When niacin doesn't work

20. September 2007 William Davis (7)
Dan had the usual collection of metabolic syndrome lipoprotein abnormalities:

low HDL of 28 mg/dl, triglycerides 280 mg/dl, 90% of his LDL particles were small.

Along with elimination of wheat and junk foods, exercise, and fish oil, I asked Dan to add niacin. I usually ask people to buy SloNiacin and begin at 500 mg per day with dinner, increased to 1000 mg per day at dinner after 4 weeks.

Dan came back several months later. His lab results:

HDL 40 mg/dl, triglycerides 76 mg/dl.

(We didn't repeat the full lipoprotein analysis, so no small LDL value was available.) Better, though still some room for improvement. I urged Dan to stick to his program, lose some more weight off his 260 lb frame, exercise, be strict about the wheat products.

Dan returned another few months later. Lab results:

HDL 29 mg/dl, triglycerides 130 mg/dl.

Dan had lost another 8 lbs and was reasonably compliant with his diet.

What's going on here? Why would he backtrack on HDL and triglycerides despite sticking to his program?

I asked Dan where he purchased his niacin. "I got it from Sam's Club. The pharmacist said to try this 'no-flush' kind so the hot flush wouldn't bother me."

Aha! It's no wonder. "No-flush" niacin, or inositol hexaniacinate, is an outright scam. It has virtually no effect on lipids or lipoproteins in humans. It's therefore no surprise that, by replacing real niacin with the no-flush variety, Dan's blood patterns began to revert back to their original state.

Let me be straight on this: No-flush niacin is a scam. It does not work: it does not raise HDL, reduce triglycerides, nor reduce small LDL. It's expensive, too, far more expensive than the real thing. It has no business being sold by stores like Sam's Club or your health food store.

SloNiacin (Upsher Smith) has become our preferred preparation. (I obtain no compensation of any sort for saying so.) We buy it at Walgreen's.
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Comments (7) -

  • DietKing2

    9/20/2007 1:37:00 PM |

    Dr. Davis,
    While I thank you from the bottom of my heart (nice pun, eh?) for this information regarding the crappiness of flush-free niacin, it did cause me to go to bed last night all upset; yes, I've been taking the stuff religiously the last few months hoping it would drive my low HDL numbers up up up. Now I read this...grrr...
    Here's my question (yes, there's a question in here somewhere...) I'm willing to switch back to good old regular niacin, but how do I avoid that annoying flush I experienced the first time around, the one that caused me to switch to the inositol version to begin with? I eventually want to make it up to about 1500-2000mgs a day, but I have a feeling it's going to be tough!
    Any suggestions?
    Thanks!
    AdamWink

  • Anonymous

    9/20/2007 2:04:00 PM |

    Is there any issue with taking niacin first thing in the AM?

  • Dr. Davis

    9/20/2007 5:51:00 PM |

    Not as long as you eat and maintain good hydration. Remember that, upon awaking, you are quite dehdyrated.

  • Dr. Davis

    9/20/2007 5:54:00 PM |

    Two important ways :

    1) Drink lots of water, e.g., 16-24 oz if you have the flush.

    2) Increase no faster than 500 mg per month.

    Of course, you should only take higher doses of niacin with the assistance of your doctor.

    There is a larger discussion about this on the Track Your Plaque webwite, as well, under "Niacin: Ins and outs, ups and downs."

  • Anonymous

    7/13/2008 5:06:00 PM |

    I started niacin after seeing a study on the lipidsonline.org website.  I was encouraged by the results from the first analysis of my blood showing my HDL was up 20% to 42 and my LDL had crashed 25% to 58. This was 1grm "now" brand OTC Niacin combined with 40mg crestor.  However, my triGs were still high at 227.

    I raised the Niacin to 2grms and looked forward to the next blood test.  Success with TriG. Results were spectacular (105) and same with LDL (58).  But my HDL receded back to its old level of 30mg/dl.... very disappointing.  

    I asked my Dr to prescribe the Niospan in case the OTC niacin was variable..... OMG! C$280/200 tabs....... I'm in Canada so no wallgreens.  Will be trying to get some statement of quality control out of the Now product people.

    One other side effect of the higher Niacin... uber low resting diastolic.  Does this mean I should stop taking beta and ace inhibitors ?

  • buy jeans

    11/3/2010 12:22:55 PM |

    I asked Dan where he purchased his niacin. "I got it from Sam's Club. The pharmacist said to try this 'no-flush' kind so the hot flush wouldn't bother me."

  • scott bushey

    8/26/2011 12:39:20 PM |

    Just curious:

    If there is no correlation at all between high cholesterol and cardiac disease, why do you prescribe supplements like Niacin that optimize cholesterol?

    Thanks in advance,
    Scott

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HDL for Dummies

HDL for Dummies

25. May 2008 William Davis (10)
I frequently peruse conventional health websites to keep track of their message. One painfully conventional (read "drug company-supported") website that echoes the standard advice on heart disease and heart health is Everyday Health .

Since I subscribe to the newsletters for many conventional sites, I received an e-mail that took me to this Q & A about HDL cholesterol:

Q: I'm 36 years old and my good cholesterol is too low. What can I do?
– Nilsa, Florida

Dr. Lori Mosca of New York-Presbyterian Hospital responds:

A: A woman's HDL goal should be greater than 50 mg/dL (greater than 40 mg/dL in men). You can raise your HDL levels by eating a diet low in saturated fat and trans fat but high in monounsaturated fats. Lose weight if you need to and get at least 30 minutes of moderate-intensity exercise on a minimum of four days per week. If you smoke, quit. Despite positive lifestyle changes, though, some individuals may still be candidates for HDL-raising drug therapy because they are at increased risk for cardiovascular disease. Discuss your options with your health care provider.


Are you satisified with that answer? I certainly am not.

First of all, is this something you've never heard before? "Eat right, exercise, cut your unhealthy fats." Then why do people who follow this sort of conventional advice often still fail? Is the next step always medication?

Here's the part that Dr. Mosca and other conventional, drug-minded "authorities" have left out:

To raise HDL powerfully--not to 40 mg/dl for males or 50 mg/dl for females, but to 60, 70 or 80 mg/dl--think about the following strategies:

--Eliminate wheat and cornstarch products. I have droned on endlessly about this concept, but it is enormously effective. While the weight loss that inevitably follows elimination of these foods adds to the HDL-raising effect, there is also an independent effect, as well.

--Fish oil--The omega-3 fatty acids in fish oil reduce triglycerides. Triglycerides accelerate the destruction of HDL. Remove triglycerides, HDL goes up. (Though krill oil may share, even surpass this effect, we need more data than the single manufacturer-sponsored study.) Of course, this requires real doses, not the namby-pamby doses you often read about.

--Vitamin D--Achieving normal levels of 25(OH) vitamin D raises HDL with power I have never witnessed from any other strategy before, barring weight loss of 30+ lbs. Readers of the Heart Scan Blog know that just taking vitamin D is not enough. Verification with blood levels is an absolute necessity, particularly if raising HDL maximally is among your goals.

--Adding back saturated fat. I say "adding back" since most of us (including myself) went too far down the "saturated fat is bad" path over the past few years. While I do not advocate a carte blanche approach to saturated fat, I believe that adding back eggs (preferably free-range and/or omega-3 rich), lean meats, and hard cheeses is a good idea. The saturated fat in these foods raise HDL 5 or more mg/dl.

--Dark chocolate--Or other cocoa prepartions. What a cool way to raise HDL! Reach for the lowest-sugar, highest cocoa preparations.

--Alcoholic beverages--I am partial to the red wine/flavonoid-rich concept, being a wine drinker. Although all alcoholic beverages raise HDL due to the ethanol content, for benefits beyond alcohol (as well as to avoid wheat-based drinks like beer), I do believe that the bulk of data argue for flavonoid-rich red wines from southern France, Italy, and California.

--Achieve ideal weight--The toughest of all. But eliminating wheat and cornstarch makes it far easier.


Follow the conventional advice of those like Dr. Lori Mosca, and the majority of people will fail. ("It just so happens that I have a prescription drug just for that purpose!")

Buck the conventional advice, adopt strategies that won't be found in the drug ads, nor be provided by the conventionally-thinking, and you can succeed to heights you never thought possible.


Copyright 2008 William Davis, MD
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Comments (10) -

  • Ross

    5/25/2008 3:55:00 PM |

    I'm very excited to read what sounds like a possible change in your position on saturated fat (agreed: it's only one of a list of many other beneficial dietary practices, and I shouldn't focus too much on that one).  

    My own substantial weight loss, achieved by substituting fat (and saturated fat) for carbs while keeping protein intake moderate, has been such a revelation to me.  It's been quite difficult to believe that what we've been told by dietary authorities is not only incorrect, but is most likely exactly backwards.  Fat has not made me fat.  Fat has and continues to make me full.  Being full got me to a BMI of 23.  Becoming slender again has restored my athletic performance as well as improving the blood markers that most of your readers track.

    Taken as a whole, this list of dietary advice might possibly be summed up as, "Enjoy good eating in moderation."  IMHO, at the end of the day, a balanced approach is an essential part of any sustainable lifestyle.

  • Anonymous

    5/26/2008 12:58:00 AM |

    I have had what I consider great results with raising my HDL from 312 a few years ago following my physician's AHA recommendations to 51 now by doing most of the things you suggest in this blog (I am male).  My question is,  how good is this as a heart health indicator?  Even though your book suggests that only a scan will tell, I am nervous about X-rays and the cost of a scan.  Can I take some solace in my dramatically increased HDL?

  • Alan

    5/26/2008 3:15:00 AM |

    I almost totally agree.

    The only minor disagreement is that I would extend "wheat products" to include the other grains and starchy carbs. I am very cautious about all of that group.

    My major disagreement is the omission of Australia from your list of excellent dry red wine producersSmile

    Cheers, Alan, T2 Diabetic, Australia

  • Dr. William Davis

    5/26/2008 1:31:00 PM |

    Anonymous re: HDL--

    No, sorry, absolutely not. It is an indicator, not the real thing, meaning plaque.

  • Gyan

    5/27/2008 6:51:00 AM |

    If you advise eating saturated fats, then why specify "lean meats"?.

  • Anonymous

    5/27/2008 5:56:00 PM |

    What percentage of your patients don't respond to the HDL boosting therapy you advise?

    I raised my vit D level to 56, dropped wheat, increased exercise, took niaspan (albeit at only 500mg), took 3 grams omega-3/daily, took a wine extract supplement, ate  a small amount dark chocolate daily....

    And my HDL went down 1 point. My weight isn't an  issue, I think, as I'm 6'1"", about 175 lbs. My body fat is approx. 15% (not sure if that's good or not). I eventually had to drop the niaspan, as I was getting heart palpitations, but it didn't seem to be doing much for my HDL anyway.

    What is recommended for patients when their HDL won't seem to budge? And a better question... why isn't it raising on the therapies you recommend, when it does work for most patients? Are there any rare causes for low HDL, outside of genetically low HDL?

  • Anonymous

    5/31/2008 9:37:00 PM |

    I can echo the last post. I have tried all of Dr. Davis' strategies, plus others, and it's resulted in slight reductions in my already low ldl and triglycerides but no change in my low hdl. I'm in great shape, eat well, exercise regularly, no heart issues or risk factors besides the low hdl, which I assume in my case is genetic.

  • Anonymous

    9/13/2009 4:03:11 PM |

    I didn't know where else to post this question.  Is this true?

    "Another way to know if abundant HDL is valuable is to look at its particle size -- smaller is better. A large study has found that people with high HDL (above 70 mg/dL) but very large particles had more risk of heart disease than people with low HDL (under 40), probably because larger particles aren't as active. But again, there's no easy commercial test for that."  This quote appeared today at http://www.oregonlive.com/health/index.ssf/2009/09/you_docs_answering_questions_a_2.html.  Mehmet Oz is usually suspect to me, anyway, but I am still curious about this statement.

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    11/2/2010 8:24:16 PM |

    --Adding back saturated fat. I say "adding back" since most of us (including myself) went too far down the "saturated fat is bad" path over the past few years. While I do not advocate a carte blanche approach to saturated fat, I believe that adding back eggs (preferably free-range and/or omega-3 rich), lean meats, and hard cheeses is a good idea. The saturated fat in these foods raise HDL 5 or more mg/dl.

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