Because the gut is shaped throughout your life by things such as how much sleep and exercise one gets, levels of chronic stress, and of course, what food, drink and medications are ingested, the overall focus of Viome is lifestyle-based health care that can help with weight loss, sleep, mental clarity, digestive issues, your skin and more.

Viome is a gut microbiome sequencing test that can identify living microorganisms in one’s gut as well as determine what these organisms are producing and whether or not it is causing the body harm. Based on this, scores are received that provide a clear picture of how what you eat  positively, or negatively, contributes to the health of the gut microbiome and what can be done to improve it.

Book your appointment and find what your unique gut michrobiome requirements are and how to optimize your health and well-being.

Phosphatidylcholine focus:

Phosphatidylcholine (PC) has also biological and functional roles in healthy liver. It is one of the most important support nutrients for the liver, a large biological molecule that is a universal building block for cell membranes. More than 2 decades of clinical trials indicate that PC protects the liver against damage from alcoholism, pharmaceuticals, pollutant substances, viruses, and other toxic influences, most of which operate by damaging cell membranes. Dietary supplementation with PC (a minimum 800 mg daily, with meals) significantly speeds recovery of the liver. PC is fully compatible with pharmaceuticals, and with other nutrients. PC is also highly bioavailable (about 90% of the administered amount is absorbed over 24 hours), and PC is an excellent emulsifier that enhances the bioavailability of nutrients with which it is coadministered. (Kidd PM. Phosphatidylcholine: A Superior Protectant Against Liver Damage. Alternative Med. Rev. 1996) PC’s diverse benefits and proven safety indicate that it is a premier liver nutrient:

• It is the principal molecular building block for circulating lipoproteins
• It is an important emulsifier in the lungs gastrointestinal tract bile
• It manages the vast majority of life processes
• It acts as a carrier for both fat-miscible and water-miscible nutrient

Uses and doses :

Phosphocomplex® is obtained by hydrogen bonds between the polar head of phospholipids and the polar groups of pure Silybin (≥ 95%). The standardized starting material is equal to ≥29% to ≤37% of Silybin by HPLC. The enhanced absorption through gastro-intestinal tract and the increased bioavailability facilitates liver targeting, with a synergistic effect of the phosphatidylcholine phospholipid as hepatoprotector. Supported by pharmacological and clinical data. Phosphocomplex ™ is a yellow-brownish powder suitable for different formulation such as tablets, capsules and sachets.

At the recommended dosage of 80 – 160 mg/day it may be indicated as a complement product for :

• Fatty Liver –Steatosis
• Alcoholic liver disease
• Also Non Alcoholic Fatty Liver Disease
• Chronic liver disease
• Acute viral hepatitis.

Mechanisms of working of phosphocomplex :

1. Hepatocye protection : promotes hepatocyte protein synthesis, a mechanism forliver cell regeneration

2. Anti-inflammatory effects
a) mastocytes stimulated
b) neutrophil stimulation
c) leucotrine inhibition
d) Prostaglandin, lipoprotein and lnterleucin inhibition

3. Detoxification : increases GSH, increases superoxide dismutase

4. Liver protection : stimulates the flow of bile acid and the production of bile salts, and protection of hepatic tissue

The use of glutathione as a nutritional supplement is limited by its unfavorable biochemical and pharmacokinetic properties:  It is not directly taken up by cells.   It needs to be broken down into amino acids and re-synthesized into GSH.  The re-synthesis process is often impaired during diseases status.

EMOTHION® is the crystalline form of S-Acetyl Glutathione, the cutting-edge alternative developed to overcome the poor effectiveness of GSH supplementation, due to its poor absorption and its hydrolytic degradation in the body. EMOTHION® has more rapid dissolution rate and, therefore, is orally well absorbed.Once internalised into the cells, EMOTHION® increases GSH level more efficiently than normal GSH. EMOTHION® is a precursor of glutathione and works as GSH-replenishment agent.

EMOTHION® is the active form of GSH S-Acetyl Glutathione. Its crystalline form optimizes the absorption of S-Acetyl Glutathione, a molecule that exists in several polymorphic forms which can have different physicochemical characteristics that influence its dissolution rate, solubility and therefore oral bioavailabilty.

The scientific rational for effective GSH supplementation is still a debate and controversial studies have been published. Current data on long-term treatments seem to support the efficacy of oral administration, with an increased availability of GSH in cellular districts, but only after some months from the onset of treatment. However, the increased GSH levels is dose and time dependent. The intestinal enzymatic degradation which the GSH is subjected to, leads to its poor absorption and a low bioavailability and requires a very long oral GSH supplementation in order to appreciate a possible increase of its levels. EMOTHION®, on the contrary, directly increases the levels of GSH in the body. This product has been consistently tested versus qualified commercial GSH, both in pre-clinical and clinical trials.

Current data on long-term treatments seem to support the efficacy of oral administration, with an increased availability of GSH in cellular districts, but only after some months from the onset of treatment. However, the increased GSH levels is dose and time dependent. The intestinal enzymatic degradation which the GSH is subjected to, leads to its poor absorption and a low bioavailability and requires a very long oral GSH supplementation in order to appreciate a possible increase of its levels.  EMOTHION® raises glutathione levels better than the Commercial GSH Reference, after one administration only.  EMOTHION® was not detected in the form of S-Acetyl GSH, either in plasma or in the cell fraction, confirming that it is soon quickly de-acetylated and converted in its active metabolite glutathione.

Cognitive Health : EMOTHION® may support cognitive health through the increase of GSH levels, the most prevalent antioxidant in the brain. The brain is particularly vulnerable to oxidative damage due to the high levels of unsaturated lipids, oxygen, redox metal ions, and relatively poor antioxidant systems. Increasing glutathione levels remains a promising therapeutic strategy to slow or prevent mild cognitive impairment (MCI) and Alzheimer’s disease (AD), where the oxidative stress has been associated with their onset and progression (19).

Anti-Aging : GSH is central and critical to all of the primary processes of cellular protection. Oral supplementation of EMOTHION® raises the level of GSH that naturally decreases with age, improving cellular health and function, helping to repair the damage caused by free radicals and their accumulation in the body cells (5, 14)

Anti-Inflammatory : EMOTHION® provides ready-to-use GSH that helps to fight inflammation at the source, where the inflammatory status occurs, helping to repair the oxidative damage and its progression. Low-grade and chronic inflammation is a highly significant risk factor for elderly people, as most if not all age-related diseases share an inflammatory pathogenesis (15).Skin Health By raising the GSH levels, EMOTHION® may improve quality, health and appearance of skin, the body’s first line of defence against exogenous injuries, such as oxidants, UV rays, toxins and infections. By topical and oral application the GSH released by EMOTHION® may minimize age spots and wrinkles of exposed skin. Glutathione is also known as whitening and skin-lightening (24).

Liver Health : EMOTHION® protects liver functions through the natural replenishing of GSH, the primary factor affecting liver activities and health. The liver contains the majority of the body’s glutathione, used to detoxify the body and to regulate immune function (17, 18).

Immune Function : EMOTHION® is useful to increase GSH levels proposed to increase the innate and the adaptive immunity as well as conferring protection against infections (16). Energy Production and Cellular Metabolism EMOTHION® provides free glutathione which can assist cellular metabolism through the prevention of anomalies and dysfunction of mitochondria, the organelle responsible for cellular energy production. Loss of function in mitochondria can result in the excess fatigue and other symptoms that are common in almost every chronic disease (20, 21). Athletic Performance and Recovery The GSH frees by EMOTHION® may benefit athletic performance, by controlling oxidative stress and free radical formation during exercise. Increased strength and endurance, decreased recovery time from injury, less pain and fatigue and an increase in muscle-promoting activities may be associated with the use of glutathione.

GSH improves the health and quality of mitochondria as it directly provides free glutathione which can assist cellular metabolism through the prevention of anomalies and dysfunction of mitochondria, the organelle responsible for cellular energy production. Loss of function in mitochondria can result in the excess fatigue and other symptoms that are common in almost every chronic disease (20, 21).

Athletic Performance and Recovery : The GSH frees by EMOTHION® may benefit athletic performance, by controlling oxidative stress and free radical formation during exercise. Increased strength and endurance, decreased recovery time from injury, less pain and fatigue and an increase in muscle-promoting activities may be associated with the use of glutathione.

References:

1. Wu G et al. “Glutathione metabolism and its implications for health.” J Nutr. 2004.
2. Calvin CA et al. “Blood glutathione decreases in chronic diseases.” J Lab Clin Med 2000.
3. Erden-Inal M et al. “Age-related changes in the glutathione redox system.” Cell Biochem Funct 2002.
4. Van Lieshout EM, Peters WH. “Age and gender dependent levels of glutathione and glutathione S-transferases in human lymphocytes.” Carcinogenesis. 1998.
5. Erden-Inal M et al. “Age-related changes in the glutathione redox system.” Cell Biochem Funct 2002.
6. Witschi A et al. “The systemic availability of oral glutathione.” Eur J Clin PharmacoI 1992.
7. Allen J and Bradley RD. “Effects of oral glutathione supplementation on systemic oxidative stress biomarkers in human volunteers”. J Alter Compl Med 2011.
8. Ballatori N et al. “Glutathione dysregulation and the etiology and progression of human diseases.” Biol. Chem. 2009.
9. Vogel JU et al. “Effects of S-acetylglutathione in cell and animal model of herpes simplex virus type 1 infection.” Med Microbiol Immunol 2005.
10. Okun JG et al. “S-Acetylglutathione normalizes intracellular glutathione content in cultured fibroblasts from patients with glutathione synthetase deficiency.” J Inherit Metab Dis 2004.
11. Gnosis In House Studies:” Efficacy of EMOTHION® (S-Acetyl Glutathione) on the recovering from a severe acetaminophen induced hepatotoxicity in a mouse model.” In Press.
12. Owen JB, Butterfield DA. “Measurement of oxidized/reduced glutathione ratio.” Methods Mol Biol. 2010.
13. Gnosis in house study. “EMOTHION® (S-Acetyl Glutathione) and l-glutathione comparative single dose crossover study in healthy volunteers”. In Press.
14. Rebrin I, Sohal RS. “Pro-oxidant shift in glutathione redox state during aging.” Adv Drug Deliv Rev 2008.
15. Rahman I. “Inflammation and the regulation of glutathione level in lung epithelial cells.” Antioxid Redox Signal 2008.
16. Ghezzi P. “Role of glutathione in immunity and inflammation in the lung.” Int J Gen Med. 2011.
17. Lu SC. “Glutathione synthesis.” Biochimica et Biophysica Acta 2014.
18. Morris D et al. “Glutathione and infection.” Biochimica et Biophysica Acta 2012.
19. Pocernich CB, Butterfield DA. “Elevation of Glutathione as a Therapeutic Strategy in Alzheimer Disease.” Biochim Biophys Acta. 2012.
20. Marí M et al. “Mitochondrial Glutathione, a Key Survival Antioxidant.” Antioxid Redox Signal 2009.
21. Kurokawa T et al. “Mitochondrial glutathione redox and energy producing function during liver ischemia and reperfusion”. J Surg Res. 1996.
22. Aoi W et al. “Glutathione supplementation suppresses muscle fatigue induced by prolonged exercise via improved aerobic metabolism.” J Int Soc Sports Nutr. 2015.
23. Kerksick C, Willoughby D. “The Antioxidant Role of Glutathione and N-Acetyl-Cysteine Supplements and Exercise-Induced Oxidative Stress.” J Int Soc Sports Nutr. 2005.
24. Arjinpathana N, Asawanonda P. “Glutathione as an oral whitening agent: a randomized, double-blind, placebo-controlled study.” J Dermatolog Treat. 2012

Strict vegetarians and vegans can also have a higher risk of methylation impairments due to a potential deficiency of vitamin B12. Evidence exists that well-planned vegetarian diets provide numerous health benefits and are appropriate for all stages of the life cycle. It is also known that animal foods provide micronutrients that are nonexistent or available only in limited amounts in plant foods. Restriction or exclusion of all animal foods may therefore result in low intake of certain micronutrients such as vitamin B-12, thereby affecting vitamin B-12 status and elevating plasma homocysteine concentrations.

Integrative and functional medicine tailors care to the individual, and this is why the term personalized medicine is gaining such popularity.Since everyone is different, the treatments may differ from person to person.

Methylation is sort of an antioxidant recycling process in your body, and it’s needed for optimal brain and immune system health. Proper methylation produces your body’s top disease-fighting antioxidant glutathione. When your glutathione levels are low, so is your immune function.
Depletion of glutathione is due to a multitude of factors including : Toxic exposure, antidepressant medications and other chronic pharmaceuticals, Birth control pills, Diabetic medications, Antacid medications, MTHFR gene mutations and glutathione polymorphism gene SNPS.

Methylation function in patients can be gauged by running a homocysteine test. Homocysteine is supposed to be converted to glutathione via methylation. If homocysteine levels are high, methylation isn’t functioning well. I honestly believe that everyone should have their homocysteine level;s checked. In order to have a healthy immune system, you need to have a healthy microbiome, and conditions associated with dysbiosis, or an imbalance between beneficial and pathogenic bacteria (such as SIBO and leaky gut syndrome) can drastically suppress healthy immune function.

Having optimal brain-immune-gut axis function overall is a crucial way to optimize your immune system, so tackle health from all sides to thrive. Managing stress is also key.

Homocysteine levels above 7 UMOL/L have been shown to cause brain inflammation, destruction of the blood-brain barrier, and decreased immune health. The good news is that in the presence of methyl-donors like vitamin B6, B9, B12 homocysteine is converted to glutathione. TMG, SAMe are other supplements that can be used.

Homocysteine and Autoimmunity :
Healthy methylation pathways and balanced homocysteine levels protect your DNA. Methylation helps keep good genes “”turned on”” and bad genes “”turned off””, but when methylation is impaired, it can result in an autoimmune response.

Homocysteine and Brain Function:
Homocysteine levels above 7 UMOL/L have been shown to damage the protective blood-brain barrier (leaky brain syndrome), and are linked to neurologically-based autoimmune spectrum diseases like multiple sclerosis, Parkinson’s disease, and Alzheimer’s.

Preventing and reversing autoimmune decline is essential for protection of the brain, neurotransmitter function, and myelin rep[air and myelin health, which is the sheath protecting nerve fibers. This all depends on healthy methylation pathways.

Homocysteine and Heart Function:
High homocysteine levels are linked with heart or cardiovascular damage. Heart disease is the leading cause of death for both men and women, so everyone should be concerned about their homocysteine levels. Many autoimmune conditions, such as lupus and autoimmune thyroid disease (Hashimoto’s or Graves), also increase the risk for heart attack and stroke, as all these systems and processes are connected by a web-like interconnection of bodily systems.

Elevated homocysteine levels can be caused by a number of factors, including folate and B-vitamin deficiency, pre-existing atherosclerotic disease, diabetes and various drugs. Epidemiological evidence, as well as data from retrospective and prospective studies, supports an association between elevated homocysteine levels and increased risk of cardiovascular disease. Lowering homocysteine levels by administration of folate and vitamins B6 and B12 is associated with a significant decrease in vascular risk but remains the subject of ongoing debate Although some lipid-modifying treatments have been shown to increase homocysteine levels, there is no evidence that this attenuates or compromises the beneficial effects of such treatments on cardiovascular risk according to some studies.

If you have high homocysteine levels, there are a couple of things you can do to lower your health risks and restore homocysteine to normal levels. One thing I suggest is running another lab, to get more information. This is the methylation gene mutation tests (MTHFR, COMT) which can shed light on specific genetic reasons why your homocysteine level might be higher than normal.

The more gene polymorphisms you have, the more methylation impairments you’re likely to experience, which can lead to higher homocysteine levels. For example MTHFR gene mutations has been associated in many cases with autoimmunity, such as Hashimoto’s 9an autoimmune thyroid condition). . Knowing your risk factors is the first step to optimizing your health and personalizing your therapies.

In addition to homocysteine and MTHFR mutation tests, there are other functional and Integrative medicine doctors that will probably recommend for optimal DNA health. So a visit to a functional or Integrative medicine practitioner can help you find solutions. One thing you can do on your own right now, however, if you have high homocysteine levels or an autoimmune condition, is to optimize your B vitamin levels, to support methylation.

The type of B vitamins you take is important. Be sure to go for the activated forms of folate, B6, and B12:

• L-5-MTHF Folate: Methylfolate
• B6: Pyridoxyl-5-Phosphate (P5P)
• B12: Methylcobalamine

Quatrefolic is the newest best form of folic acid/folate, but if not available methylated forms of folic acid are superior to non-methylated forms of folic acid.

Elevated plasma total homocysteine is a marker of folate and cobalamin deficiency and a strong independent risk factor for coronary artery, cerebrovascular and peripheral arterial disease. More recently it was also implicated in pregnancy complications and birth defects, as well as in vascular dementia and Alzheimer’s disease.

METABOLISM AND DETERMINANTS OF HOMOCYSTEINE
Homocysteine is a sulphur amino acid derived from metabolism of the essential amino acid methionine. It lies at the branch point in one-carbon metabolism between two metabolic pathways (remethylation and trans-sulphuration). Folate, vitamins B2, B6 and B12 are essential cofactors and deficiencies result in hyperhomocysteinemia.

Genetic factors:	Effect on tHcy
Congenital homocystinuria (homozygous CBS defect)1	­­­
Heterozygosity for CBS defect	­
MTHFR C677T homozygosity2	­
Methionine synthase deficiency	­
Physiologic determinants:
Increasing age, male sex	­
Pregnancy/ premenopausal	¯
Lifestyle determinants:
Smoking, coffee, alcohol	­
Exercise	¯
Clinical conditions:
Vitamin deficiency (folate, B12, B6)	­ – ­­­
Renal failure	­­
Hyperproliferative disorders (eg psoriasis, solid tumors, leukaemia)	­
Hypothyroidism	­
Drugs:
Folate antagonists, eg methotrexate, trimethoprim, anticonvulsants (phenytoin), cholestyramine	­
Cobalamin antagonists eg nitrous oxide, metformin	­
Vitamin B6 antagonists eg niacin, isoniazide, theophylline	­
Other: cyclosporin A, fibrates, diuretics	­

*1 CBS: Cystathionine B-synthase, incidence of homozygous defect 1/200 000
*2 MTHFR C677T: Methylene tetrahydrofolate reductase thermolabile variant, homozygosity associated with increased CVD risk in association with folate deficiency, incidence 12% of Caucasian population

SAMPLING, REFERENCE LIMITS AND CLASSIFICATION

• The preferred sample for determination of plasma total homocysteine (tHcy) is a single EDTA-sample on ice (falsely elevated in serum), fasting or within 3 hours following a light breakfast (protein-rich meal increase tHcy by 10-15% after 6-8 h), preferably ambulatory (lower if supine).
• In adults with good vitamin status the upper reference limit is generally regarded as 12 umol/L. according to our conventional laboratory testing. The use of separate reference limits for children, adults, the elderly and pregnant women is advocated.
• In integrative medicine we target a value of 6.3 – 7umol/L for ideal health.

Upper reference limits for tHcy according to conventional lab testing
Basal tHcy (umol/L)	Folate supplemented	Nonsupplemented
Pregnancy	8	10
Children < 15 years	8	10
Adults 15-65 years	12	15
Elderly > 65 years	16	20
Post-methionine (100 mg) load tHcy (4-6h)	5 times basal or 40 umol/L increase above fasting	Clinical value is uncertain – not recommended for routine use
American Heart Association Classification of hyperhomocysteinemia
Moderate (­)	Intermediate (­­)	Severe (­­­)
15-30	30-100	>100

HYPERHOMOCYSTEINEMIA AND FOLATE/COBALAMIN DEFICIENCIES

• otal homocysteine is a good screening test for folate/cobalamin deficiencies.
• The combination of an increased tHcy and low vitamin concentration improves patient identification.
• With absent/non-specific symptoms, tHcy is superior to vitamin measurements as primary screening test.
• If tHcy is elevated or borderline with symptoms, both of the specific vitamins (B12/RBC-folate) should be determined to establish a diagnosis.
• Treatment of pernicious anaemia by folate only in the presence of B12-deficiency may result in irreversible neurological damage.

 

HYPERHOMOCYSTEINEMIA AND PREGNANCY COMPLICATIONS

• Increased tHcy is associated with an increased risk of placental vasculopathy, which is related to preeclampsia, recurrent early pregnancy loss, premature delivery, low birth weight, and placental abruption or infarction.
• Maternal hyperhomocysteinemia is also related to the following birth defects: neural tube defects (NTDs), orofacial clefts, clubfoot, and Down syndrome.
• Folic acid supplements in the periconceptual period and the first few weeks of pregnancy reduce the risk of NTDs and other complications. In addition, the MTHFR 677TT genotype and cobalamin deficiency have also been implicated as risk factors.

HYPERHOMOCYSTEINEMIA AND COGNITIVE IMPAIRMENT

• A dose dependent association has been noted between tHcy and Alzheimer’s disease. Increased tHcy or low folate often precedes cognitive decline. There are as yet no randomised trials that have assessed the effects of tHcy-lowering therapy on cognitive function.
• Because of the contributory effect of folate/cobalamin deficiencies in patients with psychiatric disorders, cognitive impairment or dementia, assessment of vitamin status (tHcy and/or vitamin levels) should always be done in these patients and treated appropriately.

WHO SHOULD ESPECIALLY BE TESTED FOR HOMOCYSTEINE?

1. Risk factor for Cardiovascular disease :

Until the results of randomised clinical trials proving that lowering of homocysteine levels are indeed associated with reduction in CVD risk, widespread screening cannot be justified. According to the American Heart Association the following individuals should be tested:
a. Family history of cardiovascular disease
b. Premature atherosclerosis (< 40y)
c. Atherosclerosis with no known conventional risk factors (hypertension or hyperlipidemia)

2. Thrombo-embolic disease:

Part of routine hypercoagulability profile.

3. To diagnose homocystinuria:

a. Children/young adults with unexplained thrombotic disease, failure to thrive, mental retardation, psychiatric disease, lens dislocation, progressive myopia, or connective tissue disorders.
b. Any person with severe hyperhomocysteinemia not explained by vitamin deficiency or renal failure.

4. Screening test for individuals with or at risk of developing cobalamin or folate deficiency:

a. Symptoms suggestive of vitamin deficiency:
i. Hematological: Anemia, macrocytosis
ii. Neurological: peripheral neuropathy/myelopathy
iii. Psychiatric diseases: mood changes, asthenia, memory problems, dementia.
iv. Adverse pregnancy outcome: measure tHcy with adverse early pregnancy outcome or 3 months post-partum if birth defect.

b. Patients at high risk of vitamin deficiency:
i. Elderly (> 75y): screening every 3-5 years recommended
ii. Newborns/infants: Vegetarian mothers, exclusively breastfed > 6 m
iii. Poor diet: Vegetarians (no cobalamin supplements), alcohol/drug addicts, elderly, psychiatric disease, dementia
iv. GIT disease causing malabsorption/achlorhydria
v. Chronic use of certain drugs.

TREATMENT OF HYPERHOMOCYSTEINEMIA

1.  Exclude folate and cobalamin deficiencies and treat appropriately.
2. If vitamin levels are normal, consider other common secondary causes (eg drugs, renal impairment, hypothyroidism).
3. Consider genetic causes, depending on level of tHcy elevation (if severe congenital homocystinuria , if moderate consider testing for MTHFR C677T polymorphism).
4. Patients with CVD and increased tHcy (> 15 umol/L): Treat as above PLUS promote healthy lifestyle AND optimal treatment of known causal risk factors (eg lipids and hypertension).

Supplements to consider : B vitamins, homocysteine like lowering formulas, TMG, SAMe, quatrefolic, emothion (S-acetyl glutathione if glutathione levels are lower than expected as well)

QUATREFOLIC® VS FOLIC ACID

In the recent years increasing evidence of the advantages of reduced folate vs folic acid have been found. The rational use of reduced folate (particularly reduced and methylated such as Quatrefolic®) is derived from the inability of a part of world population to assimilate and metabolize folic acid from food or supplements (the most of folate assumption is coming from folic acid man-made version in supplements and added to foods).

Folic acid and also food folate are not biologically active and need to be converted to the metabolically active 5-methyltetrahydrofolate (5-MTHF) through a multi-steps process where the enzyme methylenetetrahydrofolate reductase (MTHFR) owns a key role. Some individuals, due to their unique genetic patterns and expression, have polymorphic forms of this enzyme and do not produce adequate or effective MTHFR (references 5,6,7)

Methylenetetrahydrofolate reductase (MTHFR) is one of the most important enzymes in human physiology, deficiencies in production or function of this enzyme have been associated with increased risk of different diseases.

Quatrefolic® is the glucosamine salt of (6S)-5-methyltetrahydrofolate and is structurally analogous to the reduced and active form of folic acid so Quatrefolic® completely bypasses the “damaged” MTHFR conversion step and delivers a “finished” folate the body can immediately use without any kind of metabolization.

References

1. Refsum H, et al. Facts and recommendations about total homocysteine determinations: An expert opinion. Review. Clin Chem 2004; 50(1): 3-32.
2. Clarke R, Stansbie D. Assessment of homocysteine as a cardiovascular risk factor in clinical practice. Review. Ann Clin Biochem 2001; 38: 624-632.
3. Rasmussen K, Moller J. Total homocysteine measurement in clinical practice. Review. Ann Clin Biochem 2000; 37: 627-648.
4. Welch GN, Loscalzo J. Homocysteine and atherothrombosis. Review article. NEJM 1998; 338(15): 1042-1050.
5. Patanwala I et al. Folic acid handling by the human gut: implications for food fortification and supplementation. Am J Clin Nutr. 2014
6. Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014
7. Ulrich CM, Potter JD. Folate supplementation: too much of a good thing? Cancer Epidemiol Biomarkers Prev. 2006
8. Pietrzik K et al. Folic acid and L-5-methyltetrahydrofolate: comparison of clinical pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 2010
9. Lawrence, Kripalani et al. “Profiling National Mandatory Folic Acid Fortification Policy Around the World.” New York: Springer; 2012
10. Kelly et al. “Unmetabolized folic acid in serum: acute studies in subjects consuming fortified food and supplements.” Am J Clin Nutr 1997:65:1790-5
11. Jamil K. Clinical Implications of MTHFR Gene Polymorphism in Various Diseases. Biol Med. 2014
12. Wilcken B et al. Geographical and ethnic variation of the 677C>T allele of 5,10 methylenetetrahydrofolate reductase (MTHFR): findings from over 7000 newborns from 16 areas worldwide. J Med Genet. 2003
13. Morris MS et al. “Circulating unmetabolized folic acid and 5-methyltetrahydrofolate in relation to anemia, macrocytosis, and cognitive test performance in American seniors”. Am J Clin Nutr. 2010

Then it is put spinner machine called a centrifuge for specific rotation, temperature and time. There is splitting of the blood into three parts, the top platelet poor area, the middle platelet rich area and at the bottom the whole blood. We use the platelet rich area mostly, and some of the platelet poor area. There is also a procedure called the PRF i.e. platelet rich fibre that is used mainly overseas which also has quite good reviews. We activate the platelets by means of chemicals or via light therapy. The injury we cause to the skin is the best activator as your broken-up collagen causes best activation of your won platelets. We use your stimulated own platelets to cause repair and rejuvenation.

After the Vampire facial your skin will be tougher, softer, smoother and the small wrinkles would have disappeared. I at least like two follow up treatments in the first year and then it can be repeated every two years. Generally, I like to treat the face, hands and neck area. The body rejuvenates and repair itself by improving the collagen as well as the elastin and soft tissue structure of the skin. Some countries the PRP is combined with stem cell therapy. In South-Africa the MSC has not approved the chemicals needed to activate stem cells used in the rooms, but we are able to stimulate them with soundwaves at selective centres. We do manual liposuction under local anaesthetic; the fat also gets centrifuged and then the stem cells are removed from the fat and then activated with sound waves. These stem cells can then also be treated for multiple therapies. This method of harvesting the patients own stem cells were researched and developed by aesthetic doctors.

There are multiple uses for platelet therapy. It is mostly known for it’s first application the Vampire facial, which makes you look bloody afterwards. You combine it with micro needling of the face. This will make the patient look even more red. Some people will confuse micro-needling with the Vampire facial, but Vampire facial relates to blood withdrawn from the patient, and micro-needling many other therapeutics is used to needle it into the face.

I personally prefer that both therapies should be done at the same time to have maximal effect and I prefer to include face, neck and hands as a whole therapy. Therefore, I pull enough blood, even up to 16 tubes depending on what I am going to do.

Excluding the facial, we also use it to treat sport injuries, especially joints, tendons and ligaments. This is especially important in professional athletes where the use of cortisone is contra-indicated.  We also use it in different chronic type arthritis to decrease pain and improve repair and conditioning of joints and soft tissue. The vets also use it especially in the treatment of injuries in horses. PRP is also used in hair restoration and rejuvenation especially where there are active follicles that can be stimulated. PRP can also be very important in treating of chronic wounds and certain surgeons will use it directly after surgery for acute wound healing.

Recently we discovered that we can use it in male and female intimate therapies. In men we do a penile shot of PRP where they struggle with erectile dysfunction due to radiation therapy, high cholesterol, high blood pressure and diabetes. There are also studies showing that there is minimal increase in size and girth. In men the post procedural suction regimen is extremely important as it causes spread of the PRP throughout the penis. It could also be used in Pyronines disease where there is soft tissue shrinkage causes angulation of the penis, a rare soft tissue disease in men that can make penetration problematic.

In women it increases the sensuality, libido, sensitivity and sexuality of genitalia in women. Basically, the female variant of the male injection. It also helps with he is tightening of the vagina and renewal of vaginal, g-spot and clitoral cells.

The Vampire facial is one of the multiple therapies that we can use PRP for and the future holds many advances. The use of the Vampire facial decreases the structure of the skin which in turn decreases the need for other aesthetic procedures like botulinum toxin and dermal fillers.

Written by Dr. Quinten D. Fourie. MBBCh (Wits), PGPN (Boston)

Autonomic Activity – Represents the power or strength of the ANS. The higher your Autonomic Activity is, the healthier you are and the higher your coping ability is to handle stress. Autonomic Balance – Represents the balance between the SNS (Sympathetic Nerve System) and the PNS (Parasympathetic Nerve System) which is controlled by the ANS. An unbalanced ANS can lead to physical problems and disease. Cartesian system of SNS/PNS axes – To the right of the point of Autonomic Balance (PNS > or = 0) represent basically healthy people, while those to the left (PNS < 0) mostly represent temporarily dysfunctional or chronically sick people.

1 PNS prevalence with the average level of SNS activity:

This category represents PNS dominance. It is usually observed when a patient is resting or during the first stage of sleep (specifically, dreamless sleep). In the second stage of sleep, SNS activity is generally increased, at times markedly so. This category is further subdivided into four subcategories, depending on the state of PNS (slight, moderate, significant, sharp). This category is somewhat limited, since it can only be observed in patients with strictly median values of SNS activity.

2 Increase in PNS and SNS activities:

This category is subdivided into sixteen different combinations of PNS/SNS activity. It is characteristic of mostly healthy subjects. One distinctive area in this category represents what might be called the “high sympatho-adrenergic” state corresponding to a significant increase in SNS (points [10,10], [10,50], [50,10], [50,50]. A person reaches this state when he/she experiences a major energy boost (i.e., a sharp SNS increase). The “high sympatho-adrenergic” state is characterized by a sudden adrenaline surge similar to what an athlete feels before a competition or a tiger before a jump. There is an interesting correlation between our results and the popular “Theory of Stress” by Selye. According to this theory, stress could be subdivided into 2 categories: 1) stress as a positive idea, and 2) distress as a negative idea.

Categories 1 through 3 represent basically healthy persons, but we have to keep in mind that healthy people may have two different physiological states. One state has a low level of sympathetic activity and the other has a significant increase in sympathetic activity. Both states are distinguished by an increase in parasympathetic activity. In Selye’s stress theory, an increase in PNS and a significant increase in SNS reflect “positive” stress while a decrease in PNS and a significant increase in SNS reflect distress. Condition of a healthy person with a significant increase in SNS and an increase in PNS (our “high sympatho-adrenergic” state) thus corresponds to Selye’s idea of “positive” stress.

3 SNS Prevalence:

This category represents an increase in SNS combined with a median value of PNS. From the physiological standpoint, this category represents a transitional stage between the second and fourth categories.

4 PNS decrease with SNS increase:

This category can apply to both clinically sick and clinically healthy individuals (defined as those not requiring medical intervention). However, the use of the term “healthy” is not always appropriate since functional imbalance from stress, physical exhaustion, nervous tension, infection, intoxication (including drugs and alcohol), exacerbation of chronic conditions, and many other causes may still be present. In such cases a decrease in PNS due to depressed PNS nerve centers can be observed, along with a simultaneous Sympathetic activation, which is triggered by the struggle of the nervous system to balance itself. When Sympathetic activation is high (points: [0.1,10], [0.1,50], [0.05,10] [0.05,50]), a person reaches an “acute” state characteristic of an acute illness or extreme stress/dysfunction. The “acute” section of Category 4 with a decrease in PNS and a significant increase in SNS clearly corresponds to Selye’s idea of distress as a “negative stress”

5 PNS decrease with average level of SNS:

This category, like the third, is transitional. Everything that pertains to the fourth category can be related to it, but here, SNS activity is within median values. This means that stress, or nervous overload is unlikely. This category may often reflect a depression in the receptor system of PNS, indicating the possibility of chronic pathology.

6 SNS and PNS decrease:

The sixth category, especially beyond the point 0.1 on either axis, reflects a general involuntary degeneration of both SNS and PNS nervous centers. The majority of cases found in this category are either elderly patients or those with diseases causing a significant decrease in the sensitivity of the entire receptor system along with partial degeneration of nervous centers. Examples are the elderly people, patients suffering from cancer or any other disease causing similar expression of ANS centers. Point [0.5,0.5] of this category is an exception to this. It represents an nsignificant, general decrease in ANS and approximates the point of Autonomic Balance. It can be interpreted as a border line value of Autonomic Balance. Points [0.5,0.7], [0.5,0.1], [0.5,0.05] are usually, though not exclusively, found in patients with hyperkalemia or excessive levels of potassium ions, which alter the usual polarized state of the cardiac muscle fibers leading to a decrease in the rate and force of contractions.

7 Autonomic Balance:

It is a category, even though formally it is only a point, and all other points in its vicinity that belong to the other eight categories can be interpreted as borderline values of the Autonomic Balance. The central point is circled in red; the extended “Autonomic Balance” area is marked with a red dotted line.

8 SNS decrease with average level of PNS:

This category, like the third and fifth, is transitional. Everything that pertains to the sixth and ninth categories can be related to it, but here, PNS activity is within median values.

9 Increase in PNS with decrease in SNS:

The ninth category is rather unusual because normally an increase in PNS is accompanied by an increase in SNS. This rare condition is found in water polo athletes, long-distance runners, navy seals and persons with special heart training for deep-sea diving.

Sympathetic dystonia: This may be a sign of accelerated aging, chronic mental fatigue, overwork, lack of sleep or possibly the presence of any chronic health condition causing a decreased regulatory function of the sympathetic nervous system. If similar results appear 3 or more times in a row, it is recommended that one should have a thorough health checkup. Maintaining a healthy lifestyle may help improve the functioning of the autonomic nervous system.

Relaxation response: This may be a sign of achieving a mental/physical restful condition and healthy relaxation. If similar results appear 3 or more times in a row and there is no information about any special training skills, it is recommended to perform a thorough health check up. Establishing and maintaining a healthy life style may help to improve the autonomic function.

Autonomic dystonia: This is likely a sign of an accelerated aging process, physical or mental fatigue, chronic stress, or the presence of a chronic health condition associated with depressed regulatory function of the autonomic nervous system. If similar results appear 3 or more times in a row, it is recommended that one should have a thorough health checkup. Maintaining a healthy lifestyle may help improve the functioning of the autonomic nervous system.

Balanced autonomic normotonia: (Optimal Balance) This is a sign of optimum performance in the regulatory function of the autonomic nervous system Total autonomic hypertonia: (High Energy Balance) This is a sign of a high level of performance in the regulatory function of the autonomic nervous system, which is typical for active healthy individuals, athletes and other trained people. If similar results appear 3 or more times in a row, it is a sign of good health. Maintaining a healthy lifestyle may help to keep the autonomic nervous system functioning at an optimal level.

Vagal dystonia: This may be a sign of physical or mental fatigue, chronic stress, possibly the presence of a chronic health condition causing a decrease in the regulatory function of the parasympathetic nervous system. If similar results appear 3 or more times in a row, it is recommended that one should have a thorough health checkup. Maintaining a healthy lifestyle may help improve the functioning of the autonomic nervous system.

Stress response: This may be a sign of physical or mental stress or the presence of any acute health issue causing an increase in the function of the sympathetic nervous system. If similar results appear 3 or more times in a row, it is recommended that one should have a thorough health checkup. Maintaining a healthy lifestyle may help improve the functioning of the autonomic nervous system.

Tachogram: The bumpier the red section the better your heart if functioning.

Stress Assessment: Presents an assessment of the accumulated physical and mental stress; these two types of stress are used to assess the general stress levels present in an individual.

Mental Stress Index: Represents the body’s adaptability to internal and external stress that are placed on the body every day. Mental Stress Index indicates the function of the ANS. If your stress resistance is low it can led to physical problems and disease. This represents the level of stress your body is experiencing at the present time.

Physical Stress Index: This represents the fatigue or activity of the body on a cellular level.

Lipolysis is a technique that has gone viral, besides the different lipo-sculpting techniques. There are only a few molecules approved in South-Africa for Lipolysis. Most molecules used are derivatives of phosphatidylcholine. There is another molecule that is only indicated for the chin in America. Phosphatidylcholine can be used in South-Africa for medicinal purposes, general intravenous fat-loss therapy and sculpting lipolysis. It is of utmost importance that the correct molecule of the phosphatidylcholine is used for the specific indication, otherwise it will not be effective, and the patient might be unsatisfied with the result. If the deep injectable type is used correctly and planned carefully, it can give a good sculpting result. If the intravenous type is used, it needs to be exchanged with blood, thus some of the patient’s blood is mixed with the phosphatidylcholine and then re-injected into the patient. It should not be given as a mixture of a drip.

There are companies that have rights to sell deoxycholic acid that is a derivative of the phosphatidylcholine molecule. The deoxycholic acid is indicated and registered for the sculpting for the whole body. The deoxycholic acid must be repeated a few times but has comparative results to liposuction. It can be used for sculpting if injection is planned carefully and the injector is well trained and experienced.

The best candidate for lipolysis injections are people with small areas of stubborn fat, and best areas to be used are the abdomen, hips, abdominal circumference, chin, arms and even the upper thighs. Certain techniques can be used to improve definition in specific areas. This is however a technique for an advanced injector and good planning is of utmost importance. Remember lipolysis only hastens the process to get rid of stubborn fat, but it still does not replace a good diet and exercise. Important to note, that the patient would rather loose centimetres, or look aesthetically improved and will not necessarily loose weight in kilograms on the scale. This is not a procedure for the obese patient. This is a safe molecule to be used in adults only.

Deoxycholic acid is a more natural product and more accepted by the body. It causes less amount inflammation as seen in phosphatidylcholine which can cause large amount of swelling, pain, redness and warm areas. Deoxycholic acid is a less painful injection and local anaesthetic is very seldom needed. For best results, the procedure needs to be repeated 2 to 4 times to get best results and can be done every 6 weeks. Although deoxycholic acid shows quicker results, it may still take a few months to show the result. Other advantages include the enhancement of bile flow, through which fat is excreted. It can remove sludge and gall stones from the gallbladder and treats a fatty liver and may improve calcified blood vessels as well as the cholesterol.

Although there are various techniques that are conservative or invasive, but I prefer lipolysis with deoxycholic acid, sometimes with other mixtures. Deoxycholic acid is my first choice as studies indicate that it could be equivalent to liposuction, but with less pain and side effects.

Written by Dr. Quinten D. Fourie. MBBCh (Wits), PGPN (Boston)

1. Heavy Metals: Mercury, Manganese, Lead, Aluminum etc
2. Pharmaceutical Drugs: Pain Killers, Prozac, etc
3. Other Drugs: Nicotine, Tobacco / Vaping Chemicals, LSD, heroin, marijuana, PCP, cocaine, alcohol
4. Formaldehyde, chlorines, Harmful PCBs
5. Food Preservatives
6. Pesticides & Herbicides
7. Anesthetics
8. and a lot of others.

Is the Niacin Detox Safe? Niacin is something that you already create in your body.  It is converted from your amino acids, tryptophan.  When detoxing, most people use niacin above its RDA value and don’t experience any problems other than the flushing effect.  Since one can build up a tolerance to niacin, most people can start at 100 mg and slowly build up to taking even 3000 – 5000 mg per session. Frequently flushing is much less after the first week, if an extended program is undertaken. One  can slowly build a tolerance to niacin by increasing the niacin dosage by 100 mg to 200 mg per detox session.  In a shortened  5 day detox, at Dr Craige Golding Medical practice we suggest you do the following :

Day 1: 100 mg niacin capsules

Day 2: 200 mg niacin capsules

Day 3: 300 mg niacin capsules

Day 4: 400 mg niacin capsules

Day 5: 500 mg niacin capsules If you feel that the flush is too strong for you, try lower amounts of 50mg and do 50mg increases. You may find after doing the 5 day detox with us, that you want to do a second week with colonics and or oral gastrointestinal detox….we use Emothion (Absorbable oral glutathione, chlorella, activated charcoal, and sometimes bentonite clay or zeolite.

The sauna we use at the practice is a wellness infra red light sauna imported from the USA. The infra-red sauna increases the body temperature and improves the detoxification via sweating through the skin in combination with all the added benefits of multicour light and crystals installed in the sauna.

Which binder to take? Activated Charcoal is the most popular among the main detox doctors. In an interview from Dr. George Yu, MD and Dr Joseph Mercola, DO, activated charcoal is extremely safe and effective in pulling and removing toxins from your G.I. tract. In fact, you can’t overdose on it. For ongoing detox and colon support which is needed for life, one can use chlorella, emothion (absorbable oral glutathione), activated charcoal or bentonite or blue clay (HealthyClay) in capsules which makes it super easy to take with you.

We also do extra plasma electrolytes and Vitamin C during the day, and make us of Phosphatidlycholine and an All blend oil to aid in toxin release and fat cell breakdown. Potassium and salt supplementation is also done due to the increased sweat loss in the sauna and loss of electrolytes during the sweating process.

Flush Exercise (we have a treadmill for the exercise component before the sauna, which should ideally be done, or some form of exercise to cause dilation of one’s blood vessels) Sauna Shower is provided (in a private room with the Sauna machine. Absolute privacy is provided with the ability to allow you to do your niacin and infra red sauna and shower in absolute privacy on your own or with a friend, or family member.

Clay where used (1.5 to 2.5 hours after niacin) Colonic (Always after the niacin detox part and can be much later in the day) Magnesium Salt Soak (example Epsom salt baths) can also be entertained once at home after the niacin sauna is done (later in the day) / Bath Niacin Detox Program (Detailed):

Please Note: You might experience Your Flush Later when you’re in the Sauna

▪Drink plenty of fluids before and while doing the sauna. Need minerals to bind with toxins and to replenish what you loose in sweating. Drink Electrolytes IMMEDIATELY after sauna.
▪Take our chlorella, activated charcoal, emothion and/ or Healthy Clay 1 hour after sauna:

Shower: Rinse off sweat to prevent your skin from reabsorbing the toxins. For the best effects, cold shower is optimal, but don’t let that stop you. Hot or cold shower gets the toxins off the skin. Cold shower stimulates greater immune system response.

Clay mops up the toxins and has a rebound effect where 1.5 to 2.5 hours after taking you release more toxins.
Colonic first 5 days in a row after you sauna is an option and we can refer for colonic hydrotherapy in cases where it is deemed necessary.
Electrolytes/Minerals/Vitamins:

You will be provided with electrolytes, salt, and potassium tablets during the sauna at the practice.

You MUST super hydrate since doing sauna.

Vitamin C in afternoon AFTER the sauna/colonic protocol, and in the evening in 1000 mg doses at a time 2-4 times per day for 2000 to 4000 mg per day during this cleanse.

You may be able to do higher amounts. As Andrew Saul says, “take enough C to be symptom free, whatever that may be”! Your body will let you know by giving you loose stools. That means increase time between doses or take less at a time 500 mg instead of 1000). Take Vitamin C depending on when you do your niacin/exercise/sauna/colonic.

If doing niacin sauna part of protocol first thing in the day, then start the vitamin C 2 hours after your sauna.

If you do the protocol at the end of the day, then you will do your vitamin C intake first thing in morning up until 1 hour prior your niacin intake. (Niacin releases histamines and C is an anti- histamine.)

Minerals like calcium and magnesium will also be provided to take after the sauna is completed.

Vitamin D3 with K, at bedtime (suggested 5000 – 10000 IU) is suggested. It will help you sleep also.

Vitamin D is something you will not want to over dose on and good idea to have blood levels checked with one of our practitioners.

Food? This detox works wonders without changing your diet but NO ALCOHOL and NO COFFEE is suggested during the detox. Suggest “Clean Eating” with no processed foods. If you can, and if taking clay, wait one hour after taking clay to eat. You may have a smoothie or some fruit but no oils right before doing the niacin is recommended.

Some people get upset stomach on niacin so they can do a smoothie or something light, and need to individualize your food and schedule to make this detox work.

This detox is not about food. It’s about binding with chemicals and getting them out of the body using the supplements and detox modalities. Enjoy your meals during this detox.

We Offer all the Detox supplements and Niacin, vitamin C, Electrolytes and supplements .

The following conditions are contraindicated for the 5 day detox:

1. People that are PREGNANT
2. LACTATING or taking PSYCHOTROPIC MEDICATIONS
3. Narcotics and Anti-Anxiety Medications and those who have
4. GOUT.

You will need to be OFF your Narcotic or Anti Anxiety Meds because the Niacin removes it and you may feel a withdrawal. It is better to come off those medications and then do the protocol.
Dr Golding and our practitioners can assist you withdraw medications where indicated.

This protocol has been documented to really help drug addicts, nicotine addicts and alcohol addicts as well. Ideally do not do the protocol while taking any drugs, including caffeine and cannabis. If you were to drink coffee with taking the niacin you would have a bad reaction.

Disclaimer: You may want to consult with your doctor : With any diet, exercise, or supplement change, you might want to consult your doctor first before attempting any detox to make sure it is right for you. Everyone is different. At Dr Craige Golding Medical practice we are very educated and experienced with detoxification and in particular the wonders of niacin and vitamin C.

We have been recommending sauna therapy for detoxification to many of our patients who have high levels of various chemicals found in their toxicity screening tests offered at The Dr Craige Golding medical practice, or metals results. The fundamental principle that governs detoxification is that heat liberates toxins from fats, which then gets flushed out by the sweat and carried off by the blood to the liver, kidney, and GI tract. The sauna detoxification protocol that follows is perhaps more reasonable for the average patient and is designed to maximize detoxification without causing undue stress to the patient. Sauna should be started after other metabolic supports have been implemented (such as those indicated by the results of the organic acid testing, oligoscan testing and nutrigenomic testing.

The Case for Sauna Therapy

The use of sauna for liberating toxins from the adipose tissue has been fairly well established as being effective for the treatment of toxicity for many years. The studies that I have read were all published before infrared technology existed. So, it is safe to say that sauna of any sort is likely to benefit patients with toxicity. Infrared technology claims that it is able to cause a more vigorous sweat at lower temperature, which may create a more comfortable experience for the user (less time needed and at a less high temperature). Infrared technology also claims that it can penetrate deep within the tissue for effective elimination. While visceral fat (the fat surrounding the organs) is certainly capable of housing toxins, it is the adipose tissue found in the subcutaneous layer that is viewed as the primary culprit for toxin accumulation. To reach the subcutaneous tissue, you simply need heat. Heat can be generated internally. Consequently, exercise is an excellent way to generate heat and burn the fat housing the toxin to begin with. Many patients are too sick to consider this as an option but patients who can tolerate exercise should be encouraged to do so. Better yet, do both exercise and sauna therapy. The fact that we have a heated infra-red sauna will also provide the necessary vasodilation that exercise does.

Heat helps to destabilize lipophilic compounds just enough so that they can become mobilized by the fluids that are simultaneously released during heat exposure. Some compounds can be liberated directly into the sweat while others will be transported by the blood stream into the liver for metabolization and/or conjugation. The vasodilatation that is induced by heat exposure provides an increased blood flow to these organs. Nicotinic acid (niacin or niacinamide) can induce flushing in doses above 50 mg which will subsequently increase blood flow to the liver and kidney. It is often used as a part of detoxification protocol because of what is referred to as rebound lipolysis. High dose niacin is used therapeutically to inhibit free fatty acid release, decrease LDL, and increase HDL. This effect is soon compensated for and free fatty acids return to normal and in some cases above normal. The rebound effect varies from study to study but is generally considered mild. It is the release of free fatty acids that also causes the release of toxins in the body. Practitioners are hoping to achieve a greater degree of toxin release through this rebound effect that niacin can have about two hours after administration.

In addition to the rebound lipolysis and vasodilatation, niacin also inhibits oxidation in the vasculature which is an important factor with detoxification. It is worth exercising caution with niacin in patients with diabetes, history of gout, on blood thinners, and who have MTHFR/methylation gene mutations. The rebound effect is associated with insulin resistance in many studies. Patients who are already diabetic tend to have the greatest difficulty with this. High dose niacin can also cause elevations in uric acid, increased prothrombin time, and decreased platelet counts. It can also cause stress to the methylation pathway because this compound requires methylation to be eliminated. In fact, there are documented cases of hyperhomocysteinemia occurring in patients taking 1000 mg of niacin per day, which is the standard dose for a flush. I typically only recommend niacin as part of the detoxification protocol in patients who have demonstrated their ability to tolerate it or who have minimal risk for methylation pathway disruption.