Question for Marjorie

[Guest guest]

As a veterinarian, my knowledge of nutrition does not extend much

beyond Eukanuba Large Breed Puppy, so I wonder if you can answer a

question for me: My understanding is that Nicomide is vitamin

B3.......assuming enough is being taken in your diet, doesn't

supplementing it just increase the level in your urine?

I have highly inflammatory rosacea that has not responded well to any

antibiotic (tried long term tetracycline, erythromycin, minocine, and

doxycycline). I have been trying to avoid low dose accutane(not

overkeen on needles, so the need for repeat liver enzyme levels

bothers me) and thought I might give B3 a try.

Thanks Marjorie.

[Guest guest]

> As a veterinarian, my knowledge of nutrition does not extend much

> beyond Eukanuba Large Breed Puppy,

Yeah, but then there's Life As A Dog, englishvet, so who knows?

> so I wonder if you can answer a

> question for me: My understanding is that Nicomide is vitamin

> B3.......

Here's what I've learned: Nicomide's main ingredients is niacinamide

(= nicotinamide), which is the main breakdown product of niacin (=

nicotinic acid). Vit B3 is a general term that refers to both niacin

and it's niacinamide (and a few other variants).

When taken in small doses (a few milligrams, around the minimum daily

requirement doses) there doesn't appear to be a difference between

niacin and niacinamide. The niacin flush, which has an interesting

mechanism and is obviously of great importance to us rosaceans,

doesn't begin before 35 mg. so any dose less than that in any form of

vitamin B3 should be fine. But that's all for dietary supplementation.

Daily mega doses of niacin and niacinamide -- say over 100 mg, and

certainly over 1 gram -- have significantly different side effects,

some good and some bad. Primarily, niacin lowers cholesterol, whereas

niacinamide is being touted for a wide range of benefits, from anti-

inflammatory to anti-aging to anti-cancer effects. There's excellent

evidence supporting the use of niacin in treating high cholesterol,

but as you all know, I'm having a very tough time finding good

evidence supporting the clinical use of niacinamide applicable to

rosaceans.

Unfortunately, when taken in mega doses, both forms carry with them

the potential for significant liver damage -- but (the good news) I'm

not seeing any reason for concern about that below 1.5 grams/day. The

dose in Nicomide is 750 mg.

That's Nicomide's main ingredients; the other two ingredients are

zinc (in the form of zinc oxide) and folic acid. I'm not entirely

clear why they have been added, I've read several possible reasons

why.

kindly emailed me Sirius Lab's phone number, and I have a call

out to someone on their medical staff. I'll keep everyone posted on

what I learn.

> assuming enough is being taken in your diet, doesn't

> supplementing it just increase the level in your urine?

Good question. The minimum daily requirement (MDR) only tells us what

is required to avoid becoming deficient in the vitamin. You're right,

Vit B3 is in lots of foods so most people with any kind of reasonable

diet will not develop pellegra.

But that's not to say that normal intake is at or near the upper

limits for the body's absorption or metabolism of niacin or

niacinamide. In some vitamins that's true, but apparently not for Vit

B3. While urinary excretion probably increases proportionally to

increased intake or supplementation, apparently so does the amount

absorbed through the GI tract and utilized by the body. But there

must be some limit where GI receptor are totally saturated and

further absorption is impossible, and whatever receptors are involved

in utilization likewise too must become saturated; at that point, the

rest will just be excreted, as you note.

Interestingly, I noticed that many clinical studies using more than 1

gram have divided the daily niacinamide dose into three times a day.

It may be that 1 gram is that upper limit of absorption/utilization

(or it may be that taking more than 1 gram causes stomach upset, or

the preparation isn't manufactured in higher doses. I don't know.)

> I have highly inflammatory rosacea that has not responded well to

any

> antibiotic (tried long term tetracycline, erythromycin, minocine,

and

> doxycycline). I have been trying to avoid low dose accutane(not

> overkeen on needles, so the need for repeat liver enzyme levels

> bothers me) and thought I might give B3 a try.

I think I'm going to join you. I'm not convinced an oral dose is anti-

inflammatory specifically for the skin, but it appears reasonally

well studied from a safety profile perspective and appears safe as

long as the dose is kept below 1.5 grams.

A critically important disclaimer for everyone still reading : I'm

not advocating taking any form of vitamin B3 for anyone, all I'm

doing is sharing my knowledge and personal thoughts for ME, not for

anyone else on the planet. I want to actively discourage a " well, if

she thinks it's OK to take and she's a doctor then it must be OK for

me " mentality. I know next to nothing about anyone's clinical

condition, no matter how articulate the information is provided, and

I know for a fact how misleading cyberspace diagnoses and treating

can be.

Many posters contribute very good information, but there's also much

misinformation being dispensed here. Everyone uses his/her judgment

in posting and in reading posts, and I know most of you accept what's

said here with sophistication and insight. I trust the same is true

here regarding vitamin B3.

A number of people on this board dispense advice, suggesting or

outright telling people what they should or shouldn't do. Instead, I

want to share what I understand and don't understand about rosacea

and medicine based on my training and work and self-education, and

share my personal experiences as a person with rosacea. I rarely

intend to advise beyond the obvious, and I don't engage in private

email conversations. I respect that boundary, for what are excellent

reasons to me.

Marjorie

Marjorie Lazoff, MD