When niacin doesn't work 20. September 2007 William Davis (7) 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.