B-Vitamins Saving My Butt (what to do?)

[grape_scotch]

background:
severe to moderate mecfs over 3 years (typical symptoms including pots)

long covid in Oct 2023 new symptoms
- insulin resistance
- tachycardia
- high blood pressure
- ravenous appetite
- chest tightness

My long covid symptoms were kicking my butt for like two months. I believe my body was being very wasteful because I had to eat tons of protein and carbs to relieve my symptoms. I gained so much weight. I was eating every two hours. At first I didnt understand what was going, I didn't understand metabolism. All I felt was ravenous hunger and terrible symptoms.

I started to get an idea of what was going on. I got a glucose monitor which showed insulin resistance. I feel as if I'm battling for my life when I get hungry. BP goes up to 160/95 sometimes. Tachycardia to 100 along with chest tightness. I see a cardiologist, all test come back negative.

In an act of desperation, I start megadosing B-vitamins. I experiment with different amounts for like a month straight. With hiccups but also noticable relief and improvement. The sensation of lactate and incessant gnawing of hunger subsides significantly.

Ultimately I landed up on this stack:

- 300mg TTFD (B1)
- 30-60mg Riboflavin 5 Phosphate (B2)
- 1000-1500mg Niacinamide (B3)
- 500-1000mg Pantothenic Acid (B5)
- 50mg Pyridoxal 5 phosphate (B6)
- 40mg Biotin (B7)
- No B12 because of high blood levels. No folate because I think I get enough.

And later for the kast two weeks before issues I felt an additional improvement with
- 15000IU Retinol palmitate (even though I eat liver 1-2 times a week. for the past month. I think I had a deficiency before for the last two years)
- 2000 IU Vitamin D (blood levels have akwayd been in range)
- Vitamin E mixed tocophorels 200 IU (have always loved this product)
- Vitamin K mk4 5-10mg (also never had issues in the past)
- zinc picolinate 15mg (felt effects quite noticably)

(I noticed that beef liver began to taste awful to me and had gave me nightmares once. However the addition of vitamin A in high doses improved my cold reslience and ketaris pilaris skin condition on arms after a decade. Ketaris pilaris improved by 80%. So my guess is the copper overload.)


The interrealtionships between these are quite dynamic but I felt that this was doing the job for me. I felt stable for about 2 months, and then I ran into major problems.

BP spiked to 180/100, heart rate 110, extremely hungry, high lactate feeling, severe anxiety. (Early February 2024)

And that all happened when I switched my TTFD B1 for benfotiamine. I didn't connect the dots because I had taken benfo a year ago without issue. I thought I had become imbalanced from all the B-vitamins. So I discontinued everything and my long-covid symptoms return.

Glucose is staying elevated so I take biotin and benfotiamine because I noticed it is effective for lowering glucose levels. and makes me feel better until the high blood pressure, hunger, tachycardia return a few hours later.

So for the last week I've been experiencing these horrible ups and downs.

I have stopped benfotiamine. I dont get high bp anymore. I switched to thiamine hcl. 5 GRAMS per day. Its the only thing that helps. I also added the TTFD for thiamine, 200mg per day.

For now I am treading water. I still get high-ish like 150/90 is the highest it will go but I still have to eat to relieve it. Tachycardia like 100 sometimes. Chest tightness relieved by thiamine HCL. So I still feel I'm living moment to moment. And I feel that without B-vitamins I will crash, or if not, something worse.

I'm seeing my doctor soon on Wednesday. But I did request for her to call me back sooner. But I believe she's been out of the office.

I cant continue with these symptoms. I am again desperate so I am going to start back the vitamins again that made me feel sooo much better.

Last time I did it wrong too. No attention to my glucose levels, glycogen, glycogenolysis, and all that jazz.

why do b-vitamins make me feel so much better? I respond really well to thiamine.

I am taking cofactors like selenium, glycine and trying to eat well rounded.

I feel that I have no choice but to take these vitamins.

All labs appear normal. I have gotten quite extensive labwork too.

thanks for you time and advice

 

[Judee]

What type of doctor? Because unless she's a functional MD or something like that, she's may strongly discourage you on the supplements. They've been trained against them. Just be aware that may happen.

Are you in any of the FB groups that talk about TTFD usage. There's Elliot Overton's group, "Addressing Thiamine Deficiency and Paradoxical Reactions." That might be a good group to get advice on what in your stack is causing the high BPs.

Another one is Chandler Marrs' group. She has a website HormonesMatter.com but I can't remember the name of her FB group. It has the word "mitochondria" in the title though. If I remember when I go on FB later today or tomorrow, I'll try to make a note and come back and post it here.

There are also some threads on Thiamine and TTFD. Here's one of them but you could check for others. https://forums.phoenixrising.me/thr...eficiency-as-a-main-contributor-to-cfs.89406/

@Mary and some others also talk about taking co-factors with it and most of the time the co-factors I see mention are minerals like phosphorus and potassium and magnesium. I don't see any minerals on your list. Those may help with things like high bp and heart rate.

I hope you can figure all this out especially since they were helping you so much. My thought is to try to go back to the exact stack that was helping you and maybe add the minerals and see if those help the negative side effects to diminish. Or alternatively, you could slowly start adding things back in one at a time and see if you get those symptoms after a particular addition. ??

 

[Wishful]

It may not be as simple as "nutrient x does this to cells". It could be that the supplements alter the microbiome, or alter some body function not directly related to ME, and many steps later, results in a reduction in some ME symptoms.

One possible path to take is to minimize the variables, then test supplements one at a time to see what each does. Then you can test supplements plus one theoretical (meaning it works that way in normal healthy people) cofactor to see whether that helps further.

Judee's suggestion of starting with the exact stack that worked before (no guarantees that it is still optimum, since ME keeps changing) is another possible path. That does seem more complicated, but if it does still work for you, you'd at least be more comfortable while experimenting. Being brainfogged, lethargic, and achey really doesn't make trying to figure out health issues easier.

 

[Mary]

@grape_scotch - a couple of things you might look into: B1 (thiamine HCL) gave me a good boost in energy, followed by severe fatigue, which turned out to be hypophosphatemia (low phosphate) due to refeeding syndrome. I wouldn't call phosphorous a co-factor for B1 - I think refeeding syndrome is a different animal than a co-factor. Usually refeeding syndrome affects people who are starving or severely malnourished but people with ME/CFS do seem prone to this condition. This link has a good definition of refeeding syndrome:

Refeeding syndrome: what it is, and how to prevent and treat it​

Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally5). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphataemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.1 6​

And some of the symptoms of hypophosphatemia are high BP, tachycardia.

Refeeding syndrome involving potassium often occurs when replenishing B12 and methylfolate though you say you're not taking these 2 B's. But potassium also can cause high BP and tachycardia. My potassium dropped quite badly when I started taking methylfolate. I had to start taking potassium in 2010 and still take it, roughly 1000 mg a day in divided doses. We are all different and a dose which works for me may not work for someone else. I'm afraid we have to work this out for ourselves.

Also, persons with ME/CFS can have normal serum levels of potassium but may be low intracellularly - nothing is easy with us! This thread explains how this occurs: https://forums.phoenixrising.me/thr...ded-in-methylation-treatmt.18670/#post-283712

So I think it's possible you may be experiencing some version of refeeding syndrome with your high BP etc.

I found a relatively easy way to see if someone is dealing with low potassium is to drink several glasses of low-sodium V-8 or tomato juice (high in potassium) and if low potassium is the culprit, people generally start to feel better in a few hours.

I did the same thing with kefir - dairy is high in phosphorous - when I suspected low phosphorous after the post B-1 severe fatigue. A few hours after 2 or 3 glasses of kefir, my unusual severe fatigue started to abate.

 

[Bluebluesky]

Lots of good information and advise further up the thread.

- No B12 because of high blood levels. No folate because I think I get enough.

Paradoxically high b12 blood levels often is a sign of b12 deficiency. It is because b12 will accumulate in the bloodstream because there is a problem with the mechanism (methylation) that should bring it into the cells and put it to use there. So you can't really rely on blod testing for b12.

So I would recommend that you take both b12 - and folate, since b12 won't work without folate. b12 and folate can't hurt you no matter how much you take. (Exept that b12 might work 'too well', making potassium and other nutrients tank.) It could be that b12 is the main culprit here, since other b vitamin deficiencies often follow along with b12 deficiency.

The theory is that if you get enough b12 it will pass into the cells anyway.

One possible path to take is to minimize the variables, then test supplements one at a time to see what each does. Then you can test supplements plus one theoretical (meaning it works that way in normal healthy people) cofactor to see whether that helps further.

This method requires patience, but it gives you so much more control because you'll know which symptoms are related to which nutrient.

 

[LINE]

Some general notes:

When I read tachycardia, I immediately think of magnesium. Magnesium is a critical mineral that is involved in hundreds of enzymatic reactions. Keep in mind that magnesium comes in many forms, and it is often a guessing game which form may be good. UltraMag is a blend that contains a blend of different forms. Magnesium is lost with any stress be that physical, emotional or biochemical (immune, trauma etc).

Vitamin C (as QualiC) is a game changer for many.

You are making good choices with Vitamin E and K2,

Selenium is a good choice since it is involved in immunity and detoxification.

B vitamins are major catalysts and become depleted with any stress environment. Best to keep it at a wide spectrum (rather than focusing on just a single b vitamin).

I did not look thoroughly through your b vitamin stack - I don't see choline - I bring that up since one of its uses is that it serves as a methyl donor (but all B vitamins serve as methyl donors (this is also called methylation)).

Vitamin B2 is orientated to a number of pathways but involved in immune function.

Polyphenols are found in plants and serve as very powerful molecules. They have a wide range of activity, certain ones are able to target specific pathways. For example, the polyphenols found in cacao (raw dark chocolate) target the cardiovascular system.

Of course, dark chocolate is just one such example, there are others which I can give more details. Some other suggestions are turmeric, ginger, moringa, Ceylon cinnamon etc.

 

[JES]

This method requires patience, but it gives you so much more control because you'll know which symptoms are related to which nutrient.

Yep. I always take one supplement at a time for a couple of weeks to properly evaluate its effect. Ideally this would be months, but life is too short.

The dosages above are also rather high if I may add.

Benfotiamine is indeed a known supplement used by diabetics. Benfotiamine is *probably* more bioavailable than regular thiamin at least, so you should not take the same dose of it and expect the same effect. Have you been evaluated by a doctor regarding your high blood pressure and sugar because those are not classic ME/CFS symptoms?

 

[gregh286]

background:
severe to moderate mecfs over 3 years (typical symptoms including pots)

long covid in Oct 2023 new symptoms
- insulin resistance
- tachycardia
- high blood pressure
- ravenous appetite
- chest tightness

My long covid symptoms were kicking my butt for like two months. I believe my body was being very wasteful because I had to eat tons of protein and carbs to relieve my symptoms. I gained so much weight. I was eating every two hours. At first I didnt understand what was going, I didn't understand metabolism. All I felt was ravenous hunger and terrible symptoms.

I started to get an idea of what was going on. I got a glucose monitor which showed insulin resistance. I feel as if I'm battling for my life when I get hungry. BP goes up to 160/95 sometimes. Tachycardia to 100 along with chest tightness. I see a cardiologist, all test come back negative.

In an act of desperation, I start megadosing B-vitamins. I experiment with different amounts for like a month straight. With hiccups but also noticable relief and improvement. The sensation of lactate and incessant gnawing of hunger subsides significantly.

Ultimately I landed up on this stack:

- 300mg TTFD (B1)
- 30-60mg Riboflavin 5 Phosphate (B2)
- 1000-1500mg Niacinamide (B3)
- 500-1000mg Pantothenic Acid (B5)
- 50mg Pyridoxal 5 phosphate (B6)
- 40mg Biotin (B7)
- No B12 because of high blood levels. No folate because I think I get enough.

And later for the kast two weeks before issues I felt an additional improvement with
- 15000IU Retinol palmitate (even though I eat liver 1-2 times a week. for the past month. I think I had a deficiency before for the last two years)
- 2000 IU Vitamin D (blood levels have akwayd been in range)
- Vitamin E mixed tocophorels 200 IU (have always loved this product)
- Vitamin K mk4 5-10mg (also never had issues in the past)
- zinc picolinate 15mg (felt effects quite noticably)

(I noticed that beef liver began to taste awful to me and had gave me nightmares once. However the addition of vitamin A in high doses improved my cold reslience and ketaris pilaris skin condition on arms after a decade. Ketaris pilaris improved by 80%. So my guess is the copper overload.)


The interrealtionships between these are quite dynamic but I felt that this was doing the job for me. I felt stable for about 2 months, and then I ran into major problems.

BP spiked to 180/100, heart rate 110, extremely hungry, high lactate feeling, severe anxiety. (Early February 2024)

And that all happened when I switched my TTFD B1 for benfotiamine. I didn't connect the dots because I had taken benfo a year ago without issue. I thought I had become imbalanced from all the B-vitamins. So I discontinued everything and my long-covid symptoms return.

Glucose is staying elevated so I take biotin and benfotiamine because I noticed it is effective for lowering glucose levels. and makes me feel better until the high blood pressure, hunger, tachycardia return a few hours later.

So for the last week I've been experiencing these horrible ups and downs.

I have stopped benfotiamine. I dont get high bp anymore. I switched to thiamine hcl. 5 GRAMS per day. Its the only thing that helps. I also added the TTFD for thiamine, 200mg per day.

For now I am treading water. I still get high-ish like 150/90 is the highest it will go but I still have to eat to relieve it. Tachycardia like 100 sometimes. Chest tightness relieved by thiamine HCL. So I still feel I'm living moment to moment. And I feel that without B-vitamins I will crash, or if not, something worse.

I'm seeing my doctor soon on Wednesday. But I did request for her to call me back sooner. But I believe she's been out of the office.

I cant continue with these symptoms. I am again desperate so I am going to start back the vitamins again that made me feel sooo much better.

Last time I did it wrong too. No attention to my glucose levels, glycogen, glycogenolysis, and all that jazz.

why do b-vitamins make me feel so much better? I respond really well to thiamine.

I am taking cofactors like selenium, glycine and trying to eat well rounded.

I feel that I have no choice but to take these vitamins.

All labs appear normal. I have gotten quite extensive labwork too.

thanks for you time and advice

I know those feelings well. The tach comes from carb ingestion and body not.processing the glucose.

You need to stay on low carbs or very little.and often.
Or ar night the problem isn't as bad
My symptoms mimick yours
It's happens when metabolic switch seems.off.
I can get really bad skipped beats as well..
That's Hairy
Yeah the heavy lactate coming from the carb and sugar getting dumped into lactate somehow.

 

[Hopesprings86]

Hi, sorry I'm late to join this discussion, just wanted to share my own similar experience here. I've kept this long story as brief as possible, hope it's somewhat readable.

I've had pots/fatigue long-term (for over 20 years). I discovered the Hormones Matter website a couple of years ago, this introduced me to the possibility of low thiamine being implicated in autonomic dysfunction and many other issues.

By this point I'd seen many doctors and had some dreadful experiences previously trying to take prescribed medications so I had all but given up on conventional medicine helping me.

I decided to begin on a high dose methylated b complex supplement + magnesium + coq10. For the first few days I split the b complex capsules into a more moderate dose and didn't really notice much effect. Gradually I worked up to taking a complete capsule.

I started to feel somewhat different, my mood seemed improved, getting out of bed was easier, normally I would take a long time to adjust to gravity when I woke up but this seemed to help, my co-ordination was better, my mind more focused. There were many small things I noticed that were positive improvements. I was delighted, but I wasn't completely better, I wanted to see how far I could go. Could I completely recover if only I upped the dose even more? So two weeks into this experiment I decided to get some additional thiamine hcl capsules to add to what I was already taking...

Unfortunately this was a mistake, shortly after taking the first dose of additional thiamine my body went into a physical panic. I went into extreme tachycardia, much worse than any I've ever experienced before. I spent some time literally collapsed on the floor trying to stabilise my heart rate. It was terrifying. Fortunately I recovered from this fairly quickly and ceased my supplement regime. That was two years ago. In hindsight I was too impatient trying to force myself into a recovery. My considered viewpoint now some time has passed is that thiamine was helpful in my case, but the dose needs to be moderate, gradual improvement is a big achievement and one I am happy with. I've just started again this week on a low dose, wiser from my previous adventure.

 

[grape_scotch]

Lots of good information and advise further up the thread.

Paradoxically high b12 blood levels often is a sign of b12 deficiency. It is because b12 will accumulate in the bloodstream because there is a problem with the mechanism (methylation) that should bring it into the cells and put it to use there. So you can't really rely on blod testing for b12.

So I would recommend that you take both b12 - and folate, since b12 won't work without folate. b12 and folate can't hurt you no matter how much you take. (Exept that b12 might work 'too well', making potassium and other nutrients tank.) It could be that b12 is the main culprit here, since other b vitamin deficiencies often follow along with b12 deficiency.

The theory is that if you get enough b12 it will pass into the cells anyway.


This method requires patience, but it gives you so much more control because you'll know which symptoms are related to which nutrient.

Thanks. I'll give this a try.

 

[grape_scotch]

Thanks. I'll give this a try.

so a

Some general notes:

When I read tachycardia, I immediately think of magnesium. Magnesium is a critical mineral that is involved in hundreds of enzymatic reactions. Keep in mind that magnesium comes in many forms, and it is often a guessing game which form may be good. UltraMag is a blend that contains a blend of different forms. Magnesium is lost with any stress be that physical, emotional or biochemical (immune, trauma etc).

Vitamin C (as QualiC) is a game changer for many.

You are making good choices with Vitamin E and K2,

Selenium is a good choice since it is involved in immunity and detoxification.

B vitamins are major catalysts and become depleted with any stress environment. Best to keep it at a wide spectrum (rather than focusing on just a single b vitamin).

I did not look thoroughly through your b vitamin stack - I don't see choline - I bring that up since one of its uses is that it serves as a methyl donor (but all B vitamins serve as methyl donors (this is also called methylation)).

Vitamin B2 is orientated to a number of pathways but involved in immune function.

Polyphenols are found in plants and serve as very powerful molecules. They have a wide range of activity, certain ones are able to target specific pathways. For example, the polyphenols found in cacao (raw dark chocolate) target the cardiovascular system.

Of course, dark chocolate is just one such example, there are others which I can give more details. Some other suggestions are turmeric, ginger, moringa, Ceylon cinnamon etc.

I started eating egg yolks for more choline.

 

[grape_scotch]

What type of doctor? Because unless she's a functional MD or something like that, she's may strongly discourage you on the supplements. They've been trained against them. Just be aware that may happen.

Are you in any of the FB groups that talk about TTFD usage. There's Elliot Overton's group, "Addressing Thiamine Deficiency and Paradoxical Reactions." That might be a good group to get advice on what in your stack is causing the high BPs.

Another one is Chandler Marrs' group. She has a website HormonesMatter.com but I can't remember the name of her FB group. It has the word "mitochondria" in the title though. If I remember when I go on FB later today or tomorrow, I'll try to make a note and come back and post it here.

There are also some threads on Thiamine and TTFD. Here's one of them but you could check for others. https://forums.phoenixrising.me/thr...eficiency-as-a-main-contributor-to-cfs.89406/

@Mary and some others also talk about taking co-factors with it and most of the time the co-factors I see mention are minerals like phosphorus and potassium and magnesium. I don't see any minerals on your list. Those may help with things like high bp and heart rate.

I hope you can figure all this out especially since they were helping you so much. My thought is to try to go back to the exact stack that was helping you and maybe add the minerals and see if those help the negative side effects to diminish. Or alternatively, you could slowly start adding things back in one at a time and see if you get those symptoms after a particular addition. ??

Thanks a lot I just joined those groups. I'm getting plenty of electroltyes. I'm sure I'm getting lots of phosphorous from beef and milk. And calcium hydroxyapatite.

Still trying to balance things out but its very difficult to know.

 

[grape_scotch]

@grape_scotch - a couple of things you might look into: B1 (thiamine HCL) gave me a good boost in energy, followed by severe fatigue, which turned out to be hypophosphatemia (low phosphate) due to refeeding syndrome. I wouldn't call phosphorous a co-factor for B1 - I think refeeding syndrome is a different animal than a co-factor. Usually refeeding syndrome affects people who are starving or severely malnourished but people with ME/CFS do seem prone to this condition. This link has a good definition of refeeding syndrome:

Refeeding syndrome: what it is, and how to prevent and treat it​

And some of the symptoms of hypophosphatemia are high BP, tachycardia.

Refeeding syndrome involving potassium often occurs when replenishing B12 and methylfolate though you say you're not taking these 2 B's. But potassium also can cause high BP and tachycardia. My potassium dropped quite badly when I started taking methylfolate. I had to start taking potassium in 2010 and still take it, roughly 1000 mg a day in divided doses. We are all different and a dose which works for me may not work for someone else. I'm afraid we have to work this out for ourselves.

Also, persons with ME/CFS can have normal serum levels of potassium but may be low intracellularly - nothing is easy with us! This thread explains how this occurs: https://forums.phoenixrising.me/thr...ded-in-methylation-treatmt.18670/#post-283712

So I think it's possible you may be experiencing some version of refeeding syndrome with your high BP etc.

I found a relatively easy way to see if someone is dealing with low potassium is to drink several glasses of low-sodium V-8 or tomato juice (high in potassium) and if low potassium is the culprit, people generally start to feel better in a few hours.

I did the same thing with kefir - dairy is high in phosphorous - when I suspected low phosphorous after the post B-1 severe fatigue. A few hours after 2 or 3 glasses of kefir, my unusual severe fatigue started to abate.

thanks. I think this is a refeeding syndrome. and the phosphate issue can be part of the reason I eat so much beef and milk during these episodes.

I take plenty of electrolytes and doesnt seem to do the trick. nonetheless I will still take them because I found a good balance.

so for refeeding syndrome. electroltres and phosphorous can do trick? think I need more phosphorous

 

[Mary]

so for refeeding syndrome. electroltres and phosphorous can do trick? think I need more phosphorous

@grape_scotch - I don't think it's that simple. What do you mean, specifically, by electrolytes? How much of what are you taking? e.g., I have to take 1000 mg of potassium a day, in divided doses to keep my potassium up. I also have to take phosphorous almost daily. But I don't take calcium.

So you may need extra potassium. I don't know if you do or not, but I'd suggest again you get some low-sodium V-8 or tomato juice, drink several glasses, and see if it helps you high BP and other symptoms you may be having. And if it helps, you might consider a potassium supplement. And again, as I said above, blood levels of potassium may not give an accurate picture of potassium levels for persons with ME/CFS because we can have low intra-cellular potassium despite seemingly normal blood levels.

Someone else suggested magnesium for you. You might need extra magnesium.

I don't know of any easy way to find out exactly what you need, apart from just trying things, generally one at a time so you can know what is doing what to you. But I would not rely on something like gatorade for electrolytes, and I would look at each electrolyte individually.

 

[Lena9701]

thanks. I think this is a refeeding syndrome. and the phosphate issue can be part of the reason I eat so much beef and milk during these episodes.

I take plenty of electrolytes and doesnt seem to do the trick. nonetheless I will still take them because I found a good balance.

so for refeeding syndrome. electroltres and phosphorous can do trick? think I need more phosphorous

Strangely enough this happened to me as well! I got a lot of help from adding b vitamins separately, was doing great on thiamine hci and then got really messed up from a short time on benfotiamine. I'm pretty much recovered from that now after over a month. I actually vaguely remembered your post on Reddit when it happened (I told you to post here lol). How are you doing now?

 

[Slushiefan]

When I noticed I had what felt like tachycardia from restarting B vitamins (I had to stop them a year ago due to not feeling well when I took them, but I really missed the energy), it was eventually validated by a notification of high heart rate by my apple watch. I was definitely feeling very dizzy that particular day along with fatigue, nausea, and a severe malaise.

That particular day my wife suggested I take a 1000mg vitamin C - she said it would lower the levels of B vitamins in the blood.

I'll be darned if not within 20 minutes after taking the C that I started to feel much better, and about 3 hours later I was back to normal. It also did not defeat the effects I was getting from the B vitamins such as increased energy and focus, it just reduced them a little while removing all of the dizziness, fatigue, nausea, and malaise symptoms.

When that worked, I researched my side effects on the board here, and found mentions of overmethylation and reduced phosphorous/phosphate. To combat this slow release Niacin (I guess Niacin boosts phosphate and phosphorous) was suggested. So I added Niacin to my daily supplementation along with keeping the B vitamins. I also took a C whenever I felt the side effects returning (you can definitely feel when it is happening - it is no fun).

The first week while waiting on the niacin I took C about 7 times (one each day as it kept returning), the second week after adding niacin it was around 5 times, the third week about 2 times, and it eventually just trailed off to not needing the C.

I don't know if it will continue to work forever, but I have been going strong on all the B vitamins since adding the Niacin for about a month now. All the benefits, none of the side effects - so far.

And if the tachycardia comes back again, I know an immediate solution is to add a C, which will buy time to figure out the next step.