Study suggests mandatory addition of Vitamin B3 to all UK bread may raise risk of heart disease

A study has linked high levels of vitamin B3, commonly added to breads and cereals, to a greater risk of strokes and heart attacks. The UK government requires this addition to white and brown bread.

Also known as niacin, the vitamin is used to “fortify” many breakfast cereal products and has previously been recommended to lower cholesterol. Some scientists and health experts dispute whether lowering cholesterol is beneficial to health.

Researchers found that those with a chemical called 4PY in their blood, related to the body breaking down excess niacin, had significantly higher risk of strokes, heart attacks, and other cardiac conditions.

Dr. Stanley Hazen, a physician from the Cleveland Clinic in Ohio, said niacin could be a “previously unrecognised yet significant contributor” to cardiovascular disease.

‘The main takeaway is not that we should cut out our entire intake of niacin [but] a discussion over whether a continued mandate of flour and cereal fortification with niacin could be warranted,” he said.

The NHS recommends a daily allowance of niacin of 16.5mg for men and 13.2mg for women. The study, published in Nature Medicine, revealed that one in four people consumed too much and had high levels of 4PY in their blood.

It is a legal requirement to fortify all white flour sold in the UK with niacin, and the amount that must be added — 2.4mg per 100g — was increased by the government in 2022, with the policy expected to come into effect later this year, once the formal process of notifying the World Trade Organisation and EU Commission has been completed.

Bread And Flour Regulations Require Fortification

The Bread and Flour Regulations of 1988 lay down labelling and compositional standards for bread and flour, and specify that four vitamins and minerals must be added to all white and brown flour—calcium, iron, thiamine (Vitamin B1) and niacin, with folic acid set to be added soon.

​Wholemeal flour is exempt as the wheatgerm and bran from the grain included in the final flour are natural sources of vitamins and minerals.

​There is no legal requirement to bolster breakfast cereals with vitamins and minerals, but makers can voluntarily do this in line with government guidelines, and manufacturers often market their products as being “fortified.”

Niacin can be obtained from various foods, including meat, poultry, and oily fish and in nuts, pulses and seeds in lesser amounts. A deficiency of the vitamin can cause a potentially lethal condition called pellagra, with wide-ranging symptoms said to include skin and mouth lesions, anaemia, headaches, delirium—and even, if left untreated, death.

Many countries other than the UK mandate the supplementation of niacin in certain foods, as well as the addition of other vitamins and folic acid, which is said to prevent birth defects— although some studies have suggested there could be risks to high folate levels, including autism.

Niacin deficiency is rarely seen in developed countries, and it is generally associated with poverty, malnutrition or malnutrition secondary to chronic alcoholism.

According to Dr. Hazen, niacin used to be prescribed in high doses to individuals with high cholesterol levels, adding: “Even though it lowered cholesterol, it didn’t lower the risk of heart attack or stroke. It raised the question, what else was niacin doing that counteracted the benefits? We think we have found the answer here.”