There are a few supplements I take regularly, including conservative amounts of vitamin D and fish oil (both of which help keep me free of asthma symptoms). Recently I’ve added 25-50mg of niacinamide (also known as nicotinamide, a form of vitamin B3, similar to niacin but without the flushing side effect) a few times a week to my regimen. Here are the reasons why:

Protection Against Alzheimer’s Disease, Cognitive Enhancement

Long-term niacin deficiency in humans is associated with cognitive decline and an increased risk of Alzheimer’s disease. In a 2008 mouse study, high dose niacinamide was demonstrated to reverse Alzheimer’s (as did this more recent study).

As far as I know there has yet to be a human trial using niacinamide to treat Alzheimer’s, but small studies like this one that show the reversal of memory loss and cognitive decline with dietary, supplement, and other lifestyle interventions are possible. It’s not yet known if high-dose niacinamide supplementation could be an effective treatment for Alzheimer’s in humans, but there does seem to be enough evidence to support supplementation as a preventative measure.

Personally I have experienced a mild nootropic effect (increased focus, mental clarity, mood boost) from small amounts of sublingual niacinamide (it has a bitter taste, but I don’t mind it). This older study investigates potential similarities in both molecular structure and activity between niacinamide and the nootropic piracetam.

Possible Protection Against Staph Infection

Supplementation with niacinamide boosts gene activity that enhances the immune response against staph infection. Given the rise of MRSA (a strain of the staph bacteria that is resistant to most antibiotics), niacinamide may be an important weapon in the fight against dangerous bacterial infections.

I could only find one anecdotal report of someone using niacinamide supplements to prevent recurring staph infection (click caution for gory picture), but for MMA fighters, hospital workers, and other people routinely exposed to nasty strains of s. aureus, it may be wise to keep niacinamide levels higher rather than lower.

Another weapon against MRSA: this 1,000-year-old Viking remedy using garlic, onion, wine, and cow bile.

Reduction of Acne, Psoriasis, and Actinic Keratosis

This overview found that both topical and oral use of nicotinamide (another name for niacinamide) reduced acne.

This comprehensive article in Dermatology Times discusses the many benefits of niacinamide as an anti-aging supplement, especially in regards to skin. Niacinamide reduces inflammation, reduces skin sensitivity, and fights against bacterial infection, making it helpful in broad range of skin conditions including psoriasis (in combination with calcipotriene) and actinic keratosis.

Another study showed that topical niacinamide was effective in reducing age spots (melasma).

Improve Joint Flexibility

According to one study, niacinamide supplementation improved joint mobility for patients with osteoarthritis.

This article discusses the history of the study of niacin and arthritis, which has been investigated since the early forties.

Why Don’t I Take More?

Some of the studies I cited used very high doses of niacinamide. This may be safe for short periods of time, but I’m wary of megadoses of any vitamin. High doses of niacinamide consume methyl groups and may lead to methylation imbalance and long-term problems like insulin resistance. This is reason to be wary of anti-aging supplements like Elysium that include high doses of niacinamide (in its nicotinamide riboside form).

My guess is that people with MTHFR 677 and MTHFR 1298 mutations (less efficient methylators) may be more susceptible to side effects of high doses of niacinamide. Personally I get headaches and an upset stomach from doses as low as 100mg (I am heterozygous for both MTHFR genes). I’m not sure if the two are related, but I’m in favor of avoiding side effects and sticking with the minimum effective dose for all supplements.

High doses of niacinamide may inhibit the SIRT enzymes, which in turn may decrease longevity (compounds like resveratrol enhance SIRT activity). Though moderate SIRT inhibition may be the mechanism via which niacinamide improves cognition. Though a comment on the same article highlights the complexity of the chemistry:

One must be careful when calling nicotinamide an “inhibitor” in this experiment. While it is true that our lab showed that nicotinamide is a direct inhibitor of SIRT1 enzyme, it is also a precursor of NAD+, and NAD+ is a co-substrate (i.e., activator) of SIRT1.”

Summary

I’m convinced there’s enough evidence in the pro column for niacinamide as supplement to take a conservative dose a few times a week. Increasing levels of dietary and supplemental niacinamide may contribute to improved cognition, healthy skin, and healthy joints.