Five Frequently Asked Questions About Treating High Cholesterol with the B Vitamin Niacin

Most doctors are caught up in the idea that statin drugs are the one and only proven therapy for high cholesterol levels and their resulting increased risk for cardiovascular disease. Treatment with the B vitamin niacin, however, can be the closest thing to a perfect treatment for high cholesterol in people who have encountered muscle pain or memory problems when using statin medications.

Niacin is the B vitamin also known as vitamin B3. It is not always safe to take megadoses, but most people can safely take enough niacin to keep high cholesterol in control. Here are five frequently asked questions about using niacin for cholesterol.

Q. What is niacin? Is it the same as nicotinic acid?

A. Niacin is the B vitamin also known as nicotinin acid and vitamin B. It’s especially abundant in red meat, chicken, turkey, beans, and whole grains. It is crucial in keeping energy production inside every cell in the body from producing so many free radicals that energy production process shuts down, and it’s also involved in hormone production and protein synthesis.

Q. What are the benefits of niacin for cardiovascular health?

A. Individual results differ, but in general taking high-dose niacin:

  1. Lowers the number of small LDL particles, the kind that are associated with heart disease.
  2. Increases HDL, often by 20 to 35%. No other treatment, whether “natural” or pharmaceutical, increases HDL more.
  3. Decreases triglycerides, usually about 30%. Taking niacin with 4000 mg of fish oil a day is especially effective for lowering triglycerides.
  4. Blocks the release of fatty acids from fat cells (by making it safer for fat cells to burn them for fuel).
  5. Improves the action of nitric oxide synthase, giving results all over the body comparable for both men and women that are comparable to the localized benefits of Viagra, Cialis, and Levitra for men.

In the Coronary Drug Project, 1000 survivors of heart attacks were put on 3000 mg of quick release daily for six years. Taking this dosage of niacin reduced the number of second, non-fatal heart attacks by 27%, and the number of strokes by 26%. In the HDL-Atherosclerosis Treatment Study, taking both niacin and simvastatin (Zocor) reduced rates of death by 90%.

Q. Which form of niacin is better, slow-release or immediate-release?

A. Niacin can trigger facial flushing, similar to a blush caused by embarrassment, or worse, if you have a skin condition called rosacea. The slow-release form of niacin doesn’t cause flushing, but it doesn’t stop cholesterol synthesis in the liver, either. Immediate-release niacin stops cholesterol production in the liver for a short time, but then lets liver activity go back to normal for the next 20 to 21 hours of the day. There is no risk of liver damage, as there is from continuous-release niacin, and there is better lowering of cholesterol.

Q. Can I take niacin if I have rosacea?

A. If you have the form of “adult acne” known as rosacea, you should not take niacin supplements. You will need to use other methods to lower high cholesterol.

Q. Is there anything I can do to stop the flushing I get after I take immediate-release niacin?

A. In most people, flushes only last 10 to 20 minutes, and after a few weeks, they go away. However, you can stop flushing by:

  1. Taking your niacin supplement with a handful (up to 2 oz/60 g) of almonds, walnuts, pecans, macadamias, peanuts, or pistachios, which slow down the absorption of the vitamin, and which also help raise HDL.
  2. Taking your niacin supplement with a baby aspirin. Do not take even a baby aspirin without doctor’s direction if you use blood thinning medications.

Don’t take niacin if you have rosacea or gout, and don’t take high-dose niacin if you have peptic ulcer disease. If you have diabetes, be sure to monitor your blood sugar levels when you take the drug. Niacin therapy usually causes all blood sugar readings to go up about 5 mg/dl (0.3 mmol/L).