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Alcohol and Niacin, What's the connection?

Updated: Jul 31, 2023


Alcohol intake and Niacin deficiency

Chronic alcohol dependence (CAD) has many adverse health effects, contributing to liver damage, GI disturbances, neurotransmitter alterations, cognitive impairment, glucose dysregulation, and deficiencies of a wide range of nutrients, especially B vitamins such as thiamine, folate, and niacin.


The CAD and niacin connection can be explained as alcohol can decrease the availability of tryptophan and interfere with tryptophan’s conversion to niacin and nicotinamide adenine dinucleotide (NAD).

When discussing niacin deficiency, the first thing that comes to my mind is Pellagra, a disease that can result from CAD and poor diet, with niacin and tryptophan deficiency as the main feature. Much evidence has shown that niacin supplementation is effective in treating Pellagra. So, can niacin also be a clinical utility for treating alcoholism, CAD, and the long-standing effects of alcohol use?


On this topic, it’s worth sharing the story of Bill Wilson, the founder of Alcoholics Anonymous. At the end of his life, Bill expressed that he wanted to be remembered for his work with niacin as a treatment for alcoholism. In the 1950s, he met Dr. Abram Hoffer and learned about his research on niacin therapy. Bill was sober from alcoholism but suffered from lingering alcohol cravings and mood-related symptoms. He became so intrigued that he experimented with 1000 mg of daily niacin and completely overcame these lingering symptoms. Unfortunately, but not surprisingly, regardless of Bill’s tireless effort to promote the benefits of niacin therapy for alcoholism, his message was mostly dismissed by the medical establishment.


Dosing of Niacin


Skin flushing is a known side effect of nicotinic acid but rarely occurs with nicotinamide. The tolerable upper intake level for adults for both nicotinic acid and nicotinamide set by The Food and Nutrition Board is 35 mg/day. While this applies to the general population, it’s not the recommended dose for individuals under medical treatment for conditions such as Pellagra and CAD. To treat Pellagra, The World Health Organization recommends 300 mg/day of oral nicotinamide in divided doses for 3 to 4 weeks, and it’s often combined with a vitamin B-complex formula.


So, for treating CAD and alcohol-related symptoms, nicotinamide or nicotinamide riboside (NR) is a preferred form of niacin due to its non-flushing nature. But there isn’t a unified optimal dosage for everyone; it should be individualized. Various dosages have been studied, and the observation has been that 100 - 2,000 mg of nicotinamide or NR are generally well tolerated but sometimes can induce minor side effects. However, more severe reactions, such as nausea, vomiting, and liver toxicity, have been observed at very high doses (≥10 g/day) (Niacin | Linus Pauling Institute | Oregon State University, n.d.).

Besides niacin’s potential to treat CAD, and Pellagra, very interestingly, I found a 2018 animal study that concluded NR is a promising nutritional intervention to prevent or reverse alcohol-induced liver injuries by regulating intracellular NAD homeostasis, restoring mitochondrial function, and improving lipid metabolism (Wang et al., 2018).



Jenny Noland, MS, CNS, CNGS, CKNS, LDN, MBA

Functional Nutritionist in Eugene, Oregon

Board-Certified Nutrition Specialist

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References:

Badawy, A. A. B. (2014). Pellagra and Alcoholism: A Biochemical Perspective. Alcohol and Alcoholism, 49(3), 238–250. https://doi.org/10.1093/ALCALC/AGU010

Niacin | Linus Pauling Institute | Oregon State University. (n.d.). Retrieved March 13, 2023, from https://lpi.oregonstate.edu/mic/vitamins/niacin

Wang, S., Wan, T., Ye, M., Qiu, Y., Pei, L., Jiang, R., Pang, N., Huang, Y., Liang, B., Ling, W., Lin, X., Zhang, Z., & Yang, L. (2018). Nicotinamide riboside attenuates alcohol induced liver injuries via activation of SirT1/PGC-1α/mitochondrial biosynthesis pathway. Redox Biology, 17, 89. https://doi.org/10.1016/J.REDOX.2018.04.006

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