Niacin assessment and information

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Niacin

Updated on 30th January 2008 by Dr Charles Tweed and Alistair Tweed.

Intro
Niacin is also known as Vitamin B3 and is one of the water soluble vitamins. In the form of nicotinamide, it is an essential component in the two coenzymes NAD and NADP. These coenzymes are integral to the redox reductions whereby all cells derive energy from the breakdown of carbohydrates fats and proteins. The disease state pellagra develops if the diet is deficient in Niacin. It is also important in the repair of DNA (which has implications for cancer prevention) and also cell signalling. Niacin is primarily used in the management of cardiovascular disease and lipid/cholesterol levels. Please see below for the main benefits of Niacin supplementation and the major studies supporting them.

Cardiovascular [1, 2, 3, 4, 24, 25]
High cholesterol [5, 6, 8]
HDL [7]
Cancer [9, 10, 11, 12, 13, 14, 15, 16, 17]
Diabetes [18, 19, 20]
HIV/AIDS [21, 22, 23]
Lipoprotein(a) [27]

Please see the Google Scholar links below for dynamic, constantly updating data of recent studies so that you can research Niacin's benefits for yourself.

The science
Niacin has been shown to reduce raised cholesterol levels and improve HDL (good cholesterol) levels in multiple studies. The most powerful one followed more than 8,000 men who had had a heart attack. Half received Niacin, half did not. The treatment arm had a 10% reduction in total cholesterol, a 26% reduction in triglycerides and improved cardiovascular outcomes: a 27% reduction in heart attacks and a 26% reduction in strokes and mini-strokes (TIAs). After 9 years the treatment group had a 10% survival advantage, which is pretty spectacular. In addition it has been shown to increase HDL cholesterol and lower Lipoprotein(a) which is a powerful predictor for cardiovascular disease in young men - and this is a trick that no other agent has been able to do. Delving a little deeper, it appears Niacin also alters the subclasses of the lipoproteins to a more favourable profile.

Safety
All this good news – there has to be a down side, and of course, there is with some variants of Niacin. The dosages used in these studies were large compared to usual daily intakes: 2-3 grams/day vs ~20mg/day. When taking sup-optimal varieties of Niacin at these doses, a small proportion of people develop liver dysfunction as evidenced by abnormal liver function tests. This is particularly true of the slow release preparations. Instant release preparations tend to cause nausea and skin flushing and itching. In people prone to gout, Niacin may rarely precipitate flare ups. Fortunately, the form Niacin we sell, inositol hexanicotinate, appears to have none of these adverse effects. We therefore recommend AOR's Niacin as part of your age management regime. As usual, we do not recommend Niacin to women who are either intending to be pregnant or pregnant or breast-feeding.

aging-management.com Buyer's Guide and Recommendation
If you wish to improve your cardiovascular risk profile as part of your age management regime, we suggest you take between 2 to 3 grams/day of AOR's Niacin. This recommendation is particularly for people with a raised cholesterol, low HDL cholesterol or raised Lipoprotein(a). We recommend starting at a low dose and increasing over a couple of weeks until your target dose has been achieved.

References:

(Back) Knopp RH. Drug treatment of lipid disorders. N Engl J Med. 1999;341(7):498-511.
(Back) Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with Niacin. J Am Coll Cardiol. 1986;8(6):1245-1255.(PubMed)
(Back) Guyton JR, Capuzzi DM. Treatment of hyperlipidemia with combined Niacin-statin regimens. Am J Cardiol. 1998;82(12A):82U-84U; discussion 85-86U. (PubMed)
(Back) Brown BG, Zhao XQ, Chait A, et al. Simvastatin and Niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001;345(22):1583-1592. (PubMed)
(Back) Cheung MC, Zhao XQ, Chait A, Albers JJ, Brown BG. Antioxidant supplements block the response of HDL to simvastatin-Niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol. 2001;21(8):1320-1326. (PubMed)
(Back) McKenney J. New perspectives on the use of Niacin in the treatment of lipid disorders. Arch Intern Med. 2004;164(7):697-705. (PubMed)
(Back) Wink J, Giacoppe G, King J. Effect of very-low-dose Niacin on high-density lipoprotein in patients undergoing long-term statin therapy. Am Heart J. 2002;143(3):514-518.(PubMed)
(Back) Kashyap ML, McGovern ME, Berra K, et al. Long-term safety and efficacy of a oncedaily Niacin/lovastatin formulation for patients with dyslipidemia. Am J Cardiol.2002;89(6):672-678. (PubMed)
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(Back) Gensler HL, Williams T, Huang AC, Jacobson EL. Oral Niacin prevents photocarcinogenesis and photoimmunosuppression in mice. Nutr Cancer. 1999;34(1):36-41. (PubMed)
(Back) Weitberg AB. Effect of nicotinic acid supplementation in vivo on oxygen radicalinduced genetic damage in human lymphocytes. Mutat Res. 1989;216(4):197-201. (PubMed)
(Back) Lampeter EF, Klinghammer A, Scherbaum WA, et al. The Deutsche Nicotinamide Intervention Study: an attempt to prevent type 1 diabetes. DENIS Group. Diabetes. 1998;47(6):980-984. (PubMed)
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(Back) Schatz DA, Bingley PJ. Update on major trials for the prevention of type 1 diabetes mellitus: the American Diabetes Prevention Trial (DPT-1) and the European Nicotinamide Diabetes Intervention Trial (ENDIT). J Pediatr Endocrinol Metab. 2001;14 Suppl 1:619-622. (PubMed)
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(Back) Murray MF, Langan M, MacGregor RR. Increased plasma tryptophan in HIV-infected patients treated with pharmacologic doses of nicotinamide. Nutrition. 2001;17(7-8):654-656. (PubMed)
(Back) Tang AM, Graham NM, Saah AJ. Effects of micronutrient intake on survival in human immunodeficiency virus type 1 infection. Am J Epidemiol. 1996;143(12):1244-1256. (PubMed)
(Back) Schaefer EJ, Asztalos BF.Increasing high-density lipoprotein cholesterol, inhibition of cholesteryl ester transfer protein, and heart disease risk reduction. Am J Cardiol. 2007 Dec 3;100(11A):S25-31. PMID: 18047849
(Back) Sanyal S, Karas RH, Kuvin JT.Present-day uses of Niacin: effects on lipid and non-lipid parameters. Expert Opin Pharmacother. 2007 Aug;8(11):1711-7. Review. PMID: 17685887 [PubMed - indexed for MEDLINE]
(Back) John M. Morgan, MD; Christina M. Carey, PA-C; Anne Lincoff, MD; David M.Capuzzi, MD, PhD The Effects of Niacin on Lipoprotein Subclass Distribution 01/19/2005 Preventive Cardiology
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