What kind of niacin

B-complex vitamins are needed for a healthy liver, healthy skin, hair, and eyes, and to help the nervous system function properly. Niacin also helps the body make various sex and stress-related hormones in the adrenal glands and other parts of the body. Niacin helps improve circulation, and it has been shown to suppress inflammation.

You can meet all of your body's needs for B3 through diet. It is rare for anyone in the developed world to have a B3 deficiency. In the U. Severe deficiency can cause a condition known as pellagra. Pellagra is characterized by cracked, scaly skin, dementia, and diarrhea. It is generally treated with a nutritionally balanced diet and niacin supplements.

Niacin deficiency also causes burning in the mouth and a swollen, bright red tongue. Very high doses of B3, available by prescription, have been studied to prevent or improve symptoms of the following conditions. However, at high doses niacin can be toxic. Researchers are trying to determine if inositol hexanicotinate has similar benefits without serious side effects. But results are inconclusive. Niacin, but not niacinamide, has been used since the s to lower elevated LDL bad cholesterol and triglyceride fat levels in the blood.

However, side effects can be unpleasant and even dangerous. High doses of niacin cause:. A time-release form of niacin reduces flushing. But long-term use is associated with liver damage. In addition, niacin can interact with other cholesterol-lowering medicines. You should not take niacin at high doses without your doctor's supervision.

In one study, men with existing heart disease slowed down the progression of atherosclerosis by taking niacin along with colestipol. They experienced fewer heart attacks and deaths, as well. 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. Their risk of death was also lower.

In another study, 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. In type 1 diabetes, the body's immune system mistakenly attacks the cells in the pancreas that make insulin, eventually destroying them.

Niacinamide may help protect those cells for a time. More research is needed. Researchers have also looked at whether high-dose niacinamide might reduce the risk of type 1 diabetes in children at risk for the disease. One study found that it did. But another, larger study found it did not protect against developing type 1 diabetes.

The effect of niacin on type 2 diabetes is more complicated. People with type 2 diabetes often have high levels of fats and cholesterol in the blood. Niacin, often along with other medications, can lower those levels.

However, niacin may also raise blood sugar levels, which is particularly dangerous for someone with diabetes. For that reason, if you have diabetes, you should take niacin only under the direction of your doctor, and you should be carefully monitored for high blood sugar.

One preliminary study suggested that niacinamide may improve arthritis symptoms, including increasing joint mobility and reducing the amount of non-steroidal anti-inflammatory drugs NSAIDs needed.

Alzheimer disease: Population studies show that people who get higher levels of niacin in their diet have a lower risk of Alzheimer disease. No studies have evaluated niacin supplements, however. Cataracts: One large population study found that people who got a lot of niacin in their diets had a lower risk of developing cataracts.

Skin conditions: Researchers are studying topical forms of niacin as treatments for rosacea, aging, and prevention of skin cancer, although it is too early to know whether it is effective. Although there is no evidence that it helps treat any of these conditions, researchers are also studying the use of vitamin B3 in treating:.

Bread and cereals are usually fortified with niacin. In addition, foods that contain tryptophan, an amino acid the body coverts into niacin, include poultry, red meat, eggs, and dairy products. Niacin is available as a tablet or capsule in both regular and timed-release forms.

The timed-release tablets and capsules may have fewer side effects than regular niacin. However, the timed-release versions are more likely to cause liver damage.

Regardless of which form of niacin you are using, doctors recommend periodic liver function tests when using high doses above mg per day of niacin. Generally, high doses of niacin are used to control specific diseases. Such high doses must be prescribed by a doctor who will increase the amount of niacin slowly, over the course of 4 to 6 weeks. Take niacin with meals to avoid stomach irritation.

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable health care provider. Side effects may include diarrhea, headache, stomach discomfort, and bloating. High doses 50 mg or more of niacin can cause side effects.

The most common side effect is called "niacin flush," which is a burning, tingling sensation in the face and chest, and red or flushed skin. Taking an aspirin 30 minutes prior to the niacin may help reduce this symptom. At very high doses, used to lower cholesterol and treat other conditions, liver damage and stomach ulcers can occur.

Some types of niacin are more effective at raising blood levels than others. If you want to take high doses of niacin for health reasons, make sure to do so under medical supervision. Niacin vitamin B3 is a very important nutrient for your body.

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Here is a list of 15 foods that are rich in calcium, many of which…. Health Conditions Discover Plan Connect. Warwick, R. What is niacin flush? Symptoms of niacin flush. Why people take large doses of niacin. Is it dangerous? The significant differences in plasma levels of NA that are achieved after similar oral doses of IHN and NA may account for the different effects observed in clinical studies.

Overall, the evidence indicates that IHN produces only slight increases in plasma NA, but these changes are not large enough to significantly alter plasma lipid profiles. NM is readily bioavailable 2 and is effective in preventing the classical signs of niacin deficiency pellagra. Niacin therapy may be initiated with an extended-release nicotinic acid drug or an immediate-release preparation such as free nicotinic acid.

Niacin therapy should be avoided in individuals with liver abnormalities, peptic ulcer disease, and gout. Measurement of serum lipids and hepatic function should be evaluated as niacin is titrated. Although flushing is a common side effect with both the free nicotinic acid and the extended-release forms, it is possible to ameliorate this symptom by ingesting niacin with food, avoiding alcohol, and, for those individuals on aspirin therapy, consuming aspirin one-half hour before ingesting niacin.

The free nicotinic acid form can be taken with multiple meals in divided doses, making it possible to achieve therapeutic goals. This chemical form fully supports the NM-dependent coenzyme activities and may properly be called niacin.

In addition to supporting coenzyme functions, NA at high intakes is an effective antihyperlipidemic agent, and an ER-NA prescription drug product has been approved by the US Food and Drug Administration.

It is one of the few lipid-altering agents that have been shown to decrease mortality due to heart attacks. Clearly, NA is a very effective and inexpensive agent for improving health outcomes in persons with elevated lipid levels at risk for heart disease, but its utility is limited by poor patient compliance due to the generally unacceptable flushing reaction.

Some publications support this classification, 17 while others contradict it. IHN has been discussed as a better tolerated and safer alternative to NA and ER-NA, 44 , 45 but data on the efficacy of IHN for lowering serum lipids do not support the hypothesis that the chemical forms are clinically interchangeable.

Even though the data presented by Welsh and Ede 19 are suggestive of a beneficial effect, they are inconsistent with the majority of available evidence and are not convincing enough to serve as the basis of a general recommendation for the use of IHN in controlling blood lipids.

Another IHN clinical study included 41 hyperlipidemic individuals who showed a mean reduction in total cholesterol of 8. However, it is important to note that the same reduction in serum lipids has been observed in studies using chlorophenoxyisobutyrate alone.

The limited evidence of reductions in serum lipids by IHN observed in published studies is offset by several reports of IHN having no effect on serum lipids. Another study of 59 normolipidemic and dyslipidemic patients showed that IHN had no significant effect on total cholesterol. No beneficial or adverse effects were observed after 6 months of treatment.

While the evidence to support the use of IHN for dyslipidemic disorders is weak to contradictory, there are reports suggesting that IHN may have a beneficial effect on endothelium-dependent vasodilatation. Blood flow improvements are therapeutically important in conditions resulting from peripheral vascular insufficiency, such as Raynaud's disease and intermittent claudication.

The clinical research literature includes promising results from several studies on the use of IHN for improving blood flow in these conditions. IHN is not recommended for use in children. However, IHN does not appear to work solely via general peripheral vasodilatation, and it is hypothesized that its activity may also be mediated through a reduction in fibrinogen, improvements in blood viscosity, and resultant improvement in oxygen transport.

Like NA, this chemical form fully supports the classic niacin function of providing NM coenzymes and preventing pellagra. Higher doses of NM have been tested for a variety of possible benefits related to several disease conditions such as depression, 55 but results are inconsistent and NM is not generally recognized as an effective treatment for clinical depression or high plasma triglyceride and cholesterol levels.

This form of niacin has the potential to produce several different adverse effects, depending on the intake.

It is initiated via prostaglandin D2-mediated vasodilatation of small subcutaneous blood vessels. The vasodilatation is associated with an unpleasant sensation of intense warmth and itching that commonly starts in the face and neck and can proceed down through the body. Skin-flushing reactions usually persist over only a few doses until the body develops a natural tolerance.

The daily dose is generally administered over several hours in three parts to reduce flushing. Each portion may be increased gradually until the desired total dose is achieved. Liver function tests and tests for uric acid, fasting blood glucose, and lipid levels should be conducted as the dose is administered. When used as an antihyperlipidemic agent, adverse reactions may require decreased dosage or discontinuation in favor of other agents.

Flushing effect. Important modifiers of flushing risk include empty or full stomach; dissolved versus crystalline form of NA; and bolus administration versus intake spread over several hours.

The flushing effect can be managed effectively in most patients, provided they are given proper instructions and the dose is slowly titrated upward to reach therapeutic levels. In the original studies cited by the IOM as the source of data to identify flushing as the critical effect for the risk assessment to establish a tolerable upper intake level UL , 2 NA was administered in bolus doses, which may have little relevance to NA consumed in food.

Furthermore, the flushing effect, while definitely a nuisance, may or may not qualify as a hazard in risk assessment and thus as an appropriate basis for the UL. Certainly, a UL based on the flushing effect would have no implication for risk related to hepatic and intestinal effects, which occur only at much higher intake levels.

Hepatotoxicity and gastrointestinal toxicity. Hepatotoxicity is detected most often as increases in serum levels of selected liver enzymes, 39 but the severity of hepatotoxicity can range from elevated liver enzymes to acute liver failure. There is a strong correlation between the minimal adverse effects identified through clinical trials and those suggested by the published anecdotal case reports. Many severe reactions to NA, especially liver toxicity, have involved ill-advised or uninformed switching from NA preparations to ER-NA formulations without adjusting the dose.

The gastrointestinal side effects ranged in severity from nausea to, in the extreme, recurrence of peptic ulcer that had been asymptomatic for 7 years. Such an application, it should be noted, constitutes a pharmaceutical use, not a dietary supplement use. Furthermore, the ER-NA forms may also provide greater pharmacological benefit at any given dose. This form of niacin has been tested at multigram intakes, with inconsistent evidence of adverse effects. Although these effects might have been caused by NM, they are not unique to any specific substance or condition.

However, the studies in which the highest doses were administered primarily looked for possible beneficial effect in patients with type 1 diabetes mellitus, and it is unclear how the possible adverse effects were evaluated. There are no reports of flushing associated with IHN, but evidence demonstrating a meager increase in serum NA after administration and the lack of substantial evidence of the typical NA effects on serum lipids suggest that release of NA from IHN is very limited or extremely slow.

However, there is no evidence to support such speculated effects. NA intakes in that range may lead to the risk of hepato- and gastrointestinal toxicity, 39 and the development of these effects, rather than the low-dose dermal vasodilatation that may be judged to be a nuisance rather than a hazard, would be the critical effect for assessing risk and establishing a UL value.

An alternative method of risk assessment is to identify the highest intake that has adequate data to sufficiently exclude a risk of adverse effects. The resulting value is termed the highest observed intake, 9 an intake with sufficient data to reasonably conclude that adverse effects are not known at this intake. Tolerable upper intake levels and related values for nicotinic acid, nicotinamide, and inositol hexanicotinate. This analysis indicates that, contrary to the common and mistaken perception, the four major forms of niacin in the marketplace NA, ER-NA, IHN, and NM are not bioequivalent with respect to efficacy or safety.

While all four forms possess the ability to fulfill the nutritional requirement for niacin in humans when intakes are sufficiently high, they have distinct dose-related effects pertaining to cardiovascular benefits and adverse effects, including flushing and hepatotoxicity.

NA is strongly associated with an uncomfortable dermal flushing effect, which is decreased with ER-NA formulations. However, NA and ER-NA are considered safe and effective antihyperlipidemic drugs for use under medical supervision and monitoring.

ER-NA formulations substantially reduce the risk of flushing reactions but carry a greater risk of liver toxicity. Evidence suggests IHN may improve conditions associated with peripheral vascular insufficiency, such as Raynaud's phenomena and intermittent claudication, but it does not support the efficacy of IHN as a dyslipidemic agent. No adverse events or dermal flushing have been reported for IHN. NM is effective in fulfilling the nutritional requirement for niacin and preventing niacin deficiency.

Evidence suggests NM has no effect on serum lipids and is not associated with dermal flushing effects. Other therapeutic effects of NM are under investigation. Collectively, all forms of niacin perform essential biochemical functions and prevent niacin deficiency, but IHN has very limited supporting data.

Full recognition of the unique effects of NA, ER-NA, IHN, and NM at higher doses can assist consumers and clinicians in choosing the correct agent while understanding the risks associated with each form.

Furthermore, regulators and policymakers should consider the variable efficacy and safety profiles of these four agents when establishing public policy. Declaration of interest. DM and JH are employed by The Council for Responsible Nutrition, a trade association representing dietary supplement manufacturers and ingredient suppliers. There are no other relevant interests to declare. Modern Nutrition in Health and Disease , 10th ed.

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