Niacin: Myths and Facts

Don't fall for this gimmick. Niacin is among the most helpful of treatments for gaining control over heart disease risk. It raises HDL, corrects small LDL, reduces triglycerides (along with its friend, fish oil, of course), reduces lipoprotein(a), and dramatically contributes to reduced heart attack risk. No-flush niacin does none of this.

The same warning goes for other niacin scams like nicotinamide. Though it may look and sound like niacin, also called nicotinic acid, nicotinamide possesses none of the benefits of niacin.

Make it easy on yourself

Here are the steps I advise that really make taking niacin easy and tolerable:

1) Take niacin with dinner or other substantial meal.

2) Take with 2 extra glasses of water. If you experience the hot-flush later on, drink an additional 2 8-12 oz glasses of water, i.e., a total of 16-24 oz). Extra hydration is extremely effective for blocking the hot-flush. Conversely, people who are chronically underhydrated are most prone to bothersome hot flushes. (Of course, discuss this with your doctor if you are on any kind of fluid or salt restriction or have a problem with fluid retention.)

3) Take a 325 mg, uncoated aspirin. This is usually necessary in the beginning or with any increase in dose; it is rarely needed chronically.

This is not to say that there aren't occasional people who are truly and genuinely intolerant to niacin. It does happen. But those people are a small minority, less than 5% of people in my experience. Niacin is far more effective and safe than most physicians would have you believe.

Besides prescription Niaspan®, I've used the slow-release preparation SloNiacin® which is available without a prescription in many pharmacies. Slow-release niacin preparations like Niaspan® and SloNiacin® should only be taken once per day. Beware of the slow-release preparations sold in health food stores, since the pattern of release of niacin is often not well-controlled. Just plain niacin, also called immediate-release niacin, is widely available but is more likely to cause the hot flush; however, this form can be taken twice a day in smaller doses. Increase the dose of immediate-release niacin very gradually (e.g., start with 100 mg twice a day and increase in 100 mg quantities).

Because of a small risk of liver and other more concerning side-effects, niacin treatment should be conducted with the help of your doctor, particularly if you take more than 500 mg per day.