Niacin (vitamin B3) is a biomolecule required by all forms of life. It functions as a precursor to NAD, an enzymatic co-factor in hundreds of metabolic pathways. Niacin is called a vitamin because the body can only synthesize it slowly and therefore requires a small but adequate amount from the diet. The reason that we cannot synthesize adequate amounts of niacin can be traced back to evolutionary pressure. Over millions of years, niacin was readily available from plant- and animal-based foods, so our bodies have evolved to rely on this dietary source.  However, larger amounts of niacin than the minimum required by the body are helpful because they allow our metabolic pathways to function at full speed for optimal health and to prevent disease. Some individuals are dependent upon high levels of niacin for health because of their genetic background or because of severe stress. For these individuals, much higher doses of niacin than the minimum dose can prevent and reverse disease. And for the rest of us, high doses of niacin are beneficial — and even necessary — for many aspects of health.

This new expanded edition nearly doubles the original Niacin: The Real Story, (from 228 to now 490 pages). It has several new chapters and appendices and more than 600 references to document recent advances in scientific knowledge about niacin. Several chapters focus on the different forms of the molecule niacin, how it works, safety of niacin supplements, and how to take niacin supplements. Other chapters describe how niacin can help to prevent and reverse a variety of diseases and other conditions, including arthritis, ADHD, many forms of mental illness, cardiovascular disease, aging, alcoholism, Alzheimer’s, cancer, cholera, Huntingdon’s disease, migraine, multiple sclerosis, nephritis (kidney inflammation), Parkinsonism, PTSD, Raynaud’s disease, and a variety of skin conditions. There is a special chapter focused on the recent COVID-19 pandemic: how niacin can help the body recover from infection and reduce the risk of “Long COVID.”

A major focus of the book is how niacin supplements, along with adequate doses of all the other essential nutrients (vitamins and minerals) and a healthy diet that avoids sugar and processed foods, can prevent and even reverse a variety of diseases. This orthomolecular theme is developed in the chapter “Pandeficiency Disease.” This theme is based on avoiding deficiencies of vitamins and minerals that contribute to a wide variety of conditions. Some vitamins are needed only in small milligram or microgram daily doses, but others such as vitamin C and niacin are needed in much higher doses, depending on the body’s state of stress, inflammation, and disease. The optimal dose varies with the individual and the state of inflammation and disease because biochemical stress in the body can deplete vitamin and cause deficiencies — which in turn can cause many different types of disease.

The book contains several interesting and significant new sections and chapters. The chapter entitled “Reversing Arthritis with Niacinamide” has been expanded, now including some of Dr. Kaufman’s notes and a memoir written up as his final unpublished paper. Niacin: The Real Story is the only book in print to present Kaufman’s own case notes and niacinamide protocol details. In these new sections, Dr. Kaufman documents his discovery of niacin and niacinamide treatments during his medical education, along with his observations of the nutritional deficiencies in the typical diet that caused pellagra (caused by a severe deficiency of niacin) and that also tended to cause osteoarthritis.

Many of the patients in the early years of his practice in the 1940s were referred by other physicians who wanted to get rid of their most complaining and difficult patients. At the time, the only treatments for arthritis were aspirin, hot paraffin dips, or heat treatment of joints. With his careful observations of symptomatology, Kaufman realized that most had a niacin deficiency — and these symptoms are summarized in detail. He explains that he soon found that most of these patients had a deficiency of niacin in their diets — proven by rapid improvement after niacinamide treatment. He reported that he treated all his patients with kindness, respect, and adequate doses of niacinamide — and soon after starting niacinamide treatment with up to 2000 mg or more per day, taken in divided doses, the patients “became easy to take care of medically” and had “astonishing improvements in their health.” Kaufman took their complaints seriously and found that a niacin deficiency was independent of family income. Well-to-do families could afford a nutritionally good diet, even if they did not do so.

Although by 1940 enriched flour was fortified with thiamine, niacin, riboflavin and iron, Kaufman realized that for most individuals, the doses of these essential nutrients from foods made with enriched flour were inadequate. So his treatment with adequate doses of niacinamide became more widely appreciated and soon his practice was full. Patients recovered with a “high degree of wellness and maintained this as long as they continued taking niacinamide.”

The new section on Erectile Dysfunction may interest many readers. Adequate doses of niacin taken long-term can help to prevent atherosclerosis, hyperlipidemia, and related coronary disease, and it also is a vasodilator. Because niacin (but not niacinamide) normalizes blood lipids, its long-term circulatory benefits may facilitate a male’s erection. While the vasodilation produced by niacin is not as long as produced by ED drugs, the niacin flush typically lasts about half an hour.  But since niacin also helps to improve mood and possibly sexual interest, generally the sense of calmness from a goodly dose of niacin may tend to diminish passion. In a related topic, adequate doses of niacin and the consequential flush that dilates blood vessels have been employed by people to ameliorate Raynaud’s syndrome (cold hands and feet due to reduced blood flow).

There are several new Appendices, including “An Interview with Abram Hoffer, MD, PhD.” Hoffer, a brilliant doctor and scientist, explains that he successfully treated thousands of schizophrenia patients with niacin. He also had excellent success treating depression, and showed that niacin lowered total cholesterol. Hoffer then explains that niacin is not dangerous or toxic at tolerable doses, and that adequate doses of vitamins (in particular, niacin) produce a recovery rate of 90 percent in schizophrenics.

Niacin is a vitamin, not a drug. Each individual may require a different daily dose. Dr. Hoffer says: “A person’s upper limit is that amount which causes nausea, and, if not reduced, vomiting. The dose should never be allowed to remain at this upper limit. The usual dose range is up to 3,000 mg daily, divided into three doses, but occasionally some patients may need more. The toxic dose for dogs is about 5,000 milligrams per 2.2 pounds (1 kilogram) body weight. We do not know the toxic dose for humans since niacin has never killed anyone.” But what about that “niacin flush”? “Most people flush when they first start taking high doses and gradually get adapted to it, unless they stop for a few days and then resume. A few cannot ever get used to it and take no-flush niacin. The intensity of the flush is variable. Generally the people who need it the most flush the least. That includes arthritics, schizophrenics, and elderly people with cardiovascular disease. Some schizophrenics do not flush until they get well — and then they do. But the presence of the flush or its intensity can not be uniquely used measure the need as there are too many variables such as food in the stomach, whether the drink with it is hot or cold, the kind of food, other medication. Antipsychotics reduce the intensity of the flush as do aspirin and antihistamines.”

In this revised edition of Niacin: The Real Story, authors Hoffer, Foster, and Saul clearly present the practical details of niacin treatment. Inevitable physician skepticism, and questions about niacin’s proven safety and effectiveness, are thoroughly addressed in this book. However, this is NOT a biochemistry textbook — to most of us, that is a relief. But since even a basic working knowledge of niacin can profoundly improve the health of so many patients, this vitamin becomes very interesting very quickly.

The book provides vitamin dose protocols and a chapter on safety of niacin, to assist you in learning the proper doses along with supplements of other vitamins and minerals. It explains that by taking niacin at appropriate daily doses, you can prevent and reverse osteoarthritis (the most common form), elevated cholesterol and cardiovascular disease, and several types of mental illness including schizophrenia. You can determine the correct dose by starting at a very low dose, 20 mg (milligrams) per day, and then gradually increasing the dose over several weeks up to 1000 mg/day or more in divided doses. The skin flush that comes with taking a large niacin dose gradually disappears over several weeks. The flush can be avoided by replacing the niacin dose with niacinamide — but this doesn’t help to correct high cholesterol as does niacin.