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  Vitamin B3 (Niacin)  
 
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Niacin is used in the process of releasing energy from carbohydrates, forming fat from carbohydrates and to process alcohol. Vitamin B3 comes in two basic forms—niacin (also called nicotinic acid) and niacinamide (also called nicotinamide). Inositol hexaniacinate, a “flush-free” niacin, is also available and has many of the same benefits of niacin, and is becoming increasingly popular. Dietary niacin and niacin formed within the body from the amino acid tryptophan are converted to niacinamide. Niacinamide is the biologically active form of niacin. Niacin, in doses as low as 50mg, may cause flushing, headache, and stomachache in some people. Larger amounts can cause liver damage, and elevated blood levels of uric acid and may raise homocysteine levels. Symptoms caused by niacin supplements, such as flushing, have been reduced with sustained-release niacin products but these forms of niacin have caused significant liver toxicity, and are not advised. Niacinamide and inositol hexaniacinate have not been linked with the side effects associated with niacin supplementation.

Pellagra, the disease caused by a frank vitamin B3 deficiency, is rare in modernized societies. Symptoms include loss of appetite, dermatitis, diarrhea, mental changes, beefy tongue, and digestive and emotional disturbance.
Frequent causes of a deficiency include a poor diet, alcoholism, isoniazid therapy and carcinoid tumors. Rarely a deficiency can occur in the presence of hyperthyroidism, diabetes mellitus, cirrhosis, pregnancy or lactation.

The RDA for men and women is in the range of 14-18mg, and is easily achieved. Prescribed doses of the supplement go as high as 3gm per day and sometimes higher.

The best food sources of vitamin B3 are peanuts, brewer’s yeast, fish, and meat. Some vitamin B3 is also found in whole grains. Vitamin B3 is found in most vitamin supplements, but additional supplementation is needed to achieve many of the researched health benefits.

NIASPAN offers significant advantages over IR and SR niacin. Older niacin preparations are available in immediate-release (IR) and sustained-release (SR) formulations. IR niacin, with its multidose regimen and frequent, intense flushing, has a history of poor patient compliance and tolerance.

Sustained-release niacin is dosed less frequently, which may decrease the incidence of flushing. But use of SR niacin has been associated with potentially severe adverse effects including significantly elevated liver transaminase levels. These events can usually be detected by appropriate monitoring, but use of SR niacins has been reported to result in hepatotoxic effects in up to 50% of patients. In addition, the US FDA has issued a guidance stating its opposition to the sale of OTC products for the treatment of hypercholesterolemia.

Prescription NIASPAN utilizes Once-a-Night tablet dosing and an innovative HydroGel Programmed-Release formulation to control drug release. The result is a niacin preparation that maintains traditional niacin lipid-altering efficacy, while avoiding the safety and tolerability pitfalls common with other niacin preparations.
 

 
 

Vitamin B3 (Niacin) can help with the following:
 
 
Addictions  Alcoholism Recovery
 John Cleary, M.D., observed that some alcoholics spontaneously stopped drinking in association with taking niacin supplements. Cleary concluded that alcoholism might be a manifestation of niacin deficiency in some people and recommended that alcoholics consider supplementation with 500mg of niacin per day. His research suggests that niacin supplementation may help wean some alcoholics away from alcohol. Niacinamide or inositol hexaniacinate, safer forms of the same vitamin, might have similar actions.

Autoimmune

  Multiple Sclerosis / Risk
 Please also see the article about the approach that Fred Klenner, MD used with MS.

Digestion

Not recommended for:
  Gastric/Peptic Ulcers
 In rare cases, niacin has aggravated peptic ulceration.

Hormones

  Histapenia (Histamine Low)
 One simple test you can do yourself is to get some nicotinic acid in a 50mg dose. Nicotinic acid is the flush producing niacin. If you have a flush from one dose of 50mg of nicotinic acid (taken on any empty stomach) then you have histamine levels.

A low histamine person would probably require a dose of about 250mg of nicotinic acid to have that flush. If no flush from 50mg of nicotinic acid then you might try 100mg dose to double check this. If that doesn't work you might try once more a total of 200mg or 250mg of nicotinic acid just to make sure that you do in fact have low histamine levels and that supplement is the kind to cause a flush.

  Low HGH (Human Growth Hormone)
 There is some evidence that the use of niacin improves GH release from the pituitary gland.

Lab Values

  Elevated LDL/HDL Ratio
 In patients with CAD and well-controlled LDL levels, elevation of HDL with niacin improved endothelial function. HDL levels increased from 30 to 40mg/dL in the niacin-treated patients but not the controls.. [American Heart Journal 08/26/2002]

Niaspan is a newer form of niacin that does not appear to cause the liver problems associated with the older sustained-release preparations.

Drug companies are getting in on the benefits of niacin, by combining it with statin drugs, or using it alone in products like Niaspan, Niacor (Nicolar) and Slo-Niacin

  Elevated Total Cholesterol
 Probably the best form of vitamin B3 to use for the purpose of cholesterol reduction is inositol hexaniacinate (flush-free niacin). It is often given at 500mg tid for two weeks, then increased to 1,000mg tid. If using regular niacin, start out with 100mg tid working up to 1,000mg tid with meals. Niacinamide, as a supplemental vitamin, is not effective for lowering cholesterol. Niacin may also be helpful by transforming small unprotective HDL particles into larger ones which do offer a protective cardiovascular effect.

  Elevated Triglycerides
 In a study of people with high cholesterol, niacin not only reduced LDL and triglycerides by 17% and 18%, respectively, but it also increased HDL by 16%.

  Uric Acid Levels Low

Metabolic

  Metabolic Diet Type
  Meniere's Disease
 Individual reports have suggested that taking vitamin B3, especially as niacin, along with vitamin B6 improves their response. In addition, on bad days, using a B-complex several times a day instead of only once can help also.

  Anorexia / Starvation Tendency
 Anorexia is one of the first symptoms of pellagra, and it has been suggested that anorexia nervosa is simply sub-clinical pellagra. Niacin deficiency causes low NAD levels which causes deterioration in the Krebs cycle. With low ATP, sodium accumulates inside the cell, causing it to swell. When niacin is given, the most dramatic change is the movement of fluid out of the body. In anorexia nervosa, supplementation may improve appetite and mental state. Case Reports: 4 patients with anorexia nervosa and 1 patient with bulimia all responded rapidly to supplementation with niacin 500mg daily. [ Int Clin Nutr Rev 9( 3): pp.137-43, 1989]

Musculo-Skeletal

Not recommended for:
  Gout / Hyperuricemia
 The vitamin niacin, also called nicotinic acid, can raise uric acid levels, so should not be used by people who have gout.

Nervous System

  Bell's Palsy
 74 consecutive Bell's palsy patients were treated with niacin at a dose of 100-250mg with "excellent results" noted in all patients within 2 to 4 weeks. [Arch Otolaryngol 68: pp.28-32, 1958]

Nutrients

  Vitamin B3 Requirement

Organ Health

  Diabetes Type II
 Although niacin increases low levels of high-density lipoprotein cholesterol, which frequently accompany diabetes, past guidelines did not recommend the use of niacin in patients with diabetes because of concerns about adverse effects on glycemic control; however, this was based on limited clinical data. A 2000 study suggests that lipid-modifying dosages of niacin can be safely used in patients with diabetes and that niacin therapy may be considered as an alternative to statin drugs or fibrates for patients with diabetes in whom these agents are not tolerated or fail to sufficiently correct hypertriglyceridemia or low HDL-C levels. [JAMA. 2000;284: pp.1263-1270]


Not recommended for:
  Hepatitis
 Large doses of naicin may further increase the already elevated liver enzymes usually seen in hepatitis.

Risks

  Increased Risk of Alzheimer's / Dementia
 A small increase in the intake of niacin was associated with a reduced risk of Alzheimer's disease in a study
of 815 elderly adults followed for an average of just over 2 years. The difference occurred with 22mg per day consumed compared to 12mg per day. The dietary intake of other B-vitamins was not associated with this reduced risk. [Gerontological Society of America 55th Annual Scientific Meeting, November, 2002]

Uro-Genital

  Dysmenorrhea, Painful Menstruation
 Niacin (and possibly flush-free niacin) at 100mg every 2 to 3 hours in acute cases has been used. Please start using niacin at least one week before your anticipated period. 200mg per day taken throughout the menstrual cycle would make sure that the maximum benefit would be achieved [Am Practice Digest Treat 1952;3: pp.892-3].
 
 


KEY
May do some good
Likely to help
Highly recommended
May have adverse consequences
Avoid absolutely







GLOSSARY

Amino Acid:  An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.

Carbohydrates:  The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.

Cirrhosis:  A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.

Dermatitis:  A general term used to refer to eruptions or rashes on the skin.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Diarrhea:  Excessive discharge of contents of bowel.

FDA:  The (American) Food and Drug Administration. It is the official government agency that is responsible for ensuring that what we put into our bodies - particularly food and drugs - is safe and effective.

Gram:  (gm): A metric unit of weight, there being approximately 28 grams in one ounce.

Hepatotoxic:  Being toxic or destructive to the liver.

Hypercholesterolemia:  Excess cholesterol in the blood.

Hyperthyroidism:  An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.

Inositol:  Usually considered part of the vitamin B complex. It is thought that along with choline, inositol is necessary for the formation of lecithin within the body. Involved in calcium mobilization.

Lactation:  Production of milk; period after giving birth during which milk is secreted in the breasts.

Milligram:  (mg): 1/1,000 of a gram by weight.

Niacin:  (Vitamin B-3): A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.

Over-The-Counter:  A drug or medication that can legally be bought without a doctor's prescription being required.

Pellagra:  A disease caused by a deficiency of thiamine (B1), usually occurring in alcoholics or in persons with malabsorption disorders.

RDA:  Recommended Daily Allowance of vitamins or other nutrients as determined by the FDA. U.S. RDAs are more widely used than RDAs, and focus on 3 age groups: Infants of 0-12 months; Children of 1-4 years; Adults and children of more than 4 years.

Tryptophan:  Essential amino acid. Natural relaxant and sleep aid due to its precursor role in serotonin (a neurotransmitter) synthesis. Along with tyrosine, it is used in the treatment of addictions.

Yeast:  A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.