by Andrew W. Saul

The safety record of the B-complex vitamins is extraordinarily good. Since their discovery, beginning with thiamin (B-1) in 1911, many thousands of studies have verified an unequaled therapeutic value of these essential substances. Side effects have been rare, and toxicity is nearly nonexistent, even at the highest doses. Some cautions are in order, of course, and here are some of the most important. 

Vitamin B-6 (pyridoxine) has been reported to cause temporary neurological symptoms such as heaviness, tingling or numbness of the limbs in persons taking very large doses.  It is very important to realize that such cases are not common, and when they do occur usually result from huge doses of pyridoxine TAKEN ALONE. The B-vitamins are a team, and work best as a team. Upsetting the balance by taking a lot of just one is like devoting all your baseball practice time to your pitcher. You might get a lot of strikeouts, but if anybody hits one, you are in trouble. No one player has ever won a World Series by himself, and no single B-vitamin can do the job that the whole "team" can do. 

B-6 by itself in doses of 2,000 to 6,000 milligrams daily (that's one thousand to three thousand times the US RDA!) can produce side effects and is therefore way too much to take.  Very, very few persons report symptoms on 1,000 mg daily, and only the rarest reports go any lower.  When taken with, or as part of, a complete B-complex supplement, B-6 side effects other than a harmless deeper-colored urine are virtually unknown. 

Premenstrual tension symptoms often improve dramatically with only a few hundred mg/day of extra B-6. There is no need to "push the envelope" and take thousands of milligrams when hundreds will do. At least 50 to 100 mg of supplemental B-6 daily is a virtual necessity for women taking oral contraceptives. The "pill" causes some abnormal physiological changes that create a deficiency of B-6, as well as lower serum levels of thiamine (B-1), and riboflavin (B-2), and niacin (B-3), and folic acid, and B-12, and vitamin C! (Wynn, V. Lancet, March 8, 1975) 

Laboratory animals receiving the human B-6 dose equivalent of just 75 mg daily do not get strokes, even when fed a lousy diet (Atherosclerosis, vol. 22, 1975, pp 125-127)  Since women on oral contraceptives are three times more likely at any age to have a stroke, there is an important lesson here.  B-6 deficiency produces hardening of the arteries (Rinehart and Greenberg, American Journal of Pathology, vol. 25, 1949, pp 481-496.)  Furthermore, B-6 is necessary in order for your body to produce lecithin.  Lecithin, a lipid- transporting substance from soy, has been used clinically to clear out fatty livers... and even clogged arteries.  Another connection. 

Niacin (vitamin B-3) has been used in doses up to tens of thousands of milligrams per day for over 40 years by psychiatrists. It is an effective alternative treatment for severe depression, psychotic behavior, and schizophrenia. Most physicians have ignored niacin's usefulness until rather recently. Niacin has finally gained popularity as one of the cheapest ways to lower serum cholesterol.  Changes in liver enzyme tests have been reported in persons taking high daily doses of niacin. For more information on this and other niacin side effects, please look at http://www.doctoryourself.com/omns/v15n19.shtml

A number of important points have generally gone unnoticed: 

 1. Niacin is much better tolerated when given with vitamin C. Abram Hoffer, M.D. pioneered high dose niacin therapy back in the 1950's. He repeatedly published his observations that gram-sized doses of vitamin C greatly improve a patient's niacin   tolerance.  Dr. Hoffer recommended at least as much vitamin C per dose as niacin.   With three thousand milligrams of niacin per day, then, one would need a minimum of three thousand milligrams of vitamin C. The medical profession's unfounded resistance to large doses of vitamin C is embarrassingly well known. It is useless to blame niacin for side effects caused by ignoring expert medical advice on how to use it correctly along with vitamin C. 

  Vincent Zannoni at the University of Michigan Medical School has shown that vitamin C protects the liver itself. Even doses as low as 500 milligrams daily helped prevent fatty buildup and cirrhosis. 5,000 mg of vitamin C per day appears to actually flush fats from the liver. (Ritter, M. "Study Says Vitamin C Could Cut Liver Damage," Associated Press, October 11, 1986)  F. R. Klenner, M.D. showed that very large doses of vitamin C (between 500 to 900 mg per kilogram body weight per day) can cure hepatitis in two to four days (Smith, L. H., ed. Clinical Guide To The Use Of Vitamin C, Life Science Press, Tacoma Washington, 1988, pp 22-23). 

 2. Niacin is also one of the team of B-vitamins and needs any massive intake to be at least partly balanced with the rest of the B-complex, just like B-6 mentioned above. Would you pay for a tune up for your car and change only one spark plug? If you have several kids, would you feed only one? Would you pay for cable TV if there were only one channel? Taking only one B-vitamin is neither logical nor efficient. So avoid doing it unless there is a good reason. 

 3. Many, perhaps most, persons showing changes in their liver enzyme tests upon ingestion of large amounts of niacin have been using alcohol. Accurate information about sizable alcohol consumption is very difficult to get from a patient: the more they use, the less they'll tell. Two thirds of all American adults drink alcohol, averaging out to be about three drinks per day, seven days a week, 52 weeks a year. If you do not drink that much, then somebody out there is drinking MORE. 

  Alcohol does nothing if it doesn't hurt the liver.  The French have the highest per capita consumption of alcohol in the world. They also have the world's highest percentage of deaths from cirrhosis of the liver. Working hard, the human liver can detoxify about one drink every two hours. Know anyone who drinks at a faster rate than that? Then marvel that they have a liver that functions at all. Alcohol is a drug, and consumption and abuse is more widespread and more serious than most persons imagine. Over two thirds of all hospital admissions of the elderly are alcohol related. (New York State Office of Alcoholism and Substance Abuse Services, Oasas Today,  1:1, Sept-Oct. 1992) 

   The liver undergoes profound changes in both its endoplasmic reticula and its   microsomal enzymes in order to detoxify alcohol.  The unbalanced introduction of very  large doses of niacin to an overloaded liver may well overtax an alcohol-strained system.  This is likely where some changes in liver function tests come   from (American Journal of Medicine, vol 86, April, 1989, page 431 and vol. 87, August 1989, page 248; American Journal of Cardiology, vol. 64, October 1, 1989 page 728). 

 4. Any hepatotoxic effects of niacin are almost invariably associated with the sustained release form (Journal of the American Medical Association, March 2, 1994). Sustained release niacin generally enables higher doses with less "flushing." However, that warm sensation called flushing indicates niacin saturation. Sustained release delivery may therefore be hiding this sign that the body has had enough niacin at a given time. 

 5. Simply reducing the dosage reduces side effects. (Naito, H. "Reducing Cardiac Deaths with Hypolipidemic Drugs," Postgraduate Medicine, vol 82, no. 6, November 1987; Figge, H. L. et al: "Nicotinic Acid: A Review of its Clinical Use in the Treatment of Lipid Disorders," Pharmacotherapy, Vol. 8, no. 5, 1988) Since the regular "immediate release" form of niacin also is effective in lowering total cholesterol and actually improves beneficial HDL levels, why not just use the plain tablets? Take less, but more often, and you approximate the idea of a sustained release tablet, but with a lower dose. If there is a flush, reduce the dose. The idea is to be comfortable. It is better to be able to use less of the vitamin for a long time than to use a lot, have trouble, and quit. American physicians often over prescribe anyway, and niacin is no exception. 

Niacin is not a magic cholesterol bullet, nor is cholesterol the only factor in heart disease.  Niacin is PART of the picture, part of the B-vitamin team, and part of a total health program.  Granted, niacin is indeed important. This is shown by even our inadequate US RDA, which recommends many times more niacin than any other B-vitamin. However, persons truly seeking to lower their cholesterol need to eat more fiber, more vegetables (especially carrots), more vitamins E and C, and to exercise more. They also need to eat less sugar, less fat, less meat, and reduce stress. There are zero harmful effects (and countless side benefits) in taking these steps. 

People who do not want to change their diet and do not want to change their lifestyle ask doctors for a pill instead. There is no such thing as monotherapy for cardiovascular disease. If there was, we'd all use it and be saving literally a million lives each year. Is it really that big a surprise that niacin alone isn't enough to do the job right? 



Ray, O. and Ksir, C. Drugs, Society and Human Behavior, chapter 9.  Mosby, 1990  (I'm sure most of the great book titles are already taken, so don't be fooled by this one. This is an excellent book: clear, fact-filled and well written.) 

Williams, R. J. Nutrition and Alcoholism (1951) and Alcoholism: The Nutritional Approach (1959) may be out of print but are worth the search. 

Therapeutic Uses of the B-Vitamins:

Bicknell and Prescott, The Vitamins in Medicine, 3rd ed., 1953 (This out-of-print work stands as the definitive summary of most all vitamin research up to the date of its publication.  There are many thousands of references here.) 

Cheraskin, et al: Psychodietetics, Bantam Books, 1974 (A deservedly popular book, loaded with references.)

Hoffer, A. and Walker, M. Orthomolecular Nutrition, Keats, 1978 ("Orthomolecular" essentially means "megavitamin." Good introductory work.) 

Pauling, L. How To Live Longer and Feel Better, Freeman, 1986. Revised and updated, 1996. (Still the best single health book ever written. Here is a good place to begin your investigation of vitamin therapeutics. http://www.doctoryourself.com/livelonger.html

Psychiatric Utility of Niacin: 

Hawkins, D. and Pauling, L. Orthomolecular Psychiatry, Freeman, 1973 (Here, in one big volume, is more information than most doctors ever want to admit exists on using niacin, especially in treating depression and psychoses.) 

Hoffer, Abram. Niacin Therapy in Psychiatry, Charles Thomas, 1962 (This is what started it all; note the publishing date. Nobody knows niacin like Dr. Hoffer.) 

Hoffer, A. and Osmond, H. The Chemical Basis of Clinical Psychiatry, Charles Thomas,Springfield, Ill. (Even more in depth study of the biochemistry and uses of niacin.) 

Remember to try your library's Interlibrary Loan service to obtain out-of-print works. 

Copyright  C  2022, 2007 and prior years Andrew W. Saul. 

Andrew Saul is the author of the books FIRE YOUR DOCTOR! How to be Independently Healthy (reader reviews at http://www.doctoryourself.com/review.html ) and DOCTOR YOURSELF: Natural Healing that Works. (reviewed at http://www.doctoryourself.com/saulbooks.html )


Andrew W. Saul


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