Any particular types of snacks helpful when taking niacin? I sometimes eat a handful of nuts, or an apple,  when taking niacin, hoping it will reduce the possibilty of flush -- just curious if some foods are better than others.

Also, since niacin can raise histamine, has any studies been done on taking an anti-histamine along with high dose niacin? Or how about some vitamin C (natural histamine reducer) at the same time as niacin?

And finally, any real differences between Niaspan, Slo-Niacin and Enduracin (besides cost)? The only difference I can find is that Slo-Niacin might tax the liver a bit more, since it takes longer to fully absorb. The others are absorbed within 6-8 hrs, I believe.

What about the use of Quercetin. There is a recent article showing it may inhibit the niacin flush. At least that was the result in rats. The study was published in the British Journal of Pharmocology Jan 2008
Anne

Dr Davis, the flush of Niacin has been of little bother to me. However each winter when I go to Florida from my cold north home, the Niacin itchy rash appears on my chest. This year I finaly found that Benadryl extra strength eliminated it after three applications. It has to be the increased sunshine that kicks it in. I hope others may find this helpful...Niacin is a life saver and still vastly under rated. Thanks for your informative blogs. Over&Out

I've noticed what seems to be a correlation between flushing and eating spicy foods -- foods that contain peppers containing capsaicin.  Has anyone else noticed this?

It seems that I can pretty much count on getting a flush response 30-60 minutes after eating spicy food.  

Dr. Davis, any thoughts?

Nice post - and I swear I don't know how doctors do it, repeating your self over and over.  I forward your blog wittings to family and friends.  And because of that I'm the one they naturally come to when looking for TYP advice.  

For what ever reason, no matter how many times I repeat myself, people forget two items with niacin:  1)hydrate to limit flush 2) avoid time release niacin as that can dangerously poison your liver - along with telling your doctor you are taking niacin. Grrrrr.........

Sorry, as a long-time niacin user I have to say the advice to increase hydration is good in general, but inadequate in itself to quickly eliminate a niacin flush. You can test this yourself. The next time you experience a big flush, go consume a large quantity of water...see if your flush quickly reduces.  It won't.

On those rare occasions when water by itself is insufficient, then an adult (325 mg), uncoated aspirin or 200 mg ibuprofen can also be used to accelerate relief.

"Sorry, as a long-time niacin user I have to say the advice to increase hydration is good in general, but inadequate in itself to quickly eliminate a niacin flush. You can test this yourself. The next time you experience a big flush, go consume a large quantity of water...see if your flush quickly reduces. It won't."

Okay. And as a long-term niacain user, myself, who just read this earlier tonight and who just tried drinking water when experiencing a flush, I will say that it does work. For me, at least.

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Power to the people!
Thanks for leading the way.

Wow!  That sure is interesting.  I've run into so many lay people that know more than their specialists do about cutting edge treatments and preventions.  It *is* threatening to doctors and they lash out at us all the time.  

Well, I'll be happy when this crop of fuddy duddies retires and some newer, hopefully better educated about how to utilize wonderful resources their patients are using, takes their place.

It's the 'doctor as god' syndrome.

Even more important it that ordinary folks have instant access to the medical journals. In the 1980s, to read journal articles and follow the citations I used to have to drive to a medical school, go into the basement stacks, and hunt up each journal individually. To see the online indexes I would have to wait patiently until all the medical students were done with the 4 terminals and one was free.

It would take a whole day to follow one series of citations.

Now I can do the same operation in minutes, at home.

What I find sad though, is that of all people I know, physicians are the least likely to read the actual research articles involving new drugs and treatments, or even, at times, to have heard about their findings beyond the soundbyte level that shows they read about it in a summary newsletter.

Doctors are often annoyed when patients have done research they haven't bothered to do, but sadly, this does not seem to motivate them to dig in.  

This is one reason why doctors are often years behind the patient community in learning about the dangerous and even fatal side effects of the drugs they prescribe.

I had posted about the heart-related dangers of Avandia, for example several years before they were "discovered" by doctors. The research data was there by then. And even now most doctors are not aware that both Avandia and Actos cause dangerous levels of osteoporosis with long term use. That information has been around for more than two years.

I took an article that I printed from the internet to my doctor . He told me that he never reads anything patients bring him from the internet. When I said it was from a peer reviewed journal, he told me that did not matter as it came from the internet - huh?

Patients also need to take responsibility. They need to understand how activity, diet and lifestyle impact health. They need to question their doctors and get copies of all tests. On this forum, and ones similar to it, we meet people who are well informed on health issues. I know too many people who tell me "If my doctor thought that (insert vitamin D, blood glucose, heart scan, etc) needed to be checked, he would have done it".  I can't believe all the people who accept "normal" as the answer to test results. I had a doctor tell me "normal" once and then I found out the wrong test had been done!!

Kudos to the docs who are willing to listen to their patients and make them partners in health care. Kudos to the patients who learn about their health issues make changes in their lifestyle to optimize their health.

I love the leveled playing field - it saved my life.

Oh Dr. Davis, you make me think!

Perhaps the beautiful text of the _Gray's Anatomy_ we had around the house (the real one, my father had been a chiropractic student post WWII) may have sowed the seeds of dissent with many aspects of common "modern" medical practice?  An inquiring mind and a little common sense is a... dangerous thing?  Hardly!

Knowledge is powerful... so what if it makes some cold, rigid and paternalistic doc uncomfortable?  It's MY health and MY life at stake, not his or hers.

If history is a guide, I think it's fair to say that what is common practice today, will be outmoded and archaic in a few years.  Hopefully in it's place will be a true HEALTH care system, not the current pharma and equipment-driven SICKNESS care system.

Thanks for the great blogs, so thought provoking AND informative.

Regards,

madcook

The problem is exponentially compounded by the intrusion into the physician/patient relationship of the insurance companies, and by the fear of litigation if "standards of care" which are imposed by professional associations are violated.  As regards standards, they are desirable and necessary, but how are they derived?  In many cases, guidelines such as those put forth by the American Diabetes Association, which blatantly advocates a carb-rich diet which is harming, even killing, people  daily, must owe their existence at least in part to influence by drug companies.  In the light of the latest fiasco about obesity in children and the advocated use of statins for them, unless a miracle occurs, we will see  pediatricians forced to adopt a standard of care which will inevitably lead to great harm.  When will the litigation be brought to bear on the real culprits?  There is not enough money in the world to compensate.  I don't mean to imply that these are the only factors in the "I know better than you and your health is more my concern than yours" attitude, but they complicate and compound it greatly.  Even genuinely caring and open-minded health professionals, and I'm sure there are many, are caught in this corporate/state web.  Power to the people, and to the free market, indeed-- and it may come about through forums like this one if we are determined and lucky.

There was a blog entry in "Kevin.MD" last year that said it all - "Do you know more than your doctor?"  Of course, this piece totally put down anything that the patient/client might bring to the mix.  When will doctors realize that their clients have brains?

This thread could go in many directions, but having worked in a hospital during college (as a computer engineering student) - what amazed me is the requirements for pledging the medical fraturnity.  Multiple days without ever leaving the hospital.... Then my cousin's daughter finishes Stanford Med School and almost dies in a car accident falling asleep after two days without leaving the hospital.

How do we expect doctors to read new materials when they have been programmed to work more than any union would allow, or any person should.  Can you image Pilots being allowed to work a 24 hour shift?

Doctors are over committed and they shouldn't be - they should have time to "give care".  Not sure if this is greed, the need to pay litigation insurance or what.. but it seems the root cause of much of what is discussed here.

Drugs are easy solutions to a lack of time to learn about alternatives.