A mom and "wholistic" chiropractor's musings and roadmap with Down syndrome

Posts tagged ‘supplements’

The use of Resveratrol and EGCG in Trisomy 21/ Down syndrome

Resveratrol (from grapeskins or Knotweed) and EGCG (from Green tea) have multiple benefits, including supporting cell health, anti-aging benefits, immune response support, healthy inflammatory function, anti-oxidant effects, and brain and neurological support. However,  Resveratrol and EGCG are two phytochemicals with very important roles in TNI (targeted nutritional intervention- the name for the protocol to address gene over-expression caused by Trisomy 21/ Down syndrome.)

Plant polyphenols as natural drugs for the management of Down syndrome and related disorders.    https://www.ncbi.nlm.nih.gov/pubmed/27826066

The polyphenols resveratrol and epigallocatechin-3-gallate restore the severe impairment of mitochondria in hippocampal progenitor cells from a Down syndrome mouse model.  https://www.ncbi.nlm.nih.gov/pubmed/26964795


Resveratrol is used in T21 to address Micro RNA 155.An elevation of MicroRNA – 155 causes permeability in the Blood Brain Barrier (BBB), which allows toxins and other things to get to the brain and nervous system tissue.In Trisomy 21/ Down syndrome, people have a minimum of a 30% – 50% over expression. This results in constant access to the brain of toxins that might otherwise be filtered by this barrier. A damaged blood brain barrier will not let everything cross it to enter the brain but neither will it efficiently keep every harmful thing out of the brain. Studies have proven that it reduces 155 by upregulating MicroRNA-633. Since 633 is a tumor suppressor gene, this is a plus.

Studies have confirmed that Resveratrol heals the BBB in Alzheimer’s disease. The mechanism in AD and DS creating the permeable BBB is the same. There is every reason to believe that Resveratrol takes care of this, but it is not know to what degree.

“The homeostasis of the central nervous system (CNS) environment is maintained by the BBB, which separates the brain from the systemic blood circulation. The cerebral capillaries are organized such that the brain is protected from blood-borne compounds, since a strict homeostasis of the neuronal environment and an intact barrier are essential for optimal brain functioning. However, during various neurological diseases the permeability of the BBB may be changed. This review will discuss the role of the BBB and especially of the CEC in various neuroinflammatory diseases.”http://pharmrev.aspetjournals.org/content/49/2/143

Resveratrol also protects from hypoxia, an issue in Ds because of the high amount of sleep apnea in the Ds population.

Protective effect of resveratrol against chronic intermittent hypoxia-induced spatial memory deficits, hippocampal oxidative DNA damage and increased p47Phox NADPH oxidase expression in young rats. http://www.ncbi.nlm.nih.gov/m/pubmed/26940604/

Neuroprotective role of trans-resveratrol in a murine model of familial Alzheimer’s disease.  https://www.ncbi.nlm.nih.gov/pubmed/25024312

But there is another issue In Trisomy 21/ Down syndrome where resveratrol is particularly useful.

Resveratrol helps repair telomere shortening by upregulating telomerase. Studies suggest that it does not require large doses to effect telomere length.

Immortalization of epithelial progenitor cells mediated by resveratrohttp://www.nature.com/onc/journal/v27/n17/full/1210886a.html

SIRT1 prevents replicative senescence of normal human umbilical cord fibroblast through potentiating the transcription of human telomerase reverse transcriptase gene.   http://www.ncbi.nlm.nih.gov/pubmed/22197555


What does this mean for people with Down syndrome?

It means Resveratrol may be an answer to yet another serious issue in DS.

“It is suggested that telomere repair is directly related to cell survival (fact) and human longevity (both fact and probability). In DS the telomeres are very short in comparison to normal controls and they simply do not repair at the rate seen in the non DS population. Giving our children the ability to repair the telomeres may help prevent rapid aging, Alzheimer’s disease, Leukemia, and other age related diseases, including autoimmune diseases associated in younger people and even small children with DS. One very important result may be giving our children an additional decade or more of healthy life.

The tips of chromosomes (think about the tips of a shoe string) are called telomeres. These prevent the destruction of DNA and serve other purposes. Every time a cell divides telomeres shorten. It’s as it the tips are chipped off during cell division. But the human body produces an enzyme called telomerase that activates and repairs the telomeres instantly. What a miracle. But not for our children. The telomeres shorten but are not easily repaired. In time, they are too short to sustain life and it may well be a major reason for premature death in DS. Remember, on average, our children’s lives are 20 years shorter than a non DS individual. That means that DS is a terminal disease by definition because death is directly related to it. But! Resveratrol upregulates telomerase and allows the repair of telomeres. You can see how critical Resveratrol is for our children.”

-Dixie Lawrence, T21 biochemist and Ds researcher


EGCG is used to down regulate DyrK1a, and enhance learning, cognition and memory.

Green tea polyphenols rescue of brain defects induced by overexpression of DYRK1A.  https://www.ncbi.nlm.nih.gov/pubmed/19242551

Epigallocatechin gallate: A useful therapy for cognitive disability in Down syndrome? https://www.ncbi.nlm.nih.gov/pubmed/28203607

Combined Treatment With Environmental Enrichment and (-)-Epigallocatechin-3-Gallate Ameliorates Learning Deficits and Hippocampal Alterations in a Mouse Model of Down Syndrome. https://www.ncbi.nlm.nih.gov/pubmed/27844057

Neprilysin is a zinc-dependent metalloprotease that cleaves peptides at the amino side of hydrophobic residues and degrades the amyloid beta peptide whose abnormal misfolding and aggregation in neural tissue has been implicated as a cause of Alzheimer’s disease.

Neprilysin is low in the brain of both AD and Down syndrome patients. A recent study found that a DYRK1a inhibitor, harmine, upregulated Neprilysin in both DS and AD.

Neprilysin Is Suppressed by Dual-Specificity Tyrosine-Phosphorylation Regulated Kinase 1A (DYRK1A) in Down-Syndrome-Derived Fibroblasts https://www.jstage.jst.go.jp/arti…/…/40/3/40_b16-00825/_html

Harmine, the compound utilized in the above study is not an option for use in DS as there are numerous issues involving both side effects and availability. However, EGCG is very similar in structure and also acts as a DYRK1a inhibitor and has the identical effect on Neprilysin, increasing its levels in the brain.

(-)-Epigallocatechin-3-gallate attenuates cognitive deterioration in Alzheimer’s disease model mice by upregulating neprilysin expression. https://www.ncbi.nlm.nih.gov/pubmed/…


Resveratrol- start with .5 – 1 mg/kg (1 mg of resveratrol per 1 kg of body weight).  Do this does 2 times a day, spaced at lest 8 hours apart.  Gradually increase the dose to 4-5 mg/kg.

EGCG- start with .5-1 mg of EGCG per kg of body weight.  Gradually increase the does anywhere from 3-5 mg.kg.  Some studies and protocols for much higher amounts.


EGCG needs to be separated from folate (like in NuTriVene) by 4 hours, as EGCG can effect one of the enzymes in the folate pathway.

At doses much higher than we are using in T21, liver and kidney stress have bee noted.  If your child is low in ferritin, be sure to monitor it, and additional supplementation with a high quality iron and adding organ meats to the diet may be warranted- as EGCG can in some cases, have a chelating effect on iron.

NuTriVene Products

Nutrivene products- the foundation of Targeted Nutritional Intervention (TNI)


NuTriVene-D is the main supplement in the treatment of Down syndrome, and the one to start with. It was developed by a team of researchers and scientists.  It’s purpose is to provide nutritional agents, such as vitamins, minerals and amino acids, in specific forms and amounts to help offset or manage several of the genes over-expressing in Trisomy 21/ Down syndrome.

“The Daytime Formula targets all the aberrant nutritional needs of kids with DS. It corrects the damage to the folate/methyl cycle caused by the over expression of the CBS gene. It provides all of the missing precursors for normal thyroid function. It provides nutrients found in low quantities necessary for immune response. It targets oxidative stress caused by the over expression of SOD1. There are there antioxidant enzymes in the oxidative triad that must be in levels sufficient to work in synergy. When they do not work, the cells fill up with hydrogen peroxide. Hydrogen peroxide then becomes the most deadly free radical known to man, the hydroxyl free radical. So, in addition to providing other antioxidants, Nutrivene Daytime Formula upregulates the two antioxidant enzymes that are NOT located on chromosome 21, Catalase and Glutathione Peroxidase and therefore far too low for the triad to function. But by up regulating them as much as possible, this triad functions much better. The Daytime Formula normalizes the child’s biochemistry as much as possible in the exact levels required.”

– Dixie Lawrence, DS Biochemist and Researcher

To read the list of article about Nutrivene-D please go here http://www.nutrivene.com/educational_information.php



If you have an infant, start with the NuTriVene Daily Formula.  It comes with dosage information, as dosage is based on the weight of your child.  I recommend starting at 1/4 of the dose for your child, and gradually work up to the full dose.  The full dose split into 2 doses a day ensures your child has better blood saturation of the product.

There are 2 other parts of NuTriVene,  the NuTriVene Daily Enzymes and the NuTriVene NightTime Formula.


The NuTriVene enzymes are digestive enzymes.  These help to break down food so that it is more easily digested, and nutrients are better absorbed and assimilated by the body.  For infants, do not start this product until solids are introduced….however infants on formula may benefit from this product.  Infants with acid reflux  may have a worsening of reflux with this product.  Dosage recommendations come with this product.

To use, you can open up the capsule and sprinkle into or onto food, until your child is old enough to swallow pills.  Our webstore also carries some other digestive enzyme options, including a chewable one!


NuTriVene NightTime formula helps provide nutrients to support growth hormone and serotonin production.

Growth hormone can be deficient in people with T21.  This product makes sure the nutrients are available for the pituitary gland to make growth hormone.  The nutrients also help the body make serotonin, a neurotransmitter that can help with sleep, which is often low in children with T21/Ds.  Tis will better aid children with Ds to get into REM sleep- which is crucial for growth and development.  Dosage recommendations come with the product.

Please note that while all people with Trisomy 21 have genes that are over-expressing, each person still has an individual and unique biochemistry, and may be best served by working with a practitioner who specializes in TNI, to customize a specific protocol.

Connor’s Current Supplement Program

Most Current Protocol  

7 months old-

After running labs and re-muscle testing him with Autonomic Response Testing

(see http://articles.mercola.com/sites/articles/archive/2010/01/09/The-Absolute-Best-Muscle-Testing-System-I-Know-of.aspx   and   http://articles.mercola.com/sites/articles/archive/2010/02/27/what-to-do-when-doctors-and-naturopaths-fail-you.aspx)

This is Connor’s protocol. ( New ones in BOLD)

Nutrivene-D daily- dosed by weight

Designs for Health Mito PQQ – 1/3 capsule/ day ( taken separate from the Nutrivene D)

PSC Embryonic Plant Stem Cell Remedies- Ash, Beech, Black Currant, Crab Apple, Dandiion, Caraway, Fig, Linden Tree, Rosemary, White Birch Flower Male Catkins.  I use Arresto Prevento and Broncho Modulato as needed.

Designs for Health Neuro Mag (Magnesium threonate- able to transport magnesium to brain cells)

Pekana Kelan– to treat the OHS scar

Premier Research Labs Green Tea ND 1/8 tsp with Mito PQQ

Neurobiologix Neuro Immune Stabilizer (transdermal folate, B12, B6 and Vit D cream) and Transdermal Glutathione.  

Designs for Health GPC Liquid- am going to increase dose to 1200 mg/ day

“Connor’s Blend” (doTERRA DDR Prime and Citrus Bliss) applied to feet and spine am and pm

Professional Complementary Health Formulas- Brain Enhancement Liquescence (1/3 dropper 3 times a day)

Safe Care Rx- Children’s Growth and Development 1 spray- 3 times a day

Discontinued- Infant DHA (!) and Probiotics

4 months old- added Designs for Health Mito PQQ- 1/3 capsule, once a day- to help support mitochondrial health and support heart after Open Heart Surgery (AVSD repair.)

Age 10-12 weeks- based on some labs I ran, his magnesium is low.  I am adding Senseable Supplements MgCl drops 5 drops 2 times a day to his Nutrivene- D bottles.  I will also start Designs For Health MagneGel- a transdermal magnesium gel that will raise his intracellular levels of magnesium faster than oral.

Added PSC Broncho Modulato 10 drops 3-6 times a day and PSC Hornbeam 3 drops, 3 times a day.  My husband brought home a cold with a cough, and Connor started getting stuffy.  This is concerning because of the Heart Defect.  The Broncho Modulato provides a wide variety of support to the lungs, and will help prevent the cold from settling in the lungs.  If he gets more symptomatic, I will do the dose hourly.  Hornbeam is a great decongestant.

We are continuing to diffuse doTERRA Breathe with Arbor Vitae added.  I have periodically been applying diluted On Guard and Breathe to Connor’s feet as well.  I REALLY want to make sure he does not get sick.  At over 3 months old, with a Complete AV Canal, (see http://dsdaytoday.blogspot.com/2011/04/heart-down-syndrome.html) he still has not gone into heart failure, and is continuing to gain weight.  I attribute this minor miracle to chiropractic, and his supplement protocol. 🙂

Added Designs for Health GPC (glycerophosphocholine) is a supportive nutrient for the brain, kidneys, muscles, testes and other organs, and is a building block for cell membrane phospholipids. Without the presence of this nutrient in the brain, we could not think, sleep or remember. – See more at: http://catalog.designsforhealth.com/GPC-Liquid-2oz?sc=2&category=3789#sthash.Qqs6ORJA.dpuf

Age 8 weeks PSC Beech 1-2 drops, 3 times a day- for growth, and for genetic support with Ds especially. Also supports immunoglobulins. Fig 1 X 3 (1 drop- 3 times a day in pumped breast milk) White Birch Flower Male Catkins 1 X 3 Caraway (1:10) 1-3 drops a day- based on bowel- better for gas/ colic…bipolar/biphasic for constipation and diarrhea *Ash 1 X 3- to support AVSD and adrenals * Rosemary and Maize 1X3 ( I added these back because I want the rosemary for the cognitive and nervous system supports- supports myelin…added maize because it helps with heart tissue) Next up- dogwood and horsetail – to see if we can keep him of Lasix while buying time before the surgery to correct the heart defects. Note- I stopped Arresto Prevento after talking to the PSC guru- we both have found that AP is better for dealing with viruses after the onset of symptoms, versus preventatively. So we are saving it for when we need it- he is getting immune support also from other PSCs in the protocol. Supplements Nutrivene –D 1/8 tsp per day Vit D 500 IU 1 drop every other day Nordic Naturals Infant DHA ½ ml 1-2 times a day will need to increase dose when he hits 11 pounds, which will be soon! J doTERRA Equal parts DDR prime and Citrus Bliss with FCO (fractionated coconut oil) applied to bottom of feet 2 times daily. On Guard diffused during the day, Breathe at night sometimes adding Arbor Vitae D/C lemon and cardamom as I suspected he was getting a rash from it- even diluted. Will add back one at a time to see- my suspicion is lemon. Age 6 weeks- 7 weeks PSC *Beech 1-2 drops, 3 times a day- for growth, and for genetic support with Ds especially. Also supports immunoglobulins. Fig 1 X 3 (1 drop- 3 times a day in pumped breast milk) White Birch Flower Male Catkins 1 X 3 *Caraway (1:10) 1-3 drops a day- based on bowel- better for gas/ colic…bipolar/biphasic for constipation and diarrhea D/C Arresto Prevento, Crab Apple, Maize, and Rosemary Supplements Nutrivene –D 1/8 tsp per day Vit D 500 IU 1 drop every other day Nordic Naturals Infant DHA ½ ml 1-2 times a day doTERRA Equal parts DDR prime and Citrus Bliss with FCO (fractionated coconut oil) applied to bottom of feet 2 times daily. On Guard diffused during the day, Breathe at night sometimes adding Arbor Vitae D/C lemon and cardamom as I suspected he was getting a rash from it- even diluted. Will add back one at a time to see- my suspicion is lemon. Age 1- 6 weeks PSC Fig 1 X 3 (1 drop- 3 times a day in pumped breast milk) Arrresto Prevento 3 X 3 Hornbeam 1 drop 1-3 times depending on congestion White Birch Flower Male Catkins 1 X 3 Mazie 1 X 3 Rosemary 1 X 3 Crab Apple (1:10) 1 drop Supplements Nutrivene –D 1/8 tsp per day Vit D 500 IU 1 drop every other day Nordic Naturals Infant DHA ½ ml 1-2 times a day doTERRA Equal parts DDR prime and Citrus Bliss with FCO (fractionated coconut oil) applied to bottom of feet 2 times daily. On Guard diffused during the day, Breathe at night sometimes adding Arbor Vitae Lemon and Cardamom on torso for congestion and gas

Connor’s Initial Supplement Program- Age 1-6 weeks

This is a rough compilation of the protocol I started Connor on right after we got the Ds diagnosis. I will be continuing to post updates to his plan, and I will do separate posts about each type of therapy (PSCs, biomed, doTERRA oils, etc.)

My initial bio-med plan for Connor

These products are what have tested for Connor to start with.

PSC (www.epsce.com) plant stem cells or embryonic phytotherapy

These were the the first oral supplements we started with- as I have use them extensively for kids with ASD and for people with other chronic illness like CFS, Lyme, etc. They are very safe, gentle, and powerful.

Fig- we started with this to help increase his appetite while he was struggling with jaundice early on and not nursing much- resulting in dehydration. I am keeping him on it because it is a great one for gentle neurotransmitter support- and it is a main one to help with all gut issues- reflux, inflammation, low digestive enzyme production, food allergies etc. It is said that children with DS can have a lot of GI issues- I do not know what the direct correlation with the different expressions of the additional chromosome are in relation to this, or if it’s just that most of these kids are on the standard, crappy America diet- loaded with crap, GMOs and etc…but I am not taking any chances!

Arresto Prevento and Hornbeam- some of Connor’s initial blood work came back with some issue with white blood cells- a disorder called TMD- transient myeloproliferative disorder. Also, it seemed a few weeks old he got Danica’s cold…he was kind of snuffly. So I started him on hornbeam, as it helps greatly with congestion AND increase platelets (which were low at the time) and Arresto Prevento. Arresto Prevento has 3 embryonic plants in it- Black elder, Echinacea and Yarrow. These plants modulate and support immune function- and black elder is also loaded with antioxidants that support multiple organ systems of the body. People with DS are said to often have low immune function. The extra expression of the SOD from the additional chromosome causes increased oxidative stress, which in turn creates a lot of the symptom picture in DS. So Arresto Prevento works on multiple systems in the body in multiple ways.

White Birch Flower Male Catkins- Connor’s initial blood work came back with an elevated TSH- suggesting congenital hypothyroidism, as well as elevated T4. The medical approach was to wait a week and repeat labs. Many symptoms in DS are identical to hypothyroid symptoms- there is a lot of cross over. I couldn’t wait and see if he has congenital hypothyroidism- so I started WBFMC. Unlike medical treatment, when they thyroid is supported with drugs, WBFMC supports the entire endocrine and immune system…so adrenals, gonads, thyroid etc. were all being supported, The beauty of plant based medicine, especially PSCs, is that plants like WBFMC will support the thyroid if it is too high OR too low- so I felt safe giving it to Connor to help support his endocrine system immediately while we waited for more tests. I feel he became a lot more alert after starting the WBFMC. Yes, the jaundice was also starting to level out at the same time, so maybe I can’t give it all the credit, and I don’t care- I was just happy to see my boy’s eyes open!

A few days later I started him on Maize and Rosemary. I had spent a few days researching all the PSCs and their influence as antioxidants, which ones stimulate glutathione and catalase, without over stimulating SOD…and we had some more labs back at this time. I started rosemary for it’s benefits on the liver and the brain…and maize because honestly- it felt intuitively like I needed to. Maize is kind of the ‘multi mineral’ of PSCs, in oligoelemntal form….it is one of the plants highest in brassinosteroids, which have a huge effect in the body on immune and endocrine regulation.

A few days later- Connor seemed to me to have some constipation issues. Now, he wasn’t REALLY constipated- meaning, if I had run it by any medical person they would say he wasn’t- he was pooping daily, and they were wet/ seedy/ yellow like the good breastmilk poops should be- but they were these little multiple little squirts throughout the day, and he seemed a bit uncomfortable to me. So I muscle tested him and added crab apple. This is a PSC that was on my radar of ones to test him on soon anyway- as it has multiple actions in the body as an antioxidant, increasing glutathione and catalase…and is the ‘multi vitamin’ of the PSC world. It is also is great for teaching the bowel proper peristalsis. So I added it, and I feel like his stool elimination is much better and consistent now. I know everyone says that breast fed babies maybe don’t poop daily- but to be honest, that has never set right with me. Crabapple is also a PSC that helps with ammonia, which can be elevated in people with DS because of the over expression of CBS.

Other PSCs I will consider adding

Caraway- instead of crab apple- for it’s brassinosteroid properties, and it has a different effect on the gut…is better for gas and colicky like things.

Ginko biloba- for it’s effect on modulating GABA- as that pesky extra chromosome causes increase in GABA< resulting in delayed hippocampal function. Ginko in the regular herb form has been foind to be very helpful, in PSC form it SHOULD be phenomenal.

Once I get the next set of labs done- I’ll see where he is with his immune system. I am thinking of adding Betulinic Acid, or grapevine, if the TMD (transient myeloproliferative Disorder- a blood disorder found in people with Down syndrome) still needs to be tweaked.

Linden tree if he needs serotonin support and more nervous system detox.

Wheatgrass- catalase and glutatione, GABA antagonist, tryptophan support,

Silver Fir- good for pediatric growth condiditons


Nutrivene-D- as it is a multi and antioxidant formula formulated with DS needs in mind. Though I am not a fan that it is all USP grade stuff, it is methylated where it needs to be…and right now- Connor may need these things in these forms, versus food form. I do not want to start him on food form supplements now- maybe when he is older. Plus, he muscle tests huge for it…his body seems to really want it.

Klaire Labs infant probiotic- but only a few times a week- his body does not want it every day.

Nordic Natural Infant DHA- to help make sure he has a lot of DHA for membrane support. I am also considering FCLO (fermented cod liver oil) which I may do transdermally.

Vitamin D drops 400 IU- I drop daily.

Other supplements to look at soon (though several of these are in Nutrivene- D)

Choline, Phosphatidyl serine and choline

Glutathione (transdermal)

MucoMyst ( not a supplement, but a drug- nebulized N- Acetyl Cysteine)

Magnesium L- threonate

Minerals (selenium, zinc, copper, iodine…)

More methylation support (maybe Neurobiologix Immune stabilizer cream…)

L Carnitine, L methionine, L- tyrosine, taurine

Digestive Enzymes

Nutrivene Nighttime formula

Acetyl- l carnitine

Lithium orotate

L- carnosine

Alpha lipoic acid

5 HTP or tryptophan


Cannabis oil (no THC)

Bee venom?



Calcium AEP


doTERRA Oils (he is already on frankincense and wild orange…and we diffuse On Guard and Breathe) but I will have a whole protocol of oils.

Soon after Connor was born, we put Balance on his feet to help him integrate earth side, and Frankincense on his head, to anoint him.

We used myrrh on his navel to help it heal cleanly.

I started using geranium with him to help with the jaundice.

When it looked like he might be getting D’s cold at just 2 weeks old, we started diffusing Breathe, On Guard and Arbor Vitae, and I applied lemon and cardamom to his chest and back. I extended it down to his belly as well, as cardamom is good for the gut/bowel. He had a GIGANTIC poop a few hours after doing this. Citrus oils in general help to increase the body’s production of glutathione, so we will be using lots of those.

When we found out he had Ds, we started wild orange and frankincense on the bottom of the feet a few times daily, on the advice of Dr. Lawton.

I have now added DDR prime to his topical regimen, as it is loaded with antioxidant oils and is said to help cells remember what is ‘normal”. And I diffuse citrus oils and frankincense during the day.

As he gets older or tests for them, I may do more with Immortelle, Helichrysum, and the other neurological oils like Vetiver, cedarwood….

This is Connor’s protocol up to 6 weeks old. I plan to do more in depth blogs specifically about the Plant Stem Cells and a webinar on doTERRA oils and Down syndrome.



Fig 1 X 3 (1 drop- 3 times a day in pumped breast milk)

Arrresto Prevento 3 X 3

Hornbeam 1 drop 1-3 times depending on congestion

White Birch Flower Male Catkins 1 X 3

Mazie 1 X 3

Rosemary 1 X 3

Crab Apple (1:10) 1 drop


Nutrivene –D 1/8 tsp per day

Vit D 500 IU 1 drop every other day

Nordic Naturals Infant DHA ½ ml 1-2 times a day


Equal parts DDR prime and Citrus Bliss with FCO (fractionated coconut oil) applied to bottom of feet 2 times daily.

On Guard diffused during the day, Breathe at night sometimes adding Arbor Vitae