Nancy O’Hara, M.D. 150 Danbury Road Wilton, CT 06897 drohara

1. Our CanariesWhy All The Asthma, Allergies, ADHD and ASD?Autism OneSaturday, May 23, 2009Chicago, IL Nancy O’Hara, M.D. 150 Danbury Road Wilton, CT 06897 www.drohara.com

3. Genetics Don’t Cause Epidemics • Increases Over the Past 20 Years • Autism: 6000% Increase • 1/10,000 to 1/150 (Fombonne et al, JAACAP, 2001) • ADHD: 400% increase 7x increase in prescriptions (Swanson et al, Neuropsych Rev 2007) • Asthma: 300% Increase • Allergies: 400% Increase • Diabetes: 103% Increase 5 x increase in <5 year old (Bingley, 2007)

4. The Perfect Storm:Four Catastrophic Changes • Toxin Proliferation • Hydrocarbons • Heavy metals • Other (hormones, antibiotics, chemicals) • Nutrition Deterioration • Vaccination Rates Increased (3 -> 34) • Ability to Detoxify Decreased • Debilitation of Methylation and Sulphation

5. Oxidative Stress Toxins Inflammation Pieces of the Puzzle Impaired Glutathione and Sulfate

6. Toxins - Metals • Mercury • Lead • Arsenic • Other

7. Mercury Sources • Vaccines (187.5 mcg mercury) • Amalgams • Fish • Environmental • Foundries (coal – burning) • Medical/dental waste • Fluorescent bulbs

8. Mercury – Amalgams • Approximately 17mcg of mercury released from one amalgam daily (mostly from chewing) • 8 amalgams ~ 136 mcg mercury vapor released daily • 15 % (17mcg) absorbed daily • Travels from blood to all organs and cells • Mercury can concentrate in placenta during gestation and in fetuses (liver, kidney tissue) and infants (kidney, brain tissue) • If >8 amalgams, statistically significant increase in autism • 17 mcg/day absorbed by pregnant mother • 270 during pregnancy • 4590 mcg during gestation

9. Mercury Fish • 6 oz (170 grams) flounder = 42.5 mcg Hg (0.6 mcg/kg for 70 kg man) • 6 oz swordfish = 2.4 3 mcg/kg • Most in swordfish, shark, tuna and sea bass • Mercury affects fertility – Hong Kong study • Subfertile (4.5 ppm) males had 40% more mercury than fertile (3.9 ppm) males • Vegetarians – very low levels of mercury (0.38 ppm)

10. Texas autism rates, by school districts Potential association between autism rates, environmental mercury other toxins in TexasPalmer, et al., Health and Place, 12 (2006) 203–209 1990-1993 1998-2000

11. All Reporting Facilities, All ChemicalsTRI-(1987-2002) Map shows 3,683 of 48,205 facilities reporting nationwide On average, for each 1000 lb of environmentally released mercury, there was a 43% increase in the rate of special education services and a 61% increase in the rate of autism.Palmer et al. Health & Place 12 (2006) 203–209 Autism rates Total toxicity Chemicals-TRI (Toxic Release Inventory)

12. United Nations Environment Program Global Mercury Assessment, 2002

13. Lead • Poisons developing nervous system • Decrease in IQ (inverse correlation between IQ and blood levels at all ages (British Medical Journal 1996) • Abortifacents

14. Lead Sources • Metal Foundry • Poorly regulated factories engaged in metal finishing, grid insertion, welding, casting • Herbal Pills, cosmetics • Cans, ceramics with lead solder • Chili powder • Cooking with Petroleum • Toys painted with lead paint • Exhaust emissions from leaded petrol • Insecticides • Lead pipes • Burning of newspapers, batteries

15. Other Heavy Metals and Toxins • Arsenic • Pressured-treated wood • Inorganic chickens (plus fed fish meal) • Cadmium (industrial, incinerators) • Antimony (flame retardants – Australia study: SIDS) • Food additives • MSG (neurotoxin) • Fluoride • China study: 7 point decrease IQ in community with high fluoride levels

16. Toxins - Chemicals • 80,000 manmade chemicals • Need 6,320 million tests to evaluate pairs • 9 tested pesticides • 7 of 9 found to be neurotoxins • None have been banned

17. Chemicals • PCBs/dioxins • Disrupt thyroid and other hormonal loops • Depress vitamin A • Alter serotonin synthesis • Impair cognition • Depress IQ • Increase preservative behavior in newborn monkeys fed levels commonly found in human BM (Rice, EnvRes, 1999)

18. Chemicals • PDBE • Flame retardant • Endocrine effects • Perchlorates • Rocket fuel, fireworks • Endocrine effects • Pesticides and Herbicides • Carcinogens, neurotoxins (Vibera, ToxAppPharm, 2003)

19. Phthalates & Bisphenol A (BPA) • Sources • Plasticizers (#3 & #7) • PVC • Polycarbonate • Food wrap • High Correlation allergic rhinitis, eczema, asthma and house dust concentration of phthalates

20. Genetic Predisposition • “Genes load the gun, environment pulls the trigger” (Sudhir Gupta, MD) • Results in toxicities, nutritional deficits, infections, inflammation, immune dysfunction • Epigenetics • DNA of cell switched on/off -> profound function changes (Anway et al, Science, 2005)

22. Oxidative Stress Toxins Inflammation Pieces of the Puzzle Impaired Glutathione and Sulfate

25. Glutathione • Detoxifies heavy metals and chemicals • Antioxidant • Preserve mitochondrial integrity and promotes ATP production • Protects lining of gut • Promotes normal T cell function

26. Oxidative Stress Toxins Inflammation Pieces of the Puzzle Impaired Glutathione and Sulfate

27. THE IMMUNE-GUT-BRAIN AXIS

28. Development of Mucosal Immunity • Balance of good and bad flora • Healthy gut flora: • Plays a crucial role in maturation of the immune system • 70% immune system in gut (sIgA) • Sub-optimal stimulation of the sIgA-dependent mucosal barrier function → increased frequency of: • allergies & asthma • autism • inflammatory mucosal disorders • Increased Risk of Systemic Inflammation

29. Dysbiosis A state of imbalanced microbial ecology both bacterial & fungal that contributes to disease The overgrowth of micro-organisms of low intrinsic virulence induces disease • by altering the nutritional status and/or • the immune response of the host • elimination capacity

30. How does it all fit? • Maternal presence of decreased Ω3 & increased Ω6, leads to increased inflammation • Commensal flora cultivated over 1st 2 years of life provides the baseline for immune development • Early introduction of solid foods, esp. grains and sugar alters flora • Early vaccination stimulates TLRs (innate immune system) and exacerbates TH1/TH2 imbalance and dysregulation!

31. What lies behind us and what lies before us are small matters compared to what lies within us.

32. How Does It All Fit?The Immune Load • Pathogens Overload (viruses, bacteria, yeast) • Antibiotic Use (depletion probiotics) • Insufficient Nutrient Load (Poor diet, junk foods) • Digestive enzyme deficiency (Lactose) • Vaccination Excess • Stress

33. How Does It All Fit?What Does It Mean • Digestive impairment • Inflammation, leaky gut • Immune deficiency  greater susceptibility to dysbiosis, inflammation, and food sensitivities  further immune deficiency (vicious cycle) • Yeast overgrowth, bacterial dysbiosis

34. Oxidative Stress Toxins Inflammation Pieces of the Puzzle Impaired Glutathione and Sulfate

35. Factors Contributing to Oxidative Stress Inflammation Infection ASD ADHD LD Genes Environment Hormones Gut Inflammation Brain Inflammation Immune dysfunction Timing

36. Four Phases of DetoxificationAbnormalities Found with Oxidative Stress • Phase I – keeping toxins in gut to safely exit body (dysbiosis, impaired immunity, slow transit) • Phase II – toxins moved from gut to liver and converted into water-soluble material; “make sticky” (antioxidants, silymarin) • Phase III – Conjugate toxins with detoxifying nutrients (GSH, taurine, NAC) • Phase IV – Alkalinity more efficient

37. What Can We Do? • Reduce and Eliminate Further Exposure • Efflux Existing Toxins (Detoxification) • The Three R’s • Remove (germs, allergens, toxins) • Replenish (nutrients, good foods, probiotics) • Repair (inflammation, malabsorption, methylation)

38. Reduce Further Toxins • Remove Amalgam Fillings • Reduce Seafood (tuna, shark, swordfish, sea bass) • Eat Organic Chicken • Filter Water • Eliminate Pollutants • Avoid Vaccination containing mercury (flu)

39. Avoid Further Toxins • Avoid lead • www.cehca.org • www.leadcheck.com • Avoid #3 (PVC), #6 (styrene) and #7 (BPA) plastics • www.checnet.org

40. Enhance Output of Toxins • Correct constipation – all stool is toxic • Maintain good hydration/fiber intake • Maintain alkalinity (diet, HC03) • Exercise to sweat

41. Keep Your Faith in All Beautiful Things: In the sun when it is hidden, in the spring when it is gone.

42. What do we need to give to or get out of our children? • Exercise/Activity • Basic nutritional changes (change in diet..) • Fresh, unprocessed, unrefined, unadulterated • Varied and rotational (try to vary day to day) • Non-allergenic (crave that which most sensitive to) • Protein (every 4-5 hours) • Vegetable juicing • Organic (especially pears, apples, peppers, celery, strawberries, cherries, grapes, spinach, lettuce, potatoes)

43. What To Do? • Treat Constipation • At least 1 normal stool/day • Mg • Vitamin C • Fiber • Senna • Diet changes

44. What To Do? • Remove • Junk food, sugar, and other empty calories • Food additives – Artificial Sweeteners (Aspartame), MSG, Dyes, Preservatives, etc • Raw animal food/unpasteurized food – risk of food-borne illness • Food Sensitivities – yours and those of your affected child • Instead of Gluten, consider quinoa, amaranth, millet, rice or other grains • Instead of Casein, consider potato or almond milk

45. What To Do? Remove Germs • Bacteria (history of positive response to antibiotics) • Virus • Monolaurin (Lauricidin) • Valtrex • Cyclovir (acyclovir, valacyclovir, famcyclovir, gancyclovir) • Virastop • Fungus • Antifungal medication (Nystatin, Diflucan, Sporonox, Lamisil, Nizorel) • OTC (Citrus extract, caprylic acid, saccharomyces boulardii) • Diet (not because yeast in our diets is infective…) • Parasites (have to treat) • B hominis (treat with Bactrim and Humatin or Yodoxin or herbals)

46. What To Do? • REMOVE AMALGAMS – When? How? • At least 3 to 6 months before conception while under the care of a competent/holistic Physician and Dentist • PRE-Amalgam replacement regimen • Start at least 3-4 wks prior • Consider a good Probiotic, Glutathione, Vitamin C, Vitamin E, Milk thistle, B-Vitamins, Zinc, Magnesium, etc. • Consider taking Activated Charcoal 15 minutes before procedure starts (to help bind swallowed mercury and prevent circulation of the metal) AND immediately after the procedure • POST-Amalgam replacement regimen • Continue at least 4 to 6 weeks after • As above plus… consider IV Vitamin C within 24 hours of procedure, double glutathione dose, amino acid complex (mercury may deplete or impair utilization of several amino acids, far infrared sauna therapy 3x/week

47. What To Do? Replenish and Support Digestion • Enzymes (speeds disassembly of foods; • -ase) • Mixed (helps kids with poor digestion) • Plant based (papaya and pineapple) • Peptidase specific (helps specific peptide digestion) • Symptomatic (yeast die off) • Activated charcoal (mop up toxins) • Alka Seltzer Gold (alkaline)

48. What To Do? • Replenish Probiotics • Promote growth of healthy flora • Discourage pathogens • Support digestion • Produce SCFAs, reduce pH, synthesize vitamins • Control inflammation and promote oral tolerance • Encourage peristalsis • Minimum of 10 billion CFU/day, often > 50 billion CFU/day

49. What To DoFatty Acids and Immunity • ESSENTIAL FATTY ACIDS (EFAs) • DHA more important during pregnancy and breastfeeding periods (DHA is in breast milk, not std formulas) • Associated with brain development, visual acuity and decreased inflammation • Maternal DHA levels ↓ in 3rd T – 200 mg/day DHA increases level in mom, but need higher doses (~1000 mg/day) to also ↑ levels in infant. • Take with antioxidant (Vit E) to prevent free radical damage • Make sure product is pure • Sources: tilapia, trout, DHA-rich eggs (if not allergic)

50. What To DoFatty Acids in Childhood Both DHA and EPA are important (any ratio of 33-66% DHA:EPA is recommended) Dosages need to be tailored in line with severity of the condition. Children 1-4 yrs 600-1800mg DHA/EPA per day Children 4-12 yrs 1000-3500mg DHA/EPA per day