Niacin: Can It Help Your Cardio Health?

By: Byron J. Richards, Board Certified Clinical Nutritionist
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More than 50 years of research1 indicates that niacin can help lower your triglycerides, raise your HDL cholesterol (good cholesterol), improve your circulation, and lower your LDL cholesterol and Lipoprotein A. These effects are likely to positively support weight management.  It has long been known that niacin helps widen your blood vessels which helps relax your arteries, thereby improving your circulation. This finding, along with its ability to promote healthier levels of blood fats and cholesterol has sparked considerable interest in its potential for cardiovascular health. One long term study showed that niacin reduced mortality by 11%.2 

Niacin intake also produces undesirable side effects that stop many people from using it. These include an irritating flushing effect, upset stomach, excessive skin itching, potential liver toxicity (in very high doses), and possibly raising blood sugar (in very high doses). None of these undesirable effects of niacin have been reported with a safe and effective non-flushing form of niacin called inositol hexanicotinate3 (IHN). This enables you to get the benefits of niacin without the risks. 

How Niacin Works

Your cellular engines (mitochondria) convert food to energy (ATP) through a complex process, similar to a production line in a factory. When something on the production line is not functioning up to par, it affects everything else down the line. Niacin is the backbone of two key enzymes (workers on the production line) known as NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate) who perform an important role in how your cells make energy. They are also team players, helping as many as 200 energy-related enzymes do their work. The ability of your body to break down fats, carbohydrates, and proteins to make energy, is dependent on having adequate niacin. 

These niacin-containing enzymes play many other roles in your body, including assisting your DNA to repair itself when damaged.  Niacin is especially active in your circulatory system. The inositol hexanicotinate form of niacin has been shown to help serious circulation problems like Raynaud’s disease4 (fingers turning blue upon cold exposure) and Intermittent Claudication5 (poor circulation to calf muscles when walking). 

The classic severe niacin deficiency disease is called Pellagra. The symptoms included a scaly and darkly pigmented rash, vomiting, diarrhea, and dementia and often result in death.  The common theme of all these symptoms is that blood does not flow to the affected body organ. Pellagra is not common in the U.S. and has historically appeared during times of famine. 

More subtle deficiencies of niacin, which involve energetic problems and circulation issues show up as:
• Fatigue and weakness (as niacin is needed by energy-producing enzymes).
• Skin problems (may be a factor in acne, rashes, dermatitis or psoriasis as a result of reduced blood flow to the skin).
• Poor appetite, bright red tongue, and/or diarrhea (poor blood flow to digestive tract).
• Mood stability issues, irritability, memory problems, and/or headaches (poor blood flow to the head).

Pellagra is prevented with 11 mgs of niacin per day. This is the basis for our government’s recommended amounts of this nutrient (20 mg per day). Since many of the symptoms above are caused by other factors, it is often difficult to assign them to just niacin. However, increasing your intake of niacin may improve any of the issues on the above list by enhancing your circulation or energy production. 

This review discusses the use of much higher amounts of niacin that have been shown to enhance metabolism and support cardiovascular health. Researchers have found that niacin intake far above levels that relate to Pellagra, may have positive metabolic effects on cholesterol, triglycerides, and circulation. 

HDL Cholesterol

HDL cholesterol is called good cholesterol. You need it in adequate amounts to haul LDL back to your liver, like a tow truck. It will also remove LDL cholesterol from your arterial walls and bring it back to your liver for elimination. If your levels of HDL are low then LDL levels elevate in your blood and are more likely to be damaged. This damaged LDL cholesterol is more likely to form plaque and without enough HDL there is no easy way to remove it from your arteries. 

Niacin works to raise your HDL cholesterol6 levels by a very unique method of action, selectively telling your liver not to break down HDL so fast.  It also increases the amount of helpful small particles of cholesterol that comprise HDL, including the very important ApoA1. ApoA1 is needed to energize HDL so it can effectively do its job, which includes anti-inflammatory and antioxidant effects on the walls of your arteries. Niacin is the most effective compound known for boosting HDL cholesterol and ApoA1.

LDL Cholesterol, Triglycerides, and Weight Loss

At the same time niacin raises the good cholesterol, it helps to naturally reduce the formation of LDL cholesterol. Studies show that inositol hexanicotinate7 (IHN) reduces the liver’s synthesis of VLDL cholesterol (very low density lipoprotein), in turn reducing the synthesis of LDL cholesterol. Your LDL contains the highest amount of cholesterol, your HDL contains the highest amount of protein, while your VLDL contains the highest amount of triglycerides.  Because your VLDL is built of LDL particles, like Lipoprotein A (an LDL with a protein attached), the net result of lowering VLDL synthesis is to reduce both LDL and Lipoprotein A. This is a good thing because too much Lipoprotein A interferes with how your body dissolves clots in your circulation. If your Lipoprotein A levels are too high, you’re more likely to have an increased risk for stroke.  Niacin’s effect on cholesterol is highly cardiovascular protective8.

Niacin not only reduces the triglyceride-rich VLDL9 it also reduces the free floating triglycerides in your circulation. It should be pointed out that VLDL is a main way that triglycerides are transported to your stored fat and dropped off. This means that high levels of VLDL are an indicator that weight gain is taking place. It is now recognized that higher levels of triglycerides in your blood are a risk for worsening cardiovascular health. These triglyceride “fat blobs” form traffic jams that push up your blood pressure and reduce the correct entry of leptin into your brain, in turn producing leptin resistance and setting the stage for insulin resistance. Niacin’s nifty way of reducing triglyceride levels has the net result of being helpful in terms of reducing leptin problems and supporting weight management. 

LDL cholesterol—while often called bad because it can end up in the walls of your arteries if it is damaged—is actually vital for transporting fat-soluble nutrition around your body (including your fat-soluble antioxidants). A major component of LDL and VLDL is a cholesterol particle called ApoB.10  The higher the amount of ApoB in the LDL or VLDL the smaller and denser is the size of the LDL or VLDL, the easier it is damaged, and the more likely it is to form plaque. Niacin helps change the make-up of LDL and VLDL so that there is less ApoB on board. It replaces it with a higher level of triglyceride-containing cholesterol particles, which in turn are lighter and more buoyant. These more buoyant LDL and VLDL particles are much less likely to be damaged or to form plaque. Of course, having fat soluble antioxidants on your LDL (like tocotrienols, carotenes, vitamin K, and Q10) offer further synergistic protection for your LDL or VLDL, helping to reduce the damage that may lead to plaque formation.

A study with Type 2 diabetic patients11 has now shown that niacin reduces the number of immune cells that are sticking to the walls of arteries (monocyte adhesion). This is a necessary step in the process of damaged LDL cholesterol becoming plaque. Furthermore, the same study showed that niacin boosted adiponectin levels in this insulin resistant patient population. Adiponectin is required for proper insulin function and not only helps reverse Type 2 diabetes but is also a major circulatory antioxidant. Thus, niacin at this dose (1500 mg a day) has multiple benefits in addition to lipid modulation.

There are many ways to help lower triglycerides, beginning with the Five Rules of the Leptin Diet. Exercise also helps clear triglycerides by using them for fuel in your muscles.  Likewise, there are a variety of healthy metabolic strategies to help lower cholesterol in a safe and effective way, with diet and exercise as your foundation. IHN’s novel method of reducing LDL synthesis will work synergistically with other nutrient strategies to help improve cholesterol fitness and cardiovascular health. For example, DHA fish oil is known to help lower triglycerides while promoting arterial flexibility and health, citrus extracts (like tangeretin and nobiletin) are known to help reduce levels of ApoB and triglycerides, lower LDL and boost HDL, tocotrienols lower LDL as well as protect it and the lining of your arteries, and pantethine helps lower triglycerides and LDL by transporting them better in metabolism. There are many synergistic angles to this equation, and IHN is one more tool in the metabolic toolbox that favors healthy metabolism of calories and better cardiovascular health.

What Kind of Niacin and How Much to Take

I prefer the no-flush niacin called inositol hexanicotinate (IHN). This is a slow release form of niacin comprised of six molecules of niacin bound to one molecule of inositol. As it is metabolized niacin levels gradually rise, peaking about 10 hours after ingestion.  In Europe this form of niacin is sold as a prescription (Hexopal) and has been extensively tested for safety up to doses of 4,000 mgs per day. There are no reports of liver problems from this form of niacin and it does not cause a flush. 

The niacin flush and upset stomach that are so common in other forms of niacin cause many people not to take niacin who may benefit. The niacin flush triggers mast cells to release chemicals, and constantly doing this is not likely to be beneficial. Our new understanding of mast cells, linking nerves, immunity, and behavior, indicates that constantly triggering them is likely to have multiple undesirable side effects that have not currently been assigned to niacin.

In addition to the IHN form of niacin there is also a fast release type and an extended release type sold as a prescription (Niaspan) and often used in combination with statin drugs.  Both of these types induce the niacin flush that is undesirable. High doses of these forms of niacin (above 4000 mg) have been associated with liver problems and in some cases slightly elevating blood sugar. These more significant problems are seldom seen with these forms of niacin in doses from 2,000 – 3,000 mg a day.

It is prudent for anyone taking any form of niacin to take it along with a liver protecting herb such as Milk Thistle (silymarin) simply to be on the safe side. If a person has elevated liver enzymes or another liver problem then higher niacin intake is not a good choice.

In general, a dose from 1200 mg – 1800 mg a day is likely to help circulation, boost HDL, and improve the condition of LDL (make it more buoyant). Higher doses, up to 4000 mg a day, can be used to help lower LDL.  Niacin can be divided into two or more doses a day. Take one dose in the morning and another at bed to help fat metabolism while sleeping. 

This article was originally published on Novemeber 12, 2008.  It was updated on February 7, 2011.

Referenced Studies:
  1. ^ Niacin Helps Multiple Aspects of Cardiovascular Health  Arch Intern Med.  McKenney J.
  2. ^ Niacin Reduces Mortality  J Am Coll Cardiol.  Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, Friedewald W.
  3. ^ Safety and Effectiveness of Inositol Hexaniacinate  Alternative Medicine Review  Kathleen A. Head,
  4. ^ Inositol Hexanicotinate Helps Raynaud’s Disease  Clin Rheumatol.   Sunderland GT, Belch JJ, Sturrock RD, Forbes CD, McKay AJ.
  5. ^ Inositol Hexaniacinate Helps Intermittent Claudication  Alternative Medicine Review  Kathleen A. Head,
  6. ^ How Niacin Raises HDL Cholesterol  Journal of Lipid Research  Lin-Hua Zhang, Vaijinath S. Kamanna, Michael C. Zhang and Moti L. Kashyap.
  7. ^ Inositol Hexanicotinate Lowers Lipids and Body Weight  Nutr-Rep-Int  Abou El Enein, Ahmed M. Hafez, Youssef S. Salem, Hassan. Abdel, M. 
  8. ^ Niacin Supports Cardio Health in Multiple Ways  Expert Opin Pharmacother.  Kostner K, Gupta S.
  9. ^ The Many Helpful Mechanisms of Niacin  Am J Cardiol.  Kamanna VS, Kashyap ML
  10. ^ Niacin Boosts HDL’s ApoA-1 and Decreases LDL’s and VLDL’s ApoB  Arteriosclerosis Thrombosis and Vascular Biology.  Lamon-Fava, S., Diffenderfer, M., Barrett, P.R., Buchsbaum, A., Nyaku, M., Horvath, K.V., Asztalos, B., Otokozawa, S., Ai, M., Matthan, N., Lichtenstein, A.H., Dolnikowski, G., Schaefer, E. 
  11. ^ Niacin Reduces Monocyte Adhesion, Boosts Adiponectin  Tavintharan S, Woon K, Pek LT, Jauhar N, Dong X, Lim SC, Sum CF. Niacin results in reduced monocyte adhesion in patients with type 2 diabetes mellitus. Atherosclerosis.  2010 December Department of Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore

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