Last updated: 21 Jan 2012 at 10:07
Niacin – the best “drug” for lowering cholesterol and raising HDL
Campain report by Patrik Holford, 21 January 2012
Vitamin B3 (niacin) is the most effective substance, even better than statins, for both lowering LDL cholesterol, but importantly raising HDL. Niacin is usually given in doses of 1,000mg to 2,000mg, in a non-blushing or slow-release form since, in high doses, it causes vasodilation.
There are many good reasons to supplement high dose niacin, which is both available on prescription and in health food stores. According to a major review of what works in the New England Journal of Medicine, “the most effective way” to lower cholesterol is with the B vitamin niacin (also called B3), not statin drugs.
A number of studies show that it is effective not only in raising the good HDL by as much as 35%, but also in reducing LDL by up to 25%. By way of comparison, statins only raise HDL by between 2% and 15%. Niacin also reduces levels of two other markers for heart disease – lipoprotein(a) and fibrinogen, the latter of which is also involved in binding lipoproteins to the artery. Niacin is more effective than any drug for lowering lipoprotein(a), another marker for heart disease risk, lowering high levels by about a third when high doses of niacin, 1 gram or more, are given for several months. One study from the University of Arkansas for Medical Sciences, reported a 35 per cent decrease in lipoprotein(a) after 26 weeks on niacin . Other studies have shown the same thing and a recent review concludes that no drugs really do this effectively and that ‘the strongest effects are seen with niacin at high doses.’ 
The most obvious side-effect of taking fairly high doses is a blushing effect which is diminished by taking with food, but non-blush or extended-release niacin is now easily available. Other reported side-effects include dyspepsia (indigestion), raised plasma glucose and uric acid levels, although these last two have not been confirmed in recent studies. Overall, it has nothing like the side-effects associated with statins. Niacin was actually discovered to lower cholesterol back in the 1960′s, as a ‘side-effect’ of giving high doses to those with schizophrenia as a highly effective therapy pioneered by the late Dr Abram Hoffer. So, it has only taken 50 years for this discovery to come to market, largely because drug companies have explored ways of combining it with substances, or processes that effectively ‘slow release’ it, which can be patented. You can buy straight niacin for very little, and while taking 500mg twice a day will produce major flushing for the first couple of days, the blushing soon diminishes as long as you keep going. A recent big review of niacin trials found that because it had a “markedly beneficial” effect on a particularly dangerous combo of risk factors – a low level of the good cholesterol HDL and high levels of triglyceride fats in the blood – it might be particularly useful in treating people heading towards diabetes . Studies have shown that it inhibits atherosclerosis, reduces risk of heart attack and, if taken over 15 years lowers risk of death [v]. The strongest evidence, however, has come from trials combining statins with niacin . I suspect that, as the patents for statin drugs run out the option of getting a patent of a combination of niacin plus drug, is seen as one way to extend the process of making money from statins.
However, all was going well until a study called AIM-high, combining niacin with statins last year was stopped because the niacin wasn’t adding benefit to the drug regime . The study gave two groups aggressive statin therapy plus either 2,000mg of slow-release niacin or a ‘placebo’ of 50mg of niacin – enough to induce a vasodilatory blush hence to ‘disguise’ whether a person was in the ‘active’ treatment group or not. There was no difference in risk between the two groups of a cardiovascular event. I suspect the most likely reason is that the statins interfered with the ability of nutrients to make a difference. Another possibility is that the so-called placebo actually had a beneficial, hence contributing to no perceivable difference between the two groups. (Click here if you’d like to hear a debate on this trial from one of the authors.) [Link to see speaker below] What we really need is a niacin vs statin trial, but that’s not in the interest of the pharmaceutical industry who make lots of money from statins and fund most of these trials.
My recommendation, especially if you have low HDL, would be to take the niacin instead of the statin. After all, it lowers LDL cholesterol, triglycerides and Lp(a), raises HDL, has clinical evidence of reducing risk of cardiovascular disease and death, and is a naturally occurring nutrient, with no side-effects beyond the blushing effect.
You need 1,000mg a day for a therapeutic effect. Some people take 500mg of pure niacin twice a day with a meal and report the blushing stops after a few days. (best to try 100mg first, twice a day will meals until the blushing effect subsides – it lasts for about 20 minutes). You can also get a slow-release form of niacin, called Niaspan, on prescription. There’s also a non-blushing form called inositol hexanicotinate. How well this lowers cholesterol isn’t known since it hasn’t been tested in clinical trials.
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Wishing you the best of health,
 M.D. Ashen and R.S. Blumentahl, ‘Clinical Practice. Low HDL cholesterol levels’, New England Journal of Medicine, 2005; 353(12):1252-60  D. Holmes, ‘An answer to angina’, Holistic Health, 1995; 46:20-23  I. Gouni-Berthold, HK Berthold, ‘Lipoprotein(a): Current Perspectives’, Current vascular pharmacology, 2 May 2011. [Epub ahead of print]  M. J. Chapman, et al., ‘Niacin and fibrates in atherogenic dyslipidemia: Pharmacotherapy to reduce cardiovascular risk’, Pharmacology & Therapeutics, 2010; 126(3):314–45  P.L. Canner, K.G. Berge, et al., ‘Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin’, Journal of the American College of Cardiology, 1986; 8, 1245−1255.  M. John Chapman, P. Giral, et al., ‘Niacin and fibrates in atherogenic dyslipidemia: Pharmacotherapy to reduce cardiovascular risk’, Pharmacology & Therapeutics, 2010; 126:314–345  AIM-High Investigators, ‘Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy’ New England Journal of Medicine, 2011 November 15
Click here to see Patrik’s article on his website