What nutritional supplement increases "good" HDL cholesterol 10-20 mg/dl, reduces triglycerides, reduces small LDL particles (the number one cause for heart disease in the U.S.), even reduces risk for heart attack substantially with no side-effects? It doesn't even require a prescription.

If we believed the advertising claims, that bill would fit inositol hexaniacinate, commonly known as "no-flush" or "flush-free" niacin. 

Sound too good to be true?

Yes, it does. And, indeed, it is too good to be true.

While niacin─the real stuff─does raise HDL, reduce small LDL particles and achieve all those other wonderful effects, it also can cause an annoying "hot flush" that feels like the warm flush of acute embarrassment. It occasionally causes more intense rashes. This has dampened enthusiasm for niacin, despite its unquestioned benefits.

I've used plenty of niacin in my program for reversal and control over coronary disease (plaque) and have found it an invaluable component of our approach. However, some people struggle with the hot flush effect. No matter how hard they try, some people simply cannot tolerate the feeling. (This applies to about 10% of people; the other 90% do just fine, provided they hydrate well.)

No-flush niacin is an attempt to remedy the situation. There are dozens, perhaps hundreds, of different brands of no-flush niacin available. The problem is that, while no-flush niacin does indeed contain niacin, humans are unable to metabolize the molecule and allow it to work. In other words, nothing happens.

Why nutritional supplement scams can be dangerous

Let me tell you about a patient of mine, Gwen.

Gwen felt miserable and defeated. No wonder. After a botched bypass operation just 12 months earlier with failure of 3 out of 4 bypass grafts, she had since undergone 9 heart catheterization procedures and received umpteen stents. She presented to me for an opinion on why she had such aggressive coronary disease (despite Lipitor®).

No surprise, I helped Gwen identify several new causes of heart disease, including a very severe small LDL pattern: 100% of LDL particles were small.

Given her stormy procedural history, I urged Gwen to immediately drop all processed carbohydrates from her diet, including any food made from wheat or cornstarch, both of which are extravagant triggers of small LDL. (She and her husband were shocked by this, by the way, since she'd been urged repeatedly to increase her whole grains by hospital dietitians.) I also urged her to begin to lose the 30 lbs of weight that she'd gained following the hospital dietitians' advice. (This is easy with wheat and cornstarch elimination.) She also added fish oil at a higher-than-usual dose.

I asked her to add niacin, the most effective agents for reduction of small LDL particles. (My preferred brand for safety and effectiveness is the Sloniacin® brand, made by Upsher Smith, an over-the-counter preparation sold in many pharmacies. Over-the-counter Enduracin® is another choice, as is prescription Niaspan®. I always opt for the least expensive; the prescription form is 20-fold more expensive.)