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IMPORTANT
The material in this guide is for informational use only. It should not be used as a substitute for advice from a health care professional. Please consult with a health care professional regarding the application of this material to your own personal needs and situation.

This publication is not intended to diagnose, treat, cure or prevent any disease.

TAble Of cONTeNTs
INTRODUCTION What if I Dont Have A Doctor Right Now? So Where Do I Begin? What Is a Poor Nutritional Profile? Products to Correct a Poor Nutritional Profile How Long Should I Try These Products? SPECIAL DIETS The Gluten-Free/Casein-Free Diet Explained How Long Must I Use the GF/CF Diet? Casein Restriction Gluten Restriction Frequently Asked Questions about the GF/CF Diet The Specific Carbohydrate Diet (SCD) THE IMPORTANCE OF GASTROINTESTINAL HEALTH Signs of Gastrointestinal Disturbances The Intestinal Immune System Gastrointestinal Tract: A Top Priority Digestive Function Digestive Enzymes Digestive Irregularities How Long Should the Trial Period be on Enzymes? Probiotics How Long Should the Trial Period be on Probiotics? IMMUNE SUPPORT General Facts About Our Immune System Signs of Immune Deficiencies Sleep Issues BIOCHEMICAL PATHWAYS Sulfation Methylation Oxidative Stress BEHAVIORAL CONSIDERATIONS TOXIC LOAD/HEAVY METALS What Could be Signals of a Toxic Load Burden? Minimizing the Toxic Load Detox-Aid Advanced Formula How Does Detox-Aid Advanced Formula Work? Heavy Metal Detoxification DONT OVERLOOK THE HYPOALLERGENIC FACTOR Why Arent All Products Made to be Hypoallergenic What Have Been the Results of Individuals Using Kirkmans Hypoallergenic Line? IDEAS ON HOW TO GET YOUR CHILDREN TO TAKE NUTRITIONAL SUPPLEMENTS APPENDIX A Step-by-Step Recap of Interventions The Top Three Interventions to Try Next Possible Steps The More Complicated Interventions Laboratory Testing Kirkmans Customer Service Staff and Technical Staff Can Help NOTES Kirkman Contact Information 6 6 7 7 8 10 11 11 11 12 13 14 15 16 16 17 18 18 19 19 21 21 21 22 22 23 24 25 25 25 26 27 29 29 30 30 30 31 32 33 33 35 36 36 36 36 36 37 37 38 39

TAble Of cONTeNTs

beGINNeRs GUIDe
TO bIOMeDIcAl AND DIeTARy INTeRVeNTIONs
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INTRODUCTION
Biomedical and dietary interventions in individuals can be very challenging and complex. This guide is an attempt to simplify the approach and provide an understanding and background for biomedical interventions, along with a logical sequence for the individual or parent and doctor to follow. Many Kirkman customers attend conferences, read articles or books, hear media programming or consult with their physician only to come away overwhelmed, confused and unsure where to begin. This guide should help map out a logical approach for the parent and doctor to agree upon. It is formatted so as to coincide with the information found on the Kirkman Roadmap that is on the inside cover of this book or you can download or order from Kirkmans website at www.kirkmanlabs.com. A simplified recap of the step-by-step interventions described in detail in this guide is provided in Appendix A . This recap is provided to help you prioritize the biomedical and dietary considerations that may meet your special requirements.

You may want to try nutritional supplements to get started.

What If I Dont Have a Doctor Right Now ?

Kirkman always recommends that the interventions described in this guide be carried out under the care of a physician who specializes in the care of individuals with sensitivities. Such doctors can be hard to locate and once located can have a significant waiting period for appointments. Add to this delay the time needed to perform necessary laboratory tests, and it can be an extremely long time before the physician begins a treatment regimen for your child. In the meantime, you may want to try certain supplements or special diets. These interventions are okay to try on your own as long as you follow the instructions regarding the diet and on supplement labels.

So Where Do I Begin?
Generally speaking, most physicians recommend correcting poor nutrition first, since most individuals with special dietary requirements exhibit poor eating habits. Often this involves basic nutritional supplements as well as a special diet, although one can be done without the other to start. If you are already on a special diet, just start the supplementation, while if you are not on either, you may start one or the other or both.

What Is a Poor Nutritional Profile?

A poor nutritional profile is a series of nutritional deficiencies that may be present in an individual. It is very prevalent in individuals with dietary sensitivities for numerous reasons. Some of these reasons include: Special diets such as the gluten-free/ casein-free (GF/CF) or the Specific Carbohydrate Diet (SCD) may be in place, which are not nutritionally balanced. A persons tastes and attitudes can be such that an individuals diet is very deficient in vitamins, minerals, or other nutritional necessities. A facet of biochemistry can be irregular, making the absorption of nutrients sub-optimal. Poor nutrition can often be (though not always) recognized by: Vision issues Unhealthy skin tone Extreme tiredness or lack of energy Behavioral issues Failure to thrive Frequent illness 7

Many children with sensitivities crave the foods to which they are allergic.

Parents often detect some or most of these conditions prior to a physicians evaluation or laboratory testing. Correcting a poor nutritional profile is crucial to good health in individuals with dietary sensitivities. For those on a casein free diet, calcium

supplementation is essential to proper bone development and growth. Furthermore, a comprehensive vitamin and mineral supplement is essential when the diet is unbalanced and deficient, which is often the case if all food categories including protein, fruits, vegetables and carbohydrates are not consumed. Cod liver oil and omega-3 fatty acid supplements can help support good vision and healthy skin. Irregularities in biochemical pathways are often supported by B-6/magnesium supplements, folic or folinic acid, or sulfation aids. Certain nutrients are essential for proper support of the immune system. Zinc, vitamin A, vitamin C, vitamin E, and selenium are examples of nutrients that improve immune response. Sub-optimal levels of these nutrients can sometimes lead to poor immune response. A physicians evaluation and laboratory testing will help confirm these deficiencies and point you and the doctor in the right direction, but until such time as that evaluation and testing takes place, these nutritional options are safe and do not cause serious side effects as long as one does not exceed safe levels that your nutritionist or physician recommends. Sometimes a poor nutritional profile can be due to enzyme insufficiency. If this is the case, even eating a well balanced diet and taking supplements may not be the entire answer. Pancreatic digestive enzymes each do a specific job and digest a specific food group. Individuals deficient in lipase probably wont digest fats and oils properly and wont fully absorb oil soluble nutrients like vitamins A , D or E. Those deficient in lactase wont digest lactose and may be lactose intolerant. Other people may have a shortage of starch digesting enzymes or protein digesting enzymes. When this is the case, usually digestive discomforts such as bloating or indigestion are present to help the parent or physician recognize the problem. When these situations are present, then supplementing with the proper digestive enzyme product may improve poor nutrition.

Products to Correct a Poor Nutritional Profile

The selection of products used to correct a poor nutritional profile should be based on the individuals needs and how aggressive an approach the individual or parent wishes to take. If the patient is extremely sensitive or seems to have severe gastrointestinal issues, the less aggressive approaches would be recommended. Regardless of which approach is utilized, begin with about a 1/4 dose for a few days and gradually work up to the recommended dose. This will minimize any potential side effects or sensitivities.

The most aggressive approach to correct a poor nutritional profile would be a form of Super Nu-Thera, the high B-6/magnesium multivitamin/mineral developed by Dr. Bernard Rimland. Many clinical studies with positive outcomes have been done on this type of product using a variety of subjects. Super Nu-Thera comes in liquid, powder, capsule and tablet forms, some flavored and others hypoallergenic in nature. The hypoallergenic forms are generally recommended due to the extreme sensitivity of many patients to flavoring agents and sugars. Some children, however, need the product flavored in order to get compliance so those forms are also offered. A dosage chart based on Dr. Rimlands initial recommendations is enclosed with Super Nu-Thera orders and is outlined below. The dosage is based on weight. This dosage chart only refers to the three original forms of Super NuThera: powder, liquid, and caplets. Some newer forms of the product such as Nu-Thera and hypoallergenic capsules do not correspond exactly. In those cases, the product labels or Kirkmans customer service or technical departments can be of assistance on the correct dosage.

Super Nu-Thera and Nu-Thera products are available in various tastes and textures.

As mentioned before, always start by giving a 1/4 dose for a few days and gradually increase the dosage every few days until the desired dosage is reached. Some doctors recommend less than Dr. Rimlands suggested dosage.

A less aggressive approach may be tried utilizing NuThera, which is a condensed form of Super Nu-Thera. It consists of the same basic nutrients at lower potencies in an easy to swallow, small, #3 capsule. This product is hypoallergenic and has less taste impact if the capsule is opened and the powder is mixed in food or drink. Another product suitable for a middle-of-the-road approach is Thera Response, a hypoallergenic, mid-potency, multi-vitamin/mineral product formulated at the request of several physicians desiring a mid-potency product. 10 The least aggressive plan would be to use a standard multi-vitamin/mineral product such as our Childrens Chewable Multi-Vitamin/Mineral Wafers or Childrens Multi-Vitamin/Mineral Hypoallergenic capsules and add the vitamin B-6 and magnesium gradually using Kirkmans Vitamin B-6/ Magnesium Chewable Wafers or P5P/Magnesium Glycinate capsules. Each B-6 chewable wafer contains 50 mg. of B-6 with 25 mg. of magnesium. Start with one daily and work up to as many as five daily , provided the increased dosages seem to be improving the child. By using multi-vitamins/minerals with high B-6/magnesium content, you are also trying an intervention that addresses behaviorial, learning and social issues, as well. Regardless of which approach you use, if the individual is on a caseinfree diet, be sure to add a calcium supplement supplying at least 800 mg. daily. Kirkman has calcium supplements available in powder and capsule forms.

Nu-Thera and Thera Response offer midpotencies.

How Long Should I Try These Products?

You should use the products for at least four weeks in order to provide an opportunity for an improvement to be seen. If no results are seen, the high B-6/magnesium portion can be dropped, and you can revert to a more standard potency multi-vitamin/mineral product.
Add B-6 or P-5-P/ Magnesium to a good multi-vitamin.

SPECIAL DIETS
The individual may already be on a special diet before trying to correct poor nutrition. If so, certainly stay on track if it has improved the individuals health, which it does in many cases. If a special diet is not being used, this is a must to try. The most popular diet with the greatest success rate is undoubtedly the gluten-free/casein-free (GF/CF) diet. All of Kirkmans products are casein- and gluten-free for this reason. 11

The Gluten-Free/Casein-Free Diet Explained

Many individuals find it necessary to go on a gluten- and/or casein-free diet as a result of food allergies or medical conditions. Whatever the reason, managing a gluten-free/casein-free (GF/CF) diet is not as easy as it sounds. One must learn which products contain casein and gluten and get used to carefully reading product labels. In addition, one must learn where casein and gluten can hide from the consumers view on a label. Once the parameters are understood, what seemed like an impossible diet to comply with becomes much more tolerable and manageable.

Vegetables are a source of good nutrition on special diets.

How Long Must I Use the GF/CF Diet?

The trial period should be about six months. If significant improvement results, the diet could prove to be a lifelong necessity. If no improvements are noted, then obviously the diet need not be continued. Be sure to use caution in your evaluation, because sometimes improvements are slow and subtle, and going off the diet can cause some regressions.

Casein Restriction
Casein is present in dairy products. Eliminating casein sounds simple just remove all dairy products from the diet including: Milk in all forms (including skim, powdered and goats milk) Butter Cheese Yogurt Lactose Whey Caseinates

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Unfortunately, it is not that simple. Most prepared foods contain dairy products such as powdered milk, cheese or whey. Soup mixes usually do, as well. You must read the labels carefully to be sure dairy products are not present in frozen or canned foods. You must also check bakery goods and snacks for the presence of the above casein sources. Reading the labels is a critical issue. There are acceptable casein-free substitutes available. Milk alternatives made with rice, potato or soy are commercially available in specialty sections of grocery or health food stores. Some sensitive individuals also react to soy, so be careful on this issue. There are also dairy-free yogurts and mock cheese products marketed. Using your imagination along with these specialty products will allow you to create your own versions of recipes that traditionally contain dairy products. A 1998 book by Lisa Lewis, Ph.D. entitled Special Diets For Special Kids gives hundreds of valuable creative ideas for casein- and gluten-free diets. Eggs and most types of mayonnaise do not contain casein. There are also dairy-free margarines available, but read the labels carefully because some contain whey.

Special diets require that you read all food labels carefully.

Gluten Restriction
Gluten restriction is more difficult and requires more effort than casein restriction. It is also easier to be fooled because gluten can be hidden in a lot more products. The following grains contain gluten and must be avoided: Wheat Oats Barley Rye Semolina Spelt Triticale Kamut

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These grains are present in most commercial cereals, breads, flours, baked goods, instant mixes and prepared foods. Reading the label carefully is mandatory to ensure their absence. However, this often becomes challenging because natural or artificial flavorings along with spices, gravies and dressings can also contain gluten. If in doubt, you will have to check with the manufacturer of the product. Fortunately, there are safe, alternative grains and flours for gluten-free diets. Acceptable grain substitutes are: Sweet rice Brown rice White rice Tapioca Potato starch Beans flours (Garfava and Garbonzos) Lentil Corn

Kirkmans non-porous, washable production rooms can be completely washed down after each operation assuring a completely casein and gluten free manufacturing facility.

Another factor that makes gluten-free dieting difficult is the contamination factor. For example, wheat flour makes a very good anti-caking or anti-stick compound for some manufactured or packaged products and is not listed on the label because it is not a component of the actual product. Rather it is used to dust the manufacturing or packaging equipment to prevent tackiness. Also, a factory that packages a gluten-free product may use the same packaging line as it did for one containing gluten without a thorough cleaning in between. Know your supplier and, if

in doubt, call and ask about potential contaminations and request a copy of the suppliers standard operating procedures, which should outline how their equipment is cleaned. If the supplier or manufacturer will not share this information with you, chances are they are hiding something. If everyone in the family is not gluten-free, be careful of in-home contamination from pots, pans, cutting boards, utensils, countertops and dishes. Most individuals sensitive to gluten are sensitive at minute levels (a few parts per million). What might seem insignificant such as wheat residue on a breadboard could have serious repercussions to the glutensensitive person. 14 As with casein, Lisa Lewis, Ph.D., has extremely valuable and creative ideas for gluten-free cooking in Special Diets For Special Kids. This publication is remarkably helpful in understanding and implementing a GF/CF diet. Many parents beginning the CF/GF diet worry about finding enough foods which are legal for the diet but still nutritious and fulfilling for an individual. These alternatives are described in this book.

Frequently Asked Questions about the GF/CF Diet

Q: Doesnt everyone need to drink milk to get calcium? A: No. Calcium is available from non-dairy sources such as potato, rice or soy milks, plus calcium supplements can be used to ensure the daily recommended amount is consumed. Q: Dont all children need milk to be healthy? A: The American Dairy Association has led parents to believe that. The truth is, children do very well without milk, as long as calcium requirements are obtained elsewhere. Q: What else besides milk has casein? A: All forms of milk (powdered, goats, skim) plus cheese, butter, cream cheese, cottage cheese, whey and caseinates contain casein. Q: What contains gluten? A: Wheat, oats, barley, rye, semolina, some food starches, alcohol from grain, spelt, and kamut contain gluten. A lot of prepared packaged foods contain gluten as do many restaurant foods. Flour, crackers, and snack foods also generally contain gluten.

Q: My child only likes McDonalds Chicken McNuggets as a protein source. Do they have gluten? A: Yes, they are rolled in wheat flour before frying. You can make your own nuggets, however, using rice flour or bean flour. These are glutenfree. Q: Do French fries have gluten? A: Only if wheat flour is used as an anti-stick agent. Ask the restaurant. Also be careful about the possible contamination with gluten if the fries are cooked in pre-used frying oil. Q: Do vitamins and other supplements have casein or gluten? A: They can. Check the labels list of ingredients (required) and check for milk products like caseinates, lactose or whey, and for any grains or starches that could contain gluten. Also, some flavorings can contain gluten. Kirkman products are all casein- and gluten- free. Q: Ive removed casein and gluten from my childs diet and he/she still seems to be allergic to foods. What does this mean? A: First, check to make sure no hidden casein or gluten could be present. Some individuals are also allergic to other ingredients such as soy and corn. Ask your doctor to check this out. 15

The Specific Carbohydrate Diet (SCD)

This diet has been tried on individuals who have severe gastrointestinal discomforts such as bloating, gas, diarrhea, constipation and severe food intolerances. The SCD diet limits the intake of sugars to simple monosaccharides such as honey, fructose and dextrose, and eliminates the intake of disaccharides and polysaccharides such as sucrose, molasses, mannitol, sorbitol, xylitol and inulin. It also greatly restricts the consumption of starches and other types of carbohydrates. The theory behind the diet is based on the assumption that toxic organisms present in the gut thrive on disaccharides and starches, and that their elimination will starve out these organisms. The main foods consumed on this diet are, therefore, protein, vegetables, fruits, seeds and nuts. A book on this diet by the late Elaine Gottschall is entitled Breaking the Vicious Cycle: Intestinal Health Through Diet.

THE IMPORTANCE OF GASTROINTESTINAL HEALTH

Cleaning up the gastrointestinal tract is imperative in sensitive individuals. One of the special diets above may be a very good start in many patients, but may not complete the job. Physicians have known for centuries that a well-functioning gastrointestinal tract and digestive system are crucial to good health. When digestion is working optimally, other organs and systems in the body have a better chance of working optimally, as well. This is because the digestive system is responsible for processing the nutrients in our food, which in turn are used for growth, reproduction, development, tissue repair, healing, and for the normal functioning of every organ in the body. Therefore, the digestive system is very much responsible for supporting the health of the body as a whole. In addition to providing fuel for the body through nutrition, the intestinal tract also plays an integral role in the functioning of the immune and nervous systems. This association is often referred to as the gut-brain connection.

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Signs of Gastrointestinal Disturbances

There are many distinct, recognizable signs of gastrointestinal disturbances, but if the individual is unable to communicate the signs may not be obvious to the caregiver. Some of the signs are:

Abdominal discomfort or cramping (often includes crying, screaming or holding the abdomen) Constipation, diarrhea, or alternation between the two Indigestion, bloating, gas Inadequate digestion evidenced in stools No formed stools Inflammation Yeast or bacterial overgrowth Serious food sensitivities

When gastrointestinal disorders are suspected, a thorough examination by a gastroenterologist is called for. The evaluation very well may include

an endoscopy and biopsy. Based on this evaluation, the physician has many options to help. These options may include:

Prescription anti-fungals, antibiotics, or other drugs OTC medications or supplements Special diets including GF/CF or SCD Probiotics to support good flora and crowd out undesirable organisms Products that support tissue healing Digestive enzymes 17

The Intestinal Immune System

The intestinal tract represents an important barrier between the external world and the internal environment, and there are a number of immune mechanisms built into the gut lining that help ensure that invading organisms from the outside are neutralized before they can do potential damage inside the body. It is postulated that up to 70% of the bodys immune system is associated with the digestive tract. This intestinal immune system is known as Gut-Associated Lymphatic Tissue. When the specialized immune cells that line the digestive tract detect an unknown or possibly harmful substance (called an antigen), they signal the immune system to provide antibodies to help fight these antigens. Another immune defender that is present in the lining of the gut wall is known as Secretory Immunoglobulin A (SIgA). When antigens are present, SIgA can help to trap them in the mucous layer of the intestinal tract, thereby rendering them ineffective. The immune system has an integral involvement with the digestive system, and imbalances of the gastrointestinal tract often occur concurrently with immune dysfunction. Further discussions of the immune system will follow later in this guide.
Optimal digestion positively impacts other body systems.

Gastrointestinal Tract: A Top Priority

Because of its involvement in the rest of the body processes, the gastrointestinal tract should be the top priority in getting proper care for sensitive individuals. Without the proper functioning of the GI tract, trying to correct other areas may be futile. Discuss this priority with your physician early in your association. Prior to an examination by a physician and/or a gastroenterologist, one can very safely try a special diet, a comprehensive probiotic or a digestive enzyme to help alleviate gastrointestinal discomforts. Often these interventions improve the quality of life for the individual by improving overall health, gastrointestinal status and discomfort related behavioral issues.

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Digestive Function
Closely related and sometimes concurrent with gastrointestinal discomforts are digestive irregularities. These are often present when the gastrointestinal tract is not healthy. The primary function of the digestive tract is to break down the large particles of food that we eat into small molecules that can cross over the intestinal lining, enter the bloodstream, and become fuel for the various metabolic processes in the body. In order to accomplish this function, the intestinal tract is involved in four primary activities: digestion, absorption, assimilation and elimination. Digestion is the breakdown of the food particles into usable nutrient forms. Absorption is where those usable nutrients cross the gut wall and pass from the intestine to the bloodstream. Assimilation is utilization of the products of digestion for energy and the bodys metabolic processes, while elimination is, of course, the excretion of the bodys waste products through the intestines and kidneys.
Digestion begins in the mouth with salivary secretions.

Digestion begins in the mouth with salivary secretions, then continues in the stomach where secretions of hydrochloric acid and pepsin form a material called chyme. The pancreas then releases enzymes into the duodenum of the small intestine as the chyme also passes into the duodenum.

Digestion and absorption then continues and is essentially completed in the small intestine. The final stage of digestion is completed in the large intestine and colon where waste accumulates and is then eliminated.

Digestive Enzymes
Digestive function irregularities are prevalent in sensitive individuals. The majority of these are the result of the stomach not secreting enough hydrochloric acid or the pancreas not releasing enough pancreatic digestive enzymes. When these situations occur (and they often occur together), supplemental digestive enzymes are often tried to help support the insufficiencies. When we talk about supplementing with digestive enzymes, it is the pancreatic enzymes that we are talking about. These are the enzymes that have specific jobs and act only on specific types of food substrates. When digestive enzyme supplementation is called for or recommended by a health professional, it is imperative that the proper combination of enzymes is chosen so as to address the problems at hand. For example, lipase only digests fats; it does not act on proteins or sugars. Sucrase only digests sugars; it has no effect on fats or proteins. Proteases and peptidases act on protein, casein and gluten -- other enzymes do not.

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Digestive Irregularities
There are many recognizable indicators that digestive discomforts are present in an individual. Some of these can be:

Bloating and/or abdominal pain or cramping Irregular bowel habits or abnormally loose or mushy stools Constipation, diarrhea, or alternating between the two Discomfort after eating Excessive gas Extreme sensitivity to dairy and grains Very odorous bowel movements Undigested food in the stool Oily, greasy, and/or floating stools

As discussed earlier, a specific enzyme combination must be selected based on an individuals specific needs. There are many different enzyme products in the marketplace including :

Lipase - addresses fat digestion Lactase - aids lactose intolerance

Peptidase/Protease - digest proteins and peptides including casein and gluten DPPIV (Peptidase) - targets casein and gluten Multi spectrum enzymes - digest all food groups Carbohydrate digesting enzymes - address carbohydrates

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If you know that a person needs a specific enzyme, such as lipase for fats, you can look for that specific enzyme-containing product. Ususally, however, individuals are not sure, in which case a multi-spectrum digestive enzyme would be the product of choice. Multi- spectrum enzyme products help digest all food groups including proteins, fats, starches and other carbohydrates, sugars, celluloses and fiber.

No other commercially available enzymes contain the Isogest fraction.

Kirkman has advanced digestive enzyme products containing Isogest, a patent pending enzyme component with isomaltase activity. No other commercially available enzymes contain the Isogest fraction. Kirkman Enzym-Complete II/Isogest formula and Maximum Spectrum EnzymComplete II DPPIV/Isogest Formula are the two products of choice. The latter product is fruit-free, which is important in those individuals sensitive to pineapple or papaya fruit.

How Long Should the Trial Period be on Enzymes?

Improvements of the digestive symptoms should be quite rapid. If no improvements are noted in about four weeks, supplementation can be stopped.

Probiotics
Often, enzyme insufficiency is accompanied by a poor ratio of gut flora present in the intestinal tract. A healthy intestinal tract normally has a good balance between healthy, desirable flora and unhealthy bacteria or yeast, while a compromised intestinal tract lacks this good balance of flora. In these instances taking a probiotic with the enzymes is a possible solution and helps maximize the enzyme activity. The probiotics are blends of beneficial flora that set up residence in the small intestine and help to crowd out the unwanted organisms. When enzymes and probiotics are taken together, it is recommended that the enzyme be taken at the very beginning of the meal with the probiotic following about one half hour later. When enzymes are not being used concurrently, the probiotic should be taken at the beginning of the meal.

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How Long Should the Trial Period be on Probiotics?

The trial period on probiotics should be about two months because it takes time for the organisms to set up residence and begin crowding out the unwanted organisms. As a result, the improvements can be quite gradual and subtle. Improved stools and fewer digestive symptoms should be evident after the trial period.

Probiotics are beneficial bacteria that help crowd out unwanted bacteria.

IMMUNE SUPPORT
General Facts About Our Immune System
The immune system is a complex and dynamic network of many soluble components including cells, membranes, and a mini circulatory system separate from blood vessels. These entities all work together to protect us from infection by opportunistic microbes, bacteria, viruses, fungi and parasites that abound in our environment. The immune system also constantly scans our bodies for any signs of abnormal cell growth. Our bodys first line of defense against unwanted intruders consists of our skin, our body enzymes, such as saliva and stomach acid, and our protective epithelial cells, which line our bodys mucosal surfaces. These physical factors combined with specialized white blood cells make up our innate immune system, which is rather non-specific and broad- spectrum in nature. More complicated is our bodys adaptive immune system, which is far more sophisticated and deals with specific fragments of any potentially harmful or foreign material. These fragments are called antigens and they are dealt with in the immune system by antigen receptors. Once an antigen receptor adapts to one of these invading fragments, it retains antigenic memory so that it may quickly neutralize that antigen if it invades the body again. There are many specialized white blood cells that work together to coordinate overall immune response. T cells are responsible for cellular immunity while B cells produce antibodies in response to antigens. Then there are NK natural killer cells that kill off certain infected targets, granulocytes, which remove bacteria and parasites by releasing toxic compounds, and macrophages that engulf and destroy foreign material. There are two major types of T cells: Th1 and Th2. Th1 cells drive immunogenic responses, while Th2 cells drive antibody production by B cells and are especially important in responding to allergens. Compro-

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Pictured are viruses attacking healthy cells in the blood.

mised immune systems usually display a Th1 to Th2 cell shift that causes an increase in food and environmental allergies . The success of our immune system relies on an incredibly elaborate and dynamic regulatory/communications network composed of millions of cells and is a sensitive system of checks and balances. Genetic make-up and environmental invasions can result in the immune process going terribly wrong. Serious infections and other health consequences can result. 23

Signs of Immune Deficiencies

The signs of an immune problem are often quite easy to recognize over time. Persistence of the following conditions are key to suspecting immune deficiencies:

Frequent illness Continuous food allergies or an increased number of such allergies Inadequate detoxification as indicated by laboratory testing Low glutathione levels as indicated by laboratory testing Impaired methylation
Frequent illness may be a sign of a weak immune system.

Sensitive individuals are especially prone to immune problems. In the case of children, parents observations conveyed to the physician are extremely important in helping the doctor recognize the problem, which is often hard to judge at an office visit. There is a long list of nutritional products that support a healthy immune system including :

Zinc Vitamin A Vitamin C Vitamin E Selenium Beta Glucan Coenzyme Q-10 or Idebenone N-Acetyl Cysteine Colostrum Cranberry Extract Garlic

Kirkman carries a wide variety of products that support the immune system.

Olive Leaf Goldenseal Reduced L-Glutathione Dimethylglycine or Trimethylglycine

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You may recognize some of the above nutrients as being present in the multi-vitamin/mineral you may be using. To better support a compromised immune system, additional supplementation of the nutrient is recommended. Increasing zinc to 50 mg. daily, vitamin C to 1000-3000 mg. daily, vitamin E to 200-400 IU daily, selenium up to at least 75 mcg. daily, and Coenzyme Q-10 up to 100 mg. daily may be beneficial. Kirkman also carries other combination products comprised of many of the above immune boosting nutrients.

Sleep Issues
Sleep issues in sensitive individuals are not much different from sleep problems in the general population. These can include:

Trouble falling asleep Periodic night awakenings Restlessness Nightmares

It must be remembered, however, that these sleep tendencies could be all or in part due to underlying conditions such as digestive issues, gastrointestinal tract issues such as ulceration, reflux, or inflammation or other causes of pain.
Kirkmans sleep support products include Magnesium, Melatonin, L-Taurine, and Gaba

The dietary supplements often useful in supporting restful sleep are:

Magnesium Melatonin L-Taurine GABA

All of these supplements are safe and usually without side effects, and should be tried one at a time for about a week in the order listed above. If one supplement does not seem to help, stop and try the next one .

BIOCHEMICAL PATHWAYS
Sensitive individuals often exhibit certain tendencies in several biochemical pathways. Each of these individual pathways has a unique purpose and an abnormality can lead to health issues. A description of those pathways most often disrupted follows.

Sulfation
The sulfation process is linked to an enzyme system known as phenol sulfotransferase (PST). Normally, PST is involved in a process called sulfoconjugation, whereby a group of potentially harmful chemicals known as phenols are attached to sulfate and thereby eliminated from the body. When there is a deficiency of sulfate in the bloodstream, phenolic compounds may build up in the body, and this in turn can interfere with neurotransmitter function. Sulfate deficiency and the resulting impairment of PST activity may explain some sensitivity reactions to a variety of phenolcontaining foods, such as apples, grapes, chocolate, food colorings, and some herbs and spices. Very sensitive individuals seem to have only about 1/5th of the normal level of sulfate in their bodies, the rest having been excreted excessively in the urine. In addition to the phenolic buildup described previously due to sulfate deficiency, sulfur and sulfate also play other important roles in the body including: Detoxification processes Releasing certain pancreatic digestive enzymes Activating the hormone CCK 25

Many individuals with sensitivities have reduced sulfate levels in their body.

Sulfation can often be supported by oral sulfate, topical Epsom salt products, or by giving individuals Epsom salt baths. Magnesium sulfate products and Epsom salt baths are perfectly safe interventions that can be tried at home without concern by simply following the label instructions.

Methylation
Methylation is a series of very important biochemical reactions in the body that are responsible for overall good health. In sensitive individuals, this process is very often lacking to some degree, making these individu-

als poor methylators. A properly functioning methylation pathway has rewarding health benefits including:

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Proper brain function Healthy detoxification Proper reproduction DNA protection Healthy, normal, non-premature aging process

There are many nutritional supplements that support proper methylation. You should discuss these options with your physician carefully, because each individual is unique and requires a methylation improvement program specifically tailored to his or her requirements. Products your doctor may use to support the methylation process include:

Kirkman offers a wide range of antioxidants to support those with oxidative stress.

Methyl Vitamin B-12 Dimethylglycine or Trimethylglycine Folic or Folinic Acid Vitamin B-6 SAMe Selenium Zinc Phenol reducers The methylation pathway is complicated and a physician should be consulted to determine interventions.

Oxidative Stress
Individuals with dietary sensitivities can have elevated oxidative stress. Certain toxins called oxidants enter the body and begin causing oxidative tissue damage known as oxidative stress. These toxins can be in the form of chemicals, pesticides, heavy metals, and other environmental pollutants. Some of these cell-injuring oxidants are known as free radicals. It is important to minimize oxidative stress damage by consuming antioxidants, which retard the process. Some of these antioxidants include vitamins C, E, and A, selenium, melatonin, carnosine, carnitine, pycnogenol, grapeseed extract and CoEnzyme Q-10. There are laboratory markers that measure levels of antioxidant compounds present in the body. Talk to your doctor about appropriate testing and subsequent supplementation with antioxidants.

BEHAVIORAL CONSIDERATIONS
Behavioral disturbances are very common in diet sensitive individuals. Because each individual is different and displays different behavioral traits, it is challenging to find the right interventions for a given person. Often, laboratory test results are of no value here because what causes one individual to behave a certain way may have quite a different effect on another. Sometimes doctors and parents are forced to use trial and error evaluations of various interventions until the correct regimen is found for a given patient.

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The most common behavioral disturbances involve the following symptoms:

Speech delay or absence of speech Unable to put words or sentences together Learning disabilities Lack of social skills Lack of eye contact Aggressive behavior Passive behavior Depression Anxiety Tics or abnormal neurological responses

The list of supplements and interventions that have been used in dealing with these behavioral issues is long. Some of the more popular ones include:

High B-6/magnesium supplements High potency multiple vitamins and minerals (some may include higher B-6/magnesium potencies as well) Dimethylglycine or Trimethylglycine Taurine Carnosine Creatine Inositol Omega-3 fatty acids Cod liver oil HBOT (Hyperbaric Oxygen Therapy) Coenzyme Q-10 or Idebenone

You may have already tried the multi-vitamin/mineral supplementation with high B-6/magnesium as your first intervention so you will have evaluated its effectiveness. Often lack of eye contact due to insufficient vitamin A in the diet can be improved by cod liver oil, as demonstrated by Dr. Mary Megson of Richmond, Virginia. Generally, a thorough examination by your physician is preferred before any of the above interventions are begun, however many of the products listed are perfectly safe and present no side effects when taken. So in cases when a physician is not available for a period of time, vitamins, minerals, omega-3 fatty acids, cod liver oil and Coenzyme Q-10 are certainly harmless to try and could prove very beneficial. It should be remembered, however, that only one product should be tried at a time. Other interventions like dimethylglycine or trimethylglycine, HBOT, creatine, carnosine and inositol normally require a physicians involvement for maximum safety.

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TOXIC LOAD/HEAVY METALS

Substantial evidence is emerging linking many medical conditions to negative environmental influences present in our world. Negative environmental factors have been implicated in a myriad of medical irregularities. The frequency of many of these medical conditions is increasing, which leads to further speculation that outside environmental causative factors are involved. Included in the list of environmental insults that can affect disease states are toxic chemicals, heavy metals, PCBs, and pesticides present in the products we use, and contaminants in the air we breathe and the water we utilize and drink. These environmental pollutants can affect the body in numerous ways. Natural body defense mechanisms such as immune response can be bombarded with the insults, thereby becoming less effective because of the toxic load. Another area of intense research is how environmental factors affect the genetic makeup of an individual. There are many genes in our body that are considered environmentally responsive, which means that they can be altered by environmental factors. If you alter a genes makeup, the potential exists for changing the normal development of a person. Some of these changes can be immediate and some may take many years to manifest. Depending on which gene is involved, an individual can become vulnerable to changes in metabolic pathways, physical development, immune response, brain development and function, and nervous system development and function.

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What Could be Signals of a Toxic Load Burden?

The following symptoms could be present as a result of toxic burden:

Learning or speech difficulties Lack of social skills Aggressive behavior Passive behavior Poor immune response Biochemical pathway issues

Minimizing the Toxic Load

Sensitive individuals often have severe toxic burdens. This can be compounded by the fact that a biochemical pathway known as methylation is often compromised. A doctors evaluation is needed to determine if this pathway is not working properly. Nutritional interventions can support improvement of this condition. Certain nutrients are considered natural detoxifiers and can help minimize the negative impact of toxic exposures and enhance the bodys natural detoxification process. Examples of such vitamins and minerals are zinc, vitamin C, vitamin E and selenium. Other nutritional factors that can be helpful are taurine, N-acetyl cysteine and glutathione. Being selective about the products we use or the foods we eat can greatly influence our toxic load. The FDA has already issued warnings about how much fish we should eat because of the mercury content. Using other food products or dietary supplements with ultra high purity - such as those with a hypoallergenic designation - is another means of minimizing our toxic load. This is also true for personal care products and cleaning agents we use. And dont forget about the air we breathe and the water we drink and cook with. The purer our water and air, the less environmental contamination. Numerous air and water filtration products are available to improve air and water purity. Kirkman has recently introduced the Kirkman Kleen line of personal care and cleaning products that are formulated with safe ingredients so as not to contribute to a toxic load in the home.

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Kirkman Kleen personal care and cleaning products lines were designed without harsh chemicals, allergens or toxins.

Detox-Aid Advanced Formula

When environmental toxins are encountered by the body, a detoxification process must occur to prevent a toxic overload. In sensitive individuals, the detoxification pathways are often compromised requiring the system to obtain a boost from the outside. Kirkmans Detox-Aid Advanced Formula was specially formulated to provide that boost to help support the bodys natural detoxification processes.

How Does Detox-Aid Advanced Formula Work?

The ingredients in Detox-Aid Advanced Formula and how they work to help the detoxification process are described below:

As toxins become active in the body, glucuronic acid combines with the toxins to form a non-toxic molecule called a glucuronide which can be excreted into bile, thereby eliminating the toxin. An en-

zyme called beta-glucuronidase present in the body largely as a by product of intestinal flora can disassemble that non-toxic molecule which then frees up the activated toxin again. Calcium D-glucarate acts to prevent that disassembly process of the glucuronide by becoming D-glucaro-1, 4-lactone, the direct inhibitor of the betaglucuronidase. Without this inhibition process, the cleaving of the glucuronide would lead to the toxin being reabsorbed by the intestinal mucosa. Turmeric is a powerful antioxidant that increases the formation of the detoxifying glucuronides. Turmerics antioxidant properties also aid glutathione in doing its job. Reduced L-glutathione is required by the bodys cells in order to detoxify. N-acetyl cysteine provides cysteine that is used in the body to form glutathione, the bodys cell detoxifier. Cysteine is also the major source of taurine that is produced by the body. Taurine is an essential component of bile formation. Bile flow into the intestinal tract is a major detoxifiction route in the body, along with sweat, urine, breath, hair and nails. Milk Thistle contains silymarin which is a very powerful antioxidant that supports the protection of cells. It also supports liver function, which is instrumental in body detoxification processes. In human and animal studies, silymarin has exhibited its protective effects. Olive Leaf Extract is present in Detox-Aid Advanced Formula for controlling the growth of undesirable intestinal flora that tend to thrive in the presence of sulfur compounds such as glutathione and N-acetyl cysteine. Selenium is present due to the fact that it is an antagonist toward ingested metals including lead, mercury, aluminum and cadmium.

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Heavy Metal Detoxification

Detox-Aid Advanced formula assists in the bodys natural removal of ingested heavy metals and works synergistically with heavy metal detoxifying compounds such as DMSA, EDTA, Chemet, and DMPS. These chelating agents should be used only under the supervision of a physician, as laboratory testing must be routinely performed to monitor kidney, liver and cell conditions. You may be in the beginning stages of trying to eliminate toxins that are present in our environment. We should all be doing that. Some will remain, however, as we still have to eat, breathe and drink to sustain our lives. Kirkmans Detox-Aid Advanced Formula can help to enhance our bodies detoxification processes.

Detox-Aid supports the bodys natural detoxification processes.

DONT OVERLOOK THE HYPOALLERGENIC FACTOR

We have already discussed the GF/CF diet, which restricts casein and gluten in an individuals diet. Other dietary restrictions may be necessary for sensitive individuals or individuals with special dietary requirements. These may include soy, corn, rice, sugar, egg or preservatives. 32 As we work with parents and doctors in developing appropriate dosage forms, it has become evident that many of our customers have extreme sensitivities and allergies to many naturally occurring ingredients and to nearly all excipients (inactive ingredients) normally found in nutritional supplements and traditional foods. It has always been Kirkmans goal to formulate all products to be as palatable as possible so as to make administration and compliance easy, especially for the parents. Some of the flavorings and formulation aids used to make these products taste good are the very ingredients to which some of our customers are sensitive. Kirkman is committed to having a broad product line that will meet the needs of all of our customers. To cover the needs of those children who are extremely sensitive or allergic to many commonly used ingredients, Kirkman has developed a full line of hypoallergenic products in two-piece, hard-shell capsules. The capsule shell is made from plant cellulose, not from beef or pork gelatin as most capsules are. Capsules manufactured from beef or pork can contain potential allergens associated with animal derived ingredients. Kirkmans capsule shells, known as vegetable capsules, are manufactured from plant cellulose derived from pine trees. This fibrous cellulose is an inert material and is allergen free. Furthermore, these hypoallergenic products contain no fillers, flavors, preservatives or common formulating aids that could cause sensitivity or allergic reactions. As a result, Kirkmans hypoallergenic line is free of casein, gluten, soy, flavors, colors, animal derivatives, sugar, heavy metals, pesticides and other environmental impurities. If you try some of the interventions discussed in this guide and seem to notice a reaction or sensitivity to products that are flavored, colored or contain potential allergens, it is strongly recommended that you try the same product type in our hypoallergenic line. You may find that the reaction or sensitivity disappears.

Why Arent All Products Made to be Hypoallergenic?

Most manufacturers of nutritional supplements provide products to drug chains, food chains and mass market distributors. The majority of the population is not sensitive to a common list of ingredients usually called pharmaceutical excipients. Some of the most common ingredients on that list include stearic acid, gelatin, eggs, dextrose (corn sugar), corn starch, sucrose, polyvinylpyrrolidone, sodium chloride, milk or dairy derivatives, wheat or grain derivatives, and soy. In addition, various flavorings and colorings are often used. For those individuals without sensitivities or allergies to these ingredients or the impurities present in those ingredients, no problematic side effects become evident to the user. Manufacturers use these standard ingredients because of cost and because they contribute to production efficiency. As an example, capsule shells made from gelatin cost less than half of those made from plant cellulose, plus production using animal gelatin shells is often twice as efficient. The fillers and capsule production aids Kirkman uses in our hypoallergenic line are the most inert ingredients known and are selected so as not to contain known potential allergens. In addition to the plant cellulose in the capsule shell, Kirkman uses non-allergen excipients such as silicon dioxide, various cellulose gums, di-calcium phosphate, inulin (from the chickory root), and L-leucine. Vegetable grade magnesium stearate may be used in minute quantities as a lubricant when necessary. Raw materials selected for Kirkmans hypoallergenic line were selected to be the purest available minimizing the content of heavy metal impurities such as lead, mercury, cadmium and aluminum. Other environmental contaminants are also screened including pesticide and PCB residues, and bacterial and yeast levels are carefully monitored. In formulating the hypoallergenic line, Kirkman used only one criteria: providing the best non-allergen product line possible. Ingredient choice and purity, plus the science behind those selections, were the only considerations. Cost and production efficiencies were not considered. Helping the extremely sensitive individual was our primary goal. 33

What Have Been the Results of Individuals Using Kirkmans Hypoallergenic Line?
Individuals using the hypoallergenic product line have essentially eliminated all sensitivities, allergies and reactions that had previously been an issue. The response to these products has been phenomenal with physi-

cians and customers from all over the world continuing to compliment and thank Kirkman for developing this line that was so very much needed in the world of dietary supplements. Individuals exhibiting sensitivities and allergies have benefited greatly from this product line. It is Kirkmans goal to offer a hypoallergenic version of all products developed in the future. This product line is a significant breakthrough in allowing extremely sensitive individuals to get the supplements they need without worrying about additives, allergens or impurities.

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HOW TO GET YOU CHILDREN TO TAKE NUTRITIONAL SUPPLEMENTS

Many of your children need to take numerous supplements at once and at multiple times during the day. This becomes very challenging for the parents and, of course, the children. At Kirkman we are asked regularly for ideas on how to administer the supplements so that the children will take them. We have listed some ideas below that we compiled from our discussions with parents. This is by no means the complete list. We encourage you to experiment to find what works for you and your child. 35

Flavor food or drinks. ( maple, cherry and strawberry.) Mix in orange juice Mix in lemonade Mix in red grape juice Mix in pear juice Mix in baby food prepared juices Mix in Juicy Juice Mix in V-8 Splash Use yogurt Use pudding Use fruit sorbets Try cocoa Try Hersheys syrup Try peanut butter, cashew butter or almond butter Make a fruit smoothy in a blender Make a protein drink (rice or soy) in a blender Mix in honey or jelly Make popsicles that include the vitamins (especially good for the Super Nu-Thera powders and liquids) Put doses of the supplements in rice crispy treats Sprinkle non-heat sensitive products on a pancake before flipping Mix in ketchup and let the kids drag their French fries through it Put the products in scrambled eggs (after theyre cooked) Put products in spaghetti sauce (after its been cooked) Hide products (especially liquids) in box drinks If you use Coromega, add other supplements to it Calcium, magnesium, other minerals and Flax (EFA) can be used in cooking and baking Baby foods work great for hiding supplementsMix supplements in Vances Dari-Free or other milk substitute

There are many ways to help your child take nutritional supplements.

APPENDIX A Step-by-Step Recap of Interventions

There is not an absolute regimen that one should follow when beginning biomedical and dietary interventions in sensitive individuals, but there are some logical sequences that a parent can follow until guidance by a specialty physician is in place. 36

The Top Three Interventions to Try

Without question, the top three include: 1) Improving nutrition 2) GF/CF diet 3) Improving the condition of the gastrointestinal tract These top three can actually be tried in any order and all physicians may not agree as to which order is desirable. So steps 1, 2, and 3 could involve in any order:

Super Nu-Thera or Nu-Thera The gluten-free/casein-free diet Probiotics and/or digestive enzymes (a multi-strain probiotic such as Pro-Bio Gold or Multi-Flora Spectrum would be a good start, in conjunction with EnZym-Complete/DPP-IV II with Isogest formula)

Next Possible Steps

If sleep is an issue, the interventions listed for sleep improvement could be tried as described in the Sleep Issues section. If the symptoms of an immune problem are present, several of the products for immune support can be tried. If vision support is needed, cod liver oil could be tried.

The More Complicated Interventions

When it comes to behavioral issues or metabolic pathway irregularities such as methylation, sulfation and detoxification, a specialist physician is really needed to assess the situation. Many complicated intricacies of

physiology exist in this area , plus potential side effects must be monitored. A multi-vitamin/mineral supplement with high B-6/magnesium may have helped begin the process, but numerous other options are specific to the individual and require a medical examination and guidance.

Laboratory Testing
When you begin working with a specialized physician, he or she will undoubtedly request laboratory tests that are specifically tailored to a patients needs. Examples of these tests are: Urinary peptides Urinary organic acids Food allergy panel Plasma sulfate Stool analysis Toxic metals Red blood cell elements Essential fatty acids Lymphocyte TH1/TH2 Liver and kidney function Myelin Basic Protein Ammonia 37

You probably wont need all the tests, rather you may want to select ones based on a medical evaluation.

Kirkmans Customer Service Staff and Technical Staff Can Help

The journey through dietary and biomedical interventions is not an easy one. Your doctor will be your main source of guidance as you progress. Kirkman has been supporting parents on their journeys with their children for decades. Please feel free to call our customer service or technical staff if you need assistance .

NOTes

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see us at www.kirkmanlabs.com

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Customer Service (clockwise from top left: Sonia, Kathy, Amy, Rhonda, Shirley, Melisa, Carrie, Kari-Jane, Beth and Racheal.)

6400 SW Rosewood Street Lake Oswego, Oregon 97035 Telephone: (800) 245-8282 (888) KIRKMAN (503) 694-1600 Fax: (503) 682-0838 E-Mail: Ordering: kirkman@kirkmanlabs.com Customer Service: rhonda@kirkmanlabs.com Technical Support: support@kirkmanlabs.com Servicio al Cliente en Espanol: sonia@kirkmanlabs.com Linea Directa en Espanol: (503) 783-2714

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