Niacin Therapy as Used by Abram Hoffer, M.D.

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alternative_medicine_forum From: Frank Sun, 22 Aug 2004 17:35:38 -0700 (PDT) Niacin Therapy as Used by Abram Hoffer, M.D.http://www.doctoryourself.com/hoffer_niacin.htmlNiacin Therapy as Used by Abram Hoffer, M.D.Vitamin B-3: Niacin and Its Amideby A. Hoffer, M.D., Ph.D.The first water soluble vitamins were numbered insequence according to priority of discovery. But aftertheir chemical structure was determined they weregiven scientific names. The third one to be discoveredwas the anti-pellagra vitamin before it was shown tobe niacin. But the use of the number B-3 did not stayin the literature very long. It was replaced bynicotinic acid and its amide (also

known medically asniacin and its amide). The name was changed to removethe similarity to nicotine, a poison. The term vitamin B-3 was reintroduced by my friendBill W., co-founder of Alcoholics Anonymous, (BillWilson). We met in New York in 1960. Humphry Osmondand I introduced him to the concept of mega vitamintherapy. We described the results we had seen with ourschizophrenic patients, some of whom were alsoalcoholic. We also told him about its many otherproperties. It was therapeutic for arthritis, for somecases of senility and it lowered cholesterol levels. Bill was very curious about it and began to takeniacin, 3 g daily. Within a few weeks fatigue anddepression which had plagued him for years were gone.He gave it to 30 of his close friends in AA andpersuaded them to try it. Within 6 months he wasconvinced that it would be very helpful to alcoholics.Of the thirty, 10 were free of anxiety, tension

anddepression in one month. Another 10 were well in twomonths. He decided that the chemical or medical termsfor this vitamin were not appropriate. He wanted topersuade members of AA, especially the doctors in AA,that this would be a useful addition to treatment andhe needed a term that could be more readilypopularized. He asked me the names that had been used.I told him it was originally known as vitamin B-3.This was the term Bill wanted. In his first report tophysicians in AA he called it "The Vitamin B-3Therapy." Thousands of copies of this extraordinarypamphlet were distributed. Eventually the name cameback and today even the most conservative medicaljournals are using the term vitamin B-3. Bill became unpopular with the members of the board ofAA International. The medical members who had beenappointed by Bill, felt that he had no businessmessing about with treatment using vitamins. They also"knew"

vitamin B-3 could not be therapeutic as Billhad found it to be. For this reason Bill providedinformation to the medical members of AA outside ofthe National Board, distributing three of his amazingpamphlets. They are now not readily available.Vitamin B-3 exists as the amide in nature, innicotinamide adenine dinucleotide (NAD). Purenicotinamide and niacin are synthetics. Niacin wasknown as a chemical for about 100 years before it wasrecognized to be vitamin B-3. It is made fromnicotine, a poison produced in the tobacco plant toprotect itself against its predators, but in thewonderful economy of nature which does not waste anystructures, when the nicotine is simplified bycracking open one of the rings, it becomes theimmensely valuable vitamin B-3. Vitamin B-3 is made in the body from the amino acidtryptophan. On the average 1 mg of vitamin B-3 is madefrom 60 mg of tryptophan, about 1.5% Since it is

madein the body it does not meet the definition of avitamin; these are defined as substances that can notbe made. It should have been classified with the aminoacids, but long usage of the term vitamin has given itpermanent status as a vitamin. The 1.5% conversionrate is a compromise based upon the conversion oftryptophan to N-methyl nicotinamide and itsmetabolites in human subjects. I suspect that one dayin the far distant future none of the tryptophan willbe converted into vitamin B-3 and it then will trulybe a vitamin. According to Horwitt [1], the amountconverted is not inflexible but varies with patientsand conditions. For example, women pregnant in theirlast three months convert tryptophan to niacinmetabolites three times as efficiently as innon-pregnant females. Also there is evidence thatcontraceptive steroids, estrogens, stimulatetryptophan oxygenase, the enzyme that converts thetryptophan into

niacin.This observation raises some interesting speculations.Women, on average, live longer then men. It has beenshown for men that giving them niacin increases theirlongevity. [2] Is the increased longevity in women theresult of greater conversion of tryptophan into niacinunder the stimulus of their increase in estrogenproduction? Does the same phenomenon explain thedecrease in the incidence of coronary disease inwomen? The best-known vitamin deficiency disease is pellagra.More accurately it is a tryptophan deficiency diseasesince tryptophan alone can cure the early stages.Pellagra was endemic in the southern U.S.A. until thebeginning of the last world war. It can be describedby the four D's: dermatitis, diarrhea, dementia anddeath. The dementia is a late stage phenomenon. In theearly stages it resembles much more theschizophrenias, and can only with difficulty bedistinguished from it. The only

certain method used byearly pellagrologists was to give their patients inthe mental hospitals small amounts of nicotinic acid.If they recovered they diagnosed them pellagra, ifthey did not they diagnosed them schizophrenia. Thiswas good for some of their patients but was not goodfor psychiatry since it prevented any continuinginterest in working with the vitamin for theirpatients who did not recover fast, but who might havedone so had they given them a lot more for a muchlonger period of time, the way we started doing thisin Saskatchewan. I consider it one of theschizophrenic syndromes.IndicationsI have been involved in establishing two of the majoruses for vitamin B-3, apart from its role inpreventing and treating pellagra. These are its actionin lowering high cholesterol levels [3] and inelevating high density lipoprotein cholesterol levels(HDL), and its therapeutic role in the schizophreniasand

other psychiatric conditions. It has been foundhelpful for many other diseases or conditions. Theseare psychiatric disorders including children withlearning and behavioral disorders, the addictionsincluding alcoholism and drug addiction, theschizophrenias, some of the senile states. Itsefficacy for a large number of both mental andphysical conditions is an advantage to patients and totheir doctors who use the vitamin, but is difficult toaccept by the medical profession raised on the beliefthat there must be one drug for each disease, and thatwhen any substance appears to be too effective formany conditions, it must be due entirely to itsplacebo effect, something like the old snake oils.I have thought about this for a long time and havewithin the past year become convinced that thisvitamin is so versatile because it moderates orrelieves the body of the pernicious effect of chronicstress. It therefore frees

the body to carry on itsroutine function of repairing itself more efficiently.The current excitement in medicine is the recognitionthat hyperoxidation, the formation of free radicals,is one of the basic damaging processes in the body.These hyperexcited molecules destroy molecules anddamage tissues at the cellular level and at the tissuelevel. All living tissue which depends on oxygen forrespiration has to protect itself against these freeradicals. Plants use one type of antioxidants andanimals use another type. Fortunately there is a wideoverlap and the same antioxidants such as vitamin Care used by both plants and animals. There is growingrecognition that the system adrenaline -> adrenochromeplays a major role in the reactions to stress. I haveelaborated this in a further report for this journal.[4]The catecholamines, of which adrenalin is the bestknown example, and the aminochromes, of

whichadrenochrome is the best known example, are intimatelyinvolved in stress reactions. Therefore to moderatethe influence of stress or to negate it, one must usecompounds which prevent these substances from damagingthe body. Vitamin B-3 is a specific antidote toadrenalin, and the antioxidants such as vitamin C,Vitamin E, beta carotene, selenium and others protectthe body against the effect of the free radicals byremoving them more rapidly from the body. Any diseaseor condition which is stress related ought thereforeto respond to the combined use of vitamin B-3 andthese antioxidants provided they are all given inoptimum doses, whether small or large as inorthomolecular therapy. I will therefore list brieflythe many indications for the use of vitamin B-3.For each condition I will describe one case toillustrate the therapeutic response. For eachcondition I can refer to hundreds and thousands ofcase

histories and have already in the literaturedescribed many of them in detail. [5]Psychiatric1) The Schizophrenias. I have reviewed this for thisjournal. [6]2) Children with Learning and/or Behavioral Disorders.In 1960 seven year-old Bruce came to see me with hisfather. Bruce had been diagnosed as mentally retarded.He could not read, could not concentrate, and wasdeveloping serious behavioral problems such as cuttingschool without his parents' knowledge. He was beingprepared for special classes for the retarded. Heexcreted large amounts of kryptopyrrole, the firstchild to be tested. I started him on nicotinamide, onegram tid. Within four months he was well. He graduatedfrom high school, is now married, has been fullyemployed and has been paying income tax. He is onecase out of about 1500 I have seen since 1960. Current treatment is more complicated as described inthis Journal. [7]3)

Organic Confusional States, non-Alzheimers forms ofdementia, electroconvulsive therapy-induced memorydisturbances. In 1954 I observed how nicotinic acid relieved asevere case of post ECT amnesia in one month. Sincethen I have routinely given it in conjunction with ECTto markedly decrease the memory disturbance that mayoccur during and after this treatment. I would nevergive any patient ECT without the concomitant use ofnicotinic acid. It is very helpful, especially incardiovascular-induced forms of dementia as itreverses sludging of the red blood cell and permitsproper oxygenation of the cells of the body. Forfurther information see Niacin Therapy in Psychiatry.[8]In September 1992, Mr. C., 76 years-old, requestedhelp with his memory. He was terribly absentminded. Ifhe decided to do something, by the time he arrivedwhere he wanted to do it he had forgotten what it washe wanted to do. His short-term

memory was very poorand his long-term memory was beginning to be affected.I started him on a comprehensive vitamin programincluding niacinamide 1.5 G daily. Within a month hebegan to improve. I added niacin to his program. ByFebruary 1993 he was normal. April 26, 1993, he toldme he had been so well he had concluded he no longerneeded any niacin and decreased the dose from 3.0 G to1.5 G daily. He remained on the rest of the program.Soon he noted that his short term memory was failinghim again. I advised him to stay on the full dose therest of his life. 4) An antidote against d-LSD,9,10 and againstadrenochrome. [5]5) Alcoholism.Bill W. conducted the first clinical trial of the useof nicotinic for treating members of AlcoholicsAnonymous. [11] He found that 20 out of thirtysubjects were relieved of their anxiety, tension andfatigue in two months of taking this vitamin, 1 G tid.I found it very

useful in treating patients who wereboth alcoholic and schizophrenic. The first largetrial was conducted by David Hawkins who reported abetter than 90% recovery rate on about 90 patients. Since then it has been used by manyphysicians who treat alcoholics. Dr. Russell Smith inDetroit has reported the largest series of patients.[12]Physical1. CardiovascularOf the two major findings made by my research group inSaskatchewan, the nicotinic acid-cholesterolconnection is well known and nicotinic acid is usedworldwide as an economical, effective and safecompound for lowering cholesterol and elevating highdensity cholesterol. As a result of my interest innicotinic acid, Altschul, Hoffer and Stephen [3]discovered that this vitamin, given in gram doses perday, lowered cholesterol levels. Since then it wasfound it also elevates high density lipoproteincholesterol thus bringing the ratio of total over

HDLto below 5. In the National Coronary Study, Canner [2] showed thatnicotinic acid decreased mortality and prolonged life.Between 1966 and 1975, five drugs used to lowercholesterol levels were compared to placebo in 8341men, ages 30 to 64, who had suffered a myocardialinfarction at least three months before entering thestudy. About 6000 were alive at the end of the study.Nine years later, only niacin had decreased the deathrate significantly from all causes. Mortalitydecreased 11% and longevity increased by two years.The death rate from cancer was also decreased.This was a very fortunate finding because it led tothe approval by the FDA of this vitamin in mega dosesfor cholesterol problems and opened up the use of thisvitamin in large doses for other conditions as well.This occurred at a time when the FDA was doing itsbest not to recognize the value of megavitamintherapy. Its position has not altered

over the pastfour decades. Our finding opened up the second major wave ofinterest in vitamins. The first wave started around1900 when it was shown that these compounds were veryeffective in small doses in curing vitamin deficiencydiseases and in preventing their occurrence. This wasthe preventive phase of vitamin use. The second waverecognized that they have therapeutic properties notdirectly related to vitamin deficiency diseases butmay have to be used in large doses. This was thesecond or present wave wherein vitamins are used intherapy for more than deficiency diseases. Ourdiscovery that nicotinic acid was anhypocholesterolemic compound is credited as the firstpaper to initiate the second wave and paved the wayfor orthomolecular medicine which came along severalyears later.2. ArthritisI first observed the beneficial effects of vitamin B-3in 1953 and 1954. I was then exploring the

potentialbenefits and side effects from this vitamin. Severalof the patients who were given this vitamin wouldreport after several months that their arthritis wasbetter. At first this was a surprise since in thepsychiatric history I had taken I had not asked aboutjoint pain. This report of improvement happened sooften I could not ignore it. A few years later Idiscovered that Prof. W. Kaufman had studied the useof this vitamin for the arthritides before 1950 andhad published two books describing his remarkableresults. [13] Since that time this vitamin has been avery important component of the orthomolecular regimenfor treating arthritis. The following case illustrates both the response whichcan occur and the complexity of the orthomolecularregimen. Patients who are early into their arthritisrespond much more effectively and are not left withresidual disability. K.V. came to my office April 15, 1982.

She was in awheelchair pushed by her husband. He was exhausted,depressed, and she was one of the sickest patients Ihave ever seen. She weighed under 90 pounds. She satin the chair on her ankles which were crossed beneathher body because she was not able to straighten themout. Her arms were held in front of her, close to herbody, and her fingers were permanently deformed andclaw-like. She told me she had been deeply depressedfor many years because of the severe pain and hermajor impairment. As she was being wheeled into myoffice I saw how ill she was and immediately concludedthere was nothing I could do for her, and had todecide how I could let her know without sending hereven deeper into despair. However I changed my mindwhen she suddenly said, "Dr. Hoffer, I know no one canever cure me but if you could only help me with mypain. The pain in my back is unbearable. I just wantto get rid of the pain in my back." I

realized thenshe had a lot of determination and inner strength andthat it was worthwhile to try and help her.She began to suffer from severe pain in her joints in1952. In 1957 it was diagnosed as arthritis. Until1962 her condition fluctuated and then she had to gointo a wheelchair some part of the day. She was stillable to walk although not for long until 1967. In 1969she depended on the wheelchair most of the time, andby 1973 she was there permanently. For awhile she wasable to propel herself with her feet. After that shewas permanently dependent on help. For the three yearsbefore she saw me she had gotten some home care butmost of the care was provided by her husband. He hadretired from his job when I first saw them. Heprovided the nursing care equivalent to four nurses on8 hour shifts including holiday time. He had to carryher to the bathroom, bathe her, cook and feed her. Hewas as exhausted as she was

but he was able to carryon.She was severely deformed, especially her hands,suffered continuous pain, worse in her arms, and hipsand her back. Her ankles were badly swollen and shehad to wear pressure bandages. Her muscles also werevery painful most of the day. She was able to feedherself and to crochet with her few useful fingers,but it must have been extremely difficult. She was notable to write nor type which she used to do with apencil. A few months earlier she had been suicidal. Ontop of this severe pain and discomfort she had noappetite, was not hungry and a full meal wouldnauseate her. Her skin was dry, she had patches ofeczema, and she had white areas in her nails. I advised her to eliminate sugar, potatoes, tomatoesand peppers, (about 10% of arthritics have allergicreactions to the solanine family of plants). She wasto add niacinamide 500 mg four times daily (followingthe work of W. Kaufman),

ascorbic acid 500 mg fourtimes daily (as an anti-stress nutrient and forsubclinical scurvy), pyridoxine 250 mg per day (foundto have anti-arthritic properties by Dr. J. Ellis),zinc sulfate 220 mg per day (the white areas in hernails indicated she was deficient in zinc), flaxseedoil 2 tablespoons and cod liver oil 1 tablespoon perday (her skin condition indicated she had a deficiencyof omega 3 essential fatty acids). The detailedtreatment of arthritis and the references aredescribed in my book. [14]One month later a new couple came into my room. Herhusband was smiling, relaxed and cheerful as he pushedhis wife in in her chair. She was sitting with herlegs dangling down, smiling as well. I immediatelyknew that she was a lot better. I began to ask herabout her various symptoms she had had previously.After a few minutes she impatiently broke in to say,"Dr. Hoffer, the pain in my back is all gone." She

nolonger bled from her bowel, she no longer bruised allover her body, she was more comfortable, the pain inher back was easily controlled with aspirin and wasgone from her hips, (it had not helped before). Shewas cheerful and laughed in my office. Her heart wasregular at last. I added inositol niacinate 500 mgfour times daily to her program. She came back June 17, 1982, and had improved evenmore. She was able to pull herself up from the proneposition on her bed for the first time in 15 years,and she was free of depression. I increased herascorbic acid to 1 gram four times daily and addedvitamin E 800 IU. Because she had shown such dramaticimprovement I advised her she need no longer come tosee me.September 1, 1982, she called me on the telephone. Iasked her how she was getting along. She said she wasmaking even more progress. I then asked her how hadshe been able to get to the phone. She replied she

wasable to get around alone in her chair. Then she addedshe had not called for herself but for her husband. Hehad been suffering from a cold for a few days, she wasnursing him, and she wanted some advice for him.After another visit October 28, 1983, I wrote to herdoctor "Today Mrs. K.V. reported she had stayed on thewhole vitamin program very rigorously for 18 months,but since that time had slacked off somewhat. She isregaining a lot of her muscle strength, can now sit inher wheelchair without difficulty, can also wheelherself around in her wheelchair but, of course, cannot do anything useful with her hands because herfingers are so awful. She would like to become moreindependent and perhaps could do so if something couldbe done about her fingers and also about her hip. I amdelighted she has arranged to see a plastic surgeon tosee if something can be done to get her hand mobilizedonce more. I have asked her

to continue with thevitamins but because she had difficulty taking so manypills she will take a preparation called Multijetwhich is available from Portland and contains all thevitamins and minerals and can be dissolved in juice.She will also take inositol niacinate 3 grams daily."I saw her again March 24, 1988. About 4 of hervertebra had collapsed and she was suffering more painwhich was alleviated by Darvon. It had not beenpossible to treat her hands surgically. She had beenable to eat by herself until six months before thislast visit. She had been taking small amounts ofvitamins. She was able to use a motorized chair. Shehad been depressed. I wrote to her doctor, "She hadgone off the total vitamin program about two or threeyears ago. It is very difficult for her to swallow andI can understand her reluctance to carry on with this.I have therefore suggested that she take a minimalprogram which would include

inositol niacinate 3 gramsdaily, ascorbic acid 1 gram three times, linseed oil 2capsules and cod liver oil 2 capsules. Her spirits aregood and I think she is coming along considering thesevere deterioration of her body as a result of thearthritis over the past few decades." She was lastseen by her doctor in the fall of 1989.Her husband was referred. I saw him May 18, 1982. Hecomplained of headaches and a sense of pressure abouthis head present for three years. This followed aseries of light strokes. I advised him to take niacin3 grams daily plus other vitamins including vitamin C.By September 1983 he was well and when seen last March24, 1988 was still normal.3. Juvenile DiabetesDr. Robert Elliot, Professor of Child Health Researchat University of Auckland Medical School is testing40,000 five-year old children for the presence ofspecific antibodies that indicate diabetes willdevelop. Those who have

the antibodies will be givennicotinamide. This will prevent the development ofdiabetes in most the children who are vulnerable.According to the Rotarian for March 1993 this projectbegan 8 years ago and has 3200 relatives in the study.Of these, 182 had antibodies and 76 were givennicotinamide. Only 5 have become diabetic compared to37 that would have been expected. Since 1988 over20,100 school children have been tested. None havebecome diabetic compared to 47 from the untestedcomparable group. A similar study is underway inLondon, Ontario. 4. CancerRecent findings have shown that vitamin B-3 does haveanti-cancer properties. This was discussed at ameeting in Texas in 1987, Jacobson and Jacobson. [15]The topic of this international conference was"Niacin, Nutrition, ADP-Ribosylation and Cancer," andwas the 8th conference of this series.Niacin, niacinamide and nicotinamide adeninedinucleotide (NAD)

are interconvertable via a pyridinenucleotide cycle. NAD, the coenzyme, is hydrolyzed orsplit into niacinamide and adenosine dinucleotidephosphate (ADP-ribose). Niacinamide is converted intoniacin, which in turn is once more built into NAD. Theenzyme which splits ADP is known as poly (ADP-ribose)polymerase, or poly (ADP) synthetase, or poly(ADP-ribose) transferase. Poly (ADP-ribose) polymeraseis activated when strands of deoxyribonucleic acid(DNA) are broken. The enzyme transfers NAD to theADP-ribose polymer, binding it onto a number ofproteins. The poly (ADP-ribose) activated by DNAbreaks helps repair the breaks by unwinding thenucleosomal structure of damaged chromatids. It alsomay increase the activity of DNA ligase. This enzymecuts damaged ends off strands of DNA and increases thecell's capacity to repair itself. Damage caused by anycarcinogenic factor, radiation, chemicals, is thus toa degree neutralized or

counteracted.Jacobson and Jacobson, conference organizers,hypothesized that niacin prevents cancer. They treatedtwo groups of human cells with carcinogens. The groupgiven adequate niacin developed tumors at a rate only10% of the rate in the group deficient in niacin. Dr.M. Jacobson is quoted as saying, "We know that diet isa major risk factor, that diet has both beneficial anddetrimental components. What we cannot assess at thispoint is the optimal amount of niacin in the diet...The fact that we don't have pellagra does not mean weare getting enough niacin to confer resistance tocancer." About 20 mg per day of niacin will preventpellagra in people who are not chronic pellagrins. Thelatter may require 25 times as much niacin to remainfree of pellagra.Vitamin B-3 may increase the therapeutic efficacy ofanti-cancer treatment. In mice, niacinamide increasedthe toxicity of irradiation against tumors.

Thecombination of normobaric carbogen with nicotinamidecould be an effective method of enhancing tumorradiosensitivity in clinical radiotherapy wherehypoxia limits the outcome of treatment. Chaplin,Horsman and Aoki16 found that nicotinamide was thebest drug for increasing radiosensitivity compared toa series of analogues. The vitamin worked because itenhanced blood flow to the tumor. Nicotinamide alsoenhanced the effect of chemotherapy. They suggestedthat niacin may offer some cardioprotection duringlong-term adriamycin chemotherapy. Further evidence that vitamin B-3 is involved incancer is the report by Nakagawa, Miyazaki, Okui,Kato, Moriyama and Fujimura [17] that in animals thereis a direct relationship between the activity ofnicotinamide methyl transferase and the presence ofcancer. Measuring the amount of N-methyl nicotinamidewas used to measure the activity of the enzyme. Inother words, in animals

with cancer there is increaseddestruction of nicotinamide, thus making lessavailable for the pyridine nucleotide cycle. Thisfinding applied to all tumors except the solid tumors,Lewis lung carcinoma and melanoma B-16.Gerson [18] treated a series of cancer patients withspecial diets and with some nutrients including niacin50 mg 8 to 10 times per day, dicalcium phosphate withvitamin D, vitamins A and D, and liver injections. Hefound that all the cancer cases were benefited in thatthey became healthier and in many cases the tumorsregressed. In a subsequent report Gerson elaborated onhis diet. He now emphasized a high potassium oversodium diet, ascorbic acid, niacin, brewers yeast andlugols iodine. Right after the war there was no readysupply of vitamins as there is today. I would considerthe use of these nutrients in combination veryoriginal and enterprising. Dr. Gerson was the firstphysician to emphasize the

use of multivitamins andsome multiminerals. More details are in Hoffer. [19]Additional evidence that vitamin B-3 is therapeuticfor cancer arises from the National Coronary Study,Canner. [2]5. Concentration Camp SurvivorsIn 1960 I planned to study the effect of nicotinicacid on a large number of aging people living in asheltered home. A new one had been built. I approachedthe director of this home, Mr. George Porteous. Iarranged to meet him and told him what I would like todo and why. I gave him an outline of its properties,its side effects and why I thought it might behelpful. Mr. Porteous agreed and we started thisinvestigation. A short while after my first contactMr. Porteous came to my office at University Hospital.He wanted to take nicotinic acid himself, he told me,so that he could discuss the reaction moreintelligently with people living in his institution.He wanted to know if it would be

safe to do so. That fall he came again to talk to me and this time hesaid he wanted to tell me what had happened to him.Then I discovered he had been with the Canadian troopswho had sailed to Hong Kong in 1940, had been promptlycaptured by the Japanese and had survived 44 months inone of their notorious prisoner of war camps. Twenty-five percent of the Canadian soldiers died inthese camps. They suffered from severe malnutritionfrom starvation and nutrient deficiency. They sufferedfrom beri beri, pellagra, scurvy, infectious diseases,and brutality from the guards. Porteous, a physical education instructor, had beenfit weighing about 190 pounds when he got there. Whenhe returned home he weighed only 2/3rds of that. Onthe way home in a hospital ship the soldiers were fedand given extra vitamins in the form of ricepolishings. There were few vitamins available then intablets or capsules. He seemingly

recovered but hadremained very ill. He suffered from both psychologicaland physical symptoms. He was anxious, fearful andslightly paranoid. Thus, he could never be comfortablesitting in a room unless he sat facing the door. Thismust have arisen from the fear of the guards.Physically he had severe arthritis. He could not raisehis arms above his shoulders. He suffered from heatand cold sensitivity. In the morning he needed hiswife's help in getting out of bed and to get startedfor the day. He had severe insomina. For this he wasgiven barbiturates in the evening and to help awakenhim in the morning, he was given amphetamines. Later I read the growing literature on the Hong Kongveterans and there is no doubt they were severely andpermanently damaged. They suffered from a high deathrate due to heart disease, crippling arthritis,blindness and a host of other conditions. Having outlined his background he then

told me thattwo weeks after he started to take nicotinic acid, 1gram after each meal, he was normal. He was able toraise his arms to their full extension, and he wasfree of all the symptoms which had plagued him for solong. When I began to prepare my report [20] Iobtained his Veterans Administration Chart. It came tome in two cardboard boxes and weighed over ten pounds,but over 95% of it was accumulated before he startedon the vitamin. For the ten years after he started onthe vitamin there was very little additional material.One could judge the efficacy of the vitamin byweighing the chart paper before and after he startedon it. Porteous remained well as long as he stayed onthe vitamin until his death when he was LieutenantGovernor of Saskatchewan. In 1962, after having beenwell for two years, he went on a holiday to themountains with his son and he forgot to take hisnicotinic acid with him. By the time he

returned homealmost the entire symptomatology had returned. Porteous was enthusiastic about nicotinic acid andbegan to tell all his friends about it. He told hisdoctor. His doctor cautioned him that he might damagehis liver. Porteous replied that if it meant he couldstay as well as he was until he died from a liverailment he would still not go off it. His doctorbecame an enthusiast as well and within a few yearshad started over 300 of his patients on the vitamin.He never saw any examples of liver disease fromnicotinic acid. I have treated over 20 prisoners from Japanese campsand from European concentration camps since then withequally good results. I estimated that one year inthese camps was equivalent to 4 years of aging, i.e.four years in camp would age a prisoner the equivalentof 16 years of normal living. George Porteous wanted every prisoner of war from theeastern camps treated as he had

been. He was notsuccessful in persuading the Government of Canada thatnicotinic acid would be very helpful so he turned tofellow prisoners, both in Canada (Hong Kong Veterans)and to American Ex-Prisoners of War. These Americanveterans suffered just as much as had the Canadiansoldiers since they were treated in exactly the sameabysmal way. The ones who started on the vitaminshowed the same response. Recently one of thesesoldiers, a retired officer, wrote to me after beingon nicotinic acid 20 years that he felt great, owed itto the vitamin and that when his arteries wereexamined during a simple operation they werecompletely normal. He wrote, "About two years ago, Iwas hit, was bleeding down the neck. The MDs took theopportunity to repair me. They said the arteries underthe ears look like they had never been used." There is an important lesson from the experiences ofthese veterans and their response to

megadoses ofnicotinic acid. This is that every human exposed tosevere stress and malnutrition for a long enoughperiod of time will develop a permanent need for largeamounts of this vitamin and perhaps for severalothers. This is happening on a large scale in Africa where thecombination of starvation, malnutrition and brutalityis reproducing the conditions suffered by theveterans. Those who survive will be permanentlydamaged biochemically, and will remain a burden tothemselves and to the community where they live. Willsociety have the good sense to help them recover bymaking this vitamin available to them in optimumdoses?DosesThe optimum dose range is not as wide as it is forascorbic acid, but it is wide enough to requiredifferent recommendations for different classes ofdiseases. As is always the case with nutrients, eachindividual must determine their own optimum level.With nicotinic acid this

is done by increasing thedose until the flush (vasodilation) is gone, or is soslight it is not a problem. One can start with as low a dose as 100 mg taken threetimes each day after meals and gradually increase it.I usually start with 500 mg each dose and often willstart with 1 gram per dose especially for cases ofarthritis, for schizophrenics, for alcoholics and fora few elderly patients. However, with elderly patientsit is better to start small and work it up slowly.No person should be given nicotinic acid withoutexplaining to them that they will have a flush whichwill vary in intensity from none to very severe. Ifthis is explained carefully, and if they are told thatin time the flush will not be a problem, they will notmind. The flush may remain too intense for a fewpatients and the nicotinic acid may have to bereplaced by a slow release preparation or by some ofthe esters, for example, inositol

niacinate. Thelatter is a very good preparation with very littleflush and most find it very acceptable even when theywere not able to accept the nicotinic acid itself. Itis rather expensive but with quantity production theprice might come down.The flush starts in the forehead with a warningtingle. Then it intensifies. The rate of thedevelopment of the flush depends upon so many factorsit is impossible to predict what course it willfollow. The following factors decrease the intensity of theflush: a cold meal, taking it after a meal, takingaspirin before, using an antihistamine in advance. The following factors make the flush more intense: ahot meal, a hot drink, an empty stomach, chewing thetablets and the rate at which the tablets break downin liquid. From the forehead and face the flush travels down therest of the body, usually stopping somewhere in thechest but may extend to the toes.

With continued usethe flush gradually recedes and eventually may be onlya tingling sensation in the forehead. If the personstops taking the vitamin for a day or more thesequence of flushing will be re-experienced. Somepeople never do flush and a few only begin to flushafter several years of taking the vitamin. Withnicotinamide there should be no flushing but I havefound that about 2% will flush. This may be due torapid conversion of the nicotinamide to nicotinic acidin the body.When the dose is too high for both forms of thevitamin the patients will suffer from nausea at first,and then if the dose is not reduced it will lead tovomiting. These side effects may be used to determinewhat is the optimum dose. When they do occur the doseis reduced until it is just below the nausea level.With children the first indication may be loss ofappetite. If this does occur the vitamin must bestopped for a few days and

then may be resumed at alower level. Very few can take more than 6 grams perday of the nicotinamide. With nicotinic acid it ispossible to go much higher. Many schizophrenics havetaken up to 30 grams per day with no difficulty. Thedose will alter over time and if on a dose where therewere no problems, they may develop in time. Usuallythis indicates that the patient is getting better anddoes not need as much. I have divided all patients whomight benefit from vitamin B-3 into the followingcategories.Category 1. These are people who are well or nearlywell, and have no obvious disease. They are interestedin maintaining their good health or in improving it.They may be under increased stress. The optimum doserange varies between 0.5 to 3 grams daily. The samedoses apply to nicotinamide.Category 2. Everyone under physiological stress, suchas pregnancy and lactation, suffering from acuteillness such as the

common cold or flu, or otherdiseases that do not threaten death. All thepsychiatric syndromes are included in this groupincluding the schizophrenias and the senile states. Italso includes the very large group of people with highblood cholesterol levels or low HDL when it is desiredto restore these blood values to normal. The doserange is 1 gram to 10 grams daily. For nicotinamidethe range is 1 1/2 g to 6 g. Nicotinamide does not affect cholesterol levels.Side EffectsHere are Dr. John Marks' conclusions. [21]"A tingling or flushing sensation in the skin afterrelatively large doses (in excess of 75 mg) ofnicotinic acid is a rather common phenomenon. It isthe result of dilation of the blood vessels that isone of the natural actions of nicotinic acid and onefor which it is used therapeutically. Whether thisshould therefore be regarded as a true adversereaction is a moot point. The reaction

clearsregularly after about 20 minutes and is not harmful tothe individual. It is very rare for this reaction tooccur at less than three times the RDA, even in verysensitive individuals. In most people much largerquantities are required. The related substancenicotinamide only very rarely produces this reactionand in consequence this is the form generally used forvitamin supplementation."Doses of 200 mg to 10 g daily of the acid have beenused therapeutically to lower blood cholesterol levelsunder medical control for periods of up to 10 years ormore and though some reactions have occurred at thesevery high dosages, they have rapidly responded tocessation of therapy, and have often cleared even whentherapy has been continued."In isolated cases, transient liver disorders, rashes,dry skin and excessive pigmentation have been seen.The tolerance to glucose has been reduced in diabeticsand patients with

peptic ulcers have experiencedincreased pain. No serious reaction have been reportedhowever even in these high doses. The availableevidence suggests that 10 times the RDA is safe (about100 mg)."Dr. Marks is cautious about recommending that doses of100 mg are safe. In my opinion, based upon 40 years ofexperience with this vitamin the dose ranges I haverecommended above are safe. However with the higherdoses medical supervision is necessary.Jaundice is very rare. Fewer that ten cases have beenreported in the medical literature. I have seen nonein ten years. When jaundice dose occur it is usuallyan obstructive type and clears when the vitamin isdiscontinued. I have been able to get schizophrenicpatients back on nicotinic acid after the jaundicecleared and it did not recur.Four serious cases have been reported, all involving asustained release preparation. Mullin, Greenson & Mitchell (1989) [22]

reported that a 44 year-old manwas treated with crystalline nicotinic acid, 6 gramsdaily, and after 16 months was normal. He then beganto take a sustained-release preparation, same dose.Within three days he developed nausea, vomiting,abdominal pain, dark urine. He had severe hepaticfailure and required a liver transplant. Henkin,Johnson & Segrest found three patients who developedhepatitis with sustained release nicotinic acid. Whenthis was replaced with crystalline nicotinic acidthere was no recurrent liver damage. [23]Since jaundice in people who have not been takingnicotinic acid is fairly common it is possible thereis a random association. The liver function tests mayindicate there is a problem when in fact there is not.Nicotinic acid should be stopped for five days beforethe liver function tests are given. One patient whohad no problem with nicotinic acid for loweringcholesterol switched to the slow

release preparationsand became ill. When he resumed the original nicotinicacid he was well again with no further evidence ofliver dysfunction. I have not seen any cases reportedanywhere else. I have described much more fully theside effects of this vitamin elsewhere. [24]Inositol hexaniacinate is an ester of inositol andnicotinic acid. Each inositol molecule contains sixnicotinic acid molecules. This ester is broken downslowly in the body. It is as effective as nicotinicacid and is almost free of side effects. There is verylittle flushing, gastrointestinal distress and otheruncommon side effects. Inositol, considered one of thelesser important B vitamins, does have a function inthe body as a messenger molecule and may add somethingto the therapeutic properties of the nicotinic acid.ConclusionVitamin B-3 is a very effective nutrient in treating alarge number of psychiatric and medical diseases butits

beneficial effect is enhanced when the rest of theorthomolecular program is included. The combination ofvitamin B-3 and the antioxidant nutrients is a greatanti-stress program.Reprinted with the permission of the author:Abram Hoffer, M.D., Ph.D.Suite 3 - 2727 Quadra StVictoria, British Columbia V8T 4E5 CanadaReferences1. Horwitt MK: Modern Nutrition in Health and Disease.Fifth Ed. RS Goodhart and ME Shils. Lea & Febiger,Phil. 1974.2. Canner PL, Berge KG, Wenger NK, Stamler J, FriedmanL, Prineas RJ & Freidewald W: Fifteen year mortalityCoronary Drug Project; patients long term benefit withniacin. American Coll Cardiology 8:1245-1255, 1986.3. Altschul R, Hoffer A & Stephen JD: Influence ofNicotinic Acid on Serum Cholesterol in Man. ArchBiochem Biophys 54:558-559, 1955.4. Hoffer A: The Schizophrenia, Stress andAdrenochrome Hypothesis. In Press, 1995.5. Hoffer A:

Orthomolecular Medicine for Physicians.Keats Pub, New Canaan, CT, 1989.6. Hoffer A: The treatment of schizophrenia. In Press1995.7. Hoffer A: The Development of OrthomolecularMedicine. In Press, 1995.8. Hoffer A: Niacin Therapy in Psychiatry. C. C.Thomas, Springfield, IL, 1962.Hoffer A & Osmond H: New Hope For Alcoholics,University Books, New York, 1966. Written by FannieKahan.Hoffer A & Walker M: Nutrients to Age WithoutSenility. Keats Pub Inc, New Canaan, CT, 1980.Hoffer A & Walker M: Smart Nutrients. A Guide toNutrients That Can Prevent and Reverse Senility. AveryPublishing Group, Garden City Park, New York, 1994.9. Agnew N & Hoffer A: Nicotinic Acid ModifiedLysergic Acid Diethylamide Psychosis. J Ment Science101:12-27, 1955. 10. Ivanova RA, Milstein GT, Smirnova LS & FantchenkoND: The Influence of Nicotinic Acid on an ExperimentalPsychosis

Produced by LSD 25. Journal ofNeuropathology and Psychiatry of CC Korsakoff64:1172-1176, 1964. In Russian. Translated by Dr. T.E.Weckowicz.11. Wilson B: The Vitamin B-3 Therapy: The FirstCommunication to A.A.'s Physicians and A SecondCommunication to A.A.'s Physicians, 1967 and 1968.12. Smith RF: A five year field trial of massivenicotinic acid therapy of alcoholics in Michigan.Journal of Orthomolecular Psychiatry 3:327-331, 1974.Smith RF: Status report concerning the use of megadosenicotinic acid in alcoholics. Journal ofOrthomolecular Psychiatry 7:52-55, 1978.13. Kaufman W: Common Forms of Niacinamide DeficiencyDisease: Aniacin Amidosis. Yale University Press, NewHaven, CT, 1943.Kaufman W: The Common Form of Joint Dysfunction: ItsIncidence and Treatment. E.L. Hildreth and Co.,Brattelboro, VT, 1949.14. Hoffer A: Orthomolecular Medicine For Physicians,Keats Pub, New Canaan, CT,

1989.15. Jacobson M & Jacobson E: Niacin, nutrition,ADP-ribosylation and cancer. The 8th InternationalSymposium on ADP- Ribosylation, Texas College ofOsteopathic Medicine, Fort Worth, TX, 1987.Titus K: Scientists link niacin and cancer prevention.The D.O. 28:93-97, 1987.Hostetler D: Jacobsons put broad strokes in theniacin/cancer picture. The D.O. 28:103-104, 1987.16. Chaplin DJ, Horsman MP & Aoki DS: Nicotinamide,Fluosol DA and Carbogen: a strategy to reoxygenateacutely and chronically hypoxic cells in vivo. BritishJournal of Cancer 63:109-113, 1990.17. Nakagawa K, Miyazaka M, Okui K, Kato N, Moriyama Y & Fujimura S: N1-methylnicotinamide level in the bloodafter nicotinamide loading as further evidence formalignant tumor burden. Jap. J. Cancer Research82:277-1283, 1991.18. Gerson M: Dietary considerations in malignantneoplastic disease. A prelimary report. The Review

ofGastroenterology 12:419-425, 1945.Gerson M: Effects of a combined dietary regime onpatients with malignant tumors. Experimental Medicineand Surgery 7:299-317, 1949. 19. Hoffer A: Orthomolecular Oncology. In, AdjuvantNutrition in Cancer Treatment, Ed. P. Quillin & R. M.Williams. 1992 Symposium Proceedings, Sponsored byCancer Treatment Research Foundation and AmericanCollege of Nutrition. Cancer Treatment ResearchFoundation, 3455 Salt Creek Lane, Suite 200, ArlingtonHeights, IL 60005-1090, 331-362, 1994.20. Hoffer A: Hong Kong Veterans Study. JOrthomolecular Psychiatry 3:34-36, 1974.21. Marks J: Vitamin Safety. Vitamin InformationStatus Paper, F. Hoffman La Roche & Co., Basle, 1989.22. Mullin GE, Greenson JK & Mitchell MC: Fulminanthepatic failure after ingestion of sustained-releasenicotinic acid. Ann Internal Medicine 111:253-255,1989.23. Henkin Y, Johnson KC &

Segrest JP: Rechallengewith crystalline niacin after drug-induced hepatitisfrom sustained-release niacin. J. American MedicalAssn. 264:241-243, 1990.24. Hoffer A: Niacin Therapy in Psychiatry. C. C.Thomas, Springfield, IL, 1962.Hoffer A: Safety, Side Effects and Relative Lack ofToxicity of Nicotinic acid and Nicotinamide.Schizophrenia 1:78-87, 1969.Hoffer A: Vitamin B-3 (Niacin) Update. New Roles For aKey Nutrient in Diabetes, Cancer, Heart Disease andOther Major Health Problems. Keats Pub, Inc., NewCanaan, CT, 1990.Please pass this message or article on to someone else so that they may learn also.Community Newsletters.http://www.alternative-medicine-newsletter.infoCommunity Message Boards.http://www.alternative-medicine-message-boards.info"Do not let either the medical authorities or the politicians mislead you. Find out what the facts are, and make your own decisions about how to live a happy life and how to work for a better world." - Linus PaulingGetting well is done one step at a time, day by day, building health and well being..list or archives: :........ - post:............. alternative_Medicine_Forum digest form:...... -digest individual emails: -normal no email:......... -nomail moderator:........

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