Is Niacin a Lacking Piece of the COVID Puzzle?

Whereas nutritional vitamins C and D have garnered a lot consideration within the combat in opposition to COVID-19, B nutritional vitamins also can play an vital position, based on two latest papers — niacin (B3) specifically.

The primary, “Be Effectively: A Potential Function for Vitamin B in COVID-19,”^1,2,3,4 was revealed within the February 2021 subject of the journal Maturitas. The paper is the results of a joint collaboration between researchers on the College of Oxford, United Arab Emirates College and the College of Melbourne, Australia.

Whereas no research utilizing B nutritional vitamins have been carried out on COVID-19 sufferers, the researchers stress that, primarily based on B nutritional vitamins’ results in your immune system, immune-competence and pink blood cells (which assist combat an infection), supplementation could also be a helpful adjunct to different prevention and therapy methods. As famous by the authors:⁵

“There’s a want to spotlight the significance of vitamin B as a result of it performs a pivotal position in cell functioning, vitality metabolism, and correct immune operate.

Vitamin B assists in correct activation of each the innate and adaptive immune responses, reduces pro-inflammatory cytokine ranges, improves respiratory operate, maintains endothelial integrity, prevents hypercoagulability and might cut back the size of keep in hospital.

Due to this fact, vitamin B standing ought to be assessed in COVID-19 sufferers and vitamin B could possibly be used as a non-pharmaceutical adjunct to present remedies …

Vitamin B not solely helps to construct and keep a wholesome immune system, however it might doubtlessly stop or cut back COVID-19 signs or deal with SARS-CoV-2 an infection. Poor dietary standing predisposes folks to infections extra simply; due to this fact, a balanced eating regimen is critical for immuno-competence.”

B Nutritional vitamins Play Many Roles in COVID-19 Illness Course of

Importantly, B nutritional vitamins can affect a number of COVID-19-specific illness processes, together with:⁶

• Viral replication and invasion
• Cytokine storm induction
• Adaptive immunity
• Hypercoagulability

The paper goes on to element how every of the B nutritional vitamins will help handle varied COVID-19 signs:⁷

Vitamin B1 (thiamine) — Thiamine improves immune system operate, protects cardiovascular well being, inhibits irritation and aids in wholesome antibody responses. Vitamin B1 deficiency may end up in an insufficient antibody response, thereby resulting in extra extreme signs. There’s additionally proof suggesting B1 could restrict hypoxia.

Vitamin B2 (riboflavin) — Riboflavin together with ultraviolet mild has been proven to lower the infectious titer of SARS-CoV-2 beneath the detectable restrict in human blood, plasma and platelet merchandise.

Vitamin B3 (niacin/nicotinamide) — Niacin is a constructing block of NAD and NADP, that are very important when combating irritation.

Vitamin B5 (pantothenic acid) — Vitamin B5 aids in wound therapeutic and reduces irritation.

Vitamin B6 (pyridoxal 5′-phosphate/pyridoxine) — Pyridoxal 5′-phosphate (PLP), the lively type of vitamin B6, is a cofactor in a number of inflammatory pathways. Vitamin B6 deficiency is related to dysregulated immune operate. Irritation will increase the necessity for PLP, which may end up in depletion. In keeping with the authors, in COVID-19 sufferers with excessive ranges of irritation, B6 deficiency could also be a contributing issue. What’s extra, B6 may play an vital position in stopping the hypercoagulation seen in some COVID-19 sufferers.

Vitamin B9 (folate/folic acid) — Folate, the pure type of B9 present in meals, is required for the synthesis of DNA and protein in your adaptive immune response. Folic acid, the artificial kind usually present in dietary supplements, was not too long ago discovered8 to inhibit furin, an enzyme related to viral infections, thereby stopping the SARS-CoV-2 spike protein from binding to and gaining entry into your cells. The analysis9 suggests folic acid could due to this fact be useful throughout the early levels of COVID-19. One other latest paper10 discovered folic acid has a robust and steady binding affinity in opposition to SARS-CoV-2. This too suggests it might be an appropriate therapeutic in opposition to COVID-19.

Vitamin B12 (cobalamin) — B12 is required for wholesome synthesis of pink blood cells and DNA. A deficiency in B12 will increase irritation and oxidative stress by elevating homocysteine ranges. Your physique can get rid of homocysteine naturally, supplied you are getting sufficient B9 (folate), B6 and B12.11 Hyperhomocysteinemia — a situation characterised by abnormally excessive ranges of homocysteine — causes endothelial dysfunction, prompts platelet and coagulation cascades and reduces immune responses. B12 deficiency can also be related to sure respiratory issues. Advancing age can diminish your physique’s capacity to soak up B12 from meals,12 so the necessity for supplementation could improve as you grow old. In keeping with “Be Effectively: A Potential Function for Vitamin D in COVID-19”:13 “A latest examine confirmed that methylcobalamin dietary supplements have the potential to scale back COVID-19-related organ injury and signs. A scientific examine performed in Singapore confirmed that COVID-19 sufferers who got vitamin B12 dietary supplements (500 μg), vitamin D (1000 IU) and magnesium had diminished COVID-19 symptom severity and dietary supplements considerably diminished the necessity for oxygen and intensive care help.”

Niacin — A Lacking Piece of the COVID-19 Puzzle?

The second paper,¹⁴ “Enough Niacin Provide: The Lacking Puzzle Piece to COVID-19 and Past?” (which is a preprint and has but to endure peer evaluation), focuses particularly on niacin (B3), elevating the query of whether or not this vitamin may truly be a vital participant within the COVID-19 illness course of. As famous within the summary:

“Definitive antiviral properties are evidenced for niacin, i.e., nicotinic acid (NA), as coronavirus illness 2019 (COVID-19) remedy for each illness restoration and prevention, to the extent that reversal or development of its pathology follows as an intrinsic operate of NA provide.

This detailed investigation supplies an intensive disentanglement of how the downstream inflammatory propagation of ensuing extreme acute respiratory virus 2 (SARS-CoV-2) an infection is fully prohibited or reversed upstream out the physique to expeditiously restore well being with well-tolerated dynamic supplementation of enough NA (i.e., ~1-3 grams per day).”

As famous on this paper, a main hallmark of COVID-19 pathology is the cytokine storm, which might result in a number of organ failure and dying. Marked elevations in proinflammatory cytokines are accountable for this chain of occasions, most notable of that are interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCP-1).

In case you can lower and management these damaging cytokines, you stand a superb probability of thwarting the cytokine storm and the downstream injury it causes. Nicotinamide adenine dinucleotide (NAD+) performs an vital position on this, and niacin is a constructing block of NAD. As defined in “Be Effectively: A Potential Function for Vitamin D in COVID-19”:¹⁵

“NAD+ is launched throughout the early levels of irritation and has immunomodulatory properties, identified to lower the pro-inflammatory cytokines, IL-1β, IL-6 and TNF-α. Current proof signifies that concentrating on IL-6 might assist management the inflammatory storm in sufferers with COVID-19.”

Apart from markedly lowering proinflammatory cytokines, niacin has additionally been proven to:¹⁶

• Scale back the replication of quite a lot of viruses, together with vaccinia virus, human immunodeficiency virus, enteroviruses and hepatitis B virus
• Scale back neutrophil infiltration
• Have anti-inflammatory impact in sufferers with ventilator-induced lung harm

Niacin Modulates the Bradykinin Storm

COVID-19 additionally triggers bradykinin storms. Bradykinin is a chemical that helps regulate your blood stress and is managed by your renin-angiotensin system (RAS). The bradykinin hypothesis supplies a mannequin that helps clarify among the extra uncommon signs of COVID-19, together with its weird results on your cardiovascular system.

Researchers have found SARS-CoV-2 downregulates your physique’s capacity to degrade or break down bradykinin. The tip result’s a bradykinin storm, and this seems to be an vital think about lots of COVID-19’s deadly results, maybe even extra so than the cytokine storms related to the illness. As bradykinin accumulates, the extra severe COVID-19 signs seem.

Vitamin D has a vital impression on the RAS,¹⁷ and might due to this fact assist stop a bradykinin storm, however niacin additionally performs an vital position. As famous in “Enough Niacin Provide: The Lacking Puzzle Piece to COVID-19 and Past?”:¹⁸

“Speedy-release NA [niacin] administration has been reported as extremely efficient in stopping the lung tissue injury concerned on this … pathology. As a matter of truth, authors of a March, 2020, paper¹⁹ in Nature for this very motive conclude with suggestion of niacin supplementation to COVID-19 sufferers as a ‘sensible strategy.'”

The paper additionally expounds on the position of NAD+, and why niacin is a helpful technique for enhancing NAD+:²⁰

“The main results of COVID-19 are evidenced to contain tryptophan metabolism and the kynurenine pathway in direction of depletions of those precursors of NAD+ …

Solely enough dosage of immediate-release NA — via its processing within the mammalian physique to kind NAADP [nicotinic acid adenine dinucleotide phosphate, a calcium mobilizer] — results in an inverse potential vitality pump again upstream, from the core up and in the end out the physique, of the downstream ensuing propagation of such inflammatory illness that spreads into the cells.

This is made potential by the aptitude of NAADP to be readily fashioned by enough NA provide to induce Ca2+ [calcium] channeling again upstream out the physique of built-up or ensuing irritation, representing kinetic vitality … that by electron gradient, strikes downstream into the physique.

Trying to revive NAD+ with different NAD+-precursors except for NA (e.g., nicotinamide, nicotinamide riboside, nicotinamide mononucleotide) solely truly briefly and in a way, artificially, raises NAD+ ranges, till they imminently deplete again down with additional ensuing irritation.

NA is the truth is the one compound to readily produce NAADP if wanted in acidic environments (as is attribute to ensuing inflammatory illness pathology), which in flip supplies a possible vitality/H+ pump-out motion of its inverse, downstream kinetic (warmth) vitality irritation to in the end restore NAD+ to regular, pre-inflammatory ranges, in addition to different inflammatorily-depleted cofactors and biochemical pathways in direction of a extra thermodynamically homeostatic well being standing …

The ‘niacin pink flush’ the truth is is that this thermodynamic exfoliation of ensuing illness, toxins, and (restoration of) free radical-damaged compounds being H+ (potential vitality) pumped out the physique.

It represents the anti-inflammatory or thermodynamic (i.e., vitality transfer-like) remedy in motion that solely and solely enough oral consumption of immediate-release NA is able to (readily) undertaking with efficiency.”

Really useful Use

The paper²¹ goes deep into the biochemical features of how niacin works in your physique, so in the event you’re involved in that, chances are you’ll need to learn via it. In abstract, because it pertains to COVID-19, the vital factor to perceive is that there seems to be a causative hyperlink between low niacin standing and SARS-CoV-2 an infection.

In keeping with the authors, SARS-CoV-2’s capacity to invade your physique depends on whether or not calcium signaling can correctly proceed, which in flip depends on the presence of NAADP. And, as defined within the quoted part above, niacin kinds NAADP in your physique. NAADP-dependent calcium signaling is accountable each for the inhibition of viral entry into cells and driving the virus out of already contaminated cells.

And, once more, the authors stress that “nothing exterior of sufficiently, dynamically provided niacin is able to readily resulting in the NAADP provide wanted in these acidic environments for therapeutic motion that counteracts inflammatory illness development.”

In addition they level out that the flushing you get from niacin is a part of how the niacin drives inflammatory free radicals out of the cells. As you proceed to take the complement at a constant, sufficiently excessive dose, that flushing will steadily reduce, which is an indication that your physique is reaching a wholesome homeostasis.

“This represents maybe the perfect state that ought to be labored as much as and maintained thereafter — by way of niacin dosing — to respectively reverse out and stop irritation,” the authors state.²²

Whereas the flushing may be uncomfortable, the authors stress that it’s “certainly protected,” and truly “ought to be sought when wanted for its anti-inflammatory properties.”

Recommended Dosing

As a “well being restorative remedy” for these identified with SARS-CoV-2, they suggest beginning with a dose of 500 milligrams of immediate-release niacin, two to a few instances a day, ideally inside the first 48 hours of symptom onset. As your flush response lessens, improve your dose to 1,000 mg, two to 3 times a day.²³

“For the subgroup of sufferers nonetheless struggling with excessive cytokines profiles from deep, remnant injury of beforehand skilled SARS-CoV-2 an infection — termed the ‘long-haulers’ — alleviation from ailment(s) in direction of full well being restoration to pre-infection state from initiating and sustaining the aforementioned dosage routine has constantly been reported to imagine inside two days and to incrementally comply with additional over the course of weeks.”²⁴

Though the authors recommend you should utilize niacin prophylactically, utilizing that very same dose, I disagree. In keeping with the authors:²⁵

“By readily offering enough NAADP, this identical NA dosage routine is able to serving as prophylaxis, which may be interpreted because the bodily/biochemical incapacity of enough development of SARS-CoV-2 so as to enter into the physique and/or thereafter induce replication, an infection onset, or illness development in a beforehand uninfected host.”

There could also be some worth to the excessive doses in acute COVID-19 infections however I’m skeptical. I’m an enormous fan of NAD+ augmentation and have been utilizing it for years. My analysis suggests you actually solely want about 25 mg per day of niacin, which won’t trigger flushing in practically anybody. I consider most would profit from taking 25 mg of niacin each day, ideally in a well-balanced B advanced, which might have thiamine (B1) that has additionally been proven to be helpful in COVID-19.

Different options to high-dose niacin could be nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), which is my private favourite. I consider that compounding these into rectal suppositories would keep away from a lot of the methylation of the complement and provide you with greater NAD+ tissue ranges.

One other draw back of high-dose niacin is that it breaks down to nicotinamide and in excessive doses, nicotinamide will inhibit Sirt1, which is an vital longevity protein.

Personally, I consider a superior technique to high-dose niacin in acute COVID-19 could be to make use of nebulized hydrogen peroxide at 0.1%. I have by no means seen or heard of this intervention failing within the therapy of COVID-19.

The way to Enhance Your Vitamin B Standing

As a normal rule, I like to recommend getting most if not your whole diet from actual meals. It will work effectively for many B nutritional vitamins, however not in the event you’re utilizing niacin therapeutically, as described above. For that, you have to to take a complement.

That mentioned, the checklist beneath will present you which ones meals comprise which B nutritional vitamins, in addition to present normal steerage on dosage in the event you’re taking a complement. In case you’re making an attempt to enhance your vitamin B standing, additionally contemplate limiting sugar and consuming extra fermented foods.

The explanation for that is as a result of the whole B group vitamin collection is produced inside your intestine, assuming you’ve healthy gut flora. Consuming actual meals, together with loads of leafy greens and fermented meals, will present your microbiome with vital fiber and useful micro organism to assist optimize your inner vitamin B manufacturing.

Nutrient	Dietary Sources	Complement Suggestions
Vitamin B1	Pork, fish, nuts and seeds, beans, inexperienced peas, brown rice, squash, asparagus and seafood.26	The really helpful each day allowance for B1 is 1.2 mg/day for males and 1.1 mg/day for girls.27
Vitamin B2	Eggs, organ meats, lean meats, inexperienced greens resembling asparagus, broccoli and spinach.28	The RDA is 1.1 mg for grownup ladies and 1.3 mg for males. Your physique can not take in greater than about 27 mg at a time, and a few multivitamins or B-complex dietary supplements could comprise unnecessarily excessive quantities.29
Vitamin B3	Liver, rooster, veal, peanuts, chili powder, bacon and sun-dried tomatoes have among the highest quantities of niacin per gram.30 Different niacin-rich meals embrace baker’s yeast, paprika, espresso espresso, anchovies, spirulina, duck, shiitake mushrooms and soy sauce.31	The dietary reference consumption established by the Meals and Diet Board ranges from 14 to 18 mg per day for adults. Larger quantities are really helpful relying in your situation. For a listing of really helpful dosages, see the Mayo Clinic’s web site.32 The dosage really helpful as an anti-inflammatory, health-restorative remedy in “Enough Niacin Provide: The Lacking Puzzle Piece to COVID-19 and Past?”33 is 500 mg two to a few instances a day, working your manner as much as 1,000 mg, two to a few instances a day because the flushing lessens.
Vitamin B5	Beef, poultry, seafood, organ meats, eggs, milk, mushrooms, avocados, potatoes, broccoli, peanuts, sunflower seeds, chickpeas and brown rice.34	The RDA is 5 mg for adults over the age of 19. Pantothenic acid in dietary dietary supplements is usually within the type of calcium pantothenate or pantethine.35
Vitamin B6	Turkey, beef, rooster, wild-caught salmon, candy potatoes, potatoes, sunflower seeds, pistachios, avocado, spinach and banana.36,37	Nutritional yeast is a superb supply of B nutritional vitamins, particularly B6.38 One serving (2 tablespoons) incorporates practically 10 mg of vitamin B6. To not be confused with Brewer’s yeast or different lively yeasts, dietary yeast is constructed from an organism grown on molasses, which is then harvested and dried to deactivate the yeast. It has a pleasing tacky taste and may be added to quite a lot of totally different dishes.
Vitamin B9	Contemporary, uncooked, natural leafy inexperienced greens, particularly broccoli, asparagus, spinach and turnip greens, and all kinds of beans, particularly lentils, but additionally pinto beans, garbanzo beans, kidney beans, navy and black beans.39	Folic acid is an artificial kind of B vitamin utilized in dietary supplements; folate is the pure kind present in meals. (Suppose: Folate comes from foliage, edible leafy crops.) For folic acid to be of use, it should first be activated into its biologically lively kind (L-5-MTHF). Practically half the inhabitants has problem changing folic acid into the bioactive kind as a result of a genetic discount in enzyme exercise. For that reason, in the event you take a B-vitamin complement, ensure it incorporates pure folate somewhat than artificial folic acid. Dietary yeast is a superb supply.40 Analysis41 additionally exhibits your dietary fiber intake has an impression in your folate standing. For every gram of fiber consumed, folate ranges elevated by practically 2%. The researchers hypothesize that this enhance in folate degree is because of the truth that fiber nourishes micro organism that synthesize folate in your massive gut.
Vitamin B12	Vitamin B12 is discovered virtually solely in animal tissues, together with meals like beef and beef liver, lamb, snapper, venison, salmon, shrimp, scallops, poultry, eggs and dairy merchandise. The few plant meals which can be sources of B12 are literally B12 analogs that block the uptake of true B12.	Dietary yeast is excessive in B12, and is very really helpful for vegetarians and vegans. One serving (2 tablespoons) supplies practically 8 mcg of pure vitamin B12.42 Sublingual (under-the-tongue) wonderful mist spray or vitamin B12 injections are additionally efficient, as they permit the big B12 molecule to be absorbed instantly into your bloodstream.

Source