50 replies to this topic

[mandible]

I have a book about orthomolecular medicine from Andrew Saul where he also writes about how great niacin is that and that it helps with many problems, also depression. I have depression and I have already tried out various ssri and other antidepressants with little success. Currently I'm on cymbalta (snri).

I wanted to try niacin. I already wanted to order a nicotinamid product which has 250mg but then I read at wikipedia that niacin at doses above 3gr can cause liver diseases. This worries me. I thought that niacin is totally safe, at least it sounded this way in the book.

http://www.ncbi.nlm....pubmed/11126400

 

 

LOL, I just read some threads here about niacin and parkinsons. Now I am even more confused. If this stuff can cause parkinsons then how can the author write about it and

act like it's totally safe?
 

Edited by mandible, 20 January 2015 - 11:50 PM.

[mikeinnaples]

Niacin has been beaten to death on the boards, not only in topics about Niacin (nicotinic acid) itself, but in NAD+ , NR, and Niacinamide threads as well. Take a look at the huge NR thread as it details alot of Niacin information as well.

[Dolph]

And Andrew Saul is a terrible quack by the way. Niacin is useful for quite a few things, but it won't ease your depression.

[niner]

 

I have a book about orthomolecular medicine from Andrew Saul where he also writes about how great niacin is that and that it helps with many problems, also depression. I have depression and I have already tried out various ssri and other antidepressants with little success. Currently I'm on cymbalta (snri).

I wanted to try niacin. I already wanted to order a nicotinamid product which has 250mg but then I read at wikipedia that niacin at doses above 3gr can cause liver diseases. This worries me. I thought that niacin is totally safe, at least it sounded this way in the book.

http://www.ncbi.nlm....pubmed/11126400

 

 

LOL, I just read some threads here about niacin and parkinsons. Now I am even more confused. If this stuff can cause parkinsons then how can the author write about it and

act like it's totally safe?

 

The paper you linked is about niacinamide (nicotinamide), not niacin.  They are not the same thing.  You're using the terms interchangeably, but they have different effects.

[mandible]

Okay, could somebody just tell me what the current opinion on niacin and nicotinamide is?

 

I wanted to try it for depression and since I feared the flush I was going for nicotinamide. Is niacin safer? Does it also have the parkinson's risk?

 

And why is Saul a quack? Does this mean he cannot be trusted at all? Great. I have 2 of his books. I thought what he writes about the different vitamins

and their safety and use is a good guideline.

He also refers a lot to Dr.Hoffer who took niacin for decades and obviously did well on it. Do you know Dr.Hoffer? He also has a book about niacin. Is he okay?

[1thoughtMaze1]

all I can tell you is that I took 500 mg of niacin today for the first time and I almost spontaneously human combusted. The flush came on very strong, like my skin was on fire, so if you are going to try it, start with a lower dose to see if you're as sensitive to it as me.

 

 

 

[mandible]

This sounds bad. Why do they not make smaller pills? This is stupid.

 

I'm also not even sure if high dosed niacin would be safe with an antidepressant. What if niacin itself boost serotonin? Then it could be dangerous.

[niner]

Mandible, people have been taking high dose niacin for decades.  I use a 500 mg slow release version that I take twice a day.  I'm using it because I have a relatively obscure dyslipidemia-- a dangerously high level of lp(a).  Aside from the flush, a possible downside of high dose niacin is that it may raise your blood sugar.  I've never heard of it being used as an antidepressant.

[Dolph]

I've never heard of it being used as an antidepressant.

 

Yes, I think the ONLY person arguing for this use of niacin is Saul, who takes the quackery of "orthomolecular medicine" to a whole new level...

[Turnbuckle]

NADH is known to help depression, and some vendors sell a combination of B3 and B2 as precursors, as NADH itself is quite expensive. VRP sells 90 caps of 100 mg B2 + 500 mg B3 for $25, whereas you can get them separately from iherb for less that half that. I took B3 every day for decades and found it was good for both mood and mental acuity. Now I take a dose of 2 grams once or twice a week--spacing it out so I can get the maximum flush.

 

If you do take a lot of B3, I suggest you also take an OTC acid reducer like pepcid.

 

For depression you can also try TMG and/or Sam-e, though together they work better.

Edited by Turnbuckle, 22 January 2015 - 03:00 PM.

[caruga]

Is there some reason people are preferring niacin to niacinamide?

[niner]

Ratings on the previous three posts may constitute "abuse of the rating system", and can get you banned from this site if we see a pattern.  Administrators can see who makes the ratings, so it's just a matter of looking it up.   Please try to be civil.  If you have a strong disagreement with someone's post, reply to it and explain what's wrong.

[mikeinnaples]

This sounds bad. Why do they not make smaller pills? This is stupid.

 

I'm also not even sure if high dosed niacin would be safe with an antidepressant. What if niacin itself boost serotonin? Then it could be dangerous.

 

They make smaller pills and you can also use a pill cutter on tablets. The flush isn't fatal or even dangerous, but it can be quite discomfortable for those experiencing it the first time. If the flush bothers you, you can always try taking an aspirin 30 minutes prior. I have heard it help some people.

 

The best it just to take a few week slowly ramping up your dose. I take 2g with no flush unless I drink something hot shortly after.

Is there some reason people are preferring niacin to niacinamide?

 

Lots of reasons, one of which is the affect on lipid profiles.

 

As I mentioned before, we have a wealth of information here that goes into the details that is easily accessible with the search function.

[Gerrans]

Ratings on the previous three posts may constitute "abuse of the rating system", and can get you banned from this site if we see a pattern.  Administrators can see who makes the ratings, so it's just a matter of looking it up.   Please try to be civil.  If you have a strong disagreement with someone's post, reply to it and explain what's wrong.

 

What some of those ratings buttons are doing on a civilised discussion forum I do not know.

[mandible]

Check this out! Already 500mg are enough to cause damage. I am absolutely shocked. Then how can Saul act like it's totally safe?

In one of his books he writes that 3000mg daily are safe!

Is he not aware of these studies or what? Seriously, this makes me angry.

 

http://lpi.oregonsta...itamins/niacin/

 

Hepatotoxicity (liver cell damage), including elevated liver enzymes and jaundice, has been observed at intakes as low as 750 mg of niacin per day for less than three months (84, 85). Hepatitis has been observed with timed-release niacin at dosages as little as 500 mg/day for two months, although almost all reports of severe hepatitis have been associated with the timed-release form of niacin at doses of 3 to 9 grams per day used to treat high cholesterol for months or years (24).

[caruga]

Is there some reason people are preferring niacin to niacinamide?

 

Lots of reasons, one of which is the affect on lipid profiles.

 

As I mentioned before, we have a wealth of information here that goes into the details that is easily accessible with the search function.

 

 

Does anyone know the mechanism of action?  Bile-formation uses up a lot of NADPH, but that would apply to niacinamide as much as niacin.

[Turnbuckle]

Check this out! Already 500mg are enough to cause damage. I am absolutely shocked. Then how can Saul act like it's totally safe?

In one of his books he writes that 3000mg daily are safe!

Is he not aware of these studies or what? Seriously, this makes me angry.

 

http://lpi.oregonsta...itamins/niacin/

 

Hepatotoxicity (liver cell damage), including elevated liver enzymes and jaundice, has been observed at intakes as low as 750 mg of niacin per day for less than three months (84, 85). Hepatitis has been observed with timed-release niacin at dosages as little as 500 mg/day for two months, although almost all reports of severe hepatitis have been associated with the timed-release form of niacin at doses of 3 to 9 grams per day used to treat high cholesterol for months or years (24).

 

 

Where's the paper?

[mandible]

84.  Hendler SS, Rorvik DR, eds. PDR for Nutritional Supplements. Montvale: Medical Economics Company, Inc; 2001.

85.  Vitamins. Drug Facts and Comparisons. St. Louis: Facts and Comparisons; 2000:6-33.

 

They don't provide links. Maybe they are not available.

[Turnbuckle]

84.  Hendler SS, Rorvik DR, eds. PDR for Nutritional Supplements. Montvale: Medical Economics Company, Inc; 2001.

85.  Vitamins. Drug Facts and Comparisons. St. Louis: Facts and Comparisons; 2000:6-33.

 

They don't provide links. Maybe they are not available.

 

Neither one are primary sources in any case.

[mandible]

Okay, but what does this change? Do you doubt that these cases really happened?

 

 

[Turnbuckle]

Okay, but what does this change? Do you doubt that these cases really happened?

 

 

Doubt what cases? Without any research paper, there's nothing to discuss.

[niner]

 

Ratings on the previous three posts may constitute "abuse of the rating system", and can get you banned from this site if we see a pattern.  Administrators can see who makes the ratings, so it's just a matter of looking it up.   Please try to be civil.  If you have a strong disagreement with someone's post, reply to it and explain what's wrong.

 

What some of those ratings buttons are doing on a civilised discussion forum I do not know.

 

Yeah, I agree.  It's basically an anonymous push-button insult machine.  At first I was ok with it, but I've come around on that.  I don't like it, and think it does more harm than good.  (I should add, in case it's not obvious, that I do not control the configuration of the forum.)

Edited by niner, 23 January 2015 - 01:36 AM.

[mandible]

Isn't it enough to know that obviously people got liver damage from 500mg?

[niner]

 

Okay, but what does this change? Do you doubt that these cases really happened?

 

Doubt what cases? Without any research paper, there's nothing to discuss.

 

I wouldn't say "nothing".  I think that a more reasonable perspective on it is that there appear to exist case reports of hepatitis in people who took large doses of niacin.  There's not a lot to discuss there, but it isn't nothing.  It should be possible to track down the original references, assuming the reviews that were cited are available.

 

As it stands, niacin probably isn't colossally harmful, given the large number of people who have used it in pharmacologic doses.  It would be difficult to find any drug that some person somewhere hadn't had an adverse reaction to.

 

There's still the issue of its efficacy, or (more likely) lack thereof as an antidepressant.

[Turnbuckle]

 

 

Okay, but what does this change? Do you doubt that these cases really happened?

 

Doubt what cases? Without any research paper, there's nothing to discuss.

 

I wouldn't say "nothing".  I think that a more reasonable perspective on it is that there appear to exist case reports of hepatitis in people who took large doses of niacin.  There's not a lot to discuss there, but it isn't nothing.  It should be possible to track down the original references, assuming the reviews that were cited are available.

 

As it stands, niacin probably isn't colossally harmful, given the large number of people who have used it in pharmacologic doses.  It would be difficult to find any drug that some person somewhere hadn't had an adverse reaction to.

 

There's still the issue of its efficacy, or (more likely) lack thereof as an antidepressant.

 

 

There's nothing to discuss with regard to second hand reporting in an old PDR. If you go to the newest one, you don't find any such information, probably because a couple of drug companies started selling niacin in conjunction with other drugs for cholesterol reduction. Those didn't work out, of course, possibly because it was ER rather than IR niacin.

 

NIH says this--

 

Hepatotoxicity

Niacin in doses above 500 mg daily causes transient, asymptomatic elevations in serum aminotransferase levels in up to 20% of people.  The elevations are rarely greater than 3 times the upper limit of the normal range and usually resolve spontaneously even with continuation of the drug.  The effect is partially dose related and is more common with doses above 3 g/day.  In some patients, there is an overall decrease in serum proteins synthesized by the liver and, in some instances, coagulopathy with an increase in prothrombin time and decline in serum albumin, coagulation factors and apolipoproteins.  These changes resolve rapidly upon stopping therapy and may not recur with lower doses.

 

Niacin can also cause serious hepatotoxicity, but this is uncommon.  Significant hepatotoxicity is particularly common with high doses of sustained release niacin.  In many cases, the injury becomes apparent after a dose increase or after switching from the regular crystalline to a sustained release form.  The pattern is primarily hepatocellular, although cases with a cholestatic pattern have been described.  The patients present with jaundice, itching, nausea, vomiting and fatigue.  When the injury is the result of switching from the crystalline to the sustained release form, the injury may present acutely within days or a few weeks with a prodromal period of nausea, vomiting and abdominal pain, that is followed by jaundice and pruritus.  Early during the injury serum aminotransferase levels are very high and then usually fall rapidly with discontinuation or dose lowering.  The clinical phenotype resembles acute hepatic necrosis, suggesting a direct toxic effect.  Imaging studies of the liver may reveal areas of hypodensity ("starry sky liver") interpreted as focal fatty infiltration that resolves after stopping the drug.  Liver biopsy typically shows varying degrees of centrolobular necrosis with only mild inflammation.

 

Mechanism of Injury

The mechanism of hepatotoxicity is assumed to be an intrinsic toxic reaction related to high serum levels of niacin that overwhelm the high affinity, low concentration nicotinic acid receptors (that are responsible for the flushing response).  The finding that niacin can be restarted at lower doses after an episode of clinically apparent injury indicates that the hepatic damage is unlikely to be idiosyncratic or due to hypersensitivity.

 

http://livertox.nih.gov/Niacin.htm

 

 

 

[mandible]

To me this sounds frightening. If niacin can cause problems then is it really worth taking it? What are the benefits or high doses niacin?

 

[Turnbuckle]

To me this sounds frightening. If niacin can cause problems then is it really worth taking it? What are the benefits or high doses niacin?

 

NIH says nearly the same thing about statins--

 

 All of the statins have been associated with mild-to-moderate serum aminotransferase elevations during therapy that are typically transient, asymptomatic and may resolve even with continuation without dose adjustment.  All have also been associated rare instances of clinically apparent acute liver injury.  Cases with autoimmune features have been reported with atorvastatin, simvastatin, rosuvastatin and fluvastatin, as well as with combinations of these agents with ezetimibe. 

 

 

And looking at one statin in particular--

 

Hepatotoxicity

Lovastatin therapy is associated with mild, asymptomatic and usually transient serum aminotransferase elevations.  In summary analyses of large scale studies with prospective monitoring, ALT elevations above normal occurred in 3 to 5% of patients, but were above 3 times the upper limit of normal (ULN) in only 0.4% compared to 0.1% of placebo recipients.  These elevations were more common with higher doses of lovastatin, being greater than 3 times ULN in 0.1% of patients receiving 20 mg daily, 0.9% with 40 mg and 1.5% with 80 mg daily.  Most of these elevations were self-limited and did not require dose modification, although discontinuation is recommended for any elevation above 10 times and for persistent elevations above 5 times the ULN.  Lovastatin is also associated with frank, clinically apparent hepatic injury, but cases are rare.  The onset of clinical injury ranges from a few weeks to several years.  The pattern of injury is typically cholestatic, but can be hepatocellular.  Rash, fever and eosinophilia are uncommon as are autoimmune features.  The injury usually resolves rapidly upon stopping lovastatin, but instances of prolonged cholestasis have been reported (Case 1).

 

Mechanism of Injury

The cause of hepatic injury from lovastatin is unknown.  Lovastatin is largely metabolized in the liver (via CYP 3A4) and metabolites are excreted in bile.  The mild, self-limited ALT elevations are likely due to a toxic intermediate of drug metabolism and the reversal of these elevations due to adaptation.  The idiosyncratic, clinically apparent liver injury associated with lovastatin may be due to failure of adaptation.

 

Outcome and Management

The ALT elevations that occur with lovastatin therapy often resolve spontaneously within a few weeks without discontinuation.  Rare cases of acute liver failure and even death from liver failure have been reported to be due to lovastatin, although the causality in these cases was not always clear.  In the average case, complete recovery is expected within 1 to 2 months of stopping lovastatin, but instances of prolonged cholestasis and some degree of vanishing bile duct syndrome have been reported.  In view of the wide scale use of lovastatin, clinically apparent and severe liver injury is extraordinarily rare.  Recurrence of injury with rechallenge has been reported and should be avoided.  Switching therapy to another statin after lovastatin induced injury is apparently safe, but few instances have been reported, and it should be done with careful monitoring for recurrence.

 

 

 

They don't even mention mitochondrial injury, but it does occur. Statins are extremely dangerous drugs, but niacin? All I can say is I took it (the IR form) every day for about 30 years with no trouble (at least after OTC acid reducers became available), but statins almost killed me in just a few months.

Edited by Turnbuckle, 23 January 2015 - 02:29 AM.

[mikeinnaples]

To me this sounds frightening. If niacin can cause problems then is it really worth taking it? What are the benefits or high doses niacin?

 

You are being overly alarmist. Do yourself a favor, follow my advise, and actually spend some time reading the weath of information about Niacin (nicotinic acid) on the boards.

 

 

The information on mechanism of action, risk and lack thereof, and a million other things are already there waiting for you to read it. Then make your own informed decision.

[mandible]

I haven't read every thread on this forum about niacin but I came across on which was about niacinamide and parkinson's. This is also concerning.

Now I don't know if niacin is safer than niacinamide. Basically I really don't know the nerves and the time to now study niacin. I was simply wanting to

take something against depression. But the last thing I need is to cause more stress for myself by having to worry wether niacin is safe or not.

[Dolph]

Dude, it's reasonably safe, as proven by literally decades of use in millions of users. But it won't ease your depression! Not so terribly difficult, right?