Fake Niacin: Readily Available at your local store!

If you or someone you know takes Niacin, please share this blog with them.  This is critical information.

Where is Niacin found?

There are many sources of niacin on this planet.  Niacin is found in many foods, supplements, and it is readily available in the American diet.  Needless to say, modern American doctors never see Niacin deficiency which causes the 4 D’s:  Dermatitis (Skin Disease), Diarrhea, Dementia, and Death.  Niacin deficiency is easily reversed with dietary niacin intake or supplementation.

Fake NiacinIf Niacin deficiency is so rare, why should I take Niacin?

Niacin in modern supplement used for its cholesterol lowering properties.  It has been used for centuries, and it is given in much larger amounts than is needed to prevent Niacin deficiency.  Niacin was proven effective to lower cholesterol back in the 1980’s with clinical trials.  Not only did it lower cholesterol, but it improved people’s life expectancy by reducing their likelihood of having a heart attack or stroke.

After the 80’s, the statin medications (Lipitor, Crestor, Zocor, etc) were discovered.  Statins became the new King of the Jungle, and they simply dominated the cholesterol arena for years … and still do.  Niacin was then kicked to the side.

However, after years passed by, modern medicine became keenly aware of the difference between GOOD (HDL) and BAD (LDL) cholesterol.  For years, we were treating only total cholesterol, which is a simple addition of BAD + GOOD = TOTAL.  Well, as it turns out, we do not need to treat high total cholesterol that is caused by elevated good cholesterol.  It was then thought that only BAD cholesterol needed to be treated.  Statins only lower bad cholesterol, and they usually do not affect good cholesterol.  Although some have shown that they actually reduce good cholesterol.

Niacin re-emerged into modern medicine for its good cholesterol boosting properties.  Many Americans have low good cholesterol because of lack of activity, poor dietary choices, and genetics.  It is known that niacin boosts good cholesterol levels without exercise, so it was being recommended to patients who have low good cholesterol.

What about the latest studies suggesting that niacin is ineffective?  My good cholesterol is low, should I take niacin?

Not necessarily.  This is what makes modern medicine fun (for me).  Theoretical benefit does not always equate to real world benefit.  As it turns out, Niacin definitely boosts good cholesterol levels into adequate goals.  It makes your numbers look much better, and it does not take mega doses to do it.  However, when niacin was studied in further detail in the 21st century (remember that it showed benefit in the 80’s), it was studied in conjunction with statin medications.  It was studied with statins because statins, by this time, had shown enormous benefits across many different populations of patients (heart attacks, strokes, aneurysms, kidney disease).  Therefore, clinical trials were designed with statins + niacin to assess for benefit.  In the trials, the patients who were given niacin had higher good cholesterol levels which usually correlates to better health, but their outcome data was unchanged.  This means that although they had better good cholesterol levels, they still had the same amount of heart attacks, strokes, and death compared to those who had lower good cholesterol without niacin.

Take Home Message:  You can take Niacin to boost your good cholesterol, but it won’t change your life expectancy.

On a side note, there have been several drugs identified that are POTENT stimulators of good cholesterol (way beyond niacin’s abilities), yet they have not become available as prescription drugs because they have not been able to prove benefit.  There is something about the human body’s natural good cholesterol that cannot be replicated … yet.

What is fake Niacin?

If you have been told to take Niacin, you have probably experienced the closest thing to a hot flash that menopausal women would describe.  Niacin’s largest side effect is flushing of the skin all over the body.  It will make your face, arms, trunk, and legs turn beet red.  You will feel ridiculously hot because you are not meant to have that much blood running through your skin.  Remember, blood is hot – it’s 98.6 degrees.  This sensation resembles standing still in direct Austin sunlight with no breeze on a 100 degree day – its hot and uncomfortable.  What is worse is that once you enter this state of flushing, you cannot turn it off … it must wear off.  You missed your chance to prevent the flush!

After experiencing this horrible flush, you probably ran to the store to find “Flush-Free Niacin.”  Then, you took it and did not have any flushing, so you continued to take it.  However, what you did not realize is that Flush-Free Niacin is not active against cholesterol.  Flush-Free Niacin is Nicotinamide, and it will not do anything besides treat Niacin deficiency (useless).  The real niacin that you are looking for is Niacinamide, and it causes flushing for most people, but it works. The way that I remember this is by thinking of Nicotine (in cigarettes) which is bad for your health, so NICOTINamide is also bad. NIACINamide has niacin in the name, so it is good.

I was at a warehouse store this weekend, and I came across a niacin product that upset me because it clearly states that it improves cholesterol.  However, when you flip the bottle over, you find some other ingredient called:  Inositol HexaNICOTINate.  Notice the “NICOTIN” in the name?  It is not real niacin.  It must say “NIACIN” in the ingredient in order to be the effective niacin.

Why should I take Niacin?

Although I just finished bashing niacin’s effectiveness, it is extremely useful for one subset of patients.  There is a genetic cholesterol problem that causes elevated levels of Lp(a), which is a sticky particle that causes plaque build-up and early cardiovascular disease.  Niacin is the only drug at this time that is known to reduce the level of this sticky protein.  It usually requires large doses of niacin (upwards of 4,000mg).  I will discuss Lp(a) in more detail in another blog in the future.  For now, go here to read information already found on our webpage.

niacin3 niacin4

How do I stop this awful flushing?!?!

There are several tips for reducing the amount of flushing that occurs with real niacin.

  1. Take a wax-coated or extended release version of Niacin like the one we sell at our office from PURE.  Currently, I recommend all patients buy Niacin from us because it is a great product that contains real niacin and the cellulose coating limits the flushing.  Moreover, it is only $12 for ninety 500mg capsules (price subject to change).  Please be careful when switching niacin products if you are on large doses, you can cause liver problems.  Ask your doctor before switching.
  2. Take a full dose aspirin 30 minutes before taking your niacin (if aspirin is safe for you).  If flushing begins to develop, take baby doses of aspirin (chewed) every 15 minutes until flushing subsides.  Max dose of aspirin is 650mg every 6 hours (3,900mg per 24 hours).
  3. Take niacin with your largest meal since food delays niacin’s absorption which limit its flushing ability.  Do NOT take it before bedtime because you will wake up in the middle of the flushing episode, and it will be too late to dose yourself with aspirin to abort the flush.
  4. If you are taking more than 1 pill per day, you can spread out the pills throughout the day (with meals).
  5. Get the prescription version of Niacin which has a better absorption profile and limits the flushing.