Clinical Use of Vitamin B-3
Niacin is also called nicotinic acid, and niacinamide is called nicotinamide.
For most conditions the two forms are interchangeable. But niacin normalizes blood lipid levels and niacinamide does not. Niacin lowers low density lipoprotein cholesterol in blood; the amount of decrease depends upon the initial level. The higher the baseline level, the greater is the percentage decrease. It also lowers triglycerides, lowers Lipo-A and most important of all it elevates high density lipoprotein cholesterol (HDL). The amount of HDL in blood is the most important single measure of cardiovascular risk. Niacin may be taken together with the statins. A combination of a statin and niacin is already available. Niacinamide has no effect on blood fats. The modern slow release or non flush forms may be used when there are side effects patients find intolerable.
Niacin was the first nutrient released by the FDA to lower cholesterol levels. This was very fortunate because this made it legal for any physician to use it for other indications as well. Another unique aspect to the history of niacin is that it was not patented, cannot be patented, and its use in orthomolecular medicine was discovered with minimum funds; it is one of the few compounds with this history. Usually the total cost of a drug from conception until it is available in every drug store has been estimated at several hundred millions of dollars. And finally, our niacin-cholesterol finding is credited as the first major assault on the vitamins-as prevention paradigm.
For all other conditions either form may be used. The decision which one to use depends upon a large number of factors such as age, the cosmetic effect of the flush, whether cardiovascular problems are present and the dose needed. Some people cannot tolerate one form and may then be given the other. If the tolerance level for both forms is very low one can use both together since the therapeutic effect is additive. If patients can not tolerate more than 1.5 grams of each daily they can take 1.5 grams of each form and the total dose becomes 3 grams and is tolerable. Many patients do well with lower doses. There is no way of determining in advance how much will be needed. Fortunately, it is so safe that one can depend upon trial and error to determine the best dose, and often patients will do that themselves.
The usual starting dose of niacin is 500 to 1000 milligrams taken immediately after meals, three times daily. If one is worried about the intensity of the flush one can start with 100 milligrams and increase it slowly. A few find this much more pleasant.
The dose of niacin seldom needs to go above 2 grams taken three times daily. It may be increased, but eventually the subjects will develop nausea and later vomiting if the dose is too high and is not decreased or stopped. The optimum dose range is very wide. The same doses are used with niacinamide but the tolerable dose range is narrower; more people develop nausea with niacinamide above 6 grams daily than with niacin. Children are more tolerant to these doses. The dose is not related to size, age or body weight. Some children will not complain of nausea. They simply lose their appetite. Vitamin B-3 must be given at least three times daily. It is water soluble and very quickly excreted, making it very safe as the levels cannot build up, but also means it has to be taken frequently and regularly.
Usually the vitamin will have to be taken forever. That is why it is so important that it is safe, tolerable and economical. The indications are both psychiatric and physical. The psychiatric indications include the schizophrenias, some schizoaffective patients, most children with learning and/or behaviour disorders, and those with early senility. The common physical indications include arthritis and high blood cholesterol.
Nature loves to use fail-safe mechanisms. We have two kidneys, two lungs and I suppose if it were mechanically possible we would also have had two hearts. In the same way, nature uses its nutrients in many ways. Another example is the fact that ascorbic acid protects against the deposition of plaque, against the development of atherosclerosis, even in the presence of high blood cholesterol. This was first reported by Linus Pauling and was of course rejected by the medical professions. One cannot patent vitamin C for this. A recent report by a group of workers1 in New Delhi showed that rabbits made hypercholesterolemic and given enough ascorbic acid did not develop atherosclerosis. My co-worker Professor R. Altschul at the University of Saskatchewan in 1955 was the first to find that niacin lowered cholesterol in rabbits. He used the niacin I gave him from the supply I had for treating schizophrenia. By combining niacin and ascorbic acid we not only make normal all the blood lipid levels but we also ensure that even if the cholesterol remains a bit too high it will cause no harm because of the ascorbic acid.
For more information, click below:
- Vitamin B-3
- Negative Side Effects
- Niacin Flush or Vasodilatation
- Positive Side Effects
- Clinical Use of Vitamin B-3
- Niacin and Other Medications
1 Das S, Ray R, Snehlata, Das N and Srivastava LM. Effect of Ascorbic Acid on Prevention of Hypercholesterolemia Induced Atherosclerosis. Molecular and Cellular Biochemistry. In Press 2005.