dedicated to dr.abram hoffer


The prevalence of arthritis is increasing in both Canada and the United States. In the former country, for example, it rose from 12.7 percent in the period 1994-1995 to 19 percent in 2000-2001. It is typically more common in both females and the elderly. At age 15-24 only 2 percent of the Canadian population has arthritis, but this figure rises steadily with maturity to 4.7 percent at age 25-34, 8.8 percent in those aged 35-44, 17 percent in those between 45-54, 29.8 percent in 55-64 years old, and 39.9 percent at ages 65-74. In the elderly, that is those 75 years older or more, this figure reaches 47.5 percent. Almost half the Canadian population older than 75 years, then, has arthritis, and this illness is the third most common cause of disability in the country, costing some $4.8 billion each year. Arthritis is even more of a problem in the United States, where its prevalence is roughly 35 percent. By age 18-44, 19 percent of the American population has arthritis; this figure rises to 42.1 percent at ages 45-64, while more than half, 58.8 percent, of Americans 65 or over suffer from the ailment. Arthritis cost the USA $82 billion in 2001.

In 1954, a 67-year-old woman was not well. She described her health problems: an inability to see from her left eye, painful arthritis in her hands, tiredness, and generally feeling unwell. Hoffer “knew” that these were all old age changes and that there was nothing anyone could do about it. However, he also “knew” that one should offer some hope; that is offer a placebo if nothing else. By this time he had several years experience with niacin and niacinamide, had taken them himself and knew they were safe. He also felt that the initial flushing would give greater credibility to the placebo and could not do her any harm.

At his urging, she agreed to take 1 gram of niacin three times daily after meals. About one month later, she wrote that she was very much better, could see again, that the arthritis was leaving her hands and “those little bumps on her finger joints (Heberden’s nodes) were going away”. Hoffer was delighted but “knew” that none of this could be true as Heberden’s nodes never went away, and that there was no treatment for old age and its associated changes. But when she was seen again she was very much better. Her mind was clear and the arthritic nodes were flattening out and not as prominent. She remained on high dose niacin until she died in 1975 at age 88.

Bill Kaufman2 was the first to report that niacinamide in large doses, starting from 250 milligrams taken four times daily, was useful in reversing the changes normally associated with old age. His primary interest was in reversing arthritic symptoms, but he observed significant associated improvement in other functions. Kaufman wrote, “Ever since 1943 I have tried to call my work on niacinamide to the attention of leading hematologists, nutritionists and gerontologists through conversations with them, by sending them copies of my monograph and paper on this subject and by two talks given on the usefulness of niacinamide and other vitamins which I gave at International Gerontological Congresses in 1951 and 1954. I think two factors have made it difficult for doctors to accept the concept that continuous therapy with large doses of niacinamide could cause improvement to joint dysfunction and give other benefits; (a) the advent of cortisone and (b) the fact that my use of the vitamins was such a departure from the recommended daily allowance for vitamins by the National Research Council”.

Dr. Hoffer then prepared a brief report of his work supported by the results of six cases3. One patient with osteoarthritis became normal, another with rheumatoid arthritis became much better, two arthritis cases became normal, one patient with both schizophrenia and arthritis became completely well, while the last, who suffered from vascular nodulitis, was much improved.

Since then many patients with arthritis have recovered or become much better when they took vitamin B-3. A most dramatic case came for help in a wheelchair, pushed by her very tired and sick-looking husband. She was sitting on her legs crossed over as she could not extend them. She had been sick for the previous 20 years and had had every known treatment for arthritis including hormones and gold injections. Nothing had helped. Her hands were totally useless and she was crippled. Her husband had to carry her around the house, even to the bathroom. He provided her with the equivalent care of four nurses, around the clock. No wonder he was totally exhausted and sick. Hoffer “knew” she could not be helped, since such very chronic deteriorated arthritis cases generally did not do well. She said to her doctor, “I know that you cannot help my arthritis, but the pain in my back is terrible. All I want is some relief from it”. He started her on a vitamin program of which the main constituent was niacin, but he did not really expect to see much improvement. She returned a month later in her wheelchair, again being pushed by her husband. This time, however, she was sitting in her chair with her feet dangling straight down. Her husband looked relaxed and had lost his dreadful sick look. She immediately said “THE PAIN IS GONE”. She was so much better that Hoffer began to think that maybe, with skillful surgery, some function might be restored to her hands.

Six months later she telephoned. She called about her husband who had a cold. She was able to get around in her home with her wheelchair. She wanted some advice about how to help him. This woman died several years later, having achieved her goal of a pain free existence.

A November 1999 Nutrition Science article by Dan Lukaczer4 ND reported, “A few years ago, Wayne Jonas from the NIH Office of Alternative Medicine in Bethesda, Md., conducted a 12-week, double-blind, placebo-controlled study of 72 patients to assess the validity of Kaufman’s earlier observations that niacin was of great benefit to the elderly, reducing arthritis. Jonas reported that niacinamide at 3 g/day reduced overall disease severity by 29 percent, inflammation by 22 percent and use of anti-inflammatory medication by 13 percent.” Patients in the placebo group either had no improvement or worsened.

Although these may be considered only modest changes, Kaufman noted that improvement among his patients started after four to twelve weeks – the time at which Jonas’ study stopped. He also found that people might continue to improve for up to a year before they plateau. Jonas’ recent study identified no significant side effects, but to be safe, those who opt for long-term niacinamide therapy should have their liver enzymes periodically assessed by a doctor. Dan Lukaczer ND, the author of the article in Nutrition Science, is the director of clinical services at the Functional Medicine Research Center, a division of HealthComm International Inc., in Gig Harbor, Washington.

1 Kaufman W (1943): Common Forms of Niacinamide Deficiency Disease: Aniacin Amidosis. Yale University Press, New Haven. Conn.

2 Kaufman W (1949): The Common Form of Joint Dysfunction: Its Incidence and Treatment. EL Hildreth and Co, Brattleboro, Conn.

3 Hoffer A: Treatment of Arthritis by Nicotinic Acid and Nicotinamide. Can Med Ass J 1959;81: 235-238.

4 Jonas WB, Rapoza CP, & Blair WF. The Effect of Niacinamide on Osteoarthritis: A Pilot Study. Inflamm Res; 1996;45:330-4.