Case Study: Homocysteine, B12, and folate

Homocysteine is an amino acid that occurs in the body as an intermediate in the metabolism of methionine and cysteine. Folic acid is a vitamin of the B complex, found especially in leafy green vegetables, liver and kidney. (Both these definitions are from the New Oxford American Dictionary on my MacBook.) Folic acid is B9, and folate is a salt of folic acid, but the two names are used interchangeably.

Homocysteine is normally broken down and recycled so that it doesn’t accumulate. This relies on sufficient amounts of vitamins B12, B6 and B9 being available to facilitate this process. Homocysteine, abbreviated Hcy, is a highly inflammatory substance associated with much higher risks of cardiovascular events. Research (AHJ 2004) has shown that rHcy causes endothelial dysfunction and damage, accelerates thrombin formation, inhibits native thrombolysis, promotes lipid peroxidation through free radicle formation and induces vascular smooth muscle proliferation and monocyte chemotaxis. 

Naturally, we should strive to keep Hcy levels in our blood as low as possible. There is no healthy minimum for it. In other words, the lower the better. And conversely, the higher its concentration, the worse off you are in terms of the potential for damage to the arteries and cardiovascular events. For a detailed look at Hcy in relation to vascular disease, read this article by Dr Neville Wilson, (thanks Ivor Cummins).

Last week I explained something about Hcy, B12, and folate to my son who was getting ready to go back to university for his second year (studying Philosophy and Modern History at St-Andrews). Afterwards, I thought it would be useful to share this with you, and I started working on this post.

This story is drawn from my own personal history. It is a case study with me as the primary subject using data I have collected from regular blood tests over these last seven years. However, I also use data from both my mother’s and my son’s blood test results that happen to be critical for understanding my own blood test results. Below, I describe the whole story and analysis of the data in detail. If you are not interested in the details, the punchline is this:

If your homocysteine levels are high, you should supplement with B12 and fully active folate in order to ensure the body has what it needs to process it. Some people lack the enzyme needed to activate the folic acid we get from food. This prevents the body from breaking down homocysteine that consequently accumulates in the blood.  This is a genetically transmitted trait, which I think I have inherited and transmitted to my son. Because of it, we must supplement with activated folate to ensure breakdown of Hcy.


The first time I read about Hcy was many years in Anthony Colpo’s book The Great Cholesterol ConThe subject was discussed towards the end of the book in a short chapter, but I was left with a strong impression. Colpo emphasized that Hcy—unlike cholesterol—was a good predictor for heart disease. And it wasn’t just good: it was one of the best. But this wasn’t the only reason it made such an impression on me.

I read Colpo’s book after reading Uffe Ranvnskov’s Fat and Cholesterol are Good for You, and Malcom Kendrik’s The Great Cholesterol Con, both of which were about fat, cholesterol and heart disease, but neither of which discussed homocysteine. Then I read Gary Taubes’s Good Calories, Bad Calories, and again, Hcy wasn’t given the share of attention it seemed to deserve based on Colpo’s comments. If you’re new here, or if you need a refresher, you should read But what about cholesterol and At the heart of heart disease.

The first time I got my Hcy levels checked was on August 27 in 2012. The result was 18.3 micromol per litre. On the results, the reference range was 5 to 15; moderately elevated was 15 to 30; and elevated was indicated as anything greater than 30 micromol per litre. Beside the middle range, it was written vitamin deficiency in parentheses. But it wasn’t written what vitamin deficiency would cause elevated Hcy. The doctor from whom I had requested the test didn’t know either. (As you might have experienced for yourself, most MDs don’t really know much when it comes to blood test results.)


I had already started supplementing with B12 by that time. Most of us, as vegetarians, quickly and usually angrily dismiss nutritional advice or warnings of potential problems from deficiencies that non-vegetarians love to offer when they find out we don’t eat meat. We usually interpret these as justifications of their feelings of guilt for not being vegetarians themselves. At least I know I did when I was vegetarian. Although most people who do give their unsolicited advice are rarely knowledgeable in the subject matter, I now know that I was dead wrong about my quick dismissal of several things in relation to dangerous deficiencies that come about when we eliminate meat and animal products from our diet. Vitamin B12 is surely the best example.

It was after reading this article on B12 by Mercola that I came to realize how disastrous were the consequences of living with low levels of B12, and in my case, how disastrous were the consequences of having been vegetarian for 20 years. I started supplementing right away, and got my first B12 blood test a few months later in 2010 on September 8. The result was 271 pg/ml. According to the lab who did the test, this was within range. But I knew it wasn’t. I knew this was much too low, and that I desperately needed to correct this as fast as possible, stop and hopefully reverse the neurological degradation associated with my long-standing B12 deficiency.

In that article was also underlined the connection between low B12 and high Hcy levels. It read: Cardiovascular and cerebrovascular diseases have a common risk factor – increased homocysteine levels in blood. Studies show insufficient amounts of folic acid and vitamin B12 can elevate your homocysteine levels, potentially increasing your risk for heart disease and stroke. So, of course I was worried. I was also angry at myself for having been so stupid and stubborn all these years… these 20 long years. But at least I now knew what I had to do: I needed to boost B12 levels and keep them high.

And I did. Look at how my B12 levels evolved over 7 years:


Blood B12 levels measured over seven years since September 2010.


Does seeing this make you wonder how the Hcy levels evolved? My expectation was that Hcy would drop as B12 rose. With some time delay of course, but still: as B12 levels increased, homocysteine concentration would decrease. Here is what happened:


Blood homocysteine levels measured over five years since August 2012.

Not so obvious to interpret, right?

Let’s look at all the tests in which both B12 and Hcy were measured, and plot them one against the other. It’s called a correlation plot, and this is what we find:


Homocysteine plotted against B12. Data point numbe labels show chronological order of tests.

So, there clearly is an inverse relationship between levels of Hcy and B12. There is no doubt in this. But at least for me, it’s not very tight. The correlation coefficient and the uncertainty on it quantify this relationship.

The coefficient can have any value between -1.0 and 1.0: a value of 1.0 signifies perfect correlation; a value of -1.0 signified perfect anti-correlation; and a value of 0 signifies that there is no correlation at all. The uncertainty on the coefficient quantifies how well the coefficient is determined from the data points, and therefore how loosely or tightly they are spread around the overall trend in the data set.

A coefficient of -0.66, as we found, tells us that there is indeed an anti-correlation in the relationship between Hcy and B12 concentrations. The uncertainty of 0.22 tells us that the correlation is not so tight. And when we look at two time series above, we see that although B12  has been above 600 pg/ml since 2014, Hcy levels remained more or less flat until the end of 2016.

My initial interpretation was that because I had been B12 deficient for basically 20 years, correcting that long-standing deficiency, and repairing the damage caused by it to the body and in particular to the nervous system, required maintaining consistently high levels of B12 for a long time, allowing the body the time needed to repair itself: two decades of B12 deficiency could obviously not be corrected in a few months. Maybe it was only after these 7 years of intensive B12 supplementation that the positive results were beginning to manifest themselves in this way.

And by intensive, I mean pretty serious. I started taking oral supplements of 2000 mcg per day; then transitioned to patches which are more effective because the B12 is absorbed directly through the skin without having to go through the digestive system; and finally moved on in early 2015 to monthly intramuscular injections of 5000 mcg of methycobalamin. Nevertheless, Hcy remained pretty much the same, even after months of injections. What was going on? Why wasn’t Hcy dropping?


Maybe you are thinking that there might be another way we could use to check how much influence B12 levels have on Hcy? Well, I have something I think is quite remarkable to share with you.

At the very end of July 2014, I brought my mother to a specialized blood analysis clinic, and ordered the complete set of tests listed on my essential blood test reference sheet. The results came back a few days later: her B12 was at 292 pg/ml; her folic acid was at 11.6 ng/ml; and her Hcy was at 30.5 micromol/l. She was 82 and, just for the record, it was the first time in her life that her B12 and Hcy levels had been measured in a blood test.

I immediately got a friend of hers and ex-nurse to give her methylcobalamin injections a couple of times a week. Five weeks later in early September we repeated the test for homocysteine. The result was 9.5!

My 82 year old mother’s homocysteine levels went from 30.5 to 9.5 micromol/l in 5 weeks following 10 injections of 1 mg doses of methylcobalamin B12.

She was out of the red. At least on that front. Hcy of 9.5 micromol/l is still moderately elevated when we consider that we would ideally have none. But 30.5 was dangerously high. This, to my mind, is strongly indicative of the crucial importance and immediate effect of vitamin B12 on homocysteine metabolism.

It wasn’t a tightly controlled experiment where everything was kept the same except the one variable under investigation, which in this case would have been the B12 injections. It wasn’t, because my mother did also at the same time adopt a new dietary regimen, following an alkalizing, very low carb, low protein, high fat, intermittent fasting cleansing protocol I had designed for her, that also included quite a number of other supplements. All were food supplements: vitamins A-D-K2, niacinamide, co-enzyme Q10 as ubiquinol, phospholipids as sunflower lecithin, omega-3s as krill oil, turmeric extract, tulsi extract, chlorella and spirulina, magnesium, zinc, iodine, etc.

Certainly it is true that everything influences everything else, but there’s no question in my mind that as far as homocysteine was concerned, the most important element in this protocol was the intramuscular injection of methylcobalamin approximately every three days. There is also no question that achieving such a drop in Hcy levels at such an advanced age and in so little time is nothing short of amazing.

The point of my retelling of this was to present direct evidence of the strength of the relationship between B12 levels and Hcy concentration. I think it does. Obviously, you are to draw your own conclusions.


Coming back to my case, in the fall of 2013 I stumbled upon The Complete Blood Test Blueprint in which Joseph Williams, a knowledgeable, experienced, and kind MD, was interviewed by Kevin Gianni, the host of Renegade Health, in a series of interviews that covered a large number of blood tests in great detail. I learned a lot things listening to Dr Williams. Admittedly, I was disappointed by the lipid panel discussion, and in particular by the discussion of cholesterol and lipoproteins. But putting this aside, I was generally very impressed.

Dr Williams talked about B12 deficiency at length, but I was already well versed in the subject by that time. I had recently read the book Could it be B12?, made detailed notes of it, and then posted for you B12: your life depends on it. Dr Williams also talked about Hcy. In that discussion was mention of the fact that in addition to B12 (cobalamin), B6 (pyridoxine) and particularly B9 (folic acid) were also essential for breaking down Hcy. I didn’t really think much of it, simply because my diet was and always had been rich in leafy greens, which naturally ensured a high intake of folic acid.

A few years and several blood tests later, I listened to the interviews again. And this time, something caught my attention in the part on homocysteine that hadn’t the first time: it was mentioned, in passing towards the end of the discussion, that some genetically predisposed people lacked the enzymes needed to activate folic acid; and that these people therefore needed to supplement with the already active form of B9 called tetrahydrofolic acid.

It caught my attention because by that time I had several measurements of Hcy that, even with my continued and even intensified B12 supplementation, were not showing evidence of going down. Remember: I started injections in early 2015. But there was something else that made this comment stand out for me: my son’s recent blood test results.


In July 2016 I brought my son to get a complete blood test that comprised all the markers I usually test for, together with all the major hormones, in order to have a baseline for him in his prime. It is certainly true that we can talk about optimal levels for each of the hormones we know and can test for. But our own personal ideal hormonal profile is unique to us. And the best time to get a baseline is when we are 18 years old: full grown adults at our youngest.

Laurent’s B12 was 578 pg/ml, his folic acid was 23 ng/ml, and his Hcy was 10.9 micromol/l. At 18, having had no major health issues, no accidents or serious diseases, a remarkably healthful fresh, green, organic, low carb, high fat diet of unprocessed whole foods for most of his life, I thought that this slightly elevated Hcy could be due to one of three things: either his body was still B12 deficient and just slowly building up its B12 stores, even though the three of us had all started with supplementation and patches at the same time; he was one of these people Dr Williams had made reference to who lacked the enzyme to activate folate, and therefore couldn’t effectively break down Hcy; or both.

I immediately ordered activated folate for us, and we started taking it in August 2016. If you take a look at the second plot that shows my Hcy levels as a function of time, you can see that it was just around 18 micromol/l at the end of July. And half a year later, towards the end of 2016, my Hcy level was the lowest it had ever been. Obviously, I was very happy to see this major improvement in achieving a drop in Hcy, something I had been trying to do for so many years. Therefore, also obviously, I continued taking activated folate. As you can see from the next two data points in 2017, Hcy was measured at 10 and then 8 micromol/l. We haven’t made another blood test to check Laurent’s levels. We’ll do that around Christmas at the end of this year when he comes back for the holidays.

Can we see how strong the relation between folate and Hcy actually is? We can plot the measurements we have one against the other like we did above for B12 and Hcy. What we find is this:


Homocysteine plotted against folate. Data point number labels show chronological order of tests. Arrows mark upper limits.

The relationship is very clear and linear. But I have to admit that I have cheated your eye a little bit. The measurements of folic acid are capped at 24: any value above that is simply reported as greater than 24. This was the case in tests (4), (8), (9), and (10). I show this with little arrows pointing towards higher values. Because the last three measurements were so close together in time, for the sake of clarity in the plot, I placed them at 25, 26 and 27, inversely proportional to the Hcy level. This is why they appear to follow the line. Otherwise, they would be at on the left edge of the arrows, one on top of the other, aligned with point (4), all at 24 on the x-axis. Note that I also plotted my son’s results (labelled as such), adding a data point at (23, 11).


What can we conclude from this investigation? Well, it isn’t totally clear cut and straight forward. I admit. But let’s review the facts:

For me:

  • I was 38 years old at the time of my first B12 test.
  • My B12 levels were low for 20 years: 270 pg/ml when first tested after few months of supplementation.
  • My Hcy levels were high at 18 micromol/l about two years after starting B12 supplementation.
  • B12 is necessary to break down Hcy.
  • It took me 3 years of oral and patch B12 supplementation to reach 600 pg/ml.
  • In early 2015 I started monthly B12 injections.
  • Only after almost 2 years of injections did my Hcy levels drop below 10 micromol/l.
  • But this precipitous drop in Hcy was concurrent with the start of supplementation with activated folate.

For my mother:

  • She was 82 years old at the time of her first B12 test.
  • Her Hcy levels were very high at 30 micromol/l.
  • Her B12 levels were low for who knows how long: 292 pg/ml when first tested.
  • She received approximately 10 injections of 1 mg in five weeks.
  • Her homocysteine levels dropped from 30 to 9.5 micromol/l.

For my son:

  • He was 18 years old at the time of his first B12 test.
  • His homocysteine levels were moderately high at 11 micromol/l.
  • His B12 levels were 578 pg/ml.

In addition to this, we have the plots above that show inverse relationships both between Hcy and B12, and between Hcy and folic acid. From this, there are at least three very clear conclusions we can draw:

  1. Low levels of B12 are associated with high levels of homocysteine,
  2. Higher levels of b12 are associated with lower levels of homocysteine, and
  3. Raising B12 levels leads to a decrease in homocysteine concentration.

At this stage and with the data we currently have, going further is more speculative. But here is what I think:

  1. I am one of these people that lacks the enzymes to activate folic acid.
  2. I might have inherited this trait from my mother or from my dad (considering how well she responded to intensive B12 therapy), and it was probably transmitted to my son.
  3. I was B12 deficient, and correcting this deficiency didn’t lower my Hcy levels.
  4. It was only when I started taking activated folate supplements that Hcy levels dropped quickly and significantly.

The reason I think this comes from two lines of reasoning. The first is that, as I just mentioned, it is only when I started taking activated folate that my Hcy levels dropped below 10 for the first time in seven years since the start of B12 supplementation.

The second is that even though both my mother and I were definitely B12 deficient, both probably for a long time, and that this would necessarily have led to an accumulation of Hcy in the blood that would have been greater in her case than in mine due to her age; my son was only 18 years old, and could not have been B12 deficient, at least not for almost 10 years. Nevertheless his Hcy levels were moderately elevated.

This is what I told him the other day. It took me only 5 minutes to tell him; it has taken me a lot longer to write this post. But I think the details are important if we are to understand things well. And by this I mean know what we understand, and know what we do not understand; know what conclusions we can make, and know what is hypothesis or speculation.

It’s not possible to be sure at this stage. We need more data and more experiments. But it’s not easy to gather such data, just because it takes a long time and strong commitments to be consistent with a supplementation programme over months and often years. If you have similar data and are willing to share, I would be happy to take a look at them.

Data like these trace and reveal so much about what’s happening inside our body, below the skin, far deeper than our eyes can see. But we can only begin to understand these measurements and the processes that drive their evolution by spending the time to look at them in detail. This is what we did here together. I hope you found it interesting.

Do you know what are your blood levels of homocysteine, B12, and folate? If not, you better get that checked out.

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Want to lose weight? Here’s what you need to know in under 1000 words

One, you don’t want to lose weight: you want to lose fat. You don’t want to lose muscle or bone because they are very important functionally and metabolically. What you want to lose is fat. So weight loss needs to be reworded as fat loss.

Two, roughly speaking, the body is generally either storing surpluses or using reserves.

Three, the major fuels for the body are glucose and fatty acids.

Four, for the body to use fat reserves, insulin levels must be low. Fat cannot be efficiently utilized as long as insulin is high, because insulin promotes storage.

Five, the thyroid gland regulates metabolism and brain function. It requires adequate amounts of iodine without which it cannot work properly. To ensure healthy metabolic function, iodine supplementation is critical.

That’s what you need to know. If you want more details, I can expand a bit.

Insulin regulates fat storage

Every second that we are alive, trillions of biochemical reactions take place. The energy currency is adenosine triphosphate, ATP. Mitochondria produce ATP primarily using glucose or fatty acids. Fatty acids produces a lot more, but glucose is much easier to use. Both are used but one always dominates. In general, if there is glucose to be used, fatty acids are not much. For fat loss, we want to promote fat burning for ATP production to fuel cellular activity.

High glucose levels from carbohydrate intake trigger insulin secretion. This is necessary to bring the glucose into the cell, and to get rid of it from the bloodstream where it causes damage to the tissues by glycation. Within the cell, glucose can be either fermented without oxygen or oxidised with oxygen. Lower oxygen levels (and very high short term metabolic needs) promote fermentation. Higher oxygen levels (and lower metabolic ATP production rates) favour oxidation. More fermentation leads to greater accumulation of lactic acid, which further decreases oxygen levels. Red blood cells do not have mitochondria and therefore can only produce ATP by fermenting glucose.

Lower glucose leads to lower insulin. This triggers the release of fatty acids and glycogen into the bloodstream. If sustained, low glucose leads to the production in the liver of ketones primarily to fuel the brain whose cells can either use glucose, ketones, or medium chain fatty acids because longer molecules cannot pass the blood-brain barrier.

The higher the glucose, the higher the insulin, and the faster the uptake and storage of nutrients from the bloodstream into cells. The lower the glucose, the lower the insulin, and the faster the stored fat can be released and used.


Amount of glucose stored as fat and amount of fat released from fat cells as a function of insulin concentration. Plot taken from

The most metabolically active tissue is muscle. The more muscle we have, the more energy is used, and the faster both glucose and fat are burned to supply fuel to the cells. The more we use our muscles, and the more intensely we use them, the more they grow, and the more efficiently they burn both glucose and fat. Also, the stronger the muscles, the stronger and denser the bones will be. This is very important.

Therefore, as we burn more fat, we burn fat more efficiently. As we use our muscles more intensely, we burn more fat. And as we build more and stronger muscle, we burn even more fat even more efficiently, and make the bones stronger.

Different Carbohydrate Intolerance Levels

These mechanisms are universal in animals, but each animal is different, and each person is different. As far as fat loss is concerned, the individuality of people is related to their predispositions to insulin resistance and carbohydrate tolerance, (or actually, intolerance). Every person is differently intolerant to carbohydrates and differently predisposed to insulin resistance.

This is why in a group eating the same diet, there are people who are thin, people who are chubby, people who are fat, and everything in between. Basically, the greater the predisposition to insulin resistance (and the more sedentary), the lower the tolerance to carbohydrates will be, and the fatter you will tend to get. In contrast, the lower the predisposition to insulin resistance (and the more active), the higher the tolerance to carbohydrates, and the thinner you will tend to be.

This translates into different thresholds in the amount of carbohydrate we can eat without negative metabolic consequences, and consequently, the amount under which we must stay in order to burn fat instead of storing it. As a guideline, if you want to burn primarily fat for your body’s energy needs, this threshold would be around 20–25 grams per day if you are fat; around 30–50 gram per day if you are neither fat nor thin, and could be around 80–100 grams per day if you are very thin.

But no matter what your personal threshold happens to be, it will always be the case that the lower the intake of carbohydrates, the lower the glucose and insulin will be, and the more efficiently your body will burn fat as fuel.

Fat Loss Rate

The amount of fat that is burned is determined by the energy balance. The greater the total amount of energy we use, the greater the total energy needs. Total energy needs will mostly be met by energy from food intake and energy from fat reserves. If food energy intake is high, the need for stored energy will be low. If intake is lower, the need for energy from fat reserves will be higher.

Pushing this to the limit—maximal usage of fat stores—we would provide the protein necessary to maintain muscle and other active tissues and nothing more. In this situation, basically all energy needs would be supplied by stored fat reserves and glycogen when needed. This is greatly enhanced by resistance training.

The amount of protein needed is proportional to muscle mass and muscular activity. As a guideline, you can use 1–1.5 grams per kg of lean mass per day in the case of little physical activity, and 2–3 g/kg/d in the case of high muscular activity levels. Excessive protein is not great, but more is almost always better than less.

Fat burning and protein synthesis can be further optimised by intermittent fasting. Extending the time between feedings allows glucose and insulin to drop lower, which increases the rate of fat burning. And by eating fewer but larger amounts of protein in a meal is better because protein synthesis increases in proportion to the amount consumed.

Thyroid function regulates metabolism. Iodine is used in every cell, but in the thyroid, it is concentrated to more than 100 times the average of other tissues, because iodine is the main structural component of thyroid hormones. Iodine supplementation is critical because most soils are highly depleted. It is water soluble and very safe to supplement with.


  • High insulin from carbohydrate intake promotes fat storage.
  • Low insulin from restricting carbohydrates promotes fat loss.
  • Individual predispositions determine the threshold of carbohydrate tolerance.
  • Below this threshold fat is used as the main source of cellular fuel.
  • The rate of fat loss depends on balance between energy needs and energy intake.
  • Maximal fat loss rates are achieved by supplying just the protein needed to sustain lean tissues.
  • Iodine supplementation is critical to healthy thyroid, metabolic and brain function.

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A simple 10-step arthritis treatment plan

What are the most important things we can do to stop and reverse the degeneration, and alleviate the stiffness and pain of arthritis? You can be sure that no matter how bad things are, there are many things that will help, and they don’t involve pharmaceuticals.

We looked in some detail at how to treat arthritis in Treating Arthritis I and II, and have at least one of our readers, an artist, Catherine Bath, who has been able to alleviate a great deal of her stiffness and pain, and recover a good amount of mobility and ease of movement by following the various recommendations we made there and throughout this blog.

Here, prompted by a request from a good friend who needs it, we present a simple treatment plan with the most important elements, and just the essential details needed to understand why the interventions are useful, and how to put them into practice right away.


Illustration of painful, inflamed, arthritic joints. (Image taken from Everyday Health)

1. Hydrate and alkalise

This is the most important point of all. Without it nothing will work, really. Every joint works thanks to the cartilage that allows the bones to move within it without rubbing against one another. Arthritis is always characterised by the degradation of this cartilage and the pain associated with the inflammation caused by the bones not moving properly or rubbing inside the joints. Cartilage is water (85% by weight) held together in a matrix made mostly of collagen, and chronic dehydration is the first cause of cartilage breakdown (details in Your Body’s Many Cries for Water).

Metabolic acids (mostly uric acid) can only be excreted efficiently by the kidneys when there is an excess of both water in which to dilute the acid, and salt to help carry it out in the urine. Without excess water, the kidneys will prioritise retaining as much of it as they can. Without excess salt, the uric acid will be recycled instead of being excreted in order to to maintain the concentration gradient in the medulla of the kidney that ensures its ability to reabsorb as much water as possible. Chronic dehydration and avoidance of salt, coupled with the drinking of acidic liquids and eating of acid-forming foods inevitably leads to chronic acidosis.

To maintain the pH of the blood at 7.365 in spite of the continuous flow of acids into it from the muscles and digestive system, two main coping strategies are available: 1) The body’s main acid buffering mechanism using the reserves of alkalising minerals stored in the bones and teeth to counterbalance the acid load. If you don’t quite understand the implication here, this means erosion of the bones and teeth to put into the blood some of the alkalising calcium, phosphate and magnesium as acid-buffering minerals. 2) The crystallisation of the uric acid to pull it out of circulation, but then storing it into tissues, of which the joints, regrettably for arthritis sufferers, seem to be used preferentially, even though all tissues can be used for this to a certain extent.

The strategy is simple: drink alkaline water (either naturally so, or made to be with pH drops) on an empty stomach, and allow at least 30 minutes before eating. Aim for 3 litres per day. One litre before each meal, drank over a period of one to two hours, is a simple rule of thumb and easy schedule to remember. And aim for 2 full teaspoons of unrefined salt with your meals.

2. Magnesium chloride and sodium bicarbonate baths

Magnesium is at the very top of the list of supplements for anyone in any circumstance. We explored and explained why in Why you should start taking magnesium today.

Transdermal magnesium and bicarbonate therapy is the best way to simultaneously replenish magnesium stores in the cells, while alkalising the tissues directly by transdermal absorption of magnesium and sodium bicarbonate. If you have a bath tub, do this once or twice per week, or more if you can or need it. Add two cups of each magnesium chloride and baking soda, and soak for 45 to 60 minutes.

I also recommend that in addition to this—but crucially if you don’t have a bath—you take magnesium supplements. I take a fat-bound magnesium supplement called L-Threonate. Another alternative is the amino acid-bound supplement called magnesium glycinate (using glycine). Both of these form maximise absorption. Take it with meals.

3. Silicic acid, collagen, hyaluronic acid, and proteolytic enzymes

An essential constituent of hair, skin, and cartilage. Absorption is poor and slow. This means you need to take small amounts every day for long periods of time. Every morning, first thing, with your first glass of water. You will need to do this in cycles of three months on, three month off. I take Silicea, a concentrated water-soluble silicic acid gel by the German brand Huebner.

Collagen and hyaluronic acid will help greatly in rebuilding the damaged cartilage. Look for type II collagen for better absorption. Now Foods has good products at good prices. Also, glucosamine, chondroitin, MSM have all been shown to be useful for joints.

Proteolytic enzymes are responsible for breaking down, building, and repairing tissues. They can be amazing in accelerating a healing process, no matter what it is. Therefore, this is an essential supplement to take in treating arthritis.

4. Vitamin D3 and K2

These are the two vitamins that control and regulate the availability and deposition of calcium. Vitamin D3 makes it available, and vitamin K2 directs it to the bones and teeth.  Lots of vitamin D3 without K2 will lead to calcification with calcium being deposited all over the place in the arteries and soft tissues. Lots of K2 without D3 will lead to a depletion of available calcium in the bloodstream because it will be stored away in the bones and teeth. K2 is also used to decalcify soft tissues by pulling out and redirecting the deposited calcium from the tissues to the bones.

Vitamin D deficiency is universal in the west, and so is vitamin K2 deficiency. Arthritis sufferers need large doses of both for extended periods of time (at least a year). I recommend taking a combo supplement containing both in an optimal ratio, and take as many capsules as needed to bring vitamin D intake to 20 000 – 50 000 IU per day with breakfast and lunch. For years I took DaVinci’s ADK combo, which I think is one of the best. Now I take Life Extension’s D and K combo, without vitamin A, because its presence dampens the activity of vitamin D3. However, vitamin A promotes the healing of tissues. You can take both, alternating between the two.

Another of our readers who had his entire adult life an arthritic wrist that caused him pain and trouble whenever he used his hand for anything at all, followed my suggestion of taking 50 000 IU of vitamin D3 per day, together with the appropriate amount of vitamin K2 to match in the D3 intake, for six months. Within the first month, he found incredible improvement, something he had never been able to achieve using all the methods and drugs that had been proposed to him by MDs. After three months, his wrist was completely healed. He continued for the entire 6 months just to be sure, and now, his painful, debilitating, arthritic wrist that he was living with for more than 20 years, is a thing of past, a bad memory.

5. Vitamin C

Whole food vitamin C is essential for healing and keeping tissues and cells healthy. And there is definitely a difference between whole food C and ascorbic acid. We discussed this in Vitamin C is not vitamin C. This is not specific to arthritis, but everyone with arthritis should be loading up on it. I take The Synergy Company’s Pure Radiance C. You should take at least three capsules, but better 6 capsules per day, split evenly with each meal.

6. Turmeric extract

Turmeric is one of if not the most powerful natural anti-inflammatory. And inflammation is a hallmark of arthritis. You should take an extract that concentrates the curcuminoids, but you should also think of making yourself hot turmeric drinks, adding as much turmeric to your soups and curries as the flavours and combinations of foods will allow. It always needs to be taken with a lot of fat to maximise assimilation.

7. Food

Naturally, you will have guessed that my recommendations for food are the same as always, but even more important in this case when we are trying to bring inflammation as low as possible, and maximise healing:

  • no simple or starchy carbs because they cause inflammation, tissue damage, and metabolic disorder, except for berries once in a while;
  • unlimited unprocessed saturated fats from coconut oil, butter, and animal sources;
  • enough high quality protein from healthy animals including organ meats, especially liver; and
  • as many green veggies as you like, especially leafy like spinach, kale and lettuces, watery like cucumbers, fibrous like celery and broccoli.
  • Avocados are fantastic to eat as often as you want. Walnuts and hazelnuts are excellent health-promoting nuts (either roasted, or raw and soaked, subsequently dehydrated or not).

8. Sunshine, fresh Air, exercise and sauna

Go out in the sun, go for long hike, expose your skin, breath deeply, run up the hills, work your muscles at the gym if you can, go to Pilates and yoga classes, do lots of stretching whenever you can, and go to the sauna when you can. Make sure you stay 15 minutes to get really hot and for the heat to penetrate into the tissues and joints.

9. Iodine

Iodine is the universal medicine. Everyone needs it, and everyone should be supplementing with it. You can read for yourself why in Orthoiodosupplementation. Start at 12.5 mg and work your way up to 50 mg per day. Increment by 12.5 mg each week. Take the supplements on weekdays and give the kidneys a break on weekends. I take Iodoral, and recommend that. Using the generic Lugol’s solution is as good but less convenient.

10. Melatonin and good sleep

Good sleep is absolutely essential for repair and healing. Make sure you get plenty every day. Melatonin has, in addition to its effects in helping you sleep, many other amazingly health-promoting effects that we will explore in another article sometime soon, I hope.

Last words

Are there more supplements you can take? Of course there are. I personally take all of the above and several others. I wanted to stick to the things which I believe most essential. If I were to recommend additional supplements, I would say to take

  • omega-3’s, which are useful for lowering inflammation, as well as tissue healing and repair. I take Life Extension’s Mega EPA/DHA. Don’t take more than the recommended dose. Omega-3’s are very easily oxidised, and should always be taken in very small quantities.
  • Niacin in the form of niacinamide is also a universally useful supplement because it provides molecular building blocks needed by every single cell to produce energy. I take 500-1000 mg/day, but you could take 3000 mg (1000 mg with each meal). Niacin supplements will also do wonders for your mood (see No more bipolar disorder?).
  • Ubiquinol, the active form of Co-enzyme Q10, is also essential in cellular energy. I would recommend at least 50 mg per day, but more (like 100 or even 200 mg) would probably be better.
  • Vitamin B12 is crucially important for health. And the older we get, the more critical it becomes. I get an injection of 5 mg every month, and recommend that for everyone (see B12: your life depends on it).

Keep in mind that the timescale for improvements is long: on the scale of months. If you think that is too slow, ask yourself how old you are, and how long it took to get to the state you’re in. Now, with the answers in mind, remind yourself to be patient. You need to be determined to get better, consistent with your new regimen, and patient. But I assure you that you will get better. And please, keep me posted on your progress.

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Eat your salt, and eat your fat

A couple of months ago, I had just gotten to the locker room at the gym, when a buddy of mine came in. Changing into his workout clothes, looking at himself in the mirror with his shirt off, he said he was tired of this layer of fat over his abs, that he just couldn’t get rid of it no matter how much he tried. He’s a handsome Columbian guy in his mid thirties, super nice, friendly, and easy going, big open smile with nice white teeth. He’s well built, strong, with balanced musculature but … there’s not much definition.

Everyone wants to be cut, of course, and when you’re working out 5 or 6 times a week, like he does, and you can’t get cut, you get frustrated by that. Quite understandable. Meanwhile, I work out typically three times, and I’m “rallado” as he says to me. In english, the term is shredded: so lean that under tension, we see the muscles fibres. In my case, we can see them in every muscle, including the abs. He knew that, obviously, since I’ve been like this ever since we first met a year and a half ago. The only thing that’s changed is that I’ve put on some muscle and use heavier weights in my workouts.

And so, naturally, that was my queue:

– You just need to cut the carbs. The fat is going to melt off on its own in no time. Especially if you are working out the way you do. Just stick to meat and vegetables. Make it simple for yourself. Have eggs and avocados for breakfast, and meat and veggies the rest of the time. If you can skip breakfast, that’s even better: you’ll give your body a longer time to burn fat.

– Alright! I’ll try it!

After our workout, we said goodbye, and he told me he was going to Columbia for a while for his work (he’s part of a several-generation, several-family-member meat business based there, but lives here in Madrid with his wife and young child). He said that even though they always serve so rice, pasta, and potatoes with every meal, he would do his best to stick to the plan of having only meat and veggies. I gave him a good handshake, told him he could do it, and that it was important to be strict for the first month to allow for a good transition to fat-burning.

A few weeks later, he came back. We bumped into each other at the gym again. I was doing chest and back, he had come to do shoulders. He looked noticeably different: his face was smaller, his features more defined, his neck was thinner and more visible, his eyes were whiter and his skin was smoother. He looked 5 years younger! As soon as I saw him, I told him he looked very good, thinner in the face and neck, younger, and clearly healthier. He was happy to hear me say it, of course. He said that many people had told him that he looked younger, and obviously, he could also see it himself when he looked in the mirror. But it’s always nice when someone tells us we look good; it doesn’t happen very often. He had already lost 4 kg.

We saw each other a few more times at the gym like that, working out, but it took a while before he told me that he was feeling weak, that he couldn’t push as much weight as before, that he was often tired, and strangely, often in an angry mood. Naturally, he thought it was because he wasn’t eating carbs. That somehow he was carb-deficient.

– Do you add plenty of salt and fat with your meals meat and veggies?

– No! I don’t! I haven’t added salt to food in years. And I don’t add fat either.

– That’s the problem. You need to start right away. Lots of salt, and lots of fat with your food, whenever you eat.

– What kind of salt, and what kind of fat?

– Unrefined sea salt, organic butter and coconut oil, and olive oil with salads. With every meal. When you go low carb, you not only get rid of accumulated water in your tissues due to the chronic inflammation triggered by carbohydrate exposure (that’s why your face and neck thin out in the first week or two), but you also excrete more salt in the urine. It’s crucial to eat plenty of unrefined salt every day.


Organic butter and unrefined salt


Two days later, when I got to the gym, he was already into his workout, and he was pushing heavy weights on the benchpress, he was walking around with a spring in his step, and he was smiling. I didn’t even need to ask, but I did anyway:

– So, how are things going? Lots of salt and fat?

– Yes! And I feel great! I feel strong, I feel powerful, I’m not tired, and I’m not angry anymore.

– Fantastic! Glad to hear that. And from now on, you’ll always feel like this. No ups and downs, no weakness or lack of energy, no hunger pangs, no mood swings.

Each time we saw each other at the gym in the next weeks, I could tell he was getting more defined. The last time we met, he was again walking around feeling strong and working heavy weights with a smile on his face, and he looked ripped, a lot more defined. And he knew it too. I could tell by the self-confidence.

When we parted, I told him he looked good, that he looked more defined, and more energetic. He was happy: “Thanks a lot for all your advice. It’s really made a huge difference. I feel great, and my abs are starting to show!”

Not eating enough salt and not eating enough fat is a classic mistake that too many people do. We have been brainwashed into thinking we should avoid fats and we should avoid salt. So, when we cut the carbs, we continue to avoid fat and avoid salt. Then, we get tired and weak, and we think it’s because we don’t eat carbs. Totally not! We’re just not getting enough salt and fat.

And so, we have to repeat this, and repeat it over and over again. Eventually, it sinks in. Especially when we feel the difference it makes. Just like it happened in this case with my Columbian buddy at the gym. So, what’s the moral of the story?

You want to feel strong, and energetic? You want to look healthy and young? You want to get ripped with tight 6-pack abs? The formula is simple:

Cut the carbs. Fast intermittently. Drink alkaline water on an empty stomach. Work heavy weights 3 times a week. Eat enough protein. Eat your salt. And eat your fat. Try it. You’ll see. It works like a charm.

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Case study: old man can’t walk

Some time ago, a childhood friend of mine sent me this message:

I want to help this man. He has a problem with his tendons in both legs. In the morning, he can’ t stand up. Can you recommend some minerals and vitamins? Maybe some exercises that can help? Your advice is important.


The old man that can’t walk from the pain in his legs.

That’s all he wrote. So, I replied:

How can I give any advice? I don’t know anything about him. I help/treat people with a complete eating and drinking programme. Vitamins and mineral supplements are only used as adjuncts to correct deficiencies. So, before saying anything, I need to know some basic things:

How old is he? What work does he do or did? How long has this problem been developing for? Does he drink water and how much? What does he drink? What does he eat every day? Does he have other complaints? How is his digestion? How is his skin (any rashes or dry skin or eczema)? What kind of other problems has he had in his life? And anything else about this health that could be useful?

Here’s what I got back:

  • How old is he? What work does he do or did?  He’s 81. He was a manager.
  • How long has this problem been developing for?  The problem started when he was around 65. It has gotten much worse in the past 2 years.
  • Does he drink water and how much?  He drinks little water, 0.5 litres a day.
  • What does he eat every day?  He eats meat, potatoes, tomatoes, some cheese, and a lot of bread.
  • Does he have other complaints?  Heart, kidneys.
  • How is his digestion?  He has problems going to the bathroom every day. He goes once every three days.
  • How is his skin (any rashes or dry skin or eczema)? His skin is fine.
His doctor told him to exercise, but he can’t even stand up or move properly.

With this info, I was able to get a better idea, and did my analysis of the situation.  This is what I replied:

Here is my diagnosis:
This man has been chronically dehydrated for most of his life. Being chronically dehydrated is one of the most health-damaging situation we can be in, but because it is not acute, the consequences are manifested over long periods of time. 
The lack of water first leads to a deterioration of the digestive system and digestive function: of the stomach (poor digestion and ulcers), and of the intestines (damaging of the lining, ulcers, and leaky gut), constipation and from it toxins and pathogenic bacteria going back from the colon into the bloodstream. 
Second, it leads to deterioration of the kidneys and the nephrons (little filters in the kidneys), because the only way to get the acids out of the blood is to dilute them in water, but if there is a lack of water, then the kidneys do everything they can to keep this water, because water is more important to keep than to get rid of acid. Therefore, not only do the kidneys get destroyed little by little, but the body accumulates the uric acid everywhere in the soft tissues, starting in the joints, and then in the tendons, ligaments and muscles. This leads to incredible stiffness, pain, and eventually to not being able to move.
Third, because our diet is usually rich in calcium but very poor in magnesium, everyone tends to be over-calcified and to accumulate calcium everywhere in the blood vessels, soft tissues of the joints, and in the muscles. This is made much worse by over-acidification and chronic dehydration. Calcification also leads to stiffness, pain, and eventually, to not being able to move properly.
Therefore, the most important things to do in order or priority are the following:
  1. Drink a lot more water (at least 3 litres per day), on an empty stomach (at least 20 minutes before eating), and making sure it is alkaline water (high pH 9-10).
  2. Take baths with 2 cups (500 g) of sodium bicarbonate and 1 cup of magnesium chloride (or magnesium sulphate). The bicarbonate and magnesium will be absorbed into the body through the skin, and will dissolve uric acid and calcium deposits throughout the body. 
  3. Drink juice of green vegetables to remove acid buildup in the body, and clean out the intestines.
  4. Take supplements of magnesium (the best form is L-Threonate, because it is bound to fat and is 100% absorbed) in order to help remove build-up of calcium.
  5. Take supplements of vitamins A-D-K2 (I recommend DaVinci’s combo supplement because of the high concentration of K2), as these are the most important fat-soluble vitamins, and K2 is the only nutrient that can effectively de-calcify blood vessels and soft tissues.
  6. Take supplements of vitamin C and collagen to help rebuild the cartilage and heal the damaged soft tissues, especially the blood vessels and the joints. It is essential to take whole-food vitamin C, and high quality collagen.
  7. Stop eating sugar, bread, cheese, yogurt, and eat basically very big salads and fatty meats like lamb, veal and porc (only outdoor-living animals).
Good luck, and make sure to let me know how things evolve. If you don’t understand something, just ask.


Three weeks later, I got his note from him:

Today I called the old man’s wife. She told to me that since yesterday he has no pain, and can move his arms and legs a lot better.  He drinks more than 2 litres of water per day, eats and takes the supplements as you prescribed. His grandson translated your message for him. I am very impressed. Thank you so much for you help. Your method works.

It’s a nice feel-good story, isn’t it? Here’s the thing, though. How many millions of people do you think are in the same situation as the one in which this man was? Suffering like he did, for decades growing older, stiffer, less mobile, and in more pain, until the end, which by that point comes as a relief from this difficult and painful life. And from what? Dehydration. Simple dehydration. Long-standing, chronic dehydration.

How much water do you drink each day? What’s the pH of the water you drink? How much salt do you eat each day? How much bread and potatoes do you eat? How is your digestion? How often do you go to the bathroom, and how is the wipe? Such simple things, so crucial to health.
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The Iodine Papers 2 – Orthoiodosupplementation

In this paper, the authors continue their investigation and quantitative assessment of how much iodine is needed for optimal health and function of the whole body. As the title emphasises, the primary aim in this paper is to determine the ideal amount of supplemental iodine in light of the fact that it is difficult to get as much as is needed through diet alone in most of the world.

The major themes are 1) what the authors have termed iodophobia, the widespread but entirely unfounded fear of iodine, which continues to pervade in the mentality of physicians, and consequently, in that of the general population; 2) iodine needed for optimal thyroid health; and 3) iodine needed for extra thyroidal tissues. Because the effects of prolonged iodine deficiency in cells leads to cancer, and because the second-most iodine-dependent tissues are those of the mammary glands of the breasts of females, much of the discussion is concerned with cancer of the thyroid and breasts.

The conclusion is the same as in their first paper: an optimal daily amount of iodine is around 12.5 mg of which 5 mg is in the form of iodine, primarily for the thyroid gland, and 7.5 mg in the form of iodide, primarily for the breasts and other extra-thyroidal tissues.

Orthoiodosupplementation: Iodine sufficiency of the whole human body by Guy E. Abraham, MD, Jorge D. Flechas, MD, and John C. Hakala, RPh


Supplemental iodine for optimal health of thyroid, breasts, skin, and whole body. Long-term average daily iodine intake according to authors should be at least 12.5 mg, and provide both iodine and iodide.

The paper begins with the authors’ motivations, presented clearly in the first two paragraphs. They contrast, on the one hand, that it is known and recognised that iodine is the only element required for and in the synthesis of hormones; that these hormones are involved in embryogenesis, differentiation, cognitive development, growth, metabolism, and regulation of body temperature; that iodine is most concentrated in the thyroid; that iodine is the most deficient trace element in the world with more than one third of the world’s population known to be clearly iodine-deficient; and that low iodine is the world’s leading cause of intellectual deficiency.

Whereas, on the other hand, that optimal amounts of iodine for the human body have never been evaluated nor determined; that supplementation has been considered adequate if it prevented cretinism, simple goitre, and symptoms of hypothyroidism; that it has been assumed that the role of iodine was essentially restricted to the synthesis of T3 and T4, so much so that it has become dogma; and that when thyroid stimulating hormone (TSH) assays became available, iodine urine testing was abandoned as irrelevant, and eventually forgotten to the point where today, most clinical doctors will go through the entire career without ever ordering a urine iodine test.


The fear of iodine, which most likely has its roots in the work of Wolff and Chaikoff (1948), and which we will examine on another occasion, is present and widespread in the literature for all audiences. It is found in the textbooks used in medical schools, in professional journals, in non-technical publications that appear in health magazines, and in books written for the general public by medical professionals. The authors present a number of examples from different sources spanning this range of different kinds of publications intended for different audiences.

They seem to attribute much of the burden for the spread of iodophobia in the US, at least in the last few decades, to one individual, an endocrinologist by the name of Ridha Arem, who was a longtime editor of a professional periodical read by at least 25k endocrinologists throughout the country, and the author of the popular book The thyroid solution: A revolutionary Mind-Body program that will help you, first published in 1999 and currently in its third edition (2017).

In this book, on page 305 of the 1999 edition, Arem writes: “research has clearly established that the high dietary intake iodine content in some areas of the world has resulted in a rise in the prevalence of thyroiditis and thyroid cancer.” A single reference is given in support of this statement: a paper written by Harach & Williams, entitled Thyroid cancer and thyroiditis in the goitre region of Salta Argentina, before and after iodine prophylaxis, and published in 1995 in the journal of Clinical Endocrinology (43:701-6). In this paper, however, no high iodine intake is present or involved in any part of the study.

Harach & Williams (1995) measured urine iodine before and after introduction of iodised salt, and evaluated thyroiditis and thyroid cancer rates. Urine iodine was 9.3 +/- 1.7 mcg/g creatinine before and 110 +/- 13 mcg/g of creatinine after iodisation. There was no change at all in the rates of invasive forms of cancer, and for papillary carcinoma the numbers were 0.78/100k/year before and then 0.84/100k/year after iodisation, which they recognise as insignificant. Not only do these data not support Arem’s claims, but they are not even applicable to an evaluation of the potential effects of high iodine intake. Arem does not provide any other references.

On the same page Arem also writes: “to function normally, the thyroid requires 150 mcg/d … In the US, iodine consumption ranges between 300-700 mcg/d.” No reference is given to support this statement. And this statement is demonstrably false: the National Health and Nutrition Examination Survey, NHANES III (1988-1994), showed that the median iodine in urine was 145 mcg/L, and that at least 15% of US women were markedly deficient, with less than 50 mcg of iodine per litre of urine.

The reason why measuring iodine in urine over 24 hours is a good way to evaluate iodine sufficiency, is because most of it is excreted. If the body’s tissues (thyroid glands, breasts, stomach lining, skin, etc) have all the iodine they need, then we would excrete close to the entirety of the iodine we consume. The greater the discrepancy between ingested and excreted iodine, the greater the deficiency. But because it is water soluble and hard to store, a long time is needed to replenish iodine stores in the tissues. Hence, for this reason, supplementation with larger doses than those needed for optimal maintenance, and extended over many years, are usually needed to restore iodine sufficiency and balance within the body’s most iodine-dependent tissues like the thyroid, breasts, and skin.

In a review paper on iodine ‘excess’ published in 2000 and included in a reference textbook used by endocrinologists in a section entitled Iodine as a pathogen, Roti & Vegenakis the authors report the decline in iodine intake in the US, stating that in 1971-74, it was found that 27.8% of people tested excreted more than 500 mcg/L, whereas in the intervening 15-20 years, this number dropped to 5.3% (1988-1994). Having taken—entirely arbitrarily—500 mcg/L as indicative of excess iodine, the authors present these figures as encouraging and positive in the prevention of iodine ‘excess’, completely ignoring the remarkable discrepancy with the observations of mainland Japanese that show both an iodine intake that is 100 times greater than the US average, and the lowest incidence of goitre and hypothyroidism: figures presented by Finley & Bogardus in 1960, and more recently also in further studies by Thomas et al. in 1983 and 1986.

Moreover, in their review, Roti & Vegenakis note that Amiodarone, a drug commonly used to treat heart arrhythmia, contains 75 mg of iodine per 200 mg tablet (note that this is mg and not mcg), and causes hypothyroidism in 25% of patients that take it. They automatically attributed this to the iodine, but do not investigate the issue further, either by looking at studies on high iodine intakes, or by themselves organising a trial to test this hypothesis, treating arrhythmia using iodine alone without the other pharmaceuticals found in Amiodarone. No such trial has ever been carried out, by the way. Only comparisons between different pharmaceutical drugs.

As a third example of iodophobia and misinformation about iodine in the US, the authors use Dr Shames’s article in the July 2002 issue of Bottom Line Health magazine, and debunk three statements of fundamental significance:

1) Shames writes that iodine deficiency is a thing of the past. However, as mentioned above, NHANES III (1988-1994) found 15% of women to be iodine deficient.

2) Shames writes that iodised salt is sufficient to prevent iodine deficiency. However, iodised salt contains at most 75 mcg of iodine per gram, and since most people eat around 5 g/d, this makes at most 375 mcg/d. This amount may be enough to prevent cretinism and goitre, but to obtain even the bare minimum of 5 mg needed by the thyroid, one would have to eat 65 g of iodised salt per day, which is obviously absurd.

3) Shames writes that people living near coastlines could even be getting too much iodine. However, studies in several countries found no difference in iodine intake between inland and coastal regions.

The unfortunate reality is that all those people who will have read either Arem’s books, Roti & Vegenakis’s reviews, Shames’s articles, or any other published works expressing in similar terms, from a position of authority, statements unsupported by evidence or simply and demonstrably false, will rarely be in a position to question or doubt their validity, and will therefore be left with the entirely unfounded negative predisposition towards iodine transmitted by the authors of these publications.

Iodine for the thyroid gland

The cold war was a period during which the fear of nuclear war, and the subsequent nuclear fallout that would sweep across the region around the explosion was very strong. This fear was shared by most people: parents and grandparents, political leaders and scientists. It was known that the thyroid concentrates iodine: more than 100 times the concentration of other organs and tissues (modern measurements in Delange 2000). It was also known that nuclear fallout would come with a release of large amounts of radioactive iodine in the environment. The nuclear explosion was therefore, in its immediate aftermath, most dangerous for its devastating effects on the thyroid: the thyroid gland would soak up all of that radioiodine, which would destroy it, breaking down its cells from within.

The only way to prevent the thyroid from soaking up all that radioactive iodine from the nuclear fallout would be to fill up the receptors of its cells with normal iodine, and thereby minimise the capture of the radioactive isotopes from the explosion. Because iodine is water soluble and not stored very well, to both provide the thyroid with the iodine it needs and protect it from radioactive iodine in the case of a nuclear accident, one would have to take moderately high amounts of iodine every day, or a very large amount as soon as possible before, during or after exposure, and continue for the early period following the explosion, until the levels of radio iodine contamination have dropped. The iodine receptors in the thyroid, breasts, and other tissues being occupied by normal iodine, the radioactive isotopes would have nowhere to latch on, and would therefore simply be excreted in the urine.

Studies were carried out to determine the amount needed to suppress uptake of radioactive iodine. A defined amount of supplemental iodine would be taken, and then a fixed amount of radioiodine administered. Measuring the amount of radioiodine retained by the thyroid in proportion to the amount administered would give the protection factor associated with the amount of supplemental iodine.

Several groups did such experiments. The results of five groups are presented in Figure 1 below. On the x-axis, we have the amount of iodine in mg consumed per day. On the y-axis, we have the percentage of radioiodine taken up by the thyroid. Naturally, the less iodine is consumed, the higher the percentage of radioiodine retained by the thyroid, and conversely, the more supplemental iodine is taken, the lower the percentage of radioiodine uptake.


Figure 1.  Percentage of radioactive iodine absorption as a function of daily iodine intake. The data are those presented in Table 1 and Figure 1, and the original papers from which they were taken are listed and represented with different symbol. The RDA range is shown by vertical lines at its lower and upper limits of 150 and 290 mcg. The data are presented on a log-log scale. The best fit power-law model is shown as the dashed line, and its parameter values are given.

The greatest protection is conferred by the highest amounts of supplemental iodine, as we can see on the right end of the scale: taking 100 mg/d results in a mere 0.5% uptake, and implies excretion of 99.5% of the radioactive isotope of iodine. At 50 mg/d, uptake is around 1.5%, and excretion around 98.5%. At 20 mg/d, uptake is still below 2% with excretion over 98%, and even at 3 mg/d, uptake is only around 5%, with 95% excretion of the radioactive iodine.

The scale, both on the x-axis and on the y-axis, is logarithmic. This means they have equal spacing in powers of 10. And so, the tick marks between 0.1 and 1 represent steps of 0.1, those between 1 and 10, represent steps of 1, and those between 10 and 100 represent steps of 10 units. The units are mg on the x-axis, and percentage points on the y-axis. A linear relationship (a straight line) in log-log space, as the one we see in this plot, shows to a power-law relation, and power-laws tell us that change is very fast.

In this case, this tells us that increasing iodine intake from nothing to even a little bit, makes a big difference in terms of decreasing the uptake of the radioactive iodine. On the other hand, it also means that as we keep increasing the amount of supplemental iodine, the decrease in uptake becomes less and less significant. Hence, it is very easy to protect the thyroid against nuclear fallout by decreasing uptake of radioiodine from 100% to 20% by taking just 0.7 mg of iodine per day, but to get maximum protection, we need to take 50–100 mg/d. The great news is that we can get full protection, without having to worry about a thing from all this supplemental iodine, because it is basically harmless, and excesses are eliminated.

The authors present these data (together with other data that we don’t discuss here) in a table, and then in a graph, which is logarithmic only in x, but linear in y. Therefore, they interpret the relation—which is clearly linear in log-log space, but not in semi-log space—as showing evidence of four different parts with different slopes and different physiological meanings. I believe the single power-law is both simpler and more natural a model to characterise the relationship between supplemental iodine and radioactive iodine uptake by the thyroid. I therefore skip reporting on the details of their analysis of the slopes and x-axis intercepts and interpretation of their meaning.

In addition, the authors rightly point out that none of these studies were intended to measure the optimal amount of supplemental iodine. They were motivated by providing a framework for crisis management in the event of a nuclear war. Nevertheless, their scientific value in understanding iodine needs for optimal thyroid function is indeed great. Other studies intended on measuring thyroid absorption of iodine are mentioned: those of Thompson et al (1930), Wagner et al. (1961), and Fisher et al (1965), all pointing to a maximal absorption rate of iodine of about 600 mcg/d. This is interesting, but not enough because absorption rate will depend on state of deficiency or sufficiency, and will also evolve as iodine levels are replenished, assuming more iodine is provided than is absorbed. But two other cases stand out.

Plummer, a clinician who treated people suffering from Grave’s disease, a severe form of goitre, hypothesised that the hyperthyroidism associated with this condition was caused by iodine deficiency, and furthermore, that it was this deficiency that also caused such a high post-operative mortality rate. He therefore gave his patients 20-30 drops of Lugol’s solution before and 10 drops after operations—that’s 125-187.5 mg before and 62.5 mg after—and happily saw the mortality rate drop to zero. Of course, this didn’t prove his hypothesis as correct; this is never really possible in science. But it is strong supporting evidence, and did show that it was highly likely to be the case. And given that he knew iodine supplementation was harmless, he also knew that it could only help. He was right, and the benefit to his patients couldn’t have been greater: it was life over death. It was, naturally, an easy decision to make. He knew that, and now, so do we.

Koustras et al (1964) performed extensive studies with meticulous accounting of iodine balance on people to quantify the relationship between the amount ingested and retained over a period of several weeks with daily supplementation. This is what they concluded: “From our evidence, it appears that, from all the doses we used, the thyroid took up about 6-7 mg of iodine before an equilibrium in plasma inorganic iodine was reached.” This seems to be, from several lines of evidence, a good estimate of what the thyroid needs.

Iodine for the mammary glands and other tissues

Having established that the thyroid needs 6-7 mg of iodine per day, the authors need to estimate how much is needed by the rest of the body. Because breast tissue concentrates as much iodine as the thyroid, and because, as reported previously, goitre is six times more—that’s 600% more—common in teenage girls as it is in teenage boys, it is essential to consider iodine needs of the mammary glands. Here are some facts the authors present that are associated with the problem of iodine deficiency in women:

  • Japanese have the world’s highest intake of iodine (14 mg/d from 5 g of seaweed, on average), and the lowest incidence of goitre, hypothyroidism, and breast cancer (Finley & Bogardus 1960; Thomas et al 1983, 1986).
  • There is a strong inverse correlation between iodine intake and cancers of the breasts and ovaries, and a strong positive correlation between thyroid volume and breast cancer incidence: 13 ml in Irish women without versus 20 ml in women with breast cancer (Thomas et al 1983, 1986).
  • There is a strong inverse correlation between free T4 and breast cancer. In 5 different ethic groups from Hawaii, Britain and Japan, the highest levels of free T4 in Japan were associated with the lowest incidence of breast cancer. But T4 therapy doubles incidence of breast cancer. Therefore, it is obviously not T4 that protects against breast cancer in Japanese women, but iodine, which, at the same time, ensures optimal T4 levels. (Ghandrakant, Kapdim & Wolfe 1976; Hinze et al. 1989)
  • The amount of iodine needed to prevent FDB and breast cancer is at least 20-40 times greater than what is needed to prevent goitre (Esquin et al. 1995).
  • Thyroid and skin concentrates iodide; breast concentrate iodine. Both are needed.
  • US intake is about 100 times less than in Japan. In the 1960’s iodine was used as an anti-caking agent in flour, which made the average intake approximately four times greater than it is today. Incidence of breast cancer was then 1 in 20. Iodine in flours was replaced by iodine-displacing bromine. Incidence of breast cancer in 2000 (publication date) reported as 1 in 8.
  • Iodine deficiency is without a doubt just as important a cause of thyroid cancer as it is of breast cancer. In 2001 in the US, there were 19500 new cases of thyroid cancers, and of these, 14900 were in women. That’s 75%. Now, in 2017, estimates are for 56870 new cases of which 42,470 will be in women. That’s still 75%, and it’s also about 400% more cases than 15 years ago.

To determine with the greatest precision where iodine is most concentrated within the tissues of the body, and how much is kept, Berson and Yallow (1954) used traceable radioiodine to determine, in addition to what has already been discussed about iodine being most concentrated in the thyroid, breasts, and skin, that the total exchangeable pool of inorganic iodine ranged from 7 to 13 mg across their study. This means, that besides those most iodine-dependent tissues that trap and concentrate it, the body as a whole uses at least this amount on a daily basis.

Given this large amount used by the whole body, iodine must have several other functions besides protecting the structure and ensuring the proper physiology of the thyroid and breasts. Derry (2001) reviewed iodine’s general properties and benefits to a healthy body. He found that iodine works in organs as an antimicrobial agent, that it has a potent apoptotic function in the body’s surveillance mechanisms against abnormal cells, that it has the ability to trigger differentiation, and that, in addition, iodine has powerful antioxidant properties, which confer it equally powerful protective effects on the DNA of cells, because it enhances the singlet to triplet transition, and because the most damaging reactive oxygen species that damage our DNA and other large molecules are usually singlets.

Naturally, these effects strongly depend on the concentration of the available iodine circulating in the fluids of the body. Using fluid concentration measurements in the work of Szent-Gyorgy (1957), the authors estimate that an average daily intake of 12.5 mg of iodine, which at the same time, they underline, would offer protection from nuclear fallout at the 3-4% level, would also be sufficient to confer all of iodine’s antimicrobial, apoptotic, antioxidant and DNA-protecting effects.


The paper ends with an epilogue where the authors express some difficulties in understanding, in the context of evolution, why humans would have evolved needing so much iodine while recognising how hard it is to obtain as much as is needed. In my opinion, there is no difficulty there from the perspective of evolutionary theory. The first homo sapiens in our lineage, those that developed speech, swept across the world, and came to dominate every last part the planet, in all likelihood evolved on a coastline somewhere in south western Africa eating seafood and seaweed. Many believe that it was their diet, rich in animal foods from the sea that gave them this advantage over other species and even other sub-groups of sapiens scattered here and there on the continent. In fact, it is very likely that it was their iodine-rich diet that conferred to them this evolutionary advantage, which was the intelligence for which sapiens are known.

For most of our evolutionary history, bands of humans would have continued to live near coastlines because of all the obvious advantages this offered. As local and global populations grew, bands would scatter in search of more readily available resources and less competition in their ability to access and use them. Those groups that stayed on the coastlines or in areas where the soil was rich in iodine, became the most successful because they were the most intelligent. Those groups that went further inland or lived in areas where the soil was poor in iodine, grew progressively less intelligent and less successful from one generation to the next.

There is no problem at all with such a scenario, and, in fact, modern observations and data collecting techniques confirm this: areas where iodine deficiency is common, have the highest incidence of hypothyroidism, goitre, breast cancer, thyroid cancer, but also cretinisms and intellectual deficiency. As attested by a joke used in some towns in the goitre belt when someone does or says something stupid: “Are you iodine deficient, or something?”

It wouldn’t at all be surprising if, with sufficiently large data sets, we found a strong and tight correlation between iodine intake and IQ levels within populations from the same genetic pool, but also globally across diverse populations from different gene pools. Many other factors come into play. Nevertheless, iodine during pregnancy and childhood is certainly one of the most important for proper intellectual development.

For us, each with our own particular genetic makeup and recent ancestral evolutionary history, each with our personal and family history, each with our time in our mother’s womb, our childhood and teenage hood upbringing and diet, what this means is that we better make sure we take all the iodine we need to first correct, and then prevent the wide spectrum of problems that iodine deficiency and iodine insufficiency bring about. Might as well maximise our health as well as intellectual potential in this simple way. The costs are insignificant, the risks quasi non-existent, and the potential benefits are tremendous.


This paper is very similar in spirit and purpose to the authors’ first paper. In this second paper, they recall and restate several points they had made in the previous, and extend their detailed investigation of how much iodine is needed for optimal health and function of the whole human body. The main points to remember are that:

  • The fear of iodine is widespread, but wholly unjustified and unfounded.
  • Iodine is most highly concentrated in the thyroid gland.
  • Iodine is essential and crucial for the normal development, and subsequently, normal function of the brain through its action on the thyroid gland.
  • Iodine deficiency is the world’s leading cause of intellectual deficiency.
  • In females, iodine is equally concentrated in the breasts as it is in the thyroid.
  • Iodine deficiency is known to cause cretinism and intellectual deficiency, hypothyroidism and goitre, nervousness, anxiety and restless leg syndrome, fibrocystic breast disease, thyroid cancer, and breast cancer.
  • Iodine deficiency causes goitre in women 6 times more often than in men.
  • Breast cancer now affects 1/8 women. In the 1960’s it affected 1/20.
  • Thyroid cancer rates have quadrupled in 15 years from 2001 to 2016.
  • 75% of thyroid cancer cases are in women.
  • The thyroid gland needs approximately 6 mg of iodine per day.
  • The mammary glands and rest of the body need approximately 6-8 mg per day.
  • The Japanese are the only known population with iodine sufficiency from diet, which provides on average 14 mg of iodine from seaweed.
  • Minimum average requirement for iodine sufficiency is around 12.5 mg/day.
  • As is the case for most micronutrients, some people need more, some less.
  • It will often be necessary to consume a lot more for extended periods in order to overcome and/or reverse the effects of a long-standing insufficiency or deficiency.
  • Maximum protection of the thyroid from nuclear fallout is gotten at 50-100 mg/day.

We will continue this series with an article by the same three authors entitled: Measurement of urinary Iodine Levels by Ion-Selective Electrode: Improved Sensitivity and Specificity by Chromatography on Anion-Exchange Resin.

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No more bipolar disorder?

Our world is replete with diseases of all sorts, illnesses of all kinds, ailments countless in numbers. Modern medicine views these in isolation, and therefore also attempts to treat them in isolation: we have a headache, we take an aspirin; we have high blood sugar, we take insulin injections; we have high cholesterol, we take statin drugs to disrupt the manufacturing of cholesterol in the liver; we have cancer, we are given toxic poisons that kill our cells and hope the cancer will be weakened; we have arthritis or multiple sclerosis, and we are given immune suppressants because it is thought that our own immune system has turned against us, attacking the very body it is intended to protect. We have no idea why, but this is what we do, and this is also what we believe we should be doing.

In psychiatry, we treat so-called mental illnesses. But because we are even more clueless in this realm of the subtle functioning of the brain and mind than we are of the subtle functioning of the body and its organs, we look for drugs that suppress the behaviours which are symptomatic of the “illness” we have been diagnosed with. It’s very simple: we take uppers and stimulants when we are down and low, and downers and sleeping pills when we are high and excited. Because we all do it, we think it’s perfectly normal.

When we take a close look, we see that there are no diseases, no illnesses, no ailments that are not caused by biochemical imbalances, we see that all of our health problems are rooted in problems in the biochemistry, and we see that the functioning of the body and the functioning of the mind cannot be considered independently, because they are both nothing other than the functioning of the whole body-mind.

Surely a most striking example of this is the now almost forgotten disease condition called pellagra. The name comes from the contraction of the Italian pelle (skin) and agra (sour), and was first used by Francesco Frapolli treating people in the 1880’s in Italy where more than 100k suffered from it. But this wasn’t unique to Italy. The same was true in Spain and in France in the late 19th century. In the US, it reached epidemic proportions in the American south where it was estimated that between 1906 and 1940, more than 3m  were affected, and more than 100k actually died from it. Can you image that? That many people, millions of people, in quite a restricted region, walking around in manic states, delusional states, paranoid states, seeing and hearing things, talking or even yelling to themselves and others around them, completely incoherent and, in addition, covered in red, sore, flaking and bleeding skin on the arms, neck, face? What a nightmare it must have been.

In all countries and all cases, pellagra was associated with poor nutrition, and more specifically, associated with corn-based diets in which the maize was not treated with lime in the traditional way. Similarly, in all countries and all cases, it was found that a nutritious diet based on fresh animal foods very quickly resolved the problems that afflicted the sufferers of this disease. So, even in the late nineteenth century, they had figured out how to treat and prevent it. But didn’t know why if they replaced the corn and starches with meats and vegetables people got better.

Pellagra would usually first manifest as skin problems: eczema and psoriasis-like irritations and lesions. Then, it brought about anxiety, depression, irritability and anger. And eventually, periods of full blown mania, visual and auditory hallucinations, extreme fear, paranoia, bipolar and schizophrenic behaviours.


Now, if you know someone, if you have been close to someone diagnosed with bipolar disorder, with schizophrenia, with anxiety disorders, depression, or paranoia, you will immediately recognise in this list of symptoms those you saw in this person, surely to different degrees, and surely in the most extreme during a full blown crisis. Without a doubt, at least for bipolar disorder, these symptoms are all present, often simultaneously, and sometimes in close succession. And do you know what pellagra is? It’s vitamin B3 deficiency.

Yes, pellagra, this terrible disease that caused such awful skin conditions and straight out madness in people, this disease that made these poor people act in ways indistinguishable from those of manic-depressives and schizophrenics, was a simple vitamin B3 deficiency.

When this was understood, niacin fortification was mandated, and the epidemic affecting millions of people in the southern United States was resolved almost instantly. After decades of rampant “mental illness” among so many, so fear, so much anxiety, so much terror within families and communities, so much pain and suffering, and tens of thousands of deaths, a little added niacin ended this national disaster that was the pellagra epidemic almost overnight. The fact that you have most likely never heard of pellagra goes to show how effective niacin fortification has been in preventing it. But something else happened.

Following the introduction of niacin fortification, half the patients held in psychiatric wards were discharged. Just like that, they got better, and went home. There was at least one psychiatrist who noticed this remarkable coincidence: his name was Abram Hoffer. He wondered why so many got better, but also why only a half? What about the other half? Could it be that they just need a little more niacin? Hoffer was an MD, a board-certified psychiatrist, and a biochemistry PhD. He was also the Director of Psychiatric Research for the province of Saskatchewan in Canada, a position he held from 1950, when he was hired and appointed by the department of public health, until 1967, when he opened a private practice.

What he did to check this hypothesis—that maybe more of the psychiatric patients were not mentally ill at all, but just in need of greater amounts of niacin—was to conduct a study. He chose schizophrenics because they are among the most difficult to treat, and also because together with bipolar patients, they have many of the symptoms associated with pellagra. The results were stunning: 80% of the schizophrenics given B3 supplementation recovered. And these results aren’t anecdotal—the word often used in a pejorative or derogatory manner to dismiss important observations or evidence that fall outside the narrow realm of the conventionally accepted. These were the results of the first double-blind placebo-controlled nutrition study in the history of  psychiatry.

What double-blind placebo-controlled means is that he took two equally sized groups of people diagnosed with schizophrenia, and then randomly and blindly, both on the patient’s end as well as on his end, gave half of them 3000 mg of flush-less niacin per day in three doses (niacin has a flushing effect that would be noticed, but either inositol hexanicotinate or niacinamide can be used instead). He gave the other half a placebo, which would have been a pill that looked identical, but contained no niacin or anything else that could have any significant effect on them (like powdered sugar or a starch of some kind). And in the end of the trial, when they looked at which patient got what, they found that 80% of niacin-treated recovered, whereas none in the placebo group showed significant improvements.

Over the years, Hoffer treated thousands of people with remarkable success. With simple vitamin B3 supplementation he continued to successfully treat people suffering from schizophrenia, but also people suffering from attention deficit disorder (ADD), general psychosis, anxiety, depression, obsessive-compulsive disorder (OCD), and bipolar disorder. In fact, he considered pellagra, bipolar disorder, and schizophrenia to be the manifestation of niacin deficiency on different scales, and the sufferers to be niacin-dependent to different extents. Obviously, this is the only natural conclusion he could have drawn given how effectively niacin resolved psychiatric symptoms in these people, but also in light of the fact that each individual seemed to need somewhat different amounts to have these positive effects.

The expression niacin-dependent was used to emphasise that they needed to take it on a daily basis. Naturally, an essential vitamin is not only essential in the sense that it is absolutely needed, but also in the sense that it needs to be consumed regularly because it is not manufactured within the body-mind. Deficiencies develop when the diet lacks in these essential nutrients, and grow more severe as time goes on. When the nutrients are then reintroduced, the deficiencies can be corrected. Some nutrients are abundant, some are rare. Some are easily absorbed, some are not. Some are more easily stored, and some cannot really be stored at all.

In addition, besides the fact that in any given population there is always—for the very same essential nutrient—a range of nutritional needs that vary between individuals based both on their genetic predispositions and on what they do, countless other factors influence and affect the amounts of essential nutrients that each needs to be healthy. These include various kinds of injuries the body-mind, and in particular the gut where absorption of nutrients take place, may have incurred at one point or another from an infection, a virus, a bacteria, a bad diarrhoea we had when we were babies, a childhood disease we don’t even remember, and really anything that could have damaged a specific part of the intestine where a specific family of nutrients are absorbed.

Any such injury could result in a greatly increased need for a particular nutrient that, without knowing about it, could not be supplied in adequate amounts from diet alone, and would inevitably develop into a progressively more severe deficiency whose effects on the body-mind would eventually appear as dysfunctions that would, without a doubt, have physical as well as psychological or psychiatric manifestations. Why? Because there is no body that functions independently of the mind, and there is no mind that functions independently of the body. There is only this single body-mind.

Niacin and B vitamins in general are water-soluble. This means that we pee most of them out, and therefore it also means that we need to have them every day, or nearly, in order to prevent the development of deficiencies. The experience from the last decades of the nineteenth and the first five decades of the twentieth century in Spain, Italy, France, and  in the US, showed that a single vitamin deficiency, a simple niacin deficiency, could cause extreme symptoms that included severe psychiatric dysfunctions. It also showed that even very small amounts of B3 added to the otherwise nutrition-less white bread that was eaten as a staple could cure millions of pellagra sufferers, and prevent the disease from developing in the bulk of the population.

Unexpectedly, niacin-fortification coincided with a large number of the psychiatric ward patients getting well enough to go home. This observation prompted a study with niacin supplementation which showed that in 80% of the schizophrenia patients treated with niacin, symptoms disappeared in the same way they had in pellagra sufferers, but with higher doses of niacin. It was also shown that a similarly high cure rate was seen in people suffering from ADD, psychosis, anxiety, depression, OCD, and, in the point we wanted to emphasise in this article, bipolar disorder. In almost all cases, niacin supplementation resolved the dysfunctional behaviours and psychiatric symptoms. What varied were the amount of vitamin B3 needed to achieve recovery, and the speed with which symptoms would come back upon interruption of the supplementation.

Therefore, whether you are among the lucky people who never were niacin deficient, among the lucky people who need very little niacin, or among the less lucky ones who are deficient, who do need more of it than most, or who are suffering from anxiety or depression, schizophrenia or bipolar disorder, doesn’t it make sense to just start taking a little bit of extra B3 each day? Doesn’t it make sense to give your body-mind the amount of vitamin B3 it needs, recognising that for each one of us this amount may be different, that for some it will be a lot more than for others, but resting in complete assurance that no ill effects will come from it, because niacin supplementation is harmless, and that the only disadvantage of it being harmless, even in large doses, is that we need to take it daily.

And given how inexpensive any form of niacin is, shouldn’t we be giving it in large amounts to every patient in every hospital, psychiatric ward, and medical institution? We should, but this will probably never happen. What we can do is take care of ourselves, of those people closest to us like our children and spouses, siblings and parents, of those people we care about like our friends, colleagues, and even simple acquaintances who come to us for advice or just to share their concerns about a health issue. And one of the simplest and most effective things we can to improve our own health and the health of those around us is by taking a little B3 supplement every day. It could just make you feel more relaxed, more focused, calm and at ease, as it does for me, or it could completely transform your world, bringing you from a state of hyper-anxious, paranoid, delusional and hallucinatory mania, back to a relaxed, helpful and trusting, conscientious and reasonable self, giving you the gift of your own life back to yourself.

Could it really be this simple and this amazingly miraculous? No more pellagra, no more schizophrenia, no more bipolar disorder, just with a little B3 supplementation? Well, maybe. You try it, and let me know.

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