Niacin Side Effects: Preventing the Niacin Flush

niacin-flush-before-afterAnyone who has taken niacin, at least the right kind of niacin (that being nicotinic acid) has probably experienced the niacin flush side effect. Even after years of taking 2,000mg of niacin a day, I still occasionally get it.

Sometimes it’s no more than a slight tingling in the skin on the back of my neck, other times a large portions of my body will turn red, like a sunburn, and feel as though I’d just been rubbed down with Ben Gay. It’s often accompanied by itching, especially on my scalp and the back of my neck.

First off, realize this niacin flush isn’t dangerous. Niacin causes the small blood vessels called “capillaries” to expand, resulting in a large increase in blood flow to the skin. This is what causes the flushing effect of the skin — more blood in the capillaries feeding the cells.

As part of this process, the cells nourished by the capillaries often produce histamine. Histamine is a natural substance produced when a cell is eliminating toxins. It’s the histamine that causes the itching and tingling sensations.

Some people are so bothered by this side effect that they give up on niacin all together, even though as far as side effects go for drugs that are as effective as niacin, the flush is well worth it. For some the flush is more than a mere nuisance — it can last for hours and the itching can be intolerable.

If you’re looking at a less than optimal cholesterol profile (and especially low HDL levels) and you’ve been considering niacin, or even already tried it an experience the flush, here are a few things you can do to help lessen or even prevent the flush.

The first step is to ramp up to you therapeutic your niacin dose slowly. For most people, the flush effect will fade away over time. Don’t forget that if you plan on taking more than 500mg of niacin a day to consult with your doctor first.

  • Week 1: 250mg morning
  • Week 2: 250mg morning, 250mg evening
  • Week 3: 500mg morning, 250mg evening
  • Week 4: 500mg morning, 500mg evening
  • Week 5: 1,000mg morning, 500mg evening
  • Week 6: 1,000mg morning, 1,000mg evening

The second thing is to make sure you’re hydrated. A niacin flush can be a sign of dehydration. When you take your niacin dose, take it with a minimum of 12 ounces of water. More is better. You can also take it with a meal. This will slow its absorption somewhat and prevent or mitigate the flush.

If you’re still getting the flush, trying drink more water. Downing another 16 – 24 ounces of water gets rid of it for almost 90% of sufferers. And usually in just a few minutes.

Now one problem here might be if you’re taking your niacin before bed. Chug all that water and you’ll be up all night urinating. So back up your niacin dose to dinner time, or at least three hours before you go to bed.

Another tip: aspirin. If you can’t get the flush to respond to drinking a bunch of water, try taking a single, uncoated aspirin (325mg). If you’re one of those who can’t tolerate aspirin, you can try 200 mg of ibuprofen.

Lastly, watch your alcohol intake. Alcohol can aggravate the flush. To avoid that, don’t drink within 2 hours before or after taking your niacin.

Even though most people don’t know it, and doctors don”t recommend it, and drug companies don’t want you to use it, Niacin is best thing going for reducing small LDL particles, raising HDL, and reducing lipoprotein(a). Not even statin drugs can do that much, and their side effects can be much worse.  It”s definitely worth working through the flush to get the health benefits.

A word about no-flush niacin. Regular niacin that can cause the flush is nicotinic acid. The no-flush niacin form is inositol hexanicotinate. While inositol hexanicotinate is effective for treating vitamin B deficiencies (niacon is vitamin B3), it HAS NO EFFECT AT ALL on your cholesterol profile. If you want to try niacin therapy for improving your cholesterol profile, it has to be the nicotinic acid form.


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