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Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition

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The role of thiamine and diet in the development of Autism Spectrum Disorders

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Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition

  1. 1. Lucine Health Sciences, Inc. | Hormones Matter Thiamine Deficiency Disease Dysautonomia, and High Calorie Malnutrition Calorie Malnutrition
  2. 2. Lucine Health Sciences, Inc. | Hormones Matter Introduction Who, what and why.
  3. 3. Lucine Health Sciences, Inc. | Hormones Matter
  4. 4. Lucine Health Sciences, Inc. | Hormones Matter Authors Derrick Lonsdale, MD, FACN, CNS, retired • Cleveland Clinic, Pediatrics 20 years • Head of Biochemical Genetics • Private practice 20 years specializing in nutrient-based therapy. • Over 100 published papers in medical journals • 68 articles on Hormones Matter
  5. 5. Lucine Health Sciences, Inc. | Hormones Matter Authors Chandler Marrs, MS, MA, PhD • Independent research scientist, writer, women’s health, mitochondria • Neuroendocrinology, maternal health • Academic articles on maternal health • Lucine Health Sciences, Hormones Matter • Medication/vaccine adverse reactions research • 250 articles published on Hormones Matter • Micronutrient Deficiencies and Mitochondrial Dysfunction. In Integrative Therapies for Depression. J Greenblatt and K Brogan, Eds.
  6. 6. Lucine Health Sciences, Inc. | Hormones Matter What I Do Officially
  7. 7. Lucine Health Sciences, Inc. | Hormones Matter What I Really Do o150,000+ monthly views o1200+ articles and growing o150 guest contributors/writers • 18 PhDs, 5 MDs, 2 DPTs oThousands of comments Cause trouble.
  8. 8. Lucine Health Sciences, Inc. | Hormones Matter Listen and learn
  9. 9. Lucine Health Sciences, Inc. | Hormones Matter And try to untangle The untanglible.
  10. 10. Lucine Health Sciences, Inc. | Hormones Matter What I have learned oEnvironment matters • Perhaps more than genetics oHealth and disease are both sudden and slow • Thresholds and tipping points oAll about the mitochondria • Mitochondria determine everything • At nexus of disease and health • Cause and consequence And thiamine is really that important.
  11. 11. Lucine Health Sciences, Inc. | Hormones Matter Thiamine and Mitochondrial Function An indissoluble relationship
  12. 12. Lucine Health Sciences, Inc. | Hormones Matter What is thiamine? oVitamin B1 (thiamin, thiamine) found in • Lean pork, poultry and other meats, wheat germ, liver and other organ meats, eggs, fish, beans, peas, nuts, whole grains, garlic. oAntagonized by • High carbohydrate/sugar diets, coffee, tea, betel nuts, raw fish • Many (all) pharmaceutical, environmental, and industrial chemicals oCritical for • Mitochondrial energy production, protein expression, and general function, and array of CNS/PNS functions
  13. 13. Lucine Health Sciences, Inc. | Hormones Matter Why is thiamine important oCofactor for multiple enzymes involved in mitochondrial energetics • Transketolase • Pyruvate dehydrogenase complex (PDC) • Lactate dehydrogenase (LDH) • Alpha ketoglutarate dehydrogenase (a-KDH) • Branched-chain alpha-keto acid dehydrogenase (BCKDH) • Alpha oxidation in peroxisomes (HACL1) oOften works together with other co-factors • Magnesium • Riboflavin (B2) • Alpha lipoic acid (ALA) Without thiamine, mitochondrial respiration grinds to a halt.
  14. 14. Lucine Health Sciences, Inc. | Hormones Matter Thiamine is critical for ATP production And ATP is critical for life.
  15. 15. Lucine Health Sciences, Inc. | Hormones Matter Thiamine and hypoxia oMolecular oxygen consumption • Whether and how effectively blood oxygenation occurs depends upon vitamins and minerals • Hypoxia absent obstruction HIF signals ~100 other proteins involved in: angiogenesis, erythropoiesis, iron and glucose metabolism, growth factors and apoptosis.
  16. 16. Lucine Health Sciences, Inc. | Hormones Matter An aside: HIF and women’s health Endometriosis and Heavy Menstrual Bleeding: Two Sides of the Same Molecular Coin • Endometriosis • HIF controls spread of endometriotic lesions • Invasion into other tissue • HIF supra-elevated • Heavy menstrual bleeding • Decreased HIF • Both involve mitochondrial survival cascades
  17. 17. Lucine Health Sciences, Inc. | Hormones Matter Thiamine regulates protein expression oSuccinate thiokinase forms forms a multienzyme complex with the alpha-ketoglutarate catalyzes succinyl- CoA>succinate oSuccinate dehydrogenase oxidizes succinate to fumarate and uses the electrons generate to catalyze reduction of ubiquinone to ubiquinol for complex II (TCA>ETC linkage) o20% ↓ Malate dehydrogenase = ↓ ATP from 38 to ~13 units (in culture) o↓ Pyridoxal kinase: dietary vitamin B6 into the active cofactor form pyridoxal 5′-phosphate (PLP)
  18. 18. Lucine Health Sciences, Inc. | Hormones Matter Thiamine insufficiency or deficiency oReduced ATP • Reduced cellular energy: spotty energetics • Reduced oxygenation – chronic, low level hypoxia • Mitochondrial dysfunction, apoptosis and necrosis • Misfolded proteins oIncreased compensatory survival signals • HIF • Inflammation • ROS • Mitochondrial death spiral Reduced ability to meet bioenergetic demands of everyday stressors
  19. 19. Lucine Health Sciences, Inc. | Hormones Matter Traveling PDC Enzyme
  20. 20. Lucine Health Sciences, Inc. | Hormones Matter
  21. 21. Lucine Health Sciences, Inc. | Hormones Matter If thiamine is that important Why don’t we monitor it?
  22. 22. Lucine Health Sciences, Inc. | Hormones Matter If we think of thiamine deficiency oWe think of late stage, frank deficiency in specific populations with purely neurological symptoms • Wernicke’s encephalopathy in chronic alcoholics • Ataxia, nystagmus, confusion/memory loss oWe miss the earlier symptoms in this and other populations • And we mostly miss Wernicke’s too • 80% of alcohol related Wernicke’s missed 1 • 58% of pediatric Wernicke’s missed2 • Unknown % of hyperemesis gravidarum Wernicke’s missed • Only 16% cases exhibit classic triad1 1. J Neurol Neurosurg Psychiatry. 1986 Apr;49(4):341-5.; 2. Pediatr Neurol. 1999 Apr;20(4):289-94.
  23. 23. Lucine Health Sciences, Inc. | Hormones Matter Lonsdale & Marrs, 2017
  24. 24. Lucine Health Sciences, Inc. | Hormones Matter We don’t consider the broader population o76% of diabetics (type 1 and type 2) o29% of obese patients, 49% post bariatric surgery o40% of community dwelling elderly, 48% of elderly patients in acute care o55% of cancer patients o20% ER patients (random sample, UK) o33% congestive heart failure patients o38% pregnant women, more with hyperemesis o30% psychiatric patients Lonsdale & Marrs, 2017
  25. 25. Lucine Health Sciences, Inc. | Hormones Matter Partly because oWe fail to recognize • More subtle, metabolic disturbances • Mitochondria regulate metabolism. Starve the mitochondria of thiamine, alter metabolism. o Phenotypically distinct • Non-linear, but chronic time course of symptom development o Symptoms wax and wane before reaching critical point • That there is a problem • We solved nutrient deficiency, didn’t we?
  26. 26. Lucine Health Sciences, Inc. | Hormones Matter Reframing nutritional considerations Industrial food production and high calorie malnutrition
  27. 27. Lucine Health Sciences, Inc. | Hormones Matter Why don’t we consider thiamine in clinical care? “Only a small percentage of the population had total usual intakes (from dietary intakes and supplements) below the estimated average requirement (EAR) for the following: vitamin B-6 (8%), folate (8%), zinc (8%), thiamin, riboflavin, niacin, vitamin B-12, phosphorus, iron, copper, and selenium (<6% for all).” We think thiamine deficiency is rare.
  28. 28. Lucine Health Sciences, Inc. | Hormones Matter Fortification programs solve nutrient deficiencies “Fortification contributed greatly to intakes of many micronutrients, reducing the percentage of the population having intakes belowthe Estimated Average Requirement (EAR) without adding appreciably to the percentage having intakes above the Upper Tolerable Intake Level (UL).” Or do they?
  29. 29. Lucine Health Sciences, Inc. | Hormones Matter If we dig a little deeper “Without added nutrients, a high percentage of all children/adolescents had inadequate intakes of numerous micronutrients…”
  30. 30. Lucine Health Sciences, Inc. | Hormones Matter Where fortification and enrichment come into play High calorie malnutrition
  31. 31. Lucine Health Sciences, Inc. | Hormones Matter Junk food and nutrient sufficiency? An oxymoron.
  32. 32. Lucine Health Sciences, Inc. | Hormones Matter Dietary assumptions oImpact how we view • Food and nutrition in general • Food and poverty oFrame conversations and research on mitochondrial functioning • Calories in, ATP out • Calorie restriction = mitochondrial health
  33. 33. Lucine Health Sciences, Inc. | Hormones Matter Unpacking dietary assumptions oCalorie insufficiency sole determinant of malnutrition • So long as there are sufficient calories malnutrition is rare oEmpty calories plus enrichment and/or fortification provide nutrient sufficiency • Up to a point, this may be true oIndustrial foods are equivalent to ‘real’ food
  34. 34. Lucine Health Sciences, Inc. | Hormones Matter On the one hand oPoverty and subsistence level malnutrition in non-western countries • Limited absolute calories • Fortification postpones outright malnutrition oPoverty and subsistence level malnutrition in western countries • Adequate or excess calories • Processed foods are cheaper than real food • Fortification postpones and disguises outright malnutrition
  35. 35. Lucine Health Sciences, Inc. | Hormones Matter For example: o Autism rates for each state compared to infant nutrition • Duration of exclusive breast-feeding • Participation in WIC program • Infant nutrient levels oAssociations between • ↑ WIC =↓ autism • ↑Breastfeeding (by nutrient starved moms) = ↑infant nutrient deficiency + ↑ autism rates J Am Coll Nutr. 2011 Oct;30(5):348-53.
  36. 36. Lucine Health Sciences, Inc. | Hormones Matter Similarly oThiamine fortified foods prevent frank deficiency in non-western countries with food scarcity
  37. 37. Lucine Health Sciences, Inc. | Hormones Matter On the other hand oFood abundance and high calorie malnutrition • Partly from excess calories (3500 kcal daily) • 1.9 billion adults are overweight • 41 million children <5 years • 30-40% of Americans • Partly from industrial farming and agriculture • Even healthy food is devoid of nutrients oCalories and fortification disguise malnutrition • Thiamine dependent enzymes cannot meet the processing demands of high calorie, carbohydrate dense diets o Cannot converted ingested thiamine into TPP
  38. 38. Lucine Health Sciences, Inc. | Hormones Matter Global Report on Nutrition oMalnutrition is alive and well, even in first world countries …multiple interleaving forms of malnutrition ranging from child and adult micronutrient insufficiency to obesity. International Food Policy Research Institute. 2014. Global Nutrition Report 2014: Actions and Accountability to Accelerate the World’s Progress on Nutrition. Washington, DC.
  39. 39. Lucine Health Sciences, Inc. | Hormones Matter Digging a little bit deeper oConventional agriculture • Pesticide/herbicide drenched produce genetically modified to withstand the toxins1 • Limited genomic diversity2 • 70% of world’s diet comes from 15 crops • Cultivated out 95% of ~200,000 plant metabolites oMineral depleted soils • ~85% reduction in US and Canada3 1. 2. Daniell & Ryan 2012. DOI: 10.5772/33500; 3. Marler & Wallin, 2006. http://www.nutritionsecurity.org/PDF/NSI_White%20Paper_Web.pdf
  40. 40. Lucine Health Sciences, Inc. | Hormones Matter Conventionally grown produce oCarries high toxic load • Glyphosate plus adjuvants1,2 • Chelate minerals, • Blocks glycine (analog) • Alters vitamin A metabolism • Destroys gut bacteria • Damages mitochondria (ETC I, III), reducing ATP by 40% • Endocrine and nervous system disruptor oContains ~40 % fewer nutrients than the same foods 50 years ago3 oHigher in sugar content4 1. Serralini et. al., Seneff et al. 3. Bull Environ Contam Toxicol. 1979 Jun;22(3):357-64. 4. Daniel & Ryan, 2012, The nutrigenome and gut microbiome: chronic disease prevention in crop phytochemical diversity.
  41. 41. Lucine Health Sciences, Inc. | Hormones Matter Industrial meat production oRaised in unsanitary conditions oHeavy use of antibiotics and hormones • 85% of world’s antibiotics oPoor feed quality oHigher chemical load • EDCs banned elsewhere permitted here oHigher saturated fat content oLower micronutrient content Lonsadle & Marrs 2017
  42. 42. Lucine Health Sciences, Inc. | Hormones Matter High calorie malnutrition oPoor food quality • All sorts of nutrient deficiencies oMismatch between caloric and nutrient intake
  43. 43. Lucine Health Sciences, Inc. | Hormones Matter Restricted diet and thiamine deficiency
  44. 44. Lucine Health Sciences, Inc. | Hormones Matter What else causes thiamine deficiency • Alcoholism • Current and familial • A sweet and high-carbohydrate food-liking pattern was 48% heritable
  45. 45. Lucine Health Sciences, Inc. | Hormones Matter Thiamine deficiency • Bariatric surgery • Absorption of thiamine occurs in small intestine • Parenteral nutrition • Gut dysbiosis: both cause and consequence • Candida overgrowth, SIBO, trehalose (↑ microbial virulence)
  46. 46. Lucine Health Sciences, Inc. | Hormones Matter Pharmaceutical, environmental, and industrial chemicals damage the mitochondria and/or deplete nutrients by one mechanism or another. Toxicol Sci. 2013 Jul;134(1):1-17. doi: 10.1093/toxsci/kft102. Epub 2013 Apr 29. ; Am J Physiol Cell Physiol. 2007 Jul;293(1):C12-21. Epub 2007 May 2.; Mol Interv. 2010 Apr;10(2):98-111. doi: 10.1124/mi.10.2.7; J Child Neurol. 2014 Sep;29(9):1241-8. doi: 10.1177/0883073814538510. Epub 2014 Jul 9. Poor nutrition and high toxic load: a recipe for disaster.
  47. 47. Lucine Health Sciences, Inc. | Hormones Matter Genetic factors: transporters oGenetic/epigenetic alterations in transporters • Solute Carriers (SLC): 395, 52 families • SLC19A1: folate, but thiamine mono- and di- phospho derivatives are substrates for SLC19A1 • SLC19A2 (ThTr1): systemic thiamine transport –TRMA, most highly expressed in muscle • SLC19A3: (ThTr2): intestinal thiamine absorption – biotin responsive basal ganglia disease • SLC25A19: mitochondrial TPP carrier –Amish microcephaly • SLC35F3: thiamine, hypertension https://doi.org/10.1016/j.bbabio.2017.03.006; Mol Aspects Med. 2013 Apr-Jun; 34(0): 10.1016/j.mam.2012.07.006. doi: 10.1016/j.mam.2012.07.006; J Am Coll Cardiol. 2014 Apr 22;63(15):1542- 55. doi: 10.1016/j.jacc.2014.01.007. SNPs common in individuals with chronic illness and medication reactions
  48. 48. Lucine Health Sciences, Inc. | Hormones Matter Enzyme activity Plasma thiamine, thiamine monophosphate similar in ASD children and controls but TPP 24% lower in ASD group, suggesting problem absorbing, metabolizing thiamine.
  49. 49. Lucine Health Sciences, Inc. | Hormones Matter Ann Neurol. 2017 Sep;82(3):317-330. doi: 10.1002/ana.24998. Epub 2017 Aug 30.
  50. 50. Lucine Health Sciences, Inc. | Hormones Matter 20-50% of the population One crisis away from overt thiamine deficiency Who is thiamine vulnerable?
  51. 51. Lucine Health Sciences, Inc. | Hormones Matter “There is often something sinister about familiar concepts. The more familiar or ‘natural’ they appear, the less we wonder what they mean; but because they are widespread and well-known, we tend to act as if we know what we mean when we use them.” Devisch, I. & Murray, S., 2009. doi:10.1111/j.1365-2753.2009.01232.x Rethinking nutrient adequacy Maybe we haven’t solved nutrient deficiency after all.
  52. 52. Lucine Health Sciences, Inc. | Hormones Matter Revisiting mitochondrial energetics Beyond the black box
  53. 53. Lucine Health Sciences, Inc. | Hormones Matter Mitochondria Energy
  54. 54. Lucine Health Sciences, Inc. | Hormones Matter So long as there are sufficient calories (macronutrients) We get ATP.
  55. 55. Lucine Health Sciences, Inc. | Hormones Matter All this happens magically
  56. 56. Lucine Health Sciences, Inc. | Hormones Matter “The presumption is that all calories are created equally e.g. that calories are calories and no matter the origins of those calories, the end result will be ATP. Indeed, from the mitochondrial perspective, each fuel, no matter its origins, will be broken down to its carbon skeleton and through a series of reactions, the final output will be ATP. In that sense, the fuel source makes little difference: the net result will be ATP.” Lonsdale & Marrs, 2017
  57. 57. Lucine Health Sciences, Inc. | Hormones Matter “However, and this is a big however, what this perspective fails to recognize, is to get from fats, proteins and carbohydrates to ATP, there is an entire factory of enzymatic reactions that absolutely require non- caloric nutrients - vitamins and minerals – to function properly.” Thiamine is top among them. Lonsdale & Marrs, 2017
  58. 58. Lucine Health Sciences, Inc. | Hormones Matter More than just calories 22 vitamins and minerals
  59. 59. Lucine Health Sciences, Inc. | Hormones Matter While all the nutrients are important… • Thiamine is the gatekeeper. • Transketolase • PDC • LDH • HACL1 • Sitting atop, at the entry points for processing pathways
  60. 60. Lucine Health Sciences, Inc. | Hormones Matter TPP
  61. 61. Lucine Health Sciences, Inc. | Hormones Matter TPP ↓ATP Functional changes in the mitochondria Altered chemistry
  62. 62. Lucine Health Sciences, Inc. | Hormones Matter When the mitochondria lag oHigh energy organ systems impacted most dramatically • Nervous system • Cardiovascular system • Gastrointestinal • Musculature oMetabolic changes locally <> systemically
  63. 63. Lucine Health Sciences, Inc. | Hormones Matter Spotty energy: autonomic instability
  64. 64. Lucine Health Sciences, Inc. | Hormones Matter Biochemistry for Medics: http://www.slideshare.net/namarta28/thiamin
  65. 65. Lucine Health Sciences, Inc. | Hormones Matter • Fatigue, exercise intolerance, decreased wakefulness (orexin/hypocretin) • Cyclic vomiting , gastroparesis and pseudo bowel obstructions • Myalgia, myopathy, neuropathy • Migraines, seizures, syncope • Ataxia and tremors • Hormone disorders • Depression, mania, anxiety, psychosis • Cognitive impairment • Diabetes, metabolic, inflammatory and immune dysfunction Symptomatically General autonomic instability, affecting everything that the ANS regulates
  66. 66. Lucine Health Sciences, Inc. | Hormones Matter “…Mitochondrial dysfunction doesn’t really cause anything, what it does is predisposes towards seemingly everything. It’s one of many risk factors in multifactorial disease. It can predispose towards epilepsy, chronic fatigue, and even autism, but it doesn’t do it alone. It does it in combination with other factors… it predisposes for disease throughout the entire system.” Dr. Richard Boles, Geneticist
  67. 67. Lucine Health Sciences, Inc. | Hormones Matter Mitochondria at the nexus of health and disease by design
  68. 68. Lucine Health Sciences, Inc. | Hormones Matter From the lab to the clinic Induced and expressed thiamine deficiency
  69. 69. Lucine Health Sciences, Inc. | Hormones Matter Thiamine deficiency o 3 groups of female rats: Ad lib, thiamine supplemented, thiamine deprived (TD) oTD group • 2.5 weeks: • weight loss, anorexia, hair loss, drowsiness, no neurological signs • 4.5 weeks: rapid progression of symptoms, decline of health over next 5 days • incoordination with walking, impairment of the righting reflex, reluctance to walk, walking backwards in circles, imbalance, rigid posturing and eventually a total loss of righting activity and severe drowsiness • Thiamine injection corrected within 24 hours J Clin Invest. 1968 Oct; 47(10): 2268–2280. doi: 10.1172/JCI105912
  70. 70. Lucine Health Sciences, Inc. | Hormones Matter Threshold effect o Brain thiamine across time • Neurological symptoms apparent when cerebral thiamine concentrations reach 20% of normal. • 80% thiamine depletion before recognizable neurological symptoms develop • Recovery begins when concentrations climb to 26% of normal. • 6% over depletion state improves function J Clin Invest. 1968 Oct; 47(10): 2268–2280. doi: 10.1172/JCI105912
  71. 71. Lucine Health Sciences, Inc. | Hormones Matter Maternal TD and brain development oTime dependent, process and region specific disturbances of neuronal development • Reduced hippocampal neuronal density (nd) and size (s) • Prenatal TD: 39.67%nd, 7.97%s (Dentate gyrus, CA4) • Perinatal TD: 26.75%nd, 12.95%s (Dentate gyrus, CA4) • Postnatal TD: 14.2%nd, 10.77s (CA1) • Perinatal TD: cell differentiation • Postnatal TD: axon, dendrite growth, synaptogenesis and myelinogenesis Acta Neurobiol Exp (Wars). 2005;65(4):387-98.
  72. 72. Lucine Health Sciences, Inc. | Hormones Matter TD in infancy: the Israeli experience oOctober – November 2003 infants hospitalized with encephalopathy symptoms included: • Lethargy, vomiting, constipation, nystagmus, seizures, coma oSoy based formula without thiamine fed to 600- 1000 infants • ~20 infants hospitalized • 3 died acutely, 1 died after 6 year vegetative state • 10 severely developmentally delayed, epilepsy and other disorders
  73. 73. Lucine Health Sciences, Inc. | Hormones Matter Israeli experience continued o20 infants exposed to TD formula initially considered non-neurologically affected re- evaluated at 3 years • Initial presenting symptoms: lethargy, irritability, constipation, vomiting o~ 50% had developmental delays • Language and motor development • Moderate to severe Brain. 2011 Jun;134(Pt 6):1720-39. doi: 10.1093/brain/awr068. Epub 2011 May 9.
  74. 74. Lucine Health Sciences, Inc. | Hormones Matter
  75. 75. Lucine Health Sciences, Inc. | Hormones Matter Primary vs secondary TD Ann Neurol. 2017 Sep;82(3):317-330. doi: 10.1002/ana.24998. Epub 2017 Aug 30.
  76. 76. Lucine Health Sciences, Inc. | Hormones Matter Time course of symptoms oEarly/mild TD • Sleeping, fatigue, anorexia, depressed mood, reduced activity, apathy, parasthesias, muscle pain, dizziness, cognitive fuzziness. o Moderate/prolonged, without caloric restriction • Compensatory reactions (lactate and inflammation), instability becomes a cardinal feature. • Mitochondria are increasingly incapable of meeting energy demands and minor stressors initiate symptoms. • Mood lability, irritability, fearfulness progressing to agitation, cognitive impairment, and difficulty finding words, comprehending text and memory issues become more prominent. Depending upon the patient, GI dysmotility symptoms such as gastroparesis, excessive vomiting, diarrhea and/or bowel irritability might emerge, along with neuropathic pain and ataxias, tremors and syncope; cardiac instability, palpitations, precordial distress on exertion (pseudoangina), insomnia, anorexia, nausea, vomiting, weight loss, hypotension, bradycardia at rest, and tachycardia with sinus arrhythmia on exertion
  77. 77. Lucine Health Sciences, Inc. | Hormones Matter Non-linearity of expression Stressors evoke symptoms.
  78. 78. Lucine Health Sciences, Inc. | Hormones Matter Low thiamine, elevated B9 and B12
  79. 79. Lucine Health Sciences, Inc. | Hormones Matter Thiamine and ASD o Small pilot study – 10 children • TKA and TPPE pre and post • Pre, 30 days, 60 days urinary measures of SH-reactive metals, total protein, sulfate, sulfite, thiosulfate and thiocyanate; hair analysis • Autism Treatment Evaluation Checklist (ATEC) forms • Treated TTFD 50mg 2X per/day rectally 60 days • At baseline, 3 showed TD, 6 high arsenic, 10 traces of mercury • Results: 8 improved ATEC, arsenic decreased, but variable increase excretion of other metals
  80. 80. Lucine Health Sciences, Inc. | Hormones Matter Treatment
  81. 81. Lucine Health Sciences, Inc. | Hormones Matter
  82. 82. Lucine Health Sciences, Inc. | Hormones Matter
  83. 83. Lucine Health Sciences, Inc. | Hormones Matter Take home oNutrients matter, thiamine a bit more than others • Two questions to ask in clinical care • What nutrients does the patient need for health? • Is he/she getting them? • And perhaps a third question • Is the toxic load too high for mitochondria to clear?
  84. 84. Lucine Health Sciences, Inc. | Hormones Matter Mind your mitochondria. Feed them well and life will be good.
  85. 85. Lucine Health Sciences, Inc. | Hormones Matter Websites o LucineHealthSciences.com I Business o HormonesMatter.com I Online health journal Social Media o Facebook page/group: Hormones Matter, Understanding Mitochondrial Nutrients o Email: chandler@lucinehealthsciences.com or chandler@hormonesmatter.com How to find me

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