Niacin: A Vitamin, But Also a Drug
For: Cholesterol Drugs and Vitamins Add Up to a Surprise, March
2002
When people have high blood cholesterol levels that they can't lower via diet and other life-style changes, they are usually put on prescription drugs known as "statins". But there is an old standby, much less expensive, that may also be employed: the B vitamin niacin, in massive doses. It is also used for people who have high levels of triglycerides (fats in the blood).
Important note: Some people assume that it's safe to take high-dose niacin on their own because it's a vitamin, "natural," and available without a prescription. But there are definite risks. You should begin niacin therapy only under medical supervision.
Pluses and minuses
Niacin is also called nicotinic acid or vitamin B3. In addition, there are sustained-release versions; one brand (Niaspan) is available only by prescription. The typical doses of niacin, 1 to 3 grams per day (50 to 200 times the RDA), can reduce total cholesterol and LDL ("bad") cholesterol by up to 30%. Niacin can substantially increase HDL ("good") cholesterol and reduce triglycerides, both by up to 30%, and may have other beneficial effects on blood lipids. Other anti-cholesterol drugs have little or no effect on HDL and triglycerides.
Taken in therapeutic doses, niacin is a drug, with potential side effects like any drug. The most common of these are flushing and itching. Nausea, blurred vision, and headache may also occur. Liver damage and small increases in blood sugar are among the more serious risks. The sustained-release version is supposed to reduce the flushing and has to be taken only once daily (instead of two or three times a day), but there are still questions about its effectiveness and long-term safety (especially for the liver) compared to regular niacin. Unfortunately, some people try another form of niacin called niacinamide (also known as nicotinamide) because it doesn't cause flushing, but it does not lower cholesterol.
If you have high cholesterol or high triglycerides, discuss your drug choices with your doctor. Though niacin is sold in health-food stores, you can't depend on the advice of the sales clerks there. You'll also need regular checkups and blood tests to make sure the niacin isn't doing more harm than good. In some cases, niacin is prescribed along with a statin drug or another kind of cholesterol-lowering drug.
If you have liver disease, diabetes, gout, peptic ulcers, or glaucoma, if you are a taking blood thinner, or if you are a heavy drinker, niacin therapy may not be a good choice for you.
Remember this: Before taking niacin or any other cholesterol-lowering drug, it's important to try life-style changes—and to stick to them even if drugs later become necessary. These steps include cutting down on saturated fat and dietary cholesterol, losing weight if needed, giving up smoking, and exercising more.
UC Berkeley Wellness Letter, December 2000
