For a simple, available treatment that can dramatically reduce risk for heart attack, niacin has suffered more than its share of knocks, insults, and undeserved criticisms.
Is it deserved? Does this simple nutritional supplement, B vitamin, and component of food deserve this barrage of snubs? Or, can it be used intelligently to advantage-safely and effectively?
Niacin myths- From a health website:
A Cholesterol-Busting Vitamin?
Niacin is safe - except in people with chronic liver disease or certain other conditions, including diabetes and peptic ulcer. . . It has numerous side effects. It can cause rashes and aggravate gout, diabetes, or peptic ulcers. Early in therapy, it can cause facial flushing for several minutes soon after a dose, although this response often stops after about two weeks of therapy and can be reduced by taking aspirin or ibuprofen half an hour before taking the niacin. A sustained-release preparation of niacin (Niaspan®) appears to have fewer side effects, but may cause more liver function abnormalities, especially when combined with a statin.
Strange. After a headline designed to pull readers in, the article then proceeds to scare the pants off you by articulating a litany of side-effects. Most readers would understandably be frightened of giving niacin a try after reading that list of dangers.
Are these warnings warranted? Is niacin as dangerous as they make it sound?
I would argue that it is not. In fact, I would argue that niacin is among the safest, most effective, and wonderfully inexpensive ways to correct the causes of heart disease and reduce the risk of future heart attack available today-when used properly.
Critics of niacin (perhaps more accurately described as those ignorant of the real power and usefulness of niacin) often complain about the frequent bothersome side-effects of niacin. Is niacin really that troublesome? No, it's not. In fact, if used properly, niacin is among the most effective and safe tools available for correction of low HDL, small LDL and other triglyceride-containing lipoproteins, and lipoprotein(a). 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). Unlike widely-prescribed statin drugs that reduce LDL cholesterol particles across the board regardless of size, niacin lowers the amount of small LDL particles, the most damaging variety, much more than the less harmful large LDL particles.
Despite the fact that niacin is:
1) A vitamin-vitamin B3 (deficiency is called pellagra)
2) One of the oldest cholesterol-reducing agents around with a long-standing track record of effectiveness and safety
3) Available as a prescription drug as well as a variety of "nutritional supplements"
most physicians remains shockingly unaware of its benefits, effects, and side-effects. Most, in fact, are either ignorant or frightened of advising their patients on niacin use. As a result, I commonly have to ask my patients to resume the niacin that their primary care physician has (wrongly) stopped because of itchy feet, grumpiness, groin rash, urinary tract infections, nightmares, diarrhea, hair loss, runny nose, etc. All of these are REAL reasons doctors have advised patients to stop niacin (though none were actually due to niacin).