Inositol can be used in place of gluten and early reports show it may be superior.  500 mg to 1,000 mg a day has been adequate in the release of serotonin to keep up with the turnover stimulated by Respen-A Blended Chord.  Inositol is available in a powder or capsule from various manufactures.  It virtually is tasteless and dissolves well in water.  Early reports show that a once a day dosing has been adequate, but depending on the child, you may find that dividing the dose up into three servings a day may be beneficial.

The rationale behind going from the original Respen-A to the Respen-A Blended Chord is the following:
There are two forms of MA0: MAO-A and MAO-B. The MAO-A:MAO-B ratio is much like a teeter-totter in that environmental factors that inhibit MAO-A activity usually boost MAO-B activity. Decreased activity in MAO-A is common in autism. A decrease in MAO-A results in a dysfunction in the mitochondria resulting in lactic acid production. This results in calcium phosphate being pulled from the compartmental stores in the body such as the bones. The phosphate neutralizes the acid, leaving high amounts of unbound calcium. This free calcium goes into the cells, such as mast cells, causing an inflammatory response and tissue damage. Tissue damage stimulates cholesterol production because cholesterol is needed for tissue repair. Thus, research shows that an MAO-A deficiency is associated with high cholesterol levels. But interestingly, many children with autism have low cholesterol levels. This may be explained by the fact that when MAO-B activity gets really high it inhibits production of cholesterol. This may also explain why high cholesterol levels often precede low cholesterol levels. Stress inhibits MAO-A. The decrease in the MAO-A:MAO-B ratio causes an increase in cholesterol. But as stress continues and becomes prolonged, the MAO-A activity becomes very low and the MAO-B activity becomes very high and this can result in very low cholesterol levels due to inhibition of cholesterol synthesis.

So we hypothesized that it may be beneficial to try and work on both sides of the MAO-A:MAO-B ratio. The Respen-A 4X formulation is aimed at increasing the MAO-A, but would Respen-A have a greater effect on the symptoms of autism if it worked on both sides of the equation; increasing the MAO-A and lowering the MAO-B? Thus, the Respen-A Blended Chord formulation was adopted. One of the metabolites of reserpine appears to boost MAO-A activity and decrease MAO-B activity. Thus the Respen-A Blended Chord is a 4x homeopathic dilution of reserpine and a 12C dilution of a reserpine metabolite.

The Respen-A Blended Chord was first tested in a small sample of 3 patients who had used the original Respen-A 4X formulation for 6-12+ months. On the Respen-A Blended Chord, they reported more initiation of language, better attention, better motor planning and dexterity, more affection, more empathy and awareness of others emotions and needs and a desire to help and respond to others. They also reported that a little bit of gluten every 1 1/2 -2 hours was an absolute MUST with the Respen-A Blended Chord.

We then increased the sample size of the Respen-A Blended Chord to 20 patients to see if these same benefits were consistent in a larger sample since often the response to a treatment can vary from individual to individual. The majority of the larger sample reported similar benefits as seen in the small 3 patient sample. Parents reported that they felt the Respen-A Blended Chord was superior to the Respen-A 4x.

So as of July 1, 2011, all pharmacies will begin compounding and dispensing the Respen-A Blended Chord and the original Respen-A 4x will no longer be available. The patient instructions are the same for Respen-A Blended Chord as for the original Respen-A 4x:

• 2000 mg of calcium each morning with breakfast MUST be taken prior to putting on the disc.
• All supplements that will negate the original Respen-A 4x will still in fact negate the new Respen-A Blended Chord (such as EFA’s, oils, Enhansa, high Vitamin D, etc)
• A serving of meat must still be eaten daily to keep up with the serotonin turnover. (If meat cannot be eaten, you may supplement with 500mg of L-Tryptophan daily or100-150mg of 5-HTP 3-4 times a day.)
• Also, a small amount of gluten (such as a 1/4-whole cracker, depending on the child) MUST be taken every 1 1/2 hours to 2 hours throughout the day if they are on a strict Gluten Free Diet.

  THE DIFFERENCE in the Respen-A 4x and Respen-A Blended Chord however, is that with the Respen-A Blended Chord it is recommended to start with only a 1/2 disc of the Respen-A Blended Chord as most patients have found the 1/2 disc to be the optimal dose of the Respen-A Blended Chord. Thus, if the patient is careful when opening the individual disc packages, so as to not tear the paper/foil backing, they can remove the disc, cut it in half with a pair of scissors and then place one half of the disc back into the package and reseal the paper/foil backing and place the package back in the refrigerator to be used the following day. Thus, a month’s supply of Respen-A Blended Chord may provide treatment for 2 months. (Note that if you are using less than 1/2 disc, you can only get the packaging to effectively reseal one time.)

  We are also holding a webinar on June 28, 2011 at 4:00pm Pacific Time to address the new formulation and our findings from those children that have tried both formulations. If you would like to join this webinar, please contact us at info@respen-a.com with your email address and we will make sure you are listed on the recipient list of our webinar invites. From what we have seen, we are very excited about the new Respen-A Blended Chord coming soon!

 Research has shown that prebiotics are more effective than probiotics in most cases to resolve dysbiosis.  Prebiotics are the optimal food for the bacterial flora in the intestines, whereas probiotics contain the favorable bacteria for the intestines.  The reason prebiotics have been more effective than probiotics at reversing dysbiosis is because it doesn’t do much good to just keep reintroducing the good bacteria into the intestinal tract if you don’t provide them with their optimal food source (soluble fiber).  Yeast is a very opportunistic organism, meaning they can thrive on a wide variety of food sources.  But the favorable bacterial flora in the intestines cannot.  The optimum food for the bacteria is soluble fiber,which our diets are becoming very deficient in.  Without this optimum food source of soluble fiber, the bacteria will not flourish, resulting in yeast overgrowth due to lack of competition from the bacteria.   Of course if the dysbiosis is due to the administration of antibiotics, then a probiotic would be indicated followed with prebiotics.

 A very good prebiotic is frucotooligosaccharides (FOS).  FOS is a soluble fiber consisting of sucrose and fructose but the way the two simple sugars are bound together, our body can’t digest them but the bacteria can flourish on them.  The exception to when FOS should not be supplemented is if a bad bacteria such as Klebsiella is present in the stool as this bad bacteria will flourish on FOS as well.  So the stools must be negative for the bad bacteria before supplementing FOS. 

 The key to supplementing FOS to get the most benefit is to take 2,000-3,000 mg of FOS all at one time each day.  The reason for this is as the bacteria utilize the FOS, they produce a protein the stimulates gene expression of two very important calcium binding proteins, Calbindin D9k and Calbindin D28k.  In order to stimulate gene expression, a particular protein must be present in a finite concentration, which is achieved if 2,000 –3,000 mg of FOS are taken all at once.  The Calbindin D9k is needed for calcium and other mineral absorption from the intestines.  The Calbindin D28k is needed to protect the cells from too much calcium influx that can result in cell damage and inflammation. 

 Many doctors and parents are reporting that the gastrointestinal problems including dysbiosis have resolved in their patients and children respectively after starting Respen-A with FOS.

 Many parents have reported that their child’s constipation is resolved within days of starting the Respen-A.  It is recommended to stop the increased magnesium supplements when starting Respen-A as these can result in loose stools or diarrhea.  Also the increased magnesium intake can interfere with the calcium absorption that is necessary when using Respen-A.

 The active ingredient in Respen-A stimulates MAO-A activity resulting in H2 production, which in turn stimulates gastric acid and digestive enzyme production.  Many parents have reported that their child no longer needs the digestive enzymes after starting Respen-A.  Digestive enzymes can be taken with Respen-A but they may not be necessary.

 One important thing about taking FOS, don’t divide up the dose as directed on the bottle to get the optimal effect of FOS.  As the bacteria eat the FOS, they produce a protein that stimulates our bodies’ gene expression of two very important calcium binding proteins, calbindin D9k and calbindin D28k.  The calbindin D9k is needed for calcium and other mineral absorption from the intestines and calbindin D28k protects the cells from too much calcium influx into the cells that can cause exitotoxicity and result in inflammation and cell damage.  Whenever you are stimulating gene expression, the protein concentration must be within a finite range.  2,000 -3,000 mg of FOS must be taken all at once in order to get this protein produced by the bacteria in the finite range to stimulate the production of the calcium binding proteins.

 The active ingredient in Respen-A is reserpine, which increases the activity of MAO-A, thus reducing the production of lactic acid.  This reduction in lactic acid production reduces the amout of free calcium influx into the mast cells.  Respen-A also, has an added benefit, reduces calcium by pushing it into the urine and into the bones, which in turn reduces the hypersensitivity of the mast cells.  Consequently, a child using Respen-A, overtime may find that they can tolerate some dairy products in their diet once again.

The active ingredient in Respen-A is reserpine.  Research shows that reserpine will double the activity of MAO-A.  Thus by increasing the activity of MAO-A with Respen-A, the serotonin level is decreased and converted into its active aldehyde metabolite.  Because of this breakdown of serotonin by MAO-A, serotonin must be replenished, such as through eating meat or taking the supplement of L-Tryptophan daily.  We have found that in some children on a gluten free diet, just eating meat or taking L-Tryptophan, isn’t adequate after being on Respen-A.  These children often show improvement in the first month to six months of using Respen-A and then they start to exhibit a return of their symptoms or become withdrawn, depressed, and sad.   We find that these children have needed to add back into their diet a little bit of gluten.  The reason is, L-Tryptophan from meat is the precursor to producing serotonin.  The serotonin that is produced, is then stored in vesicles in the cell.  The serotonin must then be released or mobilized from these vesicles into the synapse (the nerve junction), where it can be converted by MAO-A to its active aldehyde.  Gluten triggers the mobilization and release of the serotonin from the vesicles.

Many parents have inquired as to why the need to discontinue the EFA supplements such as Flaxseed oil, Primrose oil, Fish oils and Omega3 when using the Respen-A™ disc or Respen™ Spray. We have found that these oils, which contain a high concentration of polyunsaturated fats, will negate the effects of Respen-A™ and Respen™ Spray.

A possible explanation for this phenomenon is that the body works in ratios, and this is a means of checks and balances. Some of the ratios in the body are sodium to potassium, calcium to magnesium, copper to zinc, and even polyunsaturated fats to saturated fats. Polyunsaturated fats contain double bonds, which is what makes them maintain their liquid state when refrigerated. Polyunsaturated fats are structural components in the cell membrane making the cell membrane fluid and flexible. The cell membrane has an inner and outer membrane with protein channels that must be lined up between the outer and inner cell membranes so that they form a channel that transverses the cell membrane, allowing the cell to import and export things. If the cell membrane were too fluid, these protein channels would not be lined up and the cell would not be able to import and export efficiently. Thus, the cell membrane also has saturated fats in the cell membrane, which are straight chains with single bonds and act like ties or rebar that help maintain the structural position of the protein channels in the cell membrane.

The body tries to keep the polyunsaturated fats and saturated fats in a specific ratio. The body has no control over what we feed it, so if we ingest a large concentration of polyunsaturated fats such as what is in the EFA supplements, the body will burn the excess polyunsaturated fats, trying to bring it back into balance with the saturated fats. Polyunsaturated fats with double bonds create lipid peroxides when they are broken (metabolized) in the body. Lipid peroxides are neurotoxic and they inhibit monoamine oxidase-A (MAO-A), which is the enzyme we are trying to boost with the reserpine in Respen-A™ or Respen™ Spray.

The best way to get a balance of saturated and polyunsaturated fats, is to eat whole foods such as meat, fish, and nuts as these contain both polyunsaturated fats and saturated fats in a ratio that is more balanced for our body.