NAD Therapy - Too Good To Be True

NAD Therapy! Too Good to be True?
Copyright Verwey, 1989 2009

Index
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5-9
10-26
27-32
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33-42
43-55
56-62
63-73
74-84
85-91
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92-94
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Index
Foreword by Dr Abram Hoffer
Introduction
Energy Requirements for The Journey of Life from the Womb to the Tomb
The Goal of NAD Therapy: Normal Energy Metabolic Processes for Optimal
Wellbeing
NAD Energy Deficiency(NED): The Focus of NAD Therapy
NAD Therapy: The Biochemical Basis
Biomarkers in NAD Therapy
Clinical Roots of NAD Therapy: Alkogen Treatment Centre
NAD Therapy Outcome: Renewed Life?
Applications for NAD Therapy: NAD Energy Deficiency Related Syndromes
(NEDRS)
Applied NAD Therapy: Diabetes as Case Study
NAD Therapy: The Nutriceutical Supplements
A Bird's Eye view of NAD Therapy
International Application of NAD Therapy
A Letter from the Father of NAD Deficiency Diseases
Closing Notes
Acknowledgements
Copyright and Reader's Responsibility
Bibliograpy
Foreword by Dr Abram Hoffer

I became interested in the pyridine nucleotide cycle, NADNADH in the early 1950's after
we had demonstrated that vitamin B3, one of the main precursors of this system tripled
the recovery rates of acute schizophrenic patients compared to a placebo. The pure
vitamins are the natural precursors in the body of the pyridine nucleotide cycle. Either
niacinamide or niacin yielded the same beneficial results. This conclusion was based
upon the first prospective double blind randomized controlled therapeutic trials in
psychiatry in world psychiatry, we completed between 1952 and 1960. But it was not
possible to obtain any NAD to be used in therapeutic trials until around 1960 when I was
given an NAD prepared in a medium designed to bypass the destructive processes in
the stomach. In order to become familiar with its potential therapeutic effect I began to
treat a small number of my patients at Royal University Hospital in Saskatoon. Some of
these were already responding to larger doses of vitamin B3 and some had not yet been
started on treatment. I gave them 1 gram capsules once daily. To my astonishment
and delight there were almost an immediate response and patients who would
ordinarily take 3 to 6 months to shows an adequate response to vitamin B3 were
responding on NAD in days and weeks.
One of the more chronic patients was a patient I had transferred to my ward from a
mental hospital where she had been treated for many years with no success. I did not
think she would respond but after 7 days or so she was very much better and after a few
weeks she was well enough to be discharged. The psychiatrist who had been treating
her in the mental hospital saw her under my care and he was also very surprised. It
appeared clear that NAD was doing something when properly prepared. But I could not
continue the studies because the company that was providing it discontinued their
studies. I then went through a most terrible period because my supplies of NAD
ran out and I had to deal with my patients who had done so well relapse back into
their original disease. My patient we had discharged into the community had to be
re-admitted, had to be returned to the mental hospital where she died several
years later. She had not responded to vitamin B3 but had to NAD.
A couple of half-hearted short term therapeutic trials were conducted in the United
States using a different preparation which could not bypass the stomach and using
chronic deteriorated patients of the type resident in mental hospitals in those days up to
30 years and more and these investigators saw no response. When I tried to use pure
NAD given as a powder, I saw no response. Dr. N Kline at Rockland State Hospital in
New York used our test, the HOD test for before and after evaluation I saw the scores
before and after and there was a response but he ignored the results of that test. After
that I was no longer able to obtain any NAD and continued with our vitamin B3 studies
which eventually became known as orthomolecular psychiatry and medicine.
This new work with NAD Therapy is very exciting and I think is right on target. It is
indeed an NAD Energy Deficiency (NED) because in the absence of this coenzyme
cycle almost all the reactions in the body run down. Energy is indeed essential not
only to drive our muscles but to digest our food, even to think and to feel. But we will
have to rid ourselves of the old vitamin-as-prevention concept which was so useful in
helping us isolate the synthesis of the vitamins. The old idea that each deficient vitamin
causes one deficiency disease is rapidly being buried in the dust bin of medical history.
If one looks at pellagra, for example, the symptoms are so wide ranging and pervasive
that it was a very difficult diagnosis to make until pure niacin became available. In the
Southern United States of America where pellagra was endemic the test was to give
their patients in their mental hospitals this new vitamin. If they recovered in a matter of
weeks, they were diagnosed as pellagra. If they did not, they remained schizophrenic. A
single metabolic error or deficiency can cause an amazing variety of conditions
depending on many factors for which we have no explanation.
Multiplicity of symptoms and large differential diagnosis does not mean that the condition
is not caused by a single deficiency and this has to be identified. The old paradigm is
being replaced by the new one the vitamin-as-treatment paradigm. NED is pervasive
around the world and will become much more prevalent.
I congratulate Theo Verwey and his colleagues for this remarkable advance in
using this concept and in using a simple test, the ratio of pyruvate to lactate as a
diagnostic measure, to indicate the dose, duration of treatment etc. I realize that he
has made a very complete review of the literature. For instance, not many know about
our 1960 studies with oral NAD.
When the clinical founded Energy Values based on the lactate and pyruvate blood tests
and the NAD Therapy protocols outlined in the E-book NAD Therapy! Too Good to be
True? are empirically confirmed there will be an enormous change in modern psychiatry.
It will mark the retirement of the present psychiatric paradigm which can be best
described as a system which uses' descriptive diagnostic terms which have no causal or
treatment relevance.
The new system will depend upon laboratory tests to determine where the error in the
metabolism of the body lies and will indicate which nutrients should be used to correct
that error. Psychiatry has always been forced to deal with and to treat diseases for which
there has been no known cause and for whom there has been no adequate treatment.
Thus, in 1900 the differential diagnoses of the major psychoses included dementia
praecox, scurvy, pellagra and tertiary syphilis of the brain. But as soon as the cause and
the correct treatment were discovered, these diseases were removed from the field of
psychiatry and taken over by general medicine. The finding that vitamin B3 cured
pellagra eradicated this disease in most high technical societies. The same for scurvy.
Penicillin removed the syphilis patients from psychiatric care. Dementia praecox
remained and was renamed schizophrenia. This has still remained the province of the
psychiatrists but with the work described in this book and so much other work shows that
schizophrenia will also be taken over by the rest of medicine. The newer work on the
important role on the essential fatty acids, omega three especially lead by Dr. David
Horrobin, the work we did over so many years with the megavitamin approach make this
prophecy a certainty.
Megavitamins are coming into their own. A recent report by DB Ames shows that the 50
genetic diseases that require megavitamin therapy comprise only a small proportion of
the total that will eventually be recognized and properly treated. Diagnosis will become
more secure not only to indicate the presence of absence of schizophrenia but to
indicate what the treatment ought to be.
The recent topical niacin test for schizophrenia developed by Dr. David Horrobin will
clear up the confusion between the psychoses and the other psychoses but in the end
the use of laboratory markers may remove the need for the clinical diagnosis. Thus we
found that the urine test for krytopyrole, further developed by Dr. CC Pfeiffer, selected
those patients with uniform biochemistry and improved response to treatment no matter
what they were called clinically.
Psychological diagnosis may become a pleasant diversion but will eventually be of little
interest in the same way that serologic test for syphilis is much more important than the
extensive clinical descriptions of this disease in vogue before these tests were
developed. I have given a lot of attention to the schizophrenias because I think this
condition presents us with a very good example of what will happen with all of the NED
conditions. And the NADNADH system, plays a major role in the genesis and in the
treatment of schizophrenia.
For these reasons I consider the information in the E-book: NAD Therapy! Too Good to
be True? so valuable and important and I fully expect to see the corroboration of this
work world wide once it becomes known to the medical profession and even more when
the general public of sick people and their families hear about it.
Dr Abram Hoffer
MD PhD FRCP)
Victoria, British Columbia
April 2002
Introduction
In 1994, approximately 3000 prescriptions for fluoxetine hydrochloride (Prozac) were
written for infants aged younger than one year, this alarming statistic was cited in an
article in the Journal of the American Medical Association, (Vol. 283 No. 8, February 23,
2000). Approximately 10 per cent of all babies are born with a maternally inherited NAD
Energy Deficiency (NED) which they themselves can not yet verbalized in
understandable terms to their caregivers. Some of these energy deficient babies will be
diagnosed as depressed and end up using antidepressants before their first birthday.
Fortunately for these babies there are two simple and non invasive blood tests that will
show us their metabolic energy levels. The costs of these two blood tests are only
R192.00, but it will save thousands of rands in treatment and unmeasurable pain,
despair and premature death. "Depressed newborns had higher umbilical lactate levels
than vigorous newborns irrespective of the method of delivery. Umbilical cord blood
levels of lactate, base deficit, and pH were measured in 452 liveborn infants. In vigorous
newborns, the mean umbilical arterial and venous concentrations of lactate were lowest
with elective cesarean section, higher with cesarean section performed during labor, and
highest with vaginal delivery."723
Some of these NAD energy deficient babies will grow up and run in to inexplicable
problems as adults, others will never reach the age of three years. "At that stage I... I felt
I was working under immense pressure. I was so tired and I had no energy. I had been
married for a few months, my second marriage, and I wasn't feeling too well at that
stage. I did have a few patients who had problems, or whom I noticed were always
coming back for their Pethidine injections. They were allegedly suffering from migraine,
but they clearly only came for the Pethidine. One day I just injected myself with one of
these vials"32. (Dr Jaques Botha, medical doctor in treatment as a Nutrimalaika patient
for his prescription drug abuse).
In Alkogen's therapy rooms, patients, of all walks of life and age groups, reveal that they
are even too exhausted to pray and feel that nothing will help. Some are even too tired
to express this or to accept the redeeming love of God. Others attempt in vain to make it
through another day by using self-medication in the form of prohibited or undesirable
chemical substances or unhealthy eating habits. Some indulge in socially inexplicable
behaviour in order to feel human for a brief while. The entire process is complicated
further because their beloved and significant others often do not understand their
weariness of life, or can no longer put up with it. We have often labelled many of them
with professional stereotypes, like depressive, alcoholic, eating disordered, hyperactive,
drug-dependent, delinquent, co-dependent, chronic fatigued and many others. Few of
those who provide support understand that these persons might simply lack the
metabolic energy to continue. Because there is no existing concept, we can refer to
them as the unfortunate persons who suffer from NED. As will become evident in the
later chapters, NED can be defined as the physical state that develops when the body
does not have enough coenzyme 1 (NAD) molecules and accompanying energy
metabolic cofactors to generate enough metabolic energy on cellular level to maintain
the body in a constant state of health.
"Nicotinamide adenine dinucleotide (NAD), is an energy "currency" of the cell, all

cellular life requires it and there is a concomitant pantheon of proteins that
interact with it".762
NED exerts a negative effect on man as a whole and therefore ought to be dealt within a
multiprofessional manner. This ebook therefore specifically aims to provide deeper
insight into the latest information on the body's biochemical functioning in respect of
metabolic energy. We often care for the body passively, by depending on medical
science to maintain it, by reframing our diseases on a psychological level or by praying
and hoping for miracle cures on a spiritual level. Scientific knowledge in the biochemical
field has also not yet been recorded in SELF-HELP diaries and reading material that are
easily accessible, as is the case with spiritual and psychological issues. This statement
merely points out that relevant and therapeutical information on the subject of
biochemistry is not readily available to the public. This ebook is an attempt to, in
particular, discuss the importance of NAD Therapy as a safe and natural generator of
cellular energy in the treatment of NED.
The goal in writing this ebook is to provide a clear and simple account of the key ideas of
NAD Therapy and its therapeutic application in NAD Energy Deficiency related
syndromes (NEDRS). Although we wanted NAD Therapy to be accessible to readers in
all of the related disciplines, we could not cover all of these perspectives in detail. NAD
Therapy simply starts with the normalising of the cellular energy metabolic production on
mitochondrial level, resulting in an energenetic person ready for appropriate medical or
psychiatric interventions, psychotherapy, pastoral counselling or any other applicable
form of therapy. We also chose not to produce a rigorous formal treatment approach.
We did not reach for the highest possible level of scientific integration of the various
seemingly unrelated concepts. We tried to choose a level of detail that points the
therapeutic inclined in the right directions without distracting from the simplicity and
potential generality of the underlying ideas.
We first came to focus on what can be referred to as NAD Therapy in late 1988. As you
may be aware, many of the chronic ailments that human beings suffer from, tend to take
root in an energy metabolic deficient cellular environment. For instance: "As the
biological techniques for measuring mitochondrial function have become increasingly
refined since the 70s, more than a hundred diseases have been identified as having a
mitochondrial basis. Although these overt mitochondrial diseases affect only a small
percentage of our population, we wonder to what degree subtle "subclinical"
mitochondrial impairment may be involved in more common complaints. Are overt
mitochondrial diseases just the "tip of the iceberg" of a much larger and as-yetunidentified metabolic deficiency? The vast majority (90%) of the energy needs of the
human body are met by mitochondrial oxidative phosphorylation. Oxidative
phosphorylation is a highly refined and efficient system for producing the prodigious
amounts of energy that are required to maintain the structure and function of the body,
and regulate body temperature in warm blooded animals. Oxidative phosphorylation
takes place entirely in mitochondria (tiny cellular organelles that closely resemble
bacteria in both size and structure)."82
When cells are exposed to a NAD deficient environment, their structure change or they
simply die and are disposed of by the body. "It is postulated that a decrease in
nicotinamide adenine dinucleotide (NAD) concentration has a primary association with
carcinogenesis. The following observations are presented as evidence:
1. NAD and adenosine triphosphate (ATP) concentrations are lower in cancer cells;
2. chemical carcinogens and radiation can cause a lowering of NAD concentration

in precancerous cells:
3. biosynthesis of NAD in Ehrlich ascites tumor cells is altered; and
4. NAD is involved in regulating deoxyribonucleic acid (DNA) synthesis.
The lowering of NAD concentration would lead to the expression of oncogene and/or
virogene according to the protovirus hypothesis, and the cellular characteristics of
cancer cells can also be explained through the lowering of cellular NAD."48
One of the most important aspects to note about NAD Therapy is the sheer breadth of its
application. It is useful and valuable for so many different symptoms and health issues.
A good way to understand NAD Therapy is to consider two of the examples and possible
applications that have guided its development. These two examples share features that
are so basic that they are easy to overlook.
"Because insulin was discovered in l922 and niacin in l937, no one realized the
importance of NAD deficiency in diabetes, even though a small group headed by Tom
Spies in l939 published their study of low NAD levels in diabetics. But a lapse of niacin
research during and after World War II gave the pharmaceutical companies a voice of
unquestioned authority over the new practicing clinicians who had no real experience
with niacin deficiency cases and had not lived through events of the Pellagra years in the
South, indeed did not recognize the symptoms of pellagra. I discuss this disease in my
recent publication on the NAD Deficiency Diseases, wherein I describe the subclinical
pellagras (Cleary 1986), and their response to the administration of niacin. The reason
antidiabetic agents work is that they mimic the action of NAD which is very low in
diabetes, causing a release of insulin from the beta cells, but they do not restore function
of the mitochondrial Krebs cycle as NAD does, they do not cure this problem.639"
"Vit B3 treatment took time - often months - before it produced benefits. It was most
effective with early schizophrenics - those treated within a year after onset. In cases of
longer duration, it sometimes helped when combined with other treatment (sic), including
electroshock. Then, late in 1965, Dr. Hoffer began to work with a new chemical, NAD, a
derivative of nicotinic acid. Produced as an experimental drug, it seemed to do
everything the vitamin did - but in days. Early in 1966, at a New York medical meeting,
after three months of trials with NAD, Dr. Hoffer made a preliminary report. Of 17
patients treated, 13 had shown dramatic improvement. A woman hospitalized for eight
years seemed almost completely recovered three days after NAD treatment began. It
seemed to Dr. Hoffer that NAD was the active form of nicotinic acid; that in normal
circumstances, the body converted nicotinic acid from food into NAD but that in the
schizophrenic the conversion couldn't take place, with the result that large amounts of
adrenaline were turned into adrenochrome. There will be further studies to clarify the
NAD question.640"
It is important to note the latest research findings regarding niacin and nicotinamide. It
appears that most of the therapeutical benefits ascribe to these compounds are actually
only possible by means of its conversion to NAD in the cells. For example:
"The beneficial effects of nicotinamide for the treatment of HIV infection appear to
be linked to cellular utilization of NAD. Nicotinamide appears to be void of any
cell-free reverse-transcriptase inhibition or virucidal activities. However, several
cell-associated observations link HIV, nicotinamide, and NAD. HIV-infected cells

demonstrate an increase in the ADP ribosylation of proteins, a phenomenon in
which NAD is used as the ADP-ribose donator to covalently modify proteins. As a
general feature, nicotinamide inhibits ADP ribosylation reactions. Protein ADP
ribosylation can occur in the nucleus, in the cytoplasm, and on the cell surface of
lymphocytes. PARP is a nuclear enzyme that catalyzes the formation of ADPribosepolymers that attach to multiple different proteins. The activity of PARP is
critical to the integration of foreign DNA, including proviral DNA; inhibition or
absence of this enzyme interrupts the HIV life cycle. Along with poly-ADP
ribosylation, monoribosylation steps also involve proteins in cells, including the
ADP ribosylation of both HIV Tat protein and cellular defence. The antimicrobial
action of nicotinamide might also work through the modulation of certain histone
deactylase reactions (i.e.,Sir2 proteins) that use NAD in the silencing of
chromosomal DNA".767
The role of NAD in the therapeutic functions of other medications also becomes
available with latest research: "We recently developed a class of novel antitumor agents
that elicit a potent growth-inhibitory response in many tumor cells cultured in vitro.
WK175, a member of this class, was chosen as a model compound that showed strong
in vitro efficacy. WK175 interferes with the intracellular steady-state level of NAD(+),
resulting in a decreased cellular NAD(+) concentration. We found that WK175 induces
apoptotic cell death without any DNA-damaging effect... These results imply that
decreased NAD(+) concentration initiates the apoptotic cascade, resulting in the
antitumor effect of WK175."772
The pioneering work of the world renowned Dr. Hoffer with NAD and its precursors, as
recorded in various books and articles, was the main cornerstone in the development of
NED and NAD Therapy. He is deservedly recognized as one of the five individuals who
pioneered the new medicine for the 21st century. "Once again, the synthesis of a new
idea that incorporated biochemical genetic individuality, nutritional modulation of gene
expression, and functional physiology resulted in a leap forward into the field of
biologically based psychiatry. These five individuals pioneered the new medicine for the
21st century. The recognition that our genes do not determine our disease, but instruct
us regarding the optimal environment for health represents a major shift in medical
thinking. The acceptance of this model within the medical paradigm is no longer in
question. It is just a question of how long it will take for this model to be fully integrated
within the standard practice of medicine. The contributions of Archibald Garrod, Linus
Pauling, Roger Williams, Hans Selye, and Abram Hoffer have created a force of change
that cannot be held back, because truth is its own vector".651
Many concepts, dealt with briefly in this ebook, are relatively new and those who require
more information should refer to this ebook's bibliography. For instance: "Fifty years ago,
in the early days of biology, so little was known about the cell that all of the proteins
outside of its nucleus were grouped into one big "cytoplasmic soup." Now, as the list of
known cellular ingredients continues to expand beyond the capacity of any recipe card,
two Rockefeller University scientists are taking a step back to ask whether there might
be a better way to organize the current thinking about a particularly important class of
proteins inherent to all living cells".793 The aim of this ebook is not to provide a
comprehensive review of each theme addressed, but only brief and introductory notes
and guidelines are provided to stimulate the reader's own research. This is unavoidable,
since the literature on NAD and other energy metabolic related concepts consist of
thousands of scientific articles, which one person cannot assimilate meaningfully, during
the course of a lifetime. Therefore only a selection is presented, to stimulate further
research.
Energy Requirements for The Journey of Life from the Womb to the Tomb
All of the billions of people, except a few who ever walked this earth, started life as a
single set of DNA in an egg fertilized by a sperm. The DNA in each cell does not weigh
more than one six-millionth of one-millionth of a gram. It is difficult to comprehend that
this little speck of DNA (kept intact by sufficient cellular NAD, also known as coenzyme
1) was capable of starting a process, which led to our fingernails and toenails, our
eyebrows and eyelashes and our range of functioning organs, including the hundred
billion cells in the brain.729 "Nicotinamide adenine dinucleotide (NAD), an energy
"currency" of the cell, all cellular life requires it and there is a concomitant pantheon of
proteins that interact with it".762
2.1 OUR BODY: THE HOST OF LIFE
Irrespective of whether one is old or young, male or female, black or white, holy or sinful,
prostitute or nun, pope or punk, all of us share this one common denominator of a
physical body, which is the host of human life. During our life, our bodies constitute us.
We need a body to be able to complete this earthly part of our life. None of our
achievements, ideas, failures and emotions would be possible without our bodies. We
travel through life, while we actually remain completely ignorant about how our bodies
function, thereby missing out on an entire dimension of our existence.
One of the most horrible evidence of this ignorance of the body and its functions is the
high incidence of many unwanted and teenage pregnancies. During 1999 in the USA
alone, 8 720 legal abortions were carried out on 14 year old girls; 88 420 in the age
group 15 to 17; 152 520 in the age group 18 to 19 and 422 550 in women aged 20 to 24
years old.724 A total of 672 210 lives were legally ended in the USA during 1999 by no
choice of their own. The abortion figure for the world during 1999 is 26 million legal
abortions and 20 million illegal abortions. This means that 126 027 new lives were
aborted every day during 1999.728
Every healthy baby that is fortunate enough to see the light of day represents three
kilograms of potential. Its little body is a collection of various chemicals, namely
approximately 10 per cent protein, 10 per cent fat, 1 per cent sugar and 75 per cent
water. Their composition is orchestrated by the 100 000 genes, which the baby inherited
by means of the 23 pairs of chromosomes from its parents.729 In order to build our
bodies, approximately 74 of the 114 chemical elements are grouped into certain
genetically-related chemical compounds. Chemical elements are the basic building
blocks, like oxygen, hydrogen, phosphate, carbon, nitrogen, gold, iron, zinc and iodine,
amongst others. We obtain these chemical elements from the food, air and water that we
take in. Experts estimate that an adult's body is composed of approximately R 23.00's
worth of chemical elements, mostly a few buckets of water. The final product, the living
body, is however priceless. These genetic instructions determined and organize our
entire physical life. And what a life it will be! For the 10% of babies who are born NAD
deficient, the major cause of NAD Energy Deficiency (NED), this life can be one long
nightmare. Some NED babies will not even make it to the age of two years.
Each healthy young one, who shows up in the developing world, can expect to live for
approximately 72 years if it is a boy and 78 years if it is a girl. This little bundle, which is
10
helpless and dependant at this stage and if we assume it is a girl, her body will transform
and convert itself many times during these three-quarters of a century and the resultant
will be dependent on the metabolic energy available. From when she is a baby and
changes into a young child, an adult and ultimately into the grey years and death, she
will needs lots of NAD energy to beat a continuous series of challenges and have to
adapt to them. Her body will need NAD energy and nutrients to grow, until it contains
ten-thousand billion cells, which will almost all undergo a constant cycle of death and
renewal.729 For each of these growing and renewal processes, from each individual cell
to the whole body, constantly needs sufficient ATP generated by NAD from food to
maintain quality of life. Babies with NED will have problems with NAD energy production
due to their genetic predisposition and will not live a healthy life. During her life she will:
Talk for up to ten years.

Breathed 41 million times and inhaled about 173 million litres of air.
Walk 22 000 kilometres.
Drive for one year in a car.
Sleep for 22 years.
Be paid for nine years of work after at least changing her career three times.
Talk for two-and-a-half years on the telephone.
Fall in love twice, have sex more than 3 000 times and kiss for two weeks.
Grow 28m fingernails, 950km of hair and 2m of hair in her nose.
Discard 19 kg of dead skin.
Spend five years eating and drinking.
Renew her skeleton 11 times.
Renew the inner lining of her stomach 32 448 times.
To successfully complete and enjoy all of the above, her body will have to
manufacture about 1140 tons of ATP using 950 tons of NAD to reach the
average age of 78 years.
Thanks to modern science, we are today able to look inside ourselves on cellular level,
in a way in which no previous generation could do it. For instance, the importance of the
mitochondria and its role in NED in families are more highlighted in research since the
70's. Genetic and chronic NED is transferred from the mother to her children and are
already present at the time of conception. The manifestation of NED will vary from each
of her children, for example the eldest can suffer from asthma (energy block = 47) since
age two; the second child, a brilliant doctor only developed Alzheimers disease (energy
block = 71) in his sixties and the third and last daughters NED showed up at age 30
because she could not have children of her own due to fertility problems (energy block =
62). All of this could be assessed just after birth by two simple blood tests (the
biochemical indicators of NED): the lactate and pyruvate tests and the lactate/pyruvate
ratio. NED can be successfully addressed by NAD therapy and the nutriceutical
supplements involved. NED can also be ignored, but this does not change anything to
the destruction, to which it leads. Genuine caring couples planning their new families will
already attend to their planned childs NAD energy needs even from before conception.
Even before they plan the kids room they will ensure a proper sperm, ovum and womb
for this precious new life.
The story of the human body is spelled out over millions of years and this story is also
retold and improved on by each of us during our life. We live our bodies, but
nevertheless we are not as intimately acquainted with it as we could be. This is, for all
11
living creatures, in a way the greatest story, which has ever been told. It starts with those
two cells - the largest one in the human body and one of the smallest, namely an ovum
and a spermatozoon, an egg and a sperm cell. The unborn child is a human being, just
as you and I are, from the moment of, or just following the moment of, conception when
the two cells unite. Regarding the constituting ovum and the sperm the resultant baby
will has no choice, but to accept its genetic code as the blueprint for his life.729 So much
then for choosing again.
2.2 CONCEPTION: THE START OF THE JOURNEY
For 38 weeks two individuals are linked to each other, while the one is developing inside
the other one. The amount of NAD energy (ATP, mainly generated from food particles
and NAD in the mitochondria of each cell) available to both the developing child and
mother will too a great extent determine the quality of life for each. The mother is
nevertheless, almost like the father, actually merely a bystander, irrespective of how
close the physical linkage between her and her unborn baby is. The child, to whom she
gives life, is not part of her, the way that a blossom is part of a plant's bole. It is a
separate human being, a stranger irrespective of how close the physical link is between
her and her unborn baby. The developing child is genetically as different from her as any
of his brothers and sisters are different from each other.729
THE OVUM: The ovum, the egg, stores all the necessary material to initiate the growth
of the embryo. It contains ribosomes, about 50,000 species of mRNA, tRNA, and
morphogenetic factors, yolk proteins and the cell nucleus. The ovum (oocyte) is viable
for only 48 hrs following ovulation, during which it moves along the ovarian tube where it
may be fertilized. During oocyte maturation, lactate and pyruvate are the sources of
energy.721 The egg had been formed before the woman's birth and waits twenty, thirty,
forty or more years before it is prepared and released for fertilization. The ovum contains
mitochondria each with its own set of DNA. This number of mitochondria is fixed per
ovum and is transferred to the embryo. "Levels of lactate, pyruvate, oxy- and
carbohaemoglobin were shown to change regularly during women's menstrual cycle
reflecting changes in metabolism in respect to forming and destroying of the ovum".690
THE SPERM: "Capacitation is a complex series of molecular events that occurs in
sperm after epididymal maturation and confers on sperm the ability to fertilize an egg. In
most cases, capacitation media contain energy substrates, such as pyruvate, lactate and
glucose, a cholesterol acceptor (usually serum albumin), NaHCO(3), Ca(2+), low K(+),
and physiological Na(+) concentrations".689 Out of perhaps 200-400 million sperm cells
which are poured out, there are only one-hundred survivors left in the race by the time
when they will have reached the egg. It after all requires thousands of rowing
movements with the tadpole tail, to move a sperm one centimetre forward. "Low
osmolarity, low lactate concentrations or the protein content may be responsible for the
loss of sperm motility".720
As soon as the first sperm and the egg cell meet each other, the outer membrane of the
two merge and chemical changes in the egg quickly prevent more sperms from entering
it. Only the sperm's head penetrates the egg cell and the tail and its mitochondria drops
off the sperms head and is lost. When the sperm cell is inside the egg, it releases a
chemical signal which activates the egg. The sperm's head is then drawn towards the
core of the egg and their genetic material merges. This is the moment of conception,
12
when the genetic composition of a new individual is created. The DNA from the father's
sperm combines with DNA from the mother's ova. If the fertilization (uniting of the two
cells) does not take place, both cells will die. The cells are from human beings, but are
not human beings. The embryo is already genetically male or female, and a completely
unique individual. Will he have his father's blue eyes and his mother's wide feet? The
blueprint for all of these inherited traits is established at this time. It is a unique human
being, for none like it ever existed before, and none quite like it will ever exist again. It is
a real person, just as real as you and I. Genetically; it is totally different from the body of
the father or the mother. Organically, it is independent, programmed from within, growing
in an orderly manner, moving toward further maturity.729
"It was known that immediately after an egg and sperm fuse, a wave of calcium ions
sweeps through the cell, triggering fertilisation. But scientists have spent the last decade
trying to discover what triggered this calcium release. Tony Lai, of the University of
Wales College of Medicine, tackled the problem by taking a candidate enzyme, PLCzeta, and injecting it into unfertilised eggs. He immediately saw the wave of calcium
sweep through the cell. The egg cell then began to divide and grow as if it had been
fertilised. "It's only when you get to the blastocyst stage that the embryo stops growing,"
says Lai "It's at this stage that you require the male genes to kick in. You need the full
genetic complement after this."776
The mother is completely unaware of all of these things which occur inside of her, but as
soon as this has taken place she is hosting her child. Or one should rather say that
another human being is creating himself, while he is using the mother like a parasite. A
human being's development can in no way be compared to, for example, the assembling
of a car. Although needing the protective environment of his mother's body, this living
being is completely independent in its functions from the very beginning of his or her life,
and at only ten days of age takes over complete physiologic control of certain functions
within the mother's body. One example of this is that the unborn child stops his or her
mother's menstrual periods.729
All of us were once an infant - that kept growing into an adult. The only difference is
nutrition and time. Nothing else has been added. You are a continuum person. You
began when the two cells united within your mother or in a test tube. Since then you
grew until you reached adulthood. You are now more developed than when you were in
your mother, but you were all there, back then.
The fertilized ovum begins growing by dividing into two cells. One of these cells will form
the embryo's body and internal organs. The other cell will form the external system that
the embryo will need to survive in the womb; the amniotic sac and chorion (the blood
vessels that will later make up the placenta). First the fertilized egg divides
approximately every 12 hours. It divides first into 2 cells, then 4, 8, 16, 32, 64 and so on.
As a result there is soon a huge quantity, more than a million cells, after only twenty
divisions. The dividing cells form three layers, much like a cake with a filling in the
centre. The outer layer will in time form the skin, as well as nails, hair, lenses of the eye,
salivary glands and all nervous tissue, including the brain. The central layer will create
muscles, bones, cartilage, veins and kidneys. The inner layer will produce the gullet,
stomach and intestines, as well as the liver, pancreas, bladder and the lining of each
lung. The heart also starts as a group of cells underneath the brain. How this instruction
is given exclusively to this group of cells is a mystery. It indeed remains a secret, the
13
same way that a large part of the development of the embryo still remains a mystery.729
From this it is more than clear that irrespective who you are, you simply started out as
two cells merging as one and multiplying into the billons of cells who you are today.
Ignore the maintenance of your cells and you will certainly pay a dear price on cellular
level.
"Since mitochondria were established to carry their own functional genome, a new
mechanism of genetic nonmendelian inheritance, maternal inheritance, was discovered.
All the mitochondria in the newly formed zygote are derived from the ovum (i.e.,
maternally derived). Mitochondrial DNA is more vulnerable to mutations in the oxidizing
environment of mitochondria; its repair mechanisms are poor compared to nuclear DNA.
Mutations in mitochondria accumulate in cells until a threshold is reached. Eventually,
the proportion of mutant mitochondria exceeds wild type, resulting in the manifestation of
impaired cell function."722 Since the 70s, more than a hundred diseases have been
identified as having a mitochondrial basis. .. The vast majority (90%) of the energy
needs of the human body are met by mitochondrial oxidative phosphorylation. Oxidative
phosphorylation takes place entirely in mitochondria (tiny cellular organelles that closely
resemble bacteria in both size and structure)."82 "Pyridine nucleotides (NAD, NADH,
NADP etc.) are mostly stored within mitochondria where they are involved in different
functions ranging from energy metabolism to cellular signalling".687
"Mitochondria play a central role in both programmed cell death (apoptosis) and the
morphological changes indicative of cell death caused by enzymatic degradation
(necrosis), through the opening of the mitochondrial permeability transition pore (MPTP).
Subsequent mitochondrial permeability transition pore closure allows ATP levels to be
maintained, ensuring that cell death remains apoptotic rather than necrotic. The cells of
most tissues have a finite lifetime with a few cells dying at any one time and being
replaced by new cells. Such cell death is known as programmed cell death (apoptosis)
and is strictly controlled. A particularly dramatic example of apoptosis is seen in tissue
remodelling during embryo development. Apoptosis also occurs following a moderate
insult, insufficient to kill the cell outright but enough to cause significant cell damage.
(e.g. A short period of hypoxia or exposure to low doses of a chemical toxin). In contrast,
if the initial damage to a cell is too severe, the precisely regulated process of apoptosis
is not possible and cell death occurs by necrosis .The cell and its organelles swell and
the plasma membrane ruptures with the loss of intracellular contents into the
surrounding medium. This attracts neutrophils which cause an inflammatory response
and secondary damage to the tissue. In many cancers it is an impairment of apoptosis
that leads to unrestrained cell proliferation and an insensitivity to chemotherapeutic
agents. Clinically it would be desirable to inhibit cell death in the former situations and
stimulate it in the latter. In recent years it has become apparent that mitochondria play a
critical role in the mechanism of both apoptotic and necrotic cell death, in addition to
their widely recognized function in the provision of ATP to sustain function".798
FIRST WEEK: Between 6 to 9 days the embryo implants in his or her mother's uterus.
"Implantation of the fertilized ovum into the endometrium is the most difficult process of
early pregnancy. Even among perfectly fertile couples, as many as one third of all
pregnancies are lost due to deficient implantation. Implantation and formation of
placenta is the major determinant of fetal growth and development".721, 734 "During
implantation, extravillous trophoblasts breech uterine vessels that are embedded in a
decidual cell matrix. Through this invasive process the embryo gains requisite access to
14
the maternal blood supply, while risking exposure to high circulating glucocorticoid
levels. Thus, the expression of 11 beta-HSD (whose catalytic activity is NADP(+)dependent, and NAD(+)-dependent) by the decidual cell layer may be essential in
regulating cortisol exposure of the developing embryo prior to placentation".741
2.3 LIFE IN THE WOMB: THE FIRST LEG OF THE JOURNEY
Life in the womb is generally depicted as being a time of peacefulness and serenity, but
the reality is a little different. "The body of the mother responds to pregnancy by a weight
gain (12 kg in the average). This increase appears in the second and third trimester of
the pregnancy. This increase involves the growth of the uterus from 50 g to 1000 g and
the growth of the fetus and fetal membranes. The breasts grow by 1 kg. About 1.5 kg of
extra body fat and increased volume of the extracellular fluid and blood contribute as
well. The volume of blood increases by about 30%. The basal metabolic rate increases
by about 15%. The cardiac output increases by about 30 - 40% above normal. Placental
circulation involves about 625 ml of blood per minute.719 All of this needs lots of NAD
energy for both her and her newly developing baby.
"Prostaglandins E2 and F2 alpha regulate a number of physiological functions in
reproductive tissues, and concentrations of these bioactive modulators increase during
pregnancy. Corresponding to the increase in circulating levels of prostaglandins during
pregnancy is an increase in enzymes that metabolize these agents. Three
prostaglandin-metabolizing enzymes induced during pregnancy are NAD(+)-dependent
15-hydroxyprostaglandin dehydrogenase (PGDH), NADPH-dependent carbonyl
reductase, and cytochrome P450-dependent prostaglandin omega- or 20hydroxylase."650
TWO WEEKS: The embryo's heart is beating. Throughout his or her development, the
embryo's body is fully functional, though the organs are still developing and incomplete.
The embryo has a separate brain divided in three segments; the forebrain, midbrain, and
hindbrain and spine. The placenta is forming. Limb buds, the beginnings of arms and
legs, are forming.734 "NAD is a very specific component, an essential component of your
body. If you do not have it, none of your systems functions and this includes your brain.
If you don't have NAD, you die; it's as simple as that."65 "NAD-dependent
methylenetetrahydrofolate dehydrogenase-methenyltetrahydrofolate cyclohydrolase
(NMDMC) catalyzes the interconversion of 5,10-methylenetetrahydrofolate and 10formyltetrahydrofolate in mitochondria of mammalian cells, but its metabolic role is not
yet clear. Its expression in embryonic tissues but not in most adult tissues as well as its
stringent transcriptional regulation led us to postulate that it may play a role in embryonic
development. To investigate the metabolic role of NMDMC, we used a knockout
approach to delete the nmdmc gene in mice. Heterozygous mice appear healthy, but
homozygous NMDMC knockout mice die in utero".766
FOUR WEEKS: Circulation to and from the placenta begins. The placenta is a very
special, amazing organ that connects the mothers circulatory system with the embryos.
The placenta filters oxygen out of the mothers blood into the baby's. It also gathers
nutrition for the embryo. And lastly, the placenta sifts waste out of the embryo's blood.
Soon the embryos own kidneys will begin to function, and share this work with the
placenta. The embryo has hands with ridges that will grow into fingers, and twosegmented arms. The embryo has feet, thighs, and calves. Internal organs are growing.
15
The tongue, oesophagus and stomach are well developed, as are the kidneys. The
embryo's liver, gall bladder, and pancreas have been developing for several days. Lungs
begin to develop. The thyroid and other glands are forming. The embryo's face and
sensory organs are forming. He or she has eyes, including a retina that already has
colour, as well as ears, a nose, and mouth. Reproductive organs are beginning to
form.734, 735
FIVE WEEKS: The brain divides into more specialized segments. The telencephalon is
the primitive cerebrum, the 'thinking' part of the brain and is responsible for sensory
perception, memory, learning, and conscious thought. The diencephalon develops into
the thalamus and the hypothalamus, the 'feeling' part of the brain serving as a relay
station between the senses and the brain. The hypothalamus produces basic drives and
emotions such as hunger, thirst, pleasure, and fear. The cerebellum, medulla, and pons
are responsible for unconscious physical processes like blood circulation or breathing,
as well as reflexes, muscle coordination and movement. The embryo has a palate,
completely with tiny tooth buds. His or her face is nearly finished forming and looks
reasonably human, though lacking the muscles needed for facial expressions like
smiling or frowning. The embryo begins to move.734
SIX WEEKS: The embryo looks like a baby in miniature, though his or her head is still
very large compared to the rest of the body, because the brain is growing so quickly. "Lmyo-inositol-1-phosphate synthase (EC 5.5.1.4) from mammalian fetal and adult brain
differ considerably with respect to their stability towards different temperatures between
25-65 degrees C. This property has been found to be associated with the presence of
the synthase co-factor, NAD, bound to the enzyme protein. The lower thermal stability of
the fetal enzyme increases in presence of added NAD (0.8 mM) whereas the higher
thermal stability of the adult brain enzyme declines when NAD is specifically removed
from the enzyme".795 The embryo has distinct fingers. All the embryo's organs and organ
systems have been developed, though they are still immature and need time to finish
growing. Several organ systems, including the circulatory system (heart) and nervous
system (brain) are already functioning. The embryo has distinct toes.734, 736
EIGHT WEEKS: The unborn baby is now called a 'fetus', because he or she has finished
with the process of creating and only growing and developing of his whole body is left.
Eyelids begin to form.734, 736 "As long as fetal oxygen reserves are not depleted, fetal
metabolic functions will continue aerobically, even though fetal hypoxemia is present. As
O2 reserves are exhausted in some tissues, fetal hypoxemia will be associated with
tissue hypoxia, the net result of which will be anaerobic metabolism, lactic acidosis, and
tissue death. Whether a fetus is adequately oxygenated or not is a function of the
quantity of oxygen reserve available. A fetus with a substantial oxygen reserve can
compensate fully for most interference in its oxygen supply and can maintain oxidative
metabolism under a variety of conditions. In contrast, a fetus with minimal oxygen
reserves will not tolerate even the mildest degree of O2 deficiency without developing
tissue hypoxia or even death in utero."724
9 TO 10 WEEKS: The fetus touches his or her own face and sucks his or her thumb,
and makes breathing and swallowing motions. The sense of smell begins to develop.
The fetus urinates and experiences hiccups. He or she is moving almost constantly, and
can step, kick, somersault, stretch, and move his or her arms. At the end of the ninth
week, the critical developmental phase will have passed. The rest of the pregnancy is
16
characterized by a rapid increase in size and further growth and differentiation between
organs and tissues.735, 736
11 TO 13 WEEKS: At about twelve weeks it will already have turned into a little acrobat,
who rolls from the back to the front, while it tumbles through the fluid and waves with its
little arms and legs as if it wants to explore its environment. Even the facial muscles are
exercised with little frowns and movements of the lips. The fetus's bone marrow begins
to produce white blood cells. The fetus's external reproductive organs are visibly male or
female. The inner parts of the ear are formed, and the fetus may be able to hear. The
bones become hard, like in adults bones, whereas they had previously been soft. "We
propose a role of extracellular NAD(+) in bone homeostatic control".771 The sense of
taste develops.734, 736
14 WEEKS: Fetuses display individual personality. The fetus can experience pleasure
and happiness or displeasure and fear. Fetuses at this age are also startled, and their
heart rates increased, by loud unpleasant noises. The mother, may first feel her baby
kicking. He or she is finally strong.736
15 TO 16 WEEKS: The fetus's nerves are being coated with a fatty substance called
myelin. Myelin makes faster nerve transmissions possible and insulates the nerves so
that impulses can be sent over longer distances. The fetus has fingerprints.
19 WEEKS: This is the youngest that any baby has been born and survived. Babies
born this young may have problems with infections, since their immune systems are still
immature, and may have trouble breathing. In mothers "the second half of the normal
pregnancy was characterized by an increase in activity of hexokinase, in content of 2,3DPG, ADP, by a distinct decrease in ATP, NAD and the ratio ATP/ADP".739
24 WEEKS: This is the age at which the laws in most consider a baby "viable", or able to
survive outside the womb.
30 WEEKS: "At thirty weeks of gestation, there are 6 million ova in the ovary of the
female fetus; at birth, there are one million of them; 300,000 to 400,000 are present at
the onset of puberty, but only 400 follicles develop sufficiently to expel the ovum. After
menopause, there are no follicles present."721
38 WEEKS: This is the age at which a baby should, ideally, be born. At 38 weeks the
baby's lungs are fully functional and his or her immune system is ready for the outside
world.
Its phenomenal rise over a period of nine months, from a bunch of little cells to a welldeveloped baby, is over. There is more growth in the first part of life than in the last part
of it. The human body has completed 90% of his or her growth at the time of birth. Only
10% occurs between birth and adulthood. None after that. The fetal brain gives the birth
signal. Also, it is believed that the fetal brain activates the synthesis of estrogens, which
increase uterine contractility.721 It is ready to commence on the first significant and
dangerous journey, which it will ever undertake. The second journey will only be
dangerous for some of us, although the departure is caused by death.
17
2.4 BIRTH: CROSSING THE FIRST BRIDGE

All of us have already undertaken it, fortunately only once. It was the time, when you
decided that the time had arrived to exchange the snug watery world of your mother's
womb for the greater world outside of it. You had to get out of there, but your greatest
obstacle was the size of your head. The tension was enormous and overwhelming.
Eventually everything was over and you slipped out. You gasped for breath. Your lungs
expanded. Suddenly they were filled with air. You screamed, probably. Someone cut
your umbilical cord, which had been your life line. The noise was terrible.729
You had just completed the most significant journey of your life. You were born and were
merely one of the nine human beings born every second of the day. A baby's first breath
requires a huge amount of strength, to overcome the surface tension, which had kept the
lungs closed when they had been filled with fluid. The lungs contain chemicals, to relieve
the surface tension and to prevent the lungs from collapsing, when the first breath is
exhaled. These chemicals are produced deep into the pregnancy and this creates
problems for babies, who are born prematurely. Undeveloped lungs are often the critical
factor, which limits very premature babies' chance of survival.729
"Sudden Infant Death Syndrome (SIDS) has been also linked to exposure to ambient
carbon monoxide... Fetal hypoxia caused by exposure to carbon monoxide could be a
factor contributing to SIDS deaths." 769 "Blood glucose, pyruvate and lactate were
examined during hospitalization of 13 cases of acute carbon monoxide poisoning
developing from short (less than or equal to 1.5 h) or long (10-14 h) exposure. CO
intoxication resulted in increased blood levels of all carbohydrate metabolites studied.
Increased levels of pyruvate and lactate were much more pronounced and lasted for a
longer time following long, compared with short, CO exposure despite similar blood
COHb level (about 40% at the beginning of hospitalization). The results showed
difference in biochemical effect of short and long single exposure to CO that could not
be detected by the measurement of COHb".296 "Infant patients with "cerebral lactic
acidosis" show neurological symptoms, elevated levels of lactate in CSF, little or no
systemic acidosis and levels of lactate in blood so slightly elevated that they would be
overlooked. Lactate elevation confined to CSF and brain has been described in
biotinidase deficiency and in some mitochondriopathies."727
"There is a need for metabolic screening facilities in developing countries. A battery of
four simple tests namely arterial blood gases, blood ammonia, urinary ketones and blood
lactate in tertiary health care centers is advocated".727 "The purpose of the study was
differential diagnosis of lactic acidosis in 44 children aged from 2 weeks to 4 years. In all
of them the lactate level in repeated determinations exceeded 27 mg/100 ml. From the
point of view of clinical manifestations the children were divided into three groups: 26
with hepatomegaly and hypoglycaemia (I), 6 with ataxia and retardation of somatic
development (II), 12 with mental retardation and muscular hypotonia (III).714 "We have
therefore determined fetal and maternal lactate concentrations and acid-base status
under various conditions in 589 women at the end of gestation and during labor. The
results show that metabolic acidosis develops in all fetuses because of increased
production of lactic acidosis is primarily of fetal origin."721 "Umbilical cord blood levels of
lactate, base deficit, and pH were measured in 452 liveborn infants. In vigorous
newborns, the mean umbilical arterial and venous concentrations of lactate were lowest
18
with elective cesarean section, higher with cesarean section performed during labor, and
highest with vaginal delivery. This suggests a rise in the fetal lactate level in response to
labor. Depressed newborns had higher umbilical lactate levels than vigorous newborns
irrespective of the method of delivery"723 Global surveys conservatively estimate the
occurrence of inherited metabolic disorders in the range of three to four per thousand
live born infants. Macrocephaly and microcephaly are common. Approximately 5% of
children are either macro- or microcephalic.
Another danger, which the newly born must beat, is control of temperature. Foetuses in
the womb do not have such concerns, because they can enjoy their mothers' warmth.
After birth babies are however seldom capable to even do something simple, like
shivering, which is important for adults to produce warmth. There are however brown
deposits of fat around the baby's neck, shoulders, breastbone and spine. When he gets
cold, his little body starts to burn the fat in an unique metabolic process, which releases
a lot of heat and metabolic energy.729
Then there is the baby's appetite. It is enormous in proportion to its body weight. During
the earliest days it can eat 3 per cent of its weight, but it increases rapidly to more than
10 per cent. Around the tenth day, the baby will already, with a lot a slurping and
sucking, have consumed the same amount of milk as its body weight. Around this time it
will gain approximately twenty grams in weight every day, or about one gram for every
twenty grams which it consumes. If an adult consumed similar percentage of his body
weight, he would have to process seven or more kilograms per day.729 Your baby eats
so much because he needs lots of NAD energy to sleep and grow. "You no sooner fall
into a deep sleep when you're awakened by the only member of your family who seems
to be getting enough rest: your baby! If you're feeling a bit frazzled and exhausted by
your baby's erratic sleep patterns, you're not alone. According to Dr Richard Ferber,
author of Solve Your Child's Sleep Problems, newborn babies typically sleep about
sixteen or seventeen hours per day, but rarely for more than a few hours at a time".757
Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age: "There
were a total of 23,173 injuries; 636 resulted in death. The overall annual rate for children
aged 0 to 3 years was 371/100,000. Children aged 15 to 17 months had the highest
overall injury rate before age 15 years. For children 0 to 12 months of age, there was a
different leading cause of specific injury for each 3-month period: other falls from height
(0-2 months), battering (3-5 months), falls from furniture (6-8 months), and non airway
foreign body (9-11 months). Hot liquid and vapour injuries were the leading specific
causes for children 12 to 17 months. Poisoning by medication was the leading specific
cause of injury for all age groups from 18 to 35 months and exceeded poisoning by other
substances. Pedestrian injury was the leading specific cause of injury for all age groups
from 36 to 47 months. Fall from furniture has the highest rates of specific causes of falls
from age 3 to 47 months."743 Even worse than this is: the so-called medically
unexplained chronic fatigue in childhood which may cause considerable disability and is
substantially familial.740 Chronic fatigue amongst schoolchildren must be differentiated
from psychosomatic disorders and absenteeism119. The average energy block of children
and adults suffering from chronic fatigue is 74.
"Most children develop a clear-cut sense of whether they are boys or girls at a young
age. This sense of being "a boy" or "a girl" is called gender identity, a term that came
into the medical literature in the 1950s. For most children this develops somewhere
19
between 18 and 30 months of age. After gender identity is formed, gender stability
develops. Gender identity is not the same as gender, which is commonly used to mean
the biologic identity. For most people, gender identity matches with biologic gender, but
there is condition called gender identity disorder (GID) in which biologic gender is not the
same as the gender identity of the person. This is a rare disorder but one that lead to a
lot of heartache and turmoil for both the affected child and his parents."759 Adolescents
and adults with gender identity problems have an average energy block of 66.
Learning a language is a survival mechanism for the baby and in this regard the child
has a phenomenal capacity to acquire language during its first six years. Thereafter it
will never be easy again, to learn how to speak a language; schoolchildren will attest to
this. Research indicates, that people who learn a language when they are older use
another part of the brain, than when the baby does it for the first time.729
At the same time when a language is being acquired, social skills are developed. At the
most basic level the child must become aware that he is an individual, who differs from
all other people and things. As all parents know and realize to an ever-increasing extent
over the years, a child's growing up consists of much more than learning skills, the ability
to stand straight, learning words, drawing circles, becoming stronger and more clever. It
consists of developing a unique person, someone who realizes that he is an individual.
There is however a small hurdle, which must be traversed. Puberty and the
accompanying period of adolescence are the rockiest part, which remains on the road to
adulthood.729
2.5 PUBERTY: OUR BIOLOGICAL DESTINATION
We often suffer from the misconception that we are in one way or the other in control of
our bodies. It is however, the least true with regard to the physical aspect, our biological
composition which controls us. This is seldom as obvious as during the tempestuous
years of puberty. "Although more than 82% of the 104 pregnant teens (age between 13
and 18) were aware of where to get birth control, they demonstrated no deep
understanding of the menstrual cycle and its relationship to intercourse and only 11%
used effective contraception. Of the birth control non-users 74% of the girls reported
they did not want to get pregnant. In spite of unprotected coitus, most girls were
surprised at conception."752
Puberty is not only a time of confusion for adolescents, but also a time which continues
to confuse scientists. The exact causes and the reason why it happens at that stage of
life remain a mystery.729 We know that the nervous system and hormones are involved,
but social and psychological factors and nutrition also play a part. The changes in these
years during which maturing occurs are normally spread over four years and can quite
normally start at any time between the age of eight and thirteen years in girls and nine
and fourteen years in boys.729
In a normal group of children there can therefore be pubertal children, who range in age
from eight to eighteen. This means that some underwent all of their pubertal changes
before others of the same age have even started with it. This leads to great unhappiness
amongst those, who feel that they matured prematurely, too late, or simply because they
are different from their friends. Since girls start changing approximately eighteen months
20
before boys, girls can be bigger, stronger and physically more advanced than their male
classmates. This can also lead to emotional tension.729
Like most processes in the body, the commencement of puberty is brought about by the
brain. The hypothalamus, a small structure with the size of a grape's pit in the center of
the brain, starts to secrete large quantities of hormones. They, in turn, stimulate the
pituitary gland, which is also located in the brain, to produce two hormones, which are
known as LH and FSH. First they are released during the night, in regular deliveries,
while the child is sleeping. As puberty progresses, more of it is secreted, until the adult
pattern has been reached, which will prevail throughout life.729
LH and FSH are identical in boys and girls and in men and women. The effect of it on
the targeted tissues is different however. In boys LH binds with specific groups of cells
and this stimulates them, to increase their production of testosterone. It is interesting that
production of testosterone also depends on the hormone prolactin, which is better known
for its stimulation of milk secretion in women. This very male hormone is the key to
sexual maturing. It increases the size of the genitals, develops the structures which
produce sperms, stimulates the growth of hair in the face, on the chest and in the pubic
region, increases muscle mass and bone density, lets the larynx or voice box expand
and arouses the sexual drive.729
In girls and women the hypophysis secretes its hormones in a monthly pattern. FSH,
which is the abbreviation of follicle-stimulating hormone, lets egg follicles ripen in the
ovary. It stimulates the ovaries to produce estrogen, which is the key to puberty in girls,
even before ovulation begins. Estrogen causes the depositing of fat on the breasts,
buttocks and thighs. It has a special effect on the pelvic bones; it flattens and widens the
legs.729
Estrogen receptors in the skin make the skin soft and smooth, while the male skin in
contrast responds to testosterone by becoming thicker and stronger. LH controls the
levels of the other female hormone, progesterone, which plays a determining role in the
menstrual cycle.729
If there is not enough NAD for these processes it can cause a lot of problems for the
incumbants. NAD deficiency can lead to insufficient NAD for the production of the male
hormone, i.e. testosterone, and the female luteinisation hormone. It could, in the case of
men, be the explanation for the feminisation syndrome (loss of beard, enlarged breasts
and low sex-drive) and the masculinisation syndrome in women (menstrual problems,
increased beard-growth and deeper voice)125.
This is puberty. It is not the same as adolescence, although it forms part thereof.
Adolescent characteristics, like increase in size, weight, strength and intelligence, are
merely proportional changes. When puberty commences, our children who are perfectly
adapted up to a point, are nevertheless not capable of carrying out the instruction to be
fertile and multiply.729
By the time when puberty has been completed, we shall already have traversed the last
hill and we shall be looking at the peak of the mountain, for which all of the previous
physical developments in us prepared us. We shall still have to learn a lot, but
biologically we have already reached our destination. Physically, mentally and socially
21
we can occupy our position as independent members of the human race. And, if we
choose so now, we can transfer the genes, which formed us, to the next generation.729
In a study about defloration "82.3% report "love" as their main motive, 12.5% report to
have done it "out of curiosity" and only in 7.2% it happened "by chance". Only 36.4%
were prepared psychologically for the act of defloration. In 42% the coitus occurred at
parties and 43.7% in the evenings.753 Overall, 91% of the 2933 sexually active female
respondents indicated that their first intercourse was voluntary. 76% of women 13 years
or younger at first intercourse, compared with 90% of those 19-24 years old,
characterized their first intercourse as voluntary.754 The truth is not embedded in this
statistics regarding our postpubertal body which belong to us, but who easily renders its
biochemical control to our opposite sex partner. So rather dont play house before you
married and ready for parenthood.
2.6 ADULTHOOD: OUR PSYCHOLOGICAL DESTINATION?
As a species, we performed extremely well. Homo sapiens is not particularly strong, nor
particularly fast, agile or well-adapted to the cold or heat. The billions of human beings
on this planet however occupy a larger part of the earth's land area than any other
species. Our 1.4 kg of nerve tissue, the intellectual seat of our species, is obviously by
far the most difficult part of our body to comprehend. We do not know why it is so large
and how it happens, that it is so clever. In one way or the other its billions of cells and its
millions of connections are operating in such a way that we not only call ourselves homo
sapiens, which means wise man, but some indeed earn this special name.
It is mankind's grey matter energized by NAD, in conjunction with an agile hand and the
ability to talk, which in any case require a good brain, which made this form of life the
most comfort-oriented, most widely distributed, most intelligent, most extroverted, most
creative and potentially the most devastating earthly species, which has ever existed.729
Derivatives of niacin, mainly in the form of NAD and NADP coenzymes, are found
abundantly in brain tissue. In the case of niacin deficiency, the brain's supply of NAD
declines sharply and the functioning of the brain is disturbed; malfunctioning of the brain
(dementia) is indeed one of the primary characteristics of pellagra. If the NAD deficiency
lasts for an extended period, permanent brain damage develops144.
Our brain is probably the host of our spirit and definitely the seat of our soul. "A team of
neuroscientists from the University of California at San Diego said the most intriguing
explanation is that the seizure causes an over stimulation of the nerves in a part of the
brain dubbed the "God module". "There may be dedicated neural machinery in the
temporal lobes concerned with religion. This may have evolved to impose order and
stability on society," the team reported at a conference last week. The results indicate
that whether a person believes in a religion or even in God may depend on how
enhanced is this part of the brain's electrical circuitry, the scientists said. If the research
is correct and a "God module" exists, then it might suggest that individuals who are
atheists could have a differently configured neural circuit. A spokesman for Richard
Harries, the Bishop of Oxford, said whether there is a "God module" is a question for
scientists, not theologians. "It would not be surprising if God had created us with a
physical facility for belief," he said."726 Nobody have to be a slave of his/her NAD
deficient body/brain or of its physical drives. By using the available knowledge you can
22
manage your body and taking care of it, then your body becomes your wonderful host
and friend.
During adulthood most people marry and start a new generation. We teach our children
to wait for this time in life so that they can choose their spouse with wisdom and love.
Reality shows that our body do the choosing in most cases, it is called assortative
mating. The finding in this study of an increased prevalence of psychiatric disorder in the
first-degree relatives of the ill spouses would support the hypothesis of assortative
mating, that there is a tendency for individuals with a predisposition to psychiatric illness
to marry, rather than the existence of a marital interaction which causes an increased
concordance for psychiatric illness.755 "Our results indicate that assortative mating is
common among parents of extremely obese children and adolescents... We interpret our
results as being consistent with the hypothesis that an increased rate of assortative
mating has contributed to the recent rise in obesity rates in several countries."756
Marriage partners choose each other through assortative mating, due to similar NAD
energy levels. Someone, who is addicted to religion (energy block = 62) and with a
mission in life to save her husbands soul, will therefore for example marry an alcoholic
(energy block = 66), someone who needs NAD energy more than so-called love. All of
this is not visible on the external level at the time of marriage, but this will only become
apparent after several years of marriage. So much then for let your heart speak in
choosing the mother of your children. NED can be ignored, but it does not change
anything to the destruction, to which it definitely leads.
Due to their ignorance of their bodies and the possible role of NED some so-called
adults have just enough energy to conceive a child and enjoy the act, but do not have
enough energy to provide a safe, healthy and loving environment for the child to develop
and grow up. Various excuses will be provided for not taking care of their young ones.
"Throughout the world, an unknown number of children, most likely in the millions, are
kept in orphanages and other non-penal institutions. Many of these children are kept in
grossly substandard facilities and provided with inhumane care; many are left to die.
Ironically, those responsible for nurturing and providing for the children they take into
their care often physically and sexually abuse the children, and subject them to other
cruel and degrading treatment. Even in institutions that are clean and provide adequate
food, staff often neglect children, leaving them to lie alone in cribs or small beds with no
stimulation, play, or adult attention." Even worse than this is the many children whose
NED are ignored by their parents in the best of households.
2.7 AGING: THE LAST LEG OF THE JOURNEY
Each one of us, who lives today, is the product of successful reproduction. Our parents
succeeded in reproducing us, their parents were successful in reproducing them and in
this way one can trace the story of success back to the beginning.729
While we are moving through the early stages of life, our bodies change and develop to
deal with the challenges of each new age. What happens then? Sooner or later each
one of us realizes that we aged. The road gradually goes downhill, after we have
reached the peak of physical performance. We become less competent in virtually every
aspect, particularly during the last leg of our journey.729
23
Our physical appearance changes. We shall probably become shorter, more crooked,
stiffer, grey, more bald, more wrinkled, have a drier, thinner and discoloured skin, with a
double chin or a pointy chin, a different voice, bad hearing, poor eyesight, varicose
veins, ineffective memory, larger earlobes and a broader, longer nose. Science has not
yet presented a universally acceptable theory about ageing, but with our ever-increasing
knowledge about molecular biology it is not surprising that research is concentrated on
the internal functioning of cells. It can help to answer one of the most difficult questions
about ageing.729 Nutritional deficiencies are prevalent in the elderly, particularly among
the frail, institutionalized, or impoverished. Muscle dysfunction is linked to inadequate
intake of energy and protein, providing evidence for defects in morphology, physiology,
and function.
We know that most tissues in the body are constantly coming and going. New
differentiated cells can be produced during adult life in either of two ways: they can form
by the simple duplication of existing differentiated cells, which divide to give pairs of
daughter cells of the same type; or they can be generated from relatively undifferentiated
stem cells. Rates of renewal vary from one tissue to another. The lining of the intestine is
replaced every three days, red blood cells are replaced every 120 days, the skin is
constantly discarding dead cells while new ones are being pushed to the surface, even
your skeleton will replace all of its cells every seven years. There are few things in our
body, which are older than ten years.729 Even in a slowly renewing tissue, a small but
persistent imbalance between the rate of cell production and the rate of cell death will
lead to disaster. If 2% of the hepatocytes in a human divided each week but only 1%
died, the liver would grow to exceed the weight of the rest of the body within 8 years.
Homeostatic mechanisms must operate to adjust the rate of cell proliferation and/or the
rate of cell death in order to keep the organ at its standard size. Menopause in Females:
At the age of 40 or 50 years or later, the menstrual cycles usually become irregular and
ovulation fails to appear (anovulatory cycles). The reason for it is the disappearance of
the ova from the ovaries. All were either released or degenerate. When the cycles
cease, menopause takes place. The loss of estrogen then causes: thinning of the
vaginal epithelium; decreased vaginal secretion; decreased breast mass; hot flushes,
night sweats and vaginal dryness; often heart disease; osteoporosis, decreased bone
mass; psychic sensation of dyspnea; aging skin; irritability; fatigue; anxiety; mental
deterioration and some loss of memory and sometimes psychotic states.719
Why do we therefore not always look and function, as if we are very young? Why do our
earthly bodies not live forever? Each cell contains the body's complete genetical code in
the DNA, which is stored in its core, and these DNA controls the cell's actions and
reactions. In chemical terms, DNA is a huge, extremely complex molecule. The DNA
must nevertheless create a perfect copy of itself, every time when the cell splits.
Problems arise, when this does not happen.729 One of the main reasons for DNA failure
is NAD deficiency. NAD plays a major role in repairing DNA44, 156, 196.
Damage due to free radicals and accumulating faults in the DNA are however not the
complete story of ageing. A mighty factor is simple the lack of NAD energy to lessen the
wear, due to continual affrontations, which bombard our bodies externally as well as
internally. Polluting substances, toxins, natural radiation, viruses, bacteria and the
ultraviolet light from the sun are attacking us all from the external environment, while our
cells must fight internally against dangerous waste products and the hormonal
consequences of physical and psychological tension.729
24
Since the body is such a complex and intimately integrated entity, degeneration in one
system also makes its consequences felt elsewhere. The ear degenerates. Balance
degenerates in its wake. Since vision also deteriorated, the chances of accidents are
much greater. Bones break more easily when the person falls and bedriddenness have
more permanent consequences on the muscular system, balance and strength of bones.
What starts as subtle changes leads over the years to weakness and brittleness in
adults, who once upon a time were healthy, reduced ability of most physiological
systems and an ever increasing vulnerability to diseases and death?729
2.8 DEATH: OUR SPIRITUAL DESTINATION?
Death does not come suddenly, but gets the better of us while we are becoming ever
more susceptible to it. After forty the rate of death doubles with every eight years with
which the age advances, until all of us are ultimately caught by it. All of us know that that
is our fate, but why is it like that?. Even if one becomes one-hundred years of age, you
merely lived 5 214 weeks. Throughout the world hundreds of people die each second.
Death is not a rare event, but it is the only event where NAD energy plays virtually no
role. We nevertheless live from day to day and devote too little attention to the departure
from earthly life, which awaits all of us.729 This departure takes place, when the spirit
leaves the body and soul, until they are re-united again in the hereafter. Put briefly, one
can say that the body's billions of cells are held together by the spirit and the body
returns to dust, after the spirit has departed from it.
We consider death to be an accident, which affects people here and there, but not as an
omnipotent conqueror. By leading a healthy life, we enhance our quality of life. It
however does not ensure longevity as is abundantly claimed by the owners of various
nutritional supplements. Until recently, most people died at home. The family, often
including the children, gathered around the deathbed, watched the death and discussed
issues. In today's developed world, most people die in hospitals and in other
institutions.729
Nowadays we do not see much of this finality and unfortunately many lost the religious
anchors, on which previous generations could depend on so well. More than ever before
death is still the great unknown entity to many people. If death comes suddenly, a
completely healthy body can within moments become transformed to a state in which it
cannot continue to live. Most deaths however come slowly, with a gradual collapse of the
bodily systems.729
The last gasps of breath when death finally arrives are often accompanied by a rasping
sound, which is referred to as the death rattle. It is caused by spasms in the muscles of
the vocal cords. Immediately before death there is often a brief period, which is referred
to as the agonal phase (derived from the Greek word agon, which means struggle). The
muscles might, because of acid in the blood, start to jerk spasmodically and sometimes
there is a brief jerking or swelling in the chest or shoulders.729
The battle against death is scary to people who witness it, but the dying person is
usually too ill to be aware of it. As soon as death occurs, the eyeballs expand when the
muscles which control the iris give up control for the last time. Sometimes the eye sheds
a last tear, which is referred to as the lacrima mortis.729
25
Decomposition can be observed after approximately 48 hours in a moderate climate, or

sooner if it is warm. It manifests itself initially as a green discoloration on the abdomen,
which darkens to purple and then black. The early stages of decomposition are caused
by digestive enzymes in the intestine. The body literally starts to digest itself from inside.
Intestinal bacteria rapidly take control and the physical body is destroyed.729
Our bodies are built from atoms, which have already existed since the beginning of the
universe. It is a fundamental law of physics that matter cannot be made or destroyed.
The same atoms, which formed our planet, are absorbed in food, air and water to form
our bodies for a short period and when we die, they are returned so that they are
absorbed elsewhere. They are taken up in the food chain as nutrients for plants and
small animals, which live in soil.
26
The Goal of NAD Therapy: Normal Energy Metabolic Processes for Optimal
Wellbeing
A lot of myths exist about energy for living and about what it actually is. By dissecting
everything into its smaller components one will eventually end up with nothing. This is
the wonder of life, that only God could have created everything from nothing. The NAD
energy required by our bodies is not mysterious vibration but is applicable chemical
compounds changing from one form to another, and during the change, NAD energy is
released that can be used for all human activities. Just as a motor car cannot run on
potatoes, our bodies cannot function on the vibrations of music or whatever. The nett
result is: if the required chemical compounds are not present no appropriate NAD energy
can be released for utilisation by our bodies' cells, irrespective of other vibrations or
resonances that could still be available. Prof Hans Krebs received the Nobel prize for
medicine and physiology in 1953 for describing the cell's energy metabolic cycle and all
the chemical compounds involved.
No behaviour is possible without the body, during the earthly part of one's life. All human
activity (irrespective of whether it occurs on purpose, instinctively, knowingly or
unknowingly), except dying, requires NAD energy to take place, to be suppressed,
maintained or controlled. If the body has enough NAD energy in a usable form at its
disposal, it can perform activities like eating, laughing, mourning, obedience, sleeping,
praying, deciding, learning, playing, contemplation, conversion, attending church,
concentration, cellular replacement, breathing, digestion, dreaming, sport, working, sex,
temperature regulation and millions of other functions. The greater the amount of usable
NAD energy and available quantity thereof, the higher the quality of life and functioning.
The brain, for example, uses ten times more NAD energy than any other organ and has
a very limited supply of NAD energy, which has to be replenished continuously. The
bodies of NED sufferers do not on their own produce enough NAD energy, to be able to
perform all of these activities and this makes their bodies unstable.
"Energy metabolism is defined as the sum of complex and integrated chemical reactions
by which the body derives energy from the environment and maintains the proper
functioning of all biologic processes. The final common pathway for all these processes
is the complete oxidation of carbohydrates and fats and partial oxidation of proteins to
carbon dioxide and water. These processes occur primarily in the mitochondria and are
coupled to the biochemical reactions of the tricarboxylic acid cycle (better known as the
Krebs cycle)".547
"At the cellular level, energy is used to make new proteins, to bring nutrients into a cell
and expel cellular wastes, to repair damaged DNA, to synthesize neurotransmitters, etc.
At the organ level, the heart uses energy to pump blood, the kidneys use energy to filter
wastes while recycling precious nutrients, the brain uses energy to conduct electrical
nerve impulses, the lungs use energy to take in oxygen and expel carbon dioxide and so
on. At the level of the whole person, we use energy to walk, run, talk, chop wood, lift
objects, work a computer keyboard, ad infinitum. The energy source for all these levels
is the same - it is the bio-energy molecule ATP (adenosine triphosphate) the "universal
energy currency of the cell"567.
27
Energy cannot be created or destroyed, it can only be converted from one form into
another. This rule also applies to the generation of energy in the human body. The
energy, that is stored in food, must be released or produced in the body, by means of
particular chemical reactions referred to as metabolism. Dietary carbohydrate from which
humans gain energy enters the body in complex forms. The major source of dietary
carbohydrate for humans is starch from consumed plant material. This is supplemented
with a small amount of glycogen from animal tissue, disaccharides such as sucrose from
products containing refined sugar and lactose in milk544.
3.1 FROM FOOD TO METABOLIC ENERGY
"Food is of no use to our body until we have allowed the cells of our body to convert the
food energy (organic energy) into chemical energy through respiration. Cell respiration is
when organic material (the food we eat) is converted into chemical energy within the
cells to provide the energy we use to perform our everyday activities. Chemical energy is
stored within the bonds between carbon and hydrogen. Every time a bond is broken
energy is released due to the exothermic reaction that takes place, that is, energy is
given to the body. Glucose is a good energy store because of the six carbon-hydrogen
bonds. However, the main source of energy is one that is produced within our body. It is
the universal energy carrier, ATP, formally known as adenosine triphosphate"546.
Digestion is a complex process. The cells that line the digestive tract secrete into the
lumen of the gut a variety of substances, such as hydrochloric acid and digestive
enzymes, to break down food molecules into simpler nutrients. The cells absorb these
nutrients from the gut lumen, process them, and then release them into the blood for
utilization by other cells of the body. All of these activities are adjusted according to the
composition of the food consumed and the levels of metabolites in the circulation.
The first step in the metabolism of digestible carbohydrate is the conversion of the higher
polymers to simpler, soluble forms that can be transported across the intestinal wall and
delivered to the tissues. The breakdown of sugars begins in the mouth. Saliva is slightly
acidic and contains lingual amylase that begins the digestion of carbohydrates. Once the
food has arrived in the stomach, acid hydrolysis contributes to its degradation; specific
gastric proteases and lipases aid this process for proteins and fats, respectively. The
mixture of gastric secretions, saliva, and food, known collectively as chyme, moves to
the small intestine. The resultant glucose and other simple carbohydrates are
transported across the intestinal wall to the hepatic portal vein and then to parenchymal
liver cells and other tissues. There they are converted to fatty acids, amino acids, and
glycogen, or else oxidized by the various catabolic pathways of cells544. Most of these
pathways are in the mitochondria, whose outer membrane forms an aqueous channel
through which proteins up to 10,000 daltons can pass and go into the intermembrane
space.742 The average person's body contains enough glycogen to provide energy for 612 hours. In contrast to this, it contains enough fat to provide energy for up to 40 days149.
An adult man produces enough heat every day during the metabolism of energy, to boil
almost 40l of water209.
Energy is also required to enable these digestive and metabolic processes. Between 5%
and 10% of the energy that is available in the body is required for metabolising food.
Various factors play a role in the generation, storage and utilisation of energy, and
28
include the body's surface-area, age, gender, thyroid hormones, dopamine, serotonin,
adrenaline, body temperature and women's menstrual cycle143.
3.2 MAJOR PATHWAYS OF ENERGY METABOLISM
Glucose is oxidised by all tissues to synthesise ATP. The first pathway which begins the
complete oxidation of glucose is called glycolysis. The normal pathways are briefly
described320, 545:
3.2.1 Glycolysis
Glycolysis (the breakdown of glucose to pyruvate and lactate, occurs in the cell
cytoplasm): Glucose + 2 ATP + 4 ADP + 2 NAD -> 2 Pyruvate + 2 ADP + 4 ATP + 2
NADH + energy. Oxidation of glucose is known as glycolysis. Glucose is oxidized to
either lactate or pyruvate. Under aerobic conditions, the dominant product in most
tissues is pyruvate and the pathway is known as aerobic glycolysis. When oxygen is
depleted, as for instance during prolonged vigorous exercise, the dominant glycolytic
product in many tissues is lactate and the process is known as anaerobic glycolysis.
"These studies demonstrate that orderly glycolysis in the erythrocyte is regulated by the
NAD-to-NADH ratio and also provide a method that makes possible the in vitro study of
erythrocyte glycolysis."235
The conversion of pyruvate to lactate, under anaerobic conditions, provides the cell with
a mechanism for the oxidation of NADH (produced during the G3PDH reaction) to NAD
which occurs during the LDH catalyzed reaction. This reduction is required since NAD is
a necessary substrate for G3PDH, without which glycolysis will cease. Normally, during
aerobic glycolysis the electrons of cytoplasmic NADH are transferred to mitochondrial
carriers of the oxidative phosphorylation pathway generating a continuous pool of
cytoplasmic NAD.546, 733
3.2.2 Gluconeogenesis
Gluconeogenesis is the biosynthesis of new glucose, (i.e. not glucose from glycogen).
The production of glucose from other metabolites is necessary for use as a fuel source
by the brain, testes, erythrocytes and kidney medulla since glucose is the sole energy
source for these organs. Under fasting conditions, gluconeogenesis supplies almost all
of the body's glucose to the brain as energy from ketone bodies which are converted to
acetyl-CoA. Synthesis of glucose from three and four carbon precursors is essentially a
reversal of glycolysis. The three reactions of glycolysis that proceed with a large
negative free energy change are bypassed during gluconeogenesis by using different
enzymes. Lactate is a predominate source of carbon atoms for glucose synthesis by
gluconeogenesis.730, 733
3.2.3 The Pyruvate Dehydrogenase Complex
The pyruvate dehydrogenase complex (which oxidizes pyruvate to enter the citric acid
cycle, operates only under aerobic conditions): Pyruvate + NAD + Coenzyme A -> CO2
+ acetyl-CoA + NADH + energy. Cofactors required for pyruvate dehydrogenase include
five different coenzymes namely: thiamine pyrophosphate (TPP) from thiamin; flavine
29
adenine dinucleotide (FAD) from riboflavin; Coenzyme-A (CoA), from pantothenate;

nicotinamide adenine dinucleotide (NAD), from vitamin niacin and alpha-lipoic acid.544
3.2.4 The Citric Acid Cycle (Krebs Cycle)
The citric acid cycle (which completes the oxidation of carbohydrates and other
substrates to carbon dioxide, occurs in mitochondria of cells): Acetyl-CoA + 3 NAD +
FAD + ADP -> 2 CO2 + Coenzyme A + 3 NADH + FADH2 + ATP. Regulation of the TCA
cycle, like that of glycolysis, occurs at both the level of entry of substrates into the cycle
as well as at the key reactions of the cycle. Fuel enters the TCA cycle primarily as
acetyl-CoA. The generation of acetyl-CoA from carbohydrates is, therefore, a major
control point of the cycle. This is the reaction catalyzed by the PDH complex. The PDH
complex is inhibited by acetyl-CoA and NADH and activated by non-acetylated CoA
(CoASH) and NAD. Since three reactions of the TCA cycle as well as PDH utilize NAD
as cofactor it is not difficult to understand why the cellular ratio of NAD/NADH has a
major impact on the flux of carbon through the TCA cycle.737
3.2.5 Electron Transport and Oxidative Phosphorylation
Mitochondrial oxidative phosphorylation in vivo is dependent on the degree of reduction
of the intramitochondrial reducing power ([NADH]/[NAD], cytoplasmic energy state
([ATP]/[ADP][Pi]) and intracellular oxygen pressure. Electron transport and oxidative
phosphorylation (occurs in membranes of mitochondria in cells only under aerobic
conditions). Nutritional implications and chemical structures are NAD and FAD. While
the large quantity of NADH resulting from TCA cycle activity can be used for reductive
biosynthesis, the reducing potential of mitochondrial NADH is most often used to supply
the energy for ATP synthesis via oxidative phosphorylation. Oxidation of NADH with
phosphorylation of ADP to form ATP are processes supported by the mitochondrial
electron transport assembly and ATP synthase, which are integral protein complexes of
the inner mitochondrial membrane. Oxidative phosphorylation traps this energy as the
high-energy phosphate of ATP. In order for oxidative phosphorylation to proceed, two
principal conditions must be met. First, the inner mitochondrial membrane must be
physically intact so that protons can only re-enter the mitochondrion by a process
coupled to ATP synthesis. Second, a high concentration of protons must be developed
on the outside of the inner membrane.731, 742 "A prolonged decrease in ATP levels
underlies a number of neurodegenerative disorders. Defects in oxidative phosphorylation
are associated with a number of neurodegenerative disorders."748
"The precise relationship between mitochondrial DNA mutations, impairment of oxidative
phosphorylation and clinical phenotypes is not well understood. The prevailing view is
that defects in ATP generating capacity due to mitochondrial DNA defect leads to energy
failure, cellular dysfunction and eventually cell death in the affected tissues."765
3.2.6 The Pentose Phosphate Pathway
The pentose phosphate pathway (an alternate pathway for glucose oxidation). The
pentose phosphate pathway is primarily an anabolic pathway to generate reducing
equivalents, in the form of NADPH, for reductive biosynthesis reactions within cells, to
provide the cell with ribose-5-phosphate (R5P) for the synthesis of the nucleotides and
nucleic acids and to metabolize dietary pentose sugars derived from the digestion of
30
nucleic acids as well as to rearrange the carbon skeletons of dietary carbohydrates into
glycolytic/gluconeogenic intermediates.738
3.2.7 Beta-Oxidation of Fatty Acids
Beta-oxidation of fatty acids (occurs in mitochondria of cells, only under aerobic
conditions): Chemical structures and nutritional implications are coenzyme A (CoA), from
pantothenic acid; flavin adenine dinucleotide (FAD), from riboflavin (vitamin B2) and
nicotinamide adenine dinucleotide (NAD), from niacin. Fatty acid oxidation is reduced as
this process requires NAD as a cofactor. Glycogenolysis is the breakdown of glycogen to
glucose.732
3.3 ENERGY FACTORIES: THE MITOCHONDRIA
The mitochondria are essentially the body's power plants. All mitochondria are inherited
from our mothers via the ovum, with virtually no mitochondria coming from our fathers,
because the sperm head that penetrates the ovum in fertilization does not contain any
mitochondria548, 549. If a number of the mitochondria in the ovum are defective, problems
may arise as they divide and the infant is formed. If the defective mitochondria are in the
muscles, the muscles may be weak due to poor energy production. This is true for all the
body's organs including the brain549. Depending on where a metabolic block is in an
inborn error of metabolism, we can try to provide energy from foodstuff that does not
need that particular defective metabolic pathway550. "Pyridine nucleotides (NAD etc) are
mostly stored within mitochondria where they are involved in different functions ranging
from energy metabolism to cellular signalling. Here we discuss the mechanisms of
mitochondrial NAD(+) metabolism and release that may contribute to the crucial roles
played by these organelles as triggers or amplifiers of physiological and pathological
events".687
The mitochondria are small structures which are present in all cells. The quantity of
mitochondria varies amongst the different types of cells. Liver cells, for example, contain
many more mitochondria than sperm cells129. The energy that is generated, is
apportioned for use in cellular activity, for storage as chemical compounds that are rich
in energy (like ATP and NAD derivatives), and the remainder is released as heat39. The
primary "objective" of the energy metabolism is the manufacturing of ATP (about 50kg
per day in the average human being) thereby providing the power for all cellular
activities370.
Ninety per cent of the body's energy is provided by the mitochondria's process of
oxidative phosphorilisation. It is an extremely effective system for providing sufficient
energy, to maintain the body's structure and functioning, and for regulating the body's
temperature. The process consists of two metabolic processes that are closely linked to
each other, i.e. the citric-acid cycle and the electron-transfer chain. In complex I of the
electron-transfer chain, NAD to NADH is involved; in the citric-acid cycle three NAD to
NADH compounds are involved82. The citric-acid cycle cannot function without the
availability of NAD and NADP. Slight deviations in the activity of the mitochondria can
lead to weakness, fatigue and cognitive problems51, 68.
Mitochondria have a crucial role both in energy production and the viability of the cell
and recently mitochondria have been implicated in programmed cell death (apoptosis).
31
Although much smaller than the nuclear genome, MtDNA is equally important. MtDNA
defects and the resulting mitochondrial dysfunction are important contributors to human
degenerative diseases, ageing and cancer356. Mitochondria play a pivotal role in cellular
metabolism and in energy production in particular. Defects in structure or function of
mitochondria, mainly involving the oxidative phosphorylation, mitochondrial biogenesis
and other metabolic pathways, have been shown to be associated with a wide spectrum
of clinical phenotypes. The ubiquitous nature of mitochondria and their unique genetic
features contribute to the clinical, biochemical and genetic heterogeneity of
mitochondrial diseases357, 361.
The Krebs or citric acid cycle is the final common pathway of food components, and is
also the source of basic structural or anabolic molecules that feed and support organ
maintenance and neurological function. This fundamental pathway of energy flow is
critical for all organ systems. Conversions of the Krebs cycle intermediates are under the
control of enzymes that often require vitamin-derived cofactors and minerals for their
function. Mild inborn errors of energy metabolism which may be compatible with survival
at least into young adulthood, but not with normal development of mental and
neurological functions, have been associated with the abnormal spilling of the Krebs
cycle's intermediates532.
3.4 ENERGY SYSTEMS USED DURING EXERCISE
The Cori cycle operates during exercise, when aerobic metabolism in muscle cannot
keep up with energy needs. Glucose synthesized in liver and transported to muscle and
blood. A highly exercising muscle generates a lot of NADH from glycolysis but without
oxygen there is no way to regenerate NAD from the NADH (need NAD!). Lactic acidosis
can and would result from insufficient oxygen (an increase in lactic acid and decrease in
blood pH). So, the NADH is reoxidized by reduction of pyruvate to lactate by enzyme
lactate dehydrogenase. Results in replenishment of NAD for glycolysis. Then the lactate
formed in skeletal muscles during exercise is transported to the liver where it is used for
gluconeogenesis. Lactate is transported through the bloodstream to the liver. Lactate is
oxidized to pyruvate in the liver. Liver lactate dehydrogenase reconverts lactate to
pyruvate since has high NAD/NADH ratio. Pyruvate is used to remake glucose by
gluconeogenesis. Glucose is transported back to the muscles via the bloodstream.733
3.4.1 LESS THAN 10 SECONDS
The immediate energy system provides energy rapidly but for only a short period of time.
It is used to fuel activities that last for about 10 or fewer seconds. For example weight
lifting and picking up a bag of groceries. Components include existing cellular ATP
stores and creatine phosphate (CP).733
3.4.2 10 SECONDS TO 2 MINUTES
The nonoxidative (anaerobic) energy system used at the start of an exercise session
and for high intensity activities lasting for about 10 seconds to 2 minutes. Examples, 400
meter run or to dash up several flights of stairs. Creates ATP by breaking down glucose
and glycogen. Does not require oxygen. Two key limiting factors (1) body's supply of
glucose and glycogen is limited (2) nonoxidative system results in the production of lactic
acid.733
32
3.4.3 LONGER THAN 2 MINUTES

The oxidative (aerobic) energy system requires oxygen to generate ATP. The aerobic
production of energy does not produce any toxic waste products and so is the preferred
system for prolonged exercise. Used during physical activity that lasts longer than 2
minutes (e.g. distance running, hiking ATP production takes place in cellular structures
called mitochondria. Can use carbohydrates (glucose and glycogen) or fats to produces
ATP. The actual fuel source depends on: intensity and duration of the activity as well as
the fitness status of the individual.733
3.4.4 LONGER THAN 70-92 MINUTES
In general, carbohydrate use increases with increasing intensity and falls with increasing
duration of an activity. Fats are used for lower intensity exercise. Glycogen stores are
finite, and inevitably become depleted during long continuous exercise lasting in excess
of 70-92 minutes (the more intensive the exercise, the quicker the glycogen is depleted).
This applies not only to endurance events, such as marathon running but also to
intermittent exercise sports such as soccer and rugby. When glycogen stores have been
used up, the muscles attempt to cover their energy needs from fat metabolism.
Unfortunately, because fat cannot supply energy at as rapid a rate as carbohydrate, the
competitor is forced to slow down or reduce his/her rate of work to the level at which
energy expenditure and energy synthesis are matched. This situation is made worse by
the fact that when glycogen stores in the muscles are used up, blood glucose
(hypoglycemia) reduces the supply of glucose to the brain, contributing to the feeling of
exhaustion and causing a decrease in technique and the ability to make correct
decisions.733
3.4.5 RECOVERY AFTER EXHAUSTIVE EXERCISE
Choice of diet has a dramatic effect on glycogen recovery following exhaustive exercise.
A diet consisting mainly of protein and fat results in very little recovery of muscle
glycogen even after 5 days! On the other hand a high carbohydrate diet provides faster
restoration of muscle glycogen. Even though, however, complete recovery of glycogen
stores takes about 2 days. During a prolonged exercise session, carbohydrates are the
predominant fuel at the start of a workout, but fat utilizations (aerobic) increases over
time. Carbohydrate metabolism is an energy system that does not depend on oxygen,
but is only available for a short period of time as it rapidly causes fatigue. One of the
reasons for this fatigue is the accumulation of lactic acid which quickly reduces the ability
of the muscles to contract effectively. Lactic acid in the muscles can cause discomfort
both during and after exercise, and total recovery will not occur until the excess lactic
acid produced during exercise has been fully degraded. 733
33
NAD Energy Deficiency(NED): The Focus of NAD Therapy
Research indicates that 10% of the world's population is suffering from NED, mostly
manifesting as chronic fatigue syndrome (CFS), substance abuse, depression, stress,
anxiety and various other chronic illnesses. NED is a spectrum disorder, which is initially
difficult to understand. Grandmother might, for example, be suffering from NED masked
as obesity, her son's workaholism masked his NED and her granddaughter might be a
drug addict. The daughter-in-law is a religious addict, who never misses any prayer
meeting. All of them wonder where the granddaughter could pick up this dirty and sinful
habit. All four of these seemingly unrelated conditions are masks of NED, which are only
revealed on different levels and in different ways. This e-book will clearly demonstrate
the golden thread of NED that exists amongst these various "unrelated disorders" and
the effective role of NAD Therapy in the treatment thereof.
NAD Energy Deficiency (NED) differs from energy deficiency that is defined as the lack
of food and in its worst state is called famine. NED is the cellular energy metabolic
state, irrespective of the amount of food available or consumed, that develops and
persists when there is not enough molecules of NAD and the other energy
metabolic cofactors or energy factories (mitochondria) to convert the organic
energy in food to chemical energy for use in the cells, tissues and organs. NED is
insufficient chemical energy for life and must not be confused with the spiritual or
psychological exhaustion, which often accompanies it or is confused with it. There are
several definitions and descriptions of physical energy and they lead to confusion on the
part of most people. Parents, for example, incorrectly think that a hyperactive child
(kinetic energy) possesses too much physical energy, when he merely has to little
energy (chemical) to lead a controlled life. Before the organic energy in food can be
carried into the body's cells it must first be converted by means of several steps, like
digestion and metabolic processes, so that it can then be released as chemical energy in
the cells. Such released energy in cells only then becomes available, so that conscious
and subconscious activities (kinetic energy) can take place on the physical,
psychological and spiritual level. Research indicated, that 90% of our physical energy
must be made available from the biochemical processes in the cells. Some people
experience problems with the metabolic processes, even though enough nutritional
particles are available due to a lack of sufficient mitochondria for the final conversion of
nutritional particles to an adequate amount of chemical energy cannot be made
available. Such conditions are referred to as NED, in order to distinguish them from
chronic fatigue, which is merely one form of NED.
4.1 THE COURSE OF NED
Genetic NED is already present at birth in some babies and symptoms vary greatly. The
symptoms and signs depend on where and which organs are affected by NED, and vary
from person to person. In most cases of NED, it manifests itself in children in the form of
changes in sleeping patterns, academic stress, problems with concentration,
hyperactivity, behavioural problems and academical underachievement. After puberty
sexual problems might arise and problems start developing with regard to relationships.
In another group of persons with NED, it can only be highlighted after a job has been
accepted in low productivity, workaholism and high degree of absence are displayed. In
elder persons and the aged NED can hide behind masks like Alzheimer or Parkinson's
34
disease. The NED masks of the youth years such as enuresis and academic stress can
be exchanged in later years for masks of alcoholism or toxic relationships. In brief, it
means that NED can become visible as a result of non-execution or over-execution of
any activity, which requires energy for the execution thereof.
4.2 NED IS A SPECTRUM DISORDER
Fatigue is a prominent disabling symptom in a variety of medical and neurologic
disorders268. The familiar example of how white light viewed through a prism, splits into
the colours of a rainbow is a good analogy of what is meant. NED can be viewed as a
form of a spectrum disorder. In other words, one common cause (NED) can cause,
maintain or contribute to a variety of disorders. All cells, tissues, organs and systems in
our bodies need energy to function optimally. An NED can cause, depending on the cell
location, various symptoms and disorders ranging from cell death to death itself.
4.3 THE MOST COMMON CONDITION IN THE 21st CENTURY
Dr Ali predicts in a group discussion of professionals, that chronic fatigue (which can be
viewed as a form of NED) will probably be the most common condition in the 21st
century, for which treatment will be sought3. Dr Gentile provided the following criteria
during the same discussion, as an indication of chronic fatigue88:
Exhaustion, which lasts for more than six months, without any diagnosed cause.
No diagnosed physical cause of illness, that would provide an explanation.
Sleeping disorders and no revitalisation on waking.
Low tolerance of stress that is often associated with exhaustion and a vague
sense of discomfort a few days after having participated in sport or strenuous
physical activity.
Another well-known example that can also serve as an example of what is meant by
NED, is the blocking of the recycling of nicotinamide adenine dinucleotide (NAD) by
acetaldehyde. Restricting NAD recycling can lead to symptoms like problems with
memory, irritability, problems with concentration, depression, apathy, low intellectual
energy, increased anxiety and panic, increased craving for alcohol, sugar and nicotine,
decreased sex drive and increased premenstrual tension214.
4.4 METABOLIC INDICATORS OF NED
"The researcher must account for and reflect on innumerable variables. The clinician
must choose key variables and act"455. Treatment differs from research in so much that it
must be based on sound research findings and that it must be feasible and affordable.
There are various methods to measure energy metabolic deficiencies in research, but
only a few are affordable and feasible to be used in daily practice. Treatment is also
based on the most cost effective methods to obtain results in the alleviation of patients'
suffering. The metabolic indicators of NED (lactate and pyruvate blood tests) that are
reviewed in this publication meet the requirements of affordability, feasibility and general
accessibility for most practitioners.
4.5 NED INHERITED, ACQUIRED AND INDUCED
35
"Recent advances in our understanding of the structure and function of the mitochondria
have led to the recognition that inherited and acquired mitochondrial dysfunction may be
responsible for diseases affecting the liver and other organ systems. Secondary
mitochondrial hepatopathies are conditions in which the mitochondria are major targets
during liver injury from another cause, such as metal overload, certain drugs and toxins,
alcoholic liver injury, and conditions of oxidant stress. Treatment of these disorders is
currently empirical, involving agents that may improve the redox status of mitochondria,
promote electron flow, or act as mitochondrial antioxidants"535.
Many acquired conditions including infections, severe catabolic states, tissue anoxia,
severe dehydration and poisoning can lead to hyperlactacidaemia. All these causes
should be ruled out before considering inborn errors of metabolism436. "Lactic acidosis is
associated with both inherited and acquired metabolic diseases. Lactic acid metabolism
in the presence of altered gluconeogenesis, anaerobic glycolysis, and acid-base balance
is a major factor in many disorders. Inborn metabolic errors accompanied by
derangement of metabolic pathways of glucose, pyruvate, amino acids, and organic
acids and toxic and systemic conditions that promote tissue hypoxia or mitochondrial
injury result in lactic acidosis. In the presence of acquired disorders, treatment is
directed initially toward modification or cure of the primary condition and then toward
eliminating acidosis and other metabolic complications. Specific therapy is available for
some inborn errors of metabolism"536. The rare congenital lactic acidosis is a
consequence of enzyme defects. The acquired form is relatively common in critically ill
patients537.
4.5.1 Genetic NED (Irreversible & Chronic)
"Primary disorders of energy metabolism are those in which the primary insult
affects the cellular machinery required for energy metabolism. A typical example
would be a defect in a gene coding for a mitochondrial protein.320
"All mitochondrial DNA in a cell is derived from the unfertilized ovum (sperm have
virtually no mitochondria), and hence all characteristics encoded by the
mitochondrial DNA are maternally inherited641". "Pyridine nucleotides are mostly
stored within mitochondria where they are involved in different functions ranging
from energy metabolism to cellular signalling. Here we discuss the mechanisms
of mitochondrial NAD(+) metabolism and release that may contribute to the
crucial roles played by these organelles as triggers or amplifiers of physiological
and pathological events".687
"Mitochondrial diseases are a group of disorders characterized by morphological
or functional defects of the mitochondria, the organelles producing most of our
cellular energy. As the only extranuclear site carrying genetic information, the
mitochondria add an important chapter into the inheritance patterns of genetic
diseases. Mitochondrial DNA (mtDNA) is exclusively maternally inherited in
humans, but a mitochondrial disorder may follow either maternal or Mendelian
inheritance, depending on the site of the primary gene defect.359
4.5.2 Acquired NED (Irreversible & Chronic)
"Secondary disorders are those in which the derangements of energy

metabolism are presumably secondary to some other insult but may still be
important for the cellular pathophysiology".320"
36
A number of acquired conditions including infections, severe catabolic states,

tissue anoxia, severe dehydration and poisoning can give rise to
hyperlactacidaemia. All these causes should be ruled out before considering
inborn errors of metabolism".436
4.5.3 Induced NED (Reversible & Temporary)
"The ratio of lactate/pyruvate was elevated in both sexes after the 25% fat-calorie
period".542
We have reported a case of lactic acidosis induced by ingestion of sustainedrelease nicotinic acid".314
"Several tumour-therapeutic drugs reduce NAD and NADH levels, thereby
inhibiting glycolytic energy production."631
"In the case of hypoxia, or other causes of inhibition of the electron transport
chain, NADH accumulates and the supply of NAD is depleted. This pushes the
balance between pyruvate and lactate dramatically in favour of lactate further
exacerbating its production in these circumstances. This change also occurs with
alcohol abuse with alcohol dehydrogenase depleting NAD and producing
NADH.642"
4.6 CHRONIC NATURE OF NED

Research shows that NED is most often genetic and chronic in nature and, if it is not
treated effectively, continuously and appropriately, it will have a progressive and
destructive course. Like chronic diseases, NED is characterized by sociomedical and
psychological characteristics. NED must therefore be managed continuously from a
multiprofessional approach. There are no "quick-fix" solutions in the short-term, because
although it is treatable it is not curable. NED shares the characteristics of chronic
diseases which can be summarized as follows134:
The condition is, or seems to be, irreversible.

Patients with chronic diseases place a great demand on the available healthcare
resources.
Chronic conditions are often treatable, but not curable.
The multidimensional nature of chronic diseases often demands major
adjustments to the lifestyle of the patient and his family.
In contrast to patients with acute diseases, which are treated in particular by
medical and nursing staff, patients with chronic diseases are more generally
treated by their family and resources in their community.
Chronic diseases often rob patients of their familiar and identity-related roles, and
demand that they must develop an alternative lifestyle.
Many chronic diseases in the long term require incorporation of and adaptation to
special regimes of treatment.
4.7 GENDER AND NED

The rate of fatigue among women has been reported to be higher than among men. Life
events such as childbirth, menopause, and socially imposed roles may confer unique
vulnerability272. Chronic fatigue was the primary and most commonly mentioned health
concern by 153 women participating in one study. Fatigue was ranked first by 27.5%
37
women and as one of the top 10 complaints by 80.4% women. They ascribed their
fatigue to a combination of home and work activities (63.4%), poor sleep (38.2%), lack of
time for themselves (34.1%), lack of exercise (32.5%), financial worries (28.5%),
relationship problems (22.0%), emotional causes (17.9%), taking care of ill or frail family
members (13.8%), lack of social or individual support (9.8%), poor physical health
(8.9%), working in home or child care (3.3%), or gender bias/harassment (2.4%)271.
4.8 PLEAS FOR ENERGY
"I finally reached the point where I felt that everything was too much for me. I felt as if I
were no longer able to deal with even the smallest things. I had a flat in the city and lived
alone. I reached the stage where I would come home from work in the evenings and
simply close the door behind me. I didn't talk to anyone. I didn't go out or visit friends. By
eight in the evening I was already in bed, waking up only at seven the next morning,
barely in time to go to work. I experienced a complete withdrawal from society... People
either feel okay or they don't. I never felt okay. I was extremely depressed and I basically
felt that there is nothing worth living for. When I came to Nutrimalaika, I was considering
suicide on a daily basis. It was the one thing I thought of all the time, more so than
anything else"247.
These pleas for physical energy to be able to go on with a meaningful life, are echoed by
thousands of patients every day in consulting rooms. Due to various reasons few people
really understand the actual role of energy, and specifically the chemical energy
processes in our bodies. Despite the teaching of biology to millions of children and
students, most patients think of energy as something mystical and out of reach of
ordinary man. They view the restoration of energy, by applicable supplementation, as
unthinkable and too simple a remedy for a long-lasting and debilitating problem affecting
their whole being. This and other reasons keep them tied down in their destructive state
of continuous suffering.
Although becoming tired is normal, staying tired for prolonged periods is abnormal as is
to be chronically and untimeously plagued by NED. Most people revitalise their physical
energy by means of nutrition, rest and sleep. There is however a group of people
(including children even at birth) that experience severe problems in revitalising their
energy levels through these natural means. If the body has a sufficient and regular
supply of energy in an accessible and usable form at its disposal, it can perform
activities, like eating, regulating temperature, sleeping, praying, laughing, grieving,
working, cellular life and making love.
All human activities except dying, on all levels of being, require physical energy to be
performed. If too little or irregular physical energy is available, due to any of a variety of
possible factors, various bridging mechanisms (i.e. substances and or behaviour) are
used to cope with the NED. Some of these bridging mechanisms can develop into fullblown disorders. To discuss the disorders associated with NED for clarification
purposes, one can broadly refer to them as NEDRS. The concept "NED" serves only as
an umbrella description and is not a diagnostic entity in itself. It is only offered as a
possible concept to facilitate comprehensive treatment and understanding.
38
4.9 COPING MECHANISMS WITH NED

Coping strategies with NED include energy conservation, energy restoring efforts,
enhancing resistance to fatigue, and temperature control320. It is a natural phenomenon
to immediately and subconsciously revert to one or other form of recovery when we
experience problems. At Nutrimalaika it is observed that people, unaware of their
underlying NED, desperately try to manage their NED by adopting one or more of the
following coping mechanisms:
Active coping styles: this can be viewed as an active approach (restoring energy) to
deal with the underlying NED. These persons respond very well to the treatment
approach discussed in this book.
Using chemical substances and behaviour (legal, illegal and natural) to increase
their energy levels, or to suppress the symptoms of NED. Examples of this are
substance dependency, obesity, bulimia, workaholism, insomnia, sex or love
addiction and the abuse of certain prescribed drugs.
Attempting to address and deal with the trigger, by means of therapy and
counselling. The prerequisite for achieving success with this process, is that
sufficient energy must be available to facilitate change. The patient can draw the
wrong conclusion, that neither counselling nor therapy works. An example of this
is the "revolving door syndrome" where patients constantly change therapists
and treatment regimes.
Attempting to increase stamina, in other words, an attempt is made to
accomplish more with the little energy that is available. Examples of this are
excessive exercising and exercise dependency.
Passive coping styles: this can be viewed as a passive approach (conserving energy)
to deal with the underlying problem. These persons initially experience problems to
comply with the treatment approach outlined in this book. However, when their energy
levels stabilises they too benefit from treatment to become actively involved in treatment.
Reducing activities that require energy, or adapting to low energy levels.

Examples of this are lower productivity, depression, chronic fatigue syndrome,
sexual anorexia and excessive sleeping.
Using inappropriate energy to deal with energy related problems on another
dimension of being. For example using only spiritual interventions (waiting or
relying on miracles alone) to alleviate physical problems for which effective
treatment exists.
Substituting one form of coping mechanism with another and wrongly believing
that the underlying NED is effectively dealt with. Various treatment approaches
set "positive" addictions (e.g. lifelong support groups) as the treatment goal for
chronic disorders.
Living only on one dimension of being and neglecting or ignoring the existence of
the other dimensions of being and refraining from being a fully integrated human
being. Religious addiction and co-dependency are possible examples of this
coping mechanism.
39
4.10 PATIENTS' VIEWS OF NED

If we as therapists listen carefully to what our patients are saying, we will be able to hear
these energy deficiencies and also the pain and shame revealed to us. To illustrate this
point the following abstracts from published interviews, with patients treated for various
disorders, are provided.
"Very tired, completely exhausted. I could not concentrate. By noon I was completely
exhausted. I could not sleep at night - I was too tired to sleep. You are too tired to lift
your arms. I think I had other symptoms like pain in the legs and in my lower back. I don't
know what caused them... I didn't have any energy. When a piece of paper landed on
my desk, I felt like tearing it up, whereas in the past, I found it very rewarding to create
order. I am very meticulous. Things have to be done in a certain way, filed in a certain
way, and balanced in the same way. It started getting to me. I didn't have the energy or
the drive to do all these things. I struggled to do things that used to be easy. It was a
matter of "I cannot work one minute longer". By twelve o' clock my work day was over. I
tried to hide it from my management team"181.
"You start to neglect your relationship with God and with your family. You don't rest
properly. Finally I realised that I was such a devoted minister that I almost destroyed
myself, simply because I kept on giving of myself. I kept on giving, and did not receive
anything in return from God or my family. It is a vicious cycle. I realised that there was a
certain day in the week that I didn't have much to do. I considered it my "day off". I would
drink quite heavily to drown the tiredness, the desperation, the depression, because I
didn't have the energy, or inner strength left, for I had given my all for other people. I had
nothing left, I ended up a frustrated person, angry with everybody, and drinking was all
that was left to do"35.
"My marriage ended in divorce about 13 years ago. I received custody of the children.
My life virtually fell apart. I couldn't get my life together and became depressed. About
eight years ago I started seeing the psychologist. Before the time I kept thinking there
had to be more to life than what I was experiencing at that stage. Nothing made me
happy. I didn't know what happiness meant and I didn't know myself. All I knew was that
God had to have something better in mind for me. That was when I went for help, and
the psychologist and I have come a long way since"127.
"I always had a hard time at school. I never took part in physical activities such as
football, and that definitely had an effect. You know, when you take part in a sport where
you exert yourself physically with other people, you make friends more easily. Not being
able to keep up, affects many areas of your life ... for one thing it is very difficult to
concentrate. A lack of energy affects everything you do. You just do less. Even your
state of mind is affected. What I mean is that you may feel down when there is
absolutely no reason to feel that way. The more energy you have, the more you give, the
better you feel, the more you can do. I mean, the experience you had ... you are what
you have achieved. It gives you a chance to experience things"60.
"My family did not see me for almost four years, because of my involvement with her.
She could not socialise and talk to people. So we both became withdrawn. I lost my
friends. Then it was only she and I. Then I felt I could not take it any more. This was after
I got divorced from her. A deadly tired feeling came over me. I did not want to live
40
anymore. I did not want to work anymore. I did not want anything. Nothing in life could
cheer me up anymore"255.
4.11 THE PAIN AND SHAME OF NED
NED (expressed as fatigue) is a common symptom reported by patients. For both
professionals and patients, discussions related to the subject of fatigue are frustrating
and unsatisfying, because of differences in expectations, a narrow focus in therapeutic
approach or solutions and management269. In the process to unravel the mysterious
cause of alcoholism, the important role of sufficient energy for effective living in general
was noticed by the author. Patients generally describe NED, irrespective of the
presenting disorder, as fatigue, tiredness, weariness, depression, lack of physical
energy, failure to cope, powerless, exhaustion, stress, feeling strained, feeling empty,
helplessness, feeling drained and various other symptoms and signs.
"In addition to arising from multiple etiologies, fatigue is also multidimensional in its
manifestation and impact. Its effect on the quality of life of the patient is comparable to
that of pain. Experienced by most patients as an extremely frustrating state of chronic
energy depletion, it leads to loss of productivity which can reduce self-esteem. As a
subtle and chronic symptom, it also places people at risk for being questioned about the
authenticity of their complaints, particularly during the post-treatment, disease-free
survival period. Patients themselves are reluctant to complain of fatigue, perhaps
because they believe little can be done about it"569.
Research shows that 77% of subjects with chronic fatigue syndrome (CFS), the lack of
energy for sensible living, were called "psychological cases" by one or more of the
physicians consulted. Most of these CFS sufferers were experiencing problems with
stigmatization as expressed by estrangement (95%), attribution of CFS to psychological
causes by others (77%), using an educational disclosure coping strategy (77%) and had
to be secretive about their symptoms (39%)267. This stigmatization is not limited to CFS
alone but applies to all other forms of NED.
4.12 PSYCHOLOGICAL INDICATORS OF NED
NED has a negative or inhibitory effect on the psychological functioning of the sufferer.
Objective psychometric testing with the 16 Personality Factor Test (16PF SA92)
indicates that the following five personality factors are most often found amongst NEDsufferers.
4.12.1 Ego Strength: Immature (C-)
Approximately 56% of NED sufferers will probably be irritated rapidly by people and
issues and are dissatisfied with their earthly existence and family. They become
frustrated quickly and are often overwhelmed by the limitations in their life. They feel
inadequate to deal with the demands of life. They are unpredictable with regard to their
interests and attitudes. They become upset easily, avoid their duties and tend to leave
projects in a state of non-completion. They are prone to worry about issues and are
comfortable to interact with others in a confrontational manner. Their lack of energy
makes it difficult for them, to complete their daily tasks successfully. They also find it
difficult to utilise their egostrength and are therefore very dependant on other for
41
assistance and guidance. They often experience problems with handling emotion,
frustration and impulses, or with finding a realistic outlet for it. At times they are
overwhelmed by it and this leads to emotional outbursts and other immature actions.
They brag about the many projects, which they complete at work and for others, but the
most important project, namely the quality of their life, remains undealt with.
4.12.2 Impulsivity: Serious (F-)
They set themselves difficult targets and react with hostility, if these targets are not
achieved. They are quiet, introspective, pessimistic and obsessed with correctness.
They are able to engross themselves in boring work and often become very upset by
change and unexpected events. They often suffer from symptoms, like headache,
phobias, worrying, depression and/or nightmares. They are perceived by others, as very
serious persons. This factor was found amongst 46% of persons, who suffer from NED.
This characteristic of NED sufferers, makes it practically impossible for them to
accommodate humour, which on its own can be a healing function.
4.12.3 Insecurity: Worrying (O+)
They tend to belittle themselves and prefer to be broody over everything. They are
emotionally very sensitive and easily become worried and scared. They are subjected to
feelings of inferiority and inadequacy. They often feel excessively exhausted, avoid
stimulation and tend to be emotionally unstable. They normally exhibit an excessive level
of morality and commitment to duty, which causes them a lot of anxiety. They
experience their serious feelings of guilt as a vague internal conflict, which they cannot
control easily. This factor was found, amongst 46% of persons, who suffer from NED.
4.12.4 Tension: Driven (Q4+)
They are tense and irritable persons, who become upset easily by small issues. They
are excessively tense and restless. Furthermore, they are very impatient and easily lose
their temper. Irrespective of how exhausted they feel, they still experience an obligation
to do things. They feel dissatisfied with themselves, because none of their numerous
projects are completed successfully. They experience intense feelings of rejection and
suffer from a lot of sexual frustration. As a result of the above-mentioned characteristics,
they tend to exhibit anxiety-related disorders. Their psychological energy is often
inadequate for dealing with situations and this leads to great anxiety and irrational
concerns. This factor was found amongst 41% of persons, who suffer from NED.
4.12.5 Boldness: Restrained (H-)
The person is usually very shy, suffers from an unusually poor self-concept and
experiences problems expressing himself. The person avoids careers requiring intimate
interpersonal contact and prefers to have one or two intimate friends. Frequently he
displays a pronounced and prolonged reaction to threats and trepidation. His greater
sense of duty, dedication to work and regard for authority leads to panic-stricken
reactivity. In the presence of the opposite sex he is very inhibited and quiet. His
withdrawn nature and hostile privacy are often the result of previous experience of
human contact being exhaustive.
42
4.13 HUMAN FUNCTIONING AND NED

The well-known psychologist, Maslow, had already compiled his hierarchical model of
needs many years ago. We can extend it, by linking it to energy. Maslow's postulated
integrated model of needs will be considered as a basis to illustrate human functioning. It
represents a good example of the various needs that humans experience and that
require sufficient energy to be met and maintained. As can be seen clearly in the
following table, it also integrates all three the dimensions of being, i.e. spirit, soul and
body.
Furthermore, one can suggest the possibility that the energy, required to satisfy the need
meaningfully, increases in proportion to the level of the need. In other words the
progress to the next level requires a certain amount of energy to achieve satisfaction. All
human activity and needs require energy to be performed or not to be performed. No
behaviour is possible, without the body. One cannot walk or sit without a body, nor can
one speak, think, pray or subscribe to religious faith without a body. According to this
model we would require the most energy to reach and maintain the transcendental level.
Furthermore if there is a decrease in energy it follows that the person will revert to a
lower level of functioning. Although this is merely an idea which warrants further
investigation, it is daily observed in practice.
4.14 HIERARCHY OF NEEDS ACCORDING TO MASLOW108
According to Maslow, transcendence is the highest need, which can be satisfied, and it
can only be satisfied satisfactorily if the other seven needs are satisfied. Transcendence
is the ability of a person, to succeed in spite of limited ability and unfavourable
circumstances, and to help others to achieve self-fulfilment. If someone's energy level
declines, it firstly exerts a negative influence on one's transcendental need, then on selfactualisation, thereafter on the aesthetic needs then the cognitive needs, then respect,
then love and intimacy, then safety and security and lastly the physiological needs of
e.g. nutrition, sleep, sex etc. In other words, persons who suffer from serious NED
function mostly on the bodily level
43
NAD Therapy: The Biochemical Basis

Various researchers emphasise the central and vital role of NAD in most processes of
life136, 191. Dr Davis stresses the importance of NAD, as follows: "NAD is important for
energy. If you have too little NAD, many of your enzymatic reactions fail to function and
then you cannot produce the energy. You cannot produce ATP. NAD supplements must
also be added to the minimum maintenance. NAD is a very specific component, an
essential component of your body. If you do not have it, none of your systems functions,
and this includes your brain. If you don't have NAD, you die; it's as simple as that. You
will never have no NAD. You will always have a little NAD, because your electrontransfer chain possesses areas in which energy is generated, the electrons take in NAD
and release it. In this way, it causes the functioning of the electron-transfer chain. This is
why I say, that NAD is not a nutritional supplement. NAD is an essential and highly
specialised component of the body, which requires it to function"65. Despite the fact that
most of us have learned about NAD at school while studying biology, it remains relatively
unknown as a nutriceutical energy metabolic supplement especially for NED.
5.1 BIOSYNTHESIS OF NAD
NAD is a co-enzyme that is mainly absorbed from food or produced naturally in the body
from certain nutritional elements, by means of various biochemical processes105, 259 .
"Most niacin in food is in the form of NAD or NADP. Niacin is absorbed in the small
intestine, mostly in the form of NAD or NADP"369. NAD is mainly obtained from the NAD
that is present in food38. NAD can be produced in the liver, in particular, under the
control of the hormones that are secreted by the adrenal glands259. Nicotinamide is an
important precursor of NAD, under physiological conditions151. Tryptophan is another
important precursor of NAD and the body obtains a large proportion of NAD from this
source. In the case of human nutrition, 60 mg tryptophan is the equivalent of 1 mg
niacin64.
"NAD is synthesized in red cell from nicotinic acid and PRPP through the formation of
nicotinate mononucleotide and desamido-NAD. Synthesis of one mole of NAD requires
two moles of ATP. NADP comes from NAD phosphorylation by NAD-kinase
(EC.2.7.1.23). NAD and NADP analysis on a population with ATP level ranging from 800
to 2500 nmoles/ml red cells showed a close correlation between ATP and pyridine
cofactors. Moreover, NADP level appeared to be dependent of the redox-state of
NADP/NADPH couple. Subjects with low NADPH (G-6-PD) deficient red cells, (Hb Koln)
showed lower NADtot/NADP tot ratio, suggesting a NAD-kinase equilibrium shift toward
NADP related to lower levels of the negative effector NADPH."796 "Nicotinamide
mononucleotide adenylyl transferase (NMNAT) is an essential enzyme in all organisms,
because it catalyzes a key step of NAD synthesis. However, little is known about the
structure and regulation of this enzyme... NMNAT appears to be a substrate of nuclear
kinases and contains at least three potential phosphorylation sites".786
5.2 BIOCHEMICAL FUNCTIONS OF NAD
NAD was the first co-enzyme to be identified in 1905 by Harden and Young138. NAD has
more than 100 functions in the human metabolism. Even the activity of the citric-acid
cycle, which is found in most cells, becomes restricted in the lack of NAD and NADP154.
The body constantly requires NAD and if the NAD level becomes too low, the need for it
44
is activated in the primitive part of the brain. This biochemical action cannot be controlled
by the mind or changed by willpower. Alcohol and the metabolites, which it creates,
suppress this need for NAD. Excessive exercising and the associated secretion of
endorphins also suppress the need for NAD51.
5.2.1 Metabolic Detoxification of Chemical Substances
NAD has already been used successfully since 1939, for the short-term treatment of
alcoholism51. O'Halleren was however the acknowledged leader in treating various types
of substance dependencies with the aid of NAD supplements. He used NAD to treat
alcohol-, heroin-, cocaine-, morphine-, meperidine-, codeine-, amphetamine-,
barbiturate- and sedative dependents166. NAD does not have the same side-effects as
nicotinic acid at high dosages, like serious flushing and the release of histamine211.
The intracellular metabolism of alcohol, and possibly also of other chemical substances,
requires NAD or derivatives thereof, in order to take place. Ninety per cent of alcohol is
absorbed almost immediately in the body's cells; the remaining 10% is discharged
mainly in the urine. Acetaldehyde is the first metabolite of various chemical substances,
including alcohol, that is produced26, 133, 166, 173, 176, 227, 249. Acetaldehyde is also formed
during stress. Acetaldehyde is used as a preservative in certain dairy products214. The
last step in the metabolic detoxification process occurs in the citric-acid cycle, where
three NADs are involved in the process. This cycle is also responsible for the conversion
of proteins, carbohydrates and fats into ATP. This is a purely biochemical autonomic
reaction, and neither the person's will or any other form of control can be exercised over
it. The biochemical reactions can be simplified as follows:
Chemical Substance + NAD -> Acetaldehyde + NAD -> Acetate + CoA -> AcetylCoA +3NAD(H) -> ATP + H2O + CO2 + Heat
Ethanol toxicity is closely related to its metabolism in the liver. The elevated NADH/NAD
ratio (i.e. NAD deficiency) results in alterations of the intermediary metabolism of lipids,
carbohydrates, proteins, purines, hormones and porphyrins. This shift in metabolic
pathways results in hyperlactacidaemia, lactacidosis, ketosis and hyperuricaemia.
Furthermore, excess NADH can results in free radical production491, 492, 493.
The NADH that builds up, e.g. during e.g. alcohol metabolism, will drive pyruvate to
lactate which can lead to acidosis. The pyruvate is now not available for
gluconeogenesis and if, as is common in serious alcoholism, the patient is not eating
properly, hypoglycemia can result. The high NADH/NAD ratio will affect other processes
such as b-oxidation. One clinical manifestation is liver disorders associated with
alcoholism: fatty liver, alcoholic hepatitis and, sometimes, cirrhosis. The burden on
oxidizing systems also leads to increased use of the P450 or microsomal oxidizing
system which can have important effects on steroid metabolism and other processes
involving this system491, 492, 493.
5.2.2 Repairing DNA
NAD and niacin (a precursor of NAD), play an important role in defending cells against
DNA damage by genotoxic particles. Research shows that niacin supplementation,
particularly for persons who initially have lower levels, improves the level of NAD in
45
blood and lymphocytes99. NAD plays a major role in repairing DNA44, 156, 196. Research
shows that damage to DNA can possibly stimulate the biosynthesis of NAD and that the
repair of DNA can be increased and accelerated in cells with increased levels of NAD112.
Cytotoxic substances reduce the intracellular levels of NAD and can lead to the death of
cells. DNA strand breakage decreased proportionately to NAD concentrations over time
in lymphocytes exposed to oxygen radicals367. The results suggest a general correlation
between DNA damage and acute lowering of cellular NAD pools377, 564.
"Rejoining of DNA single-strand breaks generated by treatment of plasmids with gammarays, neocarzinostatin, or bleomycin was catalyzed inefficiently by human cell extracts.
The reaction was strongly promoted by the addition of NAD+, which was employed for
rapid and transient synthesis of poly(ADP-ribose)... NAD(+)-promoted DNA repair by
soluble cell extracts also occurred with alkylated DNA as substrate and was suppressed
by 3-aminobenzamide. A similar stimulatory effect by NAD+ was observed for repair of
ultraviolet-irradiated DNA, and this could be ascribed to the presence of pyrimidine
hydrates as minor radiation-induced DNA lesions".788
5.2.3 Generating Energy
During one of our dieticians lectures in Nutritional Biochemistry at Pretoria University, an
individual's theoretical daily need for NAD, assuming that none is recycled, was
calculated. The calculation showed, that the average person's body contains
approximately 16 grammes of NAD and that it had to be recycled 2 160 times during
every 24 hours through the body. Had the body lacked the ability to recycle NAD
successfully, 35,91 kg of NAD (approximately 72 000 containers of NutriNAD, or 7,2
million MultiNAD or MalaikaNAD capsules) would have to be taken every day, in order to
supplement it. NAD plays an important role in the production of ATP (the basic energy
molecule) in the body.
NAD and NADP, which are pyridine nucleotides, are rated as being amongst the
important high energy compounds in the biochemistry of organisms138. The reduction of
NAD plays an important part in the citric-acid cycle and contributes to the production of
22 molecules of ATP from one molecule of glucose38. NAD and its derivatives NADH,
NADP and NADPH have regulatory functions in the generation of triose phosphates and
pyruvate from glucose607. NAD is reduced to NADH in the metabolism of glucose. The
hydrogen molecule is obtained from the metabolism of fats, carbohydrates and proteins.
The activated NADH plays a part in several critical bodily functions, amongst others, in
the continued production of ATP, which is the basic energy compound in the body45.
NAD plays an important role in the release of energy from carbohydrates, fats and
proteins137. In the absence of oxygen, pyruvate must be converted to lactate to
regenerate NAD from NADH in the cytoplasm. In the presence of oxygen, the
mitochondria can reoxidize cytosolic NADH by an indirect process, involving the
mitochondrial "shuttle systems"348.
5.2.4 Improving Immunity
Phagocytes use NADPH as a source of energy, to destroy pathogens. The NAD(P)H,
that is available, is also used to protect the body against free radicals and to, in this way,
prevent illnesses and damage. High dosages of ascorbic acid can supplement the
activity of the NAD(P)H, which is only available to a limited extent45. Research on the
46
effect of the Epstein-Barr virus on lymphocytes, indicates that the cultivated cells' levels
of NAD were lower. The addition of NAD restored the levels within two hours. The study
also discusses the effect of NAD on the mitochondrial metabolism and the relationship
between NAD and the activity of complex I in cultured human cells194.
5.2.5 Improving Brain Functions
The brain is metabolically speaking one of the most active organs in the body and
consumes approximately 20% of all energy generated21, 350. Its weight-to-energy ratio is
ten times more than that of most other organs. The brain does not really have any
reserves of energy, in the true sense of the word, and must therefore be supplied
continuously with energy by the body. The brain, as a whole, consumes approximately 4
x 1021 molecules of ATP per minute and this increases during REM sleeping. During the
first ten years of a child's life, the brain consumes up to twice as much energy as during
adulthood212. When pyruvate oxidation is impaired, glycolysis will run faster than normal
to try to make up for deficient ATP production. This will cause more production of lactate.
The brain relies on oxidation of glucose as an energy source and has a limited ability to
oxidize fatty acids. In cases of severe energy depletion mental retardation is not
surprising348. NAD plays an important part in the production of ATP in cells38.
Derivatives of niacin, mainly in the form of NAD and NADP coenzymes, are found
abundantly in brain tissue. In the case of niacin deficiency, the brain's supply of NAD
declines sharply and the functioning of the brain is disturbed; malfunctioning of the brain
(dementia) is indeed one of the primary characteristics of pellagra. If the NAD deficiency
lasts for an extended period, permanent brain damage develops144.
Scientists have discussed the possible use of NAD for the treatment of
neurodegeneration155 and the improvement of brain functions. NADH plays a role in the
synthesis of the neurotransmitters, i.e. noradrenaline and dopamine, which are important
for maintaining a positive state of mind42. South African research on NAD, that was
conducted for the manufacturer, also confirms the normalising effect of NAD on the
neurotransmitters, i.e. dopamine, adrenaline and noradrenaline. NAD probably plays a
role in the production of serotonin and other neurotransmitters in the brain214.
5.2.6 Normalizing Cell Functions
"The corepressor CtBP (carboxyl-terminal binding protein) is involved in transcriptional
pathways important for development, cell cycle regulation, and transformation. We
demonstrate that CtBP binding to cellular and viral transcriptional repressors is regulated
by the nicotinamide adenine dinucleotides NAD+ and NADH".779
"NAD is the substrate of a novel chromatin-associated enzyme-ADP-ribosyl transferase
(ADPRT). In this study, the cell-cycle dependent change in cellular NAD content was
observed in a line of human amnion FL cells. It was found that the cellular NAD content
of FL cells was highest in G1 and lowest in S/G2-G2. 3AB, a potent ADPRT inhibitor,
can inhibit the cell cycle dependent change in cellular NAD content and also inhibit DNA
synthesis in the S phase and extend the S phase. The results indicate that ADPribosylation may be involved in DNA replication and cell cycle progression. It was also
found that the DNA-damaging agents, MNNG, MMS and 4NQO could lower cellular NAD
content in a dose-dependent way".780
47
"Hepatocytes were found to be remarkably resistant to suicidal NAD+ depletion due to

consumption for chromatin-associated poly(ADP-ribose) biosynthesis, which normally
follows infliction of DNA damage in mammalian cells... This differential behaviour,
demonstrable also with other carcinogens, can be attributed to the different NAD+
biosynthetic capacities of these cells".781
"Marked depletion of intracellular NAD+ prior to toxicity and a protection against toxicity
associated with maintenance of NAD+ suggest a possible role for the maintenance of
intracellular NAD+ in cellular integrity." 782
"Many cellular enzymes use NAD+ as coenzyme or substrate, depending on the nature
of the enzymatic reaction. Under certain conditions the cellular NAD+ concentration may
become rate-limiting for such enzymes. For instance, when eucaryotic cells are exposed
to high concentrations of DNA-damaging agents, the resulting DNA strand breaks may
stimulate the nuclear enzyme poly(ADP-ribose) polymerase (PARP) to such an extent
that the cellular pool of NAD+, which is the substrate for this enzyme, is severely
depleted, possibly leading to acute cell death".783
"When mouse leukemia cells are treated with gamma-radiation or neocarzinostatin the
intracellular NAD and ATP levels fall rapidly. We have shown that the ATP response is a
consequence of the decreased NAD level. We suggest that this low NAD level results in
decreased glycolytic activity and that there is a subsequent accumulation of
phosphorylated sugars associated with the fall in ATP. Under these extreme conditions,
therefore, the NAD level probably regulates the rate of glycolysis in cells which are
utilising a rapidly metabolisable sugar as their energy source".784
"Ionizing- and ultraviolet-radiation cause cell damage or death by directly altering DNA
and protein structures and by production of reactive oxygen species (ROS) and reactive
carbonyl species (RCS). These processes disrupt cellular energy metabolism at multiple
levels. The formation of DNA strand breaks activates signalling pathways that consume
NAD, which can lead to the depletion of cellular ATP. Poly(ADP)-ribose polymerase
(PARP-1) is the enzyme responsible for much of the NAD degradation following DNA
damage, although numerous other PARPs have been discovered recently that await
functional characterization. Studies on mouse epidermis in vivo and on human cells in
culture have shown that UV-B radiation provokes the transient degradation of NAD and
the synthesis of ADP-ribose polymers by PARP-1... Identifying approaches to optimize
these responses while maintaining the energy status of cells is likely to be very important
in minimizing the deleterious effects of solar radiation on skin".785
"Peroxynitrite and hydroxyl radicals are potent initiators of DNA single strand breakage,
which is an obligatory stimulus for the activation of the nuclear enzyme poly(ADPribose)synthetase (PARS). Rapid activation of PARS depletes the intracellular
concentration of its substrate, NAD+, slowing the rate of glycolysis, electron transport
and ATP formation. This process can result in acute cell dysfunction and cell necrosis.
Accordingly, inhibitors of PARS protect against cell death under these conditions. In
addition to the direct cytotoxic pathway regulated by DNA injury and PARS activation,
PARS also appears to modulate the course of inflammation by regulating the expression
of a number of genes... In vivo data demonstrate that inhibition of PARS protects against
various forms of inflammation, including zymosan or endotoxin induced multiple organ
failure, arthritis, allergic encephalomyelitis, and diabetic islet cell destruction".787
48
"Recent studies point to the naturally occurring molecules in expression of radiation

damage and in protection. DNA repair was shown to be one of the parameters that can
be modified to attain improved protection. The need for a natural compound that can
enhance DNA repair in order to improve cellular protection focused our attention on
nicotinamide (NA). The effects of addition of NA, a precursor for NAD+ synthesis, on the
DNA repair capacity following gamma and ultraviolet irradiations were studied in several
repair-proficient and repair-deficient cell lines. The addition of low concentrations of NA
(less than 3 mM) resulted in increased repair synthesis in the repair-proficient cells.
Addition to repair-deficient cells resulted in decreased repair synthesis. Cells which
repair damage from one type of radiation, and not from another, responded accordingly
to the presence of NA. However, addition of high concentrations of NA to repairproficient cells resulted in decreased repair synthesis. Thus, nicotinamide can improve
the repair capacity in a concentration-dependent manner, but it clearly requires the
existence of functional repair processes."789
"An intimate relationship exists between DNA single-strand breaks, NAD metabolism,
and cell viability in quiescent human lymphocytes. Under steady-state conditions, resting
lymphocytes continually break and rejoin DNA. The balanced DNA excision-repair
process is accompanied by a proportional consumption of NAD for poly(ADP-ribose)
synthesis. However, lymphocytes have a limited capacity to resynthesize NAD from
nicotinamide. An increase in DNA strand break formation in lymphocytes, or a block in
DNA repair, accelerates poly(ADP-ribose) formation and may induce lethal NAD and
ATP depletion".790
"These data indicate for the first time hormonal modulation of NADase resulting in two
signals: (1) enhancement of NAD+ which may explain the increase in ADP ribosylation
and activation of cholera-toxin substrates leading to facilitation of protein secretion; (2)
suppression of cell cADP-ribose and consequently intracellular Ca2+ which may explain
the melatonin-induced inhibition of protein secretion".791
"Extracellular NAD is degraded to pyridine and purine metabolites by different types of
surface-located enzymes which are expressed differently on the plasma membrane of
various human cells and tissues... ATP was found to be the main labelled intracellular
product of exogenous NAD catabolism; ADP, AMP, inosine and adenosine were also
detected but in small quantities... These results confirm that adenosine is the NAD
hydrolysis product incorporated by cells and further metabolized to ATP, and that
adenosine transport is partially ATP dependent".792
5.3 NAD(H) IN FOOD
Free nicotinic acid (vit B3) and nicotinamide (active form) are present in nature in only
small amounts. Nicotinic acid is mainly bound to macromolecules in plants, while
nicotinamide is usually a component of NADP (coenzyme form) in the animal world.
Nicotinic acid can be formed in humans from the metabolism of dietary tryptophan.
Important sources of preformed niacin include beef, pork, wheat flour, maize (corn) flour,
eggs and cows milk. Human milk contains a higher concentration of niacin than cows
milk. In unprepared foods, niacin is present mainly in the form of the cellular pyridine
nucleotides NAD (coenzyme 1)and NADP.
49
Raw food contains the amounts of NADH detailed in the following table. Cooked food
contains much less NADH because some of the NADH is lost during the preparation23.
The NAD co-enzyme continuously varies between the NAD or NADH compound in the
body68, 83, 105. Other derivatives of NAD are NADP and NADPH138. For the sake of
completeness, the figures have been converted to show the quantity of food required to
be taken to match the NAD used in one NutriNAD capsule.
RAW FOOD EQUIVALENT FOR EACH NUTRINAD CAPSULE
10kg of raw red meat

12.5kg of poultry
14.3kg of fish
25kg of yeast
250kg of potatoes
500kg of grain
5.4 STORAGE OF NAD IN CELLS

"Pyridine nucleotides are mostly stored within mitochondria where they are involved in
different functions ranging from energy metabolism to cellular signalling. Here we
discuss the mechanisms of mitochondrial NAD metabolism and release that may
contribute to the crucial roles played by these organelles as triggers or amplifiers of
physiological and pathological events".687 There are two pools of NAD in most cells. One
is the inner mitochondrial pool and the other is the cytoplasmic pool. "Tissue levels of
NAD appear to be regulated primarily by the concentration of extracellular nicotinamide,
which in turn is controlled by the liver in a hormone-sensitive manner. Hepatic regulation
involves the conversion of excess serum nicotinamide to 'Storage NAD' and inactive
excretory products, and the replenishment of serum nicotinamide by the hydrolysis of
'Storage NAD.' Tryptophan and nicotinic acid contribute to 'Storage NAD,' and thus are
additional sources of nicotinamide627."
5.5 POSSIBLE CAUSES OF INDUCED NAD DEFICIENCY
It appears from literature that several factors can lead to NAD deficiencies. Genetics,
nutrition, chemical substances and certain diseases possibly play a part51. Mitochondrial
disorders could be a cause68. Nutrient dependency, ageing and nutrient deficiencies are
possible causes105. Malfunctioning of the liver and adrenal glands might play a role259.
NAD possibly cannot be recycled properly. The contributing potential of digestive
problems can be added to this214. In the case of certain disorders, for example an
overactive thyroid gland, too much energy is released as heat and it is stored
inadequately68.
NAD deficiencies are probably also induced or aggravated by the following chemical
substances:
biopsy-proven zidovudine myopathy resulted in a high lactate:pyruvate ratio538.

patients on valproic acid had reduced lactate and lactate:pyruvate ratios539.
elevated lactate in white matter and the possible response to antioxidants
suggests mitochondrial dysfunction in progressive spongiform
leukoencephalopathy following inhalation of heated heroin vapor540.
50
lactic acidosis is induced by ingestion of sustained-release nicotinic acid542.

the mean plasma lactate concentration was elevated in 42 patients poisoned with
paracetamol543.
parvovirus infection was accompanied by rapid depletion of intracellular NAD
stores565.
NAD synthesis is decreased significantly in thalassemic red blood cells566.
The ratio of lactate to pyruvate was elevated in both sexes after a 40-day period
of a 25% fat-calorie restricted diet. The lactate and pyruvate decreased
significantly only in males (pyruvate greater than lactate) but not in females314.
DNA-damaging agents N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), methylmethanesulphonate (MMS) and 4-nitroquinoline-N-oxide (4NQO) could stimulate
ADP-ribosyl transferase (ADPRT) activity and reduce the cellular NAD content in
a dose-dependent way564.
Several tumor-therapeutic drugs reduce NAD and NADH levels, thereby
inhibiting glycolytic energy production631.
5.6 THERAPEUTIC CHARACTERISTICS OF NAD

"Nicotinamide mononucleotide adenylyltransferase (NMNAT), a member of the
nucleotidyltransferase alpha/beta-phosphodiesterases superfamily, catalyzes a universal
step (NMN + ATP = NAD + PP(i)) in NAD biosynthesis. Localized within the nucleus, the
activity of the human enzyme is greatly altered in tumor cells, rendering it a promising
target for cancer chemotherapy."778 NAD-deficiency disorders include conditions like
anorexia nervosa, substance dependency, early diabetes, heart problems, hypertension
and various behavioural disorders. NAD deficiencies can develop as a result of diets that
lead to lower NAD levels. Approximately 10% of people suffer from a serious and
possibly chronic lack of NAD, which can often also be of a genetic nature51. Therapy with
NAD precursors like nicotinamide might have remedial effects on possible biochemical
abnormalities, thereby retarding progression of diabetic microangiopathy607. "NAD and
NADH are converted into each other in numerous different metabolic activities. In some
metabolic reactions it is NAD which is the needed catalyst, with NADH a useful byproduct, in other reactions the situation is reversed638".
5.6.1 Patents for NAD Therapy
NAD was patented in 1964, for the treatment of drug dependency. It was registered in
1966, for the treatment of alcoholism. The patent for the use of NAD supplementation in
the treatment of ileus and shock was awarded in 1967. The patent for use in the
treatment of schizophrenia was also approved during the same year. Shortly thereafter,
the patent for the use of NAD in the treatment of arthritis was also approved. A patent is
registered which generates NAD or nicotinamide adenine dinucleotide phosphate
(NADP) in the body344.
5.6.2 Determining NAD Levels
NAD is present in all body cells and it is clinically not easy to measure it. Researchers
found in their experiments, that the absolute conversion-speed of NAD is 78 000
molecules per second per cell and that it has a half-life of between 48 and 78 minutes186.
NAD's half-life in the brain is approximately 3-4 days and in the liver approximately 10
hours64. High-pressure fluid-chromatography measurements can be used to measure
51
levels of NAD. The measuring method can be replicated easily and is a reliable method
for measuring levels of NAD in human blood195, 197. Standard blood-tests, which provide
an indication of NAD levels, consist of the lactate and pyruvate, -hydroxybutyrate and
acetoacetate measurements138. The latter two measurements indicate the mitochondrial
levels of NAD/NADH and this is a useful measurement for determining possible defects
in the citric-acid cycle. In the presence of NAD or NADP 15-18% of the cortisol was
converted to cortisone: no other products could be detected443.
"A significant decline of cellular energy after aerobic performance was detected with both
approaches to a similar extent (P<0.01). However, the extracellular NADH
metabolisation assay (ENMA) is more convenient to perform than the determination of
intracellular ATP/ADP. Due to its easy and versatile handling, a huge array of possible
applications like monitoring the training efficiency of athletes, the fitness of senior
citizens or the recovery from disease may be envisioned."775
5.6.3 Duration and Effect of NAD Therapy
NAD is not a drug and it takes a while before its effect can be consciously experienced.
Most people become aware of an increase in energy after four or six weeks'
supplements. It is furthermore also important to bear in mind, that NAD Therapy only
provides energy for dealing with problems and cannot solve problems on its own. It
provides the energy that is necessary to be able to identify and deal with the
psychological and mental problems, which contribute or are due to low levels of energy.
Clinicians found during their treatment of a patient with MELAS, that the supplements'
effect could be observed in the level of erythrocytes, after 6 weeks' treatment. The blood
level of lactate to pyruvate declined by 50% within 3 days and its urine level declined
within two weeks. Clinical improvement and reduction of scarring in the brain, as
determined by MRI scans, occurred within a month140.
"Alkylating agents cause a marked depletion of cellular NAD+ levels by activating
nuclear ADP-ribosyl transferase (ADPRT), which utilizes NAD+ as a substrate in the
synthesis of poly(ADP-ribose). As a consequence of NAD+ depletion, it is possible that
cellular ATP pools could be depleted. Because of this, exogenously supplied NAD+ had
been proposed as a way to counteract some of the effects of an alkylator. We found that
exogenously supplied NAD+ significantly increased intracellular levels of NAD+."777
5.6.4 Safety of NAD Therapy
NAD Therapy has been used intravenously in South Africa since 1974 and, according to
the manufacturer, no side-effects have yet been reported by clinicians. More than 15 000
NAD supplements (500 mg per drip) have been administered intravenously at
Nutrimalaika since 1989, to more than 6 000 patients, who ranged in age from as young
as 9 - 90. Furthermore, no race-, gender- or age-related contra-indications were
encountered. Since 1995 many patients have used 50mg of NAD orally dissolved in
340ml of carbonated sodawater. This has now become the norm because almost all of
the 6 000 patients at Nutrimalaika and those of the 120+ participating private
practitioners have changed to the 50mg NutriNAD capsules specifically formulated for
such use.
52
The following information is based on results from research, that was provided by the
manufacturer of the intravenous form of NAD. The same quality of NAD is also used in
the MultiNAD capsules. The lethality dosage (LD50) of NAD is as follows:
1 360mg/kg IV - mouse
3 500mg/kg IM - mouse
2 610-3 050mg/kg IM - rat
1 780mg/kg IM rabbit
2 900mg/kg IM dog
2 900mg/kg IV dog
Results of acute toxicity do not indicate any pathological changes in mice, rabbits, rats or
dogs. Results of chronic toxicity after 52 weeks, during which NAD of up to 300 mg/kg
was administered intramuscularly to rats every day, indicate no toxicity that can be
attributed to NAD. Haematological evaluations, blood-chemical measurements and
histopathological examinations of the heart, liver, kidneys, spleen, gonad, adrenal
glands, thyroid and pituitary gland did not yield any significant changes. The same
research indicates no significant changes during reproduction and gestation in rats. The
NAD infusion is terminated on all patients during pregnancy, irrespective of these
findings. During pregnancy only the capsules are continued with.
5.6.5 Stability of NAD Therapy
The NAD in the NutriNAD, MalaikaNAD and in the MultiNAD capsules consists of the
same form of NAD. NAD is a powder, that ranges in colour from white to pale yellow.
The NAD vials have an expiry date of two years after manufacturing, when stored in a
refrigerator. If the NAD is in any solution, it will remain stable in a refrigerator for at least
a week. All NAD preparations must therefore preferably be in powder form and must be
stored in a refrigerator or cool place. A Canadian company recently changed their bottles
to read NAD instead of NADH. NAD, known as Coenzyme 1, plays an important role in
energy production. The company, felt that NADH was less stable as a supplement than
NAD638.
5.6.6 Alternative Names for NAD
NAD is also referred to in literature as diphosphopyridine nucleotide (DPN), nadide,
adenine-D-ribose-phosphate-phosphate, cozymase, coenzyme 1, D-ribose-nicotinamide,
vitamin PP and enzopride.
5.6.7 NAD Therapy and Interaction with Other Medication
No contra-interaction with any other medication, like antidepressants, neuroleptics or
other medications, was reported with the use of the NAD containing capsules. It was
however found, that the dosages of some medications (antihypertensives, insulin,
medication for cholesterol, antidepressants, anxioliticums etc) have to be decreased in
time. What however does happen, are that side-effects similar to an overdose of other
medications, which are used at the same time, often come to the fore. Medication for
blood pressure is an example of this. NAD stabilises the person's blood pressure and
therefore the dosages of the medication for blood pressure must be adjusted
accordingly, to prevent side-effects such as a too high or low blood pressure. What also
53
happens often, is that other symptoms and conditions, which were masked by the NED,
become apparent to the NED sufferer, when the body becomes stabilised. It is then
incorrectly referred to as side-effects of NAD Therapy.
5.6.8 Contra-indication for NAD Therapy
According to the manufacturer, no contra-indication has been reported since 1974 by
any clinician, for the use of NAD. NAD must however be used with care in persons with
Gilbert's disease, in whom it can cause serious abdominal pain65.
5.7 HOMEOPATHY AND NAD THERAPY
Many of the medications, that are utilised in the practising of homeopathy, in the form of
tablets and injections, contain NAD. The use of NAD Therapy is in line with the natural
order, that is adhered to by disciplines which use natural healing. These medications are
used to treat a large variety of conditions and particularly in homotoxicology. These
medications have furthermore been used for many years.
5.8 POPULARITY OF NAD THERAPY
Although NAD Therapy were used in the treatment of alcoholism since 1939, patented in
1964 and the NAD vials officially registered in 1974 in South Africa it is still relatively
unknown by treatment professionals. A possible explanation is that treatment
professionals not working with substance dependency or those working with substance
dependency from the moral treatment approach would probably be not aware of NAD
Therapy and its energy related characteristics. NAD has been available as oral
supplements in capsule form since 1997 in South Africa. An international researcher
ascribes the relative unpopularity of NADH, also applicable to NAD therapy, to its high
cost of around 10,000 dollars per kilogram346. Several laboratories around the world are
currently involved in studies for the development of NAD analogues for therapeutical
applications92. Although NAD is part of all nature and man since creation, NAD Therapy
is relatively new. The chronological course of NAD reveals that it only picked up
momentum since the ground breaking article of Prof Cleary in 1986.
1905 The coenzyme nicotinamide adenine dinucleotide (NAD) is identified

1939 NAD is first used for the treatment of alcoholism
1955 Dr Hoffer uses NAD for the treatment of schizophrenia
1961 Dr OHalleren uses NAD-drips for the treatment of all chemical addictions
1970 The role of the mitochondria in various diseases are outlined
1974 The NAD-drips are registered and manufactured in South Africa for the
treatment of acute and chronic alcoholism
1986 Prof Cleary writes the first article on NAD Deficiency Diseases
1989 Alkogen is founded for the outpatient treatment of all chemical addicts with
NAD-drips In May 2004 the name is changed to Nutrimalaika.
1993 Mitochondrial DNA are identified as mainly maternally inherited
1994 Patients with a variety of disorders are treated at Alkogen with NAD-drips
1997 Alkogen Products manufactures the capsule MultiNAD and other nutritional
supplements containing the metabolic energy cofactors
2000 The Afrikaans edition of this NAD Therapy e-book was published
54
2002 The first edition of this NAD Therapy e-book is published in which more
than 100 disorders relating to NAD Deficiency are discussed
2003 Alkogen Products manufactures the capsule NutriNAD with 50mg pure
NAD replacing the NAD-drips in the Alkogen Products treatment program
2003 Prof Cleary published the first international article on Alkogens NAD
Therapy
2003 Nutrimalaika, the nurses-led centres, is founded for the treatment of infants
and children up to 12 years, old suffering from NED with MalaikaNAD (especially
formulated for children) and NutriNAD supplements.
5.9 SPORT AND NAD THERAPY

"We previously reported that the blood NAD levels are decreased by severe exercise.
College female students exercised moderately with bike-ergometers. The blood NAD
levels elevated after moderate exercise. However, the blood NAD levels decreased after
all-out exercise. The changes in whole blood tryptophan (a precursor of pyridine
nucleotides) levels were similar to that in NAD. The glucose levels in whole blood and
the non-esterified fatty acid levels in serum decreased according to exercising time." 774
The Cori Cycle operates during exercise, when aerobic metabolism in muscle cannot
keep up with energy needs. Glucose synthesized in liver and transported to muscle and
blood. A highly exercising muscle generates a lot of NADH from glycolysis but without
oxygen there is no way to regenerate NAD from the NADH (need NAD!). Lactic acidosis
can and would result from insufficient oxygen (an increase in lactic acid and decrease in
blood pH). So, the NADH is reoxidized by reduction of pyruvate to lactate by enzyme
lactate dehydrogenase. Results in replenishment of NAD for glycolysis. Then the lactate
formed in skeletal muscles during exercise is transported to the liver where it is used for
gluconeogenesis. Lactate is transported through the bloodstream to the liver. Lactate is
oxidized to pyruvate in the liver. Liver lactate dehydrogenase reconverts lactate to
pyruvate since has high NAD/NADH ratio. Pyruvate is used to remake glucose by
gluconeogenesis. Glucose is transported back to the muscles via the bloodstream. 733
55
Biomarkers in NAD Therapy
"This is mitochondrial medicine ... We can fix these blockage but they have to be
understood by competent laboratory work and interpretation... There is nothing
accidental or random... You go to the biochemical substrates and look at them instead of
covering it up with drugs... A rational person will not oppose simple blood and urine
studies for additional study of their case, especially when faced with the possibility of
being on drugs the rest of their lives. A rational person will not feel threatened by this.
When I approach physicians and talk to them, to partner with them to get the tests I want
ordered for a patient, I rarely encounter resistance"674.
Existing blood tests, which are internationally available and in use since 1925, are used
and provide good indicators of a person's biochemical energy level. The two tests, which
are used, are the lactate and pyruvate tests. The person's lactate and pyruvate are
measured in venous blood by pathologists and the results are used to determine three
energy values. The tests can also be conducted on arterial blood, cerebrospinal fluid and
tissue biopsies from affected organs, to obtain more accurate results. The blood tests
are generally available from most pathologists. Prior arrangement must however be
made, to ensure that the required test tubes are available. The large range of normal
values of the tests provides for 95% of the variation in the normal population. The
chance that someone will present with NED, is therefore only 5%. Blood tests, which
were conducted by independent pathologists for Nutrimalaika on more than 2 000
persons with one or the other form of NED or NEDRS, indicate that 87% exhibit a
deviation in respect of one or more of the energy values. This finding is also reported in
the more than 600 scientific articles, which were consulted.
"Concentrations of the energy-related substances lactate, pyruvate, glucose, and
hypoxanthine were measured, and the lactate/pyruvate ratio was calculated".280 "Lactate
and Pyruvate: These two compounds provide useful insight to basic metabolic factors
due to their position in the physical energy production process. Pyruvate is the anaerobic
breakdown product of glucose. Its further conversion to acetyl-CoA requires the pyruvate
dehydrogenase enzyme complex. Pyruvate dehydrogenase requires cofactors derived
from thiamin, riboflavin, niacin, lipoic acid, and pantothenic acid for optimal function."532
"Laboratory studied showed elevated levels of lactate and pyruvate in cerebrospinal fluid
(CSF), without notable elevated levels in serum.643"
6.1 ENERGY VALUES DERIVED FROM THE BLOOD TESTS
The separate measurement of lactate and pyruvate, as well as the ratio between the
two, provide a unique perspective of the energy metabolism, as well as several cues on
how to improve the production of physical energy. In order to make it more
comprehensible, it was transformed into three Energy Values each with a normal value
at 100+. An energy value of 100 (borderline value) only means, that there is enough
physical energy available for an ordinary day. Energy values higher than 100 means that
the person has enough physical energy to engage in new projects or can handle daily
demands more effectively. Most people shy away from new concepts and therefore it
was decided, to refer to it as "energy values", because these are indicators of the NAD
energy production. The debt of chemical energy is visible in cellular, tissue and organ
damage and loss of quality of life over time.
56
Due to the general low physical energy levels of NED patients their blood are collected
in a non fasting state, but the normal range for fasting values are used in the calculations
of the Energy Values. Venous blood samples of more than 3 000 patients with NEDRS
related complaints were collected at Nutrimalaika of which 87% clearly showed an NAD
Energy Deficiency. Follow-up blood tests after 6 week of NAD supplementation showed
an improvement in the average energy blocks of patients from 52 to 81. International
research show that clinical improvement takes up to 12 weeks. Follow-up blood tests are
now only done after 12 weeks of treatment. physical energy is visible in cellular, tissue
and organ damage and loss of quality of life over time.
6.2 ENERGY VALUE I (Lactate to Pyruvate Ratio: Normal Range lower than10)239,
749
This value is an indication of the ratio between the measurements of lactate and
pyruvate, and provides a reliable measurement of the NAD levels in the blood. The
normal value is set at 100+ and values, which are lower than 100, indicate the possibility
of an NAD deficiency. On their own, the two blood measurements might seem to be very
good, but if they are viewed in relation to each other a more reliable indication of the real
availability of physical energy becomes clear.
Formula for Energy Value I (Normal Value is 100+)
Use both of the Pyruvate and Lactate values reflected on the blood test results
Formula: (Pyruvate value x 1000) Lactate value
This formula is based on the following biochemical reaction that continually takes places
in our bodies:
10 x Lactate = 1 x Pyruvate
Energy Value I can be explained better, by comparing it to the concepts of financial

assets and liabilities, and the relationship between the two, which is referred to as
liquidity. Someone could be a millionaire if you look at his assets alone, but if his
liabilities are taken into the equation and it greatly exceed his assets he is actually
technical insolvent. Amongst the almost 3 000 patients, who were tested at Nutrimalaika,
53% deviated in respect of this value. Deficiencies on this value normalises with NAD
supplements.
"Measured enzymatically in blood or CSF as an index of impaired pyruvate

metabolism due to defects of glucose oxidation (fed state) or gluconeogenesis
(fasted). The ratio of lactate to pyruvate reflects the NAD/NADH ratio and is
useful in distinguishing primary defects of pyruvate metabolism from defects of
electron transport (or oxidation).49
Lactate itself is a dead-end metabolite, metabolized only by lactate
dehydrogenase. The extent and direction of that reaction is determined by the
free [NAD]/[NADH][H+] ratio of cytoplasm with which lactate and pyruvate are in
near-equilibrium. Pyruvate is a crossroads of most of the major degradative and
synthetic pathways, but present in about one-tenth the amount of lactate.
Information on the content of both lactate and its redox partner pyruvate is likely
57
to provide more information on the metabolic state of tissue than are

measurements of lactate alone."239
"The accumulation of intermediates reflects the increased lactate-to-pyruvate
ratio; this leads to a secondary imbalance of the nicotinamide adenine
dinucleotide-to-reduced nicotinamide adenine dinucleotide (NAD-to-NADH)
ratio".235
6.2.1 Increased Lactate to Pyruvate Ratio

The lactate to pyruvate ratio proved to be the clinically most useful parameter in the
evaluation and monitoring of mitochondrial diseases, showing higher sensitivity than
lactate measurements only293. One study shows that lactate and pyruvate concentrations
increase slightly at low levels of exercise without a change in lactate to pyruvate ratio
until a threshold work rate at which lactate abruptly increases without pyruvate. The
resulting increase in lactate to pyruvate ratio is progressive as work rate is stepped up
and suddenly reverses when exercise stops297. A normal profile, even after stress and
loading, does not rule out an inborn error of lactate to pyruvate oxidation436.
6.2.2 NAD Deficiency
The coenzyme nicotinamide adenine dinucleotide (NAD) plays a fundamental part in
many enzyme reactions involved in all cellular energy production282. NAD and its
derivatives' NADH, NADP and NADPH have regulatory functions in the generation of
triose phosphates and pyruvate from glucose366. "Measured enzymatically in blood or
CSF as an index of impaired pyruvate metabolism due to defects of glucose oxidation
(fed state) or gluconeogenesis (fasted). The ratio of lactate to pyruvate reflects the
NAD/NADH ratio and is useful in distinguishing primary defects of pyruvate metabolism
from defects of electron transport (or oxidation)49. A higher level of lactate to pyruvate is
characteristic of NAD deficiency265. Low levels of physical energy in cells can play a role
in the development of various diseases. Various factors can provide an explanation for
low levels of energy in cells of which NAD deficiency is one of the major role players51.
6.3 ENERGY VALUE II (Increased or Decreased Pyruvate Level: Normal Range 0.03
to 0.08)
As has already been explained, pyruvate must be converted by various co-factors into
particles, which can be used by the energy factories. If too much pyruvate accumulates,
which usually happens as a result of too few co-factors, or if too little is available,
production of physical energy cannot occur to an adequate extent.
Formula for Energy Value II (Normal Value is 100+)
Use only the Pyruvate value reflected on the blood test results
If Pyruvate Value is between 0 to 0.048 then Pyruvate Value 0.0003
If Pyruvate Value is 0.049 and greater then 8 Pyruvate Value
The metabolic basis for this formula can be oversimplified viewed as follows:
Pyruvate + NAD + CoA -> ATP + H
58
2O + CO2
Pyruvate + NADH -> Lactate +NAD
Deviations in respect of this value is like having money in the bank, but not being able to
withdraw it for use. Amongst the approximate 2 000 patients, who have already been
tested at Nutrimalaika, 54% showed deviations and 12% had borderline values.
Research indicates, that various pathological conditions are in particular associated with
increased levels of pyruvate. Low Energy Values II normalises with NAD and co-factor
supplementation.
6.3.1 Increased Pyruvate Level
Increased blood pyruvate levels are reported in several disorders, including liver
disease, congestive heart failure, diabetes mellitus, muscular dystrophy, thiamine
deficiency, and various tumorous disorders281. Elevated levels of pyruvate may reflect a
failure of the enzyme due to a functional need for cofactors derived from thiamin,
riboflavin, niacin, lipoic acid, and pantothenic acid for optimal function. Levels of
pyruvate in the tissues are further controlled by the biotin-containing protein, pyruvate
carboxylase, which controls the first step in the reformation of glucose from pyruvate.
Multiple forms of pyruvate carboxylase deficiency, some of which are biotin responsive,
have been reported278, 532.
6.3.2 Decreased Pyruvate Level
Low pyruvate levels indicate an accumulation of NADH and probably reflect severe
mitochondrial dysfunction279.
6.4 ENERGY VALUE III (Increased or Decreased Lactate Level: Normal Range 0.50
to 2.20)
This value indicates, that there is too much or too little lactate in the blood. The normal
value is again set at 100+.
Formula for Energy Value III (Normal Value is 100+)
Use only the Lactate value reflected on the blood test results
If Lactate Value is between 0 to 1.00 then Lactate Value 0.005
If Lactate Value is 1.01 and greater then 220 Lactate Value
This formula is based on the following biochemical reaction that continually takes places
in our bodies:
Lactate + NAD -> Pyruvate + NADH
Lactate accumulates as a result of many factors, amongst others exhaustion as a result
of activity or other causes. Too little lactate creates problems in respect of physical
energy for the organs, which use it as a source of energy. Lactate + NAD is converted
into Pyruvate + NADH. Research indicates that various pathological conditions are
59
associated in particular with increased levels of lactate. Amongst the approximately 2

000 patients, who were tested at Nutrimalaika, only 16% suffered from deviations in
respect of this value. Low Energy Values III normalises with NAD and cofactor
supplementation.
6.4.1 Increased Lactate Level
"Lactic acidosis in infants is a serious emergency. The vast majority of cases have an
acquired cause. These include IV glucose given to a newborn; shock, even hypoxia,
from different causes; infectious and parainfectious causes (e.g., sepsis even without
shock, bacterial meningitis, urinary tract infection with the lactate-producing bacterium
Enterobacter cloacae, Reye syndrome); poisoning by salicylates; seizures (seizures lead
to increase in CNS lactic acid that results in increase in systemic lactic acid as in
patients with bacterial meningitis); liver failure; and short gut syndrome."750 Symptoms
associated with inherited form of lactic acidosis is: episodic lactic acidosis from early
infancy, failure to thrive, and hypotonia with or without features that may suggest specific
defects.
Lactic acidosis is associated with both inherited and acquired metabolic diseases. Lactic
acid metabolism in the presence of altered gluconeogenesis, anaerobic glycolysis, and
acid-base balance is a major factor in many disorders. Lactic acid can be formed only
from pyruvic acid; therefore, disorders that increase pyruvate concentration, enhance
lactic acid formation, or reduce lactic acid degradation cause lactic acidosis. Inborn
metabolic errors that are accompanied by derangement of metabolic pathways of
glucose, pyruvate, amino acids, and organic acids as well as toxic and systemic
conditions that promote tissue hypoxia or mitochondrial injury result in lactic acidosis.536
"Patients exhibiting a disorder of lactate metabolism suffer a high hospital mortality rate
and are at risk for developing multiple organ failure. The mortality rate of critically ill
patients with a blood lactate level greater than 5 mmol/L and an arterial pH less than
7.35 is 75% at 6 months."751
To date, no therapy specifically designed to lower arterial blood lactate levels has
reduced mortality significantly541. Lactate accumulates when there is a block in the final
oxidative phosphorylation stage of energy production. Such a block results in the
inactivation of the Krebs cycle. Increased lactate is a common condition that can be
caused by a variety of metabolic problems532. The ability of the mitochondria to oxidize
substrates and generate energy is integral to normal homeostasis and to the ability of
cells to survive in the face of impending energy failure. Lactic acidosis is a common and
readily visible biochemical marker for mitochondrial dysfunction. Lactic acidosis
represents only the most obvious example in which acquired or congenital abnormalities
of mitochondrial energy generation contribute to the expression of a broad spectrum of
clinical disorders360.
Research findings suggest that elevated CSF lactate levels reflect the severity of
metabolic impairment of the brain301. Disorders of the mitochondrial energy production
can manifest in many tissues and may lead to various types of diseases. Since defects
can occur on many sites of the oxidative phosphorylation system, molecular diagnosis
can be difficult. Lactate measured in various body fluids is still the best selective
screening parameter503.
60
Acute lactic acidosis may actually present with no clinical symptoms or be manifest by a
variety of non-specific symptoms such as fatigue, confusion, stupor, and coma.
Respiratory collapse and shock may occur632. Numerous specific disorders affect
oxidative metabolism. Lactate elevation frequently occurs and additional laboratory
abnormalities often assist in focussing investigation. Diagnostic specificity may require,
besides the blood and urine studies, tissue sampling, cerebral imaging, in vivo studies of
tissue energetics, or molecular genetic analysis363.
"However, either lactate overproduction or impaired elimination alone is insufficient to
explain the development of lactic acidosis, because the liver has a large capacity to
eliminate lactate via gluconeogenesis and oxidation, some patients with lactic acidosis
have minimal or no liver metastasis, many with widespread liver metastasis or serious
liver disease rarely develop lactic acidosis, the kidney is able to excrete about one third
of lactic acid and, moreover, in one study, lactate overproduction by tumor cells was not
demonstrated."707
"Infant patients with "cerebral lactic acidosis" show neurological symptoms, elevated
levels of lactate in CSF, little or no systemic acidosis and levels of lactate in blood so
slightly elevated that they would be overlooked. Lactate elevation confined to CSF and
brain has been described in biotinidase deficiency and in some mitochondriopathies."727
6.4.2 Lactate Induced Sensitivity
Lactate infusion is currently the most universally studied of the pharmacological
challenge tests in panic disorder. Analysis of lactate infusion studies to date suggests
that patients susceptible to panic attacks are much more sensitive to lactate than are
healthy controls or patients with other psychiatric disorders without panic attacks311.
Sodium lactate infusions induce panic attacks in patients with panic disorder, but not in
control groups. Late panickers had significantly elevated baseline cortisol levels445.
Significant predictors of lactate-induced panic were prelactate infusion fear and the
interaction of high cortisol levels and low hyperventilation levels444. Prolactin levels
increased in all groups during lactate infusion. The elevated baseline prolactin for male
panickers supports a relationship between prolactin and anticipatory anxiety446. Lactateinduced panic was associated with significant blood flow increases bilaterally in the
temporal poles; bilaterally in insular cortex, claustrum, or lateral putamen; bilaterally in or
near the superior colliculus; and in or near the left anterior cerebellar vermis450.
6.4.3 Decreased Lactate Level
Decreased lactate is seen in people with very little physical activity. Highly trained
athletes have such efficient conversion of lactate to pyruvate that they also display lower
lactate levels278.
61
6.5 THE ENERGY BLOCK: (Lowest Value of Energy Values I, II or III)

When looking at the energy blocks of the almost 2 000 patients, who have already been
tested at Nutrimalaika, one sees that as many as 87% had problems with one or more of
the energy values. A further 5% had borderline values of 100.
Energy Block (Normal Value is 100+)
Lowest Value of Energy Value I, Energy Value II or Energy Value III
Elevations in lactate and pyruvate are markers for a variety of metabolic blocks278.
Production of physical energy in cells consists of several biochemical processes. The
cellular production of energy is possibly only as effective as indicated by the energy
block, because the processes take place in interdependent cycles. The energy block
indicates the lowest of the three energy values and what might be the reason for the
chronic fatigue or the problem for which help is sought. It is, for example, like a watch
which consists of several gears. If one of the gears malfunctions, it however affects the
functioning of the entire watch negatively. When looking at the energy blocks of the
almost 2 000 patients, who have already been tested at Nutrimalaika, one sees that as
many as 87% had problems with one or more of the energy values. A further 5% had
borderline values of 100
6.6 NOTES
These tests reflect the physical energy values in the venous blood. It is more accurate in
arterial blood, cerebrospinal fluid and the effected tissue. In case of substance abuse or
use of pain killers the physical energy values are falsely increased and more accurate
values will be available after 6 weeks of use of supplementation. NAD supplementation
only shows clinical improvement after 4-12 weeks of treatment. Repeat the blood tests
after 12 weeks to determine the maintenance supplementation program.
62
Clinical Roots of NAD Therapy: Alkogen Treatment Centre
Alkogen Treatment Network was an officially registered private treatment network

consisting of a multiprofessional group of private practitioners using NAD Therapy in
treating NEDRS sufferers regardless of race, gender or age. Alkogen Treatment
Network was the first centre in South Africa to use NAD Therapy on an outpatient basis
to people suffering from NED. The oral nutritional supplements NutriNAD, MalaikaNAD,
MultiNAD, EmCegene Forte, GeneClear and GeneSlim were specifically developed in
collaboration with leading clinicians to facilitate NAD Therapy. These supplements are
also exported to and prescribed and dispensed by international private practitioners.
Alkogen Treatment Network had treated people from all over the globe but especially in
South Africa. Many practitioners also referred patients for evaluation and programme
formulation, and then continued with the treatment in collaboration with their local
resources. As a result many practitioners and centres across the country collaborated
with Alkogen Treatment Network in terms of treatment. Since 1989 - 2004 more than 7
000 patients and their relatives had been benefiting from their individualised treatment
programmes at Alkogen Treatment Network.
"The needs of people with chronic conditions are fundamentally different from
those of other individuals. Chronic diseases are multidimensional,
interdependent, disabling, interpersonal, and ongoing. Unfortunately, our current
healthcare environment defies the logic of these characteristics. We are not
multidimensional; we are highly specialized. We are not interdependent; we are
highly fragmented. We focus more on disease than we do on disability. We
frequently ignore the benefits of interpersonal relations. And we respond to the
crisis of the moment, not to the ongoing nature of chronic conditions"582.
At Alkogen Treatment Network the application of NAD Therapy was based on the results
of recognised and accredited medical, psychological, nursing, pastoral and dietary
evaluations supported by findings from research. Providing NAD Therapy within the
centre ensures the availability of both the most advanced conventional treatment and
care as well as accurate information and guidance with regard to NAD Therapy. This
service allows the patient and the multiprofessional network of practitioners to focus not
only on the patient's physical symptoms, but also on his or her overall quality of life. NAD
Therapy ensures that most of the patients can be reintegrated successfully into their
community, without expensive hospitalisation, examinations and medication. It actually
entails more than treatment and is better seen as an energy management approach
based on behavioural-genetic principals adhered to by both the practitioners and the
patients.
"Of the 503 respondents, 82 (16%) had considered utilizing alternative therapy
for cancer after a diagnosis was made. Most respondents were moderately
familiar with alternative therapy, such as nutrition therapy (59%), herbal therapy
(63%), and acupuncture (62%). Only 6% of respondents actually saw a provider
of alternative therapies; providers were most frequently nutritionists, counsellors,
herbalists, and massage therapists. The user patient profile clearly indicates that
usage is highest in patients with a diagnosis of at least 1 year. Seventy-five
percent reported that they would prefer to receive a referral from their doctors,
while 20% would prefer to use a telephone referral line. Two thirds of patients felt
63
that alternative care providers should be encouraged by the medical profession,

and 85% indicated that alternative care should be offered at the cancer center as
part of oncology treatment".808
7.1 ALKOGEN TREATMENT NETWORK AND THE MEDIA
Alkogen Treatment Network has featured in more than 60 national articles and radio
interviews, and has even received coverage on a well-known Sunday evening currentaffairs programme on an international TV channel. Two examples are printed here:
"The truth of the matter is that many of our most competent and gifted people drinks.
And most of them drink because of a genetic (hereditary) biochemical predisposition in
their brains, and as an attempt to escape from the nagging depressive and negative
feelings (which the rest of us don't have!) that they experience... Alkogen Treatment
Network is doing sterling work in this regard... thank God for the major breakthroughs in
this important field!"660
"We trust that the Lord will bless you (Alkogen Treatment Network) and use you,
especially in a country such as ours where people are sometimes hesitant to seek
advice, because they believe that it is a disgrace... The Lord makes available people
with the necessary training, expertise and skill, and you should not hesitate to contact
these people (Alkogen Treatment Network)".661
7.2 THE BEHAVIOURAL-GENETIC APPROACH
Behavioural genetics, i.e. the science that studies the interaction between environmental
factors and genetic factors, has already become well-established and the findings from
research can no longer be ignored or denied. The findings are incorporated on all levels
of treatment, for the patient's benefit. Up to 40% of the variation during metabolic resting,
the thermal effect of food and the allocation of energy during a low or average level of
exercising can be attributed to genetic characteristics33. Researchers found in their study
of 216 identical twins and 144 non-identical twins, that genetic factors played a
significant role in events during a lifetime, which cannot be linked to the person's will20. It
is important to bear in mind, that the presence of heredity in respect of a characteristic
does not mean that it cannot be modulated. Myopia is a good example of an inheritable
characteristic, which can nevertheless be modulated. On the other hand, this means that
a strong environmental component (for example parentage) cannot be changed
easily192.
7.3 GENERAL TREATMENT CONSIDERATIONS
Irrespective of the treatment discipline or approach there are a few general factors that
are mutual to all disciplines. If neglected all treatment efforts will most probably be just
superfluous and of no real benefit to the patient. Experience has shown that when
teaching patients, healthcare providers concentrate more on information concerning the
illness rather than to help patients learn to manage their own treatment628.
"National survey data do not support the view that use of CAM therapy in the
United States primarily reflects dissatisfaction with conventional care. Adults who
use both appear to value both and tend to be less concerned about their medical
64
doctor's disapproval than about their doctor's inability to understand or

incorporate CAM therapy use within the context of their medical management."814
7.3.1 Diagnosis
Most of the patients that were referred to Alkogen arrived with confirmed diagnoses
made by medical practitioners, including medical specialists. These diagnoses excluded
any laboratory tests regarding energy metabolic deficiencies and this were requested
from the major laboratories in South Africa.
The differential diagnosis of chronic fatigue (as an example of NED) is extensive and
includes medical disorders, altered physiological states (e.g., pregnancy, exertion),
psychiatric disorders, lifestyle derangements, drugs, and controversial entities (e.g.,
chronic candidiasis, food allergies, environmental illness, and chronic fatigue syndrome).
The most common diagnoses are psychiatric disorders, including mood, anxiety, and
somatoform disorders. A comprehensive approach to diagnosis and management is
necessary, including structured psychiatric interviewing, functional assessment, and
elicitation of the patient's diagnostic beliefs. Patients often believe they are suffering from
an organic medical disorder (e.g., viral or immunological) and resist psychiatric labelling
of their symptoms and referral to mental health practitioners602, 603, 605. Patients with
fatigue reported more medically unexplained physical symptoms, greater perceived
stress, more pathological symptom attributions, and greater worries about having
emotional problems than did other patients606.
7.3.2 Non-compliance
Non-compliance is higher in chronic conditions, in activities requiring change in life-style,
and in clinician-initiated visits. Non-comprehension of instructions is held to be the most
frequent cause of non-compliance. Non-compliance is a threat to the course of
treatment, increases unnecessary diagnostic procedures, and complicates evaluation of
effectiveness576. Evidence from compliance research shows that digressions from the
prescribed treatment is the rule rather than the exception578. Clinical features such as
positive symptoms are associated with non-compliance but the strongest clinical
relationship is with a "dual diagnosis", usually with an associated alcohol abuse.
Patients' and relatives' beliefs about the disorder and about medication are of
considerable importance in determining compliance, and can be understood in terms of
the treatment paradigm. The costs of poor compliance to sufferers and to society alike
are considerable, and effective ways of improving it are a crucial part of good
management579.
7.3.3 Involvement of Family Members
After having lived for many years with someone who suffers from NED, companions and
others who are involved adapt to the person's condition, often referred to as codependency. As soon as the recovery has started, they must adapt again and often find
this difficult to accomplish. Treatment is furthermore hindered, because those who are
involved often suffer from similar conditions, which in turn require treatment. Clinical data
at Alkogen Treatment Network shows that NED runs in families and that most family
members are also suffering from NED, most oftenly as co-dependency. It means that the
treatment professional cannot really rely on the loved ones of the identified patients to
65
cooperate fully, without addressing the loved ones' NED. Research indicates that people
choose companions who are similar to themselves. This is referred to as assortative
mating. Assortative mating can be defined as the process of choosing a mate on the
basis of characteristics that are shared by both partners14, 148, 147, 75, 78, 85, 109, 201.
7.4 MEDICAL MANAGEMENT
A base-line assessment was established during the first interview. Relevant special
examinations were arranged if deemed necessary. If no contra-indications were found,
the physician issued a prescription for NAD Therapy and the supporting medication, as
was determined clinically and based on the calculated energy levels per the blood tests.
Supporting medication was initially only prescribed for the first week and renewed at the
follow-up visits. The frequency of follow-up visits, in the case of acute patients was also
determined by the physician. If there were medical reasons for hospitalisation or other
interventions, the physician arranged it in consultation with the rest of the practitioners.
Medication, which was being abused at the time, were phased out in time and this was
explained to the patient. The consulting physician monitored and adjusted conventional
medication prescribed for the specific disorder in accordance with the improvement on
the initiated NAD Therapy.
"The public's increasing use of complementary and alternative medicine (CAM)

poses unique challenges for primary care physicians in knowledge and patient
communication. The objective of our study was to assess Alberta family
physicians' interest in CAM information and the type of information sources they
currently use. Response rate was 34% (n = 346). Physicians indicated having
limited knowledge of CAM, but were interested in evidence-based CAM
information such as randomized controlled trials and systematic reviews on
acupuncture, herbal medicine, massage, chiropractic treatment and meditation.
Most respondents did not make use of reliable information sources that are
available on the Internet."809
"Responses were obtained from 149 GPs (40% response rate after one
reminder) and 24 nurses and 32 other primary care team members. One hundred
and seventy-one (83%) respondents had previously referred (or influenced
referral) for CAM treatments, the main reasons cited were: patients request
(68%), conventional treatments failed (58%) and evidence (36%) (more than one
reason could be given). Only 12 respondents (6%) were against any integration
of CAM in mainstream primary care. Most respondents felt that CAM therapies
should be provided by doctors (66%) or other health professionals trained in
CAM (82%). Twenty-six percent of respondents agreed with provision of CAM by
non-state-registered practitioners. It was felt that the integration of CAM could
lead to cost savings (70%), particularly in conditions involving pain, but also cost
increases (55%) particularly in 'poorly defined conditions'."815
"The results of major surveys show that there is an increase in the use of
complementary and alternative medicine (CAM) in the United States. The best
predictor of CAM use is higher level of education. Currently, more than 70
medical schools offer some type of training in alternative medicine. As patients
have greater access to information, their needs and values change. They
become more involved in their overall health care and are taking a more natural
and holistic approach to achieving well-being. Physicians need to be familiar
with proven CAM therapies in order to advise patients about these modalities and
66
the potential benefits and limitations. CAM practitioners should be licensed and
regulated in scope of practice to provide a high standard of care, and be
sufficiently educated in conventional medical science(s) in order to recognize
how, where, and why their respective complementary practice is most effective
for integration."816
"Female physicians, particularly those who were especially health conscious or at
higher risk of heart disease or osteoporosis, used supplements at rates at least
equal to those of women in the general population. Half of the physicians took a
multivitamin-mineral supplement; 35.5% of these did so regularly. However,
</=33% took any supplement other than calcium and <20% did so regularly.
Regular vitamin-mineral supplement use increased with age, and antioxidant
intake was higher in those at high risk of heart disease. Those with a history of
osteoporosis were nearly 3 times as likely as those with no history to take
supplemental calcium regularly. Those who took any supplement regularly also
consumed more fruit and vegetables daily than did occasional users or
nonusers."818
7.4.1 Supporting Medication

Additional prescription medicine is normally in the form of thioridazine (10 mg) and
clonidine (0.025 mg), which the patient keeps at hand with his nutriceutical supplements
and which can be used regularly during the day. Clinical practitioners found, that
clonidine can be prescribed for use as often as six times or more per day, to deal with
withdrawal from substances or other addictions. Research indicates, that thioridazine
helps to recycle the NAD in the body. A dopamine blocker, like flupenthixol (0.025 mg)
can be added for persons, who suffer from serious anxiety. Chlordiazepoxide (5 mg) can
be used for a short period. Zopiclone (for dealing with sleeping problems) can also be
used for short periods. In the case of drug abuse and abuse of prescribed agents, it is
recommended that bromocriptine must be used in the morning and afternoon. In
instances of serious aggression, 50mg carbamazepine must be started immediately.
Supporting medication normally consists of clonidine (0,025 mg), which the patient
carries on his person and uses during the course of the day. Clonidine can be prescribed
up to and as often as six times or more per day for dealing with withdrawal from a
substance340. Clonidine is recommended for treating other forms of dependency.
Clonidine blocked lactate-induced panic in four of ten subjects, a significant effect412.
Clonidine has been found useful in the treatment of obsessive-compulsive behaviour,
anxiety, panic attacks, phobias, mania, memory defects, schizophrenia and narcolepsy...
The major side effect of clonidine is tiredness or a feeling of being sedated. Fortunately,
this is often short-lived and usually disappears by the end of the first week or
two"58.Clonidine produced significantly greater decrements in anxiety within one hour in
the patients with panic disorder than in the controls413.
A dopamine blocker, like thioridazine (10 mg) or flupentixol (0,25 mg), can be added.
"The effect of the phenothiazines, thioridazine and chlorpromazine, on the increased
hepatic NAD level of rats fed clofibrate, a hypolipidaemic drug, has been investigated.
Short-term (6 days) addition of phenothiazines to the diet negatively affected diet intake
and body-weight gain, but increased liver weight and hepatic NAD levels... In the
hepatocytes, NAD was maintained at the high level until the phenothiazine concentration
was increased to 0.2 Mm".656 "Phenothiazine therapy brings about cognitive restoration -
67
with a decrease in psychotic thinking, projection, suspiciousness, perplexity, and ideas

of reference - and a normalization of psychomotor behaviour in both retarded and
hyperactive patients"657. "Mellaril or other major tranquillizers with minimal side effects
can be used to relieve neurotic anxiety or psychotic symptoms. Drug abusers tend to
have a very low tolerance for the side effects of phenothiazines. They also dislike the
noneuphoric effects of these drugs. When patients can be persuaded to take them
regularly, they can be very helpful"115.
7.5 NURSING MANAGEMENT
The nursing sister forms the pivotal core of the solution to the almost insurmountable
problems our society faces in caring for the chronically ill of all ages. Alkogen Treatment
Network Nurses-led Centres provide excellent care and guidance of NED and NAD
Therapy to young mothers and their small children, families, adults and the elderly who
suffers to get along as best they can with the strengths they have. The nursing sister is
the essential consultant in NAD Therapy and the integrated model of energy metabolic
management of the patients programme, patients family, community, and employers.
The principal concerns of the nursing consultation are patient advocacy and delivery of
safe, optimal nutriceutical nursing care. The nursing programme starts with the collection
of blood samples for despatching to the pathologists for analysis and determination of
the metabolic NED indicators.
Prior to administration of the nutriceutical supplements, nursing sisters must be
knowledgeable of indications, actions, use, side-effects, and adverse reactions
associated with the supplements. The nursing sister must be competent in nursing
interventions and their implementation. The nursing sister is accountable for achieving
effective implementation of the NAD Therapy, and for evaluating and documenting
deviations from an expected outcome, including the implementation of corrective action.
Patient support requires that the nursing sister act in the best interest of the patient.
Professional autonomy requires that the nursing sister practise within the defined scope
of nursing practice.
The nursing sister provides monitoring, supervision, routine quality control, and expertise
regarding nutriceutical supplements and procedures. Assessment is based on
knowledge, experience, and observation. Observations include patient status and review
and interpretation of data. Assessment should be documented and communicated to
other members of the healthcare team. Monitoring optimizes the benefits related to NAD
Therapy. Monitoring of the patient include clinical data, patient response and compliance
to the NAD Therapy.
Comprehensive patient education is the key factor in the delivery of NAD Therapy in the
outpatient setting. The nursing sister should build a comprehensive education program
for the NED patient population based on the patients and/or caregivers physical and
mental capabilities; ability, desire, and demonstrated participation in care; education and
support of family and significant others; introductions and descriptions of roles and
responsibilities of other treatment professionals involved in the patient's care; record
keeping required of the patient and significant others; and proper use, care, storage, and
disposal of all products and equipment used in the patient's treatment.
68
"She must furthermore also determine from the patient, whether he is indeed using the
medication. Some of them feel that they do not really have to drink it, like the doctor
prescribed. The nursing sister must provide some information on the treatment, arrange
appointments and so forth. I think, that the nursing sister is responsible for the patient,
during almost 99% of the time, during which the patient is with us. Then, if all goes well,
she ensures that he will see the clinical psychologist, behavioural geneticist and
dietician. She will put the patient at ease, by letting him feel that he is being cared for"34.
The patient is also informed about, and encouraged to use, prescribed medication. In the
case of re-entering NAD Therapy after relapses a history of medications used must first
be obtained, in order to determine whether the patient indeed used the medication,
followed the dosage and maintained the usage intervals340.
"With an ever-increasing number of consumers reportedly using nonconventional methods of disease management, nurses have now been
recognized as key providers in education on complimentary and alternative
medicine (CAM). The risk of herb-drug interactions secondary to consumer use
of alternative medicines further increases the need for nurses to assume the role
of patient educators in the area of CAM. Many nurses, however, feel rather illprepared to properly care for patients using CAM due to inadequate instruction
on the subject matter during their training. A survey questioning CAM education
was administered to 148 nursing schools and collected over a 3-month period.
The results indicate that nearly half of the responding schools offered some form
of education on CAM in their curriculum with electives being the primary form of
instruction."811
7.6 DIETARY MANAGEMENT

"Diet-therapy represents an elective approach to the treatment of several inborn errors of
metabolism. According to the type of disease, dietary intervention can be addressed to
three different goals: a) dietary restriction (global or partial) of one or more nutritional
components that become "toxic" because of the occurring enzymatic defect; b)
supplementation with a given defective nutritional component; c) elimination through the
use of diet and drugs of the accumulated "toxic" compounds. These interventions are
aimed at bypassing the metabolic block and to avoid the accumulation of intermediate
"toxic" substrates"596.
"Diet therapies promoted for the relief of CFS symptoms by the authors of five CSF selfhelp books were evaluated on the basis of nutritional adequacy and scientific rationale.
Unproven diet therapies for patients with CFS include megavitamin/mineral
supplements; royal jelly and other dietary supplements; and elimination, avoidance, and
rotation diets. Claims that these therapies relieve CFS symptoms and promote recovery
are anecdotal and have not been substantiated by clinical research. The yeastavoidance and sugar-free diets, both promoted to combat Candida Albicans overgrowth,
are of questionable value in treating patients with CFS. The rotation diet is not balanced
and does not meet the current recommended dietary intake levels. Diet strategies that
call for the avoidance of food additives, preservatives, sweeteners, and other ingredients
are not supported by available evidence and are not practical for patients with CFS. A
diet plan for patients with CFS should be based on sound nutritional principles and
common sense"519.
69
"More than 900 dietitians in the state of Washington were surveyed to determine
their personal patterns of dietary supplementation. Seventy-five percent of the
population responded; of the respondents, nearly 60% reported the use of some
nutritional supplement. The most commonly used supplements were
multivitamins plus minerals and vitamin C only, with 21% and 19% of the
population choosing these supplementation patterns, respectively. Among
subgroups of the population, supplement use was most common among
pregnant and lactating women and underweight individuals. It is clear that many
dietitians have chosen to utilize some nutritional supplement for personal
health."820
7.7 PSYCHOLOGICAL MANAGEMENT

The role of the psychologist could be compared to that of a conductor of a large
orchestra. In other words, it is all about rendering important psychotherapeutic input, but
also harmonising, synchronising and making NAD Therapy part of the daily lives of the
patient and his loved ones. The persons must be enabled to continue with their lives with
dignity and independence.
The primary purpose of psychological treatment in NAD Therapy is to therapeutically
guide the sufferer of NED, so that he grows into a mature and independent person. The
characteristics of a psychologically healthy person, amongst other things, includes the
person's utilisation of energy. Healthy adaptation is the effective utilisation of energy
without wasting any. The psychologically healthy person has a low level of fear, not
many worries and few emotional conflicts that require energy. The available energy can
therefore be utilised to achieve the set objectives. Furthermore, the person depends little
on ego defence-mechanisms and thus does not use energy in order to maintain it and
therefore available energy can be channelled into appropriate behaviour233.
"Respondents to a mail survey of a random sample (N = 424) of Clinical

Members of the American Association for Marriage and Family Therapy provided
information about their contexts of practice, use of complementary and
alternative medicine (CAM), and relationships with CAM providers. Consistent
with both national trends and the experience of psychologists as reported in a
similar survey, the results of this survey suggest that marriage and family
therapists have been affected significantly by and have a growing awareness of
CAM practices."817
7.8 PASTORAL MANAGEMENT

The practice of pastoral counsellors is not well understood by most health professionals,
although evidence suggests that advantages can be gained by increasing the interaction
between the two groups508. Spirituality is an important aspect of health care that is not
often addressed in primary medical practice. Controversy surrounds the role of spiritual
issues in medical practice. Some of this originates from confusing spirituality with
religion511. Spiritual healing is accepted by only 5% of the surveyed general practitioners
70
in Australia507. Clinical intervention that would increase a patient's level of spiritual

awareness and his or her level of comfort associated with a personal perspective on
disease could help decrease the patient's level of psychosocial distress. Despite the
medical establishment's bias to the contrary, religion and spirituality are positively
associated with both physical and mental health461.
"While the growth in usage and practice of varying forms of complementary and
alternative medicine (CAM) continues apace, social science has increasingly
turned to CAM's often individualistic approach to health and illness. CAM has
been perceived as both partly a cause of and a response to the well-documented
ideology in modern healthcare of 'individual responsibility for health'. This
occasionally manifests in a 'victim-blaming' ideology amongst both orthodox and
CAM practitioners alike. These issues emerged as key themes in an
ethnographic study of a Centre for spiritual healing in the North of England."821
7.9 PHARMACEUTICAL MANAGEMENT

Psychopharmacological developments ensure that a constant stream of new medication
is introduced, which could be to the benefit of those who suffer from NED. Although a
variety of pharmacological agents has been used to treat patients with chronic fatigue
syndrome none has been shown to effect a complete resolution of symptoms. Data
obtained from studies suggest that the underlying pathophysiological abnormality is a
disorder of sleep regulation. This results not only in profound fatigue and lethargy but
also reduced sensory threshold for pain, disordered temperature regulation,
cardiovascular abnormalities, disturbed higher cerebral function and mental
depression526.
"Four hundred eighty-four responses were received, with 77% of respondents

indicating that they had personally used CAM and 60% correctly identifying that
CAM was comprised of more than just botanicals and nutritional agents. The
most commonly used CAMs were herbal and vitamin supplements (74%), which
was significantly above use of the next most frequent CAM, massage therapy
(6%). Most pharmacists (71%) reported offering CAM products for sale; however,
27% of these practices did not have access to CAM information for pharmacy
staff or patients. Pharmacists generally viewed CAM positively and believed that
they enhanced the customers' image of pharmacy (57%), increased customer
numbers (87%), and could increase annual sales (72%). Ninety-one percent of
respondents believed that it is necessary for pharmacists to have knowledge of
both CAM and conventional medicine to be able to inform patients about their
treatment options."810
7.10 MANAGEMENT OF CHILDRENS PROGRAMME

"Children are our future, they are our best hope, their suffering our worst fear. Our
actions can help or hinder their development. With the resources that the world has at
hand, it is possible to break the cycles of poverty and disease." (Nelson Mandela). Many
children under the age of 12 years depend on multiple sources of care, and they rely on
school personnel as important sources of health information. Many parents do not know
where they could go for confidential services or for other services their children may
need553. Society is failing to meet the developmental needs of its young children. Social
71
and cultural changes have created an urgent need for interventions that promote healthy
development in young children struggling with role ambiguity, the breakdown of family
and social support networks, and a future that seems vague or even absent556.
NED is a major causative factor in the presenting disorders for which children need help.
Some of the presenting disorders include academic stress (concentration problems,
reading problems), autism, eating disorders, bed wetting, sexual problems, dyslexia,
asthma, attention-deficit-hyperactivity disorder, Tourette syndrome, violence addiction,
chronic fatigue syndrome and various others. One South African study found a niacin
deficiency (a major precursor of NAD) of 4% amongst white, 12% amongst Indian and
28% amongst black pupils213. In general, health care programmes do not achieve the
goal of collaborative, coordinated, and integrative services to young children with chronic
or disabling conditions552
"The use of vitamin and mineral supplements by children and teenagers in

NHANES II was examined for relationships with demographic variables, dietary
intakes from food, and biochemical measures of nutritional status and was
compared with use reported in other nutrition studies. The number of regular
supplement users decreased with age until about age 13, when the percentage
of boys using supplements plateaued at about 10% but the percentage of use
among girls increased. In general, children were more likely to receive
supplements if they came from families with a household head who was white
and better educated."813
"More than half of all US 3-year-olds (54.4%) were given some vitamin and
mineral supplement. The most common supplements consumed were
multivitamin-mineral with iron (59% of supplement users) and multivitaminmineral without iron (26.4%). Children who received any supplements tended to
have mothers who are non-Hispanic White, older, more educated, married,
insured, receiving care from a private health care provider, have greater
household income, and took supplements during pregnancy. Child health
characteristics associated with supplement use included first birth order and
having eating problems or poor appetites."819
7.11 SELFHELP APPROACH

Regarding the selfhelp approach to NAD Therapy Alkogen Treatment Network
wholeheartedly subscribes to the following statement by Dr Abram Hoffer (on his official
website): "No one should take any supplements until they have become familiar with
their properties and how to use them. It is advisable always to work with a
knowledgeable physician. But if they can not find any physician or orthomolecular
nutritionist they should go ahead on their own using the information now readily available
on nutrition and vitamin supplements. They should advise their doctors what they are
doing and which supplements they are using. By listing the vitamins and dose ranges I
am not suggesting that every person need to take them all. This is an individual matter
based on discussions with their doctor. The vitamin and mineral supplements are
compatible with medication and with the diet". (Dr Abram Hoffer)
"Over half of U.S. adults use vitamin or mineral supplements, and some are likely
using supplements to treat chronic diseases or risk factors for disease.
Information on the relationship between supplement use and medical conditions
72
is useful to health professionals to understand the self-medication behaviour of

their patients, and important for researchers because medical conditions may be
potential confounding factors in observational studies of supplement use and
disease risk. Supplement use (mean number used at least once a week) was
higher among respondents who were older, female, highly educated, Caucasian,
and of normal body mass index. For several conditions, the relative odds of using
specific supplements were consistently higher for men than for women.
Supplement use was associated with many medical conditions in this cohort."812
73
NAD Therapy Outcome: Renewed Life?

"For many years, Dr. Maltz had a flourishing practice as a reconstructive and cosmetic
facial surgeon. He was inspired to move from treating "outer scars" to "inner scars" after
observing that so many patients' unhappiness and insecurities were not cured, as they
and he had believed would occur when he gave them the perfect new faces they
desired. Dr. Maltz first wrote of this discovery in his book "New Faces, New Futures." In
this groundbreaking book, Dr. Maltz suggested that many people "see themselves"
inaccurately, their perceptions distorted by unchallenged and often erroneous beliefs
imbedded in the subconscious mind."768 In line with this phenomenal work we can view
the success of NAD Therapy in a similar light, the psychological consequences of NED
lasts longer and outshine for some time the beneficial effects of a renewed and
energized body by NAD Therapy. "No man having drunk old wine immediately desires
new, for he says, 'The old is better." (Luke 5:39).
"I also want to tell you about the child, both children. The mother has two children, a son
and a daughter. A neurologist diagnosed the little girl as suffering from Tourette's
syndrome, for a long time. She does not suffer from the full extent of the syndrome. The
little girl was held back for a year at school, because she did not perform well. She did
not perform well, in spite of the fact that she had been a dedicated pupil, since she is
hyperactive. In any event, the other day we gave her the capsules with magnesium.
After her mother had arrived at home (her daughter was going to write a history paper
the following day), she asked her to come over, so that she could test her. She was
amazed. She could not believe that her child had overcome the problem - her daughter
knew her history! She had been using the capsules for approximately a week. At this
stage, she has not yet noticed such a marked difference in the little boy. Perhaps one
has to add other medication. The little boy is however calmer. He immediately stopped
twitching his eye. His face was always contorted and it was very distracting when he
pulled his little face in this way. The only thing that he is still doing, is to clear his
throat"162.
The success of any treatment is determined by various factors, like the nature, etiology,
extend and type of disorder that has to be dealt with. Previous treatment efforts also
affects the success of the current treatment. The cost of the treatment is another
important factor, as is the patient's ability to pay for the service. The patient's perception
of his disorder and frame of reference also determine the treatment's success. The same
applies to the theoretical approach and frame of reference of the persons, who provide
support and health professionals. Some of these factors will be discussed in greater
detail.
Current treatments for NED are symptom-based, with psychological, pharmacological
and rehabilitation treatments providing some relief but no cure524. Most chronic illnesses
start at a cellular level. Though biological causes differ, the symptoms they cause are
similar. Fatigue, pain, loss of energy and sleep problems are not uncommon. These
symptoms often interfere with everyday life and may require a change in the patient's
social activities. Other common problems with chronic illnesses are depression, fear and
concern for the future. It is important to learn that because similarities exist among
chronic illnesses, the central management tasks and skills one must learn to live with
different chronic illnesses are also similar.
74
You must learn problem-solving skills, how to respond to trends in your disease, as well
as overcoming physical and emotional problems. Other skills include developing and
maintaining exercise and nutrition programs, learning relaxation techniques to deal
effectively with stress, making decisions about when to seek medical help, working
effectively with your health care provider, appropriate use of medications, finding and
using community resources, talking about your illness with family and friends, and if
necessary, changing social activities. Take control of the illness rather than let the illness
take control of you. In order to do this, it is essential to understand the characteristics of
your chronic illness and the role of NED. The patients experience and understanding
are often the best indicators of the path's course. Self-management is most effective
when the clinician encourages and facilitates learning by the patient and the patient
responds by participating in decisions.
8.1 RENEWED HOMEOSTASIS
For our bodies to maintain homeostasis (a good state of health) it needs NAD energy
from cellular to systems level to function together in harmony. Homeostasis reflects the
ability of the body to maintain relative stability and to function normally despite constant
changes on any level of being. Changes may be external or internal, spiritual,
psychological or physical and the body must respond appropriately. Our bodies use
homeostasis mechanisms to maintain its stable internal environment. Homeostasis
mechanisms work much like a thermostat that is sensitive to temperature and maintains
a relative constant room temperature whether the room gets to hot or cold. If chronic
NED is present it leads the way for infection, genetic vulnerability, the immune system
and intricate cell signalling and biochemical pathway alterations to set in and a chronic
homoeostasis of chronic illness to develop. In particular, some subtle metabolic changes
in cells may be crucial to the striking lack of energy and the marked fatigue that may last
for hours or days. Over time we adjust to this state of chronic homoeostasis of chronic
illness.704, 760, 761
The initiating of NAD Therapy normalizes the NAD energy levels starting from cellular
structures to the 11 physical systems and eventually the whole body. This normalising
take time and it varies with the bodily structures effected by the NED. Refer to chapter
two for the renewal cycles of some of these bodily structures. Some renewal cycles take
place on an hourly basis where as others can take years. A given structure makes
possible a certain level of useful energy, and adequate energy makes possible the
maintenance of the structure, and the advance to a higher and more efficient structural
level. The biological idea of stress refers to the difficulty of adapting, and this involves
energy, structure, and insight/ orientation. Given enough energy, we adjust our structure
to achieve full adaptation, and with insight, we can minimize the amount of energy and
structural change needed, for example just by a change of pace or rhythm. Change of
structure can involve the growth of new cells, or the enlargement or modification of
existing cells, and the shrinking or dissolution (apoptosis) of existing cells, allowing their
substance to be used elsewhere. During this normalizing of NAD energy and the
renewal of bodily structures the NED sufferer has to adopt to the development of a more
healthy homeostasis. This is often experienced as unsettling and needs time to adjust
to.704, 760, 761
"Body composition studies conducted during correction of protein energy malnutrition
(PEM) have demonstrated that a significant portion of weight gain after unintentional
75
weight loss from catabolic disease represents the addition of body fat and extracellular
fluid, not added protein mass. Correcting PEM is multifactorial and requires a greater
length of time to reverse than to develop".763 Muscle dysfunction is linked to inadequate
intake of energy and protein, providing evidence for defects in morphology, physiology,
and function. Important during any recovery phase from chronic NED is the diet and
proper nutrition. The relationships between energy and protein intakes on protein
metabolism depend on the nutritional and clinical state of the patient. The efficiency with
which protein retention occurs is greater in depleted or starved patients than in patients
suffering from accidental trauma, acute infection or burns. The latter patients are often
hyper metabolic with a decrease in lean tissues and a net loss of proteins from the body.
NED-sufferers experience a similar loss of lean body mass and the replacement with fat
tissue. It is therefore important to identify the nutritional and clinical conditions of the
patients when one deals with the complex problem of energy-protein relationships.763
Even if it does not feel like it all the time, the patient can be assured that the NAD
Therapy performs its function fully on the biochemical level. Dr Petrus Retief (consulting
medical doctor at Alkogen Treatment Network) summarizes it as follows: "The chemical
imbalance develops as a result of an NAD deficiency and immediately after you have
administered the NAD you will have restored the chemical imbalance. They immediately
experience an improvement in emotion, they sleep better, are more positive and their
regular processes of thought can occur much easier and better." The capsules contain
natural nutrients that are part of our biochemistry since the day of creation. In other
words it is not just natural ingredients like herbs or cannabis, but are essential metabolic
coenzymes and cofactors that form an integral part of our biochemistry. Some people
experience an initial discomfort when their biochemistry normalizes due to the NADTherapy. A similar discomfort is experienced initially when one get a new pair of
spectacles that are 100% correct according to the result of your eye test.
"The sudden restoration of nutrient intake, especially carbohydrates, in severe
malnutrition will suddenly reactivate a number of dormant metabolic pathways. Lack of
key micronutrients, especially thiamine and other B complexes, will allow glucose to go
through oxidative phosphorylation resulting in lactate (lactic acid). The sudden
availability of carbohydrates will exceed down regulated cell demands, necessitating
energy for fat production and leading to a further energy deficit. In addition, there will be
a shift of the previously depleted electrolytes, potassium, phosphorous, and magnesium,
back into cells, resulting in potentially severe hypokalemia, hypomagnesemia, and
hypophosphatemia. These compounds must be returned into the intracellular
compartment".763
8.2 OBJECTIVE MEASUREMENT OF TREATMENT OUTCOME
In chapter 9 various studies were quoted some of which included double-blind studies
regarding the treatment outcome of NEDRS with NAD, derivates or precursors of it. At
Alkogen Treatment Network it was not deemed necessary, since it was easy to follow
the objective parameter of the energy values based on the pre-treatment blood test
results done by independent pathologists. Both normative and ipsative measurements
are possible because of the available energy values. An ipsative assessment measures
the patient's improvement against his or her own previous energy value. A normative
assessment measures the patient's energy value against the known normal energy
values that are available. In NAD Therapy, a patient's improvement is compared with his
76
own earlier energy value, with a view to determining whether any improvement has been
made. In all cases, however, the benchmark energy value against which any
improvement is measured is the person's own improvement - not the improvement of
groups or subgroup of patients as a percentage success figure. On average the average
energy block of patients on NAD Therapy shows an improvement from a pre-treatment
level of 52 to a follow-up treatment level of 81 after 6 weeks on NAD Therapy. This
biochemical improvement is also experienced on physical, emotional and spiritual level.
8.3 SICK ROLE AND BENEFITS
In practice treatment professionals should proceed in a manner that communicates
concern, supports functionality, and avoids dysfunctional illness behaviour and
accidental validation and reinforcement of disability525. Chronic conditions such as NED
could lead to acceptance of the sick role by the person, which, to a large extent, takes
away his own sense of responsibility and leads him to surrender to a state of
dependence. This poses an obstacle in the process of recovery and return to the
community. Benefits usually go hand in hand with the acceptance of the sick role and
impedes the success of the treatment178, 233. It sometimes appears as if the patient is
afraid to accept his recovery and to take up his responsibilities.
8.4 FUNDING
"The National Chronic Care Consortium advocates for a next-stage reform strategy that
is rooted in principles of care critical to serving people who have chronic diseases and
disabilities. People with chronic diseases and disabilities are the fastest-growing,
highest-cost, most complex user segment in healthcare. Almost 100 million Americans
have one or more chronic conditions. Chronic conditions account for about 80% of all
deaths and 90% of all morbidity. Seventy percent of all medical costs relate to people
with chronic conditions. One half trillion dollars a year is spent on problems of chronic
illness. If we are going to adequately address the cost containment problems of the
future, if we are going to maintain quality care over the long term, it is absolutely vital
that we give more attention to the problems of chronic disease and disability"582.
8.5 RESPONSIBILITY
Self-care is an important element in the successful management of a long-term illness.
However, people with chronic illnesses are often reluctant to adopt self-care
behaviors353. "Long-term care, public health, home care, and alternative therapies are
likely to become more mainstream. The foundation of care is likely to move from
hospitals and nursing homes to the home and to community care centres which
empower people to define and manage their own care through the use of new self-care
technologies, reinforced by institutions that blend the expertise of public health, primary,
acute, and long-term care"582.
8.6 THE "HONEYMOON PHASE"
Although all NED sufferers' bodies beg them for NAD Therapy, some first need
convincing by their blood before they will do it. A very few dislike life so much or are in
such a state of despair that they do not want to do it at all. It is very simple to do, but
90% of those who eventually do it will stop or interrupt it while in their honeymoon phase.
77
A privileged 60% will quickly resume doing it again out of free will. The rest, if still
fortunate enough to be able to remember it, will eventually be forced by their chronic
suffering to do it again. Even though the necessity for it is clearly indicated by the NED
sufferers' blood tests results and the daily suffering from their chronic illness, most will
reject NAD Therapy after a few weeks in a false belief that their bodies can now make it
on their own. When one enters the honeymoon phase of NAD Therapy it is important to
remember that one's feelings and outlook will change as NAD Therapy goes on. After
the first few weeks of slight discomfort on NAD Therapy, which first clean the blood and
cells of many toxins, one feels much more oneself, more alert and less fatigued. This is
called the "honeymoon phase".
The honeymoon phase, can be very seductive where people retain their improvement
with little or no NAD Therapy for the first few months or so following the treatment. As
time goes on, however, the full impact of the regained energy required to maintain the
quality of life and to manage this chronic NED one is suffering from, will hit home. One
will not necessarily feel progressively better, one's spirits may drop, and discouragement
and disillusionment may set in as one's body has adopted to the increased energy levels
gained from NAD Therapy. This is quite normal and the staff and existing patients will be
of help if one let them know how one feels. Keep in mind that others have been down
this road before. It is difficult to rely on family and friends to assist during this phase
because most often they also suffer from NED, mainly as co-dependency or religious
addiction.
8.7 GOOD NUTRITION
"Fad diets that restrict the types of food we eat may actually jeopardize our overall
health. Such weight loss schemes are based on the erroneous notion that eating only a
few specific foods can lead to better health. On the contrary, says University of Arkansas
anthropologist Peter Ungar - humans evolved to consume the widest possible range of
foods, and limiting that variety can lead to serious health risks. Rather than whittling your
diet down to a select group of foods, a healthier approach to nutrition is to expand the
variety of foods you eat. After all, says Ungar, that's what four million years of evolution
has designed the human body to do".794
The following abstract regarding athletes' nutritional needs can be seen as a perfect way
of dealing with the nutritional needs of the NED sufferer. "Athlete" is replaced with
"patient" for explanatory purposes. "Good nutrition is one of the elements necessary for
optimal performance. The patient should consume a diet composed of a wide variety of
foods to help ensure that nutrient needs are met, whereas maintenance of ideal weight
is the indicator of adequate calorie intake. The best diet is one that considers
physiological, sociological, and psychological factors, i.e. an individualized diet. The
meal should consist of foods the patient likes, tolerates well, and usually eats. The main
nutrition consideration during the all-day meet is fluid replacement, and patients should
be encouraged to drink ample water, especially when in a hot environment. Foods and
beverages the patient likes, taken in small amounts throughout the day, can ward off
hunger, provide needed calories, help maintain blood glucose levels, and meet fluid
needs. Although vitamins and minerals taken at levels in excess of the RDA have been
shown not to benefit performance, use of high levels of supplements is not uncommon
among patient. Patients are often unaware that some nutrients can be toxic when taken
in excess"345.
78
8.8 DELAYED RECOVERY REACTION

"To be honest however, I had serious doubts about it (NAD Therapy) during the initial
phases, and I rejected the treatment. But, with hindsight I realise that the NAD
supplements worked miracles for me, without any real effort on my part. While the
number of treatments had been accumulating gradually, I regained my mind and ability
to think rationally. The most dramatic aspect of my treatment is that it didn't require any
great effort on my part. All that was required, was merely patience, compliance and
tolerance"47.
Just as it takes some time for some of the negative effects of NED to crystallised into
symptoms, it can take just as long before the full effect of NAD Therapy becomes visible.
"Delayed recovery-reaction" is a state which develops when improvement occurs after a
long period of treatment and after the initial treatment had been ceased. The individual,
in this instance, finds it difficult to associate the improvement with the therapeutic
interventions which induced it. The opposite is also true. The side-effects of certain
medications can become visible only after a long period and are then attributed
erroneously to more recent events244.
8.9 THERAPEUTIC ATMOSPHERE
"We think about individuals and families in terms of patients who are recipients of our
care, rather than as active participants, if not primary managers, in the ongoing care
process. When we think about self-help strategies, we think about individuals doing for
themselves what healthcare professionals might normally do rather than empowering
individuals to maintain an ongoing, quality, healthy lifestyle, regardless of their stage of
disability. We need to integrate care with the values, norms, and conditions of those we
serve, as well as their family and community of residence."582. NAD Therapy advocates
patients' involvement and co-responsibility from day one of contact. Patients are
empowered and motivated to take effective control of their abilities to manage their lives.
8.1 SETBACKS AND RELAPSES
"Then I went to Alkogen Treatment Network. They really helped me a lot and meant a lot
to me. Then I also regained control. I became used to it. I felt, that I could wait for longer
periods, before getting my NAD supplements. Instead of, for example, every month, like
I had used to have it, I stretched it to two or three months. I also abandoned the little
green and blue pills. I stopped using them completely. I stopped everything. I then had
an irresistible craving for a drink. I was salivating, that is how much I craved a drink!
Instead of driving to Alkogen Treatment Network, I gave in to temptation. The craving for
a drink was stronger than the desire to go to Alkogen Treatment Network. I had a drink
and this has happened a few times, since I have been using Alkogen Treatment
Network"217.
"Then my brother-in-law had arranged my admittance and there the clinical psychologist
and I started with this treatment and the assortment of NAD supplementation and
medication, which he arranged to be administered to me. Suddenly I had felt well and I
could take on the world. I think it was a little arrogant, I had a little too much selfconfidence. I was there for about two weeks. I left. My wife and I then went on holiday
and didn't experience any problems. I returned to my practice. Initially, I had continued
79
with the medication and everything remained under control. I didn't have any problems.
After a while I thought 'No, I no longer need this'. After a little while I merely started using
pethidine again. More and more, at an increasing rate"32.
The main reason for setbacks and relapses is contained in the above-mentioned extract.
It is difficult for persons, who suffer from NED, to accept that it is chronic in nature and
requires continuous treatment on all levels. The medications and other treatments have
a slow effect and after their use has been ceased, it also takes a long time, before the
therapeutical effect disappears completely. Patients find it difficult to link the effect of
NAD Therapy with the consequences, after its use has been ceased. This is similar to
the situation that prevailed initially, during which the initial effect of undesirable
behaviour or substances could also not be linked to the subsequent consequences.
8.11 CYCLICAL AND SEASONAL EFFECT
"Yes, terribly, especially at this time of the year. My doctor calls it "seasonal depression".
I noticed that I had felt exactly the same last year and when I had again felt the same
this year, I went to receive NAD. I notice it, because I had not received it last week and
felt extremely tired and listless last Friday. I then went to the doctor, this time just for
NAD. He had a nice chat with me. He told me, that I would also have to use medication
with it and also receive NAD. After a few months we shall take another look, after I shall
have used NAD with vitamins, to see what it does to my system. I however feel much
better. Then I indeed felt much, much better. One becomes completely relaxed"342.
With NAD Therapy there are periods of improvement and lapses according to the
person's available energy level and energy expenditure. The literature refers to this,
amongst many other things, as binges, relapses, setbacks, dipsomania, post-acute
withdrawal and craving. This could also be related to what literature describes as cyclical
or seasonal effects. The NAD Therapy must be adapted accordingly during these
periods. Patients use the medications in the same way, as they would previously, for
example, have used the prohibited or undesirable substances. In other words, more
NAD infusions or capsules are taken prior or during these relapses.
During winter an increased loss of heat occurs amongst persons with seasonally
affective disorder (SAD)6. There is an atypical increase in appetite for carbohydrates,
increase in mass and drowsiness during winter amongst their group of SAD sufferers128.
There is a decline in tryptophan, which is an important precursor of NAD, that is followed
after the summer by depression in the winter, when they suffer from SAD163. Biological
factors, which contribute to SAD, run in families135. Studies confirm the role of genetical
factors and the role of serotonin in SAD206.
8.12 IGNORANCE
"I think that this is precisely, what my problem was. I would, in my opinion, never have
solved it, because what is offered as therapy now, is in fact in a way the exact opposite
of what any doctor would have recommended, namely 'You must take in energy with
food, so that your body can burn it, because you don't have the levels of energy, which
you ought to have'. If you receive any other treatment, they would not have addressed
this and you would, in my opinion, have been at the mercy of a route, that would have
led you to nowhere. This treatment uses the natural vitamins and minerals, which your
80
body needs. The other side of the coin is that your overall pattern of thought becomes
positive and you say to yourself 'I am not so bad'. I didn't lose my self-image completely
during the process"181.
Ignorance, even on professional level, contributes significantly to unsuccessful
treatment. NAD Therapy is based on recognised evaluations, objective and independent
blood tests results and proven findings from research. It is also well-documented in
"Dreams for Fragile People"222. This book is based on more than 600 scientific articles,
which are readily accessible to those who are interested. Knowledge is within the reach
of everyone, who truly desires it. Knowledge promotes insight and understanding, which
have therapeutical value on their own. Knowledge is also the cornerstone of all
treatment.
8.13 SUPPORT GROUPS
Support groups are in particularly popular amongst persons, who suffer from chronic
conditions like NED. Although it fits into the treatment of NED, it is often wrongly
considered to be effective treatment on its own and soon turns into addiction to support
groups. Support groups are very popular amongst the relatives of persons, who suffer
from NED, and become the focus of treatment, instead of a source of assistance. No
support group or any other therapeutic intervention can restore or stabilise the NAD
Energy Deficiency of any NED sufferer. Only the correctly formulated NAD supplements
at the correct dosage and with regular use can, at best, lead to stabilising it. Another
danger, which is inherent in support groups, is that they normally operate without
ongoing professional guidance and then they can easily be taken over by a member, for
other purposes than the reason for which the group was intended.
8.14 USERS' EXPERIENCE OF NAD
Most of the below-mentioned abstracts are from personal interviews, that had been
conducted with individuals, for inclusion in the book "Dreams for Fragile People"222. It is
recommended, that readers study the complete interviews for more details to get the full
picture.
"In December he was still lying in the fetal position. He did not know, what was
happening around him. He seemed to be completely senile. We kept on
administering the NAD supplement, while my husband was not here. Suddenly I
realised, that he started asking questions; he wanted to know more. He was
aware that we were doing something to him, but did not know what it was. In
spite of his state of confusion, he said that this stuff was working. What is quite
remarkable, and I do not know whether it was a coincidence but I had noticed it,
was that whenever we administered the NAD supplement, he sat still, in spite of
his confusion and disorientation. He did not move his hand or arm while the NAD
supplement was entering. He just stared at me with his beautiful eyes and said
softly that it was working. The next thing we knew, was that he was walking
around"162.
"I last received the NAD supplementation two or three months ago and feel now,
that I am starting to tire. It therefore definitely makes a big difference. One can
definitely feel when one uses the NAD. You feel much, much better during the
next few days. I feel much healthier. It is like the clinical psychologist explained,
81
that when you are in a state of depression everyone tells you to do something
else, or to tackle a new project, or that you must occupy your mind with
something else, but you lack the energy. Now I have the energy to do it. I started
last week to lecture temporarily at a college. This is something, which I previously
would never have considered. This is something new that I tried, which I would
never have accomplished previously, because I had not had the energy to do
it"247.
"I no longer use the NAD supplements intravenously, but rather in capsules, that
is the vitamin capsules that contain NAD, and I am very certain that it is the
reason why I am still moving around. It enables me, to get up and make my bed
on my own"127.
"I also battled with sexual needs. Since I had started using NAD supplements, I
also have more control over sexual impulses. I think that I have more energy to
manage sexual issues. I went to the so-called escort agencies on several
occasions to deal with sexual urges. It bothered me a lot, because I am a
believer. This lead to a lot of guilt. I did not know what I should do and then
thought about contacting Alkogen Treatment Network. I also completed a
psychometric test. It indicated, that when I am under pressure, I am readily
inclined to do wrong things, like these sexual matters. I am not dependent on
alcohol or such things, but sex was my weakness. It appeared from the tests,
that I suffer from low levels of energy and cannot overcome my problems. Then I
received NAD supplements"246.
"I wanted to stop smoking. My father suffered a heart attack. My little daughter
said to me: 'Daddy, you will die if you don't stop smoking'. This and the NAD
supplements suppressed 'you feel like smoking, you feel like smoking, you feel
like smoking'. It was a psychological matter for me, together with the NAD
supplements. The NAD supplements helped me and relieved the withdrawal
symptoms greatly. This was my experience. It felt to me, as if I slept better.
Previously, I slept very badly and restlessly, and it feels now as if I am more
peaceful, more relaxed"165.
"I received a NAD supplement for the first time a few months ago. During the
entire year I had literally spent every waking hour praying, but started to think
that prayer on its own would not help. This sounds awful, because I believe that
God can accomplish anything. I truly believe this, but he did not do anything for
me until I had made this incredible effort. Admittedly, I drink the little pills now
and receive the NAD supplements. I assume that it probably calmed me down.
Indeed, I only felt like doing things, after I had started to feel better. Then I
completed the course in gardening"341.
"I realised, that if I don't set aside time and get the NAD supplements and the
support from the medicine, I shall lose everything that is dear to me in life. This
includes my work and the desire to work amongst the congregation. It was
therefore a radical decision in favour of important and urgent issues, which
enabled me to say 'Today I shall go to Pretoria"35.
"Well, this was after I had no longer been using sleeping pills. My daughter told
me about Alkogen Treatment Network and that I must speak to the clinical
psychologist. It certainly helps. It has been helping me for months. When I say
that it helped, I mean that I didn't have the urge to do anything. Well, how can I
describe it? It provides me with energy, a lot of energy. I am not tired, like I used
to be. I always used to be very tired. The business that I owned produced a lot of
stress and the sleeping pills helped to alleviate the fatigue. After today's NAD
supplementation I shall sleep wonderfully for a few days. I use my cholesterol
82
tablets and pills for diabetes together with the NAD supplementation. I use
magnesium and carnitine every day"215.
"I had been using cannabis for approximately three months, before I was caught.
You don't notice it while you are smoking the cannabis, but nothing bothers you.
You go through life with your eyes closed, if you know what I mean. You don't
care about anything and if anything bad happens to you, you just accept it. You
feel, that it doesn't matter. Your attitude is 'Let's roll another zol'. It numbs your
brain, if you ask me. What bothered me the most, was that my brain was so
clear, approximately two weeks after I had started with the NAD. I could
concentrate at school. It felt, I don't know, as if I was somehow happier. I also
use other pills. I find that the NAD gives me a lot of energy during the day. I don't
get as tired, as I used to. Last year and this year it helped me to concentrate. The
little blue pill definitely helps me a lot. If I get anxious, I immediately take one of
them"184.
"But I come for my NAD supplementation. Twice per week during the first three
weeks. But what happened then is that I had thought that it is this miraculous
substance, which they were giving me, the NAD supplement. I woke up the next
morning. I could still see the walls and I could not yet fly. What was going on?
But after the fourth or fifth, I had noticed that something was happening. I am
clearer. I can think better on my feet. I am still as active, but I am much calmer. I
can still hit the ceiling, but I can be controlled. Getting angry... because I have a
terrible temper ... but I can control myself now"113.
"My daughter, Anneretha, 'collapsed' in August 1997, as a result of fibromyalgia
(burnout). She was in grade 11 at that stage and didn't go to school during the
last two quarters of last year, but rested at home. She received very good
medical, psychological and pastoral support. Her recovery was however very
slow. In February 1998 a friend, who was working part-time as a nurse at
Alkogen Treatment Network, encouraged us to visit the psychologist at Alkogen
Treatment Network. From conversations with him, we became aware, as a
family, of the complexity and sensitivity of one's body. Since then, Anneretha has
been participating in the support programme and her progress accelerated. This
year she could attend approximately half of her classes and passed her
examination in June. We are confident, that she will be able to complete her
grade-12 year this year"608.
"Since I have stopped drinking and have been using the NAD supplements, I can
think more clearly. I am not limited to making impulsive decisions and stick with
my choices. I think more about them and about the advantages and
disadvantages, before I take the plunge. Previously I had simply decided that I
liked it, did it and that was it. And that possibly meant trouble"255.
"I don't feel anything, but I can feel the effect afterwards. I already feel it the
following day. It has already happened, that I think about alcohol. I would, for
example, sit and work in my workshop. Then I cannot concentrate on the ring or
bangle, which I am making. I start to think about alcohol. Then I think 'I must go
and get the NAD supplement'. The next day, I go. The day after the
supplementation, I had noticed that I was no longer thinking about alcohol. Then I
concentrate on my work"217.
"The NAD also changed my personality very, very significantly. Previously I could
spend days on my own, without speaking to anyone and being as happy as a
lark. Now I like to be amongst people all of the time and to go out and so on.
Quite amazing. Very different"60.
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"In a demanding and busy job, NAD had restored my flagging energy and
brought back a healthy balance to life, since I had received energy to always
remain positive and could make (considered) decisions much more easily. My
energy recovered to such an extent, that I want to and can take on new and
additional tasks and tackle them. The recovery of the levels of NAD in my body
provided physical and emotional energy, so that I can now effortlessly visit more
members of the congregation and provide pastoral support. My appetite
improved markedly and I am therefore physically also more healthy. Paying
attention to my family in a meaningful way became a joy, rather than a duty. NAD
isn't just another miraculous cure on the market, it's simply a physiological
necessity for the demanding time, in which we are living. In short, NAD helped to
put back the swing in my step, the smile on my face and the song in my
heart!"609.
"I had already felt that I had more energy after the first NAD supplementation. I
immediately started to drink fewer dieting pills and completely ceased using them
within 2 weeks. I had more power to fight against the binges. It was as if I could
think better and more realistically about everything. I had the strength to fight
against my problem. My head felt open and my thoughts were clearer. As time
went by, it became easier to manage my problem. I didn't suffer any side effects
from the treatment. The capsules helped me between the supplementation.
Whenever I had felt that I could no longer carry on, I used additional capsules.
They provided me with the energy, that was required to carry on"610.
84
Applications for NAD Therapy: NAD Energy Deficiency Related Syndromes

(NEDRS)
1. Energy by Confirmed Diagnosis
Fatigue (being without physical energy, strength, power) is one of the most general and
least understood symptoms of many chronic and disabling conditions. Clinically, the
spectrum of syndromes associated with primary disorders of energy metabolism is
widespread320. This review must be seen as only explorative in nature and not as the
setting of rigid rules or the making of any diagnostic, etiology or treatment claims
regarding the disorders reviewed as possible NEDRS. Furthermore the main aim is to
stimulate further research and also to highlight the possible role of an underlying NED in
the disorders discussed. We will only record the metabolic indicators of NED for each
disorder included. This review is not supposed to be an exhaustive list of all possible
articles related to each disorder.
9.1 CRITERIA FOR INCLUSION
The metabolic indicators of NED (refer to as Energy Values I, II, III and the Energy
Block) as well as treatment with NAD Therapy will apply as basis for inclusion of the
listed disorders. Since 1989 we have treated various disorders associated with NED with
NAD Therapy at Alkogen Treatment Network. The application of NAD Therapy have to
be investigated further, especially on an empirical level. Most patients receiving NAD
Therapy showed good clinical improvement substantiated by the post test improvement
in their energy blocks as per follow-up blood tests. The time span of improvement varies
per disorder treated. The rationale for the improvement is possibly one or more of the
biochemical functions of NAD and/or the other cofactors of the energy metabolic cycle.
9.2 PRO VISOR ON NAD THERAPY AND NEDRS
No claims what so ever are made in this chapter for the cure of incurable diseases by
the application of NAD Therapy. The results speak for themselves. The discussion has
been kept on a factual basis. At the same time it must be remembered that many
patients come for NAD Therapy after they have tried everything else and they are in a
state of despair. We are only endeavouring to show that NAD Therapy has definitive and
science based therapeutic value. Of this there can be no doubt when all the facts are
carefully considered, the opponents of NAD Therapy notwithstanding. The reader should
acknowledge the fact that NAD Therapy has advanced beyond the experimental stage.
Sixty years have passed since NAD Therapy made its original appearance as a
treatment modality for alcoholism and the broad principles from which it emerged is now
better understood from the latest biochemical studies on coenzyme NAD.
9.3 APPLICATION OF NAD THERAPY
The blood tests results done by independent pathologists were obtained from the clinical
records at Alkogen Treatment Network or participating practitioners. The diagnoses were
made by the treatment professionals of the patients that they consulted prior to joining
the Alkogen Treatment Network treatment program. They include medical specialists like
psychiatrists and neurologists. In all cases the NAD Therapy was only initiated after the
patients were examined by a medical doctor and a recommendation to this effect. In all
85
cases NAD Therapy was requested by the patients. Since 1989 various medical doctors
formed part of the multiple professional treatment team of Alkogen Treatment Network.
Some notes refer to the clinical use of NADH, one of the derivates of the NAD coenzyme
others are NADP and NADPH366.
9.3.1 STEPS IN NAD THERAPY
"I went there and met the clinical psychologist. He chatted a little with me and explained
some stuff for me. He didn't make any sense to me. Let me be honest. Nothing makes
sense to anyone, when they go to Alkogen Treatment Network for the first time. They tell
you about your deficient NAD level and so on, and these things don't make sense to you,
because you aren't a medical expert. The language and so on, which he uses, makes no
sense at all to me, but I was willing to give it a try. I took my first NAD supplement. The
blood tests were done. They then didn't say anything after that and I didn't understand
what was going on. I however went there for my NAD supplements. Twice per week
during the first three weeks. During the fourth or fifth week I however noticed, that
something was happening. I feel clearer. I reason more logical. I am as active as before,
but much calmer. I can still blow my top, but are in control".113
It is always good to be fully informed about all the particular details before one
commences with any new thing, especially therapy. Keep in mind that memory
impairment dominates the cognitive complaints of patients with chronic fatigue
syndrome527. The same finding is also found at Alkogen Treatment Network which
shows that prospective patients are easily flooded with all the new concepts and detail of
NAD Therapy, because of their average energy block of 70 instead of 100 plus. The
rapid physical changes which take place in the NED sufferer during the first few weeks
on NAD Therapy, impede the process to meaningfully assimilate new information. So
based on this observation it is recommended to first follow these 8 steps set out in this
synopsis. The detailed rationale and treatment application of NAD Therapy can then be
studied as and when the physical energy level improves due to the effect of NAD
Therapy.
No one's life is perfect. We all have dreams, tough circumstances, problems and losses
to deal with. But some people's lives appear to be more enjoyable than others. Have you
ever questioned why? A vital difference is most often the amount of physical energy they
have available to deal with what happens to them or to let things happen in their lives.
Although we always have a choice, 10% of persons are born with NED, that if untreated,
stops them from realizing their choices. During the journey of life, the energenetic
participant's dreams come true, while the passive spectator's dreams often turn into the
worst nightmares.
So do not reframe the Dreams of NED Sufferers, rather help them change their
Physical energy Levels and then let them reach for their Dreams.
If you think that you or someone special to you has a problem with a chronic disorder,
you will particularly benefit by studying this chapter to see if the condition is associated
with NED. Even the fact that you are reading this synopsis is an exceptional victory. It
means you are considering an energenetic life for yourself or someone precious to you.
The following 8 steps provide a synopsis of NAD Therapy for persons who might be
suffering from NED.
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Step 1: Please read these steps carefully, arrange a consultation with your
health professional and discuss this information before making a final decision.
This synopsis is based on more than 600 relevant scientific sources and clinical
experience with more than 6 000 patients on NAD Therapy prescribed by 140+
private practitioners. These are discussed in the rest of this e-book. This e-book
is made available free of charge to all truly concerned individuals. It is therefore
strongly recommended to give a copy (printed or electronic) to your health
professional. On their journey to an energenetic life, most persons will not
overcome the following stumbling block: "The distance is nothing; it's only the
first step that is difficult" (Marquise du Deffan).
Step 2: Arrange for the lactate and pyruvate blood tests to be done. No prior
fasting is required. These tests are internationally in use and are reliable
indicators of your biochemical energy level. The blood tests' normal values
ensure that 95% fall within the normal range and only 5% of testees will present
with NED. The tests are generally done by most pathologists. Prior arrangement
must however be made, to ensure that the required test tubes are available. For
full details on blood tests see chapter 6. If it is impossible to do the two blood
tests look up your disorder or a disorder of similar severity and use the Average
Energy Block as basis for your NAD Therapy.
Step 3: Use the results of the blood tests and calculate the energy levels and
determine the energy block. The formulae are outlined in Chapter 6. The online
calculators to calculate the energy values and recommended NAD Therapy
Programme are available at http://www.energyequalsempowerment.com
Step 4: Use the calculated or identified Energy Block and determine the
recommended NAD Therapy Programme
Step 5: Consult your family doctor concerning the use of the supplements and if
need be a prescription for the NAD IV-therapy and/or any supporting prescription
medication. You or your family doctor can consult with our resident pharmacist to
clear any possible uncertainties.
Step 6: Follow the recommended NAD supplementation program or prescription
of family doctor for 12 weeks and then arrange for follow-up blood tests to be
done in week 12. Guard against the "honeymoon phase" and use the new gained
physical energy in a responsible manner. For instance during weeks 6 to 12 work
attentively through the NAD e-book to update you on the treatment rationale.
Step 7: Use the results of the follow-up blood tests to determine the maintenance
number of capsules to be used. Keep in mind that this is the minimum required
and can be increased during periods of excessive physical energy expenditure
on both positive or negative stressors.
Step 8: Gradually start to take care of any psychological and/or spiritual energy
blockages that have developed over your years of living with NED. Consult with
councillors who are knowledgeable in your appropriate problem domain and the
NAD Therapy approach. Regularly work through the NAD e-book and similar
literature to familiarize yourself with the new insights that accompany your
gradual improvement over time.
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List of NED Related Syndromes (NEDRS)

NED Related Syndromes - A
Average NAD Energy Value

(normal 100+)
Academic Stress
74
Acute Renal Failure
50
ADHD (Attention-deficit-hyperactivitydisorder)
75
Ageing and Longevity
81
Alcoholism
66
Alcoholism in Remission
81
Allergy and Food Intolerance
66
Alopecia
62
Alzheimers Dementia
71
Arthritis
77
Asthma
47
Autism
70
NED Related Syndromes - B

(normal 100+)
Bipolar Disorder
92
Breast Cancer
56
Brucellosis
77
Bulimia Nervosa
78
NED Related Syndromes - C

(normal 100+)
Cancer
55
Cannabis Dependency
72
Cardiac Disorders
78
Chronic Fatigue Syndrome (CFS)
74
Chronic Sinusitis
66
Cocaine Dependency
72
Co-dependant Child
78
Co-dependant Husband
71
Co-dependant Mother
70
Co-dependant Wife
78
88
Concentration Problems
72
NED Related Syndromes - D

(normal 100+)
Depression
70
Diabetes
64
Downs Syndrome
59
Dyslexia
53
Dystonia
56
NED Related Syndromes - E

(normal 100+)
Enuresis (bed wetting)
88
Epilepsy
64
NED Related Syndromes - F

(normal 100+)
Fanconi Syndrome
80
Female Incontinence
78
Fibromyalgia
62
NED Related Syndromes - H

(normal 100+)
Hallucinogen Dependency
77
HIV / AIDS
54
Hypercholesterolemia
63
Hypertension
77
Hypoglocemia
71
NED Related Syndromes - I

(normal 100+)
Impotence
48
Infertility
62
Insomnia
83
Irritable Bowel Syndrome
80
NED Related Syndromes - L

(normal 100+)
Lupus Erythematosis
98
NED Related Syndromes - M

(normal 100+)
Marfans Syndrome
34
89
Migraine and Headaches
78
Multiple Chemical Sensitivity Syndrome
77
Muscular Dystrophy
63
Myalgic Encephalomyelitis
80
NED Related Syndromes - N

(normal 100+)
Nicotine Dependency
67
NED Related Syndromes - O

(normal 100+)
Obesity
63
Opioid Dependency
73
Over-training
77
NED Related Syndromes - P

(normal 100+)
Parasuicide
59
Parkinsons Disease
60
Pathological Gambling
79
Peripheral Arterial Occlusive Disease
73
Porphyria
69
Prescription Medication Abuse
73
Psoriasis
89
Pulmonary Emphysema
74
NED Related Syndromes - R

(normal 100+)
Religious Dependency
62
NED Related Syndromes - S

(normal 100+)
Seasonal Affective Disorder
53
Sedative Dependency
69
Self-mutilation
53
Sex Dependency
60
Stress and Burnout
74
Stroke
88
Stuttering
88
Suicide
56
90
NED Related Syndromes - T

(normal 100+)
Thyroid Disorders
66
Tourettes syndrome
75
Trichotillomania
41
Turners Syndrome
48
NED Related Syndromes - V

(normal 100+)
Violence Dependency
69
91
Applied NAD Therapy: Diabetes as Case Study

In chapter 9 a comprehensive list of chronic disorders associated with NED was given.
On most of these disorders hundreds of articles and books are published and new
research findings are reported virtually on a weekly basis. Health professionals rightfully
ask questions on the relevancy of NAD Therapy for each of the NEDRS listed. In this
chapter a brief outline is provided using the knowledge gained in the previous chapters
to illustrate the relevancy of NAD Therapy to diabetes as an example. By referring to the
literature references provided for each NEDRS a similar outline can be developed for
each NEDRS.
10.1 THE PATIENT AND HER HUSBAND'S COMMENTS ON NAD THERAPY
"I've been a Diabetic for 21 years, underactive thyroid, high cholesterol, high blood
pressure and kidney damage. After the birth of my child, I started experiencing very low
energy levels. My husband was lucky if I pitched up at work to do the banking, before
2pm the afternoon. Even when I had a quiet weekend and lots of sleep and rest, I still
didn't have enough energy the Monday to start the week. My immune system was nonexistent. I had colds the whole winter through; if somebody with a cold gets close to me I
would get it".
"When we looked at alternative treatments for my child, we heard about NAD. We had
our blood tested and started the treatment immediately. I have experienced a drastic
change within two weeks. I could get to work at 9:00 a.m., helped in the shop, do my
child's therapy and some house work. Another wonderful thing is that you do not
experience dips like when you take a tonic, your energy levels are constant. If it was not
for NAD, I think even my wonderful husband's patience would have run out."
My husband's Comments: "The NAD Therapy has given me back my wife. We can
now have an active family and social life. Praise God for those that helped and guided
us with the NAD Therapy. For our lives have turned for the better, a lot better."
10.2 HER NAD THERAPY PROGRAM
Based on the results of her blood tests the following NAD Therapy program was
developed for her. Her husband also received NAD Therapy because of his low energy
values.
10.3 BIOCHEMICAL MARKERS OF NED IN DIABETES
The patient had an NAD Energy Block of 67 which is a bit higher than the average
NAAD Energy Block of 64 measured by patients with diabetes.
10.4 ABSTRACTS FROM INTERNATIONALLY PUBLISHED ARTICLES ON NED
AND DIABETES
"In diabetes, glucose metabolism via the Krebs cycle is impaired, and this leads to
reduced cellular energy and elevated blood sugar levels. When a cell is damaged by
oxidation injury, cytosol NAD levels fall and ATP levels decrease, If the DNA strand
breaks can be repaired, and the cell regains lost NAD, the energy system can function
92
again, but frequently cell death ensues. Thus organ failure is the result of energy failure
on a cellular level, because of oxidation damage of the mitochondrial membranes and/or
low NAD. In the case of the beta cell in the pancreas this means that proinsulin
production ceases until NAD levels in the cytosol are restored639.
"Thus, in diabetes, aerobic glycolysis gradually shifts to anaerobic glycolysis under
ischaemia, with accumulation of lactate and acid metabolites that in turn induce
myocardial deterioration.644"
"Nicotinamide adenine dinucleotide (NAD) and its derivatives NADH, NADP and NADPH
have regulatory functions in the generation of triose phosphates and pyruvate from
glucose. In many studies of the influence of the diabetic state on relationships between
pyridine nucleotide and glucose metabolism, the focus has been on the sorbitol pathway.
Less attention has been paid to other aspects of the role of pyridine nucleotides in
pyruvate formation from glucose, in particular the effects of the NAD precursors
nicotinamide and nicotinic acid on glucose metabolism... Reference is also made to the
following three current hypotheses for mechanisms underlying diabetic microangiopathy:
1. Chronic glucose overutilization, caused by hyperglycemia, in tissues which lack insulin
receptors and therefore are freely permeable to glucose. 2. Enhancement of sorbitol
pathway activity with an ensuing decrease in the ratio of NAD/NADH. 3. Enhanced
utilization of both glucose and pyridine nucleotides in formation of triose phosphates and
pyruvate. Therapy with NAD precursors like nicotinamide might have corrective effects
on these proposed biochemical aberrations, thereby retarding progression of
microangiopathy".607
"Taken together, it is proposed that high doses of nicotinamide primarily affect ADPribosylation reactions in beta-cells as well as in immune cells and the endothelium. As a
consequence, cell death pathways and gene expression patterns are modified, leading
to improved beta-cell survival and an altered immunoregulatory balance645".
"Autoimmune processes are involved in pancreatic beta-cell destruction in type 1
diabetes... Generation of free radicals, DNA strand breaks, activation of the enzyme poly
(ADP-ribose) polymerase (PARP), and depletion of intracellular nicotinamide adenine
dinucleotide (NAD) appear to be common factors in beta-cell death, whether mediated
by oxygen radicals, nitric oxide, or streptozotocin. Nicotinamide, a soluble B group
vitamin which offers protection against these toxic stimuli, is at high doses a free radical
scavenger, a potent inhibitor of PARP, and protects against depletion of intracellular
NAD. A sound scientific rationale therefore exists for its use in human prediabetes, and
promising pilot studies have been performed in ICA-positive first-degree relatives and
school children. No serious side effects have been reported from its use at the doses
proposed in man or other species646".
"The causes of cytokine-induced beta cell death are less well defined, but important
factors may be nitric oxide-mediated DNA damage, depletion of NAD levels and toxic
effects of oxygen free radicals and eicosanoids generated in addition to nitric oxide647".
"As a result of beta cell destruction, islet cell antibodies (ICA) can be demonstrated in
the circulation. These antibodies can be detected up to eight years prior to overt IDDM.
Nicotinamide, a vitamin B3 derivative, interferes with the immune mediated beta-cell
93
destruction by reducing the content of FR and NO and thereby reducing their deleterious
effects. At the same time, nicotinamide increases the intracellular NAD pool, thus
increasing the energy supply of the cell. Nicotinamide protects against chemically
induced as well as spontaneous diabetes in animal models of the disease. Recently,
open clinical studies have suggested that nicotinamide when administered to humans
can prevent or delay clinical onset of IDDM648".
"In hypoxic tissues these vascular changes are linked to metabolic imbalances
associated with impaired oxidation of NADH to NAD and the resulting increased ratio of
NADH/NAD. In hyperglycemic tissues these vascular changes also are linked to an
increased ratio of NADH/NAD, in this case because of an increased rate of reduction of
NAD to NADH. Several lines of evidence support the likelihood that the increased
cytosolic ratio of free NADH/NAD caused by hyperglycemia, referred to as
pseudohypoxia because tissue partial pressure oxygen is normal, is a characteristic
feature of poorly controlled diabetes that mimics the effects of true hypoxia on vascular
and neural function and plays an important role in the pathogenesis of diabetic
complications"649.
94
NAD Therapy: The Nutriceutical Supplements

"The potential of NAD and niacin therapy to treat diseases is now going forward in South
Africa. Theo Verwey and his group of clinicians are now the future of this movement to
reform medical therapeutics. It is the concept of NAD as a medicine, which must not be
ignored: the needed research must be allowed, encouraged, the results evaluated,
acknowledge and passed on to the young physicians of today". 697
"Some supplements and food products promise to cure everything and improve your
health - sounds too good to be true? The answer is probably yes. Dietary supplements
have few regulations about what claims they can make."652 This warning on the
American Dietetic Association's website is echoed by many other health professionals.
Oftenly this "too good to be true" stigmatization of a genuinely good supplement are
based on ignorance due to the following phenomenon: "Although researching a product
is always a good idea, Evers says most consumers don't want to spend the time it takes
to check out a product thoroughly."653
To assists the reader in critically evaluating the information recorded in this e-book a few
questions are referred to. What questions should be asked before a nutritional
supplement is recommended by a health professional or used by a consumer? Evers653
suggests asking the following:
"Have you heard of the company? If a product is truly beneficial, then there will
probably be a well-known company associated with it". According to Evers if the
company selling the product is one you have never heard of before, ask yourself
the next two questions.
"Have you heard about the supplement in the news media? Breakthroughs in
science make good news. Before a new "cure" or other product becomes
available to the public, it will be reported by the news media".653
"Where is the science? Has the product been thoroughly researched at a
university? Keep in mind that testimonials are not research. Look to see if the
product's claims can be tested for validity".653 In considering this question keep
the following in mind: "Nutraceutical manufacturers are not required to do
controlled clinical trials-scientific studies in which the effectiveness and safety of
a product is measured against a dummy pill (placebo) or a proven competitive
product. Because most nutraceuticals are natural substances that cannot be
patented, there is little incentive for manufacturers to spend many millions of
dollars on clinical studies.654
11.1 IMPORTANCE OF NUTRICEUTICAL SUPPLEMENTS

Vitamin and mineral therapy are accepted by only 23% of the surveyed general
practitioners in Australia507. Statistics for South African practitioners is not available.
However, several doctors, including specialists such as gynaecologists and specialist
physicians, are already prescribing and dispensing the nutriceutical supplements of
Alkogen Products to their patients. The supplements are also dispensed to their patients
by some dietitians, homeopaths, pharmacists and nursing sisters. It is also
recommended by pastoral counsellors and psychologists to their patients.
95
Many inborn errors have now been described that can be treated by alterations in the
diet. Such treatment requires an understanding of both the biochemistry of the defect
and of normal nutritional requirements. The principal strategies are cofactor therapy,
steps to prevent accumulation of toxic metabolites and the replacement of essential
nutrients that are deficient as a result of the metabolic block595.
It is important to note the latest research findings regarding niacin and nicotinamide. It
appears that most of the therapeutical benefits ascribe to these compounds are actually
possible by means of its conversion to NAD in the cells. For example: "The beneficial
effects of nicotinamide for the treatment of HIV infection appear to be linked to cellular
utilization of NAD. Nicotinamide appears to be void of any cell-free reverse-transcriptase
inhibition or virucidal activities. However, several cell-associated observations link HIV,
nicotinamide, and NAD. HIV-infected cells demonstrate an increase in the ADP
ribosylation of proteins, a phenomenon in which NAD is used as the ADP-ribose donator
to covalently modify proteins. As a general feature, nicotinamide inhibits ADP
ribosylation reactions. Protein ADP ribosylation can occur in the nucleus, in the
cytoplasm, and on the cell surface of lymphocytes. PARP is a nuclear enzyme that
catalyzes the formation of ADP-ribosepolymers that attach to multiple different proteins.
The activity of PARP is critical to the integration of foreign DNA, including proviral DNA;
inhibition or absence of this enzyme interrupts the HIV life cycle. Along with poly-ADP
ribosylation, monoribosylation steps also involve proteins in cells, including the ADP
ribosylation of both HIV Tat protein and cellular defence. The antimicrobial action of
nicotinamide might also work through the modulation of certain histone deactylase
reactions (i.e.,Sir2 proteins) that use NAD in the silencing of chromosomal DNA".767
11.2 NECESSITY FOR NUTRICEUTICAL SUPPLEMENTS
No medication exists that can replace or imitate the required nutrients or energy
metabolic cofactors and coenzymes which a patient is deficient in or dependant on. It
can only be supplied as a nutriceutical supplement with the identified nutrients as
ingredients. With medical treatments, approximately 25% of fibromyalgia patients
improve, but the beneficial effects of medical treatment rarely persist more than a few
months. All subjects in one study had received some form of medical treatment prior to
taking the nutritional supplements, but none with enduring success. Nutritional
supplements resulted in a significant reduction in presenting symptom severity, with
continued improvement in the period between initial assessment and the follow-up591.
"A detailed review of the literature suggests a number of marginal nutritional deficiencies
may have etiologic relevance. These include deficiencies in various B vitamins, vitamin
C, magnesium, sodium, zinc, L-tryptophan, L-carnitine, coenzyme Q10, and essential
fatty acids. Any of these nutrients could be marginally deficient in CFS patients, a finding
that appears to be primarily due to the illness process rather than to inadequate diets. It
is likely that marginal deficiencies not only contribute to the clinical manifestations of the
syndrome, but also are detrimental to the healing processes"523.
The 84 studies reviewed in patients (n= 2570) with predominantly chronic conditions
living in the community suggested that: oral nutritional supplements produce
demonstrable clinical (including functional) benefits, but the nature and extent of these
benefits vary with the underlying chronic condition; oral nutritional supplements increase
total energy intake with more than 50% of the energy additional to that from habitual
96
food intake; improvements in body weight, enhanced total energy intake and body
function following oral nutritional supplements appear to occur more frequently in
individuals with a BMI < 20 kg/m>2 than in those with a BMI 20 kg/m2.592
Nutritional approaches are available for the management of several different classes of
inborn metabolism errors593, 595. The inherited defects lead either to alterations of the
apoenzymes or to deficiencies of enzymes involved in the processing or reutilization of
the vitamins. The application of pharmacological doses of vitamins can be useful in
these disorders in order to overcome diminished apoenzyme binding, to saturate
residual activities of defective processing enzymes, to compensate for pathological
losses, or for acting as electron carriers594.
11.3 BRAIN FUNCTIONING AND NUTRACEUTICAL SUPPLEMENTS
Patients with chronic fatigue syndrome without psychiatric comorbidity were impaired
relative to controls and patients with chronic fatigue syndrome with concurrent
psychiatric disease on tests of memory, attention, and information processing604. Each
brain cell is a functional unit and messages are transmitted between the brain cells, by
means of neurotransmitters crossing the synapses. Brain cells can create several
synaptic links to other brain cells183, 264.
The three nutrients, tryptophan, tyrosine and choline, when administered in the natural
form or simply ingested in food, act like "drugs", resulting in important changes in the
chemical functioning of the brain. This illustrates a novel aspect of nutrition's effects on
the brain and provides the basis for new modes of therapy for patients with metabolic,
neurological or psychiatric brain diseases517. The levels and possible function of several
neurotransmitters can be influenced by the supply of their dietary precursors. The
neurotransmitters include serotonin, dopamine, noradrenaline, histamine, acetylcholine
and glycine, which are formed from tryptophan, tyrosine, histidine, choline and
threonine514.
In particular precursor availability to the brain influences the rates of synthesis of
serotonin, the catecholamines, and acetylcholine by brain neurons. The diet readily
influences brain neurotransmitter formation via this mechanism515. Dietary amino acids
have also been found to alter pain tolerance thresholds518. Research evidence suggests
that neurotransmitter precursors can be helpful in patients with mild or moderate
depression516.
11.4 THE BRAIN AND CHEMICAL SUBSTANCES
Chemical substances, in the form of allergens, drugs, toxic materials, medication or even
food, can change the synaptic functioning dramatically if they are ingested. Chemical
substances can be taken deliberately, unwittingly with food, or can be produced by
activities that take place in the body. Exercise, as an example, places stress on the body
and the body responds by secreting hormones and endorphins, to counter or stop this
unnecessary exertion. This leads to a temporary feeling of happiness and satisfaction76,
257, 263
.
Natural substances that are ingested can also act as chemical substances in some
persons' bodies, for example in allergies to food. Chemical substances also have a
97
neurotoxic, genotoxic or carcinogenic effect on the user. Some of these chemical

substances are also absorbed in the brain132. There are several ways in which chemical
substances can alter the natural functioning of neuronal transmission. The following
eight mechanisms, with which chemical substances modify the activity of neuronal
transmission are briefly described:
chemical substances can increase or decrease the production of

neurotransmitters;
certain chemical substances impede the movement of neurotransmitters to the
axons' ends;
storage of neurotransmitters in the vesicles, that are found in the axons' ends, is
often also affected in various ways by chemical substances;
chemical substances can also affect the release of neurotransmitters by, for
example, releasing them prematurely;
chemical substances can affect the enzyme that is responsible for the
metabolism of the neurotransmitters;
chemical substances can inhibit the re-absorption of neurotransmitters in the
axons' ends, by blocking the gaps in the ends;
chemical substances can activate the receptor in the post-synaptic brain cell, by
imitating the activity of a neurotransmitter, and
chemical substances can also block the receptor, in which case the appropriate
neurotransmitter cannot activate the receptor for the purpose of carrying the
electrochemical message any further139.
11.5 SUPPORTING ENERGY METABOLIC COFACTORS

In addition to NAD various other important cofactors exist both in the NAD energy
system and in the general biochemistry of the human body. The cofactors identified as
important from the independently done blood tests for Alkogen Products and which are
included in the various nutriceutical supplements are related here for informational
purposes only. Hundred's of research articles clearly illustrate that a number of
nutritional deficiencies may have etiologic relevance in NED. These include deficiencies
of various B vitamins, magnesium, zinc, L-tryptophan, L-carnitine, coenzyme Q10, and
essential fatty acids. Any of these nutrients could be deficient in NED patients, and it
appears to be largely due to the illness process rather than to deficient diets. It is likely
that nutritional deficiencies not only contribute to the clinical manifestations of the
syndrome, but also are detrimental to the healing processes. Because of the rarity of
serious adverse reactions, the trouble in ruling out marginal deficiencies, and because
some of the therapeutic benefits of nutritional supplements appear to be due to
pharmacological effects, it seems logical to supplement NED patients with nutrients523.
Alkogen Products is constantly in a process of refining the physical measurement
techniques with a view to eventually determine a cost-effective method to differentiate
treatment more accurately per patient. The more accurate one measures, the more one
learns. Unfortunately this also increases the cost of measuring. This process is
constantly updated to enable one to give a specific treatment to a specific patient.
However, most physical deviations in NED require the same underlying nutriceutical
treatment, such as carnitine, magnesium, NAD and other vitamins.
98
A Bird's Eye View of NAD Therapy

Some people are completely unconcerned about their age. They will also readily say,
that they do not know how old they are. They have a youthful attitude towards life and
also possess the obvious lust for life, which much younger people have. I think that it is
safe to say, that all of them simply continue to grow. They are set in the conviction, that
they are as old as they feel.
All of us know such people and one sometimes wonders, why there are so many days of
depression and fatigue, which destroy your dreams of feeling youthful. Your dreams
changed into deceit. Depression then is mercifully a suitable diagnosis. A little pill will
hopefully help.
Thoughts have a very great effect on your health. On the other hand, it is also true that
there must be stability in your body, at the cellular and biochemical level, in order to be
able to be of healthy mind. As long as there are no stable bodily processes, dreams will
always be deceitful. There can be no predictability or confidence, without stable bodily
processes. People, who lack this stability, are often trapped in an addiction to a chemical
substance, money, relationships and/or food. If the body is not stable, it is very difficult to
live with yourself.
There is a particular area of instability in the biochemistry of our bodies, which
contributes to problems with memory, irritability, problems with concentration,
depression, a decrease in mental energy, anxiety, chronic fatigue and a craving for
alcohol, nicotine and sugar. This condition is a deficiency in nicotineamide-adeninedinucletide (NAD). We refer in this instance to a metabolic energy deficiency!
You read correctly: We are dealing here with a measurable energy deficiency. Most of
the symptoms, which are referred to in the above-mentioned, are merely masks which
hide the actual problem. Behind these masks there is most probably a genetic defect and you can definitely do something about it.
All human activities require energy. Each cell in your body has a particular function and
requires energy, to be able to do its job. This energy is produced by various chemical
processes in the cells, in little "power plants", which exist as small parts in the cell. We
refer to such a power plant as the mitochondrium.
Food, which we consume, is converted into glucose by means of digestion. The glucose
is the fuel in the power generators. Most processes in a power plant, which releases
energy, however require a particular assistant. We call such an assistant a co-enzyme.
Without the co-enzyme, the power plant will simply not function.
NAD is a co-enzyme, which maintains the processes in all power plants. It is therefore
clear, that if there is a deficiency in NAD or if there are too few power plants in the cells,
that there is an energy deficiency. NAD is also produced by the body on its own, from
food.
A metabolic energy deficiency refers to a deficiency in chemical energy, with which 10%
of all people are burdened. As a result of a genetic deficiency in mitochondria (power
plants), this energy deficiency will clearly be observed in families, where various masks
99
hide the deficiency. Grandmother might therefore suffer from obesity, her son from
workaholism, her daughter from depression and her granddaughter might be a drug
addict.
The egg cell of the woman starts with a shortage of power plants. The children inherit no
power plants from their father, because all of his "power generators" are located in the
tail of the sperm cell and the tail is discarded during conception. The daughter and son
will therefore inherit an energy deficiency, but the son can marry a woman, who has
enough power plants. The problem therefore ends at that stage. The daughter however
spreads the problem.
There are standard laboratory tests, which indicate a metabolic energy deficiency. A
blood sample is taken and lactate and pyruvate blood tests are used, which are good
indicators of the biochemical energy level. Three NAD Energy Levels and the NAD
Energy Block are then calculated. The NAD Energy Block is then used as basis to
recommend a NAD Nutrition Protocol.
100
International Application of NAD Therapy

The lactate and pyruvate blood tests used to determine the NAD Energy block values
are internationally in use and the relative affordability of these tests make them available
to most people.
The NAD Energy Block value can be calculated with the accurate and easy to use NAD
Energy Level calculator at http://www.energyequalsempowerment.com
The NAD Energy supplements are internationally available through an E post service
and can be ordered online at http://www.nadenergy.net
A Letter from the Father of NAD Deficiency Diseases
101
Dear Theo
I would like very much to contribute to your e-book and perhaps explain how my interest
began and the experiences that changed my life when the truth about NAD therapy was
revealed to me in 1980. I feel very much an obligation to help humanity with my
discovery. The future of the world is truly in our hands. We must face powerful interests
that want to suppress our discovery i.e.. the medical establishment and the
pharmaceutical companies, perhaps even some of our governments. My own
government who I served as a medical officer during the Vietnam War prosecuted and
imprisoned me for 3 years after I tried to help some drug addicts with the niacin therapy I
had developed for use on alcoholics.
That is why I could not treat any more people; my license was revoked by a federal
judge. I turned to the library and the laboratory to continue my work on the discovery. In
prison I met the most afflicted members of our society; the real predators that suffered
so much from addictions, so my 3 years were not wasted. We had vitamins in prison and
I found a case of acute pancreatitis that was in severe pain. I gave him 250 mg capsule
of time-release nicotinic acid (commonly called niacin) and the pain was gone in about
an hour. I had hoped to try this on other pancreatitis suffers but never had the chance; it
was my most dramatic response to niacin. A Mafia man from Chicago had asked me to
see the black man who suffered from the pancreatitis and was most impressed with the
outcome. After that many others began taking niacin and benefited from the effects. The
other diseases in the prison population included early diabetes and in several cases they
reverted to normal with niacin 500 mg daily and exercise. Hypertension was another that
reverted to normal on the same niacin therapy. It was the results of my prison
"doctoring" that developed my thinking about NAD Deficiency Diseases.
John Patrick Cleary, M.D. was born in Kenosha, Wisconsin on October 16, 1933. He
graduated from Washington Park High School as valedictorian in a class of 351 on June
6, 1952. He corresponded with Albert Schweitzer about working in Africa at his Hospital,
but was advised to go to medical school first. Medical training was begun at UWMadison in 1952 in the premed program and resulted in the degrees of Batchelor of Arts
with a minor in German Language in 1956 and Medical Doctor in 1959. Internship was
served at Santa Barbara Cottage Hospital and Santa Barbara County Hospital in 1960 in
Santa Barbara, California. A Residency in Psychiatry at University of Colorado Medical
Center was served for the only first year in 1961 Interest in Psychiatry began during his
undergraduate training when he studied Anthropology, Psychology and Primatology.
Reading Sigmund Freud was a helpful start to develop his later theories on the Predator
Response Mechanism since Freud had no good explanation for the psychopathology of
sociopathy or criminal behaviour. Dr. John MacDonald was his advisor at the U.of C.
Medical Center and criminal behaviour was his special interest. John left after only
completing the first year of the three year program because of family needs His wife and
3 children were not doing well with the low income and lack of time with him. He quit and
went to work at Camarillo State Hospital in California where he was placed in charge of
a research ward that was treating schizophrenia in a randomized study of 5 modalities.
After only 14 months he had to leave because of his own mental health. It was just too
much for a sensitive person like himself. Looking back you could say that he was being
groomed for a real revelation later in life.
102
His clinical practice began in 1966 when he was drafted into the U.S.Army as a medical
officer during the Vietnam War. Prior to this he had been a medical consultant to the
State of Wisconsin Disability Determination Unit. It was a desk job dealing with claims for
disability filed with Social Security in his State. Practicing in the Army developed his
skills in general medicine that he continued after his 2 years of service were done.
Following the Army duty in 1968 he opened his office to practice general medicine.
Practice as a rural doctor in the Cross Plains-Middleton area gave him time to think
about the drug and alcohol problems that were so evident in the military.
A new way of treating addictions was sorely needed. In 1980 Dr. Cleary was appointed
to the temporary position of medical director of Dane County Detox Center for the first 3
months of that year. During this time he saw 20 or 30 patients each day for the full 3
months. The detox program was required to keep patients only 5 days or less and as a
result the same hard-core addicts rotated thru the clinic. The County Supervisors asked
how he could improve the program if he was given the permanent position of medical
director? He replied that the patients needed to stay longer than 5 days if the addiction
cycle was to be broken. This was the wrong answer for the Board and the job was given
to someone else.
Later in 1980 he was treating a 60 year old man in his private practice for hyperlipidemia
with niacin. The patient was placed on niacin 500 mg daily in the form of 250 mg timerelease capsules twice daily. He returned after a month and was overjoyed that he had
quit drinking 3 or 4 pitchers of beer every night to help him sleep.
The treatment was then tried on 12 more alcohol addicts with the same results in 11
cases. It took 3 or 4 weeks of niacin 500 mg daily to relieve the addiction. The man who
failed on the treatment was totally dependent on the social life of his bar and was unable
to quit. The best result was seen in a 30 year old man who had worked at a Salvation
Army Shelter for Alcoholics. He was cured of his alcohol addiction and went back to
college to finish his education. Trials of niacin on drug addicts addicted to cocaine and
opiates proved the treatment was fundamental to all substance addictions. Dealing with
drug addicts was not a good idea however since it led to conflict the Drug Enforcement
Agency. Investigation of addicts was not allowed and the doctor was sent to prison for 3
years in 1984. Prison was a lot like the medieval monastery. One has time to reflect,
study and write. His first publications were done from prison.
Living with criminals gave him a chance to study human predators up close. It was soon
very clear that addictions to alcohol and drugs of abuse were very prevalent in prisoners
confined in medium and minimal security facilities of the federal system. The flow of
drugs and alcohol into the prisons was possible because of corrupt guards and high
demand from the predatory prisoners. A general theory of addiction was proposed that
alcohol addiction had a common pathway in the brain with other drug addictions and that
the correct therapy would cure both. The treatment with niacin was proven to work in
both alcohol and other drugs of abuse in the small pilot study done in the early 1980s
prior to being imprisoned. It was therefore hypothesized that raising brain NAD levels by
giving niacin cures both alcohol and drug addictions.
A search of medical literature revealed that Dr. Cleary was not the first to uncover the
niacin therapy for addiction. Professor Otenello published in 1946 Minerva Medica his
use of niacin and thiamine injections to detox morphine addicts. Hoffer and Osmond
103
published the results of using niacin and vitamin C in the 1950s to treat schizophrenia
and that the alcoholic schizophrenics stopped drinking alcohol with this treatment.
Russell Smith published his study of 500 alcoholic priests treated with niacin therapy
over a 5 year period with good results in 50 to 60%. Paul OHolleran reported on his use
of NAD by injections to treat over 11, 000 alcoholics and 108 drug addicts. The real
question was why has this treatment not become widely used? This question continues
to trouble me since I had only wanted to help solve the problem and tell the story of how
we can end the war on drugs successfully.
After release from prison I continued my work in the medical library and wrote more
articles about niacin therapy. I hypothesized that the secondary diseases of alcohol
addicts would respond to niacin therapy since they were also caused by low NAD. In
1987 I started to work in the lab at the University Wisconsin-Madison Medical School
and continued until I retired in August 2001. I now live on my farm outside Cross Plains,
Wisconsin and try to carry on my quest to make this treatment more available to the
suffering public. I feel that Alkogen has done what I hoped we could have done at
University Wisconsin-Madison. I congratulate them on carrying out my dream.
God has truly blessed us all.
John Cleary
104
Closing Notes
In clinical practice, one encounters a group of infants, children, adolescents, adults and
aged persons whose depression, alcoholism, chronic fatigue or other chronic conditions
fail to respond effectively to treatment, that is currently available. Except for their
diagnosed disorders, most of these individuals do experience energy metabolic
deficiencies and their conditions are aggravated by the presence of NAD Deficiency.
Clinical experience and international research find, that the majority of patients benefit
from NAD Therapy. NAD Therapy, in oral supplementation capsules supported by wellfounded multiprofessional programmes and internationally used blood tests, form the
foundation of Alkogen Treatment Network's treatment approach. Thousands of highly
scientific studies have already been conducted in this field, across the world. The
findings are however related to studies, which cover a wide field of study, and have so
far not yet been integrated meaningfully, in a proper and applicable model of treatment.
NAD is a coenzyme, which is produced or absorbed naturally in the body, from certain
nutritional particles. The coenzyme varies continuously between the NAD and NADH
compound in the body. NAD has more than 100 functions in the human metabolism.
Approximately 10 per cent of humans suffer from a serious and chronic deficiency of
NAD. NAD Therapy is in use for the treatment of substance dependency since 1939 and
is now only becoming a treatment possibility for the NEDRS listed in this e-book.
Although everyone can benefit from NAD Therapy, its use over a long period is essential
for approximately 10% of persons, in order to ensure that they can maintain their quality
of life. NAD Therapy is more effective if supported by individualised, multiprofessional
treatment, which includes a personal diet, prescription medication, pastoral counselling
and individual psychotherapy.
105
Acknowledgements
These are the professional people, who also want to help, but who sometimes feel stuck
in an old paradigm and approach which is no longer appropriate or useful. The
colleagues who participated in the whole process which lead to this book, took part as
fellow human beings and as professional people in interviews, comments and personal
support. For this I am sincerely thankful.
I have experienced uneasiness when working in areas where the professional and
academic lines were vague. But this too is part of changing reality, especially at the
growth point of change, and it is to be expected that the boundaries between academic
and professional disciplines will continue to change, with much overlap, and this is to be
welcomed. I am grateful for the practical and academic support and help from
colleagues in various professions.
Specialist Medical Consultants
Dr Sterna Franzsen, Dr IJ Lessing, Dr Petrus Retief (Snr), Dr Stella Verster, Dr Nanno
Bakker, Dr Lienkie van Niekerk, Dr Fred van der Riet
International Consultants
Prof John P Clearly (USA), Dr Abram Hoffer (Canada), Dr Ian Hyams (UK), Dr Alta Smit
(Canada), Dr Fritz Steyn (Canada), Dr Debrah Baker-Racine (Canada), Dr Andr Oertel
(Australia), Dr Koos Engela (Ireland), Dr Christopher Ross (UK), Dr Johannes and Zelda
Heyns (USA), Dr Kobus du Preez (Canada), Dr Petrus Retief (Jnr) (Canada)
Pharmaceutical Consultants
Prof Roy van Brummelen, Derick Schaffner, Peter Parks, Charl Munting, Werner
Verwey, Tuanette de Beer
Medical Consultants
Dr Ockie van Wyk, Dr Thys Pienaar, Dr Jabra van Wyk, Dr Wilna Haveman, Dr Hendrik
van Wyk, Dr Cas Breedt, Dr Bernard van Heerden, Dr Nelis Marais, Dr Anton Botha, Dr
Alida Wolfaard, Dr Tanja Redelinghuys, Dr Leon van Heerden, Dr Danie Robbertze, Dr
Ria Smuts, Dr Charl Stevens, Dr Erika Coertzen, Dr Paul Dijkstra, Dr Johan Pretorius,
Dr Jonathan Marchand , Dr Martie Brits, Dr Johan Viljoen, Dr George Coetzee, Dr Du
Toit van Rooyen , Dr Le Roux van Niekerk, Dr Hannes Fouch, Dr Peter-Sephire,
Dr Louma Erasmus, Dr Douw de Jongh, Dr Des Theron, Dr David Liebenberg, Dr Estelle
Burger, Dr Francois Landsberg, Dr Johan Portwig, Dr Petrus Gunter, Dr PA Goosen, Dr
Rachel Bouwer, Dr Ronel du Toit, Dr Christo Smith, Dr Johan Botha
Nursing Consultants
Sr Corrie Boy, Sr Marieta Pretorius, Sr Chantelle van Tonder, Sr Anita van der Merwe,
Sr Magda Grobler, Sr Marie Visser, Sr Rentia van Zyl, Sr Elsabe Kruger, Sr Dorrette van
den Berg, Sr Karin van der Merwe, Sr Ria Venter, Sr Esmarie Venier, Sr Maggie van
106
Niekerk, Sr Retha Jacobs, Sr Riana Pienaar, Sr Brechtje Malherbe, Sr Anita Venter, Sr

Marieta Pieterse, Sr Hannetjie Botha, Sr Reda Jacobs, Sr Mari Lombard, Sr Antoinette
du Preez, Sr Gedina De Wet, Sr Sarie Hyman, Sr Joey van Tonder, Sr Doreen Swart, Sr
Petro Joubert, Sr Machtild Struckman, Sr Vicky Holtzhausen, Sr Benita Grobler, Sr
Bertha Strydom, Sr Ria Bekker
Dietary Consultants
Ina Vosloo, Corn van Zyl, Marie-Henritte Botha, Sally Tarlton, Elsabet Scholtz
Psychlogical Consultants
Prof Johan Schoeman, Prof Elsabe Swanepoel, Koos Fourie, Russel Mathews, Dr Daan
Steyn, Len Kok, Marita van der Riet
Pastoral Consultants
Prof Murray Janson, Dr Gustav Gous, Dr Vorster Combrink, Rev Charl Botha, Ina
Jordaan, Rev Japie Venter, Rev Johan Eloff, Yvonne de Winnaar, Rev Ben van der
Walt, Dr David Scott
Homeopathic Consultants
Dr Johan Oberholzer, Dr Johan Prinsloo, Dr Guido Gillisen, Dr Natalie Christie, Dr Alby
Ford, Dr Wim Rademan, Dr I Badat, Dr Marike de Klerk, Dr Stefan Groenewald
Journalists
Lerinda Steyn, Martie Swanepoel, Elretha Louw, Amalia van Jaarsveld, Willa Vos, Ruda
Landman, Helen Naude, Bettie Kemp, Alvin Bruinders, Karen Blume, Alet Rademeyer,
Marie Opperman, Victor Horne, Liezel Joubert, Willem Pelser
Biokineticists
Adel Mc Donald, Rhode Steinmann, Dr Stefan Schoeman
Social Workers
Maria Venter, Selma Lampbrecht, Martinette van Niekerk, Piet Kruger, Annemarie de
Villiers, Helena Marais, Dr Natasha Pretorius, Wanda Rossouw
Legal Pracitioners
Adv Dewald Visser, Christie Blignaut, Raymond Eastes, Elke de Klerck.
Speech Therapist
Carin Smit
107
Physiotherapist
Hannelie van der Vyver
Behavioural-genetic and Biochemical Consultant
Dr Henry Davis
Education
Mr Cassie Vorster (principal), Mr Gerrie Lategan (principal), Carina van Heerden,
Michael Heine, Adriaan du Plessis, Desire Schoeman
108
Copyright and Reader's Responsibility
Copyright Verwey, 1989 - 2009

All rights reserved. No part of this ebook may be reproduced in any manner, without
the prior written permission of the copyright holder, except for the purpose of reasonable
research or review.
Publisher: Alkogen Publishers, PO Box 1558, Nigel, 1490, South Africa
This ebook (in its original and intact format without any alterations) can be distributed
freely, as a printed or electronic copy, by any truly concerned person to be of help to
NAD Energy Metabolic Deficiency Sufferers.
Readers' responsibility: It is possible, that some readers do not agree with some views
in this book. It is assumed, that they are mature enough not to continue reading, if the
content upsets them. Where suggestions are made, it is the reader's prerogative, choice
and responsibility to accept them or to reject them. The editor does not accept any
responsibility for others' actions in this regard and points out that it is always essential to
consult experts, like dieticians, pharmacists, nurses, doctors, councillors, therapists and
other members of the professional team. The suggestions are not prescriptive, but rather
information for reflection.
Indemnification: Issued without prejudice to any rights. The medical, legal,
psychological, behavioural-genetic, spiritual, dietary and nursing information and other
procedures contained in this book are intended only to serve as information, and the
intention is not that these should replace any consultation with your professional
practitioners in this regard. No claims and diagnosis should be implied from this
publication. The information is based on scientific studies, clinical experience, or as cited
in each article reviewed. The results or findings reported or referred to may not
necessarily occur or be present in all individuals. Consult your physician, and/or
pharmacist for any health problem and before using any supplements or before making
any changes in prescribed medications. Any attempt to prevent, diagnose and/or treat a
medical condition and/or disorder must be made only by appropriately registered
professionals. Although the editor does refer to specific treatment and supplements, he
does believe that similar products or treatment will probably be of same benefit. Any
action is always accompanied by a measure of risk, and the editor therefore does not
accept any responsibility for any possible side-effects or other consequences that may
arise when using any of the solutions, preparations, supplements, principles, medication,
procedures and/or techniques contained, discussed or referred to in this publication.
The information in this ebook is constantly updated and is subject to differing
interpretations. It is up to the reader to verify it thoroughly before applying any
information contained in it.
The Illustrations and Pictures contained in this ebook are for illustration purposes
only and do not imply any specific detail. It remains the property of the respective
Owners.
109
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NAD Therapy! Too Good to be True?

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Foreword by Dr Abram Hoffer

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

"Nicotinamide adenine dinucleotide (NAD), is an energy "currency" of the cell, all

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

2. chemical carcinogens and radiation can cause a lowering of NAD concentration

Copyright Verwey, 1989 2009

cell-associated observations link HIV, nicotinamide, and NAD. HIV-infected cells

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Talk for up to ten years.

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

2.4 BIRTH: CROSSING THE FIRST BRIDGE

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Decomposition can be observed after approximately 48 hours in a moderate climate, or

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

adenine dinucleotide (FAD) from riboflavin; Coenzyme-A (CoA), from pantothenate;

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

3.4.3 LONGER THAN 2 MINUTES

Copyright Verwey, 1989 2009

NAD Energy Deficiency(NED): The Focus of NAD Therapy

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

4.5.2 Acquired NED (Irreversible & Chronic)

"Secondary disorders are those in which the derangements of energy

Copyright Verwey, 1989 2009

A number of acquired conditions including infections, severe catabolic states,

4.5.3 Induced NED (Reversible & Temporary)

4.6 CHRONIC NATURE OF NED

The condition is, or seems to be, irreversible.

4.7 GENDER AND NED

Copyright Verwey, 1989 2009

Copyright Verwey, 1989 2009

4.9 COPING MECHANISMS WITH NED

Reducing activities that require energy, or adapting to low energy levels.