Niacin, also known as niacin and vitamin B3, is a kind of B vitamins (also water-soluble), is an important precursor of metabolism-related coenzymes NAD and NADP, and participates in more than 400 physiological reactions in the body, such as antioxidant, DNA manufacturing and repair, cell signaling, etc. Note 9
As a nutritional supplement, nicotinic acid may have potential effects such as lowering cholesterol, regulating triglycerides, preventing cardiovascular disease, and arthritis. However, the use of large doses of nicotinic acid may bring side effects, the most common being hot flashes, which will be detailed below.
What are the types of nicotinic acid?
In health food stores, there are three common types of nicotinic acid, nicotinic acid, Niacinamide and Inositol Hexaniacinate.
Nicotinic acid: the chemical formula of nicotinic acid, mainly used to lower blood lipids, but has hot flashes side effects.
Niacinamide: Chinese niacinamide, which is a nicotinic acid derivative, does not have lipid-lowering properties and does not trigger flushing reactions.
Nicotinamide: Chinese translated as inositol hexanicotinate or polyhexanicotinic acid, it has all the medical properties of nicotinic acid, but does not cause flushing, and is slightly more expensive.
What are the recommended empirical benefits of nicotinic acid?
1. Nicotinic acid can lower cholesterol
The most prestigious pharmacological effect of nicotinic acid is to lower blood lipids, but to achieve this effect, very large doses are often required, and side effects are often derived. Therefore, at present, nicotinic acid is often combined with drugs and the dose is reduced to make up for the lack of drugs
A double-blind controlled trial (3414 hyperlipidemic patients treated with statin) showed that nicotinic acid (extended-release formulation, 1500 to 2000 mg daily) improved HDL cholesterol (20% increase) and LDL cholesterol (17% reduction) compared with placebo, but there was no significant difference in clinical outcomes (e.g., hospitalization or death) between the two groups. Note 1
The mechanism of nicotinic acid regulating cholesterol is not achieved by increasing HDL synthesis, but by inhibiting beta-chain ATP synthetase in liver cells and preventing the liver from catabolizing HDL. Note 2
2. Nicotinic acid can reduce the risk of cardiovascular disease
Due to changes in life and dietary patterns, cardiovascular disease has gradually shifted from the elderly population to the middle-aged and middle-aged population, and has become the first non-infectious fatal factor in the population under 70 years old, accounting for about 37%
A systematic literature review and meta-regression analysis (11 studies, 9,959 participants) suggested that nicotinic acid, either alone or in combination with lipid-lowering drugs, helped reduce cardiovascular disease events (but stroke events were less significantly associated). Note 3
The authors mention that these changes are not related to the regulation of cholesterol, but may be related to the regulation of inflammatory mediators (C-reactive protein, phospholipase A) that nicotinic acid has, inhibits atherogenic chemokin, and increases the hormone that protects blood vessels: adiponectin.
3. Nicotinic acid is beneficial for osteoarthritis
In normal joints, there is cartilage between the bones as a cushion, which acts like a shock absorbing pad, which allows flexible movements and reduces friction.
Osteoarthritis is a chronic inflammatory disease caused by the gradual depletion of cartilage with age or trauma, with a lifetime prevalence rate of about 45% (60.5% for obese patients), often causing patients with mobility difficulties, which is the main reason for poor quality of life in the elderly.
A preliminary double-blind controlled study (12 weeks, 72 patients with osteoarthritis) found that oral niacinamide helped improve total joint impact scores, improve joint flexibility, and reduce the use of anti-inflammatory drugs. Note 6
*Conclusion: Oral nicotinamide may have a positive effect on osteoarthritis, but the relevant evidence is still insufficient and needs to be further confirmed by more studies.
4. Nicotinic acid helps slow down skin photoaging
Skin photoaging refers to the premature aging of the skin caused by long-term ultraviolet radiation (mainly sunlight), which is characterized by wrinkles, spots, pigmentation, roughness, loss of tone, dryness, telangiectasia, laxity, skin cancer and melanoma. Note 8
A double-blind controlled study (12 weeks, 50 women with photoaging facial features) applied topically with Niacinamide emulsion helped reduce facial fine lines and wrinkles and increase elasticity, as well as other indicators such as pigmentation, dull yellow complexion, and erythema. Note 7
The mechanism behind it may be related to the fact that nicotinamide increases collagen and glycosaminoglycan synthesis and decreases protein glycation.
What are the side effects of Niacin?
There is no known risk of ingesting nicotinic acid in food, but large doses in supplement form often cause side effects (more than 50 mg, or more).
Common side effects are niacin flush on the face, chest and neck, which is mainly caused by vasodilation, but is often accompanied by tingling and burning sensation, which gradually subsides as the body adapts.
Other milder side effects include gastrointestinal upset, exhaust, dizziness, nausea, vomiting, etc.
When the dose is greater than a few grams per day, serious adverse reactions may occur such as liver damage, gout, peptic ulcer, arrhythmia, and vision loss.
It has been clinically observed that large doses of nicotinic acid cause abnormal glucose tolerance and cause blood glucose levels to rise. Note 4
A meta-analysis of 11 cardiovascular-related studies with a follow-up period of 3.6 years and 26,340 participants showed that nicotinic acid therapy (daily doses ranging from 1 g to 4 g) increased the risk of diabetes (34%) with or without lipid-lowering drugs. Note 5
Safety precautions applicable to both Niacin and Niacinamide
- Do not exceed the recommended dose (35 mg daily) for pregnant and nursing mothers
- Drinking alcohol can exacerbate niacinic acid hot flashes (due to the fact that alcohol dilates blood vessels)
- Patients with liver and kidney dysfunction, diabetes, peptic ulcer, gout, arrhythmia, inflammatory bowel disease, migraine, alcoholism and other patients may have more serious adverse reactions and should avoid taking it, or consult a doctor before use
- Long-term high-dose use requires regular monitoring of liver function
- Do not take nicotinic acid for two weeks before surgery
- May increase histamine secretion and contribute to worsening allergy symptoms
- Do not use if you have low blood pressure or take antihypertensive drugs (as it may lower blood pressure)
- People who have had gout or hyperuricemia should not use large doses, which may increase the incidence of gout
- People with coronary artery disease or unstable angina should not use large doses, which may cause heart rhythm problems
Possible drug interactions
- Do not combine with bile acid sequestrants, statins, antibiotics (tetracycline/tetracycline), antiepileptic drugs, anticoagulants, blood pressure-lowering or glycemic drugs, which may interfere with drug absorption or affect efficacy
- The use of nicotine patches may increase the incidence of nicotinic acid flushing
- Low-dose aspirin is often used to reduce flushing reactions, but is best used under physician supervision