Implementing Nutritional Analysis into Clinical Practice

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Implementing Nutritional Analysis into Clinical
Practice

• Relevant Studies in
• Autism and ADHD
• Mary Ann Block, DO
• Grant from Spectracell Labs

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• If you eat a balanced diet,
• why would you need to take
• nutritional supplements?

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• What Is a Balanced Diet?

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• Grocery Store Food
• vs
• Organic Food
• Journal of Applied Nutrition, 1993

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Basic Biochemistry

• Magnesium over
• 350 Biochemical Processes

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• Because suboptimal vitamin status is associated
  with many chronic diseases, from cardiovascular
  disease to cancer, it is important for physicians
  to identify patients with poor nutrition or other
  reasons for increased vitamin needs.
• Journal of American Medical
  Association June 19, 2002

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Many Factors Affect Nutrient Status

• Dietary Intake
• Absorption
• Transport
• Storage
• Receptors
• Activation
• Inhibition

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Many Factors Affect Nutrient Status

• Metabolism
• Excretion
• Hormonal Status
• Genetic Influences
• Disease
• Lifestyle Factors
• Pharmaceuticals

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Many Factors Affect Nutrient Status

• Gender
• Socioeconomics
• Culture/Ethnicity
• Pregnancy
• Exercise
• Tobacco / Alcohol
• Age

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Biochemical Individuality

• Roger Williams
• Pioneer in Biochemistry
• Professor at The University of Texas at Austin,
  1939 to 1986
• Discovered the B-vitamin, Pantothenic Acid, and
  concentrated and named Folic Acid
• Wrote 21 books and nearly 300 articles
• Elected to the National Academy of Sciences, 1946
• President of the American Chemical Society, 1957

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Biochemical Individuality

• Differing nutritional needs for optimal
  function among different people

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Biochemical Individuality

• Recognition that
• nutritional status can influence the expression
  
• of genetic characteristics

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Nutritional Needs in Autism

• DHA
• (docosahexaenoic acid)
• 861 autistic kids
• 123 controls
• Infant formula lacking DHA in formula had
• increased risk of developing autism
• compared with breast-fed infants
• Int. Breastfeed J, 2006

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Nutritional Needs in Autism

• Magnesium B6
• Significantly improved social interactions,
  communications intellectual function
• Magnesium Res. , 2006

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Nutritional Needs in Autism

• Vitamin B12
• Helps cells grow
• Maintains normal cell function
• Improves neurologicalsymptoms
• Am. J. Clinical Nutrition, 2001

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Nutritional Needs in AutismMethylated Vitamin B12

• Block Center Case studies
• Potty training
• Improved sleep
• Improved speech
• Improved behaviors
• The Block Center

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• A
• Demand for a
• Healthy
• Diet

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Nutritional Needs in ADHD

• Vitamin B6
• More effective than Ritalin in double-blind
  cross-over study
• Biological Psychiatry, 1979

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Nutritional Needs in ADHD

• Magnesium
• Deficiency in children characterized by excess
  fidgeting and learning difficulties
• Magnesium in Health Disease, 1980

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Nutritional Needs in ADHD

• Niacin
• Improved hyperactivity, school performance
  ability to maintain social relationships
• Schizophrenia, 1971

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Nutritional Needs in ADHD

• Zinc
• Deficiencies result in hyperactivity
  irritability
• Levels significantly lower than controls in
  children diagnosed as ADHD
• Biological Psychiatry, 1996

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Nutritional Needs in ADHD

• DMAE
• dimethylaminoethanol
• Improves behavior, concentration, organization
  problem solving ability
• J Pediatrics, 1958

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Nutritional Needs in ADHD

• Essential Fatty Acids
• Lower levels in boys
• diagnosed ADHD
• Am. J. Clinical Nutrition, 1995

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Nutritional Needs in ADHD

• DHA
• Significant number of boys with health
  learning problems had lower levels of DHA
• Clinical Pediatrics, 1987
• Lipids, 2003

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Nutritional Needs in ADHD

• Evening Primrose Oil Fish Oil
• Showed significant improvement in ADHD symptoms
  of hyperactivity and inattention
• J. Developmental BehaviorPediatrics, 2007

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• How to Test for
• Nutritional Deficiencies

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Hair Analysis

• Not an accurate indicator of nutritional state
• The state of health of the body may be entirely
  unrelated to the physical and chemical condition
  of the hair
• There are no data that indicate that low
  concentrations of an element signify low tissue
  levels nor that high concentrations reflect high
  tissue stores.

AMA Committee on Cutaneous Health and Cosmetics
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Autistic Population

• Lower in Hair
• Higher in Body

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Urine Analysis
Urine tests only measure nutrient metabolites
over a very short window, usually 24 hours
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Serum Analysis

• Serum testing only measures nutrient status
• outside the cell in the serum (Magnesium not in
  serum)

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Serum Analysis
Serum only measures static nutrient levels,
regardless of utilization
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Serum Analysis

• Serum measurements
• assume everyone
• has the same
• nutritional needs

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Intracellular Analysis

• Functional Intracellular Analysis (FIA)
• of
• Vitamins, Minerals Antioxidants

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Functional

• Because it assesses how a persons own cells
  actually utilize various nutrients

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Intracellular

• Because the growth rates of each patients own
  white blood cells are evaluated when exposed to a
  series of very specific nutrient environments

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FIA TestingBiochemical Individuality

• The optimum nutrient level for one person may
  be suboptimal for another, thus accounting for
  differences in age, illness, medications and
  genetic factors

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• FIA testing measures LONG-TERM
• nutrient status
• (3-6 months)

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• FIA Measures
• Intracellular Status
• of 30 Important Micronutrients

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Vitamins

• Vitamin A Vitamin D
• Vitamin E Vitamin B1
• Vitamin B2 Vitamin B3
• Vitamin B6 Vitamin B12
• Biotin Folate
• Pantothenate

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Minerals

• Calcium
• Magnesium
• Selenium
• Zinc
• Copper

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Amino Acids

• Asparagine
• Carnitine
• Glutamine
• Serine

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Antioxidants
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CARBOHYDRATE METABOLISM, FATTY ACIDS
METABOLITES

• Lipoic Acid Oleic Acid
• Choline Inositol
• Fructose Sensitivity
• Glucose/Insulin Metabolism

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Spectrox

• Total Antioxidant Function
• (Vitamin C, Selenium, Glutathione, Vitamin E)

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How does FIA Work?

• Control media contains minimal level of each
  nutrient to support optimal lymphocyte growth
• (18 years research at UT-Austin for patented
  control media)
• Lymphocytes are introduced into several different
  wells
• Nutrients in cell culture are individually
  manipulated
• Each nutrient test is performed in triplicate to
  ensure reproducibility
• Growth depends on intracellular reserves of
  nutrients

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Why use lymphocytes?

• Lymphocytes provide a long term nutritional
  marker
• Contain a genetic marker (nucleated cell)
• Closely tied with immune function
• Representative of overall health

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SpectraCells FIA Report

• Easy to read
• Comprehensive analysis
• Supplement recommendations
• Food sources for deficient nutrients

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Incorporating FIA in your practice
Wide scope of medical applications
Menopause Obesity Osteoporosis Pregnancy PMS Sport
s Medicine
Allergies ADHD Alzheimers Arthritis Autism Cancer
Chronic Fatigue
Depression Diabetes HIV Heart Disease Hypertension
Macular Degeneration
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Incorporating FIA in your practice
Accurate nutritional assessment is important to
all patients
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Incorporating FIA in your practice

• Identify Deficiencies
• Treatment Plan Repletion with supplementation
  and diet
• Monitor Progress every 6-8 months

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Magnesium

• The Bivalent,
• Cationic
• Step Child
• (everyone knows about Calcium)

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Magnesium DeficiencySymptoms

• Migraines Hypertension Asthma
• Osteoporosis Insomnia Fatigue
• Constipation Anxiety Depression
• Tachycardia Arrhythmia Urticaria
• Hyperactivity Hyperlipidemia Spasms
• Seizures Aches/Pains Allergies
• GI Disturbances Hypokalemia PMS
• Dysmenorrhea Neuropsych sx Stroke
• Sudden Death

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Diseases Associated withMagnesium Deficiency

• Allergies Alzheimers Asthma
  Apnea Diabetes Hypertension Migraine Prematurity
  PMS
• SIDS Autism Stroke
• Cancer Multiple Sclerosis
• Mitral Valve Prolapse
• Chronic Fatigue
• Myocardial Infarction

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Causes of Magnesium Deficiency

• Alcoholism Chronic Diarrhea
• Dieting GI Disturbances
• Diabetes Cytotoxic Agents Diuretics
  Hyperthyroidism
• Allergies Chronic Stress
• Estrogen Chronic Diseases
• Pain Calcium (Dairy) Lactation

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Tools to Treat Magnesium Deficiency

• Dietary Sources Soy, Nuts, especially cashew and
  almonds, Peas, Beans, Wheat, Peanuts, Greens,
  Banana, Avocado, Potato, Oatmeal, Spinach,
  Salmon, Black Strap Molasses.
• Nutritional Supplementation Adults 1000mg/day,
  Children ages 4-6, 300mg/day, ages 7-11,
  600mg/day.
• To bowel tolerance.
• IM and IV

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Testing for Magnesium Deficiency

• Functional Intracellular Analysis
• or
• Magnesium Challenge

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MAGNESIUM CHALLENGE PATIENT INSTRUCTIONS

• DISCONTINUE ALL MAGNESIUM FOR 5 DAYS PRIOR TO
  STARTING THE TEST
• Begin collecting urine on assigned day (do not
  start with the first early morning specimen, void
  this specimen into the toilet). Collect every
  drop for the next 24 hours. Do not miss any. Do
  not leave urine in the heat.
• Bring the urine to the office at your scheduled
  appointment time. At this time you will receive
  a magnesium injection. (12 and older receive 2
  injections)
• Immediately begin the second 24 hours. Collect
  all urine for the next 24 hours. Bring the
  second container of urine to the office for
  analysis. Keep it refrigerated if there is any
  delay in your return.

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Magnesium Challenge Physician Instructions

• Combine
• Magnesium Sulfate 50 soln. inj., 2 ccs
• Lidocaine 2 inj. 1 cc
• In 3cc syringe with 25 gauge, 1.5 needle
• Fill 2 syringes for adults one for children age
  7-12
• Give one, deep IM, Z-Track in each hip
• Must give Z-Track, otherwise very painful

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Computing for Magnesium Deficiency

• Total magnesium in first 24 hour urine plus the
  amount of magnesium given to patient minus the
  amount of magnesium in 2nd 24 hour urine, divided
  by the amount of magnesium given to patient. For
  example
• Amount of magnesium in first 24 hour
  urine 100mg
• Plus the amount of magnesium given to the patient
  (adult) 200mg
• Total available to be released into the
  urine 300mg
• Amount of magnesium in 2nd 24 hour urine 125mg
• Total retained by the patient 175mg
• Divided by the amount of magnesium given to
  patient 175/200
• Percentage of magnesium injected that the patient
  retained 87.5
• Any percentage greater that 20 is considered to
  be magnesium deficiency and should be treated.

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Treatment Protocol for Magnesium Injections
(Adult)

• Supplies
• Magnesium sulfate 50 solution, 4mEQ/mL
• Pyridoxine hydrochloride 100mg/mL
• Lidocaine HCL 2 20mg/mL
• 5cc syringes
• 18 gauge needles
• 25 gauge 1 ½ inch needle
• With the 18 gauge needle draw up 2cc Magnesium,
  1cc pyridoxine, 1cc Lidocaine in 5cc syringe.
  Change needle to 25 gauge 1 ½ inch needle.
  Injection should be given deep IM Z-track in the
  hip, twice weekly for four weeks then once weekly
  for four weeks, then PRN. Alternate hips each
  time injection is given. Oral magnesium should
  be taken daily.

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Treatment Protocol for Magnesium Injections
(Child)

• Supplies
• Magnesium sulfate 50 solution, 4mEQ/mL
• Pyridoxine hydrochloride 100mg/mL
• Lidocaine HCL 2 20mg/mL
• 5cc syringes
• 18 gauge needles
• 25 gauge 1 inch needle
• With the 18 gauge needle draw up 1cc Magnesium, ½
  cc pyridoxine, ½ cc Lidocaine in 5cc syringe.
  Change needle to 25 gauge 1 inch needle.
  Injection should be given deep IM Z-track in the
  hip, twice weekly for four weeks then once weekly
  for four weeks, then PRN. Alternate hips each
  time injection is given. Oral magnesium should
  be taken daily.

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Magnesium References

• 1. Consider Magnesium Homeostasis Staging of
  Magnesium Deficiencies, Mansmann, HC, MD,
  Pediatric Asthma, Allergy and Immunology,
  19937(4)211-215.
• 2. Electrophysiological Effects of Fenfluramine
  or Combined Vitamin B6 and Magnesium on Children
  with Autistic Behavior, Martineau, J, et al,
  Developmental Medicine and Child Neurology,
  198931721-727.
• 3. Clinical Aspects of Chronic Magnesium
  Deficiency, Seelig, MS, Magnesium in Health and
  Disease, New York, Spectrum Publishing, 1980.
• 4. Magnesium Deficiencies and Therapeutic
  Uses, Matz, Robert, MD, Hospital Practice, April
  30, 1993 79-92.
• 5. The Importance of Magnesium in the Management
  of Primary Postmenopausal Osteoporosis, Abraham,
  GE, MD, et al, Journal of Nutritional Medicine,
  19912165-178.

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Magnesium References

• 6. Serum and Salivary Magnesium Levels in
  Migraine and Tension-Type Headache Results in a
  Group of Adult Patients, Sarchielli, Paola, et
  al, Cephalgia, 19921221-7.
• 7. Magnesium in Psychotherapy, Hofle,K
  Magnesium Research, 1988.
• 8. Central Nervous System Magnesium Deficiency,
  Langley, WF, Arch Internal Medicine, 1991
• 9. Behavior and Magnesium Metabolism,
  Henrotte,JG, Magnesium, 1986.
• 10. Clinical Review The Clinical Importance of
  Hypomagnesemia, Juan, David, Surgery, 1982.
• 11. Magnesium Growing Clinical Importance,
  Altura, Burtaon, et al, Patient Care, 1994.

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• Implementing
• Nutritional Analysis
• and Treatment
• Can Save and Improve Lives