Nicotinamide | Vitamin B3 & Skin cancer

Nicotinamide is a form of Vitamin B3, also known as niacin or nicotinic acid. Nicotinamide has been shown to play an important role in DNA repair from UV damage. It has demonstrated benefits in protecting against nonmelanoma skin cancer and actinic keratoses, precancerous lesions. Read more...

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Topics

• What is nicotinamide?

• Why is nicotinamide so important to our skin health?

• Which foods contain niacin?

• What are the symptoms of a niacin deficiency?

• Who is at risk for pellagra?

• Are there symptoms of nicotinamide excess?

• How can niacin levels be tested?

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What is nicotinamide?

Nicotinamide is a form of Vitamin B3, also known as niacin or nicotinic acid. We can get niacin from our diet, both plant and animal sources, or it can be manufactured in the liver from tryptophan in our diet.

Why is nicotinamide so important to our skin health?

ATP is a source of energy in our body. For our bodies to produce ATP, a coenzyme called NAD or nicotinamide adenine dinucleotide (NAD) is required. Nicotinamide is the precursor to this coenzyme. There are about 400 enzymes in the body that also require nicotinamide to work.

Nicotinamide has been shown to play an important role in DNA repair from UV damage. It has demonstrated benefits in protecting against nonmelanoma skin cancer and actinic keratoses, precancerous lesions. A study published in the New England Journal of Medicine found that oral nicotinamide at 500 mg twice daily for 12 months led to a reduction of 23% in the rate of new nonmelanoma skin cancers, basal cell carcinoma, and squamous cell carcinoma, development. There was also a noted reduction in the development of actinic keratoses. A study evaluating the impact of nicotinamide on protecting against both UVA and UVB damage on melanocytes, the cells that can form melanoma, found a protective effect in vitro.

Which foods contain niacin?

According to the NIH Health Information fact sheet on niacin, there are a number of plant and animal sources for niacin. These include:

• Beef liver

• Chicken breast

• Marinara sauce

• Turkey breast

• Salmon

• Tuna

• Pork

• Beef

• Brown Rice, White Rice

• Peanuts, Cashes

• Breakfast cereal

• Potatoes

• Sunflower seeds

• Bread, whole wheat and white

• Pumpkin seeds

• Lentils

• Bananas

• Raisins

• Tomatoes

• Broccoli

• Apple

• Spinach

• Eggs

• Onions

• Milk

• Chickpeas

• Apples

• Yogurt

The average adult requires between 14 mg to 18 mg of niacin equivalents (NE on a daily basis) based on gender, pregnancy, and lactation status. Tryptophan in the diet is believed to convert to niacin on a 60 to 1-ratio; in other words, 60 mg of tryptophan can be converted to about 1 mg of niacin.

What are the symptoms of a niacin deficiency?

A niacin deficiency is referred to as a condition called Pellagra. Pellagra can result from a deficiency of niacin in the diet and is still found in the world today. In the United States, it was prevalent as recently as the 1930s, however, wheat flour is enriched with niacin to reduce the incidence of this condition.

Pellagra manifests as:

1. Symmetric photosensitive skin eruptions

2. Gastrointestinal symptoms such as vomiting, constipation, and diarrhea

3. Neurologic and psychiatric findings such as depression, headaches, paranoia, fatigue, hallucinations, and suicidal behavior

This constellation of findings has been referenced as the 3 D’s :

• Dermatitis

• Diarrhea

• Dementia

The treatment for pellagra is Nicotinamide 300mg daily along with a B complex vitamin.

Who is at risk for pellagra?

The groups at the highest risk for developing pellagra include:

• Nutrition deficit: This can be from lack of niacin in the diet as well as from malabsorption such as those with inflammatory bowel disease, alcoholism, and post-surgical from various GI procedures. There may also be a deficiency in other B complex vitamins that play a key role in the absorption of niacin which further contributes to a deficiency.

• Hartnup Disease: a genetic condition that interferes with tryptophan absorption

• Carcinoid Syndrome: Neuroendocrine GI tumor that lends to tryptophan’s conversion to serotonin instead of niacin.

• Medications: Isoniazid (a drug used to treat tuberculosis) can induce pellagra

Are there symptoms of nicotinamide excess?

Niacin in high doses can be linked to flushing and gastrointestinal symptoms. Large doses of nicotinic acid can increase blood glucose levels.

How can niacin levels be tested?

There is no reliable blood test for niacin deficiency. Medical literature tends to recommend testing by looking for metabolites in the urine including N′methyl-nicotinamide (NMN) and N′-methyl-2-pyrindone-5 carboxamide (2-pyridone) as lower with levels of NMN < 0.8/mg indicative of a niacin deficiency. However, a review of our regional laboratories' test menus did not have testing available. If not available, testing for serum niacin and tryptophan tends to be more available. Although some sites recommend testing for NAD and NADP, a study from 2007 demonstrated that checking these levels did not reliably test for niacin deficiency.