Vitamin B3 - Niacin

Vitamin B3, also known as niacin/nicotinic acid, is one of 8 B vitamins. It comes in two other forms:

• niacinamide (nicotinamide) 
• inositol hexanicotinate 

These additional forms have different effects from niacin.

All of the B vitamins, commonly referred to as B-complex vitamins, help convert carbohydrates into glucose, which the body uses for energy. B vitamins also help the body use fats and protein and are essential for a liver,  skin, hair, and eye health, as well as helping the nervous system function.

Niacin also helps the body make various sex and stress-related hormones in the adrenal glands and other parts of the body. It can improve circulation and suppress inflammation. All B vitamins are water-soluble, meaning the body doesn't store them.

It's rare for anyone in the developed world to have a vitamin B3 deficiency. In most developed countries, alcoholism is the main cause of vitamin B3 deficiency.

High cholesterol

Niacin has been used since the 1950s to lower elevated LDL bad cholesterol and triglyceride levels in the blood. However, side effects can be unpleasant and even dangerous. High doses of niacin cause:

• Flushing of the skin
• Stomach upset (which usually subsides within a few weeks)
• Headache
• Dizziness
• Blurred vision
• An increased risk of liver damage

A time-release form of niacin can reduce flushing, but long-term use of the time release form has been associated with liver damage. 

Niacin can interact with other cholesterol-lowering medicines and you shouldn't take niacin at high doses without your doctor's supervision.

In one study, men with heart disease slowed down the progression of atherosclerosis by taking niacin along with colestipol. They experienced fewer heart attacks and deaths.

In another study, people with heart disease and high cholesterol who took niacin along with simvastatin (Zocor) had a lower risk of having a first heart attack or stroke, along with an overall lower risk of death. 

A study also showed that men who took niacin alone seemed to reduce the risk of having a second heart attack, although it did not reduce the risk of death.

The Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2 study investigated the incremental effect of adding niacin (1 gram daily) to statin therapy in 167 patients with known CHD and low HDL levels on carotid intima-media thickness (CIMT), a surrogate endpoint for the development of atherosclerosis. 

The addition of extended-release niacin prevented the increase in CIMT compared to simvastatin monotherapy. A comparative efficacy trial (ARBITER6) also showed a significant reduction of baseline CIMT with extended-release niacin (2 grams daily for 14 months), as opposed to ezetimibe (a cholesterol-lowering drug), in patients on statins.

The effects of niacin are dose-dependent. Doses of niacin higher than 1 gram/day are typically used to treat hyperlipidemia. 

A placebo-controlled study in 39 patients taking statins (cerivastatin, atorvastatin, or simvastatin) found that a very low dose of niacin, 100 mg daily, increased HDL cholesterol by only 2.1 mg/dL, and the combination had no effect on LDL cholesterol, total cholesterol, or triglyceride levels. 

At the pharmacologic dose required for cholesterol-lowering effects, the use of niacin should be approached as if it were a drug. Individuals should only undertake cholesterol-lowering therapy with niacin under the supervision of a qualified health care provider in order to minimize potentially adverse effects and maximize therapeutic benefits.

Niacin Stimulates Growth Hormone

While extolling the benefits of niacin, one frequently overlooked side effect is that niacin is a powerful releaser of growth hormone.

Quabbe and colleagues administered 500 mg niacin intravenously to humans and noted a dramatic rise in growth hormone. In a second phase of their study, they simultaneously administered an infusion of fatty acids. Note that the fat completely blunted any rise in growth hormone.

The practical take-home lesson of this study is that anyone using niacin as a growth hormone stimulant should take it on an empty stomach (glucose and insulin also inhibit growth hormone, as well as fatty acids).

The results is the MENS. (Melatonin, Exercise, Niacin, Sleep) routine. This routine has shown good success with young people whose growth plates are still open.

In order for the Niacin to properly work, it is recommended to take on an empty stomach, 3+ hours after eating or in the morning upon waking up. After taking the niacin, you cannot eat for another 3 hours so it is best to take it at night before bed or morning right after waking up. Take every odd day, take melatonin every odd day before sleep, Melatonin helps decrease excess estrogen and promotes good sleep. Sprint for 5 minutes every other day, sprinting increases GH. Sleep 8-10 hours a day.

Dietary versus Blood Serum Cholesterol

Dietary cholesterol has no bearing on blood serum cholesterol. Cholesterol is a very large molecule. It has to be broken down into tiny fragments to be absorbed through your gut wall, at which point these building blocks are normally used for something else. All the cholesterol in your blood/body is produced by your liver.

And that's ignoring the fact that when people talk about 'good cholesterol' and 'bad cholesterol' they're not actually talking about cholesterol but rather the cholesterol transporters.

LDL (low density lipoprotein/'bad cholesterol') transports the actual cholesterol molecules in the blood from the liver to wherever needs it. Cholesterol is vital for regulating cell membrane fluidity - you'd die without it.

HDL (high density lipoprotein/'good cholesterol') transports it back to the liver when its finished.

An overall poor diet (many different and complex factors - none of which are how much cholesterol you consume in your diet) causes the overproduction of LDL and underproduction of HDL, so more is going out than is coming in, leaving fatty deposits in your arteries which causes high blood pressure and all the knock on effects.

Best and Cheapest way to Manage Cholesterol

Niacin, also known as nicotinic acid or vitamin B3, has long been regarded as one of the most effective weapons in managing cholesterol. It can lower levels of triglycerides, fatty acids and to a lesser extent, the "bad" kind of cholesterol (LDL) while at the same time powerfully increasing the "good" kind (HDL).

But there's a catch – a big one. Patients don't like to take niacin because in most of them, it causes embarrassing, uncontrollable intense flushing, a rush of blood to the face and other skin surfaces accompanied by a prickling sensation.

Now, however, scientists have identified the discrete molecular pathways that are triggered when niacin enters the body, and they say that knowledge may lead to a revival of niacin-based treatments as therapies of choice.

Read the full article....

Niacin, Lipids, and Growth

A study in Archives of Internal Medicine (Guyton, et al, 2000) confirms the superiority of niacin (vitamin B3) as a lipid-lowering agent.

A proprietary timed-release version of niacin (Niaspan) was compared to the pharmaceutical drug gemfibrozil (Lopid). The study involved 399 male and female subjects ranging in age from 21 to 75, all of whom had low levels of HDL (high density lipoproteins - "good cholesterol") less than 40 mg/l. Other criteria for inclusion in this study were triglycerides less than 400 mg/l, and LDL (low density lipoproteins - "bad cholesterol") less than 260 mg/l. Niacin was administered once daily at bedtime.

The niacin dosage was begun at 375 mg/day, and then increased progressively over the course of the study, and maintained at a level of 2,000 mg nightly for 8 weeks. The duration of the study was 16 weeks. Subjects took an aspirin as-needed to prevent flushing.

Gemfibrozil 600 mg was administered twice daily over the entire 16 weeks. Niacin increased HDL levels over 25%, compared to an increase of 13.3% due to gemfibrozil. Gemfibrozil actually raised LDL (the "bad cholesterol"), while niacin slightly lowered this fraction. Gemfibrozil lowered triglyceride levels by 40%, compared to a 30% decrease from niacin.

Thus, niacin resulted in an overall improvement in the lipid profile which exceeded that induced by gemfibrozil. However, niacin favorably altered several other cardiovascular risk factors as well.

• Apolipoprotein levels were significantly (20%) reduced by niacin, but were not altered by gemfibrozil.
• Both substances reduced serum apolipoprotein levels by the same amount.
• Fibrinogen, a third risk factor, was reduced by niacin, but increased 6-9% by gemfibrozil. The authors concluded, "Niaspan, 2,000 mg, had a significantly better effect on fibrinogen levels than gemfibrozil."

These results support many previous studies on the use of niacin as a lipid-lowering nutrient.

For example, in the Coronary Drug Project, which enrolled men with a previous myocardial infarction, niacin use resulted in a 26% decrease in second non-fatal heart attacks over a six-year period, and an 11% decrease in total mortality after 15 years of followup.

Niacin Improves Microcirculation

Anyone who's taken niacin (nicotinic acid) has no doubt experienced the niacin flush, but are there any benefits to this (for some) uncomforatable flushing and tingling of the skin?

Here's a study (Influence of xantinole nicotinic acid on cutaneous microcirculation in patients with coronary artery disease and hyperlipoproteinemia) that took 8 adults (admittedly a small sample) who had already been identified with coronary artery disease, gave them nicotinic acid, and then measured the microcirculation bloodflow in teh skin resulting from the vaso dilation caused by the niacin.

"...nicotinic acid (NA) dose dependently lowers plasma levels of atherogenic lipoproteins and increases blood flow through vasodilation. The aim of this study was to evaluate the effect of NA on cutaneous microcirculation in patients with coronary artery disease and hyperlipidemia."

The results:

"The administration of 1000 mg of NA resulted in a significant improvement of the cutaneous microcirculation in patients with coronary artery disease and hyperlipidemia."

So taking niacin resutls in increased blood flow to the skin, which could be beneficial for healing or other therapeudic purposes.

Niacin Interactions

Niacin can have possible interaction with other medications or drugs you may be taking. If you are currently taking any of the following, you should talk with your doctor before taking Niacin.

Blood thinners
Niacin can potentially increase the effect of these medications, increasing the risk of bleeding.

Alpha blockers and blood pressure medications
Niacin can increase the effectiveness of medications taken to lower blood pressure.

Statins 
Some studies indicate taking niacin with simvastatin (Zocor) appears to slow down the progression of heart disease. However, the combination may also increase the likelihood for serious side effects, such as muscle inflammation or liver damage. If you are taking a statin, consult with your doctor before taking any Niacin supplement.


Cholesterol-lowering medications 
Niacin binds the cholesterol lowering medications known as bile-acid sequestrants and may make them less effective. Bile-acid sequestrants include colestipol (Colestid), colesevelam (Welchol), and cholestyramine (Questran). Take niacin and these medications at different times of the day (not together).

Tetracycline 
Don't take Niacin at teh same time as the antibiotic tetracycline, Niacin can interfere with absorption and effectiveness. All vitamin B complex supplements should be taken at different times from tetracycline.  Niacin in the morning, tetracycline in the evening for example.

Anti-seizure medications
Phenytoin (Dilantin) and valproic acid (Depakote) have been associated with Niacin deficiency in some people. Taking Niacin with carbamazepine (Tegretol) or mysoline (Primidone) may increase levels of these medications in the body.
  Diabetes medications
Niacin has the potential to increase blood sugar levels. People taking medications used to treat high blood glucose levels should closely monitor blood sugar levels when taking Niacin.

Nicotine patches 
Using nicotine patches while taking Niacin can increase the potential of experiencing a Niacin flush.


Isoniazid (INH)
INH is a medicine used to treat tuberculosis and can cause Niacin deficiency.

Some medications can lower Niacin levels:

• Fluorouracil 
• Cycloserine (Seromycin) 
• Mercaptopurine (Purinethol) 
• Azathioprine (Imuran) 
• Levodopa and carbidopa 
• Chloramphenicol (Chloromycetin)

 If you're taking one of these medication, discus the need for a Niacin supplement with your doctor.