Most people have heard of niacin, also known as Vitamin B3.  Virtually every processed food product with any form of wheat in it has niacin added.  For those that pay attention to product labels, niacin is seen regularly.

Despite the high degree of familiarity with the name niacin, we would guess that most persons would be hard-pressed to describe the benefits of the appropriate form and dosage of niacin in their diets.  Particularly when thought of in the context of fracture healing or back surgical recovery for example.

B Vitamins as a group have a reputation as anti-stress vitamins.   That is just one of their attributes.  Please read the following information to learn some of the other important functions that are specific to vitamin B3 for more rapid and better healing from either accidental or surgically induced trauma.

 The B-vitamins are very important in supporting healing during surgical recovery or other injury.  This is also true of vitamin B3, more commonly known as Niacin, which has important anti-inflammatory effects, promotes actions to protect traumatized or injured tissue, and has other substantial roles in the process of wound and tissue healing.

It is important to remember that the increased physical demands of healing after surgery cause the body to be in what is known as a hypermetabolic state.  This hypermetabolic state is a time of increased metabolism and biologic activity with highly increased nutritional demands.  This is what occurs after surgery or accidental injury as the body is working extra hard to heal as quickly and as well as possible.  During this time of increased baseline physiologic demand, especially during the first few weeks after surgery, the body’s needs for key nutrients and energy sources are raised.  This means an increased need for protein and amino acids, energy foods, water, as well as critical vitamins and minerals.  Vitamin B3 is among these critical vitamins, and making sure the body has the right levels to meet the increased demands of healing is key to ensuring your best surgical recovery. 

To be sure a body gets what it needs to heal its very best, surgeons often recommend that patients increase their intake of certain vitamins and minerals in preparation for surgery and after surgery to make sure the body is ready to heal.  The right amounts of these vitamins and minerals are very important in this setting, and there are strategies (as at the end of this article) to help guide you. 

During surgical recovery, a regular dose of vitamin B3 is simply not enough to get the greatest benefit.  There are many good regular supplemental sources of vitamin B3, but vitamin B3 works to your best overall advantage when taken in an optimized dose as in a surgery support multivitamin formula that contains complimentary levels of other B-vitamins and the other micronutrients crucial to your best surgical outcome.  These nutrient forms and doses have proven scientific benefit in supporting best healing while minimizing the potential for post-operative complications.

What about Niacin specifically in helping a patient to heal after surgery?  Niacin is the water-soluble B vitamin that is also known as vitamin B3. Nicatinamide is the amide form of B3, and is the active derivative of niacin that is used by the body to form the co-enzymes nicatinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP).  On the cellular level, humans gain most of their energy from different types of oxidation-reduction reactions, and as many as 200 enzymes require niacin co-enzymes NAD and NADP for electron transfer to complete these fundamental energy-deriving processes.  These are critical in the cellular metabolism of fats, proteins, carbohydrates, alcohols, fatty acids and cholesterol (Cervantes-Laurean D 1999), and are particularly important in meeting the markedly increased metabolic demands for healing tissue during surgical recovery.

During disorders or circumstances of medical stress (that include immune system dysfunction, diabetes, age-related diseases and surgical stress), niacin (vitamin B3) acts as a robust cytoprotectant that regulates cellular inflammatory activation, early apoptotic phosphotidylserine exposure, and late degradation of DNA. (Maiese K 2009)  These are all very important processes in ensuring best healing, particularly during the most acute phases of wound healing in the first days to weeks after surgery.  Niacin is also involved and governs a set of unique cellular pathways that are believed to be primary in determining both cellular survival and longevity. (Maiese K 2009).

The benefits of optimally-dosed niacin for the surgical patient include those as outlined above, as well as scientific evidence that shows:

• Neuroprotective effects and protection of central and peripheral nerves (Chong ZZ 2004) (Anderson BW 2006) (Feng Y 2006), • Support of vascular integrity (blood vessels), and • Preservation of cerebral (brain) and endocardial (heart) endothelial cell health and integrity,  and other similar effects (Sadanaga-Akiyoshi F 2003) (Cox MJ 2002).

Considering these and other factors, it becomes even more obvious how important it is to make sure you get the right amount and form of niacin (B3) peri-operatively to make sure you heal as well and as quickly as possible after a surgical procedure.  This type of vitamin support program is at its very best in the setting of elective surgery, like plastic surgery procedures, elective orthopedic procedures like shoulder scopes, shoulder (rotator cuff repair) (carpal tunnel surgery), hip or knee replacement, (knee surgery) such as knee scopes or (knee ACL repair), and other elective surgical procedures.  In these elective surgery settings, the patient has the chance to get their vitamin levels elevated for a week or more before surgery, and then can continue with a clinically-targeted (nutritional supplement) for 4-6 weeks after surgery as well. 

There is still great benefit to taking a supportive, targeted vitamin regimen after an emergent procedure (such as after a bone fracture surgery, emergent appendectomy, or other emergent procedures), but having the opportunity to have optimized levels for a week or more beforehand is ideal.

Niacin (vitamin B3) levels increased to optimum amounts from the typically recommended daily intake for the surgical patient will support the:

•Ideal capacity of the management of oxidative stress and cellular survival in traumatized tissues (to particularly include oxidatively-sensitive tissues such as nervous and cardiac tissue)

•Optimal inflammatory cell modulation (as critical during early-phase wound healing)

•Cellular energy management during times of peak metabolic demand during healing

 Vitamin B3 (niacin) recommended for the surgical patient: 25 mg/day.  Although this level is only 25% above the typical daily RDA value, most surgeons with expertise in nutrition regard this level as sufficiently elevated to meet the outlined goals specific to the majority of surgical patients, while concurrently avoiding the potential for flushing as a side effect (in keeping with the tolerable upper intake level of 35mg/day as per Food and Nutrition Board recommendations).

There are many good supplemental sources of Niacin, but it best when taken in a balanced combination as in a targeted surgery support multivitamin formula that contains complimentary levels of other B-vitamins and other key micronutrients.  Rather than take a handful of pills as individual vitamins that can be expensive and difficult to organize, we recommend a simplified and organized single surgical multivitamin program as a much better approach for most patients.

An excellent example that represents the best solution available is SurgiPlex MD by Top Doctors Labs.

It is safe and effective in supporting your best and most rapid recovery from all types of surgical procedures or accidental injuries.

Doctors will commonly recommend  SurgiPlex MD to be taken as a surgery support vitamin supplement for 1 week before surgery and 3 weeks after surgery.  A sixty tablet bottle is intended to be taken as a four week surgical recovery program.  More complex surgeries can benefit from an 8 week SurgiPlex MD program – 1-2weeks before surgery and up to 6 weeks after.  SurgiPlex MD is available in select surgeon offices, select pharmacies, or visit online at www.topdoctorslabs.com.

Your greatest benefit is achieved when taken along with a healthy balanced diet, and by drinking plenty of fresh water daily to stay well hydrated before and after surgery.  After completion of a four week Surgiplex MD program, patients are then usually advised to transition back to a regular daily (nutritional supplement) formulation to support general health on an ongoing basis.

 Last week we talked about Vitamin B-1.  Learn More.

References

Anderson BW, Bradbury KA, Schneider JS. “Neuroprotection in Parkinson models varies with toxin administration protocol.” Eur J Neurosci, 2006: 24(3):3174-3182.

Cervantes-Laurean D, McElvaney NG, Moss J. “Niacin.” In Modern Nutrition in Health and Disease, 9th edition, by Olson JA, Shike M, Ross AC, eds Shils M, 400-411. Baltimore: Williams and Wilkins, 1999.

Chong ZZ, Lin SH, Maiese K. “The NAD+ precursor nicotinamide governs neuronal survival during oxidative stress through protein kinase B coupled to FOX3a and mitochondrial membrane potential.” J Cereb Blood Flow Metab, 2004: 24:728-743.

Cox MJ, Sood HS, Hunt MJ, Chandler D, Henegar JR, Aru GM, Tyagi SC. “Apoptosis in the left ventricle of chronic volume overload causes endothelial dysfunction in rats.” Am J Physiol Heart Circ Physiol, 2002: 282: H1197-H1205.

Feng Y, Paul IA, LeBlanc MH. “Nicotinamide reduces hypoxic brain injury in the newborn rat.” Brain res Bull, 2006: 69:117-122.

Maiese K, Chong ZZ, Hou J, Shang YC. “The vitamin nicotinamide: translating nutrition into clinical care.” Molecules, 2009: 14(9): 3446-85.

Sadanaga-Akiyoshi F, Yao H, Tanuma S, Nakahara T, Hone JS, Ibayashi S, Uchimura H, Fujishima M. “Nicotinamide attenuates focal ischemic brain injury in rats: with special references to changes in nicotinamide and NAD+ levels in ischemic core and penumbra.” Neurochem Res, 2003: 28:1227-1234.