Vitamin B-3: Niacin and It's Amide

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Vitamin B-3: Niacin and It's Amide

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

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

 

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

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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,

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Canaan, CT, 1990.

 

 

 

 

 

[Guest guest]

Really interesting article and I would like to try some B3 because I have

been suffering from depression, bad fatigue and my memory is extremely bad

as well.

 

But the article has confused me. I wrote down all the different words

concerning vitamin B3:

 

niacin

niacinamide

nicotinamide adenine dinucleaotide

nicotinic acid

 

What is the difference? Which one should I be looking for? I had a look at

some shops that sell B3 and found:

 

B3 Niacin (Nicotinic Acid) 500 mg

B3 Niacin as Nicotinamide 500 mg

Niacinamide

 

Again, which is the best? Also, what brand should I go for? I'm in the UK

and it's hard to find high dose supplements so I suppose I will be ordering

from the USA.

 

All the best

Ulrike