Humans have evolved from our ancestral hunter-gatherer roots into modern day life, with obvious benefits, such as longevity, medical advances and scientific knowledge. The nature of our environment has seen titanic shifts; the food we eat, the air we breathe, the water we drink, all present very different challenges for a system which evolved in a different era. The presence or absence of chemicals, desired or toxic, radiation of all different kinds, the panoply of modern stressors, all contribute to potential imbalances in our system.
In recent decades nutritional health has been emphasised, along with a variety of focussed campaigns. A survey noted that a majority of educated Americans knew their blood pressure and cholesterol levels, and physical health and fitness are universally seen as an essential part of preventative medicine, even when some are less diligent than others in practice. Brain health has a bit of catching up to do, particularly as we live longer, partly as a consequence of the pursuit of nutritional and cardiac health, and campaigns to limit tobacco and alcohol consumption.
The brain, or Central Nervous System (CNS), is the core of our being. The body is simply a mechanism to keep it safe and carry it around, allowing the necessary activities to ensure onward transmission of DNA. We (especially doctors) tend to create artificial distinctions within this holistic system; physical and medical, psychiatric and neurological, even health and disease. Beside the extraordinary range of normal physiological processes under CNS control, there is a constant war against potential disease, which is remarkably successful most of the time. Immunological defences are increasingly being elucidated, leading to new potential treatments, although there is a surprising lack of understanding of the placebo response. Something which is 'all in the mind' is often dismissed as not worthy of further scientific exploration, whereas, arguably, the ability of the brain to heal apparently physical illnesses is one of the most interesting and exciting areas for future research.
At BIONAD CLINIC we try to take a holistic overview, whether a presenting problem be, in conventional terms, neurological, immunological, psychological or simply a distorted response to stress. More difficult to quantify is the future absence of a problem. For example, someone who successfully gave up smoking a decade earlier might not realise that on a particular Saturday afternoon, it would have been the day that the first cancer cell appeared in their lung, leading to their premature death, had they not quit cigarettes.
Approximately one quarter of our energy intake is consumed by the CNS. Neurones have no 'down' time, even when we are asleep, so energy must be constantly provided. As well as oxygen and glucose (or ketones when in starvation mode), other vital ingredients are essential. Prominent among these are vitamins, particularly B vitamins. There are elaborate systems in place to ensure the right amount are in the right place at the right time, and equally complex, but very efficient, waste disposal mechanisms.
Perhaps the greatest miracle of evolution is homeostasis. This refers to the way in which balance is maintained under such a huge array of different circumstances, external and internal. Our body temperature stays at 37 degrees centigrade, whether at the equator or the North Pole (with the help of a few variations in clothing). Lying, sitting or standing, we maintain the same blood pressure, and the same amount of blood reaches the brain. Imagine how difficult this must be for a giraffe. There is of course a maximum capacity for homeostatic mechanisms, and many things can tip them out of balance in a way that may persist, reversibly or irreversibly.
Disease, wherever it manifests in the body, may be conceived as homeostatic disturbance. The thyroid gland, located in the neck and responsible for regulating the metabolic 'tick-over' speed of the body, is under homeostatic feedback control from the pituitary gland, beneath the brain, determining whether more or less hormone is produced. The story does not end there, because the pituitary gland is itself under the control of a part of the brain, the hypothalamus, which can make the pituitary produce more or less thyroid stimulating hormone, depending on the overall CNS assessment of what is required. Thus an end result of an overactive thyroid gland can have a range of different causes, depending on where the primary imbalance occurs. The consequences may present in all sorts of ways. Heart palpitations may point to a cardiologist, diarrhoea to a gastroenterologist, hand tremors to a neurologist, or panic attacks to a psychiatrist. And so on!
At BIONAD CLINIC we try to look holistically at the big picture, with an emphasis on brain health, alongside promoting maximally efficient cellular function, regardless of the subspecialised task of any particular cell. The last decade, with its remarkable technological advances, has seen an explosion of knowledge about what goes on inside cells, and how cells 'know' when to die. The function of mitochondria, tiny intracellular structures, 'a factory within a factory', whose DNA is maternal only, is better understood.
Vitamins, especially the B group, are essential for neuronal function. Vitamin B3, also known as Niacin, is one of these, converted in cells to NAD+ (Nicotinamide Adenine Dinucleotide), a chemical at the centre of the metabolic cycle of cells and mitochondria. In simple terms NAD+ helps convert food energy into cellular energy. Over time NAD+ levels within cells fall, and at some point this contributes to the programmed death of the cell. All sorts of things can accelerate this rate of decline. The nature of the food we eat, genetically modified, and with umpteen previously unknown chemicals added and subtracted, the intestinal flora, altered by antibiotics and other drugs, creating absorption difficulties, the innumerable stressors, chemical and physical, which were unknown to our ancestors, all of these factors can contribute to NAD+ decline.
It is worth looking at what happens in extreme Niacin deficiency. All vitamins have diseases linked to total deficiency. Scurvy results from total absence of Vitamin C in the diet. A few hundred years ago sailors on long voyages routinely developed scurvy, until the Royal Navy discovered that adding limes (a rich source of Vitamin C) to their diet prevented it, hence the American nickname for the British, Limeys. The deficiency disease for Niacin is Pellagra.
An epidemic of Pellagra occurred in the southern United States, at the beginning of the twentieth century among poorer people, when maize was introduced as a staple crop without protecting it from Niacin depletion (via a technique known to the Incas but forgotten by our civilisation). Patients suffered from Dermatitis (skin problems), Diarrhoea (not dissimilar since the inside of the gut is really also the outside of the body; while skin keeps everything out except sunlight, the gut has to let selected things through), Dementia and Death. Medical students learn this as the 4 D's, and then promptly forget about it for the rest of their practising life.
The Dementia of Pellagra is interesting, since studying the records of patients reveals a spectrum of symptoms mimicking neurological disorders, such as Alzheimer's disease and Parkinson's disease, as well as psychiatric disorders, such as Depression, Anxiety and Alcoholism. Blame for the artificial distinction between neurology and psychiatry can, at least in part, be laid at the feet of Sigmund Freud, giving rise to, as one observer put it, 'brainless psychiatrists' and 'mindless neurologists'. This devastating and potentially fatal array of symptoms can be prevented by a relatively small dose of Niacin.
Conventional medical orthodoxy believes that the amount of a vitamin required to prevent its deficiency disease is all that is needed. Anything more than this is wasteful, at best harmlessly excreted, at worse damaging. While the latter is true for a small number of vitamins, huge doses of Niacin appear to show no convincing evidence of harm. Indeed the opposite is the case; large doses lead to the identical improvements in cholesterol (more 'good' and less 'bad') as are produced by statin drugs, but without the approximately ten per cent incidence of significant side effects caused by the latter. This does not necessarily mean that Niacin has the same effect on cardiovascular mortality as statins, but large scale studies have not yet taken place.
Absence of disease does not necessarily mean presence of health. Telling an athlete that he is in tip top condition because he has no broken bones, has not had a heart attack, does not have lung cancer and has intact neuromuscular pathways, is probably not the best guarantee of winning a gold medal. There may be many situations in which giving more of a chemical the body is designed to process ('orthomolecular medicine') can benefit health above and beyond simply preventing the deficiency disease at the very extreme end of the spectrum.
At BIONAD CLINIC we like to offer people informed choice. We make no outlandish claims, but are aware that, via the Internet, everyone can now access knowledge previously confined to doctors and scientists. Separating 'good' from 'bad' science is difficult, even with a scientific background. High dose Niacin has been used for many decades, and, interestingly, was recommended by one of the founders of Alcoholics Anonymous as something all recovering alcoholics should take. There is no convincing evidence of harm (the Latin phrase 'Noli Nocere' or 'Do No harm' is a guiding principle for doctors) and tantalising suggestions of benefit. The derivative NAD+ is hard to synthesise and needs to be infused intravenously, so has not been used in the mainstream, but has for many decades been used in South Africa to assist with alcohol dependency and anxiety; more recently it has been similarly used in the United States.
Recent research suggests there may be many other possible benefits. Falling levels of NAD+ within cells do appear to have strong links to cellular ageing, but it would of course be quite wrong to extrapolate from this to a categorical statement that NAD+ infusions can prevent or reverse the ageing process of the whole organism. Nevertheless it is intriguing information. Most importantly, potential problems of gut absorption of Niacin are bypassed by NAD+ infusion, and, again, there appears to be no evidence of harm. Apart from trivial problems of inserting a cannula, occasional upper abdominal and lower thoracic discomfort appears to be the only side effect of note. Slowing the infusion rate instantly abolishes the symptom, which is of no longer term significance.
At BIONAD CLINIC we are excited about being able to offer people a treatment, while simultaneously expanding the world-wide data base of knowledge. We have taken advice from research scientists and are incorporating a variety of protocols into our programmes, in which we will invite people receiving treatment to participate. This may include a variety of questionnaires, blood saliva and hair testing, and intermittent long term follow-up. We cannot yet make unequivocal specific claims for the benefits of NAD+ infusions, but we invite people to read for themselves what is available on the Internet, and to be their own guinea pigs.