What You Need To Know About Methylation and How To Get Started

Transcription

1 What You Need To Know About Methylation and How To Get Started Copyright 2016, Kurt N. Woeller, D.O. and Educational Resource Association. This material may not be reprinted, distributed or used without permission. 1

2 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. 2

3 Lecture Overview What is Methylation? Methylation Problems and Autism Testing Options For Methylation Assessment Treatment Options for Methylation 3

4 Support Documents for Module #6 Methyl-B12 Injection Prescription Form (must be signed by licensed physician). Methyl-B12 Subcutaneous Injection Information Sheet. Dr. Woeller s Methyl-B12 for Autism ebook (pdf) Lecture slides for Methylation and Autism (pdf) Lecture slides for Methylation and Autism: note taking (pdf). 4

5 Between The Wheels 5

6 What Is Methylation? 6

7 A methyl group contains one carbon (C) atom and three hydrogen (H) atoms. The process of methylation is transferring this methyl group for the purpose of modifying a variety of chemical reactions throughout the body. 7

8 Why Is Methylation So Important? Key biochemical process commonly altered in many neurodevelopmental disorders like Autism, and neurological diseases such as Alzheimer s. The chemistry of methylation, and its impairment, explains a lot with regards to altered brain and cellular function seen in autism: Memory retention and recall Poor language development Diminished environmental awareness Multiple neurochemistry imbalances Detoxification problems Immune dysfunction 8

9 Methylation Cycle Diagram Methyl-B12 (Methionine Synthase) DMG TMG Methionine SAMe The cycle constantly spins from homocysteine to methionine. Methyl- B12 has the greatest influence through the enzyme complex called Methionine Synthase. Homocysteine P5P Glutathione (Potent Antioxidant) The overall effect of methylation is to regulate gene activity for proper cell function, as well as activate various enzymes in their role for biochemical conversions. 9

10 Methylation DNA synthesis New blood cell formation T cells Involved in DNA regulation and Immune Function Myelination and pruning Glutathione production Prevents homocysteine trapping, i.e. cardiovascular implications Supports intestinal mucosa Proper immune response to i.e. TB Helps control gene expression mutations, i.e. mental retardation, Schizophrenia Supports detoxification Membrane fluidity & phospholipid methylation attention issue Multiple enzymatic reactions requiring methylation: Melatonin Neurotransmitter levels : dopamine and norepinephrine Tryptophan methylation: serotonin 10

11 Methylation is involved in cell membrane function 11

12 Regulation of neurotransmitter conversion such as Norepinephrine to Epinephrine is dependent on methylation. 12

13 The Role of Histamine Inflammatory response Increases capillary permeability to white blood cells and various immune proteins. Gastric acid secretion Regulates various neurochemicals such as serotonin, norepinephrine and acetylcholine. Sleep-wake cycle Body temperature regulation. Appetite Erections Learning and memory 13

14 DNA methylation is a process in which methyl groups are added to DNA. In humans, we can methylate two nucleotides Cytosine and Adenine. Methylation s primary role is to modify DNA activity by suppression of DNA transcription. 14

15 15

16 Melatonin Issues In Autism The Pineal Gland produces Acetyl Serotonin Methyl-Transferase (ASMT) which converts serotonin to melatonin. Dating back to the 60s, studies in autism have reported elevated levels of serotonin in the blood. In the past 15+ years, various reports have shown abnormally low levels of melatonin in the blood or urine of people with autism. Some children with autism obtain restful sleep after taking over-thecounter melatonin. In 2008, a study analyzed ASMT and melatonin and found autism individuals tend to carry certain mutations in ASMT, and have significantly less melatonin and less ASMT in their blood compared with controls (Melke J. et al. Mol. Psychiatry, 90-98). ASMT gene - there are two identical copies, one of which resides on the X chromosome and the other on the Y chromosome. 16

17 Methylation Problems In Autism 17

18 Methylation Cycle Diagram Methyl-B12 (Methionine Synthase) DMG TMG Methionine SAMe The cycle constantly spins from homocysteine to methionine. Methyl- B12 has the greatest influence through the enzyme complex called Methionine Synthase. Homocysteine P5P Glutathione (Potent Antioxidant) The overall effect of methylation is to regulate gene activity for proper cell function, as well as activate various enzymes in their role for biochemical conversions. 18

19 Jill James, Ph.D Research on Methylation Problems in Autism Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism 1,2 S Jill James, Paul Cutler, Stepan Melnyk, Stefanie Jernigan, Laurette Janak, David W Gaylor and James A Neubrander From the Department of Pediatrics, University of Arkansas for Medical Sciences, and the Arkansas Children's Hospital Research Institute, Little Rock, AR (SJJ, SM, and SJ); Niagara Falls, NY (PC); Colden, NY (LJ); Gaylor and Associates, LLC, Eureka Springs, AR (DWG); and Edison, NJ (JAN) Results: Relative to the control children, the children with autism had significantly lower baseline plasma concentrations of methionine, SAM, homocysteine, cystathionine, cysteine, and total glutathione and significantly higher concentrations of SAH, adenosine, and oxidized glutathione. This metabolic profile is consistent with impaired capacity for methylation (significantly lower ratio of SAM to SAH) and increased oxidative stress (significantly lower redox ratio of reduced glutathione to oxidized glutathione) in children with autism. The intervention trial was effective in normalizing the metabolic imbalance in the autistic children. An increased vulnerability to oxidative stress and a decreased capacity for methylation may contribute to the development and clinical manifestation of autism. 19

20 Methylation Altered By Environmental Toxins Neurodevelopmental Toxins Deplete Glutathione and Inhibit Folate and Vitamin B12- Dependent Methionine Synthase Activity: A Link between Oxidative Stress and Autism MOSTAFA IBRAHIM-AHMED WALY and RICHARD DETH PHARMACEUTICAL SCIENCES, NORTHEASTERN UNIVERSITY, BOSTON, MA Ethanol, arsenic, lead, mercury, aluminum and the vaccine preservative thimerosal are suspected to be etiological factors for neurodegenerative and neurodevelopmental disorders. Autism is a neurodevelopmental disorder characterized by oxidative stress and impaired methylation status, including decreased activity of the folate and vitamin B12-dependent enzyme methionine synthase (MS). MS-mediated conversion of homocysteine to methionine is crucial for neurons and all mammalian cells to sustain normal methylation status, involving more than 100 different reactions. Glutathione (GSH) protects MS from oxidative inactivation by reactive oxygen species, while MS inactivation increases GSH synthesis by augmenting transsulfuration. Utilizing SH-SY5Y cultured human neural cells, we found that a 1 hour pre-incubation of cells with arsenic, lead, mercury, aluminum and thimerosal potently decreased both hydroxycobalamin (OHCbl) and methylcobalamin (MeCbl)-based MS activity, although OHCbl exhibited greater sensitivity than MeCbl. At a concentration of 100 nmol, each of these neurodevelopmental toxins caused a 60 70% reduction of intracellular GSH levels. 22 mm (0.1%) ethanol caused a similar inhibition of OHCbl- and MeCbl-based MS activity and a similar decrease in GSH levels. Our findings suggest that heavy metals and ethanol may contribute to the occurrence of neurodevelopmental disorders such as autism via a mechanism that involves oxidative stress and inhibition of Methionine Synthase activity. 20

21 Thimerosal Blocks GSH-dependent Synthesis of Methyl-B12 Hydroxycobalamin Cyanocobalamin GSH GSH Thimerosal Glutathionylcobalamin Thimerosal Methionine D4R MET Methylcobalamin Methionine Synthase S-adenosyl methionine 5-MethylTHF Homocysteine D4R HCY 21

22 Testing Options For Methylation Assessment 22

23 The Methylation Pathway: Health Diagnostics and Research Institute 23

24 24

25 Single Nucleotide Polymorphism SNP (aka. SNiP) 25

26 26

27 27

28 Adenine Thymine Cytosine Guanine 28

29 DNA is double stranded: two polynucleotides twisted into a double helix Consists of four types of nucleotides: Adenine pairs to Thymine Cytosine pairs with Guanine The sequence of nitrogenous bases carries genetic information. Base pair Nitrogenous base (A) Figure 3.20C 29

30 The Flow of Genetic Information DNA RNA PROTEINS the machinery 1 of the cells DNA 1. REPLICATION DNA Synthesis 2. TRANSCRIPTION RNA Synthesis 3. TRANSLATION Protein Synthesis Methylation 30

31 Single Nucleotide Polymorphism (SNP) Difference of one base at specific base pair position. Cytosine Thymine Adenine Guanine 5-30 million SNPs in the Human genome 31

32 Role of SNPs in Disease Predisposition Change < 1% population = mutation Change > 1% population = polymorphism Common diseases are multifactorial The genetic differences between human populations make one population more susceptible to a particular disease than another. 32

33 Journal of American Physicians and Surgeons Volume 9: , 2004 Located on chromosome 1 (1p36.3) 33

34 MTHFR gene SNPs C677T, A1298C MTHFR = MethyleneTetraHydroFolate Reductase Enzyme that methylates folic acid as 5,10 methylene- THF to 5-Methyl-THF (bioactive form) this then leads to homocysteine to methionine conversion to support the methylation cycle. Two mutations C677T and A1298C 677 related more to folate metabolism 1298 dopamine and serotonin, ammonia, tyrosine & tryptophan metabolism - some folate influence as well. Each can be - -, + -, or

35 COMT polymorphism COMT Catechol-o-methyl-transferase Deactivates neurotransmitters like dopamine, norepinephrine, and epinephrine. Deactivates certain estrogens. Deactivates environmental chemicals with a catechol structure. 35

36 Neurotransmitter Metabolites Adrenal gland Periperal nerves CNS epinephrine COMT norepinephrine Vanillylmandelic acid (VMA) CNS GI tract platelets dopamine serotonin COMT MAO-A Homovanillic acid HVA 5-hydroxyindoleacetic acid (5-HIAA) Will be discussed in Module #15 36

37 Critical Effect of Intestinal Bacteria on Brain and Nervous System Organic Acids Test Organic acids test COMT Organic acid test COMT 37

38 Whole Blood Histamine (and Basophils) Advocated by William Walsh, Ph.D. Walsh Research Institute Helps to assess functionality of the methylation. Histamine and methylation are inversely related to each other. If whole blood histamine is low, the individual will be over-methylated and if it is high, they will be under-methylated. 38

39 Under-Methylation: Some suspected symptoms and traits Addictiveness Calm demeanor, but high inner tension Chronic depression Perfectionism Seasonal allergies Self-motivated Sparse body hair Sports competitiveness Strong willed Oppositional defiance Obsessive compulsive tendencies High libido Illness denial Frequent headaches Family history of high accomplishment Dietary inflexibility Slenderness Suicidal tendencies Phobias Adverse reaction to benzodiazepines and folic acid. Positive response to SSRI s and antihistamines. 39

40 Over-Methylation: Some suspected symptoms and traits Absence of seasonal allergies Copper overload Depression Dry eyes and mouth Estrogen and antihistamine intolerance. Low libido low motivation during school years. Self-mutilation Sleep disorder, tinnitus, hirsutism, food/chemical sensitivities, artistic or musical ability. High anxiety/panic, hyperactivity Rapid speech Religiosity Tendency to be overweight Nervous legs, pacing, etc. Adverse reaction to SSRI s and SAMe, improvement with benzodiazepines. 40

41 Methylation Supplement Support 41

42 How Do We Resolve These Issues With Methylation Cycle Support High dose vitamin B6 (4mg to 8mg/lbs. max. 1000mg) with ½ as much magnesium (2mg to 4mg/lbs.). SAMe 200mg to 400mg daily Dimethylglycine (DMG) or Trimethylglycine (TMG) Folinic Acid or L-Methyl-Folate - helps support folate chemistry for methylcobalamin methylation. Methyl-B12 therapy subcutaneous injection, nasal spray, transdermal, lollipop, oral liquid, sublingual. 42

43 Methylation Cycle Diagram Methyl-B12 (Methionine Synthase) DMG TMG Methionine SAMe The cycle constantly spins from homocysteine to methionine. Methyl- B12 has the greatest influence through the enzyme complex called Methionine Synthase. Homocysteine P5P Glutathione (Potent Antioxidant) The overall effect of methylation is to regulate gene activity for proper cell function, as well as activate various enzymes in their role for biochemical conversions. 43

44 Dimethylglycine (DMG) DMG at 125mg 1 to 6+ tablets daily. On average is 2 to 3 tablets per day. No specific dosage for age or weight. 44

45 DMG (Dimethylglycine) Derived from Trimethylglycine (TMG) Has influence over folate metabolism DMG Influences: Folate (THF, 5, 10-methyleneTHF, 10-formylTHF) to influence purines (AMP, ATP, GTP) and pyrimidine (genetic influence) = cellular response and perception. Methylation of cobalamin within the Methionine Synthase complex Activation of D4 receptor leading to improved attention Benefits of DMG: Improved language, attention, and focusing Less self- stimulatory behavior Reduced hyperactivity and mood issues Dosing = 125mg to 900mg plus - average range for a 40 to 50 lbs. child about 250mg to 750mg. Need to adjust dosing according to clinical response of individual. 45

46 Trimethylglycine (TMG) TMG 125mg to 500mg+ daily 46

47 TMG (Trimethylglycine) Helps convert homocysteine into methionine through the Betaine homocysteine-methyl-transferase enzyme (BHMT). TMG becomes DMG after donating methyl group to homocysteine. General recommendations before use: Start with lower dose Consider having taurine supplemented prior, i.e. 250mg to 500mg. Main Reason: TMG causes hcy to become met. If cysteine is low, the process of taurine & glutathione production can be compromised. Dosing = 125mg to 500mg+. An average range for a 40 to 50 lbs. child about 250mg to 800mg works well. 47

48 Folate Folates derived from plants (green leafy veggies), grains, beans, as well as certain forms of yeast and bacteria. Folate provides methyl groups to cobalamin within the Methionine Synthase enzyme complex. It also provides assembly information of purines and pyrimidines. Folinic Acid (5-formyltetrahydrofolate) is a versatile form. There are many different forms of folate that need a variety of biochemical manipulation. 48

49 Folinic Acid & L-Methyl-Folate 400mcg capsule 1000mcg capsule

50 Methyl-B12 5 drops is approx = 1000mcg One tablet = 1000mcg 50

51 3.6 mg of Methylcobalamin per lollipop 51

52 Methyl-Mate (New Beginnings Nutritional Liquid ultra-concentrated methylcobalamin Pharmaceutical grade MB mcg per drop Each spray is approx. 500 mcg Adults: 1 to 3 sprays each nostril 1 to 2x per day. Children: 1 to 2 sprays daily Sold as a sublingual. Need to request nasal spray applicator when ordering. 52

53 pg/ml blood vitamin B12 Effect of method of administration on methyl B-12 absorption Nasal 1000 mcg Oral 5000 mcg Oral 2400 mcg Time- hours after administration subcutaneous 5500 mcg Nasal 1000 mcg

54 Methyl-B12 for Autism-Spectrum Disorders 54

55 Compounded and Pre-Filled 55

56 Methyl-B12 Injections 56

57 Upper Outer Quadrant 57

58 30 Degree Angle or Less 58

59 Numbing Cream Option 59

60 Methylcobalamin (B12) Many Individuals Improve in 3 Major Areas: Cerebral Cortex Function (90%) Speech and Language Function (80%) Emotion and Socialization Function (70%) 60

61 Methylcobalamin (B12) Injections All forms of Methyl-B12 can be helpful, i.e. sublingual tablets, nasal spray, but: Subcutaneous injection is gold standard Ideally, no other biomedical changes are made during 1 st 6 weeks of Methyl-B12 implementation. At the end of 6 weeks can add other support supplements such as L-methyl-folate, folinic acid, DMG, etc. Need to watch for too much methylation support: TMG if currently taking, it is suggested to discontinue before starting Methyl-B12. Hyperness, overstimulated, sleeping problems aggression. 61

62 Methylcobalamin (B12) Injections 75 to 85% plus - have positive changes that are noticeable in 1st 6 weeks. Less than 10% show no benefit, less than 5% need to stop because of intolerable side effects. 62

63 Hyperactivity 60% of time 63

64 Sleeping Disturbance 40% of time 64

65 Mouthing 30% of time 65

66 Methylcobalamin (B12) Main Side Effects: Hyperactivity most common Sleep disturbance Mouthing of objects fingers, chewing on knuckles. More easily frustrated: This can indicate a greater awareness of surroundings, more willingness to engage and participate which in certain situations can manifest as frustration because of child s limited skills and abilities. 66

67 Methylcobalamin (B12) Side effects will usually last 2 to 6 weeks. Average = 4 weeks. Tolerable versus Intolerable positivenegative scenario. If child becomes aggressive or selfinjurious this is a concern and should not be viewed as a positive or tolerable reaction. 67

68 Methyl-B12 Improving Positive Outcomes Watch for 72 hour consistency between shots: Consider increasing frequency to every 48 hours after making sure injection angle is accurate. Quick onset hyperness may need smaller dose, injection too deep. Immediate positives, i.e. eye contact, attention that is quickly lost usually injection depth is to deep. 68

69 Methyl-B12 - Improving Positive Outcomes Red urine injection depth to deep Child may also lack a lot of subcutaneous fat so B12 is naturally absorbed quicker. Do not pucker skin when injecting because it leads to ineffective dosing. If injection angle is accurate and still see 36 to 48 hour benefit with a 24 hour dropoff before the next injection is due will likely benefit from every other day dosing. 69

70 Methyl-B12 Adding Other Nutrients To The Syringe Adding Folinic Acid to the syringe (100mcg to 400mcg) may help at times with hyperactivity & overstimulation. However, anytime you add an ingredient to the Methyl-B12 syringe the base concentration (25mg/ml) will change, i.e. 12.5mg/ml, 6.25mg/ml). I personally prefer to dose Folinic Acid orally. Some doctors add N-acetyl-cysteine (NAC) a promoter of glutathione. It will change the base concentration of Methyl-B12 too. 70

71 Other Forms of B12 Hydroxycobalamin another form of B12 that seems to help some kids on the autismspectrum. Consider using if Methyl-B12 is not tolerated or a plateau effect has occurred and child is not responsive to Methyl-B12 dosing changes. Injection dosage for Hydroxy-B12 dose the same as Methyl-B mcg/kg every 3 days. 71

72 Final Thoughts of Methyl-B12 Despite all the lab testing for methylation status that is available, the best lab is the child s body. Laboratory testing certainly helps to fine tune the process of methylation support, particularly if the clinical response is not initially favorable from a trial of Methyl- B12. Laboratory testing can help isolate potential conflicts in prescribing various supplements. Methyl-B12 injections (and other forms of Methyl-B12 therapy) has been one of the most consistently beneficial therapies for individuals on the autism-spectrum. 72

73 Thank You Kurt N. Woeller, D.O. 73