7 Clinical Basis of NAD Therapy: Alkogen Clinic
Alkogen is an officially registered private treatment network consisting of a multiprofessional group of private practitioners using NAD Therapy in treating EMDRS sufferers regardless of race, gender or age. Alkogen is the first centre in South Africa to use NAD Therapy on an outpatient basis to people suffering from EMD. The oral nutritional supplements NutriNAD, MalaikaNAD, MultiNAD, EmCegene Forte, GeneClear and GeneSlim were specifically developed in collaboration with leading clinicians to facilitate NAD Therapy.
Alkogen is an officially registered private treatment network consisting of a multiprofessional group of private practitioners using NAD Therapy in treating EMDRS sufferers regardless of race, gender or age. Alkogen is the first centre in South Africa to use NAD Therapy on an outpatient basis to people suffering from EMD. 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 has treated people from all over South Africa. Many practitioners also refer patients for evaluation and programme formulation, and then continue with the treatment in collaboration with their local resources. As a result many practitioners and centres across the country collaborate with Alkogen in terms of treatment. Since 1989 more than 6 000 patients and their relatives have already been benefiting from their individualised treatment programmes at Alkogen.
"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 the application of NAD Therapy is based on the results of recognised and accredited medical, psychological, nursing, pastoral and dietary evaluations supported by findings from research. 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.
7.1 ALKOGEN AND THE MEDIA
Alkogen has featured in more than 60 national articles and radio interviews, and has even received coverage on a well-known Sunday evening current-affairs 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 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) 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)".661
7.2 THE BEHAVIOURAL-GENETIC APPROACH
Behavioural genetics, ie 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.
The differential diagnosis of chronic fatigue (as an example of EMD) is extensive and includes medical disorders, altered physiological states (eg, pregnancy, exertion), psychiatric disorders, lifestyle derangements, drugs, and controversial entities (eg, 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 (eg, 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.
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 EMD, companions and others who are involved adapt to the person's condition, often referred to as co-dependency. 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 shows that EMD runs in families and that most family members are also suffering from EMD, most oftenly as co-dependency. It means that the treatment professional cannot really rely on the loved ones of the identified patients to cooperate fully, without addressing the loved ones' EMD. 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 is established during the first interview. Relevant special examinations are arranged if deemed necessary. If no contra-indications are found, the physician will issue a prescription for NAD Therapy and the supporting medication, as is determined clinically and based on the calculated energy levels per the blood tests. Supporting medication is 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 is also determined by the physician. If there are medical reasons for hospitalisation or other interventions, the physician will arrange it in consultation with the rest of the practitioners. Medication, which is being abused at the time, will be phased out in time and this is explained to the patient. The consulting physician will also monitor and adjust conventional medication prescribed for the specific disorder in accordance with the improvement on the initiated NAD Therapy.
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 - 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. Nutrimalaika Nurses-led Centres provide exellent care and guidance of EMD and NAD Therapy to young mothers and their small children, families, adults and the eldery 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 patient’s programme, patient’s 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 EMD 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 EMD patient population based on the patient’s and/or caregiver’s 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.
“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.
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 self-help 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 yeast-avoidance 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.
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 EMD, 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.
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 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.
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 EMD. 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.
7.10 MANAGEMENT OF THE CHILDREN’S 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 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.
EMD 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.
7.11 SELFHELP APPROACH
Regarding the selfhelp approach to NAD Therapy Alkogen 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)