How to Safely Take Vitamin B3 (Niacin) for Heart Health

by Heidi Stevenson

9 November 2009

Vitamin B3 is a safe supplement that can do wonders for heart health. Although it's often deemed unsafe, it's actually a necessary nutrient. Gross deficiency results in pellagra, a disease defined by four D's: dermatitis, diarrhea, dementia, and death. Less recognized, though, is that amounts of B3 that can prevent pellagra are inadequate to protect the heart.

Because of failed attempts to pharmaceuticalize Vitamin B3 (niacin), the medical profession has been advising people to limit their intake to levels that are inadequate to sustain a healthy circulatory system. Though taking it in an unnatural manner, as will shortly be explained, can be dangerous, it is otherwise safe and beneficial.

The recommended daily dosage of 16 mg. for men and 14 mg. for women is adequate only to prevent pellagra. However, in one study, subjects were given 3,000 mg. per day for six years, resulting in a 27% reduction of non-fatal heart attacks and 26% reduction of strokes. Obviously, the risks of taking more than the RDA of niacin have been grossly overstated.

The Risky Form of Niacin

As indicated earlier, there is one way in which niacin can be dangerous—sustained release. As a rule, this is not a concern for most people, as it is provided by prescription. High dose niacin is still prescribed through this method, in spite of doctors' telling patients that high doses are dangerous, and that the only dangerous method is via sustained release.

There is one advantage in using sustained release niacin. It limits the problem is flushing, which is a common occurrence. The risks, though, clearly outweigh the benefits, and there are other means of limiting the problem of flushing.

Like all B-complex vitamins, niacin is water-soluble. That means it isn't stored in the body and needs to be replenished regularly. It also means that the risks of overdoing it are limited. Because it flushes out of the body quickly, it doesn't build up in tissues.

Avoiding Flushing

Niacin temporarily dilates capillaries, which can result in flushing—reddening of the skin that is hot and can sometimes be a bit itchy or tingly. Though not dangerous, it can be uncomfortable and embarrassing. There are, though, ways to contend with it so that most people can get past the flushing stage. Following are some suggestions:

• One approach to preventing or lessening a flush is to drink water on taking niacin. If you find that you flush, then try taking the niacin with a meal or snack of nuts, which helps slow absorption, and drink two glasses of water with the food. In many, perhaps most people, this will greatly reduce the time of the flush, often to only a couple of minutes. (Note: This amount of absorption slowing is not equivalent to taking sustained release niacin, so is not of concern.)
• There are slow release forms of niacin that can help ease flushing. These are distinct from pharmaceutical sustained release niacin because they don't act as slowly.
• Some people find that taking niacin with spicy foods or alcohol increases flushing. This isn't true of most, but is something to consider if flushing is a problem.
• Another method, though it's one that is not recommended by Gaia Health, is to take niacin with aspirin. This may ease flushing, but it does so at the increased risk of gastrointestinal bleeding.
• The best approach is probably a simple measure of patience. Start with low doses and increase them slowly as tolerance develops.

How Much Niacin?

There is no definitive answer to how much niacin is appropriate. Aside from the fact that each of us is different, little research on optimal amounts has been done. Nonetheless, there's enough information to provide guidelines.

For most people, 750 - 1,000 mg. will significantly improve heart health. Lowering cholesterol with statins does not reduce the risk of heart disease. However, high cholesterol can be a signifier for heart disease. This may sound like a difference without a distinction. However, the implication is that an underlying problem that is the real cause of heart disease results in increased cholesterol. Thus, if the underlying problem is resolved, then cholesterol is lowered—with a resulting decrease in risk of hear disease.

This, in fact, is exactly the case. Taking niacin significantly lowers the risk of heart disease, as has been documented in many studies over decades. High cholesterol is lowered by niacin— but cholesterol is only a marker, not the cause. Niacin addresses the underlying problem. Therefore, having your cholesterol levels checked is a very good way to assess the effectiveness of taking niacin. The one proviso is that it takes time. Allow at least three months between tests to determine whether the amount you're taking is adequate.

4,000-5,000 mg. of niacin is taken without harm by many people. However, there's no reason to take more than needed. As with anything else—even water—too much is harmful.

Who Should Be Careful About Taking Niacin?

Because it's passed through the liver, anyone with a liver condition, including unexplained high liver enzyme test results, should be cautious with niacin supplementation. In this case, anyone who chooses to take niacin should have blood tests to check liver enzyme levels.

Niacin dilates capillaries and reduces blood viscosity. Though there have been no indications that people with abnormal bleeding conditions are iat risk when taking niacin, it is certainly an issue that should be carefully watched while taking it.

Gout has been known to flare up while taking niacin. If you've had gout, then be aware of the potential.

During the early stages of therapy, niacin may increase blood sugar by 4-5 mg/dL. Though this is a small amount and usually not clinically significant, diabetics should be aware of it. After a few months, the small increase usually disappears.

Who Should Take Niacin?

Inadequate niacin is likely the result of moving from hunter-gathering to farming, which changed diet focus from meat and vegetables to grains. In today's world, with the heavy processing undergone by the grains that most people eat, the sad fact is that nearly everyone is deficient in the nutrient.

While taking the RDA of niacin will prevent the most immediate concern of pellagra, it will not adequately address heart health. Nearly everyone who is eating a diet high in grains, even in unprocessed whole grains, should consider supplementing niacin.