Supplement Detective

By Curtis Alexander, Pharm.D.
America’s Natural Pharmacist

Summary: The niacin cholesterol connection is a strong one and if you have low HDL cholesterol you’ll want to consider using niacin.  Over the counter (OTC) forms are lower cost but may have more flushing.  Always consult your doctor before starting niacin due to possible side effects from the high doses needed.

Dear Curtis: I wanted to look into using niacin for cholesterol control.  But, I’ve heard that it’s just a vitamin and may even be dangerous to use.  Do you have any experience with it and have you found it to be effective?

A: Let’s address the first part of your question.

There is a strong connection between niacin and cholesterol lowering.  But, like other readers, you’ve heard that niacin is ‘only’ a vitamin so it can’t do that much.

Yes, technically niacin is a vitamin.  Specifically, it’s vitamin B-3.  It also goes by the name nicotinic acid.  Some more common brand names are Niaspan®, Niacor® or Slo-Niacin®.

But, just because it’s a ‘vitamin’ doesn’t mean it isn’t worth it’s weight in gold when it comes to cholesterol control.  And, truth be told, when it comes to helping cholesterol control it’s one of the best.  But, not in the way you’ve probably heard.

You see, while almost all the focus in the last thirty years has been on lowering cholesterol to rock-bottom numbers (a practice which is starting to gain a lot of negative attention by the way – I’ll get into reasons why later) niacin is unique in the fact that it’s excellent for raising cholesterol.  Specifically, your good, or HDL cholesterol.

Drug manufacturers have tried in the past to replicate what niacin does for HDL levels without much success.  Their formulations caused more side effects than they seemed to be worth.  Also, they were much more expensive than niacin is.

Why Raise Your HDL?

While everyone calls HDL the ‘good’ cholesterol few people know why.  HDL is like a janitorial service for your blood supply.  It goes out there and basically starts collecting and sweeping up the bad (LDL) cholesterol that you have floating around.  Eventually taking it back to your liver where it is disposed of.

Also, HDL is what we call an independent risk factor for heart disease.  That means that even if your total cholesterol, triglycerides and LDL are all normal.  If your HDL is too low that is an independent risk factor for heart disease.  So, you could be doing everything right with your cholesterol levels but if your HDL is too low your still at risk.

What is the Ideal HDL Level for You?

While there is a lot of debate over the ideal total cholesterol levels today experts generally agree that the higher your HDL the better.  Specifically, whether you are a man or woman a good level to shoot for is to have your HDL greater than 60mg/dL.

If you and your doctor agree that niacin is the best option for you to raise your HDL levels you can expect to see a 15% to 35% increase in HDL levels.  How long that takes and how high is eventually goes is dependent on the dose you take and how well you tolerate the side effects of niacin.

Speaking of Side Effects

If there is a downside to niacin for cholesterol control its the side effects.  Specifically, the flushing of the skin.  While this flushing is aggravating – it is generally temporary and is not dangerous.  But, for many people, it ends up being so bothersome that they refuse to continue taking it.

I remember in pharmacy school that while niacin was mentioned, it didn’t get a lot of attention as a viable option because the flushing side effects.

Minimizing Niacin’s Side Effects

While it can be bothersome to take niacin I wouldn’t give up on it so quick.  There are a few things you can do that might be able to minimize the side effects.  For example:

1. Take niacin with food.
2. Take an aspirin before taking niacin.  Many doctors and patients have reported good results with this.  But, considering aspirins side effects (it acts as a blood thinner, can cause allergies in many people and can irritate any ulcer-like conditions) it’s best to talk this one over with your doctor before adding it in.
3. Consider a prescription form of niacin which often have a more delayed-release mechanism so the niacin isn’t dumped into your system so rapidly.

Other side effects of niacin include headache, dizziness and – in rare cases – liver toxicity.

One side effect that isn’t mentioned much, but that should probably get more attention is in diabetic patients.  You see one of niacin’s roles in your body (remember, it is a vitamin) is to convert carbohydrates into glucose (sugar) as an energy source for your body.  Obviously, raising blood sugars can be dangerous in diabetics.  So, taking it with food is a good idea but I would not take it with a real high sugar snack (which you don’t eat anyways…right?).

Before You Take Niacin

As I said above making the decision to take niacin is one that should be made between you and your doctor especially since niacin is known to cause side effects.  But, there are other things you can do before you take niacin that might substantially raise your HDL:

1. If you smoke, STOP.  This is one of the quickest ways to raise HDL.
2. Eat naturally and avoid processed foods.  Natural foods like leans meats, poultry, fish, nuts, eggs.  Also, while most dairy isn’t completely ‘natural’ is does have health amounts of niacin.  Of course, if you read this site you know that breads and cereals are also not natural foods but they are fortified with nicotinic acid.  I do not recommend these foods.  They generally do more harm than good.
3. Exercise.  Out of any non-drug thing you can do exercise is the most effective at raising HDL levels.  Please remember, smart exercise is not training for a marathon.  More and more evidence is beginning to show up proving just how counterproductive extreme exercise is to overall health (despite the popular myths out there).  Try to go for a walk everyday and if you have cleared it with your doctor mix in a more vigorous activity once or twice a week.

OTC Niacin vs. Prescription

This is going to be a very personalized decision between you and your doctor because over-the-counter niacin is often cheaper than prescription niacin.  So cost plays a role.  Prescription niacin is purported to be better tolerated as far as flushing because of its release characteristics – but there is no hard science behind this.

In then end, it’s something you and your doctor will have to decide upon.  If it were me, I would likely start out with an over the counter niacin just to try it and see how I did.  If it didn’t work for any number of reasons than I could spend a little more money and get prescription niacin.