Sunday, December 18, 2011

No Flush Niacin is No Good

No Flush Niacin is no good
No good for improving your cholesterol or triglycerides. 
And no flush niacin is no good for raising your HDL cholesterol. 
The HDL cholesterol is the so-called “good” cholesterol.

You may know that niacin is one of the B vitamins. The Recommended Daily Intake for niacin is 20 milligrams. You may see this as Daily Value on the label of the vitamin supplement you may be taking. 
Niacin can be taken as nicotinic acid or nicotinamide.

By the way, nicotinic acid has nothing to do with nicotine.
Nicotine is a very different chemical.
Nicotine is the addictive substance found in tobacco. Niacin is not nicotine.

High doses of niacin as nicotinic acid but not nicotinamide can lower cholesterol and triglycerides. Those fats in the blood are called lipids.

But, in general, you need at least 500 milligrams of niacin to see an effect on lipids. This benefit of niacin on lipids has been known since 1955. 
It is nicotinic acid that is the active substance that lowers the lipids. If there is not enough nicotinic acid produced from the pill, the lipids don't improve.

The problem is that niacin in a dose as low as 100 milligrams can cause unpleasant skin redness, itching, and burning. These symptoms are the niacin flush. The niacin flush may last about an hour or more and starts shortly after you take the pill.

And there are other possible side effects of niacin. But the flush is the main challenge.

Most people get flushing from niacin when they take immediate release niacin to lower their lipids. Prescription niacin that is extended release and marketed as Niaspan is safe and less likely to cause this flushing.

The good news is that the flushing goes away over time and there are several tips that we give our patients to keep the flushing to a minimum. Most patients who stick it out and continue on niacin therapy are not troubled by the niacin flush.

But there are two things we do not advise. 
First don't use the non-prescription slow release niacin. These supplements might work for the lipids but slow release niacin supplements appear more likely to cause liver damage.

Number two. No flush niacin is no good. The usual no flush niacin that is sold is inositol hexanicotinate. This stuff appears to deliver very little nicotinic acid. Remember nicotinic acid is the chemical that lowers the lipids.

Based upon the best evidence, inositol hexanicotinate sold as no flush niacin simply does not work. Save your money!

And check your labels. I do not recommend non-prescription niacin. Before Niaspan was available, I advised my patients to use immediate release niacin. Now, if I  tell people to take niacin I prescribe Niaspan.

But keep in mind, in terms of reducing heart attacks and strokes, niacin has far less evidence of benefit that do the statins. An old study before statins were available that was done in men who had had a heart attack showed a slightly lower chance of having a second heart attack. 
A more recent trial  in people already on statin therapy showed no benefit of Niaspan in reducing cardiovascular events.

Still niacin can still be very helpful in selected people like those with high triglycerides.
But the niacin flush must be worked through.


  1. Brilliant article, I have to agree no-flush niacin is useless. No pain no gain, I would say. However, there are some things you can do to diminish the intensity of the side effects like spreading intake over the day or taking in garlic extract prior to flushing.

    Source: niacin flush



  2. Sophie: Thanks for the comment. Interesting, I am not aware of any studies that show the benefit of garlic to reduce the niacin flush. The flush from niacin is related to substances called prostaglandins. The flush can be reduced by taking aspirin before the niacin pill. When immediate release niacin is used we give it three times a day with food and increase the dose slowly over weeks. Nowadays however, we usually use the better tolerated Niaspan (prescription only).

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