How to Take Niacin

excerpt from Niacin the real story

 

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The keys to taking niacin therapy are quantity, frequency, and duration.

 

You need to take enough, take it frequently, and take it long enough to see benefit.   

 

TAKE ENOUGH    Adequately high supplement doses need to be employed to get the job done.

 

As there is a certain, large amount of fuel needed to launch an aircraft or a spacecraft, there is a certain, large amount of a nutrient needed to cure a sick body. With vitamin therapy, speed of recovery is proportional to dosage used. Dr. Hoffer’s standard prescription was 3,000 milligrams (mg) per day. 

 

Much less is needed for prevention and daily good health maintenance. The Recommended Dietary Allowance  (RDA) for niacin is under 18 mg per day. That is far too low. In 2007, an independent review panel of twenty-two  researchers and physicians issued their recommendation for niacin intake for an adult: 300 mg per day.¹   

 

TAKE FREQUENTLY    Niacin is a water-soluble vitamin. This means that it is lost from the body easily during the course of a day or even a few hours. Therefore, divide the daily niacin dose and take a third of it with every meal.

 

Taking niacin with meals improves absorption. 

 

Dr. William Kaufman and other experienced physicians have advocated for the importance of the frequency of doses. With the water-soluble vitamins, at any given quantity, frequently-divided doses are invariably more effective.

 

TAKE IT LONG ENOUGH    Some persons will notice benefits right away. Blood lipid benefits take more time. Long-standing mental illness may respond slowly, over a period of weeks or even months. Every patient is different, and this is why we recommend that you work in close cooperation with your personal physician.   

 

HOW DO I KNOW IF NIACIN IS HELPING? There are two ways to tell if your niacin supplementation is working for you: subjectively and objectively.   

 

Subjective Proof    If you are fighting mental illness, you will know full well when you feel better. It is just that simple. Friends and family may comment positively. 

 

Placebos rarely achieve that result. Critics of Hoffer’s work have claimed that it was his pleasant, positive bedside manner that resulted in cured patients. Dr. Hoffer replied, “I am nice to all my patients. However, only the ones getting niacin get better.”   

 

Common sense caution:  Work with your doctor. Persons with a history of heavy alcohol use, liver disorders, diabetes, or pregnancy will  especially want to have their physician monitor their use of niacin in quantity.   

 

Objective Proof  Ask your physician to check and see. For example, laboratory tests can easily verify if your blood lipids are benefiting from niacin.

 

Watch especially for lower triglycerides, and higher “good” HDL.   

 

HOW MUCH IS TOO MUCH?    A person’s absolute upper limit for niacin is the amount that causes nausea, and, if not reduced, vomiting. The dose should never be allowed to remain at this upper limit. Dr. Hoffer’s usual therapeutic dose range was 3,000 mg daily, divided into three doses of 1,000 mg each. Sometimes some patients need more.  We do not know the toxic dose for humans since niacin has never killed anyone. 

 

We think that monitoring long-term use of niacin is a good idea for anyone. It consists of having your doctor periodically (perhaps once or twice a year) check your liver function with a simple blood test.

 

Correct interpretation of these monitoring tests is important.  Niacin is not liver toxic, but niacin therapy does increase liver function tests. This elevation means that the liver is active—it does not indicate an underlying liver pathology.   

 

So-Called “Safe Upper Limits”    In spite of all this, there is now a government-sponsored “Safe Upper Limit” (or “tolerable upper intake level”) for niacin consumption.

 

It is 35 mg per day.² We offer this book as a charge-leading rebuttal against the arbitrariness and absurdity of that figure. Among many reasons why it is preposterous is that the so-called Safe Upper Limit is only about twice the RDA! There is no clinical or laboratory evidence whatsoever that proves that niacin, or any other vitamin, is dangerous at double the RDA.  Instead, authoritative-sounding speculation is offered to the public in the form of statements like this: “Supplement users at risk from ignorance of tolerable upper limits … Consuming too many nutrients can lead to harmful  side-effects, a fact many users were worryingly unaware of, said researchers … The tolerable upper level of one B  vitamin, niacin, was exceeded by nearly 50 per cent of all the participants in their study who reported taking supplements … Dietary supplements exceeding the tolerable upper limits were fairly common in the U.S., as the  supplement industry is not regulated in the same way as pharmaceutical industry.”³ 

 

The authors of this paper claim that side-effect symptoms will likely occur in half of those persons taking 100  mg of supplemental niacin, and that it is impossible to identify those who are at greatest risk.⁴ We consider such  statements to be scaremongering and sensationalism. 

 

In his fifty-five years of experience with thousands of patients, Dr. Hoffer found that even 40,000 mg of niacin daily is not toxic. He estimated that over 200,000 mg per day is fatal.

 

There is a built in safety valve with niacin:  vomiting.

 

Nausea will occur far in advance of any risk of fatality. Most of us would never exceed a few thousand mg daily, an amount that orthodox physicians frequently give patients to raise HDL.

 

The safety margin is very  large. For more than twenty-five years, data collected by the American Association of Poison Control Centers  (AAPCC) confirms that there is not even one niacin-related death per year.

 

(Download any Annual Report of the  American Association of Poison Control Centers from 1983–2009 free of charge at http://www.aapcc.org/. The  “Vitamin” category is usually near the end of the report.)   

 

THE NIACIN FLUSH AND VASODILATATION (VASODILATION)    Niacin usually causes a flush a few minutes after it is taken. A few people will flush with 25 mg, more with 50 mg, and most with 100 mg. The flush begins in the forehead and works its way down the body, rarely affecting the toes. The higher the initial dose the greater the initial flush, but if any dose causes a maximum flush a larger dose  taken later will not cause a greater flush. The capillaries are dilated and the blood flow through the organs is increased. There is an internal increase in blood flow as well as in the skin, which may last up to several hours.

 

Patients must be warned that this will happen. If not, they may be very surprised and even shocked. Patients can be started on lower doses until they have adjusted to the decreased intensity of the flush. Then the doses may be increased gradually.   

 

Vitamins: How Much to Take?    In his classic health book, Supernutrition,⁵ Richard A. Passwater suggests a simple and utterly nontechnical  method to determine what amounts of vitamins you personally need to take for optimum health. Wisely, no one prescriptive list is given; no “one size fits all” approach is offered. Rather, Dr. Passwater builds a careful and well-documented case for megavitamin therapy, and then shows how to increase your own vitamin doses in two-week intervals until peak health has been achieved. Essentially, you take the smallest amounts of supplements that give the greatest results.

 

If you go over and beyond that level, your health benefits will stay the same or decline. That would be the point of diminishing returns, the point of wasting money, and/or a potentially harmful overdose.

 

If this seems like common sense, perhaps that’s because it is. Interestingly, when doctors use this very same approach with drugs, it is called a “therapeutic trial.” With drugs, it is trial and error.  With nutrients, it is trial and much, much less risk of error.    With large initial doses, the niacin flush is more pronounced and lasts longer. But with each additional dose, the intensity of the flush decreases and in most patients becomes a minor nuisance rather than an irritant.

 

To minimize flushing, niacin should always be taken right after finishing one’s meal.   

 

Each time the niacin is taken, the flush is repeated but to a much lesser degree. In most cases it is almost all gone after a week or so, and is a minor nuisance at worst.

 

However, some patients do not tolerate the flush and will have to discontinue the niacin. Non-flush preparations are available for these subjects (niacinamide)

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If the  routine is interrupted for several days and then resumed, the same sequence of flushing will occur, but the initial  flush usually will not be as strong as the original one. The intensity of the flush is minimized by taking the pills after meals and by taking them regularly, three times daily.

 

Dr Hoffer" I have been taking niacin for fifty-five years and at most have very minor flushes. It is a drier flush, not like the wet menopausal flush, or the flush suffered by male hormone blockers used in treating prostate cancer."

 

Niacinamide does not cause flushing in the majority of patients. In perhaps 1 percent of patients, it will cause a very unpleasant flush, in which case it cannot be used. Probably their bodies convert the niacinamide into niacin too rapidly. This is unlikely to be you.  Vasodilatation (often called vasodilation) is sometimes very helpful. Many patients, particularly arthritics, have  reported that they feel much better when their joints are warmed up by the flush and some will stop taking niacin  for a few days in order to experience the flush once more.

 

But for most patients, the sensation is not pleasant. It is tolerable if patients know what to expect and are properly prepared by the physician.

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The rapidity with which the flush appears depends upon the concentration of niacin achieved. When taken by mouth with a meal or snack, the rate of absorption largely depends on the amount of food in the stomach: more food means slower absorption and less flushing. Another variable would be taking niacin with either a hot or cold beverage: more flushing is likely with a hot drink.

 

Some additional and interesting therapeutic uses of niacin include treatment of Meniere’s syndrome (ringing in  the ears plus nausea) and high-tone deafness. In long-term therapy, improvement was obtained with only 150–250  mg daily.¹² Resistance to x-radiation was greatly improved at around 500–600 mg daily. Radiation-induced nausea  was also reduced.

 

Supplemental niacin could therefore be of great value for cancer patients undergoing radiation  therapy. Even healing after surgical shock and other trauma including burns, hemorrhage, and infection is more  rapid with niacin administration.

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But the intensity of  the flush is very variable. Generally, people who need niacin the most flush the least. That includes arthritics,  schizophrenics, and people with cardiovascular problems.

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