While research indicates that moderate alcohol consumption may have significant health benefits, we also know that too much alcohol wreaks havoc on the body by creating a pro-inflammatory state.
One of our patients at Parsley Health New York recently asked if we were familiar with the use of high-dose vitamins to treat alcoholism. Any doctor you ask will remember long nights in the hospital caring for patients in life-threatening alcohol withdrawal and giving IV thiamine (vitamin B1), but none of us had heard of taking a handful of vitamins to treat the addictive tendency itself.
An effective treatment for the craving for alcohol would be a breakthrough, not only for those struggling with addiction (for whom the mainstay of treatment is often social support) but also for social drinkers who are trying to cut back for other health reasons.
After reading the short book written by Abram Hoffer M.D., PhD that detailed the protocol, I took a deeper dive into more contemporary literature to see if I could find clinical evidence to support Hoffer’s claims and figure out how and why these vitamins might work for alcohol cravings.
History of the Protocol
Dr. Hoffer was a physician and biochemist who became interested in psychiatry after analyzing vitamins in cereal products for his doctoral thesis. He started working with high-dose vitamin therapy in 1950 during a research internship in a psychiatric ward. He successfully treated delirium tremens (a severe and sometimes deadly form of alcohol withdrawal) with high-dose niacin (vitamin B3) and vitamin C. He experimented with high-dose niacin for other psychiatric indications like depression, anxiety and schizophrenia. A good proportion of his patients responded and most of the ones who did carried a concurrent diagnosis of alcoholism.
He began to use the protocol for recovered alcoholics who were suffering from depression and anxiety in the absence of alcohol and noticed a marked resolution of their mood symptoms with vitamin therapy. His work with the community eventually led him to befriend the founder of Alcoholics Anonymous, Bill Wilson. After two weeks on Hoffer’s protocol, Wilson reported being permanently cured of the anxiety and fatigue that he had lived with since quitting alcohol, without the need to continue the vitamins. Hoffer and Wilson continued to work alongside each other for years, enlisting the participation of AA members to help refine Hoffer’s vitamin cocktail.
How High Dose Vitamin Therapy Works
Hoffer proposed a few mechanisms by which his protocol might fight alcohol cravings, but one that particularly stood out to me hinged on derivative of niacin called NAD+. The molecule has been the darling of anti-aging science since the publication of a seminal paper about its role in mitochondrial dysfunction in 2011 (1). The main job of NAD+ in the body is in the cellular production of energy, but it’s is also an important cofactor in the detoxification pathway of alcohol.
NAD+ can be made from niacin via intermediates like nicotinamide riboside and taking either compound as a supplement has been shown to increase NAD+ levels inside the cell. In recent years IV therapy with NAD+ has been used to treat alcohol and opiate addiction and a rapidly growing body of research suggest a role for NAD+ in the therapy of neurodegeneration, type two diabetes, fatty liver disease and metabolic decline.
Was Hoffer’s high-dose niacin working through the same pathway as the high-priced NAD+ drips offered in addiction centers today? If the answer is yes we can use recent science to tweak Hoffer’s protocol and aim for the highest elevation in intracellular NAD+ that’s possible with oral supplementation. I’m pretty sure Hoffer would high-five me about it.
How to use high dose vitamins to cut back on booze:
In addition to adjusting the protocol to increase NAD+ as much as possible, I swapped out a few vitamins for higher bioavailability formulations and suggested some blends to make the protocol easier to follow.
Here’s my special sauce to keep you off the sauce:
Core protocol
- Niacin (slow-release formulation): start with 500 mg directly after meals, 3 times per day. Try to slowly increase the dose as tolerated (niacin may make you flush) up to 2,000 mg at each meal. The most effective doses are over 3,000 mg per day.
- Nicotinamide Riboside: 300 mg per day looks like the sweet spot for maxing NAD+ levels.
- Liposomal Vitamin C: 1,500 mg 2 or 3 times per day away from food. Feel free to increase the dose — vitamin C is very safe so it’s hard to hit an upper limit here. The liposomal formulation should mitigate the side effect of GI discomfort that some people experience at high doses.
- Metabolic Synergy (supplement blend) by Designs for Health: 3 caps 2 times per day. I like this blend because it kills a few birds with one stone and optimizes nutrients for glycemic control, but if you want to take the staples separately opt for a high-dose methylated B-complex, 400 mcg of Chromium Nicotinate and 50 mg Zinc Citrate daily.
Highly suggested additions
- High Vitamin Cod Liver Oil: 1 – 3g per day. EPA and DHA are important for everyone, but especially for people repairing their brains and livers.
- Magnesium Taurate: 200 – 400 mg at bedtime. Most drinkers are magnesium deficient. The taurate formulation may be especially helpful for the anxiety and blood sugar issues that can accompany alcohol cravings. If poor sleep is more of an issue opt for the same dose of magnesium glycinate.
Additions to improve energy levels
- L-glutamine: 3 g per day between meals. L-glutamine can also help repair “leaky gut” or increased intestinal permeability, which can be caused by drinking.
- Supplements that support acetylcholine production like Alpha-GPC, N-acetyl L-carnitine, Huperzine A and pantothenic acid can promote feelings of well-being and self-control. I like the blend Acetyl-CH from Apex Energetics. Take 2 caps two times per day.
How to increase your chances of success:
1. Address stress reduction and exercise first.
Trying to change your habits around alcohol with medicines or supplements alone is a fool’s errand. Try to put a plan in place for a small amount of daily meditation (try Headspace) and 150 minutes of moderate intensity exercise weekly before you start.
2. Get a pill organizer.
And then call your grandmother because she wants her pill organizer back.
3. Tell your doctor.
Your doctor can help you get medical grade supplements, suggest testing to track your health outcomes and check in with you about your progress. It’s good to make sure they have updated list of all your supplements, too.
4. Gather data.
Get before/after stats on your reaction time (try HumanBenchmark) and cognitive function (try Lumosity).
5. Celebrate wins.
Even the small ones. Try the Winstreak app to help.
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