History of niacin usage remains very complicated

Q: On the news last week, there was a segment about niacin supplements causing heart disease in mice. I have taken B complex supplements for years to get vitamin B6 to help with my energy level after being diagnosed with fibromyalgia. I think I used to hear niacin mentioned as helping with cholesterol, so I hoped the B complex would help with that, too.

I have few fibromyalgia symptoms today, so I may not need the B complex anymore. Have you heard anything about problems with niacin?

A: The niacin story is incredibly complicated. First, some basic biochemistry. Niacin (nicotinic acid) is an essential nutrient. People who are deficient in this B3 vitamin can develop a serious health condition called pellagra.

The body converts niacin from the diet into its active form, nicotinamide adenine dinucleotide (NAD). This coenzyme is crucial for hundreds of biochemical reactions in the body.

Prior to the development of statins, doctors used to prescribe high-dose niacin to lower LDL cholesterol and raise so-called good HDL cholesterol.

One of the largest studies of supplemental niacin was called the Coronary Drug Project (Journal of the American College of Cardiology, December 1986). It was conducted between 1966 and 1975 and involved thousands of men who had experienced a heart attack.

Some took 3 grams of niacin a day — a large dose — and others took a placebo. During the study itself, men taking niacin were less likely to have repeat heart attacks, but they were no less likely to die. A 15-year follow-up, however, showed that men who had been taking niacin had an 11% lower mortality rate than those on placebo.

Fast forward 50 years to the study you refer to (Nature Medicine, Feb. 19, 2024). The authors did not perform a clinical trial involving supplemental niacin. Instead, they examined metabolites of niacin in the bloodstream.

The researchers found an association between high levels of these metabolites, possibly from dietary niacin, and the risk of heart attacks. More research is needed before we will know if supplemental B vitamins or niacin-fortified foods pose a problem.

Q: I would love any information you can provide on lowering my blood pressure naturally. My health has deteriorated rapidly since being put on pain medications for fibromyalgia and arthritis. I’ve had both for 20 years, but I didn’t need blood pressure medicine until I started taking an NSAID.

A: People in pain are in a difficult situation. The usual pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs), can raise blood pressure. That includes overthe-counter medications like ibuprofen and naproxen as well as prescription meds like celecoxib, diclofenac and meloxicam.

There are steps you can take to reduce reliance on such medications. They include anti-inflammatory herbs such as ashwagandha, Boswellia, bromelain, ginger, stinging nettle and turmeric.

A number of nondrug approaches can help lower blood pressure. These include the DASH (dietary approaches to stopping high blood pressure) diet, minerals such as calcium, magnesium and potassium, beet juice, cocoa flavonols and pomegranate juice. Regular physical activity, relaxation, sauna bathing and deep breathing exercises can also be helpful.

To learn more about pain relief and blood pressure control, you may wish to consult our “eGuides to Alternatives for Arthritis and Blood Pressure Solutions.” These online resources can be found under the Health eGuides tab at Peoples Pharmacy.com.

Getty Images/iStockphoto Niacin, which is also known as vitamin B3, helps promote a healthy nervous system, digestive system and skin. It is often included as part of a daily multivitamin or B complex supplement.