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Publix GreenWise Market Magazine - Fall 2009
Know Your Niacin
 It's the vitamin that's also a medicine shown to provide heart health benefits.
WHAT IT IS
Vitamin B3 has two main components: niacin and niacinamide. At low doses the components have identical nutritional effects, but at higher doses niacin has unique health benefits that have made it one of the best-studied vitamins around.
WHERE TO GET IT
Good food sources of niacin include poultry, red fish, meat, fortified cereal, enriched pasta, peanuts, lentils and seeds. Low doses also are found in multivitamins and B-complex vitamins. The Recommended Dietary Allowance is 16 mg daily for men and 14 mg daily for women. But for treating cholesterol problems, niacin is used at higher doses, typically 1.5 to 3 g daily (that’s 1,500 to 3,000 mg). For these levels, niacin is sold in pill form in three formulations:
- Immediate-release (crystalline) is fastest to dissolve and be absorbed by the body. It’s available mainly as a dietary supplement. The downside: It often causes flushing, similar to a hot flash, according to Ronald Goldberg, M.D., director of the lipid disorders clinic at the University of Miami Miller School of Medicine. Although this side effect may be short-lived, it can persist in some people.
- Sustained-release (long-acting or controlled-release) is slowest to dissolve and be absorbed. It’s sold as a dietary supplement. The downside: “It increases the risk of liver damage, a rare side effect of niacin, particularly when it’s used without medical supervision, and it has less of a beneficial effect on lipids,” says Goldberg.
- Extended-release (Niaspan) falls somewhere between the other types in absorption time, which reduces the risk of side effects. It’s available only by prescription.
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THE EVIDENCE SO FAR
At high doses “niacin is an important drug to help treat cholesterol problems,” says Richard Karas, M.D., director of preventive cardiology at Tufts Medical Center in Boston. A large body of research shows it can lower LDL by about 5 to 25 percent and triglycerides by about 20 to 35 percent. It also can raise good HDL by about 20 to 35 percent, more than any other cholesterol drug currently available. For decades it was thought that people with diabetes should not take niacin because it might lead to dangerous increases in blood sugar. But more recent large well-controlled studies have led doctors to revise their thinking.
“If people’s blood sugar is reasonably well controlled [at the outset], then the niacin has only a very small effect on their blood sugar levels,” says Karas. “It’s clearly something that should be monitored closely with blood tests, but having diabetes is no longer a reason not to take niacin.”
THE JURY’S STILL OUT
Severe niacin deficiency can cause dementia, but it’s unclear whether increasing niacin in a normal diet offers extra protection for your brain. One study suggested it might. In more than 6,100 people age 65 and older, higher levels of dietary niacin were associated with a lower risk of Alzheimer’s disease and age-related mental decline (Journal of Neurology, Neurosurgery, & Psychiatry, August 2004). More research is needed, however.
BOTTOM LINE
Niacin has been shown to have heart health benefits, lowering triglycerides and bad LDL cholesterol while raising good HDL cholesterol. It’s important to take high doses under a doctor’s guidance. Also talk to your medical professional about which form of niacin is right for you.
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