Niacin vs Niacinamide vs Nicotinic Acid: What Each Does (Flush, Cholesterol, Skin)

What each form does

Pellagra, the disease of severe niacin deficiency, affects the skin, digestion and nerves. [3] Diagnosis and treatment belong to a clinician.

Cholesterol and heart: nicotinic acid only

MedlinePlus says large doses of niacin can modestly raise "good" HDL cholesterol and lower triglycerides. [2] But changes in blood lipids are not the same as fewer heart attacks. A Cochrane review of 23 randomized trials (39,195 people, median niacin amount 2 g a day, median duration 11.5 months) found moderate- to high-quality evidence that niacin does not reduce death, heart attacks or strokes, and that people given niacin were more likely to stop treatment because of side effects. [4] In the HPS2-THRIVE trial of 25,673 adults with vascular disease, extended-release niacin with laropiprant did not significantly reduce major vascular events and caused more serious side effects, including problems with diabetes control. [5] Label: no good evidence of benefit for event prevention, evidence of harm at these amounts. These were study amounts, not advice. See high-dose niacin and the flush.

Skin: oral nicotinamide

In the ONTRAC trial, 386 Australian adults who had already had at least two non-melanoma skin cancers took 500 mg of nicotinamide twice daily or placebo for 12 months. The rate of new non-melanoma skin cancers was 23% lower in the nicotinamide group, and there was no benefit after stopping. [6] A later trial in organ-transplant recipients, who take immune-suppressing medicines, found no difference (207 versus 210 new cancers). [7] Label: promising but limited, in people already at high risk, under dermatology care. It does not replace sunscreen or skin checks.

Skin: topical niacinamide

Creams and serums with niacinamide are a separate question from pills. A Cochrane review of topical treatments for acne found four studies that compared nicotinamide with the antibiotics clindamycin or erythromycin; none measured the participants' own rating of improvement, and low-quality evidence showed possibly no difference in withdrawals or minor side effects. [8] For skin tone, wrinkles or "barrier" claims, Proper evidence not found in the sources we read (we searched PubMed for systematic reviews of topical niacinamide). Treat such claims as marketing claims until reviews say otherwise.

Official intake and upper levels

The countries differ, and the upper levels are for long-term use by healthy people. Read RDA, AI, DV and UL for what each term means.

Who needs extra care

Pregnancy and breastfeeding raise the RDA, but that is food-level need, not a reason for high-dose products. [2] Children, older adults, people with kidney or liver conditions, and anyone on cholesterol, diabetes or blood-pressure medicines should check with a clinician. Product amounts and forms vary, so see quality testing and certifications. For newer "NAD booster" products, see nicotinamide riboside, NMN and niacin precursors.

Related pages

Niacin (vitamin B3) profile | Pellagra | B vitamins overview