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• Physical Causes
• Infectious Diseases
• Enzyme Disorders
• Other Neurological Diseases
• Endocrine Disorders

Because the course of ALS is fatal within 3-5 years, a careful differential diagnosis is needed. The following should be considered ( Harrison 1998):

• Physical causes such as compression of the cervical spinal cord
• Infectious diseases such as Lyme disease, post-poliomyelitis, HIV infection
• Enzyme disorders in SOD, hexosaminidase A, and alpha-glucosidase
• Other neurologic al diseases such as Pick's disease and Kennedy's syndrome
• Endocrine disorders including diabetic amyotrophy and thyrotoxicosis

Physical Causes
Compression of the Cervical Spinal Cord
An MRI of the head and cervical spine is usually ordered for patients with lower neurological disease to rule out compression of the spinal cord and impingement along the spinal nerves.
Infectious Diseases

• Lyme Disease
• Post-Poliomyelitis
• HIV Infection
• Neurosyphilis

Lyme Disease. The second and third stages of Lyme disease are associated with neurological changes that may cause an axonal, lower motor neuropathy. Lyme disease is caused by the bacterial spirochete (Borrelia burgdorferi) spread by a deer tick (Ixodes dammini). The first stage of Lyme disease is present with a fever, enlarged lymph glands, and a characteristic bulls-eye pattern around the bite (Hansel et al. 1995).
Post-Poliomyelitis. Polio is an enterovirus, a genus that preferentially inhabits the intestinal tract. Reactivation of a central nervous system polio infection (post-poliomyelitis) may cause a delayed deterioration of motor neurons and muscular atrophy, including difficulty in swallowing (dysphagia) from bulbar involvement. Bulbar involvement indicates that there is a malfunction in the medulla oblongata, a structure important for collections of nerve cells lying anterior to the cerebellum (Roos et al. 1980; Onion 1998).
HIV Infection. HIV infection is associated with extreme immune system dysfunction. HIV-1 proteins Tat and gp120 have been implicated in the pathogenesis of dementia associated with HIV infection (Jain et al. 2000).
Neurosyphilis. Tertiary syphilis is seen 3-4 years after the primary infection with the spirochete Treponema pallidum. It is often seen in AIDS patients. Tertiary syphilis usually presents with hypersensitivity reactions since few organisms are present. Tabes dorsalis is associated motor and sensory losses in the lower extremities, which causes difficulties in coordination.
Enzyme Disorders

• Superoxide Dismutase
• Hexosaminidase A
• Alpha-Glucosidase

Superoxide Dismutase (SOD). Familial ALS is an autosomal dominant genetic disorder. It is caused by a defect on the gene encoding SOD on chromosome 21 (SOD1).
Hexosaminidase A.

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Tay-Sachs disease and Sandhoff's disease are autosomal recessive genetic disorders resulting from a deficiency of hexosaminidase and the accumulation in lysosomes (small bodies in cells involved in the process of intracellular digestion) of GM2 gangliosides, particularly in the central nervous system. Motor weakness, progressive ataxia, and lower motor neuron symptoms predominate in the adult form. The patients often report clumsiness in childhood and motor weakness in adolescence. The diagnosis is established by visualizing cytoplasmic bodies by electron microscopy or by detecting reduced hexosaminidase-A activity in white blood cells (Eisen et al. 1987; Harrison 1998).
Alpha-Glucosidase. Accumulation of glycogen in lysosomes in Pompe's disease is due to deficiency of a specific enzyme, alpha-glucosidase. The juvenile form is characterized by progressive proximal muscle weakness, including impairment of respiratory function ( Harrison 1998).
Other Neurological Diseases

• Pick's Disease
• Kennedy's Syndrome

Pick's Disease. Pick's disease exhibits a progressive atrophy of the frontal and temporal lobes of the brain. Swollen neurons called Pick cells and argentophilic (attracted to silver) neuronal inclusions known as Pick bodies affect the frontal and temporal cortical regions.
Kennedy's Syndrome. Kennedy's syndrome is an X x -linked, lower motor neuron disorder in which progressive weakness and wasting of limb and bulbar muscles begins in males in adult life. Kennedy's syndrome is associated with androgen (testosterone) insensitivity, manifested by excessive growth of the male breasts (gynecomastia) and reduced fertility.
Endocrine Disorders

• Diabetic Amyotrophy
• Thyrotoxicosis

Diabetic Amyotrophy. Neuropathy is a common clinical manifestation associated with diabetes. The most common presentation is that of peripheral polyneuropathy which is also referred to as 'stocking and glove neuropathy' due to the numbness and paresthesia of the hands and feet. Diabetic amyotrophy causes progressive muscle wasting, usually of the pelvic girdle and large muscles in the upper leg. Anorexia and depression may accompany amyotrophy.
Thyrotoxicosis. Thyrotoxicosis refers to the effects of excessive quantities of thyroid hormones in tissues found in patients with severe hyperthyroidism and Graves 's disease. Symptoms include feeling hot and sweaty, palpitations, frequent diarrhea from impaired digestion of fats, and a prominent essential tremor.
Assessment
Neurologists use clinical tests such as blood testing, electromyograms (EMG), magnetic resonance imaging (MRI), CT scans, and nerve biopsies to establish a profile when diagnosing ALS. These profiles will eliminate other possibilities as to what the person might be suffering from. The following labs should be considered in the diagnosis of ALS:

• Lyme disease serology
• HIV testing
• Autoimmune panel
• Thyroid panel, including thyroid-stimulating hormone (TSH), T3 and T4
• Hormone panel, including testosterone, dehydro-epiandrosterone (DHEA) and pregnenolone
• Hexosaminidase A in urine warranted when adult Tay-Sachs is suspected
• Vitamin B12 levels also useful

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After the diagnosis of ALS has been confirmed, additional lab tests can be used to identify the predominant etiology and thus direct appropriate treatment. Additional labs would include:

• A comprehensive detoxification profile
• Oxidative stress analysis
• Mineral analysis, including calcium, magnesium, copper, and zinc
• Toxin analysis, including heavy metals and chemicals
• Amino acid analysis

Treatment
Many things can be done to improve or maintain the lifestyle of a person who is suffering from the disease. First, the patient should continue his or her usual daily activities, stopping just before getting tired. Physicians often recommend specific exercises, such as breathing exercises and/or exercises to strengthen the muscles that are not affected with the disease. Foot braces, hand splints, or wheelchairs, combined with exercise, will enable the patient to remain independent for as long as possible.
Counseling can help to ease the mental anguish brought on by this disease. Family counseling can also be helpful to the person with ALS, as well as the family.
One of the side effects of this disease is uncontrolled muscle contractions or spasms. Physical therapy cannot restore normal muscle function but may help in preventing painful contractions of the muscles and in maintaining normal muscle strength and function. The physical therapist should show family members how to perform these exercises, so they can help maintain this therapy for the person with ALS.
Speech therapy may also be helpful in maintaining the person's ability to speak. Swallowing therapy is important as well, to assist with the problems of swallowing and drinking. This treatment helps prevent choking. It is recommended that the patient adopt a new head posture and positioning of the tongue. The patient should also change the consistency of the food to aid swallowing accordingly as the disease progresses.
Occupational therapy is also important. The therapist will come to the person's home and recommend where to move furniture to make it easier for the patient to move around his/her house. The therapist will also place kitchen appliances in areas where making meals will be easier. The occupational therapist will also bring devices that will help the person in making the telephone, computer, and other devices easier to use.
When the ability to breathe decreases, a respiratory therapist is needed to measure the breathing capacity. These tests should take place on a regular basis. To make breathing easier, the patient should not lie down immediately after eating. The patient should not eat large meals because they can increase abdominal pressure and prevent the diaphragm from expanding. When sleeping, the head should be elevated 15-30 degrees to keep the abdominal organs away from the diaphragm. When breathing capacity falls below 70%, noninvasive respiratory assistance should be provided. This involves a nasal mask connected to a mechanical ventilator. When the breathing capacity falls below 50%, a permanent hook-up to a ventilator should be considered.
Medications

• Baclofen (Lioresal)
• Tizanidine (Zanaflex)
• Tricyclic Antidepressants
• Rilutek (Riluzole)

Various medications can be given to the patient as ALS progresses.
Baclofen (Lioresal). Baclofen (Lioresal) is used to relieve stiffness in the limbs and throat. Patients with seizure disorder or impaired renal function should use caution. Serious adverse reactions include somnolence and stupor, cardiovascular collapse, seizures, and respiratory depression. Common adverse effects include headaches, dizziness, blurred vision, slurred speech, rash, weight gain, pruritus, constipation, and increased perspiration. Excessive dosing may lead to weakness. Baclofen may interact with alcohol, monoamine oxidase inhibitors (MAOI), narcotics, antipsychotics, tricyclic antidepressants, oral hypoglycemics, or insulin.
Tizanidine (Zanaflex). Tizanidine (Zanaflex) is a centrally acting muscle relaxant. Zanaflex may interact with alcohol (to increase somnolence, stupor) and oral contraceptives (to decrease its clearance). Zanaflex can increase hypotensive effects when administered concurrently with diuretics. Elderly patients and patients with impaired renal function should use caution. Serious reactions include hallucinations, severe bradycardia, and liver toxicity. Common adverse effects include dryness of mouth, somnolence and sedation, dizziness, malaise, constipation, increased spasms, and hypotension.
Tricyclic Antidepressants. Tricyclic antidepressants may be used to control the production of excess saliva.
Rilutek (Riluzole). Rilutek (Riluzole), the only FDA-approved drug to treat ALS, reduces the presynaptic release of glutamate. Riluzole is metabolized in the liver. It is contraindicated with active liver disease or elevated liver function tests (serum glutamic pyruvate transaminase [SGPT] or alanine aminotransferase [ALT] and glucose tolerance test [GTT]). Theophylline and caffeine may affect rate of elimination. Riluzole treatment may be associated with mild blood pressure elevation (Scelsa et al. 2000).
Unfortunately Riluzole, although described in medical journals as an effective treatment for ALS, provides almost no benefit and is associated with significant side effects in most patients. One journal noted, 'It is often said that the benefits of riluzole are marginal but the side effects are major. ' One writer commented, ' c C learly, Riluzole does succeed at one important task. It allows treating physicians to end the day assured that they did something for the ALS patients they were treating since a prescription was written--an obligation was thus fulfilled' (Rowland 1996; Ludolph et al. 1999; Perlmutter 2000).
Drug Research

• NMDA receptor antagonists
• Growth Factors
• Other Drugs

Several drugs are being studied for treatment of ALS (Hurko et al. 2000). These include:

• N-methyl-D-aspartate (NMDA) receptor antagonists m e i mantine and dextr o a methorphan
• Growth factors such as insulin-like growth factor-I, nerve growth factor, leukemia inhibiting factor, ciliary growth factor, pigment epithelium-derived factor, neurturin, and transforming growth factor-beta
• TR500, a glutathione-repleting agent
• Deprenyl, a selective monoamine oxidase B inhibitor
• Pimozide, a voltage-dependent calcium channel blocker
• Gabapentin, an antiseizure drug made from gamma-aminobutyric acid (GABA)

NMDA receptor antagonists

• Memantine
• Dextroamethorphan

Memantine. Memantine is an NMDA receptor antagonist that has been approved for use in the treatment of dementia in Germany for more than 10 years. NMDA receptor antagonists have therapeutic potential in numerous CNS disorders. Memantine does not have the side effects common to other NMDA receptor antagonists such as dizocilpine (Parsons et al. 1999; Jain et al. 2000). Memantine will be available in the U.S. in 2004 pending FDA approval. is not available in the United States.
Dextroamethorphan. Dextroamethorphan is an NMDA receptor antagonist that is being explored for use in ALS. Preliminary studies, however, did not find positive effect (Askmark et al. 1993).
Growth Factors

• Insulin-like Growth Factor I
• Nerve Growth Factor
• Leukemia Inhibitory Factor
• Ciliary Neurotrophic Factor
• Pigment Epithelium-derived Factor
• Neurturin
• TGF-Beta

Insulin-like Growth Factor I. Some authors have reported decreased IGF-I in patients with ALS (Eisen et al. 1993; Dore et al. 1996; Torres-Aleman et al. 1998). IGF-I receptors are present in the spinal cord where they mediate signal transduction via tyrosine kinase. IGF-I was found to prevent the loss of choline acetyltransferase activity in embryonic spinal cord cultures, as well as to reduce the programmed cell death of motor neurons in vivo during normal development or following axotomy or spinal transection. Clinical trials of recombinant human IGF-I have been initiated for patients with ALS (Lewis et al. 1993).
One study examined the cost effectiveness of treatment with recombinant human insulin-like growth factor I (rhIGF-I) in patients with ALS. They conclude that treatment with rhIGF-I is most cost effective in ALS patients who are either in earlier stages of the disease or progressing rapidly. The cost effectiveness of rhIGF-I therapy compares favorably with treatments for other chronic progressive diseases (Ackerman et al. 1999).
A double-blind, placebo-controlled, randomized study of 266 patients was conducted at eight centers in North America . The authors concluded that rhIGF-I slowed the progression of functional impairment and the decline in health-related quality of life in patients with ALS with no medically important adverse effects (Lange et al. 1996; Lai et al. 1997). A European placebo-controlled trial of IGF-I in ALS, however, showed no significant difference between treatment groups (Borasio et al. 1998).
Nerve Growth Factor.

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A moderate reduction in beta-nerve growth factor (beta-NGF) levels was seen in the serum of patients with ALS and multiple sclerosis. There was a statistically significant reduction in the patients who were carriers of Parkinson's disease and Huntington's disease (Lorigados et al. 1998).
Leukemia Inhibitory Factor. Leukemia inhibitory factor (LIF) was named after its effect on hemopoietic (blood-forming) cells. Studies have demonstrated a powerful effect of LIF in the survival of both motor and sensory neurons, while reducing denervation-induced muscle atrophy. LIF will also stimulate muscle regeneration in vivo when applied exogenously after injury. A human recombinant form of LIF (AM424) entered human clinical trials during 1998 (Kurek et al. 1998).
Ciliary Neurotrophic Factor. Ciliary neurotrophic factor is currently in clinical trials for the potential treatment of motor neuron disease or ALS (Lindsay 1994).
Pigment Epithelium-derived Factor. Pigment epithelium-derived factor (PEDF), a natural substance produced by the body, was located for the first time in the spinal cord and skeletal muscles of humans, monkeys, and rats. Previously, scientists believed that PEDF was found only in the pigmented layer of cells beneath the retina. Using slices of rat spinal cords kept alive in culture, PEDF showed a dramatic ability to protect cells from the toxic effects of threohydroxyaspartate (THA), a chemical that mimics the effects of ALS, causing slow death of motor neurons. The PEDF-treated sections showed a near normal neuron count compared with untreated cultures. According to Dr. Ralph Kuncl, who led the Johns Hopkins research team, protection of the spinal cord nerves in culture by PEDF was nearly complete. He went on to state that '. . If we had this same level of protection in patients with ALS, they'd experience slight muscle weakness at most.' The effectiveness of PEDF will be tested next on transgenic mouse models.
Neurturin. The same research team reported on another natural compound known as neurturin, a neurotrophic substance that will stimulate regeneration of damaged nerve cells. Neurotrophic factors, including PEDF and neurturin, are believed to protect healthy cells from the damaging effects of glutamate, a neurotransmitter that gluts the spaces between motor nerve cells, causing over - stimulation and contributing to the progression of the disease. Although Riluzole mildly restrains the immediate release of glutamate, it provides minimal protection to motor neurons as do PEDF and neurturin. The researchers predict the development of an 'ALS cocktail,' drug combinations containing neurotrophic factors, 'each working at a different point in the process' (Bilak et al. 1999).
TGF-Beta. In a commentary, Miller and Ragsdale of the University of Chicago discuss the function of transforming growth factor-beta (TGF-beta) in the programmed death, or apoptosis, of nerve cells. TGF-beta is part of a family of growth factors by the same name that are involved in many biological functions in all of the body's tissues, such as embryonic development, reproduction, and wound-healing (Miller et al. 2000).
In a study reported in the same issue, chick embryos were immunized to neutralize the three forms of TGF-beta during the restricted period of embryonic development in which 50% of the neurons that have formed experience apoptosis. Neuron death was halted in all of the cells that were destined to die, which included central nervous system motor neurons and peripheral nervous system autonomic neurons. It is possible that TGF-beta works only on those neurons that will die, acting in a way that permits rather than instructs the cells to die. In other circumstances TGF-betas may enhance neuron survival. Researchers, led by Krieglstein of the University of Saarland at Homburg , Germany, concluded that TGF-beta could function as a molecular switch, which determines the life and death of neurons (Krieglstein et al. 2000).
The authors of the commentary state that the findings may have important implication for diseases, such as ALS, which is characterized by the death of motor neurons and may involve programmed cell death. Spinal cord trauma may involve neuron death by apoptosis as well. The removal of TGF-betas may be able to reduce the death of neurons and prevent some of the disability associated with this and other conditions.
Other Drugs

• TR500
• Deprenyl
• Orap (Pimozide)
• Neurontin (Gabapentin)

TR500. TR500, a glutathione-repleting agent, is being studied for use in ALS (Hurko et al. 2000).
Deprenyl. Deprenyl (Eldepryl, selegiline hydrochloride), a selective monoamine oxidase B inhibitor, is partially effective in Parkinson's disease and can slow the cognitive deterioration in Alzheimer's disease. Studies of its use in ALS, however, did not show any significant improvement (Kuhn et al. 1996; Lange et al. 1998). Deprenyl is available from offshore pharmacies for personal use only.
Orap (Pimozide). Orap (pimozide) is a voltage-dependent calcium channel blocker that is being explored for use in ALS. One study showed a significant decrease of the index of progression of the disease in Pimozide-treated patients compared to selegiline and vitamin E. In a randomized trial 44 patients, diagnosed as either definite or possible ALS, were treated with 1 mg a day of Pimozide for 3-12 months. Statistical analysis showed a significant decrease of the index of progression of the disease in Pimozide-treated patients as compared to the others (Szczudlik et al. 1998).
Neurontin (Gabapentin). Neurontin (Gabapentin) is derived from GABA. Gabapentin prevents seizures in a wide variety of models in animals, including generalized tonic-clonic and partial seizures. In vitro, Gabapentin modulates the action of the GABA synthetic enzyme, glutamic acid decarboxylase (GAD), and the glutamate synthesizing enzyme, branched-chain amino acid transaminase. Results with human and rat brain NMR spectroscopy indicate that Gabapentin increases GABA synthesis. In vitro, Gabapentin reduces the release of several monoamine neurotransmitters (Taylor 1997; Taylor et al. 1998).
Unfortunately gabapentin was found to provide no evidence of a beneficial effect on disease progression or symptoms in patients with ALS in a Phase III randomized double-blind placebo trial (Miller et al. 2001).
Continued . . .

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The sections below contain information on the supplements Nicholas is currently taking or has taken in the past. For each supplement, I have listed why he is/was taking it and other information that I think may be useful. Please keep in mind, I have not included complete information regarding these supplements, just information as to how it applied to my son’s case. At the bottom of this list, I have included references to where I found information on supplements as that may be of use to you as well. (Bear with me, this is a work in progress.)

Klaire’s Vitaspectrum – This is the multi-vitamin & mineral supplement Nicholas took for quite some time. I was looking for something comparable to our previous supplement at a lower price from a company I could trust. This supplement costs 1/5th of what our previous (Brainchild) did, which is a huge positive. I waited a while after the switch before I changed any supplements and saw no regression from the switch. He did very well on this multi. Link to supplement Lee Silsby ASD Ultra Pure Formula – I switched from Klaire’s Vitaspectrum to this one when I was able to get this covered under our insurance (and all we had to pay was a copay which was less than the Vitaspectrum). I liked this multi as well and would have no problem recommending this one or Klaire’s Vitaspectrum. Link to Supplement Brainchild Nutritionals – This was the first multi-vitamin I ever tried with Nicholas and we saw some nice gains from it. However, the taste is disgusting and when he became more aware, it got increasingly more difficult to get him to drink his 'juice' every day. Working on swallowing capsules was the best thing I ever did. Link to supplement

Swanson Vitamin C – Once Nicholas started swallowing capsules, I could move away from the liquid vitamin C and onto capsules. I bought this powder and put it into capsules myself. I keep this on hand for colds, and we also take it as part of our everyday regiment. Link to supplement Dynamic Health Liquid Vitamin C – I like this Vitamin C. It has a tasty orangey taste to it that helps mask some of the bad supplements Nicholas takes. It’s not super delicious that you’d want to drink the whole bottle at once, but it tastes good enough to mix with juice and mask the taste of other stuff. It’s not one of those pukey-orange tasting supplements. Link to supplement (Don’t forget $5 off with code TUM744) Kirkman Vitamin C – buffered – Nicholas took this Vitamin C for quite some time before I found the liquid one above. It worked well to mask some supplements, but we just got to the point where I needed to change the taste of his supplement juice. Link to supplement Carlson Vitamin D3 (cholecalciferol) – Nicholas took this Vitamin D until I found a higher potency capsule and we switched to that one and never looked back. Link to Supplement Biotech Pharmacal 50,000iu Vitamin D3 – We switched to this brand and have not been happier. In our house, we use both the 5,000iu capsules and 50,000iu capsules as needed. Link to supplement Vitamin World 100% Natural Vitamin E d-Alpha Tocopherol – When we first started biomed, I had read about this particular Vitamin E from Vitamin World that was helping so many of our kids talk so I tried it and saw the same results – it really did help him with his babbling when we first started biomed. On several occasions I stopped giving it to him and did see a change in his speaking, so it always ended up back in the regiment. When my stash recently ran out and I went to re-order, Vitamin World had replaced it with this one. It proved to carry the same results for Nicholas. Link to Supplement Swanson Vitamin E Mixed Tocopherols – I moved from Vitamin World’s to Swanson’s at some point to see if I could cut down on the number of places I was buying supplements from, so I tried this one and saw no change in Nicholas. In addition, it was much less expensive and seemed to provide us with the same benefits as the more expensive ones. Link to Supplement Kirkman Biomax Zinc – Nicholas gets Zinc each day because he did have a zinc deficiency which presented as his constant chewing on everything – toys, his shirt, etc. Once I added Zinc, the chewies went away. Since we started chelating, the chewies did come back at one point and I had to raise his dose a bit and the chewing/mouthing has not returned. Link to Supplement Inositol Powder from Kirkman – Inositol has helped us with compliance and with symptoms of OCD, such as constantly having to play in the kitchen sink (for hours on end). It also helped stop the endless hours of water play and standing at the sink. He is much more compliant and easy going when taking Inositol. We dosed anywhere from 6 scoops on up. (IP-6 is not the version of inositol I am referring to. We did not have a good experience with IP-6 here.) Link to Supplement Biotin – Biotin has been a god-send in this house when it comes to yeast. Shaw wrote about biotin deficiency and how the biotin keeps the yeast from changing form which is what it does when it is going to invade the tissues and organs. (I’ll post a more details on this later) When yeast is present, I increase Nicholas’s daily dose from 30mg to 40mg and it does help. Link to Supplement (I also use/used Swanson’s biotin with success as well – link to supplement) Klaire Mycellized Vitamin A – I used this to do Dr. McCandless’s High Dose Vitamin A Protocol. – Link to Supplement AMLA – I tried this one for a while, not sure I really saw anything from it, then later discontinued it. Link to Supplement Swanson’s Triple Magnesium Complex – At some point, I replaced alot of Nicholas’s supplements with the Swanson brand. I switched them one at a time as the former one ran out, making sure I saw no regressions or slide backs of any kind. This magnesium worked well and I continue to order it for our family. Link to Supplement. Only physical and chaos damage are able to inflict poison. Poison is a cumulatively stacking debuff. Each application—or 'stack'—of poison remains present on the target dealing chaos damage over time until it runs its course. There is no limit to the number of poison stacks a target can have. Dec 19, 2015  The increased poison damage only affects the poison part of the damage, so only the 100 dmg/s DoT would get increased damage from that node. The increased chaos dmg nodes will both increase the initial hit damage (if it does chaos dmg) and also the poison DoT, as. Poe chaos dmg nodes map. Jan 27, 2016  Does anyone know how chaos damage nodes affect poison? I am aware that damage over time nodes and nodes like Fatal Toxins that specifically states it increases poison damage by '100%' affects poison. What I was wondering is if say 20% Chaos damage nodes will increase the poison damage amount. Mar 14, 2014  Basically its an EK build based around added chaos dmg gem. As the gem give a flat chaos dmg, this could scale nicely with the chaos nodes, and cause its not ele I would not have to worry about reflect and stuff like that. I had HC in mind making it, but could be as well used for SC. Chaos damage is one of the five damage types.It is the rarest damage type and the hardest to get resistance against. Chaos damage bypasses energy shield, reducing life or mana directly.Although chaos damage reduction is based on resistance value, it is not considered elemental damage.One can become immune to chaos damage with the Chaos Inoculation keystone passive. Revitapops – MB-12 Lollipops – I added these in at some point and I really liked them. However, if your child needs daily mb-12 shots that you are trying to replace with these, Nicholas got bored with the same flavor really quick and I could no longer rely on them. (Plus they were more expensive than his Rx for the shots.) Link to Supplement Folic Acid – Here are links to brands and versions of Folate that we tried: Klaire’s MethylFolate, Kirkman’s Folinic, Kirkman’s Folinic with MB12, Folapro

Nordic Naturals Complete Omega 3-6-9 Liquid I like Nordic Naturals’ products – and our whole family is on at least one of them. This one has done wonderfully for Nicholas since I bought his first bottle and everytime I think another one may be better for him – we always end up back at this one. Link to Nordic Naturals for more information Where to buy Green Pastures Blue Ice High Vitamin CLO I added this CLO into Nicholas’s regiment when I wanted to add a natural Vitamin A (mycellized is synthetic). Green Pastures makes excellent products and is in the process of coming out with new CLO’s. The orange version that we use will be available in their fermented CLO – which I understand to be a better option anyway. Link to Green Pasture High Vitamin CLO Evening Primrose Oil – This was a supplement I started early on because I had read that it helped with hyperactivity and it really did. This along with Gaba and epsom salt baths kept us from even thinking Risperdal was the answer for our son. If seizures are an issue or hormonal issues, do more research in these areas with regards to EPO. Link to Supplement

Klaire Labs TherBiotic Complete – This is a great probiotic and we really loved it here. We did switch Nicholas to their Detox Probiotic because on probiotics which contain a strep strain, Nicholas has a tendency to start acting obsessive (OCD). On more than one occasion and with more than one brand of probiotics, ones with a strep strain caused him to be OCD. When we stopped the probiotic with that strain, the OCD disappeared with it. This one did the same thing – produced crazy OCD symptoms which disappeared when I stopped giving it. Link to Supplement Klaire Labs TherBiotic Detox Support Probiotic – This is a great probiotic which worked really well for Nicholas. Link to Supplement Culturelle – This is one of the first probiotics I ever gave to Nicholas and it really does work well. It is still my favorite probiotic. It really helped big time with Clostridia or a tummy bug. (If your child is casein-free, they may not be able to tolerate this probiotic.) Link to Supplement Cytoflora – I used this probiotic for a while to see if it would bring us any additional language. I think this is one of those supplements that you just have to try to see if is going to work wonders for your child or not, there’s just no way to know otherwise. Link to Supplement Living Streams Probiotic – I used this one for a while, really liked it. I had 'heard' a story of a non-verbal child starting to talk when mother increased his dose per their directions, so I gave it a try. Link to Supplement Klaire Biotagen – Good PREbiotic! Link to Supplement

Kirkman DMG – We used Kirkman’s DMG for quite some time on Nicholas – and after increasing it to 3 capsules 3 times a day, we saw a major surge in language. I held him at this dose for quite some time and then stopped it to see if I lost any language. We lost a bit, but not everything we had gained. I decided to try another brand of DMG (below) which other parents said worked really well for thier child, so we switched to that version. (The other version is also liquid, so much easier to hide in juice than 9 capsules) Link to Supplement FoodScience of Vermont Aangamik DMG Liquid – This DMG definately has an effect on his language both with length of sentences and spoken clarity. This doesn’t have much of a taste, so it is super easy to mix in with juice. (125mg of DMG needs 400mg Folinic with it) Link to Supplement Kirkman GABA Gaba really helped to calm Nicholas down. He was always hyper and then he had calmed down with starting epsom salt baths, evening primrose oil, etc. But then we started mb-12 shots and he was hyper again. Gaba worked and it’s been in his daily regiment since. Link to Supplement L-Theanine (Suntheanine) from Nutricology – This helps with anxiety and stress and is very calming. Link to Supplement Custom Blend from Metabolic Maintenance – We had bloodwork done to determine the formula for this custom blend. As with other supplements, I believe it has contributed to his progress – but there were no huge WOWs with this supplement. As it is on the pricey side, I may try Klaire’s amino blend in the future and see if we find the same results. Our 'custom' blend was just their base plus additional taurine. If I had it to do over again, I would have skipped the pricy blood work and put him on an amino blend (in addition to the Taurine he was already on). Link to Supplement Acetyl L-Carnitine – I have bought this from both Klaire/ProThera and Swanson’s Vitamins and found them both just as effective. L-Carnosine – I bought the NOW! brand and with each bottle, we always got a little jump in language. I would use the bottle up, then stop, then buy another bottle months later and do it again. We never lost the speech we gained from it when we stopped it. Link to Supplement(Don’t forget $5 off with code TUM744) Creatine – Link to Supplement

Grapefruit Seed Extract – Nicholas no longer takes GSE. I used this and used this to try to get rid of yeast and it seemed as though all I did was spin my wheels doing so. I stopped the GSE when I started reading that it can slow Phase I liver function – and started using Enhansa for yeast and we were finally able to get rid of it. I love GSE for cleaning toothbrushes, fruit and vegetables — and for gargling. Anytime you feel a sore throat is inevitable – put 10 or so drops of GSE in a few teaspoons of water and gargle (and swallow) until you use it all. On very few occasions did I have to do this twice to get rid of a sore throat. Link to Supplement Advanced Formula Biocidin – We gave Nicholas this to deal with some bad bacteria we saw on one of his test results. It seemed to do the trick – although I would not use this supplement every day long term. Link to Supplement Enhansa – If I had to rank our supplements in order of importance, Enhansa would be #1, hands down. This supplement has been amazing for our son and I am very thankful to Lee Silsby for making it. The first three weeks our son was on it, die off was practically unbearable, but we saw things happening which gave us the strength to push through and we are so glad that we did. His yeast was gone for the first time since starting biomed and we were able to reduce the number of probiotics we were giving him. We were able to stop yeast-fighting enzymes such as Candex and Candidase. We were able to stop difulcan (fluconazole), but did end up having to go back on it for some reason. We did see our son go through some viral die-off as well. It’s just one of the best supplement choices I have made to date. Link to Supplement Wild Oil of Oregano – P73 – Oreganol – This has always been a great supplement for Nicholas. It helped with yeast and really helped with bacterial (strep) flares. It is not something I kept him on constantly, but when needed, it never disappointed me. The gelcaps are TINY, so if you have a capsule swallower, you’ll be fine. You can also look into rubbing into soles of feet if needed. Link to Supplement> Organic Coconut Oil – This was awesome at battling yeast and keeping it at bay. (and had to be the CHEAPEST yeast supplement ever!) Link to Supplement

Kirkman Enzym-Complete/DPP-IVV Link to Supplement Enzymedica Enzyme Defense Virastop (Protease Enzyme Supplement) – Link to Supplement Enzymedica Mucostop Link to Supplement Enzymedica Candidase Link to Supplement Candex Yeast Management System Link to Supplement Houston Nutraceuticals No Phenol – as needed for phenol effects Link to Supplement Houston Nutraceuticals Peptizyde – (as needed) Link to Supplement Houston Nutraceuticals Zyme Prime – (as needed) Link to Supplement Klaire’s Interfase–Link to Supplement

Liver life – We love LiverLife!! This was one supplement that I made sure to never run out of. I do believe this helped keep his Liver enzymes within range with long term diflucan use. Link to Supplement Milk Thistle Extract – Link to Supplement

Oxypowder – This is awesome stuff!! This is something the whole family uses from time to time as needed and it really gets the job done. I highly recommend it for anyone battling constipation. Link to Supplement George’s Always Active Aloe Juice– This is awesome stuff!! Aloe is very soothing for the gut and really helps with keeping bowels moving. This is something the whole family uses from time to time as needed and it really gets the job done. I highly recommend it for anyone who is battling constipation all the time. Best thing is – it tastes almost like water, so you can literally mix it in anything! Link to Supplement

Calm Child Herbal Syrup by Plantary Formulas – This was one of the first supplements I gave to Nicholas to calm down the hyperactivity. It worked nicely. Definately worth trying. Link to Supplement Vinpocetine – Vinpocetine was a wonderful supplement for clarity and focus. This was one that definately worth it. Link to Supplement UBQH – Integrative Therapeudics Inc UBQH Patented Stabilized Reduced Ubiquinol COQ10 – Vitaline CoQ10 4Life Transfer Factor – used both the Classic and Tri-Factor Formula (this was a good supplement!) Mannatech Ambrotose Glyconutrients – Link to Supplement Phosphatidyl Serine – Klaire’s PSerine Phosphatidyl Choline – Adrenal Cortex Extract/Glandular – Link to Supplement

Books which have great information on supplements:

Note: I am not a doctor and anything I have written on this site should not be construed as medical advice. I am a dedicated mom who has researched test results, supplements and my son’s reactions to those supplements and I am sharing what I have learned regarding what works for him. This is my way of paying it forward to the generation of autism parents behind us in tribute to those have walked before us and to those who have helped me along the way.

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