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How to Lower Cholesterol with Niacin

I’m not a doctor, but I did stay at a Holiday Inn Express last night…..

Seriously though, because of my high cholesterol levels, I’ve done a ton of research about how to lower cholesterol with supplements, diet and exercise. Time and time again, I run across testimonials about the great effects of niacin on cholesterol levels. After reading so much about it, and experiencing the beneficial effects myself (see my cholesterol experiment 1 and 2 posts), I thought I’d sort of put together everything I’ve read.

The caveat here is: consult your doctor first! Be also know that many doctors aren’t that knowledgeable when it comes to treating high cholesterol with niacin. Most of them (my own included) tend to go straight to statins. While there’s no doubt statins can be beneficial, I, for one, wanted to exhaust natural diet, supplement, and exercise alternatives first.

That desire led me to niacin (as well as fish oil and vitamin D, but those are for other posts). So here’s the scoop on niacin, present with the repeated warning: talk to your doctor before you make any significant changes to your diet or supplements.

Niacin, also known as nicotinic acid, is found in poultry, red meat, beans, and grains. It’s a member of the B vitamin family and required by the human body. Lack of niacin cause pellagra, a nutrition deficit disease.

The USRDA (recommended dietary allowance) for niacin is 16 mg a day for men and 14 mg for women. This is enough to prevent a deficit. However, when taken in greater doses, many people realize significant health benefits:

• Increases HDL (high-density lipoprotein), the good stuff, by 20-35%.
• Decreases triglycerides by up to 30%. Niacin works especially well with fish oil.
• Decreases very low-density lipoprotein (VLDL), more bad stuff.
• Decreases lipoprotein(a), which is among the most serious risk factors for heart disease.
• Decreases low-density lipoprotein (LDL), the bad stuff, by 5-25%.
• Niacin also blocks the release of fatty acids from fat cells so that fewer fatty acids are passed through to the liver. This results in fewer VLDL particles which means lower LDL and higher HDL.

The Coronary Drug Project established niacin as being able to lower heart attack risk. When heart attack survivors were given 3000 mg of immediate-release crystalline niacin daily for six years, repeat heart attacks were reduced by 27% and strokes by 26%.

In the HDL-Atherosclerosis Treatment Study (HATS), 160 subjects were given niacin and simvastatin or a placebo. Compared to the placebo group, those getting niacin and simvastatin showed a 90% reduction in death and heart attacks over three years. By comparison, statin drugs alone typically reduce heart attack risk by 25-35%.

Despite niacin’s efficacy, many doctors never consider it when faced with high cholesterol. Instead they turn to statin drugs because doctors prescribe drugs and niacin isn’t viewed as a drug. Yet Niacin can be a powerful agent in fighting heart disease, when used by itself or with other treatments, especially fish oil.

Niacin is very safe if the liver is exposed to it for only a few hours at a time. Research indicates 24-hour, day-after-day exposure over an extended time can be toxic to the liver. The very-slow-release niacin products, primarily formulated to reduce the flushing effect, can result in sustained, high levels of niacin and can cause liver toxicity in 10 – 20% of users. So does that mean niacin isn’t safe? No, it means you shouldn’t use slow release niacin.

So what type of niacin should you take? Glad you asked.

Immediate Release /Crystalline niacin

This type of niacin is inexpensive and has been shown to be effective. Be warned! The niacin here is released immediately and usually causes the dreaded niacin flush, that warm, sometimes almost burning, itchy feeling of the skin. I recommend you start small to build up tolerance to the flushing. Take it with some food and at least 8 ounces of water. Here’s a sample schedule:

• Week 1 morning: 250 mg
• Week 2 morning: 250 mg, evening: 250mg
• Week 3 morning: 500 mg, evening: 250mg
• Week 4 morning: 500 mg, evening: 500mg

Once you get to 1,000 a day, sustain that dosage for a month, then get your cholesterol panel checked to see the results. Studies have shown increasing the dose up to 3,000 mg a day can bring additional benefits. Don’t increase the dose and don’t take more than 500 mg per day without consulting your doctor! It’s recommended that you don’t take immediate-release niacin more than twice a day.

Extended Release Niacin

This type is a compromise between immediate release and slow release. It’s safer than the slow release because it doesn’t expose your liver to high niacin levels for as long, and it can reduce the flushing effect caused by the immediate release type because is released more slowly into the blood. Slo-Niacin by Upsher Smith is sold over the counter and is very popular. Niaspan is an extended-release version sold by prescription only.

Slow Release Niacin

Although this type is the best at reducing the flush response, it’s not recommended. They reduce the hot-flush effect by releasing niacin over an extended period of 12 hours or longer, which, as I noted above, can cause liver toxicity problems in 10 – 20% of users.

“No Flush” Niacin

Guess what? No Flush niacin preparations aren’t really niacin, they’re niacin derivatives. Inositol hexaniacinate and nicotinamide are widely sold as niacin alternatives that don’t cause flushes. Although they provide vitamin B3 to the body, studies have shown they are not effective when it comes to your cholesterol profile. Guess what else? It’s also the most expensive. So it doesn’t do anything for your cholesterol and is 3-4 times as much as immediate or extended release. Stay away!

How Much Niacin?

If your goal is to raise HDL and reduce LDL particles, a dose of 750-1000 mg a day is usually enough, although you can see some increase in benefits all the way up to 1500 mg a day. To reduce total LDL or lipoprotein(a), the doctor might recommend higher doses, from 1000 mg up to 4000 – 5000 mg per day. Remember, doses over 500 mg a day should only be taken under a doctor’s supervision. It can take up to three months to see the benefits of niacin.

So there you have it. If you’ve been struggling with high cholesterol, high LDL, VLDL and triglycerides, and low HDL, you should discuss niacin therapy with your doctor. It might be that you can see some positive results without exposing yourself to the potential side effects of a statin.

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