For MENSTRUAL CRAMPS niacin, vitamin B3, regulates vascular spasms, and thus opens up blood vessels to increase blood flow to the uterus. In this way niacin can relieve abdominal or pelvic muscle spasm in 87% of women.

Various factors can slow down blood flow to and from the uterus, such as nutritional deficiencies, an inflammation-causing diet, and a sedentary lifestyle. If the vessels that transport blood around the uterus are constricted and narrowed, this slows the supply of nutrients to the uterus and metabolic waste products can accumulate. Poor nutritional status and the build-up of waste products at the cellular level can cause the uterine musculature to cramp and become unable to relax. Niacin’s ability to enhance blood flow to organs makes it a valuable remedy for menstrual cramps.

Between 1906 and 1940, more than 3 million Americans were affected by pellagra which is a severe dietary deficiency of niacin. When niacin was established as a cure in 1930, many countries began to fortify processed foods and grains with that vitamin plus vitamin C, thiamin, vitamin D, and vitamin A. Niacin is found naturally in some meats, seafood, plants, and spices.

By the 1950s, evidence appeared about the benefit of niacin in the treatment of dysmenorrhea. The niacin form of vitamin B3 has been found to be effective in relieving menstrual cramps in 87% of a group of women taking 200mg of niacin per day throughout the menstrual cycle. While experiencing menstrual cramps, they then took 100mg more every two or three hours. At that time, open trials on a group of 80 women indicated that niacin supplementation provided relief of menstrual cramps for up to 90% of women whose cramps had been severe enough to require bed rest, heavy sedation, or loss of time from work.

It was believed that the dose should be high enough to be effective; we now know that the inositol hexaniacinate form can avoid flushing or other side effects. This research also suggested that the efficacy of niacin was enhanced by the daily addition 300mg of vitamin C and 60mg of rutin, as improving capillary permeability enhanced the vasodilating effect of the niacin. This work has yet to be confirmed by randomized trials.^1,2

Vitamin B3 is also important for production of the hormone serotonin which explains some of its other avenues of benefit for menstrual cramping. Without vitamin B3, tryptophan does not convert into serotonin and patients suffer from mood swings, tension, and depression. This heightened state of distress and anxiety can contribute to the increased perception of muscle cramping as pain. During menstrual cramping, the adrenal glands work under stress, plus there are lower levels of the hormone cortisol which helps to maintain healthy emotional and mental balance.

Niacin is also known as nicotinic acid, but it suffered from a PR problem in the 1940s when it was added to enrich flour and a headline in the popular press promoted “Tobacco in Your Bread.” The Council on Foods and Nutrition, an arm of the American Medical Association, thought it important to dissociate the vitamin from nicotine, to avoid the perception that vitamins or niacin-rich food contains nicotine, or that cigarettes contain vitamins.³

The inositol hexaniacinate form of niacin will not cause the unpleasant side-effects of skin flushing and itching that plain niacin can produce even at low doses. The FDA approves prescription-strength niacin, but because of its annoying side effects it is hard to reach a therapeutic dose of over 500mg with raw niacin. We avoid raw sustained-release niacin because of its potential risk of liver irritation. By contrast in our clinic, we prefer just two capsules of inositol hexaniacinate at 500-600mg daily, which is particularly safe and more effective than raw niacin, thus allowing for higher doses.

Recommendation:: Niacin as non-flush Inositol Hexaniacinate, two 500-600mg capsules 1 to 2 times daily, with meals, or as directed by your healthcare provider.

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