Nutrition is a complex subject. Between vitamins and minerals, there are more than 40 essential nutrients. Then there are herbs. Then there is the quality of food. How can you make sense of all the information available? Who can you believe?

The purpose of today’s column is to provide a rationale for setting priorities. I believe that the top priority is developing a dosage strategy for just four nutrients: vitamin C, niacin, vitamin D, and thiamine. This is not an easy task. I’ve been working on it for over a decade and I’m not close to a consistent strategy yet. That said, if you are looking for good doses to start with, click here.

Why vitamin C, niacin, vitamin D, and thiamine? What’s special about these four vitamins? Well, the inability to manage these four vitamins has caused humanity untold misery. These are the vitamins that prevent the four deficiency diseases that caused regular epidemics before the discovery of the vitamins in the early 20th century. Vitamin C prevents scurvy, vitamin D prevents rickets, niacin prevents pellagra, and thiamine prevents beriberi.

It’s hard to get enough of these four essential nutrients by eating food. If it was easy, millions of our ancestors wouldn’t have suffered from deficiency diseases. For these four vitamins, food is not enough to guarantee optimal health. That’s why our health authorities add supplemental thiamine and niacin to wheat flour and supplemental vitamin D to milk. Vitamin C is managed by vigorous promotion of fruits rich in this vitamin.

Optimal doses for these vitamins are the source of vigorous debate because most people can tolerate doses far higher than are easily obtained from food. A balanced diet will contain roughly 100 mg vitamin C, 50 I.U. vitamin D, 20 mg niacin, and 2 mg thiamine. There are many reports of individuals taking more than 20,000 mg/day vitamin C, 5000 IU/day vitamin D, 2000 mg/day niacin, and 100 mg/day of thiamine. There are also regular reports of side effects from vitamin C, vitamin D, and niacin. Side effects from high doses of thiamine are the least common because most people don’t understand that the common forms of high potency thiamine sold today (thiamine mononitrate and thiamine hydrochloride) have limited absorption in the digestive tract. Most of the thiamine in these forms in excess of 2 mg is excreted as solids. So, it isn’t surprising that 100 mg thiamine mononitrate tablets have so few side effects. Thiamine in the forms TTFD and benfotiamine are fat soluble with unlimited absorption. Once these forms of thiamine are commonly used, I expect that reports of thiamine side effects will emerge.

Many vitamin enthusiasts insist that vitamins don’t cause side effects. To me, this defies understanding. They just don’t understand where I’m coming from. 10,000 mg/day of vitamin C isn’t causing side effects? – then up the dosage to 100,000 mg/day. Trust me, the side effects will emerge. And when they emerge, they will resemble the side effects others have already reported at 1000 to 10,000 mg/day. 500 mg/day of niacin not causing side effects? Take 5000 mg/day. And on and on. All four of these vitamins cause side effects at high doses and the side effects are well described for niacin, vitamin C, and vitamin D.

So, avoiding discomforting side effects places an upper limit on dose. Unfortunately, dosing at some fixed ratio of your side effect threshold isn’t possible. Side effects thresholds change with time and state of health (e.g. one of my current strategies is to increase my daily dosage of vitamin C and niacin by more than 10-fold when fighting a respiratory infection). More unfortunately, all of these vitamins are now readily available with slightly different molecular structures (e.g. niacin comes as niacin, niacinamide, and niacin inositol). Each structure can have a different side effect profile. Further complicating the situation, these vitamins can be delivered in more ways than just pills. Niacin and vitamin C are available as skin creams. All four vitamins can be injected to provide very high doses in a small localized area. When the importance of selectively delivering these vitamins to different cellular systems is better understood, I expect many more forms of these four vitamins to become readily available.

So, the situation is complex. That’s why I have this self-appointed job. I’m writing to help people understand how high doses of these four vitamins can improve the growth and development of children and the health of adults. I’m also writing about dosage strategies, and details about the different forms of each vitamin.

I am fully aware that this column isn’t going to change minds quickly. Most people I know have remarkably strong opinions about nutrition. Apparently, I’m no exception. Fortunately, the facts are on my side. It’s just a matter of time.