Vitamin B3, also called niacin, is one of eight B vitamins. As with all B vitamins, niacin helps in the process of enzymes converting food into energy. Niacin supports the function of over 200 enzymes around the body. As a supplement it is used in an attempt to improve cholesterol, cognitive function (nootropic), prevent type 1 diabetes, improve your skin, and many more. However, some doses can also cause serious side effects and not all types of niacin are equal.
The main cause of death in North America is heart disease killing close to 1 in 4 people. The main interest and use of niacin comes from its ability to improve cholesterol which lowers risk factors for heart disease. Niacin comes in many different forms that can be found in food and/or supplements:
- Nicotinic Acid (unmodified, immediate release)
- Extended release nicotinic acid, known as “timed-release” is a form that contain an agent to slow the release.
- Niacinamide or Nicotinamide is used to treat arthritis and pellagra.
- Inositol Hexanicotinate known as “Flush-Free Niacin” or “No-Flush Niacin”.
Niacin and Cholesterol
Niacin has been thought of for improving cholesterol and triglycerides in the blood since the 1950’s1. The Mayo Clinic reported that niacin could raise HDL (good) cholesterol by more than 30 percent2 which has caused it to be used for many years for treating cholesterol problems. Newer research also suggests another mechanism of action that benefits the heart by reducing oxidative stress and inflammation which results in reduced atherosclerosis (plaque building up inside the arteries)6.
To add confusion to the benefits of niacin and cholesterol, there are some studies showing no beneficial effects at all on cholesterol; however, upon inspection many of those are done with extended release niacin3 or types of niacin that don’t cause the niacin flush. With mixed studies coming out I would still not assume it’s a simple benefit for everyone.
The Niacin Flush
The niacin flush is a common side effect of taking high doses (100mg’s and above) of supplemental niacin (nicotinic acid) which is a harmless flush that results from the dilation of small blood vessels in your skin. You feel it on your face, chest and neck, and ears which will become red, warm, and itchy. The feeling can be quite uncomfortable especially if you aren’t aware that it will happen. However, this doesn’t happen with all forms of niacin.
Comparing No-Flush Niacin vs Regular
Flush-free or no-flush niacin is a different form of niacin that is made from nicotinic acid and inositol known as inositol hexanicotinate. It is thought that it is broken down into nicotinic acid before entering the bloodstream. Since the process to break it down to its individual chemicals takes a longer time to occur it doesn’t cause the normal flush effect as it is absorbed slower, but it may have diminished effects altogether.
While this no-flush niacin works as other B vitamins to promote energy metabolism it has not been shown very well to have an effect on cholesterol levels. One study showed a very high dosage of 2,400 mg once a day of no-flush niacin is needed to effect cholesterol levels, whereas other studies have indicated that it is ineffective completely4. Looking at the sum of evidence it is doubtful that it has any positive effect on cholesterol. To further back this up, only immediate release and extended release niacin are FDA approved for treatment of dyslipidemia (an abnormal amount of lipids in the blood)5. Unfortunately, many manufacturers still market all types of niacin as beneficial for cholesterol while studies show a contradicting outcome at best.
Controlled Release Niacin Concerns
Extended release niacin is a the standard type of nicotinic acid that has been modified with a goal of reducing the niacin flush effect by releasing it over a long period of time to prevent a large spike of it hitting your system.
All the positives with none of the negatives sound too good to be true? A study done by The New England Journal of Medicine ran a study with male and female participants that were 50 to 80 years old that were taking statin medication combined with extended-release niacin and didn’t see reduced heart attacks or strokes3. The study actually found an increase in risk of death from all causes7. Proving a track record of liver concerns, there are also older studies showing elevated liver enzymes from the early 1990’s8,10 but products are still marketed without warning and clarity as to the differences between niacin types.
The Takeaway
Niacin deficiency is not common in western diets. However, there may be clinical benefit from supplementation use of nicotinic acid if you have confirmed with your doctor that your lipid profile confirms improvement is required before heading down a path of atherosclerosis. Many forms of niacin have been released on the market to increase tolerance but nicotinic acid, despite the flush experience, appears to be the best used for cholesterol issues9. While it is known as “Vitamin B3” and can be found over the counter, it is also found as a prescription and with any form any side effects should be reported to your doctor right away. Large doses of niacin can interact with different medications. Periodic tests on liver enzymes should also likely be taken to ensure no adverse effects are occurring while your cholesterol should show a favorable improvement to confirm it’s worth supplementing it. This is where your doctor comes in to monitor with blood work, and advise.
Bonus Information
Niacin can be found in some products like pre-workouts but not for its ability to convert food into an energy source like other B vitamins, instead, because of the niacin flush that elicits a rush. People think they need to feel something when taking a pre-workout. If niacin is used in a high dosage in a pre workout you know that they are going out of their way to trick the consumer into thinking something is strong and working.
- Altschul R, Hoffer A, Stephen JD. Influence of nicotinic acid on serum cholesterol in man. Arch Biochem Biophys. 1955;54(2):558-9.
- https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/niacin/art-20046208
- Effects of Extended-Release Niacin with Laropiprant in High-Risk Patients, 2014. . New England Journal of Medicine 371, 203–212. doi:10.1056/nejmoa1300955
- Norris RB. “Flush-free niacin”: dietary supplement may be “benefit-free”. Prev Cardiol. 2006;9(1):64-5.
- McKenney J. New Perspectives on the Use of Niacin in the Treatment of Lipid Disorders. Arch Intern Med.2004;164(7):697–705. doi:10.1001/archinte.164.7.697
- Kamanna VS, Kashyap ML. Mechanism of action of niacin. Am J Cardiol. 2008;101(8A):20B-26B.
- Landray MJ, Haynes R, Hopewell JC, et al. Effects of extended-release niacin with laropiprant in high-risk patients. N Engl J Med. 2014;371(3):203-12.
- Gray DR, Morgan T, Chretien SD, Kashyap ML. Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med. 1994;121(4):252-8.
- Julius U, Fischer S. Nicotinic acid as a lipid-modifying drug–a review. Atheroscler Suppl. 2013;14(1):7-13.
- Mullin GE, Greenson JK, Mitchell MC. Fulminant hepatic failure after ingestion of sustained-release nicotinic acid. Ann Intern Med. 1989;111(3):253-5.
