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Niacinamide (B3): A Little Vitamin the Mitochondria Must Have

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By Dr. Sarah Myhill, MD • • May 2, 2012

Dr. Sarah Myhill is a UK-based physician and clinical nutritionist with a special interest in fatigue. Her pioneering research suggests the cells' energy-generating mitochondria are dysfunctional in chronic fatigue syndrome (ME/CFS) patients. This article is reproduced with kind permission from her educational website (*


“Any condition associated with poor mitochondrial function, such as chronic fatigue syndrome… may well benefit from niacinamide supplementation.” - Dr. Myhill 


Vitamin B3, strictly speaking, is not a vitamin because the body can make it from the essential amino acid tryptophan. [‘Essential’ means the body must have it but cannot produce it: It must be derived from the diet.] However, if people are eating low protein diets offering little tryptophan, then niacin does become an essential B vitamin.

B3 is present in three forms, namely nicotinic acid, niacin and niacinamide. The first two cause dreadful flushing so please make sure when you purchase that you use niacinamide!

The active form of niacinamide in the body is NAD [a coenzyme found in every cell] and this is a vital intermediary in energy production.

Essentially, NAD links the two major biochemical pathways of the Kreb's citric acid cycle with oxidative phosphorylation in order that the body can make our essential energy molecule, namely adenosine triphosphate (ATP).

Without sufficient NAD, energy production is slowed and every single cell in the body will go slow.

Therefore, it is not surprising that a deficiency of NAD has widespread effects and, by implication, NAD has many therapeutic uses.

Therapeutical Uses of Niacinamide

The therapeutic uses that are now well established are as follows:

Fatigue. For the reasons given above, low B3 will result in fatigue. Any condition associated with poor mitochondrial function, such as chronic fatigue syndrome, any organ failure, and any neurological disease such as Parkinson's disease, may well benefit from high doses of NAD.

Arthritis. Work done by Dr. William Kaufman in the 1940s and written up in his book The Common Form of Joint Dysfunction demonstrated that many forms of arthritis can benefit from high dose B3. Dr. Kaufman was insistent that the full daily dose of as much as 3000 - 5000 mg be given in many small divided doses throughout the day. He got excellent results. This is an intervention well worth trying.

[See an excerpt from Dr. Kaufman's book describing use of supplemental B3 to support improved joint mobility. And see Dr. Myhill’s handout on Nutritional Treatments for Arthritis, including B3.]

Schizophrenia and Psychosis. Dr. Abram Hoffer routinely used high dose niacinamide, up to 3 grams daily, with excellent results for patients suffering from psychosis. It may take some months, or even years, to promote the full benefit.... This is taken in conjunction with other nutritional supplements.

Anxiety and Mood Swings. A study comparing the benefits of high dose niacinamide compared to diazepam [e.g., Valium] came up with the interesting result that niacinamide was more effective.

Control of Blood Sugar Levels. I find myself talking more about the control of blood sugar levels than all other subjects put together. It is not just a case of maintaining a low glycemic index diet. Taking nutritional supplements, reducing allergies, correcting hormonal imbalances and managing stress efficiently are all essential in maintaining normal blood sugar levels. [See “Blood Sugar and Hypoglycemia – the Full Story.” which explains that niacinamide and chromium are particularly helpful in supporting natural mechanisms for stabilizing blood sugar levels.]

Parkinson's Disease. A trial of high dose niacinamide is well worth it in patients with Parkinson's disease because some will see marked improvements. This may be because niacinamide also has an effect on neurotransmitter levels.

Neurotransmitter Levels (Mood and Sleep). Niacinamide may be converted by the body back to tryptophan and this is the raw material for the pathway that includes 5-HTP, serotonin and melatonin. This pathway will have profound effects on mood and sleep. So, for example, tryptophan and 5-HTP are very effective in the management of depression. Melatonin is obviously essential for quality sleep.

The Dose of Niacinamide

To get these therapeutic effects, one has to use niacinamide in much higher doses than the recommended daily allowances.

Because it is so short acting, the best effects are achieved through small doses taken regularly throughout the day. However, this is tiresome and I am presently looking for a good slow release preparation.

Up to 500mg daily can be taken without any ill effects.

In doses above this, there will be a few people who will develop abnormal liver enzymes and this is almost invariably accompanied by a feeling of nausea. In this event (nausea), therefore, check liver function tests.

Having said that, I have recommended niacinamide to hundreds of patients and have yet to see any abnormal liver function tests.

I think this is because side effects and problems with drugs and nutritional supplements almost invariably arise as a result of nutritional deficiencies. Since I like to start all my patients on a basic package of Nutritional Supplements, this situation is very unlikely to arise. [Note: For persons outside the UK, this regimen includes a good multivitamin/mineral including the B vitamins; vitamin C; the essential  omega 3 & omega 6 fatty acids; sunshine and/or vitamin D3, and sea salt.]


* This article is reproduced with kind permission from Dr. Sarah Myhill’s educational website (® Sarah Myhill Limited, Registered in England and Wales: Reg. No. 4545198.

Note: These statements have not been reviewed by the FDA. They are general information, based on the research, observations and opinions of Dr. Sarah Myhil, MD, unless otherwise noted; are not meant to replace the personal attention of a medical doctor; and are not intended to prevent, diagnose, treat or cure any condition, illness or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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