Niacin health benefit, dosage, side effects - Vitamin B 3 supplement
September 16 201
7 by Dr. Ray Sahelian, M.D.

Niacin (vitamin B3), also known as nicotinamide and nicotinic acid, is an important B vitamin that plays essential roles in a large number of energy pathways. Perhaps as many as 200 enzymes are dependent on this nutrient. Nicotinamide is part of the coenzyme known as nicotinamide adenine dinucleotide (NADH), which is sold as a supplement. I will discuss NADH later in this chapter since several studies have been published regarding this coenzyme. Good sources of niacin are meats, legumes, fish, and some nuts and cereals. The recommended daily intake, the RDA for niacin, is about 15 to 20 mg a day.
   High intake of niacin, particularly from food sources, may reduce the risk of Alzheimer's disease and age-related cognitive decline.

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Niacin for diabetics benefit - and cholesterol
There is good evidence to support the use of niacin as a health benefit for high blood lipid levels. People with diabetes often have high cholesterol and triglyceride levels. They also have low HDL (the good cholesterol) levels. Niacin, a B vitamin, reduces concentrations of triglycerides and raises levels of HDL cholesterol. However, the use of niacin in patients with diabetes has been discouraged because high doses can sometimes worsen blood sugar control. Researchers at the University of Texas Southwestern Medical Center evaluated the use and safety of once-daily extended-release niacin in diabetic patients with triglyceride problems. During a 16-week, double-blind, placebo-controlled trial, 148 patients were randomized to placebo or 1000 mg a day of niacin. Many patients were also receiving therapy with statins. Patients taking niacin had an average increase in HDL by about 20 percent and reductions in triglyceride levels by about 20 percent compared to the placebo group. Rates of adverse event rates other than flushing were similar for the niacin and placebo groups. Four patients discontinued participation owing to flushing. No harm to the liver or muscles was observed. Blood sugar levels on average rose only minimally. The researchers conclude that niacin is a treatment option for patients with type 2 diabetes who have high triglyceride and low HDL levels.
Dr. Sahelian says: Some diabetics may get benefits with a lower dose of niacin, such as 200 to 500 mg a day, which would reduce the incidence of flushing. An extended release form of niacin seems to be a good option.

In type 2 diabetes, high density lipoprotein cholesterol (HDL) loses its endothelial-protective properties -- but niacin may be able to restore the lost vasoprotective effects. Circulation 2010.

Curr Pharm Des. 2013. The role of niacin in lipid-lowering treatment: are we aiming too high? Based on the totality of existing evidence, niacin should in the mean time remain high in the list of lipid-modulating agents to be used in clinical practice, second after statins.

Erectile dysfunction, impotence
J Sexual Med. 2011. Effect of niacin on erectile function in men suffering erectile dysfunction and dyslipidemia. Niacin alone can improve the erectile function in patients suffering from moderate to severe ED and dyslipidemia.

Schizophrenia treatment?
Q. I was reading your info regards niacin and wanted to share info interesting concerning niacin and schizophrenia. I am sure you are familiar with Abram Hoffer, MD, PhD who developed orthomolecular medicine protocols. I read an article that said, " Dr. Hoffer has treated thousands and thousands of such patients for nearly half a century. At 83, he still is in actively practicing orthomolecular (megavitamin) psychiatry. He has seen medical fads come and go. What he sees now is what he’s always seen: that very sick people get well on vitamin B-3."
   A. Yes, I am familiar with Dr. Abram Hoffer and the claims about niacin treating schizophrenia but I am not yet completely convinced that it works although some scientists think otherwise and perhaps it may be of benefit in a very small number of patients.

Eur Rev Med Pharmacol Sci. 2015. Niacin-respondent subset of schizophrenia – a therapeutic review. It is well known that niacin deficiency manifests with several psychiatric manifestations. Also historically evidence has accumulated that niacin augmentation can be used for treatment of schizophrenia. However, the etiopathological associations between niacin deficiency and schizophrenia as well as the mechanism of action of niacin in its treatment. More importantly, the subgroups of schizophrenia which will respond to niacin augmentation has never been highlighted in the literature. In this article, we review three of the mechanisms in which niacin deficiency could lead to schizophrenic symptoms: (1) Niacin deficiency neurodegeneration (2) Membrane phospholipid deficiency hypothesis and (3) Adrenochrome hypothesis. We will further move towards the clinical as well as treatment related associations as reviewed from the literature. Here, we propose a model that a subset of schizophrenia can respond to niacin augmentation therapy better than other subsets because these patients have contributions in their psychotic manifestations from the neural degeneration resulting from niacin deficiency. We present a short description of our case report which showed rapid improvement in schizophrenic psychotic symptoms subsequent to administration of niacin as an augmentation therapy. We, thus, propose that niacin deficiency is a contributory factor in schizophrenia development in some patients and symptom alleviation in these patients will benefit from niacin augmentation, especially in some particular psychotic features.

Q. Can you tell me plz a safe dosage of Niacin/ B 3 for schizophrenia?
   A. I am not convinced that this vitamin is of benefit for this mental condition. Each person is different as to the dosage they can tolerate, it is a good idea to begin with low amounts.

Niacin side effects, safety, risk, overdose
The niacin flush is a very well recognized niacin side effect. No flush niacin --  or flush free -- products are available. Sometimes aspirin is recommended to prevent the side effect. Slo release niacin - also termed sr niacin -  is available. The niacin flush can be avoided by taking a smaller amount and taking a third or half of an aspirin. These adverse reactions are dose dependent, meaning lower doses do not cause as much of a flush as high doses.

This commonly used cholesterol treatment doesn't reduce the risk of heart attack or stroke in people with hardened arteries. What's more, very high doses of the vitamin may have dangerous side effects, including a potential increased risk of death; July 17, 2014, New England Journal of Medicine.

Danger of Niacin overdose
Niacin pills in high doses are sometimes taken by people to pass a urine drug test. However this method does not work and could produce severe side effects. University of Pennsylvania doctors discuss four individuals who used high doses of niacin to try to beat their impending drug screening tests. Of the four patients who arrived at his emergency room after a self-prescribed regimen, two developed severe reactions, including liver toxicity, heart palpitations and metabolic acidosis -- a potentially deadly buildup of acid in the blood. Two of the patients he and his colleagues describe suffered only skin reactions after taking high doses of niacin ahead of their workplace drug tests. The other two had more serious reactions, arriving at the emergency room after hours of nausea, dizziness and vomiting. One had elevated liver enzymes, a sign of liver injury. The recommended daily intake of niacin is about 15 milligrams for adults. But the vitamin is readily available in doses of anywhere from 50 mg to 1,000 mg. Annals of Emergency Medicine, 2007.

I have been taking Niacin 1500 mg/ day to decrease my ldl and increase my hdl’s. This has worked nicely per recent bloodwork but the last 3 days I have been getting heart palpitations; in reading your discussion I presume that the vitamin could be responsible for the palpitations so I am going to go off them for 2 days to see if they stop.

Does too much niacin cause liver damage? What is a high dosage?
   High doses could harm the liver and elevate liver enzymes, so it is best to keep the dose for long term use to 250 mg or less. I consider a high dosage if over 500 mg.

Niacin in food and in our diet
Foods rich in niacin include dairy products, poultry, fish, lean meats, nuts, and eggs. Legumes and enriched breads and cereals also supply niacin.

Food Sources
Turkey breast, roasted, (3 oz.) 43%
Peanut butter (2 tbsp.) 29%
Codfish, cooked (3 oz.) 14%

Combining with prescription medications
Heart Vessels. 2013. Extended-release niacin / laropiprant improves endothelial function in patients after myocardial infarction.

Niacin-laropiprant combo plus statin does not reduce vascular events Adding extended-release niacin plus laropiprant to statin-based LDL-lowering therapy does not prevent major vascular events in patients with atherosclerotic vascular disease.

Niacin Information
Efficacy of extended-release niacin with lovastatin for hypercholesterolemia: assessing all reasonable doses with innovative surface graph analysis.
Arch Intern Med. 2004.
Combination therapy to improve the total lipid profile may achieve greater coronary risk reductions than lowering low-density lipoprotein cholesterol (LDL-C) alone. A new extended-release niacin (niacin ER) /lovastatin tablet substantially lowers LDL-C, triglyceride, and lipoprotein(a) levels and raises high-density lipoprotein cholesterol (HDL-C) level. We evaluated these serum lipid responses to niacin ER/ lovastatin at all clinically reasonable doses. Conclusions: Niacin ER/ lovastatin combination therapy substantially improves 4 major lipoprotein levels associated with atherosclerotic disease.

Safety and tolerability of simvastatin plus niacin in patients with coronary artery disease and low high-density lipoprotein cholesterol (The HDL Atherosclerosis Treatment Study).
Am J Cardiol. 2004
The high-density lipoprotein (HDL)-Atherosclerosis Treatment Study showed that simvastatin plus niacin (mean daily dose 13 mg and 2.4 g, respectively) halt angiographic atherosclerosis progression and reduce major clinical events by 60% in patients with coronary artery disease (CAD) who have low HDL, in comparison with placebos, over 3 years. How safe and well-tolerated is this combination? One hundred sixty patients with CAD, including 25 with diabetes mellitus, with mean low-density lipoprotein cholesterol of 128 mg/dl, HDL cholesterol of < or =35 mg/dl (mean 31), and mean triglycerides of 217 mg/dl were randomized to 4 factorial combinations of antioxidant vitamins or their placebos and simvastatin plus niacin or their placebos. Patients were examined monthly or bimonthly for 38 months; side effects (gastrointestinal upset, nausea, anorexia, vision, skin, and energy problems, or muscle aches) were directly queried and recorded. Aspartate aminotransferase, creatine phosphokinase (CPK), uric acid, homocysteine, and fasting glucose levels were regularly monitored. A safety monitor reviewed all side effects and adjusted drug dosages accordingly. Patients who received simvastatin plus niacin and those on placebo had similar frequencies of clinical or laboratory side effects: any degree of flushing (30% vs 23%), symptoms of fatigue, nausea, and/or muscle aches (9% vs 5%), aspartate aminotransferase (SGOT) > or =3 times upper limit of normal, CPK > or =2 times upper limit of normal, CPK > or =5 times upper limit of normal, new onset of uric acid > or =7.5 mg/dl (18% vs 15%), and homocysteine > or =15 micromol/L. Glycemic control among diabetics declined mildly in the simvastatin - niacin group but returned to pretreatment levels at 8 months and remained stable for rest of the study. This combination regimen was repeatedly described by 91% of treated patients and 86% of placebo subjects as "very easy" or "fairly easy" to take. Thus, the simvastatin plus niacin regimen is effective, safe, and well tolerated in patients with or without diabetes mellitus.

Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia.
Am J Cardiol. 2000.
This multicenter trial evaluated the safety and efficacy of escalating doses of Niaspan (niacin extended release tablets) and placebo (administered once-a-day at bedtime) in patients with primary hyperlipidemia on the percent change from baseline in levels of low-density lipoprotein (LDL) cholesterol and apolipoprotein B. Extended-release niacin was initiated at a dose of 375 mg/day, raised to niacin 500 mg / day, and further increased in 500-mg increments at 4-week intervals to a maximum of 3,000 mg/day. A total of 131 patients were treated for 25 weeks with study medication after a 6-week diet lead-in/drug washout phase and 2-week baseline LDL cholesterol stability phase. Significant decreases from baseline in levels of LDL cholesterol and apolipoprotein B became apparent with the 500-mg/day dose and were consistent at all subsequent doses, reaching 21% and 20%, respectively, at the 3,000-mg/day dose. Significant increases from baseline in levels of high-density lipoprotein cholesterol became apparent with the 500-mg/day dose and were consistent at all subsequent doses, reaching 30% at the 3,000-mg dose. Significant decreases from baseline in triglycerides and lipoprotein(a) occurred at the 1,000-mg dose and were apparent at all subsequent doses, reaching 44% and 26%, respectively, at the 3,000-mg dose. The most common adverse events were flushing and gastrointestinal disturbance. Transaminase increases were relatively small, and the proportion of patients who developed liver function abnormalities on extended-release niacin was not significantly different from placebo. Thus, extended release niacin was generally well tolerated with no niacin toxicity and demonstrated a dose-related ability to alter favorably most elements of the lipid profile.

Q. Is non flushing niacin good for heart disease?
     A. Since a niacin supplement lowers certain lipid levels such as triglycerides, niacin may be helpful in heart disease. Niacin may not lower cholesterol to a great degree.

Q. Is niacin helpful in acne?
     A. I don't think it would influence acne in a noticeable way.

Q. What do you think of liquid niacin?
     A. It is absorbed very well from the GI system, I don't see the need for using liquid niacin.

Q. Does niacin relieve migraine headaches?
     A. I cannot find research that supports the use of niacin for migraine headache.

Q.  Does niacin improve schizophrenia?
     A. I have seen no good data that supports its use for schizophrenia.

Q. Do you know of any studies which show that the no flush niacin has similar effects on cholesterol as the flush kind?
   A. We would need to see the results of a head to head comparison of no flush niacin and regular niacin in a double blind placebo controlled trial. As of now, we have not seen such a study.

Q. I am currently taking flush-free niacin (inositol hexanicotinate) in order to try to lower my cholesterol. Does this have the same effect as regular B3 ( Niacin )?
   A. We have not seen head to head studies comparing the two forms of niacin, but our best guess is that they should have similar effects.

Q. Is the No-Flush niacin 500mg tablets an adequate replacement for 500mg Niaspan (prescription) tablets?
   A. We have not seen head to head human study comparisons between the two niacin products so we can't say for sure. We assume they would be similar, but we can't give a guarantee.

I am currently taking a maximum dose of Niaspan 500mg x 4, as a cholesterol reducer in conjunction with Welchol, as I have used all statins available and developed rhabdomyolosis type symptoms, aching back and wacked liver enzymes. Next week June 2009, I will have a lapband surgery, the niacin tabs are too large, and I understand cannot be crushed. Would a liquid niacin work the same way?
    Liquid niacin should work in a similar way.

buy No-Flush Niacin, 500 mg
Source Naturals

Niacin plays an essential role in the activities of various enzymes involved in the metabolism of carbohydrates and fats, the functioning of the nervous and digestive systems, the manufacturing of sex hormones and the maintenance of healthy skin. Inositol hexanicotinate functions as niacin without the characteristic "flush".
Buy Niacin No Flush

Supplement Facts
Serving Size: 1 Tablet
  Amount Per Serving %DV
Niacin (as inositol hexanicotinate) 500 mg 2,500%
Inositol (as inositol hexanicotinate) 142 mg
†Daily Value not established.


Buy Niacin no flush
Supplement Facts:
Niacin 500 mg - 2,500% DV
(as inositol hexanicotinate) Inositol - 142 mg