From the Guidelines
Testing and optimizing nicotinic acid, nicotinamide, and nicotinuric acid can be valuable for improving overall health and cellular function, particularly in individuals with high Lp(a) or those at risk of niacin deficiency, as evidenced by the most recent guidelines from 2022 1. These compounds are forms or metabolites of vitamin B3 (niacin) and play crucial roles in energy metabolism, DNA repair, and cellular signaling. To optimize levels, start with a blood test to determine your current niacin status. If levels are low, consider supplementing with nicotinic acid or nicotinamide, starting with a low dose of 50-100 mg per day and gradually increasing to 500-1000 mg daily as tolerated, while being mindful of the upper intake levels (ULs) of 10 mg/d for free nicotinic acid and 12.5 mg/kg body weight/d for nicotinamide 1.
Key Considerations
- Monitor for side effects such as flushing, particularly with nicotinic acid.
- Nicotinuric acid levels will naturally increase as a result of nicotinic acid supplementation.
- Regular blood tests can help track progress and ensure optimal levels are maintained.
- Optimizing these compounds may lead to improved energy levels, better DNA repair, and enhanced cellular health.
- Certain populations are at risk of niacin deficiency, including those with inadequate oral intake, poor bioavailability from grains, defective tryptophan absorption, carcinoid tumors, metabolic disorders, and the long-term use of chemotherapeutic treatments 1.
- The recommended dietary intake of niacin differs at different points in the life span, with adolescents and adults requiring 14-16 mg/day, pregnant women requiring 18 mg/day, and lactating women requiring 16 mg/day 1.
Important Precautions
- It's essential to consult with a healthcare provider before starting any supplementation regimen, especially if you have pre-existing health conditions or are taking medications.
- Be aware of the potential for niacin deficiency, particularly in individuals with certain medical conditions or those taking certain medications.
- Consider the potential benefits of niacin supplementation in preventing ischemic stroke in patients with high Lp(a), as suggested by the American Heart Association/American Stroke Association guidelines from 2011 1.
From the FDA Drug Label
The role of low-density lipoprotein (LDL) cholesterol in atherogenesis is supported by pathological observations, clinical studies, and many animal experiments. Nicotinic acid (but not nicotinamide) in gram doses produces an average 10% to 20% reduction in total and LDL cholesterol, a 30% to 70% reduction in triglycerides, and an average 20% to 35% increase in HDL cholesterol.
The value of testing and optimizing Niacin (Nicotinic Acid) lies in its ability to:
- Reduce total and LDL cholesterol by 10% to 20%
- Reduce triglycerides by 30% to 70%
- Increase HDL cholesterol by 20% to 35% However, the value of testing and optimizing Niacinamide (Nicotinamide) and Nicotinuric Acid is not directly supported by the provided drug label, as it only mentions the effects of Nicotinic Acid. 2
From the Research
Value of Testing and Optimizing Niacin, Niacinamide, and Nicotinuric Acid
The value of testing and optimizing Niacin (Nicotinic Acid), Niacinamide (Nicotinamide), and Nicotinuric Acid can be understood through their effects on various biological processes.
- Niacin and its forms play a crucial role in energy metabolism and oxidative phosphorylation 3.
- Nicotinamide supplementation has been shown to induce detrimental metabolic and epigenetic changes in developing rats, including increased weight gain, impaired glucose tolerance, and insulin sensitivity 4.
- Large supplements of nicotinic acid and nicotinamide can increase tissue NAD+ and poly(ADP-ribose) levels, but may not affect diethylnitrosamine-induced altered hepatic foci in Fischer-344 rats 5.
Niacin Status and ADP-Ribose Metabolism
Niacin status, NAD distribution, and ADP-ribose metabolism are closely linked.
- Dietary niacin deficiency or pharmacological excesses of nicotinic acid or nicotinamide can have dramatic effects on cellular NAD pools, ADP-ribose metabolism, tissue function, and health 6.
- Nicotinic acid, nicotinamide, and nicotinamide riboside have distinct and tissue-specific biosynthetic and/or ligand activities, responsible for vitamin-specific effects and side effects 7.
Food Sources and Niacin Profiles
The presence rates of nicotinic acid and nicotinamide vary in different food sources.