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Autism Made Easy
Therapeutic Nutritional Strategies
in the Autistic Spectrum of Disorders
Peta Cohen, MS., RD.Star Academy
Johannesburg, Nov 2011
www.PetaCohen.com
Therapeutic Nutritional Strategies in ASD
Defining the Problem
• Autism is treatable, recovery is possible
• Epigenetic Phenomenon (methylation)
• Complex – Whole Body, Multi-System, Metabolic
Disorder– Many targets for simultaneous treatments
• Biological Heterogeneity
• Chronic Dynamic Encephalopathy
• Disorder that Affects the Brain
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Autism- A Whole Body, Multi-System,
Metabolic Disorder
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Systems
Methylation Transulfuration
Redoxstatus
Biotransformation
Oxidative
StressInflammation
Mitochondrial
Function
Excitation
SNPs – Single Nucleotide Polymorphisms
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Autism- A Whole Body, Multi-System,
Metabolic Disorder
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Nervous System
SNP – Single Nucleotide Polymorphisms, Epigenetics
Gastro-Intestinal System
Immune System
Eco- System/Microbiome
Respiratory System
Endocrine System
Cardiovascular System
Oxidative Stress
Inflammation
Excitation
Mitochondrial Dysfunction
pH Balance/Redox Status
Impaired Methylation
Impaired Trans-Sulfuration
Impaired Detoxification
Nutrient Insufficiencies/Excess
Cerebral Folate Deficiency
Genomics ���� Proteomics ���� Metabolomics
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Autism- A Whole Body, Multi-System,
Metabolic Disorder
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Stressors
Function Dysfunction -
Systemic &
Metabolic
Feed Forward
genetics immunity
GI biotransformation
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Stress
Multiple Routes of Exposure
– Environmental• Chemical/Toxic• Infections• Sensory
– Psychological• Perception/Experience• Thoughts• Emotions
– Physiological• Structural • Trauma• Pain • Excess exercise• Poor sleep
– Metabolic• Nutritional – calories:
Insufficient/excess/imbalanced
• Oxidative stress• Chronic inflammation• Hypoxia/Impaired aerobic
energy metabolism
– Biological• Retention toxicity• Biofilm
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Dynamic Relationships
Systems
• GI – Immune – Nervous
• GI – Endocrine – Immune
• GI – Immune – Cardio
• GI – Microbiome – Immune
• GI – Immune – Respiratory
• GI – Immune - Skin
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Dynamic Relationships
Metabolic
• Oxidative stress – Inflammation – Excitation
• Oxidative stress – methylation – transulfuration –
redox status
• Oxidative stress – methylation – transulfuration -
detoxification
• Oxidative stress – Inflammation – Excitation –
Mitochondrial Uncoupling
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Biomedical Approach to Healing, Health, and
Vitality
“The most fundamental defining
characteristic of living organisms compared
to machines
is that living organisms have
the ability to repair themselves.”
Why We Age
Steven Austad
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Targeted Nutritional Strategies
“Let Food Be Thy Medicine,
And Medicine Be They Food”
Hippocrates, 400 B.C.
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Dietary Interventions –
The Need for Change
The “Right” Diet
• Clean Diet• GFCF• GFCFSF Corn Free• SCD• BED• GAPS• Low Phenol• Low Salicylate• Low Oxalate
• Glutamate/Aspartate Reduced Diet
• Low Copper• Allergy/Sensitivity
Elimination/Rotation Diet
Individualize/Customize
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Cleaning Up The Diet
• Organic• Non-GMO• Free-range, hormone free, antibiotic free• Low-sugar• Avoid high fructose corn syrup• Avoid artificial sweeteners• Avoid hydrogenated/trans fats• Avoid artificial dyes, flavors, preservatives• Avoid sulfites and sulfite dioxide• Avoid nitrates • Avoid aluminum containing baking powder• Minimize the use of food as a reward
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Cleaning Up The Kitchen
• Avoid non-stick cookware• Avoid aluminum cookware• Do not wrap food in foil• Avoid copper cookware• Do not store hot food in plastic containers• Use BPA free plastics• Use stainless steel water bottles• Use cast-iron, enamel, stainless steel, glass cookware• Use only glass in a microwave• Wrap food in recycled parchment paper• Store food in glass containers
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The “Right Diet”
When it comes to diets and nutrition,One size does not fit
everyone….Customize & Individualize
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Gluten/Casein/Soy &Corn Free
Pros– Eliminates opioids
Cons– Substitute/replacements are often highly processed and
refined
– Substitute grains are high oxalate
– Repeat consumption of the same foods may lead to
increased IgG response
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Specific Carbohydrate Diet - SCD
“Breaking The Vicious Cycle” by Elaine Gotchall
• Grain free diet• Avoids all sucrose containing foods• SCD permits the intake of simple sugars (monosaccharides)
found in honey, fruits and some vegetables• SCD prohibits the intake of double sugars (disaccharides), such
as lactose, sucrose, maltose and isomaltose found in milk, buttermilk, commercial sour cream, commercial yogurt, molasses, corn syrup, maple syrup
• SCD prohibits the intake of certain foods containing complex sugars and starches (polysaccharides) such as grains, certain legumes, potatoes, yams, parsnips, seaweed and cottonseed
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Specific Carbohydrate Diet – SCD cont…
Pros– Very healing to the GI
– Improves dysbiosis
– Improved skills
Cons– High allergenic diet
– High glutamate diet
– High oxalate diet
– Can lead to ketosis
– Can lead to hyper-ammonemia
– Permits dairy that is low lactose
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Body Ecology Diet - BED
“Body Ecology Diet” by Donna Gates
• Relies on fermented/cultured foods • Uses the principles of
expansion/contraction
Pros– Healing to the GI– Improved skills– Improves dysbiosisCons– Children don’t like the YCK and fermented vegetables– Children don’t like the meals– High oxalate– High glutamate
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Gut And Psychology Syndrome – GAPS cont…
Pros– Very healing to the GI
– Improves dysbiosis
– Improved skills
Cons– High allergenic diet
– High glutamate diet
– High oxalate diet
– Can lead to ketosis
– Can lead to hyper-ammonemia
– Permits dairy
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Gut and Psychology Syndrome – GAPS Diet
• “Gut And Psychology Syndrome” by Patricia McBride
• Gluten and casein free• Corn free• Prohibits all grains• Prohibits phenol and salicylate containing food• Prohibits all starchy vegetables and any food produced from
them: potato, yams, sweet potato, parsnip, swede, Jerusalem artichoke, cassava, arrowroot and taro
• Prohibits sugar and sugar containing foods• Prohibits starchy beans and peas: soybean, mung beans,
garbanzo beans, bean sprouts, chick peas and fava beans• Prohibits lactose and lactose containing foods: fluid or dried
milk, commercially produced yogurt, buttermilk, and sour cream
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Allergy/Sensitivity Elimination Diet
• Eliminates all IgE mediated reactive foods
• Eliminates or rotates IgG mediated sensitive foods
Pros– Decreases the TH2 dominant nature of the immune system
– Decreases the inflammatory response
Cons– May lead to the frequent consumption of other foods
• Ideal to create a 3 – 4 day Rotation Diet
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Low Phenol Diet
• Removes high phenol containing foods– In particular: apple, banana, red grape, tomato, orange,
chocolate
• Reduces the phenolic stress on the activity of the PST enzyme
Pros• Decreased phenolic symptoms• Decreased hyperactivity• May improve function of the PST enzymeCons• Removes popular fruits and vegetables
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The Feingold Diet
• Promoted to treat ADHD• Prohibits foods containing naturally occurring and
synthetic forms of salicylates– Fruit
• No berries, stone fruits, citrus fruits (except for lemon), certain apples
– Nuts• No almonds
– Vegetables• No cucumber, tomato, bell peppers
• Prohibits foods containing artificial preservatives• No BHT, BHA
• Prohibits foods containing artificial dyes– No yellow, red, blue, etc.
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Low Salicylate Diet…The Feingold Diet cont…
Pros
• Improves ADHD symptoms
• Eliminates the exposure to foods containing artificial
dyes, flavors and preservatives
Cons
• Significantly reduces the choice of fruits
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Glutamate/Aspartate Reduced Diet (G.A.R.D.)
• Reduces consumption of high glutamate/aspartate foods
• Based on veterinary research
• Promoted to decrease clinical and subclinical seizure
activity
Pros
• Reduces consumption of high glutamate foods
• May help lower ammonia levels
Cons
• Low protein
• Nut and legume free
• Limited vegetable intake
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Glutamate/Aspartate Restricted Diet (G.A.R.D.)
Foods rich in glutamate and aspartate
• Grains: Wheat, barley and oats• Dairy: All cheese. Casein is concentrated in cheese and is 20%
glutamic acid by composition• Beans: Soy, pinto, lima, black, navy and lentils• Seeds: Sunflower, pumpkin, etc.• Nuts: Peanuts, cashews, pistachios and almonds• Meats: All meats are naturally high, however, rabbit and
turkey are the highest, while lamb and eggs are the lowest. There are higher levels of glutamate in grain fed animals
• MSG in prepared foods• Diet sodas
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G.A.R.D. cont…
Foods lower in glutamate and aspartate
• Fruits, berries
• Vegetables
• Potatoes
• Lamb and eggs
• Tree nuts, such as, pecan, walnuts, macadamias
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Low Oxalate Diet - LOD
High Oxalate Foods to Avoid
• Chocolate, cocoa powder, carob• Soy beans, black beans, kidney beans, navy beans, pinto beans • Sesame oil, tahini• Blackberries, currants, dates, figs, kiwi, lemon/lime/orange peel, oranges,
persimmons, raspberries, star fruit• Buckwheat, durum wheat, wheat, millet, rye• Oregano, cinnamon, black pepper, turmeric• Almonds, cashews, hazelnuts, macadamia nuts, peanuts, pine nuts, pecans,
pistachios, walnuts • Sesame seeds• Milk thistle• Date sugar, stevia• Beets, steamed broccoli/Brussels Sprouts/carrots, celery, dandelion greens,
collard greens, Chili peppers, chard, okra, olives, potatoes, sweet potatoes, sorrel, canned tomato paste/sauce/puree, , yellow dock
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• Developed for treatment of pediatric epilepsy in the 1920s
• High-fat, adequate-protein, low-carbohydrate diet that in medicine is used
primarily to treat difficult-to-control (refractory) epilepsy in children. The diet
mimics aspects of starvation by forcing the body to burn fats rather than
carbohydrates. If there is very little carbohydrate in the diet, the liver converts fat
into fatty acids and ketone bodies. The ketone bodies pass into the brain and
replace glucose as an energy source. An elevated level of ketone bodies in the
blood, a state known as ketosis, leads to a reduction in the frequency of epileptic
seizures
• Most dietary fat is made of molecules called long-chain triglycerides (LCTs).
However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter
carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as
the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide
around half the calories. As less overall fat is needed in this variant of the diet, a
greater proportion of carbohydrate and protein can be consumed, allowing a
greater variety of food choices
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Seizures and the Ketogenic Diet
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Digestive Tract
“Health Begins in the Mouth
..Dis-ease Begins in the Gut”
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Digestive Tract
Therapeutic Nutritional Strategy 4 “R” Program1. Remove
– Diet
2. Replace– Digestion, motility
• Digestive enzymes, Betaine HCL, Aloe Vera juice, magnesium, DGL, Slippery elm
3. Repair– Leaky gut, inflammation
• Diet, pantothenic acid, vitamin A, zinc, curcumin, quercetin, bosweliaserrata, fish peptides, EFAs, probiotics, prebiotics,
4. Reinnoculate/Rebalance– Microbes
• Probiotics, prebiotics, biofilm intervention
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Biofilm
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Digestive Tract
• Biofilm – Chronic Persistent Infection– Hydrated polymeric matrix
• Invertase, serratiapeptidase, mucinase
– Fibrin• Nattokinase, lumbrakinase
– Cations for adhesion and biofilm stability• NaEDTA
– Antimicrobials• Neem, olive leaf, caprylic acid, cat’s claw, oregano oil, berberine,
grapefruitseed extract, artimesia, plant tannins, uva urse, etc.
– Binders • Citrus pectin, chitosan, activated charcoal
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Immune System
Therapeutic Nutritional Strategies
• Hypo-function– Chronic and recurrent infection
• Biofilm intervention
• Hyper-function– Allergens and hypersensitivity
• Remove offending agent
• Reduce exposure
• Quercetin, nettles, vitamin C, curcumin, MSM
• Dysregulation– Chronic inflammation
• EFAs, curcumin, quercetin, ginger, boswellia serrata
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The Endocrine
System
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Endocrine
Therapeutic Nutritional Strategies
• Stress and the HPAT Axis– Adrenal Exhaustion
• Rhodiola, ashwaganda, Bacopa, Cordyceps, glandulars
• Pantothenic acid, liposomal vitamin c, zinc, magnesium, vitamin B6
– Subclinical Hypothyroid/Wilson’s Syndrome• Zinc, selenium, iodine
• Dysglycemia• Biotin, chromium piccolinate, CLA, vanandium
• Premenstrual Dysphoria Disorder• 5HTP, SAMe, BH4
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The Nervous System
Targeted Nutritional Strategies
• Excitatory/Inhibitory Ratio• Diet• 5 HTP, SAMe, Inositol, BH4, magnesium, gaba, L-theanine, DHA, Rhodiola, taurine
• Anxiety– SNP
• ACE– Kidney/Adrenal support, gaba, L-theanine, taurine, magnesium
• Sleep– Gastro-Intestinal tract
• Diet– Serotonin/melatonin metabolism
• 5HTP, SAMe, BH4, gaba, inositol, L-theanine, melatonin
• Perfusion– Porphyrins– Iron deficient anemia
• Vinpocetine, ginkgo biloba, huprazine A
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Excitation
Glutamate Activation of the NMDA Receptor
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Excitation Support
Targeted Nutritional Strategies• Glutamate/Gaba ratio
– Diet• Low glutamate diet
– Nutrients• Taurine, magnesium, L-theanine, gaba, inositol, calm EZ, Earth Dragon
• Dopamine - NorEpinephrine/Serotonin ratio– Adrenal Support
• Rhodiola, Ashwaganda, Bacopa, Cordyceps, Adrenal glandulars• Pantothenic acid, vitamin B6, zinc, magnesium, vitamin C
• IgE/Allergies/Histamine– Diet
• Remove the allergens, high salicylate foods• Vitamin C, quercetin, nettles
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Excitation
Targeted Nutritional Strategies• Tryptophan - Serotonin – Melatonin Pathway
– Diet• Tryptophan rich foods• Tryptophan insulin relationship
– Nutrients• BH4, NADH, 5-HTP/tryptophan, SAMe, vitamin B6
• Oxidative Stress – Inflammation – Excitation– Antioxidants, Anti-inflammatories, Inhibitory support
• Oxidative Stress – Mitochondrial Dysfunction –Excitation– Antioxidants, mitochondrial support, inhibitory support
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Oxidative Stress
Targeted Nutritional Strategies
• SNPs– CBS, GST M1, GST P1
• Redox status– GSH/GSSG ratio
• Liposomal GSH, S-acetyl GSH, NAC, milk thistle, alpha-lipoic acid,
vitamin E, vitamin C, selenium, NADH
• Lipid peroxides– Vitamin E
• 8OHDG
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Oxidative Stress
• Mitochondrial function– GSH (NAC, s-acetylGSH, IV GSH, NADH, vitamin E, vitamin C), GPX
(selenium), SOD (manganese), CoEnzyme Q10, carnitine, vitamin B2– Ginkgo biloba, huperazine A, vinpocetine, d-Ribose
• Immune dysregulation– Diet– Probiotics, arabinogalactan, Vitamin D, vitamin A, vitmamin C, zinc,
curcumin, boswellia serrata, quercetin, garlic, cat’s claw, skull cap, nettles, olive leaf extract
• Toxic burden– Diet, water, environment– Silymarin, sulfurophane– S-acetyl-glutathione, liposomal glutathione, NAC, alpha-lipoic acid– Chelation– Far Infra-Red Sauna
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Credit: Dr. Ji ll James
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Credit: Dr. Ji ll James
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Credit: Dr. Ji ll James
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Credit: Dr. Ji ll James
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Inflammation Support
• Targeted Nutritional Strategies– General
• Assess the GI, immune, detox systems• Remove or reduce the offending agent/trigger
– Diet» GFCF, Allergy elimination, SCD, LOD, BED, GAPs
– Environment» Keep windows closed, reduce time outside, use mattress covers,
removed carpets, curtains, address indoor mold issues, use a hepa filter, hypoallergenic pets
– Toxins» Organic, non-GMO, water filters, air filters, bedding, bedwear, bodycare
– Treat• Probiotics, prebiotics, symbiotics, EFAs, plant sterols, ginger, quercetin,
boswelia serrate, curcumin, nettles, skull cap, TSOs• Moducare
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Methylation
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Methylation
Targeted Nutritional Strategies
• SNPs– MTHFR C677T, MTRR, MTR, COMT, CBS C699T, SHMT, AHCY
• SAMe/SAH ratio
• Methyl donors– Methyl folate, methylcobalamin, TMG/DMG, DMAE, SAMe
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Transulfuration
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Transulfuration Support
Targeted Nutritional Strategies
• SNPs– CBS, GST M1, GST P1, NAT1
• Redox status– GSH/GSSG ratio
• S-acetyl GSH, IV GSH, liposomal GSH, NAC, NADH, sulfurophane, ALA,
silymarin, vitamin C, vitamin E, methylcobalamin
• Xanthine oxidase/sulfide oxide• Molybdenum
• PST enzyme• Low phenol diet
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Credit: Dr. Ji ll James
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Credit: Dr. Ji ll James
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Credit: Dr. Ji ll James
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Mitochondria – Aerobic Energy Metabolism
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Mitochondria
Targeted Nutritional Strategies• Diet
– Macronutrients• Ketogenic diet
– Micronutrients• Nutrient vs Calorie dense
• Toxins– Diet/Environment
• Pthalates, pesticides, fungicides, herbicides, heavy metals, PVC, Bisphenol A
• Porphyrins/heme metabolism– Iron, vitamin C– Vinpocetine, Ginkgo biloba, Organic germanium
• Oxidative Stress– Vitamin C, E, zinc, manganese, selenium, glutathione, NADH– NRF2 activation
• Resveratrol, green tea, sulfurophane, curcumin, allicin,
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Mitochondria
Targeted Nutritional Strategies
• Glutamate - Calcium/Taurine - magnesium status– Magnesium, taurine
– Anti-glutamate therapy
• Aerobic Energy Metabolism– Pyruvate/lactate ratio
• Oxygen, zinc, vinpocetine, organic germanium, ginkgo biloba
• TPP, pantothenic acid, Vitamin B2, B3, magnesium
– Krebs Cycle• Vitamin B1, B2, NADH, iron, glutathione, magnesium, carnitine
– Electron Transport Chain• CoEnzyme Q10, NADH
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Biotransformation-Detoxification
Phase I and II Detoxification
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Biotransformation/ Detoxification Support
Targeted Nutritional Strategies• Reduce the Toxic Load
– Diet• Organic, non-GMO, farmed fish, predatory fish
– Environment• Pesticides, herbicides, fungicides, pthalates, PVC, bisphenol A
– Medications• CYP450 system
• Phase I– Inducers– Inhibitors
• Phase II– Conjugation
• Methionine, taurine, glycine, glucuronic acid, cysteine, glutathione, acetylation
• Oxidative Stress– Antioxidants
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Nutritional Insufficiencies/Excesses
Targeted Nutritional Strategies• Essential Fatty Acids
– EPA, DHA, GLA
• Other Fatty Acids– Arachidonic acid
• Eggs
– MCT• Coconut oil
– Omega 9s• Olive oil, safflower oil
– SCFA• Butyrate
– Eggs, red meat
• Cholesterol
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Nutritional Insufficiencies/Excesses
Targeted Nutritional Strategies
• Amino Acids– Growth/Bone support
• Diet– Protein
– GI integrity• glutamine
– Thyroid hormones• tyrosine
– Neurotransmitters• Tyrosine, tryptophan, glutamate, taurine, gaba
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Nutritional Insufficiencies/Excesses
– Methylation• Methionine, SAMe, TMG, DMG, glycine, serine
– Transulfuration• NAC, taurine, glutathione
– Biotransformation/Detoxification• Diet
– Protein
• B Complex, antioxidants, amino acid conjugants
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Nutritional Insufficiencies/Excesses
Targeted Nutritional Strategies• Essential Elements
– Adequacy– Copper/zinc ratio
• Zinc, molybdenum
• Calcium/magnesium ratio– Magnesium, taurine
• Oxidative Stress– Zinc, selenium, manganese, copper
• Electrolytes– Sodium/potasium ratio
• PICA– Iron, calcium, zinc
• Digestion– Zinc
• Sleep– Calcium, magnesium
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Nutritional Insufficiencies/Excesses
Targeted Nutritional Strategies• Vitamins
– Antioxidants• Vitamin A, C, E
– Eye Function• Vitamin A, zinc
– Mitochondrial Aerobic Energy Metabolism• Vitamin B1, B2, B3, B5
– Biotransformation/Detoxification• B Complex, anti-oxidant vitamins
– Neurotransmitter Metabolism• Vitamin B6, B12, folic acid, BH4, NADH
– Amino Acid Metabolism• Vitamin B6
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Therapeutic Nutritional Strategies
in the Autistic Spectrum of Disorders
Thank You
Peta Cohen, MS., RD
Total Life Center
11 North Dean Street
Englewood, NJ 07631
201-541-7601
www.petacohen.com
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