Abram Hoffer, M.D., Ph.D.
Background
In 1954, it was impossible to predict or even to think that my bleeding gums
would one day, 31 years later, lead to additional useful life to people with
coronary disease related to cholesterol and lipid metabolism. That year,
malocclusion of my teeth had broken down the ability of my gum tissue to repair
itself quickly enough. Because my bite was not correct there was too much wear
and tear on tooth sockets and my gums began to bleed. No amount of Vitamin C and
no amount of dental repair helped. Eventually I reconciled myself to the idea I
would soon have all my teeth extracted.
But at this time I had been treating schizophrenics and seniles and a few other
diseases with niacin, and I began also to take this vitamin, I gram after each
meal, i.e. three grams per day. I did so because I wanted to experience the
flush which comes when one first takes niacin and its gradual waning with
continuing use so I could discuss this reaction more knowledgeably with my
patients. There was also a legal issue - most doctors' defence against
malpractice suits is that they were doing what any other similar physician would
do it like circumstances. If I were sued (I have never been sued) because of
unusual discomfort or because of adverse effects from niacin, I would not be
able to use that defence since only a handful of physicians had ever used these
large quantities of niacin. I had concluded that if the unlikely did occur and I
was charged with malpractice, one of my defences would be that I had tried it
myself for at least three months without suffering any serious consequences. I
must admit I had not discussed this with any litigation lawyer. My reasons were
therefore both practical and paranoid. I had no intention of treating myself or
my bleeding gums.
Two weeks after I had started taking niacin my gums were normal. I was brushing
my teeth one morning and suddenly awakened in surprise there was no bleeding
whatever! A few days later my dentist confirmed my gums were no longer swollen,
and I still have most of my teeth. Eventually I reasoned that the niacin had
restored the ability of my gum tissue to repair itself faster than I could
damage it by chewing with my crooked teeth.
A few months later I was approached by Prof. Rudl Altschul, Chairman, Department
of Anatomy, College of Medicine, University of Saskatchewan. He had taught
neurohistology and I had been one of his students. Prof. Altschul had discovered
how to produce arteriosclerosis in rabbits. He fed them a cake baked by his
wife, Anna, which was rich in egg yolks. Rabbits fed cooked egg yolk promptly
developed hypercholesterolemia and later arteriosclerotic lesions on their
coronary vessels, Altschul and Herman (1954). Altschul had also discovered that
irradiating these hypercholesterolemic rabbits with ultraviolet light decreased
their cholesterol levels. He wanted to extend this research by irradiating human
subjects, but not one internist in Saskatoon would allow him access to their
patients. People who bake in the southern sunshine may wonder why this
"dangerous" treatment received such a negative response. Prof.
Altschul thus approached me, as Director of Psychiatric Research, Department of
Health, Saskatchewan, I had access to several thousand patients in our two
mental hospitals. I agreed to this provided that Dr. Humphry Osmond,
Superintendent of the Saskatchewan Hospital at Weyburn also agreed. This
treatment was innocuous, would not cost us anything and would help us create
more of an investigative attitude among our clinical staff. But before we
started I requested that Prof. Altschul meet with our clinical staff and present
his ideas to them.
A few weeks later he came to Regina by train and I drove him to Weyburn in my
car to meet Dr. Osmond and his staff. On the way down and back we discussed our
work. He gave me an interesting review of how he saw the problem of
arteriosclerosis, which he considered to be a disease of the intima, the inner
lining of the vessels. He hypothesized that the intima had lost its ability to
repair itself quickly enough. As soon as I heard this I thought of my bleeding
gums and of my own repair hypothesis. I then told him of my recent experience. I
asked him if he would be willing to test niacin which if it had the same effect
on the intima as it had had on my bleeding gums might have antiarteriosclerotic
power. Prof. Altschul was intrigued and agreed to look at the idea if he could
get some niacin. I promptly sent him one pound of pure, crystalline niacin from
a supply I had received earlier, courtesy of Merck and Company, now Merck, Sharp
and Dohme.
One evening about three months later I received a call from Prof. Altschul who
began to shout, "It works! It works!" Then he told me he had given
niacin to his hyperlipidemic rabbits and within a few days their cholesterol
levels were back to normal. He had discovered the first hypocholesterolemic
substance. Drug companies were spending millions to find such a compound.
But did it also work in humans? The next day I approached Dr. J. Stephen,
Pathologist, General Hospital, Regina. I was a biochemical consultant to him. I
outlined what had been done and wanted his help in some human experiments. I
assured him niacin was safe and we would only need to give a few grams to
patients. He promptly agreed. He said he would order his technicians to draw
blood for cholesterol assay from a large variety of patients, would then given
them niacin and would follow this with another cholesterol assay. I suggested we
discuss this with the patients' physicians but Dr. Stephen laughed and said they
did not know what went on in hospital and that to contact each one would
probably make the study impossible. A few weeks later the data poured in: niacin
also lowered cholesterol levels in people. The greater the initial or baseline
level, the greater the
decrease. We published our results (Altschul, Hoffer and Stephen, 1955). This
report initiated the studies which eventually proved niacin increases longevity.
Because of its importance, this paper is reproduced here. Note, it was not
double blind. However, patients did not know what they were getting or why they
were getting it. This type of impromptu research is forever impossible with
ethics committees, informed consent and so on. Thirty years ago only the
integrity of physicians protected patients against experimental harm.
At the same time we were examining the effect of niacin on cholesterol levels,
Russian scientists were also measuring the effect of vitamins on blood lipids
but they used very little niacin and found no significant decreases, Simonson
and Keyes (1961).
The finding that niacin lowered cholesterol was soon confirmed by Parsons, Achor,
Berge, McKenzie and Barker (1956) and Parsons (1961, 1961a, 1962) at the Mayo
Clinic which launched niacin on its way as a hypocholesterolemic substance.
Since then it has been found to be a normalizing agent, i.e. it elevates high
density lipoprotein cholesterol, decreases low density and very low density
lipoprotein cholesterol and lowers triglycerides. Grundy, Mok, Zechs and Berman
(1981) found it lowered cholesterol by 22 percent and triglycerides by 52
percent and wrote, "To our knowledge, no other single agent has such
potential for lowering both cholesterol and triglycerides."
The Coronary Study
The only reason for being concerned about elevated cholesterol levels is
that this is associated with increased risk of developing coronary disease. The
association between cholesterol levels in the diet and coronary disease is not
nearly as high even though the total diet is a main factor. The kind of diet
generally recommended by orthomolecular physicians will tend to keep cholesterol
levels down in most people. This diet can be described as a high fiber,
sugar-free diet which is rich in complex polysaccharides such as vegetables and
whole grains.
Once it became possible to lower cholesterol levels even with no alteration in
diet, it became possible to test the hypothesis that lowering cholesterol levels
would decrease the risk of developing coronary disease. Dr. E. Boyle, then
working with the National Institute of Health, Washington, D.C., quickly became
interested in niacin. He began to follow a series of patients using 3 grams of
niacin per day. He reported his conclusions in a document prepared for
physicians in Alcoholics Anonymous by Bill W (1968). In this report Boyle
reported that he had kept 160 coronary patients on niacin for ten years. Only
six died against a statistical expectation 62 would have died with conventional
care. He stated. from the strictly medical viewpoint I believe all patients
taking niacin would survive longer and enjoy life much more."
His prediction came true when the National Coronary Drug Study was evaluated by
Canner recently. But E. Boyle's data spoke for itself. Continuous use of niacin
will decrease mortality and prolong life. Perhaps Boyle's study was one of the
reasons the Coronary Drug Project was started in 1966. Dr. Boyle was an advisor
to this study which was designed to assess the long term efficacy and safety of
five compounds in 8341 men, ages 30 to 64, who had suffered a myocardial
infarction at least three months before entering the study.
The National Heart and Lung Institute supported this study. It was conducted at
fifty-three clinical centres in twenty-six American states and was designed to
measure the efficacy of several lipid lowering drugs and to determine whether
lowering cholesterol levels in patients with previous mycardial infarcts would
be beneficial. Niacin, two dosage strengths of estrogens, Clofibrate,
dextrothyroxine and placebo were tested.
Eighteen months after the study began, the higher dose estrogen group in the
study was discontinued because of an excess of new non-fatal myocardial
infarction s compared to placebo. The thyroxine group was stopped for the same
reason for patients with frequent ectopic ventricular beats. After thirty-six
months dextrothyroxin was discontinued for the rest of this group, again because
myocardial infarcts were increased. After fifty-six months the low dose estrogen
group study was stopped. There had been no significant benefit to compensate for
the increased incidence of pulmonary embolism and thrombophlebitis and increased
mortality from cancer.
Eventually only niacin, Clofibrate and placebo groups were continued until the
study was completed.
Canner's Study (1985)
Dr. Paul L. Canner, Chief Statistician, Maryland Medical Research Institute,
Baltimore, examined the data for the Coronary Drug Project Research Group. About
8000 men were still alive at the end of the treatment trial in 1975. This new
study was begun in 1981 to determine if the two estrogen regimens and the
dextrothyroxine regimen had caused any long term effects. High dose estrogen had
been discontinued because it increased non-fatal myocardial infarctions, low
dose estrogen increased cancer deaths and dextrothyroxine increased total
mortality, i.e. compared to placebo, Clofibrate and niacin. None of the subjects
continued to take the drugs after 1975.
The 1985 follow-up study showed no significant differences in mortality between
those treatment groups which had been discontinued and placebo or Clofibrate.
However, to the investigator's surprise, the niacin group fared much better. The
cumulative percentage of deaths for all causes was 58.4%, 56.8%, 55.9%, 56.9%
and 50.6% for low dose estrogens, high dose estrogens, Clofibrate, dextroth
yroxine, placebo and niacin, respectively. The mortality in the niacin group was
11 percent lower than in the placebo group (P = 0.002). The mortality benefit
from niacin was present in each major category or cause of death: coronary,
other cardiovascular, cancer and others. Analysis of life table curves comparing
niacin against placebo showed the niacin patients lived two years longer. With
an average followup of fourteen years, there were 70 fewer deaths in the niacin
group than would have been expected from the mortality in the placebo group.
Patients with cholesterol levels higher than 240 mg per 100 mL benefited more
than those with lower levels.
What is surprising is that the niacin benefit carried on for such a long period
even after no more was being taken. In fact the benefit increased with the
number of years followed up. It is highly probable the results would have been
much better if patients had not stopped taking niacin in 1975. Thus, E. Boyle's
patients who remained on for ten years and received individual attention had a
90 percent decrease in mortality. With the huge coronary study this type of
individual attention for the majority of patients was not possible. Many dropped
out because of the niacin flush, of these many could have been persuaded to
remain in the study if they had been given more individual attention. This is
very hard to do in a large scale clinical study of this type. Dr. Boyle, in
discussions with me, referred to this as one of the defects in the Coronary Drug
Study. I would conclude that the proper use of niacin for similar patients
should decrease mortality somewhere between 11 and 90 percent after a ten year
follow-up, with the reduction in mortality increasing as the safe natural
substance which will decrease mortality and increase longevity especially in
patients with elevated cholesterol levels.
The National Institute of Health (1985) released the conclusions reached by a
consensus development conference on lowering blood cholesterol to prevent heart
disease held December 10 - 12, 1984. This was followed by an NIH conference
statement, "Lowering Blood Cholesterol to Prevent Heart Disease",
Volume 5, No. 7. This statement reports that heart disease kills 550,000
Americans each year and 5.4 million are ill. Total costs of heart disease are
$60 billion per year. Main risk factors include cigarette smoking, high blood
pressure and high blood cholesterol.
NIH recommends that the first step in treatment should be dietary and their
recommendations are met by the orthomolecular diet. But when diet alone is not
adequate, drugs should be used. Bile-acid sequestrants and niacin are favoured
while the main commercial drug, Clofibrate, is not recommended "because it
is not effective in most individuals with a high blood cholesterol level but
normal triglyceride level. Moreover, an excess of overall mortality was reported
in the World Health Organization trial of this drug." Since niacin is
effective only in megavitamin doses, I gram three times per day, NIH is at last
promoting megavitamin therapy. The National Institute of Health asked that their
conference statement be "posted, duplicated and distributed to interested
staff ". Since every doctor has patients with high blood cholesterol
levels, they should all be interested. in fact, if they are not, some of them
will be facing litigation from angry wives whose husbands have not been treated
with niacin for their elevated cholesterol levels.
Niacin Combined With Other Drugs Which Lower Cholesterol
Familial hypercholesterolemia is an inherited disease where plasma
cholesterol levels are very high. Illingworth, Phillipson, Rapp and Connor
(1981) described a series of 13 patients treated with Colestipol 10 grams twice
daily and later 15 grams twice daily. Their cholesterol levels ranged from 345
to 524 and triglycerides from 70 to 232. When this drug plus diet did not
decease cholesterol levels below 270 mg/100 mL they were given niacin, starting
with 250 mg three times daily and increasing it every two to four weeks until a
final dose of 3 to 8 grams per day was reached. To reduce the flush patients
took aspirin (120 to 180 mg) with each dose for four to six weeks. With this
dose of niacin they found no abnormal liver function test results. This
combination of drugs normalized blood cholesterol and lipid levels. They
concluded, "In most patients with heterozygous familial
hypercholesterolemia, combined drug therapy with a file acid sequestrant and
nicotinic acid results in a normal or near normal lipid profile. Long term use
of such a regimen affords the potential for preventing, or even reversing, the
premature development of atherosclerosis that occurs so frequently in this group
of patients."
At about the same time Kane, Malloy, Tun, Phillips, Freedmand, Williams, Rowe
and Havel (1981) reported similar results on a larger series of 50 patients.
They also studied the combined effect of Colestipol and Clofibrate.
Abnormalities of liver function only occurred when the dose of niacin increased
rapidly. The first month they took 2.5 grams per day, the second month 5.0 grams
per day and 7.5 grams per day the third month and thereafter. In a few blood
sugar went up a little (from 115 to i20 mg), and uric acid levels exceeded 8 mg
percent in six. None developed gout. All other tests were normal. They
concluded, "The remarkable ability of the combination of Colestipol and
niacin to lower circulating levels of LDL and to decrease the size of tendon
xanthomas suggests that this combination is the most likely available regimen to
alter the course of atherosclerosis." The combination of Colestipol and
Clofibrate was not as effective. For the first time it is possible to extend the
life span of patients with familial hypercholesterolemia.
Fortunately, niacin does not decrease cholesterol to dangerously low levels.
Cheraskin and Ringsdorf (1982) reviewed some of the evidence which links low
cholesterol levels to an increased incidence of cancer and greater mortality in
general. Ueshima, Lida and Komachi (1979) found a negative correlation between
cholesterol levels between 150 and 200 and cerebral vascular disorders (r =
.83). Mortality increased for levels under 160 mg.
Hoffer and Callbeck (1957) reported that the hypocholesterolemic action of
niacin was related to the activity of the autonomic nervous system. We referred
to a previous study by Altschul and Hoffer where we found on normal volunteers
(medical students) that there was a linear relationship between the effect of
niacin in lowering cholesterol, the initial cholesterol levels and body weight.
The regression equation was Y = 0.95X - 0.39Z - 90 where Y is the decrease in
cholesterol level in milligrams, X is the initial cholesterol value and Z the
body weight in pounds. The multiple correlation coefficient is 0.83. When Y = 0
niacin has no effect on cholesterol levels. When Y is negative it means the
cholesterol levels were elevated by niacin. This might then be a good indication
of the optimum cholesterol levels. For a 200 pound patient Y = 0 when X is 176
mg, and for a 150 pound subject Y = 0 when X is 156 mg. This is remarkably close
to the optimum values recommended by Cheraskin and Ringsdorf and others, i.e,
180 to 200 milligrams.
Hoffer and Callbeck found that niacin also lowered cholesterol levels of
schizophrenic patients, but the schizophrenic response was represented by a
different equation Y = 0.28X -0.43Z + 53. This is shown in the following table
where expected decreases in cholesterol are calculated from two equations. (See
Table 3 page 220.) i.e. at higher levels niacin decreases cholesterol levels
more in normal subjects while at lower levels niacin did not increase the level
of cholesterol. Again niacin elevated levels in normal subjects from 150 to 176,
decreased it from 200 to 178 and from 250 to 181 mg.
How Does Niacin Work?
Niacin, but not niacinamide, lowers cholesterol levels even though both
forms of Vitamin B3 are anti pellagra and are almost equally effective in
treating schizophrenia and arthritis and a number of other diseases. Niacin-
also differs from niacinamide because it causes a flush to which people adapt
readily while niacinamide has no vasodilation activity in 99 percent of people
who take it. For reasons unknown, about I in 100 persons who take niacinamide do
flush. They must be able to convert niacinamide to niacin in their bodies at a
very rapid pace. There must be a clue here somewhere. It is believed that niacin
causes a flush by a complicated mechanism which releases histamine, interferes
in prostaglandin metabolism, may be related to serotonin mechanism and may
involve the cholinergic system, Rohte, Thormahlen and Ochlich (1977). Histamine
is clearly involved. The typical niacin flush is identical with the flush
produced by an injection of histamine. It is dampened down if not prevented
entirely by anti-histamines and by tranquilizers. The adaptation to niacin is
readily explained by the reduction in histamine in the storage sites such as the
mast cells. When these are examined after a dose of histamine, these cells
contain empty vesicles which contained the histamine and also heparinoids. If
the next dose is spaced closely enough there will have been no time for the
storage sites to be refilled and therefore less histamine will be available to
be released. After there is complete adaptation to niacin a rest of several days
will start the flushing cycle again. This decrease in histamine has some
advantage in reducing the effects of rapidly released histamine. Dr. Ed Boyle
found that guinea pigs treated with niacin were not harmed by anaphylactic
shock. Because the flush is relatively transient it can not be involved in the
lowering of cholesterol which remains in effect as long as medication is
continued. Prostaglandins appear to be involved. Thus, aspirin, Kunin (1976),
and indomethacin, Kaijser, Eklund, Olsson and Carlson (1979) reduce the
intensity of the flush, Estep, Gray and Rappolt (1977).
In 1983 I suggested that niacin lowered cholesterol because it releases
histamine and glycosaminoglycans. Niacinamide does not do so, Hoffer (1983).
Mahadoo, Jaques and Wright (1981) had earlier implicated a histamine-glycosaminoglycan
histaminase system in lipid absorption and redistribution. Boyle (1962) found
that niacin increased basophil leukocyte count. These cells store heparin as
well as histamine. He suggested that the improvement caused by niacin is much
greater than can be explained by its effect on cholesterol.
"Possibly," he wrote, "it is due to release of histamine and also
to the eventual marked diminution in the intravascular sludging of blood
cells."
It is possible the beneficial effect of niacin is not due to the cholesterol
effect but is due to a more basic mechanism. Are elevated cholesterol levels and
arteriosclerosis both the end result of a more basic metabolic disturbance still
not identified? If it were entirely an effect arising from lowered cholesterol
levels, why did Clofibrate not have the same beneficial effect? An enumeration
of some other properties of niacin may one day lead to this basic metabolic
fault.
Niacin has a rapid anti sludging effect. Sludged blood is present when the red
blood cells clump together. They are not able to traverse the capillaries as
well, as they must pass through in single file. This means that tissues will not
receive their quota of red blood cells and will suffer anoxemia. Niacin changes
the properties of the red cell surface membrane so that they do not stick to
each other. Tissues are then able to get the blood they need. Niacin acts very
quickly. Niacin increases healing, as it did with my gums. Perhaps it has a
similar effect on the damaged intima of blood vessels.
Within the past few years adrenalin via its aminochrome derivatives has been
implicated in coronary disease. If this becomes well established it provides
another explanation for niacin's beneficial effect on heart disease. Beamish and
his coworkers (1981, 1981a, 1981b) in a series of reports showed that myocardial
tissue takes up adrenalin which is converted into adrenochrome, that it is the
adrenochrome which causes fibrillation and heart muscle damage. they further
found that Anturan protects against fibrillation induced by adrenochrome and
suggest this is supported by the clinical findings that Anturan decreases
mortality from heart disease. Under severe stress as in shock or after injection
of adrenalin, a large amount of adrenalin is found in the blood and absorbed by
heart tissue. Severe stress is thus a factor whether or not arteriosclerosis is
present, but it is likely an arteriosclerotic heart can not cope with stress as
well. Fibrillation would increase demand for oxygen which could not be met by a
heart whose coronary vessels are compromised.
Niacin protects tissues against the toxic effect of adrenochrome, in vivo. It
reverses the EEG changes induced by intravenous adrenochrome given to
epileptics, Szatmari, Hoffer and Schneider (1955), and also reverse the
psychological changes, Hoffer and Osmond (1967). In synapses NAD* is essential
for maintaining noradrenalin and adrenalin in a reduced state. These
catecholamines lose one electron to form oxidized amine. In the presence of NAD
this compound is reduced back to its original catecholamine. If there is a
deficiency of NAD the oxidized adrenalin (or noradrenalin) loses another
electron to form adrenochrome (or noradrenochrome). This change is irreversible.
The adrenochrome is a synaptic blocking agent as is LSD. Thus niacin which
maintains NAD levels decreases the formation of adrenochrome. It is likely this
also takes place in the heart and if it does it would protect heart muscles from
the toxic effect of adrenochrome and from fibrillation and tissue necrosis. None
of the other substances known to lower cholesterol levels are known to have this
protective effect. Niacin thus has an advantage: (1) in lowering cholesterol
and, (2) in decreasing frequency of fibrillation and tissue damage.
Niacin as a Treatment for Acute Coronary Disease
Altschul (1964) reviewed the uses of niacin clinically where it is used as
soon as possible after an acute event. Goldsborough (1960) used both niacin and
niacinamide in this way. Patients with a coronary thrombosis were given niacin
50 mg by injection subcutaneously and 100 mg sublingually. As the flush
developed the pain and shock subsided. If pain recurred when the flush faded
another injection was given, but if pain was not severe another oral dose was
used. Then he used 100 mg three times daily. If the flush was excessive he used
niacinamide.
Between 1946 and 1960 he treated 60 patients, 24 with acute infarction and the
rest with angina. From the 24 patients, six died. Four of the angina patients
also had intermittent claudication which was relieved. Two had pulmonary
embolism and also responded.
Niacin should be used before and after every coronary bypass surgery. Inkeless
and Eisenberg (1981) reviewed the evidence related to coronary artery bypass
surgery and lipid levels. there is still no consensus that this surgery
increases survival. In most cases the quality of life is enhanced and 75 percent
get partial or complete relief of angina. I believe a major problem not resolved
by cardiovascular surgery is how to halt the arteriosclerotic process. Inkeles
and Eisenberg report that autogenous vein grafts implanted in the arterial
circuit are more susceptible than arteries to arteriosclerosis. In an anatomic
study of 99 saphenous vein grafts from 55 patients who survived 13 to 26 months,
arteriosclerosis was found in 78 percent of hyperlipidernic patients. Aortic
coronary bypass grafting accelerates the occlusive process in native vessels.
If patients were routinely placed on the proper diet and if necessary niacin
long before they developed any coronary problems, most if not all the coronary
bypass operations could be avoided. If every patient requiring this operation
were placed upon the diet and niacin following surgery, the progress of
arteriosclerosis would be markedly decreased. Then surgeons would be able to
show a marked increase in useful longevity. One would hope to have the combined
skills of a top cardiac surgeon and a top internist using diet and
hypocholesterolemic compounds.
Conclusion
Niacin increases longevity and decreases mortality in patients who have
suffered one myocardial infarction. The Medical Tribune, April 24,2985, properly
expressed the reaction of the investigators by heading their report, "A
Surprise Link to Longevity: It's Nicotinic Acid." Had they taken Ed Boyle's
finding seriously they would not have been surprised and would have gotten even
better results.
Note: In 1982 Keats published my review of Vitamin B3 (Niacin). This present
review concentrates in greater detail on only one aspect of niacin's many
beneficial properties. The two should be read together as they are companion
reports.
Derivatives of niacin have been examined for their ability to alter lipid levels
as well as niacin, It would be advantageous if the niacin vasodilation (flush)
were eliminated or removed. The main disadvantage of the niacin derivatives will
be cost. Inositol hexanicotinate is an ester of inositol and niacin. In the body
it is slowly hydrolyzed releasing both of these important nutrients. The ester
is more effective than niacin in lowering cholesterol and triglyceride levels,
Abou El-Enein, Hafez, Salem and Abdel (1983). I have used this compound, Linodil,
available in Canada but not the U.S.A., for thirty years for patients who can
not or will not tolerate the flush. It is very gentle, effective, and can be
tolerated by almost every person who uses it.
Niacin is effective in decreasing the death rate and in expanding longevity for
other conditions, not only cardiovascular
diseases. It acts by protecting cells and tissues from damage by toxic molecules
or free radicals.
One of the most exciting findings is that niacin will protect against cancer. A
conference at Texas College of Osteopathic Medicine at Fort Worth early this
year, was the eighth conference to discuss niacin and cancer, Titus (1987). The
first was held in Switzerland in 1984.
In the body niacin is converted to nicotinamide adenine dinucleotide (NAD). NAD
is a coenzyme to many reactions. Another enzyme, poly (Adenosine adenine
phosphate ribose) polymerase, uses NAD to catalyze the formation of ADP-ribose.
The poly (ADP-ribose) polymerase is activated by strands of DNA broken by smoke,
herbicides, etc. When the long chains of DNA are damaged, poly (ADP-ribose)
helps repair it by unwinding the damaged protein. Poly (ADP-ribose) also
increases the activity of DNA ligase. This enzyme cuts off the damaged strands
of DNA and increases the ability of the cell to repair itself after exposure to
carcinogens.
Jacobson and Jacobson (Hostetler (1978) believe niacin (more specifically, NAD)
prevents processes which lead to cancer. They found that one group of human
cells given enough niacin and then exposed to carcinogens developed cancer at a
rate only one-tenth of the rate in the same cells not given niacin. Cancer cells
are low in NAD.
It is not surprising that niacin also decreased the death rate from cancer in
the National Coronary Drug Study. The first cancer case I treated was given
niacin 3 grams per day and ascorbic acid 3 grams per day, Hoffer (1970).
Niacinamide also increases the production of NAD. Three grams per day given to
juvenile diabetics produced remissions in a large proportion of these young
patients, Vague, Vialettes, Lassman-Vague, and Vallo (1987). They concluded,
"Our results and those from animal experiments indicate that, in Type I
diabetes, nicotinamide slows down the destruction of B cells and enhances their
regeneration, thus extending remission time." See also Yamada, Nonaka,
Hanafusa, Miyazaki, Toyoshima and Tarui (1982). Kidney tissue is protected by
niacinamide, Wahlberg, Carlson, Wasserman and Ljungqvist (1985). It protected
rats against the diabetogenic effect of Streptozotocin. Clinically niacin has
been used to successfully treat patients with severe gIomerulonephritis. One of
my patients was being readied for dialysis. Her nephrologist had advised her she
would die if she refused. She started on niacin 3 grams per day. She is still
well twenty-five years later.
Niacin and niacinamide are protective in a large number of diseases. I will
refer to one or more its ability to reduce fluid loss in cholera, Rabbani,
Butler, Bardhan and Islam (1983). It inhibits and reverses intestinal secretion
caused by cholera toxin and E. coli enterotoxin. It reduces diarrhea associated
with pancreatic tumors in man.
It is clear Vitamin B3 is a very powerful, benign substance which is involved in
numerous reactions in the body, and which in larger doses is therapeutic and
preventative for a large number of apparently unrelated diseases. Are all these
conditions really expressions of minor and major Vitamin B3 deficiency states
due to diet, or to accumulation of toxins in the body?
It is highly likely that any human population which increased the intake of
Vitamin B3 in everyone, by even 100 mg per day and to much higher levels in
people already suffering from a number of pathological conditions, will find a
substantial decrease in mortality and an increase in longevity.
Literature Cited
Abou EI-Enein AM, Hafez YS, Salem H and Abdel, M: The role of nicotinic acid
and inositol hexanicotinate as anticholesterolemic and antilipemic agents.
Nutrition Reports International, 281:899-911, 1983.
Hoffer A: The psychophysiology of cancer. J. Asthma Research, 8:61-76, 1970.
Hostetler, D: Jacobsons put broad strokes in the niacin/cancer picture. The D.O.,
Vol. 28, August 1987, pp. 103-104.
Rabbani GH, Butler T, Bardhan PK and Islam A: Reduction of fluid-loss in cholera
by nicotinic acid. The Lancet, December 24CE31, 1983, pp. 1439-1441.
Titus K: Scientists link niacin and cancer prevention. The D.O., Vol. 28, August
1987, pp. 93-97.
Vague PH, Vialtettes B, Lassmanvague V and Vallo JJ: Nicotinamide may extend
remission phase in insulin dependent diabetes. The Lancet, 1:619-620, 1987.
Wahlberg G, Carlson LA, Wasserman J and Ljungqvist A: Protective effect of
nicotinamide against nephropathy in diabetic rats. Diabetes Research, 2:307-312,
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Bibliography
Table 1. Values for Selecting Adults at Moderate and High Risk Requiring
Treatment
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