ALE - Boston Seminar
8/27/11
Eva Bradley
Testing important since symptoms might be similar but results might be different. So protocol driven care does not work. Store test results for 7 years.
Results 20% of normal range but Vit D and Magensium is 40% normal range.
IgA - gut, RS, GU, saliva and breast milk. IGG immunity to fetus, IgE histamine response
IgE response vs IgG - IgG high incidence due to frequent exposure. Rx eliminate and rotate foot, heal gut and improve digestion vs IgE avoidance. IgE is the first line of defence opens up the gates so IgG can kick in. High IgE high asthma esp in kids and black males. IgG second line of response. 4 subclasses 75% serum immunoglobulins. IgG1 - shortterm, IgG2 oligosaccrides, IgG3 virus, IgG4 long term exposure. Serum sickness with IgG infusion and is highly inflammatory. not enough IgG people can get very sick.IgG1-3 activates kupffer cells in liver and cause inflammatory response. IgG4 does not activate complement. IgG1 has 1-2 half life, IgG4 has 21-30 days half life. Prolonged exposure to antigen stimulates IgG1 - IgG4. IgG1 has funnel shape and IgG4 has umberella structure. IgG4 displaces IgG1 or IgE from specificities. Can counteract or block inflammation.
IgG4 - tears, pancreatitis, cholangitis, peritoneal fibrosis, nephritis, lung pseudomotor inflammation
IgG4 forms large complexes with antigens from food.
IgG4 fingerstick analysis measures 30 food reactions. No difference in blood spot vs serum results. Modified ELISA testing. 20 or Greater IgG4 reactions to food is leaky gut. 5-19 IgG4 is Intestional permeability issue. Few IgG4 reaction elimination diet.
If patient on steroids do not do the test stay off testing for 60 days.
Rx. - Elimination rotation diet, EFA, Vitamin A, Zinc, Pro/Prebiotics, Stool testing for bacteria and SCFAs. Important nutrient Glutamine 10 - 15 grams per day. Seacure.
Dr. Richard Lord, PhD
Organic Acid Testing by Dr. Richard Lord, PhD
Organic acids, Amino acids, IgG testing - by Triad testing will be able to offer Focused nutritional therapies.
Metabolic markers for Functional Indicators of Nutrient deficiency - Intermediary metabolite, Enzyme, Co-enzyme, Co-factor. (LabTest) Urine test is the biochemical marker for the enzyme. Eg Histidine, becomes formiminoglutamate to glutamate if missing glutamate forminiotransferase or Tetrahydrofolic acid becomes FIGLU - which is the intermediatry Formiminogluate which says Folic acid deficiency. So Candidate for High-dose Folic acid rx. We are progressing in Nutritional intervention therapies. Amino acids refill citric acid cycle to release Succinate to the body. Ketoacid dehydrogenase enzymes uses B1,B2,B3,B5. Xanthurenate is B6 marker. B-Hydroxyisovalerate is Biotin deficiency. Methylmalonate B12 marker. Formiminoglutamate is Folate deficiency.
Fatty acid marker is Ethylmalonate. Neurotransmittor marker - Vanilmandelate, picolinate. Oxidative stress - p-Hydroxyphenyllactate (increased in high cell division can be a marker for cancer), 8hydroxy2deoxyguanosine marker for oxidative stress - damage DNA at a high rate. 3 markers for Carnitine. Fatty acids in mitochondria at carinitine shuttle undergoes beta oxidation. 6% energy production with fatty acids. Makes ATP, co2, h20. Instead fatty acids becomes adipate and sbuerate, and becomes ethymalonate. CoQ10 deficiency indicators - increased lactate elevation. Co-10 deficiency. Pyruvate - alpha ketoglutarate. Congenital lactic acidosis treatment is B1 - thiamine.
Tryptophan is released from proteins and becomes indican or becomes xanthurenate. It is a marker for B6 deficiency. Kynerate is secondary B6 deficiency marker. B12 is adenosylcobalamine of methylmalonate as marker. Beta hydroxy butyrate is marker for Ketones. High ketones is atkins diet, diabetic ketoacidosis, wasting?
Adrenal fatigue marker - picoliate goes up in inflammation esp in the brain. B6 deficienty is liver problem if that is not involved think of brain inflammation. Kynurenic, and picoliate high in chronic inflammation. High Quinolinate causes ineffective sleep. High does protein tryptophan makes high quinolinic acid. For depression 5hTP, Resvertol for chronic inflammation. Kynurenic acid and Quinolinic acid rx with magnesium. Citrate being high is ammonia being high specific marker is Oratate the liver demands of met by urea. Use Arginine, citrulline. Glutathione, taurine for hepatic recovery, alcoholic use glutathione. Benzoate, glycine, or b5 deficiency use hippurate efficiently. High bezoate, low hippurate is glycine need. Phenyl compounds elevated in detox phase 1 and phase 2. Small intestinal bacterial overgrowth. Tricarballylic aciduria is magnesium deficiency. D lactic aciduria is overuse of lactobacillus. Closteria treatment is S. Boulardii. Bacteria makes Dlactate, Humans make L acetic acids.
David Brady, ND - Consultant to Metametrix, Design lab consultant for Nutrition
Walking wounded, rattling bag of supplements. Works on easy cases general protocol not on metabolic messes. Calls himself doing investigative medicine.
All Statin targets HMGcoreductase so affects Citric acid cycle and all these markers will be elevated. Need aggresive Co-Q 10 treatment. Neurotransmitter markers high in anxiety, IBS who are hypervigilant. VMA and HVA is very low in extreme fatique. When VMA and HVA is high calming adrenal product. 5HIAA is high hydroxyindoleacetate if low drepression or insomnia or high means taking 5HTP or tryptophan, SSRI or MAOIs. Bacteria overgrowth in small bacteria causes bad breath. Small intestinal bacterial overgrowth - SIBO.
GI - 4Rs, B1,2,3,5,12, ALA 600mgper day, Co-Q10 400mg per day, NAC 1500mg/d, adrenal support, stress reduction, diet, excercise. ALA makes ATP from Pyruvate (Carbohydrate metabolism.) Liquid Carnitine 200 grams for pushing carbohydrate metabolism or weight loss. Precursor for 5HTP is either tryptophan or 5HTP with B5. After feeling better patient fasted and excercised then patient had paradoxical weight gain.
Todd LePine, MD
Clinically Applied Nutritional Biochemistry Practice.
Live in berkshires and practices in Lennox, MA. Learnt dont skimp on testing.
One major issue might trigger a major downtrend of events. Know the history. Autoimmne gut bacteria can cause autoimmune arthritis. Bacteria produces organic acids. Arabinitol on high 59. Lyme disease d arabinotol is 200. Significant yeast secondary to lyme treatment. Use Rx Optimal EFA, Kapparrest, ADP, Colon Plus, probiotics. Meditarrian foods.
Bipolar has mitochondrial activity - predicts the needs esp magnesium, HMV high means dopamine, and high oxidative stress. Start 5HTP hs, Inositol for slow upwards taper. EMWave - heartmath biofeed back tool. If neurotransmittor not in balance use 5HTP. OCD behaviors use Inositol for compulsive behaviors. Inositol will trigger mania. So do not use with Lithium. Glutamine also trigger mania.
Hepatothera forte has NAC, milk thistle, selenium, lipoic acid, vit c 2000mg, copper, coq10, b12. Patient came off in 8 week off their medications. SNIp testing - will be offered in future.
Supplement copper when dopamine high low dose
Noon Session
Kara Fitzgerald, ND
Amino acid analysis and supplementation in clinical practice - effective ways to improve patient outcomes.
Amino acids are the foundations of the foundations. Amino acid testing shows weak areas, degree of imbalance. Insulin resistance - insulin required for amino acids, transaminase reaction means B6 needs. If there is low amino acids - treat aggresively, is cost effective.
Functions of amino acids - Protein synthesis - catabolic means proteolytic, energy production, glutathione synthesis, heme synthesis, antioxidants, detoxifications, neurotransmittor synthesis, nucleic acid synthesis. Amino acids make ATP, Ketones, pyruvic acids, glucose. Amino acids are key in central energy pathways. Amino acids stimulate mitochondrial biosynthesis. Amino acid repletion will supply energy for mitochondropathy and thyroid dysfunction.
Protein adequate but - low protein choice, inadequate hcl, pancreatic enzyme, malabsorbtion, ibd, acid blockers, antacids, nsaids, antibiotic degradation of gut ecology, increased metabolic demand - can cause deficiency of amino acid.
Amino acid insufficiency - drug that increase neurotransmittor, increased stress, renal resorbption failure, glutathione depletion, increased detoxification demands. Loss of hypothalamus and develop cortisol pudge. Cytokines reduce 5HT and activates tryptophan metabolizing enzyme indolamine. Taurine is protective.
Digestion
Cephalic digestion has to be intact to liberate amino acids to plasma. Pancreas, stomach, small intestine with bicarbonate, protease, hcl, pepsin, other proteases. Plasma free amino acids work orally.
IBS, insomnia - Left shift of amino acid panel. Rx HCL, enzymes, GI repair with glutamine, aloe, MCP, marshmallow, msm, inositol, 5 htp, free form amino acid blend. low carbohydrate, hypoallergenic diet.
Sulfur containing amino acids - methylation (b12, folic acid) and sulfuration (b6, betaine). Low homocysteine is also important. Means one cannot make enough glutathione, taurine, cysteine or other amino acids. High homocysteine testing is important as we already know. Pyruvate is high if there is glutathione wasting.
Autism patient with low methionine, low homocysteine, low sulfate, high 8hydroxy 2 deoxyguanosine (high means high oxidative stress). Homocysteine levels in children with ASD was low per study by Dr. Fitzgerald. Methylation lesions read Jill James work.
Glutathione status - multiple illness
Theronine is low in glycine depletion means glutathione depletion. Check glycine, serine. Poor tryptophan means low insulin. It means it will break down protein to liberate insulin which means catabolism.
Conditional essential amino acids - arginine, taurine, glycine, serine. High bp arginine, magnesium, folate need. Asymetric dimethyl arginine important to help arginine into nitric oxide.
High Quinoloiec acid a Taurine need. Serine is the one that makes all Phospholipids so we need abundant serine for phosphatydyl choline and serine.
Case Study vegetarian physician - tachy, high bp, on propanolol - taurine low, mag deficiency causing tachycardia and high bp. Taurine high in cardiomyocytes - high taurine is cardiac damage.
Taurine can cause dysrhythmia. Taurine natural calcium channel modulator, low in vegetarians, magnesium involved in 4-8 steps of taurine synthesis.
Gamma amino butyric acid high means organic acid deficiency. Homocystine, methionine means glutathione need.
Supplement choline and methylation if there is serine deficiency disorders or glycine deficiency. Muscle specific amino acid is methylhistidine(can go up in meat intake) but look at other methylation deficiency if you want to treat muscle loss. Look at ratio of glutamic acid/glutamine acid base imbalance, hydroxyproline/proline means bone loss.
Female with hypothyroid, ibs, gerd - show low amino acids and high methylhistidine - proteolytic state - accelerated aging. will also be low in minerals. Both amino acids and minerals low with poor digestion.
4 yr old autistic boy with high phenylalanine and low tyrosine with ratio of both high. Homovanillate is low (dopamine need). It is Phenyl ketoneuria. BH4 - genetic mutations due to oxidative stress, increased with folate and vit c use. BH4 need causes high bp, serotonin synthesis affected. Dihydropteridine reductase - subclinical pku can present as autism.
Further test with urinary neopterin, biopterin. Orally give Biopterin. low phe diet, folate, tyrosine, vitamin c, iron, niacin
Tryptophan - serotonin, tyrosine - dopamine, methionine - glutathione, glycine -muscle glutathione, improve organ reserve
After adding amino acids the organ reserve tanks up first so blood level might still be low. 20 amino blood spot or urine amino testing. Retest in 6 months. Dose aminos at 10 gms daily. 20 gms if very depleted. GI dysbiosis then stop amino, reduce as symptoms amiliorate.
Amino acid analysis
David Brady
Case Study - Tryptophan and tyrosine is very low. Organic acid testing - VMA and HVA and 5HIIacetate is low - treat with precursor therapy. How to treat is to give tryptophan and tyrosine which are precursors. Post treatment HMA went up but do not treat unless symptomatic with anxiety. Migraines got better.
Amino acid synergists is a capsulated form available from design for health lab. Be cautious with renal insufficiency can increase nitrogen load.
After Break
Todd LePine
Case Study
Deprolin(?) is activated folic acid.
54 yr old female with deep depression. Positive family history, alcoholism (self medicating for anxiety of mood), menopausal. Testing show histidine, tyrosine, taurine and serine was low. Treat for 3 months. Patient has persistant low methionine and tryptophan might be genetic inclination. Patient had low cysteine. Depression workup involves what triggered the incident, vit d, EFA levels, organic acids methylmelonic acid, b12 levels. Depression if they have hope shift their perception. Lie therapy - tell people you have treated lots of patients they got better (this is a joke by the way!) ? Evox treatment.
Happiness involves curiosity, good social network and group support.
David Brady, ND
Miscellaneous Gut Facts
Zelnorm works on 5HTP for prescription IBS rx. Similarly neurotransmittor for gut facts. Use a drug that comes out as soon as possible before they develop side effect (this is a joke!) 75% of immune cells are located on the Gut. Largest nervous system that is autonomic is located in the gut. Ileocecal valve organism is 10to power of 5-6 and stomach 10to the power of 3.
Stool Analysis helps IBS, Skin issues, fatigue, autoimmune disorders, change in bowel habits, autism.
Gut microbes and Systemic pathology
Klebsiella - ankylosing spondylitis
Citrobacter, Kleb, Proteus - RA
Yersinia - Graves and Hashimotos
S Pyogens - Rheumatic fever
Camphylobactor - Guillian Barre
E Coli, Proteus - Autoimmunity
Proteus hemolysin and Proteus Urea - Rheumatoid arthritis so check Proteus antibodies - rx with cranberries, deminos.
Gut Autoimmune connection - maldigestion, leaky gut, GI infections. Treat with Bifidobacteria and lactobacteria.
Autoimmunity wax and wane. Good period is non symptomatic their microbes are normal and in symptomatic stage microbes are different. 70% gut inflammation with autoimmunity.
Thyroid Disorders - Autoimmunity and GI environment
Yersinia shows surface saturable binding sites for TSH. Yersinia enterocolica is gram negative organism.
Botanicals and herbs use whenever possible for dysbiosis. Locally acting antibiotic like rifaximin.
Herbs Alicin - Garlic, Arbutin - urva ursi, Artemisinin - wormwood, Berberine - goldenseal, Carvacol - Oregano, Oleuropin - olive leaf, Quinic acid - cats claw, thymol - oil of thyme, undecyleric acid - castor oil, caprylic acid - coconut.
Antibacterial - berberine, citrus seeds, oregon grape root, garlic thyme red, oregano, caprylic acid uva ursi
antifungal - berberine, citrus seed, black walnut, garlic, red thyme, oregano, caprylic acid, uva ursi
John Weinstock is in Tufts. Did research on Parasite therapy for IBS - Whip Worm therapy - Porcine to treat.
Fat Bugs
Phyla
Firmicutes
Bacteroidetes
Lean people 80%Firmicutes vs 20% Bacteroidetes
Increase CHO degrading enzymes. increase blood lipids, fasting induced adipose factor, increase adipocyte storage, reduce AMP kinase.
Obese patients with low carb and low fat diet changed the bacteria in gut. Prebiotic is being researched not yet available.
Autoimmune thyroid and Celiac disease
Alessio Fasano worked with mucosal biology research. Fatal food trigged autoimmunity disease. 3 Legged Stool - 3 major trigger - an antigen trigger, genetic predisposition, leaky small intestine. Hard to eliminate the trigger, cannot change gene only place to treat is Leaky small intestine. Rx Glutamine, NAC. Zonulin protein expressed by colonocytes opens the junction between mucosal cells and upregulates intestinal permeability. Happens in Type I DM, and their relatives. Pharmacy working on Zonulin receptor blocker rx in works.
Stress, Vitamin D deficiency can cause leaky gut.
Pancreatic Elastase is a digestive marker. If Elastin is low then pancreatic enzymes are very low.
Day 2 material covered by
David Brady
Case Study
History of Chronic Fatique, Pain, depression, gaining weight, macronutrient diet.
Meds on Lexapro, Xanax prn
low basal temp, thyroid fullness, mild dilation of pupils to sustained light - low adrenal reserve, multiple dental amalgams with mixed metals, normal neuralogic exams, oropharnx slightly red, vitlas wnl, positive 18 of 18 tendor points. Sign of hertogue missing half of eyebrow signifyes low thyroid function. Ferritin should be above 50 in females she was low at 30, T4 was 6.4 low end of normal, TSH 2.5 or higher thyroid is abnormal and hers was 3.47. Vitamin analysis and B12 was normal, hBA1c was normal, ana titer is positive. 92% positive for lupus.
Bone resorbtion assay - Bone collagen peptide shows the osteoporosis and catabolism.
500mg DMSA oral provocation toxic metal assay.
Neurotransmitters levels low with markers low. Rx with amino acid therapy.
Phenylalanine is low - precursor to tyrosine and catecholamine. Rx with amino acid and 5 HTP.
Patients had low T3 will do better keep them in mid 300 NR 230-420.
Rx armor thyroid (38ug t4, 9 ug t3 per grain), herbal thyroid supplement, adaptogen, epa-dha, mvi with minerals, custom amino acids, cal and mag, vitamin d, elimination diet, coq 10 200mg bid, 3 week gi antimicrobial with probiotics, fiber, zinc carnosine, vitamin u from cabbage, thermogenic formula(fat stat). Endotrim coleus, carnitine, egcg green tea, garcinia for craving, gaba etc.
For weight loss can give Carnitine 2gm bid.
8/27/11
Eva Bradley
Testing important since symptoms might be similar but results might be different. So protocol driven care does not work. Store test results for 7 years.
Results 20% of normal range but Vit D and Magensium is 40% normal range.
IgA - gut, RS, GU, saliva and breast milk. IGG immunity to fetus, IgE histamine response
IgE response vs IgG - IgG high incidence due to frequent exposure. Rx eliminate and rotate foot, heal gut and improve digestion vs IgE avoidance. IgE is the first line of defence opens up the gates so IgG can kick in. High IgE high asthma esp in kids and black males. IgG second line of response. 4 subclasses 75% serum immunoglobulins. IgG1 - shortterm, IgG2 oligosaccrides, IgG3 virus, IgG4 long term exposure. Serum sickness with IgG infusion and is highly inflammatory. not enough IgG people can get very sick.IgG1-3 activates kupffer cells in liver and cause inflammatory response. IgG4 does not activate complement. IgG1 has 1-2 half life, IgG4 has 21-30 days half life. Prolonged exposure to antigen stimulates IgG1 - IgG4. IgG1 has funnel shape and IgG4 has umberella structure. IgG4 displaces IgG1 or IgE from specificities. Can counteract or block inflammation.
IgG4 - tears, pancreatitis, cholangitis, peritoneal fibrosis, nephritis, lung pseudomotor inflammation
IgG4 forms large complexes with antigens from food.
IgG4 fingerstick analysis measures 30 food reactions. No difference in blood spot vs serum results. Modified ELISA testing. 20 or Greater IgG4 reactions to food is leaky gut. 5-19 IgG4 is Intestional permeability issue. Few IgG4 reaction elimination diet.
If patient on steroids do not do the test stay off testing for 60 days.
Rx. - Elimination rotation diet, EFA, Vitamin A, Zinc, Pro/Prebiotics, Stool testing for bacteria and SCFAs. Important nutrient Glutamine 10 - 15 grams per day. Seacure.
Dr. Richard Lord, PhD
Organic Acid Testing by Dr. Richard Lord, PhD
Organic acids, Amino acids, IgG testing - by Triad testing will be able to offer Focused nutritional therapies.
Metabolic markers for Functional Indicators of Nutrient deficiency - Intermediary metabolite, Enzyme, Co-enzyme, Co-factor. (LabTest) Urine test is the biochemical marker for the enzyme. Eg Histidine, becomes formiminoglutamate to glutamate if missing glutamate forminiotransferase or Tetrahydrofolic acid becomes FIGLU - which is the intermediatry Formiminogluate which says Folic acid deficiency. So Candidate for High-dose Folic acid rx. We are progressing in Nutritional intervention therapies. Amino acids refill citric acid cycle to release Succinate to the body. Ketoacid dehydrogenase enzymes uses B1,B2,B3,B5. Xanthurenate is B6 marker. B-Hydroxyisovalerate is Biotin deficiency. Methylmalonate B12 marker. Formiminoglutamate is Folate deficiency.
Fatty acid marker is Ethylmalonate. Neurotransmittor marker - Vanilmandelate, picolinate. Oxidative stress - p-Hydroxyphenyllactate (increased in high cell division can be a marker for cancer), 8hydroxy2deoxyguanosine marker for oxidative stress - damage DNA at a high rate. 3 markers for Carnitine. Fatty acids in mitochondria at carinitine shuttle undergoes beta oxidation. 6% energy production with fatty acids. Makes ATP, co2, h20. Instead fatty acids becomes adipate and sbuerate, and becomes ethymalonate. CoQ10 deficiency indicators - increased lactate elevation. Co-10 deficiency. Pyruvate - alpha ketoglutarate. Congenital lactic acidosis treatment is B1 - thiamine.
Tryptophan is released from proteins and becomes indican or becomes xanthurenate. It is a marker for B6 deficiency. Kynerate is secondary B6 deficiency marker. B12 is adenosylcobalamine of methylmalonate as marker. Beta hydroxy butyrate is marker for Ketones. High ketones is atkins diet, diabetic ketoacidosis, wasting?
Adrenal fatigue marker - picoliate goes up in inflammation esp in the brain. B6 deficienty is liver problem if that is not involved think of brain inflammation. Kynurenic, and picoliate high in chronic inflammation. High Quinolinate causes ineffective sleep. High does protein tryptophan makes high quinolinic acid. For depression 5hTP, Resvertol for chronic inflammation. Kynurenic acid and Quinolinic acid rx with magnesium. Citrate being high is ammonia being high specific marker is Oratate the liver demands of met by urea. Use Arginine, citrulline. Glutathione, taurine for hepatic recovery, alcoholic use glutathione. Benzoate, glycine, or b5 deficiency use hippurate efficiently. High bezoate, low hippurate is glycine need. Phenyl compounds elevated in detox phase 1 and phase 2. Small intestinal bacterial overgrowth. Tricarballylic aciduria is magnesium deficiency. D lactic aciduria is overuse of lactobacillus. Closteria treatment is S. Boulardii. Bacteria makes Dlactate, Humans make L acetic acids.
David Brady, ND - Consultant to Metametrix, Design lab consultant for Nutrition
Walking wounded, rattling bag of supplements. Works on easy cases general protocol not on metabolic messes. Calls himself doing investigative medicine.
All Statin targets HMGcoreductase so affects Citric acid cycle and all these markers will be elevated. Need aggresive Co-Q 10 treatment. Neurotransmitter markers high in anxiety, IBS who are hypervigilant. VMA and HVA is very low in extreme fatique. When VMA and HVA is high calming adrenal product. 5HIAA is high hydroxyindoleacetate if low drepression or insomnia or high means taking 5HTP or tryptophan, SSRI or MAOIs. Bacteria overgrowth in small bacteria causes bad breath. Small intestinal bacterial overgrowth - SIBO.
GI - 4Rs, B1,2,3,5,12, ALA 600mgper day, Co-Q10 400mg per day, NAC 1500mg/d, adrenal support, stress reduction, diet, excercise. ALA makes ATP from Pyruvate (Carbohydrate metabolism.) Liquid Carnitine 200 grams for pushing carbohydrate metabolism or weight loss. Precursor for 5HTP is either tryptophan or 5HTP with B5. After feeling better patient fasted and excercised then patient had paradoxical weight gain.
Todd LePine, MD
Clinically Applied Nutritional Biochemistry Practice.
Live in berkshires and practices in Lennox, MA. Learnt dont skimp on testing.
One major issue might trigger a major downtrend of events. Know the history. Autoimmne gut bacteria can cause autoimmune arthritis. Bacteria produces organic acids. Arabinitol on high 59. Lyme disease d arabinotol is 200. Significant yeast secondary to lyme treatment. Use Rx Optimal EFA, Kapparrest, ADP, Colon Plus, probiotics. Meditarrian foods.
Bipolar has mitochondrial activity - predicts the needs esp magnesium, HMV high means dopamine, and high oxidative stress. Start 5HTP hs, Inositol for slow upwards taper. EMWave - heartmath biofeed back tool. If neurotransmittor not in balance use 5HTP. OCD behaviors use Inositol for compulsive behaviors. Inositol will trigger mania. So do not use with Lithium. Glutamine also trigger mania.
Hepatothera forte has NAC, milk thistle, selenium, lipoic acid, vit c 2000mg, copper, coq10, b12. Patient came off in 8 week off their medications. SNIp testing - will be offered in future.
Supplement copper when dopamine high low dose
Noon Session
Kara Fitzgerald, ND
Amino acid analysis and supplementation in clinical practice - effective ways to improve patient outcomes.
Amino acids are the foundations of the foundations. Amino acid testing shows weak areas, degree of imbalance. Insulin resistance - insulin required for amino acids, transaminase reaction means B6 needs. If there is low amino acids - treat aggresively, is cost effective.
Functions of amino acids - Protein synthesis - catabolic means proteolytic, energy production, glutathione synthesis, heme synthesis, antioxidants, detoxifications, neurotransmittor synthesis, nucleic acid synthesis. Amino acids make ATP, Ketones, pyruvic acids, glucose. Amino acids are key in central energy pathways. Amino acids stimulate mitochondrial biosynthesis. Amino acid repletion will supply energy for mitochondropathy and thyroid dysfunction.
Protein adequate but - low protein choice, inadequate hcl, pancreatic enzyme, malabsorbtion, ibd, acid blockers, antacids, nsaids, antibiotic degradation of gut ecology, increased metabolic demand - can cause deficiency of amino acid.
Amino acid insufficiency - drug that increase neurotransmittor, increased stress, renal resorbption failure, glutathione depletion, increased detoxification demands. Loss of hypothalamus and develop cortisol pudge. Cytokines reduce 5HT and activates tryptophan metabolizing enzyme indolamine. Taurine is protective.
Digestion
Cephalic digestion has to be intact to liberate amino acids to plasma. Pancreas, stomach, small intestine with bicarbonate, protease, hcl, pepsin, other proteases. Plasma free amino acids work orally.
IBS, insomnia - Left shift of amino acid panel. Rx HCL, enzymes, GI repair with glutamine, aloe, MCP, marshmallow, msm, inositol, 5 htp, free form amino acid blend. low carbohydrate, hypoallergenic diet.
Sulfur containing amino acids - methylation (b12, folic acid) and sulfuration (b6, betaine). Low homocysteine is also important. Means one cannot make enough glutathione, taurine, cysteine or other amino acids. High homocysteine testing is important as we already know. Pyruvate is high if there is glutathione wasting.
Autism patient with low methionine, low homocysteine, low sulfate, high 8hydroxy 2 deoxyguanosine (high means high oxidative stress). Homocysteine levels in children with ASD was low per study by Dr. Fitzgerald. Methylation lesions read Jill James work.
Glutathione status - multiple illness
Theronine is low in glycine depletion means glutathione depletion. Check glycine, serine. Poor tryptophan means low insulin. It means it will break down protein to liberate insulin which means catabolism.
Conditional essential amino acids - arginine, taurine, glycine, serine. High bp arginine, magnesium, folate need. Asymetric dimethyl arginine important to help arginine into nitric oxide.
High Quinoloiec acid a Taurine need. Serine is the one that makes all Phospholipids so we need abundant serine for phosphatydyl choline and serine.
Case Study vegetarian physician - tachy, high bp, on propanolol - taurine low, mag deficiency causing tachycardia and high bp. Taurine high in cardiomyocytes - high taurine is cardiac damage.
Taurine can cause dysrhythmia. Taurine natural calcium channel modulator, low in vegetarians, magnesium involved in 4-8 steps of taurine synthesis.
Gamma amino butyric acid high means organic acid deficiency. Homocystine, methionine means glutathione need.
Supplement choline and methylation if there is serine deficiency disorders or glycine deficiency. Muscle specific amino acid is methylhistidine(can go up in meat intake) but look at other methylation deficiency if you want to treat muscle loss. Look at ratio of glutamic acid/glutamine acid base imbalance, hydroxyproline/proline means bone loss.
Female with hypothyroid, ibs, gerd - show low amino acids and high methylhistidine - proteolytic state - accelerated aging. will also be low in minerals. Both amino acids and minerals low with poor digestion.
4 yr old autistic boy with high phenylalanine and low tyrosine with ratio of both high. Homovanillate is low (dopamine need). It is Phenyl ketoneuria. BH4 - genetic mutations due to oxidative stress, increased with folate and vit c use. BH4 need causes high bp, serotonin synthesis affected. Dihydropteridine reductase - subclinical pku can present as autism.
Further test with urinary neopterin, biopterin. Orally give Biopterin. low phe diet, folate, tyrosine, vitamin c, iron, niacin
Tryptophan - serotonin, tyrosine - dopamine, methionine - glutathione, glycine -muscle glutathione, improve organ reserve
After adding amino acids the organ reserve tanks up first so blood level might still be low. 20 amino blood spot or urine amino testing. Retest in 6 months. Dose aminos at 10 gms daily. 20 gms if very depleted. GI dysbiosis then stop amino, reduce as symptoms amiliorate.
Amino acid analysis
David Brady
Case Study - Tryptophan and tyrosine is very low. Organic acid testing - VMA and HVA and 5HIIacetate is low - treat with precursor therapy. How to treat is to give tryptophan and tyrosine which are precursors. Post treatment HMA went up but do not treat unless symptomatic with anxiety. Migraines got better.
Amino acid synergists is a capsulated form available from design for health lab. Be cautious with renal insufficiency can increase nitrogen load.
After Break
Todd LePine
Case Study
Deprolin(?) is activated folic acid.
54 yr old female with deep depression. Positive family history, alcoholism (self medicating for anxiety of mood), menopausal. Testing show histidine, tyrosine, taurine and serine was low. Treat for 3 months. Patient has persistant low methionine and tryptophan might be genetic inclination. Patient had low cysteine. Depression workup involves what triggered the incident, vit d, EFA levels, organic acids methylmelonic acid, b12 levels. Depression if they have hope shift their perception. Lie therapy - tell people you have treated lots of patients they got better (this is a joke by the way!) ? Evox treatment.
Happiness involves curiosity, good social network and group support.
David Brady, ND
Miscellaneous Gut Facts
Zelnorm works on 5HTP for prescription IBS rx. Similarly neurotransmittor for gut facts. Use a drug that comes out as soon as possible before they develop side effect (this is a joke!) 75% of immune cells are located on the Gut. Largest nervous system that is autonomic is located in the gut. Ileocecal valve organism is 10to power of 5-6 and stomach 10to the power of 3.
Stool Analysis helps IBS, Skin issues, fatigue, autoimmune disorders, change in bowel habits, autism.
Gut microbes and Systemic pathology
Klebsiella - ankylosing spondylitis
Citrobacter, Kleb, Proteus - RA
Yersinia - Graves and Hashimotos
S Pyogens - Rheumatic fever
Camphylobactor - Guillian Barre
E Coli, Proteus - Autoimmunity
Proteus hemolysin and Proteus Urea - Rheumatoid arthritis so check Proteus antibodies - rx with cranberries, deminos.
Gut Autoimmune connection - maldigestion, leaky gut, GI infections. Treat with Bifidobacteria and lactobacteria.
Autoimmunity wax and wane. Good period is non symptomatic their microbes are normal and in symptomatic stage microbes are different. 70% gut inflammation with autoimmunity.
Thyroid Disorders - Autoimmunity and GI environment
Yersinia shows surface saturable binding sites for TSH. Yersinia enterocolica is gram negative organism.
Botanicals and herbs use whenever possible for dysbiosis. Locally acting antibiotic like rifaximin.
Herbs Alicin - Garlic, Arbutin - urva ursi, Artemisinin - wormwood, Berberine - goldenseal, Carvacol - Oregano, Oleuropin - olive leaf, Quinic acid - cats claw, thymol - oil of thyme, undecyleric acid - castor oil, caprylic acid - coconut.
Antibacterial - berberine, citrus seeds, oregon grape root, garlic thyme red, oregano, caprylic acid uva ursi
antifungal - berberine, citrus seed, black walnut, garlic, red thyme, oregano, caprylic acid, uva ursi
John Weinstock is in Tufts. Did research on Parasite therapy for IBS - Whip Worm therapy - Porcine to treat.
Fat Bugs
Phyla
Firmicutes
Bacteroidetes
Lean people 80%Firmicutes vs 20% Bacteroidetes
Increase CHO degrading enzymes. increase blood lipids, fasting induced adipose factor, increase adipocyte storage, reduce AMP kinase.
Obese patients with low carb and low fat diet changed the bacteria in gut. Prebiotic is being researched not yet available.
Autoimmune thyroid and Celiac disease
Alessio Fasano worked with mucosal biology research. Fatal food trigged autoimmunity disease. 3 Legged Stool - 3 major trigger - an antigen trigger, genetic predisposition, leaky small intestine. Hard to eliminate the trigger, cannot change gene only place to treat is Leaky small intestine. Rx Glutamine, NAC. Zonulin protein expressed by colonocytes opens the junction between mucosal cells and upregulates intestinal permeability. Happens in Type I DM, and their relatives. Pharmacy working on Zonulin receptor blocker rx in works.
Stress, Vitamin D deficiency can cause leaky gut.
Pancreatic Elastase is a digestive marker. If Elastin is low then pancreatic enzymes are very low.
Day 2 material covered by
David Brady
Case Study
History of Chronic Fatique, Pain, depression, gaining weight, macronutrient diet.
Meds on Lexapro, Xanax prn
low basal temp, thyroid fullness, mild dilation of pupils to sustained light - low adrenal reserve, multiple dental amalgams with mixed metals, normal neuralogic exams, oropharnx slightly red, vitlas wnl, positive 18 of 18 tendor points. Sign of hertogue missing half of eyebrow signifyes low thyroid function. Ferritin should be above 50 in females she was low at 30, T4 was 6.4 low end of normal, TSH 2.5 or higher thyroid is abnormal and hers was 3.47. Vitamin analysis and B12 was normal, hBA1c was normal, ana titer is positive. 92% positive for lupus.
Bone resorbtion assay - Bone collagen peptide shows the osteoporosis and catabolism.
500mg DMSA oral provocation toxic metal assay.
Neurotransmitters levels low with markers low. Rx with amino acid therapy.
Phenylalanine is low - precursor to tyrosine and catecholamine. Rx with amino acid and 5 HTP.
Patients had low T3 will do better keep them in mid 300 NR 230-420.
Rx armor thyroid (38ug t4, 9 ug t3 per grain), herbal thyroid supplement, adaptogen, epa-dha, mvi with minerals, custom amino acids, cal and mag, vitamin d, elimination diet, coq 10 200mg bid, 3 week gi antimicrobial with probiotics, fiber, zinc carnosine, vitamin u from cabbage, thermogenic formula(fat stat). Endotrim coleus, carnitine, egcg green tea, garcinia for craving, gaba etc.
For weight loss can give Carnitine 2gm bid.
