How does niacin help improve cholesterol levels. What are the potential side effects of taking niacin for cholesterol. Who should consider niacin as a cholesterol-lowering treatment option. How should niacin be taken properly for optimal results. What are the alternatives to niacin for managing cholesterol.

Understanding Niacin’s Role in Cholesterol Management

Niacin, also known as vitamin B3 or nicotinic acid, has long been recognized for its potential in managing cholesterol levels. However, recent research has prompted a reevaluation of its role in cardiovascular health management. While it can be effective in improving cholesterol profiles, its use has become less prevalent due to emerging evidence and potential side effects.

Niacin works by influencing lipid metabolism in the body. It can:

• Reduce levels of low-density lipoprotein (LDL) cholesterol, often referred to as “bad” cholesterol
• Increase levels of high-density lipoprotein (HDL) cholesterol, known as “good” cholesterol
• Lower triglyceride levels in the bloodstream

Despite these beneficial effects on lipid profiles, the overall impact of niacin on reducing cardiovascular events has been questioned in recent studies.

The Shifting Landscape of Niacin Usage

Why has niacin’s popularity declined in recent years. The primary reason stems from research indicating that when used in combination with statins, niacin does not significantly reduce the risk of cardiovascular events such as heart attacks and strokes beyond what statins alone can achieve. This finding, coupled with the potential for unpleasant and sometimes dangerous side effects, has led to a decrease in niacin prescriptions.

Niacin vs. Statins: Comparing Cholesterol-Lowering Medications

How do niacin and statins compare in managing cholesterol. Statins are currently considered the gold standard for pharmacological cholesterol management. They work by inhibiting an enzyme involved in cholesterol production in the liver, effectively lowering LDL cholesterol levels. Statins have demonstrated significant efficacy in reducing cardiovascular events and mortality in numerous large-scale clinical trials.

Niacin, on the other hand, offers a different mechanism of action. While it can improve overall lipid profiles, including raising HDL cholesterol (which statins do less effectively), its impact on cardiovascular outcomes has not been as definitively proven. This disparity in evidence has led to statins being preferred as the first-line treatment for most patients requiring cholesterol-lowering medication.

Types of Niacin Medications and Their Applications

What forms of niacin are available for cholesterol management. Niacin medications come in several formulations:

1. Immediate-release niacin: Rapidly absorbed and metabolized by the body
2. Extended-release niacin: Designed to be released more slowly, potentially reducing side effects
3. Sustained-release niacin: Offers a steady release of the medication over time

These medications may be prescribed under various brand names or in generic forms. In some cases, niacin is combined with other cholesterol-lowering agents in a single pill to enhance overall efficacy.

Prescription Niacin vs. Over-the-Counter Supplements

Can over-the-counter niacin supplements be used for cholesterol management. It’s crucial to distinguish between prescription niacin and over-the-counter (OTC) niacin supplements. Healthcare providers strongly advise against using OTC niacin for cholesterol control due to potential serious side effects and lack of standardized dosing. Prescription niacin is formulated specifically for cholesterol management and is administered under medical supervision to ensure safety and efficacy.

Proper Administration of Niacin for Cholesterol Control

How should niacin be taken to maximize its benefits and minimize side effects. Proper administration of niacin is crucial for achieving optimal results while minimizing adverse effects. Here are key guidelines:

• Follow the prescribed dosage and schedule meticulously
• Take niacin with meals or a light, low-fat snack to reduce flushing
• Avoid alcohol and hot beverages when taking niacin, as they can exacerbate flushing
• Do not break or chew extended-release tablets
• Consider taking an aspirin 30 minutes before niacin to reduce flushing (only if approved by your healthcare provider)

It’s important to note that niacin dosages are typically started low and gradually increased to the target dose under medical supervision. This approach helps the body adjust and minimizes side effects.

Lifestyle Modifications to Complement Niacin Therapy

What lifestyle changes can enhance the effectiveness of niacin in managing cholesterol? While niacin can be effective in improving lipid profiles, it’s most beneficial when combined with healthy lifestyle practices. These include:

• Adopting a heart-healthy diet low in saturated fats and rich in fruits, vegetables, and whole grains
• Engaging in regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise per week
• Maintaining a healthy weight or losing excess weight if overweight or obese
• Quitting smoking and limiting alcohol consumption
• Managing stress through relaxation techniques or mindfulness practices

These lifestyle modifications not only complement the effects of niacin but also contribute to overall cardiovascular health and well-being.

Identifying Candidates for Niacin Therapy

Who might benefit from niacin as part of their cholesterol management plan? While statins remain the primary choice for most patients, certain individuals may be considered for niacin therapy:

• Those with very high triglyceride levels that don’t respond adequately to other treatments
• Patients with low HDL cholesterol levels who need additional support beyond statin therapy
• Individuals who cannot tolerate statins or other primary cholesterol-lowering medications
• Those with genetic lipid disorders that require a multi-faceted treatment approach

The decision to use niacin should always be made in consultation with a healthcare provider, taking into account the individual’s overall health status, risk factors, and potential for side effects.

Contraindications and Precautions

Are there individuals who should avoid niacin therapy? Certain conditions and circumstances may preclude the use of niacin or require extra caution:

• Severe liver disease or unexplained elevated liver enzymes
• Active peptic ulcer disease
• Severe gout
• Pregnancy or breastfeeding
• Uncontrolled diabetes
• Recent history of heart attack or unstable angina

Additionally, niacin may interact with certain medications, necessitating careful review of a patient’s complete medication profile before initiating therapy.

Monitoring and Managing Niacin Side Effects

What side effects should patients and healthcare providers watch for during niacin therapy? While niacin can be effective in managing cholesterol, it’s associated with several potential side effects that require careful monitoring:

Common Side Effects

• Flushing and redness of the skin, particularly on the face and neck
• Itching or tingling sensations
• Gastrointestinal discomfort, including nausea and diarrhea
• Headache
• Dizziness or lightheadedness

Serious Side Effects

While less common, more severe side effects can occur and require immediate medical attention:

• Liver damage or abnormal liver function tests
• Severe muscle pain or weakness (myopathy)
• Irregular heartbeat or changes in blood pressure
• Severe skin reactions or allergic responses
• Unexplained vision changes
• Signs of gout or worsening gout symptoms
• Significant changes in blood sugar levels, particularly in diabetic patients

Regular follow-up appointments and blood tests are essential to monitor for these potential side effects and adjust treatment as necessary.

Alternative Approaches to Cholesterol Management

What options are available for individuals who cannot use niacin or prefer alternative treatments? While niacin and statins are common pharmacological approaches to managing cholesterol, several alternatives exist:

Other Medications

• Bile acid sequestrants: These medications bind to bile acids in the intestines, indirectly lowering cholesterol levels
• PCSK9 inhibitors: Injectable medications that dramatically lower LDL cholesterol by enhancing the liver’s ability to remove it from the bloodstream
• Ezetimibe: A medication that reduces cholesterol absorption in the intestines
• Fibrates: Primarily used to lower triglycerides and modestly increase HDL cholesterol

Natural Supplements

Some individuals may explore natural supplements for cholesterol management, although their efficacy and safety profiles are often less established than prescription medications:

• Plant sterols and stanols
• Omega-3 fatty acids
• Red yeast rice (Note: Some formulations may contain lovastatin-like compounds and should be used with caution)
• Soluble fiber supplements

It’s crucial to consult with a healthcare provider before starting any supplement regimen, as these products can interact with medications and may not be suitable for everyone.

The Future of Cholesterol Management: Beyond Niacin

How is the field of cholesterol management evolving? As research continues to advance our understanding of lipid metabolism and cardiovascular health, new approaches to cholesterol management are emerging:

Emerging Therapies

• RNA interference therapies: These innovative treatments target specific genes involved in cholesterol production
• CETP inhibitors: Medications designed to raise HDL cholesterol levels more effectively than current options
• Bempedoic acid: A newer oral medication that works similarly to statins but with a potentially reduced risk of muscle-related side effects

Personalized Medicine Approaches

The future of cholesterol management is likely to involve more personalized approaches, taking into account an individual’s genetic profile, lifestyle factors, and overall health status. This may include:

• Genetic testing to identify individuals most likely to benefit from specific treatments
• Advanced lipid testing to provide a more comprehensive picture of cardiovascular risk
• Integration of artificial intelligence and machine learning to optimize treatment strategies

As these advancements continue to develop, the role of niacin in cholesterol management may further evolve, potentially leading to more targeted and effective use of this medication in specific patient populations.

Integrating Niacin into a Comprehensive Cardiovascular Health Plan

How can niacin be incorporated into a broader strategy for cardiovascular health? While the use of niacin for cholesterol management has become more selective, it remains a tool in the broader arsenal of cardiovascular health management. When prescribed appropriately, niacin can be part of a comprehensive approach that includes:

• Regular cardiovascular risk assessments
• Tailored medication regimens based on individual lipid profiles and risk factors
• Ongoing lifestyle modifications to support heart health
• Regular monitoring and adjustment of treatment plans
• Patient education on the importance of medication adherence and lifestyle changes

By integrating niacin into a holistic cardiovascular health strategy, healthcare providers can maximize its benefits while minimizing potential risks, ultimately contributing to improved patient outcomes and quality of life.

The Importance of Individualized Treatment Plans

Why is a personalized approach crucial in cholesterol management? Each patient’s cardiovascular risk profile is unique, influenced by factors such as genetics, lifestyle, existing health conditions, and personal preferences. An individualized treatment plan that may or may not include niacin should consider:

• The patient’s specific lipid profile and cardiovascular risk factors
• Potential drug interactions with other medications
• The patient’s ability to tolerate different treatment options
• Long-term health goals and quality of life considerations
• The patient’s willingness and ability to adhere to medication regimens and lifestyle changes

By tailoring treatment plans to each individual, healthcare providers can optimize the balance between efficacy and tolerability, potentially improving both outcomes and patient satisfaction.

Niacin for cholesterol Information | Mount Sinai

Antilipemic agent; Vitamin B3; Nicotinic acid; Niaspan; Niacor; Hyperlipidemia – niacin; Hardening of the arteries – niacin; Cholesterol – niacin; Hypercholesterolemia – niacin; Dyslipidemia – niacin

How Niacin Helps

Improving your cholesterol levels can help protect you from:

• Heart disease
• Heart attack
• Stroke

Your health care provider will work with you to lower your cholesterol by improving your diet. If this is not successful, medicines to lower cholesterol may be the next step. Statins are thought to be the best drugs to use for people who need medicines to lower their cholesterol.

Research now suggests that niacin does not add to the benefit of a statin alone for reducing the risk of cardiovascular events, including heart attacks and stroke.

In addition, niacin can cause unpleasant and potentially dangerous side effects. Therefore, its use has been declining. However, some people may be prescribed niacin in addition to other drugs if they have very high cholesterol or if they do not tolerate other medicines.

Which Niacin Medicine is Right for you?

There are different brands of niacin medicines. Most of these also come in a less expensive, generic form.

Niacin may be prescribed along with other medicines, such as a statin, to help lower cholesterol. Combination tablets that include nicotinic acid plus other medicines are also available.

Niacin is also sold over-the-counter (OTC) as a supplement. You should not take OTC niacin to help lower cholesterol. Doing so could have serious side effects.

How to Take Niacin

Take your medicine as directed. The medicine comes in tablet form. Do not break or chew tablets before taking the medicine. Do not stop taking your medicine without talking with your provider first.

You take niacin 1 to 3 times per day. It comes in different doses, depending on how much you need.

Read the label on the pill bottle carefully. Some brands should be taken at bedtime with a light, low-fat snack; others you will take with dinner. Avoid alcohol and hot drinks while taking niacin to reduce flushing.

Store all of your medicines in a cool, dry place. Keep them where children cannot get to them.

You should follow a healthy diet while taking niacin. This includes eating less fat in your diet. Other ways you can help your heart include:

• Getting regular exercise
• Managing stress
• Quitting smoking

Know Your Risks

Before you start taking niacin, tell your provider if you:

• Are pregnant, plan to become pregnant, or are breastfeeding
• Have allergies
• Are taking other medicines
• Drink a lot of alcohol
• Have diabetes, kidney disease, peptic ulcer, or gout

Talk to your provider about all of your medicines, herbs, or supplements. Certain medicines may interact with niacin.

Regular blood tests will help you and your provider:

• See how well the medicine is working
• Monitor for side effects, such as liver problems

Possible Side Effects

Mild side effects may include:

• Flushing and red face or neck
• Diarrhea
• Headache
• Upset stomach
• Skin rash

Though rare, more serious side effects are possible. Your provider will monitor you for signs. Talk with your provider about these possible risks:

• Liver damage and changes to liver enzymes
• Severe muscle pain, tenderness, and weakness
• Heartbeat and rhythm changes
• Changes in blood pressure
• Severe flushing, skin rash, and skin changes
• Glucose intolerance
• Gout
• Vision loss or changes

When to Call the Doctor

You should call your provider if you notice:

• Side effects that are bothering you
• Fainting
• Dizziness
• Fast or irregular heartbeat
• Yellow skin or eyes (jaundice)
• Muscle pain and weakness
• Other new symptoms

American Heart Association website. Cholesterol medications. www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications. Updated November 11, 2020. Accessed May 3, 2022.

Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In:  Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3234-3237. PMID: 30423391 pubmed.ncbi.nlm.nih.gov/30423391/.

Guyton JR, McGovern ME, Carlson LA. Niacin (nicotinic acid). In: Ballantyne CM, ed. Clinical Lipidology: A Companion to Braunwald’s Heart Disease. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 24.

Lavigne PM, Karas RH. The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol. 2013;61(4):440-446. PMID: 23265337 pubmed.ncbi.nlm.nih.gov/23265337/.

Mani P, Rohatgi A. Niacin therapy, HDL cholesterol, and cardiovascular disease: is the HDL hypothesis defunct? Curr Atheroscler Rep. 2015,17(8):43. PMID: 26048725 pubmed.ncbi.nlm.nih.gov/26048725/.

Semenkovich CF, Goldberg IJ. Disorders of lipid metabolism. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 41.

Last reviewed on: 2/23/2022

Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

Cholesterol Control: Statins vs. Niacin

Overview

Cholesterol often gets a bad rap. While there is such a thing as “bad” cholesterol, “good” cholesterol is actually important for heart health. The key, as with all aspects of health, is balance.

Another name for “bad” cholesterol is low-density lipoprotein (LDL). “Good” cholesterol is formally known as high-density lipoprotein (HDL).

When your LDL cholesterol level is high, you might need medical treatment in the form of statins. However, due to the possible side effects, you may also be wondering about alternative treatments, such as niacin (vitamin B-3).

There are a variety of causes that can lead to high cholesterol. Some of these are out of our control and determined by genetics, and some are lifestyle choices that we can change.

Different factors that can cause or increase your risk of high cholesterol include:

• having a family history of high cholesterol
• smoking
• eating an unhealthy diet high in unsaturated fats and cholesterol
• lack of exercise
• having other illnesses, such as diabetes
• taking certain medications, including steroids and progestin
• being obese
• age (as you get older, your cholesterol level tends to rise)
• gender (LDL cholesterol rises more easily in women, though they tend to have lower “bad” cholesterol until around the age of 55)

Too much LDL cholesterol can increase your risk for heart disease. At the same time, too little HDL cholesterol can lead to the same effect. This is because HDL is responsible for removing the bad cholesterol from the blood and taking it back to the liver to be disposed, preventing the buildup of plaque in the arteries.

According to the National Institutes of Health, your ideal cholesterol levels are:

• Total cholesterol: less than 200 mg/dL
• LDL cholesterol:less than 100 mg/dL
• HDL cholesterol: 60 mg/dL or higher

Contrary to popular belief, high cholesterol isn’t caused by poor dietary choices alone. In fact, cholesterol is made in the liver. From there, it is circulated throughout the rest of the body. Thus, it can be problematic if your liver produces too much cholesterol.

In such cases, a healthy diet and regular exercise won’t be enough to control your levels. You may need statins, otherwise known as HMG-CoA reductase inhibitors, to balance the problem. Statins block the enzyme that the liver uses to make cholesterol. Statins are primarily used to help lower LDL cholesterol. They don’t increase heart-healthy HDL.

Another benefit of statins is their ability to eliminate arterial cholesterol buildup. This may reduce the risk of a heart attack, which is why statins are often prescribed to those with a high risk of heart disease.

Examples of statins include:

• atorvastatin (Lipitor)
• simvastatin (Zocor)
• fluvastatin (Lescol, Lescol XL)
• lovastatin (Mevacor, Altoprev)

Certain groups of patients are more likely to be prescribed statins than others. Women are less likely to be prescribed statins than men. The four groups most likely to be prescribed statins are:

• people who already have heart disease
• people 40 to 75 years old with type 2 diabetes
• people 40 to 75 years old who have a high risk of 10-year heart disease
• people with an exceptionally high level of LDL cholesterol

Utilizing statins are often considered to be a lifetime commitment. In many cases, you’ll have to make intense and substantial lifestyle changes in order to no longer need the medication to lower your cholesterol. Cholesterol levels will increase if you stop taking the medication, keeping you on it indefinitely in many cases.

Normally, niacin is derived from foods like chicken and tuna. It helps your body use energy from food as well as promotes healthy eyes, hair, and skin. It also supports good digestion and your nervous system.

Niacin is most commonly used in people who have high cholesterol but can’t take statins. Niacin should not be used by people with liver disease, stomach ulcers, or active bleeding. It is sometimes used in people who have already had a heart attack. Doctors are currently debating whether niacin should be used in patients who have a high risk of heart disease.

Niacin can also be used to boost your HDL cholesterol levels and decrease your levels of triglycerides, a type of fat that increases your risk of heart disease. The Mayo Clinic estimates that taking niacin supplements may increase HDL levels by 30 percent or more. However, the amount of niacin needed to have this effect is much higher than the amount normally found in the diet. At these high levels, there can be some undesirable side effects, so be sure to talk to your doctor before beginning to take high doses of niacin.

Niacin is widely available in vitamin stores, as well as in the supplement section of drugstores. Some doctors recommend prescription forms for those who may benefit from high doses.

It is common for doctors to prescribe more than one cholesterol medication. For instance, statins are sometimes taken with bile acid binding resins to help lower triglyceride levels.

To date, niacin is the only supplement that shows real promise in helping cholesterol, but it can’t decrease LDL cholesterol like statins can. Niacin is the preferable choice only if conventional medications aren’t well-tolerated.

The jury is out when it comes to combining statins with niacin. Not only can it be dangerous, but the Mayo Clinic reports that there is little evidence that combining niacin with statin medications offers any real benefits. In April 2016, the Food and Drug Administration (FDA) rescinded its prior approval of Advicor and Simcor, two drugs that combine niacin with statins.

While statins may be beneficial in cholesterol control, there are a few possible side effects. These include:

• abdominal discomfort
• constipation or diarrhea
• dizziness
• drowsiness
• headaches
• insomnia
• nausea or vomiting
• skin flushing
• muscle weakness
• memory loss

Such side effects are usually temporary when you first start the medication. Those at greatest risk for experiencing side effects from statins include people who are already taking other medications, people 65 years and older, people with small frames, and women. Having kidney or liver disease and drinking too much alcohol also increase your risk.

Niacin carries the risk of overdose, which can cause the following complications:

• high blood sugar
• infection
• internal bleeding
• liver damage
• stroke
• upset stomach

Another safety issue with niacin is that some supplements may be tainted with unknown ingredients. This can increase the risk for drug interaction, especially if you’re taking other medications for cholesterol.

Lifestyle changes are certainly the preferred method for cholesterol control. The problem is that sometimes high cholesterol can’t be lowered through healthy habits alone.

Choosing between statins and niacin depends greatly on where your own levels stand, as well as the methods you have tried thus far. You should see changes within two to four weeks of taking statins or niacin.

For those who aren’t interested in taking statins or niacin or are unable to, there are a few alternative medications available. These include:

• PCSK9 inhibitors. This medication works by inhibiting a protein called PCSK9, which regulates how the liver clears out cholesterol. By binding to the protein, you lower cholesterol. This medication was effective in lowering cholesterol in several studies. Common side effects involved swelling or rash on the injection site, muscle pain, and in a small number of patients, eye problems. Around 1 percent of participants experienced memory impairment or confusion.

Learn more about PCKS9 inhibitors »

• Red yeast rice. Considered a natural medication, red yeast rice is a traditional Chinese medicine used to lower cholesterol. It contains several ingredients thought to help lower cholesterol, such as monacolin K. Monacolin K is a compound that is similar to lovastatin. Though natural, studies about red yeast rice’s long-term safety have not been conducted, and the results are unclear. It’s not currently approved by the FDA.

It’s not safe to stop taking statins for the sake of trying a more “natural” treatment. Make sure you do your research and discuss all methods of treatment with your doctor, both conventional and natural.

A:

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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Is it possible to replace statins with dietary supplements

Atherosclerosis and dyslipidemia

September 17, 2020
ifoucare edition

Often people who are prescribed statins worry about side effects and intolerance, so they want to take dietary supplements instead. But experts believe that natural remedies can only supplement therapy, and not completely replace cholesterol-lowering drugs.

The problem with statins

Almost half of the adults who need to lower their cholesterol do not take any special medications ¹ . This is due to many factors, such as cost, distrust of drugs, and most often fear of possible side effects ^{2, 3} .

Dietary supplements are applied in a complex

BAA are food additives. They contain vitamins, minerals, antioxidants, or other compounds, but are not drugs. Certain foods are known to help lower cholesterol levels. The researchers tested different supplements: red rice, omega-3 fatty acids, spirulina, soy proteins, green tea, lupine, garlic fibers, bergamot and berberine ⁴ , but there is no conclusive evidence of their unequivocal benefit and effectiveness yet.

Natural remedies may be given to patients who cannot tolerate statins, for example due to muscle pain, the most common side effect. Other lipid-lowering drugs, such as ezetimibe and PCSK9 inhibitors, are also an alternative for many. Because treatment options are limited, supplements can help lower cholesterol levels.

It is important to know!

Scientists emphasize that natural remedies cannot completely replace drug therapy with drugs from the statin group – a proven and reliable way to reduce cholesterol levels and the risk of heart disease. Patients should also not substitute any other cholesterol-lowering medications with natural remedies without consulting their doctor. Supplements and dietary changes may only be in addition to the prescribed treatment regimen.

Supplement with garlic extract

Garlic has been used as a traditional medicine for many years. Today, many people use garlic extract supplements as a natural remedy to lower blood pressure and cholesterol levels. Garlic also contains the amino acid cysteine, which produces allicin, a substance that lowers total cholesterol. However, clinical studies have shown conflicting results ⁵ .

Garlic has been shown to regulate triglycerides and total cholesterol, but has no effect on low-density lipoprotein (LDL) and high-density lipoprotein (HDL) ⁶ . This effect was observed only if a person consumed garlic for at least two months. This suggests that the benefit of garlic in lowering cholesterol is short-lived, and after six months, the effect of consumption disappears.

Niacin (Vitamin B3)

It is one of the most effective agents for raising “good” cholesterol levels: it can increase high-density lipoprotein levels by almost 20% ⁷ . Niacin also reduces low-density lipoprotein, or bad cholesterol, by 18% and triglycerides by 36% ⁷ . The effect is dose dependent, usually 1 to 4 grams per day is required ⁷ .

But niacin can cause side effects such as hot flashes, hyperglycemia, increased uric acid levels ⁷ . A hepatotoxic effect is also possible ⁷ . Hot flashes caused by niacin are difficult to tolerate by patients and are a major barrier to the use of this drug ⁷ .

Omega-3 fatty acids and fish oil

Omega-3 fatty acids include alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). The most studied forms of omega-3 fatty acids are eicosapentaenoic acid and docosahexaenoic acid. They can lower serum triglycerides by up to 50%, but docosahexaenoic acid can raise both “good” and “bad” cholesterol levels ⁸ .

Omega-3s are generally well tolerated. The most common side effects are indigestion, diarrhea and heartburn ⁸ . Many patients complain of a fishy taste in the mouth, especially when taking high doses of supplements. Another effect that omega-3 causes is a decrease in blood clotting. Therefore, patients taking anticoagulants or antiplatelet agents should use omega-3 fatty acids with caution.

red rice

It is obtained by cultivating the yeast Monascus purpureus (red yeast) on white rice. This fermented product contains a group of monacolins, substances that inhibit cholesterol synthesis. Clinical trials have shown a significant reduction in total cholesterol, low density lipoprotein and triglycerides, an increase in high density lipoprotein ⁹ . But the level of the active substance in different samples of rice is not stable enough to speak of an unequivocal positive effect.

Do not self-medicate! Before you start taking any dietary supplement, be sure to consult your doctor!

References

1. Mercado C, DeSimone AK, Odom E, et al. Prevalence of cholesterol treatment eligibility and medication use among adults—United States, 2005-2012. MMWR Morb Mortal Wkly Rep. 2015;64(47):1305-1311. /Mercado C. et al. Prevalence of high cholesterol treatment adherence and medication use among adults—United States, 2005-2012

2. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update. circulation. December 17, 2014. http://circ.ahajournals.org/content/early/2014/12/18/CIR.0000000000000152. Accessed January 8, 2017./ Mozaffarian D. et al. Cardiovascular disease and stroke statistics – 2015 update.

3. National Heart, Lung, and Blood Institute. High blood cholesterol: what you need to know. June 2005. www.nhlbi.nih.gov/health/resources/heart/heart-cholesterol-hbc-what-html. /National Heart, Lung and Blood Institute. High Blood Cholesterol: What You Need to Know. June 2005

4. Maciej Banach, Angelo Maria Patti, Rosaria Vincenza Giglio, at all. The Role of Nutraceuticals in Statin Intolerant Patients J Am Coll Cardiol. 2018 Jul, 72 (1) 96-118./M. Banach et al. The role of nutraceuticals in patients with statin intolerance.

9 effects of vitamin B3

Vitamin B3 is an essential nutrient. Every part of our body needs this substance to function properly. There is scientific evidence that this vitamin in supplement form can help lower cholesterol levels, relieve arthritis, improve brain function, and has other benefits. By the way, this vitamin is also called niacin, and sometimes the prefix PP is added instead of B3.

However, if you take large doses of this substance in supplement form, serious side effects may occur. Therefore, it is important to understand that more is not better.

It is one of the eight B vitamins. It has two main chemical forms, each of which affects our body differently. Both forms are found in both foods and supplements.

1. Nicotinic acid: This is a form of niacin that is sold as a supplement. It is used to lower cholesterol levels and the risk of developing cardiovascular disease.
2. Niacinamide or nicotinamide: This chemical form of the vitamin does not lower cholesterol levels. However, it may help treat psoriasis and reduce the risk of non-melanoma skin cancer.

This vitamin is water soluble, which means it is not stored in significant amounts by the body. It also means that our body is able to excrete excess amounts of this vitamin in the urine. Interestingly, a small amount of this nutrient is synthesized from the amino acid tryptophan.

Like all B vitamins, vitamin B3 helps convert food into energy by helping enzymes do their job. This nutrient is the main component of NAD and NADP. These two coenzymes are involved in cellular metabolism.

It also plays a role in cell-to-cell signaling and DNA synthesis. In addition to everything, this vitamin is involved in antioxidant reactions that protect us from the development of diseases and premature aging.

The RDA for this nutrient is 16 mg for adult men and 14 mg for women. During pregnancy and lactation, the norm increases to 18 mg and 17 mg, respectively.

If a person does not get enough of this substance, they may experience the following symptoms: 4

Severe niacin deficiency, or pellagra, is most common in people who do not eat a varied diet. However, in most developed countries, severe deficits are very rare.

Note that deficiency of vitamins and minerals develops with a monotonous diet, as well as with malnutrition. In order to get the concept of a balanced diet, we recommend that you seek the advice of a nutritionist. The specialist will explain the basics of dietology, after which you will be able, both with his help and independently, to create a healthy diet for yourself.

9 effects of vitamin B3 on health0145

This vitamin has been used since the 1950s to lower high cholesterol. In fact, it reduces the level of “bad” cholesterol (low-density lipoprotein, or LDL) by 5-20%. But this vitamin is not the primary treatment for high cholesterol due to its possible side effects. It is mainly used to lower cholesterol levels in people who cannot tolerate statins.

Effect #2 – increase « good cholesterol 0145

In addition to lowering “bad” cholesterol, niacin also increases “good” cholesterol. Studies show that it increases HDL levels by 15-35%.

Effect #3 – Triglyceride Reduction

This vitamin can also reduce triglyceride levels by 20-50%. This is achieved by reducing the activity of an enzyme that is involved in the synthesis of triglycerides. At the same time, the production of both LDL and very low density lipoproteins (VLDL) is reduced. To achieve these effects, therapeutic doses of this vitamin in supplement form are needed.

Effect #4 – reduced risk of developing heart disease

The effect of vitamin PP on cholesterol helps prevent the development of heart disease. In addition, new evidence is emerging about an additional mechanism by which this vitamin benefits the heart. It can reduce oxidative stress and inflammation in the body. Both of these factors are actively involved in the development of atherosclerosis, or hardening of the arteries.

Some studies show that taking this vitamin alone (at therapeutic doses) or in combination with statins can reduce risk in people who already have heart problems. However, the results are still mixed. In a recent scientific review, scientists concluded that niacin does not significantly reduce the risk of heart attack, stroke, or death from heart disease.

Effect #5 – Protecting cells that produce insulin

Type 1 diabetes is an autoimmune disease in which the body attacks and destroys cells that produce insulin. There is research to suggest that this vitamin may protect these cells and possibly even reduce the risk of developing type 1 diabetes in at-risk children.

But for people with type 2 diabetes, things are much more complicated. On the one hand, vitamin B3 supplementation reduces high cholesterol, which is often seen in people with type 2 diabetes. On the other hand, it can increase blood sugar levels. For this reason, people with type 2 diabetes need to be very careful never to self-prescribe supplements.

Effect #6 – improves brain function

Our brain needs this nutrient, which is part of the NAD and NADP coenzymes, to provide the brain with energy and its proper functioning. Confusion in the mind and even psychiatric symptoms can be associated with a deficiency of this vitamin.

Niacin is used to treat some types of schizophrenia. It helps repair brain cell damage resulting from a deficiency of this nutrient. Preliminary research suggests that it may also help maintain brain health in people with Alzheimer’s disease. However, the results are mixed.

Skin Health Benefit #7

This vitamin helps protect skin cells from sun damage. Moreover, he does this both in the form of tablets (capsules) and in the form of a lotion. Recent studies have shown that this vitamin can help prevent certain types of skin cancer. One study showed that taking nicotinamide 500 mg twice daily reduced the incidence of non-melanoma skin cancer in people at risk.

Effect #8 – Alleviate Arthritis Symptoms

In one preliminary study, this vitamin helped relieve some of the symptoms of osteoarthritis. The participants of the experiment improved joint mobility and decreased the need for non-steroidal anti-inflammatory drugs (NSAIDs). Another study in rats found that an injection of this vitamin reduced the inflammation associated with arthritis. While the data are promising, more research is needed to confirm all of these effects.

Effect #9 – treats pellagra

Severe vitamin B3 deficiency causes a condition called pellagra. People with this disorder develop problems with the skin, gastrointestinal tract, and nervous system. Taking this vitamin in supplement form is the primary treatment for pellagra.

As already mentioned, severe deficiency of this nutrient is extremely rare. But with alcoholism, anorexia, or Hartnup’s disease, the risk of its severe deficiency increases.

Niacin in foods

This vitamin is found in both animal and plant foods. Interestingly, some energy drinks also contain B vitamins, sometimes in very high doses. But that’s just a fun fact to be aware of. In no case do not get carried away with these drinks!

Main food sources:

• Lean beef, chicken, turkey, liver, eggs,
• Salmon, mackerel
• Lentils, beans, green peas, avocados
• Peanuts, pumpkin seeds
• Brown rice, potatoes
• Milk and cheeses 03 Boiled coffee.

The best food sources of vitamin B3 are meat, poultry, red fish, legumes and seeds.

Are supplements needed?

Undoubtedly, each of us needs this nutrient.