No-Flush Niacin

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.)

Although I instructed Gwen on where and how to obtain niacin, she went to a health food store and bought "no-flush niacin," or inositol hexaniacinate. She was curious why she experienced none of the hot flush I told her about.

When she came back to the office some weeks later to review her treatment program, she told me that chest pains had returned. On questioning her about what she had changed specifically, the problem became clear: She'd been taking no-flush niacin, rather than the Sloniacin® I had recommended.

Correcting Gwen's small LDL was a crucial step in keeping her safe. No-flush niacin contributed nothing and, in fact, may have pushed her closer to yet another procedure.

What is no-flush niacin? It is inositol hexaniacinate, a molecule that indeed carries six niacin molecules attached to an inositol sugar backbone. ("Hex" means six.) Unfortunately, it exerts virtually no effect in humans. It is a scam. I have seen around 100 patients try it; all uniformly showed no effect whatsoever. Likewise, there are no clinical studies documenting effectiveness.