NIACIN & HIGH CHOLESTEROL

Q. My husband has high cholesterol. A friend told him to take niacin. I have read both that it works well for lowering cholesterol but that it can kill your liver. Should my husband be taking this or not? Thanks for your help.

A. Niacin, or B3, is one of 8 essential B vitamins. It is important for the optimal functioning of the nervous system, studied for its use with conditions such as depression and schizophrenia. It also plays a role in digestion, as it is a co enzyme involved in the process of digesting carbohydrates, fats and proteins. Recently a lot of attention has been given to Niacin for its ability to lower "bad" cholesterol while increasing "good cholesterol". Research is showing niacin to be effective in lowering LDL cholesterol, triglycerides and lipoprotein A levels. It also increases HDL cholesterol. HDL cholesterol is considered a "good" cholesterol, as these particles are able to remove cholesterol from arteries and cells outside of the liver, transport them back to the liver for excretion or re utilization. This is important in terms of preventing atherosclerosis (plaque formation inside the arteries), which in turn can increase the risk of heart disease, as well as myocardial infarction (heart attack) and stroke.

One of three forms of niacin can be used for supplementation; niacin (or nicotinic acid), niacinamide, and inositol hexanicotinate. This is where the confusion begins. For many individuals, niacin causes what is known as a "niacin flush", an itching, mild burning to the skin. Although some people actually enjoy the temporary sensation, others have had to discontinue using niacin because of it. Niacinamide was developed and marketed as a sustained release niacin, absorbed and broken down more slowly, this form has little to no flushing effect. Unfortunately, research has since shown that the potential for liver toxicity with this form of niacin is significantly higher than the nicotinic acid form. Inositol hexanicotinate is yet another form or niacin, commonly referred to as no flush or flush free niacin. The results in terms of safety for this form of niacin are excellent, with many studies citing that there is significantly less chance, if any, for liver inflammation when compared with niacinamide and niacin both. Unfortunately, the research seems to be mixed in terms of its effect on cholesterol in comparison to regular niacin. Overall the consensus seems to be that inositol hexanicotinate is still an effective and safe option for those who are unable to handle the "flush" of regular niacin.

Let's quickly tackle the topic of dosage. Most of the literature states that anything over 500 mg/day increases risk for liver inflammation. Again, keep in mind what we now know about liver toxicity based on the various forms of niacin available. For regular health maintenance, this dose will more than cover our needs. That being said, for a significant decrease in LDL cholesterol, triglyceride and lipoprotein A, levels, high dose niacin is necessary. Anywhere from 2-4 g/day is commonly used to lower these unwanted cholesterol levels. Individuals taking a dosage in this range should have their liver enzymes regularly checked by a qualified health care practitioner.

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