Niacin – To Flush, or Not To Flush
Niacin has been shown to be effective for several lipid conditions and is one of the more effective interventions to improve HDL (High-Density Lipoprotein) which can be very difficult to achieve. It can reduce LDL, Lp(a), and Triglycerides making it very attractive for improving your lipid profile.
The problem is that Niacin, in therapeutic doses, can have some very unpleasant side effects. It can affect the liver and you should have your liver enzymes monitored while you are taking high doses of Niacin. However, the most common problem with Niacin consumption is facial flushing.
No-Flush Niacin
First, don’t bother taking the ‘Non-Flushing’ form of Niacin (inositol hexaniacinate). It doesn’t appear to have any benefit for lowering your cholesterol. For benefit, we need the Nicotinic Acid form of Niacin.
Niacin CAN Cause Flushing
Niacin causes vasodilation (dilating the blood vessels) in the skin through the release of prostaglandins (PGD2) and not due to histamine. It takes time to replace this PGD2 once it is released. Therefore, if we deplete the PGD2 through Niacin and maintain the Niacin then the flushing should go away. If you stop the Niacin it will allow the PGD2 to replenish and the flushing would return the next time you take it again.
It is important to understand what you can expect with the flushing. The flushing is a skin redness, itching, and burning sensation and typically lasts 15-30 minutes then resolves spontaneously. The severity of the flushing varies from patient to patient and some patients are extremely alarmed and concerned. We have had patients tell us that they thought they were going to die.
Many times patients are relieved to know that this is not an indication of any problems in any way. We do our best to make sure that patients understand the side effects they may encounter.
The best thing is to prevent this flushing to begin with! Therapeutic doses of Niacin are often from 1.5-2 grams per day (4 tablets at 500mg each) but we recommend starting with lower doses and gradually increasing them. This gradually depletes the prostaglandins that cause the flushing and may prevent the flushing altogether.
The next thing is to take a Niacin-SR, a sustained-release niacin as lower levels of niacin are released slowly over several hours and it dramatically reduces the chances that a flush will occur as well as the severity if it does occur. This is the same principle as stated above.
How to take Revolution’s Niacin-SR
- Niacin-SR contains 500mg of niacin.
- Start with 1 tablet daily at bedtime
- If you are doing well in 3-4 weeks then increase to 1 tablet twice daily. You could take both of them at the same time before bed if that works better for you.
- If you have flushing or this seems to be going up too fast then simply cut the tablet in half (it is scored) and take 1-1/2 tablets daily.
- Try to increase again in 3-4 weeks.
- The goal is often to get from 1-2 grams of Niacin-SR each day
Some sources recommend taking 325mg of aspirin 30 minutes before taking your aspiring. We have heard several patients state that taking Niacin with apple sauce dramatically improves the flushing.
How to prevent flushing with Niacin-SR:
Niacin causes flushing in some people. If you take Niacin and don’t get flushing then there is no need to make any adjustments. However, if you DO get flushing then here are some options to prevent that flushing.
- Start with Revolution’s sustained release Niacin-SR – 500mg once daily and increase as needed. If you get flushing at this dose then we may need to try a 100mg version and gradually increase.
- Taking Niacin-SR with food, apples, apple pectin, and/or apple sauce may help reduce the flushing
- AllerDHQ 1-2 times per day may help substantially and is another option to reduce or prevent flushing. The main beneficial ingredient here is Quercetin.
- If you get flushing with taking Niacin then avoid alcohol. If you don’t get flushing then don’t worry about drinking alcohol.
- Never interrupt treatment – you’ll have to start over
- Aspirin may decrease the flushing associated with Niacin. However, you should get a CardiaX genetic evaluation because Aspirin increases the risk of cardiovascular disease events if you do not have a COMT mutation. There is more information about this on the CardiaX page.
- Wellchol may reduce the flushing associated with Niacin, blood sugar elevations, as well as help further decrease LDL.
The bottom line:
You can have flushing with niacin. While it may be unpleasant and uncomfortable, medically speaking, it is not problematic. It does not suggest any problems. It is nothing to worry about. This effect typically reduces as you continue your Niacin therapy. Get your liver checked to make sure everything stays okay.
Niaspan (500mg) costs around $100 for a 30 day supply – this is the prescription version. Niacin-SR is less than $10 for the same amount.
Contact us so that we can help you get started optimizing your health today!
