Niacin (Nicotinic Acid) a Putative Treatment for Hypochlorhydria: Re-analysis of Two Case Reports

Fifty to sixty percent of patients with symptoms of chronic or recurrent discomfort concentrated at the upper abdomen can be diagnosed with what is termed functional dyspepsia or nonulcer dyspepsia (NUD). Other symptoms include belching, bloating, heartburn, nausea or vomiting. Insufficient stomach acid, a condition known as hypochlorhydria, might be responsible for the symptoms of NUD. Two case reports suggest that niacin (nicotinic acid) might be an effective treatment for hypochlorhydria. Several mechanisms of action are proposed to outline niacin’s potential role in the maintenance of hydrochloric acid (HCl) secretion. For example, niacin directly stimulates histamine release from gastric mast cells. Increased histamine levels lead to hydrogen ion (H+) production and eventually more HCl. Another mechanism purports that subsequent increase in nicotinamide adenine dinucleotide (NADH) levels following niacin supplementation stimulates the mitochondrial production of adenosine triphosphate (ATP). ATP provides the necessary fuel to drive the process of generating HCl from parietal cells. Finally, niacin supplementation might help normalize gastric pH. Optimal gastric pH helps regulate gastrin levels, as well as supports other important physiological functions. Considering the billions of dollars spent annually on both overthe-counter and prescription drugs for this disorder, the use of niacin should be a therapeutic consideration when gastric pH analy1. Assistant Professor of Clinical Nutrition & Clinical Faculty, The Canadian College of Naturopathic Medicine, Toronto, Ontario. Correspondence: 1255 Sheppard Avenue East, Toronto, Ontario M2K 1E2. E-mail: [email protected]. 2. Apt #2 31-Meadowbrook Road, Toronto, ON M6B 2S5. email: [email protected]. sis has demonstrated hypochlorhydria. Future studies that include more patient case reports and more rigorous controls are needed before recommending this treatment to all patients who have been diagnosed with NUD.