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Now that I know what gene mutations we are dealing with (including MTH


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Okay so I have the information for my 3.5 year old from 23andme...but I am so overwhelmed about where to go from here! Only the MTHFR is something his Neurologist feels comfortable addressing, but from what I am reading it looks like other things need to be addressed before the vitamins she prescribed will take effect, and they could even have bad negative side effects if I don't address the other things first. Looking for some advice from people who have been there!
He is "compound heterozygous" for both MTHFR mutations, so she prescribed one 500 mg methylcobalamin lozenge per day, and one 7.5 mg methylfolate capsule every other day. What I am reading says "Slowly build up doses of methylfolate and methylcobalamin." Are these low doses? His vitamin B12 level was more than double what it should be - just building up in his body but not being used.
Also, his Vitamin D level was at 15 (normal is 30-100) but I don't remember her giving us any instructions to address that other than getting more sun. Should he take a Vitamin D supplement?
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Here are his gene mutations:
Homozygous mutations for:
  • VDR Taq
  • MAO-A R297R
  • CBS A360A
Here is a tiny bit of the information genetic genie provided about these mutations:
CBS Mutation:
"Dr. Yasko recommends that one supports their CBS enzyme for at least 6 weeks before starting methylation supplements. When one tries to take nutrients to support their methylation cycle before addressing the CBS upregulation, all the nutrients basically lead to nowhere. Instead of generating glutathione, the supplements may deplete the rest of the cycle"
VDR Taq:
With COMT V158M + and a VDR Taq + status, the body may have further trouble tolerating methyl donors
MAO-A R297R
MAO-A (Roamine oxidase A) is a critical enzyme involved in breaking down important neurotransmitters such as serotonin, norepinephrine, and dopamine. Combined with COMT V158M mutation, one may be more prone to develop Obsessive Compulsive Disorder (OCD), mood swings, aggressive and/or violent behavior, and personality disorders
He is Heterozygous for these mutations:
  • COMT V158M
  • COMT H62H
  • ACAT1-02
  • MTR A2756G
  • MTRR A66G
  • MTRR A664A
  • BHMT-02
  • BHMT-04
  • BHMT-08
It says since COMT + individuals often have trouble tolerating methyl donors, they tend to do better on a combination of hydroxy B12, adenosyl B12, and/or cyano B12.
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So he has several gene mutations that make it difficult for him to tolerate methyl donors, and two prescriptions for methyl vitamins waiting to be filled. Where do I start? Is this something a homeopathic Dr would be helpful for or should I try and figure this all out on my own? Thank you so much for any advice you can give, even if it is just in one of these areas.
______________________________________________________________________________________________________________________________
PS****** Posting all the info given by genetic genie below:
MTHFR Mutations

First we'll look at a few of your MTHFR mutations. According to research, these mutations are important and can be implicated in various disease states.

You have 3 heterozygous (yellow) mutation(s). These are generally not as bad as red homozygous mutation, but they may still worth paying attention to. They include:

  • MTHFR C677T
  • MTHFR 03 P39P
  • MTHFR A1298C
Now let's move on to discuss what these MTHFR mutation(s) mean.
MTHFR C677T

One function of MTHFR (Methylenetetrahydrofolate reductase) is to help convert homocysteine to methionine. A MTHFR C677T mutation means that the MTHFR enzyme may have trouble performing its task leading to high levels of homocysteine. According to Dr. Ben Lynch, impaired function of the enzyme can cause or contribute to conditions such as Autism, Chronic Fatigue Syndrome, Fibromyalgia, Miscarriages, IBS, many birth defects, Multiple Sclerosis, Alzheimer's, Bipolar Disorder, blood clots, Stroke, Chemical Sensitivity, and many other conditions.

MTHFR C677T can also lead to high homocysteine. You can ask your doctor to test for homocysteine levels. If you have high levels of homocysteine, it may be related to your MTHFR C677T mutation. But even if one has a (+/+) or (+/-) mutation, it does not necessarily mean that they will have high homocysteine levels.

As S-adenosylhomocysteine (SAH) accumulates, the COMT enzyme may become impaired. Inhibiting COMT can increase dopamine levels for those with COMT V158M (-/-), but for those with COMT V158M (+/+), the high level of SAH can lead to behavior problems and mood swings according to Dr. Amy Yasko.

 

Nutritional Support of MTHFR C677T

Supplementing with Folate (preferably as L-Methylfolate) can help alleviate the effects of MTHFR C677T as well as lower one's homocysteine levels. There are a lot of different types of folate on the market, and I recommend reading this article by Dr. Ben Lynch about folate. It might be a good idea to avoid synthetic folic acid and folic acid fortified foods such as cereals. Also, lowering other doses of forms of folate or folinic acid may be important as it can compete with L-methylfolate.

To avoid adverse effects, one can start with very low doses of folate and work to higher doses. Side effects can occur as a detoxification effect as this pathway becomes unblocked. In the case of extreme adverse effects, time-released niacin and/or potassium may be able to stop the side effects.

MTHFR 03 P39P

There is currently not enough research or data to draw conclusions from this SNP.

MTHFR A1298C

MTHFR A1298C is involved in converting 5-methylfolate (5MTHF) to tetrahydrofolate (THF). Unlike MTHFR C677T, the A1298C mutation does not lead to elevated homocysteine levels. This reaction helps generate BH4. BH4 is important in the detoxification of ammonia. The gene is compromised about 70% in MTHFR A1298C (+/+) individuals, and about 30% in people with a heterozygous (+/-) mutations.

BH4 acts as a rate limiting factor for the production of neurotransmitters and catecholamines including serotonin, melatonin, dopamine, norepinephrine, and epinephrine. A MTHFR A1298C + status may cause a decrease in any of these neurotransmitters or catecholamines. It's also a cofactor in the production of nitric oxide. If your BH4 cycle is not working effectively, you may experience mental/emotional and/or physical symptoms. Mercury, lead, and aluminum may act as a drain on BH4.

 

Adressing MTHFR A1298C

L-methylfolate supplementation may be implicated. One should start with low doses of L-methylfolate, and in the case of adverse reaction time-released niacin and/or potassium may help.

Metal detoxification (especially aluminum) can help address dysfunctions associated with MTHFR A1298C and BH4 deficiency, and can help many other biochemical abnormalities as well. Aluminum toxicity can hinder one's ability to fight infection, so addressing the gut and treating chronic bacterial infection may be important. Since the A1298C mutation can lead to excess ammonia, one can address these elevated levels with things like charcoal/magnesium flushes, Yucca Root, and L-Ornithine. Keeping ammonia low helps preserve BH4 levels.

Low doses of BH4 may be helpful after one's methylation cycle is fully supported.

All of Your Other Mutations

Now we are going to look at all of your mutations. You do not necessarily need to worry about all of these mutations, but certain mutations may cause problems in certain individuals. Genetic Genie does not look at the expression of your genes, it only looks at specific gene SNPs. Keep in mind that even if you are homozygous or heterozygous for a certain mutations, it doesn't necessarily mean there is a problem with the functioning of that gene. You have 3 homozygous (+/+) mutations and 9 heterozygous (+/-) mutations.

Here are your homozygous mutations as indicated in your SNP gene table above (not including MTHFR):

  • VDR Taq
  • MAO-A R297R
  • CBS A360A
CBS Mutations
CBS (cystathionine beta synthase) catalyzes the first step of the transsulfuration pathway, from homocysteine to cystathionine. Dr. Yasko considers addressing CBS mutations as first priority aside from addressing the gut. CBS defects are actually upregulations. This means the enzyme works too fast. In these patients, it's common to see low levels of cystathionine and homocysteine since there is a rapid conversion to taurine. This leads to high levels of taurine and ammonia. The NOS mutation can exacerbate ammonia issues. Furthermore, addressing CBS can help lower excessive levels of taurine and help detoxify ammonia. Dr. Yasko recommends that one supports their CBS enzyme for at least 6 weeks before starting methylation supplements. When one tries to take nutrients to support their methylation cycle before addressing the CBS upregulation, all the nutrients basically lead to nowhere. Instead of generating glutathione, the supplements may deplete the rest of the cycle.

Addressing the CBS Mutation

Before one starts adding supplements, it may be a good idea to get a baseline UAA from a doctor. This will determine one's Taurine levels. After about 4-6 weeks of following the CBS protocol (outlined in the book Autism: Pathways to Recovery), one should retest their UAA. Once one's UAA is at 50% or below, one can add the methylation supplements. It's important to regularly use UAA testing as taurine should remain at 50% or less. If taurine climbs one may need to address ammonia. Yucca Root and Charcoal/Magnesium flushes can help address high ammonia levels. High doses of L-Ornithine may be effective as well according to medical studies.

The CBS mutation not only leads to excess taurine, but can also lead to excess sulfur groups. For this reason, it may be a good idea to limit sulfur intake. Excess sulfur intake can trigger a stress response or chronic stress. Sulfur is normally bound to amino acids, but the CBS upregulation can instead release the sulfur groups to sulfites in the body. There are many things one may need to avoid with a CBS upregulation. Some of the items include garlic, broccoli, eggs, onions, legumes, meat, Epsom salt baths, alpha lipoic acid, glutathione, chelating agents such as DMPS, NAC, Milk Thistle, various other supplements, and much more. Please look to other sources for foods and supplements that are high in sulfur.

Supplementing with molybdenum may help as excess sulfites deplete it. Manganese is also important in ammonia detoxification. A Low protein diet can help as the body will have less ammonia to detoxify. It's important to measure molybdenum and manganese with a minerals test before supplementing.

BH4 can also become depleted with a CBS upregulation. BH4 helps regulate neurotransmitters and mood. Other mutations, such as MTHFR A1298C, Chronic bacterial infections, and aluminum can also lead to low BH4 levels. Lack of BH4 can lead to mast cell degranulation and possibly mast cell activation disorder (MCAD). While difficult to obtain, BH4 supplementation may help in the presence of BH4 deficiency.

Other supplements that may help are Slippery elm bark for the gut. And according to Dr. Yasko Molybdenum, EDTA, carnosine, and zinc may help balance the copper/zinc ratio.

The CBS Upregulation is a complicated subject and for more info, I suggest purchasing or finding the book Autism: Pathways to Recovery. Searching for other websites or online support groups talking about the subject may be of help as well.

VDR Mutations

VDR (Vitamin D Receptor) encodes the nuclear hormone receptor for vitamin D3. Low or low normal vitamin D values are often seen in those with chronic illness and even the general population. Low vitamin D is related to a lot of neurological and immunological conditions. Vitamin D stimulates enzymes that create dopamine.

VDR Fok has been associated with blood sugar issues and poor pancreatic activity.

With COMT V158M + and a VDR Taq + status, the body may have further trouble tolerating methyl donors. VDR Taq (-/-) individuals may already have higher levels of dopamine, and it's worth noting that combinations of variations COMT and VDR Taq can lead to a wide range of dopamine levels. Those that are VDR Taq (+/+) and COMT (-/-) may have lowest dopamine levels.

 

Nutritional support of VDR Mutations

Dr. Yasko advises patients to rotate methyl-containing supplements (instead of using them all daily) for those with COMT V158M + and VDR Taq (-/-).

Ginkgo biloba may increase dopamine uptake. Small doses of Mucuna Pruriens contains natural dopamine, and can be helpful for those with low dopamine.

VDR Fok + can impact vitamin D levels. Research shows that supplementing vitamin D may be beneficial. Sage and rosemary support vitamin D receptors. It may be necessary to support the pancreas when having a VDR Fok + mutation using vitamin and digestive/pancreatic enzymes.

 

MAO-A R297R

MAO-A (Roamine oxidase A) is a critical enzyme involved in breaking down important neurotransmitters such as serotonin, norepinephrine, and dopamine. While a homozygous (+/+) mutation is very common, prolonged periods of stress, violence, or trauma can lead to epigenetic changes that further decrease enzyme activity. On the table above, males only have one allele since the gene is inherited through from their mother since it is located on the X chromosome. Males are more likely to have this mutation, represented on the table as homozygous (+). Only females can be heterozygous (+/-) for this mutation. When a (+/+) MAO-A mutation is combined with a (+/+) or (+/-) COMT V158M mutation, one may be more prone to develop Obsessive Compulsive Disorder (OCD), mood swings, aggressive and/or violent behavior, and personality disorders. Chronic infection can deplete tryptophan stores, and this can be tested with an organic acid test (OAT) and urine amino acid tests (UAA) according to Dr. Yasko. This test may indicate high levels of 5HIAA (5-hydroxy indole acetic acid).

Nutritional support of MAO-A R297R

Dr. Yasko says that her Mood S RNA formula and 5HTP may help balance serotonin. Furthermore, she satiates that BH4 deficiency (often caused by aluminum toxicity), increased levels of ammonia, and MTHFR A1298C are all factors that can negatively impact serotonin levels.

There is not a whole lot of information out there on how to increase the activity of the enzyme. And while not nutritional, there is a product called Respen-A developed for Autism with intention of increasing MAO-A activity. Respen-A can only be obtained from a few compounding pharmacies and requires a prescription.

Here are your heterozygous mutations as indicated in your SNP gene table above (not including MTHFR):

  • COMT V158M
  • COMT H62H
  • ACAT1-02
  • MTR A2756G
  • MTRR A66G
  • MTRR A664A
  • BHMT-02
  • BHMT-04
  • BHMT-08
Addressing ACAT and SHMT SNPs

ACAT1-02 (acetyl coenzyme A acetyltransferase) plays a role lipid metabolism and energy generation. It can also deplete B12. As with CBS, Dr. Yasko views this as a first priority mutation. Going by Yasko's clinical experience, she says to address them first if you have elevated iron on a UEE, elevated iron on a UEE test, Short Chain Fatty Acid (SCFA) imbalances on a CSA test, suberic acid, beta hydroxyl methylglutaric acid, or other ketone and fatty acid metabolites imbalances on a MAP or OAT test; or if there are severe gut issues or muscle weakness (which can be related to aluminum retention)". She says people with ACAT or SHMT are more likely to experience gut dysbiosis. Because of disrupted flora, microbes may have an affinity for and retain toxic metals. Stabilizing the gut environment is very important.

More info to come as Genetic Genie continues to research these SNPs.

MTR/MTRR Mutations

MTRR (Methionine synthase reductase) helps recycle B12. The combination of MTR and MTRR mutations can deplete methyl B12. MTR A2756G, MTRR A66G, MTRR H595Y, MTRR K350A, MTRR R415T, MTRR S257T, and MTRR A664A all work together to convert homocysteine to methionine.

MTR (5-methyltetrahydrofolate-homocysteine methyltransferase) provides instructions for making the enzyme methionine synthase. Methionine synthase helps convert the amino acid homocysteine to methionine. To work properly, methionine synthase requires B12 (specifically in the form of methylcobalamin). An MTR A2756G mutation increases the activity of the MTR gene causing a greater need for B12 since the enzyme causes B12 to deplete since it is using it up at a faster rate. Mutations in MTR have been identified as the underlying cause of methylcobalamin deficiency. Megaloblastic anemia can occur as a consequence of reduce methionine synthase activity.

A homozygous mutation of MTR A2756G is relatively rare (<1%). Some studies have demonstrated that people with a combination of MTHFR C677T and MTR A2756G have persistently high homocysteine levels unless they are treated with both B12 and folate.

 

Nutritional support of MTR/MTRR

According to Dr. Yasko's clinical experience, one should first take into account COMT V158M and VDR Taq status. She finds that those with COMT V158M + and VDR Taq - mutations often don't tolerate methyl donors well. She says that those with these mutations should carefully balance their ratio of Hydroxyl B12 and Methyl B12. She often suggests low dose cyano B12, adenosyl B12, and vitamin E succinate. High dose methylcobalamin (5 mg per day and above) may be implicated and necessary with this mutation - especially if one is homozygous and/or has MTRR + mutations. The level of B12 one needs depends often depends on the number and combination of these mutations. Like everything else, one should slowly build up doses of both methylcobalamin and/or hydroxocobalamin to avoid adverse effects.

DMG and the supplement TMG also stimulate the BHMT pathway to convert homocysteine to methionine, but one should take caution if they are sensitive to methyl donors.

Patients with MTR/MTRR may also benefit from the combination of GABA and L-Theanine. L-Theanine is a methyl donor. They may also benefit from taurine, Pycnogenol® pine bark extract, and grape seed extract.

COMT Mutations

COMT (catechol-O-methyltransferase) helps break down certain neurotransmitters and catecholamines. These include dopamine, epinephrine, and norepinephrine. Catechol-O-methyltransferase is important to the areas of the pre-frontal cortex. This area of the brain is involved with personality, inhibition of behaviors, short-term memory, planning, abstract thinking, and emotion. COMT is also involved with metabolizing estrogens.

COMT (-/-) individuals can usually break down these neurotransmitters efficiently, but COMT (+/+) individuals may have trouble breaking these chemicals down from impaired function of the enzyme. With a COMT + status, people may have trouble with methyl donors. This can lead to irritability, hyperactivity, or abnormal behavior. They also may be more sensitive to pain.

 

Nutritional support of COMT mutations

Since COMT + individuals often have trouble tolerating methyl donors, they tend to do better on a combination of hydroxy B12, adenosyl B12, and/or cyano B12. Methyl B12 is usually much easier to tolerate for those that are COMT (-/-).

BHMT mutations

BHMT (betaine homocysteine methyltransferase) acts as a shortcut through the methylation cycle helping convert homocysteine to methionine. The activity of the enzyme can be negatively influenced by stress. The Information on this enzyme related to methylation is mostly based on Dr. Amy Yasko's clinical experience and research.

According to Dr. Yasko, a homozygous mutation of BHMT 01, BHMT 02, BHMT 04, can produce results similar to one with a CBS upregulation even if you don't have a CBS upregulation. In her book, Autism: Pathways to Recovery, She also states that a BHMT 08 mutation may "increase MHPG levels relative to dopamine breakdown (HVA)". This can result in attention type symptoms. It is common to see elevated glycine in someone with a homozygous BHMT 08 mutation.

 

Addressing the BHMT mutations

According to Dr. Yasko, limiting taurine for BHMT 01, 02, and 04 may be helpful, and supplementing NADH, SAMe, and DMG may help with BHMT 08 + status. According to the Heartfixer Analysis, one may bypass the dysfunctional enzymes by stimulating the BHMT pathway to convert homocysteine to methionine in several other ways. Phosphatidylcholine or phosphatidylserine can stimulate the BHMT pathway. A good quality lecithin is a good source of phosphatidylcholine (it usually comes from soy, eggs, or sunflower seed). Egg yolks are a good source of lecithin as well. TMG is also an option, but one should take caution if they are sensitive to methyl donors.

If you have a BHMT 01, BHMT 02, or BHMT 04 mutation and don't have a CBS mutation, information about CBS was not included in your report. If you have these mutations, you can find our info about addressing the CBS upregulation at http://www.geneticgenie.org/all-mutations.

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There's always so much information to process when you get started on this. The very first thing to remember is that your son is a toddler, so doses of anything will need to be small. The second is that he;s not going to be able to tell you how he feels, so behaviors become much more important and it becomes essential to only address one thing at a time or there's no way you'll know what's helping and what's not.

 

Yasko suggests that the first mutation to be addressed is CBS. However, she's rumored to have recently changed her views on how CBS effects ammonia. So you may want to join one of her forums to get the latest advice on that particular aspect. Because I've already been the nutty mom for so many years, collecting pee and poop samples from my kids, by the time we started treating CBS, I just couldn't bring myself to shove my way into the bathroom with my 8yr old and wait 10 min until she relaxed enough to pee onto an ammonia test strip (and my hand). I've read inconsistent things about the reliability of the strips and I just drew a personal line there. That doesn't mean you shouldn't do it, I just can't offer any guidance there. Others follow her guidance much more closely. You need to find what's practical for you, But with a toddler, I'd be cautious and go low and slow.

 

I use molybdenum for CBS and do keep an eye of sulfur. Three in my family add drops of moly to a medicine cup of water every morning. It has helped to remove a sulfur odor from urine. We've reduced the amount of protein in our diets but not severely. I strive for balance, not absence of protein. These are growing kids. Yasko recommends Yucca but Yucca is estrogenic and I don't think adding estrogen to a developing girl (or a preimenopausal mom) is a good idea. I do limit suflur foods and limit or avoid supplements and medications that are high in sulfates.

 

If it were me, I'd probably add moly drops (I get mine from yasko's site) for a week or two and reduce protein. I'm not sure I'd add any other supplements without doing a lot of research on how they effect a toddler. Next, given how bipolar your son is, I'd probably add a very small amount of methylfolate. I don't think I could wait 6 weeks. There's no way my 8 yr old could tolerate 7.5 mg of it - she takes 1/100 that amount every other day - 67 MICROgrams (mcg). Some adults may need 7.5 mg but I'd be shocked by a toddler needing that much. Since yous DS's B12 levels are high, I'd probably add just the methylfolate - one drop - http://www.holisticheal.com/methylmate-b-nutritional-supplement.html every other day, for maybe 2 weeks to see how things went. Then assuming things were improving, I'd add some methylB12 or a combo methyl+hydroxyB12 sublingual. I use this http://www.amazon.com/Source-Naturals-MethylCobalamin-Flavored-Sublingual/dp/B001G7R8J2/ref=sr_1_1?s=hpc&ie=UTF8&qid=1376917531&sr=1-1&keywords=source+naturals+methylcobalamin+vitamin+b-12 and my DD uses this http://www.amazon.com/Perque-Activated-Guard-trade-lozenges/dp/B006UKGDOQ/ref=sr_1_1?s=hpc&ie=UTF8&qid=1376917571&sr=1-1&keywords=perque+activated+b-12+guard which has both methyl + hydroxy B12. It's speculated that about 10% of a sublingual gets absorbed. Or you can start with the one your dr suggested for a lower dose, tho as you add methylfolate, your son's B12 levels should drop and you may, over time, find that a higher dose works better. Some will be trial and error and some will be a matter of how well he can tolerate sucking on the sublingual. Different brands have different tasts and dissolve at different rates.

 

I found that finding the right balance of methylfolate and methylB12 doses took about 6 weeks for my DD. If you OD him and get horrible behavior, you can stop everything for a few days and things should calm down. Then re-start at a lower dose until you find stability.

 

Once I'd added molybdenum and then found the balance of methylfolate + B12, I'd addrsss the Vitamin D. By then, winter will be on it's way and "getting sunshine" won't be a practical approach. If I'm reading your results right and your son is VDR Taq +/+ and COMT +/-, then according the heartfixer, he needs and should tolerate plenty of a D3 supplement:

Individuals (+/+) or (+/-) for VDR Taq defect have lower Vitamin D levels, make less dopamine, and will need and tolerate dopamine precursor substances and methyl donors. COMT (+/-) and VDR (+/+) behaves like COMT (-/-) and COMT -/- has low dopamine levels and needs and tolerates dopamine precursors and methyl donors (D3 is a dopamine precursor)

 

My DD takes 3000 IUs D3 and 45mg of Vitamin K daily. K is important when supplementing with D. So we use one supplement that has just D3 and one that's a combo of D3+K. But since your son is VDR Taq +/+ and his levels are so low, you may need to use 5,000-10,000 IUs. Some docs say to supplememt once a week. Not sure why. We supplement daily. My DDs levels now hover around 50, tho our dr prefers above 60.

 

That's probably enough for now. There are things you can supplement for the other mutations, like phosphatidylserine for BHMT (esp. if he has any ADHD symptoms) and keeping an eye on copper/zinc ratios for MAO-A. But that's down the road. CBS, MTHFR and VDR are the one's I'd focus on first.

 

But always realize - I am not a doctor, have no medical training and have made plenty of mistakes on my own kids. take everything I write with a grain of salt and double check it with your own research. I am only comfortable screwing up on my own kids, not someone else's!

Edited by LLM
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LLM, I just want to thank you SOOOO much for all this extremely helpful information! I read it right away but have not had time to really research everything and figure out an exact plan...I want to approach everything the right way and not make things worse. I have no idea why our Neurologist prescribed 7.5 mg - looking it up you are right - that seems so high! I am so glad you responded.

 

Thank you SO much for even posting links to where we can get everything. I greatly appreciate this! Our little guy was doing well but since starting school things have resurfaced including the raging meltdowns (most recently because we could not make a real monster appear...he INSISTED we be able to do that, and then today because he couldn't wave a magic wand and make things disappear like they do in cartoons). Tics are way better but definitely the bipolar behavior has come back - we just traded one thing for another.

 

We should get his Cunningham Panel results in a few weeks or sooner, and the hospital will run a bunch of other blood tests (Mycoplasma, Coxsackie, West Nile, Lyme) when he is under anesthesia to have a lipoma removed mid September.

 

In the meantime I am going to try the protocol you wrote about and go slow with things and hope for the best! Thank you again so much!

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One last question...what do you think about this supplement? It seems to have both Methylfolate and Methylcobalamin in it and gets great reviews...

I would just need to slice off a small bit of the pill for my nearly-4-year-old to take: Active B12 Lozenge With L-5-MTHF | Sublingal Active B12 | 1000 mcg of Pure Non-racemc L-methylfolate | 800 mcg of Methylcobalamin and Adenosylcobalamin Vitamin B12 | 60 Sublingual Tablets | Physician Formulated | Seeking Health

 

http://www.amazon.com/gp/product/B00822JNTC/ref=ox_sc_act_title_1?ie=UTF8&psc=1&smid=A2TW2XLT5W4EN7

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we take seeking health (dr. lynch's brend) chewable multivitamin which makes life much simpler. you may want to check out the ingredients and see if they are right for you. 500micrograms of b12 is not that much since it is not absorbed that well.

 

http://www.seekinghealth.com/optimal-multivitamin-60-chewable-tablets-seeking-health.html?utm_source=froogle&utm_medium=shopping&utm_campaign=products&gclid=CMfOqM_CnbkCFYuk4AodoUwAgA

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If the product you've linked were for an adult, I'd tell you to cut it in half and then build up to a full pill over several weeks. But for a 4 yr old - IMHO you won't be able to slice off a reliable section of the pill every day (so dosing would be inconsistent) and the sliver you'll end up with may crumble and not lend itself to being sucked on.

 

For kids, I find the methylfolate drops much easier to take (I put 5-10 ml of water into a medicne cup - the kind that comes with liquid medicines) and add one drop of the methylfolate. My DD then drinks that and sucks on the methylB12 lozenge. MethylB12 is poorly absorbed orally - some estimates say only 10% makes it into your system. So sucking on 1000mcg of methylB12 may not be as high as it sounds. I don't know if it's medically acurate, bu my impression from my own experiences is that it was the methylfolate that stabilized by DDs mood and the methylB12 that gives her energy. They need to be taken together, but for mood issues, IMO getting an accurate dose of methylfolate is the more important of the two and the drops are the best way to do that.

 

There's no single "right" answer but I think for young children, you're better off with drops rather than trying to use a combo product. I know some older kids here use the combo product (Thorne makes one as well). But at least while you're trying to figure out what dose you need, I'd do the first few months with the drops and then see where you're at. Maybe then a combo sublingual would make sense. JMO.

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