As I have been researching ways to improve my lipid profile, I started reading a bunch of research on Niacin (vitamin B-3). It comes in a few forms, some good, some not so much. The benefits are flat-out amazing! Niacin, also known as nicotinic acid and vitamin B3, is a water soluble, essential B vitamin which when given in high doses is effective in lowering low-density lipoprotein (LDL) cholesterol and raising high density lipoprotein (HDL) cholesterol. Which is better than statin drugs that lower all cholesterol, including the good stuff. There are 3 main forms of niacin, nicotinic acid, niacinamide and inositol hexanicotinate. The later is the extended release or sustained release that is not very safe. Niacinamide is the most common form because it does not trigger the flushing response, but is less effective for certain conditions. The best part is that niacin is cheap and pharmaceutical companies cannot patent it.
I want to do a fair and balanced report here, so I will do my best to show both sides, but frankly, I like niacin, in fact, I'm doing a niacin flush right now, my skin is starting to get red and warmer as I type.
So let's start with a recent study that headlines, "Niacin Therapy Shows No Benefits, Has Some Harmful Effects" it opens with this, "Mar. 11, 2013 — A highly anticipated study evaluating a combination of the vitamin niacin with the anti-flushing agent laropiprant finds the therapy provides no benefit to and may even be harmful for patients with vascular disease, according to research presented today at the American College of Cardiology's 62nd Annual Scientific Session. Detailed trial data is presented here for the first time."
Now, here comes the study, (I hope this serves as a lesson on how to read studies, because this one has some serious inconsistencies.) They did a good job at selection and randomization with placebo. See if you can spot the issues in isolating niacin's impact. Click the link to see an article that highlights the study details.
"The four-year study tested a combination of extended-release (ER) niacin with laropiprant in patients at risk for cardiovascular problems such as heart disease and stroke. The 25,673 patients in the study were randomized to receive ER niacin/laropiprant 2g/40mg or a placebo, and all received commonly prescribed LDL cholesterol-lowering medication simvastatin (with or without ezetimibe)."
OK, I hope you got this quiz right. They were all on statin drugs, they chose the extended release and had laropiprant to reduce the flushing effect that normally occurs with niacin. Let's take a look at their findings that they published for the world to see.
"The study did not meet the primary endpoint of reducing the chances of a major vascular event, defined as the composite of non-fatal heart attack or heart-related death, stroke, or need for angioplasty or bypass surgery. Patients receiving ER niacin/laropiprant had a similar number of major vascular events as patients receiving placebo (13.2 vs. 13.7 percent, p=0.29).
The study also found unexpected and significant excesses of bleeding (2.5 vs. 1.9 percent) and infections (8.0 vs. 6.6 percent) among the ER niacin/laropiprant patients. In addition, significantly higher numbers of patients receiving the study drug suffered serious known side effects including new onset diabetes (9.1 vs. 7.3 percent), diabetic complications (11.1 vs. 7.5 percent), gastrointestinal problems such as indigestion and diarrhea (4.8 vs. 3.8 percent), and skin issues including itching and rashes (0.7 vs. 0.4 percent)."
First, using extended release niacin has been proven to produce unacceptable side effects, primarily liver damage. "Significant hepatotoxicity is particularly common with high doses of sustained release niacin. In many cases, the injury becomes apparent after a dose increase or after switching from the regular crystalline to a sustained-release form."
Second, laropiprant has been recalled, "Merck & Co has said it is recalling Tredaptive cholesterol tablets in response to trial results that raised safety concerns and the recommendations of a European Medicines Agency safety panel." The US regulators rejected laropiprant for market release in 2008. So, why would you continue a study with a product that was rejected by the FDA?
Third, why were the subjects all on statin drugs? It seems that there are too many chemical interactions to have a reliable study. In order to study a single compound, you need to reduce the variables. Could the statin drugs inhibit the effects of niacin? We may never know.
In conclusion why have them on the least effective, most dangerous forms of niacin available? Why use laropiprant to prevent the niacin flush? Why select people who are on statins? So you can have the headlines that say niacin is harmful -- maybe?
Moving on to the benefits. One of the noted benefits is the anti-inflammatory effect on arthritis. In an excellent article, "Several researchers have reported excellent results in arthritic patients using niacinamide. While niacin opens up the blood vessels near the surface and causes a flushing sensation, niacinamide only opens up the deep blood vessels like those surrounding the joints.
In cases of moderate arthritis, outstanding results have been produced by taking 1,000 to 1,500 mg a day. In more severe cases, as much as 3,000 mg to 4,000 mg have been recommended."
For dealing with cholesterol, it raises the production of HDL and reduces triglycerides and LDL. The article continues, "One of the most effective and least expensive ways to lower blood lipids (cholesterol and triglycerides) is to take 1,000 to 3,000 mg of niacin a day.
Patients using 1,000 mg the first day, 2,000 mg the second day, and 3,000 mg each day thereafter have seen as much as a 25 percent reduction in cholesterol levels, and a 50 percent reduction in triglycerides. (Blood lipid reduction is the case where niacinamide is not as effective as niacin.)"
Another reference manual from Berkley Heart Labs concluded their study of Lp(a) (the lipoprotein(a) is one of the most dangerous blood markers for CHD) "Treatments for elevated Lp(a) levels have variably reported analyte-lowering benefits. Lifestyle modifications such as diet, weight loss, and exercise generally have little or no effect on Lp(a) levels. Compared to the well reported LDL-lowering effects of statins and bile acid sequestrants (resins), these drugs generally also have little, or no effect on Lp(a) levels. Based on the best available study data, Niacin is the most effective drug option to treat Lp(a) elevations."
This study in 2002 was conclusive though some, 21%, did not like the regimen due to the flushing response. Though it lowered their Lp(a) and improved their other lipid profiles, they did not stay with the treatment.
It's been known to help with:
Reversing heart disease
Senility, memory loss, depression, insomnia
Tinnitus, vertigo or hearing problems
Improved circulation in legs of diabetics
It's not a perfect vitamin. You need to be aware that there are side effects like irritated stomach lining or ulcers and gout flare-ups. Be sure to take niacin on a full stomach, right after a meal is best. Several sources recommend consulting your doctor prior to taking niacin, especially in high doses.
We've been taking straight niacin, 500mg as pictured above. My first dose which was about 1 hour after a meal, caused quite the rush of blood to the surface of my skin, it felt like a sunburn all over my face, neck and abdomen. It lasted about an hour and then subsided. Then the next morning dose I felt a small warming sensation, the evening dose had very little effect on me. Your body does adapt to the niacin once your levels come up. It takes about 2 days to reduce the effects, but they are not painful, some enjoy the warming feeling.
Tim & Lynette Jenné are learners first and foremost. We love to ask "why?" We question the status quo. We also love to research and find answers for ourselves. As parents of four adult children, we've learned a few things along the way that may be helpful to others. We love to live & eat clean, simple lives.