Staying Healthy with Nutrition
Elson M. Haas, M.D.
Niacin (Vitamin B3)
Information on this site is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. If you have or suspect that you have a medical problem, promptly contact your medical health care provider.
What got my attention about this vitamin was some information I came across where vitamin B3 was being used for severe depression with great results. I see so many patients today who are on mood altering medication. The above book “Staying Healthy with Nutrition” by Dr. Haas, is a wonderful resource on how food and supplements affect our health. Below is info from his book on vitamin B3. Many health experts attribute our ill health issues, physical and psychological, to the lack of nutritional value of our food. Niacin is used to support a variety of metabolic functions and to treat a number of conditions. Nutritional therapy is a viable alternative to drugs in many cases. As you learn to connect your health issues with food deficiencies, find an expert to help guide you through these alternative treatment pathways.
Niacin plays a key role in glycolysis (extracting energy from carbohydrate and glucose), is important in fatty acid synthesis and in the deamination (nitrogen removal) of amino acids, and is needed in the formation of blood cells and steroids, and is helpful in the metabolism of some drugs and toxins. It is a vital precursor for the coenzymes that supply energy to body cells. Basically, the coenzymes of Niacin help break down and utilize proteins, fat and carbohydrates.
Vitamin B3 also simulates circulation, reduces cholesterol levels in the blood of some people, and is important to help the activity of the nervous system and normal brain function. Niacin supports the health of skin, tongue, and digestive tract tissues. Also, this important vitamin is needed for the synthesis of sex hormones such as estrogen, progesterone, and testosterone, as well as other corticosteroids.
Niacin helps increase energy through improving food utilization and has been beneficial for treating fatigue, irritability, and digestive disorders such as diarrhea, constipation, and indigestion. It also stimulates extra hydrochloric acid, helps in the regulation of blood sugar (as part of glucose tolerance factor) and gives all of us a greater ability to handle stress. It’s helpful in treating anxiety and possibly depression. Niacin has been used for a variety of skin reactions and acne, as well as for problems on the teeth and gums. It is sometimes helpful in the treatment of migraine headaches and arthritis, probably in both cases through stimulation of blood flow and capillaries. This vitamin has also been used to stimulate sex drive and enhance sexual experience, to help detoxify the body, and to protect it from certain toxins and pollutants. For most of these problems and cardiovascular related ones mentioned below, the preference is to taking the “flushing” form of Niacin, or Nicotinic acid, not niacinamide. This includes cholesterol reduction.
Nicotinic acid works rapidly, particularly in its beneficial effects on the cardiovascular system. It simulates circulation and for this reason may be helpful in treating leg cramps caused by circulatory deficiency; headaches, especially the migraine type; and Meniere’s syndrome, associated with hearing loss and vertigo. Nicotinic acid also helped reduce blood pressure and very importantly, acts as an agent to lower serum cholesterol. Treatment with about 2 g a day of Nicotinic acid has produced significant reductions in both blood cholesterol and triglyceride levels. To lower the LDL component and raise the good HDL cholesterol, people usually take 50 to 100 mg. Twice daily and then increase the amount slowly over two or three weeks to 1500 to 2500 mg. Generally, for those with high cholesterol levels it has been used to help reduce the risk for atherosclerosis.
Because of its vascular stimulation and effects of lowering cholesterol and blood pressure, vitamin B3 has been used preventatively for such serious secondary problems of cardiovascular disease as myocardial infarction (heart attacks) and strokes. Also, some neurological problems, such as Bell’s palsy and trigeminal neuralgia have been helped by Niacin supplementation. In osteoarthritis, to help reduce joint pain and improve mobility, niacinamide has been used in amounts beginning at 500 mg twice daily up 2000 mg 3 times per day along with 100 mg of daily B complex.
Niacin has been an important boon to the field of orthomolecular psychiatry for its use in a variety of mental disorders. It was initially demonstrated to be helpful for the neuroses and psychosis described as the “dementia of Pellagra,” the Niacin deficiency disease. Since then, it has been used in high amounts, well over 100 mg per day and often over 1000 mg per day (up to 6000 mg), to treat a wide variety of psychological symptoms, including senility, alcoholism, drug problems, depression, and schizophrenia. Niacin has been helpful in reversing the hallucinatory experience, delusional thinking or a wide mood in energy shifts of some psychological disturbances. Though this therapy has its skeptics, as does all applications and nutritional medicine, some studies show promising results in treatment of schizophrenia with Niacin and other supplements. Other studies show little or no effect. More research is definitely needed on Niacin’s effect and mental disorders.
People on high blood pressure medication and those who have ulcers, gout, or diabetes should be very careful taking high doses of of Niacin because of its effects of lowering blood pressure, it’s acidity, its liver toxicity, its potential to raise uric acid levels, and its effect in raising blood sugar; though recently Niacin has been shown to have a positive effect on glucose tolerance (is part of glucose tolerance factor) and, thereby, on diabetes as well. Exercise and Niacin are helpful for people with adult diabetes through their positive effects on blood sugar and cholesterol.
Deficiency & Toxicity
As with other B vitamins, there are really no toxic effects from even the high doses of Niacin, though the “Niacin flush” previously described may be uncomfortable for some. However, with the use of high does Niacin in recent years, the occasional person experiencing some minor problems, such as irritation of the gastrointestinal tract and/or the liver, both of which subside with decreased intake of Niacin. In addition, some people taking Niacin experience sedation rather than stimulation.
Deficiency problems have been much more common than toxicity, and for a long period of history, the Niacin deficiency disease, Pellagra, was a very serious and fatal problem. Characterized as a disease of the “three D’s,” Pellagra causes its victims to experience dermatitis, diarrhea, and dementia. The fourth D was death.
The classic B3 deficiency occurs mainly in cultures whose diets rely heavily on corn and where the corn is not prepared in a way that releases its Niacin. One of the first signs of Pellagra or Niacin deficiency, is skin sensitivity to light, and the skin becomes raw, thick, and dry (Pellagra means “skin that is rough” in Italian). The skin then becomes darkly pigmented, especially in areas of the body prolonged by hot and sweaty with those exposed to the sun. The first stage of this condition is extreme redness and sensitivity of those exposed areas, and it is from the symptom that the term “redneck,” describing the bright rednecks of 18th and 19th Century Niacin deficiency field workers, came into being.
n general, Niacin deficiency affects every cell, especially in those systems with rapid turnover, such as the skin, gastrointestinal tract, and nervous system. Other than photosensitivity, the first signs of Niacin deficiency are noted as decreased energy production and problems with maintaining healthy functioning of the skin and intestines. The symptoms include weakness in general, fatigue, anorexia, indigestion, and skin eruptions. These can progress to other problems, such as sore, red tongue, canker sores, nausea, vomiting, tender gums, bad breath, and diarrhea. The neurological symptoms may begin with irritability, insomnia, and headaches and then progress to tremors, extreme anxiety, depression; all the way to full-blown psychosis. The skin will worsen, as will the diarrhea and inflammation of the now in intestinal tract. There will be a lack of stomach acid production (Achlorhydria) and a decrease in fat digestion and, thus lower availability from food absorption of the fat soluble vitamins, such as A, D, and E. along with other signs, symptoms and deficiency syndromes associated with these fat soluble vitamins.
Vitamin D Supplementation: An Update
Christine Gonzalez, PharmD, CHHC
Posted: 11/11/2010; US Pharmacist © 2010 Jobson Publishing
Abstract and Introduction
An estimated 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency.[1–3] This is mostly attributable to people getting less sun exposure because of climate, lifestyle, and concerns about skin cancer. The 1997 Dietary Reference Intake (DRI) values for vitamin D, initially established to prevent rickets and osteomalacia, are considered too low by many experts. DRI values are 200 IU for infants, children, adults up to age 50 years, and pregnant and lactating women; 400 IU for adults aged 50 to 70 years; and 600 IU for adults older than 70 years. Current studies suggest that we may need more vitamin D than presently recommended to prevent chronic disease. Emerging research supports the possible role of vitamin D in protecting against cancer, heart disease, fractures and falls, autoimmune diseases, influenza, type 2 diabetes, and depression. Many health care providers have increased their recommendations for vitamin D supplementation to at least 1,000 IU. As a result, more patients are asking their pharmacists about supplementing with vitamin D.
Vitamin D decreases cell proliferation and increases cell differentiation, stops the growth of new blood vessels, and has significant anti-inflammatory effects. Many studies have suggested a link between low vitamin D levels and an increased risk of cancer, with the strongest evidence for colorectal cancer. A Creighton University study found that postmenopausal women given 1,100 IU of vitamin D3 (plus calcium) versus placebo were 77% less likely to be diagnosed with cancer over the next 4 years. In the Health Professionals Follow-up Study (HPFS), subjects with high vitamin D concentrations were half as likely to be diagnosed with colon cancer as those with low concentrations.
Some studies have shown less positive results, however. The Women’s Health Initiative found that women taking 400 IU of vitamin D3 (plus calcium) versus placebo did not have a lower risk of breast cancer. Many critics have argued that this dosage of vitamin D is too low to prevent cancer. A 2006 Finnish study of male smokers found that those with higher vitamin D concentrations had a threefold increased risk for pancreatic cancer, with cigarette smoking not found to be a confounding factor. A 2009 U.S. study of men and women (mostly nonsmokers) did not confirm these results, finding no association between vitamin D concentrations and pancreatic cancer overall, except in subjects with low sun exposure. In this subgroup, higher versus lower vitamin D concentrations had a positive association with pancreatic cancer. A definitive conclusion cannot yet be made about the association between vitamin D concentration and cancer risk, but results from many studies are promising.
Several studies are providing evidence that the protective effect of vitamin D on the heart could be via the renin-angiotensin hormone system, through the suppression of inflammation, or directly on the cells of the heart and blood-vessel walls. In the Framingham Heart Study, patients with low vitamin D concentrations (<15 ng/mL) had a 60% higher risk of heart disease than those with higher concentrations. The HPFS found that subjects with low vitamin D concentrations (<15 ng/mL) were two times more likely to have a heart attack than those with high concentrations (>30 ng/mL). In another study, which followed men and women for 4 years, patients with low vitamin D concentrations (<15 ng/mL) were three times more likely to be diagnosed with hypertension than those with high concentrations (>30 ng/mL). As is the case with cancer and vitamin D, more studies are needed to determine the role of vitamin D in preventing heart disease, but the evidence thus far is positive.
Fractures and Falls
Vitamin D is known to help the body absorb calcium, and it plays a role in bone health. Also, vitamin D receptors are located on the fast-twitch muscle fibers, which are the first to respond in a fall. It is theorized that vitamin D may increase muscle strength, thereby preventing falls. Many studies have shown an association between low vitamin D concentrations and an increased risk of fractures and falls in older adults.
A combined analysis of 12 fracture-prevention trials found that supplementation with about 800 IU of vitamin D per day reduced hip and nonspinal fractures by about 20%, and that supplementation with about 400 IU per day showed no benefit. Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University have examined the best trials of vitamin D versus placebo for falls. Their conclusion is that “fall risk reduction begins at 700 IU and increases progressively with higher doses.” Overall, the evidence is strong in support of supplementing with vitamin D to prevent fractures and falls.
Autoimmune Diseases and Influenza
Since vitamin D has a role in regulating the immune system and a strong anti-inflammatory effect, it has been theorized that vitamin D deficiency could contribute to autoimmune diseases such as multiple sclerosis (MS), type 1 diabetes, rheumatoid arthritis, and autoimmune thyroid disease. Scientists have suggested that vitamin D deficiency in the winter months may be the seasonal stimulus that triggers influenza outbreaks in the winter. Numerous trials have evaluated the association between vitamin D and immune-system diseases.
A prospective study of white subjects found that those with the highest vitamin D concentrations had a 62% lower risk of developing MS versus those with the lowest concentrations. A Finnish study that followed children from birth noted that those given vitamin D supplements during infancy had a nearly 90% lower risk of developing type 1 diabetes compared with children who did not receive supplements.22 In a Japanese randomized, controlled trial, children given a daily vitamin D supplement of 1,200 IU had a 40% lower rate of influenza type A compared with those given placebo; there was no significant difference in rates of influenza type B. More studies of the influence of vitamin D on immunity will be emerging, as this is an area of great interest and it remains unclear whether there is a link.
Type 2 Diabetes and Depression
Some studies have shown that vitamin D may lower the risk of type 2 diabetes, but few studies have examined the effect of vitamin D on depression. A trial of nondiabetic patients aged 65 years and older found that those who received 700 IU of vitamin D (plus calcium) had a smaller rise in fasting plasma glucose over 3 years versus those who received placebo. A Norwegian trial of overweight subjects showed that those receiving a high dose of vitamin D (20,000 or 40,000 IU weekly) had a significant improvement in depressive symptom scale scores after 1 year versus those receiving placebo. These results need to be replicated in order to determine a correlation between vitamin D and the risk of diabetes or depression.
Only a few foods are a good source of vitamin D. These include fortified dairy products and breakfast cereals, fatty fish, beef liver, and egg yolks. Besides increasing sun exposure, the best way to get additional vitamin D is through supplementation. Traditional multivitamins contain about 400 IU of vitamin D, but many multivitamins now contain 800 to 1,000 IU. A variety of options are available for individual vitamin D supplements, including capsules, chewable tablets, liquids, and drops. Cod liver oil is a good source of vitamin D, but in large doses there is a risk of vitamin A toxicity.
The two forms of vitamin D used in supplements are D2 (ergocalciferol) and D3 (cholecalciferol). D3 is the preferred form, as it is chemically similar to the form of vitamin D produced by the body and is more effective than D2 at raising the blood concentration of vitamin D. Since vitamin D is fat soluble, it should be taken with a snack or meal containing fat. In general, 100 IU of vitamin D daily can raise blood concentrations 1 ng/mL after 2 to 3 months (TABLE 2). Once the desired blood concentration is achieved, most people can maintain it with 800 to 1,000 IU of vitamin D daily. Even though dosages up to 10,000 IU daily do not cause toxicity, it generally is not recommended to take more than 2,000 IU daily in supplement form without the advice of a health care provider. Individuals at high risk for deficiency should have a vitamin D blood test first; a dosage of up to 3,000 to 4,000 IU may be required to restore blood concentrations.
Table 2. Dosing and Blood Concentrations
||Expected Increase in Blood Concentration
Source: Reference 30.
Vitamin D supplements may interact with several types of medications. Corticosteroids can reduce calcium absorption, which results in impaired vitamin D metabolism. Since vitamin D is fat soluble, orlistat and cholestyramine can reduce its absorption and should be taken several hours apart from it. Phenobarbital and phenytoin increase the hepatic metabolism of vitamin D to inactive compounds and decrease calcium absorption, which also impairs vitamin D metabolism.
While considerable research supports the importance of vitamin D beyond bone health, further trials are required before broad claims can be made about vitamin D and prevention of chronic disease. The Institute of Medicine (IOM) is reviewing the research on vitamin D and plans to report in late 2010 regarding any updates to the DRIs for vitamin D (and calcium). Specifically, the IOM will consider the relation of vitamin D to cancer, bone health, and other chronic diseases. An important study, the Vitamin D and Omega-3 Trial, was launched in early 2010 to determine whether 2,000 IU of vitamin D3 and 1,000 mg of EPA (eicosopentaenoic acid) plus DHA (docosahexaenoic acid) daily can lower the risk of cancer, heart disease, stroke, and other diseases. This randomized trial, which will enroll about 20,000 healthy men and women, should provide more insight on vitamin D supplementation.
As the number of people with vitamin D deficiency continues to increase, the importance of this hormone in overall health and the prevention of chronic diseases is at the forefront of research. The best evidence for the possible role of vitamin D in protecting against cancer comes from colorectal cancer studies. Evidence also is strong for the potential role of vitamin D in preventing fractures and falls. At this time, further studies are needed to evaluate the role of vitamin D in protecting against heart disease, autoimmune diseases, influenza, diabetes, and depression.
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