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Detlef Schmitt's avatar

I have another example for the “Spice Cabinet Pharmacy” list. This one comes from personal experience.

I am suffering since many years from a mild form of Ankylosing Spondylitis. Mostly non-spinal enthesitis. The condition is well controlled with an anti-TNFa antibody. Due to my travel constraints I am treated every six month, although every 4 month would be more ideal. It would be more ideal because usually after about 4-5 month the pain returns and I am struggling for a month and a half before I finally receive the next treatment. Since several years I endure this pain period. However, a couple month ago I made an astonishing discovery in a self-experiment. This discovery improved my situation immensely.

I subscribe to several ScienceDaily RSS feeds. Therefore I receive daily references to scientific publications that they feel relevant. A couple month ago I found in my RSS reader inbox a publication by a Japanese group that tested the efficacy of three known plant-based anti-inflammatory compounds in combination. It turned out that the combination of menthol (ME) with capsaicin (CA) significantly increased the potency of the anti-inflammatory effect, compared to each individual compound alone.

https://www.sciencedaily.com/releases/2026/04/260408225950.htm

https://www.mdpi.com/2072-6643/18/3/376

Here is a quote from the article’s discussion section: “We demonstrated that specific phytochemical combinations produce pronounced synergistic anti-inflammatory effects, most notably a ~700-fold reduction in the EC50 value for TNF expression upon co-treatment of CA with ME.

At the time I read this article my last anti-TNFa treatment was 4.5 month ago and I was already in pain. For that reason I thought I will give this a try. I had cayenne pepper in my pantry and I bought concentrated food grade menthol in a pharmacy. Based on what I thought would be reasonable I prepared a water/menthol/cayenne pepper/chocolate drink. I didn’t expect much but was really surprised by the effect. Right after the first time I consumed this drink the pain was completely gone and the effect lasted more than 12 hours.

Over the subsequent days I plaid around with the recipe, the amount of CA and ME, the frequency and the time points of ingestion. I settled on a delicious slightly spicy recipe once a day before bed time. Now I have an effective treatment that is capable of bridging the time from when the pain reappears to the time that I receive my next anti-TNFa antibody treatment.

I told my doctor about it. He is a MD/PhD and head of a university hospital rheumatology devision. He said, he will think about how to use this result in his medical practice.

What is the take-home message from this experience? Possibly there are many other plant- and microbial-based drug combinations out there which can potentially increase the efficacy substantial compared to the individual drugs alone. However, such increases in potency can only be identified with cell-based assays, animal experiments and clinical trials. Many such combination might be known already e.g. in Chinese medicine, however, many may not be known yet. Fortunately the medicinal properties of many plant and microbial compounds and their effect on particular molecular pathways in humans are known, which allows for the educated and systematic testing of such combinations. I think this might be a fruitful area of research.

I personally would experiment with such plant-based drug combinations on myself only after some data has been published. The chance is high that a particular combination has no additive or potentiating effect.

And basing body feeling and sleep quality on eating habits can be very subjective. Finding true cause-effect relationships will be difficult. However, some might be easy to find e.g. that eating too much garlic for dinner can cause restlessness resulting in a bad night of sleep.

Another problematic is that the number of biological medicinal compounds that one can add to one’s diet is limited. Essentially most compounds in natural products databases are derived from bacteria or fungal species. You cannot add these to your diet. In many other cases the amount of active compound found in a particular plant is too low to have any significant effect in a disease situation. And increasing the dose is often not reasonable or feasible. For example, compared to my anti-inflammatory recipe above, neither taking 100 fold more menthol or capsaicin as a single drug treatment is feasible. It would taste horrible and ruin your stomach. Therefore, finding more potentiating combinations via experimentation will make a big difference in my opinion. In addition to finding 3D analogs, predicting which combinations are worthwhile to experimentally test, might be a good application for an AI.

Here is another example of a natural compound that unfortunately is not found in high enough concentration in food products. NMN (Nicotinamide Mononucleotide) is a compound that is currently being studied for its anti-aging properties. NMN is a precursor used in the body for e.g. cellular energy production, DNA repair, and metabolism. The production of this compound in the body declines with age. Supplementation with NMN has been found to be beneficial, although results are still inconclusive.

My father is now 88 years old and in a phase of decline, although still relatively fit for his age. I suggested to him to add NMN to his Dietary Supplements a couple years ago. Since then I frequently have asked him whether he feels any improvement in his well being. He didn’t know. So, I suggested to him to stop taking NMN for a while to see what that would do. Yesterday he calls me and said I should buy some more NMN for him. His supply ran out 3 weeks ago. He said, his legs are now heavier, he is more tired during the day, his sleep got worse and his brain is foggy. He has been taking 300 mg NMN per day over the last couple years. It seems NMN did make a significant difference for him. It definitely makes sense for him to continue taking it.

Unfortunately, the amount of NMN in food products is low. Avocado is one of the food items with the highest concentration of NMN. By eating one average avocado one gets about 3 mg of NMN. My father would have to eat 100 avocados daily to get the 300 mg dose that he has been taking daily over the last couple years. That is not feasible. Therefore purchasing pure NMN gram wise is the only solution. Fortunately many vendors are in this market, unfortunately including many fraudsters.

I wonder whether alternative NMN-like cell energy boosters can be found in the FooDB database. I kind of doubt it, because NMN is not a drug molecule that could be substituted with a molecule of similar 3D structure. NMN is a metabolite that itself is consumed in the process. That is not something that a similar structured molecule can replicate. However, plant-based enzyme binders that boost or inhibit key enzymatic activity of enzymes in the NAD+ pathway may do the trick, if they exist.

CD38 has been found as a key negative regulator of NAD. CD38 increases during aging. And a small molecule inhibitor for CD38 has been shown to “Ameliorate Age-Related Metabolic Dysfunction by Reversing Tissue NAD+ Decline”.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4911708/

https://www.cell.com/cell-metabolism/fulltext/s1550-4131(18)30194-3

https://www.nature.com/articles/s41574-025-01211-y

If a 3D analog to this small molecule CD38 inhibitor exits in the FooDB perhaps a food product could be identified that when eating with feasible amounts of NMN containing food products would be as effective as a 300 mg daily dose of NMN. It’s worthwhile to investigate it.

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