A niacin primer

A reader of Life Extension reminded me of a piece I wrote about niacin a couple of years back.

Anyone desiring a primer on how and why to use niacin to correct lipid and lipoprotein patterns might find this useful.

While some people, no matter what they do, cannot tolerate niacin (about 10% of people), many others enjoy spectacular benefits.

Q: I recently had a cholesterol profile blood test and learned that I may be at risk of heart disease because my levels of beneficial HDL (high-density lipoprotein) are too low. I read that niacin could help increase my HDL, but my doctor said niacin is dangerous. Whom should I believe?

A: Your doctor would be right—if we were still living in 1985. Since then, however, we have learned how to use niacin (vitamin B3) safely and effectively. Unfortunately, many physicians have not yet caught up, or are still trapped by the idea that cholesterol-lowering statin drugs are the only way to decrease cardiovascular disease risk. I have personally prescribed niacin for thousands of patients as part of our program to reverse coronary disease. In fact, niacin is the closest thing we have available to a perfect treatment that corrects most of the causes of coronary heart disease.

Continued here.

Comments (19) -

  • Ganesh Kumar

    7/29/2009 7:20:35 PM |

    Do you therefore prescribe Niaspan since its considered to be the gold standard of niacin? If so, I urge you to look up user views on side effects at http://www.askapatient.com/viewrating.asp?drug=20381.  This was key reason why I chose NOT to take Niaspan and got the HDL, triglycerides level just with Vitamin D and Omega 3s

  • Kiwi

    7/30/2009 11:17:42 AM |

    Reading through some of the comments it seems to me people are starting on too higher dose.
    I've been on niacin for almost a year and started with just 50mg/day. Yes, half a tablet.
    Slowly worked up to 500mg standard niacin then switched to SloNiacin and increased to 750mg.
    I take 75mg aspirin at the same time.
    Any slight tingling I get I know the stuff is working and it makes me feel good.

    Only problem, SloNiacin is only available from the US, so I have to import it myself. I'm pretty sure it's not legal to do this as amounts over 100mg are considered a drug in this country (NZ).
    I've just had some vitamin D confiscated by Customs for the same reason. Capsules over 1000iu available only on prescription. Tough.

  • Anonymous

    7/30/2009 1:12:55 PM |

    The primer states that niacin blocks the release of fatty acids. So if I am trying to loose fat would taking niacin be counter productive to on trying to burn fat stores to lose weight?

  • trinkwasser

    7/30/2009 3:49:25 PM |

    I wish it had worked. Frown

    Maybe because it was inositol hexaniacinate, 1000mg niacin "equivalent"

    I had gotten my HDL up from 25 to 55 primarily through low carbing and adding more saturated fat, but that was with simvastatin 10mg

    As an experiment I dropped the statin and added the niacin and also pantethine (NOT pantothenic acid) 600mg.

    Previous results:
    HDL 55 trigs 62 LDL 94
    which is close enough for jazz to your 60-60-60

    Latest results
    HDL 47 trigs 115 LDL 156

    I have now restatinated myself. Either my funky familial genes or the damage from the years of undiagnosed diabetes have caught up with me. Still it was an interesting experiment in showing that the statin actually does have a benefit over and above the diet.

    It would be interesting to see what effect the statin *plus* the niacin and pantethine has but I suspect it will be several years before I am permitted another lipid panel. They prefer saving money to saving lives here.

  • billye

    7/30/2009 8:03:22 PM |

    Is supplementing with niacin the only way to raise HDL and lower LDL without taking Staten's?  Some other doctors are recommending a magnesium supplementation using a topical magnesium oil which can raise the magnesium levels to the top of the reference scale in as little as six weeks.  I quote Dr. Mildred S. Selig MD "most modern heart disease is caused by magnesium deficiency as reported in an article by Chris Jennings "what's all the buzz
    about magnesium oil?".  

    Magnesium in our food and water is drastically lower than it was 100 years ago.  I also understand that heart disease was practically non existent 100 years ago.  If true, what a coincidenc. Hmmm!  

    As you know I respect and honor your medical opinion, so, what say you?

  • billye

    7/30/2009 8:12:16 PM |

    I forgot to mention that I also supplement with high dose vitamin D3 and high dose fish oil.  My triglycerides level is now 66 mg/dl down from 115 mg/dl.  However, there has been no movement in my HDL and LDL level so far. I am waiting for a VAP test to come back.  Bottom line, I would not like to supplement with niacin.  Who wants the discomfort of flushes or itching.  I hope that magnesium supplementation works.

  • George

    7/30/2009 9:48:55 PM |

    Dr. Davis, always appreciate the great information on your blog. I have been taking 500mg of Slo-Niacin for a year with good results. Recently in a Prevention magazine I saw a quote by Dr. Angaston stating that you should only take niacin with a statin, that niacin by itself doesn't do anything. Your thoughts?

  • Dr. William Davis

    7/31/2009 12:42:29 AM |

    The form of niacin I use in 95% of cases is Upsher Smith's Sloniacin. It has a proven and published track record and is 1/20th the cost of prescription Niaspan.

  • Dr. William Davis

    7/31/2009 12:43:14 AM |

    Niacin works great by itself. There is absolutely no need for taking it with a statin.

    I can't imagine why Dr. Agatston would say such a thing. I wonder if it's a misquote.

  • Anonymous

    7/31/2009 12:57:28 PM |

    I recall reading that slow release niacin was the more hepatotoxic form of niacin, and that plain ol' niacin was best... is "sloniacin" the same thing as "slow release niacin?"

  • Dr. William Davis

    7/31/2009 2:49:59 PM |

    Niacin has confusing terminology.

    Sloniacin is closest in properties to "extended-release" niacin rather than "slow-relase," meaning niacin is trickled out over a briefer period with extended release, a property associated with reduced hepatic toxicity.

  • Anonymous

    8/1/2009 1:33:15 PM |

    Baylor college has a great resource if you want more medical study info.  The HATS study showed the staggering impact of Niacin/Statin combo but I don't think this should encourage statin use. If anything it points to a reduction in dose for those who must take statins ( http://www.lipidsonline.org/slides/slide01.cfm?q=niacin&dpg=9 )

    I take 2grms (Now brand)at night before I go to bed.  Sure occasionally I get a flush but the benefits far outweigh the occasional discomfort:-

    "In the group receiving niacin plus simvastatin without antioxidants, LDL-C levels were lowered by 42%; the LDL-C levels in the placebo groups were unaltered. HDL-C was increased by 26% in the niacin plus simvastatin group. The combination of niacin and simvastatin reduced CHD events by 60–90%, with about a 90% reduction seen in those subjects who did not take antioxidants, possibly because the treatment-induced increase in HDL particle size was blunted by antioxidants."


  • Anonymous

    8/7/2009 4:10:03 AM |

    The primer states that niacin blocks the release of fatty acids. So if I am trying to loose fat would taking niacin be counter productive to on trying to burn fat stores to lose weight?

  • cbatterman

    9/25/2009 5:09:59 PM |

    I read a 2002 paper by John A. Pieper in VOL. 8, NO. 12, SUP. THE AMERICAN JOURNAL OF MANAGED CARE that said Slo-niacin was hepatoxic where as IR Niacin was not...Are there more recent studies that support your use of slo-niacin over IR niacin?

  • Diane

    10/7/2009 5:13:56 PM |

    I have been battling slowly rising cholesterol since going through menopause, despite a great diet, ideal weight, and an active lifestyle. I resisted any suggestion of taking statins, especially after the February 2008 WSJ article and the NYTimes Well blog post "Do Statins Make You Stupid?"

    Luckily, I have a very conservative doctor, who is not so quick to prescribe statins. First she recommended fish oil capsules, (which raised HDL but also raised LDL). After that, I tried garlic (which I had to stop after my partner commented on the smell of my skin), plant sterols, (which didn't appear to have much effect), and finally niacin.

    In July I asked my doctor for instructions on using niacin. She recommended Slo-Niacin, starting with 500 mg once a day and increasing to 500 mg twice a day.

    I went back for my three-month visit this morning. My cholesterol has dropped from 220 to 175; HDL still high at 53, LDL down to 102 from 142, triglycerides down to 85 from 160.

    I usually avoid flushing by taking it immediately after a meal and drinking lots of water with the pill. If I eat too late in the evening and go right to bed, the flushing effect is worse - you have to move around for a while.

    I am very pleased and hope that this anecdotal evidence will encourage others.

  • steve

    10/23/2009 9:02:11 PM |

    I used  550 mg Niaspan for 3 months, It made no change in my Lipid Panel. Then I used 750 mg Slow-Niasin for 3 months . My Cholesterol fell from 182 to 174 . LDL dropped from 130 to 118. Triglycerides rose from 82 to 96, HDL went up 1 point from 35 to 36. Not happy with the results .
    I am mow trying 1,000 IU of D-3 and 2,400 mg of Fish oil Supplement along with 1 heaping TBS  each of oat bran and  pure cocoa in my oatmeal every morning along with 1/4 cup of walnuts. Will get checked again in April.
    I will post my results.

  • mongander

    11/16/2009 2:26:34 PM |

    "A small 208-person trial that used ultrasound to examine arteries found that Zetia was clearly inferior to a version of the old drug niacin in preventing clogged arteries. Moreover, in a surprise finding, patients on niacin appeared to have fewer heart attacks and were less likely to die from heart disease than those who got Zetia. It is unusual for such a small trial to show a difference in heart attack rates."

  • Lynn

    3/28/2010 1:26:20 PM |

    I would like to also follow up on the comment about niacin blocking the release of fatty acids.
    I have read elsewhere that nicotinic acid inhibits lipolyis.
    I cannot seem to determine how the recommended dosage (750 mg of SLO Niacin) might set me back in my current efforts to shed body fat?

    Any further reading available on this issue anywhere? Thanks

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    11/2/2010 7:34:16 PM |

    While some people, no matter what they do, cannot tolerate niacin (about 10% of people), many others enjoy spectacular benefits.