- Research done in 455 individuals with osteoarthritis
- Niacinamide eliminated or significantly reduced osteoarthritis pain in the large majority of individuals
- Niacinamide can prevent joint replacement surgery
- Why cigarette smoking also prevents joint replacement surgery
Sometime in the 1980s (don’t remember exactly when) a 74-year-old man (we’ll call him Joe) came to Tahoma Clinic bringing copies of X-rays of his knees. He walked slowly with a cane, putting almost all his weight on one knee. He told me he’d been told that his only option was knee joint replacement surgery. We looked at his X-rays together; he said the orthopedic surgeon he’d consulted remarked that they showed “bone-on-bone” on one side, and “almost bone-on-bone” on the other. I couldn’t argue with that.
He’d refused to take any prescription painkillers or even aspirin—which, the naturopathic doctor his mother consulted “only when really necessary” had told him, was an unnatural (and of course patentable) derivative of white willow bark. White willow bark has been used for thousands of years to relieve pain. Even though he had taken increasingly large doses of white willow bark over the past few years, he’d done what the naturopath had told him—he had always taken it with food and never on an empty stomach, so he did not have any gastrointestinal irritation.
But during the last year, even the large doses of white willow bark “weren’t doing the job.” Observing his pain, his wife persuaded him to see the orthopedic surgeon, who checked his knees, had the X-rays taken, and told him his only choice was knee replacement surgery. However, he’d never had any surgery, “not my tonsils or appendix or anything else,” and was at Tahoma Clinic as a last resort just in case there was a more natural alternative. He had no other health problems, he said.
His health history showed that except for the knee problem, he’d indeed had very few health problems. He credited his mother with that, telling me that because of “the way she’d lived and raised us,” she’d had very few health problems in her entire life and “she’s still going strong at 94.” He’d continued to follow all of her health recommendations: “eat right, exercise, get a good night’s sleep, see only naturopathic doctors, and never ever take any drugs unless you’d die without them.”
He told me his younger brother had “taken a different path” after leaving home. He said his brother ate Twinkies and doughnuts a lot, didn’t eat very many vegetables at all, and had become a chain smoker. He also drank alcohol regularly—but wasn’t an alcoholic—and didn’t exercise much. Joe’s brother went to “regular doctors” who had him taking statins for high cholesterol, other patent medicines to lower blood pressure. “But one thing he doesn’t have is arthritis in his knees,” Joe remarked.
After finishing Joe’s health history and doing a physical exam, it was apparent that other than the condition of his knees, Joe’s health was indeed quite good, especially for age 74. After hearing that, Joe looked disappointed, and asked if that meant there was nothing else to do except surgery. So I told him about Dr. William Kaufman, who in the 1940s thoroughly researched and proved a safe, effective remedy for osteoarthritis pain. This remedy also improved joint mobility significantly.
His first observations concerning joint pain were made at a time when the large majority of Americans ate large quantities of processed, canned, and refined foods, purely white flour, and large quantities of sugar. Many people were so low in one or another essential nutrient that even a very small amount could make an observable difference within an hour or less.
In 1943 Dr. Kaufman published a book[i] describing the mental and physical effects of a single vitamin deficiency—niacinamide, one form of vitamin B3—in 150 patients he had seen within the prior year. In a 1998 interview,[ii] he described some of them:
Any patient I gave niacinamide had to sit in my office for at least an hour, so I could observe what happened. My first observations were made in the days before bread and other white flour products were “enriched” . . . so I really got a chance to observe the difference that niacinamide could make, starting from a position of real deficiency or semi-deficiency.
There are many more details in my 1943 book, but let’s cover a few. Within 2½ to 5 minutes after taking the first 100 milligrams of niacinamide there was a degree of physical and mental relaxation which became marked in the next 20 minutes. The first objective change, apparent within the first 5 minutes, is the relaxation of previously tense muscles, and the replacement of a drawn facial expression by a more calm one, or even a smile. Without suggestion, patients began to sit, walk and stand more erectly. Within the first 5 to 10 minutes, the color of the hands and feet might change from a sallow yellow to a healthy pinkish or ruddy color, and the hands and feet are frequently subjectively and objectively warmer. There are many more changes detailed in that book.
Chapter 3 of this book is titled “The Arthritis of Aniacinamidosis.” In it, he describes improvements in arthritic pain and mobility experienced by these patients using relatively small doses of niacinamide. These observations inspired him to do a much larger and exacting study of niacinamide’s effects on arthritis. Quoting Dr. Kaufman again: “In 1944, looking for objective data, I started precise measurement of the ranges of joint motion of every patient who had obvious arthritis, at the time of their first examination.”
He designed exacting measurement of twenty joints or groups of joints that could be observed and recorded in five minutes on a specially designed form. Dr. Kaufman’s 1949 book describes the results of this study in 455 patients with significant osteoarthritis. He explained that the changes in range-of-motion measurements were very necessary as they were objective measurements, and unlike changes in pain could not be criticized as being placebo effects.
All 455 individuals had significantly less arthritis pain, and all had significant improvements in range of motion of their joints. Dr. Kaufman explained that improvement started after three to four weeks of niacinamide use, and were maximized in three to four months. He also reported that taking higher quantities of niacinamide and taking them every few hours worked best. Although all arthritic joints could experience relief, knees, and shoulders responded best and most often, followed by neck, and then wrists and fingers.
From repeated physical examinations, Dr. Kaufman observed that continuous use of niacinamide significantly reduced swelling in connective tissue and cartilage. Laboratory testing of the “sedimentation rate” (a test still used frequently by physicians in 2016) demonstrated a significant reduction in inflammation.
He’d also observed that it was more effective if the same total daily dose of niacinamide was split into three or four smaller quantities. As Dr. Kaufamn’s research progressed, he gradually increased the overall daily amounts to be used and found that more niacinamide was more effective.
Of course, Joe heard from me only a summary version of the research findings above. But after hearing that niacinamide was most effective for knees, he looked more optimistic, rapidly asking several questions: “Where do I get that niacinamide? Is it the same as niacin? How much do I take? Is it expensive? Can it hurt anything?”
Fortunately for us, if we take more niacinamide than our bodies want to process, our livers send us a signal: nausea! At first, it’s usually just a low-grade nausea, like being on a boat and starting to be seasick. If we stop the niacinamide entirely until the nausea is gone—at most a few hours to twenty-four hours—and then resume at a lower amount, we can cautiously find what the maximum dose is for us.
Niacinamide and niacin are very similar, so they’re both called vitamin B3, but their effects can be quite different. Niacin dilates blood vessels quite markedly for some of us, making us hot all over, and sometimes itchy too! Niacinamide never does this. Niacin can lower cholesterol, but too much for any one person can raise blood sugar without giving any symptoms. Niacinamide never does that either. Niacinamide controls osteroarthritis pain, often completely. Niacin doesn’t do that.
A usually effective quantity for both men and women is a total of three grams (3,000 milligrams) daily, perhaps one gram three times daily. A few individuals have taken a total of four grams daily and reported better results. Niacinamide is available in five hundred, one thousand, and in a time-release form of fifteen hundred milligrams, which makes it easier for some—mostly men—to remember. But at the time Joe was first at Tahoma Clinic, no time-release form was available, so he chose to use one gram three times daily, which is rarely associated with nausea and is often enough to be quite effective.
Niacinamide in the “regular” (not time-release) form is available at all natural food stores, compounding pharmacies, and the Tahoma Clinic Dispensary. It’s very inexpensive (Joe was really happy to hear that, as he said his funds were very limited.) The time-release form available now costs more, but still isn’t at all expensive, and is for many more convenient.
Dr. Kaufman’s second book[iii] was published in 1949. Even though he was a 1938 graduate of the University of Michigan Medical School, none of us who attended that medical school—starting in 1965, and escaping (sometimes called “graduating”) with an MD degree in 1969—were informed about Dr. Kaufman, his research, or his book, in either classes or in our work with patients. In 1997, I asked Dr. Kaufman about that. Here’s his answer:
In my medical school years, we were drilled in great detail about vitamin deficiency disorders during our lectures in internal medicine, pediatrics, public health, neurology, psychiatry, and pathology. But after synthetic vitamins became available to treat florid deficiency diseases, not teaching about nutrition and vitamins became a national trend.
I’m not surprised they didn’t refer to my books. The reviews of my 1943 book were dismissive, because the “experts” couldn’t believe that the larger amounts of niacinamide I used in therapy improved joint mobility, muscle strength, maximal muscle working capacity, and mental functioning.
Fortunately, Dr. Kaufman’s book had “come my way” in 1976, three years after starting Tahoma Clinic. By the time Joe came in, over a hundred people I’d seen with degrees of osteoarthritis varying from mild to severe had proven to me what Dr. Kaufman had already proven in the 1940s.
Back to Joe. He didn’t return to Tahoma Clinic for over six months. He walked normally through the hallway to my office, no cane, no limp. He smiled and said, “Sorry I didn’t come back sooner; like I mentioned, finances, and Tahoma Clinic doesn’t take Medicare or insurance.”
I apologized for that, answering that at Tahoma Clinic we work only for the individuals who consult with us, and not for any “third party,” because our job is to do the best we can for each individual, not follow “standards of care” dictated by an insurance company or government agency which had never, ever worked with that individual. Joe smiled again, saying, “Just teasing you, doc. I’m very familiar with the old saying, ‘He who pays the piper calls the tune!’”
He reported what I’d mentioned might happen: he didn’t feel much less joint pain until the third week after he started the niacinamide at the rate of one thousand milligrams, three times a day. That third week he noticed a little improvement; by the third month the pain was nearly gone, and from the fourth month until now he’d had no pain. The fifth month he’d been back to the doctor who recommended surgery. “He takes Medicare and insurance,” Joe said, smiling a big smile again, letting me know he was teasing.
“He couldn’t believe it,” Joe said. “No cane, no pain, I was walking like normal! He insisted on taking more X-rays and when he saw them, he shook his head and told be this couldn’t be happening—my ‘bad knee’ was still ‘bone-on-bone.’ He asked me what I’d done; I told him, and he just walked out of the room, shaking his head.”
Joe had previously mentioned his brother’s health, so I asked him about him again. Joe said the doctor had told his brother he might be developing type 2 diabetes. “He’s taking the same drugs as before,” Joe said. “Apparently they haven’t cured his basic problem. I keep telling him about diet and exercise and the right supplements being able to prevent type 2 diabetes and lower blood pressure and cholesterol all at the same time because they all have the same cause—which isn’t a lack of drugs! But all he does is keep telling me he doesn’t have bad knees!”
Joe never returned to Tahoma Clinic. In the late 1990s, one of Joe’s children who was seeing me about bioidentical hormone treatment told me that he had died at age 87, “walking normally until the very end.”
A large majority of those who use niacinamide for osteoarthritis—most usually the one-gram-three-times-a-day” amount, although a few use more—that large majority achieve complete control of the pain after three to four months. A small minority has only partial relief. As documented so well by Dr. Kaufman, everyone achieves significantly greater range of motion. Joint replacement surgery is usually avoided.
One thing I couldn’t tell Joe was why—with all of his other health problems—Joe’s brother didn’t also suffer from osteoarthritis. Research reported in 2007,[iv] 2008,[v] 2009,[vi] 2010,[vii] and 2012[viii] all reported that osteoarthritis is a component of metabolic syndrome, the immediate precursor of type 2 diabetes. So how did Joe’s brother escape this fate?
By smoking cigarettes containing tobacco! Not kidding! But how could tobacco actually be good for anything? A little background first. In the early 20th century, when the cause of pellagra was discovered to be complete or nearly complete deficiency of vitamin B3, the biochemical structure of the two different forms of vitamin B3 was also being determined. The two were found to be so similar to nicotine (the addictive component of tobacco) that in the United Kingdom the two molecules were named “nicotinic acid” and “nicotinamide,” and are still called that today.
In these United States, “regulators” decided that these names were unacceptable. The excuse was that many of us would think we could get our vitamin B3 by smoking cigarettes! Apparently these “regulators” thought that Americans were not as smart as citizens of the United Kingdom, who all learned—and still know—the difference. So in these United States, nicotinic acid was renamed niacin, and nicotinamide was renamed niacinamide, and both are closely related to nicotine.
But how does that explain why Joe’s brother didn’t develop osteoarthritis? In 2011, researchers reported[ix] that in 11,388 men, those who had smoked cigarettes for forty-eight years or longer were 42% to 51% less likely to undergo total joint replacement than men who had never smoked. In 2013, the same research team reported about total joint replacement in 54,288 men and women. They wrote, “Compared to non-smokers, male and female smokers were respectively 40% and 30% less likely to undergo a total joint replacement.” They concluded—as they did in the first research report—that further investigation should be done about how smoking tobacco cuts the risk of osteoarthritis and consequent joint replacement surgery.
I could be wrong, but the answer seems obvious: there’s enough structural similarity between the nicotine and nicotinamide (same as niacinamide) molecules to explain the effect of both in significantly reducing joint replacement surgery. But please don’t start smoking if joint replacement surgery has been recommended for you! Lung cancer, emphysema, COPD, or higher risk of heart attack, anyone?
Lastly: remember that osteoarthritis has now been identified as part of metabolic syndrome (which proceeds to type 2 diabetes). As this article is very long already, we’ll save for another time reviews of the benefits of vitamin B3 for individuals with type 2 diabetes.
[i] William Kaufman, MD. The Common Form of Niacin Amide Deficiency Disease: Aniacinamidosis. Bridgeport (CT): Yale University Press, 1943.
[ii] 1997 interview of William Kaufman, Ph.D, MD, on the topic of niacinamide and osteoarthritis, http://www.tahomaclinic.com.[iii]Willian Kaufman, Ph.D, MD. The Common Form of Joint Dysfunction: Its’ Incidence and Treatment. E.L. Hildreth & Company, Brattleboro, Vermont 1949 [iv]Korochina IE, Bagirova GG. [“Metabolic syndrome and a course of osteoarthrosis”]. Ter Arkh. 2007;79(10):13-20. [Article in Russian] [v]Korochina IE. [“Determination of C-peptide, serum insulin, and characteristics of tissue insulin resistance in patients with osteoarthrosis”]. Klin Lab Diagn. 2008 Jul;(7):18-22. [Article in Russian] [vi]Puenpatom RA, Victor TW. “Increased prevalence of metabolic syndrome in individuals with osteoarthritis: an analysis of NHANES III data.” Postgrad Med. 2009 Nov;121(6):9-20. [vii]Velasquez MT, Katz JD. “Osteoarthritis: another component of metabolic syndrome?” Metab Syndr Relat Disord. 2010 Aug;8(4):295-305.
[viii] Zhuo Q. et al. “Metabolic syndrome meets osteoarthritis.” Nat Rev Rheumatol 2012 Dec 8(12): 729-37[ix]Mnatzaganian G et al. “Smoking, body weight, physical exercise, and risk of lower limb total joint replacement in a population-based cohort of men.” Arthr Rheumatism 2011 Aug; 63(8):2523-2530