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.