If you are looking for Best Niacin for Cholesterol, you have come to the right place. Niacin is a vitamin that helps your body make and use energy. It also keeps your skin, nails, and hair healthy. Niacin lowers cholesterol levels by blocking the way that your body makes cholesterol. Niacin may reduce your risk of heart disease by helping keep blood pressure down and may also protect against diabetes complications Here’s a list of the top niacin for cholesterol from my personal experience.
Patients should tell their doctor about all their prescription and non-prescription drugs before taking Niacin to avoid bad niacin-drug interactions especially niacin and cholesterol medication. Our Blog is the place to look for information on health and nutrition. Below are niacin side effects and benefits
Best Niacin For Cholesterol
Niacin has long been used to lower triglycerides and to increase high-density lipoprotein (HDL) cholesterol. This “good” cholesterol helps remove low-density lipoprotein (LDL) cholesterol, the “bad” cholesterol, from the bloodstream.
But niacin isn’t for everyone. People who take niacin in addition to common cholesterol medications see very little additional benefit. And niacin can cause uncomfortable and sometimes dangerous side effects.
What is niacin?
Niacin (nicotinic acid) is a B vitamin that’s used by the body to turn food into energy. Niacin also helps keep the nervous system, digestive system and skin healthy. That’s why niacin is often a part of a daily multivitamin, though most people get enough niacin from the food they eat.
When it’s used as a treatment to improve cholesterol numbers or correct a vitamin deficiency, niacin is sold in higher doses available by prescription.
Niacin is also available as an over-the-counter supplement. Supplements are not regulated like prescription medications. The ingredients, formulations and effects of over-the-counter niacin can vary widely.
Don’t take niacin without discussing it with your health care provider first because niacin can cause serious side effects when taken in high doses.
What impact does niacin have on cholesterol?
Niacin can lower triglycerides by 25% and raise HDL cholesterol by more than 30%.
Triglyceride levels over 150 milligrams per deciliter (mg/dL) or 1.7 millimoles per liter (mmol/L) have been associated with a higher risk of heart disease.
The risk of heart disease is also increased in men who have HDL levels below 40 mg/dL (1.0 mmol/L) and in women who have HDL levels below 50 mg/dL (1.3 mmol/L).
There’s currently some debate about the exact role HDL plays in the body and in the development of heart disease. But HDL has generally been thought to pick up excess bad cholesterol in the blood and take it to the liver for disposal, which is why HDL is dubbed the good cholesterol.
Despite niacin’s ability to lower triglycerides and raise HDL, research suggests that niacin therapy isn’t linked to lower rates of death, heart attack or stroke.
What side effects are associated with taking high doses of niacin?
High doses of niacin available via prescription can cause:
- Severe skin flushing combined with dizziness
- Rapid heartbeat
- Itching
- Nausea, vomiting and diarrhea
- Gout
- Liver damage
- Diabetes
Who might consider taking niacin?
In the past, it was thought that HDL levels would increase even more if niacin were added to cholesterol-lowering medications called statins, such as atorvastatin (Lipitor) and simvastatin (Zocor). But newer studies indicate that niacin provides little additional benefit when compared with statins alone.
However, niacin may be helpful in people who can’t tolerate statins or other cholesterol-lowering medications. Some studies suggest that people with high triglycerides and low HDL cholesterol may benefit from niacin.
What else can be done to increase HDL?
Lifestyle changes are helpful in boosting HDL:
- Stop smoking if you’re a smoker.
- Eat a healthy diet.
- Exercise regularly.
- Avoid consuming trans fats or partially hydrogenated oils.
What are the risks of taking niacin?
- Side effects. Niacin can cause flushing, especially when you first begin taking it. Your health care provider will probably suggest increasing the dose slowly to reduce this problem. They might also offer a time-release prescription formulation to control flushing. Niacin can cause upset stomach and diarrhea. However, all of these side effects tend to fade over time.
- Risks. Niacin does have risks. It can cause liver problems, stomach ulcers, changes to glucose levels, muscle damage, low blood pressure, heart rhythm changes, and other issues. People with any health condition including liver or kidney disease, diabetes, high blood pressure, or cardiovascular problems need to talk to a doctor before using niacin supplements. Do not treat high cholesterol on your own with over-the-counter niacin supplements.
- Interactions. If you take any medicines or supplements regularly, talk to your doctor before you start using niacin supplements. They could interact with medicines like diabetes drugs, blood thinners, anticonvulsants, blood pressure medicines, thyroid hormones, and antibiotics as well as supplements like ginkgo biloba and some antioxidants. Alcohol might increase the risk of liver problems. Though niacin is often used along with statins for high cholesterol, this combination may increase the risk for side effects. Get advice from your healthcare provider.
At the low DRI doses, niacin is safe for everyone. However, at the higher amounts used to treat medical conditions, it can have risks. For that reason, children and women who are pregnant or breastfeeding should not take niacin supplements in excess of the DRI unless it’s recommended by a doctor.
People with uncontrolled gout should also not take niacin supplements.
Niacin Side Effects and Benefits
Niacin is an important nutrient used to turn food into energy. Niacin benefits may include improving cholesterol, blood pressure, migraines, and more.
Niacin, or vitamin B3, is one of the essential B-complex water-soluble vitamins that the body needs to turn food into energy. All of the vitamins and minerals are important for optimal health, but niacin is especially good for the nervous and digestive systems. Let’s take a more in-depth look to better understand niacin benefits and its side effects.
10 niacin benefits
Niacin is naturally present in many foods and is available in supplement and prescription form, so it’s easy to get enough niacin and reap its health benefits. Tissues in the body convert niacin into a usable coenzyme called nicotinamide adenine dinucleotide (NAD), which is used by more than 400 enzymes in the body to perform essential functions.
Although niacin deficiencies are rare among people in the United States, they can become severe and cause a systemic disease called pellagra. Mild cases of pellagra can cause diarrhea and dermatitis, while more severe cases can cause dementia and even be fatal.
Pellagra is most common among adults between the ages of 20 to 50 years old, but it can be avoided by consuming the recommended dietary allowance (RDA) of niacin. The adult RDA for niacin is 14 to 16 mg per day. Niacin is readily available in foods like fish, chicken, beef, turkey, fruits, and vegetables. Niacin can also be made in the body from the amino acid tryptophan. This amino acid is found in foods such as chicken, turkey, nuts, seeds, and soy products.
Niacin is also in many over-the-counter multivitamins as a dietary supplement. Both Nature Made and Centrum adult multivitamins contain 20 mg of niacin per tablet, which is about 125% of the adult RDA. Nicotinic acid and nicotinamide are two forms of niacin supplements. Over-the-counter supplements of niacin are available in a variety of strengths (50 mg, 100 mg, 250 mg, 500 mg) that are higher than the RDA. Prescription forms of niacin include brand names such as Niaspan (extended-release) and Niacor (immediate-release) and are available in strengths as high as 1,000 mg. Niacin can be found in an extended-release formulation to lessen some side effects.
While more studies need to be conducted and supporting evidence must be determined, there are a variety of uses for niacin. In terms of health benefits, niacin potentially can:
- Control cholesterol
- Lower blood pressure
- Improve mental health
- Clear skin
- Manage migraines
- Promote joint health
- Protect cognitive function
- Support digestion
- Minimize birth defects
- Improve erectile dysfunction
1. It helps control cholesterol levels
Sometimes niacin is prescribed alongside cholesterol-lowering medications like statins to help normalize blood lipid levels. It can increase high-density lipoprotein (HDL) cholesterol, which is the healthy kind of cholesterol, by 15% to 35%. And it can decrease low-density lipoprotein (LDL), the bad cholesterol, by 5% to 25%.
Other evidence indicates that niacin is good for people with an increased risk of heart attacks and heart disease because it not only lowers LDL cholesterol but also triglycerides. Niacin can decrease triglyceride levels by 20% to 50%. The prescription formulations Niaspan and Niacor have FDA approval to treat dyslipidemia (elevated cholesterol or other fats in the blood).
2. It may lower blood pressure
Small clinical trials of using niacin have shown it has significant blood pressure lowering effects in people with hypertension. Additionally, sudden lowering of blood pressure is described in the package insert of prescription niacin. However, in larger clinical trials involving niacin and niacin-containing regimens there showed either no clear significant effects of niacin or slightly lower mean blood pressure among some niacin treatment groups compared with placebo.
More studies need to be done to determine how effective niacin can be for lowering blood pressure and reducing the risk of cardiovascular events, but so far the research seems promising.
3. It may improve mental health
Dietary habits have a significant influence on many mental disorders including depression, anxiety, schizophrenia, and bipolar disorder. This has led to the development of nutritional guidelines to help manage these conditions. Niacin deficiency has shown a possible link to some mental disorders.
Studies have documented reduced cerebral blood flow in depressed patients and improved cerebral blood flow following antidepressant treatment. Niacin is believed to increase cerebral blood flow, so there is potential to use niacin supplementation along with prescription antidepressants.
4. It’s good for the skin
Niacin is a great supplement for the skin. It can help protect skin cells from sun damage, clear acne when applied topically, and reduce redness and inflammation. Vitamin B3 in the formulation of niacinamide is often used as a natural topical skincare treatment to clear acne. Niacin can even help manage inflammatory skin conditions like bullous pemphigoid or granuloma annulare.
5. It may help manage migraines
Although it’s unclear how niacin achieves therapeutic effects, it could be beneficial for migraine and tension-type headaches and the prevention of these headaches. Niacin may prevent migraine symptoms by widening the intracranial vessels and following contractions of the extracranial vessels.
6. It promotes joint health
Vitamin B3 in the form of niacinamide has been shown to increase joint mobility and decrease joint pain, inflammation, and swelling. Because of its anti-inflammatory effect on joints, niacin may serve as a good treatment option for people with arthritis.
7. It may protect against Alzheimer’s Disease
In a study published by the Journal of Neurology, Neurosurgery, and Psychiatry, dietary niacin was concluded to be a possible protector against Alzheimer’s disease and age-related cognitive decline. A higher intake of niacin may be associated with a slower rate of cognitive decline over time.
8. It’s good for digestion
Niacin is great for the digestive system because vitamin B3 helps break down nutrients like carbs and fats into energy. If someone is deficient in niacin, they may have a hard time digesting food and might experience gastrointestinal problems over time.
9. It may prevent birth defects
According to a 2017 study published by The New England Journal of Medicine, niacin supplementation during pregnancy prevented malformations in mice. More human studies need to be done, but preliminary research indicates that niacin may help prevent nicotinamide adenine dinucleotide (NAD) birth defects in humans and lower overall birth defect rates.
On the other hand, caution is advised for niacin supplementation while breastfeeding, as there is limited human data on the effects of niacin in breastmilk. New or expecting mothers should always talk to their healthcare provider before introducing new supplements or medications during pregnancy or lactation.
10. It may improve erectile dysfunction
Erectile dysfunction (ED) is the inability to get or keep an erection. Because niacin helps improve blood flow, it may also be good for impotence. In a study published by the Journal of Sexual Medicine, a daily dose of up to 1,500 mg of niacin was enough to improve sexual function among men who had both ED and dyslipidemia. Men with dyslipidemia were studied because dyslipidemia is closely related to ED.
Niacin side effects
Niacin is an essential vitamin with great health benefits, but it’s important to know that it can also cause side effects. It’s uncommon for people to experience side effects from niacin if they’re only getting it from food sources. However, taking niacin as a dietary supplement or at prescription strength is much more likely to cause side effects, especially if high doses are consumed. Here are the most common side effects of niacin:
- Flushing (sudden reddening of the face, neck, or upper chest)
- Itching or dry skin
- Nausea
- Vomiting
- Diarrhea
- Increased cough
This list of side effects isn’t comprehensive. It’s possible to experience a wide range of side effects from niacin. Those who start taking it and experience things like low blood pressure, changes in heartbeat, jaundice, ulcers, vision problems, gout symptoms, or diabetes symptoms should talk with a medical professional to see if they should continue to take niacin.
For most people, niacin benefits will outweigh any potential for side effects. With that being said, it’s certainly possible to reduce the chances of experiencing side effects while taking niacin. Side effects like nausea, vomiting, diarrhea, and other gastrointestinal upset may be avoided by taking the niacin dose with food.
Talking to a healthcare provider about starting a low dose of niacin with gradual increases over weeks or months to the desired dose may help to reduce side effects. Also, ask about niacin extended-release formulations, as it causes less flushing. Finally, take higher doses of niacin at night before bedtime to help reduce the severity of side effects and sleep through any stomach upset.
Niacin-drug interactions
Sometimes niacin can cause side effects, worsen side effects, or lead to health problems if it’s taken with certain drugs or supplements. It’s best to talk with a doctor before taking niacin if also consuming any of the following.
- Alcohol: Consuming alcohol and taking niacin can worsen side effects like flushing and increase the risk of getting liver damage.
- Blood pressure drugs: Taking niacin at the same time as blood pressure drugs can increase the risk of experiencing low blood pressure.
- Diabetes drugs: Niacin can affect blood glucose levels, and when it’s combined with diabetes drugs it may affect blood glucose levels. Patients with diabetes should carefully monitor their blood sugar levels.
- Hepatotoxic drugs: Taking hepatotoxic drugs and niacin at the same time increases the risk of getting liver toxicity or liver damage.
- Bile acid sequestrants: Niacin and bile acid sequestrants, such as cholestyramine or colesevelam, should be separated by at least 4 to 6 hours to avoid absorption problems
- Statins: Taking higher doses of niacin with statin medications may increase the risk of myopathy or rhabdomyolysis
Niacin dosage
The recommended dietary allowance (RDA) of niacin is 16 mg for adult men and 14 mg for adult women. This recommendation increases to 18 mg per day for pregnant women and 17 mg per day for breastfeeding women. Typically, most adults will consume the RDA of niacin with a healthy, balanced diet.
Niacin supplementation formulations can differ in their directions and dosage depending on the condition. Some need to be taken with food while some need to be taken at bedtime, so it’s best to confirm with a pharmacist or doctor the correct way to take a specific type of niacin.
Higher doses are sometimes prescribed to treat medical conditions like cardiovascular disease, atherosclerosis, or dyslipidemia. It’s important to get medical advice from a health professional before taking niacin to make sure the dose is appropriate.
Niacin and Cholesterol Medication
Two large scientific studies in recent years have investigated the effectiveness of niacin in reducing cardiovascular disease risk. Their complicated results have left a lot of people asking two questions:
Learn about niacin, cholesterol, and your heart from the doctors and dietitians at the Pritikin Longevity Center in Miami, which has been helping people launch heart-healthy lifestyles since 1975.
“Is there any value to niacin for heart health?”“If I’m taking niacin, should I keep taking it?”
Here are answers from the physicians and registered dietitians involved in heart-health education at the Pritikin Longevity Center.
“First and foremost, it is always essential to discuss your medications and any potential changes to them with your personal physician,” urges Tom Rifai, MD, member of the Pritikin Scientific Advisory Board and Medical Director of Metabolic Nutrition & Weight Management at St. Joseph Mercy Oakland Hospital in Michigan.
“For most patients, there is no robust evidence that niacin can substitute for statins, or that niacin added to statin therapy has value.
“I would also argue that there is no robust evidence that statins can be an alternative to a healthy, Pritikin lifestyle. But every patient is different. Every patient has his or her own physiological profile. That’s why it’s so important to talk to your personal physician.”
Niacin and cholesterol
In years past, doctors nationwide often prescribed niacin because of its documented ability to raise HDL cholesterol (the so-called “good” cholesterol) and modestly lower LDL (bad) cholesterol and triglycerides, all of which may reduce the risk of cardiovascular disease.
Of particular interest was niacin’s HDL-raising effect because very few other drugs were known to safely and successfully increase HDL.
But the two large recent studies on niacin and HDL found that niacin, though it improved HDL numbers, did not seem to improve outcomes. Taking niacin led to no reduction in cardiovascular-related events – no reductions in strokes and heart attacks.
In the AIM-HIGH trial, a study of 3,414 people funded by the National Institutes of Health, niacin was added to a statin in one group of heart disease patients in the hope of improving HDL and reducing cardiovascular-related events. A second group of heart patients took statins alone. The result? The statin-plus-niacin group achieved no better outcomes than the statin-only group. In fact, the statin/niacin takers actually suffered a slight increase in the likelihood of stroke.
The more recent HPS2-THRIVE trial confirmed AIM-HIGH’s results. After nearly four years of follow-up involving 25,673 heart disease patients, adding niacin and an anti-flushing drug to statin therapy did not reduce the risk of coronary deaths, heart attacks, strokes, or procedures like bypasses and angioplasties.
HPS2-THRIVE also demonstrated that the possible side effects of niacin – flushing, aggravated gout or peptic ulcer, lowering of glucose tolerance, and increased likelihood of liver toxicity – reduced patient compliance with this therapy.
HDL cholesterol
But let’s step back a moment. We need to ask: Why are we focusing so much on HDL in the first place?
“We need to remember that good cardiovascular heart is not based solely on one factor, like HDL. Good cardiovascular health involves a multiplicity of factors,” points out cardiologist Ronald Scheib, MD, FACC, Medical Director at the Pritikin Longevity Center.
Among lifestyle-related factors, LDL cholesterol is likely most important, but also very critical is blood pressure, body weight, body fat, inflammatory factors, triglycerides, smoking, blood sugar, insulin levels, and now, research is finding, particles that flood the blood right after a fatty meal, called VLDL and chylomicrons, that promote the growth of cholesterol-filled plaques.
No pill – or combination of pills – is capable of keeping all these variables in good working order.
The far better approach, one that improves virtually all lifestyle-related risk factors for cardiovascular disease, is the more natural one – a very healthy lifestyle like the Pritikin Program.
When you exercise daily and eat well – an abundance of whole foods like fruits, vegetables, beans (legumes), and whole grains, all naturally low in salt, fat, sugar, and refined (“white”) carbohydrates – the following benefits happen, demonstrated in more than 100 peer-reviewed studies on the Pritikin Program:
- Decreased LDL levels
- Decreased blood pressure
- Decreased blood glucose (sugar) and insulin levels
- Loss of excess body fat
- Decreased levels of inflammatory factors
- Decreased fasting and postprandial (after meal) triglyceride levels, generally associated with decreased VLDL and chylomicrons
Moreover, it is a low-fat, fiber-rich, Pritikin-style eating plan plus daily exercise (not HDL-raising drugs) that has been scientifically documented to relieve angina, reverse atherosclerosis, and reduce cardiovascular events and total mortality. We do not have comparable data for any drug or drug combination, or for higher ‘good fat’ diets.
Reassessing HDL cholesterol
Growing research also suggests that increasing HDL, a goal of many doctors and patients nationwide, may not be so important after all.
The fact is, populations who enjoy the lowest incidences of heart disease in the world, such as the people of Okinawa and other rural regions of Japan, tend to have very low levels of HDL, often in the 20s and even lower.
Quality may trump quantity
Indeed, HDL levels tend to go down a little when people first start the Pritikin Program. But the functionality of HDL appears to improve significantly.
For heart health, in other words, what may be far more important than quantity of HDL is quality.
HDL, fats, and scavenger receptors
One of the main reasons HDL levels tend to drop on the Pritikin Eating Plan is because the diet is low in saturated and monounsaturated fats. These fats suppress the production of scavenger receptors called B1.
At first glance, squelching these scavengers seems like a good thing. That’s because they latch onto HDL particles in the blood, extract their cholesterol, then release the emptied HDL particles back into circulation, which tends to lower HDL cholesterol levels.
But this process also allows the HDL particles to return more quickly to the artery wall and pick up more LDL bad cholesterol, and, of course, that’s a very good thing.
Sponge squeezers
“Think of B1 scavenger receptors as sponge squeezers. They squeeze the HDL particle, which means the HDL is now able to soak up more LDL.”
Reverse cholesterol transport
A very low-fat, whole-foods diet like Pritikin, in effect, may be improving what scientists believe is one of HDL’s key roles in heart health – removing the garbage (LDL) from our arteries and transporting it to the “waste removal site” – our livers. This process is known as reverse cholesterol transport.
Two types of HDL
Scientists are also now learning that there are actually two different types of HDL. One is dysfunctional, or pro-inflammatory. This HDL hastens LDL build-up in the arteries.
The other type is anti-inflammatory in nature, which means it’s truly a good HDL. It decreases the amount of LDL that is embedding itself in the artery wall.
What’s really fascinating, research is finding, is that what we eat can impact, even change, the type of HDL we have. Science has found, for example, that a saturated-fat-rich diet can mess up the ability of HDL to protect against damage to arteries, and turn HDL from anti-inflammatory to pro-inflammatory.
Studies following people who adopted the Pritikin Program found the reverse: pro-inflammatory HDL became anti-inflammatory despite the fact that total levels of HDL went down a little.
Dysfunctional no more
The Pritikin Program, in short, “reverses the dysfunctional HDL,” sums up Dr. Danine Fruge, Medical Director at the Pritikin Center.
“It should also be noted that while HDL levels tend to drop, at least at first, for most people on the Pritikin Program, their HDLs don’t necessarily stay at these lower levels. If people stick to the program and continue to lose weight and exercise, odds are good their HDLs will increase, except now their HDLs will be more anti-inflammatory and more efficient at reverse cholesterol transport because of the increased scavenger receptor B1s.”
Niacin and cholesterol | Summing up
Always discuss your medications and any alterations with your personal physician. What’s right for the general public may not be right for you.
Regarding niacin, the research we have indicates that for most people, niacin does not appear to provide additional benefit when patients are well treated with statins.
The research we have also indicates that for overall good health, drugs, including statins, pale compared to the benefits of a healthy lifestyle like Pritikin. Sure, it’s easier to pop pills, but by embracing Pritikin living, you’re not only preventing cardiovascular-related events like a heart attack, you’re greatly lessening your risk of many other now-epidemic conditions in America, including diabetes, obesity, hypertension, cancer, gout, Alzheimer’s disease, and even impotence.
You’re also free of the side effects that almost always accompany drugs.
“To reduce the risk of cardiovascular disease, the general prescription is 1) improve your lifestyle and 2) take medications, if needed, in tandem with lifestyle changes,” sums up Dr. Scheib.
Health Benefits of Niacin
1. Improves blood fat levels
Niacin may help to improve your blood fat levels by:
- increasing your HDL (good) cholesterol
- reducing your LDL (bad) LDL cholesterol
- reducing your triglyceride levels
This may translate to a decrease in heart disease risk, although several studies have found no link between niacin supplementation and a decrease in heart disease risk or deaths.
It also takes high doses of niacin, typically 1,500 mg or greater, to achieve blood fat level improvements, which increases the risk of experiencing unpleasant or potentially harmful side effects.
For these reasons, niacin is not a primary treatment for high cholesterol. It’s primarily used to help improve blood fat levels in people who cannot tolerate statin drugs.
2. May reduce blood pressure
One role of niacin is to release prostaglandins, or chemicals that help your blood vessels widen — improving blood flow and reducing blood pressure. For this reason, niacin may play a role in the prevention or treatment of high blood pressure.
In one observational study of over 12,000 adults, researchers found that each 1 mg increase in daily niacin intake was associated with a 2% decrease in high blood pressure risk — with the lowest overall high blood pressure risk seen at a daily niacin intake of 14.3 to 16.7 mg per day).
A high quality study also noted that single doses of 100 mg and 500 mg of niacin slightly reduced right ventricular systolic pressure.
However, more research is needed to confirm these effects.
3. May help treat type 1 diabetes
Type 1 diabetes is an autoimmune disease in which your body attacks and destroys insulin-creating cells in your pancreas.
There’s research to suggest that niacin could help protect those cells and possibly even lower the risk of type 1 diabetes in children who have a higher chance of developing this condition.
However, for people with type 2 diabetes, the role of niacin is more complicated.
On one hand, it can help lower the high cholesterol levels that are often seen in people with type 2 diabetes. On the other, it has the potential to increase blood sugar levels. As a result, people with diabetes who take niacin to treat high cholesterol also need to monitor their blood sugar carefully .
Fortunately, a more recent review of studies found that niacin did not have significant negative effects on blood sugar management in people with type 2 diabetes.
4. Boosts brain function
Your brain needs niacin — as a part of the coenzymes NAD and NADP — to get energy and function properly.
In fact, brain fog and even psychiatric symptoms are associated with niacin deficiency.
Some types of schizophrenia can be treated with niacin, as it helps undo damage to brain cells that’s caused by a niacin deficiency
Preliminary research shows that it could also help keep the brain healthy in cases of Alzheimer’s disease. However, results are mixed.
5. Improves skin health
Niacin helps protect skin cells from sun damage, whether it’s used orally or applied as a lotion.
It may help prevent certain types of skin cancer as well. One high quality study in over 300 people at high risk of skin cancer found that taking 500 mg of nicotinamide twice daily reduced rates of nonmelanoma skin cancer compared to a control