Targeted Nutritional Intervention 




This is a recent approach which has been developed for the treatment of Down's syndrome. It may be of interest to users of the ketogenic diet.

Targeted Nutritional Intervention (TNI) is a nutritional therapy for children with Down's syndrome, using vitamins, minerals, amino acids and digestive enzymes, together with piracetam, a nootropic (mind enhancing) drug. TNI is designed to alleviate certain harmful symptoms of Down's syndrome (eg, susceptibility to infections) and to ameliorate other harmful effects of the syndrome (eg, long term degeneration).

TNI was developed by Dixie Lawrence Tafoya, to treat her daughter Madison. It is based on earlier work by Dr Henry Turkel, who was a pioneer in treating Down's syndrome as a metabolic problem. Down's syndrome is a genetic disorder, being caused by an extra chromosome (number 21). One of the consequences of this extra chromosome is that some of the normal genes are duplicated, leading to specific metabolic abnormalities. TNI is formulated to compensate these abnormalities as far as possible.

Piracetam is adjunct to TNI, although it seems to be used in most cases. Piracetam is a smart drug, primarily used to treat Alzheimer's disease and, more recently in Europe, to treat Down's syndrome. Piracetam is thought to modify the cell membrane by increasing the proportion of unsaturated fatty acids, thus affecting signal transmission between neurons; it is also though to have an effect on acetylcholine reception. Various claims have been made for its intelligence enhancing powers.

The development of TNI is now supervised by a non profit organisation, Trisomy 21 Research. Nutrivene-D is the commercial formulation of TNI approved by Trisomy 21 and marketed by   International Nutrition  .

An alternative formulation, MSB plus is marketed by NutriChem. This is not the same balance of ingredients as Nutrivene-D, and is not approved by Trisomy 21.

Piracetam was developed by   UCB Pharma   in Belgium and is available under a variety of brand names:

Avigilen, Cerebroforte, Cerebrospan, Cetam, Dinagen, Encefalux, Encetrop, Euvifor, Gabacet, Genogris, Memo-Puren, Nootron, Nootrop, Nootropil, Nootropyl, Normabrain, Norzetam, Pirroxil, Psycoton, Stimucortex, UCB-6215.

Its availability varies between countries. In the US it is an orphan drug - it is not FDA approved, but can be obtained on prescription.

There are two mailing lists for TNI. To subscribe to the DS-nutrition list, contact   Tamara Ragan  . To subscribe to the DS-TNI list send the message:

SUBSCRIBE DS-TNI first name, last name

to   DS-TNI list  .

More information on TNI can be obtained from   Trisomy 21 Research   and from the   What's up with Down's   (link not working) web site. For links, try   Aunt Gini sources of TNI information  . More in depth medical information and references are provided by   Lawrence Leichtman  , and   David Swenson   discusses some of the genetic issues. Bulletin Boards for TNI and piracetam are maintained at   Cole's corner  (link not working).

The merits of piracetam are argued by   Ward Dean and John Morganthaler  . There is a paper by   Len Leshin   summarising research on piracetam. For more general information about smart drugs see the   Cognitive Enhancement Research Institute  .

A cautionary view on the whole subject of TNI and piracetam is given by professor   Louis Pino  (link not working).

The status of TNI is broadly similar to that of the ketogenic diet. It is not generally accepted by the medical profession, but some 10,000 children are receiving TNI treatment. As yet there have been no satisfactory medical trials of TNI (nor of piracetam).

Piracetam could have direct relevance to epilepsy and has been used to treat myoclonic spasms. The formulation of   Nutrivene-D   is not directly relevant to the ketogenic diet, although many of the ingredients may be useful supplements.

return to   Related medical conditions



(checked: 15 November 2002)
(update 2.1: 18 July 2002)
(issue 2: 5 February 1998)