Psychosis, Schizophrenia, and Nutritional Therapy - Dr. Andrew Saul
Spooky: that's psychosis. Jim, a young man aged 21, was brought in to me by his Mom and Dad. They looked uncomfortable, and he looked miserable. Jim was a diagnosed schizophrenic. He was so violent that he had been - get this - kicked out of the State Hospital and sent home to his parents. You've got to love that logic.
Jim had been unmanageable, of course. He threatened his parents' lives on a daily basis and was punching holes in the walls. He slept one hour per night, and roamed the city streets the other seven or eight. Jim is one of the premier reasons to not be out too late yourself. His face was scaly and severely broken out with acne. His dietary and digestive habits were appalling, and he was, to quote Far Side cartoonist Gary Larson, just plain nuts.
I faced this unhappy trio and felt helpless. The good part of it all was that they'd caught Jim on a good day (as far as I could see) and he wasn't going to tear up the place. From somewhere I recalled the three D's of pellagra, that "extinct" niacin deficiency disease: dermatitis, dementia, and diarrhea. It was a reasonably close textbook match to the walking, talking Jim in front of me. I was also aware of the work of Abram Hoffer, MD, a Canadian psychiatrist. Since the early 1950's, Dr. Hoffer had cured a vast number of psychotic patients with megadoses of niacin and vitamin C. The success of such vitamin treatments had earned him a quack's label too, of course.
But three feet away from me was a psycho with two terrified parents. Medical science had not helped him, and had, ironically, discharged him in the face of its own impotence.
I told them about Dr. Hoffer's approach.
"We'll try anything," the father said, and the mother nodded energetically.
"Jim, how about you?" I asked.
"Yeah, I'll take the stuff," Jim said.
"I'll settle for that. Dr. Hoffer would have you take about, oh, three thousand milligrams of niacin a day, and you'll want to take about 10,000 milligrams of vitamin C daily as well."
"Why?" everybody asked at once.
"Niacin deficiency actually causes psychosis, as well as the skin and GI problems that Jim happens to be experiencing. He may just need more niacin than the average person. Probably a lot more. At really large doses, niacin has a profound calming, sedating effect. Yet it is not a drug, but a nutrient. The safety margin is huge. Hoffer has prescribed as much as 20,000 milligrams a day. He says that something in the vicinity of 40,000 to 200,000 milligrams a day is toxic. 3,000 milligrams is actually not a particularly high dose... to Dr. Hoffer."
"And the vitamin C?" the father asked.
"Niacin's side effects, such as possible elevation in liver enzyme test numbers, are minimized when you take at least the same gram amount as the niacin," I answered. "As an added precaution, I think you should take even more C than that. Linus Pauling, Ph.D. thinks that 10,000 milligrams for a man is just an everyday dose. Per human body weight, it is the same amount that a goat, cow, mouse, dog or cat would make each day. Why would nature have these animals make that much for nothing? I think we should copy their example. These vitamins, at worst, are much less risky than any of the prescriptions Jim's ever tried, at their best."
"But none of those drugs helped him at all," said his mother.
"All the more reason to give this a try," the father answered, beating me to the reply. "It can't be worse than it is now."
Jim was silent and looked at his sneakers.
"How will we know if that's enough niacin?" his mother asked.
"If he behaves better, it's enough" I said. "If he takes too much niacin, he'll flush. That means his skin will get pink, or even red, especially the face, ears and forearms. Sort of like a half-hour hot flash. You'll feel like you have a sunburn, Jim."
"That's OK with me. I like to be out on the beach or something," Jim said.
They left, and I wondered how they managed to get this far.
About two weeks later, Jim's father called for a follow up conference.
"Let me tell you what happened," he began. "You know Jim only sleeps maybe an hour a night? Well, the first night on the niacin, he slept 18 hours. He's been sleeping about 7 hours a night since."
"That's terrific," I said.
"That's not all," he said. "Last Friday morning, for the first time in I don't know how many years, Jim came down for breakfast. He walked into the dining room and said 'Good morning, Dad.'"
Even on the phone I could hear the tears in the man's voice. It was wonderful.
And niacin is cheap, non-prescription and easy to monitor: if you flush, you took too much. No flush and no psychosis means you did it right.
How can this be? The therapy is too simple. And cheap. And 65 years old.
There's more. Weeks later, Jim came in alone for an appointment. We sat down, and he told me that the niacin had worked, and that he'd stopped taking it.
"But why?" I asked. "It was helping you!"
"Yeah. Yeah. But I sort of like my sickness," Jim said.
I tried not to show my shock. This was over 30 years ago, and I hadn't yet learned that some psychotics simply prefer the psychotic state. As they get well, they may back away from the cure in favor of the disease.
Jim continued: "Whenever I get too far gone, though, I, uh, soak in a hot bath for a while and down a bottle of niacin. Then I feel fine."
A whole bottle of niacin? I thought. That is literally what he said; I remember the line like it was this morning. But it did work.
Here's the footnote: when a raving, dangerous patient can manage his illness and actually select the degree of psychosis he wants in his life, you have something unlike your standard idea of "cure." You have educated and empowered a person to take responsibility for his life. And with the freedom that includes, you can get odd results.
So how many psychiatrists does it take to change a light bulb?
One, but the light bulb has to really want to change.
It must be weird to look down from heaven at a mankind that has free will. It would be like watching a slot machine play itself. Shrinks are breaking ranks. Some are continuing to say that the emotionally ill just need someone to talk to, to understand them and reason with them. Others want to drug patients into oblivion. In general, modern psychiatry has moved away from the Freudian couch and closer to Huxley's Brave New World. Prozac, Paxil, Thorazine, and what have you are our non-fictional "soma," the mind-settling, mood-elevating wonder drugs that make psychoanalysis seem like the slow boat to China. Odd, really, that with a medical mood favoring medication over analysis, that Abram Hoffer's niacin protocol is so unappreciated. After all, if "a gram is better than a damn," why not use grams of vitamins?
The fundamental bias in both medicine and dietetics rises darkly from the swamp when you even hint of a therapeutic validity for megavitamin doses. Doctors and dietitians are far more likely to agree that patients should sit under a pine tree with their backs against the trunk, a Native American anti-depressant technique that does in fact work. Mention megavitamin dosages of vitamins for treating mental disorders, though, and you'd think you'd asked for NIH money to reanimate roadkill.
Why such resistance to such a useful nutritional tool? Perhaps because niacin therapy is really, really cheap?
Niacin, or vitamin B-3 has three common, over-the-counter forms: niacin, inositol hexaniacinate, and niacinamide. All three are water soluble and stable, white powders. Your body may obtain niacin from metabolizing the essential amino acid tryptophan, found in protein. (60 milligrams of tryptophan yields about 1 mg niacin). Tryptophan and niacin are therefore somewhat interchangeable, as a sleep aid, for instance and also as a sedative.
"Pellagra" is the classic niacin deficiency disease. It was once common in the rural South where the poor had little else to eat except tryptophan-poor foods like milled corn. The symptoms are the "Three D's": diarrhea, dermatitis, and dementia. More specific pellagra symptoms include weakness, anorexia, lassitude, indigestion, skin eruptions, skin scaling, neuritis, nervous system destruction, confusion, apathy, disorientation, and insanity.
Does this sound a bit like schizophrenia to you?
A few physicians thought so, too. In studying mental illness, tryptophan and niacin deficits, and pellagra, some doctors noticed that psychotics and other mentally ill persons frequently have assorted pellagra-like symptoms in addition to their nervous problems. From about 1900 to the mid 1930's, perhaps up to half of persons in psychiatric hospitals had pellagra. It makes one wonder: could many forms of mental illness actually be caused by a deficiency of niacin?
In the 1950's, an insightful young psychiatrist named Abram Hoffer began clinical trials to find out. He used very high doses of niacin, with very good results. But the success, convenience and relentless advertising of later (c. 1960) "wonder drugs" diminished niacin's popularity. Then, the American Psychiatric Association unscientifically trashed megavitamin therapy in the early 1970's. So now we have growing legions of nutritionally challenged, mentally-malnourished Americans who don't know, or care, that they are... because they are happily (and legally, and profitably) drugged into mood-altered la-la land! It is disquieting to see the Rolling Stones as prophets, yet an arsenal of "Mother's Little Helper" psychotropic pharmaceuticals are used by millions daily, even while doctors and dieticians condemn megavitamin therapeutics.
The many negative side effects and dangers of these drugs are now restoring interest in niacin. Even the new somas du jour, Paxil and Prozac, have serious failings. A quick read in the Physicians' Desk Reference (or PDR, available at any library) will illustrate this.
Some additional and interesting therapeutic uses of niacin include Meniere's syndrome (ringing in the ears plus nausea) and high-tone deafness. In long term therapy, improvement was obtained with only 150-250 mg daily (Bicknell and Prescott, The Vitamins in Medicine, 3rd ed., p 379).
Resistance to X-radiation was greatly improved at around 500-600 mg daily. Nausea was also reduced. Supplemental niacin could therefore be of much value for cancer patients undergoing radiation therapy. Even healing after surgical shock and other trauma including burns, hemorrhage and infection is more rapid with niacin administration.
Common sense caution: Niacin in almost any therapeutic dose will usually cause a flush. Like a hot flash, this warm (or even very warm), itchy feeling will pass. Some people enjoy the flush; some do not like it one little bit. Inositol hexaniacinate seldom causes a flush. Niacinamide virtually never causes a flush.
Niacin toxicity does exist, but is rare. Dr. Hoffer found that even 40,000 mg daily is not toxic but estimated that over 200,000 mg/day is fatal. The most psychotic person you are ever likely to meet could probably not hold more than 10,000 mg/day, and most of us would never exceed 1,000 mg daily. Medical physicians frequently give patients 2,000 to 5,000 milligrams of niacin to lower serum cholesterol. The safety margin is large. There is not even one death from niacin per year. Check CDC or AAPCC Poison Control Center statistics, the Merck Manual, and the PDR and see. Side effects of niacin therapy include flushing, skin itching, and, upon large overdose, nausea. Such symptoms vary with dose, the body's need, and volume of food, water, or soluble fiber consumed.
Dr. Hoffer has said that what side effects there may be with really high doses of niacin are largely offset by taking large doses of vitamin C. Hoffer has his patients take at least as much C as niacin. I have found that more C works even better. Side effects tend to be a significant problem primarily in people with a history of alcohol abuse.
It is a lack of niacin that is the real public health problem. The US RDA is less than 20 mg, and bodily need for niacin varies with activity, body size and illness. About half of all Americans will not get even that much from their diets. Niacin's special importance is indicated in that the US RDA for niacin is twenty or more times higher than the RDA for other B-vitamins, and that's just for everyday, healthy people.
Dr. Hoffer gave far higher doses, and it worked. I copied him with Jim, and that worked as much as Jim wanted it to.
Two very important books to continue your knowledge of niacin therapy are Dr. Hoffer's Orthomolecular Medicine for Everyone, and Dr. Hoffer's final book, Niacin: The Real Story. I would go so far as to advise reading everything Dr. Hoffer has ever written.