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The Nutrition InvestigatorThe health and nutrition blog by Dr. Roc Ordman.

Niacinamide to prevent Type I diabetes?

by Roc (click here for full post)

This is an email I received from a reader, Tom Petrie, that I think is worth sharing.  I have not had time to research it myself, but if I had or was at risk for type I diabetes, I would check it out and share it with my physician:

Niacinamide, B-3, a B-vitamin (but NOT nicotinic acid form) Against Type I Diabetes

Summary by Tom Petrie

 

  1. Niacinamide first shown in 1950 to prevent the development of Diabetes in exp. Animals.  Lazarow A., Liambies L., and tausch AJ, Protection against diabetes with nicotinamide.  J. Lab. Clin. Med. 36, 249-258, 1950.   This indicates that the use of this B-vitamin against D. is NOT new but over a ½ century old.
  2. Possilli P and Andreani D., The potential role of nicotinamide in the secondary prevention of IDDM. Diabetes Metabol Rev., 9, 219-230, 1993 as reported in M. Murray Encycl of Nutr. Supplements, 1996.
  3. Mechanism of action appears to be (a) inhibition of macrophage and interleukin-1-mediated beta cell damage and (b) inhibition of nitric oxide production.  The anti-oxidant role of B-3 may also be involved.  Andersen HU, et al., Nicotinamide prevents interleukin-1 effects on accumulated insulin release and nitric oxide production in rat islets of langerhans.  Diabetes 43, 770-777, 1994
  4. B-3 also increases insulin production and insulin sensitivity according to a1993 study (as reported in Murray’s textbook on Nutritional supplements, pg. 95):

Bingley PJ., et al., Nicotinamide and Insulin secretion in normal subjects. Diabetologia 36, 675-677, 1993.

  1. In one of the first pilot studies of newly diagnosed IDDM, 7 patients, B-3, 9, placebo:  After six (6) months, 5 of 7 on B-3 NOT taking insulin, while 2 of 9 in placebo group still not taking insulin AND had normal blood glucose numbers AND normal HgbA1c.  After 12 months, (one year), 3 patients in the B-3 group and NONE in the placebo group were in clinical remission.

Vague PH, et al., Nicotinamide may extend remission phase in insulin dependent diabetes.  Lancet I, 619, 1987

  1. Murray reports that as of April, 1995, NINE (9) studies, six (6) double-blind, THREE (3) show a positive effect compared to placebo in these terms: (a) prolonged non-insulin-requiring remission, lower insulin requirements when used, (b) improved metabolic control and (c) increased beta-cell function as determined by C-peptide secretion.
  2. Differences between positive and negative studies: (a) OLDER AGE: more difficulty! (b) higher baseline fasting C-Peptide in positive studies, (as would be expected as this indicates degree of residual pancreatic functioning, if any).  (Note: C-peptide should not be confused w/C-reactive proteins, a marker for inflammation that is possibly related to cardiovascular disease.)
  3. Children use 100 to 200 milligrams, adults, 25 milligrams per kilogram of body wt.
  4. B-3 may reduce development of Diabetes in at-risk children who have not yet developed the disease.  Of 20,000 children screened (New Zealand study reported in Encyclopedia of Nutritional Supplements, by Michael Murray, N.D., 1996, pg. 94: Elliot RBG and Pilcher CC, Prevention of Diabetes in normal school children. Diabetes Res Clin Pract 14, S85, 1991; Also, Mandrup Paulsen T, et al., Nicotinamide in the prevention of insulin dependent diabetes mellitus. Diabetes Metabol Rev., 9, 295-309, 1993), 150 eligible for study… All had Islet Cell Antibodies (ICA) at a high level, e.g., greater than 10 per ml.  Those treated with B-3, incidence of Diabetes, 8.1 per 10,000, per year…15.1 in those 12,000 children who were offered a test but who declined,   and 20.1 in 48,000 children not offered testing.  These are VERY impressive results and indicate screening (ICA values) to be a smart idea!
  5. B-3 (niacinamide) alone, w/cyclosporine or no treatment: After three months, 6 of 30 positive response (B-3 group alone); 1 of 30 (B-3 plus Cyclo group) There was no remission in the control group.  After six months, the numbers were as follows: group 1: 4/29; group 2: 3/27; group 3: 1/29, respectively.  ONE YEAR, the numbers were as follows: 4/27, 2/25, 0/28.  Also, clinical remission lasted longer (7 months) in niacinamide-treated patients than in those also receiving cyclosporin.  THESE RESULTS INDICATE THAT CYCLOSPORIN DOES NOT IMPROVE CLINICAL OUTCOME AND MAY ACTUALLY IMPAIR THE EFFECTIVENESS OF NIACINAMIDE. 

Vialettes B., et al., A preliminary multicentre study of the treatment of recently diagnosed type I Diabetes by combination nicotinamide-cyclosporin therapyDiabet Med 7, 731-735, 1990

  1. Some studies have looked at the use of B-3 (as niacinamide) w/the ‘corticosteroid’ deflazacort.  However, like the situation w/cyclosporin, the benefits for recent onset Diabetes appear better when B-3 is used alone. 

Pozzili P., et al., Combination of nicotinamide and steroid versus nicotinamide in recent-onset IDDM., Diabetes Care 17, 897-900, 1994

 

Diabetes, Prednisone:

  1. B-3 (niacinamide form) may be more effective than prednisone (and safer too); while prednisone suppresses the immune system, it also increases blood glucose!
  2. Prednisone causes ICA (islet cell antibodies) to become negative, however, this effect was transient in 4 of 10 subjects.  No patient experienced complete remission.  Insulin requirements were reduced however.
  3. Another study showed increases in endogenous insulin release AND increase in urinary C-peptide excretion.
  4. Mistura L., et al., Prednisone treatment in newly diagnosed Type I Diabetic children: 1-yr follow-up.  Diabetes Care 10, 39-43, 1987; Prednisone therapy (along with varied doses/types of insulin injections apparently NOT beneficial over the long term (15, 30, 60 milligrams given)
  5. Immunosuppressive therapy, results NOT very impressive.  Results w/Stronger drugs than prednisone used like azathioprine:  Two or three of twenty did NOT have to use insulin after one year … [This means that 17 or 18 of 20 HAD to use insulin after one year.]

This summary lends significant support to the use of therapeutic niacinamide/nicotinamide in cases of newly diagnosed Type I diabetes.

 

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