“If you can’t explain it simply, you don’t understand it well enough.” Albert Einstein
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Abstract: The VA Medical Center in Augusta, Georgia, reported the results of a six-month single-center, double-blind, placebo-controlled randomized study using Parkinson’s patients with early- and late-stage disease. They asked the question of whether low-dose daily niacin supplements could improve motor symptoms in Parkinson’s? This clinical trial assigned 21 of 47 patients to receive 250 mg niacin daily after a meal. Following the 6-months clinical study, all patients received niacin for an additional 6-months. The primary outcome measured was UPDRS III (Unified Parkinson’s Disease Rating Scale III); they also measured depression, sleep quality, cognition, and physical fatigue. Importantly, all but two patients tolerated the dose of niacin. The findings here indicate that daily treatment with low-dose niacin (250 mg/day) resulted in significantly improved motor function in Parkinson’s.
“The measure of intelligence is the ability to change.” Albert Einstein
Publication Details (Open Access, free to download, read, and print):
Wakade, C.; Chong, R.; Seamon, M.; Purohit, S.; Giri, B.; Morgan, J.C. Low-Dose Niacin Supplementation Improves Motor Function in US Veterans with Parkinson’s Disease: A Single-Center, Randomized, Placebo-Controlled Trial. Biomedicines 2021, 9, 1881. https://doi.org/10.3390/biomedicines9121881 (Click here access paper)
“You can’t use an old map to explore a new world.” Albert Einstein
Putative Biological Mechanism Being Examined in this Clinical Trial with Niacin: Niacin binds to the niacin receptor on cells in the brain (a G-protein coupled receptor), presumably macrophages. Treatment with niacin is considered anti-inflammatory. Thus, it is thought that niacin upregulates M2 anti-inflammatory macrophages and reduces pro-inflammatory M1 macrophages. This fundamentally assumes the primary process to promote Parkinson’s is neuroinflammation. Then an anti-inflammatory response to negate this neuroinflammation is a reasonable hypothesis. See the figure below to explain their story (it is patterned after the graphical abstract presented by the authors).
“Failure is success in progress” Albert Einstein
Study Description: Following the scheme detailed in the figure below, the trial began with 47 patients, and it finished with 39 patients (only two stopped due to flushing, others just discontinued, and several were dropped due to constraints of the COVID-19 pandemic). The flowchart shows randomly placed niacin (21 patients) and placebo (26 patients) at the end of 6 months, switched to open-label.
“If you want to live a happy life, tie it to a goal, not to people or objects.” Albert Einstein
UPDRS III Scores from 6 to 12 Months of 250 mg Niacin daily: In the placebo group (now receiving niacin), the mean UPDRS III Scores were significantly decreased, as were the niacin group continuing their daily treatment (see Table below). Depending on the test group, they measured changes in bradykinesia, rigidity, and resting tremor, but not in all groups.
“Once you stop learning, you start dying” Albert Einstein
Secondary Outcomes: Grip-strength showed an increase in the niacin group but not the placebo. REM Sleep changed with the placebo but not the niacin group. Sleep efficiency (light, deep, or awake time) did not significantly change.
“Thinking is hard work; that’s why so few do it.” Albert Einstein
Strengths/Weaknesses to the Study:
- A well-designed study that showed a single daily dose of niacin (250 mg) in early- and late-stage Parkinson’s improved the overall UPDRS III scores, rigidity, and bradykinesia.
- The same person performed all the UPDRS III testing throughout the study.
- Their results show that niacin improved motor function and fatigue and stabilized serotonin and REM sleep percentages.
- Grip strength showed a trend increasing with niacin but was not statistically significant.
- The 250 mg daily dose of niacin produced negligible flushing when taken after meals, which was an instruction on how/when to take niacin.
- A limitation is the study size is relatively small, and the patient population tested was primarily older white men, with fewer women and minority populations.
- Another limitation is they did not directly measure levels of niacin.
- There was no measurement of neuroinflammation to determine the fundamental mechanistic role.
- A more significant and more prolonged clinical trial is now definitely warranted.
- However, the results presented suggest that low-dose niacin improves motor functions in Parkinson’s.
“In the middle of every difficulty lies opportunity.” Albert Einstein
Conclusions: This paper was just published earlier in December. I will consider adding it to my existing treatment regimen. However, I will bring it up with my Neurologist* first (by email at least). The Mayo Clinic lists a few warnings and precautions about taking niacin (click here to read it). Let me know if you are already using niacin or decide to add it to your daily take of substances for Parkinson’s.
Please Note: A follow-up blog post has been posted with some important information. This blog post can be read here (Click here).
*Medical Disclaimer: As with anything you read, please consult your Neurologist before taking niacin. While it appears totally safe, that does not mean it is right for you to take for your Parkinson’s.
“Live life to the fullest. You have to color outside the lines once in a while if you want to make your life a masterpiece. Laugh some every day. Keep growing, keep dreaming, keep following your heart. The important thing is not to stop questioning.” Albert Einstein