Dr. Davis mentioned that sometimes people think their itchy feet is being caused by niacin. That intrigues me, since I am a diabetic and sometimes have itchy feet occasionally. What causes the itchy feet? Incidentally, I don't take niacin.
Also, does Dr. Davis have an opinion regarding CholestOff (by Nature Made) being used as a cholesterol-lowering agent?
Thanks for your comment.
Cholestoff is a combination of sterol and stanol esters. Both components clearly work to reduce LDL, occasionally as effectively as a low-dose statin drug.
However, I continue to have reservations about the sterol component. There are data, principally in the European literature, though originating with a very respected Finnish group, that suggest that there may be a segment of the population that absorbs sterol esters into the blood--which is not supposed to happen. It is probably a problem in only a small portion of the population, if at all, but it has made me wary of advocating the sterol product.
If you would like to take advantage of the stanol ester alone, you'll find that in the butter substitute, Benecol.
It is difficult to know who to trust. Too many people with "MD" or other significant initials following their names give advice but do not make attempts to convince. Thus the only ones convinced are those who mistakenly believe that the "appeal to authority" is a strong or even a valid logical inference.
In this article, Dr. Davis states, "Slow-release niacin preparations like Niaspan® and SloNiacin® should only be taken once per day" (SloNiacin, by the way, comes in 500 mg doses). Talk about "proceed[ing] to scare the pants off you"; over the counter drugs can almost always be taken several times per day, and we're talking about a vitamin here. By contrast, the book "The New 8-Week Cholesterol Cure" advises:
"The maximum daily niacin dose should not exceed 3000 mg (3 grams) of standard, crystalline, immediate-release (IR) niacin or 1500 mg (1.5 grams) of slow-release or sustained-release (SR) niacin. SR niacin formulations have been noted to have both twice the effectiveness and twice the toxicity of IR preparations, hence the difference in maximum dosages. Those dosages have been shown to provide maximum benefits while resulting in minimal side effects. larger doses are more likely to result in adverse reactions, including abnormal liver enzymes."
Now that's the schedule that I have set for myself - 3x per day: 1 when I wake up, 1 late afternoon, 1 as I'm going to bed. I've maintained this schedule for quite some time - several years, in fact, though with occasional long bouts of forgetfulness in taking the stuff. But now, having read Dr. Davis' article, I'm concerned - have I damaged my health? Irreparably?
My own doctor knows that I'm taking niacin, but he seems to be unaware that it can ever have any side effects at all. Further, in conversation he has assumed aloud that I am taking the inositol variety, thinking that it is the variety that works (or at least one of the effective varieties). Thus I'm not overwhelmed with confidence in his opinion that I'm okay at 1500 mg daily.
What to do? (I would like to read some discussion on this.)
By the way, I have made a record of my cholesterol profiles using google docs, if it is of interest. Consider it my own personal study on affecting cholesterol levels:
http://spreadsheets.google.com/ccc?key=p38ogaYRdlDNSQFVGpneuUg
Good chart. Good results. I have been taking niacin (Twinlabs Niacin, B3) for a little more than one year. 1 500 mg tablet twice/day. Along with red yeast rice and lots of fish oil (sort of by mistake since the 2000mg caps were put in the 1000mg bottle and I was taking 2-3/day). LDL went from 134 to 72. Hdl from 81 to 141 and triglycerides from 227 to 105. Wow. I had been taking the red yeast rice and fish oil for 3-4 years with gradually lowering effects but not quite good enough. So the niacin really works for me. During the year in question I also started resistance training, so that probalby helped.
My question is how long does one continue this? My doctor did check for any liver problems.
Since you didn't mention the amount of Niacin necessary to lower cholesterol, I take it that my physician will need to instruct me on the precise amount. I currently take one caplet of 500 mg's daily, though I did not ask my physician.
There is no precise amount as the effect is variable. This is why physicians need to take extra time initiating therapy with patients. There is a titration schedule, and a lot to explain regarding managing possible side effects.
Some patients get the same LDL reduction with as little as 500mg as another patient taking 2000mg.
I, temporarily, lost the use of my legs as a side effect to a lipid inhibitor. Because of, primarily, genetic reasons my total was in excess of 340 - 3 years ago and my HDL and LDL were as much out of control. After some extensive reading and speaking with a research fellowship at a Florida College I decided to begin a strict regiment of suppliments. While being monitored for increased liver enzymes the whole time, I increased my level of Niacin (Inosatol) intake to two doses of 3g per day over a two year period. Along with the Niacin, I took B6, B12, Folic Acid, and High doses of Omega 3's and 6's via concentrated fish oils. After three years, I am happy to say that I have cut all three measurements (total, hdl, ldl) in half or less. I know this wouldn't be for everyone because everyone reacts differently to the Niacin, but has helped me and no evidence of elevated liver enzymes with blood tests every six months. I am athletic, but not extremely, and have an active late 40's lifestyle. After attempting to drastically alter my diet with no significant improvement I knew I would have to try something else that was equally as drastic, so I started reading and, only while being very closely monitored by skilled medical personnel, began this regiment. Again, I would definately not recommend just jumping into this and I am still not sure if this will be a long term solution because I am not yet positive that there may not be any delayed side effects. I am never flush or show any typical signs of Niacin intake. None, whatsoever. I'm almost nervous about what would happen if I stopped taking it!
If anyone has any evidence to show me that I, for sure, shouldn't be taking these levels of Niacin, please point me in the right direction.
I'm taking 3,000 mg of immediate release niacin per day and 2k fish oil as well. I've been taking it for about 6 months and saw my HDL go from 30 to 36, LDL from 290 to 210, triglyicerides from 280 to 115. My numbers are still bad and my doctor (who is a big fan of statins and not a fan of "alternative" treatments like niacin) tells me I need to be on statins, stat. I am HOPING the numbers continue to come down, even if slowly.
I bumped up my dose to 4,000 mgs of niacin per day for a few days and started feeling pressure or pain in my left eye, as well as eye dryness. After reading about it on the internet, it appears to be an ocular issue. I am going to reduce niacin to 2k for a few days, then stay at 3k, as that appears to be my upper limit before side effects.
Liver enzymes are checked every 3 months and always perfect.
I had a horrific flushing and itching reaction to niacinamide. It has happened to me twice during a niacinamide regimen. My face, arms, and feet flushed; and my forearms, hands, and feet were so itchy I was scratching like a crazy person! I took a Zyrtec, and it helped. I'm going off of the niacinamide for fear I'll have another itchy episode.
I have just started a niacin SR regimen of 1g after lunch. I get a flush for about a half hour and it is enjoyable. It makes my skin feel warm and tingling somewhat like a sauna with the switches of pine stimulation. But that's not the best part. What I enjoy most is the two to three hour psychological boost I experience afterward. I suffer from cyclic disthymia, a kind of regularly recurring depression and this brief respite is so remarkable that I no longer take Zoloft, an antidepressant. I have also been able to reduce by half my Enalapril dosage for high blood pressure. I am a 77 year old retiree who is in need of a exercise regimen as well. I am working hard to consider it but old knee and hip arthritis is a complication.
Thank you for confirming what I have believed for a long time. Over 40 yrs ago a Dr.
prescribed niacin (taken 4 times a day..1 30 mins before each meal and 1 at bedtime) to stop the horrible headaches I was awakening with.
I get off (forget, get busy etc.) but have been botherd with bad circulation all my life.
A few years back I started having chest pain. All tests were negative. Research from peer reviewed medical journals would suggest I have small vessel disease. My BP and cholesterol have always been fine. Since the Dr's seemed to be at a loss as to what to do, I strtd myself on a routine of a multi-vitamin, plus B complex with occasional
Omega 3 and Co Q-10 . As long as I stay on this I am fine. When I get off (life happens) and I start having pain, I immediately chew up one or two niacin and an aspirin. Usually stops it in 20-30 mins.
Before I retired a pharmaceutical rep was trying to sell me on "non-flush" niacin.
If I don't flush, I know I need to take more! How would I tell with the other!
Still Ticking
I have read that niacin works by blocking the breakdown of lipids in adipose tissue. That leads to this important question:
Does niacin interfere with, or slow one's weight loss while attempting to lose weight through dieting?
I have low HDL and am overweight. Should I postpone the niacin while dieting, and start the niacin after successful weight loss? Or, is it ok to start niacin while dieting? (with no risk of the niacin messing up my dieting results.)
According to previous Niacin studies people lost an average of 4% of thier body weight while taking 3 grams (crystallyn) niacin per day. (Probably because of the inhibition of free fatty acids from adipose tissue, although niacin is NOT a diet drug.) I would not have a problem taking niacin wether dieting, or not. And niacin is especially good for people that have the metabolic syndrome (a large amount of belly fat). I would not have a problem taking niacin wether dieting, or not.
After being on Prednizone for a year, my cholesteral went thru the roof. My specialist put me on Niaspan, 1500mg daily at bedtime. Within a year, my numbers corrected. Altho I am still on it due to a genetic disposition to small carriers of LDL. For me, the hotflashes never stopped but it was better than knowing my arteries were clogging up no matter what I ate. I went into my GP's office and of course the sweating started. I was having these flashes maybe 10 times a day lasting for anywhere from 5 minutes to 30 minutes and they woke me up at night 2 or 3 times to change jammies and sheets. She put me on a patch, Catepres TTS-2. A simple little patch. I cant say that the hot flashes have completely stopped BUT they have cut done in number and duration and no longer wake me up at night. A side effect of the patch?? Altho it is a BP drug, its side effect stops hot flashes. An easy way to handle a very uncomfortable side effect of Niaspan.
In my opinion, absolutely YES!! The prednisone made my cholesteral sky rocketing and my HDL was low, my LDL was high, I am still on 1500mg daily and it has gotten my levels back to normal. In spite of Hot Flashes that for me are 5 to 10 times a day lasting anywhere from 10 to 30 minutes, I would not trade a dry body for the alternative which is plaque build up and an early death from Cardiac disease. Try your 500mg a day for a year, if u r satisfied with the results, keep on taking it. God Bless.
Thank you Deb, I suppose what concerns me most are the side effects.....of course I don't know if I'll have them or not but just how bad they are they. They really concern me.
Have you every had a fast heart rate as a result of taking Niaspan?
Could you describe in detail how the flushing episodes are? How long they last and how bad they make you feel? I would greatly appreciate hearing more from you on the side effects. And God Bless you as well.
The only side effect I have encountered with Niaspan is the flushing. I dont know where you live but I am a Canadian and moved to The Deep South 6 years ago. Let me tell ya, you never get used to the heat so living in a place that until yesterday had temps over 85, mostly closer to 100 and very humid, does not help and only exacerbates the flushing. It doesnt hurt, is similar to a hot flash from menopause, starts at your head and spreads. I have a very fast metabolism so that doesnt help either and as I said I would rather walk around in a 24x7 flush that to suffer the inevitable heart failure. I know other people including my specialist who are on Niaspan and for them, maybe 2 or 3 flushes a day. Please remember that Niaspan is simply a natural B vitamin and most side effects are associated with other forms of Niacin like the kind they say doesnt make u flush, some on that experience itchy skin but that is a natural compound that has been changed by man. Also, for most people, the flushing stops once their body adjusts to the Niaspan. I know of no other side effects with the brand name Niaspan. Have NEVER had any other side effect including a racing heart. Please do not let fear stop you from at least giving Niaspan a try, it truly is a life saver, it reduces your Tri-glycerides and LDL and increases your HDL. I am also on Zetia, Crestor and Tricor to undo the effects of the prednisone and genetics and to date, after 3 years all of my tests come back clean and my numbers are terrific. All I can say is try it, keep in touch with your doctor and in 6 months have your tests done again and see how it haas improved your numbers. Maybe just take a step out in faith but do not let fear stop you. D
For years (I'm talking 10+ years ago), anytime I attempted to take multi-vitamins, I would develop rather intense persistent flushing followed by rather lengthy and persistent headaches bordering on migraines. I saw a doctor a couple times about it and we successfully narrowed it down to Niacin as the cause. So I just assumed I was allergic to it and avoided it like the plague. It was rather difficult to find multi-vitamins that didn't contain it. Last year, I started taking "Boost" and developed the same symptoms and quickly realized there was a small dose of Niacin, but the doctor told me it was okay and was surprised how sensitive I was to it. She said to keep taking it and you'll get over it. She was right, the burn and headaches went away after a couple weeks -- I actually helped by reducing my dosage to make it more tolerable and then ramping up to regular doses. Anyways, yesterday -- I purchased Men's One Daily Vitamin Shoppe brand multi-vitamins, knowing full well there was Niacin in it. It's apparently all natural coming from whole food sources rather than the chemically created type. This stuff has really nailed me with just one dose and I'm fighting a rather strong headache and burning sensation 24 hours after taking the one and only pill. I plan on waiting for the effects to subside before taking another one. I am under the assumption that I will eventually be able to tolerate taking it once per day, but it may take a couple weeks. As for me, I have good health -- low cholesterol, good blood pressure, no diabetes, I'm lean (6'2" 165lbs, 37 year old male). I drink a lot of water (and a 2-3 cups of black coffee in the morning). I generally don't drink anything else -- very rarely drink sodas, juices, booze. My exercise is non-existent and I eat a lot of meat & carbs, but hardly any fruits and vegetables. I generally don't have a lot of sugar either and try to avoid highly processed foods, eating at home mostly and cooking with real ingredients. I used to eat a lot more junk food and fast food in the past but obviously that hasn't made a difference. Anyways, just curious if I am okay moving forward or if there is anything I should be getting checked or any tips to mitigate the effects. I do have Ibuprofen.
The Good doc says:
By itself, niacin reduces risk of heart attack by 22-30%. If added to a statin agent, heart attack risk reduction can approach 90% (as demonstrated by the HATS Trial).
The HATS trial was a very small study looking at antioxidants and niacin and statins in different combinations in patients with established coronary artery disease(CAD). The placebo group didn't have statins which is standard of care in anyone with CAD. This small effect is hardly demonstrating "heart attack risk reduction of 90%". Niacin, like folic acid, has plenty of surrogate endpoint improvements but lacks robust evidence of improved clinical outcomes. Folic acid was ultimately proven to do no good/slightly increase the risk of subsequent heart attacks when large randomized trials were conducted.
Recommending Niacin to the general population or folks diagnosed with high cholesterol is without any clinical outcome date. Recommending it to folks with CAD and an HDL <35 has a small amount of evidence. First do no harm doctor.
HATS trial — The HATS trial suggested that additional benefits may be observed in patients with low HDL-C by combining a statin (which not only lowers LDL-C but may have additional cardiovascular benefits beyond lipid lowering) with a drug that increases HDL-C [101]. This three year trial included 160 patients with clinical and angiographic evidence of CHD who had an HDL-C less than 35 mg/dL (0.9 mmol/L) and an LDL-C less than 145 mg/dL (3.75 mmol/L) [101]. Patients were randomly assigned to one of four regimens: simvastatin plus niacin; antioxidants; simvastatin plus niacin plus antioxidants; or placebo. The mean serum LDL-C and HDL-C concentrations were unaltered in the antioxidant and placebo groups, but changed substantially (-42 and +26 percent, respectively) in the simvastatin plus niacin group. Compared with placebo, patients receiving simvastatin plus niacin were significantly less likely to sustain a cardiovascular event (death, myocardial infarction, stroke, or revascularization) and experienced angiographic regression (compared with progression for the placebo group) of the most significant coronary stenosis. The magnitude of the reduction of clinical events with drug therapy (relative risk 0.1 to 0.4 compared with placebo) in this study was greater than that typically observed with studies of statins alone, suggesting that treatment designed to raise HDL-C provides additional protection beyond that attributable to simply lowering LDL-C. However, caution should be exercised when comparing results of different study populations. In addition, the study group was relatively small and the confidence intervals wide, suggesting that larger studies comparing combination therapies with statins alone may be warranted. Antioxidants did not provide any additional benefits in this study of secondary prevention (and even appeared to attenuate the positive effects of combination drug therapy), which is consistent with most other clinical trial data
After being put on hormone replacement therapy 10Mg Androgel daily for a very low Testosteron level (221) it was noted that my cholestorol had sky rocketed from 175 total to 298. Also my tryglycerides were up and my HDL was in the 30's. The doc first suggested that I stop smoking and start excercising, then noticed that I am a 6'0" 210 pound gym rat
On the advice of a pharmacist, I started to take Niacin becuase I refused statins on principal. Although I did quit smoking, it was after the resulting blood tests, therefore not a part of this.
The result was that my next tests, 90 days after the first, gave me a total drop to 215. HDL raised, LDL dropped. However flushing was a major issue for me because I suffer from chronic hives in the first place. As a result, I would either take my dose at the same time as my 180mg of fexophenadine (that did a good job of controlling it, or it was also recommended to sleep through the flush by taking it 5 minutes before sleep.
Regardless, end result is it works, but dont say that too loud or the fda will ban it unless it comes fom a pharm-giant.
I have had high cholesterol and high blood pressure. I changed my lifestyle and went on a statin and all the numbers came down. But I was having difficulty getting an erection and maintaining it. To help the good cholesterol, my doctor prescribed Niacin, 500 mg daily. After only one day on Niacin, any problems I had with erectile dysfunction disappeared. Wow. Is this coincidence or is it from Niacin?
I find it VERY interesting that lipitor ads kept over=riding the niacin information, on this web site & when I tried to leave a comment, I was put back to lipitor on the google search?? Wow! drug companies are on the defensive & very powerful if they can do that. Statins have many bad side effects so trying to destroy the reputation of supplements, seem totally disengenuous, which isn't unusual for drug companies. Not only have I found most herbal/traditional remedies to be very effective they almost always have very few or no side effects, & have been around for literally hundreds of years, unlike the laboratory concoctions which are comparitively new. Guess we know who has the power whether they deserve it or not.
My husband was up to 2000mg of niacin a day and he started having muscle pain in his arms, shoulders and legs, just as those who take statin drugs sometimes do. When he woke up in the morning, it felt like he had been lifting weights all night long. He went off the niacin and started taking CoQ10 and the pain went away about 70%. But after 2 weeks he still has some pain. He does not want to take statins. He's not wanting the pain. What to do? He is hoping all of the pain will subside, but he has stopped lifting weights at the gym and is quickly losing muscle mass.
I tried 500mgs of Niacine for the first time last evening. I woke up at 4:00 a.m. in extreme discomfort - so much so, that I thought I should be taken to hospital. My body was red and on fire. I had a prickly feeling all over and I thought I was going to be sick. I had to use a cold wash cloth to help cool myself down - it was awful. The feeling passed within an hour but I sure won't be taking Niacine ever again.
Holy smoke, 500mg for your first time?? Way too much to start with. Start with 50mg and slowly work your way up to 1500mg or whatever. Take with meals and lots of water and you'll be fine. If you feel a little warm, sit in the pool or in front of a fan. Cool tub. Whatever it takes to make you feel good... but 500mg to start with is just to much.
The NIH has a Niacin protocol that calls for low levels and titration to the effect dose of 3 total grams/day. Highly recommend taking on a full stomach after a meal in the morning and right before bed in the evening. With full stomach, the dose is effectively metered and flushing is minimal or not at all. NIH suggests taking an aspirin about 1/2 hour before a Niacin dose as another option. The regimen starts with 500 mg. morning and evening for two weeks then titrate to 1 gram BID for two weeks them to 1.5 gram BID. Flushing occurs from vasodilation that leads to a reddish rash (flushing), and the buring sensation. Would recommend increasing water consumption in general. Niacin is now actually used in some OTC skin repair treatments. I take cheap drug-store type Niacin and it has worked better than anything. My HDL went from 32 to 50+ and has stayed there for close to a decade.
On LDL, the risk of muscle pain and even deterioration can occur. One of the primary causes is CoQ10 depletion. Merck, the first to launch a statin, even patented a Mevacor/CoQ10 combination to help deal with it. It is not cheap, but stil acheap insurance fro anyone starting statin therapy. My low dose of simvastatin has dropped my LDL by ~50% and has been very effective and had no measurable impact on my previously elevated live enzymes.
Tried plant sterols before statins and had minimal LDL impact (~5%), pretty much a waste of money and they are not cheap. Take fish oil which helps skin and is reportedly helpful as a cardiovascular benefit (even an approved pharmaceutical that is just purified fish oil). Haven't seen a measureable benefit after 10 years. But it has many other benefits so keep taking it.
Niacin is the most powerful low cost solution for effectively lowering LDL cholesterol while at the same time increasing the HDL or the good cholesterol. I would highly recommend anyone to read "The New 8-Week Cholesterol Cure" by Robert E. Kowalski. It gives details as to why niacin is so effective and gives you the proper dosages to take. Also, do not waste your money taking "flush-free" niacin. It is totally ineffective. 
I was on statins for years after I had a acute heart attack at age 49. I did not realize over the years how much the statins were affecting my muscles. A few years ago, the doctor increased my statin dose. Within a week I had severe muscle weakness, cramping and generally hurt all over. I started searching online and learned about the statin side effects. I went and saw a naturopath and she took me off the statins. Gradually over a months time I felt like I was 40 years younger. It was very impressive how much better my physical feeling of well being improved.
My cholesterol went up to almost 300 mg/dL without medications.
I started taking guggulipids and niacin (as inositol hexaniacinate). I use Niasafe 600 (2 pills/day) and have never had any flushing or itching.
The two supplements are working as my cholesterol is down to 200 mg/dL. My LDL is about 110 mg/dL. I want to get my LDL down more so I am increasing the niacin to 3 pills and will see what happens. It is nice to not feel any of the statin side effects.
Hello, I would like to know whether niacin is helpful for quitting smoking cold turkey. Does anyone have any idea??
Here's some info from Dr. Abram Hoffer, MD,PHD biochemistry. http://www.doctoryourself.com/hoffer_niacin.html Hoffer practiced medicine for about 60 years and is recognized as one of the founders of orthomolecular medicine. Used niacin for decades. He also published a book on niacin which has useful info and on above site are other articles. Was co-author with Pauling on the Vitamin C book.
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Inositol hecaniacinate may be "no flush" niacin, but it is NOT "no-side-effect" niacin.
I had extreme flushing with a niacin regimen for my cholesterol, so my doctor and I tried this formulation. It is true that the extreme flushing went away, but in its place, I got extreme itching. I mean extreme, as in raking my skin so hard it bled. It was horrible.
Now, I don't know that this is a common reaction, but it certainly was mine.
By the way, there is a third formulation of Niacin available, Niacinimide, which is not mentioned in this article (or at least, I didn't notice it if it was). According to my doctor, niacinimide does not work as a cholesterol lowering agent. You need nicotinic acid.
Liam