Since the 1940s, the B vitamin, niacin, has been fortified in many staple foods like bread and cereals as a way to help address vitamin B deficiency. While this essential nutrient is crucial for skin health, energy metabolism, nervous system function, and digestive health, Dr Stanley Hazen, lead author of this study and physician scientist at the Cleveland Clinic, a US-based non-profit academic medical centre, believes consuming excessive amounts of processed foods may pose a risk because it results in elevated levels of niacin in the body.
Hazen said: “What we found is that people who are in the top 25% of the population are getting too much [niacin] and they’re making, as a result, some of these excess break down metabolite products that normally wouldn’t even be seen in a healthy diet that was natural.”
The breakdown products of excess niacin – 2PY and 4PY – were found to be associated with an increased risk of heart attacks, strokes, and other heart-related problems. In light of these findings, Hazen is calling for a discussion on fortification practices, particularly the necessity of continuing mandated niacin fortification protocols, as is currently the case in the US and UK.
Increased risk of major cardiac events associated with excess niacin
The research involved three distinct cohort groups: a discovery cohort (1,162 participants) and two validation cohorts—one from the United States (2,331 participants) and one from Europe (832 participants).
The discovery cohort’s blood plasma was examined to identify molecules associated with heart problems. The scientists found that individuals with higher levels of 2PY and 4PY in their blood were more likely to experience heart issues in the future.
The researchers also examined levels of the molecules in the two validation cohorts, finding evidence to confirm the link between an increased risk of major cardiac events and elevated levels of either molecule.
Cutting down on processed foods could help prevent excess niacin levels in the body
Niacin deficiency in a Western diet is extremely rare and recommended levels of 13-16 milligrams (mg) per day for healthy adults are easily met through consuming whole foods: 85 g of grilled chicken breast typically contains around 10.3 mg of niacin, while one tablespoon of peanuts has approximately 4.2 mg.
Despite this, niacin fortification has been mandated in many Western countries for decades, including the US and the UK, which both have specific standards for enriching a variety of staple foods like white flour, cereal grains, and infant formula.
Some brands chose to fortify their products voluntarily, cereals being one such category. Nestlé fortifies its breakfast cereals with five vitamins and two minerals, including niacin, vitamin B6, riboflavin, folic acid, pantothenic acid, iron, calcium, and, in some cases, vitamin D.
Fortification aims to address nutrient deficiencies, but a diet heavy in processed foods – often fortified themselves – could lead to excessive intake of certain nutrients. A US study on ultra-processed foods found that 82% of American adults include UPFs in their diets.
The study has sparked debate around the continuation of fortification due to the potential health risks associated with excess niacin intake. “The main takeaway is not that we should cut out our entire intake of niacin – that’s not a realistic approach," said Hazen. Instead, he advocated for open discussions around mandated fortification and increased emphasis on diets that are rich in fruit and vegetables.
