Statins are just too easy for doctors to prescribe. Niacin, on the other hand, requires a good 15-20 minutes explanation on how to use it. It could generate an occasional phone call from a patient who struggles with the annoying but largely harmless and temporary "hot-flush" feeling, a lot like a hot blush or menopausal hot flash. Given a choice, most doctors would simply choose not to be bothered. For this reason, I commonly see many, many people with uncorrected low HDLs, small LDL particles, and other patterns, all of which would improve dramatically with niacin but remain woefully neglected.
Niacin is as close as it comes to a solution that addresses most of the causes of heart disease. More, in fact, than any prescription drug available. Combine niacin with fish oil, and you've got a powerful combination strategy that reduces or eliminates an array of causes of heart disease. While niacin acts to raise HDL cholesterol, reduce small LDL, reduce triglycerides, and reduce lipoprotein(a), fish oil bolsters the triglyceride-reducing effect.
Have a serious discussion and press for confident answers if you hear your doctor reflexively telling you that the wart on your thumb should be blamed on niacin.
No flush, no effect
"Inositol Hexanicotinate is the true 'flushless niacin.' Unlike 'sustained-release' niacin, which is just regular niacin in a pill which dissolves more slowly, Inositol Hexanicotinate is a niacin complex, formed with the B-vitamin-like inositol. When you take an IHN supplement, the central inositol ring gradually releases niacin molecules, one at a time delivering true niacin. This, like "sustained-release" niacin, allows you to take niacin at clinically-proven doses without going crazy with the itch."
That above bit of nonsense adorns one manufacturer's sales pitch for its no-flush niacin. No-flush niacin is one of the biggest scams in the health food store.
Ordinarily, I love health food stores. There are lots of fun and interesting things available that pack real power for your health program. Unfortunately, there's also outright nonsense. No-flush niacin is smack in the category of absolute nonsense.
No-flush niacin is inositol hexaniacinate, or an inositol molecule complexed with 6 niacin molecules. So it really does contain niacin. However, although it works in rats, in my experience and that of many others who've used it, no-flush niacin exerts no effect in humans.
One typical example: A 41-year old woman came to my office for consultation because her doctor didn't know what to do with lipoprotein(a). She had seen a cardiologist who told her to take no-flush niacin. Both the cardiologist and the patient were therefore puzzled when lipoprotein(a) showed no drop and, in fact, was slightly higher while on the no-flush preparation.
The lack of any observable effect and no studies whatsoever showing a positive effect (there is one study demonstrating no effect), manufacturers continue to manufacture it and health food stores continue to push it as an alternative to niacin that causes the flush. It's also expensive, commonly costing $30-$50 for 100 tablets.