NAD+ Boosting Without the Flushing: Niacinamide Helps Maintain Cognitive and Cardiovascular Health While Supporting Skin and Joints

Updated 1/5/23 by Jonathan Grinstein, Ph.D.

Every cell in our body needs energy, and at the center of every energy-demanding process—from those at the microscopic end of the spectrum like breaking down nutrients and building up essential biomolecules, such as proteins, to those at the more macroscopic level like thinking or moving—is a substance called nicotinamide adenine dinucleotide (NAD+). This important chemical helps enzymes do all of these important jobs so that cells and tissues can function and stay alive. 

Various substances can be processed to produce NAD+. These related compounds can be confusing given their similarity in names, but they differ from one another in the way they are processed by our cells. While a lot of talk has been focused on nicotinamide mononucleotide (NMN) and nicotinamide riboside (NR), on the other hand, these two NAD+ precursors are actually relatively new to the NAD+-boosting game.

Niacin (also called vitamin B3 or nicotinic acid) supplements were first found and used in the 1930s to treat pellagra, a crippling disease caused by a lack of niacin.  However, there is one glaring problem with vitamin B3: many people, especially those who take higher doses of niacin, experience extreme redness, warmth, and skin flushing on the face, arms, and chest when taking supplements.

Niacinamide: A non-flushing precursor to NAD+

Niacinamide (NAM), also called nicotinamide, is a form of niacin—they even look alike at the level of their chemical structure—that doesn't cause these harmless but unwelcome side effects (known as flushing). 

Niacinamide can enter a cell directly after being ingested, whether through food or supplements. But before it can become NAD+, it must first combine with two more molecules to make NMN, which then has to go through a few changes.

Even though foods like fish, eggs, grains, and poultry contain vitamin B3 derivatives like niacinamide, many people don't consume enough of it to convert it into enough NAD+, especially since our bodies naturally produce less NAD+ as we age.

Niacinamide is highly soluble in water and is considered a safe food supplement. The NAD+ precursor is readily absorbed in the stomach and the small intestine, where it can be subsequently transported to tissues for the synthesis of NAD+.

How does niacinamide work?

Niacinamide works as an antioxidant, which stops the bad effects of oxidative stress. Oxidative stress is the buildup of harmful, inflammatory substances called reactive oxygen species (ROS). As a precursor to NAD+, niacinamide supports energy production and DNA repair. 

So, how do these increases in energy production and protection against cellular damage contribute to the support of many body systems, including the skin, brain, and joints, when niacinamide is taken as a supplement?

Niacinamide helps maintain brain health and cognition

Niacin deficiency is well known to cause serious brain damage, as seen in people with pellagra, who often feel confused and lose their memories. According to research from both human and animal studies, taking nicotinamide supplements may help keep the brain healthy and help it work better as people age. For example, giving mice with poor cognitive health niacinamide for eight months kept their cognitive performance, mitochondrial integrity, and brain cell regulation at the same level.

The brain's neurons and neuronal tissue are believed to be protected by nicotinamide. The common drop in NAD+ levels that comes with getting older is linked to a drop in BDNF, which is a protein that is important for neuron survival, growth, and development. Theoretically, increasing NAD+ levels with precursors like niacinamide could help increase BDNF levels. 

Niacinamide helps maintain cardiovascular health

Increases in cholesterol can affect the function of the heart and blood vessels (cardiovascular system). This can also make the immune system work too hard and cause it to attack the heart and blood vessels.

In mice exposed to high amounts of cholesterol in the blood, niacinamide helped maintain the levels of immune system. Another study looked at niacin and niacinamide, both NAD+ precursors were shown to help maintain the size and strength of blood vessels. 

Niacinamide helps maintain pancreatic health

Disruptions in sugar processing (glucose metabolism) are frequently signs of aging and poor health. This is caused by disruption of pancreatic beta cells, which make and release the hormones needed to keep blood sugar levels at a healthy level.

In a study on rats, niacinamide injections were found to help keep the beta cells in the pancreas healthy. This suggests that this NAD+ precursor may help keep the pancreas healthy and working well.

Niacinamide helps maintain skin health

Niacinamide, whether taken by mouth or put on the skin, is thought to protect and support the health of the skin, mostly because it acts as an antioxidant and can help the body respond to inflammation in a more healthy way. Additionally, it has been demonstrated that niacinamide promotes the synthesis of skin ceramides, which are good fats that support skin barriers and retain moisture.

Another important factor in skin health is collagen levels. Collagen is the most common protein in our bodies, so not getting enough of it can speed up the aging process and make our skin lose its elasticity, get dry, wrinkle, and sag. Niacinamide, when put on the skin or taken by mouth, may help fight these harmful substances since oxidative stress is a major cause of both internal and external aging.

Niacinamide helps maintain flexible joints

Since the NAD+ precursor encourages a better inflammatory response, which is a common worry for people with bad joint health or limited mobility, niacinamide and joint health are related. In the same way that niacinamide helps the skin make collagen to keep it healthy, it also helps the joints make collagen to make them more flexible, mobile, and comfortable.

In rats with degenerating joints, adding niacinamide to their diets helped reduce pain, limit cartilage damage, and improve knee function. According to a small study, adults with joint disorders who took niacinamide for 12 weeks had scores for joint health that were nearly one-third higher than those in the control group, and they required fewer painkillers. In addition, niacinamide supplements increased joint mobility by 4.5 degrees.

The Take-Home Message

Even though niacinamide isn't as well known as NAD+ precursors like NMN or NR, it is still thought to help increase NAD+ and support the health of the brain, heart, pancreas, skin, and joints. Even though niacinamide has a long history of clinical success in treating pellagra, there is still a dearth of research on how the drug affects human health, particularly in longer-term studies with higher doses. But as a non-flushing substitute for niacin, niacinamide can still be added to the list of reliable NAD+ precursors for the time being.