Talk:Niacin

Name "pyridine-3-carboxylate" incorrect

The suffix "carboxylate" indicates an ester or a salt of a carboxylic acid. Nicotinic acid is neither.

71.241.104.251 02:34, 12 August 2007 (UTC)

Molecular Formula and SMILES

C6H4NO2- or C6H5NO2 (neutral). The SMILES should match one or the other.

Diet

Where it says "inadequate dietary intake of vitamin B3 may also therefore lead to depression", is that "may" as in "sometimes causes depression" or "may" as in "some people think it causes depression (but there's no hard evidence either way)"?

Also, what's this "Vitamin P" business?

--221.249.13.34 05:16, 4 Nov 2004 (UTC)

I believe Vitamin P is an older name for niacin derived either from "paprika", a rich source of niacin, or from "pellagra" (or "pellagra-preventive"), referring to the deficiency disease. D021317c 21:21, 13 December 2006 (UTC)

It would be nice to have a list of a few foods or plants that are rich in niacin on this page. The Hominy page mentions that "The process also converts some of the niacin in the maize into a form more absorbable by the body"...

(I didn't write that last, unsigned paragraph.) Lye destroys a chemical (I'm drawing a blank at the moment) which blocks the absorption of niacin. According to _Understanding Nutrition_ (8th edition: instructor's edition) ISBN 0-534-54612-9, page 301, "At least 70 percent of the niacin in corn is bound to complex carbohydrates and small peptides, making it unavailable for absorption. Furthermore, corn is high in the amino acid leucine, which interferes with the tryptophan-to-niacin conversion, thus further contributing to the development of pellagra." I'm pretty sure I once knew the name of the chemical I'm thinking of. Oh, well. D021317c 21:21, 13 December 2006 (UTC)

Corn

This page links to the disambiguation page corn, but I'm not sure which sense is intended. Can you help? Thanks. — Pekinensis 23:34, 27 May 2005 (UTC)

I realized that the reference was redundant in the first place and removed it. — Pekinensis 03:56, 15 Jun 2005 (UTC)

Just a quick note, whoever added the information about tryptophan bioavailability in corn did an excellent job, wiki needs more of this level of relevant public health information. It should be cited though - did this come from any peer-refereed journal? Added a "citation needed" note.72.186.157.71 (talk) 17:54, 1 September 2008 (UTC) Never mind, there is a citation but the text was copied directly out of a medical information page. I put the text in quotes, but it looks choppy - can someone clean it up?72.186.157.71 (talk) 17:57, 1 September 2008 (UTC)

THC Elimnation

If this is true won't other drugs also be eliminated by the higher rate of metabolism? Why simply specify THC, why not DMT or DET? Or any other drug for that matter (that is metabolised by the liver)?

Food for drugheads. JFW | T@lk 23:00, 15 Jun 2005 (UTC)

Actually the Psychiatric Times reference also mentions someone trying it to mask cocaine use (and getting hospitalized as a result). However, mentioning THC here is in line with most of the literature which is reponding to the folklore - eg "Use of Niacin in Attempts to Defeat Urine Drug Testing --- Five States, January--September 2006". Morbidity Mortality Weekly Report. 56 (15). Centers for Disease Control and Prevention: 365. 2007-04-20. Retrieved 2008-03-04. No scientific evidence indicates that taking niacin can alter a urine drug test result. However, readily accessible information on the Internet lists ingestion of niacin as a way to prevent detection of tetrahydracannabinol (THC), the main psychoactive ingredient of marijuana. {{cite journal}}: Unknown parameter |MMWR_Type= ignored (help); Unknown parameter |day= ignored (help); Unknown parameter |issue_Num= ignored (help); Unknown parameter |month= ignored (help)CS1 maint: date and year (link) (emphasis mine, for the anon below who thinks we don't read actual encyclopedias) --Bazzargh (talk) 10:43, 4 March 2008 (UTC)

Since Niacin speeds up metabolism, is it now the chic replacement for ephedrine for weight loss

- In response to the above question, it probably helps with those too. THC was probably mentioned for two reasons.

  -1. Because it is the a commonly used drug that has no obvious dangers. 
  -2. Because it occupies the body for a fairly long time, as opposed to other mind altering drugs.

No, because THC is the only one that clings to fat cells.

This whole wikiepedia thing is dumb. I know for a fact than 500-1000 mg of niacin (taken right) flushes THC out out of your system in less than 6 hours. Maybe you should all start reading the actual encyclopedia and not the one where a bunch of know it all wannabe dawkins are spewing their beliefs. (Or you all could just start smoking pot, it's good man I tell ya.) P.S. Whoever posted that last comment about the fat cells, thank you for not being so dumb. — Preceding unsigned comment added by 68.10.1.118 (talk)

Well, if you know that "for a fact", please provide a citation to a reliable secondary source. --Slashme 14:48, 26 September 2007 (UTC)

Shouldn't the citation for niacin not working to flush out pot be put after it says that instead of after it says that people try to use it for that? It makes it sound like it's an unsupported claim. On a personal note I love that a guy that can't spell wikipedia and makes unreferenced claims accuses writers on this site of spewing their beliefs! 70.94.34.208 (talk) 04:38, 4 March 2008 (UTC)

Misc

It might be mentioned that Niacin is one of the 3 primary ingredients used in the enrichment process of flour.

http://www.wholefoods.com/healthinfo/enriched.html

http://frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi?TITLE=21&PART=137&SECTION=165&YEAR=2001&TYPE=TEXT

You're free to add it to the article. JFW | T@lk 13:51, 8 August 2005 (UTC)

Since this is misc, I might as well ask here, would it be good or bad for you for Niacin to be one of the ingredients of a sports drink?

Band

There's also a band called Niacin.

There's a band for every article in Wikipedia. Most of them are utterly unnotable. JFW | T@lk 13:51, 8 August 2005 (UTC)

"pootie tang"

Second paragraph, someone altered the sentence, "Nicotinic acid was first discovered from the oxidation of pootie tang" Someone playing a joke, but I have no idea what it should really say...

(I didn't contribute the paragraph above.) According to Merck Index 13 ISBN 0911910-13-1, section 6552 Nicotinic acid, "Prepn by oxidation of alkyl beta-substituted pyridines: A. Ladenburg, _Ann._ *301*, 152 (1898)." According to its list of abbreviations, _Ann._ means _Justus Liebig's Annalen der Chemie_. No information yet on discovery. D021317c 21:34, 13 December 2006 (UTC)

Composition error

Something is missing at the second line of the main niacin article, probably an eduting error. —The preceding unsigned comment was added by 24.4.16.102 (talk • contribs) 05:45, 24 January 2006 (UTC).

The words "whose derivatives" were missing. I have fixed it. Now it reads: Niacin, also known nicotinic acid or vitamin B3, is a water-soluble vitamin whose derivatives such as NADH plays essential roles in energy metabolism in the living cell. --Eddi (Talk) 00:47, 25 January 2006 (UTC)

Michalek effect

I went and googled for "Michalek effect" and came up with nothing. I find this suspicious. --kop 06:48, 24 February 2006 (UTC)

I searched even further, but I found only Wikipedia mirrors. However, Nationmaster, one of the mirrors, has some additional information. Here are both versions as of today, with differences in italics:

Wikipedia

Because niacin promotes metabolism, some believe that taking large doses will speed up the elimination of THC from the body and produce a negative result for marijuana on a drug test. There is no evidence that this is effective, and niacin is toxic to the skin and liver in overdose, especially as it releases the extra toxins. This is known as the Michalek effect due to the toxic skin conditions as well as behavioral changes when Niacin is in ones system. There is also anecdotal evidence that doses of 500-1000mg can terminate a bad trip on LSD, a synthetic indole, or enhance the MDMA experience.

Nationmaster

Because niacin promotes metabolism, some believe that taking large doses will speed up the elimination of THC from the body and produce a negative result for marijuana on a drug test. There is no evidence that this is effective, and niacin is toxic to the skin and liver in overdose. There is also anecdotal evidence that doses of 500-1000mg can terminate a bad trip on LSD or enhance the MDMA experience. Anecodotal evidence also suggests that niacin taken to remove the presence of a toxin stored in certain cells may also flood the system in a very short time period, resulting in symptoms similiar to traditional ingestion of the substances in question. This is known in some cirlces as the Michalek effect.

No references are given other than those from Wikipedia. Perhaps this is not significant anyway. --Eddi (Talk) 12:48, 24 February 2006 (UTC)

I searched Pub Med and other medical dictionaries. I am pretty confident that the condition described by the term "Michalek effect" is not scientificly investigated nor accepted by any medical clinicians as an actual phenomenon. Niubrad 03:00, 25 August 2006 (UTC)

I have checked as many sources I could for behavioral changes and the so-called "Michalek effect". None found. Will remove from article. Ifnord 04:40, 5 September 2006 (UTC)

Biosynthesis

Someone please correct the picture of the synthensis pathway with the enyzmes, I don't have a program to draw them. This should be the pathway:

Tryptophan --(Tryptophan oxygenase)--> N-formylkynurenine --> Kynurenine --> 3-OH kynurenine --(B6, Kynureninase)--> 3-0h xyanthranilic acid --> --> -->Niacin

Source: Introduction to clincal nutrition, 2nd edition Vishwanath Sardesai 2003

141.217.221.212 22:01, 25 March 2006 (UTC)AStudent

Niacin / Blood pressure

I have high blood pressure (hypertension) and have been told that niacin is no good for a person who is hypertensive is this so? why? This is a B complex suplement from a health shop.

My doctor has PRESCRIBED niacin to address my hypertension, but there are some mild side-effects: http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-niacin.html

-K

References: cleanup

I edited the references in this article to at least give descriptive names, and sort out the numbering. The web refs still need to be properly cited, though. I will put this page on my to-do list. Apart from the somewhat dodgy references, it would do me good to do a literature survey on this topic. --Slashme 09:50, 2 May 2006 (UTC)

niacin is believed to be the best treatment for many types od coronary heart disease, IT SAVE MY LIFE; refer to LIFE EXTENSION MAGAZINE --MARCH 2007.

Information not verified

I think that the part regarding the use of niacin as vasodilator should be removed since I couldn't find any reference to this use in any book of pharmacology I looked. Plico 17:13, 12 May 2006 (UTC)

Deletion

deleted text: A large amount of B3 Ingested can increase your sex drive. Plico 17:13, 12 May 2006 (UTC)

vandalism of dyslipidemias, WP:NPA discussion

When you use systematic, naked reverts & trivially refuted, uncivil labelling to describe my edit, "08:37, 23 June 2006 Ackoz (rv no pseudoscience per WP:NPOV)"[1], I construe that as a personal attack[2](it was knowably not a legitmate comment on content for a doctor). Almost everything you deleted there [3](one exception) was sourced from Dr William Parsons' latest book (and in conjunction with other conventional references). Parsons *is* the longest recognized, and best documented, US conventional medical authority on niacin for dyslipidemias[4], where you also deleted the reference to his book (best accessible reference for the public). And although you may deny this is WP:NPA, I commend review of the words "broaching", "breeching" as well as "wikilawyering"

If you want to be constructive, addressing European sources and extended, rigorous evidence on inositol hexanicotinate (IHN), would be nice. Here in North America, there seem to be a lot of IHN failures with some niacin/nicotinate interested parties, from reports of hit or miss results to outright allegations of medical/scientific fraud(!) and hydrolysis issues. Whether this is a source problem or what is going on, I don't know, but I am sure there is a problem here (# of strong medical sources) and no one publicly seems to be talking or working the problem. Reports on inositol hexanicotinate do vary.--69.178.41.55 07:01, 24 June 2006 (UTC)

Decent niacin hexanicotinate refs

For all the claims on how much better the hexanicotinate IHN is than plain niacin for dyslipidemias, there really ought to be better evidence than two VERY small human trials from 1961 (neither of which was big enough to measure any clinical endpoints). Did I miss something? Because this question surely isn't something that yields well to a standard 1965+ medline search (as I find to my frustration), which possibly is why the "pro" references all seem to be indirect: which is to say, to popular books which refer in turn to very old studies in rather obscure journals.

So, how about putting in some updated material on this compound, OR else noting that recent class A info just doesn't exist? Both are fair ways of dealing with lack of information. Breathless endorsements based on tiny 45 year-old short-term trials, are not how standard science-based, evidence-based medicine is supposed to work. Steve 16:03, 24 June 2006 (UTC)

Medical use

---

Nicotinic acid is one of the oldest drug used to treat dyslipidemia being able to affects all lipid parameters [Knopp et al. Metabolism, 1985, 34:642-650] It has been reported to lower triglycerides by 35% to 45% and LDL-c by 20% to 30% [Knopp 1985].

Niacin in large quantities is a vasodilator. Large amounts of niacin (either from vitamin B3 tablets or from treated meats) may cause dose related, harmless and short-lived sensations ranging from a mildly pleasant warm flush to tingling to extreme skin flushing resembling a sunburn, itching, gastric disturbances, and lowering of blood pressure. The amide form (strictly speaking a provitamin) does not cause these side effects, but is also not as easily assimilated by the body.

This niacin flush occurs as a result of releasing histamine about 10 minutes to 2 hours after ingesting the niacin supplement(s), typically 5-30 minutes, depending on the supplement's disintegration, dissolution and absorption. Thus, even with "pure", "immediate release" niacin supplements, absorption, and any flush, will vary greatly with nature of the supplement (capsule, tablet, excipients, press, size) and the proximal meal's timing before, during, or after, size and menu. The flushing usually recedes during the first week(s) if gram amounts are consumed in divided doses as recommended for high cholesterol treatment, starting low and increasing stepwise every several days. Sometimes aspirin and vitamin C are used to ameliorate the flush. "Slow release", "extended release" and "no-flush" formulas are available to minimize or avoid a flush, but have other practical differences that need to be carefully considered. Some persons with an unusual metabolism have an unusually large native tolerance to "immediate release" niacin without flushing, often a nutritionally or even medically significant circumstance.

Large doses of niacin (as nicotinic acid, but not the niacinamide form) are prescribed to combat high blood pressure and to broadly improve blood cholesterol levels. Niacin is used to treat dyslipidemas because of its low cost and its unique ability to improve lipid profiles for ApoB, LDL, small dense LDL, HDL, HDL_2b - an extremely good cholesterol, Lp(a), fibrinogen and triglycerides . Pharmacologic doses of niacin (1.5 to 6 grams/day in divided doses) typically reduce LDL cholesterol levels by 10 to 25 percent and triglyceride levels by 20 to 50 percent. HDL cholesterol levels are also typically increased by 15 to 35 percent. Brand-name medications include Niaspan®, Niacor® and Nicolar®. Most slow-release pharmaceutical preparations are more stressful to the liver, repeated overdosage can be dangerous. There is disagreement as to if pure, immediate release nicotinic acid is harmful to the liver, possibly due to the confusion with the more dangerous pharmaceutical preparations.

The niacin treatment discoverer, Abram Hoffer, and other orthomolecular proponents generally add a full spectrum vitamin B formulation, such as B-50, and 1 to 4 times as much vitamin C as niacin to reduce liver stress. Liver cell activation and stress is easily monitored in the liver enzyme panel along with blood cholesterol measurements. Because of the liver stress associated with heavy alcohol consumption, regular drinkers and alcoholics may experience antabuse-like reactions with pharmacologic levels of niacin.

An esterified, no-flush derivative of niacin called Inositol hexanicotinate (IHN), also known as inositol hexaniacinate, is slowly hydrolyzed and has no reported side effects using 4 grams daily. Peak blood concentrations have been reported to be at 10 hours, but suggested dosing is at least 4 times a day. It is used extensively in Europe for Raynaud's disease. There is no known monotherapeutic treatment for cholesterol dyslipidemas that is more broadly effective and as gentle.

Another form of vitamin B3, niacinamide, has been used since the 1940's for osteoarthritis and rheumatoid arthritis with tremendous success reported by William Kaufman, MD, PhD (1910-2000). Kaufman's recommended usage is about 4 grams a day in divided doses, more frequently being better. Dr. Kaufman advocated 500mg, and even 250mg doses, many times a day as being better than 1,000 mg 4 times a day. Nicotinic acid at least partially breaks down to niacinamide, so less niacinamide is needed if niacin treament for cholesterol is being used. Niacinamide may be safer for the liver than nicotinic acid, but nutritional supplement proponent and expert Michael Murray recommends testing liver function every 3 months when taking any high-dose form of niacin. Dr. Hoffer reports he has never seen liver problems result from taking any natural form of niacin with at least equal amounts of vitamin C .

Vitamin B3 has also been used in nutritional treatments of alcoholism, cancer, Bell's Palsy, schizophrenia, senility and other mental illnesses by orthomolecular practitioners . These treatments are largely based on improved circulation, NAD related energetics and cellular repairs, and the correction of abnormal indole metabolites. Often the nicotinamide form is used, as its lack of a flush is easier to self administer with new patients. Unfortunately orthomolecular psychiatric treatments remain adversarially disputed over disagreements about measurement, diagnosis, efficacy, protocols and specific populations. Recently interest in niacin as a phosphate reducing agent was generated by a clinical study from India where it was found to dramatically reduce high serum phosphate levels in chronic renal failure patients on hemodialysis.( K.Sampathkumar et al in International urology and nephrology,2006;38(1):171-4)

---

I chopped that out because it mingles confusion, repetition, poor phrasing (arrived at by serial edits I expect) misinformation, and linkspam.

Nicotinic acid but not Niacin has been used to reduce Cholesterol. It isn't very good at it. I'd want to see a reference to why a vasodilator would need to release histamine to cause flushing, and why it would be a good idea to take repeated doses of something that did that.

I do have one patient who for several reasons is treated with it. It doesn't work very well. Midgley 13:35, 25 June 2006 (UTC)

Wow, the big test of one. "Nicotinic acid" in the US is usually used synonymously with niacin e.g. labels "Niacin (as nicotinic acid)", but a point taken. Conventional US physicians, taking a hint from the apostate [Abram Hoffer] 50 years ago have achieved 90-96% compliance (vs pharma phlunkies 60-70%) and presumably as close to overall targets as they can get. Some people absolutely can't handle statins. Niacin products vary greatly, a fact you need to assess carefully in selecting a "good" brand, it makes a difference to tolerances (flushing, liver) and results (long time release TRNA over an hour doesn't help HDL much, plain NA "instant" is *slightly* less effective on LDL but great for HDL). The best selling book,8 week cholesterol cure, and the most authoritative book, CCWD, in the popular press suggest Enduracin as a very good version of EP NA. The Annals of Internal Medicine article I mentioned previously[] slightly favored Rugby for plain niacin. According to Parson's book, if you are at less 6g with *plain* NA per day, or 3g of EP NA, or the individuals gastrointestinal limits (3x normal liver enzymes), or another medical limitation, you haven't really worked the problem. Read Parson's conventional medical book, "Cholesterol Control without Diet, the Niacin Solution" if you want to be expert at administering niacin in the conventional medical sense, the guy is a highly experienced, conventional MD & expert. Some people have different metabolisms and are quite different, but a niacin tolerance requiring more is possible - there seem to be three (not mutally exclusive) directions in niacin: titrating up with one of the *preferred* NA products, adding a second agent (and pharmas will even suggest a 3rd), and the other is Hoffer's extended orthomolecular version including lots of vitamin C, the 11 component B-50 multi-B vitamin. Some lucky individuals get a 45-50% LDL lowering, a 50+% HDL rise, nuke their TG under the orthomolecular versions of niacin, etc therapy, still eat like pigs. In the original "8 week cholesterol cure" book, in a sample of 15, 1-2 of these types show up. Cheap 200 to 500 mcg chromium picolinate or polynicotinate adjuvants are research subjects, especially for "metabolic syndrome" or "syndrome X". The result varies with the individual patient and physician's niacin skill.--69.178.41.55 20:23, 25 June 2006 (UTC)

Spelling it out a little, then:- I have one patient who is (for various reasons) treated with it. This caused me to read some science on it. In common with that reading, which indicates that (half of) Niacin doesn't work well for lipids, my individual experience on which I comment for the possible interest of those reading, does not form an exception. I am indebted of course to the provider of tha advice that giving a sufficient dose of the alleged medicine is necessary before conlcuding it is not effective.

There is a lot of comment above, but none on "I'd want to see a reference to why a vasodilator would need to release histamine to cause flushing, and why it would be a good idea to take repeated doses of something that did that. " which remains relevant to the redacted text. Midgley 21:26, 26 June 2006 (UTC)

The vasodilation effect doesn't affect systemic pressure, and is harmless. Patients get used to it and most develop a tolerance for it (ie, it quits happening).

Niacin as the acid does lower cholesterol enough to be comparable to some other treatments, and is licensed for this use in various prescription formulations, by the FDA. So I do think this is worth mentioning in the article, along with effects on specific lipids. Better references for a Wiki article, from medline, are available for this, though. I think the fairest way to treat all this is to note that nicotinic acid is capable of dropping cholesterol substantially, but effects on cardiac outcomes have been too small to show up in meta analysis (though a trend is there) and meta analysis of availablee niacin treatment studies show no effect on overall mortality at all. Thus, while niacin is used by some physicians in some circumstances as a treatment to increase low HDL, especially in combination with other cholesterol drugs, class I evidence for its effect on overall health is still lacking. It appears safe. Further studies are awaited. I think this sort of thing could be defended. Indeed, niacin has its defenders in the orthodox medical community. I've criticised them, but that standard pharm use is large enough that it would be wrong not to acknowledge it. It's a "standard" medicine treatment that is still under scrutiny for ultimate benefits, if any. And it's not the first or last one, either. Steve 23:45, 26 June 2006 (UTC)

Concur. Not a treatment for hypertension. Rates a paragraph - not a long paragraph - along line suggested above. Midgley 16:01, 27 June 2006 (UTC)

Midgley -- could you produce your science? Also, are you sure nicotinic acid and not niacin is used to treat cholesterol? This doctor disagrees with you. ImpIn | {talk - contribs} 18:49, 23 May 2008 (UTC)

Meta analysis of lipid treatment

There have been enough studies of various lipid treatments that meta analysis is appropriate. Basically, we don't care about lowering cholesterol with drugs or nutrients that don't change your cardiac event rate or your mortality risk. What good does it do you to die with good numbers? That's not the point. I'm even suspicious of treatments that lower cardiac event rate, if they don't at least show a trend toward lowering mortality risk. That may be a power problem, but if you don't at least see a trend toward lower mortality, it makes you wonder a lot about some compensitory bad effect. And at the very least, it means you need to treat a BOATLOAD of people to save even one life, like tens of thousands of patients for many years. At that point, it starts to look better to spend your money and time workin on people's blood pressure and the kind of car they drive, than working ot make sure they're swallowing multiple niacin pills.

In any case, the meta anaysis shows that statins, cholesterol binding resins, and fishoil have saved lives in proper studies. There's no evidence that fibrates or niacin do, yet there have been plenty of studies: PMID 15824290. In fact, niacin, fibrate and diet therapy all flunk badly, not even showing a trend.

When it comes to lowering cholesterol or triglycerides, all these treatments of course work, though they vary a great deal in what lipids they treat (fish oil and fibrates working better on triglycerides, statins on LDL, and so on). But again, who cares about fixing numbers? The cardiac event rate is way down for statins, in keeping with lower motality, as also of course for fish oil and resins. However, it's down only about 25% for fibrates and about that much also for niacin (too few studies to give confidence limits on niacin). That's why these treatments fail to show mortality drops. In fact, there's some evidence that some older fibrates (paticularly clofibrate with 25% excess mortality in a 150,000 man-years trial, see PMID 6105515) actually increase mortality. And the most commonly used fibrate (fenofibrate) used because still on-patent, has almost no long term data at all. The old gemfibrozil from VA-HIT showed a decrease in event rate but still no mortality drop, and it had equal power to most of the statin trials which did at least show mortality decrease trends. In any case, 30 trials with 4700 subjects failed to show any mortality drop in treating coronary disease with niacin: PMID 15653014. Basically niacin, and the fibrates as a class, treat lab tests. But are a bust at saving lives. I would suggest for both of them that you're treating yourself rather than your patient. But enjoy. Steve 22:59, 25 June 2006 (UTC)

I am not sure what I said that brought the fibrates into niacin. Anyone since the CDP on Atromid would be very wary of Lucy and the football (Charlie Brown, suckered again).

The niacin story you guys are discussing is starting to get to alternative universe stuff. Most of the published long term niacin tests are for 1.5 - 3 grams/day or lower, CDP was 2 - 3 g/day of plain niacin. The serious clinical use of *plain* niacin is 3 - 6 grams per day, the best (newer) extended release formulas 1.5-2 grams targeted, with *careful* titration to 3 grams possible in a number of cases. Mixed niacin uses are possible for absolute maximum performance in some cases. The niacin story is further split by the type issues (plain(s) vs extended release (newest) and the old, slowest, most problematic time release versions (>1 hr) ). The recent test numbers, sponsored by pharmas, are at great variance with the early government plain niacin trials. CDP/Canner is really the authoritative longterm trial, an average of 6 yrs treatment, followed 15 yrs for an 11% decline in total mortality. More provocative is the earlier set of results from Dr Edwin Boyle at NIH where his data indicated that individual attention for high compliance rates and titration for effect yielded a 90% mortality reduction for those on niacin for 10 years against historical experience (yes, not a dbRCT) with a subpopulation.

The pharmas have long recognized two important facts, both in their public discussions and tacitly designing & running their tests: (1) the short term benefits of statins look better, say at less than 3-5 years, and (2) that their primary benefit is LDL, although statins do seem to have other properties. Steve as you alluded, especially for the low "high cholesterol" values, the absolute benefit numbers are very low and very expensive. I previously mentioned to Midgely that more recent "niacin" studies [5] alongside the statin were easy to identify, totally cooked to make the statin look good and/or the cheap generic look bad. Scientific misconduct type stuff (and doctors wonder why everyone is so down on them, something about the company one keeps or vice versa - I recently got correspondence from a prominent *conventional* doctor mentioning this ). Apparently pharma sponsored trials are able to attain dropout rates of 30% -40+% even 50%, whereas individual practitioners are able to hit 90-96% compliance. These dropout rates are especially important in the niacin trials because as early as 1957, Hoffer showed that some of those with *no initial flush* generally had the lowest response to niacin. The implications of this brings up the question: what if in competitive testing there is a simple way to wipe out the best responding 1/4 to 1/2 of generic niacin takers? Just don't encourage or instruct them enough to transition that crucial first week or two, or else use a slow, unskilled acclimation (rougher) protocol (most common in current textbooks) instead of a 1-2 week version with simple but careful instructions.

Some of the pharma's trials do things like open up with 3 grams of old time release niacin (ahem, rough stuff) that are sure to provoke complications & that won't help HDL as much either. Some statin studies seem to have a better TG/HDL population that don't favor niacin. If you view niacin results as an individual threshold followed by an almost linear dose response up to tolerance or 6 grams day, basically these 1.5-2g/day trials will do little for those that need 4 - 6 grams/day plain niacin or the equivalent extended release form (not TRNA).

Last time I looked (about the time of HATS?) I was underwhelmed by the statins' *long term* (>7-8 yrs) total mortality data, no real clear benefit, some slightly negative at P50 but not at P95. I don't want to get into a shouting match about statins, not my "thing". I simply recognize the *pervasive* influence of commercial interests can have in America (and "science") to "modify" negatives and trumpet any "good" (history shows clearly...). In the US circumstances, one could ethically offer cheapest, most convenient or best niacin solutions, and cheapest can be pretty darn good, better than "most convenient" in some important cases.

Old HATS - anytime one sees a pharma trial using tocopheryl acetate or pure/high dose beta carotene, that waves a red flag as streetwise, commercial test design hijinks.--69.178.41.55 22:54, 27 June 2006 (UTC)

Buying Niacin Supplements

Someone said that the amide form does not cause flushing... does anyone know of a reputable company that sells it that way? I have GNC multivitamins for pregnant/breastfeeding persons and it contains niacin in the amide form but finding a niacin supplement that way seems much more difficult and GNC doesn't carry it. There are several forms that niacin is sold in : nicotinic acid, nicotinamide, and Inositol Nicotinate. Which form is the most easily digestable? I'm also frustrated by labels that just say niacin! I guess they're refering to nicotinic acid. What other differences are there between those three different forms of niacin? Also, I know that it's best to drink a glass of orange juice with iron supplements... what's best to take with niacin supplements?

Can Someone add the different niacin products available: Extended release only available by Rx-as Niaspan. Others are dietary supplements offered over the counter products-Immediate release and Sustained Release. Sustained Release Niacin is associated with a higher risk of hepatotoxicity. (Can someone add this and reference it please-thanks)

L. Ron Hubbard

Good old L. Ron makes a pretty healthy mention of Niacin (The "Educated" Vitamin) in his book Clear Body, Clear Mind. It apparently sunburns people in the shape of a bathing suit. Also, it has something to do with the toxins! — Preceding unsigned comment added by 131.230.52.162 (talk) 19:40, 21 September 2006 (UTC)

→ It seems to be working ok for the 9/11 rescue workers - [6] Johnalexwood 11:52, 9 October 2007 (UTC)

Suggestion

Someone should add something about the difference between OTC Immediate release versus OTC Extended release--thanks — Preceding unsigned comment added by 70.113.207.158 (talk) 00:56, 29 November 2006 (UTC)

Other uses

The words "a synthetic indole" seem out of place. D021317c 21:05, 13 December 2006 (UTC)

Useful links

Note: some of these sites sell products that I can't recommend!

[7]The niacin page at Doctor Yourself.

[8]The Life Extension Foundation -- search it for niacin, Abram Hoffer, nicotinic, etc.

[9]Duane Graveline's website. See also [10]his Wikipedia page.

Search for "Hoffer" in conjunction with "niacin" for plenty of references to psychiatric and circulatory connections. As for niacin's action as a vasodilator, that's beyond controversy (and so is the role of histamine in the process). Apparently there still remains some controversy over whether it's better when trying to manage blood lipids to take a form of niacin which avoids the "niacin flush" (such as time-release forms, niacinamide, inositol hexanicotinate, etc.) or one which causes "niacin saturation" and (usually) a concomitant flush. Abram Hoffer, whose experience with niacin in large doses is utterly unparalleled, seems (to me) to be saying that only pure niacin (nicotinic acid) is effective, and if I read him correctly, the flush is unavoidable. Don't confuse the lipid-altering with the psychiatric therapies. Though schizophrenia has been treated with niacinamide (avoiding the flush), it has also been suspected of increasing the incidence of depression.D021317c 22:35, 13 December 2006 (UTC)

Niacin compoent nicotinamide and aging

If I take Naicin/ vitamin B am I taking nicotinamide? Should I avoid Niacin to live longer? The following article indicates that nicotinamide binds the sirtuin molecule to inhibit its activity.

In recent years, scientists have discovered that a family of enzymes called sirtuins can dramatically extend life in organisms as diverse as yeast, worms, and flies. They may also be able to control age-associated metabolic disorders, including obesity and type II diabetes. (http://www.wistar.org) Using the techniques of structural biology, the Wistar team demonstrated that a component(nicotinamide) of the common vitamin B3, also known as niacin, binds to a specific site on the sirtuin molecule to inhibit its activity. --Oxy49 21:09, 18 February 2007 (UTC)

• Recent studies have shown that niacinamide and not nicatonic acid (niacin) inhibit sirtuin activity. http://www.jbc.org/cgi/content/full/277/47/45099#SEC2 Flush niacin: nicatonic acid does not show same problems of inhibiting sirtuins.LucidWay 15:13, 9 July 2007 (UTC)

500 decagram

In the article, it mentions a person taking 36 capsules containing 500 decagram of niacin. 36x500=18000 decagram, or 180 kg. Of course this is incorrect, please rectify.

drinks as a source of niacin

• Diet Coke Plus
• RedBull
• 5-hour Energy

some sort of advertising thrown in^

should be changed to: most energy drinks and beer (yes beer has b vitamins)

In the flush section,

it says the effects can be mediated by taking 0.3mg of aspirin. Shouldn't that be 300mg or 0.3g?

• After poking around online, some recommend taking a baby aspirin with niacin, a baby aspirin is 80-100mg

http://www.tylermedicalclinic.com/Baby%20Aspirin.htm Normal aspirin dosage is 300-1000mg (see aspirin dosage @ wiki) I agree this needs to be changed.LucidWay 15:03, 9 July 2007 (UTC)

Nicotinic Acid and nicotinamide

I really wish that this article would cite the differences between nicotinic acid and nicotinamide. I've read some really interesting and simple articles on the internet that list the differences. Nicotinic acid helps reduce lipid levels while nicotinimide doesn't. There are several other differences... and it looks like there are some far more knowledgable people who could have written this article based on all the discussion. One more thing,what's Inositol Nicotinate? Some stores are selling this labeled as niacin. There's a difference between those 2 niacin supplements although most stores still label them both as simply niacin. What's the diffenrence with Inositol Nicotinate?

Niacinamide

Just got back from GNC. What is niacinamide? Is it related to nicotinamide?

• Nicotinamide is a niacin precursor. It is marketed as non-flush niacin, but doesn't have all of the health benefits, in fact, nicotinamide inhibits the expression of Sirt-1 a life-extension gene.LucidWay 15:02, 9 July 2007 (UTC)