Vitamin B3: How did one vitamin get so many names?

Q: Why are nicotinamide, niacinamide, niacin and nicotinic acid names for the same thing, vitamin B3? It’s confusing

How did one vitamin get so many names? Vitamin B3 is two closely related compounds, niacin and niacinamide, with each version having two different official titles.

When vitamin B was first discovered, it was thought to be only one compound. Over time, 11 separate compounds were isolated and identified, often called B complex vitamins. One B-complex vitamin, vitamin B3, was initially made synthetically by adding nitric acid to nicotine, resulting in a nicotinic acid molecule.

When vitamins began to be marketed to the general public in the 1940s, the name nicotinic acid confused consumers because it was similar to nicotine. To solve this, the Food and Drug Administration (FDA) allowed nicotinic acid to have a second name: niacin.

The original name for the other form of vitamin B3 is nicotinamide. To minimize confusion, the FDA allowed it to be called niacinamide. Today, niacin and nicotinic acid refer to one form of vitamin B3; its other form is called nicotinamide or niacinamide. Vitamin formulas containing vitamin B3 may use any of these 4 names to describe its vitamin B3 component.

Niacin and niacinamide are very similar in shape and work identically in your body to protect you from pellagra, a disease caused by a diet with inadequate amounts of vitamin B3. Pellagra became common in Asia and the United States in the early 1900s after new milling techniques created a whiter wheat flour and white rice.

This new technology removed the outer husk or germ from wheat, corn, and rice, creating a more refined flour. These new flours, cereals and white rice were tastier than whole-grain foods, and consumers overwhelmingly preferred them.

Diseases from deficiencies of B vitamins like pellagra started showing up. Stripping the outer husks or germ from cereal grains and rice removed small but vital amounts of vitamins B1, B2, and B3, folic acid, and iron.

In the United States, pellagra became very common, causing over 7,000 deaths annually for over 2 decades, until vitamin B3 was added to flour, bread, cereal, and corn. Today it's rare to be deficient in Vitamin B3 because of the mandatory addition of B vitamins and iron to refined grains, flours, and pasta.

Niacin and its close cousin, niacinamide, are identical in how they work inside your body. In fact, if you get more niacin than your body needs, your body converts the excess into niacinamide. Many multivitamin formulas use the niacinamide version of vitamin B3 instead of niacin.

Niacin has a very different effect on cholesterol and blood vessels than its close cousin, niacinamide. Niacin is used therapeutically to lower triglycerides, lower LDL (bad cholesterol), and increase HDL (good cholesterol), unlike niacinamide, which has no effect on cholesterol or triglyceride levels.

1000-2000 of niacin per day is used medically to lower LDL (“bad” cholesterol) cholesterol and increase HDL (the “good” cholesterol), while the amount in your diet needed to prevent pellagra is only 16mg of niacin equivalent (NE) for men and 14mg of NE for women. Your body can transform 60mg of tryptophan, an amino acid in meats, into 1 mg of niacin or niacin equivalent (NE).

Niacin can cause rapid heart rate, palpitations, and hypothyroidism. In contrast, large doses of niacin can cause liver problems, trigger gout or stomach ulcers, or exacerbate asthma or gall bladder disease. Niacin can also cause insulin resistance and has been shown to increase the risk of becoming diabetic.

The most common and annoying side effects of niacin are dose-related flushing, low blood pressure, and headaches. Flushing is less of a problem with slow-release niacin. Still, doses over 2 grams daily have been associated with liver problems. "No-flush" niacin is actually niacinamide, which does not affect cholesterol.

Here Are 5 Key Facts About Niacin:

1.Limit niacin to 2 grams daily.

The risk of liver problems increases in doses of more than 2 grams, especially with slow-release or long-acting formulas of niacin.

2. Avoid taking niacin with hot beverages or foods.

To minimize flushing when taking niacin, take it with food but avoid hot drinks or soup.

3. Avoid adding niacin to “statin” cholesterol drugs.

Taking prescription "statin" medication and concentrated niacin increases your risk of muscle pain and weakness.

4. Avoid taking niacin with tryptophan or 5-HT.

Tryptophan is converted to niacin in the body and can increase the risk of flushing.

5. Avoid “No-Flush” niacin (niacinamide).

Niacinamde has no effect on cholesterol or triglycerides. Stick with nicotinic acid.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com. Ó2023 Louise Achey