It can get very tough. Like I said, start out with 500 mg half a pill in the morning, half a pill in the evening and work up. This flushing. If you have never had it, it can get real Crazy. A couple times I thought I might have to go to the hospital. That's how bad it gets. Now, a little flashing around my face and chest. But before it would start in my ears and work all the way down to my knees, then you can hear your heart beating.