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Common Forms: Niacinamide, Nicotinic acid, Nicotinamide, Inositol
hexaniacinate
Vitamin B3, also called niacin, is one of eight water-soluble B vitamins. All
B vitamins help the body to convert carbohydrates into glucose (sugar), which is
"burned" to produce energy. These B vitamins, often referred to as B complex
vitamins, are essential in the breakdown of fats and protein. B complex vitamins
also play an important role in maintaining muscle tone along the digestive tract
and promoting the health of the nervous system, skin, hair, eyes, mouth, and
liver.
Niacin plays an important role in ridding the body of toxic and harmful
chemicals. It also helps the body make various sex and stress-related hormones
in the adrenal glands and other parts of the body. Niacin is effective in
improving circulation and reducing cholesterol levels in the blood. Niacin needs
can be partially met by eating foods containing protein because the human body
is able to convert tryptophan, an amino acid, into niacin.
Dietary deficiency of niacin tends to only occur in areas of the world where
people eat corn as a staple and don't use lime in fertilization. Corn is the
only grain that is low in niacin. Lime releases tryptophan which, again, can be
converted to niacin in the body. Symptoms of mild deficiency include
indigestion, fatigue, canker sores, vomiting, and depression. Severe deficiency
of both niacin and tryptophan can cause a condition known as pellagra. Pellagra
is characterized by cracked, scaly skin, dementia, and diarrhea. It is generally
treated with a nutritionally balanced diet and niacin supplements. Niacin
deficiency also results in burning in the mouth and a swollen, bright red tongue
In the United States alcoholism is the prime cause of Vitamin B3 deficiency.
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Extremely high doses of niacin (available by prescription) have been shown to
prevent and/or improve symptoms of the following conditions. Because of risk of
toxicity people should always consult a knowledgeable health care provider
before starting high doses of niacin.
High Cholesterol
Niacin is commonly used to lower elevated LDL ("bad") cholesterol and
triglyceride (fat) levels in the blood and is more effective in increasing HDL
("good") levels than other cholesterol-lowering medications. However. High doses
of niacin produce the side effects of flushing of the skin (which can be reduced
by taking aspirin 30 minutes before the niacin), stomach upset (which usually
subsides in a few weeks), headache, dizziness, blurred vision, and liver damage.
Although the time-release form of niacin reduces flushing, long-term use is
associated with liver damage.
Atherosclerosis
High doses of niacin medications are used to prevent development of
atherosclerosis (plaque along the blood vessels that can cause blockage) and to
reduce recurrent complications such as heart attack and peripheral vascular
disease (atherosclerosis of the blood vessels in the legs that can cause pain
with walking, called intermittent claudication) in those with the condition.
According to a review of major clinical trials, the use of niacin for prevention
and treatment of atherosclerosis and related conditions is "based on strong and
consistent evidence" and appears to be as effective as certain medications for
heart disease. Studies also suggest that high dose niacin may help relieve the
symptoms of claudication – namely diminish the pain experienced with walking.
A recent study also found that the combination of niacin and a
cholesterol-lowering drug called simvastatin (which belongs to a class known as
HmG CoA reductase inhibitors or statins) may dramatically slow the progression
of heart disease, reducing risk of heart attack, and even death.
Vitamin B3 and Diabetes
Because diabetes is often associated with atherosclerosis and heart disease,
people with diabetes may benefit from nutrients that help manage elevated
cholesterol levels and high blood pressure. Although niacin has been shown to
boost HDL cholesterol and decrease triglyceride and LDL levels, there has been
some concern that it may also raise blood sugar levels. In a recent study of 125
people with diabetes and 343 people without the condition, high doses of niacin
(roughly 3000 mg/day), increased blood sugar in both groups, but hemoglobin A1C
(considered a better measure of blood sugar over time) actually decreased in the
diabetes group over a 60-week follow-up period. For this reason, if you have
diabetes, niacin should only be used under the close monitoring of a qualified
health care provider.
Osteoarthritis
Some preliminary studies suggest that vitamin B3, as niacinamide, may improve
arthritis symptoms, including increasing joint mobility and reducing the amount
of anti-inflammatory medications needed. Researchers speculate that niacinamide
may aid cartilage repair (damage to joint cartilage causes arthritis) and
suggest that it may be used safely along with NSAIDs (non-steroidal
anti-inflammatory medications) to reduce inflammation. Further research is
needed to fully understand how vitamin B3 benefits people with OA and to
determine whether the results apply to large numbers of people with the
condition. It does appear, however, that niacinamide must be used for at least 3
weeks before the benefits described are seen. Experts also suggest that
long-term use (1 to 3 years) may slow the progression of the disease.
Cataracts
Dietary vitamin B3, along with other nutrients is important for normal vision
and prevention of cataracts (damage to the lens of the eye which can lead to
cloudy vision.) One study including 2900 people living in Australia found that
people who consumed the most protein, vitamin A, and vitamins B1 (thiamine), B2,
and B3 (niacin) in their diets were significantly less likely to develop
cataracts. A follow-up study also found that many supplemental B complex
vitamins (including B12, B9, B3, B2, and B1) exert a protective effect against
cataracts.
Burns
It is especially important for people who have sustained serious burns to obtain
adequate amounts of nutrients in their daily diet. When skin is burned, a
substantial percentage of micronutrients may be lost. This increases the risk
for infection, slows the healing process, prolongs the hospital stay, and even
increases the risk of death. Although it is unclear which micronutrients are
most beneficial for people with burns, many studies suggest that a multivitamin
including the B complex vitamins may aid in the recovery process.
Other
An interesting area of research currently underway is the use of niacin skin
care products as anti-aging agents, for treatment of acne, and, possibly, for
prevention of skin cancer. Dermatologists expect that there will be information
emerging about topical forms of niacin for these purposes over the next few
years.
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The best dietary sources of vitamin B3 are found in beets, brewer's yeast,
beef liver, beef kidney, pork, turkey, chicken, veal, fish, salmon, swordfish,
tuna, sunflower seeds, and peanuts.
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Niacin is available in several different supplement forms: niacinamide,
nicotinic acid, and inositol hexaniacinate. The form of niacin that is best
tolerated with the least symptoms is inositol hexaniacinate. Niacin is available
as a tablet or capsule in both regular and timed-release forms. The
timed-release tablets and capsules may have fewer side effects than the regular
niacin; however, the timed-release are more likely to cause liver damage and are
therefore not recommended for long-term treatment. Regardless of the form of
niacin being used, periodic checking of liver function tests is recommended when
high-dose (2 – 6 gm per day) of niacin is used.
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How to Take Vitamin B3
Daily requirements for niacin may be higher for those who have cancer, those
who are being treated with isoniazid (for tuberculosis), and people with protein
deficiencies.
Daily recommendations for niacin from the diet for healthy individuals are
listed below.
It is important to note, however, that only extremely high doses of niacin
(in the range of 1,500 to 3,000 mg per day in divided doses) are helpful for
most medical conditions. Such high doses are considered "pharmacologic" and must
be prescribed by a qualified healthcare practitioner. The practitioner will
instruct you on increasing the amount of niacin slowly, over the course of 4 to
6 weeks, and to take the medicine with meals to avoid stomach irritation.
Pediatric
- Infants birth to 6 months: 2 mg (adequate intake)
- Infants 7 months to 1 year: 4 mg (adequate intake)
- Children 1 to 3 years: 6 mg (RDA)
- Children 4 to 8 years: 8 mg (RDA)
- Children 9 to 13 years: 12 mg (RDA)
- Males 14 to 18 years: 16 mg (RDA)
- Females 14 to 18 years: 14 mg (RDA)
Adult
- Males 19 years and older: 16 mg (RDA)
- Females 19 years and older: 14 mg (RDA)
- Pregnant females: 18 mg (RDA)
- Breastfeeding females: 17 mg (RDA)
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Because of the potential for side effects and interactions with medications,
dietary supplements should be taken only under the supervision of a
knowledgeable healthcare provider.
High doses (75 mg or more) of niacin can cause side effects. The most common
side effect is called "niacin flush," which is a burning, tingling sensation in
the face and chest, and red or "flushed" skin. Taking an aspirin 30 minutes
prior to the niacin may help reduce this symptom.
At the very high doses used to lower cholesterol and the other conditions
mentioned previously, liver damage and stomach ulcers can occur. When taking
pharmacologic doses of niacin, your doctor or other healthcare practitioner will
periodically check your liver function through a blood test. People with a
history of liver disease or stomach ulcers should not take niacin supplements.
Those with diabetes or gallbladder disease should do so only under the close
supervision of a healthcare provider. Niacin should not be used if you have
gout.
Taking any one of the B complex vitamins for a long period of time can result
in an imbalance of other important B vitamins. For this reason, it is generally
important to take a B complex vitamin with any single B vitamin.
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If you are currently being treated with any of the following medications, you
should not use niacin without first talking to your healthcare provider.
Antibiotics, Tetracycline
Niacin should not be taken at the same time as the antibiotic tetracycline
because it interferes with the absorption and effectiveness of this medication.
Niacin either alone or in combination with other B vitamins should be taken at
different times from tetracycline. (All vitamin B complex supplements act in
this way and should therefore be taken at different times from tetracycline.)
Aspirin
Taking aspirin before taking niacin may reduce flushing associated with this
vitamin. This should only be done under the advice of a healthcare practitioner.
Blood Pressure Medications, Alpha-blockers
When niacin is taken with certain blood pressure medications known as
alpha-blockers (such as prazosin, doxazosin, and guanabenz), the likelihood of
side effects from these medications is increased.
Cholesterol-lowering Medications
Niacin binds bile-acid sequestrants (cholesterol-lowering medications such as
colestipol, colesevelam, and cholestyramine) and may decrease their
effectiveness. For this reason, niacin and these medications should be taken at
different times of the day.
As described earlier, recent scientific evidence suggests that taking niacin
with simvastatin (a drug that belongs to a class of cholesterol-lowering
medications known as HMG-CoA reductase inhibitors or statins including
atorvastatin and lovastatin as well), appears to slow down the progression of
heart disease. However, the combination may also increases the likelihood for
serious side effects, such as muscle inflammation or liver damage.
Diabetes Medications
People taking insulin, metformin, glyburide, glipizide, or other medications
used to treat high blood sugar levels should monitor their blood sugar levels
closely when taking niacin supplements.
Isoniazid (INH)
INH, a medication used to treat tuberculosis, may deplete levels of niacin and
cause a deficiency.
Nicotine Patches
The use of nicotine patches with niacin may worsen or increase the risk of
flushing reactions associated with this vitamin when used medicinally.
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Adding vitamins to the mix: skin care products that can benefit the skin
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list of all supplements, vitamins
Reviewed: 01/2006
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