Niacin for Cholesterol Problems

Fig. 2: Mechanism of niacin action. Niacin inhibits the release of free fatty acids from adipose tissue, which leads to decreased VLDL secretion by the liver. FFA = free fatty acids, TG = triglycerides, VLDL = very-low-density lipoprotein, LDL = low-density lipoprotein, HDL = high-density lipoprotein. Photo: Paulette Dennis

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Niacin known as vitamin B3 is present in dairy products, poultry, fish, lean meats, nuts, and eggs. Legumes and enriched bread and cereals also supply some niacin.

What is Niacin? How does it work?
What is Niacin? Niacin (nicotinic acid) is a vitamin B3 essential for our body to turn carbohydrates into energy. Niacin also helps to keep our nervous system, digestive system, skin, hair, and eyes healthy. It reduces the production of triglycerides and VLDL. It leads to decreased LDL cholesterol, increased HDL cholesterol, and lowered triglycerides. You should take this medicine only under a doctor’s supervision.

Nicotinamide, another form of the vitamin niacin, does not lower cholesterol levels and should not use in the place of nicotinic acid.
How does Niacin work? Niacin works by blocking the release of triglycerides from storage (body fat) and by inhibiting the liver from making more from blood sugar by blocking hepatocyte diacylglycerol acyltransferase 1 and 2 (DGAT1 and DGAT2), distinctly different enzymes for triglyceride synthesis. Results in decreased triglyceride synthesis and hepatic atherogenic lipoprotein secretion. It thus improves all lipoproteins; lower total cholesterol, LDL, triglycerides, and raises HDL cholesterol.

Available niacin brands
Common Niacin drugs available in the market are:

Niacin brand names include Niacor® - immediate release, Niaspan® - sustained release, Slo-Niacin®, Nicolar, Nicotinex Elixir, Novo-Niacin, and several others.

Niacin drug types that are available in three formulations:

IR or immediate release,
SR or sustained release or timed release
ER or extended release forms.
The doctor prescribes immediate release form niacin at the starting; discussing with the doctor, which one is best suitable for you.

What can expect from niacin drug medication? Niacin has shown to benefit all aspects of the lipid profile by lowering LDL cholesterol by 15% to 25%, lowering triglycerides by 20% to 50%, and raising HDL cholesterol by 15% to 30%.

Studies in patients with various disorders of lipid metabolism show that niacin significantly raises HDL-C and lowers total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, and lipoprotein(a).

How do you take niacin drugs? Niacin is usually started on a low dosage and gradually increases it to an average daily dose of 1.5 to 3 grams for the immediate release form, and 1.5 to 2 grams for the other forms. Niacin is usually good to take at bedtime with a low-fat snack. Take this medication with a full glass of cool water; taking with a hot drink may increase your risk of side effects such as flushing.

How much niacin do you need to lower your cholesterol? Niacin is essential for normal function of the nervous system and the maintain healthy skin and mucous membranes. Without niacin, your body cannot convert food into glucose to produce energy.

The Food and Nutrition Board has set the recommended daily allowance (RDA) for niacin at 20 mg/day and the upper safe limit (UL) at 35 mg/day. However, to treat high cholesterol, doctors prescribe 2000 mg/day niacin that is more than 50 times the UL.

Many patients argue that high dose niacin causes severe side effect and not easy tolerable. And many experienced patients suggest taking vitamin D (through lots of sunshine), 2000 mg vitamin C per day in the morning and evening (4000 total), and 100 mg/day of thiamine in the morning and evening (200 mg/day).

Niacin alone is not the best way to solve your problems with cholesterol and triglycerides. You should also be getting optimal doses of vitamin D (exposing to lots of sunshine), 2000 mg vitamin C twice daily, 100 mg of thiamine twice daily, and 250 mg extended release niacin twice or thrice per week. These doses are the upper limits recommended by the food and nutrition board. Thus 95% of the population can handle these doses without side effects.

Who can use niacin drugs?
Niacin is a B vitamin that should take only under physician supervision. Before taking niacin, consult your doctor if you are allergic to any drugs, or if you have liver, kidney, or heart disease, uncontrolled angina (chest pain), stomach ulcer, diabetes, gout, or a muscle disorder such as myasthenia gravis.

If you have any of these conditions, then you may need to adjust the dosage or not able to use it.

12+ Possible side effects of niacin
Rapid release niacin as little as 35 mg with a hot coffee on an empty stomach first thing in the morning can cause flushing. Avoid taking niacin with hot coffee.
Some of the common side effects of niacin are:

Flushing is a very common side effect of niacin. Flushing occurs in 80 % of patients. Flushing or hot flashes may be due to blood vessel’s dilation. Flushing may be less frequent with controlled release Niaspan.
Nausea, indigestion, gas, vomiting, diarrhea, and the activation of peptic ulcers.
Itching, paresthesia, and nausea each occur in about 20 percent.
Elevation of liver enzymes is relatively common on niacin and may progress to liver damage. Therefore, regular monitoring of liver tests is mandatory.
Niacin may cause insulin resistance and raise fasting glucose levels. Important if diabetes: Niacin may increase the blood-glucose level, so diabetic should be careful.
Niacin may increase plasma levels of uric acid and precipitate acute gouty arthritis. The drug should avoid in patients with a history of gout.
Nervousness, Panic, anxiety, rapid heartbeat, and fainting.
Tooth and Gum Pain
Decreased Thyroid function.
Blurred vision, lazy eye
Lower blood pressure - Important if high blood pressure: Effect of hypertension medication drug may increase while on niacin.
Headache
The extended release form may cause fewer flushing than the other forms. Patients who take niacin should closely monitor by their doctor to avoid complications from this medication drug. Self-medication should avoid because of the possibility of missing a serious side effect if not under a doctor's care.

Niacin Cholesterol Lower | Niacin Cholesterol Dosage Side Effects
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