1. The Newest Findings in the Use of Laboratory Testing in the Management of Inflammatory Disorders Mark Schauss, MBA, DB - Crayhon Research Copyright Crayhon Research 2008

2. Inflammation Inflammation (Latin, inflammatio, to set on fire) is the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants like toxins. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. In the absence of inflammation, wounds and infections would never heal and progressive destruction of the tissue would compromise the survival of the organism. However, inflammation which runs unchecked can also lead to a host of diseases, such as hay fever, atherosclerosis, and rheumatoid arthritis. It is for this reason that inflammation is normally tightly regulated by the body.

3. Inflammation There are two types of inflammation – Acute and Chronic Acute inflammation is a short-term process which is characterized by the classic signs of inflammation - swelling, redness, pain, heat, and loss of function - due to the infiltration of the tissues by plasma and leukocytes. This type of inflammation is not the kind that we will be discussing in this talk.

4. Inflammation Chronic inflammation is a pathological condition characterized by concurrent active inflammation, tissue destruction, and attempts at repair. This type of inflammation is one that can benefit greatly from the correct array of laboratory tests and the clinically relevant protocols that can be derived in a biochemically individualized manner. Some of the tests will help to pinpoint the causative factors, other test will help the patient heal.

5. Inflammation With the discovery of interleukins (IL), the concept of systemic inflammation developed. Although the processes involved are identical to tissue inflammation, systemic inflammation is not confined to a particular tissue but involves the endothelium and other organ systems. High levels of several inflammation-related markers such as IL-6, IL-8, and TNF-α are associated with obesity. During clinical studies, inflammatory-related molecule levels were reduced and increased levels of anti-inflammatory molecules were seen within four weeks after patients began a very low calorie diet. The association of systemic inflammation with insulin resistance and atherosclerosis is the subject of intense research

6. Inflammation

8. Inflammation - Asthma In numerous studies, pollution has been a driving force in the increase of asthma cases, especially pediatric. Many of the variables found in the Environmental Pollutants Biomarker test from US Biotek and through Crayhon Research, have been shown to increase asthma rates. Diesel fuel driven trucks and cars release benzene, which is known to cause inflammatory responses in the lungs as well as reduce oxygen carried by red blood cells. Inner city children, exposed to petrochemicals have some of the highest rates of asthma. –Wu, F. and T. Takaro (2007). "Childhood asthma and environmental interventions." Environmental Health Perspectives 113(6): 971-5.

9. Inflammation - Asthma Between 1980 and 1995, a report from the Environmental Protection Agency says, the percentage of children with asthma doubled, from 3.6 percent in 1980 to 7.5 percent in 1995. The percentage dropped in 1996 to about 6 percent, but by 2001 it had risen again, this time to 8.7 percent: 6.3 million children. In 1995 there were more than 1.8 million emergency room visits made for asthma. The rate was 48.8 per 10,000 among whites and 228.9 per 10,000 among blacks. Asthma-related deaths vary substantially by age group with the highest rates appearing in the elderly. Deaths due to asthma as the underlying cause were 15.1 per million among whites, and 38.5 per million among blacks.

10. Inflammation - Asthma The driving force behind the dramatic increases in asthma cannot be explained by a genetic component. The evidence is clear. Environmental pollution is the reason for the increases. Xylene can irritate the lungs. Toluene can cause a disruption of the hypothalamus which has been linked to an increase in asthmatic attacks. –Moron, L., J. Pascual, et al. (2004). "Toluene alters appetite, NPY, and galanin immunostaining in the rat hypothalamus." Journal of Neurotoxicology and Teratology 26(2): 195-200. –Nagata, S, Role of anterior hypothalamus on asthma, International Congress Series Volume 1287, April 2006, Pages 256-259 Psychosomatic Medicine - Proceedings of the 18th World Congress on Psychosomatic Medicine, held in Kobe, Japan, between 21 and 26 August 2005

11. Inflammation - Asthma Phthalates, found in air fresheners, new car smell and many plastics have been implicated in asthma. –Bornehag, C., J. Sundell, et al. (2004). "The Association between Asthma and Allergic Symptoms in Children an Phthalates in House Dust: A Nested Case- Control Study." Environmental Health Persepectives 112(14): 1393-1397. –Kolarik, B., K. Naydenov, et al. (2008). "The association between phthalates in dust and allergic diseases among Bulgarian children." Environmental Health Perspectives 116(1): 98-103. Assessing urinary output of these solvents and following the recommended protocols may be helpful in working with asthmatics. The only lab doing this test is US Biotek and can be ordered through Crayhon Research.

12. Inflammation - Asthma Another issue with some asthmatics are the levels of heavy metals, especially lead. –Joseph, C., S. Havstad, et al. (2005). "Blood Lead Level and Risk of Asthma." Environmental Health Perspectives 113(7): 900-904. Asthma is a symptom of chronic mercury poisoning according to Dr. Andrew Cutler and other mercury experts. Back as far as 1970, it was also known that arsenic can induce asthma in both children and adults. –Taub, SJ, Eye Ear Nose Throat Mon. 1970 Feb;49(2):80-1. Cadmium has also been found elevated in some asthmatics.

13. Inflammation - Asthma A Whole Blood Elements or a Hair Elements test done by Doctors Data with a LabAssist Report can be beneficial as well. Assessing and treating for heavy metal intoxication has been beneficial in reducing the number and severity of asthmatics with elevations of heavy metals. Reports have been mixed on the efficacy of chelation therapy on asthma. Lack of the use of laboratory tests be the reason for this problem. It is likely that there are multiple toxicities in asthmatics.

14. Inflammation - Allergies Many toxins like BPA (Bisphenol A) promote T H 2 cytokine production and reduces CD4 + CD25 + regulatory cells. The responses occur in both adulthood and prenatal stages. BPA also significantly promoted antigen-stimulated production of interleukin IL-4, IL-10, IL-13 in adults. BPA only stimulated increased production of IL-4 and IL-γ. Effects of prenatal BPA were far more pronounced than the effects of exposure in childhood. –Yan, H., M. Takamoto, et al. (2008). "Exposure ot bisphenol A prenatally or in adulthood promote TH2 cytokine productino associated with reduction of CD4+CD25+ regulatory T cells." Environmental Health Perspectives 116(4): 514-9.

15. Inflammation - Allergies We know that often time inflammatory reactions result in allergic responses. Since many toxins increase inflammation, the more toxic the patient, the more allergic the patient becomes. The obvious first step with people with allergies would be to order an IgG blood test. US Biotek, MetaMetrix and other offer good testing for a wide range of foods and food additives. LEAP MRT takes the allergy question one step further by looking at the inflammatory reactions to foods that precedes the IgE or IgG immune responses. Used in combination your patient will get the best benefit and most relief from allergic reactions.

16. Inflammation – Allergies In a study published in 1999 in Environmental Health Perspectives, Reichrtova et al saw a relationship between IgE and exposure to organochlorine compound found in pesticides. They correlated placental contamination with elevated levels of the blood protein IgE. These children were much more reactive and also had a high incidence of certain types of eczema. Using detoxification protocols specific to the toxins found may reduce allergic responses.

17. Inflammation - Food LEAP MRT Food Sensitivity –Inflammatory responses to food and food additives is a major problem for most people today. –Due to the increase of environmental toxicity and the inflammatory response it causes, reducing those negative responses to food is extremely important. –ALCAT is an older version of LEAP.

18. Inflammation - Food With both migraine and epilepsy, a food sensitivity test such as LEAP can be highly beneficial. With migraine Signet Diagnostics research indicates 67% of the people with migraine will receive a significant reduction in symptoms. In my experience with my daughter, seizure activity is held at bay by following the dietary protocols. Both migraines and epilepsy are worsened by the inflammatory response as are a number of other disorders such as autism, arthritis, and irritable bowel among others.

19. LEAP versus ALCAT ALCAT

20. LEAP versus ALCAT LEAP

21. Clinical Pearl An interesting finding in Celiacs disease. There is a gradient of Celiac across Europe. The lowest rates are found in the Middle East where wheat was first introduced as a dietary staple and is highest in Ireland where wheat only became staple in the late nineteenth century. Finding out the persons heritage may be helpful in determining whether you should test for Celiacs. An IgG + IgE test panel should be run on anyone suspected of Celiacs.

22. Inflammation – Fatty Acids As many of you know, Omega 3 fatty acids can be very soothing to the inflamed patient. Arachidonic Acid, an Omega 6 fatty acid is a strong marker for an ongoing inflammatory process. Testing for plasma fatty acid levels of omega 3s and 6s are helpful in assessing the patients dietary intake of these two important families of fats. It does not indicate very accurately the metabolism of the fats, only RBC membrane fatty acid testing does.

23. Inflammation – Fatty Acids RBC Fatty Acid testing can be beneficial in assessing inflammatory processes but the cost to benefit ratio is not as high as in other tests available. Dietary and supplemental intervention is more cost effective than testing. Increasing magnesium, zinc and vitamin B6 will lower arachidonic acid. Increasing omega 3 rich foods will also help reduce inflammatory responses.

24. Inflammation – Fatty Acids Benzene is known to increase the ratio of arachidonic acid to docosahexanoic acid (an omega 3 fatty acid). –Donggeun SUL, et al, Benzene increases the ratio of arachidonic acids to docosahexaenoic acids and inhibits the de novo synthesis of ceramide in the rat liver, Journal of Applied Toxicology, 25 (1), 2005. This may be one of the mechanisms behind how benzene triggers an inflammatory response. Many other petrochemical solvents like xylene, toluene, styrene also affect inflammatory processes in similar ways to benzene.

25. Inflammation – Fatty Acids Heavy metals like arsenic, cadmium, lead, mercury, etc also affect fatty acid metabolism. Before testing fatty acid balances and levels, it would be much more prudent to assess environmental toxicity issues. Environmental Pollutants from US Biotek and either a Whole Blood Elements or Hair Elements from Doctors Data, through Crayhon Research should be run first. Deal with causative factors then work on higher level chemistry and metabolism issues.

26. Inflammation - General Before we look at a sample of an environmental pollutants/metabolic profile, I want to make a comment about one test I think is critical in assessing overall chemistry as it relates to inflammation. The Comprehensive Blood Chemistry should be run on anyone suspected of having uncontrolled inflammatory processes. There are a number of markers within the test that can give us strong suggestions on how to deal with inflammation.

27. Inflammation - General Uric acid is a powerful marker of oxidation so whenever you see this elevated you need to intervene with antioxidants like Acai. Monocytes are a marker for inflammatory activity. According to the latest issue (April 2008) of Archives of General Psychiatry, people with bipolar disorder have elevations of monocytes which pump up the activity of various genes which are involved in inflammatory processes.

28. Inflammation - General People with bipolar disorder are three times more likely to develop an autoimmune thyroid disease which is a known inflammatory disorder. Many people with psychiatric disorders also have a higher incidence of type I diabetes as well other inflammatory disorders. As Dr. Hemmo Drexhage of the Erasmus Medical Center in Rotterdam said of bipolar and other psychiatric disorders Its not just a disease of the brain, it affects the whole system.

29. Inflammation – General A comprehensive blood chemistry with a LabAssist Interpretive report will help you uncover inflammatory processes. The panel we use to assess this process includes –LDL, Uric Acid, Triglycerides, sGPT, sGOT, Potassium, Monocytes, LDH, Globulin and Eosinophils LDL is a potential marker for oxidative stress and/or the presence of toxins in the blood. Uric acid is an antioxidant compound.

30. Inflammation - General Elevations in Triglycerides is linked to an inflammatory dysregulation of blood sugar control. sGPT and sGOT, both liver enzymes can be used to flag inflammation. Low Potassium is sometimes seen in acute and chronic stress which can increase inflammatory responses. Monocytes because of their affect on inflammatory responses. LDH is produced by muscle activity which can be used to monitor inflammatory activity. Globulin and Eosinophils when elevated mark an allergic and often times inflammatory reponse.

31. LabAssist TM Report EP/MP Comparisons in an Inflammed Patient

32. Contact Information Dr. Mark Schauss 5355 Capital Court #101 Reno, NV 89502 775-823-5333 marks@crayhon.com www.MarkSchauss.com www.ToxicWorldBook.com