Updated Oct. 26, 2017. Since writing this article I’m more and more convinced of the benefit of niacin to those with migraine, despite the fact that niacin is a methyl sponge. Stay tuned for more blog posts on niacin.
Migraineurs generally have high histamine, high homocysteine, low blood sugar, dilated blood vessels and consequent low blood pressure, and liver and gallbladder problems – in addition to the splitting head pain! Niacin (nicotinic acid), as it turns out, is known to contribute to, cause, or exacerbate all of these problems. On the other hand, niacin reduces glutamate and increases serotonin, which in and of itself is hugely relevant to those with migraine.
We need B vitamins, without a doubt. Migraineurs especially benefit from B2 (riboflavin), B5 (pantothenic acid), and B6 (pyruvic acid).
If you have migraines, you probably have already been prescribed B vitamins, especially methylated B12 or methylfolate. The problem is that supplementation with either single or combined B complex vitamins can often trigger migraines. Clearly, we need (some or most) B vitamins, but it appears we often can’t tolerate them. Why are we deficient and why can’t we tolerate supplementation? How do we get out of this chicken-and-egg conundrum? And is niacin (nicotinic acid) one of the culprits in migraines triggered by B vitamins?
First, a Word about Forms of Niacin and Food Sources
Niacin is available in three forms – niacin (nicotinic acid), niacinamide (aka nicotinamide), and inositol nicotinate. Niacin will cause a flush, while niacinamide and inositol nicotinate will not. While all forms are good for their ability to heal schizophrenia, niacinomide is not as effective as niacin or inositol nicotinate for lowering cholesterol. It appears that niacinamide and inositol nicotinate may be more supportive of those with migraine if it is true that they don’t trigger mast cell degranulation in the same way that niacin does (this is discussed later in this article). Slow-release niacin capsules are also available (but not recommended, according to the research I’ve done).
Foods containing niacin include turkey, chicken, liver, mushrooms, peanuts, and tuna. Nutritional yeast also contains very high levels of niacin – and is a known migraine trigger (hmmmmm . . . ). Also, you can buy histamine-degrading probiotics which produce niacin. One of the histamine-reducing strains that produces niacin, b. infantis, can be purchased as a stand-alone probiotic (I found this brand, though I have never tried it so am not promoting it specifically). B infantis also produces the b vitamins folate, biotin, and thiamine.
The Benefits of Niacin
I don’t believe in demonizing any food or essential vitamin, especially not niacin. Like all B vitamins, niacin has an important role to play in our health. Below are some of the properties of niacin, most of which are beneficial to those with migraine:
- helps reduce nitric oxide
- thins the blood
- improves cholesterol levels
- acts as a sleep aide
- has been shown to be especially helpful in healing schizophrenia, alcoholism, and arthritis
- increases serotonin levels by slowing the loss of tryptophan (a deficiency in niacinamide will
drive breakdown of tryptophan. Reduced levels of tryptophan will result in decreased levels of serotonin). (Source)
- acts as an important cofactor in glutamine synthetase enzyme, thus reducing glutamate levels (which get elevated in part due to methylfolate).
- breaks down norepinephrine, epinephrine, and estrogen (as a cofactor for the COMT enzyme)
- protects against both UVA and UVB damage (while sunscreen only protects against UVA.
- helps stimulate production of hydrocholoric acid in the stomach (Source)
Potential Problems with Niacin for Migraineurs
Nevertheless, as mentioned, niacin is a “methyl sponge”. It requires SAMe for its metabolism, and thereby contributes to a drop in methylation. Bad reactions to niacin indicate deficiencies in SAMe.
Niacin also has a range of other effects that are known to be associated with migraine. According to the Mayo Clinic, niacin supplementation may also result in the following symptoms (I have reordered these in order of their relevance to this discussion):
- stomach upset
- liver damage
- increased homocysteine levels
- insulin resistance
- abnormal heart rhythms
In addition, niacin also
- Raises histamine (again, by way of mopping up methyl)
- Contributes to a drop in methylation
- Depletes/lowers B9 (folic acid)
- Depletes/lowers B6 (which we need to produce the DAO enzyme among others)
- Dilates blood vessels (and thereby lowers blood pressure)
One testament to niacin’s ability to raise histamine is the typical face flushing that accompanies it’s use. It was previously assumed that the flushing is the result of a histamine response. It is now understood that the flushing is a result of prostaglandins. According to practitioners of Orthomolecular medicine, people with low histamine need more niacin to get the flush than people who already have high histamine (and migraines) do. It is said that people with high histamine will flush with just 50mg of niacin whereas people with low histamine may need as much as 150mg to flush.
One Major Cause of Low Vitamin B (and Niacin) Levels:
Gut Flora Imbalances
It could be said that migraine is essentially, at its root, a chemical sensitivity and lymphatic congestion issue caused by gut dysbiosis and excessive chemical pollution including pharmaceutical medications. The solution is to heal the gut by rehabilitating gut flora (with help from B vitamins), and in so doing also support the building blocks for optimal nutrient absorption, enzyme function, blood sugar metabolism, blood pressure regulation, and detoxification.
Our gut flora normally manufacture B vitamins in our body for us (with the exception of B12) – assuming the particular gut flora that produce them have not been depleted by antibiotics and medications. When our guts are assaulted by pharmaceuticals and stress, the healthy gut flora are thrown off in favor of histamine-producing bacteria and we become deficient in B vitamins; hence, the need for supplementation. Different B vitamins have different functions, but they work together as a whole family (which is why I question the use of single B vitamins).
The human gut microbiota supplies its host with essential nutrients, including B-vitamins.. . . [H]uman gut bacteria actively exchange B-vitamins among each other, thereby enabling the survival of organisms that do not synthesize any of these essential cofactors. . . [I]n addition to diet, the gut microbiota is an important source of B-vitamins, and . . . changes in the gut microbiota composition can severely affect our dietary B-vitamin requirements. (Source)
If gut flora produce B vitamins, would supplementing with a probiotic to replenish the gut flora help with B vitamin production? Maybe, in theory – but because probiotics are made through fermentation they can often trigger migraine as well. Normally I am not in favor of probiotics for migraine because the “good”, histamine-degrading bacteria are mixed in with some histamine-producing bacteria. Fine and good if you have great gut health – not so great if you already have an overload of histamine.
Dr. Stasha Gominak, a neurologist who started to help her migraine patients by improving their sleep and gut health, is NOT in favor of probiotic supplementation, but she IS in favor of vitamin D and B supplementation:
Current suggested treatments for the ‘wrong’ intestinal bacteria are probiotics and fecal transplants (poop from one person given as an enema to another person to implant the ‘right’ bacteria). Neither of these work for very long. I think the problem is not the supply of the bacteria it is the intestinal environment. We have to supply the happy, helpful bacteria what they need to thrive and they’ll replace the bad guys. My experience has been that the ‘happy, helpful’ bacteria need the proper amount of vitamin D (enough so we aren’t sucking up every bit of it for our own use, this is usually a D25OH blood level of greater than 40 ng/ml. ) plus larger doses of B vitamins for about 3 months. (Source)
The bottom line is that when gut flora are thrown off and detoxification pathways are compromised, inflammation and histamine increase as the body tries to flush out the waste that would otherwise have another means of exiting the body.
Which Bacteria Produce Niacin?
Recently, it was discovered which bacteria produce niacin:
The two most commonly synthesized vitamins of the human gut microbiota genomes were riboflavin and niacin, with 166 and 162 predicted producers, respectively. . . . . However, the two synthesis pathways are distributed differently over the five phyla. Riboflavin synthesis is mainly found in Bacteroidetes, Proteobacteria, and Fusobacteria, but it is only found in half of the Firmicutes genomes and very few Actinobacteria. In contrast, the niacin biosynthesis pathway is more evenly distributed over the genomes of the five phyla. Such differences between the distributions of these two pathways can have various explanations. First, this variation may reflect their evolutionary history; riboflavin synthesis appears to be more ancient than the NAD biosynthesis pathway. Second, the biosynthesis of riboflavin and its derivatives is a quite straightforward pathway, whereas the biosynthesis of NAD is very complex and includes numerous versions of salvage pathways in various bacterial taxa. (Source)
It’s also great news that at least one of the histamine-degrading probiotic bacteria – b.infantis – also produces niacin:
Niacin, or vitamin B3/nicotinic acid, is an essential nutrient, whose importance is often characterized by the consequences of insufficient intake. Symptoms such as nausea, skin problems, headaches, and, in severe cases, pellagra can result from niacin deficiency. . . . Similar to other B vitamins, B. bifidum and B. infantis appear to be good producers of niacin. (Source)
Methylation and Niacin
Phase 2 detoxification pathways are the routes through which our cells hook activated toxic substances up with small nutrient groups, neutralizing them and making them water-soluble so they can be eliminated in urine. One of the major detoxification pathways is called methylation. Our detoxification pathways get overwhelmed by chemical assaults, some of them exacerbated by genetic polymorphisms (like MTHFR, but also those related to sulfation and glutathionation).
These days, it’s all the rage to blame all manner of histamine issue on gene polymorphisms such as MTHFR. And that’s clearly playing a role in people’s elevated histamine issues and histamine intolerance – since those who have high histamine are undermethylated.
But as pharmacist and functional medicine practitioner Suzy Cohen points out, you can be undermethylated without the MTHFR polymorphism – because pharmaceutical medications can also compromise your methylation:
The biggest mistake you could make is thinking that methylation problems don’t apply to you because you don’t have the gene mutation . . . I assure you that your medicine has the capacity to mess up your methylation! (Source)
It’s also worth considering an alternative viewpoint on methylation, Anthony William’s perspective as a medical medium that:
The MTHFR gene mutation test is currently in its infancy and is not as accurate as the medical community believes. . . The MTHFR gene mutation test . . . is just a basic test that reveals inflammation in the body. Although this test is given under the guise of a gene test and a real gene is being looked at, it is ultimately only able to indicate if there is inflammation in the body. . . The inflammation that triggers off a positive MTHFR gene mutation test stems from toxic byproduct wreaking havoc as it moves from the liver into the bloodstream. This can play a part in producing abnormal homocysteine levels. Eventually, this “dirty” blood prevents proper methylation or the conversion of folate or folic acid. (Source)
But for those of us who are generally UNDERmethylated, taking a B complex vitamin that includes both methylated forms of B12 and Folate will be counterbalanced by the presence of the niacin. And if the amount of niacin is very high, the total overall effect could theoretically result in a deepening of the methyl depletion.
So, it’s complex.
Some Additional Considerations Re: Niacin and Methylation
When I spoke with one of the formulators at NOW supplements, they explained to me that 1) quantities of niacin in B complex vitamins are formulated based on a general target market and the ratios presented by the marketplace and competition, as well as by recommended daily allowances set by the National Institutes of Health – B complexes are NOT formulated in ratios meant to prevent undermethylation or specifically for those with migraine.
Also, you can get migraine from both under-and-over methylation, though they are accompanied by different psychological states (undermethylated being more depressive, foggy, and lethargic – overmethylated being more amped and full of tension and anxiety).
There is more to migraine than methylation.
Niacin Can Both Trigger and Treat Migraine.
What is Going on Here?
The literature and anecdotal evidence for how niacin affects migraine is all over the board. There are case reports of people getting rid of headaches using high doses of niacin, as well as a few studies that show people getting resolution of migraine with niacin (some with intravenous niacin, some via the oral route). Finally, there are also anecdotal reports of people’s migraines being triggered by niacin.
There is more to consider about niacin than the fact that it is a methyl sponge. Niacin is also a “histamine liberator”, which might be why taking it would initially raise histamine but eventually clear it out. The ability of niacin to clear out histamine (and glutamate) may explain its ability to benefit those with migraine. Dr. Hoffer, the founder of Orthomolecular medicine and huge proponent of niacin, said:
“It is necessary to give enough (B3) to empty the histamine storage sites to a level at which there is no time to replenish them by the time the next dose is taken. It may require 6 to 8 grams per day for some people.” (Source)
Using niacin to treat histadelia might seem contradictory considering it will augment the release of histamine from basophils and tissue mast cells. However, there is evidence that the niacin flush is mediated by the release of prostaglandin D2 (PGD2) from dermal macrophages and not from degranulation of basophil and tissue mast cells. Further, Hoffer suggested that daily intake of niacin gradually lowers total body histamine by chronically depleting storage levels. Niacin has a complicated mechanism of action that modulates histamine release, lowers total blood histamine, and increases the production of PGD2. (Source)
What to Do?
Given that people with digestive-based migraines generally already have high histamine, LOW blood pressure, and blood vessel dilation, it seems logical that their symptoms would be exacerbated by niacin. Because niacin depletes B6, which is needed to make the histamine-degrading enzyme DAO (diamine oxidase), additional supplementation with B6 may be beneficial for those choosing to supplement with niacin.
Upon reviewing all of this evidence for and against niacin, I initially felt very cautious about niacin, and thought it might even be the culprit B vitamin causing so many migraines in people who take a B complex. But ultimately, I’ve found that intellectual and research-based ideas of how beneficial something is only go so far. Especially when the evidence is mixed or split as to different qualities of a substance, it comes time to experiment. This is where the rubber meets the road.
While everyone may react differently, my observation in clients taking niacin with migraine is that it is actually very beneficial. It appears that its glutamate-lowering and serotonin-raising effects far outweigh its undermethylating and other effects, at least in those people with migraine who have excess glutamate as its cause. Furthermore, it appears that the flushing form of niacin works to abort migraine while the non-flushing forms do not. I also found out that coffee contains a fair amount of niacin and this may be one reason it helps to get rid of migraine. Intriguing!
Other Potential B Vitamin Migraine Triggers
I was always suspicious of methyl B12 as a stand-alone supplement, because I’ve personally experienced migraines triggered by B12. I have come across some evidence that B12 can be toxic in the presence of glutathione depletion. Glutathione is our most powerful and abundant antioxidant in the body, and migraineurs are generally low in it. (As it turns out, triptans – the most popular drug for the treatment of migraine – also deplete glutathione. This is another way of saying that triptans cause inflammation).
Not only folic acid, but also methylated forms of folate can be problematic also because they may increase glutamate and lower serotonin levels. The politics of methylfolate and which forms are available in supplement form as compared to prescription form are especially complex.
I will share more research on this topic in my online course, as well as my blog post on how I make my own customized vitamin B blend.
Empower Yourself to Heal from Chronic Migraine
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