Before testing
Begin supplementation with a high omega-3 cod liver oil to maintain adequate free vitamin A, vitamin D, and essential fatty acids.

Begin supplementation with antioxidant formulation and a multivitamin and mineral supplement without copper and iron. If dairy-free or limited dairy is being consumed, supplement with a high quality calcium supplement (1000 mg/day is recommended). Adequate magnesium should be given as well (125 – 500 mg/day) and should be dosed by age and weight.

If the person has sideways gaze and/or large (dilated) pupils in a room with adequate light, consult your physician about performing a trial of Bethanecol after adequate vitamin A has been given. Usually you will know within a few days if this drug will be effective or not. If effective, continue for about 3 months.

Begin a trial of high dose vitamin B-6 for one month. Start at a relatively low dose like 50 mg and then increase every few days until symptoms improve. Cut dose or discontinue if side effects are significant. Continue if successful.

After the vitamin B-6 trial, begin a one-month trial of sublingual Methylcobalamin (1000 mcg), TMG- Trimethylglycine (1000 mg), Folinic acid (800 mcg). Add these supplements one at a time with at least 3-4 days in between each. You may need to start lower dose and slowly increase the dosage to find out the correct dose for your child. If no benefits are seen, consider the use of subcutaneous methyl cobalamin if sublingual methylcobalamin is not successful.

After testing
Below is a brief summary by test and the markers that point to supplement recommendations that may be beneficial.

Organic Acid Test (OAT)
If any of the yeast/fungal markers are high, consider a trial of Nystatin or natural anti-yeast products such as MCT oil (caprylic acid), olive leaf extract, grapefruit seed extract, goldenseal, oregano oil, monolaurin, or combination formulas such as candicid forte. Since yeast easily becomes resistant to anti-fungal agents after a period of time, rotation of natural agents is recommended ever 2 – 3 weeks.

It is important to treat dysbiosis because it will cause impaired nutrition and also cause the production of potentially toxic byproducts from sugars or carbohydrates as well as from sulfur containing substances such as DMSA, DMPS, methionine, cysteine, glutathione, N-acetylcysteine, and lipoic acid.
If HPHPA is elevated (which indicates Clostridia overgrowth), suggest a 3 month trial of Culturelle (1 capsule daily). In many cases, Culturelle (Lactobacillus GG) alone can eliminate this bacteria. If this marker does not come down, a physician may want to prescribe a course of Vancomycin or Flagyl followed by one capsule daily of Culturelle.

Repeat organic acid test 60 days after beginning antifungal and/or antibacterial therapy to make sure selected therapies are working. Alter therapy if results are abnormal and repeat testing after 30 days.

Elevated succinic or glutaric indicates the need for coenzyme Q10 (50 mg/day).

Increase in all or any of the following markers with Fatty Acid Metabolites - ethylmalonic, methylsuccinic, adipic, suberic, or sebacic – may benefit from supplementation with L-carnitine (500 – 1000 mg/day)

If orotic acid in urine is high, seek advice from a biochemical genetics specialist. If no biochemical cause is found, investigate intestinal bleeding.

Low values on Vitamin Indicators suggest a dietary deficiency and supplementation of the specified vitamin may be helpful. High values do not necessarily indicate a need to reduce intake of any specified vitamins. If methylmalonic acid (vitamin B-12/cobalamin marker) is normal, methyl cobalamin, a different form of vitamin B-12, may still be deficient and supplementation is often beneficial.

Food Allergy and Urinary Peptide Test
Eliminate all foods that are significantly positive in an IgG food allergy test or which are indicated as problematic by urine peptide tests.

Begin supplementation with calcium and magnesium if a dairy free diet is being implemented for the first time.

Amino Acid Test
Supplement with taurine if deficiency is indicated in urine or serum amino acid test. If 3 or less amino acids are significantly low, consider supplementation with specific amino acids at doses of 250-1000 mg per day based on degree of deficiency and body weight.. If more than 3 amino acids are low and few physiological amino acids are elevated, increase protein and/or supplement with a digestive enzyme with high amounts of protease. Do not supplement with amino acids if orotic acid on organic acid test is high.

Prealbumin
Increase protein and/or add digestive enzyme in the diet if prealbumin is low or low normal and orotic acid from organic acid test is normal.

C-Reactive Protein
This may indicate sever inflammation of the intestinal tract. Tumeric and supplements with Quercetin may be beneficial.

Comprehensive Stool Analysis
Microbiology – supplement with high quality probiotics that contain the strain that is below a 3+ under “Beneficial Flora”.

If any strains were cultured under “Dysbiotic Flora”, treat with prescriptive or natural agents indicated.

Parasitology - consult with physician regarding treatment if positive.

Digestion and/or Absorption - Add digestive enzymes if any of these markers are abnormal.

Inflammation - Consider tumeric or quercetin if any of these markers are abnormal.

If fecal sigA under Immunology is low, supplement with casein-free colostrum.

Yeast and bacterial that are cultured will offer a list of prescriptive and natural agents to which the yeast or bacterial is sensitive. If deciding to treat with natural agents, consider rotation every 2-3 weeks since yeast can easily becomes resistant.

Immune Deficiency Panel
If significant IgA deficiency, casein-free colostrum may be helpful. If significant IgG deficiencies are indicated and child has frequent infections, IVIG therapy might be an option to consider.

Advanced Metallothionein Profile (AMP)
Supplement with additional zinc (25-50 mg) if zinc is low to normal and/or an elevated copper/zinc ratio or elevated free copper. Molybdenum (250 mcg) can be helpful in bringing down levels of free copper. Low Metallothionein (MT) that is not raised by zinc supplementation may indicate a genetic defect in MT function. These individuals are more vulnerable to toxic metals and may want to consider on-going chelation to prevent heavy metal toxicity. Copper-Zinc levels need to be regularly monitored to prevent zinc toxicity and copper deficiency.

Hair Metals
If hair testing indicates high levels of toxic elements and dysbiosis is under control, treat with oral chelating agents or transdermal agents like DMPS.

High aluminum can be reduced with the supplementation of malic acid.

Dysbiosis (imbalance of yeast and bacteria) treatment will typically need to continue for a year or more and will need to continue during chelation.

If hair metal results are normal, consider performing a chelation challenge test to determine the presence or absence of heavy metals. Some individuals favor performing chelation even in the absence of heavy metals in a hair test or in a chelation challenge test. Andy Cutler, Ph.D., recommends chelation if a number of other abnormalities is present in the nutritionally needed elements of the hair test. However, it may be difficult to get a prescription for chelating agents from a physician in such a case. Extremely high values for mercury, lead, arsenic, cadmium, uranium, aluminum, or antimony or a combination of a number of moderately increased hair metals should probably be treated by chelation. Other heavy metals such as beryllium, thallium, and thorium may be very toxic but are not nearly as common. Certain heavy metals such as tin, bismuth, silver, nickel, bismuth, and titanium are frequently elevated but their toxicity is not usually considered as significant as the previous group.

Elements that are low in the hair test and which correlate fairly well with dietary deficiency. These metals include iodine, selenium, manganese, molybdenum, and lithium. If these minerals are being supplemented in a multivitamin and mineral supplement, consider giving additional amounts as suggested by your physician.

Hair values for calcium, magnesium, sodium, potassium, zinc, and copper need to be assessed by blood and/or urine testing since their values in the hair cannot be interpreted easily.

Other Suggestions
Continue to retest things like organic acid profile, essential fatty acids, amino acids, food allergies and hair metals every 6 months to one year.

Try out new supplements such as carnosine, carnitine, TTFD, phosphatidyl serine, and gamma amino butyric acid (GABA) in separate trials. Discontinue if there are significant side-effects.

Consult your physician about the use of antiviral drugs or a supplement of Monolaurin/Lauriciden or coconut oil, especially if the mother had a history of genital Herpes infection during or previous to the pregnancy of the affected child. A 3-6 month trial of antiviral drugs may be needed to determine if response is significant.