Niacin – the B Vitamin – Can Too Much Hurt?

UF Complete Fluid
Fresenius Medical Care

By: Dr. John Wigneswaran MD

What is Niacin?

Niacin (also known as vitamin B3 and nicotinic acid) is an organic compound and one of the 20 to 80 essential human nutrients that your body needs. The current recommended daily allowance (RDA) is 20mg. Doses higher than that can be harmful (read below), with some supplements and prescription products containing 250mg in a daily dose.

What happens when your Niacin is low?

When Niacin levels are low one can experience nausea, skin and mouth lesions, anemia, headaches, and tiredness. Long standing niacin deficiency leads to a disease called pellagra. The lack of niacin may also be observed   in areas of widespread poverty and malnutrition where people simply don’t have access to good nutrition.

What about Niacin and your heart?

Niacin has been thought to be “heart-protective” for decades with a positive affect on cholesterol. In 1955, Altschul and other scientists described niacin as having a cholesterol lowering property for the first time.In factNiacin is the oldest cholesterol-lowering drug and was thought to have a unique anti-clot forming ability, which may have prevented worsening heart disease. In studies it was thought to reduce the “bad cholesterol”, LDL, VLDL and triglycerides while raising the “good cholesterol” or HDL. In these and other studies Niacin aloneor in combination with other cholesterol lowering agents was thought to significantly reduce the risk of cardiovascular disease and arthrosclerosis progression. However recent studies have caused physicians to rethink their approach.

So what is the current thinking?

Recent studies published in the New England Journal of Medicine and reported in the New York Times (Health, July 17, 2014) have raised concerns over the safety and effectiveness of this B Vitamin. Even though the good cholesterol gets raised and the bad cholesterol lowers, patients do not seem to get the heart benefits that many physicians assumed would happen.The study researchers found that using long-acting niacin or Vitamin B3 (high doses) to raise the HDL cholesterol level did not result in reducing heart attacks, strokes or deaths and may contribute to death. The results were presented prior to publication last year, after which the manufacturer of the niacin medication used in the study, Merck & Co., said it would stop selling the drug.

 

What are some easy facts to remember:

  1. Niacin did not seem to reduce the risk of heart disease and stroke.
  2. Niacin can cause serious side effects such as diarrhea, ulcers, muscle damage, gout, skin ulcers, infections, bleeding and even a higher risk of diabetes
  3. The current recommended daily amount of Niacin is around 20mg daily, and doses higher than this may not be helpful or associated with harm.

 

So what’s the verdict?

If you are taking Niacin, or higher doses of B Vitamins in general it is important to talk to your doctor to determine whether you are a candidate. Vitamins that are high in niacin may be harmful in the wrong circumstance, and for specific patient populations like kidney or heart patients, an appropriately formulated vitamin is important to support overall health and avoid the harm of over supplementation. ProRenal® multivitamins and Cardiamin® contain lower daily amounts of niacin (B3) and are specially formulated for the nutritional support of kidney and heart health.

 

 

 

Sources

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  2.  Villines TC, Kim AS, Gore RS, Taylor AJ (2012). “Niacin: The evidence, clinical use, and future directions”. Current atherosclerosis reports 14 (1): 49–59. doi:10.1007/s11883-011-0212-1. PMID 22037771.
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  4. Jafri H, Alsheikh-Ali AA, Karas RH (2010). “Meta-analysis: Statin therapy does not alter the association between low levels of high-density lipoprotein cholesterol and increased cardiovascular risk”. Annals of internal medicine 153 (12): 800–8. doi:10.1059/0003-4819-153-12-201012210-00006. PMID 21173414.
  5.    DrugBank: a knowledgebase for drugs, drug actions and drug targets. Retrieved 14 January 2012.
  6. Bruckert E, Labreuche J, Amarenco P (June 2010). “Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis”. Atherosclerosis 210 (2): 353–61. doi:10.1016/j.atherosclerosis.2009.12.023. PMID 20079494.
  7. Cantarella L, Gallifuoco A, Malandra A, Martínková L, Spera A, Cantarella M (2011). “High-yield continuous production of nicotinic acid via nitrile hydratase-amidase cascade reactions using cascade CSMRs”. Enzyme and Microbial Technology 48 (4–5): 345–50. doi:10.1016/j.enzmictec.2010.12.010. PMID 22112948.
  8. Cox, Michael; Lehninger, Albert L; Nelson, David R. (2000). Lehninger principles of biochemistry. New York: Worth Publishers. ISBN 1-57259-153-6.
  9.  Wan P, Moat S, Anstey A (2011). “Pellagra: A review with emphasis on photosensitivity”. The British journal of dermatology 164 (6): 1188–200. doi:10.1111/j.1365-2133.2010.10163.x. PMID 21128910.
  10. Ishii N, Nishihara Y (1981). “Pellagra among chronic alcoholics: Clinical and pathological study of 20 necropsy cases”. Journal of neurology, neurosurgery, and psychiatry 44 (3): 209–15. doi:10.1136/jnnp.44.3.209. PMC 490893. PMID 7229643.