Niacin and hydration

27. February 2008 William Davis (12)
Many people know about niacin's curious effect of the "hot flush," a feeling of warmth that covers the chest and neck, occasionally the entire body.

However, many people are unaware of the fact that hydration can block this effect. In fact, many people who were not advised of this will come to the office describing miserable experiences with niacin--hot flushes that last for hours, intolerable itching, etc.--only to experience little or none of these effects with generous hydration.

The vast majority of the time, two 8-12 oz glasses of water when the hot flush occurs will eliminate the flush within a few minutes.

Sometimes, the hot flush will occur many hours after taking niacin. Nine times out of ten, this delayed effect is also due to poor hydration. For instance, you might be engrossed in your work and forget to keep up with fluid demands. Or, it may be warm and you've lost fluids through sweating. That's when you begin to feel the hot flush creep up on you.

The cure: Lots of water. In this situation, in which you have allowed dehydration to develop, it may require more than two big glasses. Relief from the flush may also take more time, but it still works nearly every time.

On those rare occasions when water by itself is insufficient, then an adult (325 mg), uncoated aspirin or 200 mg ibuprofen can also be used to accelerate relief.

Why go to some much bother? Well, niacin remains the best agent we have for reduction of small LDL, raising HDL (although vitamin D is proving to be a powerful competitor in this arena), and reducing lipoprotein(a). How much do statin drugs contribute to these effects? Very little, if at all.

Several drug manufacturers are also working on "antidotes" to the hot flush effect of niacin that will be packaged within the niacin tablet. Naturally, it will also boost the cost up many times higher.

In the meantime, if or when you experience the niacin hot flush, just think: Put out the "fire" with plenty of water.
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Comments (12) -

  • Michael

    2/27/2008 12:43:00 AM |

    Any particular types of snacks helpful when taking niacin? I sometimes eat a handful of nuts, or an apple,  when taking niacin, hoping it will reduce the possibilty of flush -- just curious if some foods are better than others.

    Also, since niacin can raise histamine, has any studies been done on taking an anti-histamine along with high dose niacin? Or how about some vitamin C (natural histamine reducer) at the same time as niacin?

    And finally, any real differences between Niaspan, Slo-Niacin and Enduracin (besides cost)? The only difference I can find is that Slo-Niacin might tax the liver a bit more, since it takes longer to fully absorb. The others are absorbed within 6-8 hrs, I believe.

  • Anne

    2/27/2008 3:37:00 AM |

    What about the use of Quercetin. There is a recent article showing it may inhibit the niacin flush. At least that was the result in rats. The study was published in the British Journal of Pharmocology Jan 2008
    Anne

  • Anonymous

    2/27/2008 5:48:00 PM |

    Dr Davis, the flush of Niacin has been of little bother to me. However each winter when I go to Florida from my cold north home, the Niacin itchy rash appears on my chest. This year I finaly found that Benadryl extra strength eliminated it after three applications. It has to be the increased sunshine that kicks it in. I hope others may find this helpful...Niacin is a life saver and still vastly under rated. Thanks for your informative blogs. Over&Out

  • Darin T

    2/27/2008 10:29:00 PM |

    I've noticed what seems to be a correlation between flushing and eating spicy foods -- foods that contain peppers containing capsaicin.  Has anyone else noticed this?

    It seems that I can pretty much count on getting a flush response 30-60 minutes after eating spicy food.  

    Dr. Davis, any thoughts?

  • Anonymous

    2/28/2008 12:14:00 AM |

    Nice post - and I swear I don't know how doctors do it, repeating your self over and over.  I forward your blog wittings to family and friends.  And because of that I'm the one they naturally come to when looking for TYP advice.  

    For what ever reason, no matter how many times I repeat myself, people forget two items with niacin:  1)hydrate to limit flush 2) avoid time release niacin as that can dangerously poison your liver - along with telling your doctor you are taking niacin. Grrrrr.........

  • Anonymous

    3/14/2008 2:59:00 PM |

    Sorry, as a long-time niacin user I have to say the advice to increase hydration is good in general, but inadequate in itself to quickly eliminate a niacin flush. You can test this yourself. The next time you experience a big flush, go consume a large quantity of water...see if your flush quickly reduces.  It won't.

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    On those rare occasions when water by itself is insufficient, then an adult (325 mg), uncoated aspirin or 200 mg ibuprofen can also be used to accelerate relief.

  • Anonymous

    1/27/2011 7:58:52 AM |

    "Sorry, as a long-time niacin user I have to say the advice to increase hydration is good in general, but inadequate in itself to quickly eliminate a niacin flush. You can test this yourself. The next time you experience a big flush, go consume a large quantity of water...see if your flush quickly reduces. It won't."

    Okay. And as a long-term niacain user, myself, who just read this earlier tonight and who just tried drinking water when experiencing a flush, I will say that it does work. For me, at least.

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