While vitamins C and D have garnered much attention in the fight against COVID-19, B vitamins can also play an important role, according to two recent papers — niacin (B3) in particular. The first, "Be Well: A Potential Role for Vitamin B in COVID-19,"1,2,3,4 was published in the February 2021 issue of the journal Maturitas. The paper is the result of a joint collaboration between researchers at the University of Oxford, United Arab Emirates University and the University of Melbourne, Australia. While no studies using B vitamins have been performed on COVID-19 patients, the researchers stress that, based on B vitamins' effects on your immune system, immune-competence and red blood cells (which help fight infection), supplementation may be a useful adjunct to other prevention and treatment strategies. As noted by the authors:5
B Vitamins Play Many Roles in COVID-19 Disease ProcessImportantly, B vitamins can influence several COVID-19-specific disease processes, including:6
The paper goes on to detail how each of the B vitamins can help manage various COVID-19 symptoms:7
Niacin — A Missing Piece of the COVID-19 Puzzle?The second paper,14 "Sufficient Niacin Supply: The Missing Puzzle Piece to COVID-19 and Beyond?" (which is a preprint and has yet to undergo peer review), focuses specifically on niacin (B3), raising the question of whether this vitamin might actually be a crucial player in the COVID-19 disease process. As noted in the abstract:
As noted in this paper, a primary hallmark of COVID-19 pathology is the cytokine storm, which can lead to multiple organ failure and death. Marked elevations in proinflammatory cytokines are to blame for this chain of events, most notable of which are interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein-1 (MCP-1). If you can decrease and control these damaging cytokines, you stand a good chance of thwarting the cytokine storm and the downstream damage it causes. Nicotinamide adenine dinucleotide (NAD+) plays an important role in this, and niacin is a building block of NAD. As explained in "Be Well: A Potential Role for Vitamin D in COVID-19":15
Aside from markedly decreasing proinflammatory cytokines, niacin has also been shown to:16
Niacin Modulates the Bradykinin StormCOVID-19 also triggers bradykinin storms. Bradykinin is a chemical that helps regulate your blood pressure and is controlled by your renin-angiotensin system (RAS). The bradykinin hypothesis provides a model that helps explain some of the more unusual symptoms of COVID-19, including its bizarre effects on your cardiovascular system. Researchers have discovered SARS-CoV-2 downregulates your body's ability to degrade or break down bradykinin. The end result is a bradykinin storm, and this appears to be an important factor in many of COVID-19's lethal effects, perhaps even more so than the cytokine storms associated with the disease. As bradykinin accumulates, the more serious COVID-19 symptoms appear. Vitamin D has a significant impact on the RAS,17 and can therefore help prevent a bradykinin storm, but niacin also plays an important role. As noted in "Sufficient Niacin Supply: The Missing Puzzle Piece to COVID-19 and Beyond?":18
The paper also expounds on the role of NAD+, and why niacin is a useful strategy for boosting NAD+:20
Recommended UseThe paper21 goes deep into the biochemical aspects of how niacin works in your body, so if you're interested in that, you may want to read through it. In summary, as it pertains to COVID-19, the important thing to understand is that there appears to be a causative link between low niacin status and SARS-CoV-2 infection. According to the authors, SARS-CoV-2's ability to invade your body is dependent on whether calcium signaling can properly proceed, which in turn is dependent on the presence of NAADP. And, as explained in the quoted section above, niacin forms NAADP in your body. NAADP-dependent calcium signaling is responsible both for the inhibition of viral entry into cells and driving the virus out of already infected cells. And, again, the authors stress that "nothing outside of sufficiently, dynamically supplied niacin is capable of readily leading to the NAADP supply needed in these acidic environments for therapeutic action that counteracts inflammatory disease progression." They also point out that the flushing you get from niacin is part of how the niacin drives inflammatory free radicals out of the cells. As you continue to take the supplement at a consistent, sufficiently high dose, that flushing will gradually lessen, which is a sign that your body is reaching a healthy homeostasis.
While the flushing can be uncomfortable, the authors stress that it is "indeed safe," and actually "should be sought when needed for its anti-inflammatory properties." Suggested DosingAs a "health restorative therapy" for those diagnosed with SARS-CoV-2, they recommend starting with a dose of 500 milligrams of immediate-release niacin, two to three times a day, ideally within the first 48 hours of symptom onset. As your flush response lessens, increase your dose to 1,000 mg, two to three times a day.23
Although the authors suggest you can use niacin prophylactically, using that same dose, I disagree. According to the authors:25
There may be some value to the high doses in acute COVID-19 infections but I am skeptical. I am a huge fan of NAD+ augmentation and have been using it for years. My research suggests you really only need about 25 mg per day of niacin, which will not cause flushing in nearly anyone. I believe most would benefit from taking 25 mg of niacin daily, preferably in a well-balanced B complex, which would have thiamine (B1) that has also been shown to be useful in COVID-19. Other alternatives to high-dose niacin would be nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), which is my personal favorite. I believe that compounding these into rectal suppositories would avoid most of the methylation of the supplement and supply you with higher NAD+ tissue levels. Another downside of high-dose niacin is that it breaks down to nicotinamide and in high doses, nicotinamide will inhibit Sirt1, which is an important longevity protein. Personally, I believe a superior strategy to high-dose niacin in acute COVID-19 would be to use nebulized hydrogen peroxide at 0.1%. I have never seen or heard of this intervention failing in the treatment of COVID-19. How to Improve Your Vitamin B StatusAs a general rule, I recommend getting most if not all of your nutrition from real food. This will work well for most B vitamins, but not if you're using niacin therapeutically, as described above. For that, you will need to take a supplement. That said, the list below will show you which foods contain which B vitamins, as well as provide general guidance on dosage if you're taking a supplement. If you're trying to improve your vitamin B status, also consider limiting sugar and eating more fermented foods. The reason for this is because the entire B group vitamin series is produced within your gut, assuming you have healthy gut flora. Eating real food, including plenty of leafy greens and fermented foods, will provide your microbiome with important fiber and beneficial bacteria to help optimize your internal vitamin B production.
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