Infertility, Pregnancy, and Vitamin C, Vitamin D, Niacin, and Thiamine

My recent research on thiamine has convinced me that thiamine is likely to be helpful for preventing and treating infertility. In the process of researching this column, I was stunned to read statistics claiming that 10% of the population has infertility problems. This would mean that almost 20% of couples experience infertility problems. Even if the real number is only 5%, it is an astonishingly large number.

It is a long road from an egg and a sperm to a healthy adult and many difficulties can be encountered along the way. It is normal to reach adulthood with imperfections. The most important function of vitamins is to catalyze the conversion of egg and sperm into an adult. Extra vitamins can help children grow. All parents should be afraid that their children will grow up to be infertile. Extra vitamin C, niacin, and a multivitamin can prevent at least some infertility. The root causes of infertility are often traceable to events during growth and development. In previous columns I’ve discussed asthma, learning disabilities, hyperactivity, autism, anorexia, and obesity. Infertility is one more concern to add to the list. The paradigm that most children grow up healthy is wrong. A substantial fraction encounter chronic health problems by the time they reach adulthood.

Four vitamins are special – vitamin C, vitamin D, niacin, and thiamine. Read more here. These are the four vitamins associated with the four pandemic vitamin deficiency diseases scurvy, rickets, pellagra, and beriberi respectively. Read more here.

Vitamin C, vitamin D, and niacin are available in almost any pharmacy or grocery store. I recommend 4000 mg/day of vitamin C, and 250 mg time release niacin at least twice per week. For vitamin D, I recommend taking 2000 IU per day for one month, and then scaling back to the 400 IU per day found in a multivitamin. Blood levels of vitamin D should be checked every year as part of a routine physical, and should be maintained as close to the high end of normal as possible. Thiamine is also available in almost any pharmacy or grocery store. Unfortunately, the kind of thiamine in these stores is not useful. It is not well absorbed. Read more here. Fat-soluble forms of thiamine that are readily absorbed are available. The best of these is called TTFD. TTFD (fat soluble thiamine) is available as a skin cream and as powder inside gel caps. I’ve been taking the gel caps, breaking them open, and rubbing them into my skin with lotion. Read more here.

If you are struggling with infertility, or if you are a parent concerned that your children might grow up infertile, you’ve got much to gain and almost nothing to lose by trying vitamin C, niacin, vitamin D, and fat-soluble thiamine.

Vitamins, Viagra, and Erectile Dysfunction – Fat-soluble Thiamine, Vitamin C, Niacin, and Vitamin D

Recent epidemiological evidence suggests that 50% of men over the age of 40 suffer from minimal, moderate, or complete erectile dysfunction. No wonder Viagra is a blockbuster! Is this condition an inevitable part of aging? Obviously not – the other half doesn’t have a problem. Why isn’t anyone talking about causes? What’s the problem?

Like it or not, erection is controlled by the subconscious mind. So, for that matter, is sex drive. Sex drive and erections are not choices. The conscious mind can, and must, repress subconscious urges. The subconscious, however, responds to repression by intensifying sex drive and erections. Most people choose to find a way to enjoy obeying their subconscious mind.

To me, this means that erectile dysfunction is a problem with the subconscious nervous system. Something is wrong with the sensors that detect the presence of interested women, or the wiring that connects the sensors with the brain and the brain with the body, or something is wrong with the nerve circuits that process the information. In my opinion, the problem is most likely to be with the wiring and processing. Why is there such a high prevalence of failure of this wiring and nerve circuitry with age?

Thiamine deficiency is a reasonable hypothesis

Thiamine deficiency is safely and easily ruled out. It can’t, however, be ruled out by taking ordinary vitamins. Ruling out thiamine deficiency requires trying fat-soluble thiamine. Two forms of fat soluble thiamine are readily available. These are known as TTFD and Benfotiamine. Fat soluble thiamine was popularized in Japan several decades ago, yet remains underutilized there and obscure here in the U.S.

I developed a renewed interest in thiamine about 6 months ago when I had the insight that thiamine, vitamin C, niacin, and vitamin D are special nutrients because they are associated with the four human pandemic vitamin deficiency diseases beriberi, scurvy, pellagra, and rickets respectively. Read more here.

The thiamine that is commonly found in multivitamins and in the pharmacy requires special transport proteins a first time to get into the bloodstream and a second time to get into cells. Fat-soluble thiamines do not require these special proteins. Again, until you try fat-soluble thiamines, you can’t rule out the possibility that your problems having sex are partially caused by thiamine deficiency. Read more here.


If you’re having problems having sex, there is much to gain and almost nothing to lose by finding and trying fat-soluble thiamine. If you’re already taking Viagra, keep on taking it. Vitamins and drugs are rarely counter-indicated. In fact, they often work better together. The objective is to use all available means and to find the combination of drugs and vitamins that best meets your individual needs. Extra vitamins work better in combination than alone, so I recommend taking at least 2000 mg/day of vitamin C, 250 mg of time-release niacin two or three times/week, and a daily multivitamin too. Don’t give up on your sex life. It is not an inevitable problem of aging.

Vitamins and Depression: Thiamine, Niacin, Vitamin C, Vitamin D

Millions of Americans suffer from depression. Depression causes a surprising amount of discomfort. Good mental health is priceless. People spend lots of money on therapy, divorce, career changes, soothing music tapes, meditation courses, and more in a quest for good mental health. Drugs that manipulate feelings are blockbusters. Unfortunately, most people experience significant side effects and receive only partial benefits. I wouldn’t be surprised to learn that super healthy people with excellent mental health get the most benefit from prescription anti-depressants – a kind of “super” caffeine.

If you are depressed, or know someone who is depressed, here’s something new to try – fat-soluble thiamine. Two forms of fat soluble thiamine are readily available. These are known as TTFD and Benfotiamine. Fat soluble thiamine was popularized in Japan several decades ago, yet remains underutilized there and obscure here in the U.S.

I developed a renewed interest in thiamine about 6 months ago when I had the insight that thiamine, vitamin C, niacin, and vitamin D are special nutrients because they are associated with the four human pandemic vitamin deficiency diseases beriberi, scurvy, pellagra, and rickets respectively. Read more here

The thiamine that is commonly found in multivitamins and in the pharmacy requires special transport proteins a first time to get into the bloodstream and a second time to get into cells. Fat-soluble thiamines do not require these special proteins. Until you try fat-soluble thiamines, you can’t rule out the possibility that your depression is partially caused by thiamine deficiency. Read more here

If you’re depressed, there is much to gain and almost nothing to lose by finding and trying fat-soluble thiamine. Extra vitamins work better in combination than alone, so I recommend taking at least 2000 mg/day of vitamin C, 250 mg of time-release niacin two or three times/week, and a daily multivitamin too. Don’t give up on excellent mental health until you’ve tried all these vitamins together.

Vitamins and Sleep Disorders: Thiamine, Niacin, Vitamin C, Vitamin D

Millions of Americans suffer from sleep disorders. Sleep deprivation causes a surprising amount of discomfort. A good night’s sleep is priceless. People spend lots of money on high tech mattresses, fitness machines, soothing music tapes, meditation courses, sleeping pills, and more in a quest for a good night’s sleep.

Here’s something new to try – fat-soluble thiamine. Two forms of fat soluble thiamine are readily available. These are known as TTFD and Benfotiamine. Fat soluble thiamine was popularized in Japan several decades ago, yet remains underutilized there and obscure here in the U.S.

I developed a renewed interest in thiamine about 6 months ago when I had the insight that thiamine, vitamin C, niacin, and vitamin D are special nutrients because they are associated with the four human pandemic vitamin deficiency diseases beriberi, scurvy, pellagra, and rickets respectively. Read more here

If thiamine was special, where were the literature reports of safety and effectiveness for doses well in excess of the 1 to 2 mg doses needed to prevent deficiency? There is extensive literature including double-blind, placebo controlled trials for vitamin C, niacin, and vitamin D. Unlike 12 years ago when I first investigated vitamin C and B-complex vitamins, this time I had a text book on vitamins to consult – “The Nutritional Biochemistry of Vitamins.” When I read this book I learned that the common, water-soluble forms of thiamine found in food and supplements are not absorbed beyond 2 mg/dose in the digestive tract. A passing reference was made to the existence of fat-soluble thiamine, and the fact that absorption of these forms was unlimited. Once inside the body, most cells require special proteins to pull the common forms of thiamine out of the blood and into the cells where thiamine is needed. Again, fat-soluble thiamine is not limited in this way. Once in the bloodstream, fat-soluble thiamine enters all cells. Fat soluble thiamine is a somewhat fragile molecule, so cells nearer to larger arteries probably receive larger doses.

Although obscure, the fat soluble thiamines TTFD and Benfotiamine are readily available here in the USA. They can be found and purchased by searching on the internet. Unfortunately, I’m still not done explaining the problems with potency – no wonder fat-soluble thiamine remains obscure. TTFD, the preferred form of fat-soluble thiamine popularized in Japan, is not stable to stomach acid. Enteric-coated or time-release formulations are required to reliably deliver the entire dose in the pill to the bloodstream. If TTFD is purchased without special formulation, it is important to take it on an empty stomach with lots of water. TTFD is also available as a skin cream – another means of reliably delivering the entire dose to the bloodstream.

If you’re having trouble sleeping, there is much to gain and almost nothing to lose by finding and trying fat-soluble thiamine. Extra vitamins work better in combination than alone, so I recommend taking at least 2000 mg/day of vitamin C, 250 mg of time-release niacin two or three times/week, and a daily multivitamin too. Don’t give up on better sleep until you’ve tried all these vitamins together.

Dogs, Cats and Vitamin C, Vitamin D, Niacin, and Thiamine

Dogs and cats share most health problems with humans. Readers of my blog know that I believe in attacking healthcare problems by all available means. I recommend following the advice of physicians and, in addition, taking extra vitamins. Most owners, however, can’t afford to provide their pets with the same quality of healthcare that they arrange for themselves. Fortunately, for the first time in human history, pet owners have access to affordable, high-potency vitamin supplements. Because of vitamins, this seemingly tragic situation may turn out to be a blessing for both pets and their owners.

My dog was beset with a bad case of arthritis. Every time I took her for a walk and she ran around, she would return in pain. It had gotten to the point where it was affecting all four legs and I was starting to need to carry her up and down the stairs. It was a sad situation. Then she got a cancerous growth on her face. After the surgeon removed the growth, I decided to treat her with vitamin D, niacin, and vitamin C. Specifically, I treated my 60 lb dog with 800 IU of vitamin D, 125 mg of time release niacin, and 2000 mg of vitamin C every other day (I coat the pills with peanut butter and she wolfs them down). I did this because all three vitamins are known to help the body fight off cancer. The result has been nothing short of miraculous. My dog is running around like she did when she was a puppy, and she jumps in and out of the back of the car on her own. I’ll let you know about the cancer after a year has gone by. So far, however, so good.

Dogs and cats provide our society with an opportunity to test the full potential of vitamins for treating cancer, because vitamins are often the only practical approach. We took Toffee to the dog oncologist. For us, the most difficult part of the recommended radiation treatment was the sheer effort involved. We both work and we have two kids in school. We might have been able to pull together the thousands of dollars needed, but driving the dog to and from chemotherapy sessions, and then nursing her in-between was more than we could manage.

Animals (including humans) are naturally resistant to cancer. Cancer is a disease of old, older, and oldest animals. Studies of cancer have proven that the cause of cancer typically involves multiple failures of basic metabolism. It is a complex disease, and there is a lot of variability between one case and another. Even a single cancer, e.g. colon cancer, can be fairly described as a family of diseases rather than a single disease. As a result, some patients diagnosed with colon cancer live for decades and die of other causes while other patients die in months. Due to the complexity of cancer, it is a near certainly that failures of vitamin-dependent metabolic pathways are sometimes involved.

I believe that treatment with vitamins is relatively straightforward. Four vitamins are the most important. Read more here These are vitamin C, niacin, fat-soluble thiamine, and vitamin D. As a starting point, I recommend feeding dogs and cats with cancer the following daily doses: 125 mg time release niacin, 2000 mg vitamin C, 800 IU vitamin D, and 20 mg of the fat-soluble thiamine known as TTFD. Doses in this range will cause side effects. Vitamin D can be particularly toxic. The most important side effect to watch out for is nausea. Never force a nauseous pet to eat vitamin supplements. The second most important side effect to watch out for is burning, itching skin (a niacin side effect). The pet can lick the fur off the irritated spot. Other than that, just observe. If the pet seems uncomfortable, give the vitamins a break for a week. If a vitamin is the problem, the discomfort will rapidly diminish (and return again when the supplements are resumed).

Vitamins are a safe, cost-effective treatment for a wide variety of animal health problems. They are a particularly interesting approach for cancer in animals. Because they are inexpensive and readily available, vitamins are often the only practical approach. In these cases, there is much to gain and nothing to lose by supplementing pets with high potency vitamins.

Seven or more eggs a week raises risk of death

This is the title of a Reuters story as reported on Yahoo! News today. The lead paragraph says:

“Middle-aged men who ate seven or more eggs a week had a higher risk of earlier death, U.S. researchers reported on Wednesday.”

This sounds pretty definitive, doesn’t it? More evidence that we all better stop eating eggs. Those things are deadly! According to Dr. Luc Djousse and Dr. J. Michael Gaziano of Brigham and Women's Hospital and Harvard Medical School:

“Whereas egg consumption of up to six eggs a week was not associated with the risk of all-cause mortality, consumption of (seven or more) eggs a week was associated with a 23 percent greater risk of death”.

Oh, so six eggs a week seems to be OK, but seven and put your affairs in order.

Since the lipid hypothesis of heart disease has taken hold as gospel, we have been hearing about the high cholesterol in eggs. To show how well established this theory has taken hold in the conventional wisdom, the story states:

“Eggs are rich in cholesterol, which in high amounts can clog arteries and raise the risk of heart attack and stroke.”

No room for any opposing opinions there. This is why we are all encouraged to eat egg-white omelets and use Egg-Beaters®. And why do eggs have so much cholesterol anyway? There is a lot of cholesterol in eggs because there is a lot of cholesterol in chickens, just like there is a lot of cholesterol in humans. Maybe it isn’t such a good idea to be monkeying around with drugs that foul up our bodies natural mechanisms to make cholesterol.

It has been my somewhat-educated opinion that the lipid hypothesis is flat-out wrong anyway. The studies supporting the link between high cholesterol and heart disease are weak, at best. I refer you to my page on cholesterol, if you are interested in more on this.

But lets get back to the news of the study. So far we have learned that eating seven eggs a week will greatly increase your likelihood of an early demise. Also we have been reminded that eggs are high in cholesterol and we all know how dangerous that is.

The researchers studied over 21,000 male physicians taking part in a much larger study since 1981. During the study period:

“1,550 of the men had heart attacks, 1,342 had strokes, and more than 5,000 died.”

Then in paragraph 14 of the 17-paragraph story we are told:

"Egg consumption was not associated with (heart attack) or stroke," the researchers wrote.

What! Wasn’t eggs, cholesterol, heart attacks and strokes the whole story! Apparently the facts didn’t fit the story, but I do give them some credit for telling us the truth at all. After the story has now blown up as we read it, the last paragraph tells us some very important details:

“Men who ate the most eggs also were older, fatter, ate more vegetables but less breakfast cereal, and were more likely to drink alcohol, smoke and less likely to exercise -- all factors that can affect the risk of heart attack and death.”

So there you have it. Older, fatter, drinking, smoking couch potatoes die sooner. Maybe that should have been the title of the story, but then I guess it wouldn’t have been much of a story.

Prevent Anorexia – Protect Your Children with Thiamine, Niacin, Vitamin C, and Multivitamins

I am not alone in my view that anorexia is beriberi and can be prevented by use of vitamin supplements. The world’s leading orthomolecular physicians recently issued a press release expressing the same opinion. This press release has been reposted by two alternative health websites.

Primary care physicians walked away in frustration from anorexia long ago. They refer patients to specialists who believe that anorexia is a psychiatric disorder. Don’t expect my words to influence these specialists. Try to put yourself in their place. How would you react if you were a psychiatrist specializing in anorexia and you were told that anorexia was going to disappear because it is a thiamine deficiency disease? How would you feel if you were asked to help test the hypothesis that the simple act of providing children with fat-soluble forms of thiamine in addition to vitamin C, niacin, and multivitamins would prevent the disease?

You can see for yourself the reaction of an anorexia expert by going to the talk page at the “anorexia nervosa” entry at Wikipedia. I added a section on prevention which has been deleted by this expert. I am trying to persuade this expert to undo the deletion. This exchange has proven that anorexia specialists have indeed forgotten about beriberi. This expert told me that my claim that anorexia was an acknowledged clinical marker of beriberi was incorrect. But my claim is correct – the modern medical community has genuinely forgotten.

Many primary care physicians and anorexia specialists are going to react similarly. I’m afraid that parents concerned that their daughters might be showing signs of anorexia are on their own if they are interested in trying to prevent anorexia with supplements.

Fat-Soluble Thiamine, Dementia, and Other Problems of Aging

I’m going to make the case in this column that Alzheimer’s disease, senility, and dementia may be forms of beriberi, the deficiency disease caused by thiamine. Terrible diseases like MS, Parkinson’s, and ALS might also be related to thiamine. I’m going to advise everyone to take supplements containing allithiamines – fat soluble forms of thiamine that are among the known bioactive constituents of garlic.

This is going to be a short column. Thiamine is a special essential nutrient. It has not been easy for humans to reliably find enough thiamine in food. As a result, thiamine deficiency was a regular source of pandemic disease throughout the course of human history. Only three other nutrients have cause similar problems. These are vitamin C (the cause of scurvy), niacin (the cause of pellagra) and vitamin D (the cause of rickets). Thiamine is special amongst these four special vitamins because the most common forms of thiamine (thiamine hydrochloride and thiamine mononitrate) are not easily distributed throughout the body once it is ingested. The other three vitamins in their common forms freely diffuse throughout all the cells in the body. Thiamine salts require special thiamine transport proteins to cross many of the body’s membrane systems.

Slow deterioration is an inevitable part of aging. If the parts of your body that are responsible for thiamine transport start to deteriorate earlier than normal, you are in big trouble. Deprived of thiamine, deterioration is certain to accelerate.

In modern times there is a straightforward fix for this problem. The fix is to take fat-soluble forms of thiamine known as allithiamines (or eat large amounts of garlic). Allithiamines transport themselves throughout the body, and do not require the assistance of thiamine transport proteins.

If you deprive people of thiamine, they exhibit symptoms closely resembling Alzheimer’s disease. The damage is often irreversible (taking thiamine often does not reverse the symptoms), especially when thiamine deprivation is maintained for a prolong period of time. The cause of Alzheimer’s disease is presently unknown. What is the harm of taking allithiamines while scientists investigate? Allithiamines are available in almost every corner store in the form of garlic tablets. I’m sorry to say that I have no idea what the concentration of allithiamines are in garlic tablets. As a result, I recommend taking benfotiamine or TTFD, two specific allithiamines that can be purchased easily enough on the internet (I have yet to personally find a bottle of either of these two supplements on the shelves of a retail store). I will shortly be posting references to scientific literature. Many of these references were the source of the logic in this column.

Four Special Nutrients: Vitamin C, Niacin, Vitamin D, and Thiamine (B1)

Nutrition is a complex subject. Between vitamins and minerals, there are more than 40 essential nutrients. Then there are herbs. Then there is the quality of food. How can you make sense of all the information available? Who can you believe?

The purpose of today’s column is to provide a rationale for setting priorities. I believe that the top priority is developing a dosage strategy for just four nutrients: vitamin C, niacin, vitamin D, and thiamine. This is not an easy task. I’ve been working on it for over a decade and I’m not close to a consistent strategy yet.

Why vitamin C, niacin, vitamin D, and thiamine? What’s special about these four vitamins? Well, the inability to manage these four vitamins has caused humanity untold misery. These are the vitamins that prevent the four deficiency diseases that caused regular epidemics before the discovery of the vitamins in the early 20th century. Vitamin C prevents scurvy, vitamin D prevents rickets, niacin prevents pellagra, and thiamine prevents beriberi.

It’s hard to get enough of these four essential nutrients by eating food. If it was easy, millions of our ancestors wouldn’t have suffered from deficiency diseases. For these four vitamins, food is not enough to guarantee optimal health. That’s why our health authorities add supplemental thiamine and niacin to wheat flour and supplemental vitamin D to milk. Vitamin C is managed by vigorous promotion of fruits rich in this vitamin.

Optimal doses for these vitamins are the source of vigorous debate because most people can tolerate doses far higher than are easily obtained from food. A balanced diet will contain roughly 100 mg vitamin C, 50 I.U. vitamin D, 20 mg niacin, and 2 mg thiamine. There are many reports of individuals taking more than 20,000 mg/day vitamin C, 5000 IU/day vitamin D, 2000 mg/day niacin, and 100 mg/day of thiamine. There are also regular reports of side effects from vitamin C, vitamin D, and niacin. Side effects from high doses of thiamine are the least common because most people don’t understand that the common forms of high potency thiamine sold today (thiamine mononitrate and thiamine hydrochloride) have limited absorption in the digestive tract. Most of the thiamine in these forms in excess of 2 mg is excreted as solids. So, it isn’t surprising that 100 mg thiamine mononitrate tablets have so few side effects. Thiamine in the forms TTFD and benfotiamine are fat soluble with unlimited absorption. Once these forms of thiamine are commonly used, I expect that reports of thiamine side effects will emerge.

Many vitamin enthusiasts insist that vitamins don’t cause side effects. To me, this defies understanding. They just don’t understand where I’m coming from. 10,000 mg/day of vitamin C isn’t causing side effects? – then up the dosage to 100,000 mg/day. Trust me, the side effects will emerge. And when they emerge, they will resemble the side effects others have already reported at 1000 to 10,000 mg/day. 500 mg/day of niacin not causing side effects? Take 5000 mg/day. And on and on. All four of these vitamins cause side effects at high doses and the side effects are well described for niacin, vitamin C, and vitamin D.

So, avoiding discomforting side effects places an upper limit on dose. Unfortunately, dosing at some fixed ratio of your side effect threshold isn’t possible. Side effects thresholds change with time and state of health (e.g. one of my current strategies is to increase my daily dosage of vitamin C and niacin by more than 10-fold when fighting a respiratory infection). More unfortunately, all of these vitamins are now readily available with slightly different molecular structures (e.g. niacin comes as niacin, niacinamide, and niacin inositol). Each structure can have a different side effect profile. Further complicating the situation, these vitamins can be delivered in more ways than just pills. Niacin and vitamin C are available as skin creams. All four vitamins can be injected to provide very high doses in a small localized area. When the importance of selectively delivering these vitamins to different cellular systems is better understood, I expect many more forms of these four vitamins to become readily available.

So, the situation is complex. That’s why I have this self-appointed job. I’m writing to help people understand how high doses of these four vitamins can improve the growth and development of children and the health of adults. I’m also writing about dosage strategies, and details about the different forms of each vitamin.

I am fully aware that this column isn’t going to change minds quickly. Most people I know have remarkably strong opinions about nutrition. Apparently, I’m no exception. Fortunately, the facts are on my side. It’s just a matter of time.

Vitamins Protect Children from Heavy Metals: Thiamine

Thiamine, or vitamin B1, is used by the body to neutralize and/or excrete toxic heavy metals that inevitably find their way into food, water, and air. Proof of this function is provided in a study published by Derrick Lonsdale (a link to his paper is found in the references to the entry on thiamine at Wikipedia).

Unfortunately, the vitamin B1 in almost every multivitamin and B-complex vitamin is either thiamine mononitrate or thiamine hydrochloride. The body’s ability to absorb these two forms of thiamine is limited to about 2 mg per dose (see David Bender, “The Nutritional Biochemistry of the Vitamins”, an authoritative text on vitamins). Any thiamine mononitrate or hydrochloride in excess of about 2 mg exits the body into the toilet entrained with the solids (no wonder side effects from thiamine supplements are unknown!). There is another class of thiamine molecules called allithiamines. The ability of the body to absorb allithiamines is unlimited. A 150 mg capsule of an allithiamine delivers almost the entire 150 mgs into the bloodstream. I recommend that multivitamin manufacturers consider formulating their multivitamins with a mixture of thiamine mononitrate/hydrochloride and allithiamines.

Lonsdale studied the effect of allithiamine supplements on a group of autistic children. If I understood the paper correctly (see the reference in the Wikipedia entry on thiamine), the results were fantastic. Several children were transformed from severely autistic to non-autistic after 60 days of treatment. The children were screened for heavy metals before, during, and after the treatment. A surprising result from the study was a linkage between arsenic and autism. Lonsdale seemed at a loss to explain a source of arsenic that could be associated with the observed dramatic rise in autism in recent years. I can help. The average U.S. coal contains 24 ppm arsenic (just search “arsenic in coal” on google for a USGC fact sheet). If just 10% of this arsenic escapes into the atmosphere as arsine and other arsenic containing gasses, this provides a source of more than 2000 tons/year of arsenic, year after year after year. The vaporized arsenic rains down out of the sky, contaminating air, food, and water.

Affordable technology exists to cut heavy metals emissions from coal fired electric power plants by a factor of one hundred. I do not believe that scientists or the public clearly understand the connection between rising rates of children requiring special education services and heavy metals emissions from coal-fired power plants. If/when the connection is clearly established, I’m confident the problem will be swiftly resolved. In the meantime, I recommend that all parents provide their children with vitamin C, niacin, and multivitamin supplements. I also recommend that parents of children receiving special education services follow the example of Lonsdale and treat their children with 150 mg allithiamine supplements (the most readily available supplement goes by the name benfotiamine) for 60 days.

Preventing Anorexia with Vitamin Supplements: Thiamine

The vitamin B1 in almost every multivitamin and B-complex vitamin is either thiamine mononitrate or thiamine hydrochloride. The body’s ability to absorb these two forms of thiamine is limited to about 2 mg per dose (see David Bender, “The Nutritional Biochemistry of the Vitamins”, an authoritative text on vitamins). Any thiamine mononitrate or hydrochloride in excess of about 2 mg exits the body into the toilet entrained with the solids (no wonder side effects from thiamine supplements are unknown!). There is another class of thiamine molecules called allithiamines. The ability of the body to absorb allithiamines is unlimited. A 150 mg capsule of an allithiamine delivers almost the entire 150 mgs into the bloodstream. I recommend that multivitamin manufacturers consider formulating their multivitamins with a mixture of thiamine mononitrate/hydrochloride and allithiamines.

Some fraction of young women will have impaired digestive machinery for the absorption of thiamine mononitrate/hydrochloride. Others may have impaired machinery for delivering thiamine mononitrate/hydrochloride from the bloodstream into the cells of all or some subset of the multitude of nervous systems cells that need it. For these young women, today’s multivitamins and B-complex tablets formulated without allithiamines may not be sufficient to prevent anorexia.

Beriberi is the disease caused by a deficiency of thiamine. Beriberi can cause a bewildering variety of symptoms, and can be difficult to diagnose. Anorexia, however, was almost always observed and was considered an important clinical marker for beriberi. Unlike pellagra and scurvy (niacin and vitamin C deficiency diseases respectively), beriberi does not typically respond rapidly and completely to supplementation. Only the fortunate fully recover.

Like many other vitamin B1 molecules, the allithiamines are miracles of nature. Garlic was recognized in the distant past to have healing powers. The allithiamines were identified in the first half of the 20th century as a result of investigations into the chemicals in garlic that are likely responsible. Continuous work has led to a growing understanding of the possible health benefits of pure allithiamines, and they are now readily available. The most readily available allithiamine goes by the name “benfotiamine”. Typical doses are 80, 150, and 250 mg capsules. 300 mg doses have been reported to cause “skunk-like body odors” as a side effect. Sustained use of these doses is highly likely to be associated with a considerable variety of side effects, and should be carried out under the supervision of an experienced physician. There is every reason to believe that such large doses are substantially excessive for the prevention of anorexia in light of the fact that the RDA for thiamine ranges from 0.5 to 1.2 mg depending upon age.

Excellent information on thiamine is available at Wikipedia. The Wikipedia article points to two remarkable articles by Derrick Lonsdale. One of these is a recent review of thiamine. Beriberi (and therefore anorexia) has been historically associated with high carbohydrate, calorie rich diets. This type of diet remains fashionable in the developed world as a whole, and particularly in the United States.

All professionals and family members responsible for the healthcare of adolescent girls should learn more about beriberi and thiamine, and be on the lookout for the earliest possible signs of trouble with thiamine metabolism. All parents of adolescent girls should consider requiring regular supplementation with vitamin C, niacin, and multivitamins. In the likely event that the multivitamin does not contain an allithiamine, parents should consider an occasional separate benfotiamine supplement – once a month is likely to be plenty. It’s high time to put an end to the large majority of tragic cases of anorexia that can be prevented with safe, inexpensive, and readily available vitamin supplements.

Sickly Children with Pale Faces: Vitamin C, Niacin, and Multivitamins Can Help

Working together, vitamin C, niacin, and multivitamin supplements can accelerate the return of good health to a sickly infant or toddler. The word accelerate is used to acknowledge that most sickly children will regain ordinary health by following standard pediatric care. The vitamin supplements complement the treatments provided by pediatricians. The best results are obtained by using supplements and any medications/treatments advised by a child’s pediatrician.

I recommend three supplements that are inexpensive and easy to find. These are 500 mg chewable vitamin C tablets, children’s chewable multivitamins, and 250 mg time-release niacin gel caps or tablets. If you have a toddler with a pale face and dark circles under the eyes, feed him or her 6 of the vitamin C tablets, one multivitamin, and 1/2 of one 250 mg time-release niacin gel cap or tablet. Follow up with 4 more vitamin C tablets before bedtime. Many toddlers are happy to take one kid’s chewable multivitamin and lots of chewable vitamin C. These taste good. The half niacin gel cap or tablet is the only toddler-unfriendly ingredient. Fortunately, niacin has a mild flavor. Add half the contents of the gel cap (or a half tablet crushed into chunks) to ice cream or pudding, or some other soft, toddler-friendly food. The niacin may cause the toddler to flush – a temporary reddening of the skin. Although the flushing can be unpleasant, it is harmless. Further, flushing is unusual with time-release niacin gel caps at such a low dosage. Keep going with 125 mg/day of time release niacin and the vitamin C, 4 chewable tablets every morning and every bedtime until the dark circles are gone and are replaced by rosy cheeks. 4 chewable vitamin C tablets and a multivitamin should be taken every day, even when healthy. I recommend 1/2 of one 250 mg time-release niacin supplement once or twice per week for healthy kids.

Several lines of reasoning supporting my recommendations follow. Vitamins are necessary catalysts used to complete the challenging task of transforming an egg and sperm into a healthy adult. Read more here and here. Vitamins help children develop immunity towards infectious diseases. This is especially important during the early daycare years when a typical child gets 8 to 10 colds per year. Read more here, here, here, and here. Environmental toxins (heavy metals are of particular concern) are steadily accumulating in the environment making the utopian goal of error-free growth and development even more challenging. Read more here, here, here, here, and here. The ordinary rough and tumble of a healthy childhood typically causes uncountable minor injuries (wounds) such as bruises, scrapes, inflammation from viral or bacterial infections, and burns (including sun burns and chemical burns such a poison ivy). Read more here, here, and here. Finally, vitamin deficiency diseases have not been completely eliminated. Self-starvation in adolescence remains tragically common and is most often referred to as anorexia and bulimia (eating disorders). Read more here and here.

The primary concern of parents and regulators is safety. Parents can confidently provide their children with up to 4,000 mg/day of vitamin C every day and up to 10,000 mg/day when they are fighting colds. The only risk is short-term discomfort. If 500 or 1000 mg turns out to be the optimal dose for their specific child, no parent will care as long as 4000 mg/day is safe and remains free of discomforts. In other words, if a parent is supplementing his/her children with 4000 mg/day and the children are healthy and happy, that parent is unlikely to explore lower doses in order to find an optimum.

All parents, not just those of sickly children with pale faces, should consider vitamin C, time-release niacin, and multivitamin supplements for their children. The children have everything to gain and almost nothing to lose by giving this approach a try.

Obesity Part II: Why Vitamin C, Niacin, and Multivitamins May Help

Metabolic functions in the body are known to be regulated. In today’s column I will discuss the regulation of body weight, blood sugar, and vitamins.

Body weight, blood sugar, and vitamins are each vital to health. Both high and low values are life-threatening. The proposal that the nervous system is designed to continuously measure and respond to blood sugar, body weight, and vitamin status makes sense to me.

Any diabetic can tell you that blood sugar levels must be maintained within a normal range. When blood sugar strays outside the normal range the effects are immediate. Unless corrected within days, blood sugar levels significantly outside the normal range are deadly. To maintain excellent health, blood sugar levels should be continuously maintained safely inside the normal range.

If I am correct, the body perceives falling blood sugar levels (and therefore fluctuating blood sugar) as an emergency. The regulatory control systems act to correct the problem. Hunger directs the body to consume easily absorbed carbohydrates, preferentially sugar. Subconscious commands direct the digestive system to accelerate the decomposition and absorption of carbohydrates. The movement of food into the colon is halted to maximize the extraction of sugars from the food already in the small intestine. Food already in the stomach is directed into the small intestine. Extra saliva, stomach acid, bicarbonate, maltase, lactase, sucrase, and amalyase are secreted.

Since controlling blood sugar is an emergency, the blood sugar control loop over-rides other control loops regulating less urgent factors. Maintaining a set weight and maintaining cellular vitamin status are obviously less urgent.

When the body perceives falling weight, hunger directs the body to consume more energy-rich food. Subconscious commands direct the digestive system to halt the movement of food into the colon. Anyone who has tried to lose a lot of weight can attest to the effectiveness of this system. As the body loses weight, hunger becomes increasingly extreme and the movement of food into the colon will literally come to a halt to ensure that every calorie consumed – even the calories in fiber – is put to use. To accomplish this task, the calories contained in fiber are shared with bacteria hosted by the digestive tract.

When the body perceives rising weight, feelings of nausea and fullness direct the body to consume less food. Subconscious commands direct the digestive system to accelerate the movement of food. Other subconscious commands direct the metabolism to speed up, causing more calories to be released to the environment as heat.

The body reacts to falling and rising vitamin levels in a similar fashion to falling weight. Hunger, fullness, and nausea direct the body to consume more or less vitamin-rich foods. Subconscious commands direct the digestive system to accelerate or halt the movement of vitamin-rich foods. The proven laxative effect of vitamin supplements supports this hypothesis.

If I’m correct, the body operates at least three independent control loops that each depend upon the use of conscious feelings to control what and how much food is eaten, and subconscious commands to the digestive tract to control secretions and food movement. Failure of any of the thousands of body parts involved (there are probably more “nervous-system” parts than “mechanical” parts) can lead to weight gain and/or other chronic health problems. One observable – weight gain – can have hundreds or thousands of different causes. With so many different causes, there can not be a single solution to the problem.

How can vitamins help? Vitamins are a necessary component of many of the tools the body uses to build an adult from an egg and sperm. Ensuring that the body has extra vitamins available in the food and supplements eaten is a good idea. Extra vitamins in the right place at the right time can reduce the number of inevitable errors that occur during growth and development. Fewer errors mean stronger, smarter, healthier adults. Extra vitamins can have healing powers. This is particularly well understood for niacin and vitamin C and has been the subject of several of my previous columns. This means extra vitamins can help with obesity by healing the broken parts I referred to above.

If I’m correct, vitamins are monitored and controlled, greatly reducing the danger of overdosing. Overdoses can cause a laxative effect, nausea, and fatigue – clear signals to reduce consumption. In the absence of these signals (or other known vitamin side effects), it is unlikely that key vitamins are doing any harm. There is much to gain, and little to lose by responsibly and knowledgably taking multivitamins along with extra vitamin C and niacin when needed.

Obesity Part I: Why Vitamin C, Niacin, and Multivitamins May Help

The body has many parts devoted to the processing of food. As a result, food processing is subject to multiple regulatory feedback loops. Working together, these feedback loops regulate body weight. Malfunctioning of any body part responsible for processing food or malfunction of any of the feedback loops can throw off body weight on the high side or the low side. For this reason, there are multiple causes of obesity and emaciation. I’ll devote several columns to exploring this complex system.

We live in a world with abundant food. When hunger occurs, food is easily obtained and people typically eat in response until a natural feedback loop kicks in to repress the desire to eat. The feeling of fullness that stops eating is a vital component of the body’s strategy for maintaining a set weight. It is not, however, the only strategy. Once eaten, the ingestion of food into the body is not inevitable. A second vital component to regulate weight is control over the absorption vs. rejection of food once it has been eaten. All food is not absorbed. A substantial fraction is excreted as solids. This is not because the excreted solids are indigestible. Ordinary food is nearly 100% digestible. Starving people do not excrete solids. Even fiber is absorbed. The body colonizes bacteria which can break down fiber. People can digest fiber just like cows. For people, however, the digestion of fiber is inefficient, and requires a long residence time in the digestive tract. The body only allows food to reside that long in the colon when it is starving.

The digestive process is not under conscious control. The regulatory loops that control the numerous fluids secreted into various parts of the digestive tracts and that control the mechanical forces that propel food along the digestive tract are entirely under the control of the subconscious. This remarkably complex system has some ability to sort through the food we eat and absorb more of what we need most while rejecting more of what we need the least. As people age, problems inevitably arise with one or more aspects of the body’s complex weight regulation systems. The problems commonly manifest themselves as obesity or emaciation. Look for yourself inside a nursing home. How many of the residents appear to be at a healthy weight?

If you want to maintain a healthy weight, it helps to grow up healthy and strong, and to efficiently heal any damage life brings to the digestive tract. The digestive tract is regularly attacked by microbes, so this is no easy task. I’ve argued in past columns that vitamin C and niacin have proven power to facilitate wound healing, and I’ll make the same argument again here. Vitamin C, niacin, and multivitamins are especially important for children. In addition to helping to heal wounds from any injuries that toxins or pathogens cause, extra vitamins help build a healthier digestive tract and immune system in the first place. With luck, increasing use of vitamin supplements by children will lead to reduced rates of childhood obesity.

Multivitamins and Vitamin C Prevent Anorexia – Prove It Isn’t True

I believe that more than 90% of the cases of anorexia and other eating disorders are caused by vitamin deficiency. I believe the simple act of ensuring that all children take at least 500 mg/day of vitamin C and a multivitamin will prevent most cases of anorexia, bulimia, and other eating disorders. I challenge the health care community to provide statistics comparing the prevalence of eating disorder in teenagers taking at least a multivitamin and 500 mg/day of vitamin C vs. teenagers who don’t take any vitamin supplements. In the long run, I believe that >99% of eating disorders will be prevented in children who take at least 500 mg/day of vitamin C, at least 250 mg/week of time release niacin, and a daily multivitamin. I can't even ask for statistics because giving time-release niacin supplements to children is an almost unknown behavior.

Here’s what the health care community would have parents believe. I took this from a specific website, but I found similar words at most healthcare websites dealing with eating disorders:

“Eating disorders are typically precipitated and perpetuated by a combination of genetic, developmental, and psychological factors, requiring a multidisciplinary team approach (physician, psychiatrist, psychologist, dietitian) to treatment. Anorexia Nervosa is particularly difficult to treat, often necessitating repeated episodes of hospitalization to prevent extreme weight loss. Bulimia Nervosa is usually not life-threatening and may respond well to cognitive-behavioral therapy, medication or a combination of the two Binge Eating Disorder often responds well to behavior modification-based weight-loss strategies alone. Family members can render assistance by providing regular, well-balanced meals and emotional support.”

Where in that paragraph does it say that eating disorders are a known symptom of pellagra and beriberi. How does the healthcare community justify not linking the fact that eating disorders are caused by vitamin deficiency in the minds of parents? This behavior must stop. It undermines the credibility of the mainstream medical community.

For some teenage girls, problems absorbing thiamine may contribute to causing anorexia. The form of thiamine in multivitamins requires special proteins to be absorbed into the bloodstream and other special proteins to be absorbed into certain cells. Easily absorbed forms of thiamine exist. Incredibly, these forms have not yet been added to common multivitamins. So, the 99% prevention rate that I believe is possible will likely require this recommended change in multivitamin formulation in addition to adoption of niacin as a regular supplement. Read more about thiamine and anorexia here

I’ll end this column with the same words I used to end my last column on eating disorders. Anorexia is difficult and expensive to cure. Roughly 5% of the teenage girls in America struggle with eating disorders. Every parent should be afraid that their daughters might fall victim. Vitamin deficiency causes anorexia. Even for healthy children, the benefits of vitamin supplements at or below the government’s safe upper limits far outweigh the risk of any harm. What do parents and physicians of children with eating disorders say when asked why they didn’t insist that the children in their care take vitamin supplements as a preventative measure? For some unlucky children, a one RDA vitamin won’t be enough to prevent eating disorders. What do the parents and physicians of these children say when asked why they didn’t insist that these children take vitamin supplements at the safe upper limit? If, God forbid, my children develop eating disorders, I’ll know it had nothing to do with vitamin deficiency.

Vitamins May Help Prevent Heavy Metal (e.g. mercury) Poisoning

Awareness about the danger to children from heavy metal pollution is on the rise. There are many recent articles are focusing on mercury emissions from coal-fired power plants. Look here, here, here,and here. Mercury concentrates in fish. The form of mercury found in fish is acutely toxic to the youngest members of our society (both before and after birth). The form of mercury found in fish is known to cause brain damage. Levels of mercury in fish are rising because mercury emissions from industrial activity are continuously adding to the already dangerously high levels of mercury in the nation’s lakes and streams. The percentage of children requiring special education services has risen dramatically and is approaching ten percent. At some point the public will realize that there is a clear connection between these two trends.
Several previous blog entries address this issue. I asserted that vitamin supplements may protect growing children from heavy metal poisoning. Recently, the OMNS published an authoritative press release that reached the same conclusion. The press release documents extensive recent scientific studies proving that vitamins protect growing animals from heavy metals poisoning.
I have devoted two recent columns to the scientific evidence that extraordinarily high doses of vitamin C and niacin have been scientifically proven to heal wounds. I believe that the damage caused to the nervous system by heavy metals can be characterized as wounds. In many cases, I believe the wounds caused by the presence of heavy metal poisons can be healed.
Vitamin C and niacin are safe. I raised my children from the ages of 1 and 3 using vitamin C, niacin, and multivitamin supplements. All families should be afraid of the danger posed to their children by heavy metal pollution. All parents should consider niacin, vitamin C, and multivitamin supplements for their children. The children have much to gain and almost nothing to lose.

Kill Cancer with Chemotherapy. Heal the Wounds with Niacin, Vitamin C, and Multivitamins

Two weeks ago I advised cancer patients to cooperate with their physicians to kill their cancer with chemotherapy and/or radiation, and to pressure their physicians to prescribe vitamin C, niacin, and multivitamins to heal the wounds. I promised to provide references to the scientific literature that proves that vitamin C and niacin in high doses are indeed effective for wound healing. This column will discuss niacin.

The chemical structure of niacin and the discovery that it prevented pellagra were both worked out in the 1930’s. It is a simple molecule and easily manufactured. Studies of the biochemistry of niacin have worked out the vital biological roles played by this molecule. Niacin is the N in the NADP and NADPH found in all college biochemistry textbooks. This means niacin is required for cells to generate the energy they use to perform all other biological functions. To me, this makes niacin special.

Shortly after it became available for use as a pure chemical compound, reports surfaced that doses in excess of 500 mg/day (more than 25 times higher than the RDA of 20 mg) were beneficial for treating disease. Well known examples include Dr. William Kaufmann who used niacin to treat arthritis, and Dr. Abram Hoffer who used/uses niacin to treat psychiatric problems. Recently, high doses of niacin have been demonstrated to reduce inflammation, reduce injury to the brain after strokes, and to help dialysis patients (see references in the adjacent blog entry).

Hoffer’s use of large doses of niacin contributed to the discovery in the 1950’s that niacin can normalize blood lipid profiles of many heart disease patients. That discovery was followed up with multiple double-blind, placebo controlled clinical trials which proved beyond any doubt that doses of niacin of >1000 mg/day raise HDL cholesterol and lower LDL cholesterol. The other benefits of high dose niacin that I listed remain controversial.

I believe it is reasonable to conclude from this data that niacin promotes wound healing. As mentioned above, the biochemistry of niacin is not controversial. Niacin is special. The recent findings (niacin reduces injury to the brain after strokes and reduces inflammation in general) provide direct evidence of wound healing. The data from heart disease is less direct. One symptom of heart disease is injured arteries. The beating of the heart causes arterial walls to continuously expand and contract. It is known that fatty deposits accumulate on injured arterial walls at sites where this continuous expansion and contraction are the most stressful. It is reasonable to assert that some of the benefit of high dose niacin is caused by helping arterial walls at stress sites to heal. Supporting this logic is the little known fact that niacin helps heart disease patients who already have their cholesterol under control with statin drugs. I provide references to several recent reviews proving that this information is factual (see the adjacent blog entry). Niacin and statin drugs work together to provide a better outcome than either treatment used alone. This proves that niacin does more than just lower LDL cholesterol and triglycerides. Although it doesn’t prove that niacin is exerting wound healing action, it is suggestive. Combined with the other referenced clinical data and the known biochemistry of niacin, the argument is strongly suggestive.

The doses of niacin used to treat niacin are extraordinary. Physicians prescribe 1000 to 3000 mg/day. Terrible side effects are common at these doses, preventing many patients from fully benefiting from niacin. This proves that the benefits of niacin can continue to increase with dose past the point where the benefits are outweighed by side effects. I’ve shown in previous posts that niacin creams have proven benefits for treating skin conditions. I’ve added to this column evidence that niacin at high doses has still more proven clinical benefits. In light of this evidence (multiple examples of usefulness at doses above 10 RDA’s), the Food and Nutrition Board’s position that one RDA of niacin (20 mg/day) is enough is difficult to understand.

The scientific debate about the usefulness of niacin at doses more than 10 times higher than the RDA is over. The scientific debate about niacin side effects is also over. The existence of both benefits and dangers with increasing dose are well understood. It is also a well understood, consensus position that the dangers of niacin can be managed. There is negligible risk of irreversible harm when niacin is used responsibly. The scope and magnitude of niacin benefits at high doses are not well understood. Cancer patients have a lot to gain and almost nothing to lose by adding niacin, vitamin C, and a multivitamin to their daily treatment plan.

Chemotherapy and Niacin: References

(1) Can niacin slow the development of atherosclerosis in coronary artery disease patients already taking statins? Brown, B. Greg. Medicine and Cardiology, University of Washington School of Medicine, Seattle, WA, USA. Nature Clinical Practice Cardiovascular Medicine (2005), 2(5), 234-235.

Abstract

A review. Background: Low HDL-cholesterol concns. can be successfully raised by niacin. A low HDL-cholesterol level is recognized as a coronary risk factor and increases the risk of unfavorable events related to coronary atherosclerosis. Unlike for LDL cholesterol, the National Cholesterol Education Program guidelines do not provide- target levels for HDL-cholesterol concn. Few studies have investigated the effect of niacin on coronary events, alone or in combination with statin therapy. Objectives: To explore the effect of niacin on carotid intima-media thickness (CIMT), and to find out whether extended-release niacin therapy provides added cardiovascular protection to patients receiving statin monotherapy for coronary artery disease. Design: The Arterial Biol. for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2 trial was a US-based, randomized, placebo-controlled; double-blind study carried out from Dec. 2001 to May 2003. Patients aged over 30 years old were eligible for the study if they had coronary vascular disease, were receiving statin therapy and had HDL-cholesterol levels below 1.7 mM/l (45 mg/dL) and LDL-cholesterol levels under 3.4 mM/l (130 mg/dL). Men and women were excluded if their liver-assocd. enzyme levels were 3 times the upper normal limit, if they had previous liver disease or were intolerant to niacin. Intervention: Eligible patients were randomly assigned 500 mg extended-release niacin (Niaspan, Kos Pharmaceuticals) daily or placebo, both to be taken at night. After 30 days, niacin dose was raised to 1000 mg daily and maintained at this dose for 1 yr. Each patient's CIMT was assessed by linear-array 8 MHz probe ultrasonog. at baseline and at 1 yr. Anal. of CIMT images was masked. Outcome measures: The main endpoint was change in CIMT over 1 yr. An increase in liver-assocd.
enzymes, changes in serum lipid levels and admission to hospital for stroke, arterial revascularization, acute coronary syndrome or sudden cardiac death, among others, were some of the secondary endpoints. Results: Of the 167 patients on baseline statin treatment, 87 patients were assigned addnl. niacin therapy and 80 were assigned placebo. In total, 149 patients (89.2%) were reassessed at 1 yr (study end). Treatment with statin and niacin significantly increased HDL-cholesterol levels by 21%, from 1.00.2 mM/l (397 mg/dL) to 1.20.4 mM/l (47 16 mg/dL), when compared with statin and placebo (P=0.002). Although not significant, patients treated with statin and placebo had a higher av. increase in CIMT than the statin and niacin-treated patients (0.0440.100 mm vs 0.0140.104 mm, P=0.08). Importantly, the rise in av. CIMT was significant for statin and placebo-treated patients but not for patients receiving niacin (0.0440.100 mm, P<0.001 and 0.0140.104 mm, P = 0.23, resp.). Conclusion: Extended-release niacin slowed the development of atherosclerosis in adults with coronary artery disease, independently from statin therapy.

(2) Maximizing coronary disease risk reduction using nicotinic acid combined with LDL-lowering therapy. Brown, B. Greg. Division of Cardiology, University of Washington, Seattle, WA, USA. European Heart Journal Supplements (2005), 7(Suppl. F), F34-F40.

Abstract

A review. Treatment with statins markedly reduces levels of LDL-cholesterol, and large, well-designed evaluations of these agents have demonstrated redns. in cardiovascular event rates of .apprx.20-40%. Addnl. therapeutic strategies will be required to make further inroads into the substantial residual burden of cardiovascular disease in statin-treated patients. Epidemiol. studies over several decades and outcome studies with agents that raise levels of this lipoprotein (nicotinic acid or fibrates) have established low HDL-cholesterol as an important therapeutic target. Combining agents which decrease LDL-cholesterol and increase HDL-cholesterol within a single regimen might provide a means of improving cardiovascular prognosis beyond that possible with statins alone. Six randomized clin. trials involving treatment with nicotinic acid in combination with a statins or bile acid sequestrant have demonstrated regression, or markedly slowed progression, of atherosclerosis in patients at high risk of a cardiovascular event. Three of these trials, the HDL-Atherosclerosis Treatment Study, the Familial Atherosclerosis Treatment Study, and the Armed Forces Regression Study, have assocd. these benefits with significant improvements in clin. outcomes. Correcting low HDL-cholesterol in statin-treated patients may provide a means to achieve the next leap forward in the management of cardiovascular disease.

(3) Beyond LDL-cholesterol reduction: The way ahead in managing dyslipidaemia. Chapman, John. National Institute for Health and Medical Research, Paris, Fr. European Heart Journal Supplements (2005), 7(Suppl. F), F56-F62.

Abstract

A review. Observational cohort studies and anal. of the populations of intervention trials at baseline reveal a strong inverse assocn. between circulating levels of high-d. lipoprotein (HDL)-cholesterol at baseline and the risk of a fatal or non-fatal cardiovascular event. Intervention with a statin is as effective, in abs. terms, in reducing the risk of coronary events in patients across a wide range of dyslipidemic phenotypes, including those with low HDL-cholesterol. However, statins exert little effect on the levels of HDL-cholesterol, and treatment with a statin does not eliminate the excess risk assocd. with low HDL-cholesterol. Addnl. therapy is clearly required to address this residual risk. The success of clin. evaluations of agents that increase HDL-cholesterol, such as nicotinic acid or fibrate drugs, in reducing the incidence of cardiovascular events points to a way forward. Evidence from outcome studies already points to superior cardiovascular risk redns. in patients receiving a statin plus nicotinic acid, and intensive multi-drug regimens based on such combinations probably represent the way to achieve cardiovascular risk redns. greater than those possible with a statin alone. Accurate and well-validated assays for measuring HDL-cholesterol and more precise definition of optimal levels of HDL-cholesterol in patients with different levels of cardiovascular risk are required. These advances will facilitate the future drafting of guidelines that include correction of low HDL-cholesterol alongside redn. of low-d. lipoprotein cholesterol within clin. algorithms for reducing cardiovascular risk.

(4) Modern intervention strategies for managing dyslipidaemia: the case for combination therapy. Drexel, Heinz. Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Hospital, Feldkirch, Austria. British Journal of Diabetes & Vascular Disease (2005), 5(Suppl. 1), S17-S23.

Abstract

A review. A steady decline in cardiovascular mortality has occurred in recent decades, but a substantial burden of cardiovascular mortality remains. Intervention with statins, for example, has resulted in significant redns. in cardiovascular event rates in a broad range of patient populations, but these agents reduce cardiovascular event rates by only about 20-40%, despite profound redns. in low-d. lipoprotein cholesterol (LDL-C) in some trials. Low high-d. lipoprotein cholesterol (HDL-C) is a risk factor for adverse cardiovascular outcomes independent of levels of LDL-C. Well designed intervention trials have demonstrated marked improvements in cardiovascular outcomes with agents that raise levels of HDL-C. Combinations of statins with nicotinic acid, the most potent agent for increasing levels of HDL-C currently available, appear to be the most effective strategy for managing cardiovascular risk. Indeed, redns. in the risk of cardiovascular events of up to 90% relative to placebo with a nicotinic acid-statin combination were obsd. in the double-blind, randomized HDL Atherosclerosis Treatment Study (HATS). A once-daily, prolonged-release formulation of nicotinic acid, Niaspan is as effective as immediate-release nicotinic acid with superior tolerability and safety. A randomized, double-blind placebo-controlled evaluation of Niaspan added to a statin, the Arterial Biol. for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER 2) study, demonstrated significant inhibition of atherosclerosis in men with low HDL-C over only one year of treatment. Patients with low HDL-C are at elevated cardiovascular risk and combination treatment with nicotinic acid and a statin represents a rational and evidence-based treatment for this population.

(5) Natural neuroprotectants after stroke. Maynard, Kenneth I. Aventis Pharmaceuticals, Inc., Bridgewater, NJ, USA. Science & Medicine (Narberth, PA, United States) (2002), 8(5), 258-267.

Abstract

A review. Brain ischemia triggers a cascade of cytotoxic events in cells deprived of blood flow, and this cascade rapidly spreads to neighboring tissues, expanding the zone of ischemic injury. Stroke research has attempted to find agents that can protect brain tissue after stroke by limiting the extent of injury and preserving "at-risk" cells, but to date no drugs have proved successful in clin. trials. With their varied mechanisms of action and lack of serious side effects, various natural and endogenous substances are being examd. for their neuroprotective effects, with encouraging results. Nicotinamide, a crucial nutrient and deriv. of niacin (vitamin B3), is one promising agent approaching clin. testing.

(6) Extended release nicotinic acid - a novel oral agent for phosphate control. Sampathkumar, Krishnaswamy; Selvam, Manickam; Sooraj, Yesudas Santhakumari; Gowthaman, Sankaran; Ajeshkumar, Rajappan Nair Prabha. Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, India. International Urology and Nephrology (2006), 38(1), 171-174.

Abstract

Hyperphosphatemia is common in hemodialysis patients. Recent animal studies show that nicotinamide inhibits the sodium dependent phosphate co-transport in the small intestine and thereby reduces serum phosphorus levels. Nicotinic acid which is the prodrug of nicotinamide is widely used as antihyperlipidemic agent. We examd. in a prospective study whether it reduces serum phosphorus levels in hemodialysis patients. Patients who were on maintenance hemodialysis were enrolled in to the study if their predialysis serum phosphorus was more than 6 mg/dL. During the pre-trial run in period of 1 wk all phosphate binders were stopped. A single dose of extended release nicotinic acid (375 mg) tablet was given with meal. Repeat measurements of serum calcium, phosphorus and alk. phosphatase were carried out after 8 wk. Then the drug was stopped in a subgroup of patients and serum phosphorus remeasured after 2 wk. There were 34 patients with varied etiol. spectrum of end stage renal disease. They were on hemodialysis for a mean period of 8.7 mo. Serum phosphorus levels changed significantly from a pre treatment level of 7.7  1.5 mg/dL to post treatment level of 5.6  1 mg/dL (p < 0.001). There was no significant variance across age groups, sex, disease categories and dialysis duration. The calcium level increased from 8.11.0 to 8.5  1.0 mg/dL (p < 0.015). The serum alk. phosphatase level decreased significantly from 107  66 IU/l to 82  46 IU/l (p < 0.001 ). There was a significant redn. of calcium phosphate product from 63.1 + 15.1 mg2 to 48.7  10.9 mg2/dL2 (p < 0.001). Oral nicotinic acid was well tolerated. Mild pruritus was encountered in 2 patients. Oral nicotinic acid may emerge as a safe, low cost yet powerful agent for phosphorus control in dialysis patients.

(7) Anti-inflammatory effect is an important property of niacin on atherosclerosis beyond its lipid-altering effects. Yu, Bi-lian; Zhao, Shui-ping. Department of Cardiology, Middle Ren-Min Road, The Second Xiangya Hospital of Central South University, No. 139, Changsha, Hunan, Medical Hypotheses (2007), 69(1), 90-94.

Abstract

Summary: Niacin has been used for decades to lower the plasma concns. of cholesterol, free fatty acids, and triglycerides in humans, and in addn. it raises more than any other drug the levels of the protective high d. lipoprotein. These effects have been used to treat dyslipidemic states. Trials have shown that treatment with niacin reduces progression of atherosclerosis, and clin. events and mortality from coronary heart disease. The beneficial clin. efficacy of niacin appropriately emphasizes the prominent role of its lipid-altering effects; however, high expression of niacin receptor in a variety of immune cell types, lowering of inflammatory markers, and beneficial impact on adipokines expression could provide rational to the hypothesis that anti-inflammatory effect is also an important property of niacin on atherosclerosis beyond its lipid-altering effects.


(8) Raising HDL-cholesterol and lowering CHD risk: Does intervention work? Shepherd, James. Department of Vascular Biochemistry, Division of Cardiovascular and Medical Sciences, North Glasgow University Hospital Division, Glasgow, UK. European Heart Journal Supplements (2005), 7(Suppl. F), F15-F22.

Abstract

A review. Epidemiol. studies have assocd. low HDL-cholesterol with an increased risk of morbid coronary events. Accordingly, intervention to correct low HDL-cholesterol may be cardioprotective. A no. of randomized intervention studies have addressed this hypothesis using fibrates (the Veterans Affairs HDL Intervention trial, the Helsinki Heart Study, and the Bezafibrate Infarction Prevention trial), or nicotinic acid, alone [Coronary Drug Project (CDP)] or in combination [the HDL Atherosclerosis Treatment Study (HATS) and the Stockholm Ischemic Heart Disease study (IHD)]. These trials demonstrate conclusively that treatments to increase HDL-cholesterol deliver clin. significant improvements in prognosis. Of these trials, the largest improvement in outcomes occurred in the HATS trial, where the incidence of a combined coronary endpoint (coronary death, non-fatal myocardial infarction, confirmed stroke, or revascularization for worsening ischemia) was reduced by 60-90% in patients receiving treatment based on nicotinic acid combined with a statin. The benefits of nicotinic acid-based treatment appear to be durable, as significant outcome benefits were visible in the group of patients initially randomized to nicotinic acid in the CDP 15 years after randomization, i.e. 9 years after the end of double-blind treatment. The combination of nicotinic acid with a statin appears to be a rational, effective, and safe strategy for minimizing cardiovascular risk in patients with dyslipidemia.

Kill Cancer with Chemotherapy. Heal the Wounds with Vitamin C, Niacin, and Multivitamins

Last week I advised cancer patients to cooperate with their physicians to kill their cancer with chemotherapy and/or radiation, and to pressure their physicians to prescribe vitamin C, niacin, and multivitamins to heal the wounds. I promised to provide references to the scientific literature that proves that vitamin C and niacin in high doses are indeed effective for wound healing. This column will discuss vitamin C.

Large area wounds to the skin are generally referred to as burns. There are many different ways to wound the skin, resulting in many categories of burns. Sun burns, heat burns, rope burns, and chemical burns are among the most common types of serious skin wounds. The skin is the largest organ in the body, and far and away the most prone to injury. Treatments that help heal wounds to the skin are likely to help heal wounds in other organs and tissues.

The chemical structure of vitamin C was worked out in the 1930’s. Methods to synthesize pure vitamin C were worked out in the 1940’s. Shortly after it became available for use as a pure pharmaceutical compound, the first reports surfaced indicating that concentrated topical and IV solutions of vitamin C were a highly effective treatment for burns. Dr. Fred Klenner is the most well known among a handful of physicians who used vitamin C to treat burns decades ago. He documented his procedures and results. These documents are easily found on the internet by typing “Klenner and burns” into Google. Klenner’s papers report that the effect of combined IV, oral, and topical vitamin C on burns is dramatic. He reported that it is an obvious scientific result and saw no need further scientific inquiry. To him, vitamin C for burns was like penicillin for bacterial infections. The treatment obviously works.

Linus Pauling looked into Klenner’s claims and reviewed the scientific literature on vitamin C and burns for his book “How to Live Longer and Feel Better”. Pauling joined Klenner’s call for action and supported Klenner’s claims by providing references to a number of early scientific papers. I encourage everyone to read Pauling’s book and scan through the roughly 500 references provided.

In the two decades since Pauling published his controversial book, his claims about burns have been tested and confirmed by rigorous science. The subject was reviewed by Michael A Dubick at the U.S. Army Institute of Surgical Research in 2000. He concluded, “The data to date suggest that doses up to 66 mg/kg/h (120,000 mg/day!!) infused for 8-24 h after burn may be required to reduce fluid needs and tissue edema (swelling) and such doses have produced no overt toxicity.” Evidently his claims met with resistance because they led to an incredible experiment. Dubick was able to find funding to carry out an expensive blinded clinical trial with sheep. A group of sheep were placed into a drug-induced coma and then severely burned over 40% of their bodies. One group was treated with vitamin C, and another group was treated using today’s normal standard of care. Yet again the results confirm the claims that intravenous vitamin C in high doses works to heal burns. Physicians in Chicago carried out a similar study on guinea pigs with similar results. Physicians at the Shriner’s Hospital for Children in Cincinnati have carried out supporting experiments on cultured skin substitutes. The list goes on. I found no reports of unsuccessful trials testing this hypothesis that high dose vitamin C helps heal burns (wounded skin).

If you need still more evidence, please read my column from several weeks back about the scientific studies proving that vitamin C protects the skin from the damage caused by the sun (sun burn). Beyond the science, the cosmetics industry has successfully commercialized and marketed vitamin containing skin creams (this is called clinical confirmation). The burn trauma treatment industry is developing vitamin C products to treat burns. I found ten recent patents. Personally, I’ve used vitamin C and niacin creams to treat minor burns from kitchen accidents and I thought they worked great. Science has reached a verdict. Klenner was right 40 years ago. Pauling was right 20 years ago. Dubick was right 7 years ago. High dose vitamin C heals wounds.

References Proving that IV Vitamin C Heals Burns (and therefore wounds)

(1) A review of the use of high dose vitamin C for the treatment of burns. Dubick, Michael A. US Army Institute of Surgical Research, San Antonio, TX, USA. Recent Research Developments in Nutrition Research (2000), 3 141-156.

Abstract

A review. Thermal injury is assocd. with capillary leakage and tissue edema that increases the challenge of fluid resuscitation for treating the developing hypovolemia. It is postulated that free radical generation assocd. with thermal injury is an important mediator in the development of this capillary leakage. Over the past decade a series of studies in exptl. animals and 2 studies in humans have explored the use of high dose vitamin C in reducing fluid requirements and tissue edema assocd. with burns. The data to date suggest that doses up to 66 mg/kg/h infused for 8-24 h after burn may be required to reduce fluid needs and tissue edema and such doses have produced no overt toxicity. Further study appears warranted.

(2) Rationale and impact of vitamin C in clinical nutrition. McGregor, Gerard P.; Biesalski, Hans K. Institute of Physiology, Faculty of Medicine, Philipps University of Marburg, Marburg, Germany. Current Opinion in Clinical Nutrition and Metabolic Care (2006), 9(6), 697-703.

Abstract

Purpose of review: The impact of vitamin C on oxidative stress-related diseases is moderate because of its limited oral bioavailability and rapid clearance. Parenteral administration (by injection) can increase the benefit of vitamin C supplementation as is evident in critically ill patients. The aim here is to assess recent evidence of the clin. benefit and underlying effects of parenteral vitamin C in conditions of oxidative stress. Recent findings: In critically ill patients and after severe burns, the rapid restoration of depleted ascorbate levels with high-dose parenteral vitamin C may reduce circulatory shock, fluid requirements and edema. Summary: Oxidative stress is assocd. with reduced ascorbate levels. Ascorbate is particularly effective in protecting the vascular endothelium, which is esp. vulnerable to oxidative stress. The restoration of ascorbate levels may have therapeutic effects in diseases involving oxidative stress. The rapid replenishment of ascorbate is of special clin. significance in critically ill patients who experience drastic redns. in ascorbate levels, which may be a causal factor in the development of circulatory shock. Supraphysiol. levels of ascorbate, which can only be achieved by the parenteral and not by the oral administration of vitamin C, may facilitate the restoration of vascular function in the critically ill patient.

(3) Vitamin C regulates keratinocyte viability, epidermal barrier, and basement membrane in vitro, and reduces wound contraction after grafting of cultured skin substitutes. Boyce, Steven T.; Supp, Andrew P.; Swope, Viki B.; Warden, Glenn D. Shriners Hospitals for Children and Department of Surgery, University of Cincinnati, Cincinnati, OH, USA. Journal of Investigative Dermatology (2002), 118(4), 565-572.

Abstract

Cultured skin substitutes have become useful as adjunctive treatments for excised, full-thickness burns, but no skin substitutes have the anatomy and physiol. of native skin. Hypothetically, deficiencies of structure and function may result, in part, from nutritional deficiencies in culture media. To address this hypothesis, vitamin C was titrated at 0.0, 0.01, 0.1, and 1.0 mM in a cultured skin substitute model on filter inserts. Cultured skin substitute inserts were evaluated at 2 and 5 wk for viability by incorporation of 5-bromo-2'-deoxyuridine (BrdU) and by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) conversion. Subsequently, cultured skin substitute grafts consisting of cultured human keratinocytes and fibroblasts attached to collagen-glycosaminoglycan substrates were incubated for 5 wk in media contg. 0.0 mM or 0.1 mM vitamin C, and then grafted to athymic mice. Cultured skin substitutes (n = 3 per group) were evaluated in vitro at 2 wk of incubation for collagen IV, collagen VII, and laminin 5, and through 5 wk for epidermal barrier by surface elec. capacitance. Cultured skin substitutes were grafted to full-thickness wounds in athymic mice (n = 8 per group), evaluated for surface elec. capacitance through 6 wk, and scored for percentage original wound area through 8 wk and for HLA-ABC-pos. wounds at 8 wk after grafting. The data show that incubation of cultured skin substitutes in medium contg. vitamin C results in greater viability (higher BrdU and MTT), more complete basement membrane development at 2 wk, and better epidermal barrier (lower surface elec. capacitance) at 5 wk in vitro. After grafting, cultured skin substitutes with vitamin C developed functional epidermal barrier earlier, had less wound contraction, and had more HLA-pos. wounds at 8 wk than without vitamin C. These results suggest that incubation of cultured skin substitutes in medium contg. vitamin C extends cellular viability, promotes formation of epidermal barrier in vitro, and promotes engraftment. Improved anatomy and physiol. of cultured skin substitutes that result from nutritional factors in culture media may be expected to improve efficacy in treatment of full-thickness skin wounds.

(4) High-dose vitamin C infusion reduces fluid requirements in the resuscitation of burn-injured sheep. Dubick, Michael A.; Williams, Chad; Elgjo, Geir I.; Kramer, George C. U.S. Army Institute of Surgical Research, San Antonio, TX, USA. Shock (2005), 24(2), 139-144. Publisher: Lippincott Williams & Wilkins, CODEN: SAGUAI ISSN: 1073-2322. Journal written in English. CAN 143:319069 AN 2005:975444 CAPLUS (Copyright (C) 2007 ACS on SciFinder (R))

Abstract

Fluid resuscitation to maintain adequate tissue perfusion while reducing edema in the severely burned patient remains a challenge. Recent studies suggest that reactive oxygen species generated by thermal injury are involved in edema formation assocd. with burn. The present study tested the hypothesis that adding a free radical scavenger to the resuscitation fluid would reduce total fluid requirements in the treatment of severe thermal injury. Anesthetized chronically instrumented sheep received a 40% total body surface area full-thickness flame burn. At 1 h after injury, animals were resuscitated with lactated Ringer's (LR, n = 14) as control, LR contg. high doses of vitamin C (VC, n = 6), 1000 mOsM hypertonic saline (HS, n = 7), or 1000 HS contg. VC (HS/VC, n = 7) in coded bags so that investigators were blinded to the treatment. Fluids were infused at an initial Parkland rate of 10 mL/kg/h, adjusted hourly to restore and maintain urine output at 1 to 2 mL/kg/h. Sheep in the VC or HSA/C group received 250 mg/kg VC in the first 500 mL of LR or HS, and then 15 mg/kg/h thereafter. Hemodynamic variables and indexes of antioxidant status were measured. At 48 h postburn, sheep were euthanized, and heart, liver, lung, skeletal muscle, and ileum were evaluated for antioxidant status. All fluid resuscitation regimens were equally effective in restoring cardiac output to near baseline levels; no treatment effects were apparent on arterial pressure or heart rate. VC infusion significantly reduced fluid requirements and, therefore, net fluid balance (fluid in, urine out) by about 30% at 6 h and about 50% at 48 h in comparison with the LR group (P < 0.05). HS and HS/VC reduced fluid requirements by 30% and 65%, resp., at 6 h, but the vol.-sparing effect of HS was not obsd. after 36 h and that of HSA/C was lost after 12 h.
Plasma total antioxidant potential increased about 25-fold (P < 0.05) at 2 a