Source: University of Mayland Medical Center
Also listed as: Inositol hexaniacinate; Niacin; Niacinamide; Nicotinamide; Nicotinic acid
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.
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.
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.
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.
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.
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)
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.
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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- Review Date:
4/1/2002
- Reviewed By: Participants in the review process include:
Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing
section February 2001), Johnson Drugs, Natick, Ma; Steven Ottariono,
RPh (Pediatric Dosing section February 2001), Veteran's Administrative
Hospital, Londonderry, NH; Margie Ullmann-Weil, MS, RD, specializing in
combination of complementary and traditional nutritional therapy,
Boston, MA. All interaction sections have also been reviewed by a team
of experts including Joseph Lamb, MD (July 2000), The Integrative
Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000),
Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy
(March 2000), Clinical Assistant Professor, University of Mayland
School of Pharmacy; President, Your Prescription for Health, Owings
Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman,
Hawaii State Consortium for Integrative Medicine, Honolulu, HI.
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