide Polymorphisms
 Increased Susceptibility (Herbert, 2005)
Neurologic Problems
 Altered Sensitivity

Abnormal Processing
Immune System Dysregulation

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
 Maldigestion (altered enzyme function) (Horvath et al,
1999)
 Dysbiosis (change in bowel flora)
 Increased Permeability (antigens, peptides, toxins)
(Vojdani et al, 2004)
 Inflammation (enterocolitis, LNH, pro-inflammatory
cytokines) (Torrente et al, 2002)
Biochemical Peculiarities
 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
Methylation
Potential
THF SAM (SAM/SAH)
MTase
5,10- 1 MS BHMT 2 Cell Methylation
CH2THF B12 SAH
MTHFR Betaine
5- SAHH
Choline Adenosine
CH3THF
Homocysteine
1 Folate Cycle CBS
B6
Cystathionine
2 Methionine Cycle 3 B6
Antioxidant
Cysteine Potential
3 Transsulfuration
GSH GSSG
WHAT DO WE NEED TO GIVE TO
OR GET OUT OF OUR
CHILDREN?
Exercise/Activity
Basic Nutritional Changes

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
 Remove:
Sugars, junk food, germs, toxins
GF/CF/SF/YF/SCD/LOD/BED/GAPS/LP
 Replenish:
Probiotics, enzymes, EFAs, antiglutamates
 Repair/Restore:
Detoxification
Anti-inflammatories (LDN, Actos, Spironolactone,
IG, HBOT)
Responsive to Food Allergen
Antifungal trial
SCD? Elimination?

Start Here

Start Here Clean up gut Start Here Casein

Free
Methyl B12 (food and flora) Diet

Start Here
Transdermal
Gluten Free
TTFD/GSH
Diet
Digestive
Enzymes

Detoxification
therapies
Supplements Second tier
(start low and supplements
slow)
 REMOVE
Foods
 Casein (sticky protein in dairy)
100% elimination for 3 weeks
 Gluten (protein in wheat, barley, rye, hidden sources)
Tests can be inaccurate
100% elimination for 3 months
Healthy alternative not just GFCF
 Food sensitivities (IgG reactive)
 Specific Carbohydrate Diet (SCD)
Restricts all disaccharides (2 sugars) and polysaccharides
(starches)
 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
 Gut and Psychology Syndrome (GAPS)

Low Phenol (Feingold: faulty sulfation)
Apples, grapes, bananas, salicylates, artificial ingredients
 Low Oxalate Diet (LOD)
Leaky gut→oxalates not metabolized and absorbed→inflammation,
pain
Decrease leaves of plants; nuts; soy; berries
 Body Ecology Diet (BED)
Proper food combining, low acid formation, easily digested foods
Principles of anti-yeast diets including no sugars, fermented foods

GERMS

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)
 Swedo et al, 1998
 TREATMENT-STREP
Probiotics
Xylitol
Saccharomyces Boulardii/Alkalinization/Charcoal
Antibiotics (Snider et al, 2004)

IM Bicillin (1.2 million units-perhaps monthly)

Penicillin, Omnicef, Zithromax
Antimicrobial herbs
Immune Modulators (March et al, 2004)

Oral immunoglobulins
 Transfer factor/colostrum
 Mushroom extracts/plant sterols

LDN, Actos, Spironolactone, HBOT

IVIG
 REMOVE
GERMS
Bacteria (history of positive response to
antibiotics)
 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)

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)

Blastocystis hominis (treat with Bactrim and Humatin)

Probiotics

Antiparasitics (Metronidazole, Paromomycin, Mebendazole)
 Natural remedies (artemesia, pumpkin seeds, coconut)
 TSO therapy
 REMOVE
Germs
 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
 S.boulardii: 3 months (at least 3-6/day)
 Nystatin: 1,000,000 units 4X day
 Amphotericin B (oral)
Systemic
 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 9 courses of
stools antibiotics for chronic
Craved sweets OM
Red cheeks/ears Mood
No interaction with swings/sensitivities
peers 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
 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
 Detoxification (glutathione, ammonia)
 Chelation (DMSA, DMPS, EDTA)
 Homeopathy
 REPLENISH
GLUTATHIONE! (oral, inhaled, transdermal, IV)
Enzymes (speeds disassembly of foods; -ase)
 Mixed (helps kids with poor digestion)

Plant based (papaya and pineapple)

Peptidase specific (helps specific peptide digestion)
Probiotics (between meals with room temperature water)
 Reflorestation is tough
 Essential when treating dysbiosis

Miraglia del Giudice et al, 2004
Symptomatic (yeast die off)

Activated charcoal (mop up toxins)

Alka Seltzer Gold (alkaline)
 REPLENISH
Enzymes
Probiotics
Symptomatic
AntiGlutamates

Pycnogenol (Trebaticka et al, 2006)

Chamomile

Taurine, GABA
Treat High Ammonia
 Charcoal
 Fiber/Pectin

Yucca
Nutrients (MVI) (Carlton et al, 2000)
Methionine Transsulfuration to Cysteine and Glutathione
Methionine
Methylation
Potential
THF SAM (SAM/SAH)
MTase
5,10- 1 MS BHMT 2 Cell Methylation
CH2THF B12 SAH
MTHFR Betaine
5- SAHH
Choline Adenosine
CH3THF
Homocysteine
1 Folate Cycle CBS
B6
Cystathionine
2 Methionine Cycle 3 B6
Antioxidant
Cysteine Potential
3 Transsulfuration
GSH GSSG
 NUTRIENTS
Zinc (Sturniolo et al, 2001)

> 200 enzymatic functions; in energy metabolism, protein,
immunity, detox

Acne, mouth sores, spots/lines on nails, pica, loss of smell, taste
 Deficiency causes language, attention and immune issues

 Best given alone, at night (piccolinate, acetate)


Ratio with copper; taste test
Magnesium (Martineau et al, 1985)
 > 300 enzymatic functions; neuromuscular, neurotransmitters,

BP
 Deficiency causes hyperactivity, anxiety, twitches, insomnia


Sighing/salt craving/constipation
Calcium

Bone/tooth/muscle/nerve function; cell membrane permeability
 Deficiency causes rigidity, poor sleep, anxiety, teeth grinding

 Secondary deficiency


Absorption vs taste
 Nutrients Continued
Molybdenum

With deficiency – poor detoxification, chemical sensitivity

With excess – high uric acid, low copper, anemia
Selenium
 Important for redox reactions, antioxidant
 With deficiency – immune dysfunction, cell fragility

With excess – fatigue, brittle hair/nails, parasthesias
Chromium

Important for glucose control, insulin/liver function

With deficiency – insulin resistance, Syndrome X, neuropathy
Iron
 Important for oxygen transport, cell differentiation
 With deficiency – anemia, malabsorption, fatigue

With excess – liver and free radical damage
 Nutrients - Vitamins
Vitamin A (retinol)
 Immunity, vision, cell differentiation, anti-CA
 With deficiency – vision, immune dysfunction
Vitamin C (Ascorbic acid)
 Antioxidant, healing, neurotransmitter function

With deficiency – bruising, poor immune function, anxiety, depression
(diarrhea with excess)
Vitamin D
 Ca absorption, thyroid function, anti-inflammatory
 With deficiency – scaling, muscle pain, restlessness, sweating
Vitamin E
 Antioxidant, prevents lipid peroxidation
 With deficiency – jaundice, xs clotting, impaired reflexes
Folic acid (folinic, 5- THF)

Methioneine/aa metabolism, growth/brain development
 With deficiency – fatigue, weakness, immune/cognitive dysfunction
 NUTRIENTS - B VITAMINS
B12 (cobalamin – cyano, methyl, adenosyl)

Deficiency - decreased communication, anemia, memory loss,
poor balance

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)

Deficiency leads to poor communication

Give with folate to decrease hyperactivity
Keratosis pilaris
 NUTRIENTS - OTHER
EFAs (Richardson et al, 2006)

Deficiency can cause keratosis pilaris, dry, coarse hair

Cell communication
 Protection in bone, liver, lung, immune function

Amino Acids

Taurine

GABA

AKG
Phosphatidylcholine-counteracts oxidative stress, replenish
glutathione
Carnitine/CoQ10/Biotin
Spironolactone/Aldactone-anti-inflammatory, ↓ testosterone
Oxytocin

↓ anxiety/aggression; acts at amygdala
Melatonin (Reichenberg et al, 2001)

Regulates serotonin balance
 The Gut-Brain Axis of Pathology in Autism
Opioid peptides excess

Dietary Defective enzyme/ Intestinal

Microbial Inflammation
Protein permeability
environment

In autism patient
Opioid peptides excess
Low active • High TNF-α titre
tissue peptidases Systemic • High IL-1 and IL-6 titre
with antagonism carriage • Skewing to Th2
endorphins • Depression of Th1 immunity
- Decreased NK cell
- Decreased Th1 CD cell
Opioid receptors in brain - Decreased Ig A

Low sensitivity Repetitive Social Some retardation in

to pain behaviour deficiencies Cognitive development
 Putting It All Together
Diet
Baseline Nutrients
 MVI
 Probiotics
 EFAs
 Enzymes
Look At Your Child
 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.