Sunday, February 04, 2007

The Right Dose – Vitamin C and Niacin

The safety of extra vitamin C and B-complex vitamins is well understood. It is a fact that these vitamins can be safely consumed every day in doses at least double what is obtained by eating a healthy diet containing all recommended food groups. At Cforyourself.com, doses of vitamin C from 10 to 200 times higher than readily obtained from food are recommended (1000 to 20000 mg/day). Cforyourself provides evidence of a healthy debate amongst adult users about the side effects, benefits, and risks of taking higher or lower vitamin C doses within this range. It appears unlikely that there is a single, correct answer. Within the range of 1 to 20 gm/day, it is highly likely that there will be a broad distribution of answers. More and more physicians are beginning to participate in the debate. Physicians are an important resource, because optimizing vitamins is not easy. It is not a simple matter of finding your own right dose between 1 and 20 gm/day. The right dose changes with age and state of health.

Unlike for vitamin C, there is little evidence of a healthy debate about optimal B-complex vitamin doses between regular B-complex vitamin users. Here’s my view. A good starting place is an ordinary multivitamin and mineral tablet. In addition to the multivitamin, take extra vitamin B3 as time release niacin. Time release niacin tablets are typically sold in a 250 mg dose. I recommend cutting them in half and taking half a tablet 3 times a week so long as this dosage can be taken without side effects. It’s hard to discuss the frequency of side effects from long term users of niacin at this dose due to the absence of published data. If you have published information, please let me know. It is a fact that many people can tolerate far higher doses of time release niacin without experiencing unmanageable side effects. Time release niacin is the preferred treatment for controlling blood cholesterol levels. Niacin is the only treatment that both lowers bad cholesterol (LDL) and raises good cholesterol (HDL). The decision about whether to take time release niacin or statin drugs to normalize blood cholesterol levels is not the only way to think about this problem. If your cholesterol shows you at risk of a heart attack, I am unaware of any reasons not to take both niacin and the statin drugs at the same time. As long as both niacin and a statin are taken, cholesterol levels will improve.

Heart disease treatment has shed light on niacin side effects. A large fraction of patients taking the 2000 to 3000 mg/day dosage of niacin that is known to be most effective for normalizing cholesterol suffer from intolerable side effects. I do not recommend that these patients stop consuming niacin. In fact, they can’t. If they don’t consume any niacin, they will die from the niacin deficiency disease pellagra. I recommend that they drop to a dosage between 100 and 1000 mg/day. If the side effects disappear, I recommend that they stick to a dose in this range.

The experiences of heart disease patients have proven that 2000-3000 mg/day of niacin is safe, and also that most people can not tolerate niacin within this dose range. This is why far more heart disease patients take statin drugs than niacin. It has also proven that a significant fraction of heart disease patients can tolerate niacin within this dose range. At the other end of the spectrum, studying pellagra proved that people need between 5 and 15 mg/day of niacin to prevent this terrible disease. Almost everyone’s health will be optimized by a dose between 15 and 3000 mg/day. Like vitamin C, it will not be a simple matter of individuals each finding their own right dose. The optimal dose of niacin will likely prove to change with age and state of health. I recommend seeing a cardiologist for help.

Niacin has been readily available for over 30 years. Millions have purchased niacin supplements and presumably experimented with taking them. I have not found any web sites devoted to niacin. I have asked around and found no one who takes it regularly except for heart disease patients. I believe the presence of niacin supplements, and the absence of regular niacin consumers is strong evidence that most people experience side effects from 250 mg/day of niacin when taken regularly. My recommendation of 125 mg, three times a week is based upon the experiences of a handful of friends and family. Within this handful, not everyone takes even this much because of side effects.

B-complex vitamins including niacin are well known in the world of alternative medicine as a recommended treatment for children with behavior disorders. Unlike the cholesterol situation, B-complex vitamins should never be used as the sole treatment for childhood behavior disorders. Their effectiveness is not sufficiently well understood. On the other hand, B-complex vitamins should always be a part of the treatment. They are safe, there is a strong case for effectiveness, and they can be taken to complement any and all treatments recommended by physicians. One reason B-complex vitamins may be used so infrequently is that vitamin advocates often recommend doses that are too high for the majority. To be specific, Cforyourself has a section on ADD/ADHD. This section references 1000-2000 mg/day of niacin, 150 to 450 mg/day of vitamin B6, and a B-100 B-complex tablet. If you accept my logic that the absence of regular consumers of 250 mg time release niacin (the most common form, available over the counter at every drug store) is evidence that this dose causes side effects, then you will understand why references to 1000-2000 mg/day of niacin make me uncomfortable.

In summary I see a healthy debate underway between vitamin C users concerning optimum dosage. I think it is important to keep it up. I encourage more Cforyourself readers to write in and explain their vitamin C doses. Do readers regularly take extra vitamin C when they feel a cold coming on? How much? Have any readers been taking more or less vitamin C because of aging? Concerning niacin, I don’t see a debate. If you take niacin, please come to Cforyourself and help me find and organize user information.

5 Comments:

At 6:55 AM, Blogger dj1 said...

From the foregoing facts you can see that animal foods tend to be high in cholesterol. Use this information to help you create a diet that will improve your health. Eat lots of low cholesterol food and cut down on saturated fights for a diet that is healthy.How to Maintain a Normal Cholesterol Level

 
At 2:11 PM, Anonymous Anonymous said...

www.doctoryourself.com/hoffer_niacin.html is a website devoted to Niacin. I have been taking Niacin to lower my cholesterol. In addition I take powdered EmergenC 1000 mg. of Vitamin C/ Glucosamine/Condritin along with 1/2 tsp. powdered MSM for my arthritis. This combination has been very helpful in relieving my arthritis pain and symptoms.

 
At 11:51 PM, Blogger Susan said...

It's not a good idea to cut most extended-release drug tablets as you recommended. Sometimes doing so releases a large dose at one time--(depends on how the extended-release formulation was done)

 
At 8:55 PM, Blogger Dan said...

I'll 'second' the www.doctoryourself.com site for good articles about Niacin. Very helpful.

 
At 9:11 PM, Anonymous Anonymous said...

I take 2 capsules of 500mg each of the 'flush-free' Niacin daily with no side effects. I used to use the regular (flush) Niacin and had to start at .25 mg 3 times a day for a wk and then increase steadily...no side effects except a huge flush, which was very inconvenient for me at certain times, showering, going out to dinner, church, etc. That is why I switched to the 'flush-free' Niacin. I take it to lower my cholesterol and also for my restless legs, which I've endured for years and didnt know what it was. I will see the results of taking Niacin at this dosage when I return in 6 mths to doctors. My restless legs are much better and most nights I don't have any trouble with them at all, but on ocassion they will make me feel like moving for a while in the early hrs of the morning..this is happening less and less. Thank God for Niacin..In all other areas I am healthy and fine.

 

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