By Dr E Devlin (BSc, Ph.D, S.N.H.S Dip)

Niacin, Niacinamide, no-flush niacin or is it Vitamin B3?

Writing or talking about this vitamin can get a bit messy so before we start I have to clear a few technical issues up so hang on tight this won’t hurt one bit….I promise!

Both niacin and niacinamide are used interchangeably to describe vitamin B3 and are often sold under the name vitamin B3, so if you purchase vitamin B3 or a multi vitamin preparation containing vitamin B3 you could actually be purchasing either niacin or niacinamide.

To be honest mostly niacinamide is used in multi vitamin preparations as niacin can cause flushing (a harmless warm reddening of the skin that sends most people into a state of outright panic). I have seen people who have been told that niacin will cause harmless flushing, go into panic mode. Hence the reason why niacinamide (that doesn’t cause flushing in the majority of people) is preferred by manufactures.

Further complication comes with some products stating non-flush niacin on their labels when really its niacinamide that is being sold. Real no-flush is described below.

OK just hang in there all will become clear in a second….or two!

It’s time to bring out the ‘good old fashioned chemical structures’ to get this mystery solved.

Have a look at the chemical structures for both Niacin and Niacinamide below.

As you can see the differences ‘chemically’ in both niacin and niacinamide are subtle and both can legitimately be called vitamin B3, however, their function in the human body differs from one another slightly. Both can be used to prevent the disease pellagra as discussed below.

There is one more form of vitamin B3 available called inositol hexaniacinate (AKA legitimate no-flush niacin) which is basically niacin bound to inositol and is considered the genuine form of slow release niacin. Notice how genuine no-flush niacin (inositol hexaniacinate) structure is significantly different to niacinamide above.

OK so now you know about the three different forms of vitamin B3 that are sold on the market, niacin, niacinamide and inositol hexaniacinate (legitimate no-flush niacin).

How do we know what form of vitamin B3 we are buying?

The easy way to do this is by looking at the ingredients section on the label. Regardless of what it says on the front of a product label always look at the ingredients section as this will tell you what type of vitamin B3 the product contains (the same rule applies to any other ingredient by the way).

So if the front of a product label says no-flush niacin and the ingredients section says it contains niacinamide then this isn’t truly no-flush niacin as it should say inositol hexaniacinate.

There you go all sorted I said it wouldn’t be painful. Now we can look at the benefits of vitamin B3 in all its glorious forms.


Pellagra is a classical disease of Western civilization and a great pandemic raged in many countries, including the UK and America until 1942. This disease is nothing more than a niacin deficiency characterised by the four D’s: dermatitis, diarrhoea, dementia, and death. A deficiency of this precious little vitamin can also be the cause of premature aging, neurological diseases and can decrease ones immunity to a large number of infectious diseases.

The major sources of vitamin B3 are whole grain cereals, legumes, nuts and meats, however, back in the day single crop cultures (monocultures) became the fashion for financial reasons by farmers and poor people in a number of countries (Spain, Italy and the US mainly) and the main crop that brought in the dough (no pun intended) was corn. This adopted method of farming came with devastating consequences as the disease pellagra raged as a consequence of people eating this highly available crop.

It is interesting to note that natives of Central America discovered thousands of years ago that corn if treated with lime water (a calcium rich alkali) and consumed as tortillas did not cause pellagra. The reason for this is that calcium liberates the naturally bound niacin from the corn.

History lesson over let’s take a look at some of the remarkable properties of vitamin B3.

Hyperlipidemia (Excess Fat in the Blood)

In 1955, Abram Hoffer, M.D., PhD, Rudolf Altschul, M.D., and James Stephen, M.D., discovered that niacin (not niacinamide) normalised cholesterol levels (in particular LDLs) and triglycerides (Since then, over 2000 studies have been completed confirming their work). By normalising cholesterol, if a patient had high cholesterol niacin would reduce it to within normal range. Similarly if a patient had low cholesterol niacin would again raise it to what is considered normal range. It is not simply a vitamin that lowers cholesterol but one that makes cholesterol levels normal making it the most effective substance known in this area.

Niacin’s therapeutic uses:

  • It decreases LDL cholesterol.
  • It decreases triglycerides in the blood.
  • It decreases lipoprotein (a) levels (a good predictor of heart disease) and elevates HDL.
  • It inhibits free fatty acid mobilization.
  • Has anti inflammatory properties now considered important in cardiovascular disease.
  • It restores intestinal permeability to normal levels which is of absolute importance as the only way we get any life giving nutrients into our bodies is via absorption through the gut wall.

It would be wise to take your niacin with a slow release vitamin B complex tablet (all the B vitamins rely on each other for optimal function), vitamin C (heals damaged intima, the inner most layer of an artery or vein), essential fatty acids (i.e. flaxseed oil), and zinc.


Niacin is a remarkable anti-stress nutrient as Lennart Levi, M.D., Ph.D., director of Clinical Stress Research at Karolinska Institute in Stockholm, found that emotions such as fear, excitement, or pleasure release fatty acids into the blood via an adrenalin mechanism. When subjects pre-treated with niacin were exposed to identical stress, there was no increase on fatty acid mobilization. According to Abram Hoffer (a pioneer in niacin treatment) this may be one of the reasons why Vitamin B3 is therapeutic for heart attack victims. He and his colleagues observed this anti-stress effect on individuals for over thirty years.


Niacin’s flushing ‘party trick’ that often gets individuals whipped up into a state of panic actually has a very real therapeutic effect on the body in that it causes the release of histamine from our mast cells (histamines storage sites). When histamine levels are reduced, an individual has a greater protection against allergic shock reactions.  


Dr William Kaufmann, Ph.D., M.D., during the great depression had already published two books detailing the beneficial effects of niacinamide for the treatment of osteoarthritis and rheumatoid arthritis. Dr Kaufmann in previously unpublished comments noted that niacinamide is a systemic therapeutic agent which measurably improves joint mobility, muscle strength, and decreases fatigability (basically how fast someone gets tired). His notes also reveal that if a person supplements their excellent diet with adequate amounts of niacinamide, there is, in time, measurable improvements in ranges of joint movement, regardless of the patients age.

Other Conditions Treated with Vitamin B3

According to Abram Hoffer, M.D., Ph.D., and Andrew Saul, Ph.D (two leading lights when it comes to using vitamins and minerals to heal and reverse disease states) vitamin B3 is very useful in combating the following conditions also:

Alcoholism – The use of vitamin B3 for the treatment of alcoholics was first developed by Bill W., the cofounder of Alcoholics Anonymous. He had observed its beneficial effect on himself and on thirty of his associates in AA. Because of his interest in this vitamin, its use for treating alcoholics spread rapidly.

Depression – For some cases of depression, vitamin B3 is a valuable adjunct combined with proper nutrition.

Senility – Vitamin B3, especially niacin, is very helpful in reducing the onset of senility but is only one component of a comprehensive program.

Lupus Erythematosus (a systemic autoimmune disease) – A large number of LE patients use niacin as one of their successful treatments for the condition.

Leukoplakia – This is a precancerous condition of the throat. In Sweden, this condition was routinely reversed with vitamin B3 and the cancer prevented.

As you can see this little vitamin packs a lot of punch and its therapeutic effects are wide and varied far beyond the scope of this article. However, before we wrap this up it is worth mentioning that vitamin B3 can have some potential side effects worth knowing about before you jump right in with both feet.

Potential Side Effects

Any natural nutrient on God’s green earth that is used in isolation as a treatment can have both positive and negative side effects. The reason nutrients have mainly positive side effects on the human system is because they have a global effect and are not designed by nature to just treat symptoms, they actually get to the core of the problem and reverse it. For example vitamin B3 cures pellagra, using niacin to lower cholesterol will have a positive effect of decreasing the tendency for arteriosclerosis etc. It is worth noting that almost all pharmaceutical drugs prescribed by a doctor are designed to treat symptoms only and often come with sever if not sometimes deadly side effects.

The negative effects of both niacin and niacinamide are:

Flushing (a harmless red rash appears on the skin that fades after an hour) – Mainly caused by niacin intake, although its rare niacinamide will cause flushing in sensitive individuals.

Nausea and vomiting –  Both niacinamide and niacin will cause nausea and vomiting if the dose is too high. However, mild nausea comes on first as a gentle warning to back off and lower the dose.

Headache – headaches are a rare side effect, especially with niacin, and this is probably due to the histamine releasing properties of niacin.

Liver Bilirubin Levels – In some people niacin will raise their bilirubin levels which can put some doctors off using this vitamin for clinical use which is a shame as Dr Abram Hoffer (who had 50 plus years of clinical experience using niacin) mentions in his book ‘Orthomolecular Medicine for everyone’ – ‘It is likely that niacin interferes with the mechanics of the liver function test or else niacin has some effect in the live that tends to exaggerate these effects’. Niacin increases bilirubin values because it competes with bilirubin at the hepatic uptake level. However, liver function tests remain normal if the dose of niacin is built up slowly.

As with everything in life it is always a good idea to work with someone who has experience in using, in this case, nutrients in order to get the best therapeutic value out of them. Although it is very difficult to hurt yourself with natural nutrients it is a shame and missed opportunity when someone has a very mild reaction to a nutrient, that they were not expecting, and then never go near it again. Especially when all they had to do was lower the dose, take it with food, plenty of water or make some other trivial adjustment.

How many people are out there suffering with subclinical pellagra and its associated symptoms, and all the other conditions listed above, is anyone’s guess. It is hard to think that vitamin B3 could be the answer to these problems or at least help their condition in a big way.