Take Niacin for Cholesterol Troubles

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Filed Under: Heart Health, Cholesterol
Last Reviewed 07/22/2014

Take Niacin for Cholesterol Troubles

Those of you who follow my blog may remember my post titled 5 Things Your Cardiologist Won't Tell You. In that blog, I invited reader questions, and one reader asked: “Is it a problem taking niacin to lower cholesterol?”

That's an excellent question. Taking niacin (vitamin B3) to lower cholesterol works—but that's not the reason it occupies a central role in my supplement arsenal against arterial disease.

High Cholesterol Isn't The Real Culprit

Much of what passes for “high cholesterol” is in fact harmless. Your body makes and needs cholesterol to function, and the numbers from a total cholesterol test really don't mean much.

What really informs you and your doctor is the type of cholesterol fraction patterns you have. A negative cholesterol reading would be a dominant pattern of dense, small cholesterol particles, which are the most highly inflammatory and dangerous cholesterol particles. Ideally, your cholesterol particles should be predominantly large and “fluffy.”

As I have written before, the standard blood lipid tests won't reveal your cholesterol pattern. Ask your doctor to prescribe one of the new generation cholesterol tests. The tests I recommend are the VAP test at www.atherotech.com or the lipoprotein particle test at www.spectracell.com. Both are covered by Medicare and most insurance plans. If it turns out you have lots of small, dense particles, that's where niacin comes in.

Taking Niacin for Healthy Cholesterol Subtypes

The reason I highly recommend niacin is that it does an excellent job of lowering the small, dense LDL cholesterol particles. Plus, it helps superbly to raise the larger “good” HDL particles. Niacin also lowers triglyceride levels and the very dangerous cholesterol component, Lp(a). These are huge benefits.

In fact, when I treat my patients, I tell them that we're going to do all we can to increase HDL cholesterol and to keep Lp(a) numbers down. I don't dedicate nearly as much attention to total cholesterol. Keeping your HDL and Lp(a) numbers where they should be are paramount to preventing and reversing cardiovascular problems.

When it comes to Lp(a), which is by far the most dangerous form of cholesterol, niaicin is probably the only nutrient that lowers it. Fish oil can help neutralize the pro-clotting influence of Lp(a), but doesn't reduce it. At the same time, by increasing your HDL cholesterol levels niacin helps to lead to plaque regression. In fact, the higher your HDL levels, the greater the protection in your blood vessels.

One Side Effect of Taking Niacin for Cholesterol

The only downside to taking niacin is that some people experience a “niacin flush.” This tingly pins-and-needles sensation and sometimes hot flushing of the skin usually begins in the forehead and works its way down your arms and chest. It can occur initially at doses as low as 50 mg a day and typically lasts no more than a half-hour to an hour, then disappears.

The higher the initial dose you take, the greater the initial flush. Fortunately, you can minimize the intensity of the flush by taking the pills after meals. I've found that flush is most intense initially. As you continue, the intensity lessens and often within a week or two it vanishes. If you stop taking niacin for cholesterol and then resume at a later date, you may experience a full flush again.

Over the years, I have had patients who became so alarmed that they ran to the emergency room, thinking that they were having a bad physical reaction to the nutrient. However, it is nothing to be concerned about.

Some people use the non-flush form of niacin because they are uncomfortable with the flushing effect. The problem with that is you don't get the same good vascular benefits. Therefore, if you want reliable results, you should use the standard niacin for cholesterol, which is very inexpensive.

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