Niacin: Myths and Facts

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

My apologies.  I re-read the article and there was the comment about niacinamide right there at the tail end, I'd just missed it.

 

Liam.

Dr. Davis, you are correct about Niacin, it really does work.  I was on a starter kit and eventually was taking two 500 mg tablets twice a day.  It dramatically reduced my Trigliceride levels and LDL as well as my overall cholesterol.  But the total was not enough for my doctors so they wanted me to add a low does of Provacal.  I have had problems in the past with statin drugs, but figured if it was low enough I would give it a try.  I don't know if it was the combination of the two or just the Niacin by itself, but I developed extremely dry itchy skin and it started to discolor becoming very dark brown in certain areas under the arms and inner thighs. I stopped taking the Niacin and in a couple fo weeks those symptoms cleared up.  I do not know what to do.  P.S.  The doctor never told me about drinking the extra water to help with the flushes, which I still had on occasion after slowly building up my tollerance.

Sorry, on my last post it should have read Pravastatin not Pravacal.

For years, I have been taking the no-flush version of Niacin where I had no side effects, but I also came to realize that this has done nothing for me.  What helped me the most was eating healthier and exercising more and losing some weight.  I found I could not tolerate regular Niacin no matter what else I took before, during, or after taking it.  I ordered and tried the SloNiacin product you mentioned and so far have had no side effects. I started the 250mg for a few months ago and recently switched to the 500mg and only had a short term burning face problem one time during the first few days of switching to the higher mg version. Now, I have no side effects and I plan to take a blood test later this year to see if my HDL (has always been too low, now it is at 32, never higher than 37) is any higher.

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?

niacinamide  is not lmentioned in the article? .... only nicotinamide

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

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.

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 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.)

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.

I am concerned that this Doctor's comments are accurate.  He states something about patients having groin rash, etc, but Niacin was NOT really the cause.  Well, on the printout that comes WITH a Niacin prescrition, it clearly lists this and many other side affects - they ARE from taking the Niacin!