Results of a pilot study of 2 low doses (100 & 250mg) of Niacin (vitamin B3 derivative) in 47 people with #Parkinsons; 3-month double-blinded (vs placebo) run-in + 12 month open label study; 3.5 point average improvement in the UPDRS III, inflammation
Vitamin B3 trial results: Results of a... - Cure Parkinson's
Vitamin B3 trial results
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Farooqji
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Adding 250 mg of Niacin to the stack! Thanks!
you have to do it gradually at the beginning otherwise the Flush will put you through a bad quarter of an hour.
healthline.com/nutrition/ni...
Hi Gio', which product are you using and what dosage?
Io uso prodotto della vegavero pastiglie divisibili da 500mg . Una al giorno ma sono abituato al flush e non mi spaventa. Ti consiglio di partire basso a 50mg/ giorno per un po’ e vedi come va .
So, if I may ask, how is the 500 mg of Niacin working for you Gio?
I have always taken it occasionally for a month, three or four times a year, in high doses of up to 1000 mg and more. In the last three months alone I have gone up to 500 mg per day and there have always been good indicators: improved sleep, better sense of smell, more energy, and mental clarity. I am unable to assess whether it stops progression which would be beyond the acceptability of HU as you can see with this post.
I take it without ever lacking other vitamins in normal doses, minerals magnesium, calcium, lots of vegetables, olive oil and nuts. (it makes a lot of difference). I have also been on HDT for 5 years and I work full time, recovered from very mild CVirus type two months ago.
The flush is the funniest part of this vitamin 😁😁😁
Sorry for the fragmented and poorly written post but at the moment I'm falling asleep here it's one in the morning.
A warm greeting from Italy and good night.😴
Talking bout stack, this is what my husband is on but it's disappeared from Amazon shelves.
Conclusion
We have demonstrated the potential effectiveness of over-the-counter niacin enhancement as a proof of concept to support the well-being of individuals with PD. Vitamin B3 augmentation has the potential to maintain or improve symptoms. Based on the results of this effectiveness exploratory trial, a larger multicenter RCT is warranted.
Here is the same study at Researchgate.net: researchgate.net/publicatio...
So is this it? 47 patients, 12 months, no progression? I'm sorry to ask.
in reply to Bolt_Upright
I’m glad you asked. I need the same clarification. Seems too good to be true.
park_bear in reply to
I do not see any other way to interpret this:
"An average of 9 ± 6-point improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS) III (motor) score was observed after 12 months of daily niacin compared to the expected decline in score "
Personally I have been taking 500 milligrams of niacinamide daily for years. My Parkinson's has not progressed over the last four years. Perhaps this has something to do with it. Niacinamide has been shown to reduce incidence of skin cancers. As far as I have been able to tell its effect is similar to niacin with the exception of not causing flushing and not reducing cholesterol levels
Good for you park_bear!
niacinamide may be helping you, but through a different mechanism than the rationale given for this study. Nicotinic acid acts via GPR109A, but not niacinamide (aka nicotinamide)
Can the body not convert niacinamide to niacin?
I don't think there is direct interconversion between the two. Nicotinic acid is is used for its cholesterol lowering effect, which may share the same mechanism via GPR109A - but niacinamide is not effective for lowering cholesterol.
Hi ParkBear which brand of B3 r u using? I want to try
PB, I hope you are well. The reason to take niacin is two fold, 1) carbidopa/benserizide reduces niacin levels (which niacinamide can replete) and because it makes you flush (which niacinamide cannot do). Flushing is the expression of GPR109a protein which is a source of inflammation in PD. In the article,
GPR109A Protein Expression
"The interaction effect in the two-way Time × Group mixed ANOVA was significant, F(4,72) = 3.06, p = 0.022. Tukey’s simple effect analyses on each group showed that GPR109A levels decreased in the 250-mg group at 3 months, p = 0.0002. At 12 months, GPR109A levels across the groups decreased by an average of 172% compared to those at baseline, p = 0.0002, ES = 0.84."
I have been suggesting that niacin should be a standard therapy for PWP for years and continue to think it so. Here some random thoughts and trivia about niacin/niacinamide. Also, I know Dr. Laura Mischley uses increasing doses of niacin for her PWP patients and I regard her among the best therapists for PD.
First why is it called niacin called niacin when its chemical name is nicotinic acid? Shockingly (and stupidly) nicotinic acid was renamed niacin by people in the prohibition era because nicotinic acid/niacin was first synthesized by oxidizing nicotine!! We do not want innocent niacin to be related to demon tobacco!! The scientific name for niacinamide is nicotinamide just as the scientific name for niacin is nicotinic acid.
And secondly, I worked with a woman who wanted to quit smoking and once read a drug patent which posited the way to quit smoking was to take increasing doses of niacin/nicotinic acid because the flushing from niacin has a similar bodily sensation as does smoking a cigarette.
patents.google.com/patent/C...
I saw her maybe 9 months to a year later and she said her doctor loves me. From taking increasing doses of niacin she lost 80 pounds!! My external facial expression was encouraging and I said 'good for you'. Internally I was trying to not have my jaw slump open up and I was astonished. Well, with research guess what I found? Niacin can lead to decreased adipose inflammation:
Anti-inflammatory effects of nicotinic acid in adipocytes demonstrated by suppression of fractalkine, RANTES, and MCP-1 and upregulation of adiponectin
"Objective: A major site of action for the atheroprotective drug nicotinic acid (NA) is adipose tissue, via the G-protein-coupled receptor, GPR109A."
pubmed.ncbi.nlm.nih.gov/197...
Bottom line, niacin/nicotinic acid has an anti-inflammatory effect for many conditions and should be part of everyone's daily therapy (even if you do not have PD).
Silvestrov,
Very well said , I agree in everything and thanks.
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In my humble opinion there are benefits for the skin and recovery from past solar radiation which is a factor in aging. (Niacin flush blush will sometimes form on the skin drawing old burns).
It also prevents skin cancer.
A warm greeting from Italy and I wish you a life as beautiful and interesting as your works of art.
Gio
GioCas,
Thanks for your warm greeting fromm Italy! I have been off this site for a while because I was busy preparing for in a Pittsburgh art show (and 2 paintings sold!) My new gallery is the Christine Frechard Gallery and she has duel French/Italian roots and she is currently vacationing in Italy. I made a gallery of the show on my website and hope you like what the pictures, cheers!!
richardmelvin.com/christine...
Liked the pictures. I live in the Pittsburgh. I wish I had known about this sooner. You are very talented
How much should you take?
Hi Smittybear7,
The following article has people on different doses (and types) of niacin. They have some people on 100 mg of regular niacin or 250 mg doses of extended release niacin.
frontiersin.org/articles/10...
Of the two I recommend taking 100 mg of regular niacin taken with breakfast, lunch and dinner - 100 mg three times a day. The lowest minimum dose of niacin which causes flushing is 40 mg but if you take niacin with food the flushing is tolerable. It is like your skin getting a temporary suntan. The reason why I recommend regular niacin is because of the flushing.
"Niacin induces flushing through dermal Langerhans cells where the activation of G protein-coupled receptor 109A (GPR109A)...."
ncbi.nlm.nih.gov/pmc/articl...
Yes, when niacin makes you to flush, it is because it activates GPr109a. And how does niacin relieve inflammation in Parkinson's disese? Niacin Ameliorates Neuro-Inflammation in Parkinson’s Disease via GPR109A mdpi.com/1422-0067/20/18/45...
So flushing is indispensible to PD and I realize the above contradiction. I recommend taking niacin because it flushes and also recommend niacin to be taken with food because it makes the flushing more tolerable. If you can handle it without food so be it but it will be uncomfortable. You can build up to 100 mg because the longer you take niacin the less it makes you flush. Dr. Mischley places her patients on increasing doses of niacin until they reach the 3,000 mg/day limit. This is a ambitious approach but it should be approached with caution because high dose niacin can negatively affect the liver.
"Very high doses of niacin (1,300–3,000 mg per day) are sometimes used to treat high blood cholesterol levels. However, there can be side effects such as flushing of the skin, itching, nausea, increased blood glucose, stomach ulcers, and even liver damage. New forms of high-dose niacin supplements are extended release preparations to minimize these side effects (Grouper and Smith 2008). Do not take large amounts of niacin unless prescribed by your doctor! Let your doctor know if you have side effects from taking niacin supplements." edis.ifas.ufl.edu/publicati...
If you have any reservations about taking niacin (at any dose), and your liver, there are plenty of liver-protective supplements available. N-acetylcysteine, which is good for the liver and PD. Also a supplement containing silymarin, which is derived from the herb Milk thistle. Any good Milk thistle supplement should be taken at 80% silymarin concentration. 80% is the percentage of silymarin makes the supplement hepatoprotective - it will protect the liver.
Gotta go, have a good day!!
laglag in reply to
Gio's attachment explains a few negatives. Flushing, liver damage and becoming immune to it.
I did not find the liver damage and becoming immune parts.
But I did find this article saying Slow Release Niacin (the kind used in the study) was the worst for liver damage. That's not good. ncbi.nlm.nih.gov/books/NBK5...
More not good with extended release: aasldpubs.onlinelibrary.wil...
I read that slow release 800mg niacin is related to liver damage in a book called Grow Young with HGH by a Doctor Klatz.
Husband was on Niacin for a brief period. Due to side effects, he switched back to TRUE NIAGEN. He was doing a lot better on it.
I got about halfway through the many references before my endurance wore out. Almost all cases liver injury occurred at doses greater than or equal to 1.5 grams per day of sustained-release. There was one case each of liver injury at daily doses of 500, 750, and 1000 milligrams. Very odd that this occurs with sustained-release but not immediate release forms. I am inclined to pass on the whole deal and stick with niacinamide.
Hope I did not scare you off. When I corresponded with the team that did the study they were not concerned at all about 250 mg.
I'm thinking niacin plus butyrate now. I guess I'm all over the place. Guy on another forum swears by 500 mg of niacin and twice the recommended dosage of butyrate (I think he misread the label, but he is sticking with it.
I like that niacin calms inflammation in the gut too (not just the brain).
But I am not a doctor, and you have been stable for 4 years, so be careful and follow your gut 
No worries. It was good that you found the toxicity issue with the sustained-release version.
The lack of placebo control really does impair the significance of this study. Given the issues of toxicity, and flushing, and the fact that I am doing pretty okay adds up to me passing on this idea.
These 2 things just caught my eye when I read the article?
"People usually develop a tolerance to the supplements over time.". (It says tolerance rather than immune)
Long-acting niacin is associated with significantly reduced flushing, as it’s absorbed over a long time period that typically exceeds 12 hours. Because of this, taking long-acting niacin significantly reduced the chances of flushing (11Trusted Source).
However, because of the way the body breaks it down, taking long-acting niacin may have toxic effects on the liver, dependent on the dose taken (11Trusted Source).
Although uncommon, switching from an immediate-release niacin to a long-acting niacin or significantly increasing your dose can result in serious liver damage (27Trusted Source).
What’s more, niacin absorbability depends on the niacin supplement that you take.
The flush is just a histamine release -- so with that in mind I guess you could live with it.
lag lag everything is correct! the form of b3 used here is b3 Na (nicotinic acid and I am not aware that it is the slow release one), and it is the form that gives the flush. IMO the only form that works and is safe. However, there is a lot of serious bibliography about it including the last two posts by Silversted and two articles by Simon on the Sciences of Parkinson (see above). In my opinion 250 mg is a low dose.
healthunlocked.com/cure-par...
Gioc in reply to
Certainly as per the attached table. There are many testimonials here on HU of the benefits of niacin. Personally I have been using it for three years in occasional cycles with ample breaks because I think it goes with other vitamins and minerals and I feel very good. A personal example of mine is the immediate recovery of the sense of smell, sleep, mental clarity ... It is not an easy vitamin and requires expert instruction or supervision because it gives the so-called flushing. I'm glad it proved that it slows down progression, but I would have continued to take it for all other reasons anyway. Simon talks about it here:
scienceofparkinsons.com/201...
Above Simon is already talking about this research, he explains it well and what results he has given after only three months.
scienceofparkinsons.com/201...
pubmed.ncbi.nlm.nih.gov/297...
Tabella
I think I know who this will interest: Niacin, good for the microbiome.
Niacin and Butyrate: Nutraceuticals Targeting Dysbiosis and Intestinal Permeability in Parkinson’s Disease
researchgate.net/publicatio...
Maybe you are unterested:
healthunlocked.com/cure-par...
Thanks. I love my tea. I was thinking of stopping as apparently it works against high dose B1 HCL, but this tipped me back to the Tea category. Thanks!
Maybe you have already seen it, but if you scroll through the post there is something more about niacin.
Wow. This team is 6 years into this research. This looks like their first, single patient, study from 2015:
Low-dose niacin supplementation modulates GPR109A, niacin index and ameliorates Parkinson's disease symptoms without side effects
I don't know if this guy knows what he is talking about, but he has 130K views:
Very good video! Thanks for posting.
Thank you for posting this video,this person is excellent and certainly know about Niacin.(B3).
Good information on Niacin and liver damage. I might opt for immediate release instead of the Slow Release used in the trial. aasldpubs.onlinelibrary.wil...
The trial which is published with meaniful results used slow release,and the data showed 100mg twice a day to be effective,the liver page you quote showned liver damage in one patient and a higher dose 500mg.I would prefer respectfully to use the evidence based 100mg twice a day slow release as used in the trial.I should point out I am not medically qualified,and it would most helpful to see what doctors thinks of this trial.Obviously as the trial says more randomised placebo control trials should be conducted to support these results.However,the results are promising.
The first 3 months they were split with one group taking 100 mg SR and one group taking 250 mg SR.
"Subjects were randomly assigned to the placebo (n = 16), 100-mg (n = 15), and 250-mg (n = 15) slow-release niacin groups."
But then they switched up for 12 months:
"Following the 3-month test, a 12-month effectiveness trial (Gartlehner et al., 2006) of fixed-dose 250-mg slow-release daily niacin was carried out. Subjects in the placebo and 100-mg groups switched to the 250-mg regimen for 12 months, while the 250-mg group continued the same dosing regimen for 9 months (to also achieve 12 months of 250-mg supplementation)."
You are prescient though. I've been told the next study will probably be 100 mg twice a day to see if spreading it through the day helps.
Also, I decided to go ahead and use the 250 mg SR (although mine says Extended Release. Hope that is the same thing).
in reply to Bolt_Upright
May I clarify / confirm : nicotinic acid is the one to take. Not niacinamide or nicotinamide, correct? Does anyone know what brand / source thr study used? What brand did you get?
I believe I have been taking the wrong kind.
Bolt_Upright in reply to
The detail may be in this version of the report. I will try and find the brand also.
researchgate.net/publicatio...
I assume that by niacin the researchers mean very normal nicotinic acid and not slow release, that is B3 NA called niacin, but I do not find anything else written here. What is niacin is a question that perhaps only us non-experts ask ourselves.
They say slow release right in the report. I'm trying to figure out if "slow release" is the same thing as the "time released" I bought today.
Oh ….Okay thank you👍
now I understand: in the 100mg group they used normal niacin and in the 250mg group they used slow-relase niacin to avoid flushing. However it is the same substance, only the release time changes.
Quote:“Subjects were randomly assigned to the placebo (n = 16), 100-mg (n = 15), and 250-mg (n = 15) slow-release niacin groups .”
Yes. I think there is something in the report about over half the 100 mg group flushing but only 5% of the 250 mg group flushing. Makes sense if the 100 mg group got instant release.
I quote:
“Eighty percent of the subjects in the 100-mg group reported experiencing flushing during this period (from occasional to frequent), which is a common feature of niacin supplementation. Within the 250-mg group, 5% of subjects experienced the flushing response. In all cases, the symptom lasted 30–45 min, after which no other symptoms nor events occurred.”
Thanks. I started my 250 mg time released today. I am checking to make sure I'm taking the correct stuff.
I have not been diagnosed with PK. I was diagnosed with REM Sleep Behavior Disorder (for some reason I think I need to keep pointing this out).
I feel good about this.
I understand you, from my experience I'm sure it works for this.
Those who have been using niacin for years know how to manage the flush, but as this is a research with new people I suppose they have to be cautious about this.
Hi, Bolt. I believe many with RBD go on to be diagnosed with PD. How did the niacin supplementation go for you? Did it help with your sleep?
Most go on to get a PD diagnosis 
My sleep is improving. I do a lot of things. I do believe in the Niacin.
Thank you! Of interest is CQ10 , niacin and hydrogen water. Dr Shallenburger said that 1000 mg of ubiquinol =2000 mg of CQ10 could stop progression of PD.
Bolt_Upright in reply to
I checked with the team on what they used in the study:
No specific brand as they got them through a pharmacy (no prescription needed).
You can buy them anywhere like Costco, Sams, Walmart, Publix, Nature's, etc.
The particular B3 formula they used in their study is niacin, or nicotinic acid. This formula produces the flushing effect which can be avoided by taking the SR version (usually 250mg and up, they could not find SR for 100 mg), or take it at the end of a meal, and/or cool drink. Taking niacin on an empty stomach and/or hot drink will increase the severity of the flush.
Other B3 formula do not produce the flushing, like niacinamide. Niacin is the only B3 formula that they know which has an anti-inflammatory action, that is why they are interested in studying it.
You can tell which B3 you are buying by looking at the back label. If you want the niacin type, the ingredient should say "niacin" or "nicotinic acid". There should also be a statement that it may cause flushing.
They also answered my question on whether Time Released (what I bought) was the same as Slow Release (what they used for the 250 mg dose):
SR versus TR has a slight difference. SR tablets break down slowly, releasing a bit of drug/supplement at a time, continuously. TR releases a small batch at a time (non continuous), so there is a gap of time where the tablet travels through the digestive system but it is not releasing the drug/supplement.
Bolt
KERRINGTON in reply to
Hi...just wondering if you ever found out which form of niacin is recommended ?
One of the co-authors, Dr. Morgan is a Neurologist and the Director of Medical College of Georgia's Parkinson Foundation Center of Excellence
I really wish researchers would be more precise - niacin comes in different forms. I am assuming this is slow release nicotinic acid. Nicotinic acid has different activity from niacinamide (aka nicotinamide) and other forms of niacin.
This is good! Thx for sharing. I have been using NADH (B3) for a while now and I love it. I use 15 mg in the morning 30 min (along with my L/C) before breakfast and then I do my exercise routine and I’ve got much more energy! My arms and legs don’t feel heavy! It greatly depends on what kind of NADH you are taking. The niacin is not tolerated as well as nicotinamide. There is a company that has a patent which makes it very well absorbed. I ran out of the Enada brand and started using a cheaper brand without realizing the difference and it was not effective at all until I Started using Enada again. It wasn’t placebo effect because I had no idea that there was a difference. Another note of interest is that the Doctor who patented this, was also the one who came up with levodopa treatment previously. nadh.com/
Info
Have learned to be guarded about open label studies. Surely there is a viable mechanism for adverse event detection at 3 months that doesnt prevent you from continuing the blinding for the following 12 months?
I checked with the team on what they used in the study:
No specific brand as they got them through a pharmacy (no prescription needed).
You can buy them anywhere like Costco, Sams, Walmart, Publix, Nature's, etc.
The particular B3 formula they used in their study is niacin, or nicotinic acid. This formula produces the flushing effect which can be avoided by taking the SR version (usually 250mg and up, they could not find SR for 100 mg), or take it at the end of a meal, and/or cool drink. Taking niacin on an empty stomach and/or hot drink will increase the severity of the flush.
Other B3 formula do not produce the flushing, like niacinamide. Niacin is the only B3 formula that they know which has an anti-inflammatory action, that is why they are interested in studying it.
You can tell which B3 you are buying by looking at the back label. If you want the niacin type, the ingredient should say "niacin" or "nicotinic acid". There should also be a statement that it may cause flushing.
They also answered my question on whether Time Released (what I bought) was the same as Slow Release (what they used for the 250 mg dose):
SR versus TR has a slight difference. SR tablets break down slowly, releasing a bit of drug/supplement at a time, continuously. TR releases a small batch at a time (non continuous), so there is a gap of time where the tablet travels through the digestive system but it is not releasing the drug/supplement.
Bolt
More niacin esoterica. I cannot remember which article I read the following in, but the minimum amount of niacin required to make a person 'flush' is 40 mg. If you take niacin on an empty stomacy you will flush more than if you take it with food.
Interestingly, regular drinking of coffee can also contribute niacin to your diet. Of course it depends on which blend of coffee you consume.
Synthesis and Availability of Niacin in Roasted Coffee
"The coffee bean contains about 1% of trigonelline that is demethylated at temperatures approaching 200° C; it is partially converted into nicotinic acid. This operation is mainly proportional to the severity of dry heat treatment; various other physico-chemical factors also influence the synthesis of niacin during the roasting. The niacin content of weakly roasted commercial coffee is about 10 mg/100 g (American coffee) and it reaches 40 mg in heavy roasted coffees, i. e. Italian coffee. Caffeine-free coffee is lower in niacin than the corresponding raw coffee. The drinking retains 85% of the niacin formed during roasting; it is totally available for the organism and can constitute a noticeable part of the daily supply in niacin."
PD patients are found to have significantly decreased niacin levels compared to age-matched healthy controls [52]. This has been attributed to both the disease itself and the medication used to attenuate motor symptoms [58]. Sinemet, the most commonly used PD medication, includes carbidopa, which prevents the conversion from l-dopa to dopamine within the peripheral nervous system. This allows more dopamine to be taken up by the central nervous system and used where it is scarce after dopaminergic cell loss. Unfortunately, a consequence of carbidopa is reduced conversion of tryptophan to niacin. Sinemet dose and frequency are increased over time as PD symptoms worsen, but concurrently side-effects also worsen.
There are multiple forms of Vitamin B3, including nicotinic acid, nicotinamide, and nicotinamide riboside. Although all three forms provide a natural source of nicotinamide adenine dinucleotide (NAD) to the body, only nicotinic acid (niacin) binds to the anti-inflammatory GPR109A receptor [59]. In a clinical trial, it was found that the GPR109A receptor is upregulated in the white blood cells (WBCs) of PD patients [52]. After taking daily niacin supplements, the levels of the GPR109A receptor were reduced to a similar level of age-matched healthy controls. Subsequent anti-inflammatory effects have also been found in patients taking niacin. A shift in macrophages from a pro-inflammatory phenotype to an anti-inflammatory phenotype has been found after niacin supplementation, as shown in Figure 2 [60]. In LPS-activated mouse microglial cells, niacin was able to reduce IL-6 and IL-1β production [17]. Moreover, when GPR109A was downregulated with siRNA, niacin was not able to produce this effect.
A case report of a PD patient taking a high-dose niacin supplement for high triglyceride levels serendipitously found a reduction in motor symptoms, such as tremor and rigidity [61]. Unfortunately, large doses of niacin can result in flushing, secondary to the action on Langerhan’s skin cells, which have high levels of the GPR109A receptor. The PD patient taking a large dose of niacin daily had to quickly discontinue due to flushing and uncontrollable nightmares [61]. Fortunately, niacin doses of 500 mg or less, when taken with food and water, typically have little to no flushing effect. Moreover, flushing typically decreases with the continuation of niacin supplements. Other benefits to PD with niacin supplementation include an increase in quality of life [60,62] and motor symptoms [61,62]; fatigue and depression in PD may also benefit. Effects of niacin supplementation on mechanistic changes in pathophysiology, such as changes in pathologic α-synuclein levels, mitochondrial dysfunction, and leaky gut, should be investigated further
mdpi.com/2072-6643/13/1/28/htm
Niacin shifts macrophage polarization from pro-inflammatory to an anti-inflammatory
This looks like the foundation the study may have been based on:
Upregulation of GPR109A in Parkinson’s Disease 2014 journals.plos.org/plosone/a...
Interesting story from 2012: High dose B3 may offer hope in fight against 'superbugs' nutraingredients.com/Articl...
They are talking 250 mg/kg. That's about 19 grams for me!
😱😵
Vitamin B3 supplementation offers ‘significant improvement’ in glaucoma patients: Study 2020 nutraingredients-usa.com/Ar...
Worked up to 3 grams a day.
I'm not suggesting anybody take more than the 250 mg used in the B3 PD study.
This is great news and now I'm kicking myself for not starting sooner! It's been on my radar for some time, but I guess I was waiting for more and better trials. Oh well, I'll start on it now. Here's a good short video that has some ideas about how to take Niacin while mitigating the potential side effects. youtu.be/TYwCcNtm7y4
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