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.