No-flush niacin kills

Gwen was miserable and defeated.

No wonder. After a bypass operation failed just 12 months earlier with closure of 3 out of 4 bypass grafts, she has since undergone 9 heart catheterization procedures and received umpteen stents. She presented to me for an opinion on why she had such aggressive coronary disease (despite Lipitor).

No surprise, several new causes of heart disease were identified, including a very severe small LDL pattern: 100% of LDL particles were small.

Given her stormy procedural history, I urged Gwen to immediately drop all processed carbohydrates from her diet, including any food made from wheat or corn starch. (She and her husband were shocked by this, by the way, since she'd been urged repeatedly to increase her whole grains by the hospital dietitians.) I also urged her to begin to lose the 30 lbs of weight that she'd gained following the hospital dietitians' advice. She also added fish oil at a higher-than-usual dose.

I asked her to add niacin, among our most effective agents for reduction of small LDL particles, not to mention reduction of the likelihood of future cardiovascular events.

Although I instructed Gwen on where and how to obtain niacin, she went to a health food store and bought "no-flush niacin," or inositol hexaniacinate. She was curious why she experienced none of the hot flush I told her about.

When she came back to the office some weeks later to review her treatment program, she told me that chest pains had returned. On questioning her about what she had changed specifically, the problem became clear: She'd been taking no-flush niacin, rather than the Slo-Niacin I had recommended.

What is no-flush niacin? It is inositol hexaniacinate, a molecule that indeed carries six niacin molecules attached to an inositol backbone. Unfortunately, it exerts virtually no effect in humans. It is a scam. Though I love nutritional supplements in general, it pains me to know that supplement distributors and health food stores persist in selling this outright scam product that not only fails to exert any of the benefits of real niacin, it also puts people like Gwen in real danger because of its failure to provide the effects she needed.

So, if niacin saves lives, no-flush niacin in effect could kill you. Avoid this scam like the plague.

No-flush niacin does not work. Period.

Disclosure: I have no financial or other relationship with Upsher Smith, the manufacturer of Slo-Niacin.

Copyright 2008 William Davis, MD

Comments (18) -

  • Liss

    3/20/2008 2:03:00 AM |

    Dr Davis is there a way to minimize the niacin-induced flush for people with rosacea who have been advised to avoid flushing?  Thank you for making this post.  I've been taking the no-flush niacin not realizing it wasn't effective.

  • Anonymous

    3/20/2008 2:16:00 AM |

    How stressful is it on the liver?  I've taken Niacin for over a year at either 500 mg or 1 gr doses.  As soon as I started with a timed-release formula (another brand), my liver started to show signs of stress.  I went back to regular Niacin and the results were back to normal in two months.  I've been leery of time-release versions since then.

  • Anonymous

    3/20/2008 3:44:00 AM |

    Why is Slo-niacin recommended over Niaspan or Enduracin? Isn't Slo-niacin extended release, which means it takes a long time to clear out of the liver?

    Wouldn't a sustained release (6-7 hr) version, like Enduracin (if going OTC) or Niaspan be better for the liver?

  • Anonymous

    3/20/2008 1:37:00 PM |

    Slo-Niacin is a sustained release version of Niacin very much akin to Enduracin or Niaspan.  Slo-Niacin has a very good track record and a history of medical trial success without causing liver damage.

  • Ross

    3/21/2008 2:19:00 AM |

    You can minimize niacin flushing by being well hydrated, by taking a normal or enteric aspirin 30 minutes before the niacin, by gradually increasing your dose, by spreading your daily dose into three or four daily doses, and simply by having your body get used to the niacin.

    What's nice is that you can combine these strategies, taking aspirin before the niacin for a few weeks and then dropping the aspirin since your body will be more used to it.  

    But really make sure you're well hydrated as that has made the biggest difference for me.

    Oh, and don't panic.  The first time you feel the flush it will be a bit suprising.  But if you respond to it with a kick of adrenalin, it will get worse.  If you instead say, "Ah, there's the niacin." and have another glass of water, it will pass fairly quickly.

  • Dr. William Davis

    3/21/2008 12:21:00 PM |


    Thanks for the comments.

    However, please be aware that spacing your doses of niacin out DRAMATICALLY increases liver toxicity. Once per day, twice per day at most, is what I tell my patients to minimize liver toxicity.

  • Michael

    3/21/2008 6:44:00 PM |

    Thanks for the information regarding slo-niacin. I could have sworn I read somewhere that it was an extended release form (12 hrs or more), but perhaps that site was wrong.

    Is there any advice for people who get side effects from niacin not related to flush? I sometimes notice my heart beating slightly more forcefully after I take niacin. It also seems to make me a little tired after taking it.

    The flush may be minimal to non-existent,  but this side effect still sometimes occurs. I've worn a holter monitor, so it's not producing any dangerous heart beats nor tachycardia, but it's still somewhat annoying.

    Any advice?

  • Anonymous

    3/21/2008 9:58:00 PM |

    Quercetin has been shown to reduce the flushing-effect.

    "Key results:

    Niacin (7.5 mg per rat, equivalent to a human dose of 1750 mg per 80 kg) maximally increased ear temperature to 1.9plusminus0.2 oC at 45 min.

    Quercetin and luteolin (4.3 mg per rat; 1000 mg per human), administered i.p. 45 min prior to niacin, inhibited the niacin effect by 96 and 88%, respectively.

    Aspirin (1.22 mg per rat; 325 mg per human) inhibited the niacin effect by only 30%. Niacin almost doubled plasma PGD2 and 5-HT, but aspirin reduced only PGD2 by 86%.

    In contrast, luteolin inhibited both plasma PGD2 and 5-HT levels by 100 and 67%, respectively."

  • mit

    4/29/2008 7:59:00 PM |

    Big Pharma is now trying to capitalize on niacin.

    Apparently, niacin, which is available without prescription for pennies, is more effective than anything else for controlling & improving lipid/blood ratios (and more).

    Statin drugs, even though less effective and more dangerous than niacin, have been the most profitable drugs in history. Big Pharma’s “education” of physicians has, until recently, discouraged the use of niacin for obvious, bottom-line reasons.

    The fact is that niacin’s side-effects are not at all as bad as suggested by Big Pharma. Ask anyone who’s been using niacin to control cholesterol for a few months.

    See for many articles and studies on this subject.

  • Ben

    6/23/2008 3:02:00 PM |

    Dr. Davis,

    First, Let me state how happy I am to have found your blog. Niacin has really worked for me.

    Following your posts, I ordered some Slo-Niacin (500 mg). However, I'm concerned that one of the inactive ingredients is hydrogenated vegetable oil. Are you sure it's a good idea to prescribe trans-fat to heart patients?

    Thanks for your feedback.

  • Anonymous

    8/14/2008 2:49:00 AM |

    Inositol Hexanicotinate (no-flush Niacin) has been shown to lower LDL cholesterol and raise HDL by up to 30% in numerous test. Also it's shown to be less liver toxic than regular 'nicotinic acid' Niacin. Standard Niacin has been tied to numerous deaths via liver disease. So this 'article' is quite shocking when 1,000 of other physicians say the opposite. Unless you sell nicotinic acid  Smile

  • Denise

    12/17/2008 4:51:00 AM |

    I just wanted to say that I've been taking Slo-Niacin for almost 9 months now, doctor increased the dosage about 3 months ago, and until today, literally, I had never experienced any noticable side effects, and it's working.  My cholesterol has dropped almost 100 points in the past six months.  

    Today I experienced the flushing, itching, burning, fire-ants-under the skin feeling for the first time, and it was MISERABLE!!!  I have to say, working or not, if I have to go through THAT every night, I won't continue the program.  I already take Motrin and Aspirin at the same time as the Slo-Niacin,  I already drink a full glass of water with it, and I always eat something small as the combination of medications I take makes me nauseous anyway.  I took a Benadryl, which I don't normally take as I get weird side effects from that, too, but I was desperate!!

    Anyone have any idea why I would experience this particular side effect after 9 months of treatment and not earlier in the program???


  • Anonymous

    3/28/2009 3:03:00 AM |

    I wanted to clarify a few things I've read in various posts.

    First off, Slo-Release Niacin is not akin to Niaspan. Niaspan is actually Extended Release which means that it releases quicker than Slo-Release but slower than Immediate Release Niacin. The point of the ER Niacin is that it releases slowly enough to minimize the flushing (unlike IR) but quickly enough that you don't have to be as concerned with elevated liver toxicity (as with the SR).

    Also a major concern with OTC versions of Niacin is that they're not regulated by the FDA, therefore you could be getting different variations of Niacin with each new pill/bottle.  

    With Niaspan, which I have taken for about a year now, it's the only form of Niacin ER and is actually indication (by the FDA) to promote regression of plaque buildup in the arteries as well as significantly raise your HDL (good cholesterol, or as my doctor refers to it: "happy" cholesterol). Being a patient with a bad family history of stroke and heart attack, I would much rather be on something approved by the FDA and have a little (or even a lot when I first started) flushing. Think of the flushing as your arteries expanding aka you know it's working. I much prefer this over risking a heart attack or some other serious condition - physically, emotionally and financially.

    The way I take it really helped manage the flushing - I always take an aspirin 30 minutes prior and as soon as I hop in bed, I take the Niaspan. That way, if I do experience any flushing I can hopefully just sleep through it. It's also important to remember that the flushing is not a permanent side-effect, it does go away (mine took about a month).

    Happy Flushing!!

  • Anonymous

    11/1/2009 1:03:12 AM |

    In additon to taking the asprin and being well hydrated I reccomend eating some soluable fiber 30 min. before you dose and do not eat foods high in fat.  Niaspan is fat soluable and will disperse more rapidly if you have consumed a high fat content meal.  I am curious as to what dosages people are taking.  I have titrated up to 3 grams per day over six months.

  • Jennifer Lynn

    11/18/2009 11:00:18 PM |

    There are studies on No-Flush niacin.

  • buy jeans

    11/3/2010 2:55:38 PM |

    When she came back to the office some weeks later to review her treatment program, she told me that chest pains had returned. On questioning her about what she had changed specifically, the problem became clear: She'd been taking no-flush niacin, rather than the Slo-Niacin I had recommended.

  • Anonymous

    4/25/2011 4:01:26 AM |

    Doctor Ross:  I & I'm sure there are others too who are dismayed @ the disparity of opinions on 'no-flush' niacin -  This has been used for over thirty-five years in Europe, is there no record of results available there?
    & if no-flush kills, then why is it not banned? Confused as all get out!

  • Patricia Donovan

    10/26/2011 10:19:57 PM |

    Great article.

    I strongly agree with your stance that no-flush niacin is a big scam.
    It is also very logical why 'normal' niacin is that much better than the flush free version:
    When you take in 'normal' niacin, your veins will widen a little,
    enabling all the benefits associated with niacin flushing.
    However, none of this is possible with flush-free niacin.

    My source of this information is

    I also really recommend this website to all people curious about the other benefits
    of niacin flushing.