From Ronald Hoffman, MD, ANH-USA Board President and Medical Director
This past week we were regaled with headlines like:
- High levels of niacin may increase heart risk—NBC News
- Too much niacin may be bad for the heart—U.S. News and World Reports
- Excess vitamin B3 linked to increased risk of heart disease—WebMD
I must grudgingly extend my admiration to the folks at Cleveland Clinic for their awesome PR acumen! Biased media is notoriously willing to uncritically broadcast press releases about research that bashes supplements.
The authors of the study in question go so far as to suggest that we may have to rethink even the minimal amounts of B3 that we use to fortify grains—typically found in flour products and cereals.
If valid, this study might cause concern for consumers, like me, who consume multis, B complex supplements, and NAD boosters.
Though stories like these hit me like a gut punch, it’s worthwhile to put aside knee-jerk skepticism and calmly investigate the claims to determine what the real-world consequences might be.
High-dose B3—including niacin, niacinamide, nicotinamide riboside (NR), and nicotinamide mononucleotide (NMN)—are supra-physiologic pharmaceutical applications of a vitamin normally found in small amounts in foods.
For example, steak provides just 4 to 6 mg of niacin per 100 grams. So even a hearty 12 oz. steak portion would furnish only about 15 to 20 mg of niacin; The recommended dietary allowance (RDA) of niacin for adult males is 16 mg per day and 14 mg per day for adult women who aren’t pregnant.
If you don’t get enough B3, you can develop pellagra, whose incidence in developed countries has virtually vanished with food fortification. The term “redneck” originated because of the characteristic collar rash that developed in poor white Southern farmers who subsisted on diets consisting largely of unfortified corn grits with minimal animal protein—their predilection for moonshine didn’t help since alcoholism depletes B3. Pellagra also causes dementia.
The use-case for high-dose niacin is precisely for cardiovascular prevention: 1 to 3 grams daily of niacin reliably lowers total cholesterol, slashes “bad” LDL cholesterol and triglycerides, while helpfully raising “good” HDL.
Hearken back to the 80s when Robert Kowalski wrote a best-seller called “The 8-Week Cholesterol Cure”. The book sold millions of copies until its popularity was dimmed by lawsuits from readers who developed liver problems, a known side effect of unsupervised use of high-dose niacin.
Studies on the efficacy of high-dose niacin for heart disease prevention, curiously, show diminishing efficacy, depending on when they were published:
1980s: Benefits
1990s: Equivocal effects
2000s: Neutral or harmful
