Niacin: How it Helps the Heart, Brain, and Beyond

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If you’re navigating the maze of dietary supplements, you might have stumbled across Niacin or vitamin B3. Often overshadowed by its flashier siblings in the vitamin B family, Niacin holds its own with some intriguing potential benefits. This article takes a deep dive into Niacin’s role beyond energy production, digging into the research to see where the evidence leads.

What Is Niacin?

Niacin, also known as vitamin B3, is an essential nutrient that our bodies need to function properly. Since our bodies can’t produce niacin on their own, we need to get it from the foods we eat or from supplements. Niacin is found in a variety of foods like meat, fish, poultry, whole grains, and some vegetables.

Niacin plays an important role in many processes in our bodies. It helps convert the food we eat into energy and supports the health of our nervous system. Niacin also helps maintain healthy skin and is involved in producing certain hormones.

If you have any concerns about your niacin intake or want to use it for specific health reasons, it’s a good idea to consult with a healthcare professional for guidance.

Niacin’s Role At The Cellular Level

Without NAD+ in our cells, we would die…quickly. NAD+ is at the center of metabolic reactions that convert nutrients into energy and drive vital cellular processes.

One of the main reasons that niacin is so important is its connection to NAD+. Without Niacin, there is no NAD+. Niacin is integral in the creation of NAD+ (nicotinamide adenine dinucleotide), an essential coenzyme that supports countless cellular processes. The importance of NAD+ can’t be understated; it fuels the activation of Sirtuins, proteins that are sometimes referred to as the ‘guardians of the cell.’

Sirtuins have been linked to cellular health, longevity, and the repair of DNA damage, but they rely heavily on a consistent supply of NAD+ to function optimally. By ensuring sufficient niacin intake, we effectively boost the production of NAD+, directly supporting the activation of these crucial Sirtuins.

Simply put, consuming adequate niacin is an important step in a chain reaction that leads to better cellular health and longevity. The niacin you consume plays a crucial role in the production of NAD+, an essential coenzyme that energizes Sirtuins. This activation triggers a cascade of cellular benefits, such as improved energy metabolism, enhanced DNA repair, reduced inflammation, and potentially increased lifespan.

What are the Benefits of Niacin?

• Heart Health: By improving cholesterol levels, niacin helps reduce the risk of atherosclerosis, the buildup of fats, cholesterol, and other substances in and on artery walls. This, in turn, can lower the risk of heart attacks and strokes.
  • Cholesterol Management: Niacin has a significant effect on lipid profiles. It reduces LDL (low-density lipoprotein) cholesterol and triglycerides, which are linked to cardiovascular diseases if present in high amounts. Additionally, it increases HDL (high-density lipoprotein) cholesterol, which helps remove other forms of cholesterol from the bloodstream. [PMC4829575]
• Alcohol Withdrawl: Niacin was found useful in preventing delerium in people withdrawing from alcohol. [PMC3542555]
• Cellular Metabolism: Niacin is essential in the formation of coenzymes NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate). These coenzymes are involved in cellular metabolism, aiding in the conversion of nutrients into energy and supporting cellular repair processes.
• Skin Health: It contributes to maintaining healthy skin. Niacin can help treat certain skin conditions, such as acne, due to its anti-inflammatory properties. It also supports skin cell renewal and repair.
• Nervous System Function: Niacin is important for the healthy functioning of the nervous system. It plays a role in nerve signaling and can have a neuroprotective effect, potentially benefiting neurological health.
• Digestive Function: It aids in the digestive process by helping convert food into usable energy, thereby supporting the overall function of the digestive system.
• Mental Health: Niacin has been explored as a potential treatment for schizophrenia, a complex psychiatric condition characterized by symptoms like hallucinations and delusions. Some studies suggest that high doses of niacin, when used alongside other treatments, might help alleviate certain symptoms of schizophrenia by impacting brain chemistry and function. However, the effectiveness of niacin in treating schizophrenia varies significantly among individuals, and more research is needed to fully understand its role and efficacy in this context.
• Antioxidant Effects: Niacin possesses antioxidant properties, which means it can help combat oxidative stress – a process that contributes to cellular damage and aging. This antioxidant effect adds to its protective role in overall health.

The History of Pallegra and the Discovery of Niacin

The cause of pellagra was a mystery for a long time. It was prevalent in areas where corn, a staple food, was heavily consumed. Pellagra caused serious symptoms, including dermatitis, diarrhea, dementia, and eventual death. At first, it was thought to be an infectious disease because of its widespread occurrence. But, Dr. Joseph Goldberger, a public health scientist, noticed that pellagra was common among poor people who had limited diets, while it was rare among those who had varied diets.

The outbreak of pellagra in the early 20th century was largely attributed to the widespread milling of corn and other grains, a process that removed niacin from these staple foods. Milling involves the removal of the outer layer of the grain, which contains a majority of the grain’s vitamins and minerals, leaving behind the starchy endosperm. As a result, communities that heavily relied on milled corn as a dietary staple became deficient in niacin, leading to the rampant spread of pellagra. This historical event underscores the importance of whole foods in our diet and the unintended health consequences that can result from food processing methods that strip away vital nutrients.

Goldberger started a series of experiments in 1914 and found that pellagra could be prevented by a diet that included fresh meat, milk, and eggs – food items rich in proteins. However, despite his groundbreaking work, the exact substance that could prevent pellagra remained unknown.

The mystery was finally solved in the 1930s by Conrad Elvehjem, a biochemist at the University of Wisconsin. He discovered that nicotinic acid, a compound we now know as niacin, was the missing nutrient that could cure pellagra. Later work showed that tryptophan, an amino acid found in many proteins, can be converted into niacin in the body, explaining why Goldberger’s protein-rich diet worked.

Niacin For Raising Good Cholesterol: Out of Favor, But Weigh The Evidence

Niacin has been widely used to raise good cholesterol. It can increase HDL by as much as 25%. [PMC4829575] High-Density Lipoprotein (HDL) cholesterol is often referred to as ‘good cholesterol’ because it’s thought to reduce your risk of heart problems.

So, it was quite a surprise when the AIM-HIGH trial was stopped at 3 years because, at that point, it had failed to find increased benefit for niacin supplementation over statin use alone. And, yet, there are many factors that suggest this is a deeply flawed study. A critique points out that in the group that was given niacin, HDL was only a little higher than in the group given the placebo (42 vs. 38 mg/dL). Then, there is the fact is that the placebo wasn’t actually a pure placebo, but a smaller dose of niacin (50 mg), meaning that the placebo group was still getting a daily dose of niacin between 100 and 150 mg. This likely played a role in the “unexpected increase in the good cholesterol” seen in the placebo group. To complicate matters further, the placebo group was given higher doses of a statin drug along with another medication, ezetimibe, to keep LDL cholesterol levels the same as in the niacin group.

The AIM-HIGH study was also stopped prematurely after only 3 years, which definitely might have hidden potential benefits that could have been realized with more time. In a significant previous niacin trial, the Coronary Drug Project, it took 5 years of treatment and another 15 years of follow-up to observe a noticeable decrease in heart attacks, strokes, and deaths.

Not only that, but about 20% of the participants in the AIM-HIGH study had already been using niacin before the study began. The influence of this prior niacin use on the results of the study isn’t clear, as niacin is known to have a long-term effect. Lastly, after the trial, a secondary analysis was conducted on subjects who had both low HDL cholesterol and high triglyceride levels. This analysis revealed a significant 26-36% reduction in the risk of cardiovascular events, but this finding wasn’t widely publicized. Subjects in this study took extended-release (ER) niacin 1500–2000 mg at bedtime. Subjects in this study took extended-release (ER) niacin 1500–2000 mg at bedtime. For more on this, refer to the article: The “good” HDL cholesterol Under Attack! – Defending Niacin, AKA Vitamin B3. [PMC3862446]

While this scientific discussion continues, it’s important to remember that there are non-drug approaches to managing cholesterol and improving heart health. These include maintaining a healthy diet low in saturated fats, exercising regularly, maintaining a healthy weight, avoiding tobacco smoke, and limiting alcohol consumption. Even as we look forward to new scientific discoveries, these established lifestyle changes remain the cornerstone of heart disease prevention.

The HPS2-THRIVE trial is also cited as a large trial failing to show benefit for niacin. This trial has also been criticized for its flawed design. Significantly, the AIM-HIGH and HPS2-THRIVE studies don’t pertain to individuals who aren’t on statin medication, or to those who initially exhibit higher LDL levels (exceeding 85 mg/dL), elevated triglyceride levels (over 150-200 mg/dL), and low HDL levels (less than 40 mg/dL).

Niacin In Aging

There’s a connection between the amount of niacin in your diet and the levels of a super-important energy molecule called nicotinamide adenine dinucleotide (NAD) in your body. It seems that when you have less niacin, your cells’ NAD levels drop, and this is a problem because low NAD levels make it harder for cells to grow and divide. When this happens, cells can age and die prematurely.

Certain enzymes, like sirtuin proteins and others, rely on NAD to help protect our DNA and repair any damage. Sirtuins are crucial for extending the lifespan of cells and preventing premature aging. If sirtuins are faulty, it can lead to conditions like Huntington’s disease and other age-related neurological disorders. So, while the research is still unfolding, it’s clear that maintaining adequate levels of niacin in your diet could play a key role in preserving your cells’ health and longevity. [PMC4112140]

Bill W. and His Fight To Add Niacin to Alcoholics Anonymous

In the summer of 1935, a transformative movement was born when Bill Wilson, known as Bill W., and Dr. Bob started the first Alcoholics Anonymous (AA) group. Over the years, this initiative would prove to be a lifeline for countless people grappling with alcoholism.

However, despite the success of AA in helping Bill W. address his alcoholism, it had little effect on his persistent depression and anxiety. Furthermore, it wasn’t a universally effective solution for all. In search of answers, Bill W. found himself at a parapsychology conference in New York City in 1960, where he was introduced to niacin researcher Abram Hoffer by the renowned British writer, Aldous Huxley.

Hoffer enlightened Wilson about an innovative treatment for alcoholism and schizophrenia – niacin therapy. Using Vitamin B3, or niacin, they had achieved promising results. Intrigued, Wilson decided to try it himself, beginning a daily intake of 3 grams of niacin. Astonishingly, within just two weeks, his lifelong battle with depression and anxiety had significantly eased. Wilson was thrilled with this simple and effective solution and recommended vitamin therapy to his AA friends and acquaintances in the celebrity world. The results, in his eyes, were spectacular.

Wilson approached the physicians of AA, who were also members due to their own struggles with alcoholism. But, the International Organization of AA was less than receptive, asserting that Wilson, without a medical license, should not be promoting any form of vitamin treatment.

Wilson devoted the final eleven years of his life to championing niacin therapy as a supplementary treatment for alcoholics in AA groups. Despite producing three informative booklets for AA physicians, his efforts largely went unheeded. When reflecting on his legacy before his passing, Bill Wilson chose to highlight niacin therapy over AA. His choice, while perplexing to some, emphasized his belief in the transformative potential of this seemingly simple vitamin therapy.

About the Tolerable Upper Limit for Niacin

The tolerable upper limit (UL) for nutrients, including niacin, is set by the Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies. The IOM has now been renamed as the National Academy of Medicine. The UL is the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects for almost all individuals in the general population.

The tolerable upper limit (UL) for niacin is 35 mg per day for adults. But, this limit is based on the fact that higher doses lead to the side effect called “flushing.” Flushing can make your skin feel warm, itchy, and look red, and this reaction is a common reason why people with heart diseases stop taking niacin. However, the flushing usually lessens over time and doesn’t present any long-term health risks.

Even though the tolerable upper limit is 35 mg per day, many niacin supplements and multivitamins much more than this, commonly up to 500 mg. While there are concerns about the use of niacin in people with heart disease, it’s still unclear if these concerns apply to younger or healthier people taking niacin supplements.

How Nicotinamide Differs From Niacin (Nicotinic Acid)

It can be confusing to keep track of the different forms of Vitamin B₃, so the table below summarizes the differences.

How Much Niacin Do We Need?

The Recommended Dietary Allowance (RDA) for niacin, according to the National Institutes of Health:

Food Sources of Niacin

Are Niacin Supplements Safe?

Niacin, also nicotinic acid, is generally considered safe for most people when taken in appropriate amounts. However, niacin therapy is associated with a moderately increased risk of developing diabetes. [PMC4752613]

Medicines That Interact With Niacin

• Blood pressure medications: Niacin has an additive effect with blood pressure medication, so taking it with blood pressure medications could cause your blood pressure to drop too low.
• Diabetes medications: Niacin can raise fasting blood sugar levels [PMC4752613], so taking it with diabetes medications might interfere with blood sugar control.
• Statins: Statins are medications used to lower cholesterol levels. Combining niacin with statins may increase the risk of muscle pain or weakness. If this occurs, consider taking CoQ10 to counteract this statin side effect and consult your physician.
• Anticoagulant / antiplatelet medications: Niacin might slow blood clotting. When taken with anticoagulant or antiplatelet medications like warfarin, aspirin, or clopidogrel, it could increase the risk of bruising or bleeding.
• See prescribing information: [NBK541036]

Supplement Interactions with Niacin

• Zinc: High doses of niacin might lower zinc levels in the body. If you’re taking zinc supplements, discuss with a healthcare professional to ensure proper balance and avoid potential interactions.
• Chromium: Chromium might affect blood sugar levels, and since niacin can also impact blood sugar, taking these two supplements together could interfere with blood sugar control.
• Herbs or supplements that affect blood clotting:
  • Some herbs and supplements, like ginkgo biloba, garlic, or ginger, can slow blood clotting. Since niacin might also slow clotting, taking these supplements together might increase the risk of bleeding.

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Food First!

Although this article discusses supplements in detail, don’t forget that we are absolutely committed to the “Food First” approach to nutrition. When it comes to your health, the totality of your eating habits far surpasses the impact of individual nutrients or any single supplement you consume. Even though this article doesn’t delve into the broader picture of your overall diet, it’s crucial to keep this element at the forefront of our minds. Your food needs to provide all the vitamins, minerals, fiber, and phytochemicals to nourish your body systems down to the cellular level.

Food choices, rather than supplements, are the most critical factors for a healthy gut microbiome. These trillions of tiny inhabitants in your gut affect your brain waves; they orchestrate your immune system. They possess the power to create molecules that can switch genes on or off and are even capable of synthesizing neurotransmitters. Opting for organic foods and steering clear of plastic packaging (including those labeled BPA-free) is a smart move to limit toxin exposure. The sum of all these parts leads to a powerful conclusion: the ultimate key to your health lies in the quality and balance of the food you consume. Supplements are secondary.

To Sum It Up

Although Niacin (B3) is sitting there in every bottle of multivitamins or B Vitamins, niacin is far more than a standard nutrient. Its potential roles in maintaining good health, from supporting our energy production to benefiting heart health, are intriguing. Its usefulness for cholesterol is discounted, but it’s likely that we won’t be hearing the end of that. Yet, it’s important to remember that Niacin supplementation is not a standalone solution but one component of a comprehensive approach to health. Stay tuned to the evolving research and make the choices that best fit your individual health journey.

This Article is Not a Substitute for Medical Advice

Dietary supplements are not designed to diagnose, treat, cure, or prevent any disease. The Supplement Sciences website seeks to provide comprehensive access to the most relevant supplement information along with convenient online ordering. We do not provide medical advice and cannot guarantee that every product suggested is completely without risk. Since each person is unique in their health history and medication use, it is important to discuss supplements with your personal physician. Specifically, pregnant women and individuals being treated for cancer or liver or kidney problems must consult their physician about every nutritional supplement they plan to take. People taking medications for the treatment of HIV or with a history of organ transplant must not take supplements without consulting with their physician.