Before you start jumping up and down, yes we know that it is a deficiency of vitamin B1 (thiamine) that causes beri-beri, and that niacin deficiency actually causes pellagra we figured that if pseudo-environmental groups like EWG and NRDC can sit in their recycled offices day after day writing utter nonsense, we could take take a few liberties with a vitamin, especially in pursuit of a pretty good pun.
And as long as we are taking a few liberties. we should point out that vitamin B3 as used by the press is not even a vitamin it is a drug.
This is made quite clear by the FDA in their definition of drug: intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals. And, articles (other than food) intended to affect the structure or any function of the body of man or other animals.
So, if you take a multivitamin containing a little of this and that, or eat it in meats, grains, and vegetables, vitamin B3 is a vitamin. But if you take of lot of it to cut your cholesterol, it then becomes a drug. It is both the intent and dose that serve to distinguish between the two cases.
Either way, it is unlikely that anyone will be using it as a drug for much longer. It has been used for more than 50 years to lower lipids (blood fats) and is far from ideal. Even if it works, it is unpleasant to take, since it causes an itchy, hot flush that seems to be something like menopause hot flashes on steroids.
Yet, this was long before the age of the statins, so therapeutic options were poor.
The serious black eye that B3 just took is courtesy of a July 17th article in The New England Journal of Medicine, where The HPS2-THRIVE Collaborative Group opined that niacin therapy is bad news in every way: It doesn t prevent death from heart disease, it causes a myriad of side effects, including death.
The numbers are rather convincing. The trial was a rigorous study designed to measure real effects of niacin by following more than 25 thousand adults between the ages of 50 and 80 for about four years. This was not one of those retrospective trials, which are often of poor quality and useless other than to add another citation to the author s CV, but rather a randomized, controlled trial that was designed to examine the old question: Does niacin really work?
In medicine one rarely finds a clear yes-no answer. The truth often lies in between. Not this time.
The article was accompanied by an editorial (in the same issue) which was written by Donald M. Lloyd-Jones, M.D. of Department of Preventive Medicine and Division of Cardiology Department of Medicine, at the Northwestern University Feinberg School of Medicine, in Chicago.
Dr. Lloyd-Jones pulls no punches. The title alone will tip you off Niacin and HDL Cholesterol Time to Face Facts.
For example: Over a median follow-up of nearly 4 years there was no significant reduction in the primary endpoint of major vascular events associated with niacin laropipran [a drug added to reduce the unpleasant flushes].
And The lack of efficacy was uniform, with no substantive differences in response to therapy noted across the major prespecified subgroups.
In other words, it just doesn t work. But it s even worse: Of great concern was a 9% increase in the risk of death (number needed to harm, 200) associated with niacin laropiprant that was of borderline statistical significance.
ACSH s Dr. Josh Bloom says, It has been pretty clear for some time that niacin was, at best, marginally useful. Interestingly, vitamin toxicity has generally been attributed to overdose of the fat soluble vitamins, A, D, E, and K, while excess quantities of water soluble vitamins (B and C) are typically excreted in the urine, and are generally considered to be benign. This is the first exception that I am aware of.
So, what to do? Dr. Bloom continues: Take these and just about every other supplement you have wasted your money on, stick them in a bag, and chuck them in the waste disposal site or give them to someone you really dislike.
P.S. Our old friend Crazy Joe Mercola, king of the useless supplement empire, may want to update his website, since his May 14th post says this: Niacin, Exercise, and Sauna A Simple and Effective Detox Program That Can Significantly Improve Your Health. Take that for what it s worth.