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Niacin & Cholesterol Management

Niacin, also known as Vitamin B3, is vital for good health. Niacin helps convert food into energy, build red blood cell counts, and synthesize hormones. Although your body manufactures niacin, you can also obtain it from foods.

At substantially higher levels - 1000-3000mg/day - niacin in the form of nicotinic acid can significantly improve cholesterol levels. Nicotinic acid can lower LDL cholesterol by up to 15 percent, raise HDL cholesterol by as much as 35 percent, and lower triglyceride levels by 20-50 percent. At the high levels, niacin use should be taken under a physician’s care, primarily because of concerns about potential liver complications. It is recommended that liver enzymes be monitored. Also, intense flushing, where the skins turns bright red, itches, and burns is associated with high levels of nicotinic acid. Taking niacin with a small high fiber snack fiber can slow absorption, reducing the intensity of flushing. Usually flushing is a startup consequence and will lessen as time goes on. People with diabetes or gout also need to be cautious about taking niacin as it can slightly raise blood glucose and uric acid.

Nonetheless, nicotinic acid supplements have long been approved for sale by the Food and Drug Administration (FDA). Further, the intake of niacin at intermediate dosage levels -100-1000mg/day - has been shown to improve the levels of both HDLs and triglycerides. Coupled with other elements of nutrition, the intermediate dosage of niacin supplements may provide a meaningful contribution to long-term cardiovascular health.

Regardless of how much you take, niacin may have a role in advancing heart wellness. In one study, patients took 50mg of niacin in the form of nicotinic acid twice per day for three months. The patients on the niacin experienced an average 5 percent increase in “good” HDLs. Even a small increase in HDLs can significantly lower the risk of heart attacks and strokes.

In another study, 500mg/day of niacin as nicotinic acid raised HDLs by 10 percent along with lowering LDLs by 5 percent and triglycerides by 5 percent. At 1000mg/day, improvements were even more dramatic; 15 percent for HDLs and a drop of 11 percent for triglycerides and 7 percent for LDLs.

Niacin - Not All Are Created Equal

Choosing the right niacin supplements can be confusing. Three types of niacin are available--nicotinic acid, niacinamide, and inositol hexanicotinate. Only nicotinic acid has been clinically shown to be effective for cholesterol management.

To make matter even more confusing, there also are three forms of nicotinic acid—immediate, sustained, and extended release. Even relatively low levels of immediate release nicotinic acid can cause an uncomfortable flushing side effect accompanied by an intense feeling of heat, tingling, and itching. Flushing can start a few minutes to a few hours after dosing and typically subsides within 30 minutes, often much sooner.

Higher levels of nicotinic acid are available in a sustained release version. Although it reduces flushing, it has been associated with liver complications. It is believed that the release mechanism never lets the liver recover during the day. The first two forms are usually over the counter (OTC).

The third form of nicotinic acid, extended release niacin, is available as a prescription (Niaspan) and has a lower incidence of liver complications than the sustained release version. Plus, it is FDA approved and safer on the liver.

Depending on your unique conditions and health targets, niacin is a powerful nutrient that can play a role in your heart health agenda. Review your niacin intake. -- as well as all your supplement intake --with your health care provider.

Resources:

A Goldberg, et al, “Multiple-Dose Efficacy and Safety of an Extended-Release Form of Niacin in the Management of Hyperlipidemia,” The American Journal of Cardiology 85 (May 1, 2000)

Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, Third Report of the National Cholesterol Education Program Expert Panel,” National Institute of Heart, Lung and Blood Institute, National Institutes of Health, www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf,