New Niacin Study. Should we listen to it?

New niacin study suggests niacin intake increases CVD risk and this differs than previous research.

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(On average, there is around 25 mg of niacin in a multivitamin/mineral supplement)

Should We Listen to This New Study's Findings?

A recent study came out suggesting that niacin supplementation is dangerous and increases CVD due to a newly discovered pathway.

Previous research indicates the cardiovascular benefits of niacin.

Which is it?

Read yesterday's post to understand the main underlying flaw in research/

What is Niacin (B3)?

Niacin is one of the most stable B vitamins, resistant to heat, light, air, acid, and alkali effects. Niacin is absorbed from the small intestinal tract, and small amounts can be stored in the liver, but most of the excess is excreted in the urine (Haas & Levin, 2006; Marz, 1999)

Niacin can also be manufactured from tryptophan, an essential amino acid that you need to get from food or supplement sources. Only small amounts of niacin are present in foods and instead are converted from tryptophan in foods. Sixty milligrams of tryptophan will yield 1 mg of niacin (Haas & Levin, 2006; Marz, 1999).

The best sources for niacin, whether directly from food or food rich in tryptophan, include liver and other organ meats, poultry, fish, peanuts, peas, avocado, dates, figs, and prunes (Haas & Levin, 2006).

Milk and eggs are also good sources due to the level of tryptophan. Grains will have niacin, but over 90% is removed during processing, and then a manufacturer can add niacin back in (enrichment), but they are not required to enrich their grain-based products (Haas & Levin, 2006).

Niacin and LDL Cholesterol

Previous studies indicate that niacin can help lower LDL cholesterol. However, newer research indicates that lowering LDL cholesterol is not necessarily associated with reducing CVD risk; instead, we should look at the cholesterol's particle size and density to determine CVD risk.

Read more on cholesterol myths, deception, and how a generalized lipid panel cannot tell much about your CVD risk here, here, and here.

Other research has found that taking 1 g or more of niacin daily can raise homocysteine levels, and elevated homocysteine is a CVD risk factor (Haas & Levin, 2006).

However, niacin as inositol hexaniacinate may reduce LDL without raising homocysteine (Haas & Levin, 2006).

Niacin can reduce lipoprotein (a) in a dose-dependent manner by 30-40% on average, but researchers have stated that there is no benefit to adding niacin to a statin regimen.

Hmm, so what about niacin in place of a statin?

To see studies all in one place on the use of niacin for CVD, go here.

Niacin for Mental Health

Niacin has been used for mental illness at high doses of 1 g per day and up to even 6 grams for depression, alcoholism, bipolar, and schizophrenia (Haas & Levin, 2006).

Who Should Avoid Supplementing with High Dose Niacin

If you take BP medication, have ulcers or gout, and have type 2 diabetes, use caution with niacin supplements. Niacin can lower BP, be acidic, raise uric acid levels, and raise blood sugar (Haas & Levin, 2006).

Alcoholism, GI disorders, tuberculosis, and anti-seizure drugs can deplete niacin.

On to the New Study…

The article discusses niacin primarily sourced from fortified foods, so I first want to clarify what an enriched and fortified food is.

Enriched foods have the nutrients removed due to all the processing, so a manufacturer can add those nutrients back in. (Typically, these nutrients added back in are cheap, unabsorbable forms not found in nature.) Think of white bread. It is so overly processed that the fiber, protein, vitamins, and minerals have been removed, and all that is left is the starchy portion, so they add these nutrients back in.

Fortified foods are foods that never had these nutrients to begin with. Think of milk fortified with vitamin D. Many processed foods are fortified with niacin.

Fortification and enrichment are not mandatory in the US.

I think manufacturers enrich and fortify solely for marketing purposes because seeing all those vitamins and minerals listed on the ingredients label makes the product “appear” healthy.

I have known many clients who have fallen for that tactic.

The Study Author’s Drew This Conclusion

The study authors state their study:

“suggested that niacin metabolism was associated with major adverse cardiovascular events.”

They argue that “4PY increases cardiovascular risk through an inflammatory reaction”

4PY is the breakdown of excess niacin, and the researchers indicated that this is associated with heart disease.

“It (niacin) helps foster vascular inflammation through the formation of 4PY, but only in people who have too much.”

What was too much? They never mentioned calculating niacin intake.

Population

“Our cohorts were recruited at quaternary referral centers and show a high prevalence of CVD and cardiometabolic disease risk factors.”

Sixty percent were taking a statin medication. They looked at people in the UK and the US.

I would have liked to see more details on the population. Did they examine niacin intake? Was niacin sourced from whole foods, enriched and fortified foods, or supplements?

Does niacin from fortified foods increase 4PY more so than from supplements? Did being on a statin have any impact compared to those not?

These questions go back to yesterday’s post on how researchers are not required to show their data, and thus, the peer-review process and the approval to publish a study are faulty.

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Niacin amounts to prevent disease are minimal. Preventing disease and promoting optimal health are not the same thing.

“Adults additionally require at least 15 mg per day to avoid niacin deficiency syndromes, such as pellagra.”

“The United States and over 50 other nations mandate niacin fortification in staple foods to prevent pellagra despite the wide availability of foods naturally rich in niacin (for example, 6 oz of tuna or 4 oz of peanuts contain 100% of the dietary reference intake for niacin38).”

“In addition to food, 36% of US residents reported taking dietary supplements containing niacin on NHANES surveys from 1999 to 2010 (ref. 32). The US Department of Agriculture (USDA) estimates that total niacin consumption averaged 35 mg per day in 2010 (ref. 39), and NHANES surveys from 2017 to March 2020 estimated that total niacin consumption averaged 48 mg per day10—more than triple the RDA9.”

False on their US comment. Niacin fortification is not mandated here.

The study found that people who fell into the highest quartile for circulating 4PY levels had more than double the risk for cardiovascular events such as heart attack and strokes but not death.

So, the people who fell into that highest quartile, how much niacin were they consuming? Was it all from fortified junk foods?

If I am reading it correctly, I believe the niacin intake was assumed to be greater the higher the level of circulating 4PY.

What a telling statement below!

“Therapeutic niacin (1,500–2,500 mg per day) was one of the first pharmacologic agents used for the treatment of dyslipidemia11; however, its efficacy for CVD risk reduction in the modern statin era has been questioned.”

The skeptic in me asks, is it that niacin has no benefit, or is it because they want people to use a statin drug instead?

Is this study really just a tactic to reduce supplement use and increase statin use? Thoughts??

“Recent clinical trials have shown that, although niacin can reduce LDL cholesterol (and both raise high-density lipoprotein (HDL) cholesterol and lower triglycerides), in the setting of combined high-potency statin therapy, niacin not only failed to diminish CVD risk14,15, but in a meta-analysis of the most recent trials, it even heightened overall mortality16. It has thus been recognized that niacin has a more complex effect on CVD events (the so-called ‘niacin paradox’, wherein it lowers LDL cholesterol but not CVD event risk), presumably through mechanism(s) independent of cholesterol13.”

So, they looked at niacin intake with HIGH-POTENECY STATIN THERAPY in previous studies. So, was it the niacin or the high-potency statin therapy that increased mortality?

Study Viewpoints

What others have stated about the study

“To draw an inference that niacin increased cardiovascular risk in those trials is not necessarily accurate,” said Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center who did not participate in the study. “Coronary heart disease and related mortality were not significantly increased. … So I have difficulty in connecting the dots.”

William Boden, a professor of medicine at Boston University School of Medicine who did not participate in the study, was hesitant to conclude niacin excess equals cardiovascular risk.

“While it is true that in the current statin era, we do not have compelling evidence that niacin treatment reduces cardiovascular death, [heart attack], or stroke, I am wary to conclude that there is definitive evidence of harm associated with niacin based on this study,” he wrote in an email to STAT.

Additional Comments from Medscape (a propaganda site IMO)

Dr. Graham stated, “The 36 years of United States experience with statin care has demonstrable outcome benefits, against which niacin simply is not even in the same league.”

I don’t think that the doctor above has read any of cardiologist Dr. Kendrick’s books (Doctoring Data, The Clot Thickens, The Great Cholesterol Con) or examined the side effects of statins or that they only increase your lifespan by four days.

This doctor must not be aware that statin researchers only had to show that a statin reduced LDL cholesterol. They never had to show that statins improve cardiovascular disease outcomes. We need to stop looking at LDL!

A counterargument by Dr. Abbo stated

Niacin lowers lipoprotein (a) and triglycerides and it is a cheap solution compared to medications.

Another Medscape commenter asked, is this study in alignment with the coming food supply of bugs and lab-created meats?

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My Final Thoughts

Based on this study, I still do not know what is a high and inflammatory dose of niacin. I still need to know how much niacin the participants were taking and what the sources were.

The skeptic in me wonders if this study is just another paper to support statin use, reduce supplements, and ignore diet and lifestyle interventions to reduce CVD.

This is one study with a new finding. It needs to be replicated to determine if this same finding shows up again.

A typical multivitamin/mineral will have 26 mg. of niacin. If you take a B complex, it will usually contain up to 100 mg. Based on the literature, for someone who does not have CVD or a mental health condition, these lower doses appear to be okay and do not present an issue.

If you have CVD and are taking high-dose niacin, I would hesitate to suggest any dose over 1 gram. Instead, do not rely on supplements alone but make dietary changes to reduce your CVD risk. Diet is the best place to start.

For anyone with a mental illness, some research suggests very high therapeutic (short-term) dosing of over 1 gram can improve mood and reduce bipolar and schizophrenia symptoms. I would determine dosing for this category of people on an individual level.

Avoid added niacin from fortified foods. They are junk foods regardless of how many nutrients are added back in.

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Other References

Haas, E. & Levin, B. (2006). Staying healthy with nutrition. Celestial Arts.

Marz, F. (1999). Medical nutrition. 2nd ed. Omni-Press.