Niacin, vitamin B3 as cholesterol lowering

Niacin is a natural substance, also called vitamin B3, as a kind of medicine it can lower cholesterol in high doses. In 1955, Rudolph Altschul and Abram Hoffer first demonstrated the cholesterol-lowering effect of niacin (Altschul et al., 1955). Niacin lowers total cholesterol, LDL, VLDL, triglycerides and Lp(a), and increases HDL. Niacin is currently recognized as the best way to increase HDL. In addition, niacin also has effects on endothelial function, inflammation, plaque stability and blood clot formation (Keener et al., 2008).
There are sufficient studies showing that niacin helps in the prevention of cardiovascular disease. The Coronary Drug Project of the 1970s showed a 27% risk reduction, with an 11% decrease in mortality. Many other studies have confirmed the effect of niacin, usually in combination with pharmaceutical cholesterol lowering agents. The latter gives the impression that niacin only takes second place as an additional therapy, probably because it is a non-patented medicine.

Niacin preparations

A regular niacin preparation is very quickly absorbed into the blood and you will feel a feeling of warmth, itching, tingling and redness on the skin (flushing). Stomach discomfort and dizziness are also among the mild side effects. Flushing is sometimes so severe that 5% to 22% of patients do not persist in therapy (Vosper, 2009).
An immediate-release preparation (quickly absorbable) should be spread throughout the day. Start with 50 to 100 mg of niacin twice daily and build up to a dose of 1 to 2 grams. The flush can be avoided with time-release preparations that ensure a constant supply of niacin to the blood. But this entails a greater danger: liver overload and liver failure!
An intermediate-release preparation, it offers the best of both worlds. If you take niacin just before going to bed, you should experience the least amount of discomfort from the flush. No-flush preparations seem less suitable for keeping cholesterol low (Freeman, 2005). Liver, stomach ulcer and gout sufferers should be careful with high doses of niacin. Finally, niacin adversely affects glucose metabolism, although clinical studies show that diabetics tolerate niacin therapy well (Grundy et al., 2002).
The flush is harmless: patients just need to be properly informed about it. Niacin near bedtime and with a snack (yogurt, piece of fruit) help suppress the flush. Avoid alcoholic and hot drinks and spicy foods. Another proven remedy is to take an aspirin half an hour beforehand. The flush diminishes over time, but recurs from the moment a patient stops taking niacin for three days. The patient must then start again with low doses (Jacobson, 2009).

Niacin in the diet

Niacin (vitamin B3) as a vitamin is important for energy supply. Niacin can be present in the diet as nicotinic acid or nicotinamide. The vitamin is found in meat, fish, whole grains, vegetables and potatoes.
Niacin dissolves in water. Vegetables are therefore best cooked in little water and the pieces should not be cut too small.
Niacin nutritional deficiencies are rare and used to lead to pellagra, a disease associated with skin disorders, scurvy and diarrhea. Overdosage with nicotinic acid, but not with nicotinamide, via high-dose supplements can cause blood vessel dilation. Very high doses of niacin can cause damage to the liver and eyes.

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