David Berger, MDDavid Berger, MDBoard Certified PediatricianBoard Certified Pediatrician

3341 W. Bearss Avenue3341 W. Bearss AvenueTampa, FL 33618Tampa, FL 33618(813) 960-3415(813) 960-3415

www.wholisticpeds.comwww.healinghyperbarics.com

“Prevent Harm Now: How to Carry, Birth, and Raise a Healthy Child in a

Toxic World”

Topics of DiscussionTopics of Discussion• Preconception/Prenatal

Counseling• Childbirth• Vaccines• Nutrition• Avoiding and Removing Toxins• Combating Infectious and

Inflammatory Diseases

Pre-Pregnancy PlanningPre-Pregnancy Planning• Don’t allow any mercury containing products to enter the

body for 6 months prior to conception.• Have all amalgam fillings removed 6 months prior to

conception. Go to www.iaomt.org for a qualified dentist. Consider chelation after removal.

• Specific tests that I have ordered on the mother to better assess her health and the environment that the fetus will develop in:– Blood lead levels and porphyrin levels, – glutathione, cysteine, sulfate, homocysteine, amino

acid, organic acids (to assess current methylation pathway status)

– opiate peptides– yeast cultures – fatty acids profiles– Amino acid profiles– chelation challenge test

Genomic/Genetic TestingGenomic/Genetic Testing•Various laboratories are able to run testing that look for the presence of single DNA polymorphisms •The advantage of running these tests are that certain supplements can be suggested based on the DNA patterns to try and overcome these polymorphisms •These tests can be costly•Some people choose to test the mother only since she will provide the environment for the developing fetus•There is concern that the identification of a polymorphism may than label someone with a pre-existing medical condition, affecting the ability to get (or increase the cost of) health insurance

Jill James, 2004 Assessment of Jill James, 2004 Assessment of Single Nucleotide Polymorphins in Single Nucleotide Polymorphins in Children with Autism vs. ControlsChildren with Autism vs. Controls

Pre-Pregnancy and Pregnancy Pre-Pregnancy and Pregnancy NutritionNutrition

• Eat Organic – as much as possible• Avoid processed foods and additive/colorings• Increase protein intake; eat protein whenever

carbs are consumed. This can reduce the likelihood of gestational diabetes

• A good daily multivitamin (there are many, I prescribe FemOne from Metabolic Maintenance; it is 1 capsule daily)

• Fish Oil – High Potency, enteric coated products are better tolerated, especially for pregnancy women. Can freeze if still an aftertaste. Aim for about 1-2 gm combined EPA/DHA daily. I use Xymogen OmegaPure 600EC (360EPA, 240DHA)

• Calcium – 1000-1200 mg daily

(GENERAL CONSIDERATIONS)

Pre-Conception and Pregnancy Pre-Conception and Pregnancy SupplementsSupplements

Methylation/Glutathione Pathway Support– MB-12/folinic acid: at a minimum, used as a nasal

spray prepared by one of the many fine compounding pharmacists. 1250mcg MB-12 and 300mcg folinic acid per dose, to use 1 spray twice a day.

– MB-12: consider SQ injections, with a minimum dose of 2500mcg every 3 days.

– Folinic acid or Folapro: 800mcg a day. Back down to 400mcg daily if having negative reactions.

– glutathione: preferably used daily as an inhaled nebulizer or TD emu oil cream (200mg 1-2 times a day) or as oral lipoceutical (ie: Essential GSH, at ½ tsp daily).

– N acetylcysteine – I only use this with documented low plasma cysteine levels. 100mg twice a day. Can exacerbate yeast infections.

Things to ease Labor and Things to ease Labor and DeliveryDelivery

• During last trimester– Perineal Stretching Massage:

www.childbirth.org/articles/massage.html– Hypnobirthing: www.hypnobirthing.com

• To Induce Labor– Plenty of walking– Borage or Evening Primrose Capsules as a vaginal

suppository to soften the cervix– The Big “O”. Sexual Intercourse can induce or speed

up labor, especially if orgasm can be obtained.– Try to avoid artificial induction, such as the use of

pitocin. The woman’s body knows when it is ready to deliver. Pitocin may induce contractions before the cervix has been fully ripened, and often leads to a c-section when it fails

• During actual Labor– Water Birth: www.waterbirth.org

Benjamin’s BirthdayBenjamin’s Birthday

Additional Tips during Additional Tips during ChildbirthChildbirth

• A due date given based on ultrasound is estimated not definitive. The medical term for the due date is “Estimated date of confinement”.

• It is very common, and safe, for women (especially for first pregnancy) to go to 42+ weeks gestation– Non invasive testing of the fetus can be

performed with increased frequency after 40 weeks to make sure the baby is fine

• Breastfeed the baby as soon as it is deemed that the baby is stable– Babies usually have a window of wakefulness

right after birth where they are most likely to latch and give a good suck

– Nursing even before deliver of the placenta may help expel the placenta and minimize maternal blood loss as stimulating the mother’s nipples will cause the uterus muscles to contract

Infant NutritionInfant NutritionThe Importance of BreastfeedingThe Importance of Breastfeeding

•According to the Academy of Pediatrics, babies should be breast-fed for a minimum of one year and longer if desired. •Benefits of Breastfeeding include:

•Lower rates of obesity for child later in life•Reduced incidence of gastrointestinal, ear and respiratory infections (and therefore antibiotic exposure) in the child•Increased IQ in the child•Decreased incidence of Diabetes in the child•Decreased Incidence of Breast and other Cancer in the Mother

More Breastfeeding InformationMore Breastfeeding Information• Especially to establish supply, babies should be

nursed 10-12 times a day, ad lib, not scheduled• Breastfeeding is not supposed to be a painful

experience. If the mother has discomfort, it usually indicates that an improper latch.

• There are very few medications or herbs taken by the mother that would be contraindicated during breastfeeding

“Medications and Mother’s Milk” by Thomas Hale, PhD www.kellymom.com

Formula FeedingFormula Feeding• If a child must be formula fed and there is

already a child in the family with a neurodevelopmental disorder or a family history or allergies , the family can consider using one of the hypoallergenic predigested formulas instead of the standard cow milk or soy formula. – Nutramagen – Alimentum– Pregestimil• If a family is choosing to use a more standard

formula, organic versions are now available.• All baby formulas now should contain omega-

3 fatty acids, which was added to simulate breast milk.

Solid FoodsSolid Foods• All nutrition that a baby needs until 1 year of age is

provided in breast milk or formula• Babies are usually “ready” to eat when they start grabbing

at food from the parent’s plate• The earlier that a child is introduced to food the more

prone they are to developing food allergies• I recommend waiting until at least 6 months of age to

introduce any food• As children are introduced to solid foods, it is important to

try to establish early vegetable intake; even more so than fruit intake. I first introduce the various vegetables, one new food every 4 days to watch for reactions, and then bring in the fruits and meats. If a child starts to reject the vegetables on introducing the fruit, I stop the fruit for a while to continue the establishment of vegetable intake

• I recommend avoiding all processed foods and foods that have food coloring, additives, and preservatives as much as possible. I also encourage families to use whole as opposed to processed grains.

IMMUNIZATIONSIMMUNIZATIONS• I am not suggesting that we abandon our

vaccination policy• I am concerned about the growing number of

chronically ill children• There are more children with learning disabilities

and autoimmune disorders then there has ever been in the history of medicine.

• I will be discussing general concepts today, not each vaccine. For more information on this topic, I recommend Dr Stephie Cave’s book, “What Your Doctor May Not Tell You About Children's Vaccinations “

Concerns about VaccinesConcerns about Vaccines• Are we unnaturally stressing

underdeveloped immune systems beyond their capabilities in our effort to keep the children from becoming ill?

• There are inadequate safety studies for the vaccines that are currently on the market

• Are we giving too many vaccines over a short time span?

• We do not have a clear understanding of the effects of some of the vaccine components such as thimerosal, aluminum, formaldehyde, and human fetal tissue.

Immunizations - When to Give?Immunizations - When to Give?• Hepatitis B vaccine is again being recommended to give at

birth. – I see no point in this if mom is (-) on prenatal blood test. If

(+) I would give the vaccine plus the Hep B immunoglobulin• All other vaccines, except for MMR and Varicella, are

recommended to start at 2 months old– I have concerns about stressing the immune system at such

a young age– I discuss the possibility of delaying and/or splitting the

vaccines. • I recommend only giving vaccines when healthy, and waiting at

least 2 weeks after an illness or upon completing an antibiotic before giving an immunization.

• There are certain supplements I give before and after vaccines. – High dose vitamin A twice a day, the day before, of, and

after– Vitamin C, zinc and Echinacea or Larix from 3 days before to

3 days after– Specific doses are the same as listed on the article entitled

“On the First Signs of Illness” found on the Medical Topics tab at www.wholisticpeds.com

Immunization TitersImmunization Titers• Disease immunity/succeptability can be determined by

running an IgG titer for that particular infection. I typically run an IgG level for each vaccine preventable disease, about 6 months before starting Kindergarten. Then family can make an education decision on how/if to proceed and not expose a child to something they don’t need.

• For Measles, Mumps, Rubella, and Polio, positive titers would indicate long term immunity. I do not retest these.

• We used to think the same for Varicella, but patients are now showing not protected after 1 vaccine. I would repeat the titer at 10-11 years old

• For Tetanus and Pertussis, protection wears off over time. Rarely are kids protected for Pertussis at 5 years old. Usually they are still protected for Tetanus at this age. If so I would repeat the titer every 1-2 years.

Toxins - Polychlorinated biphenyls (PCBs)

•a mixture of synthetic chlorinated compounds which were banned from manufacturing in the US in 1977 but now pollute our waterways, air and soil.

•They particularly accumulate in fat once an organism has inhaled or ingested the PCB.

•According to the FDA these substances break down very slowly are still being released into the environment. PCBs can still be released to the environment from hazardous waste sites; illegal or improper disposal of industrial wastes and consumer products; leaks from old electrical transformers containing PCBs; and burning of some wastes in incinerator.

•Exposure to PCBs can produce acne-like skin conditions, and neurobehavioral and immunological changes in children. PCBs are known to cause cancer in animals.

•It is currently not possible to avoid PCBs, but certain measures can be taken to reduced exposure, such as by avoiding eating fish and game birds, and higher fat animal products.

•Whole Milk has a higher PCB content than skim milk. Farm-raised fish has higher contents than wild fish (salmon in particular has been studied for this).

•The FDA now recommends that “children not play with old appliances, electrical equipment, or transformers, since they may contain PCBs. Children should be discouraged from playing in the dirt near hazardous waste sites and in areas where there was a transformer fire. Children should also be discouraged from eating dirt and putting dirty hands, toys or other objects in their mouths, and should wash hands frequently”

PCBs (cont)

Organophosphates• Organophosphates are the basis of many

insecticides and herbicides. The can also run-off into waterways and pollute the water supply.

• Organophosphates are widely used as plasticizers and solvents.

• These substances are toxic because they alter the metabolism of acetylcholine, which causes the overstimulation of nerves and muscles.

• Measures that can be taken to decrease organophosphate exposure include buying certified organic fruits, vegetables and meats, washing commercially grown produce in a diluted soap solution or Veggie Wash, avoid the use of toxic pesticides in the home and yard (opt for natural pesticides and other products used in organic farming), and avoiding flea treatments or lice shampoos that contain these substances.

• In general, fish oil supplements have removed the PCB and Organophosphates during the manufacturing process (Melanson, Arch Pathol Lab Med. 2005)

Bisphenol-ABisphenol-A• A substance found in certain plastics

(including certain water and baby bottles), the linings of cans, and dental sealants that can mimic estrogen, which may cause hormone disruption

• May have effects on the developing fetus• Exposure to Bisphenol A is associated with

recurrent miscarriage. (Mayumi , 2005)• Calcium d-glucurate may help the body

clear Bisphenol-A• http://www.bisphenolafree.org/

Heavy MetalsHeavy Metals• Over the past decade, biomedical physicians have been

expressing concerns about exposure to heavy metals. • There has been much discussed about the mercury in

vaccines and other medications as well as in fish. In 2001, the American Academy of Pediatrics stated “Mercury in all of its forms is toxic to the fetus and children, and efforts should be made to reduce exposure to the extent possible to pregnant women and children as well as the general population”.

• More recent attention has been given to the exposure that our children have received to lead. Over 27 million toys have now been recalled due to toxic lead paint. Only a fraction of the toys that are being sold have been tested for the presence of lead. As recently as last month, there have been reports that up to 30% of inexpensive toys purchased at local retailers contained high levels of lead (and these toys have not been recalled). At this time, I recommend that no child be permitted to put any toys in their mouth if it has paint on it and is made in China.

Ways to Test for Heavy Ways to Test for Heavy MetalsMetals

• In the Home– “Over the Counter”

tests– X-ray fluorescence (XFR) technology

• In the Person– Blood Levels– Porphyrin Levels (urine and blood)– Chelation Challenge test

• DMSA, DMPS, CaNa2 EDTA• Oral, IV, Rectal

Advantages to CaNa2 EDTA Advantages to CaNa2 EDTA SuppositoriesSuppositories

• CaNa2 EDTA is FDA approved• USUALLY an easy delivery system• Does not seem to exacerbate

intestinal pathogens with the frequency of DMSA/DMPS.

• Seems to be very well tolerated. I have yet to see any negative reactions with Detoxamin

Urine Lead and Mercury Levels Pre vs. Urine Lead and Mercury Levels Pre vs. Post Rectal CaNa2 EDTAPost Rectal CaNa2 EDTA

Chart review, taking 23 consecutive patients, during Spring and Summer 2007

Patients were given Detoxamin with baseline and 8 hour post-urine collected.

Families were instructed to insert suppositories after the child had a bowel movement.

Using 375mg and 750mg suppositories in combination, with doses of 35-50mg/kg

All patients giving TD glutathione (300-600mg per dose) the night before and then at time of suppository

All patients were currently on cod liver oil, epsom salt baths and some version of (Super) Nu Thera

All urine specimens were analyzed by Doctors Data Lab.

Statistic analysis performed by Harvey Abrams, PhD , Director of Audiology Research, Walter Reed Medical Center

• Most of the time, an infectious disease is a virus, not a bacteria•It is estimated that almost 70% of antibiotic prescriptions that are written in America are not actually needed.•Newer mainstream research shows that except in patients with certain conditions, ear and sinus infections will resolve on their own over time and do not need antibiotics•There are certain supplements that can be given when a person first starts to get sick that can significantly reduce the likelihood that an infection will linger or develop into a secondary infection. This information can be found on the Medical Topics section of our webpage in the article entitled “On the First Signs of Illness”•Tests that can be performed to further evaluate for bacterial Infections and the need for antibiotics: CBC blood counts, C-Reactive Protein levels, blood cultures, urinalyses, urine cultures, chest x-rays, throat cultures • If it is determined that a child needs to take antibiotics, I always simultaneously administer high doses of probiotics, including beneficial bacteria, as well as Saccharomyces ( a friendly yeast) to keep Candida and Clostridia under control.

Bacterial vs. Viral Infections

Issues Related to the Overuse Issues Related to the Overuse of Antibioticsof Antibiotics

• The more often a given antibiotic is used, the less likely it or something similar will work in the future

• The more often that a child takes an antibiotic, the more likely that he/she will have an intestinal overgrowth of pathological yeast or bacteria.

• These organisms may lead to increased intestinal permeability (leaky gut) which then permits undigested food particles and other toxins to enter the blood stream which ordinarily should pass through the intestinal system unabsorbed.

• This can increase the potential for hypersensitivity reactions, hyper-inflammatory conditions and autoimmune diseases.

Evaluation of Patients with Evaluation of Patients with Chronic Diseases Chronic Diseases

• When I have a patient who is neurotypical and has allergies, asthma, , or autoimmune diseases, I perform a similar biomedical workup that I would conduct on a patient on the Autism Spectrum.

• Often we can minimize or even eliminate the abnormal condition by using dietary manipulation, nutritional supplementation treating intestinal pathogens, hormone balancing, heavy metal chelation, and Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Hyperbaric Oxygen TherapyTherapy

• Conditions That May Benefit– Autism/ADD– Athletic injuries– Autoimmune Diseases– Hyperinflammatory Conditions– Chemotherapy/Radiation Recovery– Rheumatic Diseases– Eczema/Psoriasis– Wound Healing (Diabetic, Post-Op and Other)

• Physiological Benefits – Increases oxygen to tissues– Increases blood flow to tissue– Reduces inflammation– Improves Neurotransmitter Imbalances

Hyperbaric Oxygen TherapyHyperbaric Oxygen Therapy(Our Proposed Study)(Our Proposed Study)

• This would be the first University based, placebo-controlled, blinded study ever performed using HBOT on children with Autism

• Joint project between Wholistic Pediatrics, USF Child Psychiatry, and USF Critical Care Medicine.

• 36 patients with Autism, ages 2-4, will be divided into treatment and placebo group. Placebo group will be offered therapy after they are done with Placebo

• Assessments will be done 2 months prior to starting treatment, immediately before starting treatment, immediately after 2 months of treatment, and 2 months after treatment has finished.