It looks like medicine is starting to look more and more into metabolic therapies for a variety of conditions, including ones of viral origin. The good news is that this will probably help a lot of people, but the bad news is that it may soon result in niacinamide also being labelled as a “novel drug” and no longer being available over-the-counter (OTC). The the people who accuse of fearmongering, I will just point out that nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN) have already been labelled as such, and are thus soon to disappear from the open market. NMN has already been pulled from most online vendors and NR is soon to follow. That leaves only niacinamide and niacin as the remaining OTC precurosr to NAD+, with niacin being an inferior choice due to its ability to raise histamine and serotonin (which is what causes the infamous “flush”). In any event, the study below demonstrated that taking 2 x 500mg niacinamide daily for 4 weeks results in quicker recovery from COVID-19 and the effects were still present at the 6 months follow-up. The letter result is what gives the authors a reason to believe that therapy with niacinamide would be helpful for long-COVID too. The proposed mechanism of action is that niacinamide improved the metabolism of the microbiome, but I think a much more likely explanation is that niacinamide, by raising NAD+ levels, helped restore the gut barrier, with the latter known to be severely disrupted as a result of COVID-19. Leaky gut increases endotoxin in the blood, which can explain the debilitating fatigue patients with long-COVID experience. Sealing the gut reduces endotoxin and thus the fatigue. In addition, the elevated NAD+ results in improved systemic oxidative metabolism and that also contributes to improved feelings of well-being, lower inflammation, and resilience to subsequent viral attacks/infections.
https://idw-online.de/de/news851759
“…In the COVit-2 trial, the team examined 900 freshly diagnosed COVID-19 patients throughout Germany, half of whom were randomised to take two nicotinamide tablets (500 mg each of CICR-NAM and conventional nicotinamide) or identical-looking placebo tablets for four weeks. The study was double-blind, i.e. neither the patients nor the members of the study team knew who was in which group. The patients underwent repeated telephone interviews regarding the course of their disease. Many also sent in stool samples regularly so that the composition of their gut microbiome could be analysed together with their disease course. The results of the COVit-2 trial show that patients with a risk factor for severe COVID-19 courses, e.g. smokers or people with previous lung diseases, who received nicotinamide were significantly more likely to have regained their normal physical performance after two weeks than patients in the placebo group. The ability to cope with normal everyday life was also significantly better in the nicotinamide group after two weeks. Even though the study did not focus on more long-term consequences of the disease such as long COVID and post COVID, the researchers still observed a promising trend at the six-month follow-up: patients who had a higher risk of post COVID and responded to nicotinamide showed fewer post-COVID symptoms.”
“…In the study, the researchers also took a closer look at the microbial community living in the gut. “The microbiome of COVID-19 patients still shows a kind of emergency metabolism around two weeks after the onset of the disease, in which the body obviously tries to compensate for the known deficits in important metabolic factors by upregulating other metabolic processes. We did not observe these changes in the nicotinamide study group – probably because the deficiency could be compensated by administering nicotinamide. At the same time, we observed a faster physical recovery in these cases. The positive influence on the microbiome is apparently related to the faster recovery,” explains Professor Philip Rosenstiel, Director of the IKMB, who led the microbiome studies. “This is the first time we have shown that influencing the microbiome, in this case through supplementation of a nutrient, can have a positive effect on a viral infection. This is an important milestone in clinical research,” says Rosenstiel.”
