31 for 21: A Rebuttal

When I graduated from highschool several years ago, I had to write a junior thesis and the easiest topic for me was Down syndrome nutrition. I had wanted to write an article to refute some of the claims often made by some people who are "against" the use of TNI. So, this was the perfect opportunity!

I chose to write a rebuttal against a somewhat popular "anti-TNI" article. Some folks had wanted to write a rebuttal to this article before, but never taken the time. So, when I had written this article, I had quite a few people thank me for doing so!

Since this article was posted on a handful of DS message boards & email groups, I got quite a bit of feedback from it. Like I mentioned above, I had a lot of people who really appreciated it, some who were pretty neutral on it and also a fair amount of people who hated it with a passion.

The article is called, Rebuttal to Dr. Leshin's & Quackwatch's Article, "Nutritional Supplements for Down Syndrome: A Highly Questionable Approach." It is on our website, so some of you may have already seen it, but I thought it would may be an interesting read for those who haven't seen it. The goal of the article is to just give the facts & research behind the use of TNI. This article is also in our book.

I will paste the first few opening paragraphs to the 29 page article here,

There is an ongoing debate between doctors, professionals, researchers and parents regarding the use of Targeted Nutritional Intervention (TNI) for Down Syndrome (DS). Nutritional supplementation is used by thousands of parents and is accepted and promoted by some doctors, professionals and researchers.

TNI is used to improve symptoms and alter the course of the syndrome. There have been studies done to show the beneficial effects of TNI, such as, enhancing the immune system, improving muscle tone, decreasing rate of infections, reducing oxidative stress, increasing antioxidant levels, and helping normalize homocysteine levels.

A handful of studies have been done which show little or no effect, but increasingly more studies have been done which show a beneficial effect. Len Leshin, M.D. wrote an article in the mid-1990's to try to refute the use of TNI and this article is still being used (as of this writing) as evidence that nutritional supplementation is very dubious in helping to change any outcomes in DS. The purpose of this paper is, by review of the literature, to rebut Dr. Leshin's article, through showing the usefulness and large asset that TNI does have. Although this author uses TNI in her own family, no personal or financial relationship exists with any company providing supplementation or alternative therapy.

Down Syndrome (DS) is a genetic disorder caused by a triplication of the 21st chromosome. Down syndrome was first discovered by Dr. John Langdon Down in 1866 [431]. In 1958 Professor Jerome Lejeune discovered Down syndrome was caused by a third copy of the 21st chromosome - Trisomy 21 [430]. It is the most common genetic cause of mental retardation in society [36], occurring 1 in every 750 live births [412]. Down syndrome has a higher rate of developing congenital heart defects, leukemia, Alzheimer’s Disease, immune dysfunction, cognitive defects, thyroid disorders, gastrointestinal anomalies [432], and nutrient deficiencies than the general population. It is believed to be due to this aneuploidy [433] of the syndrome causing gene over-expressions [255, 257-259, 400, 412-421]. It has been confirmed by a few studies that the "gene dosage effect" hypothesis is true [420-427]. That is, the phenotype of DS is caused by the over-expression of certain genes on the human chromosome 21 [420-427]. There are 225 more genes in an individual with DS [413], due to the trisomy of chromosome 21, than in an individual without DS, some of which are over-expressed. Surprisingly, chromosome 21 is a gene-poor chromosome, having only 225 genes [413], as in comparison to chromosome 22 which has 545 genes [413]. Due to the low amount of genes on chromosome 21, it makes it one of the only living autosomal trisomies (see endnote 413).

It can be seen from the study, The "gene dosage effect" hypothesis versus the "amplified developmental instability" hypothesis in Down syndrome [420], that evidence for the "gene dosage effect" does exist.

    * Herein, we review recent data and present evidence to support the theory that the phenotypic traits of aneuploid syndromes, and DS in particular, result from the increased dosage of genes encoded on the triplicated chromosome.

In other words, the above abstract is giving evidence which supports that the phenotype of DS is a result from an over-expression (increased dosage) of genes on the extra 21st chromosome.

Due to the over-expression of genes in Trisomy 21, it creates deficiencies in certain nutrients, excess and imbalances of other nutrients and processes, and altered metabolic and biochemical courses (see evidence for this below). Because of this, those involved with research regarding DS, doctors who have patients with DS, and parents of children with DS, have looked into nutritional supplements being able to ameliorate [434] some of the problems present in DS. There is much evidence of oxidative stress [256-257, 259, 317-341, 401], low antioxidant levels [70-75, 79-82, 84-85, 89-103], nutrient deficiencies [69-103, 253-254, 450] and excesses [104-113], and other processes which do not function properly [123-136]. Targeted Nutritional Intervention (TNI) has been shown to be beneficial and help amend the problems present in DS. Please see endnotes 1-38, 100-101, 254, 256, 259, 449, 451.

Now, Targeted Nutritional Intervention is various vitamin, mineral, amino acid and antioxidant supplements specifically formulated for individuals with Down syndrome. The idea of TNI has been around since the 1940's, with the work of Dr. Henry Turkel. Since that time, there have been several different formulas made. There is much difference though from the first formulas made and the present TNI formulas. The present formulas do not use mega-doses of ingredients, as the first formulas, such as Dr. Turkel's, did. At the time of Dr. Turkel's work, he did not have the knowledge that is present now that DS is caused by a triplication of the 21st chromosome. Due to the large amount of scientific evidence and research that is now present, the TNI formulas have been improved greatly. The most common ones are Hap Caps by Dr. Jack Warner (www.warnerhouse.com), Nutrichem's MSB Plus V7 (www.Nutrichem.com) and International Nutrition's Nutrivene-D and Nutrivene-AD (www.nutrivene.com). TNI targets Down syndrome's specific and different metabolic needs.

The subject of nutritional supplements for Down Syndrome (DS) tends to come up often in the world of Down syndrome. Due to the controversy regarding this subject, some who oppose Targeted Nutritional Intervention (TNI) often cite the article, "Nutritional Supplements for Down Syndrome: A Highly Questionable Approach" by Len Leshin, M.D., F.A.A.P. and published on Quackwatch's website. Through this rebuttal, a different perspective regarding TNI will be given. It will be shown, through research, that TNI is beneficial for the majority of those with Down syndrome. Majority, that is, because there are few who are not able to handle TNI, because not every person, including people with DS, are the same. TNI can be customized for some of the children who cannot handle the regular formula.

Dr. Len Leshin is a pediatrician in Corpus Christi, Texas and is the father of a boy with Down syndrome. He has a website with some information regarding Down syndrome health issues and is very opposed to Targeted Nutritional Intervention, as can be seen from his website (www.ds-health.com). Quackwatch is a website (www.quackwatch.org) that is against many things related to alternative, holistic or natural medicine.

Although Dr. Leshin's article is referenced often and viewed as a good article by those not in favor of TNI, one thing that should be noted in the very beginning of this rebuttal is that Quackwatch's article was last revised in October 1998. There has been much advance in the research regarding Down syndrome since that time [see endnote 444].

From what will be shown, it should be evident that most individuals with Down syndrome can benefit from taking a multi-vitamin that is targeted to their needs, because, their DNA (Deoxyribonucleic Acid) is completely different than someone without DS and therefore they have specific needs.