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Treating Yeast, Bacteria and Other Digestive Problems
Copyright© 2016, Kurt N. Woeller, D.O. and Educational Resource Association. This material may not be reprinted, distributed or used
without permission.
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Content Disclaimer
The material contained within this document/presentation is not intended to replace the services and/or medical advice of a
licensed health care practitioner, nor is it meant to encourage diagnosis and treatment of disease. It is for educational purposes
only. Kurt N. Woeller, D.O. (or associates) does not accept legal responsibility for any problems arising from experimentation with the information described herein. Any application of suggestions set forth in the following portions of this document/presentation
is at the reader's discretion and sole risk. Implementation or experimentation with any supplements, herbs, dietary changes,
medications, and/or lifestyle changes, etc., is done so at your sole risk and responsibility and should be discussed with your (or your
child’s) personal physician first.
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• Candida overgrowth: organism complexity and toxicity.
• Treatment options for candida
• Clostridia bacteria and digestive imbalance
• Clostridia toxins
• Clostridia and digestive bacteria intervention
• Bowel inflammation
• Remedy options for improving digestive inflammation.
Lecture Overview
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Support Documents for Module #4
• Taking Probiotic Suggestions (pdf)
• Clostridia Natural Remedy Protocol (pdf)
• Die-Off Reaction Management (pdf)
• Constipation Remedies Dosing Suggestions (pdf)
• Lecture slides (pdf)
• Lecture slides: note taking (pdf)
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Yeast & Fungal Markers
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Why Is Candida So Complex?
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Fungi - Biological Group Of Organisms
• Yeasts – ex: Candida, Saccharomyces
• Molds – ex: Aspergillus, Penicillium
• Mushrooms
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Candida Overview
• Considered a commensal organism that is a normal part of the human flora, i.e. mouth, gastrointestinal tract.
• Estimates are that Candida exists in approximately 80% of the human population without causing harm.
• Common issues linked to Candida overgrowth are thrush (oral candida), vaginal infections, skin and nail plate infections.
• HIV, cancer and other immunocompromised diseases have greater risk of Candida pathogenicity.
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Unicellular Yeast to Hypha Formation
Highly invasive at this point. Invades the mucosal lining
of the intestinal tract.
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Candida
Human macrophage
Myeloperoxidase-WBC enzymeresponse to Candida infectionClO-
Hypochlorite ion - powerful oxidizing agent-tissue damageActive ingredient of Clorox®
N-acetyl Glucosamine,Glucuronic acid
Arabinose,Tartaric acid
Hyaluronic acidIntercellular cement
References1. Jahn M, et al. Carbohydr Res. 1999, 321:228-34.
2. Shimizu MT et al. J Med Vet Mycol. 1995, 33:27-31
hyaluronidase
Production of arabinose, tartaric acids as indirect markers of invasive Candidiasis
Kills Candida
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Chemically Similar
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Malic Acid (MA) Tartaric Acid – analog to MA
Citramalic Acid – analog to MA
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Inhibited by Tartaric Acid & Citramalic Acid
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Fig. 1. The tricarboxylic acid cycle during typical metabolism. Carbohydrates and fatty acids enter the cycle as acetyl-CoA and through a series of enzymatic steps produce energy utilizing two electron carriers, nicotinamide
adenine dinucleotide (NADH) and flavin adenine dinucleotide (FADH2). NADH and FADH2 are metabolized by complex I and complex II, respectively, of the electron transport chain (ETC). Complex V of the ETC produces
adenosine triphosphate (ATP), the energy carrier of the cell.
From: Gastrointestinal dysfunction in autism spectrum disorders: the role of the mitochondria and the enteric microbiome (2015), Frye, et.al.
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Krebs Cycle & Mitochondrial Metabolites
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• Gliotoxin – can fragment the DNA of lymphocytes (T-cells), white blood cells, and macrophages.
• Gliotoxin can directly lead to immune suppression, i.e. lower Secretory IgA.
• Gliotoxin generate free radicals depleting glutathione.
Gliotoxin – immunotoxic substance produced by yeast and molds
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• Amphotericin B - 125mg to 250mg three to four times daily for 4 to 8 weeks• Biocidin – capsules or liquid• Olive Leaf Extract – shown to be effective against Aspergillus
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Testing Options for Candida
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Food IgG Profile + Candida IgG
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Yeast Culture From Stool Test
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Arabinose
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Treatment Options for Candida
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General Support Supplements
• Foundational nutrients – includes a wide variety of B-vitamins, vitamin C, D, and E, as well as minerals, calcium and magnesium, etc.
• Essential fatty acids, i.e. Cod Liver Oil, fish oil
• Multi-Strain Probiotic – VSL#3, ProBio Premium, Probiotic Support Formula.
• Additional supplements to consider:• Biotin - 1000mcg (1mg) two to three times daily
• Mitochondria Support, i.e. L-Carnitine, Ubiquinol
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High Dose Probiotics
2 capsules = 225 billion organisms 1 packet = 225 billion organisms
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Lower Dose Probiotics
1 capsule = 20 billion organisms (approximately)
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Grapefruit Seed Extract
Multiple Options:Grapefruit Seed Extract(Nutribiotic) – 5 to 15+ drops 3 times daily –strong taste, usually needs to be given in
dilute citrus juice.
10 drops = 100mg of GSE
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1 capsule = 180mg of Allicin 1 drop = 40 mcg of Allicin
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Yeast Control Packet
• Black Walnut• Goldenseal• Allimax (Garlic)• Uva Ursi• 5 to 15+ drops of
each remedy 3X daily. • Rotate one remedy
every 5 to 7 days.
New Beginnings Nutritionals
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USP Effectiveness Testing of Biocidin®
Demonstrates inhibitory activity of against both gram positive and gram negative bacteria, yeast and fungus.
Bilberry extract, Grape Seed extract, Milk Thistle, Echinacea, Goldenseal, Shiitake, White Willow, Garlic, Black Walnut (hull and leaf), Raspberry, Fumitory, Gentian, Noni, Tea Tree oil, Galbanum oil, Lavender oil, Oregano oil
TextText
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6 weeks of Biocidin – 8 drops three times daily
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Candex
• Candida cell wall is made up of various forms of fiber – Candex can help to digest these fiber components.
• No threat of resistance
• 1 to 2 capsules daily or twice between meals – 30 minutes before or 90 minutes after food.
• Useful for sensitive individuals or as an additional remedy either with botanicals or medication antifungals.
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Nystatin:• Tablet (500,000 units) - 1/2 to 3 tablets
3x/day.• Oral Suspension (100,000 units/ml) – ¼
teaspoon to 3+ teaspoons 3x/day.5ml = 1 teaspoonNOTE: can use for prolonged periods of time, i.e. multiple months. In some cases have had to use for
1 to 2+ years.
Prescription Medications
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Diflucan (Fluconazole):• Tablet = 100mg, 150mg, 200mg – used once daily
• Oral suspension – 10mg/ml or 40mg/ml
• Average daily dose = 5mg/kg/day
• Length (variable) – 15 to 30 days+
• Can rotate with other antifungals, i.e. Nystatin.
• MUST monitor liver function every to 6 to 8 weeks.
Other medications such as Sporanox and Lamisil can be used similarly (note: Nizoral – no longer use)
Prescription Medication
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Typical “Die-Off” symptoms
• Headache
• Nausea
• Fatigue
• Irritability
• Moodiness
• Digestive bloating and gas
• Fever
• Diarrhea or mixed bowel, i.e. constipation and loose stools
• Rashes
• Body itching
• Hyperactivity and increased self-stimulatory behavior
• Sleep disturbance
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Remedy Options to Help with Die-Off
• Fresh squeezed lemon water – ¼ to ½ lemon squeezed into filtered water (at least 3 to 4 ounces) 3 to 4 times daily.
• Activated Charcoal – 1 to 2 capsules twice daily, afternoon and evening. Recommendation: take 200mg to 400mg of magnesium citrate or oxide to prevent against activated charcoal induced constipation.
• Alka-Seltzer Gold (must be the ‘Gold’) – dose according to label on package. Helps to neutralize excess acids.
• Epsom salt baths (1 to 3 cups in bath water) and/or creams (applied twice daily) - available from New Beginnings Nutritionals –www.nbnus.com.
• Ascorbic acid – divided doses throughout the day totaling 2000mg to 3000mg daily.
See “Die-Off Reaction Management” document in Module 4 for supplement and dosing suggestions.
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Steps To Take Prior To Antifungal Therapy
• Dietary intervention
• Foundational supplements + Biotin, etc.
• Constipation remedies (see document in Module 4).
• Ideally, have these steps in place 2 to 4 weeks prior to starting anti-yeast treatment.
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Constipation
Remedy Examples:
• Magnesium Citrate or Oxide – 250mg to 400mg (preferably at bedtime)
• Oxypowder (www.oxypowder.com) – 1 to 4 capsules daily
• Magnesium + Slippery Elm (capsules or powder) – 3 to 6 capsules or 1 to 2 teaspoons powder daily.
• Aloe Vera Juice – 1 to 2 tablespoons with juice 1 to 3 times daily
• TruFiber (www.nbnus.com) – 1 to 2 tablespoons daily
• Ground Flax Seeds or some other non-gluten fiber – 1 to 2 teaspoons daily.
• Fleet’s Enema – 1 daily for 3 to 5 days
• MiraLax – taken once daily – ¼ to 1 capful
• High dose probiotics - increasing amounts of probiotics can lead to relief of constipation.
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Bacterial OvergrowthClostridia Bacteria Toxins
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Bacterial and Clostridia Markers
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Elevated HPHPA and High HVA in 6 year Old Chinese ASD Child
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Critical effect of intestinal bacteria on certain brain and nervous system chemicals
Organic acid test
Organic acid test
Organic acid test
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4-Hydroxyphenylacetic acid
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4-Hydroxyphenylacetic acid
• High 4-hydroxyphenylacetic acid is associated with small intestinal bacteria overgrowth due to its production by the following Clostridia bacteria: C. difficile, C. stricklandii, C. lituseburense, C. subterminale, C. putrefaciens, and C. propionicum.
• It is likely that 4-hydroxyphenylacetic is also an inhibitor of dopamine-beta-hydroxylase.
• Elevated values are common in celiac disease and cystic fibrosis, and have also been reported in transient lactose intolerance, Giardia infection, ileal resection, septicemia, and projectile vomiting.
• The elevations of 4-hydroxyphenylacetic acid in celiac disease and cystic fibrosis are so prevalent that involvement of these Clostridia bacteria may play a role in these illnesses.
• In C. difficile infections 4-hydroxyphenylacetic acid is utilized by this bacteria to produce 4-cresol.
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What About DHPPA?
• 3,4-dihydroxyphenylpropionic acid (DHPPA) is a marker for beneficial bacteria in the gastrointestinal tract such as Lactobacilli, Bifidobacteria, and E. coli – the exception is Clostridia orbiscindens which converts certain flavanoids (i.e., parsley, thyme, celery) into DHPPA.
• The quantity of C. orbiscindens in the gastrointestinal tract is negligible (approximately 0.1% of the total bacteria) compared to the predominant flora.
• DHPPA is an antioxidant that lowers cholesterol, reduces pro-inflammatory cytokines, and protects against pathogenic bacteria.
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Treatment Options for Clostridia
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Flagyl, aka. metronidazole (pill or suspension) – 250mg to 500mg 3x/day for 7 to 10 days. Cyclical dosing is an option.
Vancomycin, aka. vancocin (pill) – 125mg to 500mg 3x/day for 7 to 10 days. Cyclical dosing is an option.
NOTE: Approximate dosing range for both is 20mg to 30mg/kg divided dosages three times daily. On average = 25mg/kg/day
Cyclical Dosing Option:• One dose 3x daily for 10 days
Then every 3rd day – one treatment day for 3 weeks
• One dose 3x per day every other day for 4 to 6 weeks
Clostridia – Antibiotic Treatment
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Alternative treatments for Clostridium difficile disease: what really works? Lynne V. McFarland Journal of Medical
Microbiology (2005), 54, 101–111
125 mg–500 mg every 3 days over a
meanof 27 days
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6 weeks of Biocidin – 8 drops three times daily
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Using Botanicals Against Clostridia
Case Examples of Reduction and Elimination of Clostridia Toxins and One
Apparent Failure to Treatment
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1/9/13
8/5/2013
Vanco x 10 days + Diflucan x 30 days
Biocidin + Culturelle x 60 days
Ex: #1
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11/4/13
• Biocidin (2 capsules TID) x 14 days, then every 3rd day for additional 4 weeks did another treatment day of Biocidin (same dose).
• Culturelle – 4 capsules at bedtime
NOTE: discussed with parents if program didn’t work we would need re-implement a longer antibiotic program.
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12/19/2013
3/25/2014
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6/27/14
• Biocidin (8 drops TID) x 14 days, then every 3rd day for additional 4 weeks did another treatment day of Biocidin (same dose).
• Culturelle – 4 capsules at bedtime
Ex: #2
4-cresol – very high60
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10/21/14
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General OAT Recommendations
• Obtain initial Organic Acids Test or Microbial Organic Acids Test to obtain baseline of clostridia markers.
• Initiate antimicrobial therapy (botanical and/or medication) based on clinical presentation.
• If doing just 10 days of antibiotics, retest OAT or mOAT 2 weeks after regimen completed, and again 1 to 2 months later.
• If doing extended cyclical program, retest OAT or mOAT during the last week of therapy, and then again 1 to 2 months later.
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Bowel InflammationChronic Infections and Food Sensitivity
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Goal of Mucosal Healing
1. Nourish the intestinal lining and strengthen the first line immune defense.
2. Help protect the body against harmful and opportunistic organisms found in the digestive tract.
3. Reduce gut inflammation and improve wound healing.4. Helps with wound healing and reduction of
inflammation.5. Alleviate gastrointestinal discomfort 6. Improve nutrient absorption7. Improve digestive system function and reduce the toxic
burden on liver and other organs.
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Bromelain
• Anti-inflammatory
• Helpful in reducing and eliminating pain, aiding digestion, and accelerating healing.
• Prevent against strokes and reduces blood pressure.
• Derived from pineapple, its primary purpose as a digestive remedy is to control GI inflammation.
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L-Glutamine
• Helps maintain intestinal barrier integrity
• Preferred fuel source of enterocytes and colonocytes in the digestive system.
• Helps maintain healthy levels of Secretory IgA
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Methylsulfonylmethane
• Binds to the intestinal mucosa
• Helps to regulate the interface between luminal components and cell surface.
• As a result, substances such as allergens and parasites cannot readily bind to the mucosa.
• Aids in toxin reduction and free radical elimination
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Quercetin
• Is a potent antioxidant
• Prevents the formation of certain inflammatory mediators helping to reduce inflammation overall and subsequent pain.
• Spares against vitamin C loss and stabilizes cell membranes.
• Stabilizes mast cell degranulation
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Support Mucosa
www.BioMatrixOne.com3 capsules twice daily 15
minutes before meals
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Tumeric (Curcumin)
• Turmeric root has anti-inflammatory properties that inhibit COX-2 activity.
• COX-2 is an enzyme responsible for inflammation and pain.
• The low incidence of colorectal cancers observed in Asia is thought to be linked to high dietary intake of turmeric.
• Curcumin is a component of Tumeric which has antioxidant, anti-inflammatory and antimicrobial activity.
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2 to 4 capsules daily
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Curcumin 250
1 capsule twice daily with food
Turmeric Phytosome(Curcuma longa) root,
dried extract, min. 18% curcuminoids & phosphatidylcholine complex
250mg/capsule
www.nbnus.com
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Reduces inflammation. Inhibits biofilm formation and adherence of H. Pylori.
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Intesti-Mate
• DGL
• N-Acetyl-Glucosamine
• L-Glutamine
• Aloe Vera Gel
Dosage: ½ to 1+ scoop daily mixed in juice.
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Additional Options for Digestive Health
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Multi-Flora Probiotics
1 to 2 capsules daily – 1 capsule equals approximately 20+ billion organisms.
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Fermented Foods
Add one to two tablespoons to 1 or more meals
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Camel Milkhttp://nourishinghope.com/2011/11/camel-milk-healing-or-hype
Camel milk contains no beta-lactoglobulin and a “new” beta-casein. Therefore it is not reactive to children with autism and even non-allergenic
to those with even the most sensitive allergy to milk and casein.
www.camelmilkassociation.org
• Start with 2 to 4 ounces daily• Can increase as tolerated
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TruFiber
www.nbnus.com or other resources online
• Prebiotic• Soluble fiber• Does contain inulin (be
cautious in SIBO)• Enzymes • Support healthy bacteria• 1 level scoop mixed in 8 to
12 ounces of water or dilute juice once to twice daily.
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Other Options
• Cultured butter and/or ghee (clarified butter)
• Butyrate
• Fiber supplements:• Ground flax seed – ½ to 1 tablespoon daily• TruFiber
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Butyric Acid (butyrate)
• Butyrate – byproduct of bacterial fermentation on dietary fiber. Also, found in raw milk and butter, as well as Ghee (clarified butter).
• Beneficial in clearing high ammonia produced in the gut
• Supports against gut problems, i.e. diarrhea
• Supports the health of intestinal cells by decreasing inflammation – particularly the large intestine.
• Calcium/Magnesium, Potassium Butyrate available –600mg to 1200mg with food twice daily. Typical capsule is 600mg.
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New Beginnings Nutritionals –www.nbnus.com
2 to 6 capsules daily with food
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Gain access to comprehensive testing including Organic Acids, Comprehensive Digestive Stool Analysis, Adrenal Hormone, Hair,
Amino Acids, etc.
• All tests kits sent to your home or office• No doctor visit needed for ordering• Each lab reviewed personally by integrative medicine doctor• Written lab review provided with recommended action steps based on lab test markers• Access to professional line supplements • Great Plains Laboratory, BioHealth Laboratory, Doctors Data, ZRT, etc.
www.labtestsplus.com for a complete list of lab tests available
.
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Topic • Biomedical Diets – Which Ones and Why:
• Overview of various autism diets
• Which one is right for your child?
• What is the difference between IgG, IgE and peptide reactions to foods?
Module #5
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