Niacin flush - side effects - cholesterol control

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Benefits of niacin like increase in good cholesterol and lipid management and control outnumber its side effects - niacin flush.

Niacin, when taken for cholesterol control, in its nicotinic acid form causes reactions which are called 'niacin flush'. The necessity and benefits of niacin in nutrition are well known.
There are other uses of niacin in achieving good health. Niacin, though in its nicotinic acid form has been found to control cholesterol.


Dyslipidemia is the disorder of blood lipid levels. Usually dyslipidemia occurs as an elevation of lipid levels in the blood and is hyperlipidemia .
This increase and the lack of cholesterol control is due to many factors like genes, food habits, malnutrition and lifestyle. The side effects of chronic high levels of insulin is dyslipidemia.

Benefits of niacin in control of cholesterol

To reduce the blood serum lipids there are cholesterol control ways like exercise, regulated diet and medication.
Nicotinic acid helps in the regulation of lipid levels.
Niacin is very effective in lowering triglycerides, serum lipids and in low density cholesterol.
Niacin doses of 500 mg, 1000 mg and even 2 gm are prescribed for lipid control.
In high doses,though there is flush and side effects, serum levels of both 'very low density lipoprotein' (VLDL) and 'low density lipoprotein' (LDL) are reduced and the serum level of 'high density lipoprotein' (HDL) is increased with control of cholesterol .
Clinical trials have demonstrated that nicotinic acid effectively controls progress of atherosclerosis (fat deposits in arteries) and cardiovascular disease.
However it has these very unpleasant side effects.

Causes, signs and symptoms of niacin flush

Cutaneous reddening and pruritus (itch) are side effects of taking higher doses of nicotinic acid in cholesterol control.
Nicotinic acid adverse reactions occurs within 30 minutes of ingestion of the tablet, causing cutaneous reddening of face and neck and trunk.
Side effects like gastrointestinal upset, headache, warmth, tingling and itching of face and the trunk may also occur during flush.
There can be pricking and itching sensations on the body during the side effects.
Particularly the areas of the body which are covered by the dress show more adverse reactions like pricking sensations during the flush.
The side effects are due to dilation of the capillaries in the skin and greater blood flow to the skin.
Earlier it was believed that histamine was the cause of it. However it was found that histamine was not involved in the reactions.
It is found that Prostaglandin is the prime cause for inducing the adverse reactions like flush during cholesterol control; serotonin also has a role in the reactions.
These nicotinic acid symptoms and side effects last for about an hour and then they subside.

Treatment and remedies for niacin flush

Though niacin flush is harmless the severity of the symptoms sometimes deter people from continuing taking niacin effective cholesterol is not achieved.
The symptoms and side effects of 'niacin flush' usually subside after 60 minutes. Tolerance to nicotinic acid develops slowly and the reactions also usually taper off.
It is advised to take two to four split doses to reduce adverse reactions.
It is advised not to do exercise immediately after taking the tablets.
Starting the niacin dosage at low levels and gradually increasing it over a period of time may prevent the severity of side effects.
If there is a break in this treatment for cholesterol control, it is advised to go back to initial low doses and gradually increase it to avoid recurrence of severe side effects.
Taking aspirin or ibuprofen 30 minutes before taking niacin tablet helps in preventing it.
However as these drugs are notorious for stomach irritation and bleeding consult your healthcare provider about the dosage and suitability.
Taking hot beverages or alcohol around the time of niacin consumption may cause severity in these side effects.
Take niacin tablet along with food so that absorption will be slower and may reduce it.
Drinking up to 250 ml of water dilutes the vitamin and adverse reactions  are reduced.
If there are any indications of the start of flush, immediately take plenty of water to stop or to control it.

Say no to 'flush free' or no-flush' niacin

Inositol hexanicotinate is a very efficient vitamin B3 supplement. This vitamin B3 form is being branded and sold as 'flush free' and 'no flush' niacin.
This product is available in 200mg, 500mg and 1000mg strengths as reaction free tablets over the counter. They are only vitamin supplements.
Though it does not cause side effects, cholesterol reduction is not achieved and the purpose is not achieved.
Experiments have proved that, this 'no flush' vitamin B3 has no effects and there is no niacin reactions.
Nicotinamide and niacinamide also are not useful in cholesterol control and hypercholesterolemia management and do not cause side reactions.
The addition of amide group inhibits niacin reactions and vasodilation.
So there is no cholesterol control, no reactions and no side effects.
So the best way is to get around niacin reactions with precautions and control cholesterol for our healthy life.
Related topics:
Pellagra disease
Dr Joseph Goldberger

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Niacin flush in cholesterol control and side effects.

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