When niacin doesn't work

Dan had the usual collection of metabolic syndrome lipoprotein abnormalities:

low HDL of 28 mg/dl, triglycerides 280 mg/dl, 90% of his LDL particles were small.

Along with elimination of wheat and junk foods, exercise, and fish oil, I asked Dan to add niacin. I usually ask people to buy SloNiacin and begin at 500 mg per day with dinner, increased to 1000 mg per day at dinner after 4 weeks.

Dan came back several months later. His lab results:

HDL 40 mg/dl, triglycerides 76 mg/dl.

(We didn't repeat the full lipoprotein analysis, so no small LDL value was available.) Better, though still some room for improvement. I urged Dan to stick to his program, lose some more weight off his 260 lb frame, exercise, be strict about the wheat products.

Dan returned another few months later. Lab results:

HDL 29 mg/dl, triglycerides 130 mg/dl.

Dan had lost another 8 lbs and was reasonably compliant with his diet.

What's going on here? Why would he backtrack on HDL and triglycerides despite sticking to his program?

I asked Dan where he purchased his niacin. "I got it from Sam's Club. The pharmacist said to try this 'no-flush' kind so the hot flush wouldn't bother me."

Aha! It's no wonder. "No-flush" niacin, or inositol hexaniacinate, is an outright scam. It has virtually no effect on lipids or lipoproteins in humans. It's therefore no surprise that, by replacing real niacin with the no-flush variety, Dan's blood patterns began to revert back to their original state.

Let me be straight on this: No-flush niacin is a scam. It does not work: it does not raise HDL, reduce triglycerides, nor reduce small LDL. It's expensive, too, far more expensive than the real thing. It has no business being sold by stores like Sam's Club or your health food store.

SloNiacin (Upsher Smith) has become our preferred preparation. (I obtain no compensation of any sort for saying so.) We buy it at Walgreen's.

Comments (7) -

  • DietKing2

    9/20/2007 1:37:00 PM |

    Dr. Davis,
    While I thank you from the bottom of my heart (nice pun, eh?) for this information regarding the crappiness of flush-free niacin, it did cause me to go to bed last night all upset; yes, I've been taking the stuff religiously the last few months hoping it would drive my low HDL numbers up up up. Now I read this...grrr...
    Here's my question (yes, there's a question in here somewhere...) I'm willing to switch back to good old regular niacin, but how do I avoid that annoying flush I experienced the first time around, the one that caused me to switch to the inositol version to begin with? I eventually want to make it up to about 1500-2000mgs a day, but I have a feeling it's going to be tough!
    Any suggestions?

  • Anonymous

    9/20/2007 2:04:00 PM |

    Is there any issue with taking niacin first thing in the AM?

  • Dr. Davis

    9/20/2007 5:51:00 PM |

    Not as long as you eat and maintain good hydration. Remember that, upon awaking, you are quite dehdyrated.

  • Dr. Davis

    9/20/2007 5:54:00 PM |

    Two important ways :

    1) Drink lots of water, e.g., 16-24 oz if you have the flush.

    2) Increase no faster than 500 mg per month.

    Of course, you should only take higher doses of niacin with the assistance of your doctor.

    There is a larger discussion about this on the Track Your Plaque webwite, as well, under "Niacin: Ins and outs, ups and downs."

  • Anonymous

    7/13/2008 5:06:00 PM |

    I started niacin after seeing a study on the lipidsonline.org website.  I was encouraged by the results from the first analysis of my blood showing my HDL was up 20% to 42 and my LDL had crashed 25% to 58. This was 1grm "now" brand OTC Niacin combined with 40mg crestor.  However, my triGs were still high at 227.

    I raised the Niacin to 2grms and looked forward to the next blood test.  Success with TriG. Results were spectacular (105) and same with LDL (58).  But my HDL receded back to its old level of 30mg/dl.... very disappointing.  

    I asked my Dr to prescribe the Niospan in case the OTC niacin was variable..... OMG! C$280/200 tabs....... I'm in Canada so no wallgreens.  Will be trying to get some statement of quality control out of the Now product people.

    One other side effect of the higher Niacin... uber low resting diastolic.  Does this mean I should stop taking beta and ace inhibitors ?

  • buy jeans

    11/3/2010 12:22:55 PM |

    I asked Dan where he purchased his niacin. "I got it from Sam's Club. The pharmacist said to try this 'no-flush' kind so the hot flush wouldn't bother me."

  • scott bushey

    8/26/2011 12:39:20 PM |

    Just curious:

    If there is no correlation at all between high cholesterol and cardiac disease, why do you prescribe supplements like Niacin that optimize cholesterol?

    Thanks in advance,