Niacin is vitamin B3. It occurs naturally in plants and animals, is present in many nutritional supplements, and is added to many foods.
It’s important to note that this article is about using niacin therapeutically to treat a medical condition, not as a supplement to replace a deficiency. We use niacin to:
- Help lower cholesterol and triglycerides in the blood, especially LDL (bad cholesterol) particle numbers.
- Help lower the risk of heart attack in people with high cholesterol who have already had a heart attack.
- Treat atherosclerosis (coronary artery disease).
Combining Niacin with Statin Drugs
Some studies have shown that combining niacin and statins resulted in a 90% reduction of future cardiovascular events where a statin alone had shown only a 30-40% risk reduction.
If your history indicates cardiovascular risk and/or you have had a cardiovascular event, it is very important to add niacin to your statin program.
Advantages and Disadvantages of Niacin
The advantage of niacin is that it encourages the body to store bad cholesterol in larger particles which are less plaque-forming.
The disadvantage is expansion of the blood cells on the skin’s surface, causing “niacin flush.” Flushing is a sensation of warmth that is often accompanied by tingling and itching, and it usually reddens the skin. While the head and torso are the more common sites, a niacin flush can occur anywhere on the body, from the head all the way down to the toes.
Additional reactions, although less common, may include sweating, shortness of breath, fast heartbeat, chills, dizziness and fainting.
Flushing is not dangerous, harmful, or indicative of any complications.
How to Prevent or Reduce Niacin Flush
- Begin with a low dosage and increase gradually. Any mild flushing should subside rapidly.
- Take an “uncoated” 81 mg aspirin and, ideally, fish oil capsules right before a meal; then take niacin after your meal.
- Ideally this meal would contain fiber. Unsweetened apple sauce can be a good source of fiber and seems to reduce flushing.
- Avoid hot or alcoholic beverages directly before and after taking niacin.
- If you regularly drink alcohol, take your niacin after breakfast.
- If no alcohol is consumed, take niacin after your evening meal.
Different Forms of Niacin
OVER-THE-COUNTER NON-FLUSH. This form is not effective at lowering cholesterol and is somewhat toxic to the liver.
OVER-THE-COUNTER TIMED-RELEASE. It’s important to take one that has been studied, proven to contain what it claims, and shown to deliver the contents appropriately. The supplement we recommend and carry is Enduracin.
TIMED RELEASE PRESCRIPTION. Niaspan has a release system that’s very effective for achieving niacin’s lipid modifying capability. Ideally, you want to use a timed-release niacin that releases the dosage over 6-12 hours.
Call us for names of additional niacin products that can be trusted.
Note: Niacin is only part of a complete program of treatment that may also include diet, exercise, weight control, and other medications. Follow your diet, medication, and exercise routines very closely.
Posted in October 2014
Two recent studies have questioned the use of niacin. Both were done with patients already on statin drugs and essentially at goal. Adding niacin in these instances did not further lower the risk of cardiovascular disease.
Niacin is useful when LOW dose statins along with lifestyle and supplements don’t get patients to goal. The goal needs to be low LDL particle which wouldn’t be seen without doing advanced lipid analysis. It’s important to know when niacin might be a helpful addition for lipid lowering therapy.
I hope this answers any concerns you might have when reading about this in the media. If you have any questions, please contact me.