Is Niacin the New Folate?

In the 1990s, the discovery that folate (vitamin B9) deficiency causes many neural tube defects led to a dramatic fall in these conditions. Now, another B vitamin, known as B3 or niacin, has recently been shown to help prevent miscarriage and other types of birth defects such as heart conditions.

Source: Atigobina (CC: 4.0)

Niacin performs many functions in the body, often in a form called nicotinamide adenine dinucleotide (NAD). Having low levels of this molecule can be incredibly damaging to tiny embryos when they are first forming organs, leading to birth defects or even death. However, supplementation of niacin increases the embryo's levels of NAD, which may significantly cut down the rate of miscarriages and birth defects. It is estimated that 3% of babies around the world have significant congenital defects, and one in four women will have a miscarriage at least once in their lives. While 3% doesn't look like much, for the families affected it means everything.

How did they find that a "simple" vitamin could do so much? First, they sequenced the genes of four families with a history of miscarriages and birth defects, such as heart, vertebral and kidney problems. They found two genetic mutations that affected the pathway which produces NAD. This is serious because some of NAD's functions are in gene development and repair. Next, they used CRISPR to mimic these mutations in mice. Just like the human families, the mice had offspring with all the same birth defects and NAD deficiency. When they put niacin in the drinking water of pregnant mice, they prevented the birth defects. Niacin is found in many meats and vegetables, as well as multivitamin, prenatal and energy supplements. However, a US study found that one third of women taking pregnancy multivitamins were still low in niacin. Some pharmaceuticals and medications, such as diabetes, coeliac disease, inflammatory bowel diseases and obesity can also impair NAD pathways, so these must be addressed or be answered with supplementation.

If niacin becomes the new folate in preventing birth defects, the benefits to our world will be significant. A review of 13 studies found that folic acid at 0.2mg/day could reduce neural tube defects by 20%, but a dose as high as 5mg could reduce their risk by 85%. With 0.2mg/day the US level of fortification, prevalence of spina bifida dropped by 31% with compulsory fortification, and anencephaly by 16%. Zinc deficiency, alcohol abuse and hallucinogen use are other factors behind neural tube defects. MTHFR mutation, which is now widely discussed in natural health circles, can also raise the risk of these defects. We take vitamins for granted too often - for our most vulnerable, a short-term deficiency can mean losing everything.