Herbal Health

Technically niacin is a vitamin, a necessary nutrient in everyone’s diet. But in very high doses, many times the required daily intake (RDI) for the nutrient value, niacin can be a very effective cholesterol fighter. Niacin is available in pharmacies and health food stores, and is also known as nicotinic acid. Note that only niacin, and not the niacinamide form of the vitamin, works to lower cholesterol levels. And although you can purchase niacin without a prescription, at the high doses needed for effectiveness you require medical supervision. Never take niacin without your doctor’s permission.

Niacin decreases the liver’s manufacture of VLDL, a precursor of LDL, thus limiting the production of LDL. At the same time, it raises levels of HDL and lowers triglycerides. It performs that combination of benefits better than any other substance available, with or without a prescription. As such, the US National Cholesterol Education Program has listed it as a first-choice agent in cholesterol control.

Unfortunately, not everyone can take niacin. First there are a number of contraindications including past or present liver dysfunction, diabetes, gout, severe arrhythmias and ulcers. Second, some side effects may occur which would prevent patients from taking the large doses needed. Gastric upset may be overcome by taking niacin with meals. And the flushing which typically follows niacin’s entering the bloodstream can be limited by preceding the dose with a half tablet of aspirin about 20 to 30 minutes before. Moreover, sustained-release tablets have been developed which reduce or even eliminate the flushing for most patients.

One brand of niacin, called Endur-acin, is a sustained-release preparation which has been studied in detail by Dr Joseph Keenan at the University of Minnesota. He reported his work in the Archives of Internal Medicine in 1991.

A total of 158 patients, both men and women, completed the study. They began with a diet providing 30 per cent of kilojoules as fat and limiting cholesterol to no more than 300 milligrams daily. And they were given varying dosages of Endur-acin or placebos. Subjects receiving 1500 milligrams (1.5 grams) of Endur-acin had a 19 per cent fall in LDL cholesterol and a 10 per cent rise in HDL. This resulted in a very dramatic improvement of the cholesterol risk ratio. Smaller dosages were not as effective, and doses of 2000 mg (2 grams) produced no greater benefit.

Patients taking standard rather than slow-release niacin typically need more than 1500 mg to achieve the desired effect. In a well-publicised study showing reversal of blockage in the arteries, Dr David Blankenhorn at the University of Southern California gave patients an average of 4.3 grams of niacin along with the prescription drug colestipol. Some doctors have given patients as much as eight or nine grams daily. It will be up to your own physician to determine if you’re a good candidate for niacin therapy and, if so, what kind and how much you should use.

Let me repeat: do not take niacin without medical permission and supervision. Niacin works at the site of the liver where cholesterol is manufactured, and it places an additional burden on that organ as it is metabolised. Some studies have shown that slow-release niacin is harder on the liver than standard niacin. It would appear that while smaller doses of sustained-release niacin can achieve the cholesterol-lowering effects of larger doses of standard niacin, one can also expect the potential liver toxicity of larger doses. Reports have shown that those who switch from standard niacin to an equal dosage of slow-release niacin may have problems. Your doctor will need to study your liver function by way of a simple blood test to determine whether your body is properly handling the niacin. Moreover, your doctor will decide which form of niacin is best for you, and at what dosage.

If you or your physician would like additional information about niacin, I’ve devoted an entire chapter to it in The 8-Week Cholesterol Cure.

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Cardio & Blood/ Cholesterol