Is Niacin Effective and Safe? Here’s My Take

Filed Under: Heart Health, Cholesterol, Health Advice
Last Reviewed 02/27/2015

Is Niacin Effective and Safe? Here’s My Take
As you may have seen, a new report published in The New England Journal of Medicine has brought into question the effectiveness and safety of niacin—vitamin B3 that’s often used to control cholesterol problems. 
The primary benefits of niacin are reducing LDL cholesterol, raising HDL cholesterol, and reducing harmful Lp(a). But the report, based on the results of two recent studies, showed that high dose niacin failed to reduce the risk of stroke, heart disease, and death. Plus, it caused serious side effects—including skeletal and gastrointestinal problems, as well as diabetes.
These niacin findings are based on the results of two clinical trials. The first, called the AIM-HIGH trial, looked at 3,414 high risk patients taking prescription strength extended-release niacin. But it was halted after just three years due to the fact that scientists found few niacin benefits.
The other much larger study, called HPS-THRIVE, looked at the effectiveness of prescription strength extended-release niacin taken in combination with laropiprant, a drug that’s supposed to decrease the niacin flush. That study also called into question niacin’s effectiveness. Plus, it found that extended release niacin aggravated blood sugar control in diabetics and caused bleeding, gastrointestinal, and muscular issues.

What Do Those Niacin Findings Mean for You?

  • Long-acting niacin—which was used in both studies—comes with a lot of baggage and doesn’t work. In fact, I stopped using it years ago. The biggest problem with long-acting niacin taken at high doses is that it can cause extreme liver dysfunction.
  • In the HPS-THRIVE trial, participants received lapropiprant—a drug given to reduce niacin’s flush—along with the niacin. It’s nearly impossible to tease out the niacin benefits, or niacin safety, when a drug is given along with niacin.
  • Short-acting niacin also has baggage. Because it’s a vasodilator, niacin can cause an uncomfortable flush or a pins and needles sensation. In fact, most people can’t tolerate doses over 500 mg of short-acting niacin. 
  • For those with high Lp(a) and low HDL cholesterol, I’ve had good success with short-acting niacin. My recommendation is that you start with 250 mg of short-acting niacin three times daily, and slowly work up to 1–3 grams in divided doses three times a day. But consult your doctor first.
  • Finally, people with diabetes should not utilize niacin unless they’re closely supervised by a physician.

Now it’s your turn: Have you taken niacin?

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DISCLAIMER: The content of is offered on an informational basis only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified health provider before making any adjustment to a medication or treatment you are currently using, and/or starting any new medication or treatment. All recommendations are "generally informational" and not specifically applicable to any individual's medical problems, concerns and/or needs.

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