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Reproduced from original article:
Analysis by Dr. Joseph Mercola Fact Checked November 16, 2020
- Niacin plays an important role in photoprotection from the effect of UV radiation on DNA damage and oxidative stress and helps guard against the rising prevalence of skin cancer
- Some research has also found long-term benefits from taking niacin that lower your risk of all-cause mortality
- B vitamins help support your immune system. B3 is a precursor to NAD and may help prevent some of the worst COVID-19 outcomes from cytokine and bradykinin storms
- Seek to get your B3 from food; high dose supplements may trigger a niacin flush in which your skin will get red and tingle. Although it is irritating, it is harmless
Niacin, also called vitamin B3, is a water-soluble vitamin that is found naturally in foods, is added to processed foods and can be bought as a supplement. Niacin plays a vital role in over 400 enzymes, and one study suggests that a diet rich in niacin could protect your skin against ultraviolet (UV) radiation.1
A severe niacin deficiency called pellagra is ultimately a lethal disease. While it was common in the early 20th century, pellagra is uncommon in industrialized populations where most processed foods are fortified with niacin. Currently, pellagra is limited to people living in poverty whose diets are low in niacin and protein.2
The disease is marked by the four D’s: diarrhea, dermatitis, dementia and death. Symptoms of the condition include a brown discoloration on skin exposed to sunlight, a bright red tongue and vomiting, constipation and/or diarrhea. Neurological symptoms include headache, fatigue, loss of memory and depression.
Without treatment, the disease progresses until a person exhibits paranoid and suicidal behaviors with visual and auditory hallucinations and dies. Although this deficiency is rare in industrialized nations, insufficiency contributes to several disease entities and researchers have found:3
“Benefits of niacin supplementation have been observed in experimental models of cancer, cardiovascular disease, skin health, mental health, and oxidant lung injury.”
Niacin Protects Your Skin From UV Radiation
There are three main forms of niacin, which are dietary precursors to nicotinamide adenine dinucleotide (NAD). These are nicotinamide riboside, nicotinic acid and nicotinamide.4 Researchers in Italy studied skin cells from nonmelanoma skin cancers and treated them with different doses of nicotinamide for 48, 24 and 18 hours, after which they were exposed to UV light.
The lab studies showed the cells that were pretreated with nicotinamide were protected from oxidative stress, including damage to DNA from ultraviolet rays. In addition, the data showed niacin reduced local inflammation and the production of reactive oxygen species. Laura Camillo participated in the study and commented in a press release:5
“Our study indicates that increasing the consumption of vitamin B3, which is readily available in the daily diet, will protect the skin from some of the effects of UV exposure, potentially reducing the incidence of non-melanoma skin cancers. However, the protective effect of vitamin B3 is short-acting, so it should be consumed no later than 24 to 48 hours before sun exposure.”
The current lab study supported data from past studies demonstrating similar results. In an animal model, nicotinamide helps prevent photocarcinogenesis and protected the skin against UVA and UVB light.6 Researchers also tested nicotinamide supplements twice-daily in a human trial with people who had actinic keratosis, a precursor to skin cancer.
The nicotinamide supplements reduced the actinic keratosis by 35% relative to the placebo used in the study when it was measured at two and four months. The results were presented at the 41st European Society for Dermatological Research Annual Meeting 2011.
In a paper published in American Health & Drug Benefits, the author reported on one study investigating the use of oral nicotinamide in people who were at high risk for skin cancer.7 The data showed the supplement reduced the rate of new diagnosis of basal cell and squamous cell carcinoma after one year by 23% when the results were compared against a placebo.
Niacin also lowered the risk the participant would develop actinic keratosis. It was estimated the use of this inexpensive supplement could reduce health care costs by approximately $4.8 million each year. The investigators stressed the results were in individuals who had been diagnosed with skin cancer in the past and may not apply to other populations.
In addition, the researchers believe vitamin B3 could be used as a preventive strategy and not treatment. The lead investigator from the University of Sydney also warned the prevention did not take the place of routine care and skin examinations, commenting:8
“This form of prevention is safe and inexpensive, costing around $10 per month, and it is widely available. It is ready to go straight to the clinic for high-risk patients with a track record of skin cancer. This is a new opportunity for skin cancer prevention.”
Prevalence of Skin Cancer Is Rising
Approximately 20% of people living in the U.S. will have skin cancer by age 70.9 Experts estimate nearly 9,500 people receive a diagnosis of skin cancer every day in the U.S.10 There are four main types of skin cancer, including basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma and melanoma.
Of the nonmelanoma types of skin cancer, nearly 80% are basal cell, which develop more often on the head and neck. These types of cancer grow slowly and rarely spread. Nearly 20% are squamous cell carcinomas that can be found in areas of the skin that had been burned, exposed to X-rays or damaged by chemicals. Merkel cell is a rare and highly aggressive form of cancer.
Experts estimate over 100,000 adults in the U.S. are diagnosed with invasive melanoma each year and it is the fifth most common cancer that can develop in any age person.11 From 1982 until 2011, the rate of melanoma in the U.S. doubled.12 Since then, the number of people diagnosed has continued to rise.13
Long-Term Heart Benefits of Niacin
Nicotinic acid has been used for more than 40 years to help control dyslipidemia.14 Supplementation with nicotinic acid from 1,000 milligrams (mg) to 2,000 mg have been used daily to increase HDL and lower LDL cholesterol in carefully monitored studies. However, doses this high can produce side effects.
Some clinical trials have demonstrated patients on niacin therapy have a lower number of cardiovascular events and deaths. Other trials were not as positive. After a review of the literature, the U.S. Food and Drug Administration concluded:15
“… scientific evidence no longer supports the conclusion that a drug-induced reduction in triglyceride levels and/or increase in HDL-cholesterol levels in statin-treated patients results in a reduction in the risk of cardiovascular events.”
As I’ve written before, it is the relationship between HDL, LDL and triglycerides that is a greater predictor of heart health and not the absolute numbers of each. This means the FDA statement supports lowering LDL cholesterol with dangerous statin medications but suggests altering HDL and triglyceride levels with an inexpensive and safe supplement would have no effect on heart health.
In one study published in the Journal of the American College of Cardiology, researchers evaluated data from 1966 to 1975, looking at the effectiveness and safety of five drugs in a population of 8,341 men.16
Two medications were discontinued early in the study because of adverse events. The niacin treatment showed modest benefit in reducing the number of heart attacks, but did not reduce all-cause mortality. However, researchers followed up with the group 15 years later, nearly nine years after the participants stopped using the interventions.
They found all-cause mortality was similar to the placebo group in all drugs except niacin. Nine years after the participants stopped taking niacin, it continued to have a positive effect on their health, lowering all-cause mortality by 11% over the placebo group.
B Vitamins May Lower Risk of Worst COVID Outcomes
In the past, I have reviewed how nutrients such as vitamins C and D play a role in the treatment of COVID-19. A recently published paper has also highlighted the potential value of B vitamins.17 The paper was an international collaborative effort among researchers from the University of Oxford, United Arab Emirates University and the University of Melbourne Australia.18
Although there are no studies evaluating the efficacy of B vitamins on patients with COVID-19, the scientists advocate for research into the group of vitamins, stressing their importance to the immune system and immune competence. The paper does not suggest that B vitamins could prevent or treat COVID-19 alone.
However, as scientists have discovered many times, a single vitamin or nutritional supplement does not work alone, but in concert with others. COVID-19 has been dangerous for those with underlying medical conditions or older adults as it triggers an overactivation of your immune system and a cytokine or bradykinin storm.
Niacin and nicotinamide are important to your immune health as they are precursors to NAD+. This is a crucial signaling molecule that naturally declines with age. According to David Sinclair with Harvard Medical School, higher levels of NLRP3 inflammasomes are culprits in cytokines storms and are influenced by NAD+ levels.19
Niacin is a building block of NAD and NADP. This component is vital when combating inflammation, such as what happens during a viral infection like COVID-19. The scientists advocating for research into B vitamins explain:20
“NAD+ is released during the early stages of inflammation and has immunomodulatory properties, known to decrease the pro-inflammatory cytokines, IL-1β, IL-6 and TNF-α.
Recent evidence indicates that targeting IL-6 could help control the inflammatory storm in patients with COVID-19. Moreover, niacin reduces neutrophil infiltration and exhibits an anti-inflammatory effect in patients with ventilator-induced lung injury …
In addition, nicotinamide reduces viral replication (vaccinia virus, human immunodeficiency virus, enteroviruses, hepatitis B virus) and strengthens the body’s defense mechanisms. Taking into account the lung protective and immune strengthening roles of niacin, it could be used as an adjunct treatment for COVID-19 patients.”
Be Aware of a Niacin Flush
Niacin can be found in a wide variety of foods, including animal-based foods such as poultry, beef and fish, and nuts and grains.21 Many processed foods such as breads, cereals and infant formulas are fortified with niacin.
One of the highest sources of B3 is grass fed beef liver, and even a half a cup of chopped onions has 0.1 mg of niacin per serving. Other rich sources include brown rice, beef, pork and sockeye salmon.
If you are considering using a niacin supplement, be aware that one of the common side effects is a niacin flush. This most often happens when the vitamin is taken in large doses and usually only when using nicotinic acid. Niacinamide does not commonly produce the flushing side effect, but also does not have the same effect on cholesterol levels.22
A niacin flush doesn’t happen when you eat foods high in niacin. The condition is marked by symptoms of a burning or tingling sensation in the chest, neck and face.23 Your skin can feel warm to the touch and take on a flushed, red appearance. For some, as little as a 50 mg supplement can trigger the reaction.
Although it is irritating, and sometimes alarming, it is nonetheless harmless. Some find using a time release supplement, taking it with meals or drinking plenty of fluid can reduce the flushing effect. Taking smaller doses spread throughout the day may also reduce the potential of a reaction.
- 1 India Times, November 2, 2020
- 2 National Institutes of Health, Niacin, Niacin Deficiency
- 3 Advances in Nutrition, 2016;7(3) Niacin Deficiencies last line
- 4 Oregon State University, Niacin, bullet 1
- 5 EurekAlert! October 31, 2020 Second last para
- 6 F1000 Research, September 23, 2011
- 7, 8 American Health & Drug Benefits, 2015;8(Spec Issue)
- 9 Skin Cancer Foundation, Skin Cancer Facts And Statistics
- 10 American Academy of Dermatology Association, Skin Cancer
- 11 Cancer.net, Melanoma Statistics
- 12 American Academy of Dermatology Association, Skin Cancer, Incidence rates, bullet 8
- 13 Skin Cancer Foundation, Skin Cancer Facts And Statistics, Melanoma
- 14 Harvard TH Chan School of Public Health, Niacin Vitamin B3, Niacin And Health
- 15 Federal Register, April 18, 2016, II Withdrawal under section 505
- 16 Journal of the American College of Cardiology, 1986; 8(6) abstract
- 17 Maturitas, 2020; doi.org/10.1016/j.maturitas.2020.08.007
- 18 MSN, August 28, 2020 para 2
- 19 Aging, 2020; doi.org/10.18632/aging.103344 Increased inflammation and cytokine storms in the aged first line para 7
- 20 Maturitas, 2020; doi.org/10.1016/j.maturitas.2020.08.007 1.3 Vitamin B3
- 21 National Institutes of Health, Niacin, Food sources
- 22 MedlinePlus, Niacinamide, how does it work para 3
- 23 British Columbia Drug and Poison Information Centre,Niacin: The Facts on Flushing
Reproduced from original article:
- Dermatologists frequently prescribe biotin for people with hair loss, despite a paucity of research proving it helps
- Biotin insufficiency is more rare than other nutritional deficiencies but it does happen, leading to hair loss, depression, loss of appetite and numbness and tingling
- Biotin is important in metabolism, having demonstrated the ability to improve glycemic control and strengthen nails
- Supplementation can alter blood tests, including for thyroid, vitamin D and troponin, a marker of cardiac health
Your body uses vitamins for normal cell functioning; Essential vitamins must be consumed because they cannot be manufactured by the cells. Vitamins are grouped into two categories: fat soluble and water soluble.1 The fat soluble types get stored in fatty tissue and absorbed when eaten with dietary fat.
Water soluble vitamins are not stored by your body. Instead, excessive amounts are excreted through the urine. This means that essential water-soluble vitamins must be consumed on a regular basis to prevent any shortages. Vitamin B7, colloquially called biotin, is a water-soluble vitamin your body uses for energy metabolism.
Vitamins have different jobs within the body, including supporting your immune system, neurological system and energy metabolism. Biotin is a cofactor for an enzyme that is crucial in the metabolism of glucose, fatty acids and amino acids. It is also used in the production of hormones and cholesterol.2
Cholesterol is a fat-like substance that’s required in the right amounts for good health. Your body uses about 1,000 mg of cholesterol every day to synthesize hormones and vitamin D and to make cell membranes and the myelin sheath, which surrounds nerve cells.3 Without adequate biotin, your body can’t make enough cholesterol.
What’s Behind Your Hair Loss?
Despite a lack of research to support the idea that biotin may help address hair loss or improve skin and nail health, dermatologists have been prescribing it for years.4 Studies published in 20165 and 20176 included results having to do with the use of biotin to help thinning hair.
Although it was helpful when prescribed to those with a biotin deficiency, it didn’t appear to be useful in others. In the study published in 2016, researchers assessed patients from the Center for Dermatology and Hair Diseases who arrived with complaints of hair loss. They found that 38% of the women also had a biotin deficiency.
The most common type of hair loss in women and men is androgenetic alopecia.7 Men lose it at the front and vertex of the head, with thinning along the sides over the ear. Women start with diffuse thinning at the vertex.
By age 50, 50% of men will experience what is commonly called male pattern baldness. Interestingly, malnutrition, iron deficiency anemia and thyroid disease are also linked to hair loss. Other reasons for loss can include telogen effluvium, when the hair is lost in moderate amounts after a major body stress. Side effects from some drugs, medical illness and a fungal infection of the scalp can also cause hair loss.8
Yet, dermatologist Dr. Wilma Bergfeld from Cleveland Health Clinic finds that one of the most common causes is poor nutrition, more specifically the lack of essential vitamins. She says dermatologists start their detective work with a thorough physical exam and medical history, including family records and information on each patient’s diet, exercise and medications. She commented:9
“If your hair is falling out at the roots, often something is going wrong in your body or in your life situation. We find biotin to be very helpful for hair disorders. It also makes nails thicker, and oral biotin is exceedingly safe, even in large doses. Biotin improves hair growth and helps with inflammation. The hair follicle, the skin and the nails all benefit.”
Common Signs of Insufficiency
Insufficiency of this B vitamin is more rare than other nutritional deficiencies, but it can still occur. Since the body does not store it, your nutrient intake must be consistent. Some of the common signs of insufficiency include hair loss, brittle nails and a red, scaly rash around the eyes, nose, mouth and genitals. Other symptoms may include:10
- Loss of appetite or nausea
- Tingling in the extremities
Several of the symptoms of biotin insufficiency are neurological in nature. Researchers also suggest that biotin supplementation may be helpful in the treatment of multiple sclerosis (MS). It’s crucial in the development of the myelin sheath, which gets damaged or destroyed in MS. In one study, scientists concluded, “These preliminary data suggest that high doses of biotin might have an impact on disability and progression in progressive MS.”11
Dr. Bruce Cree is a neurologist from the University of California San Francisco. He has a special interest in the disease and commented on a study of a pharmaceutical grade biotin treatment for MS:12
“Taken together, these studies are very promising and provide hope for a condition that has thus far been largely intractable using treatments targeting neuro-inflammation. That the extension study from the SPI trial showed an apparent durability of effect suggests that high dose biotin may have disease modifying properties in addition to its proposed role in enhancing energy metabolism.
Furthermore, the positive impact of high dose biotin points to a new line of inquiry in understanding the pathophysiology of progressive MS.”
Deficiency can happen with prolonged parenteral feedings that are not supplemented with vitamin B7. Individuals who eat raw egg whites for long periods of time can also experience deficiency, since the egg whites contain a type of protein called avidin, which binds with biotin,13 thus preventing the body from absorbing the nutrient.14
Biotin Brings the Good Stuff
Biotin plays a role in metabolic function and the metabolism of carbohydrates and amino acids. The breakdown of these nutrients helps create energy. In one study of 447 people with poorly controlled Type 2 diabetes, researchers added chromium picolinate with biotin for 90 days.15
When compared to the control group who received a placebo, the intervention group showed a reduction in their hemoglobin A1c by 0.54%. Fasting glucose levels were also lower, suggesting the combination may be a successful adjuvant to medication prescribed for glycemic control.
In a second, more recent study, researchers found that the synergistic effect with chromium picolinate is well-tolerated.16 Biotin has also been tested in people with Type 1 diabetes. Scientists believe it may have the potential to slow hepatic steatosis and control diabetic neuropathy and nephropathy.17
As you might expect, since a biotin deficiency can lead to brittle nails, adding extra biotin to the diet may help strengthen them. In an animal study, researchers looked at in vitro lab results involving animal claws and hooves. They used biotin as treatment for nail disorders and found “Several observations in animals and cells lines led to the hypothesis that biotin could be used to treat human nails.”18
Although supplementation with biotin rapidly clears skin rashes associated with the vitamin deficiency, there is no scientific evidence that it can improve everyone’s skin health.19 There is evidence that both deficiency and overload can adversely affect a growing baby. Women who are pregnant should consult their OB/GYN.
Supplements May Alter Thyroid Tests
The Food and Nutrition Board has not established the upper limits for biotin supplementation.20 In 1998, scholars from the National Academy of Sciences gathered information from clinical observations and studies in which biotin deficiency was induced.21 Factors they identified that affect an individual’s body requirement include the ingestion of raw egg whites, genetic defects, anticonvulsants and pregnancy.
They found no adverse effects associated with a high intake of biotin in humans or animals. People taking up to 200 milligrams by mouth each day did not have any signs of toxicity. However, based on results from an animal study, they did find that taking doses of biotin during pregnancy can inhibit placental growth and increase the risk of miscarriage.
The doses used in the study were higher than those that are frequently recommended and they were not found to be useful in determining an upper intake level for humans. The Harvard TH Chan School of Public Health reports that an upper limit for biotin has still not been established as there aren’t negative effects noted with high intakes.22
However, even taking a low dose can interfere with diagnostic blood tests commonly used to measure hormones, such as your thyroid hormone. It can also alter results of vitamin D tests.23 This can be crucial in optimizing your vitamin D level before the fall flu season and the expected second wave of COVID-19.
Taking biotin before a thyroid test has resulted in false diagnoses of Graves’ disease and severe hypothyroidism. A single 10 mg dose taken 24 hours before a thyroid function test can taint the results. The FDA published a warning in 2017 that biotin could interfere with lab tests.24
They received a report of an individual who died following a troponin test, which had been done for markers of cardiac health. The individual had been taking high levels of biotin and the test revealed a false negative, resulting in no treatment following a heart attack.
Biotin can also interact with medications, and some medications can lower biotin levels. For instance, anticonvulsant treatments can significantly lower biotin, which may happen by increasing catabolism of biotin and inhibiting absorption.25
Start With Biotin-Rich Foods
The best way to get your biotin is through whole food, especially if you are concerned about a supplement altering your test results. However, if you steer clear of taking excessive amounts and stop taking supplements at least 24 hours before a blood test, biotin supplements can be safe. It’s important to let your physician know you are taking supplements if you must have an emergency blood test.
There are two forms of biotin found in food. The first is free biotin, found in plants. The second is protein-bound in protein-based animal foods. The free version is more readily absorbed, but your body can use both forms. Foods high in free biotin include:26,27
- Sunflower seeds
- Spinach and broccoli
- Carrots, onions and cauliflower
- Sweet potatoes
Protein-bound biotin is found in:
- Organic, free-range/pastured eggs yolks
- Organ meats such as liver and kidneys
- Dairy products such as milk, butter and cheese (ideally organic raw milk from grass fed cows)
- Seafood (just make sure it’s low in mercury and other contaminants, and wild-caught, not farmed)
One of the best sources of biotin is pastured egg yolk. Cooking the egg white deactivates the avidin, which means eating cooked eggs will not lead to a biotin deficiency. If you choose to take a biotin supplement for hair loss, the Cleveland Clinic dermatologists recommend a mega-B combination:
- 3 milligrams of biotin
- 30 milligrams of zinc
- 200 milligrams of vitamin C
- <1 milligram of folic acid
Bergfeld notes, “Occasionally, the mega B-vitamin combination gives some patients minor gastric trouble but switching them to biotin alone relieves it.”28
- 1 Medline Plus
- 2, 20, 23, 25, 27 National Institutes of Health
- 3 News-Medical, April 19, 2019
- 4, 9, 28 Cleveland Clinic, September 25, 2019
- 5 International Journal of Trichology, 2016;8(2)
- 6 Skin Appendage Disorders, 2017;3:166
- 7 American Family Physician, September 15, 2017
- 8 Harvard Health Publishing, December 2018
- 10, 14 Nutri-Facts
- 11 Multiple Sclerosis and Related Disorders, 2015;4(2):159
- 12 Business Wire, April 21, 2016
- 13, 18 Journal of Dermatological Treatment, 2017;doi.org/10.1080/09546634.2017.1395799
- 15 Diabetes Metabolism Research and Reviews, 2008;24(1)
- 16 Medical Hypotheses, 2015;85(1)
- 17 Medical Hypotheses, 2016;95:45
- 19 Greatist, July 8, 2020
- 21 National Academy of Science, 1996
- 22 Harvard TH Chan School of Public Health
- 24 Food and Drug Administration, November 4, 2019
- 26 The Healthy, August 28, 2019