Vitamin B3 Supplements

Introduction to Vitamin B3

What is Vitamin B3?

Vitamin B3, also known as niacin, is one of eight B vitamins that help the body convert food into energy. Vitamin B3 plays an important role in promoting healthy skin, nerves, circulation, and cholesterol levels. It exists in two main forms: nicotinic acid (niacin) and niacinamide.

Importance of Vitamin B3

Vitamin B3 is essential for maintaining overall health. It helps enzymes do their work in the body and is crucial for the process of metabolising fats and carbohydrates. B3 also helps with the function of the digestive system, skin health, and nerve function. Additionally, it helps convert the food we eat into energy and is important for both DNA repair and the production of hormones.

Pellagra and Niacinamide

Pellagra: A Disease Caused by Niacin Deficiency

Pellagra is a disease caused by severe deficiency of niacin. It was common in the early 20th century in poor rural communities with diets based on corn, which contains very little niacin. Pellagra is rare today in developed countries but remains an issue in regions where poverty limits diet variety.

Symptoms of pellagra include inflamed skin, digestive issues, mental confusion and dementia. Without treatment it can lead to death. Pellagra is easily treated with niacin supplements and has become very rare in Australia due to improved nutrition.

Niacinamide: An Alternative to Niacin

Niacinamide is a form of vitamin B3 that does not cause the flushing side effect sometimes seen with regular niacin supplements. It is also absorbed into the body slower than niacin, so the effects are not as rapid but do last longer.

Niacinamide plays an important role in energy metabolism and also has benefits for skin health. It is present naturally in foods and has a good safety profile. Niacinamide supplements may be a suitable option for those seeking a more gradual boost in niacin levels.

Vitamin B3 Deficiency

Symptoms of Vitamin B3 Deficiency

Mild deficiency of vitamin B3 is common, as modern diets often lack adequate sources of niacin. Symptoms of mild deficiency can include:

• Fatigue and low energy levels
• Headaches
• Digestive issues like nausea and diarrhoea
• Poor concentration and memory
• Low mood or depression

More severe deficiency over time can lead to a condition called pellagra, involving symptoms like:

• Dermatitis - a red, scaly rash on sun-exposed skin
• Dementia
• Diarrhoea
• Eventually, death if left untreated

However, such severe niacin deficiency is very rare today in Australia. Mild deficiency is more likely, causing non-specific symptoms that often go unrecognised.

Risk Factors for Vitamin B3 Deficiency

Some people are at higher risk of vitamin B3 deficiency, including:

• Alcoholics - alcohol impairs absorption of niacin and increases excretion
• Those with conditions causing malabsorption - e.g. Crohn's, coeliac disease
• People eating corn or maize-based diets low in niacin
• The elderly - impaired absorption plus inadequate nutrient intake
• Those taking certain medications - isoniazid, oral contraceptives, anti-convulsants
• Pregnant women - higher requirements for growth and development
• Exclusive breastfeeding women - high nutrient demand
• Strict vegetarians or vegans - may not get enough from plant-based diets

If in a higher-risk group, a niacin supplement may help prevent deficiency.

Niacin Intake Recommendations

Infants

Age	AI (mg/day)
0–6 months	2 (preformed niacin)
7–12 months	4 (niacin equivalents)

Children & Adolescents

Age	EAR (mg/day)	RDI (mg/day)
All
1–3 yr	5	6
4–8 yr	6	8
Boys
9–13 yr	9	12
14–18 yr	12	16
Girls
9–13 yr	9	12

14–18 yr | 11 | 14 |

Adults

Age	EAR (mg/day)	RDI (mg/day)
Men
19–30 yr	12	16
31–50 yr	12	16
51–70 yr	12	16
>70 yr	12	16
Women
19–30 yr	11	14
31–50 yr	11	14
51–70 yr	11	14
>70 yr	11	14

Pregnancy

Age	EAR (mg/day)	RDI (mg/day)
14–18 yr	14	18
19–30 yr	14	18
31–50 yr	14	18

Lactation

Age	EAR (mg/day)	RDI (mg/day)
14–18 yr	13	17
19–30 yr	13	17
31–50 yr	13	17

Reference: Nutrient Reference Values for Australia and New Zealand

Benefits of Niacin

Cardiovascular Health Benefits

Niacin supplements have been used to support cardiovascular health and lower cholesterol since the 1950s. Niacin helps reduce bad LDL cholesterol and triglyceride levels. It also raises good HDL cholesterol.

Several studies have found niacin helps reduce atherosclerosis progression and heart attack risk when used alongside statins. However, the HPS2-THRIVE study found adding niacin provided no additional cardiovascular benefit over statin therapy alone. More research is still needed.

Always consult a doctor before using niacin supplements for cholesterol or heart health - close monitoring is recommended.

Cholesterol Regulation

Niacin supplements have been shown to improve the cholesterol profile by:

• Decreasing LDL cholesterol by 5-25%
• Reducing triglycerides by 20-50%
• Increasing HDL cholesterol by 15-35%

This can lead to a significant improvement in the LDL:HDL ratio and lower heart disease risk. However, the benefits seem most apparent when niacin is used in combination with statins under medical supervision.

Other Potential Benefits

Some additional areas being researched:

• Type 2 Diabetes - Early research indicates niacin may help improve insulin sensitivity and lower blood sugar. More evidence is still needed though.
• Eye Health - One study linked niacin intake to a lower risk of age-related macular degeneration. But overall research is limited.
• Migraine - There is some early evidence that niacin supplementation may help reduce migraine frequency. Larger studies are still needed.
• Osteoarthritis - A few small studies suggest niacin may help improve mobility and reduce inflammation. But benefits are unproven so far.
• Alzheimer's Disease - Cell studies have found possible benefits, but human data is lacking.

Overall, the major proven benefit of niacin remains for cardiovascular health. Effects for other conditions need more research.

Vitamin B3 Toxicity

Side Effects of High Doses

There is very little risk of toxicity from niacin obtained normally through food sources. But larger doses from supplements can cause side effects, including:

• Flushing - vasodilation of blood vessels leads to skin reddening and a "flushing" sensation lasting 15-30 minutes. This is the most common side effect. Taking an aspirin 30 minutes prior may diminish symptoms.
• Nausea, vomiting, diarrhoea - high doses can irritate the gastrointestinal tract.
• Gout - elevated uric acid levels may worsen gout or trigger attacks in those prone to it.
• Liver damage - signs like jaundice and elevated liver enzymes. Extremely rare and only with very high doses.

To reduce adverse effects, it's recommended to start with a low dose of around 50-100mg and slowly increase over 4-6 weeks. Extended release niacin may also help minimise flushing reaction.

Safe Dosage Levels

The Upper Intake Level (UL) where adverse effects increase is:

• 35 mg/day for adults 19+
• 30 mg/day for adolescents 14-18 years
• 10-20 mg/day for children 1-13 years
• 35 mg/day for pregnant and lactating women

Doses above 2000-3000mg per day increase the risk of serious harm and provide little added benefit. Always follow dosage directions and consult a doctor for long term use.

Considerations for Taking Vitamin B3 Supplements

Vitamin B3 supplements may provide benefits, especially for those at risk of deficiency or with high cholesterol. However, factors to consider include:

• Get nutrition tested first - only supplement if deficiency is confirmed
• Increase dietary sources - meat, fish, nuts, seeds, legumes
• Use the no-flush niacinamide form - gentler on the stomach
• Start with a low dose - 50-100mg per day
• Slowly increase over 4-6 weeks - reduces flushing reaction
• Take with food - minimises side effects
• Avoid sustained release forms - increased liver toxicity risk
• Consult a doctor if also on cholesterol medication
• Monitor liver function - get frequent blood tests

Consulting a Healthcare Professional

It's recommended to have vitamin B3 levels tested before taking supplements, especially at high doses. Your doctor can recommend appropriate supplements and dosing based on individual factors like diet, medical history and medications.

Ongoing monitoring is also advised if taking high-dose niacin for cholesterol regulation, as liver function and glucose levels need to be checked.

Always consult your doctor before starting any new supplement, particularly with pre-existing conditions. Healthcare guidance is essential for safe and effective vitamin B3 supplementation.

FAQ

Is it safe to take niacin supplements long-term?

Niacin supplements are likely safe for most healthy adults when taken at recommended dosages. The tolerable upper limit before toxicity is 900mg/day. However, high doses taken long-term may increase the risk of liver damage or other side effects. It's best to have levels monitored by a doctor for long-term supplementation.

Can I take niacin with statins or other cholesterol medication?

Yes, niacin is often used together with statins to optimise cholesterol reduction. However, it's important to consult your doctor first, as niacin can enhance the effects of many medications. Your doctor will help determine safe dosing and may recommend more frequent monitoring of cholesterol levels and liver function. Never make changes to prescribed meds without medical supervision.

What's the best time of day to take niacin supplements?

Most experts recommend taking niacin supplements with food, ideally during or just after a meal. Taking niacin on an empty stomach is more likely to cause side effects like flushing and indigestion. Spreading the dosage out over the day, like one dose during breakfast and one dose during dinner, may also help minimise flushing effects.

Can niacin supplements raise blood sugar levels?

In healthy individuals, niacin supplementation within recommended upper limits is unlikely to affect blood sugar control. Early research does suggest niacin may actually improve insulin sensitivity in those with diabetes. However, very high doses (3-6 grams/day) may impair insulin secretion and raise blood sugar in susceptible individuals. It's wise for diabetics to monitor glucose levels closely whenever starting niacin.