Different "Niacin"

"Golgotha" <[email hidden]> wrote in message
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Quoted message said:

I was wondering about the differing types of Niacin: there is nicotinic acid, timed release
niacin, flush free niacin among others.

I take a rather large amount each day(4 gr). Flush free would be more tolerable as long as it's as
effective. Anyone have any thoughts?

I recall reading, unfortunately I don't remember where, that Flush free was more likely to have less
of the active ingredient than advertised. So if you go that route, go with a brand you feel
comfortable with. Remember this stuff is not regulated.

Bill

Bill

Quoted message said:

Subject: Different "Niacin"
From: "Golgotha" [email hidden]
Date: 1/4/2004 10:32 AM Mountain Standard Time
Message-id: <[email hidden]>

I was wondering about the differing types of Niacin: there is nicotinic acid, timed release niacin,
flush free niacin among others.

I take a rather large amount each day(4 gr). Flush free would be more tolerable as long as it's as
effective. Anyone have any thoughts?

Dec 22, 2003

Cheapest preparations of over-the-counter niacin most effective at lipid lowering

Seattle, WA - Many over-the-counter niacin preparations may have no free nicotinic acid (vitamin
B3)the lipid-lowering component for which the product is often marketedwhile others may have too
much, according to a new study. A survey of 29 over-the-counter products indicated that the
unregulated products contain variable doses of niacin; in some cases they contain no nicotinic acid,
and in others they have high concentrations of the agent, which could produce liver toxicity.

The paper appears in the December 16, 2003 issue of the Annals of Internal Medicine.[1]

As Dr C Daniel Meyers (Veterans Affairs Medical Center, Long Beach,
CA) and colleagues explain in their paper, niacin was one of the first agents found to lower LDL and
triglycerides while boosting HDL when given in daily doses of 1000 to 4000 mg. Large clinical
trials also showed it to reduce cardiovascular events. Nicotinic acid was never widely used,
however, because of side effects, primarily "niacin flushing": redness, itching, burning, and
paresthesias, which set in within 10 to 15 minutes of ingestion and last up to an hour. The
frequency and severity of these episodes decrease over time with repeated doses, and niacin is
thus available over the counter in the US as a dietary supplement, unregulated by the US FDA.

Meyers et al decided to take a closer look at over-the-counter preparations being marketed as niacin
after witnessing a series of hyperlipidemic patients reporting to the University of Washington
Medical Center Lipid Clinic in Seattle having failed to respond to over-the-counter niacin therapy.

When cheaper is better The researchers calculated the monthly cost for each of 29 preparations
bought from pharmacies, health-food stores, or over the internet. They then used high-performance
liquid chromatography to measure the free nicotinic acid content. Three types of preparations were
evaluated: immediate-release, sustained-release, and no-flush formulations. The researchers found
that the no-flush preparations were the most expensive, followed by the sustained-release
preparation, at less than half the cost, then the slightly cheaper immediate-release niacin
preparations. Ironically, the most expensive no-flush preparations were found to have no free
nicotinic acid, whereas the sustained-release and immediate-release preparations had comparable
nicotinic acid contentsthe cheap, immediate-release versions containing the most.

Cost and contents of niacin preparations

Measure No flush Sustained release Immediate release

Cost per month ($)
21.70
22.75
23.10

Average nicotinic acid content (mg)

24.6
25.4

"No-flush niacin is the most expensive of the niacin preparations yet contains no free nicotinic
acid and should not be used to treat dyslipidemia," Meyers et al conclude. "Sustained-release brands
are inexpensive and contain a full amount of free nicotinic acid, but several preparations have been
associated with increased hepatotoxicity."

Of note, the FDA has approved two prescription brands of niacin, one a sustained release (Niaspan®;
Kos Pharmaceuticals, Miami, FL) and the other an immediate release (Niacor®; Uspher-Smith,
Minneapolis, MN), but as the authors point out, these two drugs are considerably more expensive than
the over-the-counter alternatives.

For people wishing to try niacin for lipid lowering, the authors recommend immediate-release over-the-
counter niacin brands such as those made by Rugby Laboratories (Westbury, NY), since many of these
contain the full amount of nicotinic acid and immediate-release niacin is the only form of the agent
shown to prevent cardiovascular disease and death in clinical trials. As well, Meyers et al advocate
baseline laboratory tests for fasting glucose, liver aminotransferase levels, and uric acid in all
patients before niacin therapy begins, repeated six to eight weeks later and after any dose
increases.

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Golgotha said:

I was wondering about the differing types of Niacin: there is nicotinic acid, timed release
niacin, flush free niacin among others.

I take a rather large amount each day(4 gr). Flush free would be more tolerable as long as it's as
effective. Anyone have any thoughts?

It can be just as effective, ime.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
heartmdphd.comheartmdphd.comOpen ↗

Golgotha said:

I was wondering about the differing types of Niacin: there is nicotinic acid, timed release
niacin, flush free niacin among others.

I take a rather large amount each day(4 gr). Flush free would be more tolerable as long as it's as
effective. Anyone have any thoughts?

Vitamin B3 comes in two principal forms: niacin (nicotinic acid) and niacinamide (nicotinamide).
When taken in low doses for nutritional purposes, they are essentially identical. However, each has
its own particular effects when taken in high doses. High-dose niacin is principally used for
lowering cholesterol. High-dose niacinamide may be helpful in preventing type 1 (childhood-onset)
diabetes and reducing symptoms of osteoarthritis. However, there are concerns regarding liver
inflammation when any form of niacin is taken at high dosages.

Additionally, good evidence suggests that a special form of niacin, inositol hexaniacinate, can
improve walking distance in intermittent claudication.

When used as therapy for a specific disease, niacin, niacinamide, and inositol hexaniacinate are
taken in dosages much higher than nutritional needs, about 1 to 4 g daily. Because of the risk of
liver inflammation at these doses, medical supervision is essential.

There is no question that niacin (but not niacinamide) can significantly lower total cholesterol and
LDL ("bad"😉 cholesterol and raise HDL ("good"😉 cholesterol.

--
Patrick Blanchard, M.D. Board Certified in Family Medicine

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