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

[Guest guest]

http://www.doctoryourself.com/hoffer_niacin.html

 

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

 

Vitamin B-3: Niacin and Its Amide

by A. Hoffer, M.D., Ph.D.

 

The first water soluble vitamins were numbered in

sequence according to priority of discovery. But after

their chemical structure was determined they were

given scientific names. The third one to be discovered

was the anti-pellagra vitamin before it was shown to

be niacin. But the use of the number B-3 did not stay

in the literature very long. It was replaced by

nicotinic acid and its amide (also known medically as

niacin and its amide). The name was changed to remove

the similarity to nicotine, a poison.

 

The term vitamin B-3 was reintroduced by my friend

Bill W., co-founder of Alcoholics Anonymous, (Bill

Wilson). We met in New York in 1960. Humphry Osmond

and I introduced him to the concept of mega vitamin

therapy. We described the results we had seen with our

schizophrenic patients, some of whom were also

alcoholic. We also told him about its many other

properties. It was therapeutic for arthritis, for some

cases of senility and it lowered cholesterol levels.

 

Bill was very curious about it and began to take

niacin, 3 g daily. Within a few weeks fatigue and

depression which had plagued him for years were gone.

He gave it to 30 of his close friends in AA and

persuaded them to try it. Within 6 months he was

convinced that it would be very helpful to alcoholics.

Of the thirty, 10 were free of anxiety, tension and

depression in one month. Another 10 were well in two

months. He decided that the chemical or medical terms

for this vitamin were not appropriate. He wanted to

persuade members of AA, especially the doctors in AA,

that this would be a useful addition to treatment and

he needed a term that could be more readily

popularized. 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 to

physicians in AA he called it " The Vitamin B-3

Therapy. " Thousands of copies of this extraordinary

pamphlet were distributed. Eventually the name came

back and today even the most conservative medical

journals are using the term vitamin B-3.

 

Bill became unpopular with the members of the board of

AA International. The medical members who had been

appointed by Bill, felt that he had no business

messing about with treatment using vitamins. They also

" knew " vitamin B-3 could not be therapeutic as Bill

had found it to be. For this reason Bill provided

information to the medical members of AA outside of

the National Board, distributing three of his amazing

pamphlets. They are now not readily available.

 

Vitamin B-3 exists as the amide in nature, in

nicotinamide adenine dinucleotide (NAD). Pure

nicotinamide and niacin are synthetics. Niacin was

known as a chemical for about 100 years before it was

recognized to be vitamin B-3. It is made from

nicotine, a poison produced in the tobacco plant to

protect itself against its predators, but in the

wonderful economy of nature which does not waste any

structures, when the nicotine is simplified by

cracking open one of the rings, it becomes the

immensely valuable vitamin B-3.

 

Vitamin B-3 is made in the body from the amino acid

tryptophan. On the average 1 mg of vitamin B-3 is made

from 60 mg of tryptophan, about 1.5% Since it is made

in the body it does not meet the definition of a

vitamin; these are defined as substances that can not

be made. It should have been classified with the amino

acids, but long usage of the term vitamin has given it

permanent status as a vitamin. The 1.5% conversion

rate is a compromise based upon the conversion of

tryptophan to N-methyl nicotinamide and its

metabolites in human subjects. I suspect that one day

in the far distant future none of the tryptophan will

be converted into vitamin B-3 and it then will truly

be a vitamin. According to Horwitt [1], the amount

converted is not inflexible but varies with patients

and conditions. For example, women pregnant in their

last three months convert tryptophan to niacin

metabolites three times as efficiently as in

non-pregnant females. Also there is evidence that

contraceptive steroids, estrogens, stimulate

tryptophan oxygenase, the enzyme that converts the

tryptophan into niacin.

 

This observation raises some interesting speculations.

Women, on average, live longer then men. It has been

shown for men that giving them niacin increases their

longevity. [2] Is the increased longevity in women the

result of greater conversion of tryptophan into niacin

under the stimulus of their increase in estrogen

production? Does the same phenomenon explain the

decrease in the incidence of coronary disease in

women?

 

The best-known vitamin deficiency disease is pellagra.

More accurately it is a tryptophan deficiency disease

since tryptophan alone can cure the early stages.

Pellagra was endemic in the southern U.S.A. until the

beginning of the last world war. It can be described

by the four D's: dermatitis, diarrhea, dementia and

death. The dementia is a late stage phenomenon. In the

early stages it resembles much more the

schizophrenias, and can only with difficulty be

distinguished from it. The only certain method used by

early pellagrologists was to give their patients in

the mental hospitals small amounts of nicotinic acid.

If they recovered they diagnosed them pellagra, if

they did not they diagnosed them schizophrenia. This

was good for some of their patients but was not good

for psychiatry since it prevented any continuing

interest in working with the vitamin for their

patients who did not recover fast, but who might have

done so had they given them a lot more for a much

longer period of time, the way we started doing this

in Saskatchewan. I consider it one of the

schizophrenic syndromes.

 

Indications

I have been involved in establishing two of the major

uses for vitamin B-3, apart from its role in

preventing and treating pellagra. These are its action

in lowering high cholesterol levels [3] and in

elevating high density lipoprotein cholesterol levels

(HDL), and its therapeutic role in the schizophrenias

and other psychiatric conditions. It has been found

helpful for many other diseases or conditions. These

are psychiatric disorders including children with

learning and behavioral disorders, the addictions

including alcoholism and drug addiction, the

schizophrenias, some of the senile states. Its

efficacy for a large number of both mental and

physical conditions is an advantage to patients and to

their doctors who use the vitamin, but is difficult to

accept by the medical profession raised on the belief

that there must be one drug for each disease, and that

when any substance appears to be too effective for

many conditions, it must be due entirely to its

placebo effect, something like the old snake oils.

 

I have thought about this for a long time and have

within the past year become convinced that this

vitamin is so versatile because it moderates or

relieves the body of the pernicious effect of chronic

stress. It therefore frees the body to carry on its

routine function of repairing itself more efficiently.

The current excitement in medicine is the recognition

that hyperoxidation, the formation of free radicals,

is one of the basic damaging processes in the body.

These hyperexcited molecules destroy molecules and

damage tissues at the cellular level and at the tissue

level.

 

All living tissue which depends on oxygen for

respiration has to protect itself against these free

radicals. Plants use one type of antioxidants and

animals use another type. Fortunately there is a wide

overlap and the same antioxidants such as vitamin C

are used by both plants and animals. There is growing

recognition that the system adrenaline -> adrenochrome

plays a major role in the reactions to stress. I have

elaborated this in a further report for this journal.

[4]

 

The catecholamines, of which adrenalin is the best

known example, and the aminochromes, of which

adrenochrome is the best known example, are intimately

involved in stress reactions. Therefore to moderate

the influence of stress or to negate it, one must use

compounds which prevent these substances from damaging

the body. Vitamin B-3 is a specific antidote to

adrenalin, and the antioxidants such as vitamin C,

Vitamin E, beta carotene, selenium and others protect

the body against the effect of the free radicals by

removing them more rapidly from the body. Any disease

or condition which is stress related ought therefore

to respond to the combined use of vitamin B-3 and

these antioxidants provided they are all given in

optimum doses, whether small or large as in

orthomolecular therapy. I will therefore list briefly

the many indications for the use of vitamin B-3.

 

For each condition I will describe one case to

illustrate the therapeutic response. For each

condition I can refer to hundreds and thousands of

case histories and have already in the literature

described many of them in detail. [5]

 

Psychiatric

1) The Schizophrenias. I have reviewed this for this

journal. [6]

 

2) Children with Learning and/or Behavioral Disorders.

 

In 1960 seven year-old Bruce came to see me with his

father. Bruce had been diagnosed as mentally retarded.

He could not read, could not concentrate, and was

developing serious behavioral problems such as cutting

school without his parents' knowledge. He was being

prepared for special classes for the retarded. He

excreted large amounts of kryptopyrrole, the first

child to be tested. I started him on nicotinamide, one

gram tid. Within four months he was well. He graduated

from high school, is now married, has been fully

employed and has been paying income tax. He is one

case out of about 1500 I have seen since 1960.

 

Current treatment is more complicated as described in

this Journal. [7]

 

3) Organic Confusional States, non-Alzheimers forms of

dementia, electroconvulsive therapy-induced memory

disturbances.

 

In 1954 I observed how nicotinic acid relieved a

severe case of post ECT amnesia in one month. Since

then I have routinely given it in conjunction with ECT

to markedly decrease the memory disturbance that may

occur during and after this treatment. I would never

give any patient ECT without the concomitant use of

nicotinic acid. It is very helpful, especially in

cardiovascular-induced forms of dementia as it

reverses sludging of the red blood cell and permits

proper oxygenation of the cells of the body. For

further information see Niacin Therapy in Psychiatry.

[8]

 

In September 1992, Mr. C., 76 years-old, requested

help with his memory. He was terribly absentminded. If

he decided to do something, by the time he arrived

where he wanted to do it he had forgotten what it was

he wanted to do. His short-term memory was very poor

and his long-term memory was beginning to be affected.

I started him on a comprehensive vitamin program

including niacinamide 1.5 G daily. Within a month he

began to improve. I added niacin to his program. By

February 1993 he was normal. April 26, 1993, he told

me he had been so well he had concluded he no longer

needed any niacin and decreased the dose from 3.0 G to

1.5 G daily. He remained on the rest of the program.

Soon he noted that his short term memory was failing

him again. I advised him to stay on the full dose the

rest of his life.

 

4) An antidote against d-LSD,9,10 and against

adrenochrome. [5]

 

5) Alcoholism.

 

Bill W. conducted the first clinical trial of the use

of nicotinic for treating members of Alcoholics

Anonymous. [11] He found that 20 out of thirty

subjects were relieved of their anxiety, tension and

fatigue in two months of taking this vitamin, 1 G tid.

I found it very useful in treating patients who were

both alcoholic and schizophrenic. The first large

trial was conducted by David Hawkins who reported a

better than 90% recovery rate on about

90 patients. Since then it has been used by many

physicians who treat alcoholics. Dr. Russell Smith in

Detroit has reported the largest series of patients.

[12]

 

Physical

1. Cardiovascular

Of the two major findings made by my research group in

Saskatchewan, the nicotinic acid-cholesterol

connection is well known and nicotinic acid is used

worldwide as an economical, effective and safe

compound for lowering cholesterol and elevating high

density cholesterol. As a result of my interest in

nicotinic acid, Altschul, Hoffer and Stephen [3]

discovered that this vitamin, given in gram doses per

day, lowered cholesterol levels. Since then it was

found it also elevates high density lipoprotein

cholesterol thus bringing the ratio of total over HDL

to below 5.

 

In the National Coronary Study, Canner [2] showed that

nicotinic acid decreased mortality and prolonged life.

Between 1966 and 1975, five drugs used to lower

cholesterol levels were compared to placebo in 8341

men, ages 30 to 64, who had suffered a myocardial

infarction at least three months before entering the

study. About 6000 were alive at the end of the study.

Nine years later, only niacin had decreased the death

rate significantly from all causes. Mortality

decreased 11% and longevity increased by two years.

The death rate from cancer was also decreased.

 

This was a very fortunate finding because it led to

the approval by the FDA of this vitamin in mega doses

for cholesterol problems and opened up the use of this

vitamin in large doses for other conditions as well.

This occurred at a time when the FDA was doing its

best not to recognize the value of megavitamin

therapy. Its position has not altered over the past

four decades.

 

Our finding opened up the second major wave of

interest in vitamins. The first wave started around

1900 when it was shown that these compounds were very

effective in small doses in curing vitamin deficiency

diseases and in preventing their occurrence. This was

the preventive phase of vitamin use. The second wave

recognized that they have therapeutic properties not

directly related to vitamin deficiency diseases but

may have to be used in large doses. This was the

second or present wave wherein vitamins are used in

therapy for more than deficiency diseases. Our

discovery that nicotinic acid was an

hypocholesterolemic compound is credited as the first

paper to initiate the second wave and paved the way

for orthomolecular medicine which came along several

years later.

 

2. Arthritis

I first observed the beneficial effects of vitamin B-3

in 1953 and 1954. I was then exploring the potential

benefits and side effects from this vitamin. Several

of the patients who were given this vitamin would

report after several months that their arthritis was

better. At first this was a surprise since in the

psychiatric history I had taken I had not asked about

joint pain. This report of improvement happened so

often I could not ignore it. A few years later I

discovered that Prof. W. Kaufman had studied the use

of this vitamin for the arthritides before 1950 and

had published two books describing his remarkable

results. [13] Since that time this vitamin has been a

very important component of the orthomolecular regimen

for treating arthritis.

 

The following case illustrates both the response which

can occur and the complexity of the orthomolecular

regimen. Patients who are early into their arthritis

respond much more effectively and are not left with

residual disability.

 

K.V. came to my office April 15, 1982. She was in a

wheelchair pushed by her husband. He was exhausted,

depressed, and she was one of the sickest patients I

have ever seen. She weighed under 90 pounds. She sat

in the chair on her ankles which were crossed beneath

her body because she was not able to straighten them

out. Her arms were held in front of her, close to her

body, and her fingers were permanently deformed and

claw-like. She told me she had been deeply depressed

for many years because of the severe pain and her

major impairment. As she was being wheeled into my

office I saw how ill she was and immediately concluded

there was nothing I could do for her, and had to

decide how I could let her know without sending her

even deeper into despair. However I changed my mind

when she suddenly said, " Dr. Hoffer, I know no one can

ever cure me but if you could only help me with my

pain. The pain in my back is unbearable. I just want

to get rid of the pain in my back. " I realized then

she had a lot of determination and inner strength and

that it was worthwhile to try and help her.

 

She began to suffer from severe pain in her joints in

1952. In 1957 it was diagnosed as arthritis. Until

1962 her condition fluctuated and then she had to go

into a wheelchair some part of the day. She was still

able to walk although not for long until 1967. In 1969

she depended on the wheelchair most of the time, and

by 1973 she was there permanently. For awhile she was

able to propel herself with her feet. After that she

was permanently dependent on help. For the three years

before she saw me she had gotten some home care but

most of the care was provided by her husband. He had

retired from his job when I first saw them. He

provided the nursing care equivalent to four nurses on

8 hour shifts including holiday time. He had to carry

her to the bathroom, bathe her, cook and feed her. He

was as exhausted as she was but he was able to carry

on.

 

She was severely deformed, especially her hands,

suffered continuous pain, worse in her arms, and hips

and her back. Her ankles were badly swollen and she

had to wear pressure bandages. Her muscles also were

very painful most of the day. She was able to feed

herself and to crochet with her few useful fingers,

but it must have been extremely difficult. She was not

able to write nor type which she used to do with a

pencil. A few months earlier she had been suicidal. On

top of this severe pain and discomfort she had no

appetite, was not hungry and a full meal would

nauseate her. Her skin was dry, she had patches of

eczema, and she had white areas in her nails.

 

I advised her to eliminate sugar, potatoes, tomatoes

and peppers, (about 10% of arthritics have allergic

reactions to the solanine family of plants). She was

to add niacinamide 500 mg four times daily (following

the work of W. Kaufman), ascorbic acid 500 mg four

times daily (as an anti-stress nutrient and for

subclinical scurvy), pyridoxine 250 mg per day (found

to have anti-arthritic properties by Dr. J. Ellis),

zinc sulfate 220 mg per day (the white areas in her

nails indicated she was deficient in zinc), flaxseed

oil 2 tablespoons and cod liver oil 1 tablespoon per

day (her skin condition indicated she had a deficiency

of omega 3 essential fatty acids). The detailed

treatment of arthritis and the references are

described in my book. [14]

 

One month later a new couple came into my room. Her

husband was smiling, relaxed and cheerful as he pushed

his wife in in her chair. She was sitting with her

legs dangling down, smiling as well. I immediately

knew that she was a lot better. I began to ask her

about 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 no

longer bled from her bowel, she no longer bruised all

over her body, she was more comfortable, the pain in

her back was easily controlled with aspirin and was

gone from her hips, (it had not helped before). She

was cheerful and laughed in my office. Her heart was

regular at last. I added inositol niacinate 500 mg

four times daily to her program.

 

She came back June 17, 1982, and had improved even

more. She was able to pull herself up from the prone

position on her bed for the first time in 15 years,

and she was free of depression. I increased her

ascorbic acid to 1 gram four times daily and added

vitamin E 800 IU. Because she had shown such dramatic

improvement I advised her she need no longer come to

see me.

 

September 1, 1982, she called me on the telephone. I

asked her how she was getting along. She said she was

making even more progress. I then asked her how had

she been able to get to the phone. She replied she was

able to get around alone in her chair. Then she added

she had not called for herself but for her husband. He

had been suffering from a cold for a few days, she was

nursing him, and she wanted some advice for him.

 

After another visit October 28, 1983, I wrote to her

doctor " Today Mrs. K.V. reported she had stayed on the

whole vitamin program very rigorously for 18 months,

but since that time had slacked off somewhat. She is

regaining a lot of her muscle strength, can now sit in

her wheelchair without difficulty, can also wheel

herself around in her wheelchair but, of course, can

not do anything useful with her hands because her

fingers are so awful. She would like to become more

independent and perhaps could do so if something could

be done about her fingers and also about her hip. I am

delighted she has arranged to see a plastic surgeon to

see if something can be done to get her hand mobilized

once more. I have asked her to continue with the

vitamins but because she had difficulty taking so many

pills she will take a preparation called Multijet

which is available from Portland and contains all the

vitamins 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 her

vertebra had collapsed and she was suffering more pain

which was alleviated by Darvon. It had not been

possible to treat her hands surgically. She had been

able to eat by herself until six months before this

last visit. She had been taking small amounts of

vitamins. She was able to use a motorized chair. She

had been depressed. I wrote to her doctor, " She had

gone off the total vitamin program about two or three

years ago. It is very difficult for her to swallow and

I can understand her reluctance to carry on with this.

I have therefore suggested that she take a minimal

program which would include inositol niacinate 3 grams

daily, ascorbic acid 1 gram three times, linseed oil 2

capsules and cod liver oil 2 capsules. Her spirits are

good and I think she is coming along considering the

severe deterioration of her body as a result of the

arthritis over the past few decades. " She was last

seen by her doctor in the fall of 1989.

 

Her husband was referred. I saw him May 18, 1982. He

complained of headaches and a sense of pressure about

his head present for three years. This followed a

series of light strokes. I advised him to take niacin

3 grams daily plus other vitamins including vitamin C.

By September 1983 he was well and when seen last March

24, 1988 was still normal.

 

3. Juvenile Diabetes

Dr. Robert Elliot, Professor of Child Health Research

at University of Auckland Medical School is testing

40,000 five-year old children for the presence of

specific antibodies that indicate diabetes will

develop. Those who have the antibodies will be given

nicotinamide. This will prevent the development of

diabetes in most the children who are vulnerable.

According to the Rotarian for March 1993 this project

began 8 years ago and has 3200 relatives in the study.

Of these, 182 had antibodies and 76 were given

nicotinamide. Only 5 have become diabetic compared to

37 that would have been expected. Since 1988 over

20,100 school children have been tested. None have

become diabetic compared to 47 from the untested

comparable group. A similar study is underway in

London, Ontario.

 

4. Cancer

Recent findings have shown that vitamin B-3 does have

anti-cancer properties. This was discussed at a

meeting in Texas in 1987, Jacobson and Jacobson. [15]

The topic of this international conference was

" Niacin, Nutrition, ADP-Ribosylation and Cancer, " and

was the 8th conference of this series.

 

Niacin, niacinamide and nicotinamide adenine

dinucleotide (NAD) are interconvertable via a pyridine

nucleotide cycle. NAD, the coenzyme, is hydrolyzed or

split into niacinamide and adenosine dinucleotide

phosphate (ADP-ribose). Niacinamide is converted into

niacin, which in turn is once more built into NAD. The

enzyme which splits ADP is known as poly (ADP-ribose)

polymerase, or poly (ADP) synthetase, or poly

(ADP-ribose) transferase. Poly (ADP-ribose) polymerase

is activated when strands of deoxyribonucleic acid

(DNA) are broken. The enzyme transfers NAD to the

ADP-ribose polymer, binding it onto a number of

proteins. The poly (ADP-ribose) activated by DNA

breaks helps repair the breaks by unwinding the

nucleosomal structure of damaged chromatids. It also

may increase the activity of DNA ligase. This enzyme

cuts damaged ends off strands of DNA and increases the

cell's capacity to repair itself. Damage caused by any

carcinogenic factor, radiation, chemicals, is thus to

a degree neutralized or counteracted.

 

Jacobson and Jacobson, conference organizers,

hypothesized that niacin prevents cancer. They treated

two groups of human cells with carcinogens. The group

given adequate niacin developed tumors at a rate only

10% of the rate in the group deficient in niacin. Dr.

M. Jacobson is quoted as saying, " We know that diet is

a major risk factor, that diet has both beneficial and

detrimental components. What we cannot assess at this

point is the optimal amount of niacin in the diet...

The fact that we don't have pellagra does not mean we

are getting enough niacin to confer resistance to

cancer. " About 20 mg per day of niacin will prevent

pellagra in people who are not chronic pellagrins. The

latter may require 25 times as much niacin to remain

free of pellagra.

 

Vitamin B-3 may increase the therapeutic efficacy of

anti-cancer treatment. In mice, niacinamide increased

the toxicity of irradiation against tumors. The

combination of normobaric carbogen with nicotinamide

could be an effective method of enhancing tumor

radiosensitivity in clinical radiotherapy where

hypoxia limits the outcome of treatment. Chaplin,

Horsman and Aoki16 found that nicotinamide was the

best drug for increasing radiosensitivity compared to

a series of analogues. The vitamin worked because it

enhanced blood flow to the tumor. Nicotinamide also

enhanced the effect of chemotherapy. They suggested

that niacin may offer some cardioprotection during

long-term adriamycin chemotherapy.

 

Further evidence that vitamin B-3 is involved in

cancer is the report by Nakagawa, Miyazaki, Okui,

Kato, Moriyama and Fujimura [17] that in animals there

is a direct relationship between the activity of

nicotinamide methyl transferase and the presence of

cancer. Measuring the amount of N-methyl nicotinamide

was used to measure the activity of the enzyme. In

other words, in animals with cancer there is increased

destruction of nicotinamide, thus making less

available for the pyridine nucleotide cycle. This

finding applied to all tumors except the solid tumors,

Lewis lung carcinoma and melanoma B-16.

 

Gerson [18] treated a series of cancer patients with

special diets and with some nutrients including niacin

50 mg 8 to 10 times per day, dicalcium phosphate with

vitamin D, vitamins A and D, and liver injections. He

found that all the cancer cases were benefited in that

they became healthier and in many cases the tumors

regressed. In a subsequent report Gerson elaborated on

his diet. He now emphasized a high potassium over

sodium diet, ascorbic acid, niacin, brewers yeast and

lugols iodine. Right after the war there was no ready

supply of vitamins as there is today. I would consider

the use of these nutrients in combination very

original and enterprising. Dr. Gerson was the first

physician to emphasize the use of multivitamins and

some multiminerals. More details are

in Hoffer. [19]

 

Additional evidence that vitamin B-3 is therapeutic

for cancer arises from the National Coronary Study,

Canner. [2]

 

5. Concentration Camp Survivors

In 1960 I planned to study the effect of nicotinic

acid on a large number of aging people living in a

sheltered home. A new one had been built. I approached

the director of this home, Mr. George Porteous. I

arranged to meet him and told him what I would like to

do and why. I gave him an outline of its properties,

its side effects and why I thought it might be

helpful. Mr. Porteous agreed and we started this

investigation. A short while after my first contact

Mr. 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 more

intelligently 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 he

said he wanted to tell me what had happened to him.

Then I discovered he had been with the Canadian troops

who had sailed to Hong Kong in 1940, had been promptly

captured by the Japanese and had survived 44 months in

one of their notorious prisoner of war camps.

 

Twenty-five percent of the Canadian soldiers died in

these camps. They suffered from severe malnutrition

from starvation and nutrient deficiency. They suffered

from beri beri, pellagra, scurvy, infectious diseases,

and brutality from the guards.

 

Porteous, a physical education instructor, had been

fit weighing about 190 pounds when he got there. When

he returned home he weighed only 2/3rds of that. On

the way home in a hospital ship the soldiers were fed

and given extra vitamins in the form of rice

polishings. There were few vitamins available then in

tablets or capsules. He seemingly recovered but had

remained very ill. He suffered from both psychological

and physical symptoms. He was anxious, fearful and

slightly paranoid. Thus, he could never be comfortable

sitting in a room unless he sat facing the door. This

must have arisen from the fear of the guards.

Physically he had severe arthritis. He could not raise

his arms above his shoulders. He suffered from heat

and cold sensitivity. In the morning he needed his

wife's help in getting out of bed and to get started

for the day. He had severe insomina. For this he was

given barbiturates in the evening and to help awaken

him in the morning, he was given amphetamines.

 

Later I read the growing literature on the Hong Kong

veterans and there is no doubt they were severely and

permanently damaged. They suffered from a high death

rate due to heart disease, crippling arthritis,

blindness and a host of other conditions.

 

Having outlined his background he then told me that

two weeks after he started to take nicotinic acid, 1

gram after each meal, he was normal. He was able to

raise his arms to their full extension, and he was

free of all the symptoms which had plagued him for so

long. When I began to prepare my report [20] I

obtained his Veterans Administration Chart. It came to

me in two cardboard boxes and weighed over ten pounds,

but over 95% of it was accumulated before he started

on the vitamin. For the ten years after he started on

the vitamin there was very little additional material.

One could judge the efficacy of the vitamin by

weighing the chart paper before and after he started

on it. Porteous remained well as long as he stayed on

the vitamin until his death when he was Lieutenant

Governor of Saskatchewan. In 1962, after having been

well for two years, he went on a holiday to the

mountains with his son and he forgot to take his

nicotinic acid with him. By the time he returned home

almost the entire symptomatology had returned.

 

Porteous was enthusiastic about nicotinic acid and

began to tell all his friends about it. He told his

doctor. His doctor cautioned him that he might damage

his liver. Porteous replied that if it meant he could

stay as well as he was until he died from a liver

ailment he would still not go off it. His doctor

became an enthusiast as well and within a few years

had started over 300 of his patients on the vitamin.

He never saw any examples of liver disease from

nicotinic acid.

 

I have treated over 20 prisoners from Japanese camps

and from European concentration camps since then with

equally good results. I estimated that one year in

these camps was equivalent to 4 years of aging, i.e.

four years in camp would age a prisoner the equivalent

of 16 years of normal living.

 

George Porteous wanted every prisoner of war from the

eastern camps treated as he had been. He was not

successful in persuading the Government of Canada that

nicotinic acid would be very helpful so he turned to

fellow prisoners, both in Canada (Hong Kong Veterans)

and to American Ex-Prisoners of War. These American

veterans suffered just as much as had the Canadian

soldiers since they were treated in exactly the same

abysmal way. The ones who started on the vitamin

showed the same response. Recently one of these

soldiers, a retired officer, wrote to me after being

on nicotinic acid 20 years that he felt great, owed it

to the vitamin and that when his arteries were

examined during a simple operation they were

completely normal. He wrote, " About two years ago, I

was hit, was bleeding down the neck. The MDs took the

opportunity to repair me. They said the arteries under

the ears look like they had never been used. "

 

There is an important lesson from the experiences of

these veterans and their response to megadoses of

nicotinic acid. This is that every human exposed to

severe stress and malnutrition for a long enough

period of time will develop a permanent need for large

amounts of this vitamin and perhaps for several

others.

 

This is happening on a large scale in Africa where the

combination of starvation, malnutrition and brutality

is reproducing the conditions suffered by the

veterans. Those who survive will be permanently

damaged biochemically, and will remain a burden to

themselves and to the community where they live. Will

society have the good sense to help them recover by

making this vitamin available to them in optimum

doses?

 

Doses

The optimum dose range is not as wide as it is for

ascorbic acid, but it is wide enough to require

different recommendations for different classes of

diseases. As is always the case with nutrients, each

individual must determine their own optimum level.

With nicotinic acid this is done by increasing the

dose until the flush (vasodilation) is gone, or is so

slight it is not a problem.

 

One can start with as low a dose as 100 mg taken three

times each day after meals and gradually increase it.

I usually start with 500 mg each dose and often will

start with 1 gram per dose especially for cases of

arthritis, for schizophrenics, for alcoholics and for

a few elderly patients. However, with elderly patients

it is better to start small and work it up slowly.

 

No person should be given nicotinic acid without

explaining to them that they will have a flush which

will vary in intensity from none to very severe. If

this is explained carefully, and if they are told that

in time the flush will not be a problem, they will not

mind. The flush may remain too intense for a few

patients and the nicotinic acid may have to be

replaced by a slow release preparation or by some of

the esters, for example, inositol niacinate. The

latter is a very good preparation with very little

flush and most find it very acceptable even when they

were not able to accept the nicotinic acid itself. It

is rather expensive but with quantity production the

price might come down.

 

The flush starts in the forehead with a warning

tingle. Then it intensifies. The rate of the

development of the flush depends upon so many factors

it is impossible to predict what course it will

follow.

 

The following factors decrease the intensity of the

flush: a cold meal, taking it after a meal, taking

aspirin before, using an antihistamine in advance.

 

The following factors make the flush more intense: a

hot meal, a hot drink, an empty stomach, chewing the

tablets and the rate at which the tablets break down

in liquid.

 

From the forehead and face the flush travels down the

rest of the body, usually stopping somewhere in the

chest but may extend to the toes. With continued use

the flush gradually recedes and eventually may be only

a tingling sensation in the forehead. If the person

stops taking the vitamin for a day or more the

sequence of flushing will be re-experienced. Some

people never do flush and a few only begin to flush

after several years of taking the vitamin. With

nicotinamide there should be no flushing but I have

found that about 2% will flush. This may be due to

rapid conversion of the nicotinamide to nicotinic acid

in the body.

 

When the dose is too high for both forms of the

vitamin the patients will suffer from nausea at first,

and then if the dose is not reduced it will lead to

vomiting. These side effects may be used to determine

what is the optimum dose. When they do occur the dose

is reduced until it is just below the nausea level.

With children the first indication may be loss of

appetite. If this does occur the vitamin must be

stopped for a few days and then may be resumed at a

lower level. Very few can take more than 6 grams per

day of the nicotinamide. With nicotinic acid it is

possible to go much higher. Many schizophrenics have

taken up to 30 grams per day with no difficulty. The

dose will alter over time and if on a dose where there

were no problems, they may develop in time. Usually

this indicates that the patient is getting better and

does not need as much. I have divided all patients who

might benefit from vitamin B-3 into the following

categories.

 

Category 1. These are people who are well or nearly

well, and have no obvious disease. They are interested

in maintaining their good health or in improving it.

They may be under increased stress. The optimum dose

range varies between 0.5 to 3 grams daily. The same

doses apply to nicotinamide.

 

Category 2. Everyone under physiological stress, such

as pregnancy and lactation, suffering from acute

illness such as the common cold or flu, or other

diseases that do not threaten death. All the

psychiatric syndromes are included in this group

including the schizophrenias and the senile states. It

also includes the very large group of people with high

blood cholesterol levels or low HDL when it is desired

to restore these blood values to normal. The dose

range is 1 gram to 10 grams daily. For nicotinamide

the range is 1 1/2 g to 6 g.

 

Nicotinamide does not affect cholesterol levels.

 

Side Effects

Here are Dr. John Marks' conclusions. [21]

 

" A tingling or flushing sensation in the skin after

relatively large doses (in excess of 75 mg) of

nicotinic acid is a rather common phenomenon. It is

the result of dilation of the blood vessels that is

one of the natural actions of nicotinic acid and one

for which it is used therapeutically. Whether this

should therefore be regarded as a true adverse

reaction is a moot point. The reaction clears

regularly after about 20 minutes and is not harmful to

the individual. It is very rare for this reaction to

occur at less than three times the RDA, even in very

sensitive individuals. In most people much larger

quantities are required. The related substance

nicotinamide only very rarely produces this reaction

and in consequence this is the form generally used for

vitamin supplementation.

 

" Doses of 200 mg to 10 g daily of the acid have been

used therapeutically to lower blood cholesterol levels

under medical control for periods of up to 10 years or

more and though some reactions have occurred at these

very high dosages, they have rapidly responded to

cessation of therapy, and have often cleared even when

therapy 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 diabetics

and patients with peptic ulcers have experienced

increased pain. No serious reaction have been reported

however even in these high doses. The available

evidence suggests that 10 times the RDA is safe (about

100 mg). "

 

Dr. Marks is cautious about recommending that doses of

100 mg are safe. In my opinion, based upon 40 years of

experience with this vitamin the dose ranges I have

recommended above are safe. However with the higher

doses medical supervision is necessary.

 

Jaundice is very rare. Fewer that ten cases have been

reported in the medical literature. I have seen none

in ten years. When jaundice dose occur it is usually

an obstructive type and clears when the vitamin is

discontinued. I have been able to get schizophrenic

patients back on nicotinic acid after the jaundice

cleared and it did not recur.

 

Four serious cases have been reported, all involving a

sustained release preparation. Mullin, Greenson &

Mitchell (1989) [22] reported that a 44 year-old man

was treated with crystalline nicotinic acid, 6 grams

daily, and after 16 months was normal. He then began

to take a sustained-release preparation, same dose.

Within three days he developed nausea, vomiting,

abdominal pain, dark urine. He had severe hepatic

failure and required a liver transplant. Henkin,

Johnson & Segrest found three patients who developed

hepatitis with sustained release nicotinic acid. When

this was replaced with crystalline nicotinic acid

there was no recurrent liver damage. [23]

 

Since jaundice in people who have not been taking

nicotinic acid is fairly common it is possible there

is a random association. The liver function tests may

indicate there is a problem when in fact there is not.

Nicotinic acid should be stopped for five days before

the liver function tests are given. One patient who

had no problem with nicotinic acid for lowering

cholesterol switched to the slow release preparations

and became ill. When he resumed the original nicotinic

acid he was well again with no further evidence of

liver dysfunction. I have not seen any cases reported

anywhere else. I have described much more fully the

side effects of this vitamin elsewhere. [24]

 

Inositol hexaniacinate is an ester of inositol and

nicotinic acid. Each inositol molecule contains six

nicotinic acid molecules. This ester is broken down

slowly in the body. It is as effective as nicotinic

acid and is almost free of side effects. There is very

little flushing, gastrointestinal distress and other

uncommon side effects. Inositol, considered one of the

lesser important B vitamins, does have a function in

the body as a messenger molecule and may add something

to the therapeutic properties of the nicotinic acid.

 

Conclusion

Vitamin B-3 is a very effective nutrient in treating a

large number of psychiatric and medical diseases but

its beneficial effect is enhanced when the rest of the

orthomolecular program is included. The combination of

vitamin B-3 and the antioxidant nutrients is a great

anti-stress program.

 

Reprinted with the permission of the author:

Abram Hoffer, M.D., Ph.D.

Suite 3 - 2727 Quadra St

Victoria, British Columbia V8T 4E5 Canada

 

References

1. 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, Friedman

L, Prineas RJ & Freidewald W: Fifteen year mortality

Coronary Drug Project; patients long term benefit with

niacin. American Coll Cardiology 8:1245-1255, 1986.

 

3. Altschul R, Hoffer A & Stephen JD: Influence of

Nicotinic Acid on Serum Cholesterol in Man. Arch

Biochem Biophys 54:558-559, 1955.

 

4. Hoffer A: The Schizophrenia, Stress and

Adrenochrome 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 Press

1995.

 

7. Hoffer A: The Development of Orthomolecular

Medicine. 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 Fannie

Kahan.

 

Hoffer A & Walker M: Nutrients to Age Without

Senility. Keats Pub Inc, New Canaan, CT, 1980.

 

Hoffer A & Walker M: Smart Nutrients. A Guide to

Nutrients That Can Prevent and Reverse Senility. Avery

Publishing Group, Garden City Park, New York, 1994.

 

9. Agnew N & Hoffer A: Nicotinic Acid Modified

Lysergic Acid Diethylamide Psychosis. J Ment Science

101:12-27, 1955.

 

10. Ivanova RA, Milstein GT, Smirnova LS & Fantchenko

ND: The Influence of Nicotinic Acid on an Experimental

Psychosis Produced by LSD 25. Journal of

Neuropathology and Psychiatry of CC Korsakoff

64:1172-1176, 1964. In Russian. Translated by Dr. T.E.

Weckowicz.

 

11. Wilson B: The Vitamin B-3 Therapy: The First

Communication to A.A.'s Physicians and A Second

Communication to A.A.'s Physicians, 1967 and 1968.

 

12. Smith RF: A five year field trial of massive

nicotinic acid therapy of alcoholics in Michigan.

Journal of Orthomolecular Psychiatry 3:327-331, 1974.

 

Smith RF: Status report concerning the use of megadose

nicotinic acid in alcoholics. Journal of

Orthomolecular Psychiatry 7:52-55, 1978.

 

13. Kaufman W: Common Forms of Niacinamide Deficiency

Disease: Aniacin Amidosis. Yale University Press, New

Haven, CT, 1943.

 

Kaufman W: The Common Form of Joint Dysfunction: Its

Incidence 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 International

Symposium on ADP- Ribosylation, Texas College of

Osteopathic 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 the

niacin/cancer picture. The D.O. 28:103-104, 1987.

 

16. Chaplin DJ, Horsman MP & Aoki DS: Nicotinamide,

Fluosol DA and Carbogen: a strategy to reoxygenate

acutely and chronically hypoxic cells in vivo. British

Journal of Cancer 63:109-113, 1990.

 

17. Nakagawa K, Miyazaka M, Okui K, Kato N, Moriyama Y

& Fujimura S: N1-methylnicotinamide level in the blood

after nicotinamide loading as further evidence for

malignant tumor burden. Jap. J. Cancer Research

82:277-1283, 1991.

 

18. Gerson M: Dietary considerations in malignant

neoplastic disease. A prelimary report. The Review of

Gastroenterology 12:419-425, 1945.

 

Gerson M: Effects of a combined dietary regime on

patients with malignant tumors. Experimental Medicine

and Surgery 7:299-317, 1949.

 

19. Hoffer A: Orthomolecular Oncology. In, Adjuvant

Nutrition in Cancer Treatment, Ed. P. Quillin & R. M.

Williams. 1992 Symposium Proceedings, Sponsored by

Cancer Treatment Research Foundation and American

College of Nutrition. Cancer Treatment Research

Foundation, 3455 Salt Creek Lane, Suite 200, Arlington

Heights, IL 60005-1090, 331-362, 1994.

 

20. Hoffer A: Hong Kong Veterans Study. J

Orthomolecular Psychiatry 3:34-36, 1974.

 

21. Marks J: Vitamin Safety. Vitamin Information

Status Paper, F. Hoffman La Roche & Co., Basle, 1989.

 

22. Mullin GE, Greenson JK & Mitchell MC: Fulminant

hepatic failure after ingestion of sustained-release

nicotinic acid. Ann Internal Medicine 111:253-255,

1989.

 

23. Henkin Y, Johnson KC & Segrest JP: Rechallenge

with crystalline niacin after drug-induced hepatitis

from sustained-release niacin. J. American Medical

Assn. 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 of

Toxicity of Nicotinic acid and Nicotinamide.

Schizophrenia 1:78-87, 1969.

 

Hoffer A: Vitamin B-3 (Niacin) Update. New Roles For a

Key Nutrient in Diabetes, Cancer, Heart Disease and

Other Major Health Problems. Keats Pub, Inc., New

Canaan, CT, 1990.