Niacin and Cholesterol

Most individuals who’ve undesirable levels of cholesterol and may’t enhance them sufficiently through weight-reduction plan and train are prescribed statin medicine. However there’s additionally a vitamin, niacin—often called Bthree—that in very giant doses can enhance levels of cholesterol and scale back the danger of coronary heart assaults. In reality, when niacin’s useful impact was found in 1955, it turned the primary remedy for prime ldl cholesterol.

Who wouldn’t choose to take a vitamin over a prescription drug, you may ask. However it’s not that easy.

Although categorised as a dietary complement, high-dose niacin, in impact, is a drug, whether or not you purchase it over-the-counter or by prescription. And like all drug, it has potential unintended effects and ought to be taken below medical supervision.

As well as, there are completely different types of niacin available on the market, which range in effectiveness and dangers, so looking for it within the health-food retailer or drugstore might be complicated.

What’s extra, niacin’s anti-cholesterol credentials have been not too long ago tarnished when disappointing outcomes from a serious research have been launched, making some individuals surprise if they need to cease utilizing niacin.

What are niacin’s advantages?

The primary purpose of ldl cholesterol remedy is to decrease LDL (“dangerous”) ldl cholesterol. Statins do that significantly better than niacin does. However niacin has the benefit of elevating HDL (“good”) ldl cholesterol rather more than statins do. It additionally lowers triglycerides, fat within the blood that may improve the danger of coronary heart illness.

For these causes, niacin could also be choice for individuals who can’t tolerate statins effectively and for individuals who have very low HDL and/or excessive triglycerides. Furthermore, niacin helps individuals who have elevated ranges of small, dense LDL particles, which improve coronary threat.

What are the dangers of high-dose niacin?

The chief drawback is that it typically causes intense flushing (totally on the face and higher physique). This isn’t dangerous or long-lasting, however many individuals discover it onerous to place up with and thus cease taking the drugs. The flushing normally decreases with continued use.

Niacin can, in uncommon circumstances, trigger liver harm. It could actually elevate blood sugar barely, however is taken into account protected for individuals with diabetes. It could actually additionally improve the danger of gout and flare-ups of peptic ulcer illness.

What are the completely different types of niacin?

The shape that improves levels of cholesterol is known as nicotinic acid. The usual dose for treating ldl cholesterol is one to threegrams each day, 50 to 150 occasions greater than what’s in a fundamental multivitamin. However you’ll additionally discover different kinds on the market, resembling niacinamide and inositol hexanicotinate, which have little or no impact on ldl cholesterol.

As well as, there are three classes primarily based on the speed of launch of the niacin:

  • Fast-release niacin is efficient and least costly, however causes extra flushing. It needs to be taken two or thrice a day.
  • Sustained-release/extended-release niacin causes much less flushing. Nevertheless, some over-the-counter formulations could also be much less efficient and improve the danger of liver toxicity. The extended-release type bought by prescription (Niaspan is the best-known model) is efficient, least more likely to trigger in­­tense flushing and safer for the liver—but it surely prices much more than brand-name statins. An over-the-counter sustained-release preparation known as Slo-Niacin is much like Niaspan however a lot cheaper.
  • No-flush niacin (inositol hexanicoti­­nate) has no “free” nicotinic acid, so it has little or no impact on ldl cholesterol. Nonetheless, some labels say “helps regular ldl cholesterol.”

How are you going to scale back the flushing?

Apart from taking an extended-release product, take niacin with meals—ideally after dinner or a bedtime snack. Keep away from sizzling drinks or alcohol close to the time you are taking niacin. Additionally, take aspirin (or a associated drug, resembling ibuprofen or naproxen) earlier than the meal; even a “child” aspirin might assist. However examine together with your physician earlier than taking aspirin frequently, since it’s contraindicated for some individuals.

Backside line: Statins stay the first-line alternative as a result of they’re only at reducing LDL, are confirmed to stop coronary heart assaults and barely trigger unintended effects. Should you even have low HDL and/or excessive triglycerides, you and your physician might resolve so as to add niacin to your routine.

Discuss to your physician or pharmacist in regards to the numerous kinds, and take niacin below medical supervision. As with different cholesterol-lowering medicine, you’ll should be monitored to ensure it’s attaining the specified re­­sults and isn’t harming your liver.

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