When I have patients with high LDL (bad cholesterol) and low HDL (good cholesterol), I often have them take niacin. Recently, niacin has been getting some bad press and I wanted to share my thoughts on this. Niacin has been used for cholesterol management for over 50 years. It has been shown to increase HDL levels by 20-35%, decrease LDL levels by 5-25%, and decrease the number of the small LDL particles that cause higher cardiovascular risk.

In a 1986 study called the Coronary Drug Project, men were followed over the course of 15 years. The study showed a decrease in mortality rate of 11% for those in the niacin group versus those in the control group. In 1991, they did a follow-up study of these men. They then found that niacin was the most effective agent in lowering cholesterol.

Very recently, there were two studies posted in the New England Journal of Medicine that have caused a stir regarding the use of niacin. You may have seen the headlines? The headlines suggest that niacin may cause serious side effects and/or no benefit to cholesterol. While niacin did produce positive effects on cholesterol, the claim is that the addition of niacin showed no improvement in heart attacks, strokes, or death.

I have some issues with these studies. In both studies, all of the patients were also taking a statin drug (the main class of drugs to treat cholesterol, ex. Lipitor, Crestor, etc.), before niacin was added. Both studies did not compare pure niacin to a placebo. In one study, niacin was only added if the statin drug did not produce positive changes in cholesterol levels. On top of all of this, when niacin was added, it was not pure niacin, but was a combination of niacin with another drug that was thought to reduce the main side effect of niacin, flushing.

If you want more information and to find links to the studies, click this great article. My point is this. I think that the accusations regarding niacin are likely premature. I have been using it to treat cholesterol for some time now and have seen dramatic changes in cholesterol levels. I also know other providers who feel the same. While it is always possible that niacin has no benefit and causes many adverse reactions, I do not feel these studies do a very good job of proving it.

I have seen niacin fix issues that are not normally checked with the traditional lipid panel using a complex cardiovascular panel. I design a treatment regimen specifically designed for each person.  This often includes niacin, and until I receive better data regarding the use of pure niacin alone, I will continue to do this.  When we here headlines about recent studies, it is always important to understand what the researchers actually studied.

All this said, I never recommend using niacin without the supervision of a medical provider. It is essential to monitor liver enzymes, blood sugar, and inflammatory markers to ensure niacin’s safety. If you can get past the flushing, I still feel niacin can be an excellent treatment for reducing your cardiovascular risk, in addition to changing your lifestyle.

Does this bring up any questions for you? What are your thoughts on these studies? Have you tried niacin? Is it working for you? I would love to hear your feedback below and please share with anyone who might benefit from this information.