DIRECTORIO

ORTOMOLECULAR NEWS

ORTOMOLECULAR NEWS LETTER
VOLUMEN I / I EPOCA

Director: Lic. Nut. Miguel Leopoldo Alvarado
Noticias y Artículos de Dietética y Nutriología Ortomolecular y Antienvejecimiento para Profesionales de la Salud

INSCRIBETE A NUESTRO BOLETIN

lunes, 30 de junio de 2008

DISENTIMOS RADICALMENTE DE LAS AFIRMACIONES DE LA "CONAR" EN EL SENTIDO DE QUE “no hay ningún producto que sea dañino por sí mismo”, por lo que se buscará promover su “consumo razonable”

NOTA ACLARATORIA A LA NOTA QUE REPRODUCIMOS A CONTINUACIÓN:

 

Esta nota la reproducimos porque queremos destacar y enfatizar que disentimos radicalmente de la afirmación infundada acerca de que "no hay ningún producto que sea dañino por sí mismo", por lo que se buscará promover su "consumo razonable", como lo afirmó Ángel de León, vicepresidente de anunciantes del Consejo de Autorregulación y Ética Publicitaria (Conar).

 

Para la AHANAOA A. C., es claro que se pretende manipular al consumidor desvirtuando lo que cada vez es más claro: Todos los "productos comestibles artificiales" hechos con ingredientes refinados, nutrientes modificados (distintos a los naturales), y aditivos químicos, son sumamente tóxicos y nocivos para la salud, y deberían ser no solo disminuidos o limitados en la dieta de todo ser humano, sino, completamente prohibidos.

 

Repudiamos por lo tanto los sofismas publicitarios que promueve el Consejo de Autorregulación y Ética Publicitaria.

 

Atentamente,

 

Miguel Leopoldo Alvarado.



Voluntario, nuevo código de publicidad

Ante alimentos chatarra habrá publicidad moderada

Susana González

Empresas y agencias de publicidad pretenden modificar la promoción de alimentos industrializados dirigidos a la población infantil, pero sólo a través del cumplimiento voluntario del nuevo código del Consejo de Autorregulación y Ética Publicitaria (Conar).

A pesar de que muchos de esos productos han sido catalogados como "alimentos chatarra" por autoridades sanitarias y organizaciones de consumidores, para Conar no se trata de sacar de la televisión o limitar la aparición de los comerciales que los promueven, toda vez que consideran que "no hay ningún producto que sea dañino por sí mismo", por lo que se buscará promover su "consumo razonable", advirtió Angel de León, vicepresidente de anunciantes del organismo.

"Nuestra posición es que no existen alimentos malos, lo que hay son malos hábitos, por lo que nuestro compromiso es promover estilos de vida saludables, actitudes distintas que contribuyan a combatir la obesidad infantil, como el ejercicio", dijo Karla Avila, directora de Conar.

Los directivos ponderaron que el organismo cuenta con un nuevo reglamento y código de ética, entre cuyos artículos se incluyó uno sobre la publicidad infantil, que dice: "la publicidad dirigida al público infantil tomará en cuenta su vulnerabilidad, capacidad crítica, nivel de experiencia y credulidad. Se evitará la utilización de imágenes, sonidos, textos, lenguaje y demás contenidos que pongan en riesgo, deterioren o perjudiquen su salud física y/o mental, así como los que de forma directa o indirecta afecten negativamente el concepto de familia y la educación en los valores".

Gunther Saupe, vicepresidente de medios de Conar, refirió que en relación con el anterior código tales lineamientos son mucho más específicos y claros en la protección a la infancia y la juventud, además de que son resultado de las múltiples reuniones que el organismo autorregulatorio sostuvo con anunciantes y organizaciones "sobre los productos que engordan o que no son precisamente los más nutritivos".



--
AHANAOA A. C.
Lic. Nut. Miguel Leopoldo Alvarado
http://www.nutriologiaortomolecular.org/
http://www.seattlees.com/

domingo, 22 de junio de 2008

Orthomolecular Psychiatry in Theory




























Health

Orthomolecular Psychiatry in Theory and Practice

by Abram Hoffer, MD, PhD Drug Therapy, Aug. 1977


Dr. Hoffer is affiliated with the Huxley Institute for Biosocial Research, and is Editor-in-Chief, Journal of Orthomolecular Psychiatry Orthomolecular psychiatry is one of two branches of psychiatry currently advocating chemotherapy for schizophrenia. The other branch is toximolecular psychiatry. There are vast conceptual differences between the two and great differences in efficacy for the patient. Toximolecular psychiatry advocates the use of sublethal doses of agents not normally found in the body. Their use has not significantly improved patient recovery rate over that occurring naturally, and demands a terrible price from the patient in the form of incapacity to work and irreversible toxicity. Single drugs are used for treating schizophrenics unless additional drugs are needed to control side effects. In this approach, a drug is promoted and required for patient maintenance. Modern psychiatry generally depends on this system of drug use.


Orthomolecular psychiatry, on the other hand, emphasizes a system of treatment, not any one drug or chemical. The schizophrenic is given optimal amounts of materials that are necessary for good nutrition and optimal functioning - vitamins, minerals, fats, carbohydrates, and amino acids. The orthomolecular program requires full patient participation in changing lifestyle and discontinuing faulty eating habits. Thus, sound principles of good nutrition are inherent in the program, and they include adhering to a diet that provides high nutritional value for the individual and avoiding foods to which one is allergic. In many cases, megadoses of the essential factors are required, and patients are eventually maintained in a normal state by nutritional therapy alone. Such patients relapse much less frequently than those maintained on drugs alone.


Orthomolecular Treatment -- In Theory


Effective treatments are not any more effective because one understands why they work. Frequently there is no correlation between rationale and effectiveness. Physicians are more likely to accept a treatment when there is an explanation, even if it is erroneous. For this reason, I consider rationale something to be sought after, but a factor not nearly as relevant as proof of efficacy.


The propositions basic to orthomolecular psychiatry are as follows:

- When the brain is biochemically disorganized, so is the mind.
- There is great interindividual variation in biochemical needs and metabolic processes.
- Some nutrient requirements, especially those for vitamins, may vary up to 100-fold between individuals.


Persons who remain well on average levels of needed nutrients may develop problems if their diets become deficient or they are unable to absorb the nutrients. Others who need larger amounts will develop a dependency and require supplementation. - Deficiency disease can result from lack of, or dependency on, a particular nutrient. For example, vitamin B3-deficient patients develop pellagra. But those who are deficient because they require larger levels of vitamin B3 are actually vitamin dependent and, in my opinion, constitute a major proportion of acute or subacute schizophrenics. Prolonged malnutrition, as occurred in World War II concentration camps in the Far East, will produce dependency. Dependency may develop any time in life. - Both the biophysical (food, air, water, etc.) and psychosocial environments are important. A normal biophysical environment ensures a nomal interaction with the psychosocial environment. - A number of schizophrenic syndromes are caused by different biochemical problems, each requiring a specific treatment. Tranquilizers, like sedatives, are nonspecific. They will allow some control of symptoms for all the schizophrenias, but do not help in determining cause. Obviously, no schizophrenic suffers from a deficiency of any tranquilizer.


Orthomolecular Treatment -- In Practice


In general, the "medical model" of orthomolecular psychiatry is the basis for diagnosis and treatment. The prognosis is also discussed in earlier articles.


Nutrition


In nature, food does not exist as the proteins, amino acids, fats, carbohydrates, vitamins, and minerals described by chemists. Food is a complex of living material. When digested, the basic nutritional components in food are released. The most nutritionally valuable foods are the least processed ones. Unfortunately, 80% of the food consumed today is processed. "Nonfoods" have been stripped of all essential nutrients. To be metabolized, they must "steal" accessory nutrients - proteins, fat, vitamins, and minerals -from other foods. That is why substances containing "empty calories" are so injurious to the quality of any diet to which they are added.

Such depleted substances are best looked upon as ~junk" and avoided. Therefore, the first rule of nutritional (i.e., orthomolecular) therapy is: Eat no "junk" food to which sugar has been added. This rule excludes from the diet pastry, candy, chocolate bars, soft drinks, ice cream, and processed cereals. Most people will eventually lose the craving for sugar. Adherence to a nodunk food diet ensures that more nutritionally valuable food (fresh fruit, vegetables, fish, meat, etc.) is eaten, constituting a better diet overall.


The second rule is: Avoid foods to which one is allergic. This includes avoiding foods of which one is inordinately fond (craving may be fueled by allergy) or from which one obviously becomes sick.

The third rule is designed to minimize allergic reactions: Eat as wide a variety of foods as possible and do not depend heavily on a few.


The Light Party.

Back to Top

Back to Health Directory

Home

Orthomolecular Theory

pauling.htm
On the Orthomolecular Environment of the Mind: Orthomolecular Theory

Linus, Pauling, Ph.D.

Back

"Varying the concentrations of substances normally present in the human body may control mental disease." - Linus Pauling

"The methods principally used now for treating patients with mental disease are psychotherapy (psychoanalysis and related efforts to provide insight and to decrease environmental stress), chemotherapy (mainly with the use of powerful synthetic drugs, such as chlorpromazine, or powerful natural products from plants, such as reserpine), and convulsive shock therapy (electroconvulsive therapy, insulin coma therapy, pentylenetetrazol shock therapy). I have reached the conclusion that another general method of treatment, which may be called orthomolecular therapy, may be found to be of great value, and may turn out to be the best method of treatment for many patients." - Linus Pauling, Science, April 19, 1968, p. 265

The author defines orthomolecular psychiatry as the achievement and preservation of good mental health by the provision of the optimum molecular environment for the mind, especially the optimum concentrations of substances normally present in the human body, such as the vitamins. He states that there is sound evidence for the theory that increased intake of such vitamins as ascorbic acid, niacin pyridoxine, and cyanocobalamin is useful in treating schizophrenia. The negative conclusions of APA Task Force Report 7, Megavitamin and Orthomolecular Therapy in Psychiatry, he says, result not only from faulty arguments and from a bias against megavitamin therapy but also from a failure to deal fully with orthomolecular therapy in psychiatry- Three psychiatrists comment on Dr. Pauling's presentation.


Orthomolecular psychiatry is the achievement and preservation of mental health by varying the concentrations in the human body of substances that are normally present, such as the vitamins- It is part of a broader subject, orthomolecular medicine, an important put because the functioning of the brain is probably more sensitively dependent on its molecular composition and structure than is the functioning of other organs (1) . After having worked for a decade on the hereditary hemolytic anemias, I decided in 1954 to work on the molecular basis of mental disease. I read the papers and books dealing with megavitamin therapy of schizophrenia by Hoffer and Osmond (2,4) as well as the reports on studies of vitamins in relation to mental disease by Cleckley and Sydenstricker (5,6) and others. In the course of time I formulated a general theory of the dependence of function on molecular structure of the brain and other parts of the body and coined the adjective "orthomolecular" to describe it (1).

There is no doubt that the mind is affected by its molecular environment. The presence in the brain of molecules of LSD, mescaline, or some other schizophrenogenic substance is associated with profound psychic effects. Mental manifestations of avitaminosis have been reported for several vitamins. A correlation of behavior of school children with concentration of ascorbic acid in the blood (increase in "alertness" or "sharpness" with increase in concentration) has been reported by Kubala and Katz (7). A striking abnormality in the urinary excretion of ascorbic acid after an oral loading dose was reported for chronic schizophrenics by VanderKamp (8) and by Herjanic and Moss-Herjanic (9). My associates and I (10) carried out loading tests for three vitamins on schizophrenic patients who had recently been hospitalized and an control subjects. The percentage of schizophrenic patients who showed low urinary excretion of each vitamin was about twice as great as that of the controls: for ascorbic acid, 74 percent of the schizophrenic patients showed low urinary excretion versus 32 percent of the controls; for niacinamide, 81 percent versus 46 percent; and for pyridoxine, 52 percent versus 24 Percent. The possibility that the low values in urinary excretion of thew vitamins for schizophrenic patients resulted from poor nutrition is made unlikely by the observation that the numbers of subjects low in one, two, or all three vitamins corresponded well with the numbers calculated for independent incidence.

There are a number of plausible mechanisms by which the concentration of a vitamin may affect the functioning of the brain. One mechanism, effective COT vitamins that serve as coenzymes, is that of shifting the equilibrium for the reaction of apoenzyme and coenzyme to give the active enzyme. An example is the effectiveness of cyanocobalamin (vitamin B12) given in amounts 1,000 times greater than normal to control the disease methylmalonic aciduria (11-14). About half of the patients with this disease are successfully treated with megadoses of vitamin B12 . In these patients a genetic mutation has occurred and an altered apoenzyme that has a greatly reduced affinity for the coenzyme has been produced. Increase in concentration of the coenzyme can counteract the effect of the decrease in the value of the combining constant and lead to the formation of enough of the active enzyme to catalyze effectively the reaction of conversion of methylmalonic acid to succinic acid.

In the human population there may be several alleles of the gene controlling the manufacture of each apoenzyme; in consequence the concentration of coenzyme needed to produce the amount of active enzyme required for optimum health may well be somewhat different for different individuals- In particular, many individuals may require a considerably higher concentration of one Or more coenzymes than other people do for optimum health, especially for optimum mental health. It is difficult to obtain experimental evidence for gene mutations that lead to only small changes in the properties of enzymes. The fact that genes that lead to large and more easily detectable changes in the properties of enzymes occur, as in individuals with methylmalonic aciduria, for example, suggests that mutations that lead to small changes also occur.

Significant differences in enzyme activity in different individuals have been reported by many investigators, especially by Williams [15], who has made many studies of biochemical individuality. It is likely that thorough studies of enzymes would show them to be similar to the human hemoglobins. A few of the abnormal human hemoglobins, most of which involve only the substitution of one amino-acid residue for another in either the alpha chain or the beta chain of the molecule, differ greatly in properties from normal adult hemoglobin, leading to serious manifestations of disease.

It was in the course of the study of one of these diseases, sickle cell anemia, that the first abnormal hemoglobin was discovered (16). Most of the abnormal human hemoglobins, however. differ from normal hemoglobin in their properties to only a small extent, so that there is no overt manifestation of diseaseThere is, nevertheless, the possibility that even the small changes in properties of an abnormal hemoglobin associated with a mild hemoglobinopathy will have deleterious consequences. An example is the intolerance to sulfa drugs associated with the substitution of arginine for histidine in the locus 58 in the alpha chain or 63 in the beta chain. It is likely that individual differences in enzyme activity will in the course of time be shown to be the result of differences in the amino-acid sequences of the polypeptide chains of the apoenzymes.

More than 100 abnormal human hemoglobins are now known, and the human population may be expected to be similarly complex with respect to many enzymes, including those involved in the functioning of the brain. A tendency to schizophrenia is probably polygenic in origin. I have suggested (1) that the genes primarily involved in this tendency may well be those which regulate the metabolism of vital substances such as the vitamins.

Some vitamins are known to serve as coenzymes for several enzyme systems. We might ask if the high concentration of coenzyme required to produce the optimum amount of one active enzyme might not lead to the production of far too great an amount of another active enzyme. The answer to this question is that the danger is not very great. For most enzymes the concentration of coenzyme and the value of the combination constant are such that most (90 percent or more) of the protein is converted to active enzyme. Accordingly, a great increase in concentration would increase the amount of most active enzymes by only a few percentage points, whereas it might cause a great increase for a mutated enzyme.

The Orthomolecular Treatment of Schizophrenia
In the book Orthomolecular Psychiatry: Treatment Of Schizophrenia (17) my colleagues and I pointed out that the orthomolecular treatment of schizophrenia involves the use of vitamins (megavitamin therapy) and minerals; the control of diet, especially the intake of sucrose; and, during the initial acute phase, the use of conventional methods of controlling the crisis, such as the phenothiazines. The phenothiazines are not, of course, normally present in the human body and are not orthomolecular. However, they are so valuable in controlling the crisis that their use is justified in spite of their undesirable side effects.

Hawkins (18) stated that his initial combination of vitamins for the treatment of schizophrenia was I gin. of ascorbic acid, I gm, of niacinamide, 50 mg. of pyridoxine, and 400 I.U. of vitamin E four times a day. Other vitamins may also be given. A larger intake, especially of niacinamide or niacin may be prescribed; the usual amount seems to be about 8 gm. a day after an initial period on 4 gm. a day.

The vitamins, as nutrients or medicaments, pose an interesting question. The question is not, Do we need them? We know that we do need them, in small amounts, to stay alive. The Teal question is, What daily amounts of the various vitamins will lead to the best of health, both physical and mental? This question has been largely ignored by medical and nutritional authorities.

Let us consider schizophrenia, Osmond (19) stated that about 40 percent of schizophrenics hospitalized for the first time are treated successfully by conventional methods in that they are released and not hospitalized a second time. The conventional treatment fails for about 60 percent in that the patient is not released or is hospitalized again. Conventional treatment includes a decision about vitamin intake. Usually it is decided that the vitamins in the food will suffice or that a multivitamin tablet will also be given. The amounts of ascorbic acid, niacin pyridoxine, and vitamin E may be approximately the daily allowances recommended by the Food and Nutrition Board of the U.S. National Academy of Sciences-National Research Council: 60 mg. of ascorbic acid, 20 mg of niacin 2 mg. of pyridoxine, and 15 I.U. of vitamin E. Is this amount of vitamins correct? Would many schizophrenic patients respond to their treatment better if the decision were made that they should receive 10 or 100 or 500 times as much of some vitamins? What is the optimum intake for these patients? I believe there is much evidence that the optimum intake for schizophrenic patients is much larger than the recommended daily allowances. By the use of orthomolecular methods in addition to the conventional treatment of schizophrenia, the fraction of patients hospitalized for the first time in whom the disease is controlled may be increased from about 40 percent to about 80 percent. (19)

Ascorbic Acid
It was reported by Horwitt in 1942 (20) and by later investigators that schizophrenic patients receiving the usual dietary amounts of ascorbic acid had lower concentrations of ascorbic acid in the blood than people in good health. The loading-test results of VanderKamp (8), Herjanic and Moss-Herjanic (9), and Pauling and associates (10) have been mentioned above. In his discussion of ascorbic acid and schizophrenia Herjanic (21) concluded:

The individual variation of the need for ascorbic acid may turn out to be one of the contributing factors in the development of the illness. Ascorbic acid is an important substance necessary for optimum functioning of many organs. If we desire, in the treatment of mental illness, to provide the "optimum molecular environment," especially the optimum concentration of substances normally present in the human body (Pauling,. 1968 (1)), ascorbic acid should certainly be included (2).

There is, moreover, a special reason for an increased intake of ascorbic acid by patients with schizophrenia or any other disease for which there is only partial control. About 60 mg. of ascorbic acid a day is enough to prevent overt manifestations of avitaminosis C (scurvy) in most people. However, there are several significant arguments to support the thesis that the optimum intake for most people is 10 to 100 times more than 60 mg. These arguments are summarized in the papers and books of Irwin Stone (22) and myself (23,24). They constitute the theoretical basis for the customary use of about 4 gin. of ascorbic acid a day in the orthomolecular therapeutic and prophylactic treatment of schizophrenia. A significant controlled trial of ascorbic acid in chronic psychiatric patients was reported in 1963 by Milner (25). The study, which was double-blind, was made with 40 chronic male patients: 34 had schizophrenia, 4 had manic-depressive psychosis, and 2 had general paresis. Twenty of the patients, selected at random, received 1 gm. of ascorbic acid a day for three weeks; the rest received a placebo. The patients were checked with the Minnesota Multiphasic Personality Inventory (MMPI) and the Wittenborn Psychiatric Rating Scales (WPRS) before and after the trial. Milner concluded that "statistically significant improvement in the depressive, manic, and paranoid symptoms-complexes, together with an improvement in overall personality functioning, was obtained following saturation with ascorbic acid" (25). He suggested that chronic psychiatric patients would benefit from the administration of ascorbic acid.

We found (10) that of 106 of the schizophrenic patients we studied who had recently been hospitalized in a private hospital, a county-university hospital, or a state hospital, 81 (76 percent) were deficient in ascorbic acid, as shown by the six-hour excretion of less than 17 percent of an orally administered close. Only 27 of 89 control subjects (30 percent) showed this deficiency. Great deficiency (less than 4 percent excreted) was shown by 24 (22 percent) of the schizophrenic subjects and by only 1 (1 percent) of the controls. I have no doubt that many schizophrenic patients would benefit from an increased intake of ascorbic acid. My estimate is that 4 gm. of ascorbic acid a day, in addition to the conventional treatment, would increase the fraction of acute schizophrenics in whom the disease is permanently controlled by about 25 percent, Except for that of Milner (25), no controlled trial of ascorbic acid in relation to schizophrenia has been made, so far as I know.

Niacin and Niacinamide
The requirement of niacin (nicotinic acid) for proper functioning of the brain is well known. The psychosis of pellagra, as well as the other manifestations of this deficiency disease, is prevented by the intake of a small amount of niacin, about 20 mg. a day. In 1939 Cleckley, Sydenstricker, and Geeslin (5) reported the successful treatment of 19 patients with severe psychiatric symptoms with niacin and in 1941 Sydenstricker and Cleckley (6) reported similarly successful treatment of 29 patients with niacin. In both studies, moderately large doses of niacin, 0.3 to 1.5 gm. a day, were given. None of the patients in these studies had physical symptoms of pellagra or any other avitammosis. A decade later, Hoffer and Osmond (2,3) initiated two doubleblind studies of niacin or niacinamide in the treatment of schizophrenia. Another double-blind study was reported by Denson in 1962 (26). In 1964 Hoffer and Osmond (4) reported that a 10-year follow-up evaluation of the patients in their initial studies showed that 75 percent had not required hospitalization, compared with 36 percent of the comparison group, who had not received niacin. Similar estimates have been made by Hawkins (18). There are, however, contradictory statements by other investigators. The question of the weight of the evidence is discussed below in the section on the APA task force report.

Pyridoxine
Pyridoxine, vitamin B6 is used in the treatment of schizophrenia in amounts of 200 to 800 mg. a day by many orthomolecular psychiatrists, Derivatives of this vitamin are known to be the coenzymes for over 50 enzymes, and the chance of a genotype with need for a large intake of the vitamin is accordingly great. There is evidence that pyridoxine is involved in tryptophan-niacin metabolism.
A double-blind placebo-controlled study has been made of pyridoxine and niacin by Ananth, Ban, and Lehmann (27). Their experimental population consisted of 30 schizophrenic patients: 15 were men, 15 were women, their mean age was 41.7 years, and their mean duration of hospitalization was 10.9 years. They were randomly assigned to three treatment groups: 1) the combined treatment group, which received 3 gm. of nicotinic acid a day for 48 weeks and 75 mg. of pyridoxine a day during three 4-week periods; 2) the nicotinic acid group, which received 3 gm. of nicotinic acid a day for 48 weeks and a pyridoxine placebo; and 3) the pyridoxine group, which received 75 mg- of pyridoxine a day during three 4 week periods and a nicotinic acid placebo. In addition, neuroleptic preparations were administered according to clinical requirements for the control of psychopathology. The investigators reported that "of the ten patients in each treatment group, seven improved and three deteriorated in the nicotinic acid group, nine improved and one deteriorated in both the combined treatment group and in the pyridoxine group" (27). They also stated:

Of the three indices of therapeutic effects, global improvement in psychopathology (Brief Psychiatric Rating Scale and Nurses Observation Scale for Inpatient -Evaluation) scores was seen in all three groups: the number of days of hospitalization during the period of the clinical study was lower in both the nicotinic acid and the combined treatment group; and only in the combined treatment group was the daffy average dosage of phenothiazine medication decreased. Thus, improvement in all three indices was noted in the combined treatment group. However, several side effects were observed during the therapeutic trials, indicating that the vitamins used are not completely safe (27).


The investigators reached the conclusion that "on balance, these results suggest that the addition of pyridoxine may potentiate the action of nicotinic acid. Thus pyridoxine seems to be a useful adjunct to nicotinic acid therapy" (27). Hawkins (18) commented on this work in the following way:

The therapeutic effect was demonstrable even though the patients had been hospitalized for an average of 10.9 years, were not on hypoglycemic diets, and the doses of both pyridoxine (75 mg. daily) and vitamin B3 (3 gm. a day) were considerably below the dosages we routinely prescribe (18).

Cyanocobalamin
A deficiency in cyanocobalamin (vitamin B12), whatever its cause, leads to mental illness as well as to such physical manifestations as anemia. The anemia can be controlled by a large intake of folic acid, but the mental illness and neurological damage cannot. A pathologically low concentration of cyanocobalamin in the blood serum has been reported to occur in a much larger percentage of patients with mental illness than in the general population. Edwin and associates (28) determined the amount of vitamin B12 in the serum of every patient over 30 years old admitted to a mental hospital in Norway during a period of one year. Of the 396 patients, 61 (15-4 percent) had a subnormal or pathologically low concentration of vitamin B 12, less than 150 pg. per ml. (the normal range is 150 to 1,300 pg. per ml.). This incidence is 30 times as great as that estimated for the population as a whole. Other investigators have reported similar results and have suggested that a low serum concentration of vitamin B12, whatever its origin, may cause mental illness. In addition, of course, mental illness may accompany some genetic diseases, such as methylmalonic aciduria, which can be controlled only by achieving a serum concentration of cyanocobalamin far greater than normal.

Minerals and Other Vitamins
There is some evidence that mental illness may result from deprivation of or abnormal need for minerals and other vitamins. (See, for example, Pfeiffer, Iliev, and Goldstein (29)). Further work in this field by psychiatrists and biochemists is needed.

The APA Task Force Report
In July 1973 an APA task force of five physicians and one consultant issued a 54-page report titled Megavitamin and Orthomolecular Therapy in Psychiatry (30). In this report the Task Force on Vitamin Therapy in Psychiatry purports to present both theoretical and empirical reasons for completely rejecting the basic concept of orthomolecular psychiatry, which is the achievement and preservation of good mental health by the provision of the optimum molecular environment for the mind, especially the optimum concentrations of substances normally present in the human body.

Some Errors in the Report
It is mentioned in the report that in the treatment program of the orthomolecular psychiatrists "each patient may receive as many as six vitamins in large doses individually determined by the treating physician as well as other psychotropic drugs and hormones whose doses are also individually determined for each patient" (p. 46). The assumption is made by the task force that the optimum intake of vitamins for mental health is the conventional average daily nutritional requirement, with growth and development as the criteria: "In schizophrenia there is apparently an adequate vitamin intake for growth and development until the illness becomes manifest in the teens or early adult life" (p. 40). Mention is made in the report of the well-known genetic diseases with both psychic and somatic manifestations that can be controlled by an intake of a vitamin 100 or 1,000 times the usually recommended daily allowance, but the possibility that less obvious genetic differences could result in an increased individual need for a larger intake of vitamins in order to achieve good mental health, as discussed in my 1968 publication (1) and in the earlier sections of this paper, is rejected on the basis of arguments that have little value or pertinence. One such argument is the following:

The two theoretical bases adduced by megavitamin proponents for the effectiveness of NA therapy (nicotinic acid as a methyl acceptor and NAD deficiency) are in fact generally incompatible, because NAA [nicotinamide], when functioning as a vitamin, is bound to the remainder of the coenzyme molecule by the nitrogen of its pyridine ring and hence can no longer accept methyl groups. Essentially, then, the two views of NA as a vitamin precursor of NAD and as a methyl acceptor are incompatible, except for the possibility that there is in schizophrenia double deficit - both a vitamin deficiency and a transmethylation defect and that nicotinic acid has the happy fortune to serve two purposes simultaneously (pp. 40-42).

There is an obvious error in this task force argument. There is no incompatibility between two functions of nicotinic acid; some molecules may engage in one function and others in the other. A defect in either function might be controlled by increasing the intake of the vital substance. A "double deficit" is not needed. The authors of the report would have wen the fallacy in their argument if they had set up some equilibrium and reaction rate equations, as was done in my 1968 paper (1). The task force expresses an interesting misunderstanding of the nature of vitamins, in the following words: "By common definition a vitamin is not only an essential nutrient, but it is essential because it is transformed into a coenzyme vital for metabolic reactions" (p. 41). In fact, this is not the common definition of a vitamin; it is wrong. Some vitamins, including vitamin C, are not known to be transformed into a coenzyme. This misunderstanding by the task force may have contributed to the misinterpretation of the evidence for and the theoretical basis of orthomolecular psychiatry.
Nicotinic acid as a methyl acceptor is referred to in the report: "From Study No. 12: nicotinic acid in the dosage of 3000 mg. per day can neither prevent nor counteract the psychopathology induced by the combined administration of a monoamine oxidase inhibitor (tranylcypromine) and methionine" (p. 16). In fact, the molecular weights of nicotinic acid and methionine (a methyl donor) are nearly the same, 123 and 149, respectively. Instead of 3 gm., 16.5 gm. of nicotinic acid would have had to be given each day to accept the methyl groups donated by the 20 gm. of methionine that was given each day. The study referred to as number 12 (31), which resulted in an exacerbation of the illness of 30 schizophrenic patients who participated in it, has no value as a test of the methyl acceptor theory of nicotinic acid. Consideration of ethical principles may have kept the investigators from repeating the study with use of the proper equimolar amounts of nicotinic acid and methionine.

The Failure To Discuss Ascorbic Acid and Pyridoxine
In several places the APA task force report mentions the use of 1 to 30 gm. of ascorbic acid a day by orthomolecular psychiatrists. There are, however, no references to the literature. Milner's double-blind study (25) is not mentioned, nor is there any discussion of the many papers in which a low level of ascorbic acid in the blood of schizophrenics was reported. Neither the general theory of orthomolecular psychiatry, as presented in my 1968 paper (1) nor any of the special arguments about the value of ascorbic acid is presented or discussed in any significant way. There is, moreover, no discussion in the report of pyridoxine and no reference to the 1973 work by Ananth, Ban, and Lehmann (27) on the potentiation by pyridoxine of the effectiveness of niacin in controlling chronic schizophrenia. The title of the report, Megavitamin and Orthomolecular Therapy in Psychiatry, is completely inappropriate, and the general condemnation of megavitamin and orthomolecular therapy is unjustified.

Niacin
The report does my that it is possible that the other watersoluble vitamins will prove to be more effective than niacin but it adds;

Nonetheless, the massive use of niacin has always been the cornerstone of the theory and practice of megavitamin advocates. Since this has proved to have no value when is it employed as the sole variable along with conventional treatments of schizophrenia, the burden of proof for the complex and highly individualized programs now advocated would appear to be on the proponents of such treatment (p. 46).

I shall point out below that the principles of medical ethics prevent orthomolecular psychiatrists from withholding from half of their patients a treatment that they consider to be valuable. Controlled tests can be carried out only by skeptics. I now ask whether the task force is justified in saying that the massive use of niacin has been proved to have no value when it is employed as the sole variable along with conventional treatments of schizophrenia. My answer to this question, from a study of the evidence quoted in the report, is that it is not justified. The evidence that niacin has no value is far from conclusive. A beneficial effect of niacin or niacinamide was reported for three double-blind studies (two by Hoffer and Osmond and their collaborators (2,3,32) and one by Denson (26)) and in 12 open clinical trials by other investigators referred to in the report. On the other hand, the report mentions 7 doubleblind studies in which a statistically significant difference between the niacinamide subjects and the controls was not observed.
A failure to reject with statistical significance the nun hypothesis that the treatment and the placebo have equal value is not proof that the treatment has no value. The explicit statistical analysis of an alternative hypothesis should be carried out: for example, the hypothesis that there is a 10-percent or 20-percent greater improvement in the treated subjects than in the placebo subjects. No such analysis has been published.
In fact, some of the "negative" studies indicate that the treatment has value. The report states that "Greenbaum (33) reported a double-blind study of 57 schizophrenic children who received nicotinamide 1 gm. per 50 lbs of body weight or placebo for six months. No statistically significant differences were seen in the two groups as a result of the treatment" (P. 11). it is true that no statistically significant differences were wen, but that is not the whole truth, The principal criterion of improvement in this study was the increase in the score on a clinical scale of observable behavior categories. The average improvement in the score of the 17 children receiving niacinamide was 4.0 units and that of the 24 controls was 2.6 units (there was a third group of 16 children who were given a tranquilizer and niacinamide). The children who were given niacinamide showed a 54-percent greater improvement than the children who were given placebo. The groups were too small, however, for the difference to be significant at the 95-percent level of confidence. This study does not prove that niacinamide has no value. Rather, it indicates that niacinamide has greater value than the placebo, even though it fails to show this at the customary level of statistical significance.

The Hoffer-Osmond Diagnostic Test
Two-thirds of the report relates to niacin and one-third to the Hoffer-Osmond Diagnostic Test (HOD) (34), which has no special connection with megavitamin or orthomolecular psychiatry except that it was devised by the originators of niacin therapy. The report should have been given the- title Niacin Therapy and the HOD Test, or published as two reports, one on niacin and one on the HOD test. It would have been still better for the task force to have discussed megavitamin and orthomolecular therapy in psychiatry fully.

The Question of Controlled Experiments
The report refers to the low credibility of the megavitamin proponents, whose published results were not duplicated in studies carried out by one of the task force members (p. 48). The penultimate sentence of the report is, "Their credibility is further diminished by the consistent refusal over the past decade to perform controlled experiments and to report their new results in a scientifically acceptable fashion" (p. 48).
I have talked with the leading orthomolecular psychiatrists and have found that they feel the principles of medical ethics prevent them from carrying out controlled clinical tests, with half of their patients receiving orthomolecular therapy in addition to the conventional treatment and the other half receiving only the conventional treatment. It is the duty of the physician to give to every one of his patients the treatment that in his best judgment will be of the greatest value, Some psychiatrists, including Hoffer and Osmond, carried out controlled trials 20 years ago. They became convinced that orthomolecular therapy, along with conventional treatment, was beneficial to almost every patient. From that time on their ethical principles have required that they give this treatment and not withhold it from half of their patients. The task force is wrong in criticizing the orthomolecular psychiatrists for not having carried out controlled clinical trials during the last few years. Instead, it is the critics, who doubt the value of orthomolecular methods, who are at fault in not having carried out well-designed clinical tests.
It is also the duty of a physician to give to a patient a treatment that may benefit him and is known not to be harmful. The incidences of toxicity and other serious side effects of the doses of vitamins used in orthomolecular medicine are low. There is significant evidence that an increased intake of certain vitamins may benefit the patient. It is accordingly the duty of the psychiatrist to prescribe these vitamins for him.

The Bias of the Task Force
The last sentence of the report reads as follows:

Under these circumstances this Task Force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment," to be deplorable (p. 48).

This sentence, like others in the report, shows the presumably unconscious bias of the task force. "Promulgate" (misused here) is a pejorative word, and "catch phrases" is a pejorative expression. I do not understand why megavitamin therapy and orthomolecular treatment should be called misnomers. This concluding sentence, like many others in the book, seems to me to have been written in order to exert an unjustifiably unfavorable influence on the readers of the report.
I have written two popular books, No More War! (35) and Vitamin C and the Common Cold (24). I feel that each of them was worthwhile and that neither would have been easily replaced by a more technical book. The second book (24) was written because I had discovered in reading the medical literature that there was much evidence there about the value of ascorbic acid in decreasing both the incidence and the severity of the common cold and that this evidence had been suppressed or misrepresented by the medical and nutritional authorities. Since publication of the book, eight new studies have been reported. Every one of these has verified the value of ascorbic acid. The APA report shows the same sort of negative attitude as that shown by the authorities toward ascorbic acid in relation to the common cold. There seems to be a sort of professional inertia that hinders progress.

Conclusions
Orthomolecular psychiatry is the achievement and preservation of good mental health by the provision of the optimum molecular environment for the mind, especially the optimum concentrations of substances normally present in the human body, such as the vitamins. There is evidence that an increased intake of some vitamins, including ascorbic acid, niacin pyridoxine, and cyanocobalamin, is useful in treating schizophrenia, and this treatment has a sound theoretical basis. The APA task force report Megavitamin and Orthomolecular Therapy in Psychiatry discusses vitamins in a very limited way (niacin only) and deals with only one or two aspects of the theory. Its arguments are in part faulty and its conclusions are unjustified.


-Based on a lecture given at a meeting of the American College of Neuropsychopharmacology, Palm Springs, Calif., Dec 47 7 1973 . Reprinted with permission: Am J. Psychiatry, 131:11, November 1974. Copyright 1974 American Psychiatric Association.


References

1.Pauling, L.: Orthomolecular psychiatry. Science 160: 265-271, 1968

2.Hoffer, A.: Niacin Therapy in Schizophrenia. Springfield, Ill., Charles C. Thomas, 1962

3.Osmond, H., Hoffer A.: Massive niacin treatment in schizophrenia: review of a nine-year study. Lancet 1:316-319, 1962

4.Hoffer, A., Osmond H.: Treatment of schizophrenia with nicotinic acid: a ten-year follow-up. Acta Psychiatr Scand 40:171-189, 1964

5.Cleckley, H.M., Sydenstricker, V,P., Geeslin, LE-: Nicotinic acid in treatment of atypical psychotic states associated with malnutrition. JAMA 112:2107-2110, 1939

6.Sydenstricker, V.P., Cleckley, H.M.: The effect of nicotinic acid in stupor, lethargy and various other psychiatric disorders. Am I Psychiatry 98:83-92,1941

7.Kubala, A.L., Katz, M.M.: Nutritional factors in psychological test behavior. J Genet Psychol 96:343-352, 1960

8.VanderKamp, H: A: biochemical abnormality in schizophrenia involving ascorbic acid- Int J Neuropsychiatry 2:204206, 1966

9.Herjanic, M., Moss-Herjanic, B.L. Ascorbic acid test in psychiatric patients. J Schizophrenia 1: 257-260, 1967

10.Pauling, L., Robinson, A.B_ Oxley S.S., et a]: Results of a loading test of ascorbic acid, niacinamide, and pyridoxine in schizophrenic subjects and controls, in Orthomolecular Psychiatry: Treatment of Schizophrenia. Edited by Hawkins, D., Pauling, L San Francisco, W.H. Freeman and Co., 1973, pp 18-34

11. Orsenberg, LE., Lilljeqvist, A.C., Hsia, Y.E.: Methylmalonic aciduria: metabolic block localization and vitamin B12 dependency. Science 162: 805-807, 1968

12. Lindblad, B., Olin, P., Svanberg, B., et al: Methylmalonic acidemia. Acta Paediatr Scand.57: 417-424, 1968

13.Walker, F.A., Agarwal, A.B., Singh, R.; Methylmalonic aciduria: response to oral B12 therapy. I Pediatr 75:344, 1969

14.Rosenberg, LE,, Lilljeqvist, A.C., Hsia, Y.E., et al: Vitamin B12 dependent methylmalonicaciduria: defective B12 metabolism in cultured fibroblasts. Biochem Biophys Res Commun 37:607-614,1969

15.Williams, R.J.: Biochemical Individuality. New York, John Wiley & Sons, 1957

16.Pauling, L., Itano, ILA., Singer, S.J., et al: Sickle cell anemia a molecular disease. Science I 10: 543-548, 1949

17.Hawkins, D., Pauling, L (eds): Orthomolecular Psychiatry; Treatment of Schizophrenia. San Francisco, W.H. Freeman and Co., 1973

18.Hawkins, D.: Orthomolecular psychiatry: treatment of schizophrenia. Ibid, pp. 631-673

19.Osmond, H.: The background to the niacin treatment. Ibid,pp. 194-201

20.Horwitt, M.K.: Ascorbic acid requirements of individuals in a large institution. Proc Soc Exp, Biol Med 49:248-250, 1942

21.Herjanic, M.: Ascorbic acid and schizophrenia, in Orthomolecular Psychiatry; Treatment of Schizophrenia. Edited by Hawkins, D., Pauling, L San Francisco, W.H. Freeman and Co., 1973, pp. 303-315

22.Stone, L: The Healing Factor: Vitamin C Against Disease. New York. Grosset and Dunlap, 1972

23.Pauling, L: Evolution and the need for ascorbic acid. Proc Natl Acad Sci USA 67:1643-1648, 1970

24.Pauling, L: Vitamin C and the Common Cold. San Francisco. W.H. Freeman and Co. 1970

25.Milner, G.: Ascorbic acid in chronic psychiatric patients: a controlled trial- Br I Psychiatry 109:294-299, 1963

26.Denson, R.: Nicotinamide in the treatment of schizophrenia. Dis Nerv Syst 23:167-172, 1962

27.Ananth, J.V., Ban, T.A., Lehmann, H.E.: Potentiation of therapeutic effects of nicotinic acid by pyridoxine in chronic schizophrenic& Can Psychiatr Assoc J 18:377-382, 1973

28.Edwin, I., Holten, K., Norum, K.R., et al: Vitamin B12 hypovitaminosis in mental diseases. Acta Med Scand 177:689-699, 1965

29. Pfeiffer, C.C., Iliev, V., Goldstein, L: Blood histamine, basophil counts, and trace elements in the schizophrenias, in Orthomolecular Psychiatry: Treatment of Schizophrenia. Edited by Hawkins, D., Panting, L San Francisco. W.H. Freeman and Co. 1973. pp. 463-510

30. Task Force Report 7: Megavitamin and Orthomolecular Therapy in Psychiatry. Washington, DC, American Psychiatric Association, 1973

31.Ananth, J.V., Ban, T.A., Lehmann, ILE., et al: Nicotinic acid in the prevention and treatment of methionine-induced exacerbation of psychopathology in schizophrenics. Can Psychiatr Assoc J 15:15-20, 1970

32. Hoffer, A., Osmond, H., Callbeck, J.M., et al: Treatment of schizophrenia with nicotinic acid and nicotinamide. J Clin Exp Psychopathol 18:131-158. 1957

33.Greenbaum, G.H.C.; An evaluation of niacinamide in the treatment of childhood schizophrenia. Am J Psychiatry 127:89-93, 1970

34.Kelm, H.: The Hoffer-Osmond Diagnostic Test (HOD), in 'Orthomolecular Psychiatry: Treatment of Schizophrenia. Edited by Hawkins, D., Panting, L San Francisco. W.H. Freeman and Co. 1973, pp. 327-341

35.Pauling, L: No More War! New York. Dodd, Mead and Co. 1958

hoffer_niacin

DoctorYourself.com - Niacin Therapy Details  

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

Dosage: Niacin
Home
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.

 


Andrew Saul, PhD

AN IMPORTANT NOTE:  This page is not in any way offered as prescription, diagnosis nor treatment for any disease, illness, infirmity or physical condition.  Any form of self-treatment or alternative health program necessarily must involve an individual's acceptance of some risk, and no one should assume otherwise.  Persons needing medical care should obtain it from a physician.  Consult your doctor before making any health decision. 

Neither the author nor the webmaster has authorized the use of their names or the use of any material contained within in connection with the sale, promotion or advertising of any product or apparatus. Single-copy reproduction for individual, non-commercial use is permitted providing no alterations of content are made, and credit is given.


| Home | Order my Books | About the Author | Contact Us | Webmaster |

VISITANTE NUMERO:

CONTADOR:
View My Stats