Vitamin B3 and its Role in Arthritis and Other Conditions

Niacin, vitamin B3, is one of 8 B vitamins. It is a water-soluble vitamin involved in over 500 chemical reactions in the body and comes in several forms including niacin, also known as nicotinic acid, niacinamide, known as nicotinamide, and inositol hexaniacinate, all of which have slightly different properties and indications even though they are collectively called B3 vitamins. B vitamins help the body convert food (carbohydrates) into fuel (glucose), to produce energy.

Niacin is the form specifically used for lowering cholesterol, as niacinamide does not affect cholesterol. Niacin has diverse therapeutic effects through diverse mechanisms.¹  It is used to manage psychotic disorders such as bipolar disorder, schizophrenia, and schizoaffective disorders. It has more recently been used in clinical trials of Alzheimer’s Disease, brain tumors, Parkinson’s Disease, and Multiple Sclerosis. While niacin in higher doses used to treat these disorders initially causes skin flushing, it goes away after continued doses and dose adjustments. Niacinamide does not cause skin flushing.

Niacinamide is used to treat severe B3 deficiency known as pellagra. It has also been used in a number of other conditions such as arthritis, skin discoloration, acne, cancer, addiction, schizophrenia, and others. Dr. William Kaufman used niacinamide in divided doses each day to manage osteoarthritis and Rheumatoid Arthritis. In his book, “The Common Form of Joint Dysfunction and Treatment”, the disease information and case notes from many years of helping his patients with arthritis, he provides treatment protocols for both niacinamide as well as niacinamide in conjunction with other vitamins.

Dr. Kaufman’s work began in the pre-drug era, post-1930s, and 1940s, where substantial research was focused on vitamin therapy due to modern developments in food refining and epidemics of B3 deficiency, known as pellagra. It was in the 1940s when the U.S. government mandated that niacinamide was added to the flour. Foods relatively high in niacin include organ meats, lean meat, fish, clams, pork, dairy, nuts, seeds, whole wheat products, beans, and green leafy vegetables. Unfortunately, diet alone will not provide the amount needed to address chronic conditions. Managing weight, stress, exercise, and sleep quality are all factors. Alcohol intake also depletes B3 and other B vitamins.

While most traditional doctors do not use vitamin therapy and are trained to use drugs to manage chronic conditions, in reality, poor nutrition is at the crux of chronic disease development. Unfortunately, pharmaceuticals are associated with a high risk of side effects and potential adverse effects compared to vitamins. A 2022 study highlighted that the occurrence of chronic diseases such as arthritis, diabetes, and cardiovascular disease was linked to poor diet and lack of fruits and vegetables and that a higher intake of nutrients results in a lower prevalence of disease.² A study in 1999 confirmed the work of Dr. Kaufman, citing that non-toxic nutritional regimens, and intervening with the pathways that promote inflammatory cytokines, specifically IL-1, may provide a substantially superior alternative to NSAIDs (merely palliative and often dangerously toxic) in the treatment and perhaps prevention of osteoarthritis (OA).³  

Niacinamide is usually well tolerated, without negative or toxic side effects. It should be taken in at least 3 divided doses, as it is rapidly metabolized in the body. It is known to reduce pain and reverse arthritis. In a 1996 pilot study, Niacinamide improved osteoarthritis, improved joint flexibility, reduced inflammation, and allowed for a reduction in standard anti-inflammatory medications when compared to placebo.⁴ A more recent study in rats, showed that combining niacinamide with collagen decreased the inflammatory response in osteoarthritis. ⁵

The recommended daily amount (RDA) for niacin is 16 mg for men, 14 mg for women per day. While an upper limit of 35 mg. has been suggested, individuals have taken a lot higher doses under the guidance of their provider. The dose-limiting toxicity of niacin is nausea and vomiting. It is important to consult your doctor before increasing the dosage of niacin in order to ensure safety and effectiveness.

While providers may site concerns with the use of niacin such as liver toxicity, this myth has been debunked according to the authors of “Niacin: The Real Story” second edition. It is known that liver enzymes can increase with niacin therapy, but that this is not the same as toxicity and that liver enzymes will decrease once the therapy is decreased or stopped. Authors do recommend that regular monitoring of liver function tests is important, especially with histories of heavy alcohol use, liver disorders, or diabetes. While at an amount up to 3000 mg, niacin is generally well tolerated, even when taken for many years, there are possible adverse effects of exceeding this amount as seen in animals given 10x the amount given to humans. ⁶

Authors also cite that it is likely an underestimate that 20% of arthritis patients would benefit from additional niacin or niacin in conjunction with other vitamins. Nicotinamide has been used up to several thousand milligrams per day for individuals with arthritis. The need for niacin can vary based on body size and illness. NADH (nicotinamide adenine dinucleotide, plus hydrogen) is an activated form of niacin, but much more expensive. Tryptophan, a precursor to NAD has been connected at high doses with health concerns and is not very efficient in converting to niacin.

It is important to recognize if you have symptoms of B vitamin deficiencies. By adding niacin to your diet or supplement regimen you can potentially reduce the symptoms associated with arthritis. Your provider can order blood tests to measure your niacin and niacinamide levels. Niacin is a safe, naturally occurring nutrient that has been beneficial for those suffering from arthritis when taken as directed. It should be taken with food. Consult with your doctor before taking niacin supplements so that you can receive proper guidance and dosage recommendations specific to you.

References:

 Hoffer, A, Saul AW, Foster HD. Niacin: The Real Story. Second edition, 2023, Basic Health Publications, Inc.

The Common Form of Joint Dysfunction: Its Incidence and Treatment. Arch Intern Med (Chic). 1950;85(2):364. doi:10.1001/archinte.1950.00230080168024.

Citations:

1.  Song SB, Park JS, Chung GJ, Lee IH, Hwang ES. Diverse therapeutic efficacies and more diverse mechanisms of nicotinamide. Metabolomics. 2019;15(10). doi:10.1007/s11306-019-1604-4

2.   Nguyen HD, Oh H, Kim MS. Higher intakes of nutrients are linked with a lower risk of cardiovascular diseases, type 2 diabetes mellitus, arthritis, and depression among Korean adults. Nutrition Research. 2022;100. doi:10.1016/j.nutres.2021.11.003

3.   McCarty MF, Russell AL. Niacinamide therapy for osteoarthritis – Does it inhibit nitric oxide synthase induction by interleukin-1 in chondrocytes? Med Hypotheses. 1999;53(4). doi:10.1054/mehy.1998.0792

4.    Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: A pilot study. Inflammation Research. 1996;45(7). doi:10.1007/BF02252945

5.     Sahin K, Kucuk O, Orhan C, et al. Niacinamide and undenatured type II collagen modulates the inflammatory response in rats with monoiodoacetate-induced osteoarthritis. Sci Rep. 2021;11(1). doi:10.1038/s41598-021-94142-3

6.     Hwang ES, Song SB. Possible adverse effects of high-dose nicotinamide: Mechanisms and safety assessment. Biomolecules. 2020;10(5). doi:10.3390/biom10050687